Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Materials and methods

We investigated the surface marker expressions of tumour tissue-infiltrating lymphocytes quantitatively and classified them based on their functional populations. We extracted 109 sets of tumour tissue-infiltrating lymphocytes from 80 patients who underwent surgical resection of renal cell carcinoma, of which 44 tumour tissue-infiltrating lymphocytes were multiply extracted from 15 patients. Each tumour tissue-infiltrating lymphocyte was characterised on the basis of functional T-cell populations using ten surface marker expressions measured by flow cytometry.

Results

All sets of the tumour tissue-infiltrating lymphocytes were classified into three groups, which correlated significantly with Fuhrman grade (OR 0.253, 95% CI 0.094–0.678, P = 0.006). Importantly, both overall metastasis-free survival (HR 0.449, 95% CI 0.243–0.832, P = 0.011) and recurrence-free survival (HR 0.475, 95% CI 0.238–0.948, P = 0.035) of the patients with the higher marker expressions were significantly inferior to those of the patients with the lower marker expressions by multivariate analysis. Six specific genes for this classification identified by microarray analysis verified our results using the TCGA KIRC data set. In addition, we discovered the presence of intra-tumoural diversity in the classification of 3 (20%) of the 15 patients.

Conclusions

This study showed that the presence of classable diversity in the immunological signature of tumour tissue-infiltrating lymphocytes correlated with prognosis and tumour aggressiveness that was observed even within individual tumours in some patients with renal cell carcinoma.

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Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

Abstract

Background

Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.

Methods

Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml⁻¹ remifentanil with 0.05 μg kg⁻¹ h⁻¹ naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml⁻¹ remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.

Results

The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22–3.84) vs 3.84 (3.76–4.00) vs 3.80 (3.69–4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.

Conclusions

The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.

Clinical trial registration

NCT02856087.

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Role of in-situ simulation for training in healthcare: opportunities and challenges.

Purpose of review: Simulation has now been acknowledged as an important part of training in healthcare, and most academic hospitals have a dedicated simulation center. In-situ simulation occurs in patient care units with scenarios involving healthcare professionals in their actual working environment. The purpose of this review is to describe the process of putting together the components of in-situ simulation for training programs and to review outcomes studied, and challenges with this approach. Recent findings: In-situ simulation has been used to 'test-drive' new centers, train personnel in new procedures in existing centers, for recertification training and to uncover latent threats in clinical care areas. It has also emerged as an attractive alternative to traditional simulations for institutions that do not have their own simulation center. Summary: In-situ simulation can be used to improve reliability and safety especially in areas of high risk, and in high-stress environments. It is also a reasonable and attractive alternative for programs that want to conduct interdisciplinary simulations for their trainees and faculty, and for those who do not have access to a fully functional simulation center. Further research needs to be done in assessing effectiveness of training using this method and the effect of such training on clinical outcomes. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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NonOperating Room Anesthesia: distancing from invasive surgery, embracing the era of interventional medicine.

No abstract available

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Recent advances of simulation in obstetric anesthesia.

Purpose of review: Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. Recent findings: Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. Summary: Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Evaluation of fibroblast growth factor activity exerted by placental extract used as a cosmetic ingredient

Summary

Background

The biological activities claimed for placental extract (PE) in its medical and cosmetic applications are largely assumed to be the combined effects of its various signaling molecules and nutritional constituents. But there are considerable uncertainties about this assumption.

Aims

To determine the specific biological activity of PE at a molecular level.

Methods

Fibroblast growth factor (FGF) activity was assessed based on the ability to induce proliferation of FGF receptor (FGFR)-overexpressing BaF3 cells.

Results

Porcine PE (PPE), an ingredient in numerous cosmetics, activated proliferation of BaF3 cells overexpressing FGFR subtypes 1c, 2c, 2b, 3c, or 4, that is, all the major FGFR subtypes. The effect was suppressed largely or partially when the cells were treated with a FGFR inhibitor PD173074, and the FGFR-negative BaF3 parent cells exhibited minimal growth promotion as compared to the FGFR-expressing BaF3 cells. The high (>10 kDa) and low (<3 kDa) molecular weight fractions of PPE were effective activators of FGFR signaling. PPE was found to contain sulfated glycosaminoglycans, including heparin/heparan sulfate and chondroitin sulfate, which serve as both structural stabilizers of FGFs and indispensable cofactors for FGF-FGFR signaling.

Conclusions

These results indicate that PPE is capable of evoking FGF signaling in cells via FGFRs. Given that recombinant FGFs have proven useful for medical/cosmetic purposes, our results suggest that the medical/cosmetic utility of PPE is provided at least partly through the activation of FGF signaling in epidermal, dermal, and subdermal tissues.

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Novel immunologic mechanisms in eosinophilic esophagitis

Julie M Caldwell | Misu Paul | Marc E Rothenberg

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Urinary biomarker CXCL10, identifying site specific allograft inflammation in renal transplantation.

No abstract available

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Altered Th17 pathway in tolerant kidney transplant patients: a 'chicken-or-the-egg' dilemma?.

No abstract available

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Long-term effects of pancreas transplantation on diabetic retinopathy and incidence and predictive risk factors for early worsening.

Background: Limited data are available regarding the long-term effects of pancreas transplantation on the progression of diabetic retinopathy (DR) and the incidence of and associated risk factors for early worsening of DR. Methods: Patients who underwent successful pancreas transplantation between January 2007 and October 2015 and were followed for >= 1 year were consecutively enrolled. Variables regarding demographic, systemic, metabolic, and surgical factors were reviewed for each patient. DR progression was defined as i) development or aggravation of macular edema requiring intravitreal injections and/or ii) progression of DR severity requiring panretinal photocoagulation (PRP) and/or pars planar vitrectomy (PPV). Early worsening was defined as progression within 1 year of posttransplant. Results: Three hundred and 3 eyes of 153 patients were included in the analysis. At the pretransplant ocular evaluation, 221 eyes (72.9 %) showed advanced DR with history of PRP and/or PPV. During a mean follow-up period of 4.2 years, 62 eyes (20.5%) experienced DR progression, and early worsening was noted in 57 eyes (18.8%). DR with recent PRP within pretransplant 1 year and pancreas transplant alone were significant risk factors for early worsening. Conclusions: In 4 out 5 patients who received pancreas transplant, the degree of DR remained stable over time after transplantation. Meanwhile, early worsening of DR could occur in patients at risk, particularly within the first posttransplant year. We suggest that physicians should have a high index of suspicion and carefully monitor for early worsening of DR, and timely manage possible ocular deterioration. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Marked decrease in urgent listing for liver transplantation over time: evolution of characteristics and outcomes of Status-1 liver transplantation.

