Head and Neck Medicine by Alexandros G.Sfakianakis: 01/30/18

Τρίτη 30 Ιανουαρίου 2018

Neutrophilia, gelatinase release and microvascular leakage induced by human mast cell tryptase in a mouse model: Lack of a role of protease activated receptor 2 (PAR2)

Abstract

Background

Tryptase, the most abundant protease of the human mast cell, has been implicated as a key mediator of allergic inflammation that acts through activation of PAR2.

Objectives

To investigate the contribution of PAR2 in the pro-inflammatory actions mediated by tryptase in a mice model.

Methods

We have injected recombinant human βII-tryptase into the peritoneum of PAR2-deficient and wild-type C57BL/6 mice. After 6, 12 and 24 hours mice were euthanized, peritoneal lavage performed and inflammatory changes investigated.

Results

Tryptase stimulated an increase in neutrophil numbers in the peritoneum, but responses did not differ between PAR2-deficient and wild-type mice. Heat-inactivation of tryptase or pre-incubation with a selective tryptase inhibitor reduced neutrophilia, but neutrophil accumulation was not elicited with a peptide agonist of PAR2 (SLIGRL-NH₂). Zymography indicated that tryptase stimulated the release of matrix metalloproteinases (MMP) 2 and 9 in the peritoneum of both mouse strains. Studies involving immunomagnetic isolation of neutrophils suggested that neutrophils represent the major cellular source of tryptase-induced MMP2 and MMP9. At 24 h after tryptase injection there was increased microvascular leakage as indicated by high levels of albumin in peritoneal lavage fluid, and this appeared to be partially abolished by heat-inactivating tryptase or addition of a protease inhibitor. There was no corresponding increase in levels of histamine or total protein. The extent of tryptase-induced microvascular leakage or gelatinase release into the peritoneum did not differ between PAR2-deficient and wild-type mice.

Conclusions

Our findings indicate that tryptase is a potent stimulus for neutrophil accumulation, MMP release and microvascular leakage. Though these actions required an intact catalytic site, the primary mechanism of tryptase in vivo would appear to involve processes independent of PAR2.

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Repeated vaccination with tetanus toxoid of plasma donors with pre-existing specific IgE transiently elevates tetanus-specific IgE but does not induce allergic symptoms

Abstract

IgE responses against allergens have acquired much attention due to their pathogenic nature as mediators of allergic reactions. In contrast, IgE responses against vaccines like Diphtheria-Tetanus-Pertussis (DTP) and the potential persistence of IgE production have received relatively little attention, presumably because of the low prevalence of allergic symptoms. In general, common early sensitivity reactions against vaccines, including tetanus toxoid, consist of mild local reactions and are not contraindicative of future vaccinations (1, 2).

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Step-down of inhaled corticosteroids in non-eosinophilic asthma: a prospective trial in real life

Abstract

Background

While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled corticosteroids (ICS), studies assessing a step-down of ICS in this specific population are currently lacking.

Objectives

To assess the proportion of non-eosinophilic asthmatics in whom ICS may be withdrawn without any clinical degradation and to determine the predictive markers of a failure to stop treatment with ICS.

Methods

This prospective study was completed by 36 non-eosinophilic asthmatics, defined by sputum eosinophils <3% and blood eosinophils <400/μL. In these patients, whichever the baseline asthma control level, the dose of ICS was gradually reduced every 3 months until they met the failure criteria or successfully discontinued ICS for 6 months. The failure criteria were an ACQ score ≥1.5 with an increase from baseline >0.5 or a number of severe exacerbations during the study which was greater than the number during the year prior to the baseline visit. Receiver-operating characteristic (ROC) curves were constructed to assess predictors of a failure to stop ICS. This study is registered with ClinicalTrials. gov, number NCT02169323.

Results

In 14 patients (39%), ICS were completely withdrawn and in 10 further patients (28%), ICS were stepped-down to a reduced ICS dose without any deterioration of asthma control and exacerbation rate. Baseline predictors of a failure to stop ICS were a greater age (area under ROC curve [ROC AUC] and [95% CI]: 0.77 [0.62-0.93]) and elevated blood eosinophils (ROC AUC [95% CI]: 0.77 [0.61-0.93]). After the first step-down of ICS, the best predictor was an elevated blood eosinophil count (ROC AUC [95% CI]: 0.85 [0.72-0.99]).

Conclusions & Clinical Relevance

Withdrawing or reducing the dose of ICS is feasible in two thirds of non-eosinophilic asthmatics irrespective of baseline asthma control. An elevated blood eosinophil count may predict the failure to stop ICS.

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Temperature-controlled laminar airflow (TLA) device in the treatment of children with severe atopic eczema: Open-label, proof-of-concept study

Abstract

Background

Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression.

Objective

To evaluate the effect of the temperature-controlled laminar airflow (TLA) treatment in children/adolescents with severe AE.

Methods

We recruited 15 children aged 2-16 years with longstanding, severe AE and sensitization to ≥1 perennial inhalant allergen. Run-in period of 6-10 weeks (3 visits), was followed by 12-month treatment with overnight TLA (Airsonett^®, Sweden). The primary outcome was eczema severity (SCORAD-Index and Investigator Global Assessment-IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient oriented eczema measure (POEM), medication requirements, and healthcare contacts. The study is registered as ISRCTN65865773.

Results

There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12-month intervention period (P<0.001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75-45.15] at baseline to 17.2 [12.95-32.3] at the final visit, and IGA improved significantly from 4 [3-4] to 2 [1-3]. We observed a significant improvement in FDQLI (16.0 [12.25-19.0] to 12 [8-18], P=0.023) and DFI (P=0.011), but not CDQLI or POEM. Compared to 6-month period prior to enrollment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P=0.033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non-responders.

Conclusion and Clinical Relevance

Addition of TLA device to standard pharmacological treatment may be an effective add-on to the management of difficult-to-control AE.

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Refeeding syndrome in adults with celiac crisis: a case report

Refeeding syndrome is a rare and life-threatening pathology with polyvisceral manifestations occurring in severely malnourished patients. It is rarely described in adults with celiac disease.

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Intestinal endometriosis combined with colorectal cancer: a case series

Intestinal endometriosis is a common benign disease among menstruating women that affects the intestinal tract.

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Diagnostic patterns and delays in autoimmune blistering diseases of the mouth; a cross-sectional study

Abstract

Objectives

To describe the natural history and factors influencing diagnostic delays among patients with autoimmune blistering diseases of the mouth.

Materials and methods

In this cross-sectional study, 27 newly diagnosed patients were interviewed, and professional and patient delays were calculated. Disease extent and severity scores were determined using Saraswat scoring system.

Results

Twenty-seven patients were interviewed and examined. Patient delay was significantly longer in patients who had desquamative gingivitis as initial presentation, in those who tried to use home remedies and over the counter medications, and in patients with less severe disease. Most patients (n= 21 [77.7%]) made more than one consultation, and the mean time needed to reach a definitive diagnosis (i.e. professional delay) was 83.2 ± 21.4 days (range from 21 to 130 days). Professional delay was significantly correlated with the number of previous consultations (r=0.78), and was significantly longer in patients who had desquamative gingivitis as initial presentation.

Conclusion

Diagnosis of oral blistering diseases is often delayed. Diagnostic delay is more common in patients presenting with desquamative gingivitis and those with less severe disease. Improving patients and health care professionals' awareness about oral blistering diseases might help reduce diagnostic delay.

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Comparing Human and Mouse Salivary Glands: A Practice Guide for Salivary Researchers

Abstract

Mice are a widely utilized in vivo model for translational salivary gland research but must be used with caution. Specifically, mouse salivary glands are similar in many ways to human salivary glands (i.e., in terms of their anatomy, histology and physiology) and are both readily available and relatively easy and affordable to maintain. However, there are some significant differences between the two organisms, and by extension, the salivary glands derived from them that must be taken into account for translational studies. The current review details pertinent similarities and differences between human and mouse salivary glands and offers practical guidelines for using both for research purposes.

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Exogenous Hydrogen Sulfide Inhibits Oral Mucosal Wound-induced Macrophage Activation via the NF-κB Pathway

Abstract

Objective

This study includes exploring (1) the production of endogenous hydrogen sulfide (H₂S) after mucosal wound generation and (2) the role of compensating the change in H₂S level post mucosal wound generation.

Methods and Materials

A mucosal wound model was established in female C57BL/6J mice. Wound tissues were collected to exam the change in the endogenous H₂S level. To examine the effect of decreased H₂S, GYY4137 was intraperitoneally injected into mice at 50 mg/kg/day before mucosal wounding to compensate for the decreased endogenous H₂S. Finally, we confirmed the role of GYY4137 in inhibiting the M1 phenotype macrophage activation induced by LPS in peritoneal macrophages and RAW264.7.

