Head and Neck Medicine by Alexandros G.Sfakianakis: 07/20/17

Πέμπτη 20 Ιουλίου 2017

Concurrent Chondrodysplasia Punctata Type 2 (Conradi–Hunermann–Happle Syndrome) and Ichthyosis Vulgaris in Teenaged Twin Girls

Abstract

We present concurrent X-linked chondrodysplasia punctata and ichthyosis vulgaris in adolescent fraternal twin girls, notable for initial presentation with dry skin in adolescence, characterized by dark-brown scale typical of ichthyosis vulgaris and blaschkolinear, atrophic, scaly plaques. This constellation of findings prompted further genetic investigation. Using a multigene approach to examine 39 genes associated with congenital ichthyosis, next-generation sequencing revealed a novel heterozygous missense mutation at a mutational hotspot in the EBP gene c.439C>T (p.R147C) in conjunction with a single nonsense mutation in the FLG gene (p.R501X) in both sisters. These individuals highlight the clinical variability of Conradi–Hunermann–Happle syndrome, illustrate the possibility of co-occurrence of rare and common forms of ichthyosis, and demonstrate the utility of multigene analysis.

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Methotrexate for Severe Childhood Atopic Dermatitis: Clinical Experience in a Tertiary Center

Abstract

Background/Objectives

Atopic dermatitis (AD) affects up to 20% of children. Although the majority of patients are adequately controlled using emollients, topical corticosteroids, topical calcineurin inhibitors, or phototherapy, children with moderate to severe AD may require systemic treatment for control. The objective of the current study was to evaluate the efficacy and safety of methotrexate in children with severe AD attending a tertiary referral center.

Methods

A retrospective chart review was undertaken of all children who received methotrexate for severe AD at our tertiary referral center from November 2010 to August 2015.

Results

Forty-seven children were started on methotrexate for AD during this period. The mean Investigator Global Assessment (IGA) at the 3- to 5-month follow-up improved from 4.25 to 2.8, with further improvement to 1.9 in the patients that continued therapy beyond 10 months. Changes in the Children's Dermatology Life Quality Index (CDLQI) mirrored changes in the IGA, with improvement in the mean CDLQI from 14.4 at the start of the treatment to 7.5 at the 3- to 5-month follow-up. Further improvement in the CDLQI to 6.6 in patients who continued methotrexate beyond 10 months confirmed continued improvement in disease control beyond medium-term therapy. The treatment was well tolerated.

Conclusions

Methotrexate appears to be an effective, safe treatment for severe pediatric AD. Its therapeutic effects continue beyond the medium-term treatment period, as reflected by further improvement in IGA and CDLQI scores in patients who continued methotrexate therapy beyond 10 months.

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Autoimmunity and its association with regulatory T cells and B cell subsets in patients with common variable immunodeficiency

Publication date: Available online 20 July 2017
Source:Allergologia et Immunopathologia
Author(s): G. Azizi, H. Abolhassani, F. Kiaee, N. Tavakolinia, H. Rafiemanesh, R. Yazdani, SA. Mahdaviani, S. Mohammadikhajehdehi, M. Tavakol, V. Ziaee, B. Negahdari, J. Mohammadi, A. Mirshafiey, A. Aghamohammadi
BackgroundCommon variable immunodeficiency (CVID) is one of the most prevalent symptomatic primary immunodeficiencies (PIDs), which manifests a wide clinical variability such as autoimmunity, as well as T cell and B cell abnormalities.MethodsA total of 72 patients with CVID were enrolled in this study. Patients were evaluated for clinical manifestations and classified according to the presence or absence of autoimmune disease. We measured regulatory T cells (Tregs) and B-cell subsets using flow cytometry, as well as specific antibody response (SAR) to pneumococcal vaccine, autoantibodies and anti-IgA in patients.ResultsTwenty-nine patients (40.3%) have shown at least one autoimmune manifestation. Autoimmune cytopenias and autoimmune gastrointestinal diseases were the most common. A significant association was detected between autoimmunity and presence of hepatomegaly and splenomegaly. Among CVID patients, 38.5% and 79.3% presented a defect in Tregs and switched memory B-cells, respectively, whereas 69.0% presented CD21^low B cell expansion. Among patients with a defect in Treg, switched memory and CD21^low B cell, the frequency of autoimmunity was 80.0%, 52.2% and 55.0%, respectively. A negative correlation was observed between the frequency of Tregs and CD21^low B cell population. 82.2% of patients had a defective SAR which was associated with the lack of autoantibodies.ConclusionsAutoimmunity may be the first clinical manifestation of CVID, thus routine screening of immunoglobulins is suggested for patients with autoimmunity. Lack of SAR in CVID is associated with the lack of specific autoantibodies in patients with autoimmunity. It is suggested that physicians use alternative diagnostic procedures.

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A Medieval/Early Modern Alpine Population from Zweisimmen, Switzerland: Anthropology and Palaeopathology of a Comparative Study

Abstract

To date, anthropological comparative studies are rare from Switzerland. Therefore, this research aims to make a comparison between the alpine individuals from Zweisimmen (14^th–19^th c.), and 17 other rural and urban populations from Switzerland all dating to the medieval and early modern period. An osteoarchaeological analysis was carried out on the rural population of Zweisimmen, consisting of 134 skeletons. For each individual the arm position and orientation were observed in the field, while preservation, representation, sex, age, stature, trauma, and pathologies were recorded in the laboratory. These results were compared to data from published and grey literature in order to gain a better understanding of chronological and regional patterns in Switzerland. A chronological development was observed in the orientation, arm position, and use of a coffin, which suggests a change in burial practices and beliefs throughout time. The demographic profile represents a natural mortality, however, children and especially neonates are underrepresented in this sample. Some individuals were buried in groups, suggesting simultaneous burial caused by a period of increased mortality. Thus, the palaeopathological findings suggest that the living conditions in rural alpine Zweisimmen were similar to those of other contemporaneous populations, as well as those living in an urban setting.

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The Genetic Background of Metabolic Trait Clusters in Children and Adolescents

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Fatty Acid Composition of Plasma Phosphatidylcholine Determines Body Fat Parameters in Subjects with Metabolic Syndrome-Related Traits

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Hidradenitis Suppurativa in Children Treated with Finasteride—A Case Series

Abstract

Background

Hidradenitis suppurativa (HS) is rare in childhood, with only 2% of cases in patients younger than 11 years. It is a chronic, recurrent, debilitating condition for which no universally effective treatment has been developed. We present five cases of children with HS diagnosed between the ages of 6 and 11 years.

Methods

Patients were treated with oral finasteride 1 to 5 mg/day. All had entered puberty at the time of treatment initiation. All had normal laboratory results before starting treatment. The maximum duration of treatment was 24 months.

Results

Four patients were female. Two were overweight. Three had been previously treated with oral antibiotics, and two of these with oral isotretinoin, with partial or no improvement. Overall improvement of the disease was observed in all patients, with a reduction of the frequency and intensity of the flares. No adverse effects were observed or reported during treatment.

Conclusion

Treatment of HS can be challenging. The options available include antimicrobials, immunosuppressants, hormonal therapies, lasers, and surgery. The authors report the largest series of children with HS treated with finasteride. The results support the use of finasteride as monotherapy for the treatment of this disease in children. Further studies are necessary to fully understand the role of this drug in the management of this disease.

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Announcements

Dear Colleagues,

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EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Editorial Board

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Old and new adjuvants

Amy S McKee | Philippa Marrack

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CD8+ T cell programming by cytomegalovirus vectors: applications in prophylactic and therapeutic vaccination

Klaus Früh | Louis Picker

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Cancer immunotherapy: moving forward with peptide T cell vaccines

Takumi Kumai | Aaron Fan | Yasuaki Harabuchi | Esteban Celis

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Turbocharging vaccines: emerging adjuvants for dendritic cell based therapeutic cancer vaccines

Mansi Saxena | Nina Bhardwaj

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No pain no gain? Adjuvant effects of alum and monophosphoryl lipid A in pertussis and HPV vaccines

Thomas C Mitchell | Carolyn R Casella

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Immunological tolerance as a barrier to protective HIV humoral immunity

Kristin MS Schroeder | Amanda Agazio | Raul M Torres

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Forthcoming Events

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Will we all be replaced by machines?

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Adverse reactions to fillers should be published – on the consensus statement on adverse effects following hyaluronic acid-based fillers

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Issue Information

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Announcement

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Is DNA ploidy related to smoking?

