Are we practicing anesthesia in a 'current' manner?.

No abstract available

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Safety and efficacy of epidural analgesia.

Purpose of review: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. Recent findings: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia. The debate continues whether epidural analgesia leads to decreased complications and improved outcome. Noninferiority of alternative regional analgesic approaches, that is continuous-wound-infiltration, peripheral nerve blocks or surgical site infiltration, appears to be present and is promising for the future. Serious adverse events after epidural analgesia seem to occur more often than was previously thought and clinicians must realize that incidence rates differ in specific perioperative patient populations. Summary: Epidural analgesia for obstetric analgesic purposes is considered to be well tolerated in young, healthy women, since efficacy has been proven and complications leading to permanent neurological damage seldomly occur. Safety of epidural analgesia for perioperative and chronic pain treatment is more difficult to balance; careful selection of appropriate patients cannot be over-emphasized. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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New advancements in spinal cord stimulation for chronic pain management.

Purpose of review: To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. Recent Findings: Efficacy of SCS therapy has been significantly improved by the recent development of high frequency (HF-10 kHz) stimulation, burst stimulation, and dorsal root ganglion (DRG) stimulation. A few latest SCS modalities are in clinical trial. New approaches to guide lead placement and advances in surgical lead are introduced. Summary: HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal paresthesia and provides better coverage of low back pain. DRG stimulation results in better outcomes in patients with complex regional pain syndrome. It requires less energy and delivers consistent stimulation regardless of postural variations. Clinical trials with new SCS modalities, such as Stimwaves, are under way to make SCS wireless. Intraoperative neuromonitoring and paresthesia atlas may be used to guide lead placement. Multicolumn surgical paddle leads enable a combination of independent current control with up to 32 contacts for better programming and better coverage. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Nonoperating room anesthesia for endoscopic procedures.

Purpose of review: The purpose of this review is to take a look on some practical aspects of anesthetic care in the endoscopy suite, concerning the general approach, safety, and monitoring issues. Recent findings: Concerning propofol popularity for sedation during endoscopic procedures new studies create doubt in the safety of higher doses of propofol used for sedation. Careful titration of propofol, addition of synergistic supplements like ketamine and dexmedetomidine, and monitoring of anesthetic depth may limit the dose of propofol given to the patients. Capnography has the potential to detect airway compromise earlier than pulse-oximetry and by this enhancing patient safety. Summary: Sedation or anesthesia in the endoscopy suite is not without risk. For complex and longer lasting procedures and in patients with significant comorbidities and risk factors, good clinical judgment, built on experience, is essential and to foster this, it seems prudent to build up a group of anesthesiologists dedicated to a special sedation service. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Enhancing the quality and safety of the perioperative patient.

Purpose of review: Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. Recent findings: Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use. Postoperatively, the concept of 'failure to rescue' in the surgical patients has been explored. Summary: A clear vision of what postoperative recovery should mean for practitioner and patients; careful risk stratification and prophylactic measures to avoid postoperative complications; the judicious use of checklists and other cognitive aids to complement clinical expertise in promoting safety within each local context; and the prompt recognition and rescue of postoperative problems when they occur are all important aspects of a safe perioperative care. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Optimizing education in difficult airway management: meeting the challenge.

Purpose of review: The last 2 decades have seen a vast change in the science and technology of airway management. As a result, there is an increasing need to equip anesthesiologists with the new knowledge and skills for the safe management of a difficult airway. Recent findings: In addition to knowledge and expertise, human factors and nontechnical skills (NTS), including situational awareness, communication and team work, play an important role during difficult airway management and contribute to the outcome. Didactic sessions are useful to impart knowledge. Self-learning, interactive discussions, simulation and debriefing are important tools for teaching and training in difficult airway management. Manikin training and simulation enable development of technical as well as NTS without subjecting patients to risk and allow multiple training sessions of relatively uncommon scenarios. Guidelines are useful teaching tools, whereas cognitive tools such as the Vortex approach may be useful during a difficult airway. Summary: There is need for research on difficult airway management and optimized training methods. Research is also required to determine the barriers to adoption of guidelines and strategies to ensure widespread dissemination and implementation of guidelines and best practices for difficult airway management. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2hlNBso

Are we fully utilizing the functionalities of modern operating room ventilators?.

Purpose of review: The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. Recent findings: Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-based ventilation modes provide better leak compensation than volume-based. The integration of advanced flow generation systems and ventilation modes of the modern operating room ventilators enables clinicians to provide both invasive and noninvasive ventilation in perioperative settings. Ventilator waveforms can be used for intraoperative neuromonitoring during cervical spine surgery. Summary: The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. Video abstract: http://ift.tt/2hpXORl. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2hlNzRi

Anesthesia information management: clinical decision support.

Purpose of review: Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. Recent findings: Clinical decision support tools become more timely, accurate, and, in some instances, have been shown to improve patient outcomes. When correctly implemented, they are critical tools for optimization of perioperative care. Summary: Perioperative informaticians continue to test new and innovative ways to enhance the delivery of anesthesia care, improving the safety and efficacy of perioperative management. Future work will continue to refine tools to ensure that perioperative informatics provides clinicians timely and accurate feedback, with demonstrable evidence that a decision support system improves patient outcomes. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Long Cold Ischemia Times in Same Hospital Deceased Donor Transplants.

Background: Recent changes in deceased donor organ allocation for livers (Share-35) and kidneys (KAS) have resulted in broader sharing of organs and increased cold ischemia time (CIT). Broader organ sharing however is not the only cause of increased CIT. Methods: This was a retrospective registry study of CIT in same-hospital liver transplants (SHLT, n=4,347) and kidney transplants (SHKT, n=9,707) between 2004 and 2014. Results: In SHLT, median (IQR) CIT was 5.0 (3.5-6.5) hours versus 6.6 (5.1-8.4) hours in other-hospital LT. DCD donors, donor biopsy, male recipient, recipient obesity, and previous transplant were associated with increased CIT. MELD at transplant of 29+ or status 1a was associated with decreased CIT. SHLT CIT varied by OPO and transplant-center (p

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Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living Donor Liver Transplantation.

Background: Rituximab is a cornerstone in the regimens of desensitization for ABO-incompatible living donor liver transplantation (ABO-i LT) that makes this modality an acceptable option for liver transplantation. Plasmapheresis (PP) to reduce anti-ABO antibody titer and local infusion therapy (LI) were practiced as the strategies for desensitization before the application of rituximab and were reported as additional treatments. The aim of this study was to clarify the feasibility of monotherapy by rituximab without any additional desensitization treatments in ABO-i LT. Methods: Forty patients receiving ABO-i LDLT with Rituximab were enrolled in this retrospective study. The patients were divided into 2 groups: the rituximab with pretransplant PP and posttransplant LI (RPL) group (n=20) and the rituximab monotherapy without any additional treatment (RM) group (n=20). The groups were then compared in terms of the rates of patient survival, antibody-mediated rejection (AMR), and infection. Results: The 1-, 3-, and 5-year patient survival rates were 85%, 85%, and 85% in the RPL group and 89%, 80%, and 80% in the RM group, respectively. There was no significant difference in patient survival between the 2 groups. There were no episodes of AMR in either group. The RM group had a lower rate of fungal and viral infections than the RPL group. Conclusions: Pretransplant rituximab without additional treatments yielded satisfactory outcomes comparable to that with additional treatments such as PP and LI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Comprehensive survey of vitiligo patients in the northeast of China using a predesigned questionnaire

Abstract

To assess the sociodemographic data and clinical information of outpatients affected by vitiligo in the northeast of China, vitiligo patients or guardians who presented to the clinic were invited to participate in an exploratory questionnaire. The questionnaire consisted of two sections related to vitiligo, including sociodemographic data and clinical information. A total of 983 vitiligo patients answered the questionnaire. The rates of female and male patients were comparable. The investigated patients were mostly young and middle-aged. Most patients suffered from vitiligo in childhood or young adulthood. Vitiligo vulgaris was the most common type of vitiligo in clinic and 53.0% of patients were categorized as body surface area (BSA) of 10% or less. In response to the latest treatment, 43.6% of patients achieved good response (completely stopped or almost disappeared). More patients at active stage showed good response than the patients at stable stage (χ² = 7.866, P < 0.05). Chronic comorbid condition(s) were observed in 12.6% of patients with BSA of more than 10%, whereas those were seen in 6.0% of patients with BSA of 10% or less (χ² = 12.969, P < 0.05). In conclusion, active vitiligo seems to respond better than stable vitiligo and complications with other autoimmune diseases more frequently observed in severe patients than mild patients. The current study presented a comprehensive understanding of vitiligo in the northeast of China.

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Rapid development of cutaneous melanoma metastases after herpes zoster infection in a radiotherapy field

http://ift.tt/2fGLcou

Association between circulating prolactin levels and psoriasis and its correlation with disease severity: a meta-analysis

Summary

Background

Studies that have compared circulating prolactin (PRL) levels in patients with psoriasis and healthy controls (HCs) and determined the relation between PRL levels and psoriasis severity have shown mixed results.