Results

The production of endogenous H₂S and the expression of cystathionine b-synthase and cystathionine g-lyase in vivo was reduced significantly in early stage after wound. GYY4137 significantly inhibited the activation of the M1 phenotype induced by mucosal wound inflammation in vivo and LPS in vitro. Finally, we confirmed that GYY4137 inhibited iNOS expression via the NF-κB signaling pathway.

Conclusion

The exogenous H₂S donor GYY4137 compensated for the reduced endogenous H₂S post mucosal wound generation and inhibited the induced M1 macrophage activation. Thus, appropriate H₂S supplementation may aid in controlling inflammation associated with mucosal wounds.

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Salivary proteomics in lichen planus: A relationship with pathogenesis?

Abstract

Objectives

Oral lichen planus is a chronic, T-cell-mediated, inflammatory disease that affects the oral cavity. The oral lichen planus pathogenesis is still unclear, however, the main evidence is that the mechanisms of activation of different T lymphocytes pathways induce apoptosis with an increase of Th1 and Th17 subtypes cells, triggered by the release of cytokines; This study analysed saliva proteomics to identify protein markers that might be involved in the pathogenesis and development of the disease.

Material And Methods

Proteins differentially expressed by oral lichen planus and healthy controls were screened using mass spectrometry; the proteins found in oral lichen planus were subjected to bioinformatics analysis, including gene ontology and string networks analysis. The multiplex analysis validation allowed the correlation between the proteins identified and the involved cytokines in Th17 response.

Results

108 proteins were identified in oral lichen planus, of which 17 proteins showed a high interaction between them and indicated an association with the disease. Expression of these proteins was correlated with the triggering of cytokines, more specifically the Th17 cells.

Conclusions

Proteins, such as S100A8, S100A9, Haptoglobin can trigger cytokines and might be associated with a pathological function and antioxidant activities in oral lichen planus.

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Preserving Salivary Gland Physiology against Genotoxic Damage - The Tousled Way

Abstract

Tousled and its homologs are evolutionarily conserved serine/threonine kinases present in plants and animals. Human Tousled-like kinases, TLK1 and TLK2, are implicated in chromatin assembly during DNA replication, chromosome segregation during mitosis, as well as in DNA damage response and repair. They share a high degree of sequence similarity, but have few non-redundant functions. Our lab has studied TLK1, and found that it increases the resistance of cells to ionizing radiation (IR) damage through expedited double strand break (DSB) repair. DSBs are life-threatening lesions which when repaired restore DNA integrity and promote cell survival. A major focus in our lab is to dissect TLK1′s role in DSB response and repair and study its usefulness in averting salivary gland hypofunction, a condition that invariably afflicts patients undergoing regional radiotherapy. The identification of anti-silencing factor 1 (ASF1), histone H3, and Rad9 as substrates of TLK1 links the protein to chromatin organization and DNA damage response and repair. However, recent findings of new interacting partners that include NEK1 suggest that TLK1 may play a broader role in DSB repair. This review provides a brief overview of the DNA damage response and DSB repair, and it highlights our current understanding of TLK1 in the process.

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Resolution of unilateral sensorineural hearing loss in a pediatric patient with a severe phenotype of Muckle-Wells syndrome treated with Anakinra: a case report and review of the literature

The prevalence of human papillomavirus in pediatric tonsils: a systematic review of the literature

HPV-related head and neck cancer rates have been increasing in recent years, with the tonsils being the most commonly affected site. However, the current rate of HPV infection in the pediatric population remai...

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International consensus (ICON) on treatment of Ménière's disease

Publication date: Available online 12 January 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Nevoux, M. Barbara, J. Dornhoffer, W. Gibson, T. Kitahara, V. Darrouzet
ObjectiveTo present the international consensus for recommendations for Ménière's disease (MD) treatment.MethodsBased on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work.ResultsThe recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.

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Epiglottoplasty technique in endoscopic partial laryngectomy

Publication date: Available online 12 January 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Moulin, C.A. Righini, P.F. Castellanos, I. Atallah
The main advantage of endoscopic laser surgery for laryngeal cancer is to allow tumour resection, while limiting functional sequelae, thereby improving the postoperative course. In this type of surgery, the epiglottis is often partially resected, leaving a raw zone without any reconstruction. The surgical technique described here involves endoscopic reconstruction of the epiglottis after partial resection. The sectioned edge of the epiglottis is sutured to the base of the tongue to create a neoepiglottis and to reconstruct the vallecula, thus resembling preoperative anatomy, allowing improvement of postoperative swallowing.

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Meningeal marginal zone B-cell lymphoma: The meningioma trap

Publication date: Available online 10 January 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): Alexandre Villeneuve, François Rubin, Pierre Bonfils
ObjectiveTo report a case of marginal zone MALT lymphoma of the temporal dura mater, initially mistaken for temporal meningioma.Case reportA 60-year-old immunocompetent woman, followed for more than 10 years for temporal meningioma causing vertigo and mixed hearing loss, presented with cervical lymphadenopathy, revealing marked progression of an intracranial lesion, leading to a diagnosis of marginal zone MALT lymphoma based on histological examination of a cervical lymph node. Treatment with 6 cycles of rituximab and bendamustine allowed complete remission of cervical lymph node and intracranial lesions, confirming the diagnosis of temporal dural mater lymphoma.ConclusionPrimary dural lymphoma must be part of the differential diagnosis of meningioma. Long-term follow-up allows correction of the diagnosis.

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Physiology of the paransal sinus ostia: Endoscopic findings

Publication date: Available online 12 January 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): R. Jankowski, C. Rumeau

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A Novel Surgical Approach to Nasolabial Fistula

Abstract

Infection of hair follicle is commonly called 'boil' or furunculosis. This can result in abscess formation leading to accumulation of pus and necrotic tissue. This can be more common in immunocompromised patients such as uncontrolled diabetes mellitus. Commonest organism to cause furunculosis is believed to be Staphylococcus aureus. We present an elderly patient where multiple nasal vestibular furunculosis suppurated resulting in extensive tissue damage and nasolabial fistula. Reconstruction was delayed to accommodate tissue healing from hyperglycemic insult and necrosis. Alar advancement flap was employed to give a suitable 3 layer closure to the fistula.

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Effects of polyphenols on doxorubicin-induced oral keratinocyte cytotoxicity and anticancer potency against oral cancer cells

Abstract

Background

Normal human oral keratinocytes are highly sensitive to anticancer drugs including doxorubicin. Resveratrol, epigallocatechin gallate and tannic acid are polyphenolic compounds were reported to have cardioprotective effect when combined with doxorubicin. However, it is unknown whether these polyphenols could protect normal human oral keratinocytes against doxorubicin-induced cytotoxicity without weakening its cytotoxic potential against oral cancer cells. Here, we examined the effects of the three polyphenolic compounds on doxorubicin-induced cytotoxicity in normal human oral keratinocytes and also investigated their effects on doxorubicin potency in HSC-2 human oral squamous cell carcinoma cells.

Methods

Cell viability was evaluated followed by the analysis of apoptosis and necrosis. The changes in intracellular reactive oxygen species at the early stage after treatment were also examined.

Results

The results revealed that resveratrol in combination with doxorubicin additively augmented doxorubicin cytotoxicity in both types of cells. However, epigallocatechin gallate and tannic acid at a certain concentrations mitigated the doxorubicin-induced keratinocyte toxicity mainly due to reduced doxorubicin-induced necrosis in normal human oral keratinocytes without weaken doxorubicin anticancer efficacy. The exact mechanism is still unknown but intracellular reactive oxygen species might be not the sole factor.

Conclusions

The present study for the first time reported the effects of resveratrol, epigallocatechin gallate and tannic acid on doxorubicin-induced cytotoxicity in normal oral keratinocytes and oral cancer cells. Combined use of epigallocatechin gallate or tannic acid with doxorubicin at a certain concentrations could mitigate doxorubicin-induced keratinocyte cytotoxicity without weakening doxorubicin anticancer efficacy.

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A Novel Surgical Approach to Nasolabial Fistula

Abstract

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Nasal valve evaluation in the Mexican-Hispanic (mestizo) nose

Background

Our aim in this study was to determine the angle of the internal nasal valve in Mexican patients with the "mestizo nose" feature and without nasal obstructive symptoms. The work was prospective, comparative, and observational in nature and included patients >14 years of age who were seen in the Otolaryngology Department at the Los Angeles Lomas Hospital between April and May 2016.

Methods

The angle of the internal nasal valve was measured in 30 patients without obstructive symptoms. Endoscopic examination was performed with a 0° endoscope framed with tape at a 13-mm distance from the endoscope's tip, and digital photographs of the internal nasal valve were taken. The measurement of the angle of the internal nasal valve was made in sexagesimal degrees using Golden Ratio v3.1 (2012) software. Statistical analysis was performed using Excel v15.13.3.

Results

The angles of the internal nasal valve of the patients were (mean ± standard deviation) 24.07 ± 4.8° for the right nasal cavity and 25.07 ± 5.0° for the left nasal cavity, wider than the angle reported in the normal Caucasian nose established in the literature.