Abstract

Background

In the oral cavity, genomic instability is caused by long-term exposure to carcinogens. The aim of the present study was to evaluate the relationship between smoking and DNA ploidy

Methods

Cytological material was obtained from patients participating in the Outpatient Smoking Treatment Program of the Heart Institute (INCOR-HCFMUSP), and of the Discipline of Oral Medicine (ICT-UNESP). The inclusion criteria for all groups were the absence of a history of malignant tumors, absence of clinical signs of changes in the selected area, and alcohol consumption of less than 3 units per week. Group 1: 30 smokers before smoking cessation treatment; Group 2: 30 non-smokers; Group 3: 30 ex-smokers abstinent for at least one year. Cytological smears were collected from the floor of the mouth and border of the tongue and stained by Feulgen. Aneuploidy was evaluated using the ACIS^® III system

Results

The Kruskal-Wallis test showed no statistically significant difference (p = 0.4383) between the groups studied. No association between tobacco consumption and aneuploidy was observed in group 1 (p = 1) or group 2 (p = 0.68) (Fisher's exact test)

Conclusion

Smoking was not associated with changes in DNA content or the incidence of aneuploidy in normal oral mucosa.

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Re: Wrong tooth extraction: an examination of ‘Never Event’ data

Publication date: Available online 20 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Shofiq Islam, Uthaya Selbong, I.W. Ormiston, J.P. Hayter

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Cutaneous larva migrans occurring concurrently in a father and son

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Dermoscopy of a pigmented apocrine porocarcinoma arising from a pigmented hidroacanthoma simplex

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Herbal multicomponent extracts enhance wound healing after incision of perianal abscess and in a rat model of infected wounds

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Update on Allergen Immunotherapy for Allergic Rhinitis: Drops, Tablets, or Shots?

Abstract

Purpose of Review

Allergen immunotherapy (AIT) is the only disease-modifying treatment available for allergic rhinitis (AR). Dosing considerations, efficacy, and safety of subcutaneous (SCIT), sublingual (SLIT), and intralymphatic (ILIT) immunotherapy are discussed.

Recent Findings

Patients with AR who cannot tolerate or do not wish to continue indefinite pharmacotherapy may be candidates for AIT. SCIT is the gold standard formulation but requires repeat injections over several years and may place the patient at risk for systemic allergic reactions such as anaphylaxis. SLIT has been developed as an alternative formulation by which the patient can avoid multiple injections and physician visits as it is dosed at home. SLIT has been proven to be very safe but still requires prolonged treatment, and efficacy compared to SCIT has been questioned. ILIT is currently being developed with the goal of shortening length of treatment while maintaining the efficacy and safety of SCIT and SLIT.

Summary

SCIT and SLIT are current options for patients wishing to undergo AIT. Further studies are required to determine if ILIT may become an effective option for patients who do not wish to undergo long-term treatments.

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Traction with bilateral reverse eyelets: a simple technique for management of sagittal palatal fractures

Sagittal palatal fractures are rare, the incidence ranging from 4% to 42%. They are usually found in association with LeFort fractures and split the maxilla in a sagittal direction, which usually results in oronasal communication and buccal rotation of the fractured segments.1 Numerous techniques for their management have been described, including closed reduction and open reduction with internal fixation (ORIF).

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Re: Wrong tooth extraction: an examination of ‘Never Event’ data

After the "never" event framework was introduced, a core list of examples was drawn up in 2009 that included operations on the wrong site,1 and a further revision after April 2015 included extraction of the wrong tooth.2,3 We read with interest the article by Pemberton et al3 who found that extraction of the wrong tooth accounted for about a quarter of all procedures at the wrong site, and up to 10% of "never" events in total, all in hospital. As most dental extractions were done in primary care, this raises questions because, as far as we are aware, no data are available from this sector.

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Re: Endoscopically-assisted extracapsular dissection of pleomorphic adenoma of the parotid gland through a postauricular sulcus approach in young patients

I read with interest the recent paper by Chen et al1 and commend them on their original work. However, I would like to raise some important points.

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Use of cyanoacrylate tissue adhesive to orientate histopathological specimens

The correct orientation of specimens is important for histopathological diagnosis. Occasionally, after a resected specimen has been inspected, it may be necessary to remove a further section because of concern about involved margins. It is important to orient the second sample correctly with the first, or the potential for error is increased. The use of sutures to bind the specimens can cause artefacts, which can compromise histopathological evaluation. We describe a method to help orientate these specimens accurately.

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Management of upper and lower molars that are displaced into the neighbouring spaces

Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach.

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Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care

We aimed to identify and evaluate the clinical challenges involved in microvascular flap reconstructions of defects caused by resection of head and neck cancer among patients aged 85 and over. We designed a retrospective study of patients who were treated in the head and neck department of a tertiary referral centre from 2005 to 2015, and all patients aged 85 years and over who had reconstructions with microvascular flaps for head and neck cancer were entered into the study. A total of 24 patients fulfilled the criteria, of whom 15 were men and nine were women.

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Intraosseous spindle cell lipoma of the mandible: case report

We describe what is to our knowledge the first reported intraosseous spindle cell lipoma of the mandible. It is the first spindle cell lipoma we have seen that shows dental resorption, and the largest that we have seen published (60×30×20mm).

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Severe distortion of an orbital titanium mesh implant after recurrent facial trauma: a potential threat to the orbital contents?

Titanium mesh implants have proved their effectiveness in the reconstruction of fractures of the orbital wall, and their compromise between stiffness and elasticity allows for optimal support of the orbital contents. However, after recurrent orbital trauma, these implants (even when properly positioned) can become a potential "penetrating object" that threatens the critical adjacent anatomical structures. We report the case of a patient with recurrent facial trauma whose orbit had previously been reconstructed with a titanium implant, and which resulted in severe deformation.

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Minimally-invasive removal of a screw in the mandibular condyle using computer-assisted navigation

A sagittal fracture of the mandibular condyle is routinely fixed with screws because they can provide stability, functional restoration, and anatomical reduction.1,2 Plates and screws (and other materials used for osteosynthesis) are not routinely removed unless the patients has particular symptoms or complications,3 but it is a common procedure in the craniomaxillofacial region.3,4 When larger devices are removed we often reopen the original incisions, but because screws are so small it is better to use a different, minimal incision.

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Delayed stinging insect reactions

Systemic allergic reactions to stinging insects occur in approximately 1% of children and 3% of adults.1 Immunoglobulin E (IgE)-mediated reactions can present as systemic reactions or large local reactions.1 Systemic reactions present with symptoms related to urticaria, angioedema, airway obstruction, and hypotension (and sometimes abdominal pain, bronchospasm, or cardiac abnormalities) within 5 to 30 minutes after an insect sting.2 Large local reactions present as swelling of at least 10 cm in diameter that is contiguous with the sting site, increases in size for 1 to 2 days, and resolves over 5 to 10 days.

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Posterior canal wall reposition for management of cholesteatoma: Technique and results

Publication date: Available online 20 July 2017
Source:Auris Nasus Larynx
Author(s): Mohammad Kamal Mobashir, Waleed M. Basha, Abd ElRaof Said Mohamed, Mohammed Elsayed Elmaghawry
ObjectiveThe main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome.Patients and methodsThis study included 31 patients with primary acquired middle ear cholesteatoma. The surgical technique included complete cortical mastoidectomy, wide posterior tympanotomy, dividing the bony posterior meatal wall with a micro-sagittal saw and its removal, dissection and eradication of cholesteatoma, and repositioning the canal wall segment in its anatomical site.ResultsNo significant intraoperative complication occurred. An injury to the dura occurred in one patient. Damage of the bony posterior canal wall occurred in two patients during saw cutting. Residual cholesteatoma was found in two patients. No dislocation or necrosis of the reconstructed posterior canal wall was noted and the new reconstructed external ear canal appeared to be of near normal size, shape, and contour.ConclusionThis technique provides optimal surgical exposure and access to areas that are difficult to reach by CWU approach, allows removal of the cholesteatoma without intraoperative complications, decreases the rate of residual cholesteatoma, restores near-normal anatomy of the external auditory canal, and avoids the sequelae of the open mastoid cavity. Therefore, it would be a feasible alternative to the standard CWU and CWD procedures.

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Treatment of pharyngotympanic tube dysfunction

Publication date: Available online 19 July 2017
Source:Auris Nasus Larynx
Author(s): Holger H. Sudhoff, Stefan Mueller
Eustachian tube dysfuntion intends to describe a variety of signs, symptoms, and physical findings that result from the impairment of ET function. A large variety of methods have been employed to assess ET function in the literature. Due to the lack of high level evidence, it is difficult to draw conclusions on the effectiveness of medical and surgical treatments. There are various medical and surgical interventions available for chronic obstructive ET dysfunction including balloon Eustachian tuboplasty (BET) and laser or microdebrider tuboplasty. Consensus on diagnostic criteria for ETD is required to define inclusion criteria of future trials. There is however emerging work with reassuring, but preliminary, results that suggest evidence for safety in the surgical management of ETD. Like many newly introduced techniques the current data remains limited to non-controlled case-series, with heterogeneous data collection methods and lacking substantial long-term outcomes. Nevertheless, short-term data provide favorable results. Current treatment options comprising BET and patulous ET surgery may be offered as a treatment possibility to selected patients.

