Head and Neck Medicine by Alexandros G.Sfakianakis: 08/10/17

Πέμπτη 10 Αυγούστου 2017

Soft-diet feeding impairs neural transmission between mitral cells and interneurons in the mouse olfactory bulb

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Tomohiro Noguchi, Chizuru Utsugi, Makoto Kashiwayanagi
(Objective) The subventricular zone in mice generates a lot of neuroblasts even during adulthood. These neuroblasts migrate to the olfactory bulb and differentiate into inhibitory interneurons such as granule cells and periglomerular cells. Olfactory sensory neurons receive information from various odorants and transmit it to the olfactory bulb. Our previous study showed that soft-diet feeding impairs neurogenesis in the subventricular zone, in turn leading to the reduction of odor-induced behaviors and Fos-immunoreactivities, the latter of which are markers of neural activity, at the olfactory bulb after exposure to odors. Release of GABA from inhibitory interneurons at the olfactory bulb induces inhibitory currents at the mitral cells, which are output neurons from the olfactory bulb. (Design) In the present study, we measured spontaneous inhibitory postsynaptic currents (sIPSCs) at the mitral cells of mice fed a soft diet in order to explore the effects of changes in texture of diets on neural function at the olfactory bulb. (Results) The soft-diet feeding extended the intervals between sIPSCs and reduced their peak amplitudes. (Conclusions) The present results suggest that soft-diet feeding in mice attenuates the neural functions of inhibitory interneurons at the olfactory bulb.

Graphical abstract

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Soft-diet feeding impairs neural transmission between mitral cells and interneurons in the mouse olfactory bulb

Graphical abstract

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Treatment of Patients With Hepatitis C Virus infection (Genotype 4) With Ledipasvir-Sofosbuvir in the Liver Transplant Setting.

Background: Hepatitis C virus infection is a major cause of liver cirrhosis and hepatocellular carcinoma and the leading indication for liver transplantation. In the Middle East, genotype 4 HCV infection is the most common genotype. However, limited data exists on the treatment of genotype-4 in the liver transplant setting. We evaluated the safety and efficacy of ledipasvir-sofosbuvir (LDV/SOF) in treating HCV genotype-4 infected patients with cirrhosis or postliver transplantation. Methods: This prospective, single-arm, observational study includes cohort of patients with cirrhosis before liver transplantation (Cohort A) and a cohort of postliver transplantation patients (Cohort B). Patients received LDV/SOF (90 mg-400 mg) once daily for 12-24 weeks with or without ribavirin (RBV). Patients with creatinine clearance below 30 were excluded. Results: A total of 111 patients (61 cirrhotic; 50 postliver transplants) with HCV genotype 4 were treated in KFSH&RC; 55% cohort A and 44% cohort B received ribavirin. Sustained virological response SVR12 was 91.8% and 86% of cohorts A and B, respectively. There were no treatment-related mortality or serious adverse effects. RBV dose reduction occurred in 25% without any treatment discontinuation. SVR12 rates in cohort A were significantly higher in patients with a viral load below 800 000 (100% vs 83.9%, p value=0.022). Viral load did not impact SVR rates in cohort B. The use of RBV did not increase SVR12 and was associated with anemia. Conclusions: Ledipasvir-sofosbuvir without ribavirin is an effective and safe treatment option for patients with HCV genotype 4 infection in pre and postliver transplant setting. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Sentinel Artery in Double Eyelid Blepharoplasty: Identification, Prevention, Management.

In double eyelid blepharoplasty, unexpected bleeding may cause intraoperative hematoma, swelling, and temporary ptosis, which could cause asymmetry and prolong recovery time. In 1725 patients (3450 eyes), double eyelid blepharoplasties were performed on Chinese patients from January 2014 to July 2016 by our senior author. In 36 eyes, the authors identified a variant artery, which the authors named the "sentinel artery," located in the inferolateral superficial orbital septum. The sentinel artery courses between the orbital septum and the levator palpebrae finally drain into the peripheral arcade. This artery is uncommon since only 1.04% of eyes have it. If the artery is severed accidentally, the cleaved arterial end will retract into the levator palpebrae and bleed causing a large hematoma to rapidly form posterior to the levator palpebrae. The authors actively avoided unexpected bleeding caused by tearing up this artery while opening the orbital septum during double eyelid blepharoplasty procedure. (C) 2017 by Mutaz B. Habal, MD.

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Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible.

Background: The vascular fibula flap is an ideal choice for function and appearance reconstruction of mandible. Despite the high success rate, "late complications" such as Ti plate exposure and local infection related to osteosynthesis are not uncommon. Patients and Method: A retrospective cohort of patients who received vascular fibula reconstruction for mandible from January 2011 to December 2013 from the Department of Oral and Maxillofacial Oncology in a tertiary hospital were charted: clinical, pathological, and therapeutic factors were analyzed for late complications in univariate and multivariate analyses. Results: One hundred forty-two patients were finally analyzed with median follow-up time of 47 months; 19 of them had "late complications," which occurred at a median of 8 months. Preoperative or postoperative radiotherapy (P = 0.02), type of Ti plate (P = 0.019), and the disease characteristics (P = 0.02) were significant factors on univariate. Cox regression suggested postoperative radiation (P = 0.009) and smoking history (P = 0.037) were independent significant factors for late complications. Secondary reconstruction (P = 0.069) and preoperative radiotherapy (P = 0.086) were borderline significant. Conclusion: Postoperative radiation and smoking history are associated with late complications. Mini Ti plate should be less used. Patients with risk factors need to be observed for at least 6 to 16 months before further management. (C) 2017 by Mutaz B. Habal, MD.

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Single-Stage Reconstruction of Eyebrow Defect Using a V-Y Advancement Pedicle Flap Based on the Orbicularis Oculi Muscle.

Eyebrows play an important role in face expression and facial mimics by virtue of muscle contraction. Defects or deformity of the eyebrows result in abnormal facial expressions, and may lead to aesthetic issues for patients. The objective of this study is to report the case of a patient, with a congenital skin pigmented nevus at the right side of the eyebrow treated with direct surgical resection and followed by immediate reconstruction of the eyebrow with a V-Y advancement pedicle flap based on the orbicularis oculi muscle. (C) 2017 by Mutaz B. Habal, MD.

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Comparison of Two Different Grafts in Nasal Framework Reconstruction of Binder Syndrome: Cartilage and Silicone.

Background: Binder syndrome is a rare congenital malformation with a flat facial profile especially a depressed nose. Rhinoplasty plays an important part in the multidisciplinary surgical protocol. Different materials have been proposed to reconstruct nasal framework. But fewer evidence concerns which graft can achieve more stable and appreciated nasal contour. In this article, the authors reported surgical details and experience of nasal framework reconstruction of Binder syndrome, compare the esthetic outcomes of 2 grafts: autologous costal cartilage and L-shaped silicone covered with auricular cartilage. Methods: A retrospective study of 25 Binder syndrome patients (9 with silicone and 16 with costal cartilage) was managed. Anthropometric method was used to evaluate nasal profiles preoperatively and postoperatively. Surgical techniques, complications were reviewed. Statistics analysis was managed. Probability (P) of

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Use of the Ipsilateral Anteromedial Thigh Flap for Immediate Rescue of Nonviable Anterolateral Thigh Flaps in Head and Neck Cancer Reconstruction.

Background: It is not always possible to use the anatomically variable free anterolateral thigh (ALT) flap for reconstructive surgery. An anteromedial thigh (AMT) flap serves as a good alternative, and shares the same vascular pedicle as the ALT flap. Methods: Of 698 reconstructions performed in 2006 to 2013 following head and neck tumor ablation surgery, ALT flaps were used in 653 patients. Eighteen free AMT flaps were harvested to replace variant nonviable ALT flaps. Results: The lack of a sizable perforator in the ALT flap territory was the main reason for changing the reconstruction plan. Anteromedial thigh flap size ranged from 10 x 4 to 30 x 8 cm. The flap survival rate was 100%. The follow-up period ranged from 3 to 56 months. Conclusion: During head and neck reconstruction, when no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap without additional donor-site morbidity. (C) 2017 by Mutaz B. Habal, MD.

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Invited Commentary on: Role of Notch Signaling in the Physiological Patterning of Posterofrontal and Sagittal Cranial Sutures.

No abstract available

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Does Idiopathic Bone Cavity Involving Mandibular Condyle Need Surgical Intervention of Bone Cavity Filling?.

Idiopathic bone cavity (IBC) is a rare, asymptomatic, unilateral, oval-shaped radiolucent defect in the mandible. It is extremely rare that IBC occurs in the mandibular branch and condylar process. This article presents a 16-year-old male with IBC occuring in the mandibular branch. (C) 2017 by Mutaz B. Habal, MD.

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Seizure After Cranioplasty: Incidence and Risk Factors.