Conclusions

According to our results, the Mexican-Hispanic mestizo nose has a wider angle in the internal nasal valve than that considered normal in the literature (10°-15°). We believe it is necessary to undertake a second study and add an airflow resistance measurement with a rhinomanometry procedure so we can compare the results with those in the Caucasian population.

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Airborne and food sensitization patterns in children and adults with eosinophilic esophagitis

Background

The pathogenesis of eosinophilic esophagitis (EoE) is currently unknown, but evidence suggests that allergic sensitization to food and airborne allergens may play a key role. This retrospective study examines the rate of sensitization to both food and airborne allergens in EoE patients, and compares their sensitivity patterns to control groups.

Methods

We identified 103 patients with a diagnosis of EoE via esophageal eosinophilia (≥15 eosinophils/high-power field [hpf]), who had undergone comprehensive food and/or airborne allergen testing through either skin or in vitro methods. Food and airborne allergen sensitization was defined as positive testing in at least 1 food subgroup (milk, peanut, tree nut, seafood/fish, soy, grain, egg) or airborne subgroup (tree, grass, weed, mite/cockroach, animal, mold), respectively. The same sensitization criterion was applied to allergic rhinitis (AR) patients, with and without a clinical suspicion of food allergy (FA), in order to create control groups.

Results

Sensitization in the EoE group to at least 1 subgroup of food allergen and airborne allergen was seen in 77.1% (64/83) and 71.7% (38/53), respectively (p = 0.82). There were significant differences in sensitization between EoE and control groups for tree nut, soy, grain, and egg, but no differences noted in any of the other food or airborne allergen subgroups, even after accounting for age and gender.

Conclusion

EoE and control groups had similar airborne allergen sensitization patterns, yet dissimilar food allergen sensitization patterns, suggesting that specific allergens may play a more prominent role in the pathogenesis of EoE. The EoE group had a more uniform distribution pattern for food allergens, compared to controls.

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Risk of second primary malignancy in patients with sinonasal tumors: a population-based cohort study

Background

The 5-year overall survival rate for patients with sinonasal cancers has remained around 50% for the last 3 decades. Prior studies on head and neck cancers have suggested that 1 reason for poor survival is the frequent development of second primary malignancies (SPMs). The purpose of this study is to assess overall and site-specific risks of SPM following treatment of sinonasal malignancy.

Methods

A retrospective, population-based cohort study was performed on 2614 patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with primary sinonasal malignancy between 1973 and 2014. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to assess risk of SPM relative to incidence in the general population.

Results

A total of 422 (16.1%) patients with primary sinonasal malignancies developed a total of 480 SPMs. This cohort had a significantly higher frequency of SPMs than expected in the general population (SIR 1.32; 95% confidence interval [CI], 1.20 to 1.44; AER 53.41). Site-specific analyses of SIRs suggested highest risk of malignancy in the sinonasal tract (SIR 75.64; 95% CI, 53.53 to 103.83; AER 17.22), followed by bone, eye and orbit, oral cavity and pharynx, and lung and mediastinum.

Conclusion

Patients with history of sinonasal cancer are at significantly increased risk of developing an SPM. Careful monitoring for development of additional tumors may be warranted.

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How do dermarollers work?

Learn all about how to use dermarollers, and what effects they could have on the skin. We also look at things to consider when dermarolling.

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Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology

Abstract

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

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Individualized Adaptive De-escalated Radiotherapy for HPV-related Oropharynx Cancer

Condition: Oropharynx Cancer
Interventions: Drug: Cetuximab; Radiation: Radiation Therapy
Sponsors: University of Michigan Cancer Center; VA Ann Arbor Healthcare System
Not yet recruiting

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An Observational Study to Evaluate Lymph Metastases and Prognoses of the Patients With Esophageal Cancer

Condition: Esophageal Cancer
Intervention: Procedure: Surgeries
Sponsors: Henan Cancer Hospital; LinkDoc Technology (Beijing) Co. Ltd.
Recruiting

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Explore the Efficiency of Fiberscope-guided Nasogastric Tube Insertion

Condition: Nasogastric Tube Esophagitis
Intervention: Device: Fiberscope-Guided Nasogastric tube insertion
Sponsor: National Taiwan University Hospital
Recruiting

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Adoptive Cell Therapy Following a Reduced Intensity, Non-myeloablative, Lymphodepleting Induction Regimen in Metastatic Ovarian

Condition: Metastatic Ovarian Cancer
Interventions: Drug: Fludarabine; Radiation: Radiation; Biological: TIL administration; Drug: IL-2
Sponsor: Sheba Medical Center
Not yet recruiting

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An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.

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Resolution of unilateral sensorineural hearing loss in a pediatric patient with a severe phenotype of Muckle-Wells syndrome treated with Anakinra: a case report and review of the literature

Abstract

Background

Muckle-Wells syndrome (MWS) is a rare auto-inflammatory disease characterized by the presence of recurrent urticaria, deafness and amyloidosis. Progressive sensorineural hearing loss (SNHL) is reported to occur in up to 85% of patients occurring in the second and third decades and as early as the first decade in patients with a more severe phenotype, thus potentially having a significant impact on a child's development. IL-1 inhibitors, such as Anakinra, have been described to improve systemic inflammation, and stabilize or improve hearing status as well. However, complete resolution of hearing loss has been rarely reported. The objective of this article is to highlight the clinical presentation of a pediatric patient with a severe form of MWS and report on the complete resolution of SNHL with the use of Anakinra.

Case presentation

A 3-year-old boy was referred to our hospital to assess for the possibility of MWS given a history of hives and recurrent episodes of fever with a family history of MWS in his mother. Of note, the patient's history was significant for conductive hearing loss, speech delay, as well as recurrent acute otitis media episodes. Genetic analysis was performed and diagnosis of MWS was confirmed due to the presence of a NLRP3 gene mutation. Further work-up demonstrated the presence of papilledema and elevation of systemic inflammatory markers for which Canakinumab was initiated. Despite initiation of this treatment, audiogram evaluation demonstrated a new right-sided SNHL. Lumbar puncture also revealed aseptic meningitis. Canakinumab was eventually discontinued and Anakinra initiated. Within 7 months of treatment with Anakinra at 5 mg/kg sc daily, resolution of the SNHL was observed. With further escalation of the Anakinra dose, there was also complete resolution of the aseptic meningitis.

Conclusions

Progressive hearing loss is a significant finding in patients with MWS. Early screening as well as initiation of Anakinra can lead to complete resolution of SNHL even in a patient with a severe spectrum of MWS. However, as this case demonstrates, longer treatment duration and higher doses of Anakinra may be required to achieve this.

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Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology

Abstract

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16S rRNA profiling of the Dermatophagoides farinae core microbiome: Enterococcus and Bartonella

Abstract

Characterization of the house dust mite (HDM; Dermatophagoides farinae) microbiome is important because it may exert immunomodulatory effects on the pathogenesis of allergic diseases, owing to its ability to generate microbe-associated molecules such as lipopolysaccharides and lipoteichoic acid.[1] In a recent study, whole-genome shotgun sequencing of D. farinae revealed that Enterobacter were the most abundant bacteria[2], while another study using 16S rRNA cloning reported that Bartonella was the most abundant bacterial taxon.[3] In this study, a 16S rRNA amplicon analysis using high-throughput sequencing technology was performed; this is currently the most widely used and reliable method for microbiome community studies.

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A Case of First Branchial Cleft Fistula Presenting with an External Opening on the Root of the Helical Crus

Background. First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck. Typically, the tract of the FBCA begins in the external auditory canal and ends in the postauricular or submandibular region. Case Presentation. We present a case of a 23-year-old man who had a first branchial cleft fistula with atypical opening on the root of the helical crus. Complete excision of the tract, including the cuff of surrounding cartilage, was performed. Histopathology revealed a fistular tract lined with squamous epithelium. To our knowledge, this is the first case to be reported of type I FBCA with an opening on the root of the helical crus. The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment. Conclusions. In the patients with FBCA, careful recognition of atypical variants is essential for complete excision.

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Influences of different lower cervical bone graft heights on the size of the intervertebral foramen: multiple planar dynamic measurements with laser scanning

Abstract

The aim of this study is to evaluate the influences of different bone graft heights on the size of the intervertebral foramen, which will help determine the optimal graft height in clinical practice. Six fresh adult cadavers were used, with the C5-C6 vertebral column segment defined as the functional spinal unit (FSU). After discectomy, the C5/6 intervertebral height was set as the baseline height (normal disc height). We initially used spiral computed tomography (CT) to scan and measure the middle area of the intervertebral foramen when at the baseline height. Data regarding the spatial relationship of C5-C6 were subsequently collected with a laser scanner. Grafting with four different sized grafts, namely, grafts of 100, 130, 160, and 190% of the baseline height, was implanted. Moreover, we scanned to display the FSU in the four different states using Geomagic8.0 studio software. Multiple planar dynamic measurements (MPDM) were adopted to measure the intervertebral foramen volume, middle area, and areas of internal and external opening. MPDM with a laser scanner precisely measured the middle area of the intervertebral foramen as spiral CT, and it is easy to simulate the different grafts implanted. With the increase of the bone graft height, the size of the intervertebral foramen began to decrease after it increased to a certain point, when grafts of 160% of the baseline height implanted. MPDM of the intervertebral foramens with laser scanning three-dimensional (3D) reconstitution are relatively objective and accurate. The recommended optimal graft height of cervical spondylosis is 160% of the mean height of adjacent normal intervertebral spaces.