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Three-dimensional volumetric changes in the upper airway after maxillomandibular advancement in obstructive sleep apnoea patients and the impact on quality of life

Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder, characterized by repetitive airway obstructions, causing disruptive snoring and daytime sleepiness. Maxillomandibular advancement (MMA), which enlarges the upper airway, is a therapeutic surgical approach. However, no study has performed an upper airway sub-region analysis using validated three-dimensional (3D) anatomical and technical limits on cone beam computed tomography (CBCT). Hence, this prospective, observational trial was performed to evaluate 3D volumetric changes in the upper airway according to validated 3D cephalometric landmarks, before and after MMA, for all patients with a polysomnography diagnosis of OSA (apnoea–hypopnoea index (AHI) ≥5).

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Central nervous system anomalies in craniofacial microsomia: a systematic review

Extracraniofacial anomalies, including central nervous system (CNS) anomalies, may occur in craniofacial microsomia (CFM). This systematic review was performed to provide an overview of the literature on the prevalence and types of CNS anomalies and developmental disorders in CFM, in order to improve the recognition and possible treatment of these anomalies. A systematic search was conducted and data on the number of patients, patient characteristics, type and prevalence of CNS anomalies or developmental delay, and correlations between CFM and CNS anomalies were extracted.

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Spectrum of lesions derived from branchial arches occurring in the thyroid: from solid cell nests to tumors

Abstract

There is a group of lesions in the head and neck region derived from branchial arches and related structures which, when inflamed, are characterized by the formation of cysts lined by squamous or glandular epithelium and surrounded by a heavy inflammatory infiltrate rich in germinal centers. In the thyroid, the main source of various structures which may cause diagnostic dilemma is the ultimobranchial body. To investigate the spectrum of such thyroid lesions, the consultation files were reviewed for thyroid samples containing pathological structures regarded to arise from the ultimobranchial body. Positive reaction with antibodies against CK5/6, p63, galectin 3, and CEA, and negative reaction with antibodies against thyroglobulin, TTF-1, and calcitonin were used to confirm the diagnosis. The specific subtype of the ultimobranchial body-derived lesion was then determined based on histological examination of H&E-stained slides. Twenty-one cases of ultimobranchial body-derived lesions were retrieved from the consultation files, 20 of them along with clinical information (M/F = 6/14, mean age 55 years, range 36–68 years). Lesions derived from the ultimobranchial body were classified as follows: (hyperplastic) solid cell nests (nine cases), solid cell nests with focal cystic change (five cases), cystic solid cell nests (two cases), branchial cleft-like cyst (four cases), and finally a peculiar Warthin tumor-like lesion (one case). We suggest that the common denominator of these structures is that they all arise due to activation of inflammatory cells around the vestigial structures, which leads to cystic dilatation and proliferation of the epithelial component.

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Posterior canal wall reposition for management of cholesteatoma: Technique and results

The main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome.

http://ift.tt/2uH8uTM

The Effect of Bone Marrow Mesenchymal Stem Cells Application on Distracted Bone Quality during Rapid Rate of Distraction Osteogenesis

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604070

Distraction osteogenesis (DO) bone regenerate usually suffers from an inferior quality especially with rapid rate. This study was conducted to investigate the effect of mesenchymal stem cells (MSCs) application on different rates of distraction bone quality. Twenty-four goats were divided into group A with standard DO and group B with rapid distraction osteogenesis (RDO) both aided by MSCs. Group C with standard DO and group (D) with RDO were controls. Kruskal–Wallis test and Conover's post hoc analysis was used to evaluate significance (p = 0.05). Histomorphometry showed a strongly significant (SS) increase (p = 0.00036) in trabecular bone (TB) in group A (TB = 174.7 µm, SD = 33.5) and group B (TB = 166.8 µm, SD = 14) compared with group C (TB = 115.4 µm, SD = 19.6) and group D (TB = 86.1 µm, SD = 9.3). There was SS decrease (p = 0.00093) in osteoid percentage (OP) in group A (OP = 13.4%, SD = 2) and group B (OP = 11.5%, SD = 6.5) compared with group C (OP = 27.3, SD = 3.5) and group D (OP = 26.2%, SD = 2.6). Energy dispersive X-ray showed a nonsignificant increase (p = 0.11) in calcification (Ca2+%) in group A (Ca2+% = 17.6%, SD = 4.9) and group B (Ca2+% = 17.6%, SD = 4.3) compared with group C (Ca2+ % = 14.2%, SD = 6.7) and group D (Ca2+% = 11.5%, SD = 2.4). MSCs application improved microscopic bone quality during standard DO and RDO. However, macroscopic bone quality improvement still needs further investigation.
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Psychological Consequences of Maxillofacial Trauma in the Indian Population: A Preliminary Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604426

The aim of this article is to identify the prevalence of posttraumatic psychological symptoms following maxillofacial trauma among an Indian population sample and assess changes in these symptoms over a period of time. Forty-eight adult patients were assessed within 2 weeks of injury with two follow-up visits (4–6 weeks and 12–14 weeks). Patients were administered three self-reporting questionnaires in local language (GHQ-12; HADS; TSQ) on all occasions. Relevant sociodemographic and clinical data were obtained. Forty patients were included in the final analysis. Emotional distress was present in nine participants and five participants satisfied the TSQ criteria for a diagnosis of stress disorder. Anxiety and depression were observed in 10 and 4 patients, respectively. Characteristics associated with abnormal high scores included substance abuse, low education and income levels, facial scars, and complications needing additional intervention. These findings reveal the abnormal psychological response to maxillofacial trauma in immediate and follow-up periods. The use of such screening tools can be considered by the maxillofacial surgeon for early identification of psychological symptoms and referral to the psychiatrist.
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TLR3 Blockade in Rhinovirus-Induced Experimental Asthma Exacerbations: A Randomized Controlled Study

Publication date: Available online 20 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Philip E. Silkoff, Susan Flavin, Robert Gordon, Mathew J. Loza, Peter J. Sterk, Rene Lutter, Zuzana Diamant, Ronald B. Turner, Brian J. Lipworth, David Proud, Dave Singh, Andreas Eich, Vibeke Backer, James E. Gern, Christian Herzmann, Scott A. Halperin, Tjeert T. Mensinga, Alfred M. Del Vecchio, Patrick Branigan, Lani San Mateo, Frédéric Baribaud, Elliot S. Barnathan, Sebastian L. Johnston
BackgroundHuman rhinoviruses (HRV) commonly precipitate asthma exacerbations. TLR3, an innate pattern-recognition receptor, is triggered by HRV driving inflammation that may worsen asthma.ObjectiveTo evaluate an inhibitory monoclonal antibody to TLR3, CNTO3157, on experimental HRV-16 inoculation in healthy and asthmatic subjects.MethodsIn this double-blind multicenter randomized parallel-group study in North America and Europe, healthy and mild-moderate stable asthmatic subjects received single or multiple doses of CNTO 3157 or placebo, respectively, and were then inoculated with HRV-16 within 72 hours. All subjects were monitored for respiratory symptoms, lung function, and nasal viral load. The primary endpoint was maximal decline in forced expired volume in 1 second (FEV1) during 10-days post-inoculation.ResultsIn asthmatic subjects (N=63), CNTO3157 provided no protection against FEV1 decline (LS mean [SE]: CNTO3157 (n=30) = -7.08 [8.15] % and placebo (n=25) = -5.98 [8.56] %), or symptoms post- inoculation. In healthy subjects (N=12), CNTO3157 versus placebo significantly attenuated upper (p=0.03) and lower (p=0.02) airway symptom scores, with area-under-the-curve increases of 9.1(15.1) vs 34.9 (17.6) and 13.0 (18.4) vs 50.4 (25.9) for the CNTO3157 group (n=8) and placebo group (n=4), respectively, after inoculation. All of the severe and three of the four non-serious asthma exacerbations occurred on CNTO3157.ConclusionIn summary, CNTO3157 was ineffective in attenuating the impact of HRV-16 challenge on lung function, asthma control, and symptoms in asthma, but suppressed cold symptoms in healthy subjects. Other approaches, including blockade of multiple pathways, or antiviral agents, need to be sought for this high unmet medical need.

Teaser

Blockade of TLR3, a major viral-sensing receptor, was ineffective in reducing the impact of rhinovirus infection, a common precipitant of asthma exacerbations, on asthma symptoms and lung function.

