Head and Neck Medicine by Alexandros G.Sfakianakis: 11/15/17

Τετάρτη 15 Νοεμβρίου 2017

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review

Abstract

Background/objectives

Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature.

Methods

The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files.

Results

Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively).

Conclusion

Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.

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Ethnic differences in stratum corneum functions between Chinese and Thai infants residing in Bangkok, Thailand

Abstract

Background/Objectives

Ethnic and racial differences in infant skin have not been well characterized. The purpose of this study was to establish whether there are ethnic differences and similarities in the stratum corneum (SC) functions of Thai and Chinese infants.

Methods

Healthy infants 6 to 24 months of age (N = 60; 30 Thai, 30 Chinese) who resided in Bangkok, Thailand, were enrolled. Transepidermal water loss (TEWL) and SC hydration (capacitance) on the thigh, buttock, and upper arm were measured. Ceramide content was determined in the SC on the upper arm.

Results

SC hydration was not remarkably different between the two ethnicities at any site measured, but TEWL was significantly higher in Chinese infants than in Thai infants at all sites. Hydration of the SC was not significantly correlated with age in either ethnicity. TEWL had significant but weak correlations with age on the thigh and upper arm in Thai infants. Ceramide content was significantly higher in Chinese SC than in Thai SC. No relationship between ceramide content and TEWL or hydration was observed in either ethnicity.

Conclusion

The significant differences in TEWL and ceramide contents between Chinese and Thai infant skin could prove useful in designing skin care and diapering products that are best suited for each ethnicity.

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Correction to: Abstracts

Abstract

In Poster Sessions, the first-author name was missing from the authorship group originally listed for Abstract PS-13-001 (page S176), entitled "Gastric carcinoma with lymphoid stroma: Analysis of microsatellite instability and Epstein-Barr virus status". The correct authorship group is shown above.

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Correction to: Abstracts

Abstract

In Poster Sessions, the first-author name was missing from the authorship group originally listed for Abstract PS-01-004 (page S52), entitled "Clinicopathological features of microinvasive breast cancer". The correct authorship group is shown above.

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Correction to: Abstracts

Abstract

Due to an error with the registration system, the following abstract was regrettably omitted from the Poster Sessions. The abstract should have been included as PS-13-116 and displayed on page S199.

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Guidelines for Contributing Authors

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Editorial Board

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Use of an intraoperative navigation system and piezoelectric surgery for styloidectomy in a patient with Eagle’s syndrome: a case report

Elongated styloid process syndrome (Eagle's syndrome) is the term given to the symptomatic elongation of the styloid process or the mineralization of the stylohyoid or stylomandibular ligament. The two commonl...

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Repair of maxillary cystic bone defects with mesenchymal stem cells seeded on a cross-linked serum scaffold

Tissue engineering combining cross-linked serum scaffolds with bone-derived mesenchymal stem cells has displayed excellent results for repair of maxillofacial bone defects in animal models, but it had not been tested in humans yet. We present here a pilot clinical trial using autologous bone-derived mesenchymal stem cells (H-MSV) grown in a serum cross-linked scaffold (BioMax) for treatment of maxillary cysts in 9 patients. Cells obtained from alveolar bone were seeded in the BioMax scaffold prepared from autologous serum, expanded under GMP conditions, and subjected to osteogenic differentiation for 3-4 weeks before application.

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Should Hospitals Market Opioid-Sparing Analgesia to Patients?.

No abstract available

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Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty: A Randomized, Double-Blind, Noninferiority Trial.

Background and Objectives: Adductor canal blocks (ACBs) are associated with improved analgesia, preserved quadriceps strength, and decreased length of hospitalization after total knee arthroplasty (TKA). However, controversy remains regarding the ideal location of a continuous block within the adductor canal, and it remains unclear whether similar clinical benefits are obtained irrespective of block location. In this randomized, double-blind, noninferiority study, we hypothesized that a continuous proximal ACB provides postoperative analgesia that is no worse than a continuous distal ACB. Methods: Subjects presenting for unilateral TKA were randomized in a 1:1 ratio to either a continuous proximal or distal ACB group. The primary outcome of this noninferiority study was opioid consumption within the first 24 hours following surgery. Secondary outcomes included quadriceps strength, pain scores, distance ambulated, and patient satisfaction. Results: Seventy-three subjects, 36 from the proximal group and 37 from the distal group, completed the study per protocol. The intention-to-treat analysis demonstrated a cumulative mean intravenous morphine equivalent consumption difference between the proximal and distal groups of -7.2 mg (95% confidence interval, -14.8 to 0.4; P

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Radiofrequency Procedures to Relieve Chronic Hip Pain: An Evidence-Based Narrative Review.

Background and Objectives: Chronic hip pain from osteoarthritis and other degenerative conditions is a common problem. A few publications have recently reported analgesic success of radiofrequency (RF) procedures on nerves innervating the hip, but interpretation is hampered by lack of clarity regarding indications, clinical protocols, anatomic targets, and longevity of benefit from RF procedures. Methods: We reviewed the following medical literature databases for publications on RF procedures on the hip joint for chronic pain: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar through February 28, 2017. Existing knowledge on innervation of the hip joint was synthesized. Data on analgesic and functional outcomes and adverse effects measured at any time points following the interventions were also collected, analyzed, and reported in this narrative review. Results: Fourteen publications on ablative RF treatments of innervation of the hip joint were identified. A high success rate of these procedures in relieving chronic pain of the hip joint was reported at 8 days to 36 months after the procedures, but none of the publications were randomized controlled trials. There was evidence for improvement in function and a lack of serious adverse events of RF treatments. Conclusions: Radiofrequency treatments for the sensory innervation of the hip joint have the potential to reduce pain secondary to degenerative conditions. Ongoing concerns remain regarding the anatomic targets, as well as quality, procedural aspects, and monitoring of outcomes in publications on this topic. Randomized controlled trials of high methodological quality are required to further elaborate the role of these interventions in this population. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Cervical Foraminal Epidural Blood Patch for the Targeted Treatment of Refractory Cerebrospinal Fluid Leakage From a Dural Sleeve.

Epidural blood patches (EBPs) are routinely used to treat symptoms (eg, headaches) associated with spontaneous intracranial hypotension. Although cerebrospinal fluid leakage commonly involves the periforaminal areas of the cervical or thoracic spine, EBPs have been historically performed at the lumbar level. Recent evidence suggests that targeting the causative spinal segment may provide greater clinical benefits. While previous reports have targeted foraminal leaks with segmental thoracic or cervical injections, we present a case report detailing the novel use of a navigable epidural catheter to perform a selective EBP at the C7/T1 foramen. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention.

Background and Objectives: The purpose of this cadaveric study was to determine the pattern of anterior hip capsule innervation and the associated bony landmarks for image-guided radiofrequency denervation. Methods: Thirteen hemipelvises were dissected to identify innervation of the anterior hip capsule. The femoral (FN), obturator (ON), and accessory obturator (AON) nerves were traced distally, and branches supplying the anterior capsule documented. The relationships of the branches to bony landmarks potentially visible with ultrasound were identified. Results: The anterior hip capsule received innervation from the FNs and ONs in all specimens and the AON in 7 of 13 specimens. High branches of the FN (originating above the inguinal ligament) were found exclusively in 12 specimens and passed between the anterior inferior iliac spine and the iliopubic eminence. The ONs were innervated exclusively by high branches (proximal to the division), by low branches (from the posterior branch), and by both in 4, 5, and 4 specimens, respectively. The most consistent landmark was the inferomedial acetabulum (radiographic "teardrop"). When present, the AON coursed over the iliopubic eminence before innervating the anterior hip capsule. Conclusions: Branches of the FNs and ONs consistently provided innervation to the anterior hip capsule. The AON also contributed innervation in many specimens. The relationship of the articular branches from these 3 nerves to the inferomedial acetabulum and the space between the anterior inferior iliac spine and iliopubic eminence may suggest potential sites for radiofrequency ablation. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases

Direct immunofluorescence microscopy (DIF) of a skin biopsy specimen is the reference standard for the diagnosis of pemphigoid diseases (PD). Serration pattern analysis enables differentiation of epidermolysis bullosa acquisita (EBA) from other PD using DIF microscopy alone. However, practice gaps need to be addressed for implication of this technique in daily routine diagnostics.