Background: To investigate clinical characteristics of postcranioplasty seizures (PCS) first observed after cranioplasty after decompressive craniectomy (DC) to treat traumatic brain injury and to define factors that increase PCS risk. Methods: This retrospective study, covering the period between January 2008 and July 2015, compared PCS in postcranioplasty patients. Postcranioplasty seizures risk factors included diabetes mellitus, hypertension, time between DC and cranioplasty, duraplasty material, cranioplasty contusion location, electrocautery method, PCS type, and infection. Multivariate logistic regression analysis was performed and confidence intervals (CIs) were calculated (95% CI). Results: Of 270 patients, 32 exhibited initial PCS onset postcranioplasty with 11.9% incidence (32/270). Patients fell into immediate (within 24 hours), early (from 1 to 7 days), and late (after 7 days) PCS groups with frequencies of 12, 5, and 15 patients, respectively. Generalized, partial, and mixed seizure types were observed in 13, 13, and 6 patients, respectively. Multivariate logistic regression analysis showed increased risk with increasing age (>50 years). Cranioplasty contusion location, precranioplasty deficits, duraplasty material, and monopolar electrocautery were predictive of PCS onset (P

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Overexpression of Glypican 3 Promotes Proliferation, Regulates Cell Cycle Progression, and Inhibits Apoptosis of Human Fetal Osteoblastic Cell Line 1.19

Craniosynostosis is a complex disease condition, which involves premature fusion of cranial vault sutures and lacks desirable treatment. Previous studies have demonstrated decreased proliferation rate of osteoblasts and downregulated expression of glypican 3 (GPC3) in syndromic craniosynostosis patients. In this study, quantitative and qualitative analysis were utilized to assess the effect of GPC3 in human fetal osteoblastic cell line, hFOB 1.19. Lentiviral transfection efficiency with green fluorescent protein images was obtained after 72 hours. Western Blot and quantitative real-time polymerase chain reaction analysis results indicated that GPC3 was overexpressed in hFOB 1.19 cells transfected with recombinant lentivirus LV-GPC3-GFP. Cell proliferation was assessed by CCK-8 assay and cell cycle progression and apoptosis were analyzed by flow cytometric assay. Results revealed that GPC3 promoted cell viability, induced cell cycle entry into S phase, and inhibited cell apoptosis. These findings provide novel ideas in understanding the pathogenesis of craniosynostosis. It also provides novel insights in the treatment of craniosynostosis by targeting GPC3. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Treatment of Hemifacial Spasm Caused by the Compression of Internal Auditory Canal of Facial Nerve.

Objective: To make out the way to distinguish the offending vessels compressed the internal auditory canal part of the facial nerve. Methods: The hemifacial spasm patients were treated of microvascular decompression surgery with neurophysiologic monitoring. The patients were found that the internal auditory canal of the facial nerves was fully compressed, and the records of surgery monitoring were analyzed. Results: All the patients were recorded the delay incubation period in electromyography monitoring, and all patients were hemifacial spasm free finally. Conclusion: Some hemifacial spasms were caused by internal auditory canal compression, so during the operation, the authors should explore the whole course of the facial nerve and compress the internal auditory canal part with the aid of neurophysiologic monitoring. (C) 2017 by Mutaz B. Habal, MD.

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The Effect of Functional Mandibular Shift on the Muscle Spindle Systems in Head-Neck Muscles and the Related Neurotransmitter Histamine.

The aim of this study is to explore the effects of abnormal occlusion and functional recovery caused by functional mandible deviation on the head and neck muscles and muscle spindle sensory-motor system by electrophysiological response and endogenous monoamine neurotransmitters' distribution in the nucleus of the spinal tract. Seven-week-old male Wistar rats were randomly divided into 7 groups: normal control group, 2W experimental control group, 2W functional mandible deviation group, 2W functional mandible deviation recovery group, 4W experimental control group, 4W functional mandible deviation group, 4W functional mandible deviation recovery group. Chewing muscles, digastric muscle, splenius, and trapezius muscle spindles electrophysiological response activities at the opening and closing state were recorded. And then the chewing muscles, digastric, splenius, trapezius, and neck trigeminal nucleus were taken for histidine decarboxylase (HDC) detection by high performance liquid chromatography (HPLC), immunofluorescence, and real-time polymerase chain reaction (RT-PCR). Histamine receptor proteins in the neck nucleus of the spinal tract were also examined by immunofluorescence and RT-PCR. Electromyography activity of chewing muscles, digastric, and splenius muscle was significantly asymmetric; the abnormal muscle electromyography activity was mainly detected at the ipsilateral side. After functional mandibular deviation, muscle sensitivity on the ipsilateral sides of the chewing muscle and splenius decreased, muscle excitement weakened, modulation depth decreased, and the muscle spindle afferent impulses of excitation transmission speed slowed down. Changes for digastric muscle electrical activity were contrary. The functions recovered at different extents after removing the deflector. However, trapezius in all the experimental groups and recovery groups exhibited bilateral symmetry electrophysiological responses, and no significant difference compared with the control group. After functional mandibular deviation, HDC protein and mRNA levels on the ipsilateral sides of the chewing muscle and splenius increased significantly. HDC level changes for digastric muscle were contrary. After the removal of the mandibular position deflector, HDC protein and mRNA levels decreased on the ipsilateral sides of the chewing muscle and splenius while they increased in the digastric muscle. The difference of histamine decarboxylase content in the bilateral trapezius in each experimental group was small. After functional mandibular deviation, the temporomandibular joint mechanical receptors not only caused the fusimotor fiber hypoallergenic fatigue slow response on the ipsilateral sides of splenius, but also increased the injury neurotransmitter histamine release. The authors' results further support the opinion that the temporomandibular joint receptors may be involved in the mechanical theory of the head and neck muscles nervous system regulation. (C) 2017 by Mutaz B. Habal, MD.

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Research and Clinical Application of Three-Dimensional Location of Amygdaloid Body.

Accurately representing the spatial location of the amygdaloid body can lay an anatomical basis for the neurosurgery operation for amputation of the amygdaloid body through lateral fissure approach. As we know, there are a number of nerve nucleuses and essential structures locating around amygdaloid body in our brain, especially optic tract. However, only few research had been done to protect these tissues or nerve nucleuses. Thus, we reconstructed the three-dimensional images of the amygdaloid body of the human brain and established a coordinate system. The morphological parameters of the amygdaloid body and the three-dimensional coordinate data were measured. The spherical coordinates (R, [theta], [script phi]) were constructed by calculating the azimuth angle, elevation angle, and the distance from the coordinates origin to each amygdaloid body centroid. Sixty people brain MRI images without any visible organic disease were used in our research to investigate the average level of related parameters. The authors selected a proper coordinate origin and measured the value of anteroposterior diameter, right-and-left diameter, vertical diameter of the amygdaloid body, and the distance from the optic tract to amygdaloid body. The authors also measured the three-dimensional coordinate data of each centroid of the amygdaloid body in order to provide anatomical suggestion for surgery. The authors confirmed the nearest point from the foremost edge of the brain ventricle temporal horn to the lateral fissure, then viewed it as the coordinate origin. By means of coordinate translation, the authors got various morphological parameters and the coordinate values of each centroid of the amygdaloid body. Spherical coordinates were calculated from the three-dimensional coordinate values. The distances between the different layers of the amygdaloid body and the optic tract were also measured. The reconstruction of the three-dimensional coordinates of amygdaloid body is part of the digital engineering of the human body. The measurement of the parameters provides an important theoretical basis for the clinical amygdaloid body destruction surgery. Finally, the authors get conclusions as follows. There are no significant differences in the measured values of r1, r2, and r3 between the upper and lower diameters, the left and right diameters, the anteroposterior diameter of the amygdaloid body. The measured values of men and women are not statistically significant (P > 0.05). Spherical coordinates (R, [theta], [script phi]) calculated from the three-dimensional coordinate values and values from different sexes of the amygdaloid body are not statistically significant, either (P > 0.05). The distance between the different levels of the amygdaloid body and the optic tract (h1, h2, h3, h4, h5, h6, and h7) are not statistically significant (P > 0.05). (C) 2017 by Mutaz B. Habal, MD.

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Resurfacing of the Mid and Lower Faces by Preexpanded Supraclavicular Flap.

Extensive scarring and giant nevi on the mid and lower faces places further demands on scar resurfacing in terms of match, size, and thickness. The area of supraclavicular cervical flap is rather limited, but the expansion could expand its utility in facial resurfacing. Rectangular expanders were inserted via the incisions at the upper fringes of clavicles, and implanted under supraclavicular flap areas. After full expansion, the flap based on supraclavicular artery was elevated to cover the defects left by surgical removal of scar or tumor. Pedicle division was performed on the 10 to 14 days postoperatively. A total of 17 patients were treated with the described technique between 2005 and 2015. The dimensions of the flap ranged from 17 cm x 8.5 cm to 22 cm x 12 cm. The average size was 197 cm2. Twenty-one flaps (with 4 patients in bilateral fashion) survived completely. Epidermolysis occurred to 2 flaps, which healed by conservative management. These flaps matched well with the face in terms of the color, thickness, and texture. No obvious flap shrinkage occurred in the follow-up. The donor sites were closed primarily without loss of function or breast deformity. It is an efficient and safe method to obtain preexpanded supraclavicular flap, applying to patients with extensive scarring on mid and lower faces, especially female ones. Excellent aesthetics can be achieved without compromising function and aesthetics of donor sites. (C) 2017 by Mutaz B. Habal, MD.

