Parameters of skull vibration-induced nystagmus in normal subjects

Abstract

Hypothesis

The knowledge of vibration-induced nystagmus test (SVINT) values in the normal population is highly relevant to provide a rapid orientation on the diagnosis attitude in a patient with vertigo.

Background

Although mastoid bone vibration should only induce nystagmus in the presence of vestibular asymmetry, it has also been reported in normal individuals raising doubts as to how to interpret the SVINT. To date, no population studies involving the use of the SVINT and that establish normative values have been published.

Methods

This study was carried out at two tertiary healthcare centres on a total of 122 subjects. We stimulated at three frequencies (30, 60 and 100 Hz), in increasing order, first stimulating the right mastoid and then the left mastoid, and waiting for 30 s between each stimulus. The response was recorded with a videonystagmography system. The following variables were evaluated in each subject: the mean and maximum speed of the slow phase of nystagmus, the frequency of the nystagmatic response (NR) and the component and direction of the rapid phase of nystagmus.

Results

Only 26 subjects (20.5%) of the subjects studied here (122 subjects) developed any kind of nystagmatic response and 96 subjects (79.5%) did not display any response. Stimulation at 100 Hz provoked the largest number of responses (p = 0.04), while there was no difference in the number of responses induced by 30 and 60 Hz stimulations (p = 0.85). The frequency of nystagmus was ≤ 0.7 n/s in 80.8% of the positive responses. The mean velocity of the horizontal component of the NR was 2.2°/s (SD 1.6) and that of the vertical component was 1.3°/s (SD 1.2).

Conclusions

Healthy subjects do not generally develop to NR upon vibratory stimulation and only 20% of the subjects studied here developed any kind of NR, this being a slow and inconsistent response of low frequency. The establishment of normal values contributes to improve the orientation in clinical practice in the pathological population and this opens possibilities for tackling more reliable studies in this population.

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Effect of curcumin on bone tissue in the diabetic rat: repair of peri-implant and critical-sized defects

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F.R. Cirano, S.P. Pimentel, M.Z. Casati, M.G. Corrêa, D.S. Pino, M.R. Messora, P.H.F. Silva, F.V. Ribeiro
This study determined the effect of curcumin on bone healing in animals with diabetes mellitus (DM). One hundred rats were divided into five groups: DM+PLAC, DM+CURC, DM+INS, DM+CURC+INS, and non-DM (CURC, curcumin; PLAC, placebo; INS, insulin). Critical calvarial defects were created and titanium implants were inserted into the tibiae. Calvarial defects were analyzed histometrically, and BMP-2, OPN, OPG, RANKL, Runx2, Osx, β-catenin, Lrp-5, and Dkk1 mRNA levels were quantified by PCR. The implants were removed for a torque evaluation, the peri-implant tissue was collected for mRNA quantification of the same bone-related markers, and the tibiae were submitted to micro-computed tomography. The DM+CURC+INS and non-DM groups exhibited greater closure of the calvaria when compared to the DM+PLAC group (P<0.05). Increased retention of implants was observed in the DM+CURC, DM+CURC+INS, and non-DM groups when compared to the DM+PLAC group (P<0.05). CURC improved bone volume and increased bone–implant contact when compared to DM+PLAC (P<0.05). In calvarial samples, CURC favourably modulated RANKL/OPG and Dkk1 and improved β-catenin levels when compared to DM+PLAC (P<0.05). In peri-implant samples, Dkk1 and RANKL/OPG were down-regulated and BMP-2 up-regulated by CURC when compared to DM+PLAC (P<0.05). CURC reverses the harmful effects of DM in bone healing, contributing to the modulation of bone-related markers.



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Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve

Publication date: Available online 30 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Bhatjiwale, M. Bhatjiwale, L.D. Naik, P. Chopade
Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3). This report is novel in describing the use of dual modalities in the same session for two distinct coexisting clinical entities in two different divisions of the same cranial nerve. The use of ultra-extended pulsed radiofrequency treatment for neuropathic pain in this case is also unique. Nearly 2years after the procedure, the patient continues to have complete pain relief.



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Editorial Board/Reviewing Committee

Publication date: July 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 7





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Comparison of two physiotherapy programmes for rehabilitation after temporomandibular joint arthroscopy

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): W.A. Abboud, N. Yarom, R. Yahalom, M. Joachim, S. Reiter, O. Koren, H. Elishoov
The purpose of this study was to compare two physiotherapy programmes for rehabilitation after temporomandibular joint (TMJ) arthroscopy. The medical files of 137 consecutive patients diagnosed with closed lock and treated by arthroscopic lysis and lavage were analyzed retrospectively. Sixty-eight patients were rehabilitated with gradually increasing range of motion self-exercises (gradual programme) and 69 patients were rehabilitated with immediate full range of motion self-exercises (immediate programme). The outcome variables were maximum mouth opening (MMO) and pain (on a visual analogue scale). The postoperative measurements taken at 1 month, 6 months, and last follow-up examination available (mean of 10 months postoperative) were analyzed and compared between the two groups. The results showed significantly better MMO and pain outcomes for the immediate group than for the gradual group at the 1-month and 6-month postoperative evaluations. The results of the two groups were comparable at the last follow-up examination available. It is concluded that after arthroscopic treatment of closed lock of the TMJ, a physiotherapy programme consisting of immediate postoperative full range of motion mobilizations achieves better results (in terms of pain and mouth opening) than a physiotherapy programme consisting of gradual and controlled increases in range of motion.



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Minimally invasive orthognathic surgery: a systematic review

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. AlAsseri, G. Swennen
Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n=44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n=4), endoscopically assisted orthognathic procedures (n=17), or the use of a piezoelectric device in orthognathic surgery (n=25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.



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Clinicopathological and prognostic significance of preoperative serum epidermal growth factor levels in patients with oral squamous cell carcinoma

Publication date: Available online 26 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.-S. Lin, F.-J. Sun, P.-Y. Lin, K.-W. Chang, C.-C. Yang, C.-J. Liu
Epidermal growth factor (EGF) promotes tumourigenesis and tissue repair of epithelial and mesenchymal cells and has a role in chemotaxis, mitogenesis, cell motility, and cytoprotection. It also enhances the growth of cancers. EGF may therefore have a role in the initiation or promotion of oral carcinogenesis. The cases of 152 patients with oral squamous cell carcinoma whose preoperative serum EGF level was determined by enzyme-linked immunosorbent assay were analyzed retrospectively, along with those of 40 age- and sex-matched controls. Patients with higher levels of EGF were more likely to have neck lymph node metastasis (P=0.026), advanced stage cancer (P=0.04), and a worse survival status (P=0.0019). Multivariate analysis using the Cox proportional hazards model indicated that the EGF level was an independent predictor of poor survival (hazard ratio 1.99, P=0.018). Patients with higher preoperative serum EGF levels had significantly poorer cancer-specific survival by Kaplan–Meier analysis (P=0.032). This study indicates that a higher preoperative serum EGF level is associated with neck lymph node metastasis, more advanced stage, and poor survival. EGF should be considered as a potential prognostic biomarker and a therapeutic target for patients with oral cancer.



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Long-term outcomes of craniofacial implants for the restoration of facial defects

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): S.S. Subramaniam, O. Breik, B. Cadd, G. Peart, D. Wiesenfeld, A. Heggie, S.D. Gibbons, A. Nastri
The aim of this study was to evaluate the long-term survival of craniofacial implants and prostheses and to identify factors associated with failure in a cohort of patients. A 25-year retrospective analysis was conducted at Royal Melbourne Hospital. Data included demographic characteristics, age, site and cause of the deformity, and number and survival of implants. Odds ratios were calculated and event-to-time Kaplan–Meier analyses performed. One hundred and ten patients were included (341 implants); their mean age was 46.2 years. The overall implant survival rate was 79.5% (mean follow-up 10.6 years). Temporal implants had the highest success rate (97.0%), followed by nasal implants (87.5%) and orbital implants (63.3%); differences were statistically significant (P<0.0001 and P=0.033, respectively). Kaplan–Meier analyses to determine long-term implant and prosthesis survival found temporal implants had the highest prosthetic (P<0.0001) and implant survival (P<0.0001). Patients with congenital deformities demonstrated the highest success rate. Radiotherapy was found to increase the risk of implant failure (P=0.02). Craniofacial implant-retained prostheses are a reliable and effective option for the restoration of facial defects, with good long-term success rates. Orbital implants and those placed post oncological surgery have a higher failure rate.



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Influences of age and sex on the validity of bone scintigraphy for the diagnosis of temporomandibular joint osteoarthritis

Publication date: Available online 31 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.-H. Kang, Y.-S. An, S.-H. Park, S.I. Song
Bone scintigraphy has been used for the diagnosis of early-stage temporomandibular joint (TMJ) osteoarthritis (OA) owing to its high sensitivity. However, the diagnostic value of bone scintigraphy may be compromised when applied to patients in an age range with high bone metabolism rates. The aim of this study was to investigate the validity of bone scintigraphy as an appropriate diagnostic modality for TMJ OA. A total of 406 subjects (145 male, 261 female; age range 14–87 years) were selected, and all subjects underwent both bone scintigraphy and computed tomography (CT). The diagnosis of TMJ OA was confirmed with CT. Images obtained with bone scintigraphy were analyzed by visual and quantitative methods using the TMJ-to-skull ratio. The TMJ-to-skull ratio was significantly higher during adolescence and elderly adulthood, but differences between the sexes were not significant. The diagnostic value of the TMJ-to-skull ratio was lower in elderly adulthood in both males and females. The diagnostic utility of visual assessment was also compromised during late adulthood in both males and females. Thus bone scintigraphy has little value in the detection of TMJ OA, because the results could be influenced by age-related bone metabolism rates.