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Asthma and IgE associated polymorphisms affect expression of TH17 genes

Abstract

T_H17 cells contribute to the pathogenesis of chronic inflammatory diseases such as asthma and T_H17 pathway tagging SNPs were associated with asthma and total serum IgE levels in childhood. In this study genotype-specific effects of these SNPs on the expression of T_H17 related molecules were analyzed in peripheral blood mononuclear cells (PBMCs) before and after allergen stimulation in 61 individuals. After correction for multiple testing, protein or mRNA expression levels of several molecules, including IL-17A, IL17-F, IL-23 and IL-23 receptor, were significantly correlated with asthma-associated SNPs (located in IL17F, IL22, IL23R and IL23A) and IgE-associated polymorphisms (located in IL17A and three SNPs in IL12B). Most extensive effects on T_H17 pathway expression were observed for the asthma-associated polymorphism IL17F rs7741835. In conclusion, genetic variants in IL17F and, to a smaller degree, IL17A and IL-23 signaling genes associated with asthma and IgE levels seem functional in influencing expression of T_H17 related molecules, indicating a contribution of these mechanisms to genetic susceptibility towards asthma and atopy.

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IgE-expressing memory B cells and plasmablasts are increased in blood of children with asthma, food allergy and atopic dermatitis

Abstract

Despite the critical role of soluble IgE in the pathology of IgE-mediated allergic disease, little is known about abnormalities in the memory B-cells and plasma cells that produce IgE in allergic patients. We here applied a flowcytometric approach to cross-sectionally study blood IgE+ memory B-cells and plasmablasts in 149 children with atopic dermatitis, food allergy and/or asthma, and correlated these to helper-T(h)2 cells and eosinophils. Children with allergic disease had increased numbers of IgE+CD27- and IgE+CD27+ memory B-cells and IgE+ plasmablasts, as well as increased numbers of eosinophils and Th2 cells. IgE+ plasmablast numbers correlated positively with Th2 cell numbers. These findings open new possibilities for diagnosis and monitoring of treatment in patients with allergic diseases.

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A retrospective case control analysis of the efficacy of Gardasil® vaccination in 28 patients with recurrent respiratory papillomatosis of the larynx

Abstract

Recurrent respiratory papillomatosis (RRP) of the larynx represents a significant disease burden to patients and the healthcare system

The use of HPV 6/11/16/18 vaccination (Gardasil^®) has previously been thought to impact on disease burden in patients with RRP.

Gardasil^® vaccination did not impact on the number of endolaryngeal surgical procedures required, the interval between procedures, or the number of patients who achieved disease remission in comparison to a control cohort.

This study indicates Gardasil^® vaccination does not appear to have any effect on disease burden in patients with RRP.

The use of a control cohort profiles the natural progression of RRP.

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Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow

Abstract

Aim

To examine deprivation measured by the Scottish Index of Multiple Deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category.

Methods

All "Urgent Suspicion of Cancer" referrals to the GGC ENT department over a one-year period, between 2015-16, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms.

Results: 1998 patients were assessed, 43.4% (n=867) were male. 171 (8.6%) patients had primary head and neck cancer. 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. 71.3% of primary HNC patients were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories.

Conclusion

A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of HNC patients are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral.

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e-Inhalers

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Forthcoming Meetings

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Issue Information

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Cover Image

The cover image, by Carina Venter et al., is based on the Invited Review A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children, DOI: 10.1111/cea.13087.

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The 100 most cited articles on oral cancer

Abstract

Background

Citations analysis is one of the most widely used bibliometric tools to evaluate the academic importance of a study in a specific area of knowledge. The objective of the present study was to identify the 100 most cited articles on oral cancer and to analyse their principal characteristics.

Methods

We performed a literature search in the Web of Science database using the Science Citation Index Expanded tool to determine the number of citations of all articles on oral cancer identified up to 10th August 2017. The 100 most referenced articles were then selected and the following information was gathered: ranking based on the number of citations; citation density; citations in Scopus; number and names of the authors; language and year of publication; country and institution of origin; financial support; journal of publication, with its impact factor, category and quartile; type of research; evidence level; and area of study.

Results

The number of citations of the 100 articles varied from 1959 to 165, and the number of authors from a single author to 23. The oldest article was from 1948 and the most recent was from 2013. All the studies were published in English, the majority (56%) was from the United States and 80% were published in journals in the first quartile.

Conclusions

The majority of articles were of studies that had received financial support, were published in journals with a high impact factor and were focussed on the aetiology and pathogenesis of oral cancer.

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Type-specific persistence and clearance rates of HPV genotypes in the oral and oropharyngeal mucosa in an HIV/AIDS cohort

Abstract

Background

Oral high-risk human papillomavirus (HR-HPV) infections are frequent and persistent among HIV-positive population and are associated with an increased risk for head and neck cancer (HNC). In this study, we sought to determine the incidence, persistence, and clearance of HPV-infections in oral and oropharyngeal samples from HIV/AIDS subjects.

Methods

A longitudinal, observational, and analytical study was performed with an ongoing cohort of HIV/AIDS subjects in Mexico City (September 2013-February 2015). The study was approved by institutional committees, and demographic and clinical data were registered. At the baseline and three-month visits, oral examinations and cytobrush samples were obtained. DNA was purified, quantified and used to detect an HPV-L1 gene fragment by nested-PCR, using MY09/MY11 and GP5+/GP6+ primers. HPV-DNA products were purified, sequenced, and typed according to HPV-databases. Risk factors were assessed, and a multivariate modelling approach was used to determine independent effects.

Results

This study included 97 HIV/AIDS individuals (91% men [86.4% of which are men who have sex with men], median age: 36 years, 72.2% under HAART). From the baseline visit, HPV was observed in 55.7% (HR-HPV: 26.8%; HPV-18: 24.1%), with a higher HPV-positive samples for smokers (61.1 vs. 32.6%, p=0.005). The three-month overall HPV-incidence was 33.9%; type-specific HPV persistence was 33.3% (HR-HPV: 13.3%); and 13 of the 33 (39.4%) baseline HPV-positive individuals cleared the infection (HR-HPV: 53.8%).

Conclusions

Although HR-HPV persistence was low, and clearance of the infection was observed in most cases, a close follow-up is necessary, given the increase of HNC among HIV-subjects, particularly HPV-related cancer.

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Use of polyphenols as a strategy to prevent bond degradation in the dentin–resin interface

This study evaluated the effect of dentin pretreatment with the polyphenols quercetin and resveratrol on the resin-dentin microtensile bonding strength (μTBS) and collagen fibrils stability of the adhesive interface. Different concentrations (100, 250, 500, or 1,000 μg ml⁻¹) of quercetin or resveratrol, or a mixture of quercetin and resveratrol (3:1, 1:1, 1:3; vol:vol), as well as distilled water or 2% chlorhexidine digluconate, were applied to etched dentin. Then, a two-step etch-and-rinse adhesive was applied followed by composite restoration. Measurements of resin–dentin μTBS were made after 1 and 120 d. The stability of collagen fibrils in the hybrid layer was evaluated using transmission electron microscopy. The Student's t-test and two-way factorial anova with Tukey's test were used to analyze the effects of dentin pretreatment and storage time on μTBS values. Comparisons between μTBS measurements made on 1 and 120 d showed that resveratrol had the best performance, with significantly higher μTBS values after 120 d for all concentrations of resveratrol tested. Quercetin pretreatment resulted in a significant rise of μTBS when used at concentrations of 100 and 500 μg ml⁻¹. Quercetin + resveratrol at the ratio of 1:1 performed better than when used at ratios of either 3:1 or 1:3. Resveratrol might represent a potential approach to achieve desirable bonding stability and reduce the frequent replacement of composite restorations.

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Flat-topped papules on the face of a young boy

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Extranodal natural killer/T-cell lymphoma, nasal type, in Senegal

Abstract

Introduction

The distribution of extranodal NK/T-cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub-Saharan Africa, despite the precocity of Epstein-Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal.

