Micronuclei in Exfoliated Oral Epithelial Cells in Tobacco Users and Controls with Various Oral Lesions: A Study from Gujarat, India

Abstract

To assess and compare cytogenic damage in the form of micronuclei in various oral lesions according to duration and frequency of tobacco use. The present cross sectional study was carried out from October 2015 to October 2016. We included total 420 cases with 60 cases in each of the following subgroups, no tobacco habit with no obvious oral lesion (control) and tobacco habit with no obvious oral lesion, oral sub mucous fibrosis, leukoplakia, melanoplakia, erythroplakia, oral squamous cell carcinoma. Oral mucosal cells were collected from both sides of cheek; slides were prepared and examined for cells with micronuclei. The mean micronuclei index distribution in control group, potentially malignant group, and malignancy group was 1.14, 2.63, and 4.88 respectively and was statistically significant. The mean micronuclei index in control group, smoking tobacco and smokeless tobacco group was 1.14, 2.64, and 2.76 and was statistically significant. The mean micronuclei index was significantly higher in those using tobacco, for longer duration and with frequent tobacco use. The mean micronuclei index can be used as a potential screening tool of genotoxic damage and biomarker for epithelial carcinogenesis. The method has practical utility for warning tobacco users that higher than range has a danger of malignant event and therefore this in future can be used as reinforcement to advice of avoiding tobacco before malignancy develops.

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Auditory Lateralization Training Effects on Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Abstract

Many children with central auditory processing disorder (C)APD suffer from spatial processing disorder and benefit from binaural processing training including auditory lateralization training. There are subjective tests for evaluating auditory training effects in children with (C)APD but they rely on patient's attention and cooperation so there is a need for appropriate objective tests. The aim of present study was investigating effects of auditory lateralization training on binaural interaction component (BIC) of middle latency response (MLR). This study was an analytical interventional study. Sixty children suspected to (C)APD (40 boys and 20 girls) were selected based on inclusion criteria and were divided into two groups: control and training group. Auditory lateralization training included 12 formal sessions under headphone by using interaural time difference and performed as a game. MLR (monaural right ear, monaural left ear and binaural) and monaural selective auditory attention test (mSAAT) tests were performed in all the cases. BIC was calculated by subtracting binaural response from summed monaural responses. Covariance test showed that BIC latency decreased and BIC amplitude increased significantly and mSAAT score increased significantly in training group after auditory lateralization training (p value ≤ 0.001). In present study BIC of MLR had potential to show underlying neurophysiologic changes after auditory lateralization training in children suspected to (C)APD objectively. It is in agreement with behavioral improvements after training (mSAAT improvements).

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The effect of statins on periodontal treatment—a systematic review with meta-analyses and meta-regression

Abstract

Objective

This study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical attachment level, and intrabony defects, in comparison to mechanical periodontal therapy alone or in association with placebo.

Material and methods

Three databases were searched for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment. Weighted mean differences between baseline and 6 months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated. A high heterogeneity was detected. Therefore, a meta-regression adjusted for type of statin and year of publication was performed.

Results

Fifteen studies were included in the systematic review, and ten studies were included in the meta-analysis. In the meta-regression, the adjunct use of simvastatin, rosuvastatin, and atorvastatin additionally reduced PPD in comparison to mechanical periodontal therapy and a placebo gel (2.90 ± 0.35, 3.90 ± 0.77, 3.06 ± 0.71 mm, respectively; p < 0.05). Regarding the resolution of IBD, simvastatin and rosuvastatin significantly improved in comparison to control group (0.89 ± 0.35 and 1.93 ± 0.77 mm, respectively; p < 0.05). No statistically significant difference was found between the statins for both PPD and IBD (p < 0.05). Regarding CAL gain, simvastatin provided a statistically significant improvement as compared to the control group (2.02 ± 0.79 mm; p = 0.043).

Conclusions

The use of statins, used as sole adjuncts to mechanical periodontal treatment, improved the periodontal parameters. In the quantitative analyses, simvastatin was the only drug that showed additional benefits in all evaluated parameters.

Clinical relevance

Statins promote significantly clinical periodontal improvements when administered in association with non-surgical scaling and root planning (SRP), when compared to SRP alone or in association with a placebo.

