During the past 20 years, food allergy has dramatically increased, with a concomitant increased risk for anaphylaxis.1 Anaphylaxis is "a serious allergic reaction that is rapid in onset and may cause death."2 Foods are one of the common causes of anaphylaxis3 over medications and insect stings, and food allergy has become a worldwide concern. Anaphylaxis is inadequately treated most of the time4 because of inconsistent signs and symptoms; anaphylaxis can manifest differently in the same person, even when triggered by the same allergen.
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Σάββατο 1 Ιουλίου 2017
Epinephrine use for anaphylaxis: Too seldom, too late
Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis
In children with eosinophilic esophagitis (EoE) foods are the most common disease triggers, but environmental allergens are also suspected culprits.
http://ift.tt/2txIbza
Serum cytokine profile in pediatric Sweet’s syndrome: a case report
Sweet's syndrome is characterized by fever, leukocytosis, and tender erythematous papules or nodules. It is a rare condition, particularly in the pediatric population, and has recently been proposed to be an a...
http://ift.tt/2stOFj0
Evaluation of laser fluorescence in monitoring non-cavitated caries lesion progression on smooth surfaces in vitro
Abstract
The aim of this study was to evaluate the performance of a pen-type laser fluorescence (LF) device (LFpen: DIAGNOdent pen) to detect and monitor the progression of caries-like lesions on smooth surfaces. Fifty-two bovine enamel blocks were submitted to three different demineralisation cycles for caries-like lesion induction using Streptococcus mutans, Lactobacillus casei and Actinomyces naeslundii. At baseline and after each cycle, the enamel blocks were analysed under Knoop surface micro-hardness (SMH) and an LFpen. One enamel block after each cycle was randomly chosen for Raman spectroscopy analysis. Cross-sectional micro-hardness (CSMH) was performed at different depths (20, 40, 60, 80 and 100 μm) in 26 enamel blocks after the second cycle and 26 enamel blocks after the third cycle. Average values of SMH (± standard deviation (SD)) were 319.3 (± 21.5), 80.5 (± 31.9), 39.8 (± 12.7), and 29.77 (± 10.34) at baseline and after the first, second and third cycles, respectively. Statistical significant difference was found among all periods (p < 0.01). The LFpen values were 4.3 (± 1.5), 7.5 (± 9.4), 7.1 (± 7.1) and 5.10 (± 3.58) at baseline and after the first, second, and third cycles, respectively, among all periods (p < 0.05). The CSMH values after the second and third cycles at 20, 40, 60, 80 and 100 μm were 182.8 (± 69.8), 226.1 (± 79.6), 247.20 (± 69.36), 262.35 (± 66.36) and 268.45 (± 65.49), and for the third cycle were 193.7 (± 73.4), 239.5 (± 81.5), 262.64 (± 82.46), 287.10 (± 78.44) and 284.79 (± 72.63) (n = 24 and 23), respectively. No correlation was observed between the LFpen and SMH values (p > 0.05). One sample of each cycle was characterised through Raman spectroscopy analysis. It can be concluded that LF was effective in detecting the first demineralisation on enamel; however, the method did not show any effect in monitoring lesion progression after three cycles of in vitro demineralisation.
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Table of Contents
Source:American Journal of Otolaryngology, Volume 38, Issue 4
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Guidelines for Contributing Authors
Source:American Journal of Otolaryngology, Volume 38, Issue 4
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Editorial Board
Source:American Journal of Otolaryngology, Volume 38, Issue 4
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Trends in prescribing behavior of systemic agents used in the treatment of acne among dermatologists and nondermatologists: A retrospective analysis, 2004-2013
Despite recommendations to limit the use of oral antibiotics and increasing support for hormonal agents in the treatment of acne, it is unclear whether there have been any significant changes in practice patterns.
http://ift.tt/2tz4Ydn
Anatomic mapping and clinicopathologic analysis of benign acral melanocytic neoplasms: A comparison between adults and children
The clinicopathologic features of benign acral melanocytic neoplasms (BAMNs) remain poorly understood.
http://ift.tt/2uwKz64
CD8+ mycosis fungoides: A low-grade lymphoproliferative disorder
The prognosis of the CD8+ subtype of mycosis fungoides (MF) is controversial. Although most authors believe that determining the presence of this cell surface antigen has no prognostic value, others have observed a more indolent course for CD8+ MF compared with CD4+ MF.
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Discrepancy between the clinical and histopathologic diagnosis of soft tissue vascular malformations
Soft tissue vascular malformations are generally diagnosed clinically, according to the International Society for the Study of Vascular Anomalies (ISSVA) classification. Diagnostic histopathologic examination is rarely performed.
http://ift.tt/2ux8an7
Multiple and repeated sampling increases the sensitivity of direct immunofluorescence testing for the diagnosis of mucous membrane pemphigoid
Mucous membrane pemphigoid (MMP) is an autoimmune disease characterized by the predominant blistering of mucosal surfaces and the linear deposition of complement, IgG, or IgA along the basement membrane detected by direct immunofluorescence (DIF) test.
http://ift.tt/2tyF89y
Urolithiasis secondary to primary obstructive megaureter in an adult: a case report
Primary obstructive megaureter is relatively uncommon in adults. This condition usually regresses spontaneously or is treated during infancy. It can remain asymptomatic for decades until adulthood when symptom...