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Surgery Navigation in Treating Congenital Midfacial Dysplasia of Patients With Facial Cleft.

Aim: To explore a new accurate way for the treatment of congenital midfacial dysplasia in facial cleft patients. Materials and Methods: Between November 2015 and November 2016, 8 patients with nasal deformity and midfacial dysplasia (Tessier Nos. 3-11 cleft) were collected (median age, years; range = 15-20 years). Expanded frontal flap for nasal reconstruction and image-guided navigation-assisted surgery for modified nasal-maxillary-hard palatine osteotomy to advance the peri-pyriform bone structure were performed in all the patients. After 6 to 12 months of follow-up, the authors analyzed the differences between preoperative planning and postoperative results through computed tomography data. Results: Patients were satisfied with surgery, and computed tomography data showed that there was little difference between preoperative planning and postoperative results with the navigation-assisted surgery. Conclusion: Using expanded frontal flap with navigation-assisted surgery for peri-pyriform advancement, the authors could treat congenital nasal deformity and midfacial dysplasia effectively, accurately, and safely in craniofacial cleft patients. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Assessing the Magnitude of a Surgical Career Through His Trainees: The John L. Cameron Legacy Factor" by Cerullo M, Lipsett PA in Ann Surg 265:866-868, 2017.

No abstract available

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Review of "Negative and Positive Online Patient Reviews of Physicians-1 vs. 5 Stars" by Shemirani NL and Castrillon J in JAMA Facial Plast Surg [published online ahead of print January 26, 2017] doi: 10.1001/jamafacial.2016.2039

No abstract available

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Review of "Accreditation Council for Graduate Medical Education (ACGME) Surgery Resident Operative Logs" by Drake FT, Aarabi S, Garland BT, Huntington CR, McAteer JP, Richards MK, Zern NK, Gow KW in Ann Surg 265: 923-929, 2017.

No abstract available

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Review of "Trauma Recidivism Predicts Long-term Mortality" by Strong BL, Greene CR, Smith GS in Ann Surg 265: 847-853, 2017.

No abstract available

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Ocular surface lubricants.

Purpose of review: The purpose of this article is to provide an overview of the ocular lubricants currently available, consider the components of the various formulations and highlight the status of preservative use in the treatment of anterior ocular surface diseases. Recent findings: The primary components of ocular surface lubrication have been, in the past, based on various cellulose formulations that increase hydration. Advances in lubrication have come from areas of the human body requiring lubrication such as the skeletal joints as well as examining the use of natural components of the tear fluid. These have resulted in novel modifications of existing tear components, for example, thiolated carboxymethyl hyaluronic acid which creates crosslinking to mechanically increase retention time for ocular surface hydration. Other proteoglycans such as lubricin, having one of the lowest coefficients of friction in nature, to a lipopolysaccharide derivative of tamarind seed, may provide a unique delivery system for lubricants and medications. Summary: The present state of ocular surface lubrication is slowly advancing from the routine use of cellulose-based solutions and gels to more advanced replacement with natural tear components. The advances that are occurring on other lubricating surfaces of the musculoskeletal system are also providing some insights into potential use on the ocular surface. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Hymenoptera-induced anaphylaxis: is it a mast cell driven hematological disorder?.

Purpose of review: Hymenoptera-induced allergy (HVA) is a common cause of anaphylaxis and may be fatal. It is associated with systemic mastocytosis in about 7% of adult patients. Systemic mastocytosis is a proliferative disorder of hematopoietic mast cell progenitors. There is recent data on the association between systemic mastocytosis and HVA. Recent findings: Hymenoptera venoms are the most common immunoglobulin E-mediated elicitors of anaphylaxis in patients with mastocytosis. Some patients with systemic mastocytosis do not have cutaneous involvement and have only been identified because of HVA. These patients do have distinct demographic, clinical, and laboratory features as compared with patients with mastocytosis with skin lesions. They show a male predominance, more severe (cardiovascular) as compared to skin symptoms, lower baseline serum tryptase, less bone marrow mast cell aggregates, and KIT mutations restricted to mast cell lineage. Summary: Although hymenoptera-induced anaphylaxis is not primarily a mast cell-driven hematological disorder, the latter is present in a significant proportion of patients and has to be excluded by basal serum tryptase determination, skin inspection as well as exclusion of systemic mastocytosis by D816V mutation analysis in peripheral blood and/or bone marrow examination in selected patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Climate changes and Hymenoptera venom allergy: are there some connections?.

Purpose of review: This review aims to update the world status of the main allergenic stinging Hymenoptera. Recent findings: In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world. Summary: Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Owing to the expansion of ranges of native species and colonization of invasive ones, even in the uncertainty of present available models, new challenges presented by stinging Hymenoptera should be expected in the future. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Acrylic stent to aid placement of footplate of palatal distractor during surgically-assisted rapid palatal expansion

Publication date: Available online 10 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K.F.B. Payne, L. Dewhurst, G. Robinson, B. Edwards, K. McVeigh

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Simple method of covering maxillectomy defects with lyophilised amniotic membrane

Publication date: Available online 10 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Hazarika, A.K. Adhyapok, S.C. Debnath, K. Malik

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Should patients take vitamin D before mandibular operations?

Publication date: Available online 10 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N. Syed, G.A. Chiu, P. Korczak
Vitamin D deficiency is endemic in the United Kingdom (UK), particularly in high-risk groups. We report the outcomes of patients with low concentrations of the vitamin who had complications after reduction of mandibular fractures or osteotomy, and those who were screened preoperatively. A deficiency can be diagnosed with a simple and inexpensive blood test, and in the UK the cost of a vitamin D tablet is about £0.04/tablet/day. Patients at risk of a deficiency should be screened before mandibular operations, and those listed for orthognathic surgery or replacement of the temporomandibular joint should be asked to take a supplement before operation.

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Organoid culture systems to study host–pathogen interactions

Devanjali Dutta | Hans Clevers

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Pulmonary function in patients with eosinophilic chronic rhinosinusitis

Publication date: Available online 10 August 2017
Source:Auris Nasus Larynx
Author(s): Kensuke Uraguchi, Shin Kariya, Seiichiro Makihara, Mitsuhiro Okano, Takenori Haruna, Aiko Oka, Rumi Fujiwara, Yohei Noda, Kazunori Nishizaki
ObjectiveThere is a close relationship between upper and lower respiratory tract diseases. Chronic rhinosinusitis patients frequently have lung diseases including asthma and chronic obstructive pulmonary disease. Eosinophilic chronic rhinosinusitis is considered a refractory and intractable subtype of chronic rhinosinusitis. However, there has been no report on pulmonary function in patients with eosinophilic chronic rhinosinusitis. The purpose of this study is to examine the pulmonary function in eosinophilic chronic rhinosinusitis patients and non-eosinophilic chronic rhinosinusitis patients, and evaluate clinical factors associated with the pulmonary function of these patients.MethodsPulmonary function was measured in 53 patients with eosinophilic chronic rhinosinusitis with asthma, 58 patients with eosinophilic chronic rhinosinusitis without asthma, and 30 patients with non-eosinophilic chronic rhinosinusitis. The diagnosis of chronic rhinosinusitis was based on the definition in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012. Eosinophilic chronic rhinosinusitis was diagnosed based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scoring system. The relationship between pulmonary function and clinical parameters was assessed. These parameters included radiographic severity of chronic rhinosinusitis, peripheral blood eosinophil percentage, serum total immunoglobulin E level, and eosinophilic infiltration in nasal polyps.ResultsThe pulmonary function of the patients with eosinophilic chronic rhinosinusitis was significantly affected. The eosinophilic chronic rhinosinusitis patients had more peripheral airway obstruction as compared to the patients with non-eosinophilic chronic rhinosinusitis.ConclusionOur findings indicated latent obstructive lung function changes in the eosinophilic chronic rhinosinusitis patients. The patients with eosinophilic chronic rhinosinusitis should be carefully monitored in order to detect lung diseases.