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A novel tubulin inhibitor STK899704 induces tumor regression in DMBA/TPA induced skin carcinogenesis model

Abstract

Skin cancer is the most common type of cancer. The incidence rate of skin cancer has continuously increased over the past decades. In an effort to discover novel anticancer agents, we identified a novel tubulin inhibitor STK899704 which is structurally distinct from other microtubule-binding agents such as colchicine, vinca alkaloids, and taxanes. STK899704 inhibited microtubule polymerization leading to mitotic arrest, and suppressed the proliferation of various cancer cell lines as well as multidrug-resistance cancer cell lines. In this study, our investigation is further extended into animal model to evaluate the effect of STK899704 on skin carcinogenesis in vivo. Surprisingly, almost 80% of the tumors treated with STK899704 were regressed with a one fifth reduction in tumor volume. Furthermore, the efficacy of STK899704 was nearly two times higher than that of 5-fluorouracil, a widely used skin cancer therapeutic. Overall, our results suggest that STK899704 is a promising anticancer chemotherapeutic that may replace existing therapies, particularly for skin cancer.

This article is protected by copyright. All rights reserved.

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Eicosapentaenoic acid ethyl ester ameliorates atopic dermatitis-like symptoms in special diet-fed hairless mice, partly by restoring covalently bound ceramides in the stratum corneum

Abstract

Skin barrier dysfunction has a key role in the development of atopic dermatitis (AD). Covalently bound ceramides (Cer), which are essential lipids for permeability barrier homeostasis, are reportedly decreased in the stratum corneum (SC) of AD patients. Hairless mice fed a special diet develop pruritic dermatitis resembling human AD. Our previous study found that oral administration of the n-3 polyunsaturated fatty acid α-linolenic acid ameliorated skin barrier dysfunction in AD mice with concomitant increase in serum eicosapentaenoic acid (EPA). In this study, we examined the effects of EPA ethyl ester (EPA-E) on diet-induced AD in hairless mice. Oral administration of EPA-E ameliorated skin barrier dysfunction and pruritus in AD mice. In the SC of AD mice, covalently bound Cer were markedly diminished. EPA-E administration restored the lack of bound Cer. Our findings imply the possible therapeutic clinical application of EPA-E in the treatment of human AD.

This article is protected by copyright. All rights reserved.

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An efficient method for eccrine gland isolation from human scalp

Abstract

We describe a simple and efficient method to isolate eccrine sweat glands from the human scalp. This method is inspired by the hair graft harvesting method used in hair transplantation. Based on the recently described anatomical relationship between the scalp hair follicle and the eccrine gland, we have found that scalp follicular unit grafts are an excellent eccrine gland isolation source, especially for the coiled component. In order to make the gland visible for stereoscopic microdissection, the follicular units need to be previously stained with a vital dye like Methylene Blue or Neutral Red. The simplicity and efficiency of this isolation method should encourage further research into human eccrine sweat gland function which has always been hindered by the difficulty of gland isolation.

This article is protected by copyright. All rights reserved.

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Leiomyoma of the soft palate: Case report and review of articles

Publication date: Available online 1 February 2018
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Fahd Alharbi
Leiomyomas are benign tumors arising from smooth muscle, most commonly seen in uterine myometrium, gastrointestinal tract, skin and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity and leiomyomas of head and neck region account for less than 1% of all leiomyomas. The purpose of this article is to present a case of 18 years old male patient with a history of several months of oral leiomyoma on the right side of the soft palate. The clinical features, differential diagnosis and management of leiomyoma are discussed with review of the literatures.



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Ken Hashimoto, M.D., Ph.D. (1931–2017): A tribute

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Issue Information

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Issue Information

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Alterations of the Gut Microbiota in Hashimoto's Thyroiditis Patients

Thyroid , Vol. 0, No. 0.