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Reduction of olfactory sensitivity during normobaric hypoxia

Acute mountain sickness (AMS) is caused by a low partial pressure of oxygen and may occur above 2500m. The aim of this research was to evaluate olfactory and gustatory abilities of healthy subjects during baseline conditions and after seven hours of normobaric hypoxia.

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Improving surgical results in complex nerve anatomy during implantation of selective upper airway stimulation

The following report presents a case of two late embedded hypoglossus branches during implantation of an upper airway stimulation device that caused a mixed activation of the tongue when included in the stimulation cuff. In the end, correct cuff placement could be achieved by careful examination of the hypoglossal nerve anatomy, precise nerve dissection, tongue motion analysis and intraoperative nerve monitoring.

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Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society

Patulous Eustachian Tube (PET) is of increasing importance in otology. However, despite the abundance of diseases requiring a differential diagnosis from PET, such as superior semicircular canal dehiscence syndrome, perilymphatic fistula, acute low-tone sensorineural hearing loss, etc., there are currently no established diagnostic criteria for PET.In view of these circumstances, the Japan Otological Society (JOS) Eustachian Tube Committee proposed the diagnostic criteria for Patulous Eustachian Tube in 2012, in order to promote clinical research on PET.

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Differential roles of kallikrein-related peptidase 6 in malignant transformation and ΔNp63β-mediated epithelial-mesenchymal transition of oral squamous cell carcinoma

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Naoki Kaneko, Shintaro Kawano, Kaori Yasuda, Yuma Hashiguchi, Taiki Sakamoto, Ryota Matsubara, Yuichi Goto, Teppei Jinno, Yasuyuki Maruse, Masahiko Morioka, Taichi Hattori, Shoichi Tanaka, Hideaki Tanaka, Tamotsu Kiyoshima, Seiji Nakamura
We previously reported that epithelial-to-mesenchymal transition (EMT) was mediated by ΔNp63β in oral squamous cell carcinoma (OSCC). In this study, DNA microarray analyses were performed using ΔNp63β-overexpressing OSCC cells to identify genes associated with ΔNp63β-mediated EMT. Thereby, we focused on kallikrein-related peptidase (KLK) 6, most up-regulated following ΔNp63β-overexpression, that activates protease-activated receptors (PARs). In RT-PCR analyses, ΔNp63 was positively associated with KLK6 and PAR2 and negatively with PAR1 in OSCC cells. By ΔNp63 knockdown, KLK6 and PAR2 expression was decreased and PAR1 was increased. Furthermore, KLK6 knockdown led to enhancing migration and invasion, and inhibiting proliferation, suggesting EMT-phenotypes. Although, in the KLK6 or PAR2 knockdown cells, phosphorylation of ERK was reduced, it was restored in the KLK6 knockdown OSCC cells treated with recombinant KLK6 proteins. Immunohistochemistry showed ΔNp63, KLK6, and PAR2 were more strongly expressed in the epithelial dysplasia and central region of OSCC than normal oral epithelium, whereas PAR1 expression was undetectable. Interestingly, at the invasive front of OSCC, ΔNp63, KLK6, and PAR2 were reduced, but PAR1 was elevated. In addition, the OSCC patients with decreasing KLK6 expression at the invasive front had more unfavourable prognosis. These results suggested differential roles of KLK6 in malignant transformation and EMT; high ΔNp63β expression up-regulates KLK6-PAR2 and down-regulates PAR1, inducing malignant transformation in oral epithelium with stimulating proliferation through ERK signal activation. Moreover, KLK6-PAR2 expression is down-regulated and PAR1 is up-regulated when ΔNp63β expression is decreased, leading to EMT with enhancing migration and invasion through ERK signal reduction at the invasive front.

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Intraoperative vasoplegia: methylene blue to the rescue!

Purpose of review To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). Recent findings Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation. MTB has been used in postgraft reperfusion during liver transplantation and anaphylaxis in a limited number of cases. Additionally, this medication has been used in septic shock with promising results, but similar to the cardiac surgical population, the effects of MTB administration on clinical outcomes has yet to be elucidated. Summary MTB should be considered during vasoplegic syndrome in cardiac surgery with cardiopulmonary bypass and usage may be more effective in an early critical window, prior to end-organ hypoperfusion. Other perioperative scenarios of MTB use show promise, but additional studies are required to develop formative conclusions. Correspondence to Kamrouz Ghadimi, MD, Divisions of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Box 3094/HAFS 5691G, Durham, NC 27710, USA. Tel: +1 919 681 6532; e-mail: Kamrouz.Ghadimi@duke.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Vitamin C in sepsis

Purpose of review This narrative review summarizes recent insights into the role of vitamin C in sepsis. Recent findings Septic shock remains a major source of morbidity and mortality in critically ill patients. Although many nutritional supplements have previously been tested unsuccessfully, vitamins are still being explored as a therapeutic option in septic patients. In particular, vitamin C-containing regimens as adjunctive therapy in sepsis have received much attention. Summary In-vitro evidence supports a critical role for vitamin C in cellular mechanisms relevant to the pathophysiology of sepsis. However, whether this justifies therapeutic use of vitamin C in septic patients remains uncertain. Correspondence to Karsten Bartels, MD, MS, Assistant Professor, Department of Anesthesiology, University of Colorado Denver, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA. Tel: +1 720 848 6752; fax: +1 720 848 7375; e-mail: karsten.bartels@ucdenver.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Obstructive sleep apnea and bariatric surgical guidelines: summary and update

Purpose of review Increasing numbers of bariatric surgical procedures and the high prevalence of obstructive sleep apnea (OSA) in this population have resulted in a growing interest in the perioperative management of OSA in bariatric surgery. This review provides a summary of the first consensus guideline on this topic as well as an update of the newest literature available. Recent findings All bariatric patients should be screened for OSA and obesity hypoventilation syndrome (OHS) to reduce the risk of perioperative complications. Intraoperative precautions are preoxygenation, induction and intubation in ramped position, continuous positive airway pressure (CPAP) and positive end-expiratory pressure during induction, maintenance of low tidal volumes during surgery, multimodal anesthesia and analgesia with avoidance of opioids and extubation when patients are free of neuromuscular blockage. CPAP therapy and continuous monitoring with a minimum of pulse oximetry is recommended in the early postoperative period. Summary Multiple precautions exist to minimize the risk of cardiopulmonary complications and to enhance recovery after surgery. A combination of these procedures seems to provide optimal perioperative care of OSA patients undergoing bariatric surgery. Nearly 75% of recommendations are based on low quality of evidence, indicating the high value of experts' opinion and potential for future research. Correspondence to Christel A.L. de Raaff, MD, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands. Tel: +31 20 5108040; fax: +31 20 6854014; e-mail: calderaaff@gmail.com Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anticipated and unanticipated difficult airway management

Purpose of review Management of difficult airway is far from optimal despite of continuous progress in science and technology. The purpose of this review is to summarize the current research in the field and bring readers up to date. Recent findings New technologies for intubation make providers more confident to handle difficult airways, but there is lack of evidence indicating the reduction in incidence of 'cannot intubate cannot ventilate (CICV)'. Optimization of mask ventilation should reduce the incidence of difficult mask ventilation but it is greatly underappreciated. Even optimization of preoxygenation is not directly associated with any decreased incidence of difficult airway, but it prolongs time of safe apnea oxygenation; therefore, is likely to improve the outcome of the patients if CICV occurs. Summary Improvement of managing difficult airway relies on optimized mask ventilation, utilization of the appropriate tools for intubation, maximization of the safe apnea oxygenation time, prompt surgical airway in response to severe hypoxia in case effective noninvasive interventions are not achievable. It seems that a simplified and concise algorithm of difficult airway management needs to be established in order to enable providers to easily remember and execute. Correspondence to Yandong Jiang, MD, PhD, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA. Tel: +1 615 343 9419; fax: +1 615 936 6493; e-mail: yandong.jiang@vanderbilt.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Pulmonary effects of aging

