Use of Supplementary Patient Education Material Increases Treatment Adherence and Satisfaction Among Acne Patients Receiving Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel in Primary Care Clinics: A Multicenter, Randomized, Controlled Clinical Study

Abstract

Introduction

Poor adherence to acne treatment may lead to unnecessary treatments, increased healthcare costs, and reduced quality of life (QoL). This multicenter study evaluated the effect of supplementary patient education material (SEM) (a short video, information card, and additional information available online) on treatment adherence and satisfaction among acne patients treated with the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% gel (A/BPO) in primary care clinics versus (1) standard-of-care patient education (SOCPE) (package insert and oral instruction) and (2) SOCPE plus more frequent clinic visits.

Methods

Subjects with acne were randomized to receive once-daily A/BPO for 12 weeks plus (1) SEM in addition to SOCPE; (2) SOCPE only with two additional visits; or (3) SOCPE only. Other assessments included a subject appreciation questionnaire, a physician questionnaire, and safety.

Results

Ninety-seven subjects were enrolled. At baseline, most (87.6%) had mild to moderate acne. Better adherence was observed in the A/BPO + SEM group compared with A/BPO + more visits or A/BPO alone [mean 63.1%, 48.2% (p = 0.0206), and 56.5%, respectively]. The A/BPO + SEM group had more subjects with greater than 75% adherence (45%, 30.4%, and 25%, respectively). According to the subject appreciation questionnaire, the SEM was more helpful to adhere to treatment (56.7%) versus more visits (32.3%) and A/BPO alone (15.2%), better use the product (70%, 61.3%, and 54.5%, respectively), and better manage skin irritation (53.3%, 48.4%, and 36.4%, respectively). All physicians were satisfied with the SEM and 90% would consider using it in their practice. Safety assessment showed fewer treatment-related adverse events in the A/BPO + SEM group.

Conclusion

Use of the SEM may increase adherence of acne patients treated with once-daily A/BPO gel in primary care, consequently improving treatment and QoL in the long term.

Funding

Nestle Skin Health-Galderma R&D.

Trial Registration

ClinicalTrials.gov Identifier: NCT02307266.

http://ift.tt/2g59VTf

Staphylococcus lugdunensis Infections of the Skin and Soft Tissue: A Case Series and Review

Abstract

Introduction

Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative, Gram-positive bacterium that can be isolated as a component of normal skin flora in humans. However, more recently, it has also been documented as a culprit in skin and soft tissue infections. We describe the clinical features of five individuals with S. lugdunensis-associated skin infections. We review the characteristics of other patients that were previously described with this organism as the causative agent of skin infection.

Methods

Staphylococcus lugdunensis was correlated with the development of significant skin and soft tissue infections in five patients. The Pubmed database was used to search for the following terms: "abscess," "cellulitis," "cutaneous," "lugdunensis," "paronychia," "skin," "soft," "staphylococcus," and "tissue." The relevant and reference papers generated by the search were reviewed.

Results

One woman and four men developed S. lugdunensis-related skin infections from February 19, 2015 to May 30, 2017. The patients' ages at the onset of the infection ranged from 30 to 82 years; the median age was 70 years. Four patients were older than 65 years. The back was the most common location for the infection, followed by digits. The infection presented as cystic lesions with cellulitis or periungual abscesses. The lesions were incised or spontaneously ruptured. Patients were empirically treated with oral antibiotics; if necessary, the management was adjusted based on the culture-derived sensitivities of the organisms. The infections resolved within 10–30 days after commencing treatment.

Conclusion

Staphylococcus lugdunensis has previously been considered as a nonpathogenic organism and to be a component of normal skin flora. However, S. lugdunensis can result in significant skin and soft tissue infections, perhaps more frequently in older individuals. Its antibiotic sensitivities appear to be similar to those of methicillin-susceptible Staphylococcus aureus.

http://ift.tt/2yZs2BQ

Denosumab as a potential treatment alternative for patients suffering from diffuse sclerosing osteomyelitis of the mandible—a rapid communication

Diffuse sclerosing osteomyelitis (DSO) is a rare disease of the jaw bone. Its treatment is challenging. Different medical and surgical treatment protocols have been proposed; however, none of these treatment protocols produce reliable results. Recently, ibandronate administration has been attempted as a treatment alternative in acute cases of DSO. Due to the similar antiresorptive effect, we sought to explore the application of the human monoclonal antibody to the receptor activator of nuclear factor kappaB ligand (RANKL), denosumab, in the treatment of DSO.

http://ift.tt/2gaEwik

Evaluation of positional plagiocephaly: conventional anthropometric measurement versus laser scanning method

The incidence of plagiocephaly has increased in the 25 years since the "Back to Sleep" campaign in 1991 to prevent sudden infant death. Plagiocephaly is not considered to be a pathological condition. It is more of an esthetic impairment and could have potentially negative psychological or psychosocial consequences; therefore, treatment is recommended. The aim of this study is to compare conventional anthropometry and laser scanning – two different measurement methods – as diagnostic instruments for plagiocephaly.

http://ift.tt/2yj1YVm

Influence of Ginkgo Biloba extract (EGb 761) on expression of IL-1 Beta, IL-6, TNF-alfa, HSP-70, HSF-1 and COX-2 after noise exposure in the rat cochlea

The objective of this study was to investigate the influence of Ginkgo Biloba in early treatment of noise induced hearing loss on expression of IL-6, IL-1 Beta, TNF-alfa, HSP-70, HSF-1 and COX-2 in the rat cochlea.

http://ift.tt/2gaFxqK

Effect of V–Y plasty on lip lengthening and treatment of gummy smile

The aim of this study was to assess the effect of isolated V–Y plasty on lip lengthening and the treatment of gummy smile. An isolated V–Y plasty was performed on 14 patients with a gummy smile. In each case, measurements of upper lip length and gingival display were recorded from posed-smile photographs taken preoperatively and at 1, 3, and 6 months postoperatively. Gingival display decreased significantly and lip length increased significantly over all intervals investigated. Applying this technique after Le Fort I surgery may be beneficial; however, as with other injection or surgical lip lengthening methods, its stand-alone application should be questioned.