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The Vitamin D3 analogue calcipotriol suppresses CpG-activated TLR9-MyD88 signalling in murine plasmacytoid dendritic cells

Summary

Background

Plasmacytoid dendritic cells (pDCs) are involved in the pathogenesis of psoriasis by secreting interferon-α. Vitamin D3 analogues are widely used to treat psoriasis, and the representative analogue calcipotriol (CAL) uniquely downregulates the cytokine production and chemotactic activity of pDCs. However, the molecular mechanism of action of CAL is not well understood.

Aim

To investigate effects of CAL on the Toll-like receptor 9–myeloid differentiation primary response gene 88 (TLR9-MyD88) signalling pathway, which induces cytokine production, in murine pDCs.

Methods

pDCs were isolated from mouse spleen cells by negative selection or were generated from mouse bone-marrow cells, and were stimulated with CpG-oligodeoxynucleotide (ODN) with or without CAL for 24 h. mRNA expression of TLR9 and MyD88 was assessed by real-time PCR, and the amount of TLR9 was measured by western blotting.

Results

CAL suppressed the CpG-ODN-induced increased expression of MyD88 and TLR9 in pDCs.

Conclusions

CAL may downregulate pDCs by inhibiting TLR9-MyD88 signalling.

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Issue Information - TOC

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Issue Information - Cover

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Editorial echoes

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Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO2 laser in the treatment of immature red hypertrophic scars

Summary

Introduction

The objective was to investigate the clinical effect of an adjustable pulse width Pulsed Dye Laser (PDL) vs an adjustable pulse width PDL combined with fractional CO₂ laser in treating immature red hypertrophic scars.

Methods

Fifty-six patients (56 sites)were randomly divided into a treatment group and control group. The control group was treated with the 595 nm PDL at a fluence of 7-15J/cm² and pulse widths of 1.5-3 ms, 7 mm spot size. The treatment group was treated with a fractional CO₂ laser (UltraPulse CO₂: Deep FX, Energy: 30~50 mJ, Frequency: 300 Hz, Density 5%, Scan Shape, and Spot Size were decided by shape and area of scar) after utilizing the 595 nm adjustable pulse width PDL (Fluence: 7-15J/cm², Pulse widths: 1.5-3 ms, Spot size: 7 mm). MEBT/MEBO, previously described as a post-treatment wound ointment, was used after laser treatment. The scars of the treatment group and the control group were evaluated for changes in pigment, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) after two laser treatments.

Results

The total VSS score, as well as the score for melanin, height, vascularity, pliability in both groups, showed an obvious decrease following the treatments. There were statistically significant differences between before treatment and after treatment (P < .05); however, the total score of the VSS, and score of the melanin, height, vascularity, and pliability in the control group decreased more than that of treatment group, and there was a statistically significant difference (P < .05).

Conclusions

The 595 nm adjustable pulse width PDL combined with the fractional CO₂ fractional laser appears to have a beneficial clinical effect on fresh red hypertrophic scars, with no severe adverse reactions seen.

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The Audiology of Otosclerosis

Diagnostic audiologic procedures for otosclerosis are effective tools in identifying this condition. Audiometric data usually demonstrate a conductive hearing loss at the early stages of otosclerosis. Modern middle ear analysis procedures are becoming more popular in the better diagnosis of otosclerosis. In clinical practice, cochlear otosclerosis can also be observed. Audiologic rehabilitation of otosclerosis includes fitting of hearing aids and implantable hearing devices. Current hearing technology enables patients who do not pursue surgical correction to function well and significantly improve their communication and quality of life. Otosclerosis may also be associated with annoying tinnitus, and tinnitus management is important in the rehabilitation process.

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Stapedectomy Versus Stapedotomy

Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates. Modified stapes mobilization procedures may represent the next major development in stapes surgery in a selected patient population.

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Corrigendum to “Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology” [Br J Oral Maxillofac Surg 2017;55(November (9)):946–51]

The authors regret missing the below supplementary video clip from their above referenced manuscript.

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Post-Operative Radiotherapy for Oral SCC with Histologic Risk Factors: Are We Over-Treating?

