Head and Neck Medicine by Alexandros G.Sfakianakis: 12/11/17

Δευτέρα 11 Δεκεμβρίου 2017

Electroconvulsive therapy for manic state with mixed and psychotic features in a teenager with bipolar disorder and comorbid episodic obsessive–compulsive disorder: a case report

Comorbidity of bipolar disorder and obsessive–compulsive disorder is common in adolescence. Obsessive–compulsive disorder symptoms may be episodic and secondary to alterations in mood, and display specific fea...

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Factors affecting the outcomes of direct pulp capping using Biodentine

Abstract

Introduction

This study aimed to evaluate the prognostic value of factors with regard to the treatment outcome of direct pulp capping using Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth in which the pulps were exposed during caries removal.

Methods

Between 2010 and 2014, 112 teeth with deep carious lesions underwent direct pulp capping. The patients were followed up at 2–3 months and 1–1.5 years with a routine examination on both recall visits. Periapical radiographs were taken at 1–1.5 years. Lack of patient complaints, positive reactions to cold and electric testing, no sensitivity to percussion, and no widening of the periapical ligament indicated success. The Fisher exact test was used for statistical analysis. The significance level was P = .05.

Results

Eighty-six teeth were available for 1–1.5 years follow-up. The overall success rate was 82.6%. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Sex, initial or secondary caries treatment, occlusal or cervical/proximal caries, delayed placement of permanent filling, tooth position, and arch type did not influence the outcome.

Conclusions

A patient's age influenced the outcome of direct pulp capping using this new calcium silicate cement.

Clinical relevance

Asymptomatic vital permanent teeth with cariously exposed pulp can be treated successfully by direct pulp capping using Biodentine.

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Radiofrequency-assisted subcision for postacne scars

Subcision is a commonly performed procedure for depressed rolling scars of acne.1 Breaking up the fibrotic strands mechanically with a blade or needle leads to neocollagenosis and hematoma formation, resulting in elevation of the depressed scars. However, the excessive mechanical force often leads to trauma to the surrounding tissue, excessive bleeding, and large hematoma formation and fibrosis.

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Trends in US sunscreen formulations: Impact of increasing spray usage

To the Editor: Sunscreen is an important component of sun protection. Almost all dermatologists believe that sunscreen is safe, effective, and can reduce the risk of skin cancer.1 In the United States, many different sunscreen formulations exist, including balms, sprays, lotions, sticks, creams, foams, gels, and oils.

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Editorial Board

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Botulinum toxin type A for the treatment of localized recalcitrant chronic pruritus

To the Editor: Localized chronic pruritus is a common condition that significantly affects health-related quality of life. A variety of diseases result in localized chronic itch, which can be broadly classified as dermatologic, neuropathic, or psychogenic in nature. For patients with chronic pruritus that is refractory to conventional therapy, the burden of disease is substantial.

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Cantharidin for treatment of facial molluscum contagiosum: A retrospective review

To the Editor: Molluscum contagiosum (MC) papules are self-limited, resolving within months to years. Active nonintervention is a common management approach in children; caregivers, however, often seek treatment owing to the contagious nature of the virus, itch, embarrassment, pain, or other reasons (Fig 1). Cantharidin is a common treatment for pediatric MC, although some discourage its use on the face. We present caregiver-reported outcomes of cantharidin treatment for facial molluscum in our practice.

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Micromelanomas identified with time-lapse total body photography and dermoscopy

To the Editor: Secondary prevention efforts to detect malignant melanoma focus on lesions at an initial growth phase with diameters <6 mm; earlier detection correlates with improved survival rates.1 Two photographic approaches provide critical and complementary information in the differential diagnosis of malignant melanoma. Total body photography (TBP) traditionally provides baseline images from which macroscopic lesion changes can be detected, whereas digital epiluminescence (dermoscopic) microscopy reveals subtle changes in preexisting nevi.

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Romance, love, and sex in the dermatology department and residency program

Many businesses and academic organizations have policies that address the issue of workplace amorous relationships. Virtually all such policies forbid relationships between supervisors and those whom they supervise, or between employees of significantly different rank. Some even go so far as to prohibit relationships between employees in different departments or those reporting to different supervisors. The basis for such policies is to prohibit relationships that may affect the work environment for other employees, the productivity of the company, and to prevent the company from becoming entangled in sexual harassment suits.

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Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis

Alopecia areata (AA) is a T cell–mediated autoimmune disease that causes nonscarring hair loss.1 Some autoimmune diseases are associated with a vitamin D deficiency, including inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, and vitiligo.2,3 Previous studies that evaluated vitamin D levels in patients with AA have reached inconsistent conclusions. This study aimed to perform a systematic review and meta-analysis on the association between vitamin D levels and AA.

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Innovative modification of the USB dermatoscope for mucoscopy

There have been a number of technological advancements in dermoscopy of cutaneous lesions1; However, dermoscopy of mucosae remains a challenge, primarily because existing dermatoscopes are not well designed to explore them. Contact magnifying endoscopes and oral mucoscopes have been used in the past for contact and noncontact mucoscopy.2 But the lack of availability and versatility of these instruments and lack of expertise in handling them make them unsuitable for routine use by dermatologists in clinical practice.

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Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys

To the Editor: Racial/ethnic differences in general health care utilization exist in the United States.1 Little is known about health care utilization among racial/ethnic groups for skin diseases, including for psoriasis, the most prevalent immune-mediated disease.2 We aimed to evaluate health care utilization for psoriasis by race/ethnicity using population-based data derived from the Medical Expenditure Panel Surveys, the most complete source of information on health care utilization, cost, and health insurance coverage in the United States.

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Hidradenitis suppurativa burden of disease tool: Pilot testing of a disease-specific quality of life questionnaire

To the Editor: Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting intertriginous areas of the body that dramatically impairs quality of life (QoL) and has a substantial psychosocial burden.1,2 Full remission of HS is rare, making improvements in QoL a critical goal of therapy. Currently, when investigating the impact of HS, we are limited to generic QoL questionnaires, none of which are specific for HS. We propose a disease-specific tool that would better capture the unique burden of disease caused by HS, which is necessary to determine the impact of therapeutic interventions in clinical trials and in the clinical setting.

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Iotaderma #287

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Andrews' diseases of the skin clinical atlas

Andrews' Diseases of the Skin Clinical Atlas by William James, Dirk Elston, and Patrick McMahon is the first published atlas from the writers of Andrews' Diseases of the Skin, a renowned comprehensive dermatological text. It not only serves as a wonderful accompaniment to the Andrews text but also is a strong standalone atlas benefitting any reader, from student to practicing clinician. For a specialty that relies heavily on the physical exam, this text provides wonderful depictions of thousands of entities that help the reader learn the morphology and distribution of each diagnosis.

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Cancer risks among patients with alopecia areata: A population-based case-control study in Korea

To the Editor: Studies have shown the reduced incidence of skin cancer in patients with autoimmune dermatologic diseases, including alopecia areata (AA) and vitiligo.1,2 The aim of this study was to investigate the association between AA and several types of cancer. This study was a retrospective case-control study from the National Health Insurance Service–National Sample Cohort.3 Age, sex, location, income, and diagnostic codes based on the International Classification of Diseases, 10th edition were retrieved.

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Reply to: “Updated diagnostic criteria for frontal fibrosing alopecia”

To the Editor: We thank Vaño-Galvan et al for their letter regarding criteria for frontal fibrosing alopecia (FFA).1 The differential diagnosis of FFA is broad, and diagnostic criteria can aid in identifying this entity. We agree with many of the suggestions to our diagnostic criteria proposed in our article on the Mayo Clinic cohort of FFA patients.2

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Decreased risk of vitiligo in organ transplant recipients: A population-based cohort study

To the Editor: Vitiligo remains a major challenge in dermatology because there is no definitive cure.1 The autoimmune nature of vitiligo has been described,2 and the involvement of T cells in pathogenesis of vitiligo has also been shown in previous reports.3 While the therapeutic potential of immunosuppressants has often been raised, their role has not been well examined.