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Differential Connectivity of Gene Regulatory Networks Distinguishes Corticosteroid Response in Asthma

Publication date: Available online 20 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Weiliang Qiu, Feng Guo, Kimberly Glass, Guo Cheng Yuan, John Quackenbush, Xiaobo Zhou, Kelan G. Tantisira
BackgroundVariations in drug response between individuals have prevented us from achieving high drug efficacy in treating many complex diseases, including asthma. Genetics plays an important role in accounting for such inter-individual variations in drug response. However, systematic approaches for addressing how genetic factors and their regulators determine variations in drug response in asthma treatment are lacking.MethodsWe used PANDA (Passing Attributes between Networks for Data Assimilations) to construct the gene regulatory networks associated with good responders and poor responders to inhaled corticosteroids based on a subset of 145 Caucasian asthmatic children who participated in the Childhood Asthma Management Cohort (CAMP). PANDA utilizes gene expression profiles and published relationships among genes, transcription factors (TFs), and proteins to construct the directed networks of TFs and genes. We assessed the differential connectivity between the gene regulatory network of good responders vs. that of poor responders.ResultsWhen compared to poor responders, the network of good responders has differential connectivity and distinct ontologies (e.g., pro-apoptosis enriched in network of good responders and anti-apoptosis enriched in network of poor responders). Many of the key hubs identified in conjunction with clinical response are also cellular response hubs. Functional validation demonstrated abrogation of differences in corticosteroid treated cell viability following siRNA knockdown of two TFs and differential downstream expression between good-responders and poor-responders.ConclusionsWe have identified and validated multiple transcription factors influencing asthma treatment response. Our results show that differential connectivity analysis can provide new insights into the heterogeneity of drug treatment effects.

Teaser

Almost half of asthmatic patients do not respond well to standard treatment. We proposed a network approach to identify key transcription factors and their target genes that may determine differential drug response in asthmatic patients.

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Gamma tocopherol-enriched supplement reduces sputum eosinophilia and endotoxin-induced sputum neutrophilia in volunteers with asthma

Publication date: Available online 20 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Allison J. Burbank, Charity G. Duran, Yinghao Pan, Patricia Burns, Susan Jones, Qing Jiang, Chao Yang, Sha'Leema Jenkins, Heather Wells, Neil Alexis, Mehmet Kesimer, William D. Bennett, Haibo Zhou, David B. Peden, Michelle L. Hernandez
BackgroundWe and others have shown that the gamma tocopherol (γT) isoform of vitamin E has multiple anti-inflammatory and antioxidant actions and that γT supplementation reduces eosinophilic and endotoxin (LPS)-induced neutrophilic airway inflammation in animal models and healthy human volunteers.ObjectiveTo determine if γT supplementation reduces eosinophilic airway inflammation and acute neutrophilic response to inhaled LPS challenge in volunteers with asthma.MethodsParticipants with mild asthma were enrolled in a double-blinded, placebo controlled crossover study to assess the effect of 1200 mg of γT daily for 14 days on sputum eosinophils, mucins and cytokines. We also assessed the effect on acute inflammatory response to inhaled LPS challenge following γT treatment, focusing on changes in sputum neutrophilia, mucins and cytokines. Mucociliary clearance was measured using gamma scintigraphy.ResultsFifteen subjects with mild asthma completed both arms of the study. Compared to placebo, γT notably reduced pre-LPS challenge sputum eosinophils and mucins, including MUC5AC, and reduced LPS-induced airway neutrophil recruitment 6 and 24-hours after challenge. Mucociliary clearance was slowed 4-hours post-challenge in the placebo group but not in the γT treatment group. Total sputum mucins (but not MUC5AC) were reduced at 24-hours post-challenge during γT treatment compared to placebo.ConclusionγT supplementation for 14 days reduced inflammatory features of asthma, including sputum eosinophils and mucins, as well as acute airway response to inhaled LPS challenge when compared to placebo. Larger scale clinical trials are needed to assess the efficacy of γT supplements as a complementary or steroid-sparing treatment for asthma.

Teaser

Gamma tocopherol supplementation in mild asthmatics reduced inflammatory features of asthma as well as the acute response to inhaled LPS and should be further studied as a potential treatment for asthma.

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Leveraging Siglec-8 endocytic mechanisms to kill human eosinophils and malignant mast cells

Publication date: Available online 20 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jeremy A. O'Sullivan, Daniela J. Carroll, Yun Cao, Adriano N. Salicru, Bruce S. Bochner
BackgroundSialic acid-binding immunoglobulin-like lectin (Siglec)-8 is a cell-surface protein expressed selectively on human eosinophils, mast cells, and basophils, making it an ideal target for the treatment of diseases involving these cell types. However, the effective delivery of therapeutic agents to these cells requires an understanding of the dynamics of Siglec-8 surface expression.ObjectiveTo determine whether Siglec-8 is endocytosed in human eosinophils and malignant mast cells, identify mechanisms underlying its endocytosis, and demonstrate whether a toxin can be targeted to Siglec-8–bearing cells to kill these cells.MethodsSiglec-8 surface dynamics were examined by flow cytometry using peripheral blood eosinophils, mast cell lines, and Siglec-8–transduced cells in the presence of inhibitors targeting components of endocytic pathways. Siglec-8 intracellular trafficking was followed by confocal microscopy. The ribosome-inhibiting protein saporin was conjugated to a Siglec-8–specific antibody to examine targeting of an agent to these cells through Siglec-8 endocytosis.ResultsSiglec-8 endocytosis required actin rearrangement, tyrosine kinase and PKC activities, and both clathrin and lipid rafts. Internalized Siglec-8 localized to the lysosomal compartment. Maximal endocytosis in Siglec-8–transduced HEK293T cells required an intact immunoreceptor tyrosine-based inhibitory motif. Siglec-8 was also shuttled to the surface via a distinct pathway. Sialidase treatment of eosinophils revealed that Siglec-8 is partially masked by sialylated cis ligands. Targeting saporin to Siglec-8 consistently caused extensive cell death in eosinophils and the human mast cell leukemia cell line HMC-1.2.ConclusionTherapeutic payloads can be targeted selectively to eosinophils and malignant mast cells by exploiting this endocytic pathway.

Teaser

Our findings demonstrate that Siglec-8 can be exploited as an endocytic receptor to deliver drugs or toxins to kill human eosinophils and mast cells. This approach holds promise to treat diseases involving these cell types.

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An Enlarging Neck Mass

A man in his 50s presented with sudden onset of neck swelling, pain, respiratory distress, and jaw pain; his neck was diffusely swollen without palpable fluctuance, induration, or a discrete mass, and imaging showed a large hyperdense mass. What is your diagnosis?

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Health Literacy in Patients With Head and Neck Cancer

This Viewpoint discusses the impact of health literacy on treatment compliance and outcomes in a number of medical conditions, focusing on a general measure and a cancer-specific measure of health literacy.

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Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier—Reply

In Reply We appreciate all scientific efforts to improve care for patients with indeterminate nodules. The Afirma assay has been an excellent addition to this endeavor, and our study helpful in understanding test characteristics in a unique patient population.

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Cost as a Barrier for Hearing Aid Adoption

This Viewpoint explores the broader barriers audiologists face in providing services and technologies to those with reduced hearing ability and why cost is not the main barrier for patients.

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Addressing Estimated Hearing Loss in Adults in 2060

This population epidemiology study uses data from the NHANES to estimate the number of adults expected to have hearing loss in the next 43 years.

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Posttonsillectomy Hemorrhage in the Ibuprofen Era

The perioperative treatment of children undergoing tonsillectomy with or without adenoidectomy has changed considerably since the publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation "Clinical Practice Guideline: Tonsillectomy in Children" in 2011. Intraoperative dexamethasone has been advocated, perioperative antibiotics have been discouraged, and the previously commonly used combination of acetaminophen and narcotics (codeine or oxycodone hydrochloride) for postoperative pain management has been replaced by the alternative combination of acetaminophen and nonsteroidal anti-inflammatory drugs, principally ibuprofen. The latter recommendation is based principally on the following 3 factors: the comparative effectiveness of ibuprofen to narcotics for posttonsillectomy pain control; the absence of evidence in systematic review that the use of nonsteroidal anti-inflammatory drugs after tonsillectomy is associated with an increased risk for bleeding or clinical intervention owing to bleeding; and concerns regarding the ultrarapid metabolism of codeine and, to a lesser degree, oxycodone in specific individuals, resulting in significantly higher plasma concentrations of morphine compared with normal metabolizers. Indeed, documentation from 1969 to 2012 of multiple cases of death or overdose after tonsillectomy in pediatric patients who had taken codeine postoperatively prompted the US Food and Drug Administration to issue a black box warning in 2013 stating that codeine use was contraindicated in children for this indication.

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Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage

This cohort study evaluates the association between ibuprofen use and severity of posttonsillectomy hemorrhage using transfusion events as a marker of severity in pediatric patients undergoing tonsillectomy.

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Neurologic Evaluation in Children With Laryngeal Cleft

This medical record review proposes guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft.

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Sphenoid Sinus and Petrous Apex Mass

A man had worsening blurry vision, gait instability, headache, and nasal congestion; examination revealed bilateral visual acuity of 20/100 with intact visual fields and a well-circumscribed expansile mass occupying the left petrous apex and sphenoid sinus. What is your diagnosis?

