Editorial.

No abstract available

http://ift.tt/2vXcpd3

Management of Type I and Type II laryngeal clefts: controversies and evidence.

Purpose of review: To summarize the pediatric Type I and Type II laryngeal cleft literature, paying special attention to recent trends, including evolution of surgical techniques, standardization of outcome assessments, and utilization of management algorithms. Recent findings: There are a variety of options to choose from whenever considering Type I and Type II cleft repair, including endoscopic repair, transoral robotic surgery, and injection laryngoplasty. Conservative management including feeding therapy and treatment of comorbid medical conditions is recommended prior to repair. Validated outcome measures have arisen for swallow study interpretation and timing, as well as caregiver quality-of-life assessment. In addition, a series of medical algorithms have been proposed, which provide specific recommendations for diagnosis, treatment, and follow-up. Summary: For clefts that fail conservative management, endoscopic repair has become the gold standard. In addition, injection laryngoplasty appears to provide both a diagnostic and therapeutic option in the management of these patients. Transoral robotic-assisted endoscopic repair appears well tolerated and feasible, although broader implementation of this technology remains limited. The development and refinement of best practice algorithms can help standardize management and improve decision-making. Furthermore, incorporating validated outcome measures, recorded and followed over time, will improve both patient care and research efforts moving forward. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2h5stXe

Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap

Abstract

Purpose of Review

In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions.

Recent Findings

Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise.

Summary

Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.

http://ift.tt/2xD5mdL

The efficacy and safety of a monophasic hyaluronic acid filler in the correction of nasolabial folds: A randomized, multicenter, single blinded, split-face study

Summary

Background

The different rheological properties of hyaluronic acid (HA) filler reflect their specific manufacturing processes and resultant physicochemical characteristics. However, there are few researches about the relationship between product differences and clinical outcome when HA fillers are used for nasolabial folds (NLFs).

Aims

This study sought to compare the rheological properties, efficacy and safety of a monophasic HA filler, and a well-studied biphasic HA filler, in the treatment of NLFs.

Patients/methods

A total of 72 Korean subjects with moderate to severe NLFs were randomized to receive injections with monophasic HA or biphasic HA on the left or right side of the face. Efficacy was evaluated by the change in the Wrinkle Severity Rating Scale (WSRS) at 2, 10, 18, 26, and 52 weeks. Safety was assessed on the basis of all abnormal reactions during the clinical test period. To compare the rheological characteristics of two cross-linked HA fillers, viscoelastic analysis was performed.

Results

At week 26, the mean WSRS was 2.26±0.56 for the monophasic HA side and 2.24±0.54 for the biphasic HA side. Both treatments were well tolerated. The adverse reactions were mild and transient. Monophasic HA filler had lower elasticity and higher viscosity than biphasic HA filler.

Conclusion

Despite a number of different rheological properties, monophasic HA is noninferior to biphasic HA in the treatment of moderate to severe NLFs for 52 weeks. Therefore, monophasic HA provides an alternative option for NLFs correction.

http://ift.tt/2yaxfal

Editorial.

No abstract available

http://ift.tt/2vXcpd3

Management of Type I and Type II laryngeal clefts: controversies and evidence.

Purpose of review: To summarize the pediatric Type I and Type II laryngeal cleft literature, paying special attention to recent trends, including evolution of surgical techniques, standardization of outcome assessments, and utilization of management algorithms. Recent findings: There are a variety of options to choose from whenever considering Type I and Type II cleft repair, including endoscopic repair, transoral robotic surgery, and injection laryngoplasty. Conservative management including feeding therapy and treatment of comorbid medical conditions is recommended prior to repair. Validated outcome measures have arisen for swallow study interpretation and timing, as well as caregiver quality-of-life assessment. In addition, a series of medical algorithms have been proposed, which provide specific recommendations for diagnosis, treatment, and follow-up. Summary: For clefts that fail conservative management, endoscopic repair has become the gold standard. In addition, injection laryngoplasty appears to provide both a diagnostic and therapeutic option in the management of these patients. Transoral robotic-assisted endoscopic repair appears well tolerated and feasible, although broader implementation of this technology remains limited. The development and refinement of best practice algorithms can help standardize management and improve decision-making. Furthermore, incorporating validated outcome measures, recorded and followed over time, will improve both patient care and research efforts moving forward. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2h5stXe

Susceptibility to Dengue Virus and Genetic Polymorphisms of Tumor Necrosis Factor Alpha: A Comment

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2weY284

Chikungunya Virus-Induced Arthritis: Role of Host and Viral Factors in the Pathogenesis

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2x3kXjB

Is Dexmedetomidine a Miracle Drug for Sedation in Patients With Neuroacanthocytosis With Involuntary Movements?.

No abstract available

http://ift.tt/2wfF3KE

Mast cells derived from human induced pluripotent stem cells are useful for allergen tests

Publication date: Available online 14 September 2017
Source:Allergology International
Author(s): Akira Igarashi, Yasuhiro Ebihara, Tomoaki Kumagai, Hiroyuki Hirai, Kinya Nagata, Kohichiro Tsuji
BackgroundSeveral methods have been developed to detect allergen-specific IgE in sera. The passive IgE sensitization assay using human IgE receptor-expressing rat cell line RBL-2H3 is a powerful tool to detect biologically active allergen-specific IgE in serum samples. However, one disadvantage is that RBL-2H3 cells are vulnerable to high concentrations of human sera. Only a few human cultured cell lines are easily applicable to the passive IgE sensitization assay. However, the use of human induced pluripotent stem cells (iPSCs) to generate human mast cells (MCs) has not yet been reported.MethodsThe nuclear factor-kappa B (NF-κB)-responsive luciferase reporter gene was stably introduced into a human iPSC line 201B7, and the transfectants were induced to differentiate into MCs (iPSC-MCs). The iPSC-MCs were sensitized overnight with sera from subjects who were allergic to cedar pollen, ragweed pollen, mites, or house dust, and then stimulated with an extract of corresponding allergens. Activation of iPSC-MCs was evaluated by β-hexosaminidase release, histamine release, or luciferase intensity.ResultsiPSCs-MCs stably expressed high-affinity IgE receptor and functionally responded to various allergens when sensitized with human sera from relevant allergic subjects. This passive IgE sensitization system, which we termed the induced mast cell activation test (iMAT), worked well even with undiluted human sera.ConclusionsiMAT may serve as a novel determining system for IgE/allergens in the clinical and research settings.



http://ift.tt/2h5IZGP

Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement

Thyroid Sep 2017, Vol. 27, No. 9: 1128-1134.


http://ift.tt/2jrtJoo

Disease Severity at Presentation in Patients with Disease-Related Mortality from Differentiated Thyroid Cancer: Implications for the 2015 ATA Guidelines

Thyroid Sep 2017, Vol. 27, No. 9: 1171-1176.


http://ift.tt/2f8TRmM

Future Meetings

Thyroid Sep 2017, Vol. 27, No. 9: 1211-1211.


http://ift.tt/2jucCmb

Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies

Thyroid Sep 2017, Vol. 27, No. 9: 1194-1200.


http://ift.tt/2f9lzA2

Intermittent Dosing of Dabrafenib and Trametinib in Metastatic BRAFV600E Mutated Papillary Thyroid Cancer: Two Case Reports

Thyroid Sep 2017, Vol. 27, No. 9: 1201-1205.


http://ift.tt/2juQ8RI

Clinical Implications of Immunoglobulin G4 to Graves' Ophthalmopathy

Thyroid Sep 2017, Vol. 27, No. 9: 1185-1193.


http://ift.tt/2faTojT

Mammary phyllodes tumor with six episodes of a relapse: a case report

Phyllodes tumor is a rare breast mass. Most phyllodes tumors are benign, but occasionally some show malignancy. Even if the tumors are benign, they can easily show recurrence.

http://ift.tt/2xoSnvt

Multiple metastases to bone from squamous cell carcinoma of the oropharynx: unusual findings on positron emission tomography-computed tomography

Publication date: Available online 14 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Sayan, Z.-B. Gonen, V. Ilankovan




http://ift.tt/2yar06f

Dermoid cyst of the submandibular gland: case report

Publication date: Available online 14 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Linnard, L. Newman, A.W. Barrett




http://ift.tt/2xCPUOV

Preoperative screening for sickle cell disease and guidance from the National Institute for Health and Care Excellence (NICE)

Publication date: Available online 14 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. O'Connor, A. Power, A. Kanatas, J. Russell




http://ift.tt/2ychzDw

Survival after surgery for oral cancer: a 30-year experience

Publication date: Available online 13 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T.K. Ong, C. Murphy, A.B. Smith, A.N. Kanatas, D.A. Mitchell
Oral squamous cell carcinoma is the most common intraoral malignancy, for which we advocate radical primary resection with adjuvant treatment where indicated. The main aims of this paper are to identify the overall survival of a consecutive series of patients and to relate survival to clinical and pathological factors. Kaplan–Meier curves were produced for site, sex, TNM status, and use of postoperative radiotherapy. The data were analysed using IBM SPSS Statistics for Windows and probabilities of less than 0.05 were accepted as significant. A total of 921 patients were recorded in the database with a diagnosis of oral squamous cell carcinoma out of a total of 1958 with salivary gland conditions or other cancers of the head and neck (43.1%). The earliest date of diagnosis was 1973, and the data were censored at 31 March 2016. The database comprised 340 women (36.9%) and 581 men (63.1%). A total of 339 patients died (34.5%): 117 women (33.7%) and 222 men (65.5%). The mean (range) age at death was 73.4 (31.4–97.5) years for women and 68.7 (33.3–95.5) years for men (t (337)=3.28, p=0.001). Our overall survival was somewhat better than the 56% five-year survival reported for oral cancer in England in 2010, which may be a reflection of the treatment. This work supports the view that aggressive management may improve overall survival.



http://ift.tt/2xD4sOt

Removal of recurrent intraorbital tumour using a system of augmented reality

Publication date: Available online 13 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Scolozzi, P. Bijlenga
The most crucial step in the management of pleomorphic adenoma of the lacrimal gland is choosing the optimal approach for excision. We report the successful removal of a recurrent pleomorphic adenoma of the lacrimal gland in a 42-year-old woman using a specific microscope-based system of augmented reality.



http://ift.tt/2yaWpFs

Dentist on the ward: an introduction to oral and maxillofacial surgery and medicine for core trainees in dentistry, 7th ed, Sadler A, Cheng I. Sorejaw (2017), ISBN: 9780956937773.