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Editorial Board/Reviewing Committee

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6





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Upper airway morphologic changes after mandibular setback surgery in skeletal class III malocclusion patients measured using cone beam computed tomography superimposition

Publication date: Available online 30 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Jeong, J. Sung, S. Kim, Y. Kim, S. Shin, S.S. Kim
This study used the superimposition of cone beam computed tomography (CBCT) images to evaluate three-dimensional morphologic changes in the upper airway space of skeletal class III malocclusion patients with normally positioned maxilla who had undergone mandibular setback surgery.The upper airways of 18 subjects (10 males and eight females) who underwent mandibular setback surgery were assessed using CBCT superimposition at T0 (2weeks before surgery) and T1 (1year after surgery) according to the cervical vertebrae 1 (CV1), CV2, CV3 and CV4 reference planes on CBCT.The cross-sectional area and anteroposterior width (APW) in the CV1 and CV2 planes had significantly decreased at 1year after surgery. The largest decrease was observed in the oropharynx area. However, the APW/transverse width in the CV2 plane had increased at 1year after surgery.These findings suggest that mandibular setback surgery can cause a reduction in the upper airway space; physiologic deformation of the oropharynx occurs after mandibular setback surgery.



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Cancer-related hypercalcemia in oral cancer

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): T.-C. Lin, K.-L. Liang, L.-C. Lee, C.-Y. Hsu, T.-T. Yen
Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death. The total incidence of CRH was 6.95‰ per year. A total of 91 patients were enrolled; their median survival time was 28 days. The patients were divided into two groups by survival time, with a cut-off point of 30 days. Reduced serum albumin, leucocytosis, and clodronate use had a statistically significant effect on survival in the univariate analysis (all P<0.05). Forty-five patients (49.5%) had recurrence of CRH, of whom nine died within 30days. These nine patients had a shorter interval to the first episode of CRH recurrence (median 13 days) than those who survived ≥30days (median 28 days) (P<0.001). It was observed that a short interval to the first episode of CRH recurrence is a poor prognostic factor.



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Response to the Letter to the Editor regarding “Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM”

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E. Segna, R.H. Khonsari




https://ift.tt/2Jh2MzL

Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D. Govaerts, E. Shaheen, R. Coopman, A. De Mol, Y. Sun, C. Politis
This retrospective study was performed to verify the accuracy of horizontal and vertical repositioning of the maxilla in bimaxillary osteotomy with a focus on posterior vertical displacement. Data from 39 orthognathic patients undergoing bimaxillary surgery including a one-piece Le Fort I osteotomy with pitch rotation and advancement at the University Hospitals of Leuven (Belgium), between January 2015 and April 2016, were included in the study. Preoperative and 1-week postoperative lateral cephalograms were digitized and imported into cephalometric software. Horizontal and vertical measurements of dental landmarks were used to assess the accuracy of maxillary repositioning, and errors were reported in terms of the mean and absolute mean. The horizontal advancements were randomly under- and over-corrected an average of 1.4mm±1.2mm. Vertical repositioning of the anterior maxilla followed the planning. A tendency for under-correction was found for posterior vertical intrusion of the maxilla. The same tendency towards under-correction of posterior maxillary inferior repositioning was detected when planned movements were greater than 3mm. For all studied groups, no significant difference was found between the planning and the results achieved, validating the use of intermediate splints.



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Evaluation of saliva and plasma cytokine biomarkers in patients with oral squamous cell carcinoma

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): L.T. Lee, Y.K. Wong, H.Y. Hsiao, Y.W. Wang, M.Y. Chan, K.W. Chang
The aim of this study was to investigate potential biomarkers in human saliva and plasma to aid in the early diagnosis of oral squamous cell carcinoma (OSCC). Saliva and plasma samples obtained from OSCC patients (n=41) and non-oral cancer patients (n=24) were analyzed by Luminex Bead-based Multiplex Assay. Data were analyzed using the non-parametric Mann–Whitney U-test, Kruskal–Wallis test, and receiver operating characteristics curve (ROC) to evaluate the predictive power of 14 biomarkers individually for OSCC diagnosis. The plasma level of IP-10 in early OSCC differed significantly from that in controls. Among the salivary biomarkers, IL-1β, IL-6, IL-8, MIP-1β, eotaxin and IFN-γ and TNF-α showed significant differences between OSCC patients and controls. With respect to carcinogenesis, significant differences in plasma levels of eotaxin, G-CSF, and IL-6 were found between OSCC stages III/IV and OSCC stages I/II. The area under the curve (AUC) for OSCC vs. control was greater than 0.7 for plasma IP-10 and saliva IL-1β, IL-6, IL-8, and TNF-α. The study findings indicate that salivary biomarkers may serve a useful role as a complementary adjunct for the early detection of oral OSCC. With regard to the evaluation of tumour progression, plasma eotaxin, G-CSF, and IL-6 may help in the detection of advanced OSCC. However, the correlation between saliva and plasma biomarkers in OSCC was weak.



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Comparison of osseous healing after sagittal split ramus osteotomy and intraoral vertical ramus osteotomy

Publication date: Available online 26 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Rokutanda, S. Yamada, S. Yanamoto, K. Omori, Y. Fujimura, Y. Morita, H. Rokutanda, H. Kohara, A. Fujishita, T. Nakamura, T. Yoshimi, N. Yoshida, M. Umeda
The sagittal split ramus osteotomy (SSRO) is generally associated with greater postoperative stability than the intraoral vertical ramus osteotomy (IVRO); however, it entails a risk of inferior alveolar nerve damage. In contrast, IVRO has the disadvantages of slow postoperative osseous healing and projection of the antegonial notch, but inferior alveolar nerve damage is believed to be less likely. The purposes of this study were to compare the osseous healing processes associated with SSRO and IVRO and to investigate changes in mandibular width after IVRO in 29 patients undergoing mandibular setback. On computed tomography images, osseous healing was similar in patients undergoing SSRO and IVRO at 1year after surgery. Projection of the antegonial notch occurred after IVRO, but returned to the preoperative state within 1year. The results of the study indicate that IVRO is equivalent to SSRO with regard to both bone healing and morphological recovery of the mandible.



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Editorial Board

https://ift.tt/2svOxfL

Training Groups

https://ift.tt/2IZNRKI

Pediatric Residents’ Assessment of Atopic Dermatitis Severity for Risk Assessment of Early Peanut Introduction,

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): James Shea, Monika Martusiewicz, Lucy A Bilaver, Ozge N Aktas, Jialing Jiang, Anthony J Mancini, Ruchi S Gupta




https://ift.tt/2L73HQg

Development of Food Protein-Induced Enterocolitis Syndrome (FPIES) to egg following Immunoglobulin E (IgE)-mediated egg allergy,

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hannah Duffey, Maureen Egan




https://ift.tt/2JheLx1

Pilot study of the CAPS (Clinical extent, Area, Pruritus, Sleep) measure for atopic dermatitis severity,,✯✯✯,✯✯✯✯

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Aaron M Drucker, Natalie H Matthews, Jennie Muglia, Abrar A Qureshi
Eczema; Atopic dermatitis; Outcome measures; Severity; Symptoms; ItchAbbreviations: AD, atopic dermatitis; BSA, body surface area; CAPS, Clinical extent, Area, Pruritus, Sleep; DLQI, Dermatology Life Quality Index; EASI, Eczema Area and Severity Index; IGA, Investigator Global Assessment; POEM, Patient-Oriented Eczema Measure



https://ift.tt/2Ld5rrd

Otolaryngology resident experience with supraclavicular, submental and other regional flaps in the United States

Despite the resurgence in regional flap use, otolaryngology resident regional flap experience has been incompletely studied. We sought to characterize United States (US) otolaryngology resident exposure to, and perceptions of, supraclavicular flaps (SCFs), submental flaps (SMFs), and other regional flaps.

https://ift.tt/2socB53

“Determination of the impact of melanoma surgical timing on survival using the National Cancer Database”

https://ift.tt/2J1Mrj1

Association of family structure with atopic dermatitis in United States children

The relationship between family structure and atopic dermatitis has not previously been elucidated., Children from family structures without two married, biological parents have increased odds of AD and poorer overall health outcomes., Children from family structures without two, married, biological parents may benefit from increased surveillance, closer follow-up and optimized treatment for incident AD.

https://ift.tt/2H9ApOz

Daily Oxymetazoline Cream Demonstrates High and Sustained Efficacy in Patients With Persistent Erythema of Rosacea Through 52 Weeks of Treatment

https://ift.tt/2J47CBb

Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study

Adalimumab is approved for moderate-to-severe hidradenitis suppurativa/acne inversa., A sustained response is seen through week 168 in 52.3% of patients treated with adalimumab 40 mg weekly, with no additional safety issues identified. Adalimumab can be considered for long term control of moderate-to-severe hidradenitis suppurativa.

https://ift.tt/2syXOnE

The readability of iPledge program patient education materials

https://ift.tt/2J43aC4

A cohort study of risk factors, clinical presentations and outcomes for dermatophyte, non-dermatophyte and mixed toenail infections

https://ift.tt/2H9sK2Q

Response to: Reply to:"Determination of the impact of melanoma surgical timing on survival using the National Cancer Database"

https://ift.tt/2kGf8DE

A review of syndromes associated with blue sclera, with inclusion of malformations of the head and neck

Publication date: Available online 31 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): John K. Brooks
Blue sclera is attributed to a diversity of mechanisms, mostly arising in genetic syndromes and to lesser extents to nongenetic disorders and from medication intake. A literature search was conducted to establish a database of blue scleral associations. This article represents the most comprehensive assemblage of etiopathologies coincident with blue sclera, comprising 66 genetic syndromes, 8 disorders, and 4 pharmacologically-induced pigmentations. To increase the knowledge of the clinical significance of blue sclera, a summary of the systemic and oral maxillofacial comorbidities is provided. Recognition of the presence of blue sclera is important as it could prompt a timelier and more thorough diagnostic evaluation of possible systemic and dental malformations and may lead to improved clinical outcomes.



https://ift.tt/2xy9Ovc

Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series

Osteonecrosis of the jaw has been recently reported in patients receiving denosumab for the treatment of metastatic bone disease or osteoporosis. It is essential to investigate this disease as a new osteonecrosis entity in order to recognize its optimal management strategies.