http://ift.tt/2xGigIo

Intraoperative anaphylaxis to bacitracin during scleral buckle surgery

A 63-year-old man with a history of retinal detachment in the right eye repaired by scleral buckle presented with decreased peripheral vision in the left eye and was found to have a macula-sparing retinal detachment in the left eye, for which urgent repair by scleral buckle was recommended. The patient did not take any routine outpatient medications. Preoperative evaluation revealed no history of anesthetic complications, and he denied any drug allergies. He did not receive any preoperative prophylactic antibiotics.

http://ift.tt/2ymfqp8

Crowdsourcing dermatology: DataDerm, big data analytics, and machine learning technology

"There is art in 'big data'… in the seductive potential of its exponential, uncontrolled, ungraspable growth to improve our lives… and, ultimately, truly personal medicine."1

http://ift.tt/2ieGTFr

Gender Differences in Indoor Tanning Habits and Location

http://ift.tt/2ylDNTP

Beyond the triad: inheritance, mucocutaneous phenotype, and mortality in a cohort of patients with dyskeratosis congenita

http://ift.tt/2yl84SD

Risk of Melanoma in Patients With Multiple Myeloma: A SEER Population-based Study

http://ift.tt/2you7JS

The NPF/Corrona Psoriasis Registry: A New Collaborative Approach to Post-approval Registries

http://ift.tt/2yoFbqr

“Allergen of the Year” alkyl glucoside is an ingredient in top-selling sunscreens and facial moisturizers

http://ift.tt/2yjTNWl

Liquid nitrogen cryotherapy for chronic recalcitrant interdigital candidiasis of toe-spaces – an uncontrolled pilot study

http://ift.tt/2yozMQk

Pathogenetic insights from quantification of the cerebriform connective tissue nevus in Proteus syndrome

Plantar cerebriform connective tissue nevus (CCTN) size increases in children with Proteus syndrome, but not in adults.The presence and growth of a plantar CCTN are affected by age of the patient and extent of the precursor lesion.Knowledge of CCTN growth patterns may be useful for predicting the rate of expansion and eventual extent of sole involvement.

http://ift.tt/2youbt6

Cytokine profile changes in gingival crevicular fluid after placement different brackets types

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Ana Zilda Nazar Bergamo, Paulo Nelson-Filho, Cássio do Nascimento, Renato Corrêa Viana Casarin, Márcio Zaffalon Casati, Marcela Cristina Damião Andrucioli, Érika Calvano Kuchler, Daniele Lucca Longo, Léa Assed Bezerra da Silva, Mírian Aiko Nakane Matsumoto
ObjectiveThe aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence.DesignThe sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation^®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1β, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level.ResultsIncreased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria.ConclusionsThe bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.



http://ift.tt/2ypimmU

Multiple complex somatosensory systems in mature rat molars defined by immunohistochemistry

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Margaret R. Byers, Leanne M. Cornel
ObjectiveIntradental sensory receptors trigger painful sensations and unperceived mechanosensitivity, but the receptor bases for those functions are only partly defined. We present new evidence here concerning complex endings of myelinated axons in rat molars.DesignWe sectioned mature rat jaws in sagittal and transverse planes to analyze neural immunoreactivity (IR) for parvalbumin, peripherin, neurofilament protein, neurotrophin receptors, synaptophysin, calcitonin gene-related peptide (CGRP), or mas-related g-protein-receptor-d (Mrgprd).ResultsWe found two complex sensory systems in mature rat molar dentin that labeled with neurofilament protein-IR, plus either parvalbumin-IR or peripherin-IR. The parvalbumin-IR system made extensively branched, beaded endings focused into dentin throughout each pulp horn. The peripherin-IR system primarily made unbeaded, fork-shaped dentinal endings scattered throughout crown including cervical regions. Both of these systems differed from neuropeptide CGRP-IR. In molar pulp we found peripherin- and parvalbumin-IR layered endings, either near special horizontal plexus arrays or in small coiled endings near tangled plexus, each with specific foci for specific pulp horns. Parvalbumin-IR nerve fibers had Aβ axons (5–7μm diameter), while peripherin-IR axons were thinner Aδ size (2–5μm). Mechano-nociceptive Mrgprd-IR was only found in peripherin-IR axons.ConclusionsComplex somatosensory receptors in rat molars include two types of dentinal endings that both differ from CGRP-IR endings, and at least two newly defined types of pulpal endings. The PV-IR neurons with their widely branched, synaptophysin-rich, intradentinal beaded endings are good candidates for endodontic non-nociceptive, low threshold, unperceived mechanoreceptors. The complex molar dentinal and pulpal sensory systems were not found in rat incisors.



http://ift.tt/2yKxxbx

Cytokine profile changes in gingival crevicular fluid after placement different brackets types

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Ana Zilda Nazar Bergamo, Paulo Nelson-Filho, Cássio do Nascimento, Renato Corrêa Viana Casarin, Márcio Zaffalon Casati, Marcela Cristina Damião Andrucioli, Érika Calvano Kuchler, Daniele Lucca Longo, Léa Assed Bezerra da Silva, Mírian Aiko Nakane Matsumoto
ObjectiveThe aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence.DesignThe sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation^®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1β, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level.ResultsIncreased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria.ConclusionsThe bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.



http://ift.tt/2ypimmU

Multiple complex somatosensory systems in mature rat molars defined by immunohistochemistry