Aim

To evaluate the association between circulating PRL levels and psoriasis, and between serum/plasma PRL levels and psoriasis severity.

Methods

We performed a meta-analysis comparing serum/plasma PRL levels in patients with psoriasis with those of HCs, and examined the correlation coefficients for circulating PRL levels and psoriasis severity based on Psoriasis Area and Severity Index (PASI).

Results

In total, 12 studies assessing 446 patients with psoriasis and 401 HCs were included. PRL levels were significantly higher in the psoriasis group than in the HC group [standardized mean difference (SMD) 0.54; 95% CI = 0.18–090; P < 0.01). Stratification by age and sex revealed a significantly higher PRL level in the psoriasis group (SMD = 0.53; 95% CI = 0.15–0.91; P < 0.01). Subgroup analysis by sample size showed a significantly higher PRL level with larger sample sizes (n ≥ 80) (SMD = 0.51, 95% CI = 0.07–0.95, P = 0.02), but not with smaller sample sizes (n < 80) in the psoriasis group. Stratification by sample type revealed a significantly higher level of PRL in the sera, but not plasma of the psoriasis group. Meta-analysis of the correlation coefficients showed a positive, although not statistically significant, correlation between circulating PRL levels and PASI (correlation coefficient = 0.48, 95% CI = −0.05 to 0.80, P = 0.08).

Conclusion

Circulating PRL levels are higher in patients with psoriasis, and PRL levels may correlate with psoriasis severity.

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T-helper immune phenotype may underlie ‘paradoxical’ tumour necrosis factor-α inhibitor therapy-related psoriasiform dermatitis

Summary

Background

Therapeutics targeting tumour necrosis factor (TNF)-α are effective for psoriasis; however, in patients treated for other disorders, psoriasis may worsen and psoriasiform dermatitis (PsoD) may arise. T helper (Th) cytokines in psoriasis upregulate keratin (K)17, which modulates TNF-α transduction, leading to vascular adhesion molecule upregulation and lymphocytic extravasation.

Aim

We investigated Th phenotype and expression of K17, intercellular adhesion molecule (ICAM)-1 and vascular adhesion molecule (VCAM)-1 in psoriasis and anti-TNF-α-related PsoD.

Methods

Skin biopsies from patients with psoriasis unresponsive to TNF-α inhibitor therapy (n = 11), PsoD-related to TNF-α inhibition (n = 9), untreated psoriasis (n = 9) or atopic dermatitis (AD; n = 9) were immunohistochemically analysed for Th1, Th2, Th17 and Th22. Expression of K17, ICAM-1 and VCAM-1 was also examined.

Results

Anti-TNF-α-unresponsive psoriasis and anti-TNF-α-related PsoD showed decreased Th1 : Th2 raio and increased Th17 : Th1 ratio compared with untreated psoriasis. Anti-TNF-α-unresponsive psoriasis had significantly fewer Th1 (4% vs. 12%) and more Th17 (51% vs. 20%) cells than untreated psoriasis. No difference in Th22 cells was identified. K17 was present in all cases of untreated psoriasis and anti-TNF-α-related PsoD, 91% of anti-TNF-α-unresponsive psoriasis, and only 22% of AD. VCAM-1 and ICAM-1 in anti-TNF-α-related PsoD was akin to untreated psoriasis, but decreased in anti-TNF-α-unresponsive psoriasis.

Conclusions

These findings further the current understanding of the anti-TNF-α-related psoriasiform phenotype and support a rationale for therapeutic targeting of interleukin-17 and TNF-α in combination.

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The clinicoaetiological, hormonal and histopathological characteristics of melasma in men

Summary

Background

Melasma is relatively uncommon in males, and there is a paucity of data on male melasma, including its clinical pattern, triggering factors, endocrine profile and histopathological findings.

Aim

To characterize the clinical findings and aetiological factors, including hormonal and histopathological features, of male melasma.

Methods

Male patients with melasma and age- and sex-matched healthy controls (HCs) were recruited. Demographic profile, risk factors, clinical pattern and Wood lamp findings of patients were recorded. Sera were obtained from patients and HCs to determine hormone levels. Biopsy specimens were obtained from lesional and adjacent nonlesional skin.

Results

In total, 50 male patients with melasma and 20 HCs were recruited into the study. Mean age of patients was 27.58 ± 4.51 years. The most common clinical pattern of melasma was malar, which occurred in 52% of cases. Positive family history was present in 16% of patients, while 34% had disease aggravation with sun exposure and 62% used mustard oil for hair growth and/or as an emollient. Wood lamp examination revealed epidermal-type melasma in 54% of patients. There were no significant differences in hormone levels between patients and HCs. Histologically, epidermal melanin, elastotic degeneration, vascular proliferation and mast cells were more pronounced in lesional compared with nonlesional skin. Absent to weak expression of oestrogen receptors, progesterone receptors and stem cell factor was observed in lesional skin.

Conclusion

Ultraviolet light and mustard oil are important causative factors in male melasma. Although stress and family history may contribute, hormonal factors possibly have no role. Quantitative analysis of immunohistochemical markers would provide insight in understanding the pathogenesis of melasma.

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Systemic photodynamic therapy in folliculitis decalvans

Summary

Folliculitis decalvans (FD) is classified as a primary neutrophilic cicatricial alopecia, and is estimated to account for approximately 10% of all cases of primary cicatricial alopecia. The role of dysfunctional immune activity and the presence of bacteria, particularly Staphylococcus aureus, appear pivotal. We describe a 26-year-old man with a 4-year history of FD that was recalcitrant to numerous systemic and topical therapies, whose disease was virtually cleared during a follow-up of 25 months following a course of treatment with systemic photodynamic therapy (PDT) using ultraviolet light (100–140 J/cm²) with porfimer sodium 1 mg/kg as monotherapy. This is the first report of the use of systemic PDT as a treatment for FD. Systemic PDT has potent antibacterial effects with little or no resistance. In addition, systemic PDT provides local immunomodulation and improved scar healing. Significant adverse effects following systemic PDT with appropriate aftercare are rare. This case demonstrates that systemic PDT is a useful therapy option in the treatment of recalcitrant FD.

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Periocular cutaneous oncocytoma

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Complete resolution of extensive xanthomas associated with primary sclerosing cholangitis following liver transplantation

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Acral melanoma foot lesions. Part 1: epidemiology, aetiology, and molecular pathology

Summary

Acral melanoma (AM) is a rare subtype of cutaneous malignant melanoma (MM) found on acral skin, primarily on the soles of the feet. Although rare, it is the most common subtype of MM found in patients of African or East Asian ethnicity and has a poor prognosis, often because of the more advanced stage of presentation at diagnosis. The pathogenesis of AM is unclear, but genetic alterations, including mutations in BRAF, NRAS, and KIT have been implicated. Early diagnosis of AM is important for a better prognosis, but its identification is often challenging, leading to easy misdiagnosis. In the first of this two-part review, we review the history, epidemiology, aetiology and molecular pathology of AM; in part 2 we will review diagnosis and management.

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A novel 1-bp deletion mutation and extremely skewed X-chromosome inactivation causing severe X-linked hypohidrotic ectodermal dysplasia in a Chinese girl

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Allergic contact dermatitis caused by a moisturizer containing iodopropynyl butylcarbamate

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MicroRNAs in cutaneous lichen planus

Summary

Lichen planus (LP) is a chronic, inflammatory, papulosquamous, autoimmune disease. The pathogenesis of LP appears to be complex, with interactions between genetic, environmental and lifestyle factors. MicroRNAs (miRNAs) are short RNAs encoded in both protein coding and noncoding areas of the genome, and have been found to be involved in the pathogenesis of some inflammatory skin diseases. The aim of this study was to map the levels of miRNA (miR-)-203 and miR-125b in cutaneous LP to evaluate their possible role in the pathogenesis of the disease. In total, 40 patients with classic cutaneous LP and 40 age- and sex- matched healthy controls (HCs) were enrolled in this study. Punch biopsies (4 mm) were taken from cutaneous LP lesions of patients and from normal skin of HCs. miRNA-203 and miRNA-125b mRNA expression was estimated by reverse transcription PCR. Our analysis revealed a significantly (P < 0.001 for both) lower expression of both miR-203 and miR-125b mRNA in the LP than in the HC biopsies. No relationship was found between expression of miR-203 or miR-125b and either age, sex, presence of mucosal lesions or positivity for HCV antibodies. miR-125b and miR-203 could be involved in the pathogenesis of cutaneous LP.

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Dermoscopic features of pigmented vulvar intraepithelial neoplasia

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An interpretation of the new international MAP guideline for the management of Milk Allergy in Primary Care

General Practitioners suffer from guideline fatigue. They come fast and furious in many complicated forms. Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childho...

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Clozapine-induced acute gastrointestinal necrosis: a case report

Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastroi...