Methodology

A 5-year retrospective review of all patients with histopathological, immunohistochemical, and in situ hybridization proven cutaneous lymphomas

Results

We collected seven cases corresponding to a frequency of 1.4 cases per year. ENKTCL accounted for 10.5% of all cutaneous lymphomas, ranking second after T-cell lymphomas. Men were predominantly affected (M : F ratio of 6), and the mean age was 38.5 years ± 4.06. The mean time before consultation was 7.3 months. The lymphomas affected primarily the nasal cavity in five cases and the skin in two cases. At admission, six patients had nasal mucosa involvement, which was isolated in three cases, associated with cutaneous lesions in three cases and lymph node involvement in three cases. CD56 was positive in only one case, and Eber transcribed RNA of EBV was expressed by in situ hybridization in all patients.

Discussion

To our knowledge, we have reported the first and largest series of ENKTCL in Sub-Saharan Africa. Our study shows an intermediate prevalence between that reported from Asia, Latin America, and the West. It was also noted a young age of patients, a prolonged diagnostic delay, a frequent negativity of CD56 marker, and a very poor prognosis of the disease in our region.

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The treatment outcomes and dose de-escalation of desloratadine up-dosing in chronic spontaneous urticaria

Abstract

Background

An increase in dosages up to fourfold of second generation antihistamines is recommended for recalcitrant chronic spontaneous urticaria (CSU). No regimen guidelines about dose de-escalation, however, are mentioned once the disease is controlled.

Objective

To demonstrate the treatment outcomes and dose reduction in desloratadine assessed using the urticarial activity score over 7 consecutive days.

Methods

Medical records of all patients with CSU treated with desloratadine were collected retrospectively during a period from January 2010 to December 2013.

Results

Sixty-seven (94.4%) patients had remission of the disease with variable doses of desloratadine. The patients who had CSU concomitant with antithyroid antibodies or high erythrocyte sedimentation rates had a greater tendency not to respond to the standard dose. Once the disease was completely controlled, 67 patients finished the treatment, but 63 (94%) patients had recurrent symptoms. Sixty-three patients took the same dose that induced the response for a further 4 weeks before stopping or reducing the dose, 41/63 (65.1%), however developed urticaria again. Forty-one patients took the same dose for a further 8 weeks; only 2/41 (4.9%) patients developed the rash again. The mean follow-up period after the disease was controlled was 7.5 months.

Conclusion

Most patients need higher than the standard doses to obtain remission. Once the disease is completely controlled, however, maintenance of the same dosage for at least 8 weeks before dose reduction is suggested in order to avoid recurrence of the symptoms.

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A Practical Suggestion for Prepare Dorsal Onlay Graft

Nowadays, rhinoplasty is one of the most popular surgical procedures. Dorsal contour irregularities caused by various maneuvers, such as hump resection, are a major concern in patients who have undergone rhinoplasty. The most common graft used in this case is dorsal onlay graft which is made from sliced and crushed cartilage. Ear, nose and throat specialists usually use Swester table (mayo desk) for preparing the graft, if there is no other steril metal instrument. Crushed cartilage is done on a sterile gauze or on the tables' cover, as a result cartilage may be contaminated with particules from the tables' cover and sterile gauze. The authors recommend using the steril pack of a new sterilized surgical instrument opened on the table for the slicing or crushing process. In this way, the cartilage can be spared from contamination and the loss of some cartilage to the table during slicing or crushing can be prevented. Address correspondence and reprint requests to Fatih Arslan, MD, Department of Otolaryngology, Beytepe Murat Erdi Eker State Hospital, Beytepe 06500, Ankara, Turkey; E-mail: drfatiharslan@gmail.com Received 26 July, 2017 Accepted 18 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Impact of Velopharyngeal Surgery on the Polysomnographic Parameters After Cleft Palate Repair

Velopharyngeal surgical procedures may have adverse effect on the airway of the patients with velopharyngeal insufficiency (VPI). The aim of this study was to evaluate the polysomnographic parameters (PSG) in patients who underwent corrective surgery for treatment of VPI. The study included 39 patients who underwent 1 of 3 velopharyngeal surgical techniques; Furlow palatoplasty (12 patients), pharyngeal flap (18 patients), and sphincter pharyngoplasty (9 patients). The patients were subjected to PSG, and they were considered to have obstructive sleep apnea (OSA) with apnea-hypoapnea index (AHI) >1. Comparison of PSG parameters of patients showed insignificant difference regarding the total sleep time, sleep efficiency, arousal index, desaturation index, and minimum oxygen saturation. Significant difference was detected regarding peak end-tidal CO2 and AHI. Pharyngeal flap was detected as the most surgical technique that worsened the PSG parameters with OSA in 78% of patients, followed by sphincter pharyngoplasty with OSA in 56% of patients. Furlow palatoplasty was detected as the least impacting technique on the airway in 25% of patients who demonstrated OSA. In conclusion, velopharyngeal surgery has a variable impact on the PSG; pharyngeal flap has the most worsening effect followed by sphincter pharyngoplasty, while Furlow palatoplasty has the least adverse effect. Address correspondence and reprint requests to Mosaad Abdel-Aziz, MD, Address: 2 El-Salam St., King Faisal, above El-Baraka Bank, Giza, Cairo, Egypt; E-mail: mosabeez@yahoo.com Received 11 August, 2017 Accepted 10 November, 2017 The study was conducted in the Departments of Otolaryngology of both Cairo University and Beni Suef University, Egypt. The authors declare that they have no funding and conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cochlear Implantation in Postmeningitic Deafness

Purpose: The aim of this study is to evaluate long-term outcomes of cochlear implantation (CI) in patients with postmeningitic deafness. Methods: Twenty-seven patients with severe to profound hearing loss due to bacterial meningitis and received CI were the subjects of this study. Surgical findings and long-term audiological performances were evaluated. Speech perception and speech intelligibility of the implanted patients were evaluated with the categories of auditory performance–II (CAP-II) test and speech intelligibility rating (SIR) test, respectively. Results: Eighteen of the 27 patients had received full electrode insertion through the patent cochlear lumen. Remaining 9 patients had varying degrees of ossification throughout the cochlea and needed to be drilled to achieve partial electrode insertion. None of the patients exhibited surgical complication. Scores in both test batteries (CAP-II and SIR) were comparable between patients who received full or partial electrode insertion (P > 0.05). Conclusion: Cochlear implantation after postmeningitic deafness has favorable outcomes especially in long term. Although this type of inner ear pathology may require special considerations during surgery, it is a relatively safe procedure. Address correspondence and reprint requests to Tolgahan Catli, Saim Cikrikci Street, Karabaglar, Izmir; E-mail: tcatli80@hotmail.com Received 13 August, 2017 Accepted 9 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Novel PTCH1 Gene Mutation in Nevoid Basal Cell Carcinoma Syndrome

The purpose of this study was to report clinical characteristics, surgical results, and new PTCH1 gene mutations in nevoid basal cell carcinoma syndrome (NBCCS). Five patients were referred to the Department of Oral and Maxillofacial Surgery from local dental clinics between 2006 and 2016 to treat multiple keratocystic odontogenic tumors (KOTs). The cystic lesions were enucleated and peripheral ostectomy was performed to obtain safety margin. Recurrence and/or de novo development of KOT were assessed. Gene analysis using peripheral blood was performed in all patients to identify the mutation of PTCH1 gene. Three patients showed familial history of first-degree relatives. Of the major criteria, all patients presented KOT but only 1 patient had basal cell carcinoma. Of the minor criteria, 4 of the 5 patients presented macrocephaly and hypertelorism. During follow-up periods, all patients showed recurrence and/or de novo development of KOT in the jaw bone. Mutation analysis of PTCH1 gene showed 3 frameshifts (c.817_818ins(T), c.1226_1227ins(A), and c.2748del(C)), 1 splicing (c.1504-2A>T), and 1 missense (c.385T>C) mutation. Mutations were found in exon 1, 6, 9, 17, and intron 10. Regular follow-up is necessary because recurrence rate of KOT was very high. To help early diagnosis, it is essential to routinely perform genetic testing to detect PTCH1 gene mutations among patients with NBCCS. Address correspondence and reprint requests to Kang-Min Ahn, DDS, PhD, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Seoul Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; E-mail: ahnkangmin@hanmail.net Received 17 August, 2017 Accepted 18 October, 2017 YCS, G-HK, and S-WC all equally contributed as a first author. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Endoscopic Anatomic Study Via Grinding Partial Petrous Ridge to the Middle Fossa in Retromastoid Keyhole Approach