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Margaret R. Byers, Leanne M. Cornel
ObjectiveIntradental sensory receptors trigger painful sensations and unperceived mechanosensitivity, but the receptor bases for those functions are only partly defined. We present new evidence here concerning complex endings of myelinated axons in rat molars.DesignWe sectioned mature rat jaws in sagittal and transverse planes to analyze neural immunoreactivity (IR) for parvalbumin, peripherin, neurofilament protein, neurotrophin receptors, synaptophysin, calcitonin gene-related peptide (CGRP), or mas-related g-protein-receptor-d (Mrgprd).ResultsWe found two complex sensory systems in mature rat molar dentin that labeled with neurofilament protein-IR, plus either parvalbumin-IR or peripherin-IR. The parvalbumin-IR system made extensively branched, beaded endings focused into dentin throughout each pulp horn. The peripherin-IR system primarily made unbeaded, fork-shaped dentinal endings scattered throughout crown including cervical regions. Both of these systems differed from neuropeptide CGRP-IR. In molar pulp we found peripherin- and parvalbumin-IR layered endings, either near special horizontal plexus arrays or in small coiled endings near tangled plexus, each with specific foci for specific pulp horns. Parvalbumin-IR nerve fibers had Aβ axons (5–7μm diameter), while peripherin-IR axons were thinner Aδ size (2–5μm). Mechano-nociceptive Mrgprd-IR was only found in peripherin-IR axons.ConclusionsComplex somatosensory receptors in rat molars include two types of dentinal endings that both differ from CGRP-IR endings, and at least two newly defined types of pulpal endings. The PV-IR neurons with their widely branched, synaptophysin-rich, intradentinal beaded endings are good candidates for endodontic non-nociceptive, low threshold, unperceived mechanoreceptors. The complex molar dentinal and pulpal sensory systems were not found in rat incisors.



http://ift.tt/2yKxxbx

ATA 2017 Abstracts Available Online

We are pleased to provide complimentary access to the conference program and meeting abstracts for the 87th Annual Meeting of the American Thyroid Association, October 18-21, 2017 in Victoria, British Columbia. The Abstracts are available now on the Thyroid website:

87th Annual Meeting of the American Thyroid Association Abstracts
Abstract Author Index
Short Call Abstracts
Short Call Author Abstract Index

The post ATA 2017 Abstracts Available Online appeared first on American Thyroid Association.

http://ift.tt/2gj02Fy

The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Ennio Giulio Favalli, Maria Gabriella Raimondo, Andrea Becciolini, Chiara Crotti, Martina Biggioggero, Roberto Caporali
The introduction of biologic disease–modifying anti-rheumatic drugs (bDMARDs) has dramatically changed the management of rheumatoid arthritis (RA). However, in a real-life setting about 30–40%.of bDMARD treated patients experience drug discontinuation because of either inefficacy or adverse events. According to international recommendations, to date the best strategy for managing first-line bDMARD failures has not been defined yet and available data (especially on TNF inhibitors [TNFis]) seem to drive toward a personalized approach for the individual patient. Some TNFi partial responders may benefit from optimization of concomitant methotrexate therapy or from switching to a different concomitant sDMARD such as leflunomide. Conversely, apart from infliximab, TNFi dose escalation seems to be poor efficacious and poor cost-effective compared with alternative strategies. Albeit counterintuitive, the use of a second TNFi after the failure of the first-one (cycling strategy) is supported by clear evidences and has become widespread in the 2000s as the result of the limited alternative options till the introduction of bDMARDs with a mechanism of action other than TNF blockade. Nowadays, the use of abatacept, rituximab, tocilizumab, or JAK inhibitors as second-line agent (swapping strategy) is strongly supported by RCTs and real-life experiences. In the absence of head-to-head trials directly comparing these two strategies, meta-analyses of separated RCTs failed to find significant differences in favor of one or another choice. However, results from most observational studies, including well designed prospective pragmatic randomised analyses, demonstrated the superiority of swapping over cycling approach, whereas only few studies reported a comparable effectiveness. In this review, we aimed to critically analyze all the potential therapeutic options for the treatment of first-line bDMARD failures in order to provide a comprehensive overview of available strategies to be applied in clinical practice.



http://ift.tt/2yo2Ojk

HLA-DRB1 alleles and juvenile idiopathic arthritis: Diagnostic clues emerging from a meta-analysis

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Annalisa De Silvestri, Cristina Capittini, Dimitri Poddighe, Gian Luigi Marseglia, Luca Mascaretti, Elena Bevilacqua, Annamaria Pasi, Miryam Martinetti, Carmine Tinelli
Juvenile Idiopathic Arthritis (JIA) is characterized with a variable pattern of articular involvement and systemic symptoms and, thus, it has been classified in several subtypes. Genetic predisposition to JIA is mainly due to HLA class II molecules (HLA-DRB1, HLA-DPB1), although HLA class I molecules and non-HLA genes have been implicated, too. Here, we carried out a meta-analysis on selected studies designed to assess HLA genetic background of JIA patients, compared to healthy controls and, particularly, we focused our attention on HLA-DRB1. In summary, our meta-analysis showed four main findings regarding HLA-DRB1 locus as a genetic factor of JIA: i) HLA-DRB1*08 is a strong factor predisposing to JIA, both for oligo-articular and poly-articular forms (oJIA > pJIA); ii) HLA-DRB1*01 and HLA-DRB1*04 may be involved in the genetic predisposition of Rheumatoid Factor (RF) positive forms of JIA; iii) HLA-DRB1*11 was confirmed to be predisposing to oligo-articular JIA; iv) HLA-DRB1*04 was confirmed to have a role in systemic JIA. Importantly, the positivity for the RF seems to select the JIA clinical subset with the strongest immunogenetic similarities with the adult form of rheumatoid arthritis.



http://ift.tt/2gjFWuy

New Insights in the Pathogenesis of Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Marieke H. Heineke, Aranka V. Ballering, Agnès Jamin, Sanae Ben Mkaddem, Renato C. Monteiro, Marjolein Van Egmond
Immunoglobulin A vasculitis (IgAV), also referred to as Henoch-Schönlein purpura, is the most common form of childhood vasculitis. The pathogenesis of IgAV is still largely unknown. The disease is characterized by IgA1-immune deposits, complement factors and neutrophil infiltration, which is accompanied with vascular inflammation. Incidence of IgAV is twice as high during fall and winter, suggesting an environmental trigger associated to climate. Symptoms can resolve without intervention, but some patients develop glomerulonephritis with features similar to IgA nephropathy that include hematuria, proteinuria and IgA deposition in the glomerulus. Ultimately, this can lead to end-stage renal disease. In IgA nephropathy immune complexes containing galactose-deficient (Gd-)IgA1 are found and thought to play a role in pathogenesis. Although Gd-IgA1 complexes are also present in patients with IgAV with nephritis, their role in IgAV is disputed. Alternatively, it is has been proposed that in IgAV IgA1 antibodies are generated against endothelial cells. We anticipate that such IgA complexes can activate neutrophils via the IgA Fc receptor FcαRI (CD89), thereby inducing neutrophil migration and activation, which ultimately causes tissue damage in IgAV. In this Review, we discuss the putative role of IgA, IgA receptors, neutrophils and other factors such as infections, genetics and the complement system in the pathogenesis of IgA vasculitis.