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Extraskeletal osteosarcoma in the parotid gland: A case report

Extraskeletal osteosarcoma is a very rare tumor and accounts for 4–5% of all osteosarcomas. We describe a 47-year-old Japanese man who presented with a right parotid tumor. The patient underwent total resection with postoperative radiotherapy; however, the tumor recurred in the lung, whereupon he underwent chemotherapy and partial lung resection. After surgery, a hemorrhagic brain metastasis appeared; this tumor was extirpated to prevent bleeding into the brain, after which additional chemotherapy was administered.

http://ift.tt/2wIOwuc

3D-constructive interference into steady state (3D-CISS) labyrinth signal alteration in patients with vestibular schwannoma

To evaluate signal intensity of the inner ear using 3D-CISS imaging and correlated signal characteristics in patients with vestibular schwannoma to neuro-otological symptoms.

http://ift.tt/2ywwMz8

High-dose corticosteroids improve the prognosis of Bell’s palsy compared with low-dose corticosteroids: A propensity score analysis

The aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120mg prednisolone equivalent daily) in Bell's palsy compared with low-dose corticosteroid (60mg PSL equivalent).

http://ift.tt/2wHTuqQ

The value of three-dimensional photogrammetry in isolated sagittal synostosis: Impact of age and surgical technique on intracranial volume and cephalic index─a retrospective cohort study

The aim of this study was to compare the outcome of intracranial volume (ICV) and cephalic index (CI) between two different techniques for surgical therapy of sagittal synostosis.

http://ift.tt/2fous8F

Comparison of temporomandibular joint and ramus morphology between class II and class III cases before and after bi-maxillary osteotomy

The purpose of this study was to compare changes in temporomandibular joint (TMJ) and ramus morphology between class II and III cases before and after sagittal split ramus osteotomy (SSRO) and Le Fort I osteotomy.

http://ift.tt/2xAwJUY

Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw

Osteonecrosis of the jaw (ONJ) is a severe complication of antiresorptive medication (AM) in the treatment of bone-affecting cancer-related conditions and osteoporosis.

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Classification of the Level of Mandibular Atrophy– a Computer-assisted Study Based on 500 CT Scans

For the optimal treatment of patients with highly atrophic mandibles, it is required to assess and quantify the extent of atrophy. The classification schemes that are well established today are known to be limited with respect to objectivity and reproducibility. Thus, the aim of the study was to generate a computer-aided method of classification, investigate its applicability in comparison with the established methods, and apply it to a large set of data.

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Surgical Success of Tympanoplasty Using Composite Tragal Cartilage in Chronic Otitis Media.

This study aims to investigate the preoperative, postoperative airway hearing threshold levels, and perforation closure rates in patients who underwent primary tragal cartilage tympanoplasty. One hundred seventy-one patients who had chronic otitis media without cholesteatoma underwent primary tragal cartilage tympanoplasty with endaural approach by using underlay technique. Preoperative and postoperative airway hearing threshold levels at 500, 1000, 2000, 4000 Hz frequencies in 8 to 99 months' follow-up were found and compared with each other. Postoperative perforation closure rates were also investigated. At 500 Hz in 112 patients, at 1000 Hz in 106 patients, at 2000 Hz in 96 patients, and at 4000 Hz in 80 patients, more than 9.5 dB airway hearing gain was determined. The authors found their postoperative perforation closure rate as 84.8%. In conclusion, tragal cartilage tympanoplasty may be chosen as the primary operation technique in primary chronic otitis media patients and by this technique perforation closure rates are also acceptable in addition to satisfactory hearing gain. (C) 2017 by Mutaz B. Habal, MD.

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Proteus Syndrome With a Cranial Intraosseous Lipoma.

Intraosseous lipomas are almost exclusively seen in the long bones. Presence in the craniofacial skeleton is extremely rare. A 7-year-old male is presented with a marked craniofacial deformation from a bony tumor containing an intraosseous lipoma. This finding established a clinical diagnosis of Proteus syndrome. Given the size of the tumor, producing an extensive deformity, three-dimensional modeling was used to generate a three-dimensional printed implant. The process to achieve a successful outcome is herein described. (C) 2017 by Mutaz B. Habal, MD.

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Frontal Hyperostosis in the Patients of Craniosynostosis After Cranial Distraction Osteogenesis.

Background: Conventional fronto-orbital advancement and distraction osteogenesis (DOG) have been used to treat craniosynostosis, both of which are considered effective. During the authors' practice, a phenomenon of frontal hyperostosis has been observed in the patients of craniosynostosis after DOG, which has yet to be reported in the literature. The purpose of this study is trying to identify the factors related to the phenomenon. Materials and methods: From 1997 to 2010, all patients of craniosynostosis undergoing DOG were reviewed. The patient's age at operation, consolidation period, numbers of distractor, distance of distraction, and duration from removal of the distractors to identification of the phenomenon on computed tomography were recorded. The phenomenon was considered positive when the hyperostosis appeared on the frontal bone, where it was neither the osteotomy site nor the previous position of distractor. Results: A total of 61 patients were included in this study, including 26 syndromic and 35 nonsyndromic patients. Two syndromic and 6 nonsyndromic patients had the phenomenon. There was no statistical difference between the patients with and without the phenomenon in comparison with the age, number of the distractor, consolidation period, and the distance of distraction. Conclusion: Frontal hyperostosis happened in some patients of craniosynostosis after DOG. Although no significant difference was demonstrated, the incidence of hyperostosis was higher in nonsyndromic patients and the patients of hyperostosis had shorter distance of distraction in both syndromic and nonsyndromic groups. Although the definite cause was unknown, we should pay attention to the phenomenon after distraction. (C) 2017 by Mutaz B. Habal, MD.

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Postoperative Changes in Isolated Medial Orbital Wall Fractures Based on Computed Tomography.

The treatment has been improved on the accurate reduction of blow-out fracture for many decades. But still, it has been limited to reduce completely when surgeons are approaching by conventional technique. The authors analyzed the postoperative results using computed tomography (CT) scans after conventional open reduction of isolated medial wall fracture. Thirty-seven patients with isolated medial wall fracture were reviewed. All patients underwent preoperative, immediate, and postoperative CT scans. Two surgeons have performed the surgery by conventional open reduction with transcaruncular approach and absorbable mesh insertion. The authors evaluated changing orbital volume and distance, comparing the immediate and 6 months postoperative outcomes with preoperative outcome. The differences between immediate postoperative and 6 months postoperatively data were statistically evaluated. The authors used the distant value to minimize bias of CT view selection. Significant differences from the 2 kinds of data were observed (P

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Neonatal Mandibular Distraction Without a Consolidation Period: Is It Safe? Is it Effective?.

Purpose: Consolidation is a standard part of most post-distraction protocols. This study aims to determine whether the deliberate omission of a consolidation period following mandibular distraction (MD) in neonates with Pierre Robin sequence (PRS) affected the airway outcomes and complication rates. Patients and Methods: A retrospective chart review of 28 neonates with PRS who underwent MD for severe airway obstruction between 2009 and 2014 was performed. Neonates were split into 2 cohorts: those with a very short or no consolidation (no consolidation group, n = 18) and those with a traditional consolidation period (consolidation group, n = 10). Results: Mean consolidation length was 25 days in the conventional consolidation group and 1.5 days in the no consolidation group (P

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Review of "Yes. This is a Missed Opportunity. Let's Turn Traumatic Injury into a Life-saving Event" by Haider AH in Ann Surg 265: 854-855, 2017.

No abstract available

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Giant Peripheral Temporomandibular Osteoma With Immediate Reconstruction of Mandible.

Osteoma is a benign osteogenic tumor, which is characterized the slow-growing proliferation of compact or cancellous bone. The etiology of the lesion is not well established. Among the hypotheses, the following are related: a traumatic factor, infectious processes, or true neoplasm due to the origin of cartilaginous cells. It can present at any age, usually in young adult individuals, with equal prevalence in both sexes. The clinical characteristics of the peripheral osteoma are represented by slow asymptomatic growth, which leads to swelling and, thus, facial asymmetry. When it is related to the mandibular condyle, this growth can cause functional impairment, such as malocclusion, temporomandibular joint dysfunction, and even limited mouth-opening owing to ankylosis. (C) 2017 by Mutaz B. Habal, MD.

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The Pierre Robin Mandible is Hypoplastic and Morphologically Abnormal.

Background: For Pierre Robin sequence (PRS) patients, there is incomplete characterization of 3D differences and effects of mandibular distraction osteogenesis (MDO) on the mandible compared to normal controls. Methods: PRS infants who underwent MDO at 2 craniofacial referral centerals with pre- and postoperative computed tomography (CT) scans were identified. A group of age-matched control patients with CTs were identified in the PACS database. Demographic and perioperative data were recorded. Mandibular lengths, angles, and volumes were measured. Morphologic and outcomes data were analyzed in a case-control comparison. Results: Sixty-three CT scans were analyzed. Fifteen pre-op PRS patient and 15 control CTs were well matched in terms of age and sex. Mandibular volume (78%), ramus length (87%), and body length (95%) were all decreased in the PRS patients. Anterior symphyseal angle (84%) was significantly reduced in PRS patients while mandibular angle (102%) was maintained. Eighteen post-op PRS patient and 15 control CTs were well matched in terms of age and gender. Mandibular volumes (106%) were normalized following distraction with shorter mandibular rami (88%) and longer mandibular bodies (109%). Postoperatively, mandibular angle (100%) and anterior symphyseal angle (99%) were ultimately indistinguishable from controls. Conclusions: The mandible in PRS is dysmorphic compared to age-matched controls. Overall, they have a smaller volume, shorter ramus, and an obtuse symphyseal angle. MDO improves mandibular volume and normalizes the symphyseal angle, but results in a longer mandibular body and shorter mandibular ramus. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2fH5gHv

The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses.