Publication date: Available online 14 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): F. Alawsi




http://ift.tt/2xCQUCO

Flared sign of flail mandible on computed tomography: an unstable fracture associated with a compromised airway

Publication date: Available online 13 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): I. Papadiochos, L. Goutzanis, K.-I. Karydi, E. Kalfarentzos, N. Papadogeorgakis
A mandibular fracture alone rarely causes a life-threatening injury. The aim of this paper was to emphasise the importance of prompt identification of the radiological signs of a flail mandible in a patient with maxillofacial trauma who eventually needed definitive management of her airway.



http://ift.tt/2yadsHP

UK temporomandibular joint replacement database: a report on one-year outcomes

Publication date: Available online 13 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Elledge, A. Attard, J. Green, D. Lowe, S.N. Rogers, A.J. Sidebottom, B. Speculand
Alloplastic temporomandibular joint (TMJ) replacements are increasingly subspecialised, and supraregional centres that treat sufficient numbers to ensure high standards are emerging. Having recently reported the introduction of a national TMJ joint replacement database that is endorsed by the British Association of TMJ Surgeons (BATS), we now present the first-year outcomes. This was a review of all data in the BATS National Case Registration of TMJ Replacement as of June 2014. A total of 252 one-year outcome records were available. Key outcomes were median (IQR) improvements in interincisal distance of 9 (4–15) mm (p<0.001) and worst-sided pain score of 6 (4–8) (p<0.001). Pain scores improved or remained static at one year in all but 3 (2%) patients. There was a significant improvement in the proportion of patients who reported a good, very good, or outstanding quality of life at one year (38% at baseline to 87% at one year; p<0.001). While outcome reports from single centres for alloplastic TMJ replacements have already been published in the United Kingdom, this is the first dedicated national database in this country that will yield valuable longitudinal follow-up data. Outcomes were comparable with smaller published series and showed improvements in pain, dietary intake, quality of life, and function, with few outliers. The database has recently moved to a new software system and we hope to publish three-year and five-year outcomes in due course.



http://ift.tt/2xC8SFd

Revisiting murine models for atopic dermatitis and psoriasis with multipolar cytokine axes

Kenji Kabashima | Takashi Nomura

http://ift.tt/2facarR

Validation of the Vectra H1 portable three-dimensional photogrammetry system for facial imaging

Three-dimensional (3D) surface imaging using stereophotogrammetry has become increasingly popular in clinical settings, offering advantages for surgical planning and outcome evaluation. The handheld Vectra H1 is a low-cost, highly portable system that offers several advantages over larger stationary cameras, but independent technical validation is currently lacking. In this study, 3D facial images of 26 adult participants were captured with the Vectra H1 system and the previously validated 3dMDface system.

http://ift.tt/2xBzUMV

Pigmentary changes in patients treated with targeted anticancer agents: A systematic review and meta-analysis

The discovery of signaling networks that drive oncogenic processes has led to the development of targeted anticancer agents. The burden of pigmentary adverse events from these drugs is unknown.

http://ift.tt/2h5lA8r

Atypical features and systemic associations in extensive cases of Grover disease: A systematic review

Grover disease is an acantholytic disorder that typically occurs on the trunk of older individuals, primarily white men, in association with heat and xerosis. Cases with extensive and/or atypical distributions have been reported.

http://ift.tt/2y2ADmw

It is essential that junior staff feel confident to manage patients who attend the oral and maxillofacial...

It is essential that junior staff feel confident to manage patients who attend the oral and maxillofacial surgery department, and that they have a consistent approach to their training. Sadler and Cheng's book is written specifically for core trainees in dentistry who are embarking on training positions in OMFS in secondary care.

http://ift.tt/2fl2qaT

Dermoid cyst of the submandibular gland: case report

Dermoid cysts are subcutaneous, of ectodermal origin, and are found along the lines of embryonic fusion. They may be congenital or acquired, and occur predominantly in the testes and ovaries. Only 7% affect the head and neck, usually in the orbital area.1 We describe a rare example of a dermoid cyst in the right submandibular gland.

http://ift.tt/2xosZGd

Preoperative screening for sickle cell disease and guidance from the National Institute for Health and Care Excellence (NICE)

We are writing to draw attention to the change in NICE guideline 1.4 that was published in April 2016 and states that patients over the age of 16 should not be routinely offered testing for sickle cell disease or sickle cell trait before operation. Rather, it advises that patients should be asked if they or any member of their family have the disease.1 The guidance goes on to discuss the fact that the number of operations completed by the National Health Service (NHS) in the year 2012-2013 increased by 60% to 10.6 million, compared with those in 2002–2003, and therefore "even a small percentage of unnecessary preoperative testing can affect a large number of people".

http://ift.tt/2f9q5OU

Multiple metastases to bone from squamous cell carcinoma of the oropharynx: unusual findings on positron emission tomography-computed tomography

Metastasis to distant bone from squamous cell carcinoma (SCC) of the head and neck has been reported in 4% to 26% of cases, and nearly all involve a single bone.1–3 Multiple metastases to bone account for fewer than 0.96%.4 We report an unusual positron emission tomography-computed tomography (PET-CT) finding in a patient with SCC of the oropharynx.

http://ift.tt/2jsJUSt

Audiological Findings in Children With Mucopolysaccharidoses Type I–IV

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): María F. Vargas-Gamarra, Carlos de Paula-Vernetta, Isidro Vitoria Miñana, Isabel Ibañez-Alcañiz, Laura Cavallé-Garrido, Agustín Alamar-Velazquez
ObjectiveThe aim of our study is to reflect hearing impairment of 23 children diagnosed with mucopolysaccharidosis (MPS) type I, II, III and IV.MethodsRetrospective study of the clinical, audiological and treatment (medical vs surgical) findings of 23 children diagnosed with MPS type I, II, III and IV followed at a Tertiary Referral Hospital between 1997 and 2015.ResultsSix cases of MPS I, 8 of MPS II, 4 of MPS III and 5 of MPS IV were reviewed. 71.2% of patients had secretory otitis media (SOM) and 54% of patients had some type of hearing loss (HL). The behaviour of hearing loss was variable in each of the subgroups of MPS, finding greater involvement and variability in types I and II.ConclusionsChildren with MPS have a high risk of hearing loss. A significant percentage of transmissive HL progressing to mixed or sensorineural HL was observed. This was more common in types I and II. Periodic follow up of these patients is mandatory because of hearing impairment and consequences for their development and quality of life.



http://ift.tt/2wtmxth

A Review of Our Experience in Phonosurgery in Children

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Mikel Landa, Idoia Palicio, Leire Álvarez, Zuriñe Martínez
Introduction and objectivesDysphonia is a common problem in children, especially those of school age. Exploration of vocal folds is often difficult and less accurate in children. The most frequent lesions found in children with chronic dysphonia are vocal nodules, followed by epidermoid cysts and other congenital lesions, such as sulci and mucosal bridges. The treatment is multidisciplinary and it is fundamentally based on vocal rehabilitation. We indicate surgical treatment in children older than 9 years of age for whom the problem persists after rehabilitation, especially if we suspect a congenital lesion of the vocal fold.MethodsWe present a retrospective study of paediatric phonosurgery performed by the Vocal Pathology Unit of our Hospital over a period of 9 years (2005–2013). Fifty-one children were included, ranging in age from 9 to 16 years old. We analysed the distribution of the different lesions, both congenital and acquired. We evaluated the results by subjective evaluation by the children's relatives.ResultsWe obtained a distribution of 76% (n=39) of congenital lesions and 24% (n=12) of acquired lesions. After surgery, there was a global percentage of improvement of 90%, with better results in cases of vocal nodules, without statistical significance.ConclusionsThe evaluation of the results of this surgery is controversial and in this study is done with a single question survey administered to relatives. We found an overall result of improvement in 90% of operated cases, without any complications. We obtained better results in vocal nodules, although not reaching statistical significance.



http://ift.tt/2x6aRjP

Electromyography-Guided Hyaluronic Acid Injection Laryngoplasty in Early Stage of Unilateral Vocal Fold Paralysis

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Itziar Gotxi-Erezuma, Mónica Ortega-Galán, Ainhoa Laso-Elguezabal, Gonzalo Prieto Puga, Carolina Bullido-Alonso, Susana García-Gutiérrez, Ane Anton-Ladislao, Enrique Moreno-Alonso
Introduction and objectiveTo assess the effectiveness of electromyography-guided hyaluronic acid injection laryngoplasty in the early stage of unilateral vocal fold paralysis in terms of patient recovery from dysphonia and quality of life.MethodsBetween January and December 2014, 28 patients with unilateral vocal fold paralysis underwent electromyography and injection of hyaluronic acid in the thyroarytenoid muscle. We compared the voice handicap index, grade, roughness, breathiness, asthenia, strain scale (GRBAS), videostroboscopic parameters and maximum phonation time assessed before, 15 days and 6 months after the intervention, using the non-parametric Wilcoxon rank test.ResultsOut of the 28 patients, 1 had a haematoma in the injected vocal fold (3.57%) and 6 required second injections. The maximum phonation time of the vowel /e/ increased from 6.07 to 12.14s (15 days post-intervention) and subsequently 12.75 (6 months post-intervention). There was also a significant improvement in the grade, roughness, breathiness, asthenia, strain scale in parameters G, B and A both 15 days and 6 months after the intervention. The voice handicap index score decreased from 58.29 to 37.63 (15 days post-intervention) and 29.64 (6 months post-intervention).ConclusionsElectromyography-guided hyaluronic injection laryngoplasty in unilateral vocal fold paralysis enables, in the same intervention, neuromuscular assessment and temporary treatment of glottic insufficiency with a low risk of complications and improvement in patient's quality of life. This may reduce the need for subsequent treatments, but further research is required to confirm these findings.



http://ift.tt/2wt8Jza

Treatment of the First Bite Syndrome

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): María Costales-Marcos, Fernando López Álvarez, Laura Fernández-Vañes, Justo Gómez, José Luis Llorente
First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimise salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A.



http://ift.tt/2x5i57D

Transoral Oropharyngeal Resection Classification: Proposal of the SCORL Working Group