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Superior Canal Dehiscence Syndrome Affecting 3 Families

This case series describes the features of superior canal dehiscence syndrome in the multiple affected members of 3 families and explores the prospect of a genetic origin.

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Bilateral Hearing and Vestibular Loss in a Patient With Untreated CML

This case study describes a man in his 40s with uncontrolled chronic myeloid leukemia who presented with sudden-onset positional vertigo and profound sensorineural hearing loss.

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Experience of US Patients Who Self-identified Overdiagnosed Thyroid Cancer

This qualitative study describes the experience of US patients who independently self-identify as having an overdiagnosed cancer and elect not to intervene.

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July 2017 Issue Highlights

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Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid

This cohort study determines whether there is an association between biomarker levels in surgical drain fluid of patients with head and neck cancer and disease-free survival and cancer recurrence.

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Risks and Harms of Management of Incidental Thyroid Nodules

This review assesses the clinical dilemma of the incidental thyroid nodule, the risk for missing a significant cancer, and the potential harms of examination and reviews management recommendations for patients with these findings.

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Preoperative Calcium and Calcitriol and Hypocalcemia After Thyroidectomy

This cohort study compares the incidence of symptomatic hypocalcemia following administration of calcium and calcitriol supplementation given preoperatively and postoperatively vs postoperative therapy alone in patients undergoing total thyroidectomy.

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Unilateral Hearing Loss and Otorrhea

A man in his 70s had painless left-sided otorrhea, aural fullness, and hearing loss; temporal bone computed tomography demonstrated near-complete opacification of the left mastoid air cells and middle ear. What is your diagnosis?

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Survival After Salvage Surgery for Recurrent Oral Cavity Cancer

This cohort study evaluates overall survival in patients who undergo salvage surgery for recurrent oral cavity squamous cell cancer.

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Frontal Sinus Lesion

A woman with allergic rhinitis experienced progressive periorbital edema and proptosis of the left eye, with nasal congestion, altered sense of smell, supraorbital pain, proptosis, and periorbital edema; a CT scan revealed extensive thickening of the left frontal bone. What is your diagnosis?

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Surgery and Radiotherapy vs Chemoradiotherapy for Oral Cavity Cancer

This study compares the differences in survival between patients with locally advanced oral cavity squamous cell carcinoma treated with surgery followed by postoperative radiotherapy vs chemoradiotherapy.

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Role of Toluidine Blue Staining in Suspicious Lesions of Oral Cavity and Oropharynx

Abstract

Oral cancer; the sixth most common malignancy in the world has one of the lowest 5 year survival rates. This can be attributed mainly to the delay in diagnosis. The purpose of this study was to evaluate the efficacy of vital staining with toluidine blue dye as an adjunct to standard clinical examination to facilitate early detection of malignant lesions of oral cavity and oropharynx. A hospital based diagnostic test accuracy study was carried out on 55 subjects with oral mucosal disorders that included clinically suspicious premalignant or malignant lesions, in the Department of ENT, Academy of Medical Sciences, Pariyaram, Kannur, Kerala over a period of 2 years. All lesions were subjected to detailed clinical examination and toluidine blue staining; and dye retention was recorded with photographs. The results of staining were compared with findings on histopathological examination. The Sensitivity and specificity of toluidine blue test for the detection of malignancy was 92.6 and 67.9% respectively; and the overall diagnostic accuracy was 80%. The result was highly significant with a 'p value' <0.001. The results indicate that toluidine blue staining is a simple, non-invasive technique which can be a valuable adjunct in the diagnostic process of oral and oropharyngeal cancers.

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Serum Bupivacaine Concentration After Periarticular Injection With a Mixture of Liposomal Bupivacaine and Bupivacaine HCl During Total Knee Arthroplasty.

Background and Objectives: A relatively new technique to reduce postoperative pain for total knee arthroplasty is to inject a mixture of 266 mg of liposomal bupivacaine and 125 mg of 0.25% bupivacaine HCl with epinephrine 1:300,000 around the knee joint at the time of surgery. Currently, no publications report serum bupivacaine concentrations over time after periarticular injection of liposomal mixed with free bupivacaine. This information is important to ensure safe serum bupivacaine concentrations are maintained especially when considering supplemental or rescue peripheral nerve blocks. Methods: A total of 40 subjects scheduled for primary unilateral total knee arthroplasty with intraoperative periarticular injection of the liposomal bupivacaine and bupivacaine HCl mixture were included. Total serum bupivacaine concentrations were measured after the last injection at selected time points and calculated by gas chromatography. Quantile regression techniques were used to analyze the data over time. This study is registered with ClinicalTrials.gov (ID NCT02626559). Results: Peak serum concentration ranged from 0.17 to 1.2 [mu]g/mL and occurred from 10 minutes to 48 hours. Across all time points, the 48-hour interval had the highest mean concentration of total serum bupivacaine at 0.55 [mu]g/mL (SD, 0.27). Quantile regression showed total serum bupivacaine concentrations increased over the 48 hours measured. None of the participants demonstrated signs or symptoms of local anesthetic toxicity. Conclusions: Total serum concentrations of bupivacaine after periarticular administration of liposomal bupivacaine mixed with bupivacaine HCl remained below the described toxicity threshold (2.5 [mu]g/mL) within the first 48 hours, and no patients demonstrated signs or symptoms of toxicity. However, peak serum concentration time was not achieved within the 48-hour interval. Additional studies are needed to describe the course of serum bupivacaine levels after 48 hours and to ascertain the risk of toxicity when combining this method of periarticular injection with peripheral nerve blocks. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate.

Background and Objectives: The primary aim of this study was to review the impact of inserting thoracic epidural catheters in a preoperative block room setting on operating room efficiency. Methods: We conducted a retrospective preintervention/postintervention review of thoracic epidurals inserted over a 12-month period. The review included 6 months of data prior to implementation of the regional anesthesia block room and 6 months of data following implementation. The primary outcome measure was anesthesia-controlled operating room time, defined as time from patient arrival to the operating room to time of surgical site sterile preparation. Secondary measures included operating room waiting time for the patient arrival, thoracic epidural failure rate, and number of epidural insertion attempts. Results: Data from thoracic epidurals for 112 patients of preblock room and 142 patients of postblock room implementation were collected. Anesthesia-controlled operating room time was reduced by an average of 22.9 minutes per patient (95% confidence interval, 19.3-26.3 minutes; P

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Clarithromycin in the Management of Chronic Rhinosinusitis: Preliminary Results of a Possible Its New Use

Abstract

The aim of this study is to evaluate the efficacy and safety of prolonged therapy with low-dose clarithromycin in patients with chronic rhinosinusitis with polyps (CRSwP) after endoscopic sinus surgery (ESS). A total of 10 patients with CRSwP were identified and subjected to bilateral ESS. In post-operative patients they were treated with nasal wash with saline solution and steroid sprays (beclomethasone). During follow-up, after 30–40 days after the operation (M = 35.4 SD = +4.33), patients reported a worsening of symptoms with onset of nasal obstruction; reduction/loss of smell; headache; onset of viscous secretions and therefore all patients continued therapy with saline nasal irrigation, topical steroid therapy and started macrolide (clarithromycin 500 mg/pill: 1 pill/day for 3 days a week for 1 month). 22-item SinoNasal Outcome Test (SNOT-22) and a score to the endoscopic evaluation (endoscopic appearance score, EAS) before and after treatment were performed to evaluate efficacy of treatment. The results of the SNOT-22 and EAS showed statistically significant improvements (p < 0.05) for some parameters such as: the need to blow nose, sneezing, hyposmia, viscous mucous secretions about the SNOT-22 and reduction of secretions and edema of the nasal mucosa about the EAS. The preliminary results of our study show that the low-dose clarithromycin for a period of 1 month can improve patient complaints with CRSwP not only through the antibacterial properties but also for the immunomodulatory characteristics.

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Role of Toluidine Blue Staining in Suspicious Lesions of Oral Cavity and Oropharynx

Abstract

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Lung cancer as a paradigm for precision oncology in solid tumours

Abstract

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in the western world. However, the combination of molecular genotyping and subsequent systematic treatment of decoded target structures is a prime example of precision oncology in solid tumours. In this review, current targets of approved therapeutics and potential targets in clinical and preclinical trials are outlined. Furthermore, immune checkpoint inhibitors, as promising new therapeutic options, which have already been applied successfully in cases of lung cancer, are introduced. A major issue of targeted treatment of lung tumours is the persistent development of resistance. The underlying mechanisms and established and potentially applicable alternative therapeutic approaches are described. In this process of precision oncology, immunohistochemistry, fluorescence in situ hybridization, and parallel sequencing are crucial diagnostic tools.

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Clarithromycin in the Management of Chronic Rhinosinusitis: Preliminary Results of a Possible Its New Use

Abstract

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An Unusual Laryngeal Foreign Body

This case report describes a young patient who presented with sudden throat pain and cough from a bee stinger in the epiglottis.