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Role of an Autoinducer-2-like Molecule from Veillonella tobetsuensis in Streptococcus gordonii Biofilm Formation
Publication date: Available online 1 July 2017
Source:Journal of Oral Biosciences
Author(s): Izumi Mashima, Futoshi Nakazawa
ObjectivesDental plaque is a multispecies biofilm that causes dental caries and periodontal diseases. In particular, Streptococcus spp. and Veillonella spp. have been identified as early colonizers of oral biofilms. Coaggregation of bacterial species and/or autoinducers using the quorum sensing system has been suggested to plan an important role in biofilm formation. In our previous study, we showed that Veillonella tobetsuensis clearly promoted the development of Streptococcus gordonii biofilms. To clarify the mechanism, coaggregation between S. gordonii and V. tobetsuensis and the effect of an autoinducer-like molecule were investigated in this study.MethodsThe coaggregation assay was performed according to a previously reported method. AI-2-like molecule was detected by a Vibrio harveyi BB170 reporter assay. After partial purification, the effect of the AI-2-like molecule on S. gordonii biofilm formation was examined using the wire method.ResultsNo coaggregation between S. gordonii and V. tobetsuensis was observed. An AI-2-like molecule was detected in large amounts in the culture supernatant of V. tobetsuensis in the mid-exponential growth phase. In addition, the AI-2-like molecule produced by V. tobetsuensis significantly inhibited S. gordonii biofilm formation.ConclusionsThese results suggest that an AI-2-like molecule from V. tobetsuensis is a potential inhibitor of the development of S. gordonii biofilms and could be used for the prevention of early-stage oral biofilm formation. However, the V. tobetsuensis factors that promote the development of S. gordonii biofilms will need to be explored in future studies.
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Circadian Clock and Bone Biology
Publication date: Available online 1 July 2017
Source:Journal of Oral Biosciences
Author(s): Takao Hirai
BackgroundMany metabolic and physiological processes display circadian oscillations that are controlled by the internal circadian clock system. A molecular clock system is generated by the transcriptional-translational feedback loops of clock genes. Circadian oscillators reside in peripheral tissues where they receive timing cues from the central clock in the suprachiasmatic nucleus (SCN). Circadian rhythms have also been identified in bone and cartilage.HighlightRecent findings demonstrated that bone metabolic functions of the major cell types namely osteoblasts, chondrocytes, and osteoclasts, are closely related to an intrinsic biological rhythm, named the circadian clock. Several studies have also shown that clock genes play significant roles in bone formation and resorption. Adrenergic receptor signaling in osteoblasts was previously reported to synchronize clock genes as well as genes that are important for osteoblast function such as Ptgs2 gene encoding prostaglandin G/H synthetase 2, which is a late-limiting enzyme for prostaglandin synthesis. Since the circadian clock regulates key molecules in cellular functions of osteoblasts and osteoclasts, this system may be closely involved in the cellular functions associated with bone remodeling.ConclusionThis review focuses on the latest knowledge on the molecular mechanisms of biological clocks and their roles in bone biology, indicating the potential of this clock system in the treatment of bone disorders.
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Noise levels and sound pollution associated with various operative procedures and equipments in a pediatric dental environment – A clinical study
Publication date: Available online 1 July 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Mousumi Goswami, Darrel Singh, Binny Vashist, Sugandha Marwaha
AimTo analyse sound levels and sound pollution in a Pediatric Dental Clinic and to analyse whether the levels are significant to the extent of being a health hazard.MethodsNoise levels were measured in a Pediatric dental clinic in an institutional setting with a precision noise level meter ((HTC 1350). Recordings were taken at different times of the day, at the centre, chair-side, reception, play area and four corners of the department keeping the microphone at a distance of 6in. from the operator's ear. The noise levels of various equipments i.e. suction, micromotor, airotor were measured with the equipments turned on and during cutting operations with the microphone placed at a distance of 6in. from the sound source. The sound levels for the laboratory equipments were taken at a distance of 6in. and 2m.ResultsThe highest mean sound levels were recorded at the reception, play area and chair-side area with least mean sound levels recorded at 9:00am which increased at 11:30am & 2:00pm and reduced again at 3:30pm The maximum sounds were produced by the lathe trimmer, airotor and scaler.ConclusionNoise levels in a pediatric clinic approach the level of risk of hearing loss [85db(A)]. This would have a serious effect on both providers and patients and a concerted effort would be required to control the noise levels and thus avoid the potential health hazards that it poses.