Purpose of review As the population ages, the increase in chronic illnesses among patients with decreasing lung function will pose a major public health challenge. Determining which elderly patients are fit for surgery is an increasingly important skill. Anesthetic care of elderly patients requires an understanding of the effects that chronic diseases have on normal age-related changes in physiology and function. Postoperative respiratory complications are significantly increased in patients over 65 years of age, especially those with preexisting diseases. Recent findings Advanced age is associated with changes in the immunity of the pulmonary system. Dysregulation of pro-inflammatory mediators and antimicrobial defense systems contribute to a reduction in pulmonary function and its response to infections. Aging is also associated with a disruption of the function of alveolar macrophages, neutrophils, and natural killer cells. Summary Aging can increase the risk of postoperative complications because of a loss of physiologic reserve and airway defenses. These limitations may only become apparent after the stressors of surgery and anesthesia. Correspondence to Daniel Tran, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3rd floor, New Haven, CT 06520-8051, USA. Tel: +1 203 785 2802; e-mail: daniel.tran@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Lupus Nephritis: Persistent Challenges, New Approaches

Publication date: December 2017
Source:Clinical Immunology, Volume 185
Author(s): Chaim Putterman

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Editorial Board

Publication date: December 2017
Source:Clinical Immunology, Volume 185

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Development and face validation of a Virtual Reality Epley Maneuver System (VREMS) for home Epley treatment of benign paroxysmal positional vertigo: A randomized, controlled trial

Publication date: Available online 14 November 2017
Source:American Journal of Otolaryngology
Author(s): Reza Tabanfar, Harley H.L. Chan, Vincent Lin, T. Le, Jonathan C. Irish
PurposeTo develop and validate a smartphone based Virtual Reality Epley Maneuver System (VREMS) for home use.MethodsA smartphone application was designed to produce stereoscopic views of a Virtual Reality (VR) environment, which when viewed after placing a smartphone in a virtual reality headset, allowed the user to be guided step-by-step through the Epley maneuver in a VR environment. Twenty healthy participants were recruited and randomized to undergo either assisted Epleys or self-administered Epleys following reading instructions from an Instructional Handout (IH). All participants were filmed and two expert Otologists reviewed the videos, assigning each participant a score (out of 10) for performance on each step. Participants rated their perceived workload by completing a validated task-load questionnaire (NASA Task Load Index) and averages for both groups were calculated.ResultsTwenty participants were evaluated with average age 26.4±7.12years old in the VREMS group and 26.1±7.72 in the IH group. The VR assisted group achieved an average score of 7.78±0.99 compared to 6.65±1.72 in the IH group. This result was statistically significant with p=0.0001 and side dominance did not appear to play a factor. Analyzing each step of the Epley maneuver demonstrated that assisted Epleys were done more accurately with statically significant results in steps 2–4. Results of the NASA-TLX scores were variable with no significant findings.ConclusionWe have developed and demonstrated face validity for VREMS through our randomized controlled trial. The VREMS platform is promising technology, which may improve the accuracy and effectiveness of home Epley treatments.Level of evidenceN/A.

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Total caloric eye speed in patients with vestibular migraine

Publication date: Available online 14 November 2017
Source:American Journal of Otolaryngology
Author(s): Adam Thompson-Harvey, Anthony A. Mikulec
PurposeVestibular migraine is a common cause of dizziness that lacks a known objective test. This study examined total eye speed on caloric testing as a diagnostic marker for vestibular migraine.Materials and methodsRetrospective chart review of patients seen in a tertiary otologic practice between 2004 and 2016 who had undergone caloric testing with water irrigation and had a diagnosis of vestibular migraine (n=34). A group of patients with benign paroxysmal positional vertigo (n=10) were used as a control group. Patients were grouped into quartiles based on total eye speed.ResultsOnly patients in the lowest quartile (total eye speed<79) had a diagnosis of vestibular migraine. All other quartiles included a mix of control and vestibular migraine patients.ConclusionLow total eye speed may be suggestive of a diagnosis of vestibular migraine, but most patients with vestibular migraine do not have low total eye speed.

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New Techniques to Predict Response to Immunotherapy

The latest immunotherapy trials suggest that all subgroups benefit, yet not all patients do well. A group of French researchers is tackling this conundrum head-on.
Medscape Oncology

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Single Dose of Azithromycin Effective for Latent Yaws

Reuters Health Information

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Celebrities at Conferences: A Welcome Distraction?

Medical meetings often host famous speakers, but Tom Hanks's appearance at a recent cardiology conference was for entertainment purposes only.
theheart.org on Medscape

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Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs

This randomized clinical trial assesses whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis.

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Underuse of Sentinel Lymph Node Biopsy for Squamous Cell Carcinoma

This study examines the underuse of the sentinel lymph node biopsy in the management of high-risk squamous cell carcinoma.

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Vegetating Darier Disease Treated With Botulinum Toxin

This case report describes a patient with vegetating Darier disease treated with botulinum toxin.

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Treatment for Livedoid Vasculopathy

This systematic review uses the MEDLINE and EMBASE databases to identify the available therapies for livedoid vasculopathy and their clinical outcomes.

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Hyperpigmented Cutaneous Plaques With Ulceration on the Legs

A woman in her 80s had a well-demarcated, oval ulcer with a violaceous, dusky border and central yellow fibrin mixed with granulation tissue and numerous violaceous to dull red, indurated plaques on the legs. What is your diagnosis?

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Is Augmentation Required to Correct Malar Deficiency with Maxillary Advancement?

Publication date: Available online 14 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Chad Petersen, Michael R. Markiewicz, Michael Miloro
PurposePatients with maxillary hypoplasia also have malar deficiency, therefore planning may include consideration for simultaneous malar augmentation. The purpose of this study is to compare pre- and post-operative profiles of subjects who underwent Lefort I advancement, with and without malar augmentation, to assess the subjective perception of changes in malar eminence projection.Materials and MethodsSubjects who had maxillary advancement and mandibular setback with and without malar augmentation were evaluated via a survey consisting of pre- and post-operative photographs that were assessed by two groups: professionals and laypersons, and a visual analogue scale was used to assess the malar region. Next, pre- and post-operative images were shown side-by-side, and participants were asked to indicate which subjects had undergone malar augmentation. Statistical analysis used a Wilcoxon signed rank test, independent samples t-test, Spearman's rank order correlation, and Mann-Whitney U tests.ResultsOf 43 patients, 23 met the inclusion criteria, and only 7 of the 23 subjects received simultaneous malarplasty. Subjects in both groups were perceived as having an increase in malar eminence projection postoperatively. In both the malarplasty and non-malar cohorts, laypersons and professionals noted an increase in projection (p<.05). Laypersons tended to overestimate the number of malar procedures performed (sensitivity 59.5%, specificity 56.8%), while professionals were better able to accurately exclude malar augmentation (sensitivity 44.2%, specificity 69.9%).ConclusionsMost patients with maxillary hypoplasia undergoing Lefort I advancement may expect a subjective improvement in malar projection. The decision for malar augmentation at the time of maxillary advancement should be considered based upon patient desires, but, in general, maxillary advancement alone may be sufficient for an optimal malar esthetic outcome.