https://ift.tt/2so8aap

Enhanced radiographic visualization of resorbable foils for orbital floor reconstruction: A proof of principle

Despite the advantages and broad applications of alloplastic resorbable implants, postoperative radiological control is challenging due to its radiolucency. The aim of the present study was to evaluate the radiographic visibility of newly developed materials for orbital floor reconstruction.

https://ift.tt/2H9S5tz

Three-Dimensional Accuracy of Mandibular Reconstruction by Patient-Specific Pre-Bent Reconstruction Plates using an “In-House” 3D-Printer

The purpose of this study was to compare the three-dimensional accuracy of mandibular reconstruction following mandible continuity resection in patients treated with patient-specific, pre-bent reconstruction plates, using an 'in-house' 3D printer, with that in patients treated with conventional, intraoperatively bent plates.

https://ift.tt/2soNRJW

Influences of age and sex on the validity of bone scintigraphy for the diagnosis of temporomandibular joint osteoarthritis

Bone scintigraphy has been used for the diagnosis of early-stage temporomandibular joint (TMJ) osteoarthritis (OA) owing to its high sensitivity. However, the diagnostic value of bone scintigraphy may be compromised when applied to patients in an age range with high bone metabolism rates. The aim of this study was to investigate the validity of bone scintigraphy as an appropriate diagnostic modality for TMJ OA. A total of 406 subjects (145 male, 261 female; age range 14–87 years) were selected, and all subjects underwent both bone scintigraphy and computed tomography (CT).

https://ift.tt/2kEq18X

Changes in chronic rhinosinusitis symptoms differentially associate with improvement in general health-related quality of life

Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinus mucosa.1 CRS is characterized by nasal as well as extra-nasal symptoms related to poor sleep, ear/facial discomfort and emotional disturbance.2 Due to these associated symptoms as well as other clinical manifestations—such as acute exacerbations of CRS and exacerbation of comorbid pulmonary disease—CRS causes a significant quality of life (QOL) detriment.3–5 The clinical manifestations of CRS are also associated with significant productivity losses.

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Food-induced Anaphylaxis in Infants and Children

Recent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis.

https://ift.tt/2L8MUN2

Bedroom Exposure to Airborne Allergens in the Chicago Area Using a Patient-Operated Sampling Device

Background: In current practice, allergens in vacuum collected dust are used as surrogates for inhalable allergens. We developed an airsampling device that can be used by patients themselves for direct measurement of airborne allergen concentrations in their own homes.Objective: To demonstrate the use of this device to establish allergen concentration reference ranges in a target population. To evaluate relationships of patient-reported information to measured allergen concentrations.Methods: Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaire, informed consent forms and samplers to run for 5 days in their bedrooms.

https://ift.tt/2JjVqLB

Are there different subtypes of eosinophilic esophagitis?

Currently, eosinophilic esophagitis (EoE) is defined by the combination of clinical symptoms and pathologic findings. Patients should have symptoms of esophageal dysmotility as well as a defined (albeit somewhat arbitrarily so) level of esophageal eosinophilia. Thus, using this definition, the diagnosis of EoE is purely a phenotype, possibly allowing for multiple different etiologies to funnel into this diagnosis. In this manner, EoE is similar to other conditions that we treat, such as asthma, in which treatment strategies are evolving in an era of precision medicine.

https://ift.tt/2Ldda8Z

Dehiscencia de la lámina papirácea del etmoides

Publication date: Available online 30 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Gabriel Huguet Llull, Marta Mesalles Ruiz, Xavier González Compta




https://ift.tt/2xvQ0Zt

Extranodal involvement of diffuse large B-cell lymphoma in the head and neck: An indicator of good prognosis

In this study, we analyzed clinicopathological characteristics and survival outcomes according to extranodal involvement of diffuse large B-cell lymphoma (DLBCL) in the head and neck.

https://ift.tt/2xwLh9Y

Pediatric cochlear reimplantation: Decision-tree efficacy

Publication date: Available online 31 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): L. Distinguin, M. Blanchard, I. Rouillon, M. Parodi, N. Loundon
ObjectivesThe context leading to pediatric cochlear reimplantation (CreI) can be complex. The objectives of this study were to define initial CreI indications, analyze final diagnosis and draw up a decision-tree.MethodsA retrospective study included patients undergoing CreI between 2005 and 2015. Demographic characteristics, CreI circumstances and technical reports were collected. Circumstances indicating CreI were classified in 3 groups: performance decrement, suspected device failure, or medical. After CreI, final diagnoses were classified in 2 groups: confirmed failure (DFail) or medical (DMed).Results69 out of 734 cochlear implantation surgeries were for CreI (8%). Manufacturers' reports were available in 64 cases (93%). Two principal causes were found: trauma and infection. Initial indications were: performance decrement: 27%; device failure: 56%; and medical: 17%. Final diagnoses were: DFail: 72%; and DMed: 28%. Initial indication and final diagnosis were similar in 86% of cases. The majority of the 14% initial indication errors belonged to the "performance decrement" group. Traumatic causes correlated with risk of initial indication error (P=0.039).ConclusionApart from spontaneous device failure, the two causes of CreI were infection and trauma. Using the present decision algorithm, half of the complex cases were resolved after CreI.



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Tonsillectomy in children and in adults: changes in practice following the opening of a day-surgery unit with dedicated operating room

Publication date: Available online 30 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Bartier, I. Gharzouli, N. Kiblut, H. Bendimered, L. Cloutier, D. Salvan
ObjectivesTo study the impact of the opening of a day-surgery unit on the practice of tonsillectomy in adults and children in the light of the experience of our department, and to compare complications between day-surgery and conventional admission.Material and methodsA retrospective review was conducted of all tonsillectomies performed since the opening of a dedicated day-surgery room, using the ENT and emergency department data-bases.ResultsBetween October 2013 and December 2014, 179 tonsillectomies were performed (51 in adults, 128 in children), including 108 day-surgeries. Between 2012 and 2014, the number of tonsillectomies increased by 12.7%, with an 18.27% increase in children and stable adult rate. Within 1 year, day-surgery became predominant for children (73.19%) and equaled conventional admission for adults (47.22%). For almost all patients without same-day discharge, the reasons were organizational or due to malorientation (comorbidity, or unsuitable home environment). Day-case tonsillectomy in children showed a 30-day complications rate comparable to those reported in the literature (8.3% postoperative hemorrhage), with a higher rate in adults (35.3%). Onset of complications was at a mean 6 days in adults and 9 days in children; only 2 patients developed complications between 6 and 24hours postoperatively.ConclusionThe present study showed that opening a day-surgery unit led to changes in practice, with most tonsillectomies now performed on an outpatient basis, without increased complications, and notably immediate complications. Outpatient tonsillectomy thus seems to be a solution of choice compared to conventional admission, in terms of cost saving and of patient comfort, without sacrificing safety. The dedicated operating room facilitates scheduling and thereby increasing turnover by reducing wait time.



https://ift.tt/2Haonob

Revisiting Correlation Between Pre Operative High Resolution Computed Tomography and Operative Findings in Attico Antral Disease

Abstract

(1) To correlate the findings of high resolution computed tomography (HRCT) scans with operative findings in chronic otitis media (attico antral disease). (2) To assess the role of HRCT in chronic otitis media (attico antral disease). This prospective observational study undertaken at a tertiary level teaching hospital included 50 patients of chronic otitis media (attico antral disease) who underwent pre-operative HRCT scanning and the findings were compared with the operative findings and correlation between the two was assessed with appropriate statistical methods. HRCT findings correlated well for the status of malleus and incus, facial nerve canal, lateral semicircular canal, and sinus plate but were less accurate for stapes and tegmen plate. As for disease extent and prediction of cholesteatoma the degree of correlation was site dependent being greater in mastoid air cell system and epitympanum and lesser in mesotympanum and hypotympanum. HRCT despite of its value in management of chronic otitis media has its drawbacks and limitations. CT's accuracy of prediction in some aspects of the disease varies with the site of pathology and this point must always be kept in mind by the operating surgeon. We suggest that each health care centre should establish their own correlative indices for HRCT temporal bone imaging in COM. HRCT cannot be entirely relied upon in management of chronic otitis media patients. However against the backdrop of improved radiological skills in interpreting temporal bone ct images, improved CT machines and importantly the growing concern over medicolegal issues, the role of pre operative CT scan in COM is much more than what was thought previously. Undoubtedly, it is a very useful 'aid' to management BUT a well-trained, experienced and alert surgeon is the key for an accurate diagnosis and successful management of chronic otitis media (attico-antral disease).

https://ift.tt/2snPXd3

Parotid Gland Tumours: Our Experience

Abstract

Salivary gland tumor comprises of approximately 3 to 10% of neoplasms of the head and neck region. Parotid gland is the most commonly involved salivary gland with an incidence of 62% followed by submandibular gland and other minor salivary gland tumors. However clinical course of benign and malignant tumors resemble each other in clinical findings, we require histopatholocal or cytological diagnosis for planning of management. To analyze parotid tumors retrospectively with following objectives. (1) Demographic distribution of parotid tumors. (2) To evaluate cytological and histopathological findings of parotid tumors. (3) Correlation of cytological and histopathological findings of parotid tumors. It was a retrospective observational study involving 31 patients who presented with parotid region swelling. Pre operative FNAC (fine needle aspiration cytology) and post operative histopathology were correlated. Surgical management depended on nature of disease. Correlation of FNAC and Histopathology: among 27 cases pre operative FNAC and post operative histopathology was same and in only 3 cases reports differed. One FNAC was inconclusive. In present study, Sensitivity of FNAC is 81.81%, Specificity is 94.73% and accuracy is 90%. FNAC is usually the first investigative modality, as it is a minimally invasive, cheap, OPD procedure that can differentiate benign from malignant tumors. Knowing preoperative pathological nature of disease can help in planning of surgical process.

https://ift.tt/2supiL7

Anaplastic carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report and review of the literature

Anaplastic carcinoma of the pancreas is a rare pancreatic neoplasm with a poor prognosis. It is classified as a variant of ductal adenocarcinoma, but the clinical features and treatment of it remain unknown be...