Background: Approximately 5% of liver transplants annually are performed urgently with "status-1" designation. This study aims to determine if the demand, characteristics and outcome for status-1 liver transplantation has changed over time. Methods: We utilized the Scientific Registry of Transplant Patients (2003-2015) to characterize 2352 adult patients who underwent 2408 status-1 liver transplants and compared them between Era1 (2003-6/2009) and Era2 (7/2009 -2015). Results: Overall, there were fewer liver transplants performed with the Status-1 designation in Era2 than Era1 (1099 vs 1309). Although the number of urgent liver transplants was relatively constant with successive years, the proportion transplanted with Status-1 designation decreased markedly over time. Era2 patients were older (43.2 vs 41.7 years, p=0.01) and less likely be ABO-incompatible (1.1% vs 2.4%, p=0.01) or re-transplant (77 vs 124, p=0.03). In terms of disease etiology, the largest group was "ALF, nonspecified" (43.4%). There was no difference in proportion with drug-induced liver injury (DILI), but the subset of herbal/dietary supplements increased in Era2 (1.3% vs 0.46 %, p=0.04). Survival was increased in Era2 in the overall cohort and for patients with autoimmune disease (p

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Role of human CD200 overexpression in pig-to-human xenogeneic immune response compared with human CD47 overexpression.

Background: Macrophages play important roles in xenograft rejection. Here, we investigated whether overexpression of human CD200 or CD47 in porcine endothelial cells (PEC) can suppress macrophages activation in xenogeneic immune responses. Methods: PECs and human macrophages were incubated together, harvested and analyzed for in vitro macrophage phagocytic and cytotoxicity activity, and cytokine release. Next, PEC were injected into renal subcapsular space of humanized mice. On day 10 posttransplantation, we analyzed xenograft survival and perigraft inflammatory cell infiltrations in PEC-to-humanized mouse transplantation. Results: PECs highly expressing human CD200, CD47, or both CD47/CD200 were established by lentiviral vector transduction. Both CD200 and CD47 suppressed in vitro macrophage phagocytic and cytotoxic activity against PECs; decreased TNF-[alpha], IL-1[beta], and IL-6 secretion; and increased IL-10 secretion. However, simultaneous overexpression of CD200 and CD47 did not show additive effects. Next, PECs were transplanted into NSG mice, and human monocytes and lymphocytes were adoptively transferred 1 day after xenotransplantation. PEC xenograft cell death and apoptosis were decreased in the CD200-PEC and CD47/CD200-PEC groups. Perigraft infiltration of human T cells was suppressed by CD47; CD200 suppressed infiltration of human macrophages to a greater extent than CD47; and the CD47/CD200-PEC group exhibited the lowest level of leukocyte infiltration. In summary, overexpression of CD200 in PECs suppressed xenogeneic activation of human macrophages and improved survival of PEC xenografts in humanized mice; however, co-expression of CD200 and CD47 did not show additive effects. Conclusions: Therefore, overexpression of human CD200 in donor pigs could constitute a promising strategy for overcoming xenograft rejection. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Coexistence of Bilirubin >=10 mg/dL and Prothrombin Time-International Normalized Ratio >=1.6 on Day 7: A Strong Predictor of Early Graft Loss after Living Donor Liver Transplantation.

Background: Early allograft dysfunction (EAD) defined by serum total bilirubin (TB) >=10 mg/dL or prothrombin time-international normalized ratio (PT-INR) >=1.6 on postoperative day 7 (POD7) or aminotransferase >2000 IU/L within the first week, is associated with early graft loss after deceased-donor liver transplantation. We aimed to determine the prognostic impact of the EAD definition in living-donor liver transplantation (LDLT). Methods: We analyzed the validity of the EAD definition and its impact on early graft survival in 260 adult recipients who underwent primary LDLT. Results: Eighty-four (32.3%) patients met the EAD criteria; 59 (22.7%) and 46 (17.7%) patients had TB >=10 mg/dL and PT-INR >=1.6 on POD7, respectively, and 22 (8.5%) patients satisfied both criteria. Graft survival differed significantly when stratified according to TB >=10 mg/dL and PT-INR >=1.6 (p=1.6 resulted in higher graft mortality (RR=3.87, p<.0001 at rr="2.97," p as did tb>=10 mg/dL (RR=1.89, p=0.027 at 90-day; RR=1.91, p=0.006 at 180-day). Coexistence of TB >=10 mg/dL and PT-INR >=1.6 was strongly associated with early graft loss (59.1%, RR=6.97 at 90-day; 68.2%, RR=5.75 at 180-day). In Cox regression analysis, PT-INR >=1.6 and TB >=10 mg/dL on POD7 were significant risk factors for early graft loss (hazard ratio =4.10 [95% CI: 2.35-7.18], p=10 mg/dL and/or PT-INR >=1.6 on POD7 predicted early graft loss after LDLT, and their coexistence worsened patient outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Monocyte and macrophage immunometabolism in atherosclerosis

Abstract

Atherosclerosis is characterized by chronic low grade inflammation of arteries that results in the development of lipid dense plaques. Chronic inflammation induced by Western-type diet is associated with the risk of developing atherosclerosis, and new insights shed light on the importance of metabolic and functional reprogramming in monocytes and macrophages for progression of atherosclerosis. This review aims to provide an overview of our current understanding into how the metabolic reprogramming of glucose, cholesterol, fatty acid, and amino acid metabolism in macrophages contributes to inflammation during atherosclerosis. Recent insights suggest that transcriptional and epigenetic adaptation within innate immune cells (termed trained immunity) play an important role in the pathogenesis of atherosclerosis. We propose that metabolic changes induced by pro-atherogenic lipoproteins partly mediate these changes in trained macrophages. Finally, we discuss the possibility of manipulating cellular metabolism of immune cells for targeted therapeutic intervention against atherosclerosis.

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Preventing new sensitization and asthma onset by allergen immunotherapy: the current evidence.

Purpose of review: Specific allergen immunotherapy is considered a key candidate for a successful preventive intervention in atopic diseases. The strong association of atopic manifestations such as rhinitis and asthma with atopic sensitizations (specific serum IgE) provide a rationale for early intervention in childhood and adolescence. Recent findings: Currently, the documentation of the disease-modifying intervention effects is limited to the secondary prevention of asthma symptoms in children with allergic rhinoconjunctivitis. These effects appear to be rather allergen specific than nonspecific. Summary: Documentation on disease modification including a reduction of asthma symptoms in children, particularly with grass pollen tablets has become quite robust. It is not clear up to now, if the new onset of allergic sensitizations can be modified. So far data on primary prevention are not conclusive. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Approaches to the removal of T-lymphocytes to minimize graft-versus-host disease in patients with primary immunodeficiencies who do not have a matched sibling donor.

