Purpose of review: The purpose of this review is to summarize current evidence regarding treatment for muscle tension dysphonia (MTD) and to present recent advances in evaluation and management. Recent findings: It is generally accepted that voice therapy for MTD is effective, but current systematic reviews report limited evaluation specific to MTD patients with moderate evidence, at best, available to support voice therapy techniques. Individual studies are difficult to compare because of heterogeneity. Considerable work is underway to identify most important metrics to include in assessment, and to advance and define direct voice therapy approaches. Summary: Further standardization of assessment and treatment protocols for MTD will improve future research. Novel therapeutic techniques are under investigation. In small studies, these have found value in improving voice outcomes and measures compared with pretreatment values but have not met success greater than existing therapeutic methods. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2wAl6u3
Πέμπτη 5 Οκτωβρίου 2017
Vocal tremor: where are we at?.
Purpose of review: Vocal tremor in movement disorders is often overlooked, although it has a significant impact on quality of life. Careful observation of tremor phenomenology allows for accurate diagnosis and tailored treatment. Recent findings: The central pathways associated with various vocal tremor-associated diseases have been further elucidated. Summary: Patients are likely to benefit from a combination of medical and interventional treatments delivered within a multidisciplinary setting Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2fWmK6d
http://ift.tt/2fWmK6d
Progression level of extracapsular spread and tumor budding for cervical lymph node metastasis of OSCC
Abstract
Objectives
The progression level of extracapsular spread (ECS) for cervical lymph node metastasis of oral squamous cell carcinoma (OSCC) was previously divided into three types, and their relationships with the prognosis of patients were re-examined.
Patients and methods
The Kaplan-Meier method was used to examine overall survival (OS) and relapse-free survival (RFS) curves. Prognosis factor for recurrence was analyzed with univariate and multivariate analysis.
Results
ECS was detected in 216 cases of OSCC and analyzed. The 5-year overall survival and RFS rates of patients with type C, which was microscopically defined as tumor invasion to perinodal fat or muscle tissue, were significantly poor at 40.6 and 37.8%, respectively. The results of a univariate analysis suggested that the prognosis of ECS in OSCC patients is associated with its progression level, particularly type C. The 5-year RFS rate of type C with tumor budding was significantly poor at 31.5%. Type C with tumor budding correlated with local and regional recurrence as well as distant metastasis. In a multivariate analysis, tumor budding was identified as an independent prognostic factor.
Conclusions
These results suggest that the progression level of ECS and tumor budding are useful prognostic factors in OSCC patients.
Clinical relevance
This study indicated that the progression level and tumor budding of ECS for cervical lymph node metastasis were useful prognostic factors in OSCC patients.
http://ift.tt/2kt4IKg
Seasonal Rhythms: The Role of Thyrotropin and Thyroid Hormones
http://ift.tt/2wB8Idg
Validation of 3D documentation of palatal soft tissue shape, color, and irregularity with intraoral scanning
Abstract
Objectives
The purpose of this study was to assess the feasibility of 3D intraoral scanning for documentation of palatal soft tissue by evaluating the accuracy of shape, color, and curvature.
Materials and methods
Intraoral scans of ten participants' upper dentition and palate were acquired with the TRIOS® 3D intraoral scanner by two observers. Conventional impressions were taken and digitized as a gold standard. The resulting surface models were aligned using an Iterative Closest Point approach. The absolute distance measurements between the intraoral models and the digitized impression were used to quantify the trueness and precision of intraoral scanning. The mean color of the palatal soft tissue was extracted in HSV (hue, saturation, value) format to establish the color precision. Finally, the mean curvature of the surface models was calculated and used for surface irregularity.
Results
Mean average distance error between the conventional impression models and the intraoral models was 0.02 ± 0.07 mm (p = 0.30). Mean interobserver color difference was − 0.08 ± 1.49° (p = 0.864), 0.28 ± 0.78% (p = 0.286), and 0.30 ± 1.14% (p = 0.426) for respectively hue, saturation, and value. The interobserver differences for overall and maximum surface irregularity were 0.01 ± 0.03 and 0.00 ± 0.05 mm.
Conclusions
This study supports the hypothesis that the intraoral scan can perform a 3D documentation of palatal soft tissue in terms of shape, color, and curvature.