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): David Virós Porcuna, Francisco Avilés Jurado, Carlos Pollán Guisasola, Rosa Delia Ramírez Ruiz, Jacinto García Lorenzo, Marc Tobed Secall, Isabel Vilaseca González, José Miguel Costa González, Josep Soteras Olle, Francesc Casamitjana Claramunt, Anna Sumarroca Trouboul, Rafael Hijano Esqué, Guillem Viscasillas Pallàs, Manel Mañós Pujol, Miquel Quer Agustí
Introduction and goalsThere has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used.MethodsFrom the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours.ResultsThe classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone.The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications.ConclusionProposal for a system of classification by area to define different types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.



http://ift.tt/2wt3bnW

Sinonasal Papillomas in a Private Referral Otorhinolaryngology Centre: Review of 22 Years Experience

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Aderito de Sousa Fontes, Minaret Sandrea Jiménez, Nelson Urdaneta Lafée, Perfecto A. Abreu Durán, Liwven E. Quintana Páez, Andreina Carmina de Sousa de Abreu
ObjectivesTo evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela).Material and methodsWe reviewed 94 patients with SP that were treated at our otolaryngology centre, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed.ResultsSixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9–80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.ConclusionsComplete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.



http://ift.tt/2x50uN6

Nasal Agenesis and Other Facial Malformations: Report of a Case of Congenital Anomaly and Literature Review

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): María del Carmen Navas-Aparicio, Cinthya Mora-Mesén




http://ift.tt/2wsJBbM

Cochlear Implant in Patient With Intracochlear Schwannoma

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Carlos de Paula Vernetta, Nabil Atrache Al Attrache, Laura Cavallé Garrido, Fernando Mas Estellés, Constantino Morera Pérez




http://ift.tt/2x2QpP9

Cholesterol granuloma of ethmoid sinuses: Report of two cases

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Nadim Khoueir, Alan Shikani




http://ift.tt/2wdTPl3

Bilateral Bifid Mandibular Condyle

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Carlos Prol, Julio Álvarez, Josu Mendiola




http://ift.tt/2x2QySH

Intranasal Ectopic Tooth

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Paula Cruz Toro, Ignacio Clemente, Iván Domènech




http://ift.tt/2wedh12

Do Women With a History of Pregnancy and Endodontics, Have Higher Risk of Maxillary Fungal Ball?

Publication date: September–October 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 5
Author(s): Esteban Vergara-de la Rosa, José Galvez-Olortegui, Carlos Vargas-Armas, Tomas Galvez-Olortegui




http://ift.tt/2x47WGM

Long-Term Outcomes of Lateral Neck Dissection in Patients with Recurrent or Persistent Well-Differentiated Thyroid Cancer

Thyroid , Vol. 0, No. 0.


http://ift.tt/2f8obhm

Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume

Thyroid , Vol. 0, No. 0.


http://ift.tt/2jvbH50

Cancer Risk Stratification of Indeterminate Thyroid Nodules: A Cytological Approach

Thyroid , Vol. 0, No. 0.


http://ift.tt/2jvbtea

Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides

Publication date: Available online 14 September 2017
Source:Acta Otorrinolaringológica Española
Author(s): José Luis Pardal-Refoyo, Pablo Parente-Arias, Marta María Arroyo-Domingo, Juan Manuel Maza-Solano, José Granell-Navarro, Jesús María Martínez-Salazar, Ramón Moreno-Luna, Elvylins Vargas-Yglesias
IntroducciónLa cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos.ObjetivoElaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT.MétodoConsenso en grupo de trabajo mediante revisión sistemática y método Delphi.ResultadosSe identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales.ConclusionesLa NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.IntroductionThyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.ObjectiveTo develop a support document for guidance on the use of IONM in TPTS.MethodWork group consensus through systematic review and the Delphi method.ResultsSeven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.ConclusionsIONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.



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Clinical and pathological significance of cutaneous manifestations in ANCA-associated vasculitides

Publication date: Available online 14 September 2017
Source:Autoimmunity Reviews
Author(s): Laure Frumholtz, Sara Laurent-Roussel, Olivier Aumaître, François Maurier, Guillaume Le Guenno, Agnes Carlotti, Alexiane Dallot, Jean Louis Kemeny, Laurent Antunes, Nicolas Froment, Sylvie Fraitag, Jonathan London, Alice Berezne, Benoît Terris, Claire Le Jeunne, Luc Mouthon, Selim Aractingi, Loïc Guillevin, Nicolas Dupin, Benjamin Terrier
ObjectivesCutaneous manifestations (CM) in ANCA-associated vasculitides (AAV) are frequent, but data on clinical significance and clinical-pathological correlations are lacking.MethodsWe conducted a multicenter, retrospective study including 1553 AAV patients. Clinical, biological and pathological features have been analyzed, and tissue samples from 46 biopsies were reviewed in a blind manner.ResultsCM were more frequent in EGPA (53.0%) and MPA (51.9%) than in GPA (36.7%). Lesions more frequently associated with GPA were oral ulcers (4.6% vs. 2.5% in EGPA and 0.3% in MPA), while pyoderma gangrenosum and palpebral xanthoma were specific to GPA. Lesions associated with MPA were segmentary edema (19.5% vs. 12.7% in EGPA and 4.3% in GPA) and livedo (12.4% vs. 0.5% and 2.6%, respectively), whereas those associated with EGPA were urticarial lesions (11.5% vs. 1.9% in GPA and 3.5% in MPA) and nodules (12,2% vs. 8.9% in GPA and 4.7% in MPA). In GPA, CM patients had more frequent vasculitis than granulomatous phenotype, and poorer relapse-free and overall survival. Pathological analysis showed vasculitis and/or granulomatous infiltrates in 87.5% of GPA, in 61.1% of EGPA and in all MPA. Vasculitis was more frequently observed in purpura and nodules, while granulomas were differently located and organized within vessels or interstitium according to the type of lesions.ConclusionEach AAV seemed to be associated with a peculiar pattern of cutaneous lesions. CM are associated with poorer prognosis in GPA. Clinical-pathological correlations showed no specific feature of each AAV, whereas granulomatous infiltrates differ according to the type of lesions.



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Elevated Neutrophil-to-Lymphocyte Ratio in Metabolic Syndrome Is Associated with Increased Risk of Colorectal Adenoma

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


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Multimodal management for acute invasive fungal rhinosinusitis

Publication date: Available online 13 September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Lucia Diaz Garcia, Kent Lam
Acute invasive fungal rhinosinusitis (IFRS) is an aggressive sinonasal infection that is associated with a high risk of morbidity and mortality. Acute IFRS typically affects individuals with a deficient immune system and is characterized by a fulminant proliferation of tissue invasion by opportunistic fungal species. The early diagnosis and management of acute IFRS play important roles in improving the disease prognosis. The management of acute IFRS requires a multimodal approach that relies on both medical and surgical interventions. This article highlights general considerations for both the medical and surgical strategies for treatment of acute IFRS as a rhinologic emergency.



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Ancient wheat species and human health: biochemical and clinical implications

Publication date: Available online 14 September 2017
Source:The Journal of Nutritional Biochemistry
Author(s): Monica Dinu, Anne Whittaker, Giuditta Pagliai, Stefano Benedettelli, Francesco Sofi
Wheat is the major staple food in many diets. Based on the increase in worldwide mortality attributable to diet-related chronic diseases, there is an increasing interest in identifying wheat species with greater health potential, more specifically for improved anti-oxidant and anti-inflammatory properties. In particular, ancient varieties (defined as those species that have remained unchanged over the last hundred years) are gaining interest since several studies suggested that they present a healthier nutritional profile than modern wheats. This manuscript reviews the nutritional value and health benefits of ancient wheats varieties, providing a summary of all in vitro, ex vivo, animal and human studies that have thus far been published. Differences in chemical composition, and biochemical and clinical implications of emmer, einkorn, spelt, khorasan and various regional Italian varieties are discussed. Although many studies based on in vitro analyses of grain components provide support to the premise of a healthier nutritional and functional potential of ancient wheat, other in vitro studies performed are not in support of an improved potential of ancient varieties. In the light of existing evidence derived from in vivo experiments, the ancient wheat varieties have shown convincing beneficial effects on various parameters linked to cardio-metabolic diseases such as lipid and glycaemic profiles, as well as the inflammatory and oxidative status. However, given the limited number of human trials, it is not possible to definitively conclude that ancient wheat varieties are superior to all modern counterparts in reducing chronic disease risk.



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Inflammatory Myofibroblastic Tumour: A Case Report and A Clinical Update

Publication date: Available online 14 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Neelam N. Andrade, Paul C. Mathai, Rajpari Kamil, Neha Aggarwal




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Three dimensional reconstruction of late post traumatic orbital wall defects by customized implants using CAD-CAM, 3D Stereolithographic models: A Case report

Publication date: Available online 14 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): U. Vignesh, Divya Mehrotra, Dichen, Vaibhav Anand, Debraj Howlader
AimPurpose of this case report is to highlight the precision and accuracy obtained with patient specific implants for orbital reconstruction designed on the basis of volumetric analysis of orbital computed tomographic scan (CT) scans using virtual planning, computerised designing and manufacturing and stereolithographic models to correct late post-traumatic orbital deformities such as enophthalmos and diplopia.Material and methodsThis case report describes a patient who visited our outpatient clinic for correction of enophthalmos and persistent diplopia in upward gaze, seven months post trauma. Three dimensional (3D) virtual treatment planning was carried out by using the 3D CT data. The unaffected orbit of the contralateral side was superimposed on the deformed orbit to highlight the defect and a customized implant was designed in the desired size and shape on the virtual model using computer aided designing and manufacturing (CAD-CAM) and milled in titanium mesh for precise anatomic orbital reconstruction.ResultsThere was a marked improvement in both the diplopia in upward gaze and enophthalmos post surgery when the customized patient specific orbital implant was used.ConclusionThe concept of using customized implant with the help of 3D virtual treatment planning, 3D stereolithographic models and CAD-CAM greatly improves the correction of extremely difficult late post-traumatic orbital deformities.