https://ift.tt/2suIbxd

Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report

Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature.

https://ift.tt/2IZg1FM

Differential regulation of human monocytes and NK cells by antibody-opsonized tumors

Abstract

The monocyte network is important for therapeutic efficacy of antibody therapies against cancer. One mechanism which monocytes/macrophages use to kill cancer cells is phagocytosis. Using trastuzumab and human breast cancer cell lines as a model, we used flow cytometry to evaluate the importance of avidity, antigen density, Fcγ receptor (FcγR) expression, and FcγR polymorphisms in human monocyte phagocytosis. By increasing avidity for the tumor through the addition of pertuzumab to trastuzumab, there was a two-to-threefold increase in phagocytosis potency against the HCC1419 cell line compared to antibodies alone, while NK cell-mediated antibody-dependent cellular cytotoxicity (ADCC) failed to increase tumor cell death. Consistent with increasing the avidity through multiple antibodies, antigen density significantly enhanced phagocytosis with breast cancer cell lines that were HER2 gene-amplified compared to non-amplified tumor cells. Confirmation that high antigen density enhanced phagocytosis was obtained when HER2 was overexpressed in HER2 non-amplified cell lines. In contrast, NK cell ADCC failed to distinguish differences in tumor cell death when comparing gene-amplified and non-amplified breast cancer cell lines. The level of phagocytosis was influenced by FcγRIIa and FcγRIIIa expression. Most monocytes are FcγRIIIa⁻, and the induction of the receptor significantly enhances antibody-dependent phagocytosis. Although both receptors are involved, when blocked FcγRIIIa had a greater influence on phagocytosis. Furthermore, the polymorphism FcγRIIIa 158V significantly enhanced phagocytosis; whereas FcγRIIa 131H polymorphism appeared to improve phagocytosis but was not statistically significant. Targeting of monocytes for enhanced phagocytosis may improve the effectiveness of therapeutic antibodies to improve clinical outcomes.

https://ift.tt/2H7tu8S

Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea

This randomized clinical trial compares the outcomes of adenotonsillectomy vs adenopharyngoplasty in children with severe obstructive sleep apnea.

https://ift.tt/2J2mCva

Association of Idiopathic Sudden Sensorineural Hearing Loss With Affective Disorders

This cohort study uses a Korean nationwide database to investigate whether idiopathic sudden sensorineural hearing loss is associated with the development of affective disorders such as anxiety, depression, and bipolar disorder.

https://ift.tt/2LMmVfe

The Unrecognized Dangers of Sudden Hearing Loss

The impact of an idiopathic sudden sensorineural hearing loss (ISSNHL) on a patient can be devastating. Practitioners who treat this malady are always worried about potential life-threatening issues, such as an intracranial complication or a tumor. However, practitioners need to be aware of other life-altering consequences of a sudden hearing loss. The study by Kim et al reveals that an often-overlooked sequela is the onset of affective disorders such as depression and anxiety.

https://ift.tt/2xr7KVI

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience

Abstract

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

https://ift.tt/2J7C5KA

Nrf2 pathway modulates Substance P-induced human mast cell activation and degranulation in the hair follicle

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Laura Jadkauskaite, Rajia Bahri, Nilofer Farjo, Bessam Farjo, Gail Jenkins, Ranjit Bhogal, Iain Haslam, Silvia Bulfone-Paus, Ralf Paus

Teaser

Activation of Nrf2 in primary human mast cells exposed to oxidative stress induced by substance P suppresses pro-inflammatory gene transcription, activation and degranulation.


https://ift.tt/2JoZ1bg

Paradoxical psoriasis following anti-TNF therapy in ankylosing spondylitis: A population-based cohort study

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jung Min Bae, Hyuck Sun Kwon, Gyong Moon Kim, Kyung-Su Park, Ki-Jo Kim

Teaser

The risks of psoriasis and palmoplantar pustulosis were significantly increased in patients with ankylosing spondylitis (AS) treated with anti-TNF agents compared to AS patients treated without anti-TNF agents in the population-based cohort study.


https://ift.tt/2LcPYI2

Biological Therapies for Eosinophilic Gastrointestinal Diseases

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Joshua B. Wechsler, Ikuo Hirano
The scientific basis and the clinical application of monoclonal antibody therapies that target specific immunologic pathways for eosinophilic gastrointestinal diseases (EGIDs) are areas of active interest. There is a growing recognition of a subset of patients with eosinophilic esophagitis, or EoE, whose disease does not respond well to topical steroids or elimination diets. In addition, long-term use of corticosteroids presents risks. Systemic therapy with a biologic agent offers potential advantages as a global approach that could limit the need for multiple, locally active medical therapies and allergen avoidance. The identification of novel biologic strategies is ongoing, and the recent validation of instruments and outcome measures to assess disease activity has proved essential in demonstrating efficacy. Studies using biologics that target IL-13 pathways in the treatment of EoE have demonstrated substantial promise.



https://ift.tt/2JiM8j7

Massive Silicone Oil Migration into the Subconjunctival Space: A Leakage Mechanism Dilemma

Purpose: To report a case in which an early, massive silicone oil migration into the subconjunctival space occurred in a patient after sutureless vitrectomy with the presence of a previously implanted pars plana glaucoma drainage device. Case Report: An 80-year-old man presented with neovascular glaucoma secondary to a proliferative diabetic retinopathy in his left eye. After an intracamerular bevacizumab injection and panretinal photocoagulation, a 23-gauge pars plana vitrectomy (PPV) combined with a superotemporal Ahmed pars plana glaucoma valve implantation was performed. Afterwards, the patient underwent a new 23-gauge PPV for a dense vitreous hemorrhage. Intravitreal 1,000 centistokes silicone oil was placed to prevent recurrent intraocular bleeding. No sutures were performed. In the first postoperative month, a massive migration of silicone oil into the 360° subconjunctival space was noted until no intraocular silicone oil was observed. Conclusions: We discuss the possible leakage mechanisms in this particular case.
Case Rep Ophthalmol 2018;9:310–314

https://ift.tt/2kEfqLh

Apatinib for Esophagus Cancer

Condition:   Esophagus Cancer
Intervention:   Drug: Apatinib
Sponsor:   Affiliated Hospital of North Sichuan Medical College
Not yet recruiting

https://ift.tt/2JiACnT

Prof. dr. MirkoToš: Obituary

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Janez Rebol




https://ift.tt/2JlLdOM

Could fetal reduction induce facial cleft? Report of a case

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Chauvel-Picard, J. Massardier, A. Gleizal
We describe a paramedian cleft of the lower lip that cannot be explained by embryological development in a child with only one predisposing factor, which was fetal reduction for a multiple pregnancy. To the best of our knowledge, there has been no report of a cleft that has been induced by the reduction of a multifetal pregnancy.



https://ift.tt/2xuD1ar

Is there an ideal way to close the donor site of radial forearm free flaps?

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.M. Pabst, R. Werkmeister, J. Steegmann, F. Hölzle, A. Bartella
Radial forearm free flaps (RFFF) are the "workhorse" of reconstructive head and neck surgery, but have considerable morbidity at the donor site. The aim of this study was to review current publications about the incidence and type of morbidity and the different techniques used for closure of the site. We screened the MEDLINE database to find relevant papers using the terms "RFFF head and neck" and "RFFF donor site". Abstracts were filtered, and the full texts studied carefully. We found 1056 publications during the period 1982–2017 of which 389 were studied in full, and 39 studies were finally included in the review. We found four main methods of closure of the donor site: full-thickness skin grafts (FTSG); split-thickness skin grafts (STSG); modified techniques for raising the flap and closure of the wound by local flaps; and others (such as allografts, expanders, and vacuum bandages). For STSG and FTSG the preparation of the donor site seems to be a relevant factor. Special attention should be paid to the coverage of the flexor tendons. FTSG give better aesthetic results than STSG. Closure by local flaps may achieve primary closure of the donor site without a third surgical site, but the techniques are limited by the amount of tissue required at the site of the defect. The most common side effects are disorders of wound healing such as exposed tendons. To avoid exposure of the tendons, flexor tendons should be covered with muscle bellies when STSG are used. It is still not clear whether many other reported side effects (such as impairment of sensitivity) are induced by raising the flap or closing the donor site. There is an argument for closure of individual donor sites independently, but there is no one method of closure for all donor sites, because each has its specific disadvantages and complications.



https://ift.tt/2smjF27

Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Kamal, A.H. Ziyab, A. Bartella, D. Mitchell, A. Al-Asfour, F. Hölzle, P. Kessler, B. Lethaus
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts.Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).



https://ift.tt/2xuoRpA

Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates

The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.

https://ift.tt/2sjrRQW

Labeling Morphine Milligram Equivalents on Opioid Packaging: a Potential Patient Safety Intervention

Abstract

Purpose of Review

Given that the primary cause of overdose death in the USA is related to prescribed opioids, one potential strategy to improve awareness and decrease morbidity and/or mortality could include improved labeling. Specific patient populations which significantly struggle with adverse outcomes related to opioid abuse are seen in palliative care, chronic pain, and acute pain treatment settings.

Recent Findings

An unexplored option for improving the healthcare quality and safety for patients currently prescribed opioids would be to require pharmaceutical companies to provide a morphine milligram equivalent (MME) on opioid packaging. Some limitations to MME conversions include equianalgesic conversions being estimates at best and may not account for variations in genetics and pharmacokinetics. Changing opioid labeling requirements is feasible as it falls under the purview of the US Food and Drug Administration (FDA), which has been mandated to provide mechanisms to reduce or to minimize overdoses related to opioid prescriptions.