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Timothy Liu, Benjamin Chua, Martin Batstone
PurposeThe role of post-operative radiotherapy (PORT) remains controversial for patients with low-risk oral squamous cell carcinoma (OSCC) and adverse histologic features. The aim of this study is to examine the survival benefits in the role of PORT, when compared to surgery alone, among these patients.MethodsIn a systematic review, relevant published literature was identified in the PubMed database and eligible studies were included. Predictor variables were perineural invasion (PNI), lymphovascular invasion (LVI), and unfavourable grade. Primary outcomes were patient survival and recurrence rates. Due to the heterogeneity and insufficiency of the reported data, quantitative meta-analysis was precluded. Qualitative analysis and pooled analysis on overall survival (OS) were performed on study subjects.ResultsSix eligible studies were included with a median study period of 10 years. All studies evaluated the role of PORT in pN0 OSCC subjects with PNI, and three studies on subjects with PNI in isolation. Overall, study subjects had similar treatment outcomes between PORT and non-PORT groups. In the pooled analysis of 325 subjects, PORT was not associated with an improved OS compared to surgery alone (70.3 vs. 80.2%; p = 0.059).ConclusionNo evidence was found to support the application of PORT given the indication of histologic risk factors alone. The prescription of PORT for PNI, LVI, and unfavourable grading among otherwise low-risk OSCC needs to be approached with caution in order to avoid unnecessary harm of radiation exposure.



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Corrigendum to “Oral cancer-derived exosomal NAP1 enhances cytotoxicity of natural killer cells via the IRF-3 pathway” [Oral Oncol. 76 (2018) 34–41]

Publication date: Available online 1 February 2018
Source:Oral Oncology
Author(s): Yingnan Wang, Xing Qin, Xueqin Zhu, Wanjun Chen, Jianjun Zhang, Wantao Chen




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Reply to: professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

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History of anaesthesia: Nurse anaesthesia practice in the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America)

Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of Seven (G7) countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America) and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other G7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II.

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Reply to: emergency medicine is about collaboration, not monopolisation

No abstract available

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Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test

BACKGROUND Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se. OBJECTIVES The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo. DESIGN Randomised, placebo-controlled cross-over study. SETTING Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014. PARTICIPANTS Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials. INTERVENTIONS At separate study sessions, participants received interventions: esmolol (0.7 mg kg−1 bolus over 1 min followed by infusion at 10 μg kg−1 min−1); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg−1 min−1 and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min. MAIN OUTCOME MEASURES Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively. RESULTS Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (−1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference −3.1 (95% confidence interval (−4.4 to −1.8)), P 

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Anaesthesiology and ethics: Can the anaesthesiologist ameliorate simply and rapidly the assessment of decision-making capacity in the elderly?

No abstract available

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Standardised noxious stimulation-guided individual adjustment of remifentanil target-controlled infusion to prevent haemodynamic responses to laryngoscopy and surgical incision: A randomised controlled trial

BACKGROUND The surgical plethysmographic index (SPI) is one of the available indexes of the nociception–antinociception (NAN) balance. Individually adjusting the NAN balance to prevent somatic responses to noxious stimulation remains a challenge. OBJECTIVES To assess whether guiding remifentanil administration according to the SPI response to a calibrated noxious stimulus (NANCAL) can blunt the haemodynamic response to tracheal intubation and surgical incision. DESIGN Randomised multicentre study. SETTING Two Belgian university hospitals from January 2014 to April 2015. PATIENTS After ethic review board approval and informed consent, 48 American Society of Anesthesiologists I or II adult patients scheduled for surgery under general anaesthesia were enrolled. INTERVENTIONS Patients were randomly assigned to a SPI group, where remifentanil effect-site concentration was adjusted according to NANCAL, or a control group, where it was fixed at 4 ng ml−1. Propofol concentration was always adjusted to maintain the bispectral index close to 40. NANCAL consisted of a 100 Hz, 60 mA electrical tetanic stimulation during 30 s at the wrist before tracheal intubation and before surgical incision. MAIN OUTCOME MEASURES The primary endpoint was the efficacy of the NANCAL-guided remifentanil administration to prevent the haemodynamic response to tracheal intubation and surgical incision. The secondary aim was to compare the ability of SPI, analgesia nociception index, pupil diameter and mean arterial pressure response to NANCAL to predict the haemodynamic response to tracheal intubation and surgical incision. RESULTS Our SPI response to NANCAL-based correcting scheme for remifentanil administration was not superior to a fixed remifentanil concentration at blunting the haemodynamic response to tracheal intubation or surgical incision. Among all tested NAN balance indices, only mean arterial pressure had significant predictive ability with regard to the haemodynamic response to surgical incision. CONCLUSION Further research is needed to define the best NANCAL stimulus and the best remifentanil correcting scheme to help individualised tailoring of antinociception for each specific subpopulation of surgical patients. TRIAL REGISTRATION Clinicaltrials.gov NCT: 02884310; http://ift.tt/2B2PCiQ.