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Vitiligo-like lesions in patients receiving anti–programmed cell death-1 therapies are distinct from spontaneously occurring active vitiligo

To the Editor: We would like to thank Fukuda and Harris for their interest in our manuscript.1 Clinically, we have voluntarily characterized vitiligo-like lesions induced by anti–programmed cell death-1 (PD-1) as "multiple flecked depigmented macules" to differ from the description reported for active lesions in spontaneously occurring vitiligo (referred to as vitiligo). Indeed, in vitiligo, active lesions are associated with hypomelanotic appearance and poorly defined borders2 (as shown in Fukuda et al, Fig 1), a clinical sign completely absent in vitiligo-like lesions under anti–PD-1.

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Trends in Medicare spending on topical immunomodulators and chemotherapies

To the Editor: Actinic keratoses (AKs) and in situ/superficial carcinomas are common and costly dermatologic conditions that account for ≥5.2 million visits and $920 million in annual spending.1,2 Topical therapies are often used as field therapy for these conditions. In this study, we evaluate recent national trends in topical therapy use and costs for precancerous and in situ/superficial carcinomas in the Medicare population.

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Acknowledging the pseudo “fringe sign” in frontal fibrosing alopecia has diagnostic and prognostic implications

To the Editor: A frontal band of scarring alopecia with eyebrow involvement in postmenopausal women (ie, frontal fibrosing alopecia [FFA]) evolved from a "recently described disease" to the status of "a growing epidemic" in less than 2 decades. Since the first report by Kossard,1 additional features and variants not contemplated in the original description have been incorporated into the clinical picture. For such, I read with great interest the paper by Rossi et al reporting 3 unusual clinical patterns of FFA.

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High riding of brachiocephalic artery: A rare case of pulsatile anterior neck mass

Publication date: Available online 11 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Bao Ling Wong, Shashi Gopalan, Muhammad Nasri Abu Bakar, Ming Huei Wong
Anterior neck swellings are common presentations that are seen in otorhinolaryngology clinics. We presented a rare diagnosis of pulsatile anterior neck swelling where a high riding brachiocephalic artery needs to be considered as a differential diagnosis. This 54-year-old lady presented with anterior neck swelling for one year which appear to be pulsatile, soft and non-tender mass. Ultrasound and Doppler scan, contrast-enhanced computed tomography (CECT) scan revealed that the neck swelling corresponds to the high riding brachiocephalic artery. Hence, ultrasound scan is essential to detect any vascular lesion prior to biopsy or fine needle aspiration cytology as to avoid catastrophic hemorrhage.

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A Cost-Effective, In-House, Positioning and Cutting Guide System for Orthognathic Surgery

Abstract

Introduction

Technological advances in 3D printing can dramatically improve orthognathic surgical planning workflow. Custom positioning and cutting guides enable intraoperative reproduction of pre-planned osteotomy cuts and can result in greater surgical accuracy and patient safety.

Objectives

This short paper describes the use of freeware (some with open-source) combined with in-house 3D printing facilities to produce reliable, affordable osteotomy cutting guides.

Methods

Open-source software (3D Slicer) is used to visualise and segment three-dimensional planning models from imported conventional computed tomography (CT) scans. Freeware (Autodesk Meshmixer ©) allows digital manipulation of maxillary and mandibular components to plan precise osteotomy cuts. Bespoke cutting guides allow exact intraoperative positioning. These are printed in polylactic acid (PLA) using a fused-filament fabrication 3D printer. Fixation of the osteotomised segments is achieved using plating templates and four pre-adapted plates with planned screw holes over the thickest bone. We print maxilla/ mandible models with desired movements incorporated to use as a plating template.

Results

A 3D printer capable of reproducing a complete skull can be procured for £1000, with material costs in the region of £10 per case. Our production of models and guides typically takes less than 24 hours of total print time. The entire production process is frequently less than three days. Externally sourced models and guides cost significantly more, frequently encountering costs totalling £1500–£2000 for models and guides for a bimaxillary osteotomy.

Conclusion

Three-dimensional guided surgical planning utilising custom cutting guides enables the surgeon to determine optimal orientation of osteotomy cuts and better predict the skeletal maxilla/mandible relationship following surgery. The learning curve to develop proficiency using planning software and printer settings is offset by increased surgical predictability and reduced theatre time, making this form of planning a worthy investment.

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Placental abruption leading to hysterectomy

A 32-year-old multigravid patient at 21 weeks gestation presents with major concealed placental abruption and subsequent fetal demise. During an eventually failed misoprostol regime aiming for vaginal delivery she develops severe disseminated intravascular coagulopathy. Subsequent hysterotomy reveals Couvelaire uterus with major haemorrhage and requires subtotal hysterectomy for haemostasis. This case highlights the severity of the systemic response to abruption and fetal demise in utero and the multifactorial nature of its management.

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A novel technique for superior-based pharyngeal flaps: 10-year results with formal speech outcomes assessment

Publication date: Available online 11 December 2017
Source:American Journal of Otolaryngology
Author(s): Ryan Winters, John Carter, J. Lindhe Guarisco
PurposeDescribe a novel technique for superior-based pharyngeal flaps allowing restoration of bulk to the soft palate and intraoperative fine-tuning of lateral port size, while avoiding midline palate-splitting. Validated speech assessment tools are employed for quantitative analysis.MethodsRetrospective review of all patients who underwent superior-based pharyngeal flap in a 10-year period by a single surgeon. Pittsburgh Weighted Values for Speech Symptoms Associated with VPI and the Goldman-Fristoe Test of Articulation were used for formal speech assessment.Results78 patients met inclusion criteria with clinical data up to 10years postoperatively. 31 patients had congenital velopharyngeal insufficiency (VPI), and the remainder acquired VPI after cleft palate repair or adenoidectomy. 37 patients had a recognized syndrome. All patients noted subjective improvement in nasality, and evaluation with the validated speech assessment tools demonstrated statistically significant improvement in speech. Only one flap takedown was required in a patient with severe midface hypoplasia who developed sleep apnea several years postoperatively.ConclusionsThis technique is successful in congenital and acquired VPI, and in patients with complex craniofacial syndromes. Customization of lateral ports based on preoperative nasopharyngoscopy, and avoidance of a midline palate splitting incision, make this an attractive option for superior-based flap surgery.

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Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management

Publication date: Available online 11 December 2017
Source:American Journal of Otolaryngology
Author(s): Giuditta Mannelli, Roberto Santoro, Francesco Segala, Elisabetta Surrenti, Oreste Gallo
PurposeInvestigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients.Materials and methodsBehavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES.Results40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013).ConclusionsPre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.

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Unexpected Blooming Artifact in Brain Magnetic Resonance Imaging

Abstract Unexpected foreign bodies are occasionally discovered during magnetic resonance imaging (MRI). These are often present unknown to the patient, missed during routine pre-MRI screening and result in unnecessary delay during MRI. The authors present a patient with traumatically embedded foreign body in the scalp that escaped pre-MRI screening and caused susceptibility artifacts during brain MRI. The object was surgically removed to allow the imaging to be completed. Patients with suspicion or history of facial trauma or with dental restorations are referred to concerned specialists for compatibility of hardware, restorations and for assessing risks during MRI due to these. This patient is presented as a reminder for clinicians to probe further during anamnesis and have a high index of suspicion for foreign bodies that may be present even after trivial injuries. Address correspondence and reprint requests to Akilesh Ramasamy, MDS, Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India; E-mail: akident@gmail.com Received 22 April, 2017 Accepted 4 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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A Three-Dimensional Anthropometric Evaluation of Facial Morphology