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Expansile radiolucent lesion of the Temporomandibular Joint—A diagnostic enigma
Publication date: Available online 1 July 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Vikas Meshram, Natarajan C., Jayant Landge, Sayali Jadhav
http://ift.tt/2t3V9U4
Piezoelectric versus conventional techniques for orthognathic surgery: Systematic review and meta-analysis
Publication date: Available online 1 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Luis Eduardo Charles Pagotto, Thiago de Santana Santos, Sara Juliana de Abreu de Vasconcellos, Joanes Silva Santos, Paulo Ricardo Saquete Martins-Filho
PurposeThe purpose of this study was to perform a systematic review and meta-analysis of complications after orthognathic surgery comparing piezosurgery with conventional osteotomy.MethodsWe conducted this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a systematic search of PubMed, Scopus, Science Direct, Lilacs, Cochrane Central Register of Controlled Trials, Google Scholar, and OpenThesis to identify randomized and nonrandomized controlled trials (RCTs and nRCTs, respectively) comparing patient outcomes (operative time, intraoperative blood loss, postoperative swelling, pain, neurosensitivity) after orthognathic surgery by piezoelectric or conventional osteotomy. We pooled individual results of continuous and dichotomous outcome data using the mean difference (MD) and risk difference (RD) with the 95% confidence interval, respectively.ResultsThree RCTs and five nRCTs were selected. No difference in operative time was observed between piezosurgery and conventional osteotomies. We found a decrease of intraoperative blood loss with piezosurgery (MD -128 mL; P < 0.001) and a pooled difference in severe blood loss of 35% (P = 0.008) favoring piezosurgery. Based on pooled individual results of studies evaluating neurosensitivity by clinical neurosensory testing, our meta-analysis showed a pooled difference in severe nerve disturbance of 25% (P < 0.0001) favoring piezosurgery. Test for subgroup differences (I2 = 26.6%) indicated that follow-up time may have an effect on neurosensory disturbance. We found differences between piezosurgery and conventional osteotomy at 3 months (RD 28%; P < 0.001) and 6 months (RD 15%; P = 0.001) after surgery. Meta-analyses for pain and swelling were not performed because of a lack of sufficient studies.ConclusionCurrently available evidence suggests that piezosurgery has favorable effects on complications associated with orthognathic surgery, including reductions in intraoperative blood loss and severe nerve disturbance.
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Oral shedding of human herpesviruses in renal transplant recipients
Abstract
Objective
To describe the shedding profile of human herpesviruses in the saliva of renal transplant recipients.
Methods
This is a prospective case-control study of 50 renal transplant recipients and control group of 50 individuals (non-transplanted and immunocompetent). Mouthwash samples were collected via oral rinse and then submitted to screening for the presence of eight types of herpesviruses by using multiplex PCR. Fisher's exact, chi-square, and Student t tests were used for statistical analysis, and the significance level was set at 5%.
Results
The mean age of the study group was 49.42 ± 12.94 years, 28/50 (56%) were female, and the time elapsed after transplantation was 68.20 ± 67.19 months. Herpes simplex virus 1 (HSV-1) (P = 0.025) and Epstein-Barr virus (EBV) (P = 0.024) were, statistically, more excreted in the saliva of renal transplant recipients compared to control group. Gender (P = 1.00) and age (P = 0.563) did not influence the salivary shedding of herpesviruses in renal transplant recipients. Individuals who excreted varicella-zoster virus in saliva had a shorter mean time of transplantation (22:00 + 2.82 months) (P < 0.001).
Conclusion
Renal transplant recipients excreted herpesviruses more often than controls, especially HSV-1 and EBV, with salivary shedding of herpesviruses being more frequent in patients with recent kidney transplantation.
Clinical relevance
The present findings support other longitudinal studies evaluating the relationship between oral shedding of human herpesviruses and clinical presence of active infection and renal transplant failure.
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Effect of root canal preparation techniques on chlorhexidine substantivity on human dentin: a chemical analysis
Abstract
Objectives
Chlorhexidine binds to dentine to provide sustained action. The aim of the present study was to evaluate and compare the substantivity of chlorhexidine using manual, rotary, and reciprocating systems for root canal preparation.
Methods
Forty-five extracted human single-rooted teeth were used for this study. The samples were divided into three groups (n = 15) according to the instrumentation technique used: manual instrumentation (K-File), rotary instrumentation (ProTaper), and reciprocating instrumentation (Reciproc R25). Chlorhexidine gel (2%) was used as auxiliary chemical substance during root canal preparation. Longitudinal grooves were carved on the free surfaces of the roots, providing two halves of each root and resulting in 30 samples per group. Each group was randomly divided into three subgroups (n = 10), and substantivity was evaluated after 48 h, 7 days, and 30 days of incubation. The amount of CHX (in mg/mL) was measured through reverse-phase high-performance liquid chromatography. Statistical analysis was performed by analysis of variance and the Tukey test for post hoc comparisons (α = 0.05).
Results
The manual did not show a statistical significant difference with rotary instrumentation (P > 0.05), but higher CHX substantivity was recorded in all periods of observation when compared to reciprocating instrumentation (P < 0.05).