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Establishment of CMab-43, a Sensitive and Specific Anti-CD133 Monoclonal Antibody, for Immunohistochemistry

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


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Aggravation apparente d’un psoriasis révélant un surdosage en méthotrexate

Publication date: Available online 13 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Haber, B. Baroudjian, M. Battistella, M. Bagot, A. Petit
IntroductionLe méthotrexate (MTX) est un antimétabolite utilisé dans le traitement de certains cancers, de maladies auto-immunes et, très couramment en dermatologie, du psoriasis cutané ou articulaire. Les toxicités secondaires à un surdosage en MTX sont essentiellement cutanée, hépatique et hématologique. Nous avons observé un patient chez qui un surdosage en MTX s'est manifesté par une poussée inflammatoire érosive de plaques de psoriasis préexistantes et l'apparition de nouvelles lésions sur les paumes.ObservationUn homme de 51 ans, atteint depuis 6 ans d'un psoriasis en plaques résistant aux dermocorticoïdes, recevait pour la première fois un traitement de MTX prescrit à la dose de 20mg par semaine. Une semaine après avoir commencé le traitement, il se présentait pour fièvre, altération de l'état général et ulcérations cutanéo-muqueuses. L'examen montrait un érythème inflammatoire en partie érosif, suintant et croûteux, confiné sur les plaques anciennes de psoriasis et associé à des lésions palmaires kératosiques évocatrices de psoriasis. Un surdosage était soupçonné et l'interrogatoire confirmait que le MTX avait été pris à la dose de 20mg par jour. Le bilan paraclinique montrait une neutropénie à 1040/mm³. La biopsie cutanée était en faveur d'une toxicité du méthotrexate avec des dystrophies kératinocytaires. Les symptômes cliniques et biologiques s'amélioraient après arrêt du MTX et traitement par acide folinique, hydratation intraveineuse et alcalinisation des urines.DiscussionLa toxicité cutanéo-muqueuse liée au surdosage en MTX est rare, mais peut être prédictive d'une pancytopénie plus tardive. L'identification de ses manifestations cutanées est donc importante pour une prise en charge précoce et efficace. En particulier, la focalisation des manifestations toxiques sur les lésions préexistantes ou l'apparition de novo de pustules palmoplantaires ne doivent pas faire conclure à tort à une aggravation du psoriasis.BackgroundMethotrexate (MTX) is an antimetabolite drug used in the treatment of cancers and autoimmune diseases and frequently in dermatology for cutaneous and/or arthritic psoriasis. Toxicities due to MTX overdosage are mainly cutaneous, hepatic and hematologic. Herein, we report a case of MTX overdosage presenting as an erosive and an inflammatory flare of preexisting psoriatic plaques and with new palmar lesions.Patients and methodsA 51-year-old male with a 6-year history of plaque psoriasis resistant to topical corticosteroids was started for the first time on MTX 20mg weekly. One week later, he presented with fever, general weakness and mucocutaneous ulcerations. Physical examination revealed inflammatory, erythematous and partially erosive annular plaques strictly confined to preexisting psoriatic lesions, along with keratotic psoriatic palmar plaques. Further questioning indicated that the patient was taking MTX 20mg daily. Investigations revealed neutropenia (1040/mm³) and skin histology showed prominent dystrophic keratinocytes and confirmed the diagnosis of methotrexate toxicity. Clinical and biological improvements were observed after cessation of MTX and treatment with folinic acid, IV hydration and urine alkalization.DiscussionSkin lesions due to acute MTX toxicity are rare, but they herald later-onset pancytopenia. Identification of these cutaneous lesions might enable earlier treatment initiation. The predilection of MTX toxicity for preexisting lesions or the de novo appearance of palmoplantar pustules should not lead to the erroneous diagnosis of psoriasis flare.



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Encore trop de grossesses sous Soriatane®

Publication date: Available online 13 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




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Une consultation « tatouages » en centre hospitalier universitaire, pour qui et pour quoi faire ?

Publication date: Available online 13 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, V. Descamps




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Néoplasies associées à une sclérodermie systémique avec anticorps anti-ARN polymérase III

Publication date: Available online 13 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-B. Monfort, A. Mathian, Z. Amoura, C. Francès, A. Barbaud, P. Senet
IntroductionL'incidence des cancers est augmentée chez les patients atteints de sclérodermie systémique (ScS). De plus, des études récentes ont mis en évidence que la présence d'anticorps anti-ARN polymérase III était associée à un risque de cancer plus élevé chez les patients atteints de ScS.ObservationsNous présentons les cas de deux hommes de 56 et 23 ans atteints de sclérodermie systémique, sans anticorps anti-Scl70 ni anti-centromère, ayant des anticorps anti-ARN polymérase III. Dans les deux cas, un diagnostic de cancer de la sphère oro-pharyngée a été posé après réalisation d'examens complémentaires demandés devant des signes cliniques d'orientation.DiscussionCes observations illustrent le fait que les anticorps anti-ARN polymérase III ont un intérêt diagnostique lors de la ScS et que leur présence doit faire rechercher un cancer associé (même en l'absence de signes cliniques d'orientation).BackgroundThe incidence of cancer is increased in patients with systemic sclerosis (SSc). Further, recent studies have also shown that the presence of anti-RNA polymerase III antibodies is associated with a higher incidence of cancer in this population.Patients and methodsHerein we present the cases of two men aged 56 and 23 years presenting SSc without anti-Scl70 or anti-centromere antibodies but with anti-RNA polymerase III antibodies. Clinical symptoms led us to prescribe more laboratory exams and both patients were diagnosed with cancer of the nasopharyngeal area.DiscussionAnti-RNA polymerase III antibodies are useful for SSc diagnosis in patients without anti-centromere or anti-Scl70 antibodies. Their presence must lead physicians to screen for associated cancer, even in the absence of clinical signs.



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Moisturizers Labeled 'Hypoallergenic' May Still Have Toxic Chemicals

Many moisturizers promoted as remedies for skin problems like eczema and labeled as `fragrance-free' or `hypoallergenic' may still contain chemicals that can cause irritation, a recent U.S. study suggests.
Reuters Health Information

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Reporting of Effect Size and Confidence Intervals

This study evaluates the frequency of reporting effect sizes and confidence intervals in the results of analytical studies from JAMA Otolaryngology–Head & Neck Surgery.

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Laryngoscopic Findings and Response to Gabapentin

This cohort study examines the use of gabapentin in patients with chronic cough when vocal fold motion asymmetry is noted on videostroboscopy.

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Anesthesia Exposure and Neurotoxicity in Children

This Viewpoint discusses the implications for otolaryngologists of a recent US Food and Drug Administration warning about the association between anesthesia exposure and neurocognitive deficits in children.

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Chronic Urticaria and Irritable Bowel Syndrome: a Cross-Sectional Study of 11,271 Patients

Abstract

The human body interacts with the environment mainly through three major tissues: the lungs, skin, and gastrointestinal (GI) tract. In each one, an intensive nervous network is present, conjugated with abundant mast cells (MC). While MC-mediated disorders in airways and the skin are extensively discussed, MC-mediated disorders of the GI tract remain relatively uncommon. Since the GI tract is one of the three main environment-interacting tissues, it is reasonable that MC-mediated disorders of the GI may have the same weight and impact as asthma or chronic urticaria (CU).

This article is protected by copyright. All rights reserved.

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Novel CLDN1 mutation in ichthyosis-hypotrichosis-sclerosing-cholangitis syndrome without signs of liver disease

Abstract

Ichthyosis-hypotrichosis-sclerosing-cholangitis (IHSC is a rare autosomal recessive syndrome of ichthyosis, scalp hypotrichosis, and sclerosing cholangitis (MIM 607626).[1, 2] Oligodontia, hypodontia and dysplastic enamel have been described as well, as have intracytoplasmic vacuoles in eosinophils, mild psychomotor delay and bilateral anterior uveal synechiae.[2] IHSC is caused by homozygous mutations in the CLDN1 gene which codes for claudin-1, a key component of tight junctions in association with Occludin and junctional adhesion molecules.[2]

This article is protected by copyright. All rights reserved.

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Identification of Mutations in SDR9C7 in 6 Families with Autosomal Recessive Congenital Ichthyosis

Abstract

Autosomal recessive congenital ichthyosis (ARCI) is a heterogeneous group of disorders of keratinization. To date, ARCI has been associated with following genes: ABCA12, ALOX12B, ALOXE3, CERS3, CYP4F22, NIPAL4, TGM1, PNPLA1 and recently SDR9C7 and SULT2B1.^1-6 Furthermore, seven patients from a large consanguineous family were described as ARCI due to a homozygous mutation in LIPN.⁷ However, the first symptoms appeared only from the age of 5 years and the criterion of a congenital form of ichthyosis is not fulfilled. In this study we report the clinical and molecular findings of seven ARCI patients who carried five previously unreported mutations in SDR9C7.

This article is protected by copyright. All rights reserved.

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Disappearance of epidermal transglutaminase and IgA deposits from the papillary dermis of dermatitis herpetiformis patients after a long-term gluten-free diet

Abstract

Dermatitis herpetiformis (DH) is an itchy, blistering skin disease characterised by the deposition of granular immunoglobulin A (IgA) in the papillary dermis. It is regarded as the cutaneous manifestation of coeliac disease, an autoimmune-mediated condition affecting the small intestine. In addition to skin symptoms, DH patients have mostly subclinical small-intestinal villous atrophy and crypt hyperplasia or at least coeliac-type inflammatory changes. Moreover, DH patients have specific antibodies targeting epidermal transglutaminase (a.k.a. transglutaminase 3, TG3), the dominant autoantigen in DH ¹.

This article is protected by copyright. All rights reserved.

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Bile duct obstruction in a patient treated with nivolumab as second-line chemotherapy for advanced non-small-cell lung cancer: a case report

Abstract

Immune checkpoint inhibitors (ICIs) are becoming a standard therapy for non-small-cell lung cancer in the advanced stage. As these ICIs become widely available in clinical practice, immune-related adverse effects will become more common. Here we report a patient with lung adenocarcinoma who was treated with nivolumab and developed obstruction because of biliary inflammation. A 63-year-old Japanese man having lung adenocarcinoma with pleural dissemination complained of epigastric pain on the fifth cycle of nivolumab. Computed tomography showed wall thickening at the lower part of the bile duct and cholecystitis. Endoscopic retrograde cholangiopancreatography was repeatedly performed for drainage and stenting of the bile duct. Biopsies did not show obvious malignancy. Laboratory data on day 85 demonstrated grade 3 elevation of serum alkaline phosphatase, transaminase, and amylase levels. We initiated high-dose oral prednisone, resulting in gradual improvement of symptoms and laboratory data. Follow-up magnetic resonance cholangiopancreatography demonstrated no progression of duct obstruction, which confirmed the absence of biliary malignancy. Combined with results from previous reports, nivolumab may cause extrahepatic cholangitis.