Clinical relevance
An intraoral scanner can be an objective tool, adjunctive to the clinical examination of the palatal tissue.
http://ift.tt/2y3VjxN
Plastic Surgery Videos Need Strict Ethics Standards, Doctors Argue
Some plastic surgeons have gained large social media followings by sharing theatrical videos of surgery with entertainment, rather than education, in mind. Now experts are proposing ethics guidelines to ensure that the content of plastic surgery videos on social media isn't harmful to patients.
Reuters Health Information
http://ift.tt/2fV36Y9
Anxiety and Fear of Recurrence Despite a Good Prognosis: An Interview Study with Differentiated Thyroid Cancer Patients
Thyroid , Vol. 0, No. 0.
http://ift.tt/2ys0Q26
Adult reference intervals for IgG subclasses with Siemens immunonephelometric assays in Chinese population
To determine the adult reference intervals for the Siemens IgG subclass reagents.
http://ift.tt/2xUG8ar
Mechanical and hypoxia stress can cause chondrocytes apoptosis through over-activation of endoplasmic reticulum stress
Source:Archives of Oral Biology, Volume 84
Author(s): Ziwei Huang, Min Zhou, Qian Wang, Mengjiao Zhu, Sheng Chen, Huang Li
ObjectiveTo examine the role of mechanical force and hypoxia on chondrocytes apoptosis and osteoarthritis (OA)-liked pathological change on mandibular cartilage through over-activation of endoplasmic reticulum stress (ERS).MethodsWe used two in vitro models to examine the effect of mechanical force and hypoxia on chondrocytes apoptosis separately. The mandibular condylar chondrocytes were obtained from three-week-old male Sprague–Dawley rats. Flexcell 5000T apparatus was used to produce mechanical forces (12%, 0.5Hz, 24h vs 20%, 0.5Hz, 24h) on chondrocytes. For hypoxia experiment, the concentration of O2 was down regulated to 5% or 1%. Cell apoptosis rates were quantified by annexin V and propidium iodide (PI) double staining and FACS analysis. Quantitative real-time PCR and western blot were performed to evaluate the activation of ERS and cellular hypoxia. Then we used a mechanical stress loading rat model to verify the involvement of ERS in OA-liked mandibular cartilage pathological change. Histological changes in mandibular condylar cartilage were assessed via hematoxylin & eosin (HE) staining. Immunohistochemistry of GRP78, GRP94, HIF-1α, and HIF-2α were performed to evaluate activation of the ERS and existence of hypoxia. Apoptotic cells were detected by the TUNEL method.ResultsTunicamycin, 20% mechanical forces and hypoxia (1% O2) all significantly increased chondrocytes apoptosis rates and expression of ERS markers (GRP78, GRP94 and Caspase 12). However, 12% mechanical forces can only increase the apoptotic sensitivity of chondrocytes. Mechanical stress resulted in OA-liked pathological change on rat mandibular condylar cartilage which included thinning cartilage and bone erosion. The number of apoptotic cells increased. ERS and hypoxia markers expressions were also enhanced. Salubrinal, an ERS inhibitor, can reverse these effects in vitro and in vivo through the down-regulation of ERS markers and hypoxia markers.ConclusionWe confirmed that mechanical stress and local hypoxia both contributed to the chondrocytes apoptosis. Mechanical stress can cause OA-like pathological change in rat mandibular condylar cartilage via ERS activation and hypoxia existed in the meantime. Both mechanical forces and hypoxia can induce ERS and cause chondrocytes apoptosis only if the stimulate was in higher level. Salubrinal can protect chondrocytes from apoptosis, and relieve OA-liked pathological change on mandibular condylar cartilage under mechanical stress stimulation.