Purpose of review: Since the advent of T-lymphocyte depletion in hematopoietic stem cell transplantation (HSCT) for primary immunodeficiency, survival following this procedure has remained poor compared to results when using matched sibling or matched unrelated donors, over the last 40 years. However, three new techniques are radically altering the approach to HSCT for those with no matched donor, particularly those with primary immunodeficiencies which are not severe combined immunodeficiency. Recent findings: Three main techniques of T-lymphocyte depletion are altering donor choice for patients with primary immunodeficiencies and have improved transplant survival for primary immunodeficiencies to over 90%, equivalent to that for matched sibling and matched unrelated donor transplants. CD3+ T cell receptor (TCR)[alpha][beta]+ CD19+ depletion, CD45RA depletion and use of posttransplant cyclophosphamide give similar overall survival of 90%, although viral reactivation remains a concern. Further modification of CD3+ TCR[alpha][beta]+ CD19+ depletion by adding back inducible caspase-9 suicide gene-modified CD3+ TCR[alpha][beta]+ T-lymphocytes may further improve outcomes for patients with systemic viral infection. Summary: Over the last 5 years, the outcomes of HSCT using new T-lymphocyte depletion methods have improved to the extent that they are equivalent to outcomes of matched sibling donors and may be preferred in the absence of a fully matched sibling donor, over an unrelated donor to reduce the risk of graft versus host disease. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: an Italian perspective.

Purpose of review: The humanized anti-IgE antibody omalizumab has been available for patients with chronic spontaneous urticaria (CSU) in Italy since 2015. This review summarizes the unresolved issues and unmet therapeutic needs associated with omalizumab and discusses practical recommendations for its use in the management of CSU. Recent findings: Although modern second-generation H1-antihistamines are the standard of care for patients with CSU, adjunctive treatments (including omalizumab) may be required for effective control of symptoms in many patients. Evidence from clinical trials and experience from daily clinical practice suggest that the use of omalizumab in patients with CSU who have inadequate response to H1-antihistamines remains challenging. Summary: Based on current international guidelines, omalizumab labelling information and our experience in clinical practice, we provide treatment recommendations regarding the use of omalizumab in patients with CSU. These include: optimal treatment duration, the use of concomitant antihistamine therapy, the definition and management of disease relapse after treatment, and the management of patients with late or no response to treatment. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery

Objective: The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. Materials and Methods: The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. Results: There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P 

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Differential Diagnosis of Intramuscular Schwannoma of the Craniocervical Region

Abstract: Schwannomas in the head and neck are a relatively common condition. However, intramuscular schwannomas in the craniocervical region are extremely rare. The preoperative consideration of schwannomas is very important to preserve adjacent circulation and nerve function during the surgery in this area. Moreover, the treatment and preoperative evaluation of this condition is not firmly established in the past literatures. The authors successfully managed the intramuscular schwannoma in the craniocervical region, and provide the differential diagnoses with appropriate treatments.

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Dissemination of Information: From the Stone Age to the Social Media of Facebook

No abstract available

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Mean Platelet Volume, Red Cell Distribution Width, and Neutrophil-to-Lymphocyte Ratio Before and After Surgery in Patients With Carotid Body Tumors

Objective: Carotid body tumors (CBTs) are rare hypervascular benign tumors that originate from the paraganglia at the carotid bifurcation. The red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV) may serve as markers in inflammatory, cardiovascular, and neoplastic diseases. However, their prognostic value in CBTs is unknown. The purpose of this study was to assess the leukocyte count, MPV, RDW, and NLR before and after surgery in patients with CBTs. Methods: This retrospective trial included data from 80 patients with CBTs and 65 age-matched healthy controls. The leukocyte, neutrophil, lymphocyte and platelet counts, RDW, and MPV were extracted and NLR was calculated from the complete blood count results of participants. Results: The leukocyte and neutrophil counts as well as RDW levels were significantly increased in patients with CBTs compared with healthy controls (P = 0.005, P = 0.003, and P = 0.026; respectively). Patients with CBTs had lower lymphocytes counts (P = 0.241) and higher NLRs (P = 0.054); however, the difference was statistically insignificant. Moreover, no statistically significant difference was detected between groups in terms of platelet counts and MPV levels. Furthermore, the leukocyte count, platelet numbers, MPV, RDW, and NLR levels in patients with CBTs were not statistically significant after surgery (all; P > 0.05). Conclusion: This is the first study that documents the increased RDW levels and leukocyte count in patients with CBTs. The combined use of RDW and the leukocyte count along with other clinical assessments can be used as a biomarker for CBTs. Further clinical trials with larger cases series are required to determine the actual predictive roles of these systemic biomarkers.

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Stimuli-Responsive Biomaterials: Next Wave

No abstract available

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Review of “Alopecia Following Bicoronal Incisions” by Kadakia S, Badhey A, Ashai S, Lee TS, Ducic Y in JAMA Facial Plast Surg 19: 220–224, 2017

No abstract available

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Postoperative Changes After Closed Reduction of Nasal Fracture

Abstract: Nasal bone fracture is the most common facial fracture; however, surgery does not guarantee reduction and complications, such as undercorrection, overcorrection, and deviation, may occur. By analyzing findings of computed tomography (CT) immediately and at 3 months postoperatively, we evaluated the accuracy of reduction and long-term changes to the nasal bone. Patients with pure nasal bone fracture were evaluated from January 1, 2010 to December 31, 2011. First, we categorized fracture types according to the Stranc-Robertson classification system, using preoperative CT findings (ie, F1, F2, L1, and L2). We categorized each result of reduction by immediate postoperative CT scan findings as "Excellent," "Good," "Fair," and "Poor," with "Excellent" and "Good" ratings being considered a "Success." We evaluated changes to the nasal bone at 3 months after reduction, using the same grade. A total of 128 patients were analyzed. The results of patients in the F1 group were better than those of other patients immediately postoperatively, whereas those of the L2 group were worse. The overall success rate was 49.2% (58/118). At 3 months postoperatively, 33 cases exhibited an improvement to a higher grade, whereas 25 cases improved from an unacceptable outcome to a successful outcome, with the overall success rate being 70.3% (83/118). Immediately postoperative CT scans can be helpful for surgeons in determining whether a secondary adjustment is necessary. Incompletely reduced nasal bone showed spontaneous improvement in bony arrangement according to our study, so simple observation could be a choice.

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Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate

Introduction: The aim of the authors' study was to evaluate the effects of protraction face-mask therapy on the craniofacial and upper airway morphology in patients with unilateral cleft lip and palate (UCLP). Methods: Twenty-three growing UCLP patients (mean age: 8.3 + 2.4) were enrolled in the study group. Protraction face-mask in combination with Hyrax appliance was applied for the correction of anterior crossbite and maxillary insufficiency. Twenty-six patients with maxillary retrusion (mean age: 8.1 + 2.5) were evaluated as the control group. The pharyngeal airway morphology was assessed via the area measurements of upper airway structures on the lateral cephalometric radiographs. Results: The upper airway morphology was similar compared with the control group subjects at the beginning of the treatment. The pharyngeal airway area was increased significantly following the maxillary expansion and protraction. Nasopharyngeal area increased and the oropharyngeal area decreased significantly. There was an increase in the sagittal and vertical dimensions after the protraction therapy. Conclusion: The pharyngeal morphology in both UCLP patients and control group patients was similarly improved with the protraction face-mask therapy.