The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses. (C) 2017 by Mutaz B. Habal, MD.

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Neck Surgery Under Local Anesthesia.

The value of local anesthesia (LA) is widely recognized in oral and maxillofacial surgery. Many procedures can be performed with the use of local anesthetic alone, instilled at or near the site of surgery. The author presents a patient with neck tumor, where the tumor removal was managed under LA at outpatient clinic. Treatment and postoperative period was routine. Neck surgery under LA in outpatient environment shows a great potential in adequately selected patients. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2fGzwSK

Bilateral Subperiosteal Hematoma and Orbital Compression Syndrome in Sickle Cell Disease.

A 14-year-old boy with sickle cell disease presented with preseptal cellulitis findings as proptosis, eyelid edema, and hyperemia. His best corrected visual acuity in the right eye was 20/20 and 16/20 in the left eye. He had limited ductions in vertical and lateral gazes in both eyes. Bilateral venous tortuosity was observed in posterior segment examination. Orbital bone infarction and subperiosteal hematoma were seen in magnetic resonance imaging. He was diagnosed as having orbital compression syndrome secondary to vaso-occlusive crisis of sickle cell disease and was treated with intravenous ampicilin-sulbactam and methylprednisolone. (C) 2017 by Mutaz B. Habal, MD.

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The Effect of Dexpanthenol-Vitamin A (Nazalnem) on Silastic Splints After Nasal Septal Surgery.

Objective: To investigate the effect of dexpanthenol-vitamin A (Nazalnem) ointment applied to the surface of silastic splints with an airway immediately after nasal septal surgery on postoperative complaints and nasal mucosa function. Materials and Methods: The study enrolled 60 patients undergoing nasal septoplasty surgery. Group 1 (n = 30) received silastic splints with ointment containing dexpanthenol-vitamin A (Nazalnem), and Group 2 (n = 30), the control group, received silastic splints with vaseline. Of these patients, 2 patients from the Group 1 and 9 from the Group 2 were excluded. A thin layer of ointment was applied to the flat side of a silastic splint with an airway. The splints were removed on the second postoperative day. Patients were evaluated preoperatively and 1 and 2 weeks postoperatively using a visual analog scale and the Sino-Nasal Outcome test (SNOT-22). Mucociliary clearance (MCC) tests were performed at the same times. Results: Visual analog scale for nasal crusting, nasal congestion, and foul odor was better in Group 1 than in Group 2 both at 1 week and at 2 weeks postoperatively (P 0.05). Postoperatively, the MCC were insignificant between the groups and within the groups at 1 and 2 weeks (P > 0.05). Conclusion: Although Dexpanthenol-Vitamin A ointment had no direct effect on wound healing, it had significant effects on crusting, obstruction, and foul smell. However, silastic splints with dexpanthenol did not improve the MCC of the nose. (C) 2017 by Mutaz B. Habal, MD.

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Progress on Botulinum Toxin Type A-Induced Pain Relief in the Field of Plastics.

Objective: To retrospectively evaluate the effectiveness of Botulinum Toxin Type A (BTX-A) injections relieve pain in the field of plastic surgery and postoperative rehabilitation, and discuss the analgesic mechanism of BTX- A in plastics and related research progress. Methods: From appearance to September 1, 2016, PUBMED, EMBASE, and Web of Science were searched, using the key words related to "Botulinum Toxin Type A" and "Pain." Furtherly, nonplastic surgery-related literature was excluded by manual screening. Results: Eleven literatures met the inclusion criteria, including 6 prospective controlled cohorts, 4 patient series, and 1 retrospective cohort. These studies involved Lower Limb, Breast, Hallux, Amputees, and Temporomandibular joint disk disfigurement and enrolled 402 patients. Among the patients, 360 received intraoperative BTX-A injection at the time of the main surgical procedure, 16 injected postoperatively and 26 did not undergo surgery. And 85.32% reported pain alleviation and 69.96% got favorable side effects and no one occurred major adverse effects. But 1.83% accepted injections more than once. Mechanism analysis explained these studies' results and demonstrated the analgesic effectiveness of BTX-A in plastics with nociceptive pain, inflammatory pain, and neuropathic pain. Conclusion: The results suggest that BTX-A may induce postoperative pain associated with plastic surgeries relief. But the available data of outcome assessment involved in this review are inconsistent and failed to meet methodological rigor. And pain alleviations are influenced by many factors. So further randomized controlled clinical trials with large sample sizes are needed to support this practice, determine standard usage methods, and establish corresponding specification systems. (C) 2017 by Mutaz B. Habal, MD.

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Adipose Tissue-Derived Stromal Vascular Fraction Increases Osteogenesis in an Experimental Design Zygomatic Bone Defect Model.

Introduction: Facial bone defects are frequently encountered problems in clinical practice. Bone grafts, flaps, and alloplastic materials are often used in their treatment. This leads to donor site morbidity and prolongation of the operation. The authors have planned this study to examine whether adipose tissue derived stromal vascular fraction (SVF) has an osteogenic effect in the critical sized membranous bone defect of the zygomatic bone. Materials and Methods: Twenty male Wistar Albino rats were used. Bilateral zygomatic arches were opened with lateral incisions. A standard 3-mm bone defect was created bilaterally on the zygomatic arches of the rats. In the experiment side, the stem cell-rich SVF that was obtained by applying centrifugal process to the adipose tissue derived from the inguinal fat pad was injected into the site of the right zygomatic arch bone defect. In the control side, left zygomatic arch was left for secondary bone healing without any treatment after a 3-mm critical bone defect was created. In the postoperative 10th (n:5) and 20th weeks (n:13), the healing areas of bone defects were assessed by a 3-dimensional tomography, and then, the rats were sacrificed and bone healing was examined histologically. Results: There were no statistically significant differences on the 10th week results. At the 20th week new bone formation amount calculated from the 3-dimensional computed tomography results was significantly higher in the experiment side (P = 0.033). In the histological examination at the 20th week, there was significantly more callus formation in the experiment side (P = 0.0112). Discussion: Stem cells can increase the rate of bone healing by differentiating into certain tissues. It is predicted that adipose tissue-derived SVF rich with mesenchymal stem cells can increase bone healing in facial bone defects and this application could replace the use of bone grafts and flaps in clinical practice. As a result, it is concluded that adipose tissue-derived stem cells can potentiate osteogenesis and reduce the possibility of developing necrosis on the bone ends. (C) 2017 by Mutaz B. Habal, MD.

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Bulla Down Endoscopic Sphenoidotomy.

Surgical approach to the sphenoid sinus is still one of the most challenging steps in sinus surgery. The author describes a novel, simple, and safe technique to access sphenoid sinus to manage isolated sphenoid pathologies or approach skull base by removing the bulla ethmoidalis and temporarily lateralizing the middle turbinate during endoscopic sinus surgery. The current approach provides an effective method to access the sphenoid sinus without increasing morbidity and avoids unnecessary possible complications associated with turbinates' resection. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xkYYav

Mandibular Osteomyelitis and Cervical Lymphadenitis Due to Mycobacterium abscessus: Surgical Management of a Pediatric Cohort With a Shared Epidemiologic Exposure.

Background: Mycobacterium abscessus has been implicated as the cause of various infections in the setting of healthcare-related "outbreaks." Mandibular osteomyelitis caused by M abscessus is exceedingly rare, with only 1 patient reported in the literature. The authors describe the surgical management of 12 pediatric patients with M abscessus-related mandibular osteomyelitis and cervical lymphadenitis caused by exposure to contaminated water at a regional dental clinic. Methods: Following institutional review board approval, new suspected patients were reviewed and followed prospectively. A multidisciplinary team coordinated the surgical approach, antibiotic regimen, and follow-up for each patient. Results: Twelve patients (median age 7.5 years) received treatment of M abscessus infection. Eleven had mandibular osteomyelitis and underwent debridement along with extraction of affected teeth. Eight had lymphadenitis and underwent excision of involved nodes. Four patients (in whom surgical debridement was considered inadequate) received antibiotic therapy with a regimen of amikacin, cefoxitin, and azithromycin for 4 months. Nine of 12 patients have been followed for a median of 5 months (range 1-11 months); no patient has evidence of persistent clinical infection. Three of 4 patients treated with amikacin have high-frequency hearing loss. Conclusions: The authors describe a pediatric cohort with mandibular osteomyelitis and cervical lymphadenitis due to M abscessus following pulpotomy at a single dental clinic. Diagnosis required a high index of suspicion. Patients in our series had resolution of infection even without antibiotic therapy, suggesting that early complete surgical debridement and removal of affected lymph nodes can be sufficient as a sole treatment modality. (C) 2017 by Mutaz B. Habal, MD.