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Variations in the labyrinthine segment of facial nerve canal revealed by high-resolution computed tomography

Publication date: Available online 10 August 2017
Source:Auris Nasus Larynx
Author(s): Aiyan Jin, Peng Xu, Fengqin Qu
ObjectiveTo study variations in the labyrinthine segment of fallopian canal and the associated middle and inner ear malformations.MethodThe high-resolution computed tomography (HRCT) images of the temporal bone in 24 patients with congenital variations in the labyrinthine segment of fallopian canal were analyzed retrospectively. The length of labyrinthine segment of the facial nerve and angle of the first genu of 10 normal subjects were also measured. Based on the original axial images, multi-planar reformation (MPR) and curved-planar reformation (CPR) images of bilateral ossicular chains, inner ear structure and fallopian canal were reconstructed. HRCT features of congenital variations in the labyrinthine segment of the facial nerve were analyzed, including its beginning site, dehiscence, length, angle of the first genu and the associated middle and inner ear malformations.ResultsAmong the normal subjects, the length of labyrinthine segment of the facial nerve was 3.56±0.41mm, and angle of the first genu was 71.87±8.09°. Five types of variations in the labyrinthine segment of the facial nerve were found in 45 ears of 24 cases, including dehiscence in geniculate fossa in 25 ears, anteromedial displacement at the beginning site in 27 ears (widening of Bill's bar in 7 cases), enlargement of the angle of the first genu in 30 ears with an average value of 107.2° (96.0–126.0°), increase of length in 30 ears with an average length of 6.8mm (5.2–8.3mm) and bifurcation in one ear. Associated middle ear malformation in 6 ears and inner ear malformation in 36 ears were also found.ConclusionA variety of congenital variations may occur in the labyrinthine segment of the facial nerve and they are often associated with middle or inner ear malformations, which can be clearly displayed by HRCT with MPR or CPR images.

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Modified hybrid fixation using absorbable plate and screw for mandibular advancement surgery

The purpose of this study was to examine the skeletal stability of mandibular advancement after sagittal split ramus osteotomy (SSRO) with modified hybrid fixation using absorbable plates and screws.

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Can electromagnetic-navigated maxillary positioning replace occlusional splints in orthognathic surgery? A clinical pilot study

Because of the inaccuracy of intermaxillary splints in orthognathic surgery, intraoperative guidance via a real time navigation system might represent a suitable method for enhancing the precision of maxillary positioning. Therefore, in this clinical trial, maxillary repositioning after Le Fort I osteotomy was guided splintless by an electromagnetic navigation system.

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Clinical prognostic factors of salivary adenoid cystic carcinoma: A single-center analysis of 61 patients

Adenoid cystic carcinomas are rare malignant tumors of the salivary glands. They are characterized by a high rate of local recurrence, late distant metastasis and a poor disease-free survival. In this study, we analysed a series of 61 patients who were all treated at the University of Göttingen over a period of 21.0 years.

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Should patients take vitamin D before mandibular operations?

Vitamin D deficiency is endemic in the United Kingdom (UK), particularly in high-risk groups. We report the outcomes of patients with low concentrations of the vitamin who had complications after reduction of mandibular fractures or osteotomy, and those who were screened preoperatively. A deficiency can be diagnosed with a simple and inexpensive blood test, and in the UK the cost of a vitamin D tablet is about £0.04/tablet/day. Patients at risk of a deficiency should be screened before mandibular operations, and those listed for orthognathic surgery or replacement of the temporomandibular joint should be asked to take a supplement before operation.

http://ift.tt/2wNxd6y

Acrylic stent to aid placement of footplate of palatal distractor during surgically-assisted rapid palatal expansion

We describe a modification that ensures the correct placement of the footplate of a palatal distractor during surgically-assisted rapid palatal expansion (SARPE). The Synthes™ transpalatal distractor (DePuy Synthes, Oberdorf, Switzerland) is a modular system consisting of a central barrel and two footplates that are screwed into bone to produce a "bone-borne" distraction force.1 An advantage of the system is the ability to change the size of the central barrel (small: 16–24mm; medium: 20–36mm; large: 24–48mm) mid-way through treatment to increase the distance of distraction.

http://ift.tt/2vU5KE7

Simple method of covering maxillectomy defects with lyophilised amniotic membrane

Prosthetic rehabilitation and flap reconstruction are the main methods used to obliterate maxillectomy defects. Although cost-effective, prosthetic rehabilitation has limitations such as discomfort from the foreign body, poor retention in large defects, and the need for frequent readjustment. Flap reconstruction costs more, and surgeons need to be highly skilled with a well trained operating team. We describe a simple method to apply lyophilised amniotic membrane in subtotal maxillectomy defects, which helps to epithelialise the entire defect within a short space of time.

http://ift.tt/2uuNs85

Cone beam computed tomography-based cephalometric norms for Brazilian adults

This study established cone beam computed tomography (CBCT)-based cephalometric norms for Brazilian adults, including the assessment of sexual dimorphism. An observer performed McNamara's cephalometric analysis twice on 60 CBCT datasets acquired from patients with a normal dental occlusion, divided equally into two groups by sex. Welch's t-test was applied to assess differences between the sexes in hard tissue cephalometric measurements, and Dahlberg's formula was used to calculate measurement error introduced by the observer.

http://ift.tt/2hQcOv2

An aggressive and fatal craniofacial group A Streptococcus infection resulting from a minimally displaced orbital floor fracture

While sharp, penetrating trauma is often associated with group A Streptococcus (GAS) infections and subsequent necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS), there are scant reports in the oral and maxillofacial surgery literature regarding blunt, non-penetrating trauma in association with these conditions. With a clinical course that initially appears relatively benign following blunt trauma, NF can progress swiftly through the fascial planes and may quickly become life-threatening if the oral and maxillofacial surgeon fails to recognize some of the critical pathognomonic signs.

http://ift.tt/2fwE5C1

Vertical platysma myocutaneous flap reconstruction for oral defects using three different incision designs: experience with 68 cases

This study evaluated the effects of three different incision designs for the vertical platysma myocutaneous flap (VPMF): apron, MacFee, and T-shaped. This flap was used for the reconstruction of intraoral defects following cancer ablation in selected patients. Sixty-eight cases of VPMF reconstruction were assessed: the apron incision was used in 28, MacFee incision in 22, and T-shaped incision in 18. With regard to postoperative outcomes, there were 26 cases of flap survival and two of partial necrosis with the apron incision; 20 of survival and two of partial necrosis with the MacFee incision; 15 of survival and three of partial necrosis with the T-shaped incision.

http://ift.tt/2hPSF8B

Previously successful dental implants can fail when patients commence anti-resorptive therapy—a case series

This article reports a type of localized osteonecrosis that can occur in patients who have had successful osseointegrated implants for many years and then commence anti-resorptive therapy. Eleven female patients were identified who had successful implant insertion, but who were placed on anti-resorptive therapy (bisphosphonates or denosumab) several years later and developed osteonecrosis around the implants. In each case, the osteonecrosis occurred only around the implants and not around the patient's remaining teeth.

http://ift.tt/2fwE40V

Two-stage reconstruction of the severely deficient alveolar ridge: bone graft followed by alveolar distraction osteogenesis

Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla.

http://ift.tt/2hOAfoy

Antibody Affinity Against 2009 A/H1N1 Influenza and Pandemrix Vaccine Nucleoproteins Differs Between Childhood Narcolepsy Patients and Controls

Viral Immunology , Vol. 0, No. 0.

http://ift.tt/2uuJJHz

Pulmonary function in patients with eosinophilic chronic rhinosinusitis

There is a close relationship between upper and lower respiratory tract diseases. Chronic rhinosinusitis patients frequently have lung diseases including asthma and chronic obstructive pulmonary disease. Eosinophilic chronic rhinosinusitis is considered a refractory and intractable subtype of chronic rhinosinusitis. However, there has been no report on pulmonary function in patients with eosinophilic chronic rhinosinusitis. The purpose of this study is to examine the pulmonary function in eosinophilic chronic rhinosinusitis patients and non-eosinophilic chronic rhinosinusitis patients, and evaluate clinical factors associated with the pulmonary function of these patients.

http://ift.tt/2utaY9k

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking.

http://ift.tt/2vJTrd0

Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients – a randomized intra-individual controlled trial

Abstract

Background

Actinic keratoses (AKs) in solid organ transplant recipients (OTRs) are difficult-to-treat pre-malignancies and comparison of topical therapies is therefore warranted.

Objectives

In an intra-individual study to compare efficacy and safety of field treatment with methyl aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod (IMIQ) for AKs in OTRs.

Materials and methods

OTRs (n=35) with 572 AKs (grade I-III) in two similar areas in the face, scalp, dorsal hands or forearms were included. All patients received one MAL-PDT and one IMIQ session (3 weekly applications for 4 weeks) in each study area according to randomization. Treatments were repeated after 2 months (IMIQ) and 3 months (PDT) in skin with incomplete AK-response. Outcome measures were complete lesion response (CR), skin reactions, laboratory results and treatment preference.

Results

The majority of study areas received two treatment sessions (PDT n=25, IMIQ n=29 patients). At 3 months after two treatments, PDT-treated skin achieved higher CR (AK I-III, median 78%, range 50-100%) compared to IMIQ-treated skin areas (median 61%, range 33-100%, p <0.001). Fewer emergent AKs were seen in PDT- vs. IMIQ-treated skin (0.7 vs. 1.5 AK, p=0.04). Patients developed more intense inflammatory skin reactions following PDT (PDT 2.8, IMIQ 1.7, p<0.01) that resolved faster compared to IMIQ (median 10 vs. 18 days, p<0.01). Patient preference (p= 0.47) and cosmesis (p>0.30) were similar for PDT and IMIQ. No significant changes in laboratory results were observed.