Objectives: The aims of this study were to evaluate sexual dimorphism for facial features within Italian and Egyptian populations and to compare the facial morphology by sex between these 2 populations. Materials and Methods: Three-dimensional (3D) facial images were acquired by using the portable 3dMDface System, which captured 259 subjects from 2 population groups of Italian (n = 139) and Egyptian (n = 120). Each population was categorized into male and female groups for evaluation. All subjects in the groups were aged between 18 and 30 years and had no apparent facial anomalies. A total of 23 anthropometric landmarks were identified on the 3D faces of each subject. The independent t test was used to analyze each data set obtained within each subgroup. Results: Egyptian women tend to have distinct facial features when compared with Italian women; they had less prominent eyes, more nasal width, more height of upper and lower faces and more height of upper and lower vermilion lengths. Egyptian and Italian males demonstrated very close facial features. However, Egyptian males had more nasal width, length of alare, and mandibular height. Conclusions: Sexual dimorphism for facial features was presented in both the Italian and Egyptian populations. In addition, there were significant differences in facial morphology between these 2 populations, especially in females. Address correspondence and reprint requests to Dr. Chung How Kau, DDS, MSD, MBA, PhD, MOrth, FDS, FFD, FAMS, Department of Orthodontics, University of Alabama at Birmingham, School of Dentistry, 1919 Seventh Ave. S. Birmingham, AL 35294; E-mail: ckau@uab.edu Received 13 March, 2017 Accepted 14 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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The Hybrid Technical Management of Large and Complicated Traumatic Arteriovenous Fistula of Preauricular Region

Background: Arteriovenous fistula (AVF) is defined as an abnormal communication between the high flow arterial system and the low flow venous network, which directly connects the arterial feeding vessels and the near draining veins without normal intervening capillary bed. Arteriovenous fistula incurs in preauricular region is exceeding rare. Most of these fistulae occur as a result of an iatrogenic injury, the volume is small, feeding and draining vessels of feeding and draining are simple, and can be cured easily. However, the treatment of the large and complicated AVF after incidental trauma in preauricular region is a challenge even for senior neurosurgeon. In this study, the authors discuss the management of a traumatic AVF through combined therapeutic method of surgical ligation and transarterial embolization. It is fed by ipsilateral superficial temporal artery, internal maxillary artery, posterior auricular artery, and their accessory branches and is drained by ipsilateral common facial vein and external jugular vein. Also the etiology, clinical manifestations, pathology, diagnosis, and management are summarized. Conclusion: Large and complicated traumatic AVF in preauricular region is rare, often due from an injury in maxillofacial region, combined therapy needed. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Address correspondence and reprint requests to Jinlong Sun, Shandong Provincial Qianfoshan Hospital, Jinan, China; E-mail: jinlongsun@hotmail.com Received 16 July, 2017 Accepted 19 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Differences in the Alignment Pattern of the Maxillary Dental Arch Following Fixed Orthodontic Treatment in Patients With Bilateral Cleft Lip and Palate: Anteroposterior-Collapsed Arch Versus Transverse-Collapsed Arch

Abstract The purpose of this study was to investigate differences in the alignment pattern of the collapsed maxillary arch following fixed orthodontic treatment (FOT) in bilateral cleft lip and palate (BCLP) patients according to collapse type. Fifteen BCLP patients were divided into Group 1 (anteroposterior-collapsed arch, n = 7) and Group 2 (transverse-collapsed arch, n = 8) according to maxillary arch shape before FOT. Linear and angular variables of lateral cephalograms and dental models were evaluated before (T1) and after FOT (T2), and statistical analysis was performed. In cephalometric measurements at T1, both the groups exhibited retrusive maxillae, a Class III relationship, and lingual inclination of U1-SN. At T2, significant improvement of U1-SN was observed in both the groups (P

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Recurrent Lower Eyelid Ectropion After Graft Surgery Using Autogenous Palmaris Longus Tendon

Abstract A 78-year-old male experienced right lower eyelid ectropion following right facial trauma from a fall 5 years ago, for which he underwent autogenous palmaris longus tendon graft surgery at another clinic. Recurrence was noted 3 years after surgery. On first examination, there was outward turning of the lateral half of the right lower eyelid margin. We performed a lateral tarsal strip procedure with removal of the graft. Intraoperatively, the lateral part of the graft was located along the inferior tarsal border, whereas the medial part was located on the tarsal surface. The lateral stump had bifurcated; 1 branch had passed through a bony hole drilled at the base of the rim; and both branches had been ligated together on the rim surface. The medial side had been fixed to the medial canthal tendon. Postoperatively, the apposition of eyelid and ocular surface was good, and the patient experienced no recurrence after 1 year. Address correspondence and reprint requests to Hiromichi Matsuda, MD, Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, 4-11-1 Izumihonchou, Komae, Tokyo 201-8601, Japan; E-mail: thkmmm@yahoo.co.jp Received 21 June, 2017 Accepted 6 October, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Intraoral Pleomorphic Adenoma in Young Patients

Background: Intraoral pleomorphic adenoma (PA) is rare in young individuals, with only single clinical reports or small patient series reported previously. Aim: The aim of this study was to describe the clinicopathological features of PA in 4 patients under 18 years of age, and to discuss the differential diagnosis of pediatric patients presenting with intraoral submucosal nodules. Methods: Between 2000 and 2015, all patients of intraoral PA in patients aged ≤18 years diagnosed in the Oral Pathology Laboratory of the Universidade Federal de Pernambuco, Brazil, were retrieved for the study. Clinical data were recorded from the clinical charts. Histopathological slides stained with hematoxylin and eosin were reviewed to confirm the diagnosis. Results: There were 4 cases of PA in patients aged ≤18 years. All patients in this patient series were males, with a mean age of 16.7 years. Three cases occurred in the palate, and in 1 case, the upper lip was affected. All PAs appeared as a painless, smooth surface, well-circumscribed, and submucosal nodule. All patients were surgically excised and subsequent histopathological analysis revealed well-circumscribed tumors composed of cells that were arranged in ducts within a fibromyxoid stroma. No signs of recurrence were observed in 3 patients after a mean follow-up of 30 months. One patient is lost to follow-up. Conclusion: Although PAs are unusual in young patients, they should be considered in the differential diagnosis of oral submucosal nodules. Address correspondence and reprint requests to Danyel Elias da Cruz Perez, PhD, 4a Travessa Professor Artur de Sá, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, s/n—Cidade Universitária, CEP: 50740-521, Recife, Pernambuco, Brazil; E-mail: danyel.perez@ufpe.br Received 11 September, 2017 Accepted 8 October, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Osseous Convexity at the Anterior Fontanelle: A Presentation of Metopic Fusion?

Background: Craniosynostosis, or a premature fusion of 1 or more cranial vault sutures, results in characteristic head shape deformities. In previous reports, an osseous prominence at the anterior fontanelle has been suggestive of adjacent suture fusion and local elevation in intracranial pressure (ICP). This prominence has been termed the "volcano" sign, and has been described in the anterior fusion of the sagittal suture and serves as an indication for surgery. Methods: Two patients presented for head shape evaluation with mild metopic ridging and anterior fontanellar osseous convexities consistent with the volcano sign. Low-dose computed tomography imaging was performed in both patients due to concern for underlying craniosynostosis with elevated locoregional ICP. Results: In both patients, imaging was significant for a localized, superior forehead metopic fusion, as well as a bony, convex prominence at the site of the ossified anterior fontanelle. There were no other clinical or radiologic signs or symptoms to suggest elevated ICP. Surgery was not indicated in either patient. Conclusions: Here the authors present 2 patients with osseous convexities at the site of the closed anterior fontanelle without signs or symptoms of elevated ICP, or classic signs of metopic synostosis. The authors hypothesize that this pattern may be due to a form of mechanically induced premature fusion of a normal metopic suture that is focused superiorly at the bregma, with minimal resultant restriction of overall skull growth. This is in contrast to metopic synostosis, which primarily has a sutural pathology and leads to characteristic findings of hypotelorism and trigonocephaly. Address correspondence and reprint requests to John A. Persing, MD, Yale Plastic Surgery, PO Box 208062, New Haven, CT 06510; E-mail: john.persing@yale.edu Received 25 February, 2017 Accepted 9 June, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Haploinsufficiency of A20 causes autoinflammatory and autoimmune disorders

Publication date: Available online 11 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Tomonori Kadowaki, Hidenori Ohnishi, Norio Kawamoto, Tomohiro Hori, Kenichi Nishimura, Chie Kobayashi, Tomonari Shigemura, Shohei Ogata, Yuzaburo Inoue, Tomoki Kawai, Eitaro Hiejima, Masatoshi Takagi, Kohsuke Imai, Ryuta Nishikomori, Shuichi Ito, Toshio Heike, Osamu Ohara, Tomohiro Morio, Toshiyuki Fukao, Hirokazu Kanegane