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Osseous Flap of Galea and Periosteum Filled With Mesenchymal Stem Cells, Platelet-Rich Plasma, Bone Dust, and Hyaluronic Acid

Abstract: Reconstructive surgery to craniofacial deformities caused by tumor ressections, traumas or congenital malformation are frequent in medicine practice. It aims to provide the patients with better quality of life and functional improvement of speech, breathing, chewing, and swallowing. Many are the techniques described in the literature to recover bone defects. This study evaluated a vascularized galeal and periosteum flap in rabbits, which could possibly substitute the bone graft in reconstructive surgery, especially for facial defects. It involved rabbits, divided into 12 groups, submitted to a surgical procedure to construct the galea and periosteum cranial flap filled with fragments of cranial bone, platelet-rich plasma, mesenchimal stem cells, and hyaluronic acid. The evaluation methods included image examinations and histological analysis. The results demonstrated bone formation with the use of platelet-rich plasma, mesenchimal stem cells, and bone fragments. The use of several enrichment materials of osseous cellular stimulation improved the quality and bone tissue organization. The more enrichment factor used, the better the tissue quality result was. Much research should be done to improve the methods and to analyze if results in human have the same bone formation as it happened in rabbits.

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Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain

Objective: The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method. Study Design: A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period. Methods: After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time. Results: A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P 

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Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip

Introduction: The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. Methods: The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Results: Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P

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Olfactory Dysfunction Associated With Neuro-Behçet Disease

Introduction: Neurologic involvement associated with Behçet disease (BD) is defined as a different entity: Neuro-Behçet disease (NBD). Behçet disease presents with olfactory dysfunction. It is not known whether this is the consequence of mucosal involvement or neurologic involvement. Objective: The aim of this study was to investigate whether olfactory dysfunction was further aggravated as the result of neurologic involvement. Methods: Sixteen patients diagnosed with NBD and 16 healthy control patients with similar demographic characteristics were recruited as the healthy control group. Expanded Disability Status Scale (EDSS) scoring was used for quantification of neurological disability. All diagnoses were confirmed and categorized with magnetic resonance imaging studies in all patients individually: parenchymal or nonparenchymal. A well-established test of orthonasal olfaction developed at the CCCRC was used. Correlation analysis was carried out. Results: The mean CCCRC score of NBD patients was 4.60 out of 7, and this group was diagnosed to be moderately hyposmic, whereas the average score of the control group was 6.5; the difference was significant (P 

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Analysis of Orbital Volume Measurements Following Reduction and Internal Fixation Using Absorbable Mesh Plates and Screws for Patients With Orbital Floor Blowout Fractures

Introduction: Hinge-shaped fractures are common type of orbital floor blowout fractures, for which reduction and internal fixation is ideal. Nonetheless, orbital floor reconstruction using alloplastic materials without reducing the number of bone fragments is the most frequently used procedure. Therefore, this study analyzed and compared the outcomes between open reduction and internal fixation using absorbable mesh plates and screws, and orbital floor reconstruction, by measuring the orbital volume before and after surgery. Method: Among patients with orbital floor blowout fractures, this study was conducted on 28 patients who underwent open reduction and internal fixation, and 27 patients who underwent orbital floor reconstruction from December 2008 to September 2015. The mechanism of injury, ophthalmic symptoms before and after surgery, and the degree of enophthalmos were examined; subsequently, the volumes of the affected and unaffected sides were measured before and after surgery based on computed tomography images. This study compared the degree of recovery in the correction rate of the orbital volume, ophthalmic symptoms, and enophthalmos between the 2 groups. Result: The patients who underwent open reduction and internal fixation, and the patients who underwent orbital floor reconstruction showed average correction rates of 100.36% and 105.24%, respectively. Open reduction and internal fixation showed statistically, significantly superior treatment outcomes compared with orbital floor reconstruction. The ophthalmic symptoms and incidence of enophthalmos completely resolved in both groups. Conclusion: For orbital floor blowout fractures, open reduction and internal fixation using absorbable mesh plates and screws was a feasible alternative to orbital floor reconstruction.

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Reconstruction of Zygomaticomaxillary Buttress With Mandibular Ramus Bone Graft in Atrophic Maxillary Fracture

No abstract available

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Distraction of Fronto-Orbital Segment as a Nonvascularized Bone Graft in Craniosynostotic Patients

Abstract: Fronto-orbital advancement using distraction techniques involves the dura left attached to the osteotomized bone segment to avoid dead space formation and dural injury, whereas it is impossible to reshape the supraorbital bar and the frontal bone complex, when necessary. Our approach combines advantageous parts of conventional and distraction osteogenesis techniques as remodel and distract the supraorbital bar and frontal bone complex as a free bone graft. Twenty-seven patients either being syndromic and nonsyndromic craniosynostosis, with at least 3 years of follow-up were reviewed in this study. Mean age of the patients at the time of the operation was 23.44 ± 18.42 months and mean operative time was 4.96 ± 0.97 hours. Blood transfusion was required in all patients, with an average of 112.04 ± 44.60 mL. Amount of the distraction ranged 10 to 30 mm, a mean of 17.26 ± 4.71 mm for the right side and 18.15 ± 4.69 mm for the left side. Mean duration of consolidation was 98.26 ± 12.98 days and mean follow-up was 41.33 ± 22.92 months. In this study, result of internal distraction of fronto-orbital segment as a nonvascularized bone graft in craniosynostotic patients is reviewed to emphasize the efficacy of the nonvascularized bone graft distraction in management of craniosynostosis. Graft distraction after fronto-orbital and cranial vault remodeling appears to be safe and effective approach in correcting severe craniosynostosis deformities especially necessitating asymmetrical advancement.

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Secondary Palatal Elongation: Improvement in Speech Quality

Abstract: Cleft palate is one of the challenging problems in the field of craniofacial surgery. In particular, the conventional methods of bilateral and severe cleft palate repairs have failed to achieve normal speech. In most instances, secondary procedures such as pharyngoplasty and pharyngeal flap surgery are performed to improve speech. This study introduces secondary palatal elongation (SPE) as a new approach to cleft palate repair. The patients included usually had a short palate and unrepaired palatal muscles. The authors' procedure involved dissecting the previously repaired palatal mucosa and pushing back and cutting the nasal mucosa of the palate horizontally and further pushing it back. Then, 1 or 2 buccal mucosal flaps were used to repair the nasal mucosal defect of the palate. In case of unrepaired veloplasty from the primary surgery, the levator muscles were dissected and sutured together to perform veloplasty. The range of palatal elongation was 15 to 25 mm. Secondary palatal elongation has been performed on 17 patients since 2007 with a high rate of speech improvement. Based on this 9-year experience with performing SPE, SPE is a radical anatomic technique of palatal elongation as compared with pharyngoplasty and pharyngeal flap surgery. All 17 patients who underwent SPE showed improvement in speech, from very poor to poor speech and from normal to good speech.