Conclusion

Compared to IMIQ, PDT-treatment obtained higher AK clearance at 3-month follow-up and shorter-lasting, but more intense short-term skin reactions.

http://ift.tt/2fwgyBd

http://ift.tt/2hOtJOF

The Immune Reconstitution of the Skin Following Sex Mismatched Allogeneic Hematopoietic Stem Cell Transplant: A prospective case series utilizing fluorescent in situ hybridization and immunohistochemistry

Abstract

Graft versus host disease (GVHD) is a common, morbid, and potentially fatal complication of allogeneic hematopoietic stem cell transplantation (aHSCT).^1-3 The exact timing of the arrival of donor-derived immune cells and their profile in the skin have not been well described in humans.^4-6 Fluorescent in situ hybridization (FISH) is a technique that has been used to distinguish host versus donor-derived immune cells in patients who have undergone sex-mismatched aHSCT.⁷

http://ift.tt/2fvTjag

Acquired anhidrosis associated with systemic sarcoidosis: Quantification of nerve fibers around eccrine glands by confocal microscopy

Abstract

Neurological disorders can cause hypohidrosis and/or anhidrosis by disturbing either the central or the peripheral nervous systems.^1-3 Although a syringotropic variant of cutaneous sarcoidosis causes dysfunction of sweating, systemic sarcoidosis rarely causes hypohidrosis or anhidrosis.^4,5 Here we present a novel case of an acquired anhidrosis in a patient with systemic sarcoidosis. Furthermore, we developed a novel methodology to quantify nerve fibers around eccrine glands using confocal microscopy and found that nerve fibers around eccrine glands in anhidrotic areas are significantly decreased compared to hidrotic areas.

http://ift.tt/2fwMeWW

Osteocondroma del seno maxilar, una localización infrecuente

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ana Belén Gil Guerra, Esther Gómez San Martín, María Isabel Jiménez Cuenca

http://ift.tt/2hOIIIe

Protective barrier properties of Rhinosectan® spray (containing xyloglucan) on an organotypic 3D airway tissue model (MucilAir): results of an in vitro study

To evaluate barrier protective properties of Rhinosectan® spray, a medical device containing xyloglucan, on nasal epithelial cells (MucilAir).

http://ift.tt/2vn6Whr

Can electromagnetic-navigated maxillary positioning replace occlusional splints in orthognathic surgery? A clinical pilot study

Publication date: Available online 10 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Moritz Berger, Igor Nova, Sebastian Kallus, Oliver Ristow, Christian Freudlsperger, Urs Eisenmann, Hartmut Dickhaus, Michael Engel, Jürgen Hoffmann, Robin Seeberger
IntroductionBecause of the inaccuracy of intermaxillary splints in orthognathic surgery, intraoperative guidance via a real time navigation system might represent a suitable method for enhancing the precision of maxillary positioning. Therefore, in this clinical trial, maxillary repositioning after Le Fort I osteotomy was guided splintless by an electromagnetic navigation system.Materials and MethodsConservatively planned maxillary reposition in each of 5 patients was transferred to a novel software module of the electromagnetic navigation system. Intraoperatively, after Le Fort I osteotomy, the software guided the maxilla to the targeted position. Accuracy was evaluated by pre- and postoperative cone beam computer tomography imaging (the vectorial distance of the incisal marker points was measured in three dimensions) and compared with that of a splint transposed control group.ResultsThe repositioning of the maxilla guided by the electromagnetic navigation system was intuitive and simple to accomplish. The achieved maxillary position with a deviation of 0.7mm on average to the planned position was equally accurate compared with that of the splint transposed control group of 0.5mm (p>0.05).DiscussionThe data of this clinical study display good accuracy for splintless electromagnetic-navigated maxillary positioning. Nevertheless, this method does not surpass the splint-encoded gold standard with regard to accuracy. Future investigations will be necessary to show the full potential of electromagnetic navigation in orthognathic surgery.

http://ift.tt/2fw1Aeh

Modified hybrid fixation using absorbable plate and screw for mandibular advancement surgery

Publication date: Available online 10 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Koichiro Ueki, Kunio Yoshizawa, Akinori Moroi, Asami Hotta, Takamitsu Tsutsui, Kenichi Fukaya, Ryota Hiraide, Akihiro Takayama, Tatsuya Tsunoda, Yuki Saito, Nana Baba, Momoko Sato
PurposeThe purpose of this study was to examine the skeletal stability of mandibular advancement after sagittal split ramus osteotomy (SSRO) with modified hybrid fixation using absorbable plates and screws.Materials and MethodsA total of 54 Japanese patients were enrolled in this study. Of them, 23 who were diagnosed with mandibular prognathism underwent setback surgery with bi-cortical plate fixation using absorbable plates and screws (setback group). Another 23 who were diagnosed with mandibular retrognathism underwent advancement surgery with modified hybrid fixation using absorbable plates (advance group), and 8 who were diagnosed with mandibular retrognathism underwent advancement surgery with titanium plates (titanium group). Skeletal stability and horizontal condylar angle were analyzed by axial, frontal, and lateral cephalograms preoperatively and at 1 month, 3 months and 1 year post-operatively. The findings were compared statistically.ResultsThe advance group showed no significant difference compared with the titanium group. There were significant differences between the setback and advance groups regarding SNB, ANB, gonial angle, ramus inclination, occlusal plane, convexity and Me-Ag right in T1 naturally (P<0.05). However, in T2, there were no significant differences between the groups for the other measurements, although there were significant differences in ANB, interincisal angle, occlusal plane and Me-Ag right (P<0.05). In T3, a significant difference was seen only in Me-Ag right (P=0.0145).ConclusionThis study suggested that the use of an absorbable plate and screw was useful and reliable for mandibular advancement surgery as well as mandibular setback surgery, when the fixation method was devised successfully.

http://ift.tt/2fw1zad

Clinical prognostic factors of salivary adenoid cystic carcinoma: A single-center analysis of 61 patients

Publication date: Available online 10 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Robert Cordesmeyer, Henning Schliephake, Philipp Kauffmann, Markus Tröltzsch, Rainer Laskawi, Philipp Ströbel, Felix Bremmer
PurposeAdenoid cystic carcinomas are rare malignant tumors of the salivary glands. They are characterized by a high rate of local recurrence, late distant metastasis and a poor disease-free survival. In this study, we analysed a series of 61 patients who were all treated at the University of Göttingen over a period of 21.0 years.Materials and MethodsIn all 61 patients with salivary adenoid cystic carcinoma, clinical data, demographic data, risk factors, tumor location, tumor stage, status of surgical margin, surgical treatment, postoperative radiotherapy and follow-up interval were assessed.ResultsThe overall survival (OS) and the disease-free survival (DFS) of patients who underwent surgery and those who underwent combined surgery with radiotherapy showed no significant differences. Neither did the T-stage (T1/T2 vs. T3/T4) show significant differences in OS and DFS. Only the status of the surgical margin was significantly associated with a longer OS and a longer DFS.ConclusionThe present results confirm that the radical surgical resection with clear tumor-free margins is the most important predictor for a longer survival. Adjuvant radiotherapy should be discussed from case to case, but should not be seen as an absolute prognostic factor for OS.

http://ift.tt/2hOBPH6

American Thyroid Association Announces 2017 Research Grant Awards

ATA Awards Research Grant to Marco Medici, MD, PhD, MSc, Erasmus Medical Center

ATA Awards Research Grant to Lawrence A. Shirley, MD, MS, FACS, Ohio State University Wexner Medical Center

ATA Awards Research Grant to Jason E. Coleman, PhD, University of Florida

ATA Awards ThyCa Research Grant to Vicki Emma Smith, PhD, University of Birmingham, UK

ATA Awards ThyCa Research Grant to Jens Lohr, MD, PhD, Dana Farber Cancer Institute

ATA Awards ThyCa Research Grant to Glenn J. Hanna, M.D., Dana-Farber Cancer Institute's Center for Head and Neck Oncology

ATA Awards Bite Me Cancer Research Grant to Brian P. Danysh, PhD, University of Texas MD Anderson Cancer Center

The post American Thyroid Association Announces 2017 Research Grant Awards appeared first on American Thyroid Association.

