The nose as a predilection site of pemphigus

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Clinician, dental student and orthognathic patient perception of black and white silhouette lateral profile dimensions of ideal chin position in a chinese population

Publication date: Available online 12 October 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Zhiwei Jiang, Long Tan, Lingling Hu, Chaowei Wang, Huiming Wang, Zhijian Xie
Objectives.This study aimed to investigate differences in influence of chin prominence and length on perception of facial esthetics in Chinese dental clinicians, orthoganthic patients, and dental students.Study Design.The male and female silhouette lateral profiles were modified to obtain 28 facial profiles by altering chin prominence and length by 3 mm in the sagittal and vertical planes. Images were rated by 70 clinicians, 30 orthognathic patients, and 100 dental students on a 7-point Likert scale.Results.Perceived attractiveness is highest when the male chin prominence (MCP) was -3 mm to 3 mm, and the female chin prominence (FCP) was 3 mm. In contrast, male chin length (MCL) (0 mm to 3 mm) and female chin length (FCL) (0 mm) were considered the most attractive. In the sagittal and vertical profiles, MCP (-9 mm), FCP (-9 mm), FCL (-9 mm), and MCL (-9 mm) were ranked least attractive.Conclusions.The overall direction of esthetic opinion is similar in the orthoganthic patients, clinicians and dental students. The greater the retrusion or protrusion of the chin and the shorter or longer of the chin length, the less the rates of facial esthetics and the greater the desire for surgery.



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MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement: a randomized controlled clinical trial

Publication date: Available online 12 October 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ayman F. Hegab, Ahmed Hossni Youssef, Hossam I. Abd Al hameed, Khaled Said Karam
Objective: This prospective study examined a method using magnetic resonance imaging (MRI) to assess the appropriate effective occlusal splint vertical thickness in management of disk derangement. Study Design: Patients were diagnosed as having internal disk displacement of the TMJ and were divided into two groups. Group I (Disk Displacement with Reduction-DDR): This group was subdivided randomly into 2 subgroups. Subgroup IA (control group): patients treated using 3-mm-thick splints. Subgroup IB (study group): patients treated using MRI-based splint thickness. Group II (Disk Displacement without Reduction-DDNR): This group was subdivided randomly into 2 subgroups. Subgroup IIA (control group): patients treated using 3-mm-thick splints. Subgroup IIB (study group): patients treated using MRI-based splint thickness. The primary outcome variables were maximum voluntary mouth opening (MVMO) and visual analogue scale (VAS) for pain. The secondary outcome variable was joint sounds. The final sample was composed of 162 subjects (Group I = 90 and Group II = 72). Results: Statistical analysis showed significant improvement of the clinical outcomes in subgroups IB and IIB as compared to that in subgroups IA and IIA. Conclusion: On the basis of MRI measurements and clinical outcome, the current study recommended 4 mm and 6mm vertical splint thickness for DDR and DDNR respectively for 1 year.



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A novel ROGDI gene mutation is associated with kohlschutter-tonz syndrome

Publication date: Available online 12 October 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nalini Aswath, Sankar Narayanan Ramakrishnan, Nithya Teresa, Arvind Ramanathan
BackgroundKohlschutter-tonz syndrome (KTS) is a rare neurodegenerative disorder that presents with seizures, developmental regression and characteristic hypoplastic dental enamel indicative of amelogenesis imperfecta besides dysmorphologies. Genetic analysis has identified loss of function mutations within the coding region of ROGDI gene, which indeed has been reported in KTS patients of European or Jewish decent. In the present study, we have investigated the genetic status of ROGDI in a fourteen year old South Indian patient of Dravidian race born to consanguineous parents, who was clinically diagnosed with KTS.MethodsIn order to confirm the clinical diagnosis of KTS in the patient, primers were designed flanking each of the eleven exons of ROGDI gene. 50ng of chromosomal DNA extracted from peripheral blood of the patient and his parents were then used to amplify with the above primers and were subjected to direct sequencing with the same primers.ResultGenetic analysis identified a novel homozygous nonsense mutation in the exon 6 of ROGDI gene that caused premature termination of ROGDI translation resulting in truncation and loss of function of the ROGDI protein. Taken together, the clinical presentation and loss of function mutation in ROGDI gene confirms the clinical diagnosis of KTS.



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A rare vulval manifestation of acrochordons in a young woman

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Schnitzler syndrome: A rare cause of chronic recalcitrant urticaria successfully treated with Anakinra

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Nuclear Magnetic Resonance-Assisted Metabolic Analysis of Plasma for Mild Gestational Diabetes Mellitus Patients

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


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Low-intensity LED therapy ( λ 640 ± 20 nm) on saphenectomy healing in patients who underwent coronary artery bypass graft: a randomized, double-blind study

Abstract

Myocardial revascularization surgery (CABG) is the most appropriate treatment for coronary artery disease. Currently, the great challenge is to reduce postoperative complications, such as wound infections, dehiscence, pain, and patients' quality of life. The saphenectomy is the target of complications in 10% of cases, which can cause greater morbidity, time, and cost of hospitalization. Studies show that low-intensity laser or light-emitted diode (LED) therapy promotes positive biomodulation of the tissue repair process, culminating in a lower incidence of dehiscence, pain reduction, and improvement in quality of life. The objective of the present study was to evaluate clinically the saphenous tissue repair after LED therapy. Forty subjects of both genders who underwent CABG with extracorporeal circulation were randomly divided into two groups: the placebo (PG) and experimental (EG). The experimental group underwent low-intensity LED therapy (λ 640 ± 20 nm, 6 J/cm²) on saphenectomy. The tissue repair was analyzed by digital photogrammetry on the first and fifth postoperative day. The border closure was blindly evaluated by three researchers. The hematoma and hyperemia area was quantitatively analyzed using ImageJ© software. The results showed that in the experimental group, there were less bleeding points and no dehiscence in saphenectomy, as compared to the placebo group. There was also a smaller area of hematoma and hyperemia in the experimental group (p < 0.0009). These data lead to the conclusion that the type of phototherapy protocol employed can assist in tissue repair.

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Analysis of choroidal thickness in ocular hypertensive patients using enhanced depth imaging optical coherence tomography

Abstract

This study aimed to compare choroidal thickness between subjects with ocular hypertension (OHT) and normal individuals and explore factors affecting choroidal thickness. This study included 60 untreated newly diagnosed OHT eyes and 60 normal eyes. Choroidal thickness obtained from Cirrus HD-OCT was measured at different locations in the macular and peripapillary regions and compared between the two groups before and after adjusting for potential confounding variables. Regression analysis was performed to figure out factors influencing choroidal thickness. The macular choroidal thickness did not vary significantly between OHT patients and normal controls regardless of locations (all P > 0.05). The average peripapillary choroidal thickness was 167 ± 53 μm in OHT eyes and 185 ± 63 μm in the normal eyes; no significant differences were identified (P = 0.107). Only one of the locations in the temporal area in the OHT group demonstrated significantly thinner peripapillary choroidal thickness as compared to the normal group (P = 0.033). Age was the only significant factor affecting choroidal thickness on multivariate analysis regardless of locations (all P < 0.001). Choroidal thickness of the macular and peripapillary regions in OHT patients is not decreased significantly except one location in the temporal area of the optic disc when comparing with the normal subjects. Anatomic peripapillary choroidal thickness measurements with SD-OCT might be one more tool to track changes in OHT patients.

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A concealed giant peritonsillolith masquerading as oropharyngeal tumor

Publication date: Available online 12 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Boon Chye Gan, Irfan Mohamad, Norhafiza Mat Lazim




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2017 ATA Annual Alliance for Patient Education Public Health Forum

2017 ATA Annual Alliance for Patient Education Public Health Forum – Saturday, October 21, 2017

October 11, 2017– The public is invited to attend a free public health forum focused on thyroid disease, in which leading physicians will be present to discuss and answer questions about different types of thyroid disorders and symptoms. The informational forum is free and open to the public. Walk-in attendance is welcome although reservations are encouraged. The public forum is sponsored and organized by the American Thyroid Association (ATA) and will take place Saturday, October 21, 2017, 2:00-4:00pm at the The Fairmont Empress, Victoria, BC, Canada. Endocrinologists and Thyroid Patient Support Groups will be available to meet with thyroid patients during the forum.

Who Should Attend?

Anyone who has or cares for someone with an overactive or underactive thyroid, thyroiditis, a thyroid nodule, thyroid cancer, or a family history of thyroid problems or related disorders, including rheumatoid arthritis, juvenile diabetes, pernicious anemia, or prematurely gray hair (starting before age 30).

Do you have questions or concerns about thyroid disease? Have you experienced any of the following symptoms and wonder if they might be related to a thyroid disorder: low energy, memory loss, fatigue, depression, rapid heartbeat, restlessness, infertility, weight or hair changes, or a lump in your neck?

Anyone with questions, symptoms, or concerns about a thyroid problem should join ATA physician experts at the free public form on Saturday, October 21st. Free educational materials will be available.