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Risques en dermatologie interventionnelle chez les patients hémophiles ou atteints de la maladie de Willebrand

Publication date: Available online 14 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Say, N. Dupin, N. Stieltjes, M.-F. Avril, S. Aractingi, J. Chanal
ContexteLa maladie de Willebrand (MW) et les hémophilies A (HA) et B (HB) représentent la majorité des déficits constitutionnels en facteurs de la coagulation (DCFC). La nature et la fréquence des complications qui peuvent survenir chez ces patients lors d'un geste de dermatologie interventionnelle (DI) ne sont pas connus. L'augmentation d'incidence des cancers cutanés et leur prise en charge chirurgicale nous ont amenés à nous interroger sur cette problématique.ButL'objectif de notre étude était de déterminer la fréquence des complications hémorragiques des actes de DI pratiqués chez des patients présentant un DCFC (Hémophilie ou MW).Patients et méthodesNous avons réalisé un recueil de données chez les patients présentant un DCFC et pris en charge pour un acte de DI au sein du service de dermatologie du centre hospitalier universitaire de Cochin à Paris.RésultatsQuatorze interventions ont été réalisées chez 8 patients. Trois complications de type hémorragique sont survenues (n=3/14 ; 21,4 %) : un hématome, un saignement tardif et un saignement immédiat. Aucune de ces complications n'a nécessité de reprise chirurgicale pour hémostase ni de réanimation.DiscussionLe taux de complications hémorragiques s'est révélé nettement supérieur à celui observé en population générale. Ces complications peuvent toutefois être considérées comme non graves, permettant de conserver un rapport bénéfice/risque favorable. La prise en charge de ces malades doit être multidisciplinaire et coordonnée avec le centre de références de l'hémophilie (CRH), afin d'établir un protocole de substitution en facteur de la coagulation (FC) adapté aux caractéristiques de la pathologie et au geste chirurgical.BackgroundVon Willebrand disease (VWD) and hemophilia A and B are the most common types of hereditary coagulation-factor deficiencies. The frequency and type of complications of skin surgery in these patients are unknown. The increasing incidence of skin cancer prompted us to reflect upon this issue. While the incidence of skin cancer is increasing, the complications of skin surgery or ablative laser treatment remain unknown in this population.AimThe aim of this study was to determine the frequency of bleeding complications during and after skin surgery in patients with a hereditary coagulation-factor deficiency (hemophilia or VWD).Patients and methodsWe conducted a retrospective study in patients with hemophilia A or B or VWD undergoing skin surgery or ablative laser treatment at the Dermatology Department of the Cochin Hospital in Paris, France.ResultsFourteen procedures were performed in 8 patients. Three episodes of bleeding occurred (n=3/14, 21.4%): one hematoma, one delayed bleed and one immediate bleed. None of these complications required surgical revision or resuscitation.DiscussionThe rate of hemorrhagic complications was higher than in the general population. However, these complications can be considered non-serious and the risk-benefit ratio remains favorable. Multidisciplinary management and coordination with the reference hemophilia center are mandatory in this population to establish a coagulation-factor (CF) substitution protocol suited to the disease characteristics and the surgical procedure.

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The risk factors related to bruxism in children: A systematic review and meta-analysis

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Huaqi Guo, Tongxia Wang, Xiaohong Niu, Hui Wang, Weihan Yang, Jie Qiu, Lan Yang
ObjectiveThis systematic review was performed to determine the risk factors related to bruxism in children.DesignThis systematic review was conducted with reporting in agreement to the PRISMA statement and according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a systematic search of seven online databases, with the last search updated on 1st October 2016. The seven databases were Pubmed, Embase, Cochrane Library database, Web of Science, CNKI, CBM, and WF. The included trial type were RCT, cohort studies, and case-control studies, and bruxism symptoms were assessed by questionnaires and examinations. Eighteen out of the 5637 initially identified studies met the inclusion and exclusion criteria.Resultsgender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache, biting, cheeks tonus, perioral musculature participation, conduct problems, peer problems, emotional symptoms, mental health problems, birth weight, occupation of family head, maternal marital status, hyperactivity, family income seemed to have statistical significance from the present systematic review and meta-analysis.ConclusionsThe risk factors related to bruxism were as follows: Male, gene, mixed position, moves a lot, anxiety, the nervous, psychological reactions, responsibility, secondhand smoke, snore loudly, restless sleep, sleep with light on, noise in room, "sleep hours, ≤8h", headache, objects biting, conduct problems, peer problems, emotional symptoms and mental health problems.

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The chemokine receptor type 4 antagonist, AMD3100, interrupts experimental tooth movement in rats

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Kasumi Hatano, Yuji Ishida, Hiroyuki Yamaguchi, Jun Hosomichi, Jun-ichi Suzuki, Risa Usumi-Fujita, Yasuhiro Shimizu, Naoki Shibutani, Sawa Kaneko, Takashi Ono
ObjectiveThe aim of this study was to clarify the role of the stromal cell-derived factor-1 (SDF-1)/C-X-C chemokine receptor type 4 (CXCR4) axis in osteoclast accumulation, and the influence of orthodontic tooth movement (OTM) under mechanical force application to periodontal tissues, by administration of the CXCR4 antagonist AMD3100.DesignThe upper right first molar (M1) of rats was moved mesially with a 10-g force titanium-nickel closed coil spring. Rats were treated with phosphate-buffered saline or AMD3100 (5mg/kg), which is a SDF-1 antagonist. After 0, 1, 3, and 7days, alveolar bones in all groups were examined at each time point by micro-computed tomography and histological analysis.ResultsTooth movement was decreased significantly in the AMD3100-treated group at 1, 3, and 7days after beginning OTM. The numbers of tartrate-resistant acid phosphatase-positive multinucleated cells in the periodontal ligament around the maxillary M1 were decreased significantly in the treated as compared to the control group on Days 1 and 3.ConclusionAdministration of AMD3100 decreases OTM and osteoclast accumulation in rat molars under orthodontic force application. These findings suggest that the SDF-1/CXCR4 axis plays an important role in alveolar bone metabolism during OTM.

http://ift.tt/2AJ2I3D

The risk factors related to bruxism in children: A systematic review and meta-analysis

The chemokine receptor type 4 antagonist, AMD3100, interrupts experimental tooth movement in rats

Neurofeedback in der Behandlung des chronischen Tinnitus

Zusammenfassung

Neurofeedback ist ein Therapieverfahren unter Einsatz der Elektroenzephalographie (EEG), dessen Ziel es ist, eine Selbstkontrolle der eigenen Gehirnaktivität zu erlangen bzw. die eigene Gehirnaktivität gezielt zu beeinflussen. Diese Technik ist nachgewiesenermaßen geeignet, bestimmte Beschwerden wie Aufmerksamkeitsprobleme, Hyperaktivität, Depression oder Migräne zu verbessern. Auch zur Behandlung von Tinnitus ist dieses Verfahren in den letzten Jahren wiederholt in Studien mit dem Erfolg einer Besserung der Tinnitussymptomatik eingesetzt worden, hat sich allerdings nicht als routinemäßig verwendetes Therapieverfahren durchgesetzt. Diese Übersicht beschreibt die Rationale des Einsatzes von Neurofeedback bei Tinnitus und die bisher vorliegende Datenlage gemäß den publizierten Studien. Hierbei wird auch die alternative Methode des Neurofeedbacks, vermittelt durch Echtzeitmessungen in der funktionellen Magnetresonanztomographie („real time fMRT"), berücksichtigt. Zukünftige Möglichkeiten werden aufgezeigt, wie – orientierend an den zunehmenden Erkenntnissen über die Pathophysiologie des Tinnitus und an den verfeinerten EEG-Analysetechniken (Quellenschätzung, Konnektivität) – neuartige Neurofeedbackprotokolle zu einer nachhaltigeren Kontrolle von Tinnitusbeschwerden beitragen könnten.