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Reply to: who takes the lead in critical illness?

No abstract available

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Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review

BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) 25% of baseline), or that a recovery time longer than 15 min be accepted.

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Reply to: collaboration in emergency medical care in Europe the ten principles of CRitical Emergency Medicine (CREM)

No abstract available

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Effects of magnesium chloride on rocuronium-induced neuromuscular blockade and sugammadex reversal in an isolated rat phrenic nerve–hemidiaphragm preparation: An in-vitro study

BACKGROUND Magnesium potentiates the effects of nondepolarising muscle relaxants. However, few studies have used magnesium chloride (MgCl2). Sugammadex reverses neuromuscular block by steroidal nondepolarising muscle relaxants. OBJECTIVES To assess the effects of MgCl2 on rocuronium-induced neuromuscular blockade and its reversal by sugammadex. DESIGN In-vitro experimental study. SETTING Animal laboratory, Asan Medical Center, Seoul, South Korea, from 20 March 2016 to 3 April 2016. ANIMALS Forty male Sprague Dawley rats. INTERVENTION Left phrenic nerve–hemidiaphragms from 40 Sprague Dawley rats were allocated randomly to four groups (1, 2, 3 and 4 mmol l-1 MgCl2 group, n = 10 each). Rocuronium was administered cumulatively until the first twitch of train-of-four (TOF) disappeared completely. Then, equimolar sugammadex was administered. MAIN OUTCOME MEASURES The effective concentration (EC) of rocuronium was obtained in each group. After administering sugammadex, recovery of the first twitch height and the TOF ratio were measured for 30 min. RESULTS EC50, EC90 and EC95 significantly decreased as the concentration of MgCl2 increased (all P ≤ 0.001), except the comparison between the 3 and 4 mmol l–1 MgCl2 groups. After administration of sugammadex, the maximal TOF ratio (%) was lower in the 4 mmol l-1 MgCl2 group than the 1 mmol l–1 MgCl2 group [median 91.7 interquartile range (83.4 to 95.8) vs. 98.3 interquartile range (92.2 to 103.4), P = 0.049]. The mean time (s) from sugammadex injection to achieving maximal first twitch was significantly prolonged in the 4 mmol l–1 MgCl2 group vs. the 1 mmol l–1 MgCl2 and 2 mmol l–1 MgCl2 groups [1483.9 (± 237.0) vs. 1039.0 (± 351.8) and 926.0 (± 278.1), P = 0.022 and 0.002, respectively]. CONCLUSION Increases in MgCl2 concentration reduce the ECs of rocuronium. In addition, administering sugammadex equimolar to the administered rocuronium shows limited efficacy as MgCl2 concentration is increased. TRIAL REGISTRATION The in-vitro study was not registered in a database.

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Emergency medicine is about collaboration, not monopolisation

No abstract available

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Effects of propofol on wound closure and barrier function of cultured endothelial cells: An in vitro experimental study

BACKGROUND Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells. DESIGN An in vitro investigation. SETTING Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. MATERIALS In vitro cultures of primary human umbilical vein endothelial cells (HUVECs). INTERVENTIONS Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 μmol l-1). MAIN OUTCOME MEASURES Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation. RESULTS Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 μmol l-1 (P 

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Who takes the lead in critically ill patients?

No abstract available

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Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P 

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Professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

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

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

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Collaboration in emergency medical care in Europe: the patient is the winner

No abstract available

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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial. SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min. RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003).