Conclusions
The CHX substantivity on human dentine is lowest when using reciprocating compared to manual and rotary instrumentation.
Clinical significance
Using chemical analysis, this study showed that a manual and rotary multi-instrument system results in greater chlorhexidine substantivity on human dentin than a reciprocating single-instrument system.
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Sjogren's syndrome: New paradigms and areas for future research
Source:Clinical Immunology
Author(s): Julian L. Ambrus
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Patient preferences for the attributes of a non-invasive treatment for superficial Basal cell carcinoma: a discrete choice experiment
Abstract
To examine which attributes of a non-invasive treatment for superficial BCC (sBCC) are valued by patients, a discrete choice experiment (DCE) was performed alongside a clinical trial in which methylaminolevulinate photodynamic therapy (MAL-PDT), 5-fluorouracil and imiquimod were compared.1
Treatment options were described by the following attributes: effectiveness, cosmetic result, treatment process and side-effects. Effectiveness was defined as the probability that complete tumour clearance is achieved 12 months after treatment with levels of 75%,80%,85% and 90%.2-4
This article is protected by copyright. All rights reserved.
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Functional melanoma-risk variant IRF4 rs12203592 associated with Breslow thickness: a pooled international study of primary melanomas
Abstract
Breslow thickness is considered to be the most important prognostic tumor feature in melanoma patients and is associated with age, sex, and phenotypic risk factors for melanoma such as number of nevi. However, its association with inherited genetic variants in recently identified melanoma risk loci is largely unknown.
In a Western Australian Melanoma Health Study (WAMHS) study, published in the British Journal of Dermatology, IRF4 rs12203592, OCA2 rs1800401 and TP53 rs1042522 were significantly associated (P < 0.05) with Breslow thickness; however, these associations did not pass false discovery.
This article is protected by copyright. All rights reserved.
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Lack of Response to Intravenous Sodium Thiosulfate in Three Cases of Extensive Connective Tissue Disease-Associated Calcinosis Cutis
Abstract
Dystrophic calcinosis cutis is a debilitating condition of calcium salt deposition in the skin often occurring in association with connective tissue disease (CTD). Available treatments for calcinosis cutis are unsatisfactory, but given the recent use of topical and intralesional sodium thiosulfate (STS) to treat calcifying disorders, we sought to describe the use of intravenous (IV) STS for CTD-associated dystrophic calcinosis cutis. We report three patients with longstanding and extensive CTD-associated calcinosis cutis treated with IV STS after having failed multiple prior therapies. All three patients experienced fatigue and nausea with STS infusions, and none of the patients had notable clinical or symptomatic improvement of calcinosis. It remains to be seen whether the administration of IV STS earlier in the onset of calcinosis might be of benefit given that these patients all had longstanding and refractory CTD-associated calcinosis. Given the small number of patients in this series, further investigation into the use of IV STS in calcinosis cutis is warranted.
This article is protected by copyright. All rights reserved.
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Invasive dermatophyte infection with trichophyton interdigitale is associated with prurigo induced pseudoperforation and a STAT3 mutation
Abstract
Invasive dermatophyte infection, with extention beyond the dermis, in immunocompetent hosts is exceptionally rare. Dermatophytes are keratinophilic and are usually confined to the stratum corneum, hair and nails. Susceptibility to dermatophyte infections is incompletely understood but inherited mutations in key signaling pathways of the innate immune system have been identified.1 We report the first case of an invasive dermatophyte infection associated with abrupt onset of a prurigo induced pseudoperforation and a loss of function mutation in Signal transducer and activator of transcription 3 (STAT 3).
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Experiences of rosacea and its treatment: An interpretative phenomenological analysis
Abstract
Background
Whilst rosacea is a chronic skin condition, the condition can often have a large psychosocial impact on the individual. There is therefore a need to understand the experience of living with rosacea from the patient perspective.
Objectives
To examine the experience of living with rosacea and the experience of seeking and receiving treatment.
Methods
Nine participants took part in semi-structured interviews, which were analysed using interpretative phenomenological analysis.
Results
Three superordinate themes were identified within the data; self-consciousness, which focused on the fear of others' assigning blame to participants for having caused symptoms; avoidance, concealment, and hiding emotions, referring to the coping strategies participants employed in response to rosacea; and inconsistencies in GP treatment and guidance, which focused on the need for medical professionals to assess the psychosocial well-being of patients with rosacea.
Conclusions
Rosacea can have a negative impact on the daily life of people with the condition, contributing to lowered self-esteem, embarrassment, and feelings of shame. Engaging in emotion-focused and behavioural/avoidant-focused coping strategies increased participant's confidence and reduced their avoidance of social situations. However, such strategies might still serve to maintain underlying unhelpful cognitive processes. Consequently, it is important for medical professionals to assess for the presence of cognitive factors that might contribute to maintaining distress in patients with rosacea, and where unhelpful thoughts or beliefs are reported, patients may need to be referred for psychological support.