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Editorial Board/ Publication Information

Publication date: December 2017
Source:Molecular Immunology, Volume 92

http://ift.tt/2zLiQ5u

Perioperative Chemotherapie des Harnblasenkarzinoms

Zusammenfassung

Hintergrund

Etwa 16.000 Menschen erkranken jährlich in Deutschland an einem muskelinvasiven Harnblasenkarzinom. Standardtherapie ist dabei die radikale Zystektomie mit regionaler Lymphadenektomie. Innerhalb der ersten 2 Jahre nach erfolgter Operation erleiden bis zu 50 % der Patienten mit einem initial nicht metastasiertem Tumorstadium T2–T4a Lymphknotenbefall und/oder Fernmetastasen.

Methode

Recherche und Analyse aktueller Literatur.

Ergebnisse

Zur Eliminierung möglicher Mikrometastasen wird heute der Einsatz perioperativer Therapiekonzepte in Form einer neoadjuvanten, induktiven oder adjuvanten Chemotherapie empfohlen. Obwohl der Nutzen einer perioperativen Chemotherapie mit einer Verbesserung der Überlebensrate durch klinische Studien und Metaanalysen klar belegt ist, findet das Verfahren in Europa noch immer nur eine geringe Akzeptanz. Neben der aktuellen Datenlage werden die Vor- und Nachteile der verschiedenen Modalitäten dargestellt und diskutiert.

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CUP – Therapie nach Molekularpathologie oder mit Immuntherapie

Zusammenfassung

Die Therapie von Patienten mit einem CUP-Syndrom (CUP:„cancer of unknown primary") entsprechend dem Ursprungsgewebe ist Teil der Standardbehandlung, wenn sich in der Immunhistologie oder in der Kombination mit klinischen und laborchemischen Parametern große Ähnlichkeiten mit bekannten Tumoren erweisen. Auch mittels Genexpressions- oder Methylierungsanalysen können molekulare Ähnlichkeiten mit bekannten Tumoren nachgewiesen werden. Wenige retrospektive Untersuchungen scheinen einen Vorteil für Patienten zu zeigen, die eine Behandlung passend zu dem molekular definierten Tumor erhielten. Ein Nachweis der Überlegenheit einer auf eine solche Testung basierenden Therapiestrategie steht jedoch aus. Die Suche nach molekularen Zielen führt bei einem kleinen Teil der Patienten zur Möglichkeit der zielgerichteten Behandlung mit für andere Indikationen zugelassenen Medikamenten und kasuistischen Berichten über entsprechende Therapien.

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Complications of double free flap and free flap combined with locoregional flap in head and neck reconstruction: A systematic review

Abstract

Background

The purpose of this clinical review was to assess the feasibility of reconstructing complex head and neck defects with 2 or more free flaps simultaneously.

Methods

A total of 38 articles were reviewed. The patient population included those who received 2 or more free flaps or a single free flap plus a locoregional flap. The primary outcome assessed was rate of complications.

Results

Among double flaps, the minor complication rate was 6.96% and the major complication rate was 20.0%. In comparison, the free flap plus locoregional flap group had higher rates of minor and major complications of 30.4% and 29.5%, respectively. The median operating time was 660 minutes for double flaps and 602 minutes for free flap plus locoregional flap (P = .828).

Conclusion

Compared to the single free flap plus locoregional flap, double free flaps are relatively reliable without increasing surgical complications or decreasing flap survival, while only modestly increasing operating times.

http://ift.tt/2AMLYtj

Preventive effects of tonsil-derived mesenchymal stem cells on osteoradionecrosis in a rat model

Abstract

Background

The purpose of this study was to investigate the effects of tonsil-derived mesenchymal stem cells (MSCs) on osteoradionecrosis (ORN).

Method

We generated a mandibular ORN rat model using a combination of 20-Gy single-dose irradiation and tooth extraction. Study groups were negative control (tooth extraction only), ORN group (irradiation, tooth extraction), Matrigel-1 group (Matrigel; BD Biosciences, San Jose, CA; irradiation, Matrigel application immediately after tooth extraction), tonsil-derived MSC-1 group (irradiation, tonsil-derived MSC application immediately after tooth extraction), Matrigel-4 group (irradiation, Matrigel application 4 weeks after tooth extraction), and tonsil-derived MSC-4 group (irradiation, tonsil-derived MSC application 4 weeks after tooth extraction).

Result

Bone mineral density was significantly lower in the ORN group than in the negative control group. The tonsil-derived MSC-1 group showed significantly higher bone mineral density than did the ORN and tonsil-derived MSC-4 groups.

Conclusion

A single 20-Gy dose of irradiation combined with tooth extraction successfully generated ORN in the rat model. The tonsil-derived MSCs can be effective for bone regeneration in ORN, particularly when applied immediately after dentoalveolar trauma or surgery.

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Comparison of long-term outcomes between pull-through resection and mandibular lip-split surgery for T4a tongue/floor of mouth cancers

Abstract

Background

The purpose of this study was to determine whether the pull-through resection is better than the mandibular lip-split for advanced tongue/floor of mouth (FOM) cancers, which remains inconclusive.

Methods

A retrospective cohort study was performed on 91 patients with T4a tongue/FOM cancers from 2009 to 2014. Cases with mandibular resection were excluded. The pull-through resection was used when the mouth opening was ≥15 mm; otherwise the mandibular lip-split was used.

Results

Fifty-eight patients received pull-through resections and 33 underwent mandibular-lip splits and the mean follow-up periods were 42 and 45 months, respectively. Surgical margin, locoregional recurrence, and 5-year survival were similar between the 2 groups. The pull-through approach had a significantly shorter operation time, lower rates of flap infection, osteoradionecrosis, metal plate exposure, loss of tooth vitality, and better aesthetics.

Conclusion

Our data suggest that the pull-through resection does not compromise disease control for advanced tongue/FOM cancers and is superior to the mandibular lip-split in terms of operation time, postoperative complications, and aesthetics.

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Letter to the Editor regarding “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

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Reply to the Letter to the Editor regarding “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

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Prescription-Strength Steroid Creams Sold Without Prescription

Although the U.S. requires prescriptions for topical steroids with more than a 0.5% concentration, much stronger and potentially harmful steroid creams are not hard to find without a prescription, doctors report.
Reuters Health Information

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Blepharochalasis: A rare cause of eye swelling

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Misu Paul, Lauren Geller, Anna Nowak-Węgrzyn

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Information for Readers

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5

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Sensitization to Staphylococcus aureus enterotoxins in smokers with asthma

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Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Tadao Nagasaki, Hisako Matsumoto, Tsuyoshi Oguma, Isao Ito, Hideki Inoue, Toshiyuki Iwata, Tomoko Tajiri, Yoshihiro Kanemitsu, Yumi Izuhara, Chie Morimoto, Yumi Ishiyama, Hironobu Sunadome, Akio Niimi, Toyohiro Hirai
BackgroundSensitization to Staphylococcus aureus enterotoxins (SEs) augments eosinophilic inflammation in asthma. Recent epidemiologic studies demonstrate that sensitization to SEs is increased in healthy smokers; however, there is no evidence on the association between sensitization to SEs and eosinophilic inflammation in smokers with asthma.ObjectiveTo clarify the role of SEs on clinical indexes, including eosinophilic inflammation and lung function in smokers with asthma.MethodsThe frequency of atopic sensitization to SEs was examined in adult patients with asthma. In current or ex-smokers with asthma, the association of sensitization to SEs with eosinophilic inflammation, airflow limitation, or treatment steps was determined. Clinical indexes were examined at the first visit, and treatment steps were assessed 6 months after enrollment.ResultsOverall, 23 current smokers, 40 ex-smokers, and 118 never smokers with asthma were enrolled. The frequency of sensitization to SEs, but not to other aeroallergens, was significantly higher in current, ex-, and never smokers, in decreasing order. In current or ex-smokers with asthma, patients with sensitization to SEs exhibited higher serum levels of total and specific IgE to aeroallergens, higher blood eosinophil counts, greater airflow limitation, and more severe disease 6 months later than those without sensitization to SE. A longer smoking abstinence period was associated with serum specific IgE levels to SEs, and 3 years was the best cutoff of abstinence period to predict the absence of sensitization to SEs.ConclusionSensitization to SEs is increased in smokers with asthma, and it may be a marker of eosinophilic inflammation and severe asthma in smokers with asthma.Trial Registrationumin.ac.jp Identifier: UMIN000007818.