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Role of CDKN2A/p16 expression in the prognostication of oral squamous cell carcinoma

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Swati Shree Padhi, Souvick Roy, Madhabananda Kar, Arka Saha, Shomereeta Roy, Amit Adhya, Manas Baisakh, Birendranath Banerjee
ObjectiveCDKN2A/p16 is a known tumor suppressor gene with a homologous deletion in Oral Squamous cell carcinoma. CDKN2A/p16 is found to be inactivated in a broad spectrum of solid tumors and in more than 80% of OSCC. Molecular alteration of CDKN2A/p16 in progression of OSCC can pose an important tool for the prognosis of squamous cell carcinoma.Material and methodSystematic network analysis was carried out to obtain involvement of CDKN2A/p16 in oral cancer by polysearch and FunDO. In the present study we have screened 104 OSCC patients from eastern region of India for CDKN2A/p16 expression in recurrent and non-recurrent OSCC. The observation was validated by Comparative Genomic Hybridisation and Next generation sequencing in recurrent cases.ResultSystematic analysis revealed direct involvement of CDKN2A/p16 in oral cancer. There was a consistent downregulated expression of CDKN2A/p16 in the recurrent cases. The gene expression study confirmed a >5-fold downregulation of CDKN2A/p16 in recurrent tumors as compared to non-recurrent ones. Array CGH analysis revealed a copy number deletion in the recurrent case. Furthermore, next generation sequencing validated deletion of CDKN2A/p16 and reported it asa common variant with a nonsense mutation having stop /loss of function of the gene in recurrent cases. Recurrent cases with deleted CDKN2A/p16 expression had poor prognosis and low survival rate.ConclusionCDKN2A/p16 frequently alters in oral cancer progression with a deletion/loss of function in the recurrent cases displaying its role in aiding several molecular events for the malignant transformations occurring throughout disease progression.

http://ift.tt/2fvLzVR

Basal growth patterns (pro I-III) in AK do not correlate with the established AK I-III histological grading system. Besides the degree of upward extension, varying degrees of downward extension exist. Histological classification should consider both, upwards and downward growth patterns when assessing AK.

http://ift.tt/2uKp9SE

Factors predicting the self-evaluated health of hidradenitis suppurativa patients recruited from an outpatient clinic

Abstract

Objectives

In recent years, Hidradenitis suppurativa has received increased attention, but still lack well-defined, robust patient reported outcome measures. Such measures are likely to be influenced by contextual factors. We therefore aim to describe the association of biological and other factors with HS patient's self-evaluated health as reflected by the EQ5D VAS score.

Methods

This cross-sectional study measured basic information, Dermatology Life Quality Index, Major Depression Inventory, and Euro-QoL-5D. Information obtained through questionnaires was used to create a model showing the relation between biologic factors, questionnaire results and self-evaluated health using the stepwise method for linear regression.

HS patients (n=805) registered at our department were invited to participate. 503 (62.5%) patients replied to this survey. There was no difference in basic demographics between responders and non-responders.

Results

Possible predictors for this study were DLQI, MDI, BMI, smoking, gender. A final model for correlation with self-evaluated health was obtained.

Significant predictors for the model was DLQI (P < 0.05), BMI points above 25 and active smoking (both: P < 0.01) and MDI (P < 0.001).

Conclusion

As this is a cross-sectional study, reveals several clinically relevant correlations. Smoking appears to correlate with the highest change in VAS score, but an MDI of 10 (lower than study average) or a BMI of 40 influences the results more. This study provides an assessment of how much BMI and smoking, in relation to other factors, correlate to the self-evaluated health state of HS patients. These may therefore be relevant contextual factors to the construction and interpretation of specific patient reported outcome measures.

To improve QoL, we advocate smoking cessation and weight loss, and advice active screening for depression as over 10% of our patients qualify for a depressive diagnosis according to ICD-10.

http://ift.tt/2usDpnZ

Mucosa-associated invariant T cells infiltrate hepatic metastases in patients with colorectal carcinoma but are rendered dysfunctional within and adjacent to tumor microenvironment

Abstract

Mucosa-associated invariant T (MAIT) cells are innate-like T lymphocytes that are unusually abundant in the human liver, a common site of colorectal carcinoma (CRC) metastasis. However, whether they contribute to immune surveillance against colorectal liver metastasis (CRLM) is essentially unexplored. In addition, whether MAIT cell functions can be impacted by chemotherapy is unclear. These are important questions given MAIT cells' potent immunomodulatory and inflammatory properties. Herein, we examined the frequencies and functions of peripheral blood, healthy liver tissue, tumor-margin and tumor-infiltrating MAIT cells in 21 CRLM patients who received no chemotherapy, FOLFOX, or a combination of FOLFOX and Avastin before they underwent liver resection. We found that MAIT cells, defined as CD3ε⁺Vα7.2⁺CD161⁺⁺ or CD3ε⁺MR1 tetramer⁺ cells, were present within both healthy and tumor-afflicted hepatic tissues. Paired and grouped analyses of samples revealed the physical proximity of MAIT cells to metastatic lesions to drastically influence their functional competence. Accordingly, unlike those residing in the healthy liver compartment, tumor-infiltrating MAIT cells failed to produce IFN-γ in response to a panel of TCR and cytokine receptor ligands, and tumor-margin MAIT cells were only partially active. Furthermore, chemotherapy did not account for intratumoral MAIT cell insufficiencies. Our findings demonstrate for the first time that CRLM-penetrating MAIT cells exhibit wide-ranging functional impairments, which are dictated by their physical location but not by preoperative chemotherapy. Therefore, we propose that MAIT cells may provide an attractive therapeutic target in CRC and that their ligands may be combined with chemotherapeutic agents to treat CRLM.

http://ift.tt/2fvyTyk

The Economic Impact of Adult Hearing Loss

This systematic review evaluates available data on all relevant costs associated with hearing loss among adults.

http://ift.tt/2vnunaF

Implementing Quality Improvement and Patient Safety in Residency Education

This Viewpoint discusses practical strategies for implementing successful resident-led patient safety and quality improvement initiatives in otolaryngology–head and neck surgery residency education.

http://ift.tt/2wxt1IX

Neutrophil Extracellular Traps and Fibrin in Otitis Media

This study examines the relationship between neutrophil extracellular traps, fibrin, and bacteria in experimentally induced otitis media in chinchillas and in human temporal bones with acute onset and recurrent otitis media.

http://ift.tt/2vmMKwl

Schon deutlich besser und Ansporn für die Zukunft

http://ift.tt/2vmIdtC

Rezepturen mit Fertigarzneimitteln

http://ift.tt/2wxxLOy

Tisotumab Vedotin Continued Treatment in Patients With Solid Tumors.

Conditions: Ovary Cancer; Cervix Cancer; Endometrium Cancer; Bladder Cancer; Prostate Cancer; Esophagus Cancer; Lung Cancer, Nonsmall Cell; Squamous Cell Carcinoma of the Head and Neck
Intervention: Drug: Tisotumab Vedotin
Sponsor: Genmab
Recruiting - verified August 2017

http://ift.tt/2vS7sps

Pembrolizumab in Combination With Anti-platelet Therapy for Patients With Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

Condition: Head and Neck Cancer
Interventions: Drug: Pembrolizumab; Drug: Clopidogrel; Drug: acetylsalicylic acid
Sponsor: Medical University of South Carolina
Not yet recruiting - verified July 2017

http://ift.tt/2wLnVrR

Effectiveness of Lay Navigators in Meeting Cancer Patients' Non-Clinical Needs: A Pilot Study

Conditions: Breast Cancer; Gynecologic Cancer; Neck Cancer; Head Cancer; Gastrointestinal Cancer; Thoracic Cancer; Cutaneous Tumor
Intervention: Other: Lay Navigation
Sponsor: Stanford University
Recruiting - verified August 2017

http://ift.tt/2vSdBC0

Prevention of graying: Is KROX20 the solution?

http://ift.tt/2usNKfB

Methotrexate for treatment of vitiligo

http://ift.tt/2vRZ9cl

Topical cetirizine 1% for treatment of androgenetic alopecia

http://ift.tt/2usYs5Q

Rate of serious infection in patients who are prescribed systemic biologic or nonbiologic agents for psoriasis: A large, single center, retrospective, observational cohort study

Abstract

Background

Systemic biologic and nonbiologic agents used to treat psoriasis may or may not contribute to serious infection (SI) risk. Safety data, particularly for biologic agents, and associated risk for SI, are scarce. The study's aim was to explore the risk for SI in psoriasis patients exposed to systemic biologic or nonbiologic agents.

Methods

A large, single-center electronic medical record repository was searched between January 2010 and December 2014. Records for patients prescribed a systemic agent for psoriasis (SAP) with psoriasis or psoriatic arthritis diagnoses were included (ICD-9 codes 696.1 and 696.0, respectively). SIs were those who required hospitalization, and/or injectable antibacterial, antiviral or antifungal therapy. SIs occurring within 120 days after exposure to a SAP, were included for study.

Results

A total of 1,346 patients were exposed to a SAP between January 2010 and December 2014; 27 (2%) had a SI. Comparing biologic and nonbiologic agent exposure, no statistically significant difference for risk of SI was detectable (p = .83).