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The Effect of External Approach Septoplasty on Olfactory Function

Objective: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. Methods: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. Results: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. Conclusion: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.

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An Epithelioid Hemangioendothelioma of the Head and Neck

Abstract: An epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of the head and neck region, which carries a risk of recurrence and metastasis. Its etiology is still unclear. It frequently involves the lungs, liver, and bones. Rarely, it may manifest in other parts of the body. Pathologic immunohistochemical investigations are essential to make the definite diagnosis. As it is uncommon, there is no standardized protocol for the treatment of EHE. Herein, the authors report a rare patient with of an EHE localized in the head and neck region.

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Surgical Outcome of Simplified Horse-Shoe Technique With the Traditional Procedure in Children With Trigonocephaly

Abstract: Trigonocephaly is one of the most common types of craniosynostosis leading to triangular-shaped head and neurodevelopmental complications. Several surgical techniques have been suggested for its correction, but the newly suggested technique seems to have optimal outcomes compared with the traditional methods. Thus, the authors retrospectively evaluated the outcomes of the simplified horse-shoe technique with previous procedures performed on 169 children severe trigonocephaly during 1996 to 2015 at Mofid Hospital, Tehran, Iran. Demographic data of the patients and the surgical outcomes and complications and the need for reoperation were recorded and scored using the Whitaker system. The male-to-female ratio was 2.75:1. The mean ±  standard deviation age of all the patients at the time of surgery was 7.09 ± 7.5, 9.95 ± 7.71, 10.53 ± 6.57, and 10.59 ± 7.96 months for the traditional, horse-shoe, and simplified horse-shoe techniques, respectively. The total reoperation rate was 6.5% (4.7% in the traditional technique, 1.2% in the horse-shoe, and 0.6% in the simplified horse-shoe technique) (P 

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Is Horizontal Mattress Suturing More Effective Than Simple Interrupted Suturing on Postoperative Complications and Primary Wound Healing After Impacted Mandibular Third Molar Surgery?

Abstract: The aim of this clinical study was to compare the influence of 2 different suturing techniques on postoperative complications and wound healing after surgical extractions of impacted mandibular third molars. In this randomized split mouth study, 30 patients were examined in whom 60 consecutive surgical extractions of symmetrically positioned impacted mandibular third molars were performed. After the extractions, the surgical flaps were sutured with either the simple interrupted or horizontal mattress suturing technique. Postoperative swelling and trismus were recorded on the 2nd, 7th, and 10th days. Pain was recorded in a 7-day diary and wound dehiscence was recorded on the10th postoperative day. Statistical evaluation of data was made using Mann–Whitney U test and Pearson correlation. There were no statistical differences between the 2 suturing techniques in terms of postoperative pain, trismus, and swelling (P > 0.05). There was significantly less wound dehiscence in the horizontal mattress suturing group than in the simple interrupted suturing group (P: 0017). According to the results of this study, the horizontal mattress suturing technique is more effective than the simple interrupted suturing technique on wound healing after impacted mandibular third molar surgery, although it does not decrease the levels of pain, trismus, and swelling.

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Attentional Modulation of Envelope-Following Responses at Lower (93–109 Hz) but Not Higher (217–233 Hz) Modulation Rates

Abstract

Directing attention to sounds of different frequencies allows listeners to perceive a sound of interest, like a talker, in a mixture. Whether cortically generated frequency-specific attention affects responses as low as the auditory brainstem is currently unclear. Participants attended to either a high- or low-frequency tone stream, which was presented simultaneously and tagged with different amplitude modulation (AM) rates. In a replication design, we showed that envelope-following responses (EFRs) were modulated by attention only when the stimulus AM rate was slow enough for the auditory cortex to track—and not for stimuli with faster AM rates, which are thought to reflect 'purer' brainstem sources. Thus, we found no evidence of frequency-specific attentional modulation that can be confidently attributed to brainstem generators. The results demonstrate that different neural populations contribute to EFRs at higher and lower rates, compatible with cortical contributions at lower rates. The results further demonstrate that stimulus AM rate can alter conclusions of EFR studies.

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Colonization of the middle turbinate

Publication date: Available online 2 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Djian, A.-L. Gaultier, S. Chartier, O. Laccourreye




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Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors.

Background: A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed. Methods: Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator. Results: Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software. Conclusions: With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas. (C) 2017 by Mutaz B. Habal, MD.

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Management of a Brain Abscess Presumably Caused by Radiation Osteomyelitis of the Mandible.

In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital. A computed tomography scan showed a tumor lesion in the brain that was diagnosed as a brain abscess by magnetic resonance imaging. Neurosurgeons performed burr hole drainage of the abscess, followed by administration of antibiotics. Although impaired fine movements of the left hand remain, progress has been relatively favorable with no recurrence of osteomyelitis or brain abscess post-surgery. (C) 2017 by Mutaz B. Habal, MD.

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Efficacy of Surgery in the Treatment of Moyamoya Disease Compared With Medical Treatment.

No abstract available

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Melanotic Neuroectodermal Tumor of Infancy in the Maxilla.

Melanotic neuroectodermal tumor of infancy is uncommon and has rapid expansile growth. Melanotic neuroectodermal tumor of infancy is a very rare and benign but locally aggressive neoplasm that originates from neural crest and is composed of relatively primitive pigment-producing cells. The lesion commonly affects the maxilla of infants during the first year of life. Common treatment methods include surgical excision and resection of the tumor. The aim of this article is to present the diagnosis and treatment of a patient with melanotic neuroectodermal tumor that occurred in the anterior maxilla of a 6-month-old male baby. (C) 2017 by Mutaz B. Habal, MD.

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A Novel Reverse Periauricular Flap Reconstruction Method That Uses Additional Anastomosis to Avoid Venous Congestion for Periorbital Defects.

The aim of this study was to introduce and evaluate a method to prevent venous congestion in periauricular flap pedicled on the frontal branch of the superficial temporal artery (STA). Flaps based on the STA are therefore extremely versatile in reconstruction of the face and scalp. The literature on reconstructive possibilities provided by temporal flaps describes venous congestion, but there are currently no methods for preventing this problem. In this brief report, we describe a method to anastomose the parietal branch of superficial temporal vein and the middle temporal vein to ensure venous flow when a concomitant vein of the frontal branch of the STA is unavailable. The flap survived without venous congestion and donor sites healed with satisfactory outcomes. Color and texture match of the flap were excellent and morbidity at the donor site was usually minimal. Level of Evidence: IV (C) 2017 by Mutaz B. Habal, MD.

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Intraoral Excision of a Huge Cheek Lipoma.