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Effect of a mobile health, sensor-driven asthma management platform on asthma control

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Meredith A. Barrett, Olivier Humblet, Justine E. Marcus, Kelly Henderson, Ted Smith, Nemr Eid, J. Wesley Sublett, Andrew Renda, LaQuandra Nesbitt, David Van Sickle, David Stempel, James L. Sublett
BackgroundAsthma inflicts a significant health and economic burden in the United States. Self-management approaches to monitoring and treatment can be burdensome for patients.ObjectiveTo assess the effect of a digital health management program on asthma outcomes.MethodsResidents of Louisville, Kentucky, with asthma were enrolled in a single-arm pilot study. Participants received electronic inhaler sensors that tracked the time, frequency, and location of short-acting β-agonist (SABA) use. After a 30-day baseline period during which reference medication use was recorded by the sensors, participants received access to a digital health intervention designed to enhance self-management. Changes in outcomes, including mean daily SABA use, symptom-free days, and asthma control status, were compared among the initial 30-day baseline period and all subsequent months of the intervention using mixed-model logistic regressions and χ² tests.ResultsThe mean number of SABA events per participant per day was 0.44 during the control period and 0.27 after the first month of the intervention, a 39% reduction. The percentage of symptom-free days was 77% during the baseline period and 86% after the first month, a 12% improvement. Improvement was observed throughout the study; each intervention month demonstrated significantly lower SABA use and higher symptom-free days than the baseline month (P < .001). Sixty-nine percent had well-controlled asthma during the baseline period, 67% during the first month of the intervention. Each intervention month demonstrated significantly higher percentages than the baseline month (P < .001), except for month 1 (P = .80).ConclusionA digital health asthma management intervention demonstrated significant reductions in SABA use, increased number of symptom-free days, and improvements in asthma control.Trial RegistrationClinicalTrials.gov Identifier: NCT02162576.

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Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5

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Decreased expression of indolamine 2,3-dioxygenase in childhood allergic asthma and its inverse correlation with fractional concentration of exhaled nitric oxide

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Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Ying Hu, Zhiqiang Chen, Ling Jin, Mei Wang, Wei Liao
BackgroundThe tryptophan metabolic pathway mediated by indolamine 2,3-dioxygenase (IDO), a tryptophan-degrading enzyme, plays an important role in controlling the development of allergic inflammation. The fractional concentration of exhaled nitric oxide (FeNO) is closely associated with the allergic state and is extensively used for the clinical evaluation of airway allergic inflammation. Clinical trials have rarely assessed the expression of IDO in childhood allergic asthma and its correlation with FeNO.ObjectiveTo evaluate the IDO level in children with childhood allergic asthma and the relation between IDO levels and FeNO.MethodsThirty children older than 5 years who were diagnosed the first time with allergic asthma were selected from the pediatric outpatient department. Another 30 healthy children were selected as controls. The subjects were evaluated by complete medical history, pulmonary function test results, skin prick test reaction, FeNO concentration test result, eosinophil count, and a disease severity score. Peripheral venous blood and induced sputum were obtained to measure the concentrations of IDO metabolites (ie, tryptophan and kynurenine).ResultsThe IDO levels in the peripheral blood and induced sputum were significantly lower in patients with childhood allergic asthma than in children in the control group. The IDO level was negatively correlated with FeNO but was not significantly correlated with age, sex, blood eosinophil count, or disease severity scale.ConclusionThe expression of IDO was significantly lower in childhood allergic asthma, particularly in children with high FeNO levels. There was no significant relation between IDO levels and asthma severity.Trial RegistrationChinese Clinical Trial Register (www.chictr.org.cn) Identifier: ChiCTR-COC-15006080.

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Instructions for Authors

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5

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Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Rishi Chopra, Paras P. Vakharia, Ryan Sacotte, Jonathan I. Silverberg
BackgroundBleach baths have been proposed as a treatment for decreasing the severity of atopic dermatitis (AD). However, conflicting results have been found regarding their efficacy.ObjectiveTo determine the efficacy of bleach vs water baths at decreasing AD severity.MethodsWe performed a systematic review of all studies evaluating the efficacy of bleach baths for AD. Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus were searched. Two authors independently performed study selection and data extraction.ResultsFive studies were included in the review. Four studies reported significantly decreased AD severity in patients treated with bleach on at least 1 time point. However, of 4 studies comparing bleach with water baths, only 2 found significantly greater decreases in AD severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences. In pooled analyses, there were no significant differences observed between bleach vs water baths at 4 weeks vs baseline for the Eczema Area and Severity Index (I² = 98%; random effect regression model, P = .16) or body surface area (I² = 96%; P = .36).ConclusionAlthough bleach baths are effective in decreasing AD severity, they do not appear to be more effective than water baths alone. Future larger-scale, well-designed randomized controlled trials are needed.

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Editorial Board

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5

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Tryptophan metabolic pathway, airway nitric oxide, and allergy

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Giorgio Ciprandi, Dietmar Fuchs

http://ift.tt/2ANke7E

Treatment with omalizumab or cyclosporine for resistant chronic spontaneous urticaria

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Renee Koski, Katelin K. Kennedy

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Shiitake mushroom-induced flagellate dermatitis

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Serena Fang, Amir Bajoghli, Mehdi Bajoghli

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DRESS syndrome associated with splenic thrombosis

Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5
Author(s): Nicole LaHood, Kristin Sokol

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Cancer vaccine strategies: translation from mice to human clinical trials

Abstract

We translated two cancer vaccine strategies from mice into human clinical trials. (1) In preclinical studies on TARP, an antigen expressed in most prostate cancers, we mapped epitopes presented by HLA-A*0201, modified them to increase affinity and immunogenicity in HLA transgenic mice, and induced human T cells that killed human cancer cells ("epitope enhancement"). In a clinical trial, HLA-A2⁺ prostate cancer patients with PSA biochemical recurrence (Stage D0) were vaccinated with two peptides either in Montanide-ISA51 or on autologous dendritic cells (DCs). In stage D0, the Prostate-Specific Antigen (PSA) slope is prognostic of time to radiographic evidence of metastases and death. With no difference between arms, 74% of combined subjects had a decreased PSA slope at 1 year compared to their own baseline slopes (p = 0.0004). For patients vaccinated with DCs, response inversely correlated with a tolerogenic DC signature. A randomized placebo-controlled phase II trial is underway. (2) HER2 is a driver surface oncogene product expressed in multiple tumors. We made an adenoviral vector vaccine expressing the extracellular and transmembrane domains of HER2 and cured mice with large established HER2⁺ tumors, dependent on antibodies to HER2, not T cells. The mechanism differed from that of trastuzumab. We tested a human version in advanced metastatic cancer patients naïve to HER2-directed therapies. At the second and third dose levels, 45% of evaluable patients showed clinical benefit. Circulating tumor cells also declined in some vaccinated patients. Thus, cancer vaccines developed in mice were successfully translated to humans with promising early results.

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The Efficacy of Biologic Therapy for the Management of Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review

Abstract

Introduction

Palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) are diseases affecting the hands and/or feet that can cause marked physical discomfort and functional disability. The tumor necrosis factor-alpha antagonists adalimumab, etanercept, and infliximab, the interleukin (IL)-17A inhibitors ixekizumab and secukinumab, and the IL-23 or IL-12/IL-23 inhibitors guselkumab and ustekinumab have been well studied for the treatment of moderate to severe plaque psoriasis. Less is known about the efficacy and safety of these agents for the treatment of PP (hyperkeratotic and pustular forms) and PPP. The aim of this review was to investigate the efficacy of biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP.