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Vinegar Sock Soak for Tinea Pedis or Onychomycosis

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Diagnostic accuracy of teledermatology for nonmelanoma skin cancer: Can patients be referred directly for surgical management?

http://ift.tt/2yvTMOV

The Eyelid Grid

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Dermatologists perform more reconstructive surgery in the Medicare population than any other specialist group: A cross-sectional individual-level analysis of Medicare volume and specialist type in cutaneous and reconstructive surgery

http://ift.tt/2xYTza1

Weight change and Risk of Onychomycosis: A nationwide cohort study from Korea

http://ift.tt/2xYneAf

Dermatology in Orbit: Anticipating Skincare Requirements in the Space Age

http://ift.tt/2ywyXTC

An ecological study of skin biopsies and skin cancer treatment procedures in the United States Medicare population, 2000 to 2015

Analyses of skin cancer procedures adjusted for population changes are needed.

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Forehead horizontal primary closure: A retrospective analysis of 25 cases assessing for long-term eyebrow asymmetry

http://ift.tt/2yxZPTg

Hormonal and reproductive factors and incidence of basal cell carcinoma and squamous cell carcinoma in a large, prospective cohort

http://ift.tt/2ywu8t9

Development and Validation of the Frontal Fibrosing Alopecia Severity Score

http://ift.tt/2xYTBi9

A Quick Template for Skin Grafts

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Home-based contact immunotherapy with diphenylcyclopropenone for alopecia areata is as effective and safe as clinic-based treatment in patients with stable disease: A retrospective study of 40 patients

http://ift.tt/2xY80uP

Collision of subungual melanoma and subungual squamous cell carcinoma: a case series

Subungual squamous cell carcinoma (SSCC) and subungual melanoma (SUM) are rare tumors. Several case reports of collision of a SSCC with a SUM (SSCC-SUM) have been published.

http://ift.tt/2ywua4f

Procedures in Cosmetic Dermatology: Soft Tissue Augmentation 4th Ed. Editors: Jean Carruthers, Alastair Carruthers

http://ift.tt/2yvFT33

Risk of Developing Pyoderma Gangrenosum after Procedures in Patients with a Known History of Pyoderma Gangrenosum – A Retrospective Analysis

The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown.

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Moonlighting policies among US dermatology residency programs: a survey

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Fully digital Mohs map for micrographic surgery

http://ift.tt/2ywucJp

Application of endoscopy in otology: Changes over the last 8years in Korean Otological Society

Despite the worldwide availability of endoscope in otology, it still has not replaced the microscopic surgery as it has for nose surgery. In 2008, we administered a questionnaire on the preference of using otoscopes in Korea. In light of the worldwide availability of endoscopic ear surgery, we have now conducted a more detailed survey to determine if this preference has changed over 8years.

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Rhinophyma: Our experience based on a series of 12 cases

Publication date: Available online 21 September 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): P. Clarós, M.-C. Sarr, F.-B. Nyada, A. Clarós
IntroductionRhinophyma is a rare, benign and unsightly disease of the skin of the nose that was first described a very long time ago, as illustrated by portrait of an old man with a bulbous nose holding his grandson, by Ghirlandaio in 1490. It was described for the first time by Ferdinando Hebra Von (1816–1880), as the third stage of rosacea. The objective of this study is to report the author's experience and propose a new treatment option in the management of rhinophyma.Material and methodsWe describe our experience of rhinophyma based on a retrospective case study.ResultsWe identified 12 cases over a 12-year period, with a marked male predominance. The therapeutic approach was the same in all patients, consisting of a combination of dermabrasion, decortication and application of fibrin glue, with a favourable outcome in every case with complete epithelialisation.ConclusionRhinophyma is a rare condition of uncertain pathophysiology. Management is surgical and, in view of the many techniques and procedures proposed, we advocate the slogan "to each his own technique", until a consensus has been reached. Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results.



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Modification of fasciocutaneous radial forearm free flap to achieve two-layer closure during reconstruction of circumferential hypopharyngeal defects

Publication date: Available online 22 September 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Abu-Serriah, S. Loughran
Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects.



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Insights into the Management of Papillary Microcarcinoma of the Thyroid

Thyroid , Vol. 0, No. 0.


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Use of a fibrinogen-thrombin sponge in rhinoplasty

Abstract

Background

Although several methods have been described to address nasal dorsum augmentation and smoothing of irregularities in rhinoplasty, establishing the ideal method has proven controversial.

Objective

Here, we introduce a novel technique of cartilage grafting for nasal dorsum augmentation by wrapping cartilage in a fibrinogen- and thrombin-coated collagen patch called TachoSil®.

Material and methods

In a pilot study comprising ten cases, the use of the collagen patch was examined in various indications in rhinoplasty. Patients were clinically monitored for up to 8 months and photometric and sonographic documentation was performed pre- and postoperatively.

Results

In nine patients, the collagen patch was used for fixation of cartilage grafts in different indications: saddle nose deformities (n = 5), open roof (n = 1), nasal dorsum irregularities (n = 3). A diced cartilage graft enclosed by a bilayer of TachoSil® was applied in seven patients. Solid pieces of cartilage were either embedded in a bilayer of the collagen patch (n = 1) or covered by a monolayer (n = 1). Moreover, the collagen patch alone served as a soft tissue support in one patient with thin skin. Six patients were revision cases. All patients had uneventful healing without adverse events such as allergic reactions and infections.

Conclusion

The collagen patch TachoSil® is eligible for various indications in rhinoplasty. It is a useful material predominantly for nasal dorsum augmentation by sandwiching diced or solid cartilage in the collagen patch, leading to better graft fixation and precise profile shaping. At the same time, TachoSil® helps with blood control. Follow-up studies will be performed to assess the material's long-term behavior.

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Laryngeal and vocal alterations after thyroidectomy

Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Renata Mizusaki Iyomasa, José Vicente Tagliarini, Sérgio Augusto Rodrigues, Elaine Lara Mendes Tavares, Regina Helena Garcia Martins
IntroductionDysphonia is a common symptom after thyroidectomy.ObjectiveTo analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.MethodsProspective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).ResultsAmong the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy (LI) n=40, total thyroidectomy (TT) n=88, thyroidectomy+lymph node dissection (TT+LND) n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (LI n=6; TT n=17; TT+LND n=9) and 2 superior laryngeal nerve (LI n=1; TT+LND n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21).ConclusionVocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.



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Effects of diabetes mellitus and systemic arterial hypertension on elderly patients’ hearing

Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Laurie Penha Rolim, Alessandra Giannella Samelli, Renata Rodrigues Moreira, Carla Gentile Matas, Itamar de Souza Santos, Isabela Martins Bensenor, Paulo Andrade Lotufo
IntroductionChronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus (DM) and systemic arterial hypertension (SAH) have shown controversial conclusions.ObjectiveTo compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with DM and/or SAH, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions.Methods100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3–4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the DM group, 20 individuals in the AH group, 20 individuals in the DMAH and 40 individuals in the control group (CG), matching them with each study group, according to age and gender. ANOVA and Kruskal–Wallis statistical tests were used, with a significance level set at 0.05.ResultsWhen comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the DM group; for the AH group, significant differences were observed after 4kHz. For the DMAH group, significant differences were observed at the frequencies of 500, 2kHz, 3kHz and 8kHz.ConclusionIt was observed that the AH group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.



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Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aditi Gargeshwari, Raghav Hira Jha, Niraj Kumar Singh, Prawin Kumar
IntroductionCalcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels.ObjectiveThe present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests.MethodsThe study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP).ResultsA significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p<0.05) than the control group. However, there was no significant difference in latencies or amplitude of cVEMP and oVEMP between the groups. The proportion of individuals with absence of oVEMP was significantly higher in the osteoporosis group than the other two groups (p<0.05).ConclusionThe findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.



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The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis

Background

In many developed countries, wait times for elective surgery are increasing. Among these elective surgeries is endoscopic sinus surgery (ESS) performed for treatment of chronic rhinosinusitis (CRS). Little is known about the impact of wait times on patients' surgical outcomes. The purpose of this study was to evaluate the association between patients' wait times and postoperative patient-reported outcomes.

Methods

This study was based on a prospectively recruited longitudinal cohort of patients booked for ESS for the treatment of medically-refractory CRS in Vancouver, Canada. Patients were recruited between September 2012 and December 2016. All participants completed the Sino-Nasal Outcome Test (SNOT-22) preoperatively and 6 months postoperatively. The primary outcome measure was participants' change in SNOT-22 score. A regression model measured the association between patient-reported outcome, wait time, and potential confounders.

Results

The study included 150 participants. The mean surgical wait time was 32 weeks. The mean preoperative SNOT-22 score was 40.0. The improvement in SNOT-22 scores following ESS was 18 points. Regression analysis found no association between wait time for ESS and the change in SNOT-22 scores after surgery (p = 0.42). Only preoperative SNOT-22 score correlated with outcome scores.

Conclusion

There was no association between the gains in health-related quality of life and the length of time participants waited for surgery. The largest gains in health were concentrated among participants with the highest symptom burden, irrespective of wait time. This result suggests that it may be safe to triage patients based on symptom severity as an approach to maximizing the population's overall health.