Lipomas are benign tumors of mature adipocytes unusual in the oral and maxillofacial region. The average size of cheek lipomas in the literature ranges from 1.5 to 2.5 cm, with the maximum size of 5 cm. Their etiology remains unclear. Lipomas present, clinically, as well circumscribed, slow growing, painless masses, usually treated by complete excision. The aim of this paper is to present a 78-year-old Caucasian male patient with a huge cheek lipoma compromising facial esthetics and treated through an intraoral excision. Postoperative period was uneventful with no signs of recurrence. Concluding, the intraoral approach is a relatively simple technique that should be taken into account when considering the surgical removal of cheek lipomas. (C) 2017 by Mutaz B. Habal, MD.

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Postradiotherapy Prosthetic Management of Mandible Reconstructed With Fibular Graft.

Intraoral defects secondary to resection of mandible leading to mandibular discontinuity are very complicated to treat as the muscles exert forces on the residual portion of the mandible. Primarily this leads to disfigurement of the face. These forces also make mastication difficult due to imbalance. Ultimately it leads to poor quality of life for the patient. Apart from that the clinical outcome and prognosis of prosthetic rehabilitation of such patients is very poor. The composite fibular flap is the preferred donor site for reconstruction of most complex orofacial-mandibular defects. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. After reconstruction with free fibula graft, planning for prosthodontic rehabilitation by various methods can be carried out. Treatment strategy is dependent on the intraoral situation and patient's acceptance. This article reports various treatment considerations for implant retained prosthetic rehabilitation in a patient who had undergone mandibular reconstruction with free fibula flap. (C) 2017 by Mutaz B. Habal, MD.

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Unusual Aspergillus Infection After Dermal Filler Injection.

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection. (C) 2017 by Mutaz B. Habal, MD.

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"Internet of Things" Real-Time Free Flap Monitoring.

Background: Free flaps are a common treatment option for head and neck reconstruction in plastic reconstructive surgery, and monitoring of the free flap is the most important factor for flap survival. In this study, the authors performed real-time free flap monitoring based on an implanted Doppler system and "internet of things" (IoT)/wireless Wi-Fi, which is a convenient, accurate, and efficient approach for surgeons to monitor a free flap. Methods: Implanted Doppler signals were checked continuously until the patient was discharged by the surgeon and residents using their own cellular phone or personal computer. If the surgeon decided that a revision procedure or exploration was required, the authors checked the consumed time (positive signal-to-operating room time) from the first notification when the flap's status was questioned to the determination for revision surgery according to a chart review. To compare the efficacy of real-time monitoring, the authors paired the same number of free flaps performed by the same surgeon and monitored the flaps using conventional methods such as a physical examination. Results: The total survival rate was greater in the real-time monitoring group (94.7% versus 89.5%). The average time for the real-time monitoring group was shorter than that for the conventional group (65 minutes versus 86 minutes). Conclusions: Based on this study, real-time free flap monitoring using IoT technology is a method that surgeon and reconstruction team can monitor simultaneously at any time in any situation. (C) 2017 by Mutaz B. Habal, MD.

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Reconstruction of an Alar Defect With a Fusiform Nasolabial Turnover Flap With a Proximal, Superiorly Tapered Apex.

The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site. (C) 2017 by Mutaz B. Habal, MD.

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A Study on the Effects of the Use of Propofol in Experimental Model Inferior Epigastric Island Flap on Ischemia-Reperfusion Injury.

Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap. Thirty Sprague-Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P

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Clinical Application of Acellular Dermal Matrix in the Treatment of Aplasia Cutis Congenita on Scalp.

Aplasia cutis congenita (ACC), also called cutis aplasia, is a rare congenital abnormality characterized by focal defect of the skin at birth, frequently involving the scalp, but may affect any region of the body. Approximately 80% of patients have the defect confined to the skin and generally less than 2 cm diameter, which can be managed conservatively with dressing alone. However, some patients present large cutaneous defects and aplasia of the underlying skull may also be present. The main complications of large defects include meningeal infection, bleeding, and thrombosis, which may be deadly. Some controversy remains in the literature regarding ACC treatment, with surgical and conservative treatment modalities having proponents and opponents. This article presents the first case of a newborn with full-thickness ACC lesion of the vertex healed by conservative treatment with application of acellular dermal matrix. (C) 2017 by Mutaz B. Habal, MD.

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Intraoral Observation of the Mentalis and Incisivus Labii Inferioris Muscles.

The mentalis (MT) and the incisivus labii inferioris (ILI), which are accessory muscles of the orbicularis oris (OO) muscle, form an intertwined and three-dimensionally related complex. The purpose of this study is to clarify the relationship between the MT, ILI, and OO muscles via intraoral dissection. Twenty-two sides from 11 fresh adult Caucasian cadaveric heads were used, and the MT, ILI, and OO dissected under the surgical microscope. Next, measurements of the bony attachment were carried out on another 12 sides. The fibers of the MT were separated into 2 parts: a superior and an inferior part with the former coursing anteromedially and joining the inferior part of the OO. The latter coursed anteroinferiorly to the skin of the chin. The ILI traveled anterolaterally and joined the inferior part of the OO. Inferior labial branches of the mental nerves ran on the OO. There was a significant difference (P = 0.0001) between specimens that were edentulous or had severe periodontitis with regard to the distance from the alveolar ridge to the upper side of the quadrangle when compared with specimens with mild periodontitis. However, there was no significant difference (P > 0.05) between specimens that were edentulous or had severe periodontitis specimens with mild periodontitis with regard to the distance from the inferior border of the mandible to the lower side of the quadrangle. We believe that the observations of this study could help surgeons better understand the anatomy of the chin and minimize complications following surgical and other invasive procedures in this area. (C) 2017 by Mutaz B. Habal, MD.

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Posterior Iliac Crest Bone Graft: How Much Is Enough?.

Autogenous bone grafting is the gold standard for reconstructing craniofacial defects. Mandibular defects are reliably reconstructed with free nonvascularized bone, such as from the posterior iliac crest (PIC). In light of improved imaging, including 3-dimensional computed tomography scanning, a more accurate defect estimation is possible. A strong understanding of bone graft available is necessary. The purpose of this study was an updated review of the dissection and quantification of the amount of bone that can be safely harvested. Bilateral bicortical osteotomy was performed on 55 cadavers to obtain 110 PIC bone grafts. Demographic factors and bicortical osteotomy measurements were recorded. Average osteotomy lengths, widths, and depths were 7.4, 5.5, and 1 cm, respectively. The average bicortical osteotomy volume was 40.6 cm3. During the dissection, the authors identified 2 anatomical variants with respect to muscle insertion into the PIC. In variation 1, which occurred in 62% of dissections, the latissimus dorsi and thoracolumbar fascia did not originate from the PIC. When this occurred, the quadratus lumborum attached to the PIC. In variation 2, which occurred in 38% of dissections, the latissimus dorsi and thoracolumbar fascia originate from the PIC. By identifying the maximal bone volume obtainable from a PIC graft and noting 2 anatomical variants, this study allows for more accurate surgical planning and management. (C) 2017 by Mutaz B. Habal, MD.