Do I Need to Register?

Reservations are requested. To register or for more information, please e-mail: thyroid@thyroid.org

(Please indicate in your message the thyroid condition you are most concerned about.)

Walk-ins welcome! Please come if you have questions, symptoms, or concerns about a thyroid problem.  More information about thyroid disease and thyroid cancer is available at www.thyroid.org. Join Friends of the ATA and receive news of the latest thyroid research.

Flyer for Printing and Posting (PDF File 136 KB)

The post 2017 ATA Annual Alliance for Patient Education Public Health Forum appeared first on American Thyroid Association.

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Cardiovascular Complications in Head & Neck Microvascular Flap Reconstruction: A Retrospective Risk Stratification and Outcomes Assessment

Publication date: Available online 12 October 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Naseem Ghazali, Steven Caldroney, Donita Dyalram, Joshua E. Lubek
BackgroundTo determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction.MethodsA series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson comorbidity index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes.ResultsTwenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia.Multivariate analyses showed that RCRI (p<0.001) and amount of blood transfused (p=0.02) were independent predictors of CC.ConclusionsCardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.



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Treatment outcomes of locally advanced squamous cell carcinoma of the maxillary sinus treated with chemoradioselection using superselective intra-arterial cisplatin and concomitant radiation: implications for prognostic factors

Publication date: Available online 12 October 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Takeharu Ono, Norimitsu Tanaka, Hirohito Umeno, Shun-ichi Chitose, Buichiro Shin, Takeichiro Aso, Koutaro Onn, Mutsuyuki Hattori, Hidehiro Etoh, Tatsuyuki Kakuma, Toshi Abe
BackgroundThis study clarified the clinical results of locally advanced squamous cell carcinoma of the maxillary sinus (SCC-MS) that was treated with chemoradioselection using superselective intra-arterial cisplatin and concomitant radiation (RADPLAT). Prognostic factors were also investigated.MethodsWe retrospectively analyzed 63 locally advanced SCC-MS patients treated with initial RADPLAT followed by sequential RADPLAT (S-RADPLAT) or surgery.ResultsThe 5-year progression-free survival (PFS) and overall survival (OS) rates of patients with T3, T4a, or T4b disease were 72.2%, 46.6%, and 33.3% (p = 0.104) and 83.3%, 51.6%, and 33.3% (p = 0.031), respectively. The 5-year PFS and OS rates of the S-RADPLAT or surgery groups with T4 disease were 39.6% and 60.6% (p = 0.199) and 44.7% and 63.3% (p = 0.276), respectively. Tumor extension into the medial and/or lateral pterygoid muscle (p < 0.001) and N classification (p = 0.012) were considered significant factors for PFS. Regarding OS, tumor extension into the medial and/or lateral pterygoid muscle (p = 0.005) was considered a statistically significant risk factor.ConclusionsIt may be better for T4 non-responders to initial RADPLAT to undergo surgery. Patients with high risk factors of positive neck metastasis or pterygoid muscle extension may need adjuvant chemotherapy.



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Structural and Ultrastructural Analyses of Bone Regeneration in Rabbit Cranial Osteotomy: Piezosurgery Versus Traditional Osteotomes

Publication date: Available online 12 October 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Alexandre Anesi, Marzia Ferretti, Francesco Cavani, Roberta Salvatori, Michele Bianchi, Alessandro Russo, Luigi Chiarini, Carla Palumbo
Clinical advantages of piezosurgery have been already proved. However, few investigations have focused on the dynamics of bone healing. The aim of this study was to evaluate, in adult rabbits, bone regeneration after cranial linear osteotomies with two piezoelectrical devices (Piezosurgery Medical – PM and Piezosurgery Plus – PP), comparing them with conventional rotary osteotomes (RO). PP was characterized by an output power three times higher than PM. Fifteen days after surgery, histomorphometric analyses showed that the osteotomy gap produced with PM and PP was about half the size of that produced by RO, and in a more advanced stage of recovery. Values of regenerated bone area with respect to the total osteotomy area were about double in PM and PP samples compared with RO ones, while the number of TRAP-positive (tartrate-resistant acid phosphatase positive) osteoclasts per linear surface showed a significant increase, suggesting greater bone remodelling. Under scanning electron microscopy, regenerated bone displayed higher cell density and less mineralized matrix compared with pre-existent bone for all devices used. Nanoindentation tests showed no changes in elastic modulus. In conclusion, PM/PP osteotomies can be considered equivalent to each other, and result in more rapid healing compared with those using RO.



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Effect of various durations of smoking cessation on postoperative outcomes: A retrospective cohort analysis.

BACKGROUND: Preoperative smoking cessation is commonly advised in an effort to improve postoperative outcomes. However, it remains unclear for how long smoking cessation is necessary, and even whether a brief preoperative period of abstinence is helpful and well tolerated. OBJECTIVE: We evaluated associations between various periods of preoperative smoking cessation and major morbidity and death. DESIGN: Retrospective cohort analysis. SETTING: Adults who had noncardiac surgery at the Cleveland Clinic Main Campus between May 2007 and December 2013. PATIENTS: A total of 37 511 patients whose smoking history was identified from a preoperative Health Quest questionnaire. Of these patients, 26 269 (70%) were former smokers and 11 242 (30%) were current smokers. Of the current smokers, 9482 (84%) were propensity matched with 9482 former smokers (36%). We excluded patients with American Society of Anesthesiologists' physical status exceeding four, patients who did not have general anaesthesia, and patients with missing outcomes and/or covariables. When multiple procedures were performed within the study period, only the first operation for each patient was included in the analysis. MAIN OUTCOME MEASURES: The relationship between smoking cessation and in-hospital morbidity/mortality. RESULTS: The incidence of the primary composite of in-hospital morbidity/mortality was 6.9% (656/9482) for all former smokers; the incidence was 7.8% (152/1951) for patients who stopped smoking less than 1 year before surgery, 6.3% (118/1977) for 1 to 5 years, 7.2% (115/1596) for 5 to 10 years and 6.9% (271/3457) for more than 10 years. CONCLUSION: Smoking cessation was associated with reduced in-hospital morbidity and mortality which was independent of cessation interval. (C) 2017 European Society of Anaesthesiology

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Fascial Graft Repair of Wide Bilateral Cleft Lip Deformity.

Wide bilateral cleft lip deformity reconstruction represents a special difficulty as it affects the lip, nose, and maxillary segments making single-stage reconstruction sometimes unobtainable. Many surgical and nonsurgical techniques have been prescribed to facilitate the definitive repair. Although some of these techniques proved to be useful, they have their inherent limitations and add another treatment step with all its possible complications and costs. The authors present a new method to address muscle layer repair in 1-stage procedure. It entails using fascial graft obtained from the temporalis muscle fascia or fascia lata, to reconstruct orbicularis oris lip muscle. Seven patients of wide bilateral cleft lip deformity (mean 17 mm) with a mean age of 4.4 months were subjected to single-stage lip reconstruction. After measuring the defect between both lateral muscle segments in front of the premaxilla intraoperatively ensuring that direct muscle repair could not be obtained, a fascial graft was harvested and sutured to both muscle edges. The authors found that, regardless the defect size or premaxilla protrusion, all wide clefts could be reconstructed satisfactorily in 1 stage procedure. No serious postoperative complications have been encountered in the lip or donor areas. Early follow-up reporting of the patients revealed stable repair. However more follow-up is still needed to assess late sequelae. In conclusion, fascial graft muscle repair of wide bilateral cleft lip deformity enables early 1-stage lip reconstruction without tension. The added donor morbidity is minimal and well tolerated. (C) 2017 by Mutaz B. Habal, MD.

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Craniocervical Pseudomeningocele Following Cerebellar Meningioma Resection: Demonstration of Neck of Pseudomeningocele With Three-Dimensional Isotropic T2-Weighted SPACE Sequence at 3 Tesla (3T) Magnetic Resonance Imaging.

Postoperative pseudomeningocele is an uncommon complication of craniospinal surgery. Diagnosis is reached on a postoperative computed tomography and magnetic resonance (MR) imaging. Demonstration of the location and dimension of the dural defect before surgical therapy is a very important. T1- and T2-weighted MR images revealed a significant pseudomeningocele extending from left cervicooccipital region. Magnitude and phase-contrast-MR images showed a cerebrospinal fluid (CSF) flow into pseudomeningocele, but they no revealed dural defect. Three-dimensional isotropic T2-weighted SPACE sequence revealed a signal void indicating CSF flow into pseudomeningocele and location and exact size of dural tear. Three-dimensional isotropic T2-weighted SPACE sequence is certainly the noninvasive and optimal method for demonstrating postoperative pseudomeningocele sacs. It demonstrates a pseudomeningocele regardless of an existing communication with the dural membrane. (C) 2017 by Mutaz B. Habal, MD.

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Silicone Facial Prosthesis: A Preliminary Report on Silicone Adhesion to Magnet.