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Revision rhinoplasty – physician–patient esthetic and functional evaluation

Publication date: Available online 14 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Heloisa Nardi Koerner Vian, Cezar Augusto Sarraff Berger, Danielle Candia Barra, Ana Paula Perin
IntroductionApproximately 5–15% of patients submitted to rhinoplasty operations undergo revision surgery. Those patients have varied functional and esthetic complaints that should receive a detailed assessment that includes all the expectations the patient had before the previous procedure.ObjectiveTo draw the profile of the main esthetic-functional complaints reported by patients to be submitted to revision rhinoplasty and to correlate them with the internal and external objective nasal evaluation performed by the surgeon.MethodsA prospective study was conducted with 43 patients to be submitted to revision rhinoplasty and their respective surgeons, by applying a questionnaire about the patients' epidemiological questions and subjective esthetic-functional complaints and the respective functional deformities observed by the surgeons. Subsequently, these data were correlated with the purpose of observing the frequency of congruent reports between physicians and patients.ResultsThe presence of drooping tip and residual bridge hump were the patients' main complaints confirmed by the surgeons. The correlation between subjective obstructive symptoms and the intranasal evaluation performed by surgeons was shown to be present in 87.5% of the cases. Among the patients with respiratory symptoms, the main deformity identified was residual septal deviation in 56.25% of the cases.ConclusionThe drooping tip followed by residual hump were the main complaints reported by the patients and confirmed at the objective examination by the physicians. The presence of nasal obstructive complaints in 37.2% of the patients shows that greater attention needs to be paid to functional deformities during the first surgical procedure. The differences observed between patients' complaints and surgeons' evaluations confirm the need for detailed assessment and clarification to the patients regarding their expectations and actual surgical possibilities.



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Hashimoto's thyroiditis – an independent risk factor for papillary carcinoma

Publication date: Available online 14 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Barbora Uhliarova, Andrej Hajtman
IntroductionThe link between Hashimoto's thyroiditis (HT) and thyroid carcinoma (TC) has long been a topic of controversy.ObjectiveThe aim of our study was to determine the prevalence of TC and HT coexistence in histopathologic material of thyroidectomized patients.MethodsIn a retrospective study, the clinicohistopathologic data of 2117 patients (1738 females/379 males), who underwent total or partial thyroidectomy for thyroid gland disorder at a single institution from the 1st of January 2005 to the 31st of December 2014 were analyzed.ResultsThyroid carcinoma was detected in 318 cases (15%) and microcarcinoma (thyroid cancer ≤10mm in diameter) (TMC) was found in permanent sections in 169 cases (8%). Hashimoto's thyroiditis was detected in 318 (15%) patients. HT was significantly more often associated with thyroid carcinoma and microcarcinoma compare to benign condition (p=0.048, p=0.00014, respectively). Coexistence of HT and TC/TMC did not affect tumor size (p=0.251, p=0.098, respectively), or tumor multifocality (p=0.831, p=0.957, respectively). Bilateral TMC was significantly more often detected when HT was also diagnosed (p=0.041), but presence of HT did not affect bilateral occurrence of TC (p=0.731).ConclusionHashimoto's thyroiditis is associated with significantly increased risk of developing thyroid carcinoma, especially thyroid microcarcinoma.



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Biosimilars – neue medikamentöse Optionen

Zusammenfassung

Proteine sind anspruchsvolle Arzneistoffe – nicht nur in der Anwendung, sondern v. a. auch in der Herstellung und der Charakterisierung. So überrascht es nicht, dass es von biotechnologisch produzierten Arzneistoffen keine Generika im klassischen Sinn gibt. Allerdings sind bereits seit über 10 Jahren Biosimilars verfügbar. Lange Zeit wurde diese neue Wirkstoffklasse fast nur von einigen Spezialisten wahrgenommen. Jüngst jedoch beobachtet man Unsicherheit bis hin zu Aufgeregtheit im Zusammenhang mit Biosimilars. Grund war die Zulassung der ersten Biosimilar-Antikörper.

Tatsächlich handelt es sich bei Biosimilars nicht nur um lange für unmöglich herstellbar gehaltene Kopien bewährter rekombinanter Arzneimittel. Biosimilars werden auch nach einer Systematik zugelassen, die bei Ärzten in Teilen als suspekt wahrgenommen wird. Daher ist es wichtig, das Konzept der Biosimilar-Herstellung und -zulassung zu verstehen, um der Gefahr zu begegnen, dass bei Ärzten ein Gefühl aufkommt, aus Kostengründen Biologicals 2. Klasse verordnen zu müssen, zumal absehbar ist, dass durch Quoten und Rabattverträge den Biosimilars eine strikte Priorität bei der Versorgung der Patienten einzuräumen ist.

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The End-Diastolic Velocity of Thyroid Arteries Is Strongly Correlated with the Peak Systolic Velocity and Gland Volume in Patients with Autoimmune Thyroiditis

Background. The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance. Objective. The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT). Methods. A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography. Results. The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, ), thyroid volume (), and thyroid visual vascularization pattern (TVP, ). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg. Conclusion. The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.

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Efficacy and safety of autologous haematopoietic stem cell transplantation in systemic sclerosis: A systematic review of literature

Abstract

We aimed at assessing the efficacy of autologous haematopoietic stem cell transplantation (HSCT) for skin sclerosis and lung function in systemic sclerosis (SSc). We performed a systematic literature review in the Pubmed and Scopus databases from the earliest records to March 2016. We assessed quality using the Cochrane tool for randomized studies, Newcastle-Ottawa scale for controlled-cohort studies and an 18-item quality appraisal checklist for case series. The primary outcome was the improvement of skin thickening using the modified Rodnan Skin Score (mRSS). The secondary outcome was efficacy on lung function (using diffusing capacity of the lung for carbon monoxide (DLCO) and forced vital capacity (FVC)). The procedure safety was evaluated. The literature search identified 431 citations. There were 38 studies involving a total of 344 patients who fulfilled our inclusion criteria. No meta-analysis was performed due to a high heterogeneity. There was a significant improvement in mRSS in the majority of the reports (p<0.05), and the results were sustained for up to 8 years after autologous HSCT. The randomized studies and the 4 cohort studies showed each a slight but statistically significant improvement in FVC at 1 or 2 years. The treatment-related mortality (TRM) calculated by pooling patients of 35 studies (336 patients with a follow-up up to 146 months) was 8.3% after autologous HSCT and 1% in cyclophosphamide (CYC)-treated groups. Despite heterogeneity among the studies, autologous HSCT significantly improved cutaneous fibrosis and slightly the FVC. Safety of autologous HSCT is acceptable given the severity of the disease.

This article is protected by copyright. All rights reserved.

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Developing a protocol to identify and prioritise research questions for psoriasis: A James Lind Alliance Priority Setting Partnership

Abstract

Background

Psoriasis affects over two million people in the UK. It confers a significant psychological and social impact on individuals and an associated high economic cost to the National Health Service. There are many unanswered questions about psoriasis.

Objectives

1. To develop a protocol in order to work with patients, families, carers and healthcare professionals to identify psoriasis uncertainties.

2. To agree by consensus a top ten list of psoriasis uncertainties.

3. To disseminate prioritised unanswered questions to researchers and funders to promote work focused on answering the uncertainties considered most important by stakeholders.

Methods

A Psoriasis Priority Setting Partnership has been established to gather psoriasis uncertainties following the transparent methodology advocated by the James Lind Alliance. A Steering Group composed of stakeholders will disseminate a survey to patients, families, carers and healthcare professionals to collect information on important psoriasis questions. After removing duplications, uncertainties will be collated and checked against existing evidence to determine whether any have already been resolved. 'True uncertainties' will be circulated to stakeholders in a second survey where they will be ranked by importance. At a final workshop, information will be distilled to generate a top ten list of uncertainties.

Results

By following the protocol outlined in this paper a prioritised list of uncertainties will be identified which will be inform the psoriasis research agenda.

Conclusions

Research, targeted to address priorities identified by a range of stakeholders is imperative. This project will inform policymakers and research funding bodies of what really matters to these groups.

This article is protected by copyright. All rights reserved.

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FOLFOX-A in the Treatment of Metastatic or Advanced Unresectable Gastric, Gastro-Esophageal Junction Adenocarcinoma

Conditions:   Gastro-Esophageal Junction Adenocarcinoma;   Gastric Cancer
Interventions:   Drug: Nab-paclitaxel 150 mg/m^2;   Drug: Oxaliplatin 85 mg/m^2;   Drug: 5-FU 1200 mg/m^2 x 2 D;   Drug: Leucovorin 400 mg/m^2
Sponsors:   Al B. Benson, III, MD;   Celgene Corporation;   Big Ten Cancer Research Consortium
Not yet recruiting - verified September 2017

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A Microdose Evaluation Study of ABY-029 in Head and Neck Oncology Surgery

Condition:   Head and Neck Cancer
Intervention:   Drug: ABY-029
Sponsors:   Dartmouth-Hitchcock Medical Center;   Dartmouth College
Not yet recruiting - verified September 2017

http://ift.tt/2xzI5ta

Immunotherapy and SBRT for Metastatic Head and Neck Carcinomas

Conditions:   Head and Neck Squamous Cell Carcinoma;   Metastatic Squamous Cell Carcinoma
Interventions:   Radiation: SBRT;   Drug: Durvalumab + tremelimumab
Sponsors:   Centre hospitalier de l'Université de Montréal (CHUM);   AstraZeneca
Not yet recruiting - verified August 2017

http://ift.tt/2y8gBYE

Dendritic Cell Therapy With CD137L-DC-EBV-VAX in Locally Advanced Stage IV or Locally Recurrent/Metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Cancer
Intervention:   Biological: CD137L-DC-EBV-VAX
Sponsor:   National University Hospital, Singapore
Recruiting - verified September 2017

http://ift.tt/2xBwoCu

Organoid Based Response Prediction in Esophageal Cancer

Conditions:   Organoid;   Esophageal Cancer;   Chemoradiation
Intervention:  
Sponsor:   University Medical Center Groningen
Not yet recruiting - verified September 2017

http://ift.tt/2wc2Evy

Position Paper of Food Allergy Section the Polish Society of Allergology on the diagnosis and management of food allergies

Publication date: Available online 14 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Z. Bartuzi, M. Kaczmarski, M. Czerwionka-Szaflarska, T. Małaczyńska, A. Krogulska
The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, we also used in this publication the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).