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CD4+CD52lo T-cell expression contributes to the development of systemic lupus erythematosus

Publication date: Available online 13 October 2017
Source:Clinical Immunology
Author(s): Masataka Umeda, Tomohiro Koga, Kunihiro Ichinose, Takashi Igawa, Tomohito Sato, Ayuko Takatani, Toshimasa Shimizu, Shoichi Fukui, Ayako Nishino, Yoshiro Horai, Yasuko Hirai, Shin-ya Kawashiri, Naoki Iwamoto, Toshiyuki Aramaki, Mami Tamai, Hideki Nakamura, Kazuo Yamamoto, Norio Abiru, Tomoki Origuchi, Yukitaka Ueki, Atsushi Kawakami
The cell-surface glycoprotein CD52 is widely expressed in lymphocytes. CD4⁺CD52^hi T cells are functioning suppressor CD4⁺T cells. We investigated the role of the immune regulation of CD4⁺CD52 T cells in systemic lupus erythematosus (SLE). CD4⁺CD52^lo T cells were increased in SLE patients, in positive correlation with SLEDAI, anti-ds-DNA antibody, and IgG concentration. Circulating follicular helper-like T cells (Tfh-like cells) were also increased in SLE, in positive correlation with CD4⁺CD52^lo T cells. Chemokine receptor 8 (CCR8) expression in CD4⁺CD52^lo T cells was increased. In vitro experiments using CD4 T cells of SLE patients showed that thymus and activation-regulated chemokine (TARC), a ligand of CCR8, contributed to the development of CD4⁺CD52^hi T cells into CD4⁺CD52^lo T cells. Our findings suggest that CD4+CD52lo T-cell upregulation is involved in the production of pathogens by autoantibodies, and TARC may contribute to the development of SLE through an aberrant induction of CD4⁺CD52^lo T cells.



http://ift.tt/2gaQqZF

Overexpression of Notch ligand Delta-like-1 by dendritic cells enhances their immunoregulatory capacity and exerts antiallergic effects on Th2-mediated allergic asthma in mice

Publication date: Available online 14 October 2017
Source:Clinical Immunology
Author(s): Chen-Chen Lee, Chu-Lun Lin, Sy-Jye Leu, Yueh-Lun Lee
Dendritic cells (DCs) are professional antigen-presenting cells, and Notch ligand Delta-like-1 (DLL1) on DCs was implicated in type 1T helper (Th1) differentiation. In this study, we produced genetically engineered bone marrow-derived DCs that expressed DLL1 (DLL1-DCs) by adenoviral transduction. DLL1-DCs exerted a fully mature phenotype, and had positive effects on expression levels of interleukin (IL)-12 and costimulatory molecules. Coculture of allogeneic T cells with ovalbumin (OVA)-pulsed DLL1-DCs enhanced T cell proliferative responses and promoted Th1 cell differentiation. Furthermore, adoptive transfer of OVA-stimulated DLL1-DCs into asthmatic mice alleviated the cardinal features of allergic asthma, including immunoglobulin E (IgE) production, airway hyperresponsiveness (AHR), airway inflammation, and production of Th2-type cytokines. Notably, enhanced levels of the Th1-biased IgG2a response and interferon (IFN)-γ production were observed in these mice. Taken together, these data indicate that DLL1-DCs promoted Th1 cell development to alter the Th1/Th2 ratio and ameliorate Th2-mediated allergic asthma in mice.

Graphical abstract

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Surface roughness and bacterial adhesion on root dentin treated with diode laser and conventional desensitizing agents

Abstract

The treatments for dentin hypersensitivity (DH) may change the surface roughness of the root dentin, which can lead to biofilm accumulation, increasing the risk of root caries. The aim was to compare the surface roughness of root dentin after different treatments of DH and the biofilm formation on those surfaces. After initial surface roughness (Sa) assessment, 50 bovine root fragments received the following treatments (n = 10): G 1—no treatment; G2—5% sodium fluoride varnish; G3—professional application of a desensitizing dentifrice; G4—toothbrushing with a desensitizing dentifrice; and G5—diode laser application (908 nm; 1.5 W, 20 s). The Sa was reevaluated after treatments. Afterward, all samples were incubated in a suspension of Streptococcus mutans at 37 °C for 24 h. The colony-forming units (CFU) were counted using a stereoscope, and the results were expressed in CFU/mL. The one-way ANOVA and the Tukey's tests compared the roughness data and the results obtained on the bacterial adhesion test (α = 5%). G2 (2.3 ± 1.67%) showed similar Sa variation than G1 (0.25 ± 0.41%) and G5 (5.69 ± 0.99%), but different from group G3 (9.05 ± 2.39%). Group 4 showed the highest Sa variation (30.02 ± 3.83%; p < 0.05). Bacterial adhesion was higher in G4 (2208 ± 211.9), suggesting that bacterial growth is greater on rougher surfaces. The diode laser and the conventional treatments for DH may change the surface roughness of the root dentin, but only brushing with desensitizing dentifrice induced a higher bacteria accumulation on root dentin surface.

http://ift.tt/2yJHTIt

Implant-oriented navigation in orbital reconstruction. Part 1: technique and accuracy study