Although a silicone facial prosthesis has many advantages, silicone's limited cementation with resin or metal has caused many maxillofacial reconstructive surgeons and prosthodontists concern regarding the use of silicone-based facial prostheses. This study demonstrates 1 representative silicone facial prosthesis patient with magnet cementation to silicone using plastic clay, which will be applied to various maxillofacial prosthesis strategies in the near future. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xD0d65

Form, Function, and Esthetics in Prosthetically Rehabilitated Maxillary Defects.

Purpose: Patients with maxillofacial defects secondary to the removal of benign and malignant pathologies of midface have a profound impact on quality of life. The aim of this study was to collect and analyze the data pertaining to 4 designs of obturator by assessment of the patient with obturator functioning scale (OFS) Materials and Methods: This retrospective analysis included all the patients who underwent prosthetic rehabilitation of maxillary defects using 4 different types (conventional, cast partial, hollow bulb, and magnet retained) of obturators from 2009 to 2016 with minimum 1 year of follow up. Demographics, number, size, location, type of pathology, postmorbid dentition, and the treatment rendered were recorded. Obturator functioning scale was used to subjectively assess the patient satisfaction. Results: The mean score on OFS was 5.67 (standard deviation: 1.8). There was a fair and statistical improvement in chewing/eating, speech clarity in public/on phone, swallowing of foods and liquids, pronunciation of words, and social interaction (P

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Cleft Lip and Palate: Demographic Patterns and the Associated Communication Disorders.

Purpose: This study investigated demographical characteristics, health status, and associated communication disorders in patients with orofacial clefts (OFCs) in Northern Jordan. Methods: A retrospective study of 226 cleft patients and their families was carried out between March 2012 and September 2016 at the Speech and Hearing Clinic and the Maxillofacial Center at King Abdullah University Hospital. Data were collected by interviewing patients and caregivers, having patients or caregiver to complete a questionnaire and reviewing the patient's medical records. The frequencies of OFC type, demographic, health status, and communication disorders variables were calculated. [chi]2 analysis was used to test for significance of associated demographic and communication disorders variables with OFC type. Results: Results revealed higher percentage of males compared with female patients. The majority of OFC patients were born to families who lived in urban areas, obtained high school diploma or lower educational level, lived below poverty cutoff, and showed nonconsanguineous marriages. Most mothers took the prescribed pregnancy supplements. Only one-third of the families received health education and reported other incidences of OFCs. Twenty percent of the patients had other congenital anomalies, 80% experienced dysphagia prior to the cleft repair, dropped to 14% after the repair. Higher percentage of patients with isolated cleft palate and cleft lip and palate exhibited hearing loss, hypernasality, articulation and phonological disorders, and dysphagia compared with those with cleft lip only. None of the demographic variables was associated with OFC type. Conclusions: Data suggested that families who had children with OFCs displayed poor socioeconomic status and low educational level which may impede the delivery of health education by health practitioners. Increased risk of comorbid communication disorders and malformations in OFC patients must be emphasized and disseminated to health professionals involved in the management of patients with OFC. (C) 2017 by Mutaz B. Habal, MD.

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Craniofacial Surgery in Chile.

No abstract available

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Variability in Minimally Invasive Surgery for Sagittal Craniosynostosis.

Minimally invasive approaches to the surgical correction of sagittal craniosynostosis are gaining favor as an alternative to open cranial vault remodeling. In this systematic review, the reviewers evaluate the variability in described surgical techniques for minimally invasive correction of sagittal craniosynostosis. Articles were selected based on predetermined inclusion and exclusion criteria from an online literature search through PubMed, EMBASE, and the Cochrane library. Extracted data included the incisions, method of dissection, osteotomies performed, and type of force therapy utilized. A total of 28 articles from 15 author groups were included in the final analysis. Of the 28 articles, 17 distinct techniques were identified. Significant variation existed in both the technique and the terminology used to describe it. Access to the cranium varied between a standard bicoronal incision (n = 2), a "lazy S" incision (n = 2), and multiple short incisions along the fused sagittal suture (n = 13). Additional variations were found in the size and design of the osteotomy, the usage (and duration, if applicable) of force therapy, and the age of the patient at the time of surgical intervention. This systematic review demonstrates that minimally invasive approaches to sagittal craniosynostosis vary widely in technique with respect to the incisions, osteotomies, and force therapy used. Additionally, the terminology employed in describing minimally invasive approaches is inconsistent across centers. This discrepancy between technique and terminology presents challenges for reporting and interpreting the increasing body of literature on this subject. We recommend standard terminology be used for future publications on minimally invasive techniques. (C) 2017 by Mutaz B. Habal, MD.

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Evaluation of Sinonasal Change After Lefort I Osteotomy Using Cone Beam Computed Tomography Images.

Orthognathic surgery including Le Fort I osteotomy involves changes in the nasal septum and maxillary sinus. This study assesses nasal septum changes after Le Fort I osteotomy using cone beam computed tomography images and evaluates mucosal changes in the maxillary sinus after the surgery. This was a retrospective study of 33 patients who underwent orthognathic surgery including Le Fort I osteotomy. To assess the maxillary sinus, changes in the mucosa of the maxillary sinus were analyzed by volume and geometry. We measured the air cavity per se and mucosal thickening of the maxillary sinus using SIMPLANT (Materialise, Belgium) software. And the geometry of the distribution of the mucosa was analyzed using cone beam computed tomography images. The septal angle was decreased after surgery, but not significantly (P > 0.05). The volume reduction of the air cavity per se and the volume increase associated with mucosal thickening were statistically significant (P

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Appraisal of Function After Rehabilitation With Tongue Prosthesis.

Statement of the Problem: Prosthetic rehabilitation following total glossectomy is very complex procedure from clinical as well as laboratory point of view. The basic objective of prosthodontic rehabilitation is to deliver a comfortable as well as esthetically suitable prosthesis, which restores the impaired speech and deglutition function. Purpose: Prosthetic rehabilitation of patients after total glossectomy with tongue prosthesis to evaluate improvement in speech as well as swallowing function. Materials and Methods: Tongue prostheses were fabricated with high-temperature vulcanizing silicone and heat-polymerizing acrylic to restore the functions affected after surgical resection of tongue. Patient's speech was evaluated with Dr Speech software version 4. The speech software was used to assess different speech parameters such as maximum phonation time, fundamental frequency, intensity, jitter, and shimmer. Deglutition assessment was done subjectively by using a standardized questionnaire designed by the speech pathologist. Speech was recorded for assessment before prosthetic rehabilitation and 2 weeks after delivery of the tongue prosthesis. Results: After analysis of various speech parameters frequency range was improved with prosthesis (ie, 172.19 Hz) as compared to without prosthesis (ie, 111.47 Hz). Speech intelligibility was improved with tongue prosthesis. Deglutition assessment revealed that patient's deglutition abilities were improved. Conclusion: Tongue prosthesis helps to improve speech and articulation in patients with total glossectomy. Apart from that deglutition capability is also significantly improved. Clinical Implications: Total glossectomy affects speech, mastication, and swallowing to a greater proportion. It may also lead to psychological impairment of the patient. Tongue prosthesis efficiently improves speech and deglutition abilities of the patient leading to a better quality of life. (C) 2017 by Mutaz B. Habal, MD.

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Reconstruction of Liposarcoma Resection Defect With a Made-to-Measure Polyethylene Prosthesis Using Three-Dimensional Digital Technology.

Background: Liposarcoma is considered one of the most frequently occurring tumors of the soft tissues, representing 17% to 30% of all mesenchymal cell tumors. It is less common in the head and neck representing

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Parental Perceptions Following Cleft Lip Repair in Their Children.

Objective: Cleft lip (CL) repair at 3 months is chosen mostly out of convention and offers minimal functional benefit. Potentially, a better cosmetic outcome is possible by delaying repair. This study examines parental perceptions around repair at 3 months to determine if current guidelines are appropriate. Design: Retrospective cross-sectional survey. Setting: Tertiary-care institution. Participants: Parents of children with CL +/- P under age 6 years who underwent CL repair from 2004 to 2011 at our center were surveyed (n = 64). Response rate was 61% (n = 37). Methods: Open-ended survey asked about various aspects of parental perceptions before and after repair. Qualitative data analysis is used to interpret survey responses. Statistics: Fisher exact test using contingency tables to identify statistically significant results. Results: Nearly all (36/37) parents felt repair was important, citing reasons such as feeding, speech, and appearance. Most (28/37) felt surgery would fix the problem. A portion of parents (15/37) would delay repair if better aesthetics were possible later, but most would not (20/37). Most parents were satisfied with repair quality (33/37). On average, repair did not impact parent-child bonding, and eliminated negative interactions with strangers that parents found distressing. Conclusions: Arguably, positive parental perceptions of their child's condition reflect favorably on the child's well-being, and may outweigh any future aesthetic benefit. Therefore, current recommendations should be upheld. However, given that some parents would consider delaying repair, they could be offered this option. Future efforts should examine cultural factors, and aesthetic and developmental outcomes of repair at different ages to determine optimal repair timing. (C) 2017 by Mutaz B. Habal, MD.