Objective: This study aimed to observe the range of exposure, indications, and feasibility of the retromastoid keyhole approach via grinding partial petrous ridge to the middle fossa. Methods: Simulated endoscopic surgeries via grinding suprameatal tubercle and petrous ridge to expose the middle fossa in retromastoid keyhole approach were performed on 8 adult cadaver heads (16 sides) fixed by formalin. The maximum exposure range in endoscope was observed. The boundaries of Parkinson triangle and the anatomic structures contained by Meckel cave and cavernous sinus (CS) lateral wall were revealed. The distances from midpoint of sigmoid sinus posterior border to every important anatomic structures in the middle fossa and the length of all sides of Parkinson triangle were measured. Results: By using endoscope, the exposure of the cerebellopontine angle, ventrolateral brainstem, incisure of tentorium, petroclival region, and CS lateral wall were satisfactory. Many important anatomic structures in middle fossa were exposed well. The distances from midpoint of posterior border of sigmoid sinus to suprameatal tubercle, trigeminal semilunar ganglion, posterior curve segment of internal carotid artery were 34.42 ± 2.14, 54.52 ± 2.87, and 65.15 ± 3.13 mm. The lengths of all sides of Parkinson triangle were 18.97 ± 2.93, 16.23 ± 2.02, and 8.04 ± 2.34 mm. Conclusion: The retromastoid keyhole approach via grinding partial petrous ridge to the middle fossa by using endoscope can increase the exposure of middle fossa effectively, which is proper for most lesions in posterior cranial fossa while some parts extend to middle fossa. Address correspondence and reprint requests to Hengzhu Zhang, MD, PhD, Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China; E-mail: zhanghengzhu@sina.com Received 31 August, 2017 Accepted 18 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Nickel–Titanium Wire as Suture Material: A New Technique for the Fixation of Skin

Purpose: To introduce nickel–titanium wire as suture material for closure of incisions in cleft lip procedures. Method: Closure of skin incisions using nickel–titanium wire as suture material, with postoperative follow-up wound evaluation. Results: There was excellent patient satisfaction and good cosmetic outcome. Conclusion: Nickel–titanium wire is an excellent alternative for suture closure of cleft lip surgical incisions. Address correspondence and reprint requests to Haidong Li, MD, Plastic Surgery Hospital of the Chinese Academy of Medical Science and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144, China; E-mail: lihaidong8@gmail.com Received 8 September, 2017 Accepted 12 October, 2017 This study was supported by the Capital Clinical Feature Applied Research Fund of China (Z161100000516155). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Treatment of Sagittal Fracture of the Zygomatic Arch Root Assisted by Surgical Navigation Technology

Sagittal fracture at the temporal root of the zygomatic arch often occurs as a part of zygomaticomaxillary fractures. The authors described the application of computer-assisted navigation in the lag screw insertion for the fixation of sagittal fracture at the temporal root of zygomatic arch. Using the presurgical planning of the computer-assisted navigation system, the trajectory of lag screw insertion was designed, and the insertion depth was calculated. In the presurgical planning, the trajectory of screw insertion was placed with an anterior inclination of 10° to 15° (mean: 12.24°), and the screw insertion depth was 9.0 to 12.0 mm (mean: 10.65 mm). In the operation, the screw insertion in the fixation of the sagittal fracture was performed under the guidance of navigation system according to the presurgical planning. The postoperative CT scan showed exact reduction and fixation of the sagittal fracture in all cases. Computer-assisted navigation is a useful tool for the lag screw insertion in the precise fixation of sagittal fracture at the temporal root of the zygomatic arch in complex zygomaticomaxillary fractures. Address correspondence and reprint requests to Zhi Li, MD, PhD, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan 430079, People's Republic of China; E-mail: zhili@whu.edu.cn Received 12 September, 2017 Accepted 18 October, 2017 This study was supported by the Fundamental Research Fund for the Central Universities of China (2042017kf0206) and the Scientific Research Project of the Health and Family Planning Commission of Hubei Province (WJ2017M047). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Morphometric Measurements of Bony Nasolacrimal Canal in Children

Objective: Morphology and dimensions of the bony nasolacrimal canal duct (BNLD) as a key factor in the development of primary acquired nasolacrimal duct obstruction. We aimed to obtain detailed morphometric analysis of BNLD in children without nasolacrimal duct pathology by using computed tomography and provide standard measurements by means of age which could be utilized in planning management or in invasive interventions. Methods: Picture Archiving Communication Systems database of our hospital's radiology department was searched for this retrospective study. Subjects were under 18 years of age who had undergone a paranasal, maxillofacial, or temporal bone high-resolution computed tomography scan in last 2 years with various indications. Those with fractures including facial bones and/or nasolacrimal canal or history of nasolacrimal duct pathology were excluded from the study. We measured the diameter, angle, and surface area of BNLD. Results: A total number of 136 subjects (86 boys, 50 girls) were included in the study. The average age was 7.3 ± 5.1 years. We documented statistically significantly positive correlation between all measured diameters and ages (P 0.050). Conclusion: Our study demonstrated that development of BNLD continues during childhood, regardless of gender. Address correspondence and reprint requests to Araz Server Ela, MD, Istanbul EğitimveAraştirma Hastanesi, Kulak BurunBoğazKliniği, KasapIlyasMah, Org. Abdurrahman NafizGürman Cad, Fatih, Istanbul 34098, Turkey; E-mail: serverela@hotmail.com Received 19 September, 2017 Accepted 12 November, 2017 This manuscript was presented in 8th National Congress of Istanbul Society of Otorhinolaryngology and Head & Neck Surgery, September 22–25, 2016, in Sakarya, Turkey. The authors have no conflicts of interest to report. © 2018 by Mutaz B. Habal, MD.

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Facial Fractures

Aims and Objectives: The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. Materials and Methods: This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols. All the data were analyzed using statistical analysis that is chi-squared test. Results: A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). Conclusion: This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc. Address correspondence and reprint requests to Dr Rajarshi Ghosh, SDM College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka 580009, India; E-mail: rg_everywhere@yahoo.co.in Received 25 April, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Decannulation and Airway Outcomes With Maxillomandibular Distraction in Treacher Collins and Nager Syndrome

Background: Treacher Collins syndrome is a rare disorder (1/50,000 live births) with features that include hypoplastic orbitozygomatic complex with downward slanting eyes, and maxillary/mandibular retrusion. Obstructive sleep apnea and tracheostomy-dependence are common. This study presents the outcomes of skeletal distraction on avoidance of tracheostomy and decannulation in this patient population. Methods: The authors reviewed charts of all patients with Treacher Collins syndrome who underwent craniofacial reconstruction from 2003 to 2016. Primary outcome measures included decannulation of tracheostomy dependent patients and avoidance of tracheostomy. Secondary outcome measures included cephalometric parameters, polysomnography scores, and airway exposure scores on direct laryngoscopy. Results: Twenty-five patients underwent mandibular and maxillary advancement to resolve upper airway obstruction. Mandibular distraction was performed in 24 of 25 patients, and maxillary distraction in 14 of 25 patients. Maxillary distraction was combined with mandibular distraction in 13 of 17 to accomplish greater advancement and counter-clockwise rotation of the entire maxillary-mandibular complex. Six of 7 patients, 85.7%, avoided a tracheostomy and 39% (7 of 18) were decannulated. Cephalometric changes in sella-nasion-A point, sella-nasion-B , occlusal plane angle, and posterior airway space were equivalent between the groups who were able to clear their obstruction and those who were not. Conclusions: Treacher Collins is a very challenging disease in which to resolve airway obstruction. Thus, thorough evaluation of the entire airway for all levels of obstruction is critical to successful outcomes. Future collaborative efforts between multiple institutions can help to increase our understanding and effective management of this rare disease. Address correspondence and reprint requests to Nataliya I. Biskup, MD, 3333 Burnet Avenue, Location D, Cincinnati, OH 45209; E-mail: nataliya.biskup@gmail.com Received 2 May, 2017 Accepted 12 October, 2017 This article was presented at The American Society of Craniofacial Surgery Meeting January 23, 2017, Maui, HI. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Treatment of Mandibular Ameloblastoma Involving the Mandibular Condyle: Resection and Concomitant Reconstruction With a Custom Hybrid Total Joint Prosthesis and Iliac Bone Graft

Aim: To describe the treatment of ameloblastoma involving the mandibular body and condyle in 3 patients. Methods: This report describes 3 patients with large ameloblastomas (2 were second recurrences) treated by partial mandibular resection. Involvement of the mandibular condyle in these 3 patients made the reconstruction more challenging. Reconstruction included immediate temporomandibular joint replacement by a custom-made alloplastic total joint and mandibular body (Zimmer-Biomet, Jacksonville, FL). These devices were designed using virtual surgical planning software. The 3 patients underwent concomitant bone graft reconstruction using autogenous-free corticocancellous block bone grafts from the iliac crest. This facilitated later dental implant placement and full dental rehabilitation. Direct inferior alveolar nerve repair or nerve graft reconstruction with allograft was also carried out for all 3 patients. Maxillomandibular fixation was not used in all 3 patients. Results: All the 3 patients underwent successful surgery and recovery. Mandibular function was preserved. The concomitant bone graft allowed successful dental implant placement for subsequent planned restorative dentistry. Conclusion: Ameloblastoma involving the mandibular condyle can be successfully treated by resection and concomitant total joint replacement with an alloplastic device. This technique shows promise in that there is rapid return to excellent function thanks to rigid fixation of the construct. Mirroring software used in the prosthesis design facilitates excellent cosmetic outcomes. Address correspondence and reprint requests to Mathilde Sarlabous, DMD, FRCDC, MSc, Fountain View Oral Facial and Implant Surgery, 4288 Village Centre Court, 1st Floor, Mississauga, Ontario, Canada L4Z 1S2; E-mail: contact.sarlabous@gmail.com Received 17 June, 2017 Accepted 12 December, 2017 DJP occasionally presents continuing education seminars on behalf of Zimmer Biomet. No compensation was received for this study. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Trismus in Face Transplantation Following Ballistic Trauma