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Od Redaktora Naczelnego

Publication date: Available online 14 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Rafał Pawliczak




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Comparison of the paediatric blade of the Pentax-AWS and Ovassapian airway in fibreoptic tracheal intubation in patients with limited mouth opening and cervical spine immobilization by a semi-rigid neck collar: a randomized controlled trial

Abstract

Background. We compared the performances of the paediatric blade of a Pentax Airway Scope and an Ovassapian airway in fibreoptic tracheal intubation in patients whose necks were stabilized by semi-rigid neck collars.Methods. Ninety patients were enrolled in this prospective, open-label, randomized controlled trial. Patients were randomly allocated to one of two groups (Group OVA-FOB and Group AWS-FOB). The time to tracheal intubation, success rate of tracheal intubation, number of optimization manoeuvres (jaw thrust), and difficulty of manipulation of the fibreoptic bronchoscope were compared between the groups.Results. The time to tracheal intubation was significantly shorter (32 vs 50 s; median difference 19 s; 95% confidence interval 14–25 s; P<0.001) and manipulation of the fibreoptic bronchoscope was significantly easier for Group AWS-FOB. Optimization manoeuvres were rarely required to facilitate fibreoptic tracheal intubation in Group AWS-FOB [jaw thrust, 0 (0%); jaw thrust with anterior neck collar removal, 1 (2%)] compared with that required in Group OVA-FOB [jaw thrust, 39 (87%); jaw thrust with anterior neck collar removal, 2 (4%)]. There was no significant difference in the success rate of tracheal intubation on the first attempt between groups [Group AWS-FOB, 45 (100%); Group OVA-FOB, 44 (98%)].Conclusions. Combined use of the paediatric blade of a Pentax Airway Scope and a fibreoptic bronchoscope enabled rapid tracheal intubation, minimizing the use of external manoeuvres of the airway, in patients with limited mouth opening and cervical spine immobilization by semi-rigid neck collars, compared with use of the Ovassapian airway and the fibreoptic bronchoscope.Clinical trial registration. NCT02827110.

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Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain

Abstract

Misuse of prescription opioids, and other drugs prescribed for chronic pain, has increased, with major concerns about harm. This review was undertaken to identify validated measurement tools for risk assessment and monitoring of chronic non-cancer pain patients being considered for, or currently prescribed, analgesic drugs with abuse potential.Selected databases (Embase, Medline, Cochrane library/CENTRAL, PsycINFO, PubMed, CINAHL) were systematically searched for studies evaluating tools for risk of analgesic misuse, either before, or during, analgesic therapy for chronic pain, using predetermined inclusion/exclusion criteria. Two independent reviewers assessed abstracts, selected full texts, extracted data and assessed quality.30 studies from 1844 met inclusion criteria, including three systematic reviews, with an additional four studies from bibliography review. The studies covered 14 tools pertaining to opioid use, with none for non-opioid analgesics.Although there is no single, clear factor identifying opioid misuse, previous substance misuse appears important. Deception, including lying to clinicians, and using drugs belonging to others are common features. Smoking history may be relevant.For predicting prescription opioid misuse, the pain medication questionnaire (PMQ) and the screener and opioid assessment for patients with pain (SOAPP) had the best evidence; both developed and validated in five separate studies (four each of acceptable quality). The current opioid misuse measure (COMM) performed best screening for current misuse, developed and validated in three studies of acceptable quality. A small number of tools may accurately predict, or identify, opioid misuse. There are none for non-opioid analgesics, where there is a potential need.

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Immune Thrombocytopenia in a Child with Neuroblastoma

Thrombocytopenia is a frequent finding in patients with solid tumors. It is usually caused by bone marrow infiltration or by myelosuppression due to anticancer therapy; however immune thrombocytopenia (ITP) associated with solid tumors is rare. Neuroblastoma is the most common extracranial solid tumor in children. Here we report the case of a two-year-nine-month-old patient with adrenal neuroblastoma who presented with ITP. Paraneoplastic ITP was considered in the differential diagnosis. Bone marrow infiltration and other causes of thrombocytopenia were excluded and the patient was treated with intravenous immunoglobulin and tumor resection. Platelet count increased rapidly after surgery and complete remission of ITP was achieved.

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Multi-modality analysis supports APOBEC as a major source of mutations in head and neck squamous cell carcinoma

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Daniel L. Faden, Sean Thomas, Paul G. Cantalupo, Nishant Agrawal, Jeffrey Myers, Joseph DeRisi
ObjectivesThe mutagenic processes underlying head and neck squamous cell carcinoma (HNSCC) are poorly understood. Pan-cancer mutational signature analyses have identified a signature for APOBEC, a cytosine deaminase, in a subset of cancers, including HNSCC. The role of APOBEC activity in HNSCC remains poorly understood. Therefore, we sought to determine the role of APOBEC in HNSCC pathogenesis.Material and methodsUtilizing bioinformatic approaches we explored the role of APOBEC mediated mutations in tumor exomes, transcriptomes and germline exomes from 511HNSCC patients in the TCGA.Results58% of HNSCC were statistically enriched for the APOBEC signature. APOBEC3A expression had the highest correlation coefficient with APOBEC mutation rate. Gene specific motif analysis revealed a slight predominance of APOBEC3A mutations. Canonical pathway analysis demonstrated immune pathway upregulation in APOBEC mutation rich samples. Overall mutational burden was positively correlated with APOBEC enrichment.ConclusionsAPOBEC mediated mutations are highly prevalent in HNSCC. APOBEC3A is the most likely gene to be active in HPV+ HNSCC. APOBEC activity correlates with upregulation of immune signaling pathways, supporting the hypothesis that APOBEC activity could be activated as part of the innate immune response.



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The impact of intraoperative opioid use on survival after oral cancer surgery

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Miguel A. Patino, Rafael E. Ramirez, Carlos A. Perez, Lei Feng, Pranav Kataria, Jeffrey Myers, Juan P. Cata
ObjectivesTo investigate the impact of opioid use on cancer recurrence after oral cancer surgery. We hypothesized that the amount of opioids administered during oral cancer surgery is an independent predictor of recurrence free survival (RFS) and overall survival (OS).MethodsAfter Institutional Review Board approval, we collected demographic, tumor related, intraoperative and survival data of patients who had oral cancer surgery. Multivariable Cox proportional hazards models were used to determine the impact of important covariates on RFS and OS.Results268 patients were included. After adjusting for significant covariates, the amount of opioids administered during surgery was not an independent predictor of RFS (HR: 1.27 [CI 95%, 0.838–1.924], p=0.26). However, we observed an association between opioid consumption and shorter OS (HR=1.77, [CI 95%=0.995–3.149]. p=0.05).ConclusionsHigh requirements of opioids during surgery increase the risk of recurrence and mortality by 27% and 77%, although the association is not statically significant.



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Intraindividual homogeneity of 18F-FDG PET/CT parameters in HPV-positive OPSCC

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Shachi Jenny Sharma, Claus Wittekindt, Jennifer Knuth, Dagmar Steiner, Nora Wuerdemann, Maren Laur, Tobias Kroll, Steffen Wagner, Jens Peter Klussmann
Objectives¹⁸F-FDG PET/CT is widely used in clinical oncology. Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) represents an emerging disease that differs from HPV-negative OPSCC in clinical behavior and tumour biology. In these tumours, HPV-oncogenes might lead to distinct alterations in metabolic pathways. Therefore, we compared metabolic parameters using ¹⁸F-FDG PET/CT in HPV-positive and HPV-negative OPSCC in relation to histopathological findings.MaterialsEighty-six patients with OPSCC received pre-therapeutic ¹⁸F-FDG PET/CT. Standardised uptake volume (SUV), total lesion glycolysis (TLG) and metabolic tumour volume (MTV) were analysed for the primary tumour. SUVmax was determined for neck lymph nodes. HPV-status was determined; overall survival rates (OS) were estimated.Results32/86 patients (37.2%) had HPV-related OPSCC. Overall, PET-parameters in primary tumours of both groups did not differ significantly. Comparing early with locally advanced primary tumours, there was a significant increase in ¹⁸F-FDG uptake in HPV-negative patients (p<0.001). Positive nodes of HPV-related OPSCC showed significantly higher SUVmax values (p=0.039) compared to HPV-negative OPSCC. Strikingly, there was a higher intraindividual homogeneity of ¹⁸F-FDG uptake between primary and respective positive nodes in HPV-related primary OPSCC (p=0.001). SUV-max and –mean values did not correlate with OS in HPV-related OPSCC.ConclusionThe intraindividual homogeneity of 18F-FDG uptake in HPV-related OPSCC could reflect the more homogenously, HPV-triggered carcinogenesis compared to the mutation-driven carcinogenesis in the HPV-negative OPSCC with heterogenic ¹⁸F-FDG uptake.



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Case 28-2017: A 13-Month-Old Girl with Pneumonia and a 33-Year-Old Woman with Hip Pain

Presentation of Case. Dr. Virginia M. Pierce: A 13-month-old girl was admitted to this hospital because of pneumonia. Nine days before admission, fever and vomiting developed in the child. The vomiting resolved after 2 days, but fever (with a maximum temperature of 39.7°C) continued, and the child…

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Effectiveness and safety of secukinumab in 69 patients with moderate to severe plaque psoriasis: A retrospective multicenter study

Abstract

Secukinumab (anti-IL17A) is effective as treatment for moderate to severe plaque psoriasis, but real-life data on effectiveness and safety lack. We aimed to present real-life data of all Danish patients treated with secukinumab (n = 69). At baseline, before initiation of treatment with secukinumab 300 mg (47.8%) or off-label treatment with secukinumab 150 mg (52.2%), the median PASI score was 7.1. A total of 66.7% (34/51) and 52.9% (27/51) of patients still on secukinumab at week 12 achieved a PASI (Psoriasis Area and Severity Index)-50 and PASI-75 of 66.7% and 52.9%, respectively. A total of 83.0% (44/53) and 60.4% (32/53) of the patients had a PASI-score < 5 and PASI-score < 2, respectively, after 12 weeks on treatment with secukinumab. A third of the patients had secukinumab discontinued due to limited clinical improvement or adverse events (n = 23) within a median of 92 days (interquartile range 51–212 days). Notably, the majority of the patients may represent a particularly difficult-to-treat group of patients, as 92.8% had been refractory to other biologic treatment. A total of 26.1% (n = 18) experienced adverse events. Secukinumab appears to be an effective treatment option with a favorable side effect profile in patients with plaque psoriasis who are refractory to or have side effects of traditional biologic drugs.