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Thyroglossal Duct Cyst at the Base of Tongue: The Emerging Role of Transoral Endoscopic-Assisted Surgery.

Cystic lesions involving the tongue base are rare, generally presenting in pediatric patients, and they may encompass different pathologies such as ranula, lingual ectopic thyroid, thyroglossal duct cyst (TDC), dysontogenetic cysts, benign, and malignant tumors. This paper describes the case of a 19-year-old girl with phonation impairment and mild dysphagia due to limited tongue protrusion and movements. Radiologic examinations revealed a bulky cystic lesion at the base of tongue with displacement of extrinsic lingual muscles. A minimally invasive transoral removal of the mass was performed under the assistance of the endoscopic system. The histopathologic analysis confirmed the diagnosis of intralingual TDC. After 2 years of clinical and radiologic follow-up, no recurrence of disease was observed and the patient is completely asymptomatic. The present experience suggests that the endoscopic-assisted transoral removal of intralingual TDC can be proposed as a safe and effective procedure, alternative to traditional transcervical surgery as well as to transoral robotic surgery, leading to very appealing cosmetic results and encouraging functional outcomes in terms of phonation and swallowing. Preoperative radiologic examinations should be performed for an accurate diagnosis and appropriate selection of patients. (C) 2017 by Mutaz B. Habal, MD.

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Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face.

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xBvWnV

Influence of the Polymorphism C-509T in the TGFB1 Gene Promoter on the Response to Montelukast

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Hyperpigmentation cutanée induite par le méropénème et la lévofloxacine

Publication date: Available online 12 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Garval, V. Vuiblet, A. Durlach, G. Perceau, D. Anuset, P. Bernard
IntroductionLe méropénème (carbapénème) est un antibiotique rarement prescrit. Des effets secondaires cutanés ont été rapportés à type d'exanthème, de prurit, d'urticaire et de syndromes de Lyell ou de Stevens–Johnson. La lévofloxacine (fluoroquinolone), antibiotique largement prescrit, partage les mêmes effets secondaires cutanés, auxquels s'ajoute une action photosensibilisante. Nous rapportons un cas d'hyperpigmentation cutanée noirâtre induite par l'association de méropénème et de lévofloxacine.ObservationUn homme de 67 ans était traité par méropénème (1g×4/j), lévofloxacine (500mg×2/j) et amikacine (500mg/j) pendant 2 semaines, puis méropénème, lévofloxacine et rifampicine (600mg×2/j) pendant 4 semaines, pour une ostéite du cinquième métatarsien. Trois semaines après le début de l'antibiothérapie, une pigmentation noirâtre apparaissait, prédominant à la face antérieure des jambes. La biopsie cutanée révélait un dépôt noirâtre du derme superficiel et moyen, périvasculaire et interstitiel, coloré par les colorations de Fontana et de Perls. L'étude en microspectroscopie infrarouge permettait d'identifier la molécule de méropénème dans le derme. Après arrêt des antibiotiques, la pigmentation régressait lentement.DiscussionDes cas similaires d'hyperpigmentation cutanée noirâtre ont été rapportés après utilisation de minocycline. Dans ces cas, l'analyse histologique montrait également des dépôts dermiques de fer et/ou de mélanine, mais la nature du pigment responsable restait incertaine. Dans notre cas, l'analyse en spectroscopie infrarouge a permis de localiser le méropénème dans le derme. Deux cas d'hyperpigmentation cutanée ont été rapportés après utilisation de la lévofloxacine, avec une analyse histologique similaire.BackgroundVarious cutaneous side–effects, including, exanthema, pruritus, urticaria and Lyell or Stevens–Johnson syndrome, have been reported with meropenem (carbapenem), a rarely-prescribed antibiotic. Levofloxacin (fluoroquinolone), a more frequently prescribed antibiotic, has similar cutaneous side–effects, as well as photosensitivity. We report a case of cutaneous hyperpigmentation induced by meropenem and levofloxacin.Patients and methodsA 67-year-old male was treated with meropenem (1g×4 daily), levofloxacin (500mg twice daily) and amikacin (500mg daily) for 2 weeks, followed by meropenem, levofloxacin and rifampicin (600mg twice daily) for 4 weeks for osteitis of the fifth metatarsal. Three weeks after initiation of antibiotic therapy, dark hyperpigmentation appeared on the lower limbs, predominantly on the anterior aspects of the legs. Histology revealed dark, perivascular and interstitial deposits throughout the dermis, which stained with both Fontana–Masson and Perls stains. Infrared microspectroscopy revealed meropenem in the dermis of involved skin. After withdrawal of the antibiotics, the pigmentation subsided slowly.DiscussionSimilar cases of cutaneous hyperpigmentation have been reported after use of minocycline. In these cases, histological examination also showed iron and/or melanin deposits within the dermis, but the nature of the causative pigment remains unclear. In our case, infrared spectroscopy enabled us to identify meropenem in the dermis. Two cases of cutaneous hyperpigmentation have been reported following use of levofloxacin, and the results of histological examination were similar. This is the first case of cutaneous hyperpigmentation induced by meropenem.



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Isolated sphenoid sinus opacifications: a systematic review and meta-analysis

Background

Isolated sphenoid sinus opacifications (ISSOs) represent a relatively uncommon disease with the potential for serious complications. To better understand this disease, we performed a systematic review to further characterize the underlying pathologies, associated symptoms, and treatment outcomes of patients with ISSOs.

Methods

A systematic review of ISSO case series was performed utilizing the Medline, Embase, Web of Science, and Cochrane databases in accordance with guidelines established by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data of interest included disease pathology, associated symptoms, and treatment outcomes.

Results

Of the initial 1051 hits from the 4 databases, 17 articles, with a combined 1133 ISSO patients, were ultimately included in the review. On a weighted analysis, the underlying pathologies were classified as chronic rhinosinusitis without nasal polyps (CRSsNP) (28.3%), mucoceles (20.3%), fungal sinusitis (12.5%), malignant neoplasms (7.7%), intracranial lesions (7.0%), benign neoplasms (5.7%), chronic rhinosinusitis with nasal polyps (CRSwNP) (3.4%), and other lesions (4.7%). Cranial neuropathies were present in 16.3% (95% confidence interval [CI], 10.1-22.5%) of ISSO patients. A favorable surgical complication rate of 1.5% (95% CI, −0.1% to 3.2%) was found in patients undergoing surgery for an ISSO.

Conclusion

ISSOs are caused by diverse pathologies. Given the considerable rates of neoplastic disease and cranial neuropathies, patients affected by an ISSO should be monitored closely and treated aggressively. Prompt surgical intervention, with either diagnostic or therapeutic intent, is often indicated.

http://ift.tt/2gzNzKv

In vitro safety evaluation of human nasal epithelial cell monolayers exposed to carrageenan sinus wash

Background

Carrageenans have shown to reduce the viral load in nasal secretions and lower the incidence of secondary infections in children with common cold. Despite the widespread use of carrageenans in topical applications, the effect of carrageenans on the sinonasal epithelial barrier has not been elucidated. We investigate the effect of different carrageenans on the sinonasal epithelial barrier and inflammatory response in vitro.

Methods

Iota and Kappa carrageenan delivered in saline irrigation solutions applied to air-liquid interface (ALI) cultures of primary human nasal epithelial cells from chronic rhinosinusitis patients and controls. Epithelial barrier structure was assessed by measuring the transepithelial electrical resistance (TEER) and immunolocalization of F actin. Ciliary beat frequency (CBF), toxicity, and inflammatory response was studied.

Results

Kappa or Iota carrageenan in the different solutions was not toxic, did not have detrimental effects on epithelial barrier structure and CBF. Rather, application of Kappa carrageenan significantly increased TEER and suppressed interleukin 6 (IL-6) secretion in ALI cultures from CRS patients.

Conclusion

Kappa or Iota carrageenan solution was safe and did not negatively affect epithelial barrier function. Kappa carrageenan increased TEER and decreased IL-6 production in CRS patients, indicating positive effects on epithelial barrier function in vitro.

http://ift.tt/2i75HyY

Allergen immunotherapy: exploring areas for further inquiry

Background

Allergy-related illness impacts millions of individuals worldwide. Our objectives were to characterize current trends of clinical trials research relating to allergen immunotherapy and to describe the landscape of allergen immunotherapy in National Institutes of Health (NIH)-supported research inquiry.

Methods

On ClinicalTrials.gov, the following terms were searched: allergen immunotherapy OR allergy immunotherapy. Variables, including completion status, dates, design, study population, funder, location, and allergen were recorded. The NIH Research Portfolio Online Reporting Tools (RePORTER) system was also used to gather relevant variables.