http://ift.tt/2geOOyH
Mechanical and hypoxia stress can cause chondrocytes apoptosis through over-activation of endoplasmic reticulum stress
Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Ziwei Huang, Min Zhou, Qian Wang, Mengjiao Zhu, Sheng Chen, Huang Li
ObjectiveTo examine the role of mechanical force and hypoxia on chondrocytes apoptosis and osteoarthritis (OA)-liked pathological change on mandibular cartilage through over-activation of endoplasmic reticulum stress (ERS).MethodsWe used two in vitro models to examine the effect of mechanical force and hypoxia on chondrocytes apoptosis separately. The mandibular condylar chondrocytes were obtained from three-week-old male Sprague–Dawley rats. Flexcell 5000T apparatus was used to produce mechanical forces (12%, 0.5Hz, 24h vs 20%, 0.5Hz, 24h) on chondrocytes. For hypoxia experiment, the concentration of O2 was down regulated to 5% or 1%. Cell apoptosis rates were quantified by annexin V and propidium iodide (PI) double staining and FACS analysis. Quantitative real-time PCR and western blot were performed to evaluate the activation of ERS and cellular hypoxia. Then we used a mechanical stress loading rat model to verify the involvement of ERS in OA-liked mandibular cartilage pathological change. Histological changes in mandibular condylar cartilage were assessed via hematoxylin & eosin (HE) staining. Immunohistochemistry of GRP78, GRP94, HIF-1α, and HIF-2α were performed to evaluate activation of the ERS and existence of hypoxia. Apoptotic cells were detected by the TUNEL method.ResultsTunicamycin, 20% mechanical forces and hypoxia (1% O2) all significantly increased chondrocytes apoptosis rates and expression of ERS markers (GRP78, GRP94 and Caspase 12). However, 12% mechanical forces can only increase the apoptotic sensitivity of chondrocytes. Mechanical stress resulted in OA-liked pathological change on rat mandibular condylar cartilage which included thinning cartilage and bone erosion. The number of apoptotic cells increased. ERS and hypoxia markers expressions were also enhanced. Salubrinal, an ERS inhibitor, can reverse these effects in vitro and in vivo through the down-regulation of ERS markers and hypoxia markers.ConclusionWe confirmed that mechanical stress and local hypoxia both contributed to the chondrocytes apoptosis. Mechanical stress can cause OA-like pathological change in rat mandibular condylar cartilage via ERS activation and hypoxia existed in the meantime. Both mechanical forces and hypoxia can induce ERS and cause chondrocytes apoptosis only if the stimulate was in higher level. Salubrinal can protect chondrocytes from apoptosis, and relieve OA-liked pathological change on mandibular condylar cartilage under mechanical stress stimulation.
http://ift.tt/2geOOyH
Medication-Related Osteonecrosis of the Posterior Maxilla: Surgical Treatment Using a Combined Transnasal Endoscopic and Intraoral Approach, our experience with seven consecutive patients
Abstract
Upper jaw MRONJ if not correctly treated can lead to serious complication.
Upper jaw MRONJ is frequently associated with maxillary sinusitis, the disease can spread to other paranasal sinuses.
Combined approach is the most reliable procedure to treat odontogenic sinusitis; although MRONJ associated sinusitis is considered odontogenic there is no report in literature describing combined approach to treat MRONJ-induced sinusitis.
Buccal fat pad represents the best reconstructive option to close the bony defect.
BFPF does not allow rehabilitation through dental implant since it is adipose tissue and not bone tissue. However, guidelines do not recommend implant-supported prosthetic rehabilitation in patients with history of MRONJ so conventional dental rehabilitation should be carried out.
This article is protected by copyright. All rights reserved.
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Ipilimumab and early signs of pulmonary toxicity in patients with metastastic melanoma: a prospective observational study
Abstract
Ipilimumab, an immune checkpoint inhibitor, is approved for treatment metastastic melanoma and is a promising agent against other malignancies. There is some preliminary evidence from case reports that ipilimumab treatment may be associated with pulmonary side effects. However, data from prospective studies on ipilimumab-related pulmonary toxicity are still scarce. Serial spirometries and measurements of CO-diffusion capacity (DLCO) in patients with metastatic melanoma before and during treatment with ipilimumab were performed. A reduction from baseline of forced vital capacity (FVC) of ≥ 10%, or ≥ 15% of DLCO was defined as clinically meaningful and indicative for pulmonary toxicity. Of 71 patients included in this study, a clinically meaningful lung function decline was registered in 6/65 (9%), 5/44 (11%), and 9/38 (24%) patients after 3, 6, and 9 weeks of treatment initiation, respectively. Even after adjusting for age, concomitant melanoma treatment, progressive pulmonary metastases, and baseline pulmonary function values, mean ± SD DLCO decreased significantly during follow-up (−4.3% ± 13.6% from baseline, p = 0.033). Only 7% of patients reported respiratory symptoms. Clinically manifest ipilimumab-related pneumonitis was diagnosed only in one patient (1.4%). DLCO decline maybe an early indicator of subclinical pulmonary drug toxicity. Therefore, routine pulmonary function testing including DLCO measurement during treatment might help for risk stratification to screen for ipilimumab-related pneumonitis.
http://ift.tt/2xTO3VF
Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa
Abstract
Background
There is no published study on the influence of lymph node ratio on locoregional recurrence of squamous cell carcinoma (SCC) of the buccal mucosa. Therefore, we focused in our study on this specific anatomic subsite.