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Hidradenitis Suppurativa and electrocardiographic changes – a cross-sectional population study
Abstract
Background
Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease, recently associated with metabolic syndrome, subclinical atherosclerosis and increased risk of cardiovascular disease.
Objectives
The aim of the study was to investigate the hitherto unknown electrocardiographic changes associated with HS, which recently have been associated with significant cardiovascular burden.
Methods
Data were derived from the cross-sectional population study, The Danish General Population Study (GESUS). HS diagnosis was based on a validated self-reported questionnaire and 404 individuals met the HS diagnosis criteria and 19,001 controls without HS were identified in the population. Severity of HS was staged according to a modified Hurley score. The electrocardiographic parameters, Heart Rate (HR), PR-interval, QRS-duration, JTc-interval and QTc-interval, were obtained from 12-lead resting electrocardiograms. We investigated the difference in means by unpaired t-test or the analysis of variance (ANOVA) test.
Results
Heart rate was significantly higher (mean difference: 2.3 bpm [1.2:3.4] p<0.01) when adjusting for age and gender but when multivariate adjusting, there was no significant difference (0.3 bpm [-0.7:1.4] p=0.52). Severe HS was significantly associated with increased heart rate across all models (2.9 bpm [0.7:5.1] p=0.01). Mean QRS-duration was significantly shorter in the mild HS group, but not in the moderate- and severe HS groups
Conclusion
Mean resting heart rate in severe HS was significantly higher compared to controls. Given that resting heart rate is associated with increased risk of all-cause and cardiovascular mortality, and that HS patients have increased risk of cardiovascular events, this finding is potentially important, easily testable and intervenable.
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A hyaluronic acid-based microneedle patch to treat psoriatic plaques: A pilot open trial
Abstract
Psoriasis, a common, chronic, relapsing, inflammatory skin disease characterised by multiple erythematous papules and plaques with silvery scales, affects 0.5–3% of the world's population. Recently, great advances have been made in the treatment of psoriasis, including the introduction of targeted biological agents.1 However, topical treatment remains important; most patients have mild disease affecting less than 2% of the body surface area.2
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AGREE II assessments of recent acne treatment guidelines: how well do they reveal trustworthiness as defined by the Institute of Medicine (IOM) criteria?
Abstract
Background
Up-to-date, trustworthy guidelines are a widely relied-upon means of promoting excellent patient care.
Objectives
To determine the quality of recently published acne treatment guidelines by utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the US Institute of Medicine's (IOM) criteria of trustworthiness, Lenzer et al's red flags and CheckUp.
Methods
Systematic searches were conducted in bibliographic databases, guideline depositories and using Google™ to identify acne treatment guidelines published since 2013. Six assessors independently scored each guideline using the AGREE II Reporting Checklist. Guidelines were concomitantly assessed for trustworthiness using the IOM criteria and for Lenzer et al's red flags indicative of potential bias. Updates were screened using CheckUp.
Results
Eight guidelines were identified, two of which were updates. Lowest scoring AGREE II domains across all guidelines were rigour (6/8 poor, one fair, one average) and applicability (4/8 poor, one fair, three average). Two out of the three highest scoring guidelines were developed using AGREE II. No guideline fully met each IOM criterion and all raised at least one red flag indicative of potential bias. One updated guideline did not address seven of 16 items on CheckUp and the other did not address four. Patient involvement in guideline development was minimal.
Conclusions
Use of the AGREE II Instrument during guideline development did not have as great an effect on guideline quality as might be expected. There is considerable room for improvement in acne treatment guidelines in order to satisfy the IOM trustworthiness criteria and avoid bias.
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European Heart SCORE may underestimates cardiovascular risk after assessing cardiovascular disease with carotid ultrasound in Hidradenitis Suppurativa
Abstract
Hidradenitis suppurativa (HS) is chronic recurrent inflammatory disease affecting intertriginous areas, especially the axilla and the groin1. It is characterized by painful, deep-seated, inflamed lesions, including nodules, abscesses, and sinus tracts2. A recent meta-analysis found an association between HS and traditional cardiovascular (CV) risk factors and metabolic syndrome3.
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Peak inspiratory flow as predictor for tracheotomy
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Lesnik, J. J. Sanchez-Guerrero, O. De Crouy Chanel, C. Hervé, J. Guerlain, S. Périé
ObjectivesQuantitative evaluation of upper airway obstruction cannot be commonly performed under acute dyspnea, especially in head and neck cancer (HNC); the decision whether or not to perform airway control surgery may be difficult to reach. Peak inspiratory flow (PIF) has been previously demonstrated to be a useful tool to decide on decannulation after HNC surgery. The aim of the present study was to assess the role of PIF as a standardized non-invasive tool in quantifying severe inspiratory dyspnea requiring emergency tracheostomy.Materials and methodsA single-center prospective observational pilot study analyzed PIF measurements in 22 patients exhibiting acute dyspnea due to upper airway obstruction.Main outcome measuresThe decision whether or not to perform tracheotomy was taken prior to PIF measurement. PIF was measured with a hand-held PIF meter (In-Check method), and laryngeal fiberoscopy was then performed. Obstruction severity was defined by PIF values.ResultsPIF could be measured prior to tracheotomy (imminent in 21 cases, postponed in 1) in all cases. PIF values below 53.1 L/min (i.e., 18.3% of theoretic value) correlated with necessity for emergency tracheotomy. This threshold is concordant with that previously found for the feasibility of decannulation (60L/min).ConclusionsPIF is a non-invasive quantitative parameter assessing severity of upper airway obstruction, that may be helpful in decision-making for tracheostomy. Testing is simple, quick and reproducible.