Summary

Labeling opioid packaging with MME per dose will promote clearer communication about opioid strength between patients and physicians. Labeling MME on packaging could help prevent prescriber errors.

https://ift.tt/2Lcohz4

Randomized controlled phase III trial of adjuvant chemoimmunotherapy with activated cytotoxic T cells and dendritic cells from regional lymph nodes of patients with lung cancer

Abstract

Randomized controlled trial of adjuvant chemoimmunotherapy for lung cancer indicated a significant advantage in patients receiving immunotherapy. Herein we report the final results and immunological analysis with a median follow-up of 59.6 months. Patients with post-surgical lung cancer were randomly designated to receive either chemoimmunotherapy (group A, immunotherapy arm) or chemotherapy (group B, control arm). The immunotherapy comprised the adoptive transfer of autologous activated killer T cells and dendritic cells (AKT–DC). The 2- and 5-year overall survival (OS) rates were 96.0 and 69.4% in group A and 64.7 and 45.1% in group B, respectively. Multivariate analysis results revealed that the hazard ratio was 0.439. The 2- and 5-year recurrence-free survival rates were 70.0 and 57.9% in group A and 43.1 and 31.4% in group B, respectively. Subgroup analysis for the OS between treatment groups indicated that younger patients (≤ 55 years: HR 0.098), males (HR 0.474), patients with adenocarcinoma (HR 0.479), patients with stage III cancer (HR 0.399), and those who did not receive preoperative chemotherapy (HR 0.483) had lower HRs than those in the other groups. Immunological analysis of cell surface markers in regional lymph nodes of subjects receiving immunotherapy indicated that the CD8⁺/CD4⁺ T-cell ratio was elevated in survivors. Patients with non-small-cell lung cancer benefited from adoptive cellular immunotherapy as an adjuvant to surgery. Patients with stage III cancer, those with adenocarcinoma, and those not receiving preoperative chemotherapy were good candidates. Lastly, cytotoxic T cells were important for a favorable chemoimmunotherapy outcome.

https://ift.tt/2su8pzU

Case 17-2018: A 40-Year-Old Woman with Leg Swelling and Abdominal Distention and Pain

Presentation of Case. Dr. Molly E. Wolf (Medicine): A 40-year-old woman was evaluated at this hospital because of progressive edema of the legs, as well as abdominal distention and pain. The patient had been in good health until approximately 10 months before this evaluation, when episodes of pain…

https://ift.tt/2H9rMUe

Obturators versus flaps after maxillary oncological ablation: A systematic review and best evidence synthesis

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Yubin Cao, Changhao Yu, Wei Liu, Cheng Miao, Bo Han, Jianong Yang, Longjiang Li, Chunjie Li
Maxillary defects can be resolved by prosthetic obturation, autologous tissue reconstruction, or a combination of both. However, there is still controversy in the selection of the optimal approach. Therefore, the aim of this study was to systematically review evidences comparing the performance of obturators and flaps in patients after maxillary oncological ablation. Both electronic and manual searching approaches were conducted to identify eligible evidence. Two reviewers independently assessed the risk of bias. In addition, the same reviewers independently extracted the data. Meta-analyses were performed using Revman 5.3, and best evidence synthesis was performed. Sixteen studies were included and a total of 528 participants were analyzed. All studies were assessed at low quality. Results of this meta-analysis showed weak evidence in the difference between obturators and flaps on the outcome regarding word intelligibility (P = 0.004) and masticatory efficiency (P = 0.002). However, no differences were detected regarding speech intelligibility and nasalance. All studies were compiled into the best evidence synthesis. The sum of 31 evidences was considered. Twelve evidences were evaluated at a moderate level, such as speech, mastication, pain, salivation, taste sensations, and mouth opening. Except the outcomes of word intelligibility, masticatory efficiency, and mouth pain, other moderate evidences showed no difference between obturators and flaps. In conclusion, both obturators and flaps might be effective in patients' rehabilitation functions after maxillary ablation. However, some advantages were observed when using surgical reconstruction over prosthetic rehabilitation. Additional high-quality studies are needed to provide more solid evidence before applying these results into clinical practice.



https://ift.tt/2kCpVOT

Unravelling the molecular signatures in HNSCC: Is the homogenous paradigm becoming obsolete?

Publication date: Available online 30 May 2018
Source:Oral Oncology
Author(s): Divya Gopinath, Rohit Kunnath Menon




https://ift.tt/2stBKun

Τα σημάδια στα νύχια μπορεί να υποδείξουν πρόβλημα υγείας. http://medicalnews.gr/grammes-nyxia-shmainoun/

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

​

Targeting myeloid-derived suppressor cells for cancer immunotherapy

Abstract

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature myeloid cells with an immune suppressive phenotype. They represent a critical component of the immune suppressive niche described in cancer, where they support immune escape and tumor progression through direct effects on both the innate and adaptive immune responses, largely by contributing to maintenance of a high oxidative stress environment. The number of MDSCs positively correlates with protumoral activity, and often diminishes the effectiveness of immunotherapies, which is particularly problematic with the emergence of personalized medicine. Approaches targeting MDSCs showed promising results in preclinical studies and are under active investigation in clinical trials in combination with various immune checkpoint inhibitors. In this review, we discuss MDSC targets and therapeutic approaches targeting MDSC that have the aim of enhancing the existing tumor therapies.

https://ift.tt/2Jii1Iw

An independent relation of atopic dermatitis to exercise-induced wheezing in asthmatic children

Publication date: Available online 30 May 2018
Source:Allergology International
Author(s): Satoshi Honjo, Yoko Murakami, Hiroshi Odajima, Yuichi Adachi, Koichi Yoshida, Yukihiro Ohya, Akira Akasawa
BackgroundAtopic dermatitis (AD) and exercise-induced asthma (EIA) are common in asthmatic children, and exercise is the most common trigger other than infection for acute onset asthma attack in children. We examined whether AD is related to exercise-induced wheezing (EIW), some proxy for EIA.MethodsJapanese version of the International Study of Asthma and Allergies in Childhood questionnaires were used. For 12,405 asthmatic school children, AD was defined as itchy rash coming and going for at least 6 months at any time in the last 12 months with affecting places of flexural parts of body, and severity of AD was rated according to frequency of being kept awake at night with the itch as follows: never in the past 12 months, less than one night per week and one or more nights per week.ResultsAdjusted for frequency of asthma attack, odds ratios (OR) of children with current AD as compared to those without AD for having EIW were 1.32 (95% confidence interval = 1.15–1.52), 1.35 (1.14–1.68) and 1.10 (0.92–1.31) for primary school, junior high school and high school children, respectively. EIW was more likely observed in accordance with increasing severity of AD in the primary school children with ORs of 1.12, 1.59 and 1.54 (p for trend < 0.01), and in the junior high school ones with ORs of 1.18, 1.31, 2.03 (<0.01), respectively.ConclusionsAD may be possibly related to EIW. Further studies investigating effect of AD treatment on EIW may be required.



https://ift.tt/2kAy4Du

Interleukin 17A exacerbates ER-stress-mediated inflammation of macrophages following ICH

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Zhao Yang, Qingjun Liu, Hui Shi, Xuheng Jiang, Song Wang, Yuanlan Lu, Ji Zhang, Xiaofei Huang, Anyong Yu
IL-17A contributes to the initiation of inflammation following intracerebral hemorrhage (ICH). Endoplasmic reticulum (ER) stress acts on protein folding and contributes to inflammatory diseases. The role of IL-17A in the regulation of ER stress following ICH has not been well characterized. In this study, macrophages were stimulated with IL-17A, and then, ER stress and downstream pro-inflammatory factors were measured in vitro. In addition, brain edema and brain injury in ICH mice were assessed in vivo. We demonstrated that IL-17A induced ER stress in macrophages and thus promoted inflammation in vitro. Conversely, IL-17A inhibition attenuated ER stress and neuroinflammation. Furthermore, ERK 1/2 and p38 MAPK pathways mediated IL-17A-induced ER stress in macrophages. We also showed that IL-17A inhibition significantly attenuated ER stress and brain injury in ICH mice.In conclusion, our results demonstrate that IL 17A increases ER stress in macrophages and represents a novel mechanism in ICH.



https://ift.tt/2kDqJ6o

Seafood allergy: A comprehensive review of fish and shellfish allergens

Publication date: Available online 30 May 2018
Source:Molecular Immunology
Author(s): Thimo Ruethers, Aya C. Taki, Elecia B. Johnston, Roni Nugraha, Thu T.K. Le, Tanja Kalic, Thomas R. McLean, Sandip D. Kamath, Andreas L. Lopata
Seafood refers to several distinct groups of edible aquatic animals including fish, crustacean, and mollusc. The two invertebrate groups of crustacean and mollusc are, for culinary reasons, often combined as shellfish but belong to two very different phyla. The evolutionary and taxonomic diversity of the various consumed seafood species poses a challenge in the identification and characterisation of the major and minor allergens critical for reliable diagnostics and therapeutic treatments. Many allergenic proteins are very different between these groups; however, some pan-allergens, including parvalbumin, tropomyosin and arginine kinase, seem to induce immunological and clinical cross-reactivity.This extensive review details the advances in the bio-molecular characterisation of 20 allergenic proteins within the three distinct seafood groups; fish, crustacean and molluscs. Furthermore, the structural and biochemical properties of the major allergens are described to highlight the immunological and subsequent clinical cross-reactivities. A comprehensive list of purified and recombinant allergens is provided, and the applications of component-resolved diagnostics and current therapeutic developments are discussed.



https://ift.tt/2H4XJ08

Effects of different photobiomodulation dosimetries on temporomandibular dysfunction: a randomized, double-blind, placebo-controlled clinical trial

Abstract

Changes involving temporomandibular joint, masticatory musculature, and associated structures characterize temporomandibular dysfunction (TMD). The analgesic and anti-inflammatory effect produced by photobiomodulation has contributed to pain relief and functional improvement. However, the parameters to be used have not yet been well established. The aim of this study is to compare the efficacy of three different photobiomodulation dosimetries in the treatment of patients with TMD. A randomized, double-blind, placebo-controlled clinical trial with 44 subjects divided into the groups 8 J/cm² (n = 11), 60 J/cm² (n = 11), 105 J/cm² (n = 11), and control (n = 11). Pain, symptom severity, and joint mobility were evaluated before and after a ten-session protocol of photobiomodulation with AlGaAs laser (830 nm), at a power density of 30 mW/cm². The mouth opening increased in the 8-J/cm² group from 10.49 ± 4.68 to 15.40 ± 6.43 degrees, and in the right protrusion from 9.80 ± 4.2 to 12.56 ± 5.40 degrees after the intervention protocol (p < 0.05). All groups significantly decreased pain (p < 0.05). 830-nm laser photobiomodulation was effective in reducing TMD pain and symptoms at all doses tested. Only the doses of 8 J/cm² were effective regarding maximal opening and protrusion of the mandible.