Methods
We conducted a retrospective chart review of 95 patients from 2003-2013 with treatment-naive SCC of the buccal mucosa. Exclusion criteria were neoadjuvant chemoradiotherapy, perioperative death, N3 disease, unresectable disease, synchronous malignancy, and follow-up <3 months. Statistical analysis was performed using univariate and multivariate analysis.
Results
Significant correlations were found between locoregional recurrence and pathologic N classification (P < .001), grading (P = .001), and lymph node ratio (P < .001). Multivariate analysis indicated lymph node ratio as an independent risk factor for locoregional recurrence (P = .002). A cutoff value under 7% led to a 10.383-fold higher risk of incurring a locoregional recurrence.
Conclusion
Lymph node ratio is a useful parameter to stratify the risk of locoregional recurrence in patients with SCC of the buccal mucosa.
http://ift.tt/2xXA9Q2
Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report
Severe epistaxis is often difficult to control in patients with hereditary hemorrhagic telangiectasia (HHT). Propranolol has been shown to have antiangiogenic properties in vitro and in vivo and is commonly us...
http://ift.tt/2xkaZOf
Low-power laser irradiation inhibits PDGF-BB-induced migration and proliferation via apoptotic cell death in vascular smooth muscle cells
Abstract
Vascular restenosis after injury of blood vessel has been implicated in various responses including apoptosis, migration, and proliferation in vascular smooth muscle cells (VSMCs) stimulated by diverse growth factors underlying platelet-derived growth factor (PDGF). Previous studies evaluated the effects of low-power laser (LPL) irradiation over various wavelength ranges on VSMC events in normal and pathologic states. However, whether VSMC responses are affected by LPL irradiation remains unclear. The purpose of this study is to explore the effects of LPL (green diode laser 532-nm pulsed wave of 300 mW at a spot diameter of 1 mm) irradiation on the responses, apoptosis, migration, and proliferation of VSMCs. The effect of LPL irradiation was tested on VSMCs through cytotoxicity, proliferation, migration, and apoptotic assays. Aortic ring assay was used to assess the effect of LPL irradiation on aortic sprout outgrowth. Protein expression levels were determined by western blotting. LPL irradiation did not affect VSMC viability but slightly attenuated PDGF-BB-induced proliferation in VSMCs. In addition, LPL irradiation inhibited PDGF-BB-evoked migration of VSMCs. Aortic sprout outgrowth in response to PDGF-BB was diminished in cells treated with LPL. In contrast, LPL irradiation evoked apoptosis in VSMCs in the presence of PDGF-BB. Similarly, activation of caspase-3 and Bax, as well as p38 mitogen-activated protein kinase (MAPK), in VSMCs treated with PDGF-BB was enhanced by exposure to LPL. These findings indicate that LPL irradiation induces vascular apoptosis via p38 MAPK activation and simultaneously inhibits VSMC proliferation and migration in response to PDGF-BB.
http://ift.tt/2wzfFv8
The Use of Chewing Gum for Xerostomia and Hyposalivation After Radiotherapy for Oral and Oropharyngeal Tumors
Conditions: Head and Neck Cancer; Radiation Therapy Complication; Xerostomia; Hyposalivation
Intervention: Dietary Supplement: Chewing gum
Sponsors: Odense University Hospital; Danish Cancer Society; OPEN - Odense Patient data Explorative Network
Recruiting
http://ift.tt/2xjRXTy
Intervention: Dietary Supplement: Chewing gum
Sponsors: Odense University Hospital; Danish Cancer Society; OPEN - Odense Patient data Explorative Network
Recruiting
http://ift.tt/2xjRXTy
Are optic nerve heads of patients with helicobacter pylori infection more susceptible to glaucomatous damage?
Abstract
Background
To compare retinal nerve fiber layer thicknesses (RNFLT) of patients with or without Helicobacter pylori infection and to reveal the possible RNFLT changes after H. pylori eradication.
Materials and methods
Sixty-five eyes of 65 patients that tested positive for H. pylori (Group 1) and 48 eyes of 48 patients that tested negative for H. pylori (Group 2) were included. RNFLT analyses were performed with spectral-domain (SD) optical coherence tomography (OCT) in a total of five regions: the superior, inferior, nasal, and temporal quadrants and the average. Then, a comparison was made between groups. After H. pylori eradication in 38 patients, RNFLTs were compared with both pre-eradication values and Group 2.