Publication date: Available online 14 October 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Schreurs, L. Dubois, A.G. Becking, T.J.J. Maal
Intraoperative navigation is frequently used to assess the position of the implant in orbital reconstruction. Interpretation of the feedback from the navigation system to a three-dimensional position of the implant needs to be done by the surgeon, and feedback is only gathered after the implant has been positioned. An implant-oriented navigation approach is proposed, with real-time intuitive feedback during insertion. A technical framework was set up for implant-oriented navigation, with requirements for planning, implant tracking, and feedback. A dedicated navigation instrument was designed and a software tool was developed in order to meet the technical requirements. An accuracy study was performed to investigate the accuracy of the method in comparison to the regular navigation pointer. A proof of concept was provided. The results showed a translation error of 1.12–1.15mm for implant-oriented navigation with regular registration (pointer 0.71–0.98mm) and 0.81mm with accurate registration (pointer 0.54mm). Rotational error was found to be small (<3°). Quantitative and intuitive qualitative feedback could be provided to the surgeon in real-time during insertion of an orbital implant. Following this proof of concept and accuracy study, the implications for the clinical workflow should be evaluated. An implant-oriented approach may form the foundation for augmented reality or robotic-aided implant insertion.



http://ift.tt/2wVnZpo

Lugol's solution eradicates Staphylococcus aureus biofilm in vitro

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Torstein Grønseth, Lene K. Vestby, Live L. Nesse, Even Thoen, Olivier Habimana, Magnus von Unge, Juha T. Silvola
ObjectivesThe aim of the study was to evaluate the antibacterial efficacy of Lugol's solution, acetic acid, and boric acid against Staphylococcus aureus biofilm.MethodsThe efficacy of Lugol's solution 1%, 0.1%, and 0.05%, acetic acid 5% or boric acid 4.7% for treatment of Staphylococcus aureus biofilm in vitro was tested using 30 clinical strains. Susceptibility in the planktonic state was assessed by disk diffusion test. Antiseptic effect on bacteria in biofilm was evaluated by using a Biofilm-oriented antiseptic test (BOAT) based on metabolic activity, a biofilm bactericidal test based on culturing of surviving bacteria and confocal laser scanning microscopy combined with LIVE/DEAD staining.ResultsIn the planktonic state, all tested S. aureus strains were susceptible to Lugol's solution and acetic acid, while 27 out of 30 tested strains were susceptible to boric acid. In biofilm the metabolic activity was significantly reduced following exposure to Lugol's solution and 5% acetic acid, while boric acid exposure led to no significant changes in metabolic activities. In biofilm, biocidal activity was observed for Lugol's solution 1% (30/30), 0.1% (30/30), and 0.05% (26/30). Acetic acid and boric acid showed no bactericidal activity in this test. Confocal laser scanning microscopy, assessed in 4/30 strains, revealed significantly fewer viable biofilm bacteria with Lugol's solution (1% p < 0.001, 0.1% p = 0.001 or 0.05% p = 0.001), acetic acid 5% for 10 min (p = 0.001) or 30 min (p = 0.015), but not for acetic acid for 1 min or boric acid.ConclusionLugol's solution 1.0% and 0.1% effectively eradicated S. aureus in biofilm and could be an alternative to conventional topical antibiotics where S. aureus biofilm is suspected such as external otitis, pharyngitis and wounds.



http://ift.tt/2z783RI

Evaluation of speech reception threshold in noise in young Cochlear™ Nucleus® system 6 implant recipients using two different digital remote microphone technologies and a speech enhancement sound processing algorithm

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Sergio Razza, Monica Zaccone, Aannalisa Meli, Eliana Cristofari
ObjectiveChildren affected by hearing loss can experience difficulties in challenging and noisy environments even when deafness is corrected by Cochlear implant (CI) devices. These patients have a selective attention deficit in multiple listening conditions. At present, the most effective ways to improve the performance of speech recognition in noise consists of providing CI processors with noise reduction algorithms and of providing patients with bilateral CIs.The aim of this study was to compare speech performances in noise, across increasing noise levels, in CI recipients using two kinds of wireless remote-microphone radio systems that use digital radio frequency transmission: the Roger Inspiro accessory and the Cochlear Wireless Mini Microphone accessory.MethodsEleven Nucleus Cochlear CP910 CI young user subjects were studied. The signal/noise ratio, at a speech reception threshold (SRT) value of 50%, was measured in different conditions for each patient: with CI only, with the Roger or with the MiniMic accessory. The effect of the application of the SNR-noise reduction algorithm in each of these conditions was also assessed. The tests were performed with the subject positioned in front of the main speaker, at a distance of 2.5 m. Another two speakers were positioned at 3.50 m. The main speaker at 65 dB issued disyllabic words. Babble noise signal was delivered through the other speakers, with variable intensity.ResultsThe use of both wireless remote microphones improved the SRT results. Both systems improved gain of speech performances. The gain was higher with the Mini Mic system (SRT = −4.76) than the Roger system (SRT = −3.01). The addition of the NR algorithm did not statistically further improve the results.ConclusionThere is significant improvement in speech recognition results with both wireless digital remote microphone accessories, in particular with the Mini Mic system when used with the CP910 processor. The use of a remote microphone accessory surpasses the benefit of application of NR algorithm.



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Newborn hearing screening failure and maternal factors during pregnancy

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Yehuda Schwarz, Gabriel N. Kaufman, Sam J. Daniel
ObjectiveTemporary conductive hearing loss due to amniotic fluid accumulation in the middle ear cavity may lead to failure (false positive) in newborn hearing screening tests.The aim of this study was to identify whether amniotic fluid index has association with failure of the initial newborn otoacoustic emission (OAE) screening test.MethodsA cohort study in a tertiary hospital center (Royal Victoria Hospital, Montréal) was constructed from 70 newborns that failed the OAE test, but passed a subsequent auditory brainstem response (ABR) test, and 75 randomly selected newborns that passed initial otoacoustic emission testing. Maternal (including the amniotic fluid index in the third trimester) and newborn clinical data were extracted from medical records. Statistical association models were built to determine variables that influenced hearing screen passage or failure.ResultsThe two arms of the cohort had no significant differences in maternal or child clinical indices, including in amniotic fluid index. Calculated as individual odds ratios, maternal tobacco [95% CI of odds ratio: 0.04, 0.59, p = 0.0078], and drug use [95% CI of odds ratio: 0.0065, 0.72, p = 0.058] [borderline significance] were associated with failing the otoacoustic emission testing.ConclusionsAmniotic fluid index was not found to be associated with failure of otoacoustic emission screening in newborns. However, our study unveiled an interesting unexpected association of OAE failure with maternal smoking and/or drug use. This finding can help alleviate some of the time, cost and parental anxiety related to failed OAE screening.In selected cases of maternal smoking or drug use we might want to replace or add OAE to the ABR test in newborn hearing screening protocols, that don't perform both tests before discharge.