Background: Trismus can be a challenging consequence of ballistic trauma to the face, and has rarely been described in the setting of face transplantation. Almost half of all current face transplant recipients in the world received transplantation to restore form and function after a ballistic injury. Here we report our experience and challenges with long standing trismus after face transplantation. Methods: We reviewed the medical records of our face transplant recipients whose indication was ballistic injury. We focused our review on trismus and assessed the pre-, peri- and postoperative planning, surgery and functional outcomes. Results: Two patients received partial face transplantation, including the midface for ballistic trauma. Both patients suffered from impaired mouth opening, speech intelligibility, and oral competence. Severe scarring of the temporomandibular joint (TMJ) required intraoperative release in both patients, and additional total condylectomy on the left side 6 months posttransplant for 1 patient. Posttransplant, both patients achieved an improvement in mouth opening; however, there was persistent trismus. One year after transplantation, range of motion of the jaw had improved for both patients. Independent oral food intake was possible 1 year after surgery, although spillage of liquids and mixed consistency solids persisted. Speech intelligibility testing showed impairments in the immediate postoperative period, with improvement to over 85% for both patients at 1 year posttransplant. Conclusions: Ballistic trauma to the face and subsequent reconstructive measures can cause significant scarring and covert injuries to structures such as the TMJ, resulting in long standing trismus. Meticulous individual planning prior to interventions such as face transplantation must take these into account. We encourage intraoperative evaluation of these structures as well as peri- and postoperative treatment when necessary. Due to the nature of the primary injury, functional outcomes after face transplantation in these patients may differ substantially from those of other indications. Address correspondence and reprint requests to Edward J. Caterson, MD, Division of Plastic Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; E-mail: ecaterson@bwh.harvard.edu Received 7 July, 2017 Accepted 6 October, 2017 Drs Pomahac, Krezdorn and Bueno receive partial salary support from a research contract with the United States Department of Defense (#W911QY-09-C-0216). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the United States Department of Defense. The authors report no funding and conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Bone-Conditioned Medium Obtained From Calvaria, Mandible, and Tibia Cause an Equivalent TGF-β1 Response In Vitro

Bones with different embryological origin and mode of ossification are supposed to vary in their capacity for supporting graft consolidation. The aim of the current pilot study was to assess the TGF-β1 activity of bone chips obtained from distinct anatomic locations. Conditioned medium was prepared from bone chips harvested from pig calvaria, mandible, and tibia. Human oral fibroblasts were exposed to bone-conditioned medium (BCM) followed by reverse transcriptase polymerase chain reaction of the TGF-β1 target genes. Also an immunoassay for interleukin 11 (IL-11) and TGF-β1 was performed. The impact of BCM on alkaline phosphatase activity was determined with murine MC3T3-E1 osteogenic cells. The authors report here that BCM contains TGF-β1 in the ng/mL range. Bone chips prepared from pig calvaria, mandible, and tibia femur had a similar capacity for increasing the expression of the TGF-β1 target genes IL-11, NOX4, and PRG4. Correspondingly, immunoassays revealed similar production of IL-11 by human oral fibroblasts. Furthermore, conditioned medium obtained from the 3 bones decreased alkaline phosphatase activity in MC3T3-E1 osteogenic cells. These preliminary data demonstrate that particulated bone grafts, regardless of embryological origin, mode of ossification and morphology, release a similar TGF-β1 activity. Address correspondence and reprint requests to Reinhard Gruber, PhD, Department of Oral Biology, School of Dentistry, Medical University of Vienna, Sensengasse 2a, A-1090 Vienna, Austria; E-mail: reinhard.gruber@meduniwien.ac.at Received 10 July, 2017 Accepted 30 September, 2017 BHK and JRGM have contributed equally to this work. This research was partially funded by the Herzfeld Familienstiftung, the Osteology Foundation grant no 14-126 and the School of Dentistry of the Medical University of Vienna. The authors disclosure funding received for this work from National Institutes of Health; Wellcome Trust; Howard Hughes Medical Institute; and other(s). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2DL5BDc

Posterior Vault Distraction Osteogenesis in Nonsyndromic Patients: An Evaluation of Indications and Safety

Purpose: The purpose of this study was to evaluate the indications, safety, and short-term outcomes of posterior vault distraction osteogenesis (PVDO) in patients with no identified acrocephalosyndactyly syndrome (study) and to compare those to a syndromic cohort (controls). Methods: Demographic and perioperative data were recorded and compared across the study and control groups for those who underwent PVDO between January 2009 and December 2016. Univariate analysis was conducted using χ2 and Fisher exact tests for categorical variables, and Mann–Whitney U test for continuous variables. Results: Sixty-three subjects were included: 19 in the nonsyndromic cohort, 44 in the syndromic cohort. The cohorts had similar proportion of subjects exhibiting pansynostosis (42.1% of nonsyndromic versus 36.4% of syndromic, P = 0.667). The nonsyndromic cohort was significantly older (4.04 ± 3.66 years versus 2.55 ± 3.34 years, P = 0.046) and had higher rate of signs of raised intracranial pressure (68.4% versus 25.0%, P = 0.001) than the syndromic cohort. There was no significant difference in perioperative variables or rate of complications (P > 0.05). The mean total advancement distance achieved was similar, 27 ± 6 mm in the nonsyndromic versus 28 ± 8 mm in the syndromic cohort (P = 0.964). All nonsyndromic subjects with signs of raised intracranial pressure demonstrated improvement at an average follow-up of 22 months. Conclusion: As in the syndromic patient, PVDO is a safe and, in the short-term, effective modality for cranial vault expansion in the nonsyndromic patient. The benefits and favorable perioperative profile of PVDO may therefore be extended to patient populations other than those with syndromic craniosynostosis. Address correspondence and reprint requests to Dr Jesse A. Taylor, MD, Department of Surgery, The Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Building, 9th floor, 3501 Civic Center Boulevard, Philadelphia, PA, 19104; E-mail: jataylor@gmail.com Received 28 July, 2017 Accepted 3 October, 2017 This study has been approved by the Institutional Review Board for research involving human subjects at the Children's Hospital of Philadelphia. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Spring-Mediated Cranioplasty in Sagittal Synostosis: Does Age at Placement Affect Expansion?

Purpose: The aim of this study is to evaluate the effect of timing of surgery and spring characteristics on correction of scaphocephalic deformity in patients undergoing spring-mediated cranioplasty (SMC) for sagittal craniosynostosis. Methods: The authors conducted a review of patients with sagittal craniosynostosis who underwent SMC at a tertiary referral center between July 2011 and March 2017, with a primary outcome measure of head shape, both preoperatively and postoperatively, determined by cephalic index (CI). Patient demographics and operative details including timing of surgery and spring characteristics were collected. Differences in CI preoperation and postoperation were compared using Wilcoxon signed-rank test. Ordinary least-squares linear regression was used to assess the impact of timing, number of springs, maximum single spring force, and total spring force on postoperative change in CI. Results: Thirty-six subjects (12 males and 24 females) were included in the study. Mean age at spring placement was 3.9 months (range: 1.9–9.2) with a mean follow-up of 1.4 years (range: 0.3–5.2). The mean number of springs used was 3 (range: 2–4). The mean maximum single spring force was 9.9 Newtons (N) (range: 6.9–13.0) and the mean total spring force was 24.6 N (range: 12.7–37.0). Mean CI increased from 70 ± 0.9 preoperatively to 77 ± 1.0 postoperatively (P

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Quantification of Surgical Route Parameters for Exposure of the Jugular Foramen Via a Trans-Mastoidal Approach Exposing Jugular Foramen in Three-Dimensional Visualization Model

Objective: Surgical operation within the region of the jugular foramen presents a great challenge. The authors characterized the quantitative impact of surgical window parameters on the exposure of the jugular foramen via a trans-mastoidal approach. Methods: Computed tomography and magnetic resonance imaging data were used to establish a 3-dimensional model of the jugular foramen region. The mastoidale, posterior edge of the mastoid, and the superior edge of the bony external acoustic meatus were selected as points a, b, and c. The anterior edge of the tuberculum jugulare was selected as point d. The midpoints of line segments ab, ac, and bc were selected as points e, f, and g. Triangle abc was divided into triangles aef, beg, cfg, and efg. Surgical corridors of the triangular pyramid were outlined by connecting the above triangles to point d. Anatomic exposure was evaluated by measuring the area and volume of various structures within each route. Statistical comparisons were performed via analysis of variance. Results: The model allowed for adequate visualization of all structures. The areas of triangles beg and efg were greater than those of triangles aef and cfg (P

http://ift.tt/2EnCs1H

Cone-Beam Computed Tomography-Based Three-Dimensional McNamara Cephalometric Analysis