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Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis

Background

Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease.

Methods

Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system.

Results

A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (−24.3 ± 21.1 vs −21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (−2.0 ± 3.5 vs −0.4 ± 2.4, p = 0.090).

Conclusion

Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.

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Three-dimensional image analysis for staging chronic rhinosinusitis

Background

Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease.

Methods

Adults with rhinologic complaints undergoing computed tomography imaging were recruited at an urban, academic, tertiary care center (n = 45 with Lund-Mackay [LM] scores ≥4). Three-dimensional (3D) volumetric image analysis was performed using a semiautomated method to obtain a "Chicago-modified Lund-Mackay" (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (Total Nasal Symptom Score [TNSS]) and disease-specific quality of life, based on the Sinonasal Outcome Test-22 (SNOT-22).

Results

Chicago MLM scores were significantly associated with both symptoms (p = 0.037) and disease-specific quality of life (p = 0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM >6).

Conclusion

The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.

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Long-term follow-up on patients treated for abdominal fat using a selective contactless radiofrequency device

Summary

Background and objective

The aim of this study was to evaluate how abdominal circumferential reduction achieved after using a noninvasive radiofrequency device (BTL Vanquish, BTL Industries Inc., Boston, MA) evolves over a 4-year period.

Methods

This is a follow-up on patients who were treated in our practice for abdominal fat in an earlier published multicenter prospective study. Patients were recalled for biometric data collection 4 years (±60 days) after the last treatment. Body and weight measurements were compared to the historical data. Digital images of the treated area were taken. Independent panelists were asked to recognize the original baseline images from the 4-year follow-up images.

Results

The evaluation encompasses 13 subjects. In the original study, these patients lost on average 5.88 ± 4.14 cm of waist circumference (P < .001) while losing on average 1.29 kg. After 4 years, the same subjects had an average reduction of 4.42 ± 2.85 cm (P < .001) compared to the baseline, while gaining on average 0.50 kg. In both cases, the waist change was statistically independent of the weight change (P < .01). The patients preserved on average 75.2% of the original body contouring effect after 4 years as measured by circumference. None of the patients grew in circumference when compared to the baseline. Reviewers recognized the baseline patient images from the follow-up patient images in 82.1% cases. No long-term side effects were observed that would relate to the treatments.

Conclusions

In the study group, patients with ordinary weight changes preserved most of the original waist reduction after 4 years.

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Considerations for antibiotic prophylaxis in head and neck cancer surgery

Publication date: Available online 22 September 2017
Source:Oral Oncology
Author(s): Michael P. Veve, Susan L. Davis, Amy M. Williams, John E. McKinnon, Tamer A. Ghanem
Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e.g. antibiotic resistance, Clostridium difficile-associated diarrhea). POABP regimens should retain activity against bacteria expected to colonize the upper respiratory/salivary tracts, which include Gram-positive organisms and facultative anaerobes. However, Gram-negative bacilli also contribute to SSI in this setting. POABP doses should be optimized in order to achieve therapeutic tissue concentrations at the surgical site. Antibiotics targeted towards methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa are not warranted for all patients. Prolonged POABP durations have shown no differences in SSI when compared to short POABP durations, but prolonged durations provide unnecessarily antibiotic exposure and risk for adverse effects. Given the lack of standardization behind antibiotic POABP in this setting and the potential for poor patient outcomes, this practice necessitates an additional focus of surgeons and antimicrobial stewardship programs. The purpose of this review is to provide an overview of POABP evidence and discuss pertinent clinical implications of appropriate use.



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Standardized whole blood stimulation improves immunomonitoring of induced immune responses in multi-center study

Publication date: Available online 22 September 2017
Source:Clinical Immunology
Author(s): Darragh Duffy, Vincent Rouilly, Cecile Braudeau, Véronique Corbière, Raouf Djebali, Marie-Noelle Ungeheuer, Regis Josien, Sam LaBrie, Olivier Lantz, Delphine Louis, Eva Martinez-Caceres, Francoise Mascart, Jose G. Ruiz de Morales, Catherine Ottone, Lydia Redjah, Nina Salabert-Le Guen, Alain Savenay, Manfred Schmolz, Antoine Toubert, Matthew L. Albert
Functional immune responses are increasingly important for clinical studies, providing in depth biomarker information to assess immunotherapy or vaccination. Incorporating functional immune assays into routine clinical practice has remained limited due to challenges in standardizing sample preparation. We recently described the use of a whole blood syringe-based system, TruCulture®, which permits point-of-care standardized immune stimulation. Here, we report on a multi-center clinical study in seven FOCIS Centers of Excellence to directly compare TruCulture to conventional PBMC methods. Whole blood and PBMCs from healthy donors were exposed to LPS, anti-CD3 anti-CD28 antibodies, or media alone. 55 protein analytes were analyzed centrally by Luminex multi-analyte profiling in a CLIA-certified laboratory. TruCulture responses showed greater reproducibility and improved the statistical power for monitoring differential immune response activation. The use of TruCulture addresses a major unmet need through a robust and flexible method for immunomonitoring that can be reproducibly applied in multi-center clinical studies.One sentence summaryA multi-center study revealed greater reproducibility from whole blood stimulation systems as compared to PBMC stimulation for studying induced immune responses.



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Multiple sclerosis treatment effects on plasma cytokine receptor levels

Publication date: Available online 21 September 2017
Source:Clinical Immunology
Author(s): Sahl Khalid Bedri, Katharina Fink, Ali Manouchehrinia, Wangko Lundström, Ingrid Kockum, Tomas Olsson, Jan Hillert, Anna Glaser
Genetic variants within some cytokine receptor genes have been associated with MS susceptibility, including IL7RA and IL2RA. As these genes are expressed by cells targeted by immune-modulatory drugs, we explored the potential role of their gene products as biomarkers in monitoring MS treatment. We assessed the impact of natalizumab followed by fingolimod on the intra-individual changes of plasma protein levels of sIL-7Rα, sIL-2Rα and also sIL-6R and sgp130 in MS patients. During natalizumab treatment we observed a decline in sgp130 and sIL-7Rα levels, while subsequent fingolimod treatment lead to increased sgp130 and sIL-7Rα and decreased sIL-2Rα levels. In addition, during fingolimod treatment sIL-7Rα levels were increasing significantly more in patients homozygous for the MS risk genotype of rs6897932. We also observed an effect of the MS associated rs71624119 on sgp130 levels. These results may elucidate the pharmacodynamics of treatments and help identify biomarkers for MS outcomes.



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Regionenübergreifendes Tracking im Neugeborenen-Hörscreening

Zusammenfassung

Hintergrund und Problemstellung

Bei einem Wechsel des Zuständigkeitsbereichs zwischen dem Screening und der fachärztlichen Nachuntersuchung kommt es zu „Lost-to-Follow-up-Fällen" in der primär zuständigen Hörscreening-Zentrale. Dargestellt werden das Konzept sowie die Referenzimplementierung und die Evaluierung eines Vorschlags für ein regionenübergreifendes Tracking in Kooperation mit dem Verband Deutscher Hörscreening-Zentralen (VDHZ e. V.) als Angebot an die Entwickler von Trackingsoftware.

Methoden

Ausgehend von der Fehleranalyse realer Screeningdaten werden Methoden der Vorverarbeitung der Daten sowie die technischen Hintergründe der Schnittstelle und deren Integration in den Dateneingang von Trackingsoftware vorgestellt. Daten eines Belastungstests werden präsentiert.

Ergebnisse

Beim einem Belastungstest (Simulation von 6 Hörscreening-Zentralen mit 54.551 Kindern) wurden alle Anfragen mit einer durchschnittlichen Antwortzeit von 637 ms (SD [„standard deviation", Standardabweichung] = 266 ms/Median 613 ms) verarbeitet. Anonymisierende Eintragungen im Namen (n = 675/1,24 %) sowie doppelte Eintragungen in der Datenbank (n = 49/0,01 %) wurden erkannt.

Schlussfolgerung

Ein regionenübergreifendes Tracking bei heterogener Trackingssoftware ist ohne Nutzung einer einheitlichen Screening-ID möglich. Der hier zur Diskussion gestellte Ansatz erscheint konzeptionell und technisch dazu geeignet.

http://ift.tt/2xshYTI

Infantiles Hämangioperizytom der Nasenhaupthöhle

Zusammenfassung

Ein infantiles sinunasales Hämangioperizytom als Variante eines Myofibroms ist eine Rarität. Die Beobachtung eines infantilen Hämangioperizytoms der Nasenhaupthöhle, des Siebbeins und der vorderen Schädelbasis bei einem weiblichen Säugling mit dem Nachweis chromosomaler Gewinne (6q14q16.2 und 18q22qter) sowie chromosomaler Verluste (5q33.3q35.2, 10p11.2p12.2, 10q24.3q26.1, 15q23q25, 17p12pter und 22q11.2q13.2) wird vorgestellt. Die Behandlung erfolgte in Form einer endonasalen chirurgischen Resektion.