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Patient Preference Research in Otolaryngology

This Viewpoint discusses the importance of value as perceived by the patient in patient-centered health care.

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Posttonsillectomy Analgesia Before and After Codeine Black Box Warning

This study of insurance claims data investigates whether the 2012 issuance of a black box warning against codeine use following tonsillectomy was followed by changes in prescribing patterns.

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Nine Patients with Chronic Granulomatous Disease Having Selective Neck Dissection for Severe Cervical Lymphadenitis

Abstract

Chronic Granulomatous Disease (CGD) is a rare, inherited disorder due to an X-linked or autosomal genetic defect, in which patients experience a high rate of lymphadenitis.

To date, no studies have examined the best treatment for severe lymphadenitis in this patient population.

We present a nine CGD patient retrospective case series, examining surgical treatment of cervical lymphadenitis.

Our evolving surgical strategy shows that an initially more aggressive surgical approach (selective neck dissection) can help prevent recurrent infection.

The results found within this patient population may be relevant to other multi-nodal disease, including cancers of the head and neck region, while preserving functional and cosmetically acceptable outcomes.

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Announcements

Publication date: August 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 8

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Editorial Board

Publication date: August 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 8

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EACMFS Prizes and Awards

Publication date: August 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 8

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New Website to Collect Data on Scalp Cooling for Hair Loss

Supportive cancer care experts have established a website where patients and caregivers can share their experiences with scalp cooling for chemotherapy-induced hair loss.
Medscape Medical News

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Melanoma, Parkinson's: See One, Be Aware of the Other

A new study confirms that these two diseases may be risk factors for one another.
Medscape Medical News

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Positive allergen reaction in allergic and nonallergic rhinitis: a systematic review

Background

The diagnosis of allergic rhinitis (AR) is based on cutaneous and serological assessment to determine immunoglobulin E (IgE)-mediated disease. However, discrepancies between these tests and nasal provocation exist. Patients diagnosed as non-allergic rhinitis (NAR) but with positive nasal allergen provocation test (NAPT) may represent a local allergic condition or entopy, still suitable to allergy interventions. The objective of this study was to determine the frequency of nasal reactivity toward allergens among AR and NAR patients, and to describe the diagnostic characteristics of NAPT methodologies.

Methods

EMBASE (1947–) and Medline (1946–) were searched until December 8, 2015. A search strategy was used to identify studies on AR or NAR patients subjected to diagnostic local nasal provocation. All studies providing original NAPT data among the AR or NAR population were included. Meta-analysis of proportion data was presented as a weighted probability % (95% confidence interval [CI]).

Results

The search yielded 4504 studies and 46 were included. The probability of nasal allergen reactivity for the AR population was 86.3% (95% CI, 84.4 to 88.1) and in NAR was 24.7% (95% CI, 22.3 to 27.2). Reactivity was high with pollen for both AR 97.1% (95% CI, 94.2 to 99.2) and NAR 47.5% (95% CI, 34.8 to 60.4), and lowest with dust for both AR 79.1% (95% CI, 76.4 to 81.6) and NAR 12.2% (95% CI, 9.9 to 14.7). NAPT yielded high positivity when defined by subjective end-points: AR 91.0% (95% CI, 86.6 to 94.8) and NAR 30.2% (95% CI, 22.9 to 37.9); and lower with objective end-points: AR 80.8% (95% CI, 76.8 to 84.5) and NAR 14.1% (95% CI, 11.2 to 17.2).

Conclusion

Local allergen reactivity is demonstrated in 26.5% of patients previously considered non-allergic. Similarly, AR, when defined by skin-prick test (SPT) or serum specific IgE (sIgE), may lead to 13.7% of patients with inaccurate allergen sensitization or non-allergic etiologies.

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Novel role of surfactant protein A in bacterial sinusitis

Background

Chronic rhinosinusitis (CRS) is a common inflammatory disorder of the upper airway characterized by chronic inflammation and significant sinonasal remodeling. CRS is comprised of 2 major subgroups, based on whether polyps are present or absent. In some cases, it is characterized by colonization with opportunistic pathogens such as Pseudomonas aeruginosa (PA), Staphylococcus aureus, and other bacteria. The innate immune system of the sinonasal epithelium is the first line of defense against inhaled pathogens. Surfactant protein A (SP-A) is a member of the collectin family secreted by the airway epithelia and plays a critical role in airway innate immunity, as it can aggregate bacteria. We hypothesized that SP-A plays a role in bacterial CRS.

Methods

Air-liquid interface (ALI) cultures of nasal epithelial cells were derived from human ex-vivo healthy and CRS sinus tissues (n = 26) and challenged with PA. SP-A levels were measured with western blot and quantitative reverse transcript-polymerase chain reaction (qRT-PCR) in ALI and sinus tissues.

Results

We determined that SP-A: (i) mRNA and protein levels are increased significantly in CRS tissues compared with healthy sinuses; (ii) although primarily expressed in the lung, it is also synthesized and expressed in sinonasal epithelia; (ii) is expressed in the sinuses of an SP-A humanized transgenic mouse but not in SP-A knockout mice; (iv) mRNA levels are upregulated significantly during PA challenge, but protein levels are downregulated 4 hours postchallenge and upregulated at 12 hours.

Conclusion

Our data suggest that SP-A is expressed in the sinuses and that it plays a role in the sinus innate immune responses during bacterial infections.

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through July 28, 2017.
Watch now:

Personalized Selection Criteria for Radioiodine Administration in Low- and Intermediate-Risk Papillary Thyroid Carcinoma
Paul G. Walfish

Thyroidectomy Teaching Module
Amr Hamour, Adrian Mendez, Jeffrey R. Harris, Vincent L. Biron, Hadi Seikaly, David W.J. Côté

Transoral Endoscopic Parathyroid Cyst Removal
Jonathon O. Russell, Mai G. Al Khadem, Ralph P. Tufano

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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Thyroid High-Impact Articles

FREE ACCESS through August 1, 2017
Read now:

Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association

American Thyroid Association Scientific Statement on the Use of Potassium Iodide Ingestion in a Nuclear Emergency
Angela M. Leung, Andrew J. Bauer, Salvatore Benvenga, Alina V. Brenner, James V. Hennessey, James R. Hurley, Stacey A. Milan, Arthur B. Schneider, Krishnamurthi Sundaram, Daniel J. Toft

Clinical Features of Nivolumab-Induced Thyroiditis: A Case Series Study
Ichiro Yamauchi, Yoriko Sakane, Yorihide Fukuda, Toshihito Fujii, Daisuke Taura, Masakazu Hirata, Keisho Hirota, Yohei Ueda, Yugo Kanai, Yui Yamashita, Eri Kondo, Masakatsu Sone, Akihiro Yasoda, Nobuya Inagaki

Papillary Thyroid Cancer: The Good and Bad of the "Good Cancer"
Reese W. Randle, Norah M. Bushman, Jason Orne, Courtney J. Balentine, Elizabeth Wendt, Megan Saucke, Susan C. Pitt, Cameron L. Macdonald, Nadine P. Connor, Rebecca S. Sippel

Contrasting Phenotypes in Resistance to Thyroid Hormone Alpha Correlate with Divergent Properties of Thyroid Hormone Receptor α1 Mutant Proteins
Carla Moran, Maura Agostini, Anne McGowan, Erik Schoenmakers, Louise Fairall, Greta Lyons, Odelia Rajanayagam, Laura Watson, Amaka Offiah, John Barton, Susan Price, John Schwabe, Krishna Chatterjee

Salvage Lenvatinib Therapy in Metastatic Anaplastic Thyroid Cancer
Nicole M. Iñiguez-Ariza, Mabel M. Ryder, Crystal R. Hilger, Keith C. Bible

The post Thyroid High-Impact Articles appeared first on American Thyroid Association.

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Zur Diagnosestellung des M. Menière

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Hearing outcomes of Incus-Interposition versus Titanium-partial ossicular replacement prostheses – Our experience in 115 Patients

Abstract

Both, PORP and incus interpositions, are valuable techniques for the reconstruction of the conductive mechanism.

In our study we were able to show that, in certain aspects, the audiological outcome was better in incus remodelling reconstruction than in PORP placement.

A detailed analysis of all frequencies showed significantly better results in the incus group especially for the frequencies 250Hz, 1000Hz, 2000Hz and 3000Hz.

If clinical conditions warrant it, a reconstruction of the ossicular chain with incus interposition may be preferred to PORP.

Unexpectedly, no significant correlation between age and outcome for both groups was noted. Hence age is not to be considered as a limiting factor for partial ossicular reconstruction.