Results
The groups were similar in terms of age and gender. Temporal quadrant RNFLT was thinner in Group 1 than in Group 2 (P=.02). After H. pylori eradication, RNFLTs did not differ from pre-eradication values in Group 1 (P>.05 for all), whereas temporal quadrant RNFLT after H. pylori eradication was thinner compared to Group 2 (P=.03).
Conclusions
H. pylori may cause the localized defects on RNFL that are the early signs of glaucoma.
http://ift.tt/2fTPsEw
A Real-time Prediction Model for Post-irradiation Malignant Cervical Lymph Nodes
Abstract
Objective
To establish a real-time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation.
Methods
One-hundred-forty-four irradiation-treated patients underwent ultrasonography and ultrasound-guided fine needle aspirations (USgFNAs), and the resultant data were used to construct a real-time and computerized predictive scoring model. This scoring system was further compared with our previously proposed prediction model.
Results
A predictive scoring model, 1.35 x (L axis) + 2.03 x (S axis) + 2.27 x (Margin) + 1.48 x (Echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) were 0.89 and 0.81, respectively (p < 0.05).
Conclusions
A real-time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wyMSal
Incurable, progressive Merkel cell carcinoma: a single institution study of 54 cases
Abstract
The median overall survival, disease-free survival and survival from disease progression of patients with progressive disease was 15, 8 months and 5 months, respectively.
22 (96%) out of 23 individuals suffering from disease progression died of the disease. The overall mortality rate was 70%.
Patients with progressive MCC spend significantly more tumour related days in the hospital compared to patients without a progressive disease.
The rate of immunosuppression was significantly higher in the MCC progressive group and those patients received more often radio- and/or chemotherapy.
Despite an aggressive therapy approach and long hospitalization, survival among patients suffering from progressive MCC was very poor. Randomized clinical trials are required to assess whether aggressive systemic and local therapy is justified in Merkel cell carcinoma patients with progressive disease.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fTUykq
Novel middle ear applications for a synthetic cerebrospinal fluid (CSF) sealant
Abstract
TissuePatchDural™ is an easy to store and apply synthetic CSF sealant.
Its breakdown products are naturally occurring and non-toxic.
Its use appears safe in the middle ear.
It is shown to successfully close mastoid CSF leaks.
Its use as an adjunct in sealing middle ear fistulae is also demonstrated.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wzYv0o
Nodal factors predictive of recurrence and survival in patients with oral cavity squamous cell carcinoma
Abstract
Objectives
Lymph node (LN) metastasis of oral cavity squamous cell carcinoma (OSCC) is associated with survival outcomes. However, the relationship between different metastatic nodal factors and treatment outcomes require further elucidation. This study examined nodal factors predictive of recurrence and survival in patients with OSCC.
Methods
This prospective observational study included 157 patients with OSCC who underwent surgery between 2010 and 2015. Clinicopathological and follow-up information were recorded. Univariate and multivariate Cox proportional hazard models were performed to identify factors associated with recurrence-free survival, disease-specific survival and overall survival.
Results
Sixty-five of 157 patients (41.4%) had neck metastasis. During a median follow-up of 46 months, any recurrences and all deaths occurred in 43 (27.4%) and 43 (27.4%) of cases, respectively. All nodal factors (LN classification, size, number and ratio) and extra-nodal extension were significantly associated with all survival outcomes (P <0.001). Multivariate analyses indicated that a tumour size >2 cm and LN ratio were independentlyassociated with all survival (P <0.05). Patients with LN ratio >0.05 had six-fold higher recurrence and mortality rates than other patients (P <0.001).
Conclusion
LN ratio is an independent and predictive determinant of post-treatment recurrence and survival.
This article is protected by copyright. All rights reserved.
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Prospective multi-centre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnea
Abstract
Objectives
The aim of this study was to demonstrate in a prospective multi-centre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnea/hypopnea syndrome (OSAHS) patients.
Design
prospective study.
Setting
multicenter study.
Participants
patients suffering from obstructive sleep apnea.
Main outcomes measures
values of post-operative apnea-hypopnea index(AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS).
Results
111 BRP procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analyzed in 15 different centers. The average hospitalization period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average BMI at the time of the procedure was 27.9 ± 3.2 and the majority of the patients were men (83%). The mean pre-operative and post-operative apnea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (p < 0.001). The mean pre-operative and post-operative epworth sleepiness scale score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (p < 0.001). The mean pre- and post-operative oxygen desaturation index was 29.6 ± 20.7 and 12.7 ± 10.8, respectively (p < 0.001).