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A pigmented lesion of the nasopharynx
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J.-W. Kim, S.-D. Kim, K.-S. Cho
http://ift.tt/2tvTSpZ
L’infection à Zika virus : mise au point
Publication date: Available online 30 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Guillier, E. Amazan, A. Aoun, E. Baubion, C. Derancourt
Le virus Zika (ZIKV), initialement identifié en 1947, est un Flavivirus ré-émergent, principalement transmis par les piqûres de moustiques du genre Aedes. Jusqu'aux récentes épidémies dans les îles du Pacifique et en Amérique centrale et du sud, il était réputé à l'origine d'une maladie bénigne, asymptomatique dans la majorité des cas, ou avec des symptômes modérés non spécifiques (fièvre, éruption, conjonctivite, arthralgies…). Au cours de l'épidémie actuelle, d'une ampleur inédite, de nouveaux modes de transmission (transfusionnel, périnatal, sexuel) et des complications neurologiques sévères telles que des malformations congénitales chez les fœtus de mères infectées et des syndromes de Guillain-Barré chez l'adulte ont été mis en évidence. Cette situation, dans un contexte de potentielle pandémie mondiale à venir, a amené l'Organisation mondiale de la santé (OMS) à déclarer l'infection à ZIKV urgence de santé publique de portée internationale en février 2016.Zika Virus (ZIKV), originally identified in 1947, is a re-emerging Flavivirus transmitted mainly through bites by Aedes mosquitos. Until the recent outbreaks in the Pacific islands and Central and South America, it was known to cause benign disease, in most cases asymptomatic or with mild and nonspecific symptoms (fever, rash, conjunctivitis, arthralgia, etc.). The unprecedented current epidemic has highlighted new modes of transmission (through blood, perinatally and sexually) as well as serious neurological complications such as congenital defects in the fetuses of infected mothers and Guillain-Barre syndrome in adults. This situation, coupled with the threat of worldwide spread, prompted the WHO to declare the ZIKV a public health emergency of international concern in February 2016.
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When cancer patients suddenly have a positive pregnancy test
We present the case of non-small cell lung cancer (NSCLC) in a 48-year-old woman with an active history of smoking. The patient initially presented to her general practitioner with a progressive swelling on the neck. Further investigations diagnosed a metastatic lung tumour, and palliative chemotherapy was started. After 5 months of treatment, by newly reported amenorrhoea, cautiously before a restaging CT scan of the abdomen, a pregnancy test was performed and was positive. Both the gynaecological examination and the hormonal panel yielded no signs of pregnancy. Immunohistochemically, staining of the tumour was strongly positive for β-subunit of human chorionic gonadotropin (β-hCG) suggesting that the tumour was responsible for high β-hCG levels.
Paraneoplastic β-hCG secretion from adenocarcinomas is rare. In the literature, only a few such cases have been reported. Previous studies suggested that the ability to secrete β-hCG in tumours may correlate to some extent to chemoresistance and thus, to a worse prognosis.
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Review of phase III trial data on IL-23 Inhibitors Tildrakizumab and Guselkumab for psoriasis
Abstract
Background
The development of monoclonal antibodies targeting IL-12 and IL-23 has enhanced the therapeutic options available for psoriasis patients. Recent research suggests that IL-23 alone plays a role in the pathogenesis of psoriasis.
Objective
The objective was to review the phase III clinical trial data for the anti-IL-23 agents in order to evaluate the safety and efficacy profile of each agent.
Methods
We reviewed the results of the phase III clinical trials for the anti-IL-23 agents tildrakizumab and guselkumab. The results of phase III trials on risankizumab have not yet been reported.
Results
By week 12, the proportion of patients reaching Psoriasis Area and Severity Index (PASI 75) was greater than 60% among the most efficacious dose of each agent. The percentage of patients achieving PASI 90 at week 16 was the primary endpoint for the phase III trials for guselkumab, which was above 70%. The safety profiles of the agents were comparable, with the most commonly reported adverse events of nasopharyngitis and upper respiratory tract infections.
Conclusion
The anti-IL-23 agents demonstrated a rapid clinical improvement that is similar or superior to the improvement seen with currently marketed IL-17 inhibitors with a favorable short-term safety profile. The results of the phase III trials support the notion that IL-23 is a potential target in psoriasis treatment.
This article is protected by copyright. All rights reserved.