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Long-term follow up of IPEX syndrome patients after different therapeutic strategies: an international multicenter retrospective study

Publication date: Available online 11 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Federica Barzaghi, Laura Cristina Amaya Hernandez, Benedicte Neven, Silvia Ricci, Zeynep Yesim Kucuk, Jack Bleesing, Zohreh Nademi, Mary Anne Slatter, Erlinda Rose Ulloa, Anna Shcherbina, Anna Roppelt, Austen Worth, Juliana Silva, Alessandro Aiuti, Luis Murguia-Favela, Carsten Speckmann, Magda Carneiro-Sampaio, Juliana Folloni Fernandes, Safa Baris, Ahmet Ozen, Elif Karakoc-Aydiner, Ayca Kiykim, Ansgar Schulz, Sandra Steinmann, Lucia Dora Notarangelo, Eleonora Gambineri, Paolo Lionetti, William Thomas Shearer, Lisa Forbes, Caridad Martinez, Despina Moshous, Stephane Blanche, Alain Fisher, Frank M. Ruemmele, Come Tissandier, M. Ouachee-Chardin, Frédéric Rieux-Laucat, Marina Cavazzana, Waseem Qasim, Barbarella Lucarelli, Michael H. Albert, Ichiro Kobayashi, Laura Alonso, Cristina Diaz De Heredia, Hirokazu Kanegane, Anita Lawitschka, Jong Jin Seo, Marta Gonzalez-Vicent, Miguel Angel Diaz, Rakesh Kumar Goyal, Martin G. Sauer, Akif Yesilipek, Minsoo Kim, Yesim Yilmaz-Demirdag, Monica Bhatia, Julie Khlevner, Erick .J. Richmond Padilla, Silvana Martino, Davide Montin, Olaf Neth, Agueda Molinos-Quintana, Justo Valverde-Fernandez, Arnon Broides, Vered Pinsk, Antje Ballauf, Filomeen Haerynck, Victoria Bordon, Catharina Dhooge, Maria Laura Garcia-Lloret, Robbert G. Bredius, Krzysztof Kałwak, Elie Haddad, Markus Gerhard Seidel, Gregor Duckers, Sung-Yun Pai, Christopher C. Dvorak, Stephan Ehl, Franco Locatelli, Frederick Goldman, Andrew Richard Gennery, Mort J. Cowan, Maria Grazia Roncarolo, Rosa Bacchetta
BackgroundImmunedysregulation Polyendocrinopathy Enteropathy X-linked (IPEX) syndrome is a monogenic autoimmune disease caused by FOXP3 mutations. Because it is a rare disease, the natural history and response to treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) and immunosuppression (IS), have not been thoroughly examined.ObjectiveTo evaluate disease onset, progression and long-term outcome of the two main treatments in long-term IPEX survivors.MethodsClinical histories of 96 patients with a genetically proven IPEX syndrome were collected from 38 institutions worldwide and retrospectively analyzed. To investigate possible factors suitable to predict the outcome, an organ involvement (OI) scoring system was developed.ResultsWe confirm neonatal onset with enteropathy, type 1 diabetes (T1D), and eczema. In addition, we found less common manifestations in delayed onset patients or during disease evolution. There is no correlation between the site of mutation and the disease course or outcome, and the same genotype can present with variable phenotypes. HSCT patients (n=58) had a median follow-up of 2.7 years (range: 1 week - 15 years). Patients receiving chronic IS (n=34) had a median follow-up of 4 years (range: 2 months - 25 years). The overall survival (OS) after HSCT was 73.2% (95% confidence interval [CI], 59.4 to 83.0) and after IS was 65.1% (95 % CI, 62.8 to 95.8). The pre-treatment OI score was the only significant predictor of OS after transplant (p=0.035) but not under IS.ConclusionsPatients receiving chronic IS were hampered by disease recurrence or complications, impacting long-term disease-free survival. When performed in patients with a low OI score, HSCT resulted in disease resolution with better quality of life, independent of age, donor source or conditioning regimen.

Graphical abstract

Teaser

This international retrospective multicenter study of patients with long-term IPEX syndrome (n=96) provides data on onset, disease progression, and outcomes after different treatments to inform future therapeutic choices.

http://ift.tt/2kpynAJ

Efficacy of lentiviral mediated gene therapy in an Omenn syndrome Rag2 mouse model is not hindered by inflammation and immune dysregulation

Publication date: Available online 11 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Valentina Capo, Maria Carmina Castiello, Elena Fontana, Sara Penna, Marita Bosticardo, Elena Draghici, Luigi P. Poliani, Lucia Sergi Sergi, Rosita Rigoni, Barbara Cassani, Monica Zanussi, Paola Carrera, Paolo Uva, Kerry Dobbs, Nicolò Sacchetti, Luigi D. Notarangelo, Niek P. van Til, Gerard Wagemaker, Anna Villa
BackgroundOmenn syndrome (OS) is a rare severe combined immunodeficiency associated with autoimmunity, caused by defects of the lymphoid-specific V(D)J recombination. Most patients carry hypomorphic mutations in recombination activating genes (RAG) 1 or 2. Hematopoietic stem cell (HSC) transplantation is the standard treatment, however gene therapy (GT) may represent a valid alternative, especially for patients lacking a matched donor.ObjectiveTo determine the efficacy of lentiviral vector (LV) mediated GT in the murine model of OS (Rag2^R229Q/R229Q) in correcting immunodeficiency and autoimmunity.MethodsOS Lin^- cells were transduced with a LV encoding the human RAG2 gene and injected into irradiated OS recipients. Control mice were transplanted with wild-type or OS untransduced Lin- cells. Immunophenotype, T-dependent and independent antigen challenges, immune spectratyping, autoantibodies detection and detailed tissue immunohistochemical analyses were performed.ResultsLV-mediated GT allowed immunological reconstitution, although suboptimal as compared to wild type bone marrow transplanted OS mice, in peripheral blood and hematopoietic organs, such as bone marrow, thymus and spleen. We observed in vivo variability in the efficacy of GT correlating with the levels of transduction achieved. Immunoglobulin levels and T cell repertoire normalized and gene corrected mice properly responded to challenges in vivo. Autoimmune manifestations, such as skin infiltration and autoantibodies, dramatically improved in GT mice with a vector copy number/genome higher than 1 in the bone marrow and 2 in the thymus.ConclusionsOur data show that LV-mediated GT for Omenn Syndrome significantly ameliorates the immunodeficiency even in an inflammatory environment.

http://ift.tt/2kpymg9

An actin cytoskeletal barrier inhibits lytic granule release from Natural Killer cells in Chediak-Higashi syndrome

Publication date: Available online 11 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Aleksandra Gil-Krzewska, Mezida B. Saeed, Anna Oszmiana, Elizabeth R. Fischer, Kathryn Lagrue, William A. Gahl, Wendy J. Introne, John E. Coligan, Daniel M. Davis, Konrad Krzewski
BackgroundChediak-Higashi syndrome (CHS) is a rare disorder caused by biallelic mutations in the LYST gene, resulting in formation of giant lysosomes or lysosome-related organelles in several cell types. The disease is characterized by immunodeficiency and a fatal hemophagocytic lymphohistiocytosis due to impaired function of cytotoxic lymphocytes, mainly Natural Killer (NK) cells.ObjectiveWe sought to determine the underlying biochemical cause of the impaired cytotoxicity of NK cells in CHS.MethodsWe generated a human cell model of CHS, using CRISPR technology. We used a combination of classical techniques to evaluate lysosomal function and cell activity in the model system, and super-resolution microscopy to visualize filamentous (F-)actin and lytic granules in normal and LYST-deficient NK cells.ResultsLoss of LYST function in a human NK cell line, NK92mi, resulted in inhibition of NK cell cytotoxicity and reproduced other aspects of CHS cellular phenotype, including the presence of significantly enlarged lytic granules with defective exocytosis, and impaired integrity of endo-lysosomal compartments. The large granules had an acidic pH, normal activity of lysosomal enzymes, and were positive for the proteins essential for lytic granule exocytosis. Visualization of the actin meshwork openings at the immunological synapse revealed that the cortical actin acts as a barrier for secretion of such large granules at the cell-cell contact site. Decreasing the cortical actin density at the immunological synapse, or decreasing the lytic granule size, restored the ability of LYST-deficient NK cells to degranulate and kill target cells.ConclusionThe cortical actin and granule size play significant roles in NK cell cytotoxic function. The periodicity of sub-synaptic actin is an important factor limiting the release of large lytic granules from CHS NK cells, and could be a novel target for pharmaceutical intervention.