Conclusions
Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fMSib2
Risk of Infection in Patients with Atopic Dermatitis Treated with Dupilumab: A Meta-Analysis of Randomized Controlled Trials
Atopic dermatitis (AD) is characterized by skin barrier defects, Th2 activation, and increased risk for cutaneous and extracutaneous infections. In clinical trials, dupilumab appeared to decrease rates of skin infections in AD.
http://ift.tt/2y1PvVz
Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate to severe melasma
Melasma is a common pigmentary disorder that is often difficult to treat. Tranexamic acid (TA) has emerged as a promising treatment for melasma; however, few controlled studies exist.
http://ift.tt/2gdIrLP
Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients
This study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD).
http://ift.tt/2xTITsR
Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia: A case series
Obstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement.
http://ift.tt/2xiCRlX
Sudden Deafness during Antepartum versus Postpartum Periods
Objective: This study reviewed our experience in treating sudden deafness in antepartum (pregnant) and postpartum women during the past 2 decades. Methods: From 1997 to 2016, we have recorded sudden deafness in 16 antepartum (mean age, 32 years) and 3 postpartum (mean age, 31 years) women. Sudden deafness occurred during the 1st, 2nd, and 3rd trimesters in 5, 4, and 7 antepartum women, respectively. In contrast, the mean interval between giving birth and symptom onset in the 3 postpartum women was 18 days. Each patient underwent an inner ear test battery. Results: In 8 antepartum women treated by dextran infusion, the outcome as regards hearing was improved in 7 patients (88%) and unchanged in 1 patient. In contrast, the other 8 antepartum women selected no treatment, and only 1 patient (12%) achieved hearing improvement, exhibiting a significantly better outcome when receiving dextran treatment. For the postpartum women, 2 patients had hearing improvement when treated by antioxidants, while 1 patient retained unchanged hearing without treatment. Conclusion: Medication is needed in sudden deafness in antepartum or postpartum women rather than waiting for a natural course. No adverse effects have been identified in any of the mothers or offspring 1 year after delivery.
ORL 2017;79:274-281
http://ift.tt/2ko6lIW
ORL 2017;79:274-281
http://ift.tt/2ko6lIW
Metabolic parameters in psoriatic patients treated with interleukin-12/23 blockade (ustekinumab)
Abstract
The associations between psoriasis, metabolic syndrome and cardiovascular events are increasingly recognized. Studies have shown decreased cardiovascular events with the treatment of methotrexate and anti-tumor necrosis factor, however, effects of interleukin (IL)-12/23 blockade remain debatable. Our study investigated the effect of IL-12/23 blockade on the metabolic parameters in patients with psoriasis. We performed a retrospective cohort study to assess 93 consecutive patients with moderate to severe plaque type psoriasis who received IL-12/23 blockade (ustekinumab) for 24 weeks between January 2012 and May 2016. Metabolic parameters and disease activity (Psoriasis Area and Severity Index [PASI] score) at baseline and 24 weeks of treatment were collected. At week 24, the disease activity improved significantly (P < 0.0001), with a significant reduction of erythrocyte sedimentation rate. Conversely, body mass index was significantly elevated in PASI-75 responders at week 24 of treatment and was independent of disease severity. Fasting sugar and triglyceride levels were also elevated at week 24 in both PASI-75 responders and PASI-75 non-responders. Cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) remained unchanged. These metabolic parameters were not correlated with the improvement in disease severity after ustekinumab treatment. Nonetheless, the atherogenic index, LDL/HDL ratio and cholesterol/HDL ratio remained unchanged. Male sex and cigarette smoking are predictors of elevated plasma triglyceride levels. Our results suggest that despite tremendous improvement in disease activity after ustekinumab treatment, obesity, fasting sugar and hypertriglyceridemia still present in these patients. Regular screening of lipid profile, obesity control and smoking cessation are advised during the treatment of ustekinumab especially in male psoriatic patients with predisposing cardiovascular risks.