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Alitretinoin treatment of lichen amyloidosis

Abstract

Lichen amyloidosis (LA) is characterized by the deposition of amyloid that may respond to chronic scratching that may be secondary to atopic dermatitis, stasis dermatitis, or interface dermatitis. Despite the development of several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, and retinoids, an effective treatment for LA has not been established. A 49-year-old woman who has been treated irregularly for atopic dermatitis for 7 years presented with localized brownish papules on the left forearm and right elbow. They developed 3 months prior and were becoming more prominent despite of treatment with cyclosporine, oral antihistamines, and topical steroids for 5 months prior to presentation. A skin biopsy revealed amyloid deposition in the dermal papillae and the patient was diagnosed with LA associated with atopic dermatitis. A 6-month course of daily oral alitretinoin 30 mg produced marked improvement in the thickness and color of the hyperkeratotic papules without aggravation of the patient's atopic dermatitis. Histologic evaluation showed clearance of amyloid deposition and almost normalization of the epidermal changes. Herein, we report a case of LA treated with alitretinoin and suggest that it could be a potential treatment option for LA, especially in patients with inflammatory skin diseases including atopic dermatitis.

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Specific IgE to peanut 2S albumin Ara h 7 has a discriminative ability comparable to Ara h 2 and 6

Abstract

Background

Little is known on the clinical relevance of peanut 2S albumin Ara h 7.

Objective

To investigate the discriminative ability of Ara h 7 in peanut allergy and assess the role of cross-reactivity between Ara h 2, 6 and Ara h 7 isoforms.

Methods

Sensitization to recombinant peanut storage proteins Ara h 1, 2, 3, 6 and 7 was assessed using a line blot in sera from 40 peanut tolerant and 40 peanut allergic patients, based on food challenge outcome. A dose-dependent ELISA inhibition experiment was performed with recombinant Ara h 2, 6 and Ara h 7 isoforms.

Results

For Ara h 7.0201 an area under the ROC curve was found of 0.83, comparable to Ara h 2 (AUC 0.81) and Ara h 6 (AUC 0.85). Ara h 7 intensity values strongly correlated with those from Ara h 2 and 6 (r_s=0.81). Of all patients sensitized to 2S albumins Ara h 2, 6 or 7, the majority was co-sensitized to all three (n=24, 68%), although mono-sensitization to either 2S albumin was also observed in selected patients (Ara h 2: n=6, 17%; Ara h 6: n=2, 6%; Ara h 7: n=2, 6%). Binding to Ara h 7.0101 could be strongly inhibited by Ara h 7.0201, but not the other way around.

Conclusions & Clinical Relevance

Specific IgE against Ara h 7.0201 has a predictive ability for peanut allergy similar to Ara h 2 and 6, and possesses unique IgE epitopes as well as epitopes shared between the other Ara h 7 isoform and Ara h 2 and 6. While co-sensitization to all three 2S albumins is most common, mono-sensitization to either Ara h 2, 6 or 7 occurs in selected patients, leading to a risk of misdiagnosis when testing for a single 2S albumin.

This article is protected by copyright. All rights reserved.

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Effects of short-term exposure to sevoflurane on the survival, proliferation, apoptosis, and differentiation of neural precursor cells derived from human embryonic stem cells

Abstract

Purpose

Data from animal experiments suggest that exposure to general anesthetics in early life inhibits neurogenesis and causes long-term memory deficit. Considering short operating times and the popularity of sevoflurane in pediatric anesthesia, it is important to verify the effects of short-period exposure to sevoflurane on the developing brain.

Methods

We measured the effects of short-term exposure (2 h) to 3%, 6%, or 8% sevoflurane, the most commonly used anesthetic, on neural precursor cells derived from human embryonic stem cells, SNUhES32. Cell survival, proliferation, apoptosis, and differentiation on days 1, 3, 5, and 7 post treatment were analyzed.

Results

Treatment with 6% sevoflurane increased cell viability (P = 0.046) and decreased apoptosis (P = 0.014) on day 5, but the effect did not persist on day 7. Survival and apoptosis were not affected by 3% and 8% sevoflurane; there was no effect of proliferation at any of the tested concentrations. The differentiation of cells exposed to 6% or 8% sevoflurane decreased on day 1 (P = 0.033 and P = 0.036 for 6% and 8% sevoflurane, respectively) but was again normalized on days 3–7.

Conclusion

Clinically relevant treatment with sevoflurane for 2 h induces no significant changes in the survival, proliferation, apoptosis, and differentiation of human neural precursor cells, although supraclinical doses of sevoflurane do alter human neurogenesis transiently.

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Increased innate type 2 immune response in house dust mite-allergic patients with allergic rhinitis

Publication date: Available online 13 September 2017
Source:Clinical Immunology
Author(s): Hua Zhong, Xing-Liang Fan, Qiu-Ning Yu, Zi-Li Qin, Dong Chen, Rui Xu, De-Hua Chen, Zhi-Bin Lin, Weiping Wen, Qing-Ling Fu
Group 2 innate lymphoid cells (ILC2s) are essential in initiating and driving allergic immune responses. However, there were inconsistent findings of the ILC2 levels in allergic rhinitis (AR) patients. This study investigated the ILC2 levels in the peripheral blood of house dust mite (HDM)-allergic AR patients and their ability to secrete type 2 cytokines. The levels of ILC2s with phenotypic ILC2 characteristics were increased in the HDM-AR patients. The AR patients' symptom score and IL-13 levels were positively associated with the ILC2s in HDM-AR patients. The epithelial cytokine stimulation induced dramatic production of IL-5 and IL-13 in PBMCs of AR patients. We successfully sorted ILC2s from AR patients and identified their ability of type 2 cytokines production. The number of ILC2s increased in the HDM-AR patients and ILC2s produced the amount of TH2 cytokines in the presence of epithelial cytokines, which suggested the important role of ILC2 in AR patients.



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Asthmatic farm children show increased CD3+CD8low T-cells compared to non-asthmatic farm children

Publication date: Available online 13 September 2017
Source:Clinical Immunology
Author(s): Monika Twardziok, Paul C. Schröder, Johanna Krusche, Vera I. Casaca, Sabina Illi, Andreas Böck, Georg J. Loss, Michael Kabesch, Antoaneta Toncheva, Caroline Roduit, Martin Depner, Jon Genuneit, Harald Renz, Marjut Roponen, Juliane Weber, Charlotte Braun-Fahrländer, Josef Riedler, Roger Lauener, Dominique Angèle Vuitton, Jean-Charles Dalphin, Juha Pekkanen, Erika von Mutius, Bianca Schaub, A. Hyvärinen, A.M. Karvonen, P. Kirjavainen, S. Remes, V. Kaulek, M.L. Dalphin, M. Ege, P. Pfefferle, G. Doekes




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Low levels of the immunoregulator Semaphorin 4D (CD100) in sera of HIV patients

Publication date: Available online 14 September 2017
Source:Clinical Immunology
Author(s): Z. Vadas, D. Elbirt, S. Radian, S. Bezalel-Rosenberg, K. Mahlab-Guri, E. Toubi, I. Asher, Z. Sthoeger
IntroductionSemaphorin-4D (CD100), generated by CD4/CD8 cells, plays an important role in T cells activation. It also regulates B cell differentiation via its receptor the CD72. Both have soluble forms - sCD100/sCD72.MethodssCD100 and sCD72 levels were determined by ELISA (MyBioSource, USA).Results28 chronic HIV patients and 50 matched healthy volunteers participated in our study. Before treatment, CD4 cell counts were 267±216cells/mcl and viral load (VL) was 586,675±1,897,431copies/ml. Two years following HAART, CD4 cell counts rose to 475±264cells/mcl and VL dropped to 2050±10,539copies/ml. CD8 cell counts were stable. sCD72 levels prior and following HAART were similar to control levels. sCD100 levels before and following HAART were significantly lower compared to controls despite the significant increase in CD4 cell counts.ConclusionsThe permanent low levels of the immunoregulator sCD100 suggests a role for CD100 in the immune dysfunction and T cell exhaustion of HIV.



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A novel mutation in the JH4 domain of JAK3 causing severe combined immunodeficiency complicated by vertebral osteomyelitis

Publication date: Available online 14 September 2017
Source:Clinical Immunology
Author(s): Farah Qamar, Samina Junejo, Sonia Qureshi, Michael Seleman, Wayne Bainter, Michel Massaad, Janet Chou, Raif S. Geha
JAK3 is a tyrosine kinase essential for signaling downstream of the common gamma chain subunit shared by multiple cytokine receptors. JAK3 deficiency results in T⁻B⁺NK⁻ severe combined immune deficiency (SCID). We report a patient with SCID due to a novel mutation in the JAK3 JH4 domain. The function of the JH4 domain remains unknown. This is the first report of a missense mutation in the JAK3 JH4 domain, thereby demonstrating the importance of the JH4 domain of JAK3 in host immunity.



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The ARIA score of allergic rhinitis using mobile technology correlates with quality-of-life: The MASK study

Abstract

Mobile technology has been used to appraise allergic rhinitis control but more data are needed. In order to better assess the importance of mobile technologies in rhinitis control, the ARIA (Allergic Rhinitis and its Impact on Asthma) score ranging from 0 to 4 of the Allergy Diary was compared with EQ-5D (EuroQuol) and WPAI-AS (Work Productivity and Activity Impairment in allergy) in 1,288 users in 18 countries. This study showed that quality-of-life data (EQ-5D visual analogue scale and WPA-IS Question 9) are similar in users without rhinitis and in those with mild rhinitis (scores 0-2). Users with a score of 3 or 4 had a significant impairment in quality-of-life questionnaires.

This article is protected by copyright. All rights reserved.

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Validation of patient-reported global severity of atopic dermatitis in adults

Abstract

Background

Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research.

Objectives

We sought to validate patient-reported global AD severity in adults.

Methods

We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n=265).