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Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Annette Kaspar, Obiga Newton, Joseph Kei, Carlie Driscoll, De Wet Swanepoel, Helen Goulios
ObjectiveAn understanding of parental knowledge and attitudes towards childhood hearing loss is essential to the successful implementation of audiology services. The present study aimed to investigate parental knowledge and attitudes among parents in the Solomon Islands.Methods and materialsA total of 100 mothers and 50 fathers were administered a questionnaire via semi-structured interviews.ResultsHighest parental awareness of aetiology of childhood hearing loss was noted for otitis media (94%), noise exposure (87.3%), and family history (72.7%). The highest parental awareness concerning public health initiatives to reduce/prevent otitis media was noted for routine childhood immunizations (84%) and breast-feeding (76%). Higher rates of knowledge in fathers than in mothers included otitis media (p = 0.038), noise exposure (p = 0.007), and breast-feeding (p = 0.031). Approximately half of parents (56%) agreed that curses may cause hearing loss. Overall parental responses showed positive support for infant hearing screening programs (96%) and school-based ear and hearing health examinations (99.3%).ConclusionsHigh levels of parental readiness and support for childhood hearing services in the Solomon Islands was evident. Knowledge of aetiology of childhood hearing loss was highest for otitis media, noise exposure, and family history. Knowledge and attitudes of fathers to childhood hearing loss and hearing services was either the same or better than that of mothers.



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Reversible profound sensorineural hearing loss due to propranolol sensitive hemangioma in an infant with PHACE syndrome

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): John N. Bangiyev, Richard Gurgel, Sheryll L. Vanderhooft, J. Fredrik Grimmer
PHACE syndrome is the association of large or segmental infantile hemangiomas of the face or scalp with abnormalities within the posterior fossa, arteries, cardiovascular system, and eyes. We present a case of reversible profound sensorineural hearing loss due to a cerebellopontine angle infantile hemangioma that was successfully treated with propranolol.



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Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp

Abstract

Background

Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are approved treatments for actinic keratosis (AK).

Objectives

Compare efficacy and safety of IngMeb 0.015% gel with DS 3% gel.

Methods

Patients with 4–8 visible, discrete AK lesions on face/scalp in a 25 cm² contiguous area of skin were randomised 1:1 to IngMeb once-daily for 3 consecutive days, or DS twice-daily for 90 days, following label instruction. Patients presenting with AK lesions at Week 8 following IngMeb were offered a second IngMeb course. The primary endpoint was complete clearance of AK lesions (AKCLEAR 100) at end of first treatment course (Week 8, IngMeb; Week 17, DS). Secondary endpoints included AKCLEAR 100 at end of last treatment course and Week 17; adverse events (AEs) were assessed at these time points. Patients completed Treatment Satisfaction Questionnaires for Medication (TSQM; Week 17).

Results

AKCLEAR 100 at end of first treatment course was higher with IngMeb (34.5%) versus DS (23.5%; p=0.006). AKCLEAR 100 at end of last IngMeb course (53.3%) and Week 17 (45.1%) was higher than DS (both p<0.001). The most frequent AE was application-site erythema (IngMeb 19%; DS 12%). Treatment-related AE (TRAE) duration was shorter with IngMeb. TRAE withdrawals were lower for IngMeb (2%) versus DS (6%). TSQM scores for global satisfaction (p<0.001) and effectiveness (p=0.002) were higher with IngMeb, as was dosing instruction adherence (≥90% versus 70%).

Conclusion

AKCLEAR 100, patient treatment satisfaction and effectiveness were significantly higher with IngMeb versus DS, demonstrating superiority of IngMeb for AK treatment on face/scalp (NCT02406014).

This article is protected by copyright. All rights reserved.

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Functional Anatomic Computer Engineered Surgery (FACES) Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton

Publication date: Available online 14 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Baber Khatib, Karl Cuddy, Allen Cheng, Ashish Patel, Felix Sim, Melissa Amundson, Savannah Gelesko, Tuan Bui, Eric J. Dierks, R. Bryan Bell




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Nasolabial Flap improves Healing in Medication-Related Osteonecrosis of the Jaw

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Juliana Lemound, Thomas Muecke, Alexander-Nicolai Zeller, Jürgen Lichtenstein, André Eckardt, Nils-Claudius Gellrich
PurposeMedication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresoptive and antiangiogenic therapeutics that is difficult to treat owing to its high relapse rate. The aim of the study was to answer the question: Among patients with MRONJ, do those managed using decortication and a nasolabial flap, when compared to those managed with decortication and mucoperiosteal flaps, have better outcome respectively stable wound closure.Materials and MethodsTwo groups of patients suffering from MRONJ with intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable is treatment groups: The experimental group used the nasolabial flap for wound closure, whereas in control group a mucoperiosteal closure was performed. The outcome variable was a successful wound closure defined as symptomless and closed wound after at least 12 months. Other study variables were factors as perioperative drug holiday, duration of post-operative oral antibiotic administration, or post-operative use of nasogastric feeding tubes. Cox proportional hazard regression, Kaplan-Meier curves were used to determine factors independently associated with the dependent variable. Mann-Whitney-U test and χ²-test were used for analyses regarding group related data.ResultsBoth groups showed similar demographics. 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, whereas 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups each comprised of ten women and six men. 15 patients of each group received a bisphosphonate and one patient a monoclonal antibody therapy.All evaluated patients underwent combined treatment including decortication and intravenous antibiotic treatment. 16 patients receiving nasolabial flaps showed symptomless intact wound closure in 68.8% of the cases. 16 patients with mucoperiosteal closure developed relapse of MRONJ in 81,2% of cases, yielding the control group and revealing significant differences (p<0.001). There were no significant differences between the two groups for demographic variables. The mean time to relapse for the experimental and control group was 13.6 ± 7.8 and 8.2 ± 7.9, respectively (p =0.017).ConclusionMRONJ is a complication of the antiosteoclastic treatment of mostly oncological, palliative patients, which requires a very methodical approach to surgical treatment that has been reported in a variety of different methods. Nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity as microvascular free flaps and better long term results when compared to mucoperiosteal flaps.