This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries. Address correspondence and reprint requests to José Mario De Martino, Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação, Av. Albert Einstein, 400, Cidade Universitária "Zeferino Vaz", Barão Geraldo, Campinas, São Paulo 13083-852, Brazil; E-mail: martino@fee.unicamp.br Received 9 May, 2017 Accepted 5 October, 2017 This work was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES), a foundation within the Ministry of Education in Brazil. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Intralesional Bleomycin Injection for Propranolol-Resistant Hemangiomas

Propranolol has been the first-line treatment for alarming hemangiomas. However, some hemangiomas are propranolol-resistant. The authors reported 1 propranolol-resistant hemangioma which was treated with intralesional bleomycin injections. Sixteen months after 3 injections, the lesion still remained stable. Its potential mechanism was clarified by ultrasonic monitoring. Intralesional bleomycin injection can be considered an ideal option in treating propranolol-resistant hemangiomas. Address correspondence and reprint requests to Xiaoxi Lin, MD, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Zhizaoju Road, Shanghai 200011, China; E-mail: linxiaoxi@126.com Received 7 November, 2016 Accepted 27 August, 2017 The first 2 authors contributed equally to this work and should be viewed as co-first authors. This study was supported by grants of the National Natural Science Foundation of China (81272127, 81601699) and the Joint Research Project on Important Disease of Shanghai Health System (2013ZYJB0014). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2ElzUkN

Modified Methods of Fabricating Helix and Antihelix in Total Auricular Reconstruction Based on Different Length of Eighth Costal Cartilage

Background: Attaining an ideal appearance of the reconstructed ear depends primarily on the fabricated cartilaginous ear framework. Despite the role of eighth costal cartilage, the length of the eighth rib cartilage is difficult to anticipate, and growth of the eighth cartilage is variable. The authors discussed modified methods of fabricating helix and antihelix based on different length of eighth costal cartilage. Methods: Based on the actual length of the eighth costal cartilage, patients were divided into group A and group B. In group A, the eighth costal cartilage was divided into 2 parts. Part I was used to fashion the helix, whereas part II was used to fabricate the antihelix and superior crus. In group B, the seventh costal cartilage was cut into 3 parts. Part I and part II were used to fashion the helix, antihelix, and superior crus as group A did. Part III was assembled to the lateral part of the framework to form the inferior crus. Results: A total of 56 patients underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle. Conclusions: Based on different length of eighth costal cartilage, modified methods of fabricating helix and antihelix make full use of the autogenous costal cartilage, elevate anatomical details, and enhance the overall aesthetics of reconstructed ear. The great majority of patients have satisfactory surgical outcomes, demonstrating that personalized treatment is necessary. Address correspondence and reprint requests to Bo Pan, PhD, Department of Auricular Reconstruction, Plastic Surgery Hospital, Badachu Road 33, Beijing 100144, China; E-mail: 15098733987@126.com Received 13 December, 2016 Accepted 24 August, 2017 Ethical approval: The study was approved by the Ethics Committee of the Plastic Surgery Hospital, the Peking Union Medical College, and the Chinese Academy of Medical Sciences. This work was supported by the Chinese National Natural Science Foundation (No.81272124). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2DNe5tz

Longitudinal Study of Scar Hyperplasia Formation Following Cleft Lip Wound Healing

The purpose of this study was to observe the hyperplasia trend of scar after the cleft lip surgery in a rabbit animal model, and determine the time-point of the highest hypertrophic degree of scar after cleft lip repair. Forty New Zealand white rabbits from the same offspring were used to establish a cleft lip wound healing model using Millard surgery procedure. The scar volumes were measured and granulation tissues were observed visually in the 2, 3, 4, and 5 weeks after operation. The scar tissues were harvested at the indicated time-points. Immunohistochemical (IHC) and Western Blot analyses were performed to detect the expression level of α-smooth muscle actin (α-SMA) in the scar tissue. The scars shrunk and the volumes reduced at 3 to 4 weeks after surgery; however, at 5 weeks postsurgery, the volumes increased. IHC and Western blot analyses indicated the expression of α-SMA was significantly enhanced 3 to 4 weeks, but reduced in the 5 weeks after surgery. Overall, the degree of scar hyperplasia after cleft lip surgery in rabbits was normally distributed and the scarring was most severe in the 3 to 4 weeks after cleft lip surgery. The study confirms a novel animal model for the assessment of therapies for the treatment of scar hyperplasia of human cleft lip in future. Address correspondence and reprint requests to Wen-lin Xiao, PhD, MD, Department of Stomatology, The Affiliated Hospital of Qingdao University; The Key Laboratory of Oral Medicine, Shandong Province Education Department; No. 16, Jiangsu Road, Qingdao 266003, the People's Republic of China; E-mail: wenlinxiao@sina.com Received 3 June, 2017 Accepted 29 November, 2017 D-zZ and FL contributed equally to this work. This work was financially supported by Natural Science foundation of Shandong Province (ZR2015HM022). The authors report no conflicts of interes. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2Emjp80

Glycyl tRNA Synthetase (GARS) Gene Variant Causes Distal Hereditary Motor Neuropathy V

Distal hereditary motor neuropathies (dHMN) are a rare heterogeneous group of inherited disorders specifically affecting the motor axons, leading to distal limb neurogenic muscular atrophy. The GARS gene has been identified as a causative gene responsible for clinical features of dHMN type V in families from different ethnic origins and backgrounds. We present the first cohort of family members of Nigerian descent with a novel heterozygous p.L272R variant on the GARS gene. We postulate that this variant is the cause of dHMN-V in this family, leading to variable phenotypical expressions that are earlier than reported in previous cases. The exact cause for the observed clinical heterogeneity within the family is unknown. One explanation is that there are modifier genes that affect the phenotype. These cases highlight the possibility of considering pathogenic variants in the GARS gene as a potential cause of early onset axonal polyneuropathy with atypical presentation.

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Management of comedonal acne vulgaris with fixed-combination topical therapy

Summary

Background

Acne vulgaris (acne) is the most common skin disease we see in dermatology practice. Clinically, it is characterized by a combination of open and closed comedones (formally referred to as noninflammatory lesions) and inflammatory papules and pustules. Comedonal acne is more typical in young adolescents, but can occur in combination with inflammatory papules and pustules at any time. Topical retinoids have long been advocated for the treatment of comedonal acne.

Aims

Given the increasing recognition of the inflammatory nature of acne and the synergistic benefits seen with fixed combinations we review the latest clinical data to provide guidance on optimal management of comedonal acne.

Methods

An English language literature search of Medline, EMBASE, and the Web of Science using key terms (acne, comedonal, noninflammatory, clinical trials) was conducted, and relevant articles reviewed.

Results

Comparative data is sparse, but we show the importance of fixed combinations with and without retinoids, where treatment benefits are comparable. Adapalene 0.1%-benzoyl peroxide 2.5% gel has been shown to be comparable to clindamycin 1%-benzoyl peroxide 5% gel, and adapalene 0.3%-benzoyl peroxide 2.5% gel. A meta-analysis suggested that clindamycin 1.2%-benzoyl peroxide 2.5% gel was more effective than clindamycin-benzoyl peroxide 5% gel in noninflammatory lesions, and two equivalent clinical programs suggest additional benefits of higher doses of benzoyl peroxide (3.75% vs 2.5%) in this fixed combination.

Conclusions

Clindamycin 1.2%-benzoyl peroxide 3.75% gel may afford similar benefits to adapalene 0.3%-benzoyl peroxide 2.5% gel in this sometimes difficult to treat patient population.

http://ift.tt/2nlZqPL

Does cochlear implant brand influence patient satisfaction? A survey of 102 cochlear implant users

Abstract

Patients and parents in particular can find the decision regarding which device to have implanted difficult due to the amount of often complicated information that is available. The desire to choose the 'right' implant for themselves or their child takes on great importance due to the finality of the procedure.

There is some evidence that certain patient expectations may be linked to brand choice and marketing strategies.

This study showed that importance of language development was strongly linked with a MED-EL device, and speech improvement with Advanced Bionics.

Despite marketing strategies put forth by the three major cochlear implant companies claiming superiority over each other, there seems to be an equal level of patient satisfaction regardless of the device implanted.

The results of this study can also be seen as good news for industry in that all three brands seem to be at least equivalent in their desired outcomes; however, these results may also be seen as a potential catalyst for a change in marketing strategy.

http://ift.tt/2Fq25OT

Αρχειοθήκη ιστολογίου

Τρίτη 30 Ιανουαρίου 2018

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