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Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females

Summary

Background

Acne vulgaris is one of the commonest skin disorders affecting up to 80% of the world population at least during adolescence. Significant psychosocial effects such as depression and poor personality development have been linked with acne, especially in female adolescents. Various causative factors, including cosmetic exposure, have been attributed toward acne.

Objective

To analyze the association between frequent exposure to cosmetics and severity of acne in adolescent females.

Method

A cross-sectional analytical study was performed on 140 girls from three schools in Colombo, Sri Lanka. A self-administered questionnaire was utilized to assess the patterns of cosmetic usage. Grading acne of the participants was performed by the researchers utilizing a standard acne grading scale.

Results

The overall prevalence of acne in our study population was 91.4% with a mean acne grade of 3.09. At least one cosmetic type was used by 126 (90%) of the population. A Pearson correlation coefficient (r) value of .452 (P < .001) was obtained between cosmetic exposure and acne grade, which indicates a statistically significant correlation. A chi-square value of 22.875 was obtained at a degree of freedom of 2 (P < .001), enabling us to reject the null hypothesis that there is no significant association between cosmetic usage and acne severity.

Conclusion

Our results convey a significant positive association between frequent exposure to cosmetics and severity of acne in adolescent females. Girls of this age group must be made aware that cosmetic usage may be a potential aggravating factor for their facial acne.

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Patient-reported quality of life outcomes following treatment for oral cancer

Publication date: Available online 22 September 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Breeze, A. Rennie, D. Dawson, J. Tipper, K.-U. Rehman, N. Grew, N. Pigadas
Patient-reported quality of life (QoL) outcomes have the potential to assist clinicians in providing individually tailored treatment decisions. QoL assessments were collected prospectively for 168 consecutive patients treated for oral cancer between 1 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire. Patients were followed up for 18 months post-treatment. Sub-group analyses were performed using paired t-tests and analysis of variance (ANOVA) to compare the effects of adjunctive chemoradiotherapy, type of bone resection, and methods of soft and hard tissue flap reconstruction. The greatest statistically significant reduction in QoL for all oral cavity sub-sites was found following the treatment of floor of mouth tumours (−18.9%, P=0.018). Laser excision for matched patient cohorts resulted in improved resultant QoL compared to other excision techniques (P=0.0002). No significant difference in QoL was found when radial forearm and anterolateral thigh flaps were matched, or when fibula and scapula flaps were matched. These findings support the use of laser excision and the avoidance of postoperative radiotherapy if curative intent and survival outcomes are maintained.



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Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation

Publication date: Available online 22 September 2017
Source:Auris Nasus Larynx
Author(s): Fei Tan, Constantin Bartels, Rory McConn Walsh
ObjectiveTo explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population.MethodsA retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography.ResultsThe average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%.ConclusionThe diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.



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A case of adult congenital laryngeal cleft asymptomatic until hypopharynx cancer treatment

Publication date: Available online 22 September 2017
Source:Auris Nasus Larynx
Author(s): Kotaro Shimizu, Atsuhiko Uno, Kazuya Takemura, Naoki Ashida, Ryohei Oya, Takahiro Kitamura, Yukinori Takenaka, Yoshifumi Yamamoto
Laryngeal cleft is an anomaly of failed posterior closure of the larynx. Most cases are diagnosed and need treatment early in life due to respiratory and swallowing problems. We report an unusual case of a 66-year-old man with an asymptomatic laryngeal cleft until treatment for hypopharyngeal cancer. During concurrent chemoradiotherapy (CCRT), despite reduced tumor volume, he presented severe dysphagia and dyspnea, followed by severe pneumonia twice. Because CCRT had to be discontinued, a pharyngolaryngectomy was performed for the cancer treatment. The resected specimen showed total removal of the tumor and a total longitudinal cleft of the cricoid cartilage, classified as a type III laryngeal cleft by the Benjamin and Inglis' classification. A review of computed tomography images indicated that the redundant mucosa from bilateral edges closed the separation of the posterior cricoid cartilage and narrowed the laryngeal airway during CCRT. Adult presentations of laryngeal cleft are quite rare with only ten reported cases in English literature; the present case is of the oldest patient. Undiagnosed cases with laryngeal cleft may exist asymptomatically or without severe symptoms. The awareness of this condition may increase its diagnosis as a cause of diseases such as aspiration and recurrent pneumonia even in adult patients.



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Concomitant suppression of Th2 and Th17 cell responses in allergic asthma by targeting RORγt

Publication date: Available online 22 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hyeongjin Na, Hoyong Lim, Garam Choi, Byung Keun Kim, Sae-Hoon Kim, Yoon-Seok Chang, Roza Nurieva, Chen Dong, Seon Hee Chang, Yeonseok Chung
BackgroundAllergic asthma is a heterogeneous chronic inflammatory disease in the airway with a massive infiltration of eosinophils or neutrophils mediated by allergen-specific Th2 cells and Th17 cells, respectively. Successful treatment of allergic asthma will therefore require suppression of both Th2 and Th17 cells.ObjectiveWe sought to investigate the role of Th17 cell pathway in regulating Th2 cell responses in allergic asthma.MethodsAllergic asthma was induced by intranasal challenges with proteinase allergens in C57BL/6, Il17a−/−Il17f− /−and RORγt^gfp/gfp mice. Pharmacological RORγt inhibitor was used to evaluate its preventive and therapeutic effects in allergic asthma. Characteristics of allergic airway inflammation were analyzed by flow cytometry, histology, qRT-PCR and ELISA. Mixed bone marrow chimeric mice, fate mapping analysis, shRNA transduction and in vitro T cell differentiation were employed for mechanistic studies.ResultsMice deficient in IL-17A and IL-17F as well as in RORγt exhibited a significant reduction not only in Th17 cell responses, but also in Th2 cell responses in an animal model of allergic asthma. Similarly, mice treated with an RORγt inhibitor showed significantly diminished Th17 as well as Th2 cell responses, leading to reduced numbers of neutrophils and eosinophils in the airway. RORγt-deficient T cells were intrinsically defective in differentiating into Th2 cells and expressed increased level of Bcl6. Knock-down of Bcl6 resulted in a remarkable restoration of Th2 cell differentiation in RORγt-deficient T cells. Blockade of RORγt also significantly hampered the differentiation of human Th2 cells and Th17 cells from naïve CD4⁺ T cells.ConclusionRORγt in T cells is required for optimal Th2 cell differentiation by suppressing Bcl6 expression; this finding suggests that targeting RORγt might be a promising approach for the treatment of allergic asthma by concomitantly suppressing Th17 and Th2 cell responses in the airway.

Teaser

Inhibition of RORγt suppresses both Th2 and Th17 cell responses in the airway, and this can become a potential therapeutic target for the treatment of allergic asthma.


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Inhibition of IL-17–committed T cells in a murine psoriasis model by a vitamin D analogue

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nobuhiro Kusuba, Akihiko Kitoh, Teruki Dainichi, Tetsuya Honda, Atsushi Otsuka, Gyohei Egawa, Saeko Nakajima, Yoshiki Miyachi, Kenji Kabashima
BackgroundA better understanding of the means by which topical vitamin D analogues exert their therapeutic effect on psoriasis is of theoretical and practical importance.ObjectiveWe sought to clarify whether and how the topical vitamin D analogue calcipotriol (CAL) controls the IL-17A–mediated pathogenesis of murine psoriasis-like dermatitis in vivo.MethodsPsoriasis-like dermatitis was induced by the topical application of an imiquimod (IMQ)–containing cream on the murine ear for 4 to 6 consecutive days. For topical CAL treatment, mice were treated daily with CAL solution on the ear before IMQ application.ResultsMice treated topically with CAL exhibited much milder IMQ-induced psoriasis-like dermatitis compared with vehicle-treated mice, with impaired accumulation of IL-17A–committed T (T17) cells in the lesional skin. The IMQ-induced upregulation of Il12b and Il23a was marked in the epidermis and was abrogated by CAL application, suggesting CAL-mediated suppression of IL-23 expression. CAL inhibited Il12b and Il23a expression by Langerhans cells ex vivo stimulated with IMQ and CD40 cross-linking. Topical CAL also inhibited T17 cell expansion in the draining lymph nodes of IMQ-treated skin, implying a possible effect on T17 cell–mediated dermatitis at distant sites. In fact, topical CAL application on the IMQ-treated left ear resulted in amelioration of T17 cell accumulation and psoriasis-like dermatitis in the right ear subsequently treated with IMQ.ConclusionTopical CAL can exert its antipsoriatic effect on CAL-treated lesions and, concomitantly, distant lesions by attenuating the T17 cell accumulation in both CAL-treated lesions and draining lymph nodes.



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Pre-Pregnancy Exposure to Diesel Exhaust Predisposes Offspring to Asthma through IL-1β and IL-17A

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jerica Lenberg, Qian Qian, Zehua Sun, Rafeul Alam, Magdalena M. Gorska

Teaser

Using a mouse model we provided evidence that pre-pregnancy exposure to diesel exhaust predisposes offspring to asthma. We identified immunological mechanisms of this predisposition to facilitate future development of asthma prevention strategies.