Methods

A systematic search of the medical electronic databases (Medline, Embase, and Cochrane Library) was conducted to identify studies or case reports which both used biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP and reported treatment outcomes.

Results

The systematic search identified 579 published articles, of which 44 were included in the analysis. Seven of the articles involved randomized placebo-controlled trials, two were open label trials, and the remaining were cohort studies, case series, or case reports. In the randomized controlled trials on the treatment of hyperkeratotic PP, adalimumab, guselkumab, infliximab, ixekizumab, and secukinumab each demonstrated superiority to placebo at 16, 16, 14, 12, and 12 or 16 weeks, respectively (p < 0.05). For the treatment of pustular PP, ustekinumab 45 mg was not superior to placebo at 12 and 16 weeks, respectively (p > 0.05), although an open label study demonstrated that four of five patients on a therapeutic regimen of ustekinumab 90 mg achieved clinical clearance at 16 weeks. For the treatment of PPP, etanercept and ustekinumab 45 mg were not superior to placebo at 12 and 16 weeks, respectively (p > 0.05). A combined analysis of studies for hyperkeratotic PP demonstrated that 94.7%, 90.0%, 82.5%, 89.1%, and 86.7% of patients experienced an improvement of at least 50% upon treatment with adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab, respectively. In a combined analysis of case reports examining PPP, infliximab showed the greatest efficacy at 100.0% clinical improvement of patients from case reports, followed by ustekinumab at 58.8% clinical improvement. Few serious adverse events were reported, but several were reported in patients treated with infliximab or secukinumab.

Conclusion

Biologic therapy is effective and well-tolerated for the treatment of hyperkeratotic PP, but less data are available on the treatment of pustular PP or PPP. Adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab all showed > 80% efficacy for the treatment of hyperkeratotic PP, while infliximab and ustekinumab showed moderate efficacy for the treatment of pustular PP, and infliximab was the most efficacious treatment for PPP.

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Timing of regular egg intake for prevention of egg allergy

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Wen-Hui Jiang, Li Deng, Qing-Jian Ye, Jia-Rong Cai, Xiu-Rong Cai, Xing Li

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Obstruction phenotype as a predictor of asthma severity and instability in children

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ronald L. Sorkness, Edward M. Zoratti, Meyer Kattan, Peter J. Gergen, Michael D. Evans, Cynthia M. Visness, Michelle Gill, Gurjit K. Khurana Hershey, Carolyn M. Kercsmar, Andrew H. Liu, George T. O'Connor, Jacqueline A. Pongracic, Dinesh Pillai, Christine A. Sorkness, Alkis Togias, Robert A. Wood, William W. Busse
BackgroundSmall airways instability, resulting in premature airway closure, has been recognized as a risk for asthma severity and poor control. Although spirometry has limited sensitivity for detecting small airway dysfunction, a focus on the air-trapping component of obstruction may identify a risk factor for asthma instability.ObjectiveTo use spirometric measurements to identify patterns of airway obstruction in children, and define obstruction phenotypes that relate to asthma instability.MethodsPre- and post-bronchodilation spirometry data were obtained from 560 children in the Asthma Phenotypes in the Inner City study. An air-trapping obstruction phenotype (A Trpg) was defined as forced vital capacity (FVC) Z-score < -1.64, or an increase of FVC ≥ 10% predicted with bronchodilation. The airflow limitation phenotype (A Limit) had forced expiratory volume in 1 s (FEV1)/FVC Z-score < -1.64, but not A Trpg. The None phenotype had neither A Trpg nor A Limit. The 3 obstruction phenotypes were assessed as predictors of number of exacerbations, asthma severity, and airway lability.ResultsThe A Trpg phenotype (14% of the cohort) had more exacerbations during the 12-month study, compared with the A Limit (P<0.03) and the None (P<0.001) phenotypes. The A Trpg phenotype also had the highest Composite Asthma Severity Index, the highest asthma treatment step, the greatest variability in FEV1 over time, and the greatest sensitivity to methacholine challenge.ConclusionsA Trpg and A Limit patterns of obstruction, defined with routine spirometric measurements, can identify obstruction phenotypes that are indicators of risk for asthma severity and instability.

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Reply

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Debra J. Palmer, Susan L. Prescott, Maria Makrides

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Could Substance P be an antiviral mediator and potential therapeutic target in the nose?

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marianna Kulka

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Pathogenic Th17 inflammation is sustained in the lungs by conventional dendritic cells and TLR4 signaling

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Karim H. Shalaby, Miranda R. Lyons-Cohen, Gregory S. Whitehead, Seddon Y. Thomas, Immo Prinz, Hideki Nakano, Donald N. Cook
BackgroundMechanisms that elicit mucosal Th17 cell responses have been described, yet how these cells are sustained in chronically inflamed tissues remains unclear.ObjectiveWe sought to understand whether the maintenance of lung Th17 inflammation requires environmental agents in addition to antigen, and to identify the lung antigen-presenting cell types (APCs) that sustain the self-renewal of Th17 cells.MethodsAnimals were repeatedly exposed to aspiration of ovalbumin alone, or together with environmental adjuvants, including extracts of common house dust (HDE), to test their role in maintaining lung inflammation. Alternatively, antigen-specific effector/memory Th17 cells, generated in culture using CD4⁺ T cells from Il17a fate-mapping mice, were adoptively transferred to assess their persistence in genetically modified animals lacking distinct lung APC subsets or cell-specific TLR4 signaling. Th17 cells were also co-cultured with lung APC subsets to determine which of these could revive their expansion and activation.ResultsTh17 cells and consequent neutrophilic inflammation were poorly sustained by inhaled antigen alone, but were augmented by inhalation of antigen together with HDE. This was associated with weight loss and changes in lung physiology consistent with interstitial lung disease. The effect of HDE required TLR4 signaling predominantly in lung hematopoietic cells, including CD11c⁺ cells. CD103⁺ and CD11b⁺ conventional dendritic cells (cDCs) directly interacted with Th17 cells in situ and revived the clonal expansion of Th17 cells ex vivo and in vivo, whereas lung macrophages and B cells could not.ConclusionTh17-dependent inflammation in the lungs can be sustained by persistent TLR4-mediated activation of lung cDCs.

Teaser

Th17 cell fate-mapping indicates that inhaled house dust extracts sustain clonal expansion of Th17 cells by conventional dendritic cells through a TLR4-dependent mechanism.

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Reply

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Johanna Bellach, Kirsten Beyer

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Early life innate immune signatures of persistent food allergy

Publication date: Available online 14 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Melanie R. Neeland, Jennifer J. Koplin, Thanh D. Dang, Shyamali C. Dharmage, Mimi L. Tang, Susan L. Prescott, Richard Saffery, David J. Martino, Katrina J. Allen
BackgroundFood allergy naturally resolves in a proportion of food allergic children without intervention, however the underlying mechanisms governing the persistence or resolution of food allergy in childhood are not understood.ObjectivesThis study aimed to define the innate immune profiles associated with egg allergy at one year of age, determine the phenotypic changes that occur with the development of natural tolerance in childhood and explore the relationship between early life innate immune function and serum vitamin D.MethodsThis study used longitudinally collected PBMC samples from a population-based cohort of challenge-confirmed egg allergic infants with either persistent or transient egg allergy outcomes in childhood to phenotype and quantify the functional innate immune response associated with clinical phenotypes of egg allergy.ResultsWe show that infants with persistent egg allergy exhibit a unique innate immune signature, characterised by increased numbers of circulating monocytes and dendritic cells that produce more inflammatory cytokines both at baseline and following endotoxin exposure when compared to infants with transient egg allergy. Follow up analysis revealed that this unique innate immune signature continues into childhood in those with persistent egg allergy and that increased serum vitamin D levels correlate with changes in innate immune profiles observed in children who developed natural tolerance to egg.ConclusionEarly life innate immune dysfunction may represent a key immunological driver and predictor of persistent food allergy in childhood. Serum vitamin D may play an immune-modulatory role in the development of natural tolerance.