Results

A total of 372 clinical trials met inclusion criteria. The proportion of industry-funded clinical trials has declined over 15 years. There has been a slow decline in pollen allergy immunotherapy research, with an increase in both food and animal allergy immunotherapy research. Otolaryngologists comprised only 6.4% of clinical trials principal investigators (PIs). There was a total adjusted NIH funding of $74,986,125 for the 118 total funding years.

Conclusion

Despite an immense interest in allergen immunotherapy, this analysis demonstrates that otolaryngologists represented a small proportion of PIs leading associated clinical trials and basic science inquiry. The proportion of trials with industry sponsorship has declined considerably in recent decades. These trends could help direct future resource allocation for allergen immunotherapy.

http://ift.tt/2gABtRt

Rescue of Outer Hair Cells with Antisense Oligonucleotides in Usher Mice Is Dependent on Age of Treatment

Abstract

The absence of functional outer hair cells is a component of several forms of hereditary hearing impairment, including Usher syndrome, the most common cause of concurrent hearing and vision loss. Antisense oligonucleotide (ASO) treatment of mice with the human Usher mutation, Ush1c c.216G>A, corrects gene expression and significantly improves hearing, as measured by auditory-evoked brainstem responses (ABRs), as well as inner and outer hair cell (IHC and OHC) bundle morphology. However, it is not clear whether the improvement in hearing achieved by ASO treatment involves the functional rescue of outer hair cells. Here, we show that Ush1c c.216AA mice lack OHC function as evidenced by the absence of distortion product otoacoustic emissions (DPOAEs) in response to low-, mid-, and high-frequency tone pairs. This OHC deficit is rescued by treatment with an ASO that corrects expression of Ush1c c.216G>A. Interestingly, although rescue of inner hairs cells, as measured by ABR, is achieved by ASO treatment as late as 7 days after birth, rescue of outer hair cells, measured by DPOAE, requires treatment before post-natal day 5. These results suggest that ASO-mediated rescue of both IHC and OHC function is age dependent and that the treatment window is different for the different cell types. The timing of treatment for congenital hearing disorders is of critical importance for the development of drugs such ASO-29 for hearing rescue.

http://ift.tt/2yjBJxN

Rescue of Outer Hair Cells with Antisense Oligonucleotides in Usher Mice Is Dependent on Age of Treatment

Abstract

The absence of functional outer hair cells is a component of several forms of hereditary hearing impairment, including Usher syndrome, the most common cause of concurrent hearing and vision loss. Antisense oligonucleotide (ASO) treatment of mice with the human Usher mutation, Ush1c c.216G>A, corrects gene expression and significantly improves hearing, as measured by auditory-evoked brainstem responses (ABRs), as well as inner and outer hair cell (IHC and OHC) bundle morphology. However, it is not clear whether the improvement in hearing achieved by ASO treatment involves the functional rescue of outer hair cells. Here, we show that Ush1c c.216AA mice lack OHC function as evidenced by the absence of distortion product otoacoustic emissions (DPOAEs) in response to low-, mid-, and high-frequency tone pairs. This OHC deficit is rescued by treatment with an ASO that corrects expression of Ush1c c.216G>A. Interestingly, although rescue of inner hairs cells, as measured by ABR, is achieved by ASO treatment as late as 7 days after birth, rescue of outer hair cells, measured by DPOAE, requires treatment before post-natal day 5. These results suggest that ASO-mediated rescue of both IHC and OHC function is age dependent and that the treatment window is different for the different cell types. The timing of treatment for congenital hearing disorders is of critical importance for the development of drugs such ASO-29 for hearing rescue.

http://ift.tt/2yjBJxN

Corrigendum to “Long-term results of a phase II study of gemcitabine and cisplatin chemotherapy combined with intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma” [Oral Oncol. 73 (2017) 118–123]

Publication date: Available online 12 October 2017
Source:Oral Oncology
Author(s): Mingyao Wu, Dan Ou, Xiayun He, Chaosu Hu
ObjectivesTo evaluate long-term results of a phase II study of induction and adjuvant gemcitabine and cisplatin (GP) chemotherapy with intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC).Materials and methodsOne hundred and twelve patients (Stage III: 65, IVA-B: 47) with locoregionally advanced NPC were enrolled in this study. All patients received induction chemotherapy consisting of 1000 mg/m² gemcitabine on day 1 and 8, and cisplatin 25 mg/m² on day 1–3, every 3 weeks for 2 cycles. Adjuvant chemotherapy for 2 cycles of the same regime was given 28 days after the end of IMRT. The IMRT technique was utilized for all patients.ResultsIn total, 97.3% patients completed 2 cycles of induction chemotherapy. The overall response rate (RR) of cervical lymph nodes was 89.0%. Acute toxicities were mainly grade 1–2 myleosuppression and vomiting. And 83.9% patients completed 2 cycles of adjuvant chemotherapy. All patients finished IMRT with RR at the end of IMRT for nasopharynx, lymph nodes of neck and retropharyngeal area being 99.1%, 97.9% and 97.7%, respectively. The 5-year local control, regional control, distant metastasis-free and overall survival rates were 93.2%, 92.3%, 89.0% and 82.1%, respectively. The 5-year overall survival of stage III and IVA-B were 87.0%, and 75.5%, respectively. The incidence of grade 3–4 acute radiotherapy-related mucositis was 28.6%. Severe late toxicities were uncommon.ConclusionIMRT combined with GP for locoregionally advanced NPC is well tolerated, effective, and convenient, and warrants further studies.



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Snail-mediated cancer stem cell-like phenotype in human CNE2 nasopharyngeal carcinoma cell

Abstract

Background

Cancer stem cell (CSC)-like phenotype, which has been proven to play a critical role in invasion and metastasis of many kinds of cancers, has also been reported to be associated with epithelial-mesenchymal transition. Snail, a potent repressor of E-cadherin expression, was found to have a function to regulate the aforementioned processes.

Methods

In the current study, expression of putative CSCs biomarkers and the ratio of CSC-like CNE2 (cancer cell line) in total CNE2 were measured, and CSC-like characteristics were analyzed with tumor-sphere self-renewal and colony-forming assays. Migration and invasion properties were determined by using transwell and wound healing assays. Xenograft tumor assays in vivo were done to evaluate the function of Snail and radiation in the tumor forming ability.

Results

In human nasopharyngeal carcinoma (NPC) cells, overexpression of Snail mediates a CSC-like phenotype, which enhances the initiation, invasion, and migration ability of cancer cells.

Conclusion

Thus, Snail is a potential therapeutic target in NPC.

http://ift.tt/2i7rNl0

Study of Niraparib or Carboplatin-Paclitaxel in Combination With TSR-042

Conditions:   Metastatic Cancer;   Advanced Cancer;   Solid Tumor
Interventions:   Drug: Niraparib;   Drug: TSR-042;   Drug: Carboplatin-Paclitaxel
Sponsor:   Tesaro, Inc.
Not yet recruiting

http://ift.tt/2kJGzPE

Assessment of Metabolic & Path Response w/ RCT & ImT Before Surgery in Locally Advanced Esoph and Gastro-esoph Jction CA

Conditions:   Adenocarcinoma of the Esophagus;   Adenocarcinoma of the Gastroesophageal Junction;   Squamous Cell Carcinoma of the Esophagus
Interventions:   Drug: Monalizumab;   Drug: Oxaliplatin;   Drug: 5-Fluorouracil;   Radiation: Metabolic;   Other: Metabolic;   Procedure: Surgery
Sponsors:   Jules Bordet Institute;   Innate Pharma
Recruiting

http://ift.tt/2xBcnMM

Phase III Study of Simultaneous Integrated Boost Radiotherapy (SIB-IMRT) With or Without Concurrent Chemotherapy for Locally Advanced Esophageal Cancer - 3JECROG-P02

Condition:   Esophageal Neoplasms
Interventions:   Radiation: SIB-IMRT;   Drug: Paclitaxel;   Drug: Platinum-Based Drug
Sponsors:   Chinese Academy of Medical Sciences;   Hebei Medical University Fourth Hospital;   Tianjin Medical University Cancer Institute and Hospital;   Anyang Tumor Hospital;   The First Affiliated Hospital with Nanjing Medical University;   Affiliated Hospital of Hebei University;   Fujian Cancer Hospital;   Sichuan Cancer Hospital and Research Institute
Recruiting

http://ift.tt/2kJ7zii

Thyroid Ultrasound Elasticity (TrUE) Imaging

Condition:   Cancer, Thyroid
Interventions:   Diagnostic Test: Ultrasound;   Diagnostic Test: Shear wave elasticity imaging;   Diagnostic Test: Multi-angle compound shear wave elasticity imaging
Sponsor:   Emory University
Not yet recruiting

http://ift.tt/2xzzS8F

Paediatric anaesthesia for low-resource settings

1H022A033J02

http://ift.tt/2gf9HNc

Endocrine problems in the critically ill 2: endocrine emergencies

1A012C013J02

http://ift.tt/2yimhlA

Intraoperative ventilation and postoperative respiratory assistance

1A013C01

http://ift.tt/2gcZroH

Endocrine problems in the critically ill 1: diabetes and glycaemic control

1A012C013J02

http://ift.tt/2yiPNr5

Cardiomyopathy and anaesthesia

1A012A033J02

http://ift.tt/2geApWn

Corrigendum to “Long-term results of a phase II study of gemcitabine and cisplatin chemotherapy combined with intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma” [Oral Oncol. 73 (2017) 118–123]