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Propranolol Treatment of Vascular Anomalies Other Than Infantile Hemangioma.

Background: Oral propranolol has become first-line intervention for problematic infantile hemangioma (IH) that is not amenable to topical or intralesional therapies. Consensus data supporting its efficacy for other vascular anomalies does not exist. The purpose of this study was to determine the frequency and causes of propranolol use for vascular lesions other than IH. Methods: Referrals to our Vascular Anomalies Center between 2008 and 2017 were reviewed for patients treated with propranolol at an outside institution. Patient history, photographs, imaging studies, and/or histopathology were evaluated by an interdisciplinary team to diagnose the vascular anomaly. Our center's diagnosis was compared to the referral diagnosis to categorize patients into 3 groups: Group 1 (patients were appropriately labeled with an IH); Group 2 (individuals were erroneously diagnosed with IH); and Group 3 (subjects were diagnosed with a vascular anomaly other than IH). Results: Two hundred thirty-six patients met inclusion criteria. Group 1 (39%; n = 91) had an IH and were treated appropriately. Group 2 (20%; n = 49) was misdiagnosed with IH and incorrectly received propranolol. Group 3 (41%; n = 96) was given propranolol to treat another vascular anomaly. Propranolol did not have efficacy for vascular anomalies other than IH. Conclusions: Propranolol commonly is used to treat lesions other than IH; misdiagnosis of a lesion as IH is a common cause. Propranolol should be used with caution to treat other types of vascular anomalies because patients are subjected to the risks of the drug without data supporting its efficacy. (C) 2017 by Mutaz B. Habal, MD.

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A Pediatric Patient With an Orbital Respiratory Epithelial Cyst.

Respiratory epithelial cysts are rare orbital cysts that can arise secondary to choristomatous rests of respiratory epithelium. Approximately 15 congenital cases have been described in the literature, making it a rare disease entity. We present a case of a 14-month-old Middle Eastern male with a right infraorbital respiratory epithelial cyst. Magnetic resonance imaging of the brain and orbits revealed a right infraorbital cyst hyperintense on T1-weighted images and followed fluid density on T2-weighted images. This cyst was noted to displace the globe superiorly and inferior rectus muscle laterally. This cyst was excised using a transconjunctival approach. Histologically, the cyst wall was lined by ciliated columnar cells with interspersed mucus-containing cells and ciliated transitional epithelium was present, establishing the diagnosis of respiratory epithelial cyst. To our knowledge, this is the youngest patient with a respiratory epithelial cyst of the orbit reported in the literature. (C) 2017 by Mutaz B. Habal, MD.

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Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis.

Background: Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment. Methods: A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress. Results: All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion. Conclusion: Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment. (C) 2017 by Mutaz B. Habal, MD.

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Management of Zygomatic Fixture Complication Case Using Extra-Short Implants.

The oral rehabilitation of a patient with atrophic maxilla is one of the main challenges in implant-supported rehabilitations. The implant placement in the posterior region of the maxilla is limited by a deficiency of bone quantity and quality, besides the anatomic restriction of the maxillary sinus. The use of zygoma fixtures, anchoraged in the zygomatic bone, is a useful technique to enable the full arch rehabilitation. However, complications related to this procedure bring a lot of difficulty in solving. This study presents the use of extra-short implants as a strategy to treat a patient in whom the zygoma fixture and the fixed prosthesis failed, associated with sinusitis and alveolar bone loss. (C) 2017 by Mutaz B. Habal, MD.

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Efficiency and Duration of Orthodontic/Orthognathic Surgery Treatment.

Introduction: To investigate the combined orthodontic-orthognathic treatment times at an academic hospital in the UK and to consider the level of occlusal change in delivering this treatment by the way of comparing peer assessment rating (PAR) scores pre- and post-treatment. Methods: It was a retrospective longitudinal study of orthognathic patients between 2010 and 2013 who had completed orthognathic treatment. Analysis of records of 50 patients was carried out. Age, gender malocclusion, and skeletal pattern, extraction/nonextraction of teeth, duration of active orthodontic treatment, number of appointments, transfer of patients between orthodontists mid-treatment, and PAR scores pre and post-treatment were recorded for each patient. Results: The skeletal pattern was III in 70% of and II in 28% of patients. Mean duration of active orthodontic treatment was 27.9 months. Age, gender, malocclusion, and skeletal pattern did not seem to affect treatment times. Extraction of teeth and transfer of operators increased treatment times. The mean PAR reduction was 89% with the PAR efficiency factor (reduction in PAR scores divided by duration of treatment in months) of 1.61. Younger patients, those with class III malocclusions and patients starting with higher PAR scores, achieved greater PAR reductions. Gender, number of appointments, extractions, transfer of operators, and total duration of treatment were not shown to affect the PAR % reduction. Conclusions: Combined orthodontic-orthognathic treatment has been effective in treating patients with severe skeletal discrepancies. Transfer of operators and extractions protracted treatment times. Younger patients and those with class III malocclusions achieved higher PAR % reduction. (C) 2017 by Mutaz B. Habal, MD.

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Three-Dimensional Reconstruction of the Distribution of Neurons Contributing to Ophthalmic, Maxillary, and Mandibular Nerves in the Trigeminal Ganglion of Experimental Model.

The authors introduce a new method to build a three-dimensional (3D) model of the 3 branches of the trigeminal nerve in the trigeminal ganglion of rabbit with 3 different kinds of fluorescence. Ten adult New Zealand rabbits of both sexes weighing between 2.0 and 3.0 kg were used in the experiment. Then through an operation under general anesthesia, the maxillary and mandibular nerves were exposed, and red and gold fluorescence were applied to investigate the neurons of the maxillary and mandibular nerves. Subsequently, DiI was used as a marker for the ophthalmic neuron for the other side of the same rabbit. After receiving images of the 3 branches under a fluorescence microscope, a 3D model of the 3 branches of the trigeminal nerve could be built. The authors obtained an image of the 3 branches of neurons in the trigeminal ganglion, and a 3D model of the 3 branches of the trigeminal nerve in the trigeminal ganglion was reconstructed. In the trigeminal ganglion, ophthalmic neurons were concentrated in the anteromedial section, the maxillary division in the middle, and the mandibular division posterolaterally. Overlap was observed between the ophthalmic and maxillary neurons, and also for the maxillary and mandible neurons. (C) 2017 by Mutaz B. Habal, MD.