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Dental Implants: The Last 100 Years

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Michael S. Block
This article on the History of Dental Implants spans beyond the last 100 years of the AAOMS. It was not until materials and methods became less traumatic to the bone that implants became firmly attached to the surrounding bone. This phenomenon is now utilized to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still utilized with modification to augment the environment for an implant. Technological changes allow patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.



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Does surgical fragmentation of odontogenic keratocystic capsule interfere with the recurrence rate?

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Natália Batista Daroit, Rúbia da Rocha Vieira, Fernanda Visioli, Fabio Del Moro Maito, Márcia Gaiger de Oliveira, Pantelis Varvaki Rados
PurposeThe investigators hypothesized that fragmentation of the cystic capsule during surgery influences the recurrence rate of odontogenic keratocysts (OKC) regardless of the treatment modality chosen.MethodsThis retrospective study reviewed cases diagnosed as odontogenic keratocysts on histopathological examination at the Oral Pathology Department between 1991 and 2013. Fragmentation data were obtained from the records of the Oral Surgical Department.ResultsFragmentation of the capsules of OKCs during surgery did not affect recurrence, irrespective of the chosen treatment modality. Addition of techniques such as cryotherapy lowered the risk of recurrence of OKCs (p = 0.013) when compared with the risk of recurrence of OKCs after enucleation. Furthermore, patients with associated nevoid basal cell carcinoma syndrome (NBCCS) had a higher recurrence rate compared to those with no associated syndrome (p = 0.033).ConclusionFragmentation of the cystic capsule does not play an important role in the rate of OKC recurrence. The rate of recurrence can be modified by using additional strategies such as cryotherapy.



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Relationship between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dmitry José de Santana Sarmento, Thiara Karine de Araújo, Germana de Queiroz Tavares Borges Mesquita, Denise Nóbrega Diniz, Fátima Roneiva Alves Fonseca, Paula Frassinetti V. Medeiros, Maria Teresa Botti Rodrigues dos Santos, Gustavo Pina Godoy
PurposeThe aim of this study was describe the relationship between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses.Materials and MethodsA cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, ten of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of the patient. The Pearson's Chi-squared, Fisher's exact and Mann-Whitney tests were used for data analysis, adopting a level of significance of 5%.ResultsMarked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had class III disorders. Radiography revealed the presence of impacted teeth (75%) and the prolonged retention of the deciduous teeth (65%). It was observed that patients with enzyme replacement therapy had a lower average maximum protrusion (p=0.033). A total of 75% of mothers said they had not been advised to take their children to the dentist, and 10% of children had never been to the dentist.ConclusionPatients with mucopolysaccharidoses exhibited significant occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.



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Analysis of facial symmetry after zygomatic bone fracture management

Publication date: Available online 14 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mohamad Saleh Khaqani, Fateme Tavosi, Mahdi Gholami, Hamid Reza Eftekharian, Leila Khojastepour
PurposeThe location of the zygomatic bone plays a significant role in facial symmetry and aesthetics. The aim of this study was to determine and compare the frequency of facial asymmetry in a sample of patients who had undergone treatment of unilateral ZMC fractures (study) and a sample of normal subjects (control).Patients and MethodsThis is a retrospective controlled cross-sectional study. The primary predictor variable was the type of ZMC fracture (linear or comminuted). The primary outcome variable was facial asymmetry characterized by the bilateral difference in the position of malar eminences (ME) in three dimensions based on a CT scan. The other variables for this study were classified into demographic (age and gender) and anatomic (side of ZMC fracture). Descriptive and bi-variate statistics were computed. Statistical significance was set at P < .05 with 95% reliability.ResultsThe samples in this study consisted of 134 subjects (n =67 per each group). The mean bilateral difference of ME position in the study subjects was significantly higher than that of the control subjects. More than half of the study subjects had facial symmetry, and just about 10 percent of them had marked asymmetry, while none of the control subjects had marked asymmetry. All the subjects with marked asymmetry and about 70 percent of the study subjects who were above the maximum normal asymmetry (MNA) had a comminuted fracture.ConclusionsThe results of this study show that although the frequency of facial asymmetry in the ZMC fracture patients was higher than the normal subjects, it was found in all individuals to a certain extent. The patients' awareness about this fact can reduce their dissatisfaction.



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Effectiveness of Immersive Virtual Reality in Surgical Training - A Randomized Control Trial

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yeshwanth Pulijala, Minhua Ma, Matthew Pears, David Peebles, Ashraf Ayoub
IntroductionThe surgical training methods are evolving with technological advancements including the application of virtual reality (VR) and augmented reality (AR). Yet, twenty-eight to forty percent of novice residents are not confident in performing a major surgical procedure. VR Surgery, an immersive virtual reality (iVR) experience was developed using Oculus Rift and Leap Motion devices to address this challenge. It is a multi-sensory, holistic surgical training application, that demonstrates a maxillofacial surgical technique, Le Fort I osteotomy.ObjectiveThe main objective of this study was to evaluate the impact of VR Surgery on the self-confidence and the knowledge of surgical residents.DesignA multisite, single-blinded, parallel, randomised controlled trial (RCT) was performed. The participants were novice surgical residents with a limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self- assessment scores of trainee's confidence on a Likert scale and objective assessment of the cognitive skills. Ninety-five residents from seven dental schools took part in the RCT. The participants were randomly divided into a study group n=51, and a control group n=44. Participants in the study group used the VR Surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. A repeated measures multivariate ANOVA was applied to the data to assess the overall impact of the intervention on the confidence of residents.ResultsThe study group participants showed a significantly higher perceived self-confidence levels compared to those in the control group (p=0.034, α=0.05). Novices in the first year of their training showed the highest improvement in their confidence, compared to those in the second and third year.ConclusioniVR experiences improve the knowledge and self-confidence of the surgical residents.