Conclusion

In this population, the SI rate for biologic and nonbiologic systemic agents was clinically indistinguishable, thereby supporting consideration of the entire spectrum of available systemic therapeutic agents, both biologic and nonbiologic agents, for management of moderate to severe psoriasis.

http://ift.tt/2vSpGWK

A novel topical agent in the treatment of seborrheic keratoses: A proof of concept study by clinical and dermoscopic evaluation

Abstract

In this proof of concept study, 50 lesions from 15 patients with multiple seborrheic keratoses (SKs) were treated with a novel aqueous solution containing nitric acid, zinc and copper salts, and organic acids (acetic, lactic, and oxalic acid). Treatment consisted in the application of an amount of the solution sufficient to obtain a whitening/yellowish reaction. Application of the nitric–zinc solution was performed every other week until clinical and dermoscopic clearance or crust formation, for a maximum of 4 applications. Efficacy evaluation was performed at 8 weeks (T1) and 6 months (T2). All subjects, who reported no or minimal discomfort during and after the application of the solution, completed the study. At T1, a complete clinical and dermoscopic resolution was observed in 37 lesions after an average of 3 applications/lesion (range 2–4). A partial response, with minimal persistent residual spots, was detected in the remaining 13 lesions. All patients with complete clearance showed no relapses at a 6-month follow-up (T2). The positive preliminary results indicate that this novel solution may represent a promising alternative option for SKs especially in patients not keen or eligible to undergo invasive tissue-destructive procedures.

http://ift.tt/2usW6Uo

Irradiación de Cabeza & Cuello en la Infancia

The post Irradiación de Cabeza & Cuello en la Infancia appeared first on American Thyroid Association.

http://ift.tt/2vHGiRF

Expression and purification of norovirus virus like particles in Escherichia coli and their immunogenicity in mice

Publication date: Available online 9 August 2017
Source:Molecular Immunology
Author(s): Yuqi Huo, Xin Wan, Tong Ling, Jie Wu, Wenhui Wang, Shuo Shen
Norovirus (NoV) virus like particles (VLPs) produced in Spodoptera frugiperda (Sf9) cells have been tested in human volunteers as vaccine candidate and were shown to be protective against NoV induced acute gastroenteritis. In this study, prevailing Sydney-2012-like NoV major capsid protein gene with or without N-terminal deletions (N26 and N38, 26 and 38 amino acids deleted from N terminus，respectively) were sub-cloned into prokaryotic expression vector, pCold III and pCold IV. Soluble and insoluble proteins were detected for both vectors after induction and higher levels of protein expression were observed for constructs pCold III-N26 and pCold III-N38. Electron microscopy observation of unpurified and purified lysates indicated in vivo assembly of VLPs with two sizes in accordance with those observed in Sf9 cells. In vitro salivary HBGA-VLP binding assay demonstrated that VLPs assembled in Escherichia coli (E. coli) exhibited the same binding pattern as that of VLPs assembled in Sf9 cells. Immunization of mice with purified VLPs derived from pCold III-N38 demonstrated higher IgG antibody titers and blocking antibody titers when compared with full-length capsid protein assembled VLPs from recombinant baculovirus expression system. In conclusion, NoV VLPs produced in E. coli using pCold expression vector might be used for the development of NoV vaccine.

http://ift.tt/2wLm9Hg

Hereditary angioedema with a mutation in the plasminogen gene

Abstract

Background

Hereditary angioedema (HAE) with normal C1-INH (HAEnCI) may be linked to specific mutations in the coagulation factor 12 (FXII) gene (HAE-FXII) or functional mutations in other genes that are still unknown. We sought to identify and characterize a hitherto unknown type of HAE with normal C1-INH and without mutation in the F12 gene.

Methods

The study comprised analysis of whole exome sequencing, Sanger sequencing, and clinical data of patients.

Results

We detected a mutation in the plasminogen gene in patients with HAEnCI. The mutation c.9886A>G was located in exon 9 leading to the missense mutation p.Lys330Glu (K330E) in the kringle 3 domain of the plasminogen protein. The mutation was identified by next generation sequencing in 14 patients with HAEnCI belonging to 4 of 7 families. Family studies revealed that this type of HAE was transmitted as an autosomal dominant trait. The plasminogen gene mutation was present in all studied symptomatic patients and was also found in 9 out of 38 index patients from 38 further families with HAEnCI. Most patients had swelling of face/lips (78.3%) and tongue (78.3%). 331 out of all 3.795 tongue swellings (8.7%) were associated with dyspnea, voice changes and imminent asphyxiation. Two women died by asphyxiation due to a tongue swelling.

Conclusions

HAE with a mutation in the plasminogen gene is a novel type of HAE. It is associated with a high risk of tongue swellings.

http://ift.tt/2vRwnIU

Case 24-2017: An 8-Month-Old Girl with Fever and an Abdominal Mass

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Presentation of Case. Dr. Rajitha Venkatesh (Pediatrics): An 8-month-old girl was admitted to this hospital because of fever and an abdominal mass. The patient had been in her usual good health until approximately 6 days before admission, when she passed a large stool surrounded by clotted blood.…

http://ift.tt/2vQEXYu

Ganglioneuroma of the External Auditory Canal and Middle Ear

Objective. We report an extremely rare case of ganglioneuroma involving the external auditory canal and middle ear. Case Report. Ganglioneuromas are rare benign mature tumors thought to originate from sympathetic ganglions, with the highest incidence in the retroperitoneum, adrenal medulla, and posterior mediastinum. We present a case of ganglioneuroma of the external auditory canal and middle ear. At the age of 12 months, the patient was diagnosed with neuroblastoma stage IV with metastasis to the squamous temporal bone, bone marrow, and skull base. He received a high-risk protocol regimen resulting in complete remission. The patient later presented with recurrent right ear discharge at the age of six years and was diagnosed with ganglioneuroma of external auditory canal and middle ear after appropriate investigations. We report in this article the clinical presentation, investigations, surgical intervention, and follow-up. Conclusion. After the literature review and to our knowledge, this is the first reported case of its kind. Ganglioneuroma maturing from neuroblastoma is one of the theories describing pathophysiology of the disease. Ganglioneuroma should be considered in the differential diagnosis of patients presenting with recurrent ear discharge and decreased hearing in treated cases of neuroblastoma with metastases to temporal bone.

http://ift.tt/2wKrCOf

Diagnostic dilemma: ALPS versus Evans syndrome

Publication date: Available online 9 August 2017
Source:Clinical Immunology
Author(s): Evan Li, Amanda B. Grimes, Nicholas L. Rider, Donald H. Mahoney, Thomas A. Fleisher, William T. Shearer

http://ift.tt/2vRPyTt

Diffuse cerebral oedema from sickle cell vaso-occlusive crisis

Description

A middle-aged African-American male with homozygous sickle cell disease presented with vaso-occlusive crisis and suffered a generalised tonic-clonic seizure while in the emergency department. He had been seizure-free for more than a decade, thus was not taking antiepileptic medications. CT head revealed diffuse cerebral oedema, effacement of the fourth ventricle and obstructive hydrocephalus (figure 1). An external ventricular drain was placed with improvement of hydrocephalus, and a repeat CT head revealed right parietal hypodensity (figure 1). MRI brain and conventional cerebral angiogram showed right parietal cerebral oedema, a large arteriovenous malformation, right internal carotid artery occlusion, moyamoya disease and basilar artery aneurysm (figure 2). The patient's cerebral oedema and neurological examination initially improved after exchange transfusion; however, he developed acute subarachnoid haemorrhage from basilar artery aneurysm rupture and brainstem strokes causing coma. He underwent palliative extubation after discussion with family and is now deceased.

...

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Persisting fatigue and myalgia as the presenting features in a case of hypokalaemic periodic paralysis

We report a case of a 9-year-old boy who developed hypokalaemic periodic paralysis (HypoPP) following a prodrome of persistent fatigue and muscle aches associated with mildly elevated creatine kinase (CK) levels.

HypoPP is usually associated with a sudden onset of weakness and hypokalaemia at presentation. A review of published cases failed to identify any other reports of individuals with a similar onset of symptoms and elevated CK levels prior to the development of frank HypoPP.

In the case described above, the association of these symptoms with elevated levels of CK may have been related to the underlying mutation in the skeletal muscle calcium channels that was subsequently identified.

In cases of persisting fatigue and myalgia associated with elevated CK levels it may be helpful to consider HypoPP in the differential diagnosis.

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Regadenoson cardiac stress test-induced stress cardiomyopathy

Takotsubo cardiomyopathy, also described as apical ballooning syndrome/stress-induced cardiomyopathy, imitates acute coronary syndrome and is usually related to a massive physiological or emotional stressor. We describe perhaps the first reported case to the best of our knowledge of a 55-year-old Caucasian woman who presented with congestive heart failure after having a regadenoson cardiac stress test a few hours prior to presentation to the hospital. Transthoracic echocardiogram revealed reduced heart function. She had normal coronaries on cardiac catheterisation, and left ventriculography confirmed apical ballooning syndrome. She underwent guideline-directed therapy, and heart function improved in the repeat echocardiogram along with clinical resolution of symptoms.

http://ift.tt/2ftSLBY

A rare urological presentation of appendicitis

A 17-year-old boy with no medical comorbidities, but a significant family history of malignancy, presented to Accident and Emergency following 3 days of increasing rectal pain, symptoms of bladder outflow obstruction (poor flow, intermittent stream and hesitancy) and dysuria. Notably he had no abdominal pain. Digital rectal examination revealed a tender, enlarged prostate. Inflammatory markers were significantly raised (white cell count 17.7, C reactive protein 191). He was diagnosed clinically as prostatitis and commenced on intravenous antibiotics. Despite this his pain and inflammatory markers deteriorated, necessitating a CT of his abdomen and pelvis. This demonstrated multiloculated large thick-walled abscesses in the pelvis closely related to the rectum, prostate and seminal vesicles with some bowel wall thickening. Laparoscopy demonstrated a large colonic mass adherent to surrounding structures. The procedure was converted to laparotomy to enable resection of the mass via a limited right haemicolectomy. He recovered well and was discharged. Histopathological analysis of the specimen revealed appendicitis.