https://ift.tt/2L9GKvY

Evaluation of the effects of Er:YAG laser, Nd:YAG laser, and two different desensitizers on dentin permeability: in vitro study

Abstract

The purpose of this in vitro study was to evaluate and compare the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, PrevDent nano-hydroxyapatite toothpaste plus Repairing Serum Kit (PNH), and NUPRO Sensodyne Prophylaxis Paste with NovaMin (NPP) on dentin permeability reduction. Forty dentin discs obtained from bovine incisors were divided into four study groups: Er:YAG laser-treated (2940 nm; 0.2 W, 80 mJ/pulse, 3 Hz); Nd:YAG laser-treated (1064 nm; 1 W, 10 Hz); PNH-treated; and NPP-treated groups. The quantitative changes in permeability of each dentin disc were measured using a computerized fluid filtration method (CFFM) before and after desensitizer treatments. The data were analyzed using the Wilcoxon, paired-samples t, Kruskal-Wallis, and Mann-Whitney U tests. The dentin surfaces and tubules were also morphologically detected by scanning electron microscopy (SEM). In all groups, dentin permeability was significantly reduced after the desensitizer and laser treatments (p < 0.05). Among the groups, we detected a significant difference in only when comparing the Er:YAG laser- and NPP-treated groups (p = 0.034). SEM analysis revealed physical changes in the dentin surface in all groups. This in vitro study shows that all tested desensitizers and laser treatments reduced dentin permeability. Also, surface changes, such as complete or partial occlusion or shrinkage of dentin tubules, were observed in all groups. Although the laser groups performed best, the PNH protocol can be considered as an alternative therapeutic product. In addition, clinical and laboratory studies should be performed for this product, and their efficacy should be assessed by combined therapy with lasers.

https://ift.tt/2JhBBos

Helminth-induced regulatory T cells and suppression of allergic responses

Jayden Logan | Severine Navarro | Alex Loukas | Paul Giacomin

https://ift.tt/2Jk7lcv

Dendritic cells, T cells and lymphatics: dialogues in migration and beyond

Marc Permanyer | Berislav Bošnjak | Reinhold Förster

https://ift.tt/2JjjSwJ

Pediatric Residents’ Assessment of Atopic Dermatitis Severity for Risk Assessment of Early Peanut Introduction,

Atopic dermatitis (AD), often referred to as eczema, is one of the most common skin disorders affecting the pediatric population.1 Although pediatricians diagnose eczema frequently, classification of severity can be challenging, as score-based indices (e.g., The Eczema and Area Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD) index) are complicated and designed primarily for use in clinical trials. These instruments are used infrequently by general pediatricians and may be associated with discrepancies in AD classification between providers.

https://ift.tt/2IZFIpG

Development of Food Protein-Induced Enterocolitis Syndrome (FPIES) to egg following Immunoglobulin E (IgE)-mediated egg allergy,

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated condition characterized by repetitive vomiting 1-4 hours after ingestion of the particular food accompanied by additional symptoms such as lethargy, pallor or diarrhea.1 Atypical FPIES characterizes patients who are noted to have IgE-mediated sensitization to the FPIES-inducing food,2 and has been associated with an increased likelihood of persistent FPIES.3 A clinical conversion from an FPIES phenotype to an IgE-mediated phenotype to the same food has been described.

https://ift.tt/2spDFjG

Pilot study of the CAPS (Clinical extent, Area, Pruritus, Sleep) measure for atopic dermatitis severity,,✯✯✯,✯✯✯✯

Eczema; Atopic dermatitis; Outcome measures; Severity; Symptoms; ItchAbbreviations: AD, atopic dermatitis; BSA, body surface area; CAPS, Clinical extent, Area, Pruritus, Sleep; DLQI, Dermatology Life Quality Index; EASI, Eczema Area and Severity Index; IGA, Investigator Global Assessment; POEM, Patient-Oriented Eczema Measure

https://ift.tt/2kAs5Pa

Different Treatments With the TRV Reposition Chair

Condition:   Benign Paroxysmal Positional Vertigo
Intervention:   Procedure: Type of repositional maneuvre
Sponsor:   Aalborg Universitetshospital
Recruiting

https://ift.tt/2skyW3H

Audit of the Spanish EURECCA Esophagogastric Cancer Registry

Conditions:   Cancer of Stomach;   Cancer of Esophagus
Intervention:  
Sponsor:   Parc de Salut Mar
Not yet recruiting

https://ift.tt/2xu0Lvo

Thykamine Safety and Efficacy Study in Mild-to-Moderate Atopic Dermatitis

Condition:   Atopic Dermatitis Eczema
Interventions:   Drug: Administration of Placebo;   Drug: Administration of PUR0110 (Thykamine) 0.05%;   Drug: Administration of PUR0110 (Thykamine) 0.1%;   Drug: Administration of PUR0110 (Thykamine) 0.25%
Sponsor:   PurGenesis Technologies Inc.
Recruiting

https://ift.tt/2skyVNb

ctDNA as a Biomarker for Treatment Response in HNSCC

Condition:   Carcinoma, Squamous Cell of Head and Neck
Intervention:   Other: Blood draw
Sponsor:   The Netherlands Cancer Institute
Not yet recruiting

https://ift.tt/2xsYW1J

Re: “High Thyroid Cancer Mortality Rate in Japan: A Result of Non-aggressive Treatment Strategy, or Just an Aging Population?” By Magner (Thyroid [Epub ahead of print]; DOI: 10.1089/thy.2018.0121)

Thyroid, Ahead of Print.


https://ift.tt/2IWMr3U

No-Scar Transoral Thyroglossal Duct Cyst Excision in Children

Thyroid, Ahead of Print.


https://ift.tt/2H5yRoS

The impact of cold on the respiratory tract and its consequences to respiratory health

The increasing use, and sometimes the abuse, particularly in industrialized countries of air conditioning at home, in car, hotel and shopping centres has highlighted new emerging public health issues, resultin...

https://ift.tt/2Lb4MXE

Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis

The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

https://ift.tt/2soTTJT

Is there an ideal way to close the donor site of radial forearm free flaps?

Radial forearm free flaps (RFFF) are the "workhorse" of reconstructive head and neck surgery, but have considerable morbidity at the donor site. The aim of this study was to review current publications about the incidence and type of morbidity and the different techniques used for closure of the site. We screened the MEDLINE database to find relevant papers using the terms "RFFF head and neck" and "RFFF donor site". Abstracts were filtered, and the full texts studied carefully. We found 1056 publications during the period 1982–2017 of which 389 were studied in full, and 39 studies were finally included in the review.

https://ift.tt/2kzmd8G

Could fetal reduction induce facial cleft? Report of a case

We describe a paramedian cleft of the lower lip that cannot be explained by embryological development in a child with only one predisposing factor, which was fetal reduction for a multiple pregnancy. To the best of our knowledge, there has been no report of a cleft that has been induced by the reduction of a multifetal pregnancy.

https://ift.tt/2spNJco

Primary intestinal-type adenocarcinoma of the buccal mucosa: a case report and literature review

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kentaro Kikuchi, Shuichi Fukunaga, Fumio Ide, Miyako Hoshino, Harumi Inoue, Yuji Miyazaki, Tie-Jun Li, Kaoru Kusama
Intestinal-type adenocarcinoma (ITAC) of the primary salivary glands is extremely rare. So far, only eleven cases of primary ITAC of the oral cavity and major salivary glands have been reported. Two of those tumors arose in the floor of mouth, seven in the tongue, and two in the major salivary glands. However, it has remained unclear whether these tumors are derived from mature salivary glands and primary ITAC of the buccal mucosa has not been reported previously. Here we present the first documented case of primary ITAC arising in a minor salivary gland of the buccal mucosa. Histopathologically, the tumor resembled a well differentiated or mucinous colonic adenocarcinoma. Immunohistochemically, the tumor cells were diffusely positive for AE1/AE3, CAM5.2, CK7, SATB2, β-catenin, p53, Ki-67, MUC2 and MUC5AC. CK14 and CK20 were positive in some of the tumor cells. CDX2, CA19-9, SP-A, TTF-1, PSA, SMA, p63 and cyclin D1 were negative in the tumor cells. The present case may have originated from salivary gland duct epithelium that underwent transformation to phenotypic intestinal-type epithelium. By reference to this very rare case of primary ITAC of the buccal mucosa, we consider diagnostic markers that could be indicative of mature salivary gland origin.



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A randomized controlled study to evaluate an experimental moisturizing mouthwash formulation in participants experiencing dry mouth symptoms

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Anto Jose, Mabi L. Singh, Britta Magnuson, Arwa Farag, Roshan Varghese, Athena Papas
ObjectiveTo evaluate efficacy and tolerability of an experimental moisturizing mouthwash versus water only in participants experiencing dry mouth symptoms including those with Sjögren's syndrome (SS; n=28).Study designParticipants were randomized to the experimental Mouthwash (n=53) or Water-only (n=47) groups. For 8 days, Mouthwash participants used 1–2 doses/day at home; both groups could sip water as needed. Supervised treatment occurred on Days 1, 3, and 8 where before/after administration participants completed the Product Performance and Attributes Questionnaire (PPAQ) parts 1–4.ResultsSignificant between-treatment differences on all PPAQ questions were shown at most time points. On Day 8, at 120 minutes, there was a significant difference on PPAQ3-Question 1 ('Relieves the discomfort of dry mouth'; the pre-defined primary efficacy variable) in favor of Mouthwash versus Water (0.63 [95% confidence intervals 0.17,1.10]; P = .0084). Sub-group analysis found a significant difference favored Mouthwash in participants without SS (0.67 [0.11,1.23]; P = .0203) but not with SS (0.52 [-0.35,1.38; P = .2272). Eight, non-serious, oral, treatment-related adverse events were reported by the Mouthwash group.ConclusionsThe findings of a subjective questionnaire showed that an experimental moisturizing mouthwash provided greater relief than water only from dry mouth symptoms over 8 days.Clinicaltrials.gov: NCT02641912



https://ift.tt/2LM3006

Chronic myelogenous leukemia presenting with osteonecrosis of the jaw as a rare but debilitating toxicity of dasatinib: a case report and literature review.