To evaluate long-term results of a phase II study of induction and adjuvant gemcitabine and cisplatin (GP) chemotherapy with intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC).

http://ift.tt/2geUXy3

Efficacy of vitamins E and C for reversing the cytotoxic effects of nicotine and cotinine

Nicotine has adverse cellular and molecular effects on oral mucosa, bone, and teeth. Vitamin E (α-tocopherol) and vitamin C (ascorbic acid) are biological antioxidants with positive effects on wound healing and bone formation. This in vitro study sought to assess the cytotoxic effects of different concentrations of nicotine and cotinine (a metabolite of nicotine) on MG-63 osteoblast-like cells and human gingival fibroblasts (HGFs) in the presence and absence of antioxidant vitamins E and C (separately and combined). Cell viability and proliferation were assessed using the methyl thiazol tetrazolium (MTT) assay. Cell migration was assessed using the scratch test, and expression of apoptosis-related genes was quantitatively analyzed using real-time PCR. Dose-dependent negative effects of nicotine on the morphology, viability, proliferation, and migration of MG-63 and HGF cells were statistically significantly greater than those of cotinine. Vitamin E (separately and combined with vitamin C) was statistically significantly more effective than vitamin C (at the concentration used in this study) at improving cell viability, proliferation, and migration, and at reducing apoptosis of cells exposed to nicotine or cotinine. Based on the positive results of this study, vitamin C and especially vitamin E (systemically and/or locally) may be useful in the repair and regeneration of oral hard and soft tissues in smokers.

http://ift.tt/2i5r1Vz

Post-tonsillectomy dietary advice and haemorrhage risk: Systematic review

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Miles Bannister, Chris Thompson
ObjectivesTonsillectomy remains one of the commonest operations performed in children. Post-operative diet may affect post-tonsillectomy haemorrhage rate, although post-operative dietary advice varies. We undertook a systematic review of the published literature to assess if and how different post-operative diets were associated with differences in PTH rates following paediatric tonsillectomy, to provide an evidence base to inform individual otorhinolaryngologists' practice and for future guideline development.MethodsA systematic review of the published English literature of the PubMed, Medline and Cochrane Collaboration databases, using search terms used included 'post-tonsillectomy', 'diet', 'dietary advice', 'bleeding', 'haemorrhage', 'paediatric' &'children'.ResultsEight publications were included in the review, including 5 randomised controlled trials, 2 case-control studies and 1 cohort study. These involved 1039 patients with 545 patients following a restricted/non-additive diet after tonsillectomy and 494 patients following an unrestricted/additive diet. The average reported PTH rate of patients in the restricted diet groups was 2.3% and 0.8% in patients in the unrestricted diet groups, which is not statistically significant (p = 0.12, one tailed t-test).ConclusionPTH following paediatric surgery does not appear to be affected by different post-operative diets or regimes followed by patients. Clinicians should not change the advice provided regarding oral intake and diet following tonsillectomy surgery in children.



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Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Lai-Ying Zhang, Laurie Zhong, Michael David, Anders Cervin
BackgroundRecent evidence has challenged the practice of tonsillectomy in children with sleep-disordered breathing. Tonsillotomy (subtotal/partial/intracapsular tonsillectomy) has been proposed as an alternative with equivalent effectiveness and decreased post-operative morbidity, thus improving cost-effectiveness.ObjectiveTo systematically review the literature comparing clinical efficacy, post-operative morbidity, and cost-effectiveness of tonsillotomy and tonsillectomy in paediatric (<16yo) patients with sleep-disordered breathing.Data sourcesA systematic search of MEDLINE, EMBASE, and CENTRAL (1984–July 2014) was conducted. Papers in English directly comparing post-operative outcomes in tonsillectomy and tonsillotomy in children undergoing surgery for sleep-disordered breathing were included.Review methodsTwo authors independently assessed abstracts for relevance, with disagreements resolved by a third author. Selected studies were independently assessed regarding inclusion and exclusion criteria.ResultsThirty-two studies satisfied inclusion and exclusion criteria (19 randomised, 13 non-randomised). Patient satisfaction, quality-of-life, and polysomnographic improvement post-surgery did not vary between tonsillotomy and tonsillectomy. Tonsillotomy reduced the odds of a secondary haemorrhage by 79% (OR 0.21, 95% CI 0.17–0.27, p < 0.01), decreased post-operative pain and reduced return to normal oral intake by 2.8 days (95% CI 1.08–4.52, p < 0.01). The odds of readmission were decreased by 62% (OR 0.38, 95% CI 0.23–0.60, p < 0.01). Tonsillotomy had a slightly higher rate of symptom recurrence (4.51%) than tonsillectomy (2.55%), the long-term impact of which was unclear.ConclusionCurrent evidence supports tonsillotomy in children with obstructive surgical indications. It is likely to reduce post-operative haemorrhage, pain, and facilitate a faster return to normal diet and activity. Healthcare burden is decreased due to fewer post-operative complications and reduced need for medical re-contact. More research is necessary to assess the risk of recurrence, and further classification of secondary haemorrhage severity is required to fully clarify the clinical benefit of tonsillotomy.



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Outcomes of tympanoplasty in children with down syndrome

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Saied Ghadersohi, Jonathan B. Ida, Bharat Bhushan, Kathleen R. Billings
IntroductionThe prevalence of chronic otitis media with effusion (COME), and Eustachian tube dysfunction (ETD) is high in Down syndrome (DS) patients. This often necessitates multiple tympanostomy tube (TT) placements resulting in a higher rate of persistent tympanic membrane (TM) perforation requiring tympanoplasty for repair.ObjectivesTo assess risk factors for persistent perforation and outcomes of tympanoplasty in DS patients.MethodsRetrospective case series of 91 ears in 69 DS patients with TM perforations, who were either observed or underwent tympanoplasty. Clinical features, surgical outcomes, and hearing outcomes were assessed.Results91 ears were evaluated. Sixty perforations were observed, and 31 perforations were repaired. The closure rate was 54.8% for primary surgery, and 70.9% after secondary surgical interventions in the Tympanoplasty Group, compared to 33.0% spontaneous closure rate in the Observation Group (p < 0.001). The only risk factor for failed tympanoplasty repair was persistent COME/ETD (OR 27.2, p = 0.001). In the Observation Group perforations diagnosed at an older age, with >3 TT insertions, and with persistent COME/ETD were less likely to close spontaneously. Patients undergoing tympanoplasty had worse preoperative pure tone averages than those being observed, but significant improvement in air-bone gaps were noted in the Tympanoplasty Group (p = 0.02) post-operatively. Patients were often rehabilitated with hearing aids regardless of intervention (53.3% Observation Group, 48.4% Tympanoplasty Group).ConclusionsPersistent TM perforation in children with Down syndrome was associated with a history of COME/ETD, and multiple prior TT insertions. Tympanoplasty was successful for repair in most patients who underwent surgical intervention, but residual hearing loss was common.



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Pre- and post-operative application of acoustic rhinometry in children with otitis media with effusion and with or without adenoid hypertrophy-a retrospective analysis

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Dan Lai, Gang Qin, Junmei Pu, Lu Liu, Yiying Yang
BackgroundThere is no standardized scheme for preoperative evaluation of adenoid hypertrophy or a consensus on surgical indications for adenoidectomy in children with otitis media with effusion (OME), especially for young children intolerant to nasal endoscopic assessment. The aim of this study was to evaluate the efficacy and reliability of acoustic rhinometry (AR) in evaluating benefits from adenoidectomy in children with OME.MethodChildren with OME who were scheduled for surgical intervention were reviewed and AR tests performed preoperatively and postoperatively. The patients were divided into two groups based on the surgical strategy (Group I: tympanostomy tube placement alone; Group II: tympanostomy tube placement plus adenoidectomy). Correlation and regression analyses were performed to assess the relationship between findings of AR and nasal endoscopy. AR parameters including minimal nasal cross-sectional area (MCA), and nasopharyngeal volume (NPV), as well as scores of subjective symptoms were obtained to evaluate the utility of AR pre- and post-surgery.ResultsSixty-five children aged 4–10 years who met the inclusion criteria were included. No significant differences in gender or age distribution were observed between Group I and Group II. MCA, as well as NPV significantly decreased in Group II when compared with Group I (p = 0.000). A significant inverse correlation was observed between NPV and choanal obstruction ratio in both groups I (r = -0.625, p < 0.001) and II (r = −0.570, p < 0.001). A significant difference between preoperative and postoperative NPV and subjective symptom scores was observed in group II after adenoidectomy (p = 0.000).ConclusionAR parameters showed a good clinical correlation with findings of nasal endoscopy and thus may be useful for evaluating candidacy for surgical adenoidectomy among children with OME, especially in whom preoperative nasal endoscopic examination is not feasible. Additionally, AR can reveal the changes occurring within the nasopharyngeal passage before and after adenoidectomy.