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Eosinophils release extracellular DNA traps in response to Aspergillus fumigatus

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Valdirene S. Muniz, Juliana C. Silva, Yasmim A.V. Braga, Rossana C.N. Melo, Shigeharu Ueki, Masahide Takeda, Akira Hebisawa, Koichiro Asano, Rodrigo T. Figueiredo, Josiane S. Neves
BackgroundEosinophils mediate the immune response in different infection conditions. The release of extracellular DNA traps (ETs) by leukocytes has been described as an innate immune response mechanism that is relevant in many disorders including fungal diseases. Different stimuli induce human eosinophil ETs (EETs) release. Aspergillus fumigatus (A. fumigatus) is an opportunistic fungus that may cause eosinophilic allergic bronchopulmonary aspergillosis (ABPA). It has been reported that eosinophils are important to the clearance of A. fumigatus in infected mice lungs. However, the immunological mechanisms that underlie the molecular interactions between A. fumigatus and eosinophils are poorly understood.ObjectiveHere, we investigated the presence of EETs in the bronchial mucus plugs of ABPA patients. We also determined whether A. fumigatus-induced human eosinophils EETs release in vitro.MethodsMucus samples of ABPA patients were analyzed by light and confocal fluorescence microscopy. The release of EETs by human blood eosinophils was evaluated using different pharmacological tools and neutralizing antibodies by fluorescence microscopy and a fluorimetric method.ResultsWe identified abundant nuclear histone-bearing EETs in the bronchial secretions obtained from ABPA patients. In vitro, we demonstrated that A. fumigatus induces EETs release through a mechanism independent of reactive oxygen species but associated to eosinophil death, histone citrullination, CD11b and the Syk tyrosine kinase pathway. EETs lack the killing or fungistatic activities against A. fumigatus.ConclusionOur findings may contribute to the understanding of how eosinophils recognize and act as immune cells in response to A. fumigatus, which may lead to novel insights regarding ABPA patient treatment.

Graphical abstract

Teaser

Extracellular DNA traps, commonly found in mucus plugs of patients with allergic bronchopulmonary aspergillosis, are released by eosinophils in response to Aspergillus fumigatus


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Farm Exposure in Early Childhood is Associated with a Lower Risk of Severe Respiratory Illnesses

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Tiffany Ludka-Gaulke, Princy Ghera, Stephen C. Waring, Matthew Keifer, Christine Seroogy, James E. Gern, Steven Kirkhorn




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Childhood Chronic Prurigo: interest of Patch tests and delayed reading Skin prick tests to environmental allergens

Publication date: Available online 22 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Claire Maridet, Martin Perromat, Juliette Miquel, Christine Chiaverini, Didier Bessis, Audrey Lasek, Maryam Piram, Anne-Claire Bursztejn, Claire Abasq, Alice Phan, Ludovic Martin, Bérénice Bréchat, Jin Ho Chong, Julien Seneschal, Alain Taïeb, Franck Boralevi

Teaser

Childhood chronic prurigo is rarely studied in particular for allergic components. We propose a clinical classification according to seasonality of prurigo in three groups to help identifying causal agents and guide allergy testing with delayed readings tests.


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Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Peggy S. Lai, Amir H. Massoud, Mingcan Xia, Carter R. Petty, Amparito Cunningham, Talal A. Chatila, Wanda Phipatanakul

Teaser

An interleukin 4 receptor genetic variant (IL4Rα-Q576R) is common in children of African ancestry. There is a gene-environment interaction between this variant, school endotoxin exposure, and asthma symptoms.


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Long-term Benefits of Optimal Asthma Control in Pregnancy

Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Diane R. Gold, Augusto A. Litonjua




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HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Jing Zhao, Guoliang Wang, Guixiang Wang, Hua Wang, Shengcai Wang, Jun Tai, Lixing Tang, Jingang Gui, Jie Zhang, Xin Ni
Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is a rare benign neoplasm of the respiratory mucosa caused by human papilloma virus. Previous studies on the possible associations between HLA alleles and JORRP have shown various results in different ethnic groups. The present study aims to investigate the association between JORRP and HLA class II DRB1and DQB1 alleles in Chinese Han children. We found that the frequencies of HLA-DRB1*03:01 (pc = 0.0378, OR = 4.8) and HLA-DQB1*02:01 (pc = 0.021, OR = 4.8) alleles were significantly higher in patients with JORRP than in controls. In addition, HLA-DRB1*03:01 allele significantly correlated with aggressive JORRP (r = 0.467, p = 0.009). This was the first study on the HLA alleles in Chinese Han patients with JORRP. Future studies are required to further elucidate the correlation of HLA class II alleles and susceptibility to JORRP.



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Western herbal medicine is a useful adjunct to traditional dermatological practice

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Topical evening primrose oil as a possible therapeutic alternative in children with molluscum contagiosum

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Satoyoshi syndrome—A case report from India

Abstract

Satoyoshi syndrome was first reported in Japan in 1967. It is a rare multisystem disorder of presumed autoimmune etiology that is characterized by alopecia, intermittent painful muscle spasms, diarrhea, and antinuclear antibody positivity. We report an 11-year-old girl with Satoyoshi syndrome who presented to the dermatology department for treatment of alopecia universalis. We present this case to emphasize the importance of recognizing Satoyoshi syndrome, which could go unnoticed if not suspected.

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Effect of biopsy site on detection of gastric cancer high-risk groups by OLGA and OLGIM stages

Abstract

Background/Aims

The operative link for gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems are recommended to assess the severity of gastritis, but the optimal biopsy sites have not been clearly defined. We aimed to investigate whether the scoring of the OLGA and OLGIM stages was affected by the use of different biopsy sites.

Methods

Between 2014 and 2015, to determine OLGA and OLGIM stages, seven biopsy samples were obtained from the antrum (lesser and greater curvatures [LG] of the antrum and lesser curvature of the angle) and corpus (LG and anterior and posterior walls [AP]) in 247 patients diagnosed with gastritis, gastric adenoma, or adenocarcinoma. The OLGA and OLGIM stages were scored using four different protocols: antrum + angle + corpus LG, antrum + angle + corpus AP, antrum + corpus LG, and antrum + corpus AP. High-risk group included patients who had OLGA or OLGIM stages III and IV.

Results

For the OLGA stage, the angle + antrum + corpus LG protocol placed more patients in the high-risk group (64.4%) than the angle + antrum + corpus AP (55.5%, P < .001), antrum+corpus LG (59.5%, P = .031), and antrum + corpus AP (47.8%, P < .001) protocols. Likewise, for the OLGIM stage, the angle + antrum + corpus LG protocol placed more patients in the high-risk group (48.6%) than the angle + antrum + corpus AP (46.2%, P = .134), antrum + corpus LG (36.8%, P < .001), and antrum + corpus AP (37.2%, P < .001) protocols.

Conclusions

To prevent underestimation of OLGA and OLGIM stages, it is necessary to include an angle biopsy, and to obtain corpus biopsy specimens from lesser and greater curvature sites rather than from anterior and posterior wall sites.

http://ift.tt/2yu9pWY

Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan

Abstract

Aim

Bhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions.

Methods

A cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H. pylori immunoglobulin G (IgG) by commercial ELISA kits.

Results

There were 327 children between 4 and 19 years of age participated, 44% boys, mean age = 13.6 ± 3 years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P = .42. H. pylori prevalence was 75% among both 4-7 and 15-19 years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P = .1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR = 2.3; 95%CI = 0.9-1.7), P = .08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR = 1.7, 95% CI = [1.0-2.6], P = .05).

Conclusions

H. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.

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Editor's Choice

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The British Skin Foundation: 20 years of supporting dermatology research

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Plain language summaries

Linked Comment: Wang et al. Br J Dermatol 2017; 177:656–665

Linked Comment: Langton et al. Br J Dermatol 2017; 177:818–827

Linked Comment: Lott et al. Br J Dermatol 2017; 177:845–853

Linked Comment: Smith et al. Br J Dermatol 2017; 177:628–636

Linked Comment: Smit et al. Br J Dermatol 2017; 177:779–790

Linked Comment: González-López et al. Br J Dermatol 2017; 177:688–695

Linked Comment: Xie et al. Br J Dermatol 2017; 177:809–817

Linked Comment: Ridd et al. Br J Dermatol 2017; 177:719–734

Linked Comment: Al-Jefri et al. Br J Dermatol 2017; 177:837–844

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Why should dermatologists think of liver fibrosis?

Linked Article: Potts et al. Br J Dermatol 2017; 177:637–644.

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Melanoma burden, healthcare utilization and the potential for overdiagnosis in the elderly U.S. population

Linked Article: Lott et al. Br J Dermatol 2017; 177:845–853.

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Applying qualitative research in dermatology: understanding lived experience

Linked Article: Corr et al. Br J Dermatol 2017; 177:771–778.

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Glucagon-like peptide-1 agonists for treatment of hidradenitis suppurativa

Linked Article: Jennings et al. Br J Dermatol 2017; 177:858–859.

http://ift.tt/2flqGwO