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Alexander M. Won, Prajwal Boddu, Adegbenga O. Otun, Ruth Aponte-Wesson, Mark Chambers
This report describes a case of osteonecrosis of the jaw that developed following a routine dental extraction in a patient being treated with dasatinib, a tyrosine kinase inhibitor, for chronic myelogenous leukemia. As the role of tyrosine kinase inhibitors in cancer treatment expands, patterns of debilitating complications involving the osseous structures of the oral cavity have begun to emerge, and many long-term side effects of this promising therapy remain unknown. To limit the occurrence of known complications, health care providers and patients must be aware of the potential for serious complications of dasatinib and have appropriate protocols developed prior to their administration.



https://ift.tt/2IZxIku

Odontogenic carcinosarcoma: morphological and immunohistochemical description of one case.

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jean Nunes dos Santos, João Paulo Silva Servato, Sergio Vitorino Cardoso, Paulo Rogério de Faria, Bruno Cunha Pires, Adriano Mota Loyola
ObjectivesThe goal of this study was to describe an extremely rare case of odontogenic carcinosarcoma (OCS) and compare the findings with a literature review.Study DesignThe clinical and pathological data of an OCS affecting the posterior maxilla of a 42-year-old male patient was described. The lesion was immunostained for cell-cycle, cytokeratin (CK), and mesenchymal markers. A review of literature from 1960 to 2017 was conducted in a search for similar well-documented case reports. Descriptive statistics were calculated to compare clinical and pathological variables.ResultsIn the reported case, the percentage of Ki-67-positive epithelial and mesenchymal cells was estimated as 40% and 25%, respectively. Epithelial cells were focally positive for CKs 7, 8, 14, 18, and diffusely positive for CK19, p53, and p16. Mesenchymal cells were strongly positive for desmin, HHF-35, and vimentin. Our review showed that OCS is diagnosed mostly in advanced stage. All patients with relapsed tumors had died because of the disease.ConclusionsThe very few cases reported in the literature support that most OCSs develop in the posterior mandible in a wide age range, without gender and racial predilections. Only one other OCS case has been reported in the maxilla. Until today, the best treatment remains unknown.



https://ift.tt/2LMZEd0

Spontaneous brain activity and connectivity in female patients with temporomandibular joint synovitis pain: a pilot functional magnetic resonance imaging study

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Juan Zhang, Xin Li, Zhen Jin, Meng Liang, Xuchen Ma
Objective.It has been proposed that mechanisms in the central nervous system contribute to the development and maintenance of pain in temporomandibular disorders. Here we tested whether spontaneous brain activity and functional connectivity (FC) were altered in patients with temporomandibular joint (TMJ) synovitis pain.Study design.A prospective, cross-sectional design was adopted. Each of 8 patients and 10 healthy controls (HCs) underwent two sessions of functional magnetic resonance imaging: mouth closed and mouth open (painful for patients). Regional Homogeneity (ReHo) was used to measure spontaneous brain activity in each participant. Brain areas with altered ReHo in patients compared to HCs were identified, and their FCs with the rest of the brain were examined and compared between groups.Results.Compared with the HCs, the patients showed decreased pain-related ReHo in the right anterior insula (rAI). The rAI showed a weaker positive FC with the left mid-cingulate cortex (MCC) and a weaker negative FC with the right precuneus in patients compared with HCs. Furthermore, the rAI-MCC FC showed a negative correlation with pain intensity in patients.Conclusions.These results provide evidence supporting altered pain-related spontaneous brain activity and functional connectivity in the central nervous system in patients with TMJ synovitis pain.



https://ift.tt/2J1OKyi

Oral and maxillofacial metastasis of male breast cancer: report of a rare case and literature review

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nathalia de Almeida Freire, Bruno Augusto Benevenuto de Andrade, Nathalie Henriques da Silva Canedo, Michelle Agostini, Mário José Romañach
Oral and maxillofacial metastatic tumors are uncommon, with the breast, prostate, lung and kidney representing the most common primary sites. Less than 1% of all breast cancers occur in male patients, and to date, only eight cases of metastatic breast adenocarcinoma to the oral and maxillofacial region in a male patient have been reported in the literature. An 88-year-old male with previous history of a successfully treated primary breast adenocarcinoma 12 years earlier was referred for evaluation of an oral swelling lasting 6 months. Intraoral examination revealed a 2 cm reddish, pedunculated nodule with a smooth surface located in the left retromolar region. Imaging revealed maxillary sinus involvement. The patient was submitted to incisional biopsy, and microscopic evaluation revealed invasive tumor islands compounded by malignant epithelial cells, sometimes exhibiting ductal arrangement, which were positive for the estrogen receptor and GCDFP-15. The final diagnosis was metastatic breast adenocarcinoma. Breast metastases are exceedingly rare in the oral and maxillofacial region of male patients; however, clinicians should consider breast metastasis when evaluating reddish oral nodules in older patients, including men, especially those with a history of malignancy.



https://ift.tt/2LL5V97

Lingual cyst with respiratory epithelium: report of two cases and review of the literature

Publication date: Available online 30 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Scott M. Peters, Mark Park, Michael A. Perrino, Molly Cohen
The lingual cyst with respiratory epithelium (LCRE) is a congenital cyst of the tongue or floor of mouth that is lined predominately by respiratory-type epithelium. The terminology for this lesion was first proposed by Manor et al. in 1999, who stated that a descriptive term is best for this cyst of debatable pathogenesis. Although it is a cyst of foregut origin, the LCRE is distinguished from the traditional enteric (foregut) duplication cyst in that the latter contains gastric and/or intestinal-type mucosa and has smooth muscle within the cyst wall. This article presents two new cases of this entity as well as reviews the nineteen cases in the literature that were found to fulfill the histologic criteria of a LCRE.



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Unravelling the molecular signatures in HNSCC: Is the homogenous paradigm becoming obsolete?

Dear Sirs,

https://ift.tt/2H436N9

Upper airway morphologic changes after mandibular setback surgery in skeletal class III malocclusion patients measured using cone beam computed tomography superimposition

This study used the superimposition of cone beam computed tomography (CBCT) images to evaluate three-dimensional morphologic changes in the upper airway space of skeletal class III malocclusion patients with normally positioned maxilla who had undergone mandibular setback surgery.The upper airways of 18 subjects (10 males and eight females) who underwent mandibular setback surgery were assessed using CBCT superimposition at T0 (2weeks before surgery) and T1 (1year after surgery) according to the cervical vertebrae 1 (CV1), CV2, CV3 and CV4 reference planes on CBCT.

https://ift.tt/2skJRdt

Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

Publication date: Available online 30 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): José Ángel González García, Carlos Pollán Guisasola, Carlos Miguel Chiesa Estomba, Constanza Viña Soria, David Virós Porcuna
La cirugía transoral de la orofaringe ha presentado una importante evolución en los últimos años, al ampliarse las opciones quirúrgicas disponibles (TORS, TOUSS, TOLS), la capacidad de resecar lesiones cada vez más extensas y el número de pacientes que se beneficia de ellas. Este hecho ha provocado una evolución en la reconstrucción de los defectos quirúrgicos tras cirugía transoral. Este artículo tiene como objetivo la revisión de las posibles técnicas reconstructivas, las indicaciones y factores que tener en cuenta previamente a la cirugía, además de proponer un protocolo para valorar la necesidad de reconstrucción transoral sobre la base de la profundidad del defecto, la estadificación y el tratamiento previamente recibido.Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.



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Monophasic Synovial Sarcoma of Tongue: A Rarest of Rare Case Scenario

Abstract

Synovial sarcoma is a rare tumour of head and neck. Primary synovial sarcoma of tongue is very uncommon. Based on morphology, it can be classified as classical biphasic variant, monophasic spindle cell variant, monophasic epithelial variant and poorly differentiated variant. The authors with an index case of 74 year old lady with monophasic spindle cell synovial sarcoma of oral tongue which is one of the rarest variants (our case is the 15th case reported of synovial sarcoma of the tongue and only the 3rd case in the world which had a monophasic histopathologic pattern) studied the morphology and described the disease entity in detail. She was treated with wide local excision of sarcoma followed by adjuvant radiotherapy.

https://ift.tt/2kAYp4o

Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

https://ift.tt/2spjzWM

Successful treatment of primary bone marrow Hodgkin lymphoma with brentuximab vedotin: a case report and review of the literature

Hodgkin lymphoma usually presents with sequential enlargement of peripheral lymph nodes, and bone marrow invasion rarely occurs (approximately 3–5%). However, several cases have been reported as "primary" bone...

https://ift.tt/2srgQMq

Trichophyton erinacei Transmitted to a Pregnant Woman From Her Pet Hedgehogs

This case report describes a pregnant woman who developed tinea manus from Trichophyton erinacei infection transmitted to her from her pet hedgehogs.

https://ift.tt/2IWzDdx

Lentigo Maligna—Challenges, Observations, Imiquimod, Confocal Microscopy, and Personalized Treatment