http://ift.tt/2hDfvwK

Herpes Simplex Virus and Human Papillomavirus Coinfections in Hyperimmunoglobulin E Syndrome Presenting as a Conjunctival Mass Lesion

Hyperimmunoglobulin E syndrome (HIES) or Job's syndrome is a rare immunodeficiency disease with less than 200 cases reported worldwide, among which few cases are reported with lesions due to herpes simplex virus (HSV) or human papillomavirus (HPV). This case study presents a rare case of HIES with coinfection of HSV and HPV. A 12-year-old boy, previously diagnosed with HIES, presented with a large conjunctival mass lesion. The presence of HPV in the lesion was confirmed by biopsy and by using the line-probe assay method to detect the HPV genome. However, the mass lesion did not respond to anti-HPV therapy with topical interferon-α2b (IFN-α2b) and oral cimetidine but improved promptly after intravenous (IV) acyclovir, which is often administered for cutaneous herpetic lesions. This suggested the presence of HSV in the conjunctival mass. Review of pathology and HSV immunohistochemical staining confirmed the presence of HSV as a coinfection. The likelihood that the mass arose from an abnormal host response to HSV and HPV due to HIES was considered, but coexisting infection with these two viruses and HIES has not been reported in the literature; therefore, such cases require further investigation.

http://ift.tt/2i6alNG

Randomized controlled pilot study of the preoperative use of brimonidine 0.33%topical gel for hemostasis in Mohs micrographic surgery

Brimonidine topical gel may be useful in cutaneous surgical procedures because of its vasoconstricting properties.

http://ift.tt/2yc46OK

Lichen planus affecting the female genitalia: A retrospective review of patients at Mayo Clinic

Genital or vulval lichen planus (VLP) may have a disabling effect on a patient's quality of life. Evidence-based management guidelines are lacking for VLP.

http://ift.tt/2g5gs0n

Validity of skin cancer malignancy reporting to the Organ Procurement Transplant Network: A cohort study

The Organ Procurement Transplant Network (OPTN) registry collects data on posttransplant malignancies in solid organ transplant recipients. Complete and accurate registry data on skin cancer is critical for research on epidemiology and interventions.

http://ift.tt/2g2LJkG

Case 31-2017: A 19-Month-Old Girl with Failure to Thrive

Presentation of Case. Dr. Rachelle E. Gupta (Pediatrics): A 19-month-old girl was admitted to this hospital because of failure to thrive. The patient had been born in Puerto Rico by induced vaginal delivery after 41 weeks of gestation. Her mother did not smoke, drink alcohol, or take any…

http://ift.tt/2g4kwOk

Low-level laser irradiation induces in vitro proliferation of stem cells from human exfoliated deciduous teeth

Abstract

The aim of this study was to evaluate the effect of low-level laser irradiation (LLLI) on the proliferation and viability of stem cells from human exfoliated deciduous teeth (SHED). Cells were irradiated or not (control) with an InGaAlP laser diode (660 nm, 30 mW, continuous action mode) using two different energy densities (0.5 J/cm²—16 s; 1.0 J/cm²—33 s). Irradiation was performed at 0 and 48 h, with the laser probe fixed at a distance of 0.5 cm from the cells. Cell proliferation was analyzed at 0, 24, 48, and 72 h by the Trypan blue exclusion method and MTT assay. Cell cycle and Ki67 expression were analyzed by flow cytometry. Apoptosis-related events were evaluated by expression of annexin V/PI and nuclear morphological changes by staining with DAPI. Differences between groups at each time were analyzed by the Kruskal–Wallis and Mann–Whitney tests, adopting a level of significance of 5% (p < 0.05). The results showed that an energy density of 1.0 J/cm² promoted an increase in cell proliferation at 48 and 72 h compared to the control and 0.5 J/cm² groups. Cell cycle analysis revealed a predominance of cells in the S and G2/M phases in the irradiated groups. This finding was confirmed by the increased expression of Ki67. Low positive staining for annexin V and PI was observed in all groups, and no nuclear changes were detected, indicating that cell viability was not affected by the energy densities tested. It can be concluded that the LLLI parameters used (660 nm, 30 mW, 1.0 J/cm²) promote the proliferation of SHEDs and the maintenance of cell viability.

http://ift.tt/2zhrV5k

Chronic active Epstein-Barr virus infection with cutaneous lymphoproliferation: haemophagocytosis in the skin and haemophagocytic syndrome

Abstract

Patients with chronic active Epstein-Barr virus (EBV) infections (CAEBV) present with cutaneous manifestations including hydroa vacciniforme-like eruptions.¹ Haemophagocytic lymphohistiocytosis (HLH), a fatal complication, can occur in severe cases of CAEBV.^2,3 We retrieved 25 cases of CAEBV treated in our hospital and histopathologically characterized the skin lesions of 3 of those cases, including one case with haemophagocytosis. This is a novel report of CAEBV with haemophagocytosis in the skin.

This article is protected by copyright. All rights reserved.

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A novel combination regimen with intense focused ultrasound and pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for lifting and tightening of the aging face

Summary

Background

Intense focused ultrasound (IFUS) has demonstrated moderate efficacy for facial laxity of the aging face. Pressure- and dose-controlled transcutaneous pneumatic injections of hypertonic glucose solution (TPIG) are a minimally invasive way to deliver solution into the skin for therapeutic purposes. Recently, its application around temporal areas is known to exert early-onset lifting effects with facial contour rejuvenation.

Aims

We sought to evaluate the safety and efficacy of this novel combination regimen with IFUS and TPIG for lifting and tightening of aging face.

Patients and Methods

Twenty-two Korean subjects with mild-to-moderate facial skin laxity were evaluated after receiving a sequential single session of IFUS and TPIG treatments. Dermatologists' objective assessments for general appearance, and mid- and low faces based on photographic images were performed at 1- and 12-week post-treatment follow-ups. Patients' subjective assessments were also conducted. Skin biopsies were taken at baseline and the last visit.

Results

Among 22 subjects, twenty (91%) demonstrated improvement after 12-week follow-up. We also observed similarly improved state just after 1 week of treatments (82%: 18/22). Specifically, improvement of the mid-face was evident from the first week, while the progress of the low face improvement was observed at the twelve week. Subjective assessments paralleled these findings. No seriously adverse effect was observed during procedures. Histologic evaluation showed greater dermal collagen fibers throughout the dermis after treatments.

Conclusion

Combination treatment with IFUS and TPIG has beneficial effects for skin lifting and tightening with early-onset time.

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In This Issue

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Improvement of Foxp3 stability through CNS2 demethylation by TET enzyme induction and activation

Abstract

Since induced regulatory T cells (iTregs) can be produced in a large quantity in vitro, these cells are expected to be clinically useful to induce immunological tolerance in various immunological diseases. Foxp3 (Forkhead box P3) expression in iTregs is, however, unstable due to the lack of demethylation of the CpG island in the conserved non-coding sequence 2 (CNS2) of the Foxp3 locus. To facilitate the demethylation of CNS2, we over-expressed the catalytic domain (CD) of the ten-eleven translocation (TET) protein, which catalyzes the steps of the iterative demethylation of 5-methylcytosine. TET-CD over-expression in iTregs resulted in partial demethylation of CNS2 and stable Foxp3 expression. We also discovered that TET expression was enhanced under low oxygen (5%) culture conditions, which facilitated CNS2 DNA demethylation and stabilization of Foxp3 expression in a TET2- and TET3-dependent manner. In combination with vitamin C treatment, which has been reported to enhance TET catalytic activity, iTregs generated under low oxygen conditions retained more stable Foxp3 expression in vitro and in vivo and exhibited stronger suppression activity in a colitis model compared with untreated iTregs. Our data indicate that the induction and activation of TET enzymes in iTregs would be an effective method for Treg-mediated adoptive immunotherapy.

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Autoimmunity associated with chemically induced thymic dysplasia

Abstract

Autoimmune and inflammatory conditions are frequent complications in patients with reduced numbers of T cells. Here, we describe a mouse model of thymic stromal dysplasia resulting in peripheral T-cell lymphopenia. In Foxn1:CFP-NTR transgenic mice, the bacterial nitroreductase enzyme is expressed in thymic epithelial cells and converts the prodrug CB1954 into a cytotoxic agent. This strategy enables titratable and durable destruction of thymopoietic tissue in early embryogenesis. Our results indicate that the resulting low levels of thymic capacity for T-cell production create a predisposition for the development of a complex autoimmune syndrome, chiefly characterized by inflammatory bowel disease and lymphocytic organ infiltrations. We conclude that the Foxn1:CFP-NTR transgenic mouse strain represents a suitable animal model to optimize established clinical protocols, such as thymus transplantation, to correct various forms of thymic dysplasia and to explore novel treatment options.