http://ift.tt/2xURRWw
Dysregulation of Innate Lymphoid Cells in Common Variable Immunodeficiency
Abstract
Common variable immunodeficiency (CVID) is the most prevalent symptomatic primary immune deficiency. With widespread use of immunoglobulin replacement therapy, non-infectious complications, such as autoimmunity, chronic intestinal inflammation, and lung disease, have replaced infections as the major cause of morbidity and mortality in this immune deficiency. The pathogenic mechanisms that underlie the development of these complications in CVID are not known; however, there have been numerous associated laboratory findings. Among the most intriguing of these associations is elevation of interferon signature genes in CVID patients with inflammatory/autoimmune complications, as a similar gene expression profile is found in systemic lupus erythematosus and other chronic inflammatory diseases. Linked with this heightened interferon signature in CVID is an expansion of circulating IFN-γ-producing innate lymphoid cells. Innate lymphoid cells are key regulators of both protective and pathogenic immune responses that have been extensively studied in recent years. Further exploration of innate lymphoid cell biology in CVID may uncover key mechanisms underlying the development of inflammatory complications in these patients and may inspire much needed novel therapeutic approaches.
http://ift.tt/2yZqNmW
Influenza Vaccination in Patients with Common Variable Immunodeficiency (CVID)
Abstract
Purpose of Review
Vaccination against influenza in patients with primary antibody deficiency is recommended. Common variable immunodeficiency (CVID) is the most frequent and clinically relevant antibody deficiency disease and is by definition characterized by an impaired vaccination response. The purpose of this review is to present the current knowledge of humoral and cellular vaccine response to influenza in CVID patients.
Recent Findings
Studies conducted in CVID patients demonstrated an impaired humoral response upon influenza vaccination. Data on cellular immune response are in part conflicting, with two out of three studies showing responses similar to healthy controls.
Summary
Available data suggest a benefit from influenza vaccination in CVID patients. Therefore, annual influenza vaccination in patients and their close household contacts is recommended.
http://ift.tt/2xTAPZ0
Somatic Hypermutation Defects in Common Variable Immune Deficiency
Abstract
Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by impaired antibody production and recurrent infections. In the last 20 years, several groups have reported that B cells from CVID patients have an impaired somatic hypermutation (SHM). The reported frequency of this defect among CVID patient cohorts is highly variable and so is the methodology used to evaluate this process. Interestingly, the low level of SHM on B cells from CVID patients has been correlated with the presence of infectious and non-infectious complications. In this review, an overview of the studies regarding SHM in CVID patients is presented. We highlight the importance of SHM studies in CVID patients as a clinical tool due to the reported association with clinical complications by several groups. We also considered SHM measurement useful to guide future investigations in order to identify genetic defects involved in the development of the disease.
http://ift.tt/2yZqBEe
Electronic Cigarettes: Their Constituents and Potential Links to Asthma
Abstract
Purpose of Review
Vaping is gaining popularity in the USA, particularly among teens and young adults. While e-cigs are commonly represented as safer alternatives to tobacco cigarettes, little is known regarding the health effects of their short- or long-term use, especially in individuals with pre-existing respiratory diseases such as asthma. Flavored e-cig liquids (e-liquids) and e-cig aerosols contain airway irritants and toxicants that have been implicated in the pathogenesis and worsening of lung diseases. In this review, we will summarize existing data on potential health effects of components present in e-cig aerosols, such as propylene glycol, vegetable glycerin, nicotine, and flavorings, and discuss their relevance in the context of asthma.
Recent Findings
Recent survey data indicate that adolescents with asthma had a higher prevalence of current e-cig use (12.4%) compared to their non-asthmatics peers (10.2%) and conveyed positive beliefs about tobacco products, especially e-cigs. Similarly, a study conducted among high school students from Ontario, Canada, indicated a greater likelihood of e-cig use in asthmatics as compared to their non-asthmatic peers. Availability of different flavorings is often cited as the main reason among youth/adolescents for trying e-cigs or switching from cigarettes to e-cigs. Occupational inhalation of some common food-safe flavoring agents is reported to cause occupational asthma and worsen asthmatic symptoms. Moreover, workplace inhalation exposures to the flavoring agent diacetyl have caused irreversible obstructive airway disease in healthy workers. Additionally, recent studies report that thermal decomposition of propylene glycol (PG) and vegetable glycerin (VG), the base constituents of e-liquids, produces reactive carbonyls, including acrolein, formaldehyde, and acetaldehyde, which have known respiratory toxicities. Furthermore, recent nicotine studies in rodents reveal that prenatal nicotine exposures lead to epigenetic reprogramming in the offspring, abnormal lung development, and multigenerational transmission of asthmatic-like symptoms.