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Thermal imaging and dermoscopy for detecting inflammation in frontal fibrosing alopecia

Summary

Background

Frontal fibrosing alopecia (FFA) is an inflammatory condition of the scalp, which leads to scarring and slowly progressive recession of frontotemporal and/or frontoparietal hairline. Choice of FFA treatment is highly dependent on accurate assessment of disease phase, as medical treatments are effective only during the initial inflammatory stage.

Methods

To objectively quantify the activity of the inflammatory process in FFA, 22 female patients were examined by both infrared thermography and optical dermoscopy before tissue sampling. The presence of perifollicular erythema or scaling was considered to be strongly suggestive for appropriate scalp biopsy site. Skin temperature differences in dermoscopy-selected area >0.5°C for temperature of the reference area (lower area of forehead) were considered abnormal. For evaluation of the inflammatory infiltrate, a grading scale was used.

Results

The scale classified 14 (64%) subjects as being in the active disease phase of FFA and eight (36%) as in the inactive one. Using the thermography findings, 17 (77%) patients were considered to have the active FFA and five (23%) patients had the inactive one. The clinical assessment of active FFA was most accurate using thermal imaging combined with dermoscopy, with a sensitivity of 64%, a specificity of 88%, a positive predictive value of 90%, and an negative predictive value of 58%.

Conclusion

We believe that infrared thermography is a noninvasive and accessible imaging modality that may serve as a complementary tool in FFA diagnosis.

http://ift.tt/2tiKRgN

A new approach to assess occupational exposure to airborne fungal contamination and mycotoxins of forklift drivers in waste sorting facilities

Abstract

The waste management industry is an important employer, and exposure of waste-handling workers to microorganisms is considered an occupational health problem. Besides fungal contamination, it is important to consider the co-occurrence of mycotoxins in this setting. Forklifts with closed cabinet and air conditioner are commonly used in waste industry to transport waste and other products within the facilities, possibly increasing the risk of exposure under certain conditions. The aim of this study was to assess the fungal contamination and mycotoxin levels in filters from the air conditioning system of forklift cabinets, as an indicator to assess occupational exposure of the drivers working in a waste sorting facility. Cytotoxicity was also assessed to understand and characterize the toxicity of the complex mixtures as present in the forklift filters. Aqueous extracts of filters from 11 vehicles were streaked onto 2% malt extract agar (MEA) with chloramphenicol (0.05 g/L) media, and in dichloran glycerol (DG18) agar-based media for morphological identification of the mycobiota. Real-time quantitative PCR amplification of genes from Aspergillus sections Fumigati, Flavi, Circumdati, and Versicolores was also performed. Mycotoxins were analyzed using LC-MS/MS system. Cytotoxicity of filter extracts was analyzed by using a MTT cell culture test. Aspergillus species were found most frequently, namely Aspergillus sections Circumdati (MEA 48%; DG18 41%) and Nigri (MEA 32%; DG18 17.3%). By qPCR, only Aspergillus section Fumigati species were found, but positive results were obtained for all assessed filters. No mycotoxins were detected in aqueous filter extracts, but most extracts were highly cytotoxic (n = 6) or medium cytotoxic (n = 4). Although filter service life and cytotoxicity were not clearly correlated, the results suggest that observing air conditioner filter replacement frequency may be a critical aspect to avoid worker's exposure. Further research is required to check if the environmental conditions as present in the filters could allow the production of mycotoxins and their dissemination in the cabinet during the normal use of the vehicles.

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Cystadenoma of Minor Salivary Gland with Cervical Metastasis: Benign or Malignant?

Publication date: Available online 20 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wen-Jie Wu, Ming-Wei Huang, Yan Gao, Jian-Guo Zhang
A cystadenoma originating in the salivary gland is a rare neoplasm that can originate from the major or minor salivary glands. Although this tumor has the potential to recur if it is incompletely excised, it has been regarded as a benign tumor because it has not been determined to be associated with local tissue destruction or metastasis. This report served as an update to the current understanding of cystadenoma. The patient in this case study presented with a recurrent, painless mass in her left retromolar and submandibular regions that had persisted for more than two years. Histological analysis revealed that this lesion was a recurrent cystadenoma of the minor salivary gland, with cervical lymph nodes testing positive for tumor cells. After more than three years of clinical follow-up, no signs of recurrence has been observed. A case of cystadenoma with cervical metastasis was presented; further attention should be paid to patients with recurrent cystadenoma that may also contain lymph node metastasis.

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Clinical and Microstructural Findings in Paget's Disease of the Entire Mandible

Publication date: Available online 20 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Reinhard E. Friedrich, Andreas M. Luebke, Michael Amling, Till Koehne
Paget's disease of bone (PDB) is a chronic progressive bone disorder characterized by localized increased bone turnover and focal areas of woven bone formation. Although skull involvement is common, PDB very rarely affects the mandible. This report describes the clinical and histological findings in a 75-year old patient with PDB involving the mandible. Microstructural analyses revealed the altered quality of the bone microstructure and the depletion of the affected bone from calcium. Differential diagnosis of PDB affecting the mandible is discussed.

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In Reply

Publication date: Available online 19 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Avni Gupta, R. Sterling Haring, Eric B. Schneider

http://ift.tt/2uchAWk

Procedure Volume in Orthognathic Surgery: The Surgeon or the Hospital?

Publication date: Available online 19 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicholas L. Berlin, Derek M. Steinbacher, Charles T. Tuggle

http://ift.tt/2uMjsrZ

Delayed stinging insect reactions

Publication date: Available online 20 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Elissa M. Abrams, Allan B. Becker

http://ift.tt/2ttonO0

Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa

Objective

Patients presenting with a cervical mass are common for head and neck specialists and present a diagnostic challenge against the backdrop of a wide variety of etiologies. The objective of the present study was to evaluate the significance of a mass in the supraclavicular fossa for etiology, diagnostic procedure, and therapy.

Study Design

Individual retrospective cohort study.

Methods

We reviewed the data of 211 consecutive cases (116 male, 95 female) with excisional biopsy or tumor removal of a supraclavicular mass.

Results

In 202 of 211 cases, a biopsy was taken from a lymph node. In 182 biopsies, a malignant lymphadenopathy was found (117 metastases, 65 malignant lymphoma). The histologic findings of metastatic diseases were adenocarcinoma (48), followed by squamous cell carcinoma (22). The majority of primary carcinomas were located below the clavicle (94), in the lung (32), in the breast (29), and in the head and neck region (18). In the left supraclavicular fossa, only metastases of the genitourinary tract were significantly more frequent (16 of 17). In nonmalignant tumors (29), tuberculosis (11) was most prevalent. In 79% of biopsies, the neck mass was the first manifestation of the disease.

Conclusion

The location of a cervical mass in the supraclavicular fossa provides a strong indication of malignancy. A biopsy is mandatory in the majority of patients presenting with a supraclavicular mass. In cases of metastatic disease, the location of a cervical mass helps identify the primary site. Histologic findings are essential for further diagnostic steps, therapy, and prognosis.

Levels of Evidence

4. Laryngoscope, 2017

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Intraoperative ventilation and postoperative respiratory assistance

1A013C01

http://ift.tt/2tirJiX

Analysis of Malignant Thyroid Neoplasms with a Striking Rise of Papillary Microcarcinoma in an Endemic Goiter Region

Abstract

According to National Cancer Registry Program, Thiruvananthapuram district of Kerala, has the highest relative frequency of thyroid carcinomas; nevertheless, limited data exist regarding its socio-demographic and clinico-pathological characteristics. The aims of the study were to assess the: (1) demographic characteristics, (2) histopathological features and the relative frequency of various thyroid carcinoma cases and papillary thyroid carcinoma (PTC) subtypes, (3) rising trend of papillary microcarcinomas, and (4) associated lesions. A retrospective study wherein 170 cases of thyroid malignancies reported in our single institution over a period of 8 years period was reviewed. PTC accounted for 97% cases, followed by medullary (n = 4; 2.4%) and follicular carcinoma (n = 1; 0.6%). There was female preponderance (p = 0.0379) with a lower median age in females (p = 0.0275). Among the PTCs, conventional type constituted 53.4% cases (n = 87), followed by microcarcinomas (n = 34; 20.9%), follicular variant (n = 28; 17.2%), and others 14 cases (8.5%). Thirty-three cases (19.4%) showed multifocality, 5 cases (2.9%) extra-thyroid extension, and 19 cases (11.2%) lymph node metastasis. Two cases developed recurrences and three cases, metastasis. The associated lesions were significantly higher in females (p = 0.0059); most common being multinodular goiter (MNG; n = 67; 41.1%), followed by Hashimoto thyroiditis (n = 44; 27%) and lymphocytic thyroiditis (n = 28; 17.2%); MNG being associated with follicular (p = 0.0129), and Hashimoto thyroiditis with conventional variant (p = 0.0475). The frequency of microcarcinomas significantly increased in the past 4 years (p = 0.0291) and was associated with MNG (p = 0.0055), Hurthle cell nodule (p = 0.0315) and absent lymph node metastasis (p = 0.0147). The primary treatment modality was total thyroidectomy. Papillary microcarcinoma cases increased significantly in the past 4 years and were significantly associated with MNG and Hurthle cell nodule. It is challenging to distinguish the various PTC subtypes as recognition of these histological variants warrants better patient management.