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Orthognathic Surgical Outcomes in Patients with and without Craniofacial Anomalies

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Zohra Metalwala, Christopher Okunseri, Steven Fletcher, Veerasathpurush Allareddy
ObjectiveThe objective of this study is to examine hospitalization outcomes following orthognathic surgeries. This study tests the hypothesis that those with craniofacial anomalies have higher billed hospital charges, longer length of stay, and increased odds for developing infectious complications when compared to those without craniofacial anomalies.MethodsThe Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients that underwent an orthognathic surgery were selected. The primary independent variable of interest was presence of a congenital cleft/craniofacial anomaly. The outcome variables were occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of a presence of craniofacial anomaly on outcomes.ResultsDuring the study period, a total of 16,515 patients underwent an orthognathic surgery in the United States. Of these, 2,760 patients had a cleft/craniofacial anomaly. 7.4% of those with a craniofacial anomaly had an infectious complication (compared to 0.6% in those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared to $56,189 in those without a craniofacial anomaly). The mean length of stay in hospital in those with craniofacial anomaly was 8.8 days (compared to 1.8 days in those without a craniofacial anomaly). These differences in outcomes between those with and without a craniofacial anomaly were significant after adjusting for patient and hospital level confounders.ConclusionsThose with a craniofacial anomaly are at a higher risk for developing infectious complications, have higher hospital charges, and stay in hospital for a longer duration of time following an orthognathic surgery when compared to those without a craniofacial anomaly.



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Le Morte d’Arthur, A Commentary on Hugo L. Obwegeser

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Robert Bruce MacIntosh




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Immunohistochemical analysis on cortex-to-cortex healing after mandibular vertical ramus osteotomy: A preliminary study

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hwi-Dong Jung, Sang Yoon Kim, Han-Sung Jung, Hyung-Sik Park, Young-Soo Jung
PurposeThis study aimed to analyze the expression of specific cytokines among TGF-β superfamily over postoperative periods after mandibular VRO.Materials and MethodsA total of 4 beagle dogs were enrolled and euthanized at 1, 2, 4, and 8 weeks postoperatively for immunohistochemical (IHC) analysis using 6 specific antibodies (BMP-2/4, BMP-7, TGF-ß2, TGF-β3, MMP-3, and VEGF). The results from the surgical site and control (adjacent area) were compared.ResultsGeneralized upregulation of BMP-2/4 was observed in all healing periods while the strongest expression of BMP-7 was observed at 1 week. The strongest expression of TGF-ß2 was observed at 8 weeks with increasing pattern. The strong expression of TGF-β3 was observed at 1 and 4 weeks while VEGF at 1 week with decreasing pattern. There were no notable uptakes detected with 6 specific antobodies on adjacent bone (control).ConclusionThe absence of internal fixation following VRO lead to dynamic healing with a specific expression pattern of BMP-7 and TGF-β2. The anatomical factors including sufficient preexisting vascularity lead to the earlier expression pattern of VEGF.



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Postoperative care after tonsillectomy: what's the evidence?.

Purpose of review: The purpose of this review is to evaluate the current literature regarding postoperative management after tonsillectomy in children. Recent findings: Controversy remains regarding the ideal medication regimen to manage pain after tonsillectomy. Acetaminophen and ibuprofen are routinely used, although concerns of more severe postoperative hemorrhage with ibuprofen remain. Narcotics are prescribed commonly, but with extreme caution in children with severe obstructive sleep apnea. Although not always utilized by the authors, additional adjunctive medications such as perioperative dexamethasone, ketamine, and local infiltration of lidocaine into tonsillar pillars may decrease postoperative pain. Systematic reviews have shown that dexamethasone does not increase risk of posttonsillectomy bleeding. Summary: Adenotonsillectomy is one of the most common procedures performed on children and may have significant morbidity from postoperative pain and bleeding. Managing pain remains challenging and the optimal treatment regimen has not been definitively identified. Many medications and alternative therapies have been studied and suggest possible benefit. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Validation of a Spanish version of the EuroPrevall Food Allergy Quality of Life Questionnaire-Parental Form

Publication date: Available online 14 October 2017
Source:Allergologia et Immunopathologia
Author(s): E. Bartoll, M. Nieto, B. Selva, R. Badillo, G. Pereira, S. Uixera, A. Nieto, Á. Mazón
BackgroundFood allergy can have a major impact on quality of life of children and their parents. Questionnaires have been developed to measure the impact of this disorder. We aimed to validate the EuroPrevall questionnaire on Food Allergy-Quality of Life Questionnaire, Parent Form (FAQLQ-PF) and the Food Allergy Independent Measure (FAIM), translated into Spanish.MethodsThe internal consistency of the FAQLQ-PF and the FAIM, translated into Spanish (Spain) and completed by the parents of 74 children with IgE-mediated food allergy, were evaluated with Cronbach's alpha. To test construct validity of the FAQLQ-PF, its correlation with the FAIM was also calculated. To assess their discriminant validity, we compared the values of both depending on the number of offending foods and for children with and without anaphylaxis.ResultsThe values of Cronbach's alpha for the three domains in the FAQLQ-PF were over 0.9. The value of alpha for FAIM questions was below 0.6, which was attributed to the wording of one question. When this question was removed, alpha increased to over 0.70. There was a significant correlation between the FAQLQ-PF score and the FAIM. There were significantly poorer FAQLQ-PF scores in children with more food allergies and worse FAIM in those who had had anaphylaxis.ConclusionsThe Spanish version of the FAQLQ-PF had a good internal consistency, good construct validity and validity to discriminate patients with more food allergies and anaphylaxis. It can be used as a tool to evaluate and monitor the quality of life in families with food allergic children.



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