Teaser

The large lytic granules in Chediak-Higashi syndrome NK cells are functional, but the actin meshwork at the immunological synapse is a barrier to their exocytosis, resulting in defective CHS NK cell degranulation and cytotoxicity. Decreasing the cortical actin density, or lytic granule size, restores the ability of LYST-deficient NK cells to degranulate and kill target cells..

http://ift.tt/2jQk7S6

Associations between infant fungal and bacterial dysbiosis and childhood atopic wheeze in a nonindustrialized setting

Publication date: Available online 11 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marie-Claire Arrieta, Andrea Arévalo, Leah Stiemsma, Pedro Dimitriu, Martha E. Chico, Sofia Loor, Maritza Vaca, Rozlyn C.T. Boutin, Evan Morien, Mingliang Jin, Stuart E. Turvey, Jens Walter, Laura Wegener Parfrey, Philip J. Cooper, Brett Finlay
BackgroundAsthma is the most prevalent chronic disease of childhood. Recently, we identified a critical window early in the life of both mice and Canadian infants during which gut microbial changes (dysbiosis) affect asthma development. Given geographic differences in human gut microbiota worldwide, we studied the effects of gut microbial dysbiosis on atopic wheeze in a population living in a distinct developing world environment.ObjectiveWe sought to determine whether microbial alterations in early infancy are associated with the development of atopic wheeze in a nonindustrialized setting.MethodsWe conducted a case-control study nested within a birth cohort from rural Ecuador in which we identified 27 children with atopic wheeze and 70 healthy control subjects at 5 years of age. We analyzed bacterial and eukaryotic gut microbiota in stool samples collected at 3 months of age using 16S and 18S sequencing. Bacterial metagenomes were predicted from 16S rRNA data by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States and categorized by function with Kyoto Encyclopedia of Genes and Genomes ontology. Concentrations of fecal short-chain fatty acids were determined by using gas chromatography.ResultsAs previously observed in Canadian infants, microbial dysbiosis at 3 months of age was associated with later development of atopic wheeze. However, the dysbiosis in Ecuadorian babies involved different bacterial taxa, was more pronounced, and also involved several fungal taxa. Predicted metagenomic analysis emphasized significant dysbiosis-associated differences in genes involved in carbohydrate and taurine metabolism. Levels of the fecal short-chain fatty acids acetate and caproate were reduced and increased, respectively, in the 3-month stool samples of children who went on to have atopic wheeze.ConclusionsOur findings support the importance of fungal and bacterial microbiota during the first 100 days of life on the development of atopic wheeze and provide additional support for considering modulation of the gut microbiome as a primary asthma prevention strategy.

Graphical abstract

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Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening

Publication date: February 2018
Source:European Journal of Oncology Nursing, Volume 32
Author(s): Kyounghae Kim, Qian-Li Xue, Benita Walton-Moss, Marie T. Nolan, Hae-Ra Han
PurposeHealth literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests.MethodsUsing structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21–65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use.ResultsHigher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy.ConclusionsFindings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests.

http://ift.tt/2iWiDoh

Mannitol and the blood-labyrinth barrier

Comprehensive analysis of ectopic mandibular third molar: a rare clinical entity revisited

Ectopic mandibular third molar is a rare clinical entity with incompletely known etiology. Here, we sought to delineate its epidemiological, clinical and radiographic characteristics, and therapy by integratin...

http://ift.tt/2B5Vx96

MicroRNA 143-5p regulates alpaca melanocyte migration, proliferation, and melanogenesis

Abstract

microRNAs (miRNAs) have been shown to be closely involved in the control of melanogenesis and hair colour in mammals. Previous data also indicate that miR-143 regulates cell growth in melanoma. Here, we aimed to investigate the role of miR-143-5p in alpaca melanocytes. We found that miR-143-5p was highly expressed in the cytoplasm of alpaca melanocytes as demonstrated by an in situ hybridization assay. Prediction analysis revealed that miR-143-5p could regulate TGF-β-activated kinase 1 (TAK1) expression, which we confirmed by luciferase reporter assay, indicating that miR-143-5p controls TAK1 expression by directly targeting its 3′ untranslated region (UTR). miR-143-5p overexpression decreased TAK1 expression, which led to increased melanocyte migration and proliferation, and downregulation of microphthalmia-associated transcription factor (MITF), which regulates melanin production. These results support a functional role for miR-143-5p in regulating alpaca melanocyte migration, proliferation, and melanogenesis through direct targeting of TAK1.

http://ift.tt/2nN2aYW

Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management

Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients.

http://ift.tt/2AMAtSW

A novel technique for superior-based pharyngeal flaps: 10-year results with formal speech outcomes assessment

Describe a novel technique for superior-based pharyngeal flaps allowing restoration of bulk to the soft palate and intraoperative fine-tuning of lateral port size, while avoiding midline palate-splitting. Validated speech assessment tools are employed for quantitative analysis.

http://ift.tt/2BTYA1k

Smile Train: Making the Grade in Global Cleft Care

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1608700

The global medical and psychological burden of cleft lip and palate is large, especially in low- and middle-income countries. For decades, medical missions have sought to alleviate this burden; however, there are significant barriers to providing sustainable, high-quality cleft care using the mission model. Smile Train, an international children's charity founded in 1999, has developed a scalable model which provides support to local partner hospitals and surgeons around the world. Smile Train partners with hospitals to support cleft care treatment across the developing world. Partner hospitals are held to strict safety and quality standards. Local or regional providers are primarily used to train medical personnel. A quality assurance process developed by the Smile Train's Medical Advisory Board is used to assess cleft surgery cases and suggest additional review and training as needed. Surgical candidates are systematically evaluated and must meet specific medical criteria to ensure safety. Experienced anesthetists adhere to Smile Train's safety and quality protocols including anesthesia guidelines.Smile Train and its partners have provided more than 1.2 million safe, high-quality cleft surgical treatments since 1999. Smile Train has sponsored more than 3,000 hands-on training opportunities, 30,000 opportunities to participate in cleft conferences, and 40,000 virtual cleft training opportunities. Through rigorous self-governance and its sustainable, scalable model, this organization has elevated the standard of cleft care in the developing world.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2At8N8J

How to manage anaphylaxis in primary care

Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different com...

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Postoperative thrombocytopenia: why you should consider antiplatelet therapy?

Purpose of review This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. Recent findings Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state and contribute to acute organ failure. Summary For over 6 decades, major postoperative complications after cardiac surgery have remained unchanged. The potential influence of microthrombosis involving platelets has been underappreciated and use of perioperative antiplatelet therapy remains very limited – primarily because of a culture of fear of bleeding. Correspondence to Manuel L. Fontes, MD, Professor of Anesthesiology and Critical Care, Yale University School of Medicine, 333 Cedar Street, TMP-3, P.O. Box 208051, New Haven, CT 06520, USA. Tel: +1 203 785 2802; e-mail: manuel.fontes@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative steroid therapy: where's the evidence?