http://ift.tt/2tJLr6w

Clinico-Bacteriological Study of Chronic Otitis Media and its Prevalence in Tertiary Care Hospital

Abstract

This Retrospective observational study was done over a period of 5 years, consisting of 2530 patients with chronic otitis media (COM) attended ENT OPD of a tertiary care hospital of Central India.COM commonly occurs in the age group from 11 to 20 years (37.12%). Females are more predominantly effected than males. Mucosal type (76.4%) is more common. Complications were associated with squamous type of COM.Pus culture showed positive growth of Pseudomonas in 33.9% cases. COM is a common public health problem that is often wrongly trivialized by people. Health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the morbidity and mortality of this disease and therefore can reduce the incidence of this disease.

http://ift.tt/2udXgWc

Analysis of Malignant Thyroid Neoplasms with a Striking Rise of Papillary Microcarcinoma in an Endemic Goiter Region

Abstract

http://ift.tt/2tJLr6w

Clinico-Bacteriological Study of Chronic Otitis Media and its Prevalence in Tertiary Care Hospital

Abstract

http://ift.tt/2udXgWc

Brustkrebsfrüherkennung durch Mammographiescreening

Zusammenfassung

Das Mammographiescreening-Programm (MSP) wurde seit 2005 parallel zu Zentren für familiären Brust- und Eierstockkrebs sowie zu zertifizierten Brustzentren bundesweit implementiert. Alle Bestrebungen haben zum Ziel, die Diagnostik und Therapie von Brustkrebs zu optimieren. Das qualitätsgesicherte MSP gilt mittlerweile als Paradebeispiel evidenzbasierter Medizin. Die Arbeit gibt eine beispielhafte Übersicht wesentlicher Qualitätssicherungsmaßnahmen zur Beurteilung der Programmeffektivität. Als Ausdruck wirkungsvoller Diagnostik nehmen durch das Screening fortgeschrittene Tumorstadien ab. Aufgrund der Entwicklung dieses Surrogatparameters ist eine maßgebliche Senkung der Brustkrebssterblichkeit zu erwarten. Überdies erlaubt die Anbindung des strukturierten MSP an Krebsregister weiterführende Forschung zu Diagnostik und Therapie von Brustkrebs.

http://ift.tt/2gMSWZm

Journal de Pharmacie Clinique

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

JOURNAL DE PHARMACIE CLINIQUE
Volume 36, numéro 2, 2017

Retour sur la journée annuelle des internes en pharmacie

Cette 2^è journée scientifique placée sous le thème de l'Économie de la santé : « Le prix du médicament en France : enjeux thérapeutiques contre enjeux économiques ? ».

› Retrouvez l'article paru dans le Journal de Pharmacie CliniqueN°2-2017.

SOMMAIRE :

ÉDITORIAL

>	L'importance du réseautage ! Aude Desnoyer, Aurélie Guérin, André Rieutord

SYNTHÈSES

>	Formation et opportunités de carrières en pharmacie hospitalière : le point de vue de futurs et de jeunes diplômés du DES de pharmacie Chloé Duran, Laura di Trapani, Christel Hosselet, Marie Lenski, Evariste Delande, Delphine Heurté, Alexandre Drezet, Jérémie Zerbit, Emmanuel Cirot, Clément Delage

>	Comment le pharmacien peut-il prendre l'initiative pour coopérer avec les services cliniques ? Marc Frachette, Véronique Zardet

>	Votre temps-réponse est-il assez rapide ? Mise en œuvre d'un projet lean en pharmacie hospitalière afin de réduire le temps de préparation des ordonnances Lise Vaillancourt, Mimi Truong

>	Évaluation des technologies de santé en milieu hospitalier : organisations possibles et exemples appliqués aux dispositifs médicaux Nicolas Martelli

>	Accompagnement pharmaceutique du patient obèse à l'officine : état des lieux territorial Audrey Decottignies, Sophie Renet, Sophie Cavalier, Guillaume Pourcher, André Rieutord

CONGRÈS

2^e Journée scientifique des internes en pharmacie d'Île-de-France
Aurélie Chaigneau, Rémi Pieragostini, Marie Cabagnols, Clément Delage

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Case 22-2017: A 21-Year-Old Woman with Fever, Headache, and Myalgias

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Presentation of Case. Dr. Nkemdilim Mgbojikwe (Medicine): A 21-year-old woman was admitted to this hospital during the winter because of fever, headache, and myalgias. The patient had been well until 4 days before this admission, when fever, chills, fatigue, malaise, retro-orbital headache, and…

http://ift.tt/2tJgH5G

Primary Spheno-Petro-Clival Tuberculosis

Abstract

The increase awareness and advent of anti-tuberculosis therapy led to decline in tuberculosis. Now a resurgence of tuberculosis is with immunosuppression and with resistant strains. The detection rate of extrapulmonary is increased with the advent of newer modalities of detection, imaging, and better testing. This case series documents our experience with seven cases of primary spheno-petro-clival lesion and details of the clinical and radiological presentations of these patients. Intraoperative obtained tissue was send for histopathological and microbiological evaluation. The most common symptoms were headache and nasal discharge. The final diagnosis of spheno-petro-clival tuberculosis was confirmed in all cases with histopathology and by culture post-operatively. Skull base tuberculosis is relative rare entity in past because of late occurrence of specific symptom, incomplete radiological evaluation and it may present as neck swelling by travelling through various neck spaces. (1) Tubercular infection should be considered as differential in skull base lesion as pickup rate is increasing with advancement in technology. (2) Two of our cases had retropharyngeal abscess have focus in skull base bone. The skull base, hence, may be one of foci in undetermined sites of tuberculous infections and should be searched for.

http://ift.tt/2uaB4e4

Occult Primary with Cervical Secondary-Role of CT Scan and Evaluation Under Anesthesia

Abstract

The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (Zhuang et al. in Mol Clin Oncol 2:917–922, 2014). Prospective case Study. To know the sensitivity, specificity accuracy rate and P value of CT scan and upper aero digestive tract endoscopy with palpation of nasopharynx and oropharynx to search the primary site of cancer. 53 patient of occult primary with FNAC proved metastatic squamous cell carcinoma were evaluated to find out the sensitivity, specificity, accuracy rate and P value of imaging study and rigid endoscopic examination of upper aero digestive tract with through palpation of oropharynx, nasopharynx and evaluation under anesthesia (EUA). Punch biopsies were taken from suspicious areas and sent for histopathology examination (HPE). Taking HPE as a gold standard (Ishak et al in Rawal Med J 35:209–213, 2010) sensitivity of both EUA and imaging was found to be 100%, Specificity and diagnostic accuracy of EUA and imaging were 96.77, 83.87, 98.11 and 90.57% respectively. P value was <0.0000001 which is highly significant.

http://ift.tt/2uLvcuH

Nationales Zertifizierungsprogramm Krebs

Zusammenfassung

Hintergrund und Ziel

Im Nationalen Zertifizierungsprogramm Krebs sind die Qualitätsvorgaben der Deutschen Krebsgesellschaft und der Deutschen Krebshilfe in einer gemeinsamen Initiative vereint. Das Programm ist mit dem Leitlinienprogramm Onkologie und den Krebsregistern Bestandteil des Qualitätszyklus Onkologie, der aus dem Nationalen Krebsplan entstanden ist. Ziel des Qualitätszyklus ist die Darstellung und Verbesserung der Qualität in der onkologischen Versorgung. Dafür wird mit Hilfe von leitlinienbasierten Qualitätsindikatoren die Qualität der Behandlung gemessen und ausgewertet. Die Auswertungen werden in Zertifizierungs- und Begutachtungsverfahren genutzt, um Maßnahmen für eine Qualitätsverbesserung zu identifizieren und umzusetzen.

Ergebnisse

Das Programm ist mit jährlich über 200.000 Patienten, die mit einer onkologischen Erstdiagnose in Zentren behandelt werden, sicher implementiert und bietet eine vertrauenswürdige Orientierungshilfe für Patienten und Behandler.

Schlussfolgerung

Mit innovativen Projekten für die Datenerfassung, die Studientätigkeit und die Einbeziehung der Patientensicht wird das Programm kontinuierlich weiterentwickelt. Die daraus abgeleitete Initiative der European Cancer Centres (ECC) folgt der europäischen Diskussion und macht die wertvollen und v. a. sicher nutzbaren Instrumente für Qualitätssicherung und -verbesserung in der Onkologie auch für Zentren im europäischen Ausland nutzbar.

http://ift.tt/2uBCgJS

Αρχειοθήκη ιστολογίου

Πέμπτη 20 Ιουλίου 2017

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