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Psoriasis Patients Face Increased Risk of Heart Attacks and Death

People with psoriasis, a chronic inflammatory disease, may be more likely than others to experience heart attacks and strokes at least in part because inflammation damages their vascular system, a recent study suggests.
Reuters Health Information

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Liquid biopsy: An emerging prognostic and predictive tool in Head and Neck Squamous Cell Carcinoma (HNSCC). Focus on Circulating Tumor Cells (CTCs)

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): P. Economopoulou, I. Kotsantis, E. Kyrodimos, E.S. Lianidou, A. Psyrri
Molecular diversity and continuing evolution of metastatic tumors are not easily captured by tissue biopsies. Development of non-invasive diagnostic tools, such asanalysis of circulating tumor DNA (ctDNA), Circulating Tumor Cells (CTCs) and exosomes provides the opportunity to assess a blood sample in order to monitor tumor change and extract molecular information from cancers at a given time. "Liquid biopsy", which refers to molecular analysis of tumor's genetic features based on circulating genetic material in the peripheral blood, is already used to monitor disease response and track mechanisms of drug resistance in solid tumors. Head and Neck Squamous Cell Carcinoma (HNSCC) is a malignancy associated with advanced disease at presentation and dismal outcomes; furthermore, there is lack of biomarkers to monitor disease burden. Incorporation of liquid biopsy in the management of HNSCC might help identify patients with occult metastatic disease earlier and in a non-invasive manner. Herein, we aim to review current knowledge regarding CTCs and ctDNA in HNSCC and address open questions in this fast-evolving field of research.



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40-year incidence trends for oropharyngeal squamous cell carcinoma in the United States

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Nosayaba Osazuwa-Peters, Matthew C. Simpson, Sean T. Massa, Eric Adjei Boakye, Jastin L. Antisdel, Mark A. Varvares
ObjectivesTo determine differences in oropharyngeal squamous cell carcinoma (OPSCC) incidence between 1975 and 2014 stratified by race, sex, and age.Materials and methodsWe obtained age-adjusted OPSCC incidence rates for race and sex groups from 1975 to 2014 using the Surveillance, Epidemiology, and End Results 9 database. We defined OPSCC as cancers of the base of tongue, lingual/palatine tonsil, oropharynx, soft palate, uvula, and Waldeyer's ring. We used Joinpoint analyses to determine incidence trends for race/sex/age groupings.ResultsThere were 38,624 oropharyngeal primary tumors in the analyses. Males accounted for 74% of sample population, and whites accounted for 84% of tumors. Overall, there was a 57.3% increase in incidence of oropharyngeal between 1975 and 2014. For blacks and whites, average incidence was lower for females than males. Rates for black males aged ≥50years was highest for most of the follow-up time but decreased sharply around 1988 and were surpassed by the significant increase in incidence in white males aged 50–59 (1995–2014 APC=4.07, p<0.001) and ≥60years (2002–2014 APC=4.25, p<0.001). For males aged ≥60, whites had higher rates than blacks starting in 2010. OPSCC incidence in White males (10.99 per 100,000 person-years) surpassed rates in Blacks (10.14 per 100,000 person-years) beginning in 2008.ConclusionOPSCC has significantly increased in the United States in the last 40 years. This overall increase in OPSCC can primarily be attributed to white males. OPSCC prevention and early detection efforts could target these demographic factors to decrease rising OPSCC incidence.



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Cochlear Implantation in Patients with Keratitis-Ichthyosis-Deafness Syndrome: A Report of Two Cases

Background. Keratitis-ichthyosis-deafness (KID) syndrome is a syndrome which presents with hearing loss and visual and keratinization disorders. In such patients, hearing aids cannot be effectively used in the rehabilitation of hearing loss because of the frequent blockage of the external ear canal with epithelial debris and due to dry and tense skin of the external ear canal. Moreover, severe or profound hearing loss also limits the benefits gained from the conventional hearing aids. On the other hand, cochlear implantation is a method that has been used in limited cases in the literature. Case Report. This study presents the results of cochlear implantation applied in our clinic to two children who had been diagnosed with KID. Audiological assessments before and after the cochlear implant operation were performed using pure-tone audiometry, immittance audiometry, and auditory brainstem response (ABR), and the postoperative follow-up was conducted using pure-tone audiometry. Conclusion. Skin problems, visual disturbances, and other additional problems complicate the short-term and long-term rehabilitation after implantation in individuals with KID syndrome. Close monitoring should be exercised due to possible skin complications that may develop during the postoperative period. The families and rehabilitation teams should be warned about the possible visual disturbances and skin complications.

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Asthma predisposition and respiratory syncytial virus infection modulate transient receptor potential vanilloid 1 function in children's airways

Publication date: Available online 2 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Terri J. Harford, Fariba Rezaee, Rachel G. Scheraga, Mitchell A. Olman, Giovanni Piedimonte




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Transfer of maternal immunity and programming of the newborn immune system

Abstract

As placental mammals, the pregnant women and the fetus have intense and prolonged interactions during gestation. There is increasing evidence that multiple molecular as well as cellular components originating in pregnant women are transferred to the fetus. The transfer of maternal antibodies has long been recognized as a central component of newborn immunity against pathogens. More recent studies indicate that inflammatory mediators, micronutrients, microbial products and maternal cells are transferred in utero and influence the fetal immune system. Together, these multiple signals are likely to form a complex network of interactions that program the neonatal immune system and tune its homeostatic regulation. Maternal disorders, in particular infectious diseases, modify these signals and may thereby alter immunity in early life. Understanding maternal programming of the newborn immune system could provide a basis for interventions promoting child health.

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Issue Information

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Observational Study of Definitive (Chemo)Radiotherapy on Patients With Esophageal Cancer

Conditions:   Esophagus Cancer;   Chemoradiation;   Chemotherapy Effect;   Radiotherapy Side Effect
Intervention:  
Sponsors:   Chinese Academy of Medical Sciences;   Hebei Medical University Fourth Hospital;   Fujian Cancer Hospital;   Anyang Tumor Hospital;   The First Affiliated Hospital with Nanjing Medical University;   Affiliated Hospital of Hebei University;   Tianjin Medical University Cancer Institute and Hospital;   Beijing Hospital;   Tengzhou Central People's Hospital;   PLA Army General Hospital
Recruiting

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Onkologie

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Auf der Welle des „Allergie-Tsunami“ surfen

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Ranitidine-induced black tongue: A case report

Abstract

Black tongue is a rare, benign, self-limiting disorder caused by certain conditions and some medications. We report the first case of a child diagnosed with black tongue associated with ranitidine use. We report our case to emphasize the rare side effect of this frequently used drug. Health care professionals should be aware of the likelihood of ranitidine-induced black tongue in clinical practice.

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“Dots and lines”: A melanonychia striata in regression: Report of a case

Abstract

A 2-year-old Caucasian boy with melanonychia striata with multiple striking pits on the nail plate of one fingernail is described. Nail disorders often pose diagnostic and therapeutic challenges for clinicians, especially melanonychia striata, because of the fear of a subungual melanoma. Only a few childhood cases of melanonychia striata have been described, and the multiple pits are even less common. Dots distributed along melanotic lines is a finding referred to as "dots and lines" and can be a sign of regression of melanonychia in childeren.

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A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi

Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen.

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