Purpose of review Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. Recent findings Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability. Summary Current recommendations for perioperative stress dose steroids for patients on chronic glucocorticoid therapy are based on duration and dose of maintenance steroids. All patients should take their regular daily dose of steroid preoperatively regardless of dose or chronicity of prior treatment. Additional, stress dose steroid dosing is based on patient risk of adrenal suppression and surgical complexity and stress. Correspondence to Leon Freudzon, MD, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT 06520-8051, USA. Tel: +1 203 785 2802; e-mail: leon.freudzon@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial

BACKGROUND In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. OBJECTIVES To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Sixty women undergoing breast cancer surgery between April 2014 and February 2015. INTERVENTIONS The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. MAIN OUTCOME MEASURES Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. RESULTS PECS block combined with propofol–remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P = 0.018]. PECS block also reduced propofol mean (± SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (± 0.52) vs. Control group 3.08 (± 0.41) μg ml−1; P

http://ift.tt/2kmbGxr

When Forensic Odontology met Biochemistry: Multidisciplinary approach in Forensic Human Identification

Publication date: Available online 9 December 2017
Source:Archives of Oral Biology
Author(s): Joe Adserias-Garriga, Christian Thomas, Douglas H. Ubelaker, Sara C. Zapico
When human remains are found, the priority of the investigation is to ascertain the identity of the deceased. A positive identification is a key factor in providing closure for the family of the deceased; it is also required to issue the death certificate and therefore, to settle legal affairs. Moreover, it is difficult for any forensic investigation involving human remains to be solved without the determination of an identity. Therefore, personal identification is necessary for social, legal and forensic reasons.In the last thirty years forensic odontology has experienced an important transformation, from primarily involving occasional dental identification into a broader role, contributing to the determination of the biological profile. In the same way, "DNA fingerprinting" has evolved not only in terms of improving its technology, but also in its application beyond the "classical": helping with the estimation of sex, age and ancestry. As these two forensic disciplines have developed independently, their pathways have crossed several times through human identification operations, especially the ones that require a multidisciplinary approach. Thus, the aim of this review is to describe the contributions of both forensic odontology and molecular biology/biochemistry to human identification, demonstrating how a multidisciplinary approach can lead to a better and more efficient identification.

http://ift.tt/2iTFRM4

When Forensic Odontology met Biochemistry: Multidisciplinary approach in Forensic Human Identification

ETosis-derived DNA trap production in middle ear effusion is a common feature of eosinophilic otitis media

Publication date: Available online 11 December 2017
Source:Allergology International
Author(s): Nobuo Ohta, Shigeharu Ueki, Yasunori Konno, Makoto Hirokawa, Toshinori Kubota, Sachiko Tomioka-Matsutani, Takahiro Suzuki, Yusuke Ishida, Tasuku Kawano, Tomomitsu Miyasaka, Tomoko Takahashi, Tatsutoshi Suzuki, Isao Ohno, Seiji Kakehata, Shigeharu Fujieda

http://ift.tt/2l1o9KJ

Recent advances in understanding the roles of blood platelets in the pathogenesis of allergic inflammation and bronchial asthma

Publication date: Available online 11 December 2017
Source:Allergology International
Author(s): Tomohiro Takeda, Hideaki Morita, Hirohisa Saito, Kenji Matsumoto, Akio Matsuda
Platelets play an essential role in hemostasis to minimize blood loss due to traumatic injury. In addition, they contain various immune-associated molecules and contribute to immunological barrier formation at sites of vascular injury, thereby protecting against invading pathogens. Platelets are also crucially involved in development of allergic diseases, including bronchial asthma. Platelets in asthmatics are more activated than those in healthy individuals. By using a murine asthma model, platelets were shown to be actively involved in progression of the disease, including in airway eosinophilia and airway remodeling. In the asthmatic airway, pathological microvascular angiogenesis, a component of airway remodeling, is commonly observed, and the degree of abnormality is significantly associated with disease severity. Therefore, in order to repair the newly formed and structurally fragile blood vessels under inflammatory conditions, platelets may be continuously activated in asthmatics. Importantly, platelets constitutively express IL-33 protein, an alarmin cytokine that is essential for development of bronchial asthma. Meanwhile, the concept of development of allergic diseases has recently changed dramatically, and allergy researchers now share a belief in the centrality of epithelial barrier functions. In particular, IL-33 released from epithelial barrier tissue at sites of eczema can activate the antigen-non-specific innate immune system as an alarmin that is believed to be necessary for subsequent antigen-specific acquired immunological responses. From this perspective, we propose in this review a possible mechanism for how activated platelets act as an alarmin in development of bronchial asthma.

http://ift.tt/2iRLJ8o

A well-circumscribed lobulated tumor on the hard palatal mucosa in a child

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Alfonso Salcines, Sook-Bin Woo, Vikki Noonan, Michael J. Mansfield, Chia-Cheng Li

http://ift.tt/2jPm5BY

Microbial population changes in patients with medication-related osteonecrosis of the jaw treated with systemic antibiotics

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lieselotte De Bruyn, Ruxandra Coropciuc, Wim Coucke, Constantinus Politis
ObjectiveThis study aimed to investigate the bacterial population in patients with medication-related osteonecrosis of the jaw (MRONJ) after treatment with doxycycline and metronidazole.Study DesignThirty-eight patients with MRONJ (age range 55–88, mean age 73 + 8.82 SD) treated with doxycycline first and secondly with metronidazole were enrolled in this study. Two swabs were taken at the margin of the infected MRONJ lesion after applying pressure on the marginal mucosa and visible pus was secreted. RT-PCR was used to analyse 20 perio-pathogenic and commensal species and the total bacterial level. Bacterial counts were compared between antibiotic treatments and with a control group of orally healthy patients that didn't have periodontal pockets of more than 3 mm (n=29) by means of a Mann-Whitney U test. Comparisons between the two antibiotic treatments were performed by a paired Wilcoxon signed rank test.ResultsThe total bacterial level was significantly higher in the MRONJ patients treated with systemic antibiotics compared with the control group. However, significant lower bacterial amounts were found for 12 of the 20 investigated bacteria. We couldn't establish a significant advantage of metronidazole administration after doxycycline treatment.ConclusionOur findings suggest that the total bacterial level in MRONJ patients is higher even when treated with systemic antibiotics. The significantly different bacterial amounts of the selected species suggest an alteration in the microbial population.

http://ift.tt/2kopLu9

Molecular Testing for Oncogenic Gene Alterations in Pediatric Thyroid Lesions

Thyroid , Vol. 0, No. 0.

http://ift.tt/2B90AX1

Mannitol and the blood-labyrinth barrier

Abstract

Background

Characterization of the blood labyrinth barrier (BLB) is extremely important to determine whether the BLB can be manipulated pharmacologically. However, experiments to investigate the BLB are technically difficult to perform. In this report, we demonstrated a unique method of controlling the BLB, and established the pharmacokinetics of gentamicin in perilymph, cerebrospinal fluid (CSF) and blood with and without mannitol.

Study design

Controlled animal research project.

Methods

Permeability of the BLB and the blood brain barrier (BBB) to gentamicin with and without mannitol was studied by collecting 175 samples from 44 guinea pigs using concentrations relevant to human clinical situations. Samples were taken from two groups of 22 animals, with each animal undergoing sampling at a different time after administration of either 10 mg/ml gentamicin (4 mg/kg) (Gardena, CA) alone or gentamicin with 20% mannitol (250 mg/kg) (Mallinckrodt Inc., KY). The sample times varied from 0.5 to 17.5 h post-infusion. Samples were also taken from 4 animals as negative controls after administration of normal saline. Our goal was to simultaneously assess the pharmacokinetics of gentamicin in each of three different fluid samples in the same animal. Thus at the pre-determined post-infusion sampling time, each animal was sampled once for perilymph, CSF, and blood before being euthanized. Each animal contributed to a single time point on the subsequent pharmacokinetic curves with more than one animal per time point.

Results

Mannitol increased the rate of entry and egress of gentamicin through BLB significantly (p = 0.0044) but the effects on the BBB did not reach statistical significance (p = 0.581). Mannitol did not alter renal clearance of gentamicin from the blood (p = 0.433). The concentration of gentamicin in perilymph and CSF was always significantly lower than in blood.

Conclusions

Mannitol administration transiently increases the permeability of the BLB. Potential clinical benefits may accrue from selected timing of administration of osmotic agents such as mannitol augmenting the rate of entry and egress of compounds such as gentamicin into and out of perilymph.

http://ift.tt/2yfmQsM

Comprehensive analysis of ectopic mandibular third molar: a rare clinical entity revisited

Abstract

Background

Method

A new definition and classification for ectopic mandibular third molar was proposed based on its anatomic location on panoramic images. Thirty-eight ectopic mandibular third molars in 37 patients and 51 teeth in 49 patients were identified in our disease registry and from literature (1990–2016), respectively. These cases were further categorized and compared according to our classification protocol. The demographic, clinicopathological and radiographic data were collected and analyzed.