Summary
Comparisons of the toxicity and health effects of e-cigs and conventional cigarettes often focus on toxicants known to be present in cigarette smoke (CS) (i.e., formaldehyde, nitrosamines, etc.), as well as smoking-associated clinical endpoints, such as cancer, bronchitis, and chronic obstructive pulmonary disease (COPD). However, this approach disregards potential toxicity of components unique to flavored e-cigs, such as PG, VG, and the many different flavoring chemicals, which likely induce respiratory effects not usually observed in cigarette smokers.
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Are food allergic consumers ready for informative precautionary allergen labelling?
Precautionary allergen labelling (PAL) has resulted in consumer confusion. Previous research has shown that interpretive labels (using graphics, symbols, or colours) are better understood than the traditional ...
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Analgesia (mis)usage on a dental emergency service: a patient survey
Abstract
Objectives
Analgesics are one of the most frequently used medicines. Self-medication and misuse have been described in the literature. The purpose of this study was to document analgesic (mis)use in a population seeking emergency dental treatment.
Material and methods
Patients consulting a dental emergency service were randomly asked to complete a questionnaire on analgesic use, knowledge and information on the analgesics and on their pain history. A photobook was used as an aid to identify products used. Descriptive statistics were combined with chi-square and Mann-Whitney U testing.
Results
Ninety-eight patients were included. Acetaminophen (69.4%) and ibuprofen (65.3%) were the most frequently used products. Nearly half of the subjects (43.9%) combined at least two analgesics. Although 42.9% of subjects were aware of the maximum daily dose, 62.2% of the subjects exceeded this limit, specifically 76.6% of subjects using ibuprofen and 32.4% of subjects using acetaminophen overdosing. Females overdosed significantly more than males. Ingestion on medical advice did not affect the overdose rates significantly. No significant relation was found between the absence of knowledge on the maximum daily dose and actual overdosing. No higher pain reduction was found in patients overdosing analgesics. The average number of days patients experienced pain before consulting the emergency unit was 12. A significant relation was found between the lag time and overdosing.
Conclusions
A large portion of the patients overdosed analgesics. Even prior medical advice did not reduce significantly overdose rates.
Clinical relevance
Dentists treating emergency cases clearly need to be aware of the high risk and high rates of overdosing analgesics in their patients.
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Pseudoangiomatous stromal hyperplasia – a benign and rare tumor of the breast in an adolescent: a case report
Pseudoangiomatous stromal hyperplasia is an uncommon mesenchymal breast neoplasm.
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Effects of photobiomodulation therapy and topical non-steroidal anti-inflammatory drug on skeletal muscle injury induced by contusion in rats—part 1: morphological and functional aspects
Abstract
Musculoskeletal injuries are very frequent and are responsible for causing pain and impairment of muscle function, as well as significant functional limitations. In the acute phase, the most prescribed treatment is with non-steroidal anti-inflammatory drugs (NSAIDs), despite their questionable effectiveness. However, the use of photobiomodulation therapy (PBMT) in musculoskeletal disorders has been increasing in the last few years, and this therapy appears to be an interesting alternative to the traditional drugs. The objective of the present study was to evaluate and compare the effects of PBMT, with different application doses, and topical NSAIDs, under morphological and functional parameters, during an acute inflammatory process triggered by a controlled model of musculoskeletal injury induced via contusion in rats. Muscle injury was induced by means of a single trauma to the animals' anterior tibialis muscle. After 1 h, the rats were treated with PBMT (830 nm; continuous mode, with a power output of 100 mW; 3.57 W/cm2; 1 J–35.7 J/cm2, 3 J–107.1 J/cm2, and 9 J–321.4 J/cm2; 10, 30, and 90 s) or diclofenac sodium for topical use (1 g). Morphological analysis (histology) and functional analysis (muscle work) were performed, 6, 12, and 24 h after induction of the injury. PBMT, with all doses tested, improved morphological changes caused by trauma; however, the 9 J (321.4 J/cm2) dose was the most effective in organizing muscle fibers and cell nuclei. On the other hand, the use of diclofenac sodium produced only a slight improvement in morphological changes. Moreover, we observed a statistically significant increase of muscle work in the PBMT 3 J (107.1 J/cm2) group in relation to the injury group and the diclofenac group (p < 0.05). The results of the present study indicate that PBMT, with a dose of 3 J (107.1 J/cm2), is more effective than the other doses of PBMT tested and NSAIDs for topical use as a means to improve morphological and functional alterations due to muscle injury from contusion.
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An Element of Unsteadiness
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