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The human NAIP-NLRC4-inflammasome senses the Pseudomonas aeruginosa T3SS inner-rod protein

Abstract

While NLRC4-dependent sensing of intracellular Gram-negative pathogens such as Salmonella enterica serovar typhimurium is a beneficial host response, NLRC4-dependent sensing of the Pseudomonas aeruginosa type 3 secretion system (T3SS) has been shown to be involved in pathogenicity. In mice, different pathogen-associated microbial patterns are sensed by the combination of the NLRC4-inflammasome with different neuronal apoptosis inhibitory proteins (NAIPs). NAIP2 is involved in sensing PscI, an inner-rod protein of the P. aeruginosa T3SS. Surprisingly, only a single human NAIP (hNAIP) has been found. Moreover, there is no description of hNAIP-NLRC4 inflammasome recognition of T3SS inner-rod proteins in humans. Here, we show that the P. aeruginosa T3SS inner-rod protein PscI and needle protein PscF are both sensed by the hNAIP-NLRC4 inflammasome in human macrophages and PBMCs from healthy donors, allowing caspase-1 and IL-1β maturation and resulting in a robust inflammatory response. TLR4 and TLR2 are involved in redundantly sensing these two T3SS components.

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Requirement of glycosylation machinery in TLR responses revealed by CRISPR/Cas9 screening

Abstract

The Toll family of receptors sense microbial products and activate a defense response. The molecular machinery required for the TLR response is not yet fully understood. In the present study, we used a clustered, regularly interspaced, short palindromic repeats (CRISPR)/CAS9 screening system to study TLR responses. We employed a cell line expressing TLR with an NF-κB-driven GFP reporter. The cell line was transduced with a guide RNA (gRNA) library and stimulated with TLR ligands. The cells impaired in GFP induction were sorted, and gRNAs were sequenced. Identified genes were ranked according to the count of sequence reads and the number of gRNA target sites. The screening system worked correctly, as molecules that were already known to be required for the TLR response were identified by the screening. Furthermore, this system revealed that the oligosaccharide transferase complex (OSTC) mediating co-translational glycosylation was required for TLR5, 7 and 9 responses. Protein expression of TLR5, but not an irrelevant molecule (CD44), was abolished by the lack of OSTC, suggesting the essential role of glycosylation in TLR5 protein stability. These results demonstrate that the screening system established here is able to reveal molecular mechanisms underlying the TLR response.

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Uromodulin–SlpA binding dictates Lactobacillus acidophilus uptake by intestinal epithelial M cells

Abstract

Bacterial access to the gut immune system is a crucial process to promote host immune responses. The probiotic L-92 strain of Lactobacillus acidophilus exerts anti-allergic immunomodulatory effects upon oral administration in mice. Here, we show that microfold cells (M cells) are responsible for L-92 internalization for evoking L-92-mediated immune responses. L-92 specifically bound to uromodulin, a glycosylphosphatidylinositol-anchored protein expressed exclusively on M cells among intestinal epithelial cells. Internalization of L-92 into M cells was significantly reduced in uromodulin-deficient (Umod^−/−) mice compared to Umod^+/+ mice. Furthermore, the binding of L-92 to uromodulin was significantly decreased after removal of surface layer protein A (SlpA) from the bacteria. Our study thus revealed a crucial role of uromodulin on the M-cell surface for the uptake of SlpA-positive lactic acid bacteria into M cells, possibly leading to subsequent delivery of the bacteria to dendritic cells closely associated with M cells for immunomodulation. Our study also shed light on the possibility that SlpA and uromodulin could be used as vehicle and target, respectively, for efficient mucosal vaccine delivery.

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A filamentous bacteriophage targeted to carcinoembryonic antigen induces tumor regression in mouse models of colorectal cancer

Abstract

Colorectal cancer is a deadly disease, which is frequently diagnosed at advanced stages, where conventional treatments are no longer effective. Cancer immunotherapy has emerged as a new form to treat different malignancies by turning-on the immune system against tumors. However, tumors are able to evade antitumor immune responses by promoting an immunosuppressive microenvironment. Single-stranded DNA containing M13 bacteriophages are highly immunogenic and can be specifically targeted to the surface of tumor cells to trigger inflammation and infiltration of activated innate immune cells, overcoming tumor-associated immunosuppression and promoting antitumor immunity. Carcinoembryonic antigen (CEA) is highly expressed in colorectal cancers and has been shown to promote several malignant features of colorectal cancer cells. In this work, we targeted M13 bacteriophage to CEA, a tumor-associated antigen over-expressed in a high proportion of colorectal cancers but largely absent in normal cells. The CEA-targeted M13 bacteriophage was shown to specifically bind to purified CEA and CEA-expressing tumor cells in vitro. Both intratumoral and systemic administration of CEA-specific bacteriophages significantly reduced tumor growth of mouse models of colorectal cancer, as compared to PBS and control bacteriophage administration. CEA-specific bacteriophages promoted tumor infiltration of neutrophils and macrophages, as well as maturation dendritic cells in tumor-draining lymph nodes, suggesting that antitumor T-cell responses were elicited. Finally, we demonstrated that tumor protection provided by CEA-specific bacteriophage particles is mediated by CD8⁺ T cells, as depletion of circulating CD8⁺ T cells completely abrogated antitumor protection. In summary, we demonstrated that CEA-specific M13 bacteriophages represent a potential immunotherapy against colorectal cancer.

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Rosacea and subsequent diagnosis for Parkinson's Disease: a large, urban, single center, U.S. patient population retrospective study

Abstract

Rosacea is a chronic inflammatory, multifactorial disorder [1]. Parkinson Disease (PD), is a serious, neurodegenerative disorder, believed to be a manifestation of a complex interplay between genetic and environmental factors [2]. A recent study found an association between PD and rosacea [3].

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Autosomal recessive epidermolysis bullosa simplex due to KRT14 mutation: two large Palestinian families and literature review

Abstract

Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of skin fragility disorders characterized by trauma-induced blister formation. Four major EB types are distinguished based on the level of blister formation within the skin: EB simplex (EBS), junctional EB, dystrophic EB, and Kindler syndrome¹. EBS represents the most common type and is defined by intraepidermal cleavage.

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Acrochordons on the neck; a remarkable clinical feature of tuberous sclerosis showing different patterns

Abstract

Sachs and Lipsker¹ recently published a few patients diagnosed with tuberous sclerosis (TS) presenting with multiple loosely arranged acrochordons (molluscum pendulum) located on the posterior neck showing a lace-like distribution and they proposed the term "molluscum pendulum necklace sign" for these typically located lesions. They detected acrochordons in five cases (17%) in a retrospectively analysed consecutive series of 29 TS patients, of whom four (three adults and one child) remarkably showed this typical pattern. Whether that sign might be a new pathognomonic sign of this genodermatosis was also discussed by the authours..¹

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First genetic analysis of atypical phenotype of pseudoxanthoma elasticum with ocular manifestations in the absence of characteristic skin lesions

Abstract

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disease, characterized by mineralization and degeneration of the elastic fibers in the skin, retina, and cardiovascular system.^1-4 PXE is caused by mutations in the ATP-binding cassette subfamily C member 6 (ABCC6) gene, but it remains unknown how these mutations lead to the clinical phenotype.^2-4 Although an association between mutations and phenotypes has been postulated, no definite correlation has been established.⁵ Patients with PXE usually exhibit typical skin lesions that are frequently the first diagnostic signs.^1,6,7

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Paraneoplastic bullous pemphigoid associated with penile squamous cell carcinoma

Abstract

A 43-year-old farmer presented to us for evaluation of multiple, itchy, tense vesicles and bullae, containing clear to hemorrhagic fluid, surmounting an urticarial background on his thighs and inguinal area for 20-days (Figure 1a). He was also undergoing evaluation for bilateral metastatic inguinal lymphadenopathy detected 3 months back that had revealed squamous cell carcinoma on cytology. Search for primary was still on. Genital examination incidentally revealed a bright red, well-defined, verrucous plaque on glans penis (Figure 1b).

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Large plaque-type blue nevus with cellular nodules: a rare unrecognized melanocytic tumor

Abstract

A 24-year-old Caucasian woman referred to us due to the modification of a congenital skin lesion in her right scapular area over the past 10 months. Physical examination disclosed multiple blue/whitish nodules arising on a bluish oval plaque, 6 cm in maximum diameter (fig. 1). The patient's personal and family medical history were unremarkable and negative for melanoma and non-melanoma skin cancers. The entire lesion was totally excised. Microscopy revealed a multifocal dermal proliferation of fusiform and dendritic melanocytes arranged in irregular nodules characterized by many individual foci with the histologic appearance of common blue nevus involving the reticular dermis (fig. 2a-2b).

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