Results

These ectopic teeth were categorized into four levels, 33 in level I(upper ramus), 32 in level II (middle ramus), 15 in level III (mandibular angle) and 9 in level IV (mandibular body). The common clinical presentations included pain, swelling and limited mouth opening, although sometimes asymptomatic. Most teeth were associated with pathological lesions. Treatments included clinical monitor and surgical removal by intra- or extraoral approach with favorable outcomes. Clinical presentations and treatment options for these teeth were significantly associated with their ectopic locations as we classified.

Conclusions

Ectopic mandibular third molars are usually found in patients with middle ages and in upper and middle ramus of mandible. Surgery is preferred to remove these ectopic teeth and associated pathologies when possible.

http://ift.tt/2z14hMd

Challenges of Vaccine Development for Zika Virus

Viral Immunology , Vol. 0, No. 0.

http://ift.tt/2kVZmYx

Influence of different types of light on the response of the pulp tissue in dental bleaching: a systematic review

Abstract

Objectives

This systematic review (PROSPERO register: CRD42016053140) investigated the influence of different types of light on the pulp tissue during dental bleaching.

Materials and methods

Two independent authors conducted a systematic search and risk of bias evaluations. An electronic search was undertaken (PubMed/Medline, Embase, The Cochrane Library, and other databases) until May 2017. The population, intervention, comparison, outcomes (PICO) question was: "Does the light in dental bleaching change the response of the pulp to the bleaching procedure?" The intervention involved pulp tissue/cells after bleaching with light, while the comparison involved pulp tissue/cells after bleaching without light. The primary outcome was the inflammation/cytotoxicity observed in pulp after bleaching.

Results

Out of 2210 articles found, 12 articles were included in the review; four were in vivo studies (one study in dogs/others in human), and eight were in vitro studies (cell culture/with artificial pulp chamber or not). The light source used was halogen, light-emitting diode (LED), and laser. Only one in vivo study that used heat to simulate light effects showed significant pulp inflammation. Only two in vitro studies demonstrated that light influenced cell metabolism; one using halogen light indicated negative effects, and the other using laser therapy indicated positive effects. Given that animal and in vitro studies have been identified, there remain some limitations for extrapolation to the human situation. Furthermore, different light parameters were used.

Conclusions

The effects of dental bleaching on the pulp are not influenced by different types of light, but different light parameters can influence these properties.

Clinical relevance

There is insufficient evidence about the influence of different types of light on inflammation/cytotoxicity of the pulp.

http://ift.tt/2z0IPHf

Increased histopathological yield for granulomatosis with polyangiitis based on nasal endoscopy of suspected active lesions

Abstract

Purpose

To present the results of an endoscopic and histopathologic evaluation of suspected nasal active granulomatosis with polyangiits (GPA) lesions, describe them as seen by the ENT specialist, and propose a guide for tissue sampling of the nasal cavity to improve the yield of confirmatory histology.

Methods

Randomly selected patients seen from December 1997–October 2007 had a thorough endoscopic nasal evaluation, preceded by careful cleansing of the nasal cavity. Endoscopic lesions were described; sensitivities, specificities, and predictive values of the composites of endoscopic and histological activity were determined.

Results

Six lesions, some not previously described in detail, were observed: white submucosal nodules, mucosal swelling, polypoid nodules, vascular submucosal dilatations, bloody submucosal patches, and ulcers. Of these, polypoid nodules (PPV 100%), persistent white submucosal nodules (PPV 81%), and bloody submucosal patches (PPV 93%) had the better diagnostic performance with confirmed histological diagnosis.

Conclusions

Careful nasal cavity preparation, observation, and description of the nasal mucosa can guide tissue sampling documenting active GPA. This can lead to a better histological yield when definitive proof of the disease is needed.

http://ift.tt/2B4pJBy

Expression and enzyme activity of Cytochrome P450 enzymes CYP3A4 and CYP3A5 in human skin and tissue engineered skin equivalents

Abstract

CYP3A4 and CYP4A5 share specificity for a wide range of xenobiotics with the CYP3 subfamily collectively involved in the biotransformation of approximately 30% of all drugs. CYP3A4/5 mRNA transcripts have been reported in the skin yet knowledge of their protein expression and function is lacking. In this study, we observed gene and protein expression of CYP3A4/5 in both human skin and tissue-engineered skin equivalents (TESE), and enzyme activity was detected using the model substrate benzyl-O-methyl-cyanocoumarin. Mass spectrometric analysis of TESE lysates following testosterone application revealed a time-dependent increase in metabolite production, confirming the functional expression of these enzymes in skin.

http://ift.tt/2B4XwKT

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection

Abstract

Aim

To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer.

Materials and Methods

The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72 h, edema, complications, and duration of hospital stay.

Results

There were 36 males and 24 females with a mean age of 50.76 ± 12.6 years. Blood loss was significantly less for Group I than for Group II (p = 0.001); the operating time was significantly less in Group I than in Group II (p = 0.001); Group I had better quality of surgical field (p = 0.001); less pain on postoperative evening, day 2 and day 3 (p < 0.05); and less drainage volume at 24 and 48 h (p < 0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups.

Conclusion

The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.

http://ift.tt/2C64e1h

Neck Dissection vs Radiotherapy for Cervical Metastases in Advanced Hypopharyngeal Cancer

Condition: Hypopharyngeal Carcinoma
Interventions: Procedure: Neck dissection followed by radiotherapy(50Gy) according to risk factors; Radiation: Definitive radiotherapy
Sponsors: Tianjin Medical University Cancer Institute and Hospital; Tianjin Medical University Second Hospital; Tianjin Medical University General Hospital
Not yet recruiting

http://ift.tt/2yfqBy1

Dose‐Effect Relation of Salivary Gland Irradiation

Condition: HNSCC
Intervention: Device: PSMA PET/CT-scan
Sponsor: The Netherlands Cancer Institute
Recruiting

http://ift.tt/2At5JcL

Laudation on Prof. Alexander Berghaus

http://ift.tt/2BV3jzJ

Follicular papules and pustules in a patient with pulmonary symptoms

http://ift.tt/2jy8IcC

Actikerall: an alternative to curettage for some seborrhoeic keratoses?

http://ift.tt/2AN8HFV

Lebensqualität und Schwindel bei bilateraler Cochleaimplantation

Zusammenfassung

Hintergrund

Persistierende Schwindelbeschwerden nach Cochleaimplantation sind bekannte Einflussfaktoren auf die Lebensqualität. Mit in diesen Patientenkollektiven bisher nur teilweise eingesetzten Fragebogeninstrumenten werden die Effekte einer bilateralen Versorgung mit einem Cochleaimplantat (CI) auf die Lebensqualität sowie subjektive Schwindelbeschwerden analysiert.

Ziel der Arbeit

Es sollte untersucht werden, ob Fragebogeninstrumente eine erfolgreiche Methode zur Dokumentation von Schwindelbeschwerden und der Lebensqualität im Rahmen der Qualitätssicherung darstellen.

Material und Methoden

Es wurden 32 bilateral versorgte CI-Patienten bezüglich ihrer Schwindelsymptomatik und Lebensqualität befragt. Dabei kam der Nijmegen-Cochlear-Implant-Fragebogen (NCIQ) zum Einsatz. Bei berichteten, regelmäßigen Schwindelbeschwerden wurden zusätzlich der Schwindel-Handicap-Fragebogen (VHQ) und der Vertigo-Symptom-Scale(VSS)-Fragebogen erhoben.

Ergebnisse

Acht von 32 Patienten zeigten persistierende Schwindelbeschwerden. Die Lebensqualität, gemessen mit dem NCIQ, verbesserte sich signifikant (p < 0,001) um 23,7 % durch eine Versorgung mit dem zweiten CI. Die Schwindelbeschwerden veränderten sich geringfügig (VHQ –11,2 %; VSS +16,4%) nach der zweiten Implantation.