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Anti-inflammatory effects of tetracyclines

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Forthcoming Events

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The changing faces of Langerhans cells

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Issue Information

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Announcement

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Pleomorphic Adenoma Originating from Heterotopic Salivary Tissue of the Upper Neck: A Diagnostic Pitfall

Pleomorphic adenoma directly arising in the neck is thought to originate from heterotopic salivary gland tissue. In this article, we present the case of a 55-year-old female patient with a histologically proven pleomorphic adenoma located at the left mandibular angle, anteriorly to the sternocleidomastoid muscle and posteroinferiorly to the submandibular gland. As the patient also had an ipsilateral thyroid nodule with coarse calcifications, clinical and radiological features suggested a possible level II metastatic lymph node. However, ultrasound-guided fine needle aspiration cytology and postsurgery histopathological examination revealed a pleomorphic adenoma arising from heterotopic salivary gland tissue unrelated to a benign thyroid nodule. In this article, we provide a review of the existing literature on heterotopic salivary gland tissue and related neoplasms and discuss their imaging presentation.

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Differential expression of STAT-3 in subtypes of oral lichen planus: a preliminary study

Publication date: Available online 14 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Guanhuan Du, Junjun Chen, Yanni Wang, Tianyi Cao, Leilei Zhou, Yufeng Wang, Xiaozhe Han, Guoyao Tang
Objective.This study aimed to examine the expression of signaling transduction proteins and their possible correlation with different clinical subtypes of oral lichen planus (OLP).Study design.We examined the immunoexpression and phosphorylation status of 21 signaling transduction proteins of OLP (n=10) and normal groups (n=8) using PathScan® analysis. We detected expression of STAT-3 and p38MAPK in tissues of OLP (n=40) and normal groups (n=10) by immunohistochemistry.Results.PathScan® analysis showed that STAT-3(Ser727) expression in normal control (N), reticular OLP (R-OLP) and erosive OLP (E-OLP) group was gradually elevated (R-OLP vs N, P=0.001; E-OLP vs N, P<0.001; E-OLP vs R-OLP, P=0.002). Immunohistochemistry showed that STAT-3 expression in the epithelium of normal control, reticular OLP and erosive OLP was consistent with PathScan® analysis (R-OLP vs N, P<0.001; E-OLP vs N, P<0.001; E-OLP vs R-OLP, P=0.036). Both PathScan® (P=0.012) and immunohistochemistry (P<0.001) showed that, p38MAPK expression was significantly higher than normal controls. However, a significant difference was not seen between reticular OLP and erosive OLP groups.Conclusions.Our results provide information indicating that STAT-3 may be involved in OLP development and progression and account for different clinical manifestations.

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Patients' osteometabolic control improves the management of medication-related osteonecrosis of the jaw.

Publication date: Available online 14 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Gianluca Colapinto, Raffaele Volpi, Giovanni Forino, Vito Tricarico, Michele De Benedittis, Roberto Cortelazzi, Tiziano Testori, Massimo Del Fabbro
Objectives.Osteonecrosis of the jaws (ONJ) represents a concern for patients taking antiresorptive drugs. The aim of this study was to test the hypothesis that preoperative individualized pharmacological control of the patient's osteometabolic profile could lead to predictable healing of the surgically treated region and minimize the incidence of complications.Study Design.This prospective study included 95 test patients (53 with osteoporosis and 42 with cancer), and 94 control patients (49 with osteoporosis and 45 with cancer) who were on antiresorptive therapy and were candidates for ONJ treatment. Test patients underwent osteometabolic profile assessment and personalized pharmacological supplementation before intervention. In all cases, a drug holiday was scheduled for three months before and at least three months after the intervention. Healing was assessed clinically and radiographically.Results.In the test group, after a mean follow-up of 28.2±7.8 months only one ONJ recurrence occurred, and was successfully resolved after resuming the pharmacological protocol. Five patients reported minor complications. Overall, 100% treatment success was observed. In the control group, after 28.1±4.9 months follow-up, 6 fistulae, 19 abscesses and 34 dehiscences occurred. In total, 62.8% of patients in the control group had complications or adverse events. The difference between the two groups was highly significant.Conclusions.A strict osteometabolic control should be routinely done in the management of patients taking antiresorptive drugs.

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Relationships between temporomandibular joint disc displacements and condylar volume

Publication date: Available online 14 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Min-Seok Chang, Jeong-Ho Choi, Il-Hyung Yang, Jung-Sub An, Min-Suk Heo, Sug-Joon Ahn
Objectives.We aimed to assess the relationship between mandibular condylar volume and disc displacement status, in male and female adults.Study Design.We evaluated 122 temporomandibular joints in 61 subjects, using magnetic resonance imaging (MRI) and computed tomography (CT). MRI data were used to assign disk status as either normal disk position (NR), disk displacement with reduction (DDR), or disk displacement without reduction (DDNR). CT data were used to calculate total condylar volume and its components, cortical volume and trabecular volume. The relationships between condylar volume, and disk status, and gender were tested with two-way analysis of variance.Results.Condylar volumes significantly correlated with disc displacement, tending to decrease as displacement increased. There were significant differences in both total condylar volume and trabecular volume among the DD status (NR > DDR > DDNR), while cortical volume were significantly different only between NR or DDR and DDNR (NR, DDR > DDNR). The volume decreases associated with TMJ DD were found in both males and females, with greater decreases in men than in women as DD progressed.Conclusion.Condylar volumes are significantly associated with disc displacement status. Joints with non-reducing discs showed the smallest condylar volumes in both males and females.

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Immune checkpoint inhibitor colitis: the flip side of the wonder drugs

Abstract

Immune checkpoint inhibitors block the co-inhibitory receptors on T cells to activate their cytotoxic immune function and are rapidly being explored for the treatment of various advanced-stage malignancies. These novel drugs have already significantly increased survival rates. The first available immune checkpoint inhibitors were cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors (such as ipilimumab), followed by programmed cell death protein 1 (PD-1) and programmed cell death protein ligand 1 (PD-L1) inhibitors (such as pembrolizumab and nivolumab). Anti-PD-1 and anti-PD-L1 therapies have demonstrated better efficacy and tolerability and less severe adverse effects compared to anti-CTLA-4 agents. Idelalisib, a PI3Kδ isoform inhibitor, is another immunotherapeutic agent that is often classified separately and is currently used in treatment of chronic lymphocytic leukemia and non-Hodgkin lymphomas. Despite successful therapeutic responses, immune-related adverse events have been reported with the use of these agents. The gastrointestinal side effects, particularly diarrhea, are among the most commonly reported symptoms. The histologic features of immune checkpoint inhibitor-associated colitis show a spectrum of patterns of injury among various drug classes. There is significant overlap between immune checkpoint inhibitor-associated colitis and other colitides, making the differential diagnosis difficult—especially in the absence of clinical history. The histopathology data on immune checkpoint inhibitor-associated colitis are limited. Here we review clinical features as well as various histologic patterns of colitis associated with these groups of medications.

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Masthead

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ONDAM, T2A, PMSI, SROS, MIGAC, MERRI, SIGAPS & IF: Highly linked French financial medical acronyms…

Publication date: Available online 14 November 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, F. Rubin

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Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues

Abstract

Background

The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published.

Objective

To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues.

Methods

A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list.

Results

The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.

Conclusions

The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow.

Scientific rationale for study

With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia.

Principal findings

Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow.

Practical implications

The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.

http://ift.tt/2iVRx0g

Αρχειοθήκη ιστολογίου

Τετάρτη 15 Νοεμβρίου 2017

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