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Theophylline increases saliva sonic hedgehog and improves taste dysfunction
Source:Archives of Oral Biology, Volume 82
Author(s): Robert I. Henkin, Alexandra B. Knöppel, Mona Abdelmeguid, William A. Stateman, Suzanna Hosein
ObjectiveTo determine changes in saliva sonic hedgehog (Shh) and in taste dysfunction before and after oral theophylline treatment.DesignShh was measured in parotid saliva of both normal subjects and patients with taste dysfunction of multiple etiologies by use of a sensitive spectrophotometric ELISA assay. Taste dysfunction was defined clinically by both subjective inhibition of taste function (including acuity loss) and impaired gustometry.ResultsTheophylline treatment increased patient saliva Shh and improved taste dysfunction both subjectively and by gustometry.ConclusionsBy use of these systematic clinical measurements theophylline can be demonstrated to increase saliva Shh and improve taste dysfunction. These results are consistent with saliva Shh acting as a taste bud growth factor which stimulates stem cells of taste buds to initiate development and perpetuation of taste bud receptors. Measurements of saliva Shh provide an important marker for the presence of taste dysfunction and in the improvement by theophylline treatment.
http://ift.tt/2tB1M1H
Theophylline increases saliva sonic hedgehog and improves taste dysfunction
Source:Archives of Oral Biology, Volume 82
Author(s): Robert I. Henkin, Alexandra B. Knöppel, Mona Abdelmeguid, William A. Stateman, Suzanna Hosein
ObjectiveTo determine changes in saliva sonic hedgehog (Shh) and in taste dysfunction before and after oral theophylline treatment.DesignShh was measured in parotid saliva of both normal subjects and patients with taste dysfunction of multiple etiologies by use of a sensitive spectrophotometric ELISA assay. Taste dysfunction was defined clinically by both subjective inhibition of taste function (including acuity loss) and impaired gustometry.ResultsTheophylline treatment increased patient saliva Shh and improved taste dysfunction both subjectively and by gustometry.ConclusionsBy use of these systematic clinical measurements theophylline can be demonstrated to increase saliva Shh and improve taste dysfunction. These results are consistent with saliva Shh acting as a taste bud growth factor which stimulates stem cells of taste buds to initiate development and perpetuation of taste bud receptors. Measurements of saliva Shh provide an important marker for the presence of taste dysfunction and in the improvement by theophylline treatment.
http://ift.tt/2tB1M1H
A lung sound analysis in a child thought to have cough variant asthma: A case report
Publication date: Available online 30 June 2017
Source:Allergology International
Author(s): Eri Imai, Mayumi Enseki, Mariko Nukaga, Hideyuki Tabata, Kota Hirai, Masahiko Kato, Hiroyuki Mochizuki
http://ift.tt/2ssA0nZ
Three-dimensional printed haptic model from a prenatal surface-rendered oropalatal sonographic view: a new tool in the surgical planning of cleft lip/palate
Publication date: Available online 30 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Nicot, G. Couly, J. Ferri, J.-M. Levaillant
Three-dimensional (3D) ultrasound has significantly improved prenatal screening and perinatal care in the area of cleft lip/palate and other deformities, providing essential preoperative information to the surgical team. However, current 3D reconstruction modalities are limited primarily to display on a two-dimensional surface. In contrast, a 3D printed haptic model allows both the surgeon and the parents to develop a better understanding of the anatomy and the surgical procedure through the ability to interact directly with the printed model. The production of a 3D printed haptic model of cleft lip and palate obtained from a surface-rendered oropalatal sonographic view is presented here. The development of this 3D printed haptic model will allow the surgical team to perform preoperative planning with a highly accurate medical model, and it therefore represents a new tool in the management of cleft lip/palate. It also provides better prenatal information for the parents.
http://ift.tt/2uuvhyO
Traction suture modification to tongue-in-groove caudal septoplasty
Publication date: Available online 30 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y.A. Indeyeva, T.S. Lee, E. Gordin, D. Chan, Y. Ducic
Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty.
http://ift.tt/2twJOwF
Relevance of chromosomal band 11q13 in oral carcinogenesis: An update of current knowledge
Source:Oral Oncology, Volume 72
Author(s): Pablo Ramos-García, Isabel Ruiz-Ávila, José Antonio Gil-Montoya, Ángela Ayén, Lucía González-Ruiz, Francisco José Navarro-Triviño, Miguel Ángel González-Moles
An important event in oral carcinogenesis is the amplification of chromosomal band 11q13, in which numerous oncogenes and some tumor-suppressor genes are localized and frequently co-amplified during the malignant transformation of oral epithelium. The objectives of this study were to review published data on the involvement of 11q13 amplification in oral cancer, to provide an update on novel concepts and terminology related to gene amplification, and to explore the composition of the 11q13 amplicon in OSCC, including its most relevant amplicon cores and potential drivers. We report on the critical oncogenes and tumor-suppressor genes in 11q13 that may play a major role in oral cancer, focusing on their functions, on the characteristics acquired by their amplification, and on their clinicopathological implications. Finally, we discuss the possible usefulness of the 11q13 region as a therapeutic target in oral cancer.