Schlussfolgerung

Die Ergebnisse zeigen, dass mit den Fragebögen praktikable Instrumente vorliegen, mit denen sich Lebensqualität und Schwindelbeschwerden zur Qualitätssicherung dokumentieren lassen und die möglicherweise ergänzend oder alternativ zur apparativen Schwindeldiagnostik sinnvoll angewendet werden können.

http://ift.tt/2AaPJIc

Aggressive cutaneous squamous cell carcinoma arising from a human papillomavirus-infected epidermoid cyst of the conchal bowl

http://ift.tt/2C1tZjb

Prospective transfrontal sheep model of skull-base reconstruction using vascularized mucosa

Background

No high-fidelity animal model exists to examine prospective wound healing following vascularized reconstruction of the skull base. Such a model would require the ability to study the prospective behavior of vascularized mucosal repairs of large dural and arachnoid defects within the intranasal environment. The objective of this study was to therefore develop and validate a novel, in vivo, transfrontal sheep model of cranial base repair using vascularized sinonasal mucosa.

Methods

Twelve transfrontal craniotomy and 1.5-cm durotomy reconstructions were performed in 60-kg to 70-kg Dorset/Ovis Aries sheep using vascularized mucosa with or without an adjunctive Biodesign™ underlay graft (n = 6 per group). Histologic outcomes were graded (scale, 0 to 4) by a blinded veterinary histopathologist after 7, 14, and 28 days for a range of wound healing parameters.

Results

All sheep tolerated the surgery, which required 148 ± 33 minutes. By day 7, the mucosa was fully adherent with complete partitioning of the sinus and intracranial compartments. Fibroblast infiltration and flap neovascularization scores significantly increased between day 7 (0.3 ± 0.5 and 0.0 ± 0.0) and day 28 (4.0 ± 0.0, p = 0.01 and 2.0 ± 0.8, p = 0.01; respectively), while hemorrhage scores significantly decreased from 2.5 ± 0.6 to 0.0 ± 0.0 (p = 0.01). The inflammatory scores were not significantly different between the heterologous graft and control sides.

Conclusion

The described sheep model accurately reflects prospective intranasal wound healing following vascularized mucosal reconstruction of dural defects. This model can be used in future studies to examine novel reconstructive materials, tissue glues, and transmucosal drug delivery to the central nervous system.

http://ift.tt/2Atf5oM

The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

Background

While Eustachian tube dysfunction (ETD) is a known comorbidity of chronic rhinosinusitis (CRS), the prevalence of ETD symptoms in the CRS population is poorly understood. We sought to determine the cross-sectional prevalence of ETD in patients with CRS using the validated Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate ETDQ-7 scores with 22-item Sino-Nasal Outcome Test (SNOT-22) scores, endoscopy scores, and computed tomography (CT) scores.

Methods

A total of 101 patients with confirmed CRS completed the ETDQ-7 and SNOT-22 at their initial visit to our rhinology clinic. Lund-Mackay CT and Lund-Kennedy endoscopy scores were also obtained. Spearman's correlation coefficient (ρ) was calculated.

Results

Among the 101 patients, 49 patients (48.5%) had an ETDQ-7 score of ≥14.5, signifying clinically significant ETD. The mean ± standard deviation (SD) ETDQ-7 score of the entire cohort was 17.8 ± 10.1. There was a moderately strong correlation between ETDQ-7 and the SNOT-22 ear subdomain (ρ = 0.691, p < 0.001). The correlation coefficient between ETDQ-7 and total SNOT-22 scores was ρ = 0.491 (p < 0.001), indicating moderate correlation. ETDQ-7 scores were poorly correlated to objective measures of sinonasal disease, including Lund-Mackay CT score (ρ = −0.055, p = 0.594) and Lund-Kennedy endoscopy score (ρ = −0.099, p = 0.334).

Conclusion

Symptoms of ETD are highly prevalent among patients with CRS as documented by patient-reported outcome measures. The correlation between ETDQ-7 scores and SNOT-22 ear subdomain scores is moderately strong, while the correlation between ETDQ-7 scores and SNOT-22 scores is moderate. ETD severity does not correlate with CT score or nasal endoscopy score.

http://ift.tt/2yeRnqv

The association of air pollutants and allergic and nonallergic rhinitis in chronic rhinosinusitis

Background

There has been little investigation regarding air quality and rhinitis in the pathophysiology of upper airway disease. In this study, we assessed the impact of inhalant pollutants (particulate matter 2.5 [PM_2.5] and black carbon [BC]) on allergic rhinitis and chronic rhinosinusitis (CRS) disease severity.

Methods

CRS patients with nasal polyps (CRSwNP) and without polyps (CRSsNP) were identified. Spatial modeling from pollutant monitoring sites was used to estimate exposures for patients meeting the inclusion criteria (total, n = 125; CRSsNP, n = 67; CRSsNP, n = 58). Skin-prick, intradermal dilutional, and in-vitro testing methods were utilized to determine aeroallergen sensitization. Disease severity indicators were measured by modified Lund-Mackay score (LMS), the 22-item Sino-Nasal Outcome Test (SNOT-22), systemic steroid therapy, and number of functional endoscopic sinus surgeries (FESS).

Results

Thirty-six percent (n = 45) of patients who described rhinitis symptoms demonstrated no reactivity to aeroallergen testing. Sixty-four percent (n = 80) tested positive for at least 1 allergen, with no differences found between CRSsNP and CRSwNP (62.1% vs 67.2%). There were significant differences in air pollutants between patients testing negative and positive for allergies (nonallergic vs allergic: PM_2.5, 11.32 vs 11.07 μg/m³, p = 0.030; BC, 0.81 vs 0.76 absorbance, p =0.044). Nonallergic CRSwNP demonstrated higher PM_2.5 compared with allergic counterparts (11.48 vs 11.09 μg/m³, p = 0.032). A similar pattern was observed with BC (0.82 vs 0.75 absorbance, p = 0.017). In CRSsNP, BC correlated significantly with SNOT-22 (r = 0.55, p = 0.042).

Conclusion

Our results suggest that small inhalant pollutants may contribute to nonallergic symptomatology in patients with and without nasal polyps. Regardless of allergy status, BC may play a role in CRS symptom severity.

http://ift.tt/2A9vbQd

Pembrolizumab beim fortgeschrittenen Ösophaguskarzinom

http://ift.tt/2jMNqoB

Air exposure may be associated with the histological differentiation of a cultured epidermal autograft (JACE)

http://ift.tt/2Bxg3QZ

HLA-B*1502 haplotype screening prior to carbamazepine administration in individuals of south-east Asian ancestry nears cost-effectiveness in preventing severe cutaneous adverse drug reactions

http://ift.tt/2B2Ac0r

Proportion of melanoma excisions performed by different specialties in Australia

http://ift.tt/2Bwzqdd

Cigarette smoke extract induces oral squamous cell carcinoma cell invasion in a receptor for advanced glycation end-products-dependent manner

Oral squamous cell carcinoma (OSCC) affects approximately 30,000 people and is associated with tobacco use. Little is known about the mechanistic effects of second-hand smoke in the development of OSSC. The receptor for advanced glycation end-products (RAGE) is a surface receptor that is upregulated by second-hand smoke and inhibited by semi-synthetic glycosaminoglycan ethers (SAGEs). Our objective was to determine the role of RAGE during cigarette smoke extract-induced cellular responses and to use SAGEs as a modulating factor of Ca9-22 OSCC cell invasion. Ca9-22 cells were cultured in the presence or absence of cigarette smoke extract and SAGEs. Cell invasion was determined and cells were lysed for western blot analysis. Ras and nuclear factor of kappa light polypeptide gene enhancer in B-cells (NF-κB) activation were determined. Treatment of cells with cigarette smoke extract resulted in: (i) increased invasion of OSCC; (ii) increased RAGE expression; (iii) inhibition of cigarette smoke extract-induced OSCC cell invasion by SAGEs; (iv) increased Ras, increased AKT and NF-κB activation, and downregulation by SAGEs; and (v) increased expression of matrix metalloproteinases (MMPs) 2, 9, and 14, and downregulation by SAGEs. We conclude that cigarette smoke extract increases invasion of OSCC cells in a RAGE-dependent manner. Inhibition of RAGE decreases the levels of its signaling molecules, which results in blocking the cigarette smoke extract-induced invasion.

http://ift.tt/2jL4MCj

Αρχειοθήκη ιστολογίου

Δευτέρα 11 Δεκεμβρίου 2017

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