The word melanoma imparts considerable fear and concern in patients. Fortunately, for patients with the lentigo maligna (LM) subtype of melanoma in situ, there is overall good prognosis. The challenge of LM, however, is that it has the highest rate of local recurrence (approximately 20%) of all melanoma subtypes when treated by standard surgical excision alone, owing to frequent, unpredictable, subclinical extension. To reduce this risk, the use of Mohs surgery or staged excision has consistently demonstrated lower recurrence rates of 0.3% to 2.2% yet requires larger surgical margins for histological clearance than other in situ melanoma subtypes. Moyer et al also demonstrated that with increasing lesion size, both the surgical margin required to clear the lesion and the risk of local recurrence increased, suggesting increased subclinical spread with increasing lesion size. In addition, LM is typically located in the head and neck area, a complex zone with potential cosmetic and functional impairment owing to extensive surgery. Finally, differentiating LM from background atypical melanocytic hyperplasia can be challenging. Thus, treatments directed toward reducing the extent of surgery, minimizing morbidity, and providing a cure would enhance patient outcomes.

https://ift.tt/2H50D4K

Prevalence of Skin Cancer Examination Among Indoor Tanning Bed Users

This study uses weighted national survey data to examine the prevalence of skin cancer examinations among users of indoor tanning beds.

https://ift.tt/2IW6IGB

Lentigo Maligna Treated With Off-Label Neoadjuvant Imiquimod

This medical record review examines the rate of recurrence of lentigo maligna in patients treated with neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions.

https://ift.tt/2H3ShKP

Adolescents’ Perspectives on Atopic Dermatitis Treatment

This qualitative study examines the beliefs, experiences, and preferences of adolescents with atopic dermatitis toward their treatment via focus groups interviews.

https://ift.tt/2J0WQvu

Multidisciplinary management of oculo-auriculo-vertebral spectrum

Purpose of review Oculo-auriculo-vertebral spectrum (OAVS) is a complex disorder that is represented by wide variations in phenotypic presentation. Recent publications and systematic reviews of the available literature are presented here. Recent findings Treatment strategies vary among craniofacial centers across the country. Advances in presurgical planning, virtual surgical planning, and computer-aided manufacturing have been incorporated in the treatment of patients. The psychosocial effect of OAVS with longitudinal follow-up is now being studied. Summary Optimal evaluation and management of the OAVS patient requires an awareness of the phenotypic and genetic differences and involves a multidisciplinary team in order to effectively and appropriately diagnose and treat such patients. Correspondence to Jamie Funamura, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, 2521 Stockton Blvd, Ste 7200, Sacramento, CA 95817, USA. E-mail: jlfunamura@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2xtygha

Deconstructive SCNT reveals novel Treg subsets

Publication date: Available online 30 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Manching Ku, Eugene Ke, Mohsen Sabouri-Ghomi, Justin Abadejos, Brent Freeman, Amy Nham, Nathaniel Phillips, Kevin Y. Yang, Kathy O. Lui, Oktay Kirak

Teaser

Using single-cell transcriptomic and SCNT, we identify multiple distinct Treg subsets. We show that naturally occurring and agonist-induced Tregs are two of these subsets, which differ amongst in TCR strength, development, differentiation, and Ctla4 expression.


https://ift.tt/2kBOcF6

Saturated fatty acids, obesity and the NLRP3 inflammasome in asthma

Publication date: Available online 30 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Lisa G. Wood, Qian Li, Hayley A. Scott, Sandra Rutting, Bronwyn S. Berthon, Peter G. Gibson, Phil M. Hansbro, Evan Williams, Jay Horvat, Jodie L. Simpson, Paul Young, Brian G. Oliver, Katherine J. Baines
BackgroundBoth obesity and high dietary fat intake activate the NLRP3 inflammasome.ObjectiveWe aimed to examine NLRP3 inflammasome activity in the airways of obese asthmatics, following macronutrient overload and in immune cells challenged by inflammasome triggers.MethodsStudy 1: Cross-sectional, observational study of non-obese (n=51) and obese (n=76) asthmatic adults. Study 2: Randomized, crossover, acute feeding study in 23 asthmatic adults (n=12 non-obese, n=11 obese). Subjects consumed 3 isocaloric meals on 3 separate occasions: saturated fatty acid (SFA), n-6 polyunsaturated (PUFA) and carbohydrate (CHO); and were assessed at 0 and 4 hours. For Study 1 and 2, airway inflammation was measured using sputum differential cell counts, IL-1β protein (ELISA) and sputum cell gene expression (Nanostring nCounter). Study 3: Peripheral blood neutrophils and monocytes were isolated using Ficoll density gradient and magnetic bead separation, and incubated with or without palmitic acid, LPS or TNFα for 24 hours and IL-1β release measured (ELISA).ResultsStudy 1: NLRP3 and NOD1 gene expression were upregulated, and sputum IL-1β protein levels higher, in obese versus non-obese asthmatics. Study 2: The SFA meal led to increases in sputum %neutrophils and sputum cell gene expression of TLR4 and NLRP3 at 4 hours, in non-obese asthmatics. Study 3: Neutrophils and monocytes released IL-1β when challenged with a combination of palmitic acid and LPS or TNFα.ConclusionThe NLRP3 inflammasome is a potential therapeutic target in asthma. Behavioural interventions that reduce fatty acid exposure, such as weight loss and dietary saturated fat restriction warrant further exploration.Clinical implicationsBoth obesity and saturated fat intake cause NLRP3 inflammasome-mediated airway inflammation in asthma. Hence weight loss and dietary fat restriction warrant further exploration as anti-inflammatory strategies in asthma.

Graphical abstract

Teaser

The NLRP3 inflammasome is upregulated in obese asthmatics and following a high saturated fat meal in non-obese asthmatics. Both reversal of obesity and restriction of dietary saturated fat intake warrant further exploration as anti-inflammatory strategies in asthma.


https://ift.tt/2H2Tx0E

Ketamine Anesthesia Does Not Improve Depression Scores in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Although interest in ketamine use during electroconvulsive therapy (ECT) has increased, studies have been equivocal with regard to its efficacy. The aims of this clinical trial were to evaluate ketamine's antidepressive effects in ECT as a primary anesthetic, determine ketamine's tolerability when compared with standard anesthesia, and determine if plasma brain-derived neurotrophic factor (BDNF) is necessary for treatment response. Materials and Methods: Adults meeting criteria for treatment-resistant depression undergoing index course ECT received either methohexital (1 to 2 mg/kg) or ketamine (1 to 2 mg/kg) anesthesia in this dual-arm double-blinded randomized clinical trial (NCT02752724). The primary outcome of this study is change in depression questionnaire scores before and after ECT. Seizure data, depression severity using self-reported and clinician-assessed questionnaires, cognitive scoring, and plasma BDNF concentrations were obtained before and after completion of ECT. Results: There were no differences in seizure lengths, hemodynamics, or seizure stimuli between the ketamine (n=23;138 ECTs) and methohexital (n=27;159 ECTs) groups. Depression scores improved similarly after ECT in both groups. In the methohexital group, 15% of patients failed to achieve adequate seizures and were switched to ketamine and 26% were converted to bilateral ECT stimulus, whereas all ketamine patients achieved adequate seizures and only 4% required bilateral stimulus. Plasma BDNF increased after ECT only in the ketamine group. Conclusions: Our data show that ketamine does not significantly improve depression when compared with methohexital as a single induction agent for ECT, increases serum BDNF and does not increase rates of post-ECT agitation. Ketamine use in ECT may have some benefits for some patients that are not captured through standard depression assessment questionnaires alone. This work was supported in part by a Pilot Project Award #850 from the United States Department of Veterans Affairs. The content does not represent the views of the United States Department of Veterans Affairs or the United States Government. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors have no conflicts of interest to disclose. Address correspondence to: Charles William Carspecken, MD, MSc, MBA, Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA 19104 (e-mail: charles.carspecken@uphs.upenn.edu). Received March 2, 2018 Accepted April 23, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Automated Assessment of Existing Patient’s Revised Cardiac Risk Index Using Algorithmic Software

BACKGROUND: Previous work in the field of medical informatics has shown that rules-based algorithms can be created to identify patients with various medical conditions; however, these techniques have not been compared to actual clinician notes nor has the ability to predict complications been tested. We hypothesize that a rules-based algorithm can successfully identify patients with the diseases in the Revised Cardiac Risk Index (RCRI). METHODS: Patients undergoing surgery at the University of California, Los Angeles Health System between April 1, 2013 and July 1, 2016 and who had at least 2 previous office visits were included. For each disease in the RCRI except renal failure—congestive heart failure, ischemic heart disease, cerebrovascular disease, and diabetes mellitus—diagnosis algorithms were created based on diagnostic and standard clinical treatment criteria. For each disease state, the prevalence of the disease as determined by the algorithm, International Classification of Disease (ICD) code, and anesthesiologist's preoperative note were determined. Additionally, 400 American Society of Anesthesiologists classes III and IV cases were randomly chosen for manual review by an anesthesiologist. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve were determined using the manual review as a gold standard. Last, the ability of the RCRI as calculated by each of the methods to predict in-hospital mortality was determined, and the time necessary to run the algorithms was calculated. RESULTS: A total of 64,151 patients met inclusion criteria for the study. In general, the incidence of definite or likely disease determined by the algorithms was higher than that detected by the anesthesiologist. Additionally, in all disease states, the prevalence of disease was always lowest for the ICD codes, followed by the preoperative note, followed by the algorithms. In the subset of patients for whom the records were manually reviewed, the algorithms were generally the most sensitive and the ICD codes the most specific. When computing the modified RCRI using each of the methods, the modified RCRI from the algorithms predicted in-hospital mortality with an area under the receiver operating characteristic curve of 0.70 (0.67–0.73), which compared to 0.70 (0.67–0.72) for ICD codes and 0.64 (0.61–0.67) for the preoperative note. On average, the algorithms took 12.64 ± 1.20 minutes to run on 1.4 million patients. CONCLUSIONS: Rules-based algorithms for disease in the RCRI can be created that perform with a similar discriminative ability as compared to physician notes and ICD codes but with significantly increased economies of scale. Accepted for publication March 5, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. I. S. Hofer and A. Mahajan are working with counsel to patent the algorithms for the diseases described in this article. Reprints will not be available from the authors. Address correspondence to Ira S. Hofer, MD, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095. Address e-mail to ihofer@mednet.ucla.edu. © 2018 International Anesthesia Research Society

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