Results

At baseline and follow-up, patient-reported global AD severity significantly correlated with oSCORAD (Spearman rho=0.56 and 0.49), SCORAD (0.64 and 0.56), EASI (0.56 and 0.50), BSA (0.52 and 0.45), NRS-itch (0.60 and 0.53), POEM (0.50 and 0.48), and DLQI (0.50 and 0.49) (P<0.0001 for all). Patient-reported moderate and severe AD vs. mild AD were associated with significantly higher oSCORAD, SCORAD, EASI, BSA, NRS-itch, POEM and DLQI (P<0.0001 for all). There was moderate concordance between patient-reported AD severity (mild, moderate and severe) and previously developed severity strata for oSCORAD (kappa=0.39), SCORAD (kappa=0.47), EASI (kappa=0.37), NRS-itch (kappa=0.49), POEM (kappa=0.37), and DLQI (kappa=0.40). Among patients with severe disease at baseline, those who reported mild or moderate disease on follow-up had significantly greater absolute reductions of oSCORAD (-23.4/-9.7/-1.8), SCORAD (-33.0/-13.2/-2.3), EASI (-17.1/-9.8/-3.2), BSA (-46%/-15%/-4%), NRS-itch (-5/-2/0), POEM (-5/-2/0), and DLQI (-8/-6/-1) than those who continued to report severe disease (Kruskal-Wallis, P≤0.0003 for all).

Conclusions

Patient-reported AD severity appears to be sufficiently valid for assessing AD severity in the clinical and epidemiological setting.

This article is protected by copyright. All rights reserved.

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Mast cells and sphingosine-1-phosphate underlie prelesional remodeling in a mouse model of eczema

Abstract

Atopic dermatitis (AD) is a chronic skin inflammation that affects children and adults worldwide, but its pathogenesis remains ill-understood. We show that a single application of OVA to mouse skin initiates remodeling and cellular infiltration of the hypodermis measured by a newly developed computer-aided method. Importantly, we demonstrate that skin mast cell (MC) activation and local sphingosine-1-phosphate (S1P) are significantly augmented after OVA treatment in mice. Deficiency in sphingosine kinase (SphK)1, the S1P-producing enzyme, or in MC, remarkably mitigates all signs of OVA-mediated remodeling and MC activation. Furthermore, skin S1P levels remain unchanged in MC-deficient mice exposed to OVA. LPS-free OVA does not recapitulate any of the precursor signs of AD, supporting a triggering contribution of LPS in AD that, per se, suffice to activate local MC and elevate skin S1P. We describe MC and S1P as novel pathogenic effectors that initiate remodeling in AD prior to any skin lesions and reveal the significance of LPS in OVA used in most studies, thus mimicking natural antigen (Ag) exposure.

This article is protected by copyright. All rights reserved.

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Diffuse Idiopathic Skeletal Hyperostosis: Persistent Sore Throat and Dysphagia in an Elderly Smoker Male

Diffuse idiopathic skeletal hyperostosis (DISH) is rarely symptomatic. However, it can present with dyspnea, hoarseness, dysphagia, and stridor. An 80-year-old chronic smoker male presented with 6-month history of sore throat and progressive dysphagia. Computed tomography of the neck revealed bulky anterior bridging syndesmophytes along the anterior aspect of the cervical spine and facet effusion involving four contiguous vertebrae consistent with DISH. Dysphagia secondary to DISH was diagnosed. Fiberoptic laryngoscopy showed bilateral vocal cord paralysis. Patient's airway became compromised requiring tracheostomy tube placement. After discussion of therapeutic options, patient agreed on a percutaneous endoscopic gastrostomy tube insertion for nutritional support. Osteophytectomy was left to be discussed further.

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Current practice of allergy diagnosis and the potential impact of regulation in Europe

Abstract

In the European Union (EU), the regulatory framework regarding diagnostic allergen extracts is currently in the process of being implemented at the national level. Due to these regulations, the initial and periodic renewal expenses for the registration of diagnostic allergen extracts may render extract production unprofitable. Consequently, many extracts may be at risk of removal from the market. The current survey, which was conducted by a task force of the European Academy of Allergy and Clinical Immunology, aimed to assess the current practice of allergy diagnosis in Europe. This survey revealed that skin tests continue to be the main diagnostic procedure and are used as the first option in almost 2/3 of all types of allergic diseases and in 90% of individuals suffering from respiratory allergies. Therefore, there is a need to ensure the availability of high-quality allergen extracts to maintain the common diagnostic procedures used by EU professionals. To reach this goal, it is necessary to align efforts and establish active partnerships between manufacturers, relevant scientific societies, consumer organizations and authorities to maintain the availability of these diagnostic tools.

This article is protected by copyright. All rights reserved.

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Corrigendum

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Asthma management: A new phenotype-based approach using presence of eosinophilia and allergy

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Editorial Board

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Corrigendum

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Table of Contents

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Psychoneuroimmunologie und Krebs

Zusammenfassung

Es verdichten sich die Hinweise, dass psychische Belastungen (Distress) den Verlauf von Krebserkrankungen beeinflussen können. Bei der Aufklärung möglicher Pathomechanismen hat die Erforschung des autonomen Nervensystems mit dem Fokus auf Katecholamine und β‑Blocker die bisher wichtigsten Ergebnisse erbracht. In diesem Beitrag sollen die Entwicklung psychoneuroimmunologischer Arbeitsmodelle nachvollzogen, aktuelle Forschungsschwerpunkte skizziert und klinische Implikationen diskutiert werden.

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Aktuelle Systemtherapie des metastasierten Harnblasenkarzinoms

Zusammenfassung

Im November 2016 wurden Studiendaten zur Zweitlinientherapie des metastasierten Urothelkarzinoms mit dem PD-1-Antikörper Pembrolizumab publiziert, die einen Vorteil im Gesamtüberleben (OS) gegenüber einer konventionellen Chemotherapie mit Paclitaxel, Docetaxel oder Vinflunin zeigen. Andere PD-1/PD-L1-Inhibitoren werden in Phase-III-Studien für verschiedene Stadien des Urothelkarzinoms geprüft. In Europa wurde am 02.06.2017 mit Nivolumab der erste PD-1-/PD-L1-Antikörper zur Zweitlinientherapie des metastasierten Urothelkarzinoms zugelassen, weitere Zulassungen werden noch in diesem Jahr erwartet. Die Substanzklasse der PD-1-/PD-L1-Inhibitoren dürfte somit der neue Standard in der Zweitlinientherapie des metastasierten Urothelkarzinoms sein. Aktuelle Studien überprüfen den Einsatz von PD-1-/PD-L1-gerichteten Substanzen auch in der Erstlinientherapie des metastasierten Urothelkarzinoms. Dabei werden verschiedene Therapiestrategien verfolgt: Monotherapien mit PD-1-/PD-L1-Inhibitoren sowie deren Kombinationen mit CTLA-4-Inhibitoren oder konventioneller Chemotherapie. Es liegen bereits Daten aus einarmigen Phase-II-Studien zur Monotherapie vor. Erste Daten aus randomisierten Studien werden für Ende 2017 erwartet. Ein neuer Therapieansatz verfolgt den Einsatz von PD-1/PD-L1-Inhibitoren in der perioperativen Behandlung bei Patienten mit einem muskelinvasiven Urothelkarzinom nach chirurgischer R0-Resektion (radikale Zystektomie oder Nephroureterektomie). Zwei internationale Phase-III-Studien überprüfen derzeit eine adjuvante Immuntherapie mit Nivolumab oder Atezolizumab. Die Studienrekrutierung wird voraussichtlich Mitte 2018 beendet sein.

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Topical skin care – a domain for allergy prevention

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Atopic Dermatitis, The Skin-Disease

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Mesh penetrating the cecum and bladder following inguinal hernia surgery: a case report

Tension-free repair using mesh is a common inguinal hernia surgical procedure. However, various complications such as mesh-related infection and recurrence may develop as a result. Moreover, although rare, the...

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Optical Coherence Tomography Evolution in a Case of X-Linked Juvenile Retinoschisis: 15 Years of Follow-Up

Purpose: We present the evolution of X-linked juvenile retinoschisis (XLRS) in a male patient using optical coherence tomography (OCT) with a long-term follow-up time of 15 years. Case Description: A 10-year-old male patient presented at the Medical Retina Department of our hospital complaining for blurred vision in both eyes. At the initial presentation in 2001, his best corrected visual acuity (BCVA) was 6/12 in both eyes on the Snellen chart. Based on clinical and OCT findings, the diagnosis of XLRS was made, and it was confirmed by genetic testing. No treatment was performed, but the patient was regularly examined. His BCVA and OCT findings remained relatively stable from 2001 to 2012, when BCVA decreased to 6/18 and 6/24 in the right and left eye, respectively. In 2016, his BCVA was 6/24 and 6/36 in right and left eye, respectively, while OCT depicted significant macular thinning, accompanied by irregularities of the foveal contour in both eyes. Conclusion: Patients with XLRS should be monitored regularly to evaluate the progression of the disease and manage the potential complications.
Case Rep Ophthalmol 2017;8:459–464

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The unregulated use of melanotan-II is of public health interest to Australian dermatologists

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Expressions of p53 and PUMA in fibroblasts of systemic sclerosis patients are normal at transcription level

Summary

Background

Systemic sclerosis (SSc) fibroblasts show resistance apoptosis mechanisms, which enhances the fibrosis stage of the disease. Impaired function of p53 upregulated modulator of apoptosis (PUMA) has been related to deficits in p53-dependant apoptosis pathway. This study aimed to evaluate the transcriptional levels of p53 and PUMA mRNAs in fibroblasts from SSc patients and compare it with healthy individuals.

Methods

In this case-control study, skin biopsy samples were obtained from 19 patients with diffuse cutaneous SSc (DcSSc) and 16 healthy controls. Afterward, dermal fibroblasts were isolated and cultured. After extraction of total RNA from cultured fibroblasts, complementary DNA (cDNA) was synthesized. mRNA quantification was carried out using real-time PCR, SYBR Green PCR master mix, and specific primers for p53 and PUMA.

Results

No significant alteration was observed in mRNA expression levels of p53 and PUMA (P = .99 and .23, respectively) in fibroblasts from SSc patients compared with controls.

Conclusions

Apoptosis pathways are impaired in fibroblasts from patients with SSc, leading to chronic fibrosis. Nonetheless, PUMA/p53 pathway may not be involved in dysfunction of apoptosis mechanisms in fibroblasts of patients with SSc.

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