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Sight preserving orbital decompression: a novel multidisciplinary approach to managing severe proptosis in neurofibromatosis type 2

We describe the importance of collaboration between multiple surgical specialties in managing a complex case of sight-threatening severe proptosis in a young woman with type 2 neurofibromatosis (NF2) complicated by pre-existing contralateral blindness. Trans-nasal and lateral orbital surgical approaches were aided by stereotactic navigation to debulk a large frontal/sphenoid wing meningioma, which had been exerting pressure onto the right globe and optic nerve. The patient made an excellent postoperative recovery along with preserved residual visual acuity, normal neurology and a good aesthetic outcome.

http://ift.tt/2fv5Drs

Bimaxillary concomitant hypohyperdontia in a 10-year-old child

Numerical anomalies, either addition or deletion, are quite a common findings in human dentition. However, it is extremely rare to find both hypodontia and hyperdontia simultaneously in the same individual. This condition is referred as concomitant hypohyperdontia (CHH). Aetiology of this condition is still obscure. The prevalence of CHH has been reported to be between 0.002% and 3.1%. This case report highlights a rare occurrence of bimaxillary CHH represented by the absence of both mandibular central incisors and presence of two supernumerary teeth in the maxillary anterior segment. The rarity of such condition of mixed hypodontia as well as hyperdontia in single human dentition prompted the author to report the case.

http://ift.tt/2hMaHbM

Extramedullary haematopoiesis presenting with cardiac tamponade in a patient with polycythaemia vera

A 71-year-old man with a history of polycythaemia vera, diagnosed 4 years ago, presented to the emergency room with shortness of breath. A bedside echocardiogram revealed a large pericardial effusion with features concerning for pericardial tamponade. A left anterior thoracotomy and a pericardial window were emergently performed in the operating room and relieved the patient's symptoms. Histology evaluation of the pericardial fragments and pericardial fluid revealed the presence of trilineage haematopoietic elements without any increase in the blasts. A bone marrow core biopsy revealed an increase in reticulin fibre and increase in the number of blasts of 5%–10%, whereas peripheral blood testing was positive for JAK2 V617F mutation. This case report reviews the literature for cases of extramedullary haematopoiesis associated with myeloproliferative neoplasms.

http://ift.tt/2fv2ojW

Atypical haemolytic uremic syndrome (aHUS) and membranoproliferative glomerulonephritis (MPGN), different diseases or a spectrum of complement-mediated glomerular diseases?

Historically, patients with kidney diseases caused by genetic or acquired dysregulation of the complement alternative pathway have been grouped into clinical syndromes, C3 glomerulopathy (C3GN/DDD) and thrombotic microangiopathy (TMA), specifically atypical haemolytic uremic syndrome (aHUS). Recent data suggested that these diseases share a common pathophysiology and that patients can transition between glomerulopathies in this spectrum. Histopathologically, the main difference cited is the immunofluorescence (IF) findings, with C3 predominance in C3 glomerulopathy (compared with immunoglobulins and complements in immune complex-mediated membranoproliferative glomerulonephritis (MPGN)) and negative IF in TMA. We report a case in which a patient presented with hypertension, seizures, proteinuria, renal impairment and immune complex-mediated MPGN on kidney biopsy. Months later, she presented with classical TMA. She failed to respond to steroids and plasma exchange therapy but subsequently made a remarkable haematological and renal recovery after eculizumab treatment, thus supporting an underlying complement dysregulation and a diagnosis of aHUS.

http://ift.tt/2hMaCVw

Tetraparesia: an unusual presentation of disseminated tuberculosis

A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.

On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Laboratory results showed metabolic acidemia, severe hyperkalemia and hyponatremia, acute renal dysfunction and sterile pyuria. After hyperkalemia correction, the neurological symptoms resolved.

On the second day, he became febrile and chest radiograph and CT images showed a pulmonary bilateral reticulomicronodular pattern, left hydronephrosis and diffuse bladder wall thickening. Disseminated tuberculosis was considered as diagnosis by the coexistence of this imagiologic alterations and sterile pyuria. Acid-fast test for Mycobacteriumtuberculosis was negative, but the urine culture became positive after 2 weeks.

Antituberculosis treatment was started. One year later, he was asymptomatic and the structural urinary lesions had disappeared.

http://ift.tt/2fuQqXb

Giant hydronephrosis in a case of ureterocele with duplex system: an entity yet not reported

Ureterocele, which is a cystic dilatation of the terminal ureter, is usually associated with the upper moiety in a case of the duplex system. Giant hydronephrosis, a rare entity, is usually due to pelviureteric junction obstruction and is usually diagnosed in infants and children. We report a unique case of a unilateral complete duplex system with ureterocele with giant hydronephrosis of the upper moiety in an adult woman presenting as an abdominal lump. To the best of our knowledge, this is the first case of giant hydronephrosis associated with ureterocele in an adult patient.

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Issue Information - TOC

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Editorial Board

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100

http://ift.tt/2vplJqq

Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature

Abstract

Endoscopic surgery is now standard of care for different Endocrine Disorders; the endoscopic thyroid surgery is becoming more popular and different approaches has been practice by many thyroid surgeon worldwide. Trans-orovestibular approach, based on the principle of natural orifice transluminal surgery is truly scar free thyroid surgery and has minimal dissection. We are presenting here three cases of benign solitary thyroid nodule operated endoscopically through trans-oro-vestibular approach in one male and two female patients. Described about the approach, challenges during surgery and outcome. These surgeries documented very few in literatures in live human patients. Transoral endoscopic thyroid surgery through vestibular approach is shortest and direct remote access approach. The need of limited dissection in this approach provides less complication and excellent cosmetic outcome in strictly selected patients.

http://ift.tt/2vlCCUL

Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature

Abstract

http://ift.tt/2vlCCUL

Ultrasound versus magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: a systematic review

Publication date: Available online 10 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): B.L. Hechler, J.A. Phero, H. Van Mater, N.S. Matthews
A systematic review of published articles on ultrasound (US) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) was performed to answer the question "What is the sensitivity and specificity of US as compared to MRI in diagnosing acute and chronic joint changes in patients with JIA?" The most recent evidence was sought in published articles via a search of the PubMed, Ovid, and Embase databases. Article appraisal was performed by two reviewers. Nineteen articles reporting prospective or ambispective studies comparing US to MRI in TMJ imaging were found. Six of these articles were specific to JIA patients. The heterogeneity of these articles made comparison difficult. Of the acute and chronic changes assessed (disk displacement, joint effusion, bony deformity), only joint effusion was appropriately assessed by multiple authors, with US having a sensitivity of 0–72% and specificity of 70–83% as compared to MRI. There was a paucity of studies specific to JIA, with many studying adult, non-rheumatic patients. This systematic review found that dynamic imaging with high-resolution US improves sensitivity and specificity compared to static, low-resolution US. Additionally, there is evidence to suggest that US imaging following a baseline MRI can increase US sensitivity and specificity and may have a future role in disease surveillance.

http://ift.tt/2urbqVN

Clinical application of autogenous partially demineralized dentin matrix prepared immediately after extraction for alveolar bone regeneration in implant dentistry: a pilot study

Publication date: Available online 10 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Minamizato, T. Koga, Takashi I, Y. Nakatani, M. Umebayashi, Y. Sumita, T. Ikeda, I. Asahina
The aim of this study was to examine the efficacy and safety of autogenous partially demineralized dentin matrix (APDDM) prepared onsite, for clinical application in bone regeneration procedures related to implant dentistry, including socket preservation, alveolar ridge augmentation, and maxillary sinus floor augmentation. In this study, 16 patients underwent dental implant placement using APDDM transplantation. There were no systemic or local complications (including surgical site infection) in any of the cases, and oral rehabilitation using dental implants was successful in all cases for at least 2 years after attachment of the suprastructure. This report describes the clinical application of APDDM prepared immediately after tooth extraction to bone augmentation, taking advantage of the relatively short preparation time due to partial demineralization. APDDM, as introduced in this study, is an efficient, safe, and reasonable bone substitute. Consequently, this material has the potential to become one of the options as a bone substitute in implant dentistry.

http://ift.tt/2uIxy9k

Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery

Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.

http://ift.tt/2vQBB7Q

Αρχειοθήκη ιστολογίου

Πέμπτη 10 Αυγούστου 2017

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