http://ift.tt/2utCD5w
Combination of docetaxel, trastuzumab and pertuzumab or treatment with trastuzumab-emtansine for metastatic salivary duct carcinoma
Source:Oral Oncology
Author(s): Wim van Boxtel, Eline Boon, Willem L.J. Weijs, Frank J.A. van den Hoogen, Uta E. Flucke, Carla M.L. van Herpen
http://ift.tt/2tvcKoY
Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement
Abstract
Background: Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated.Methods: From October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125 mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery. An unadjusted comparison was specifically done to evaluate deep prosthetic infections.Results: Of a total of 3927 TKA procedures, 1442 received MP. Median LOS was 2 days in both groups, but the fraction with LOS >4 days was 6.0% vs 11.5% (P<0.001) in patients with MP vs those without, and with a reduced risk of LOS >4 days in adjusted analysis [odds ratio (OR) 0.51; confidence interval (CI) 0.39–0.68; P<0.001]. Readmission rates were 5.6% (CI 4.5–6.9) vs 4.4% (P=0.095) and 7.8% vs 7.3% (P=0.53) at 30 and 90 days with and without MP, respectively.Adjusted analysis did not identify MP to be associated with 30 day (OR 1.18; CI 0.89–1.56; P=0.25) or 90 day (OR 1.12; CI 0.86–1.46; P=0.39) readmissions. The incidence of deep infections requiring surgical intervention was 0.8% vs 0.7% with MP vs without, respectively (P=0.78).Conclusions: In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS >4 days, readmissions or infectious complications in TKA patients without contraindications.Clinical trial registration: NCT01515670.http://ift.tt/2twmeQC
Endoscopic versus microscopic type 1 tympanoplasty in the same patients: a prospective randomized controlled trial
Abstract
The aim of this study was to compare the audiologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, postoperative pain and health status. This prospective randomized controlled study was carried out in Ege University ENT Department between February 2015 and September 2016. The patients who had bilateral chronic otitis media, normal middle ear mucosa and a hearing loss difference of 10 dB or less between the two ears randomly underwent microscopic tympanoplasty in one ear and endoscopic tympanoplasty in the contralateral ear, with 6-month intervals. 13 patients were included in the study with a mean age of 36.17 ± 3.61 years (range 17–53 years, 7 female, 6 male). The improvement in air–bone gap for groups 1 (endoscopic) and 2 (microscopic) was 9.48 ± 5.23 and 9.89 ± 2.79 dB, respectively. The duration of the surgery in group 1 was significantly lower than that in group 2 (p < 0.01). VAS scores were 2.15 ± 0.37 and 3.76 ± 1.64 cm for groups 1 and 2, respectively (p = 0.006). The endoscopic approach for type 1 tympanoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery. In addition, endoscopic surgery offers comparable improvement in air–bone gap and similar graft success. The endoscopic approach has comparable audiological and morphological graft outcomes with the microscopic one. The endoscopic approach yielded better health and pain status for the same patients.
Level of evidence This is an individual randomized controlled trial. The level of evidence is 1b.
http://ift.tt/2tuTYy0
Piezoelectric versus conventional techniques for orthognathic surgery: Systematic review and meta-analysis
The purpose of this study was to perform a systematic review and meta-analysis of complications after orthognathic surgery comparing piezosurgery with conventional osteotomy.
http://ift.tt/2tzYRXc
Polymorphisms in DENND1B gene are associated with asthma and atopy phenotypes in Brazilian children
Source:Molecular Immunology, Volume 90
Author(s): Bianca S.D. Fiuza, Milca de J. Silva, Neuza M. Alcântara-Neves, Maurício L. Barreto, Ryan dos S. Costa, Camila A. Figueiredo
Asthma is a heterogeneous disease associated with a complex basis involving environmental factors and individual variabilities. The DENN Domain Containing 1B (DENND1B) gene has an important role on T cell receptor (TCR) down-regulation on Th2 cells and studies have shown that mutations or loss of this factor can be associated with increased Th2 responses and asthma. The aim of this work is to evaluate the association of polymorphisms in the DENND1B with asthma and allergy markers phenotypes in Brazilian children. Genotyping was performed using a commercial panel from Illumina (2.5 Human Omni bead chip) in 1309 participants of SCAALA (Social Change, Asthma, Allergy in Latin American) program. Logistic regressions for asthma and atopy markers were performed using PLINK software 1.9. The analyzes were adjusted for sex, age, helminth infections and ancestry markers. The DENND1B gene was associated with different phenotypes such as severe asthma and atopic markers (specific IgE production, skin prick test and IL-13 production). Among the 166 SNPs analyzed, 72 were associated with asthma and/or allergy markers. In conclusion, polymorphisms in the DENND1B are significantly associated with development of asthma and atopy and these polymorphisms can influence DENND1B expression and consequently, asthma.
http://ift.tt/2twFeOQ
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