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Ultrasound in Anesthesia, Critical Care, and Pain Management

No abstract available

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One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Christianto, A. Lau, K.Y. Li, W.F. Yang, Y.X. Su
Venous compromise is still the most common cause of free flap failure. The use of two venous anastomoses has been advocated to reduce venous compromise. However, the effectiveness of this approach remains controversial. A systematic review and cumulative meta-analysis was performed to assess the effect of one versus two venous anastomoses on venous compromise and free flap failure in head and neck microsurgical reconstruction. A total of 27 articles reporting 7389 flaps were included in this study. On comparison of one versus two venous anastomoses, the odds ratio (OR) for flap failure was 1.66 (95% confidence interval 1.11–2.50; P=0.014) and for venous compromise was 1.50 (95% confidence interval 1.10–2.05; P=0.011), suggesting a significant increase in the flap failure rate and venous compromise rate in the single venous anastomosis group. These results show that the execution of two venous anastomoses has significant effects on reducing the vascular compromise and free flap failure rate in head and neck reconstruction.



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Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Saenthaveesuk, S.-e. Zhang, G.-s. Zheng, Y.-j. Liang, Y.-x. Su, G.-q. Liao
The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. Sensory-motor functions of the upper arm donor site were recorded before and after surgery. Four flaps were successfully transferred. One flap was abandoned during surgery because of a lack of perforators, and a forearm flap was used instead. All patients survived without loco-regional recurrence or distant metastasis. Functional outcomes, especially swallowing and speech, were satisfactory. The donor site scar was well hidden, with no functional impairment. This initial experience shows that the medial upper arm free flap represents an alternative perforator flap for oral cavity microsurgical reconstruction. The well-hidden scar and better texture match compared with other flaps make it suitable for oral cavity reconstruction.



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EGFR amplification and expression in oral squamous cell carcinoma in young adults

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V. Costa, L.P. Kowalski, C.M. Coutinho-Camillo, M.D. Begnami, V.F. Calsavara, J.I. Neves, E. Kaminagakura
The aim of this study was to investigate epidermal growth factor receptor (EGFR) gene alterations in two groups of patients with oral squamous cell carcinoma (OSCC) (a test group of subjects aged ≤40 years and a control group of subjects aged ≥50 years) and to associate the results with EGFR immunostaining, clinicopathological features, and the prognosis. Sixty cases of OSCC were selected (test group, n=21; control group, n=39). The tissue microarray technique was applied to ensure the uniformity of results. Gene amplification was analyzed by fluorescence in situ hybridization (FISH), and immunohistochemical staining for EGFR was analyzed using an automated imaging system. EGFR amplification was higher in the test group than in the control group (P=0.018) and was associated with advanced clinical stage (P=0.013), regardless of age. Patients with EGFR overexpression had worse survival rates, as did patients who had T3–T4 tumours and positive margins. EGFR overexpression has a negative impact on disease progression. Despite the higher amplification of EGFR in young adults, it does not significantly impact the survival rates of affected patients.



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REAL WORLD EVIDENCE - What Is It and Does It Matter for Approval of Drugs?

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Tip to protect the tip: An inexpensive alternative to protect damage to fine instruments during sterilization

http://ift.tt/2nAmGsp

Post-exposure prevention of toxicodendron dermatitis with early forceful unidirectional washing

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Effects of Thyrotropin on Peripheral Thyroid Hormone Metabolism and Serum Lipids

Thyroid , Vol. 0, No. 0.


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The Iconography of Goiter: Five Sculptures in the Sacred Mountains of Varallo, Orta, and Varese in Italy

Thyroid , Vol. 0, No. 0.


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A Pediatric Nasopharyngeal Mass

An otherwise healthy 3-year-old boy presented with symptoms of sleep-disordered breathing, including gasping, apneic episodes at night, and nighttime nasal congestion; intraoperatively he was found to have a nasopharyngeal mass. What is your diagnosis?

http://ift.tt/2GDTxFq

Diagnostic Accuracy of Parallel vs Perpendicular Orientation of the Tuning Fork in the Identification of Conductive Hearing Loss

This study compares patients' responses to the Rinne test when performed with the tuning fork positioned parallel vs perpendicular to the external auditory meatus.

http://ift.tt/2rYh4h9

Primary Palate Trauma in Patients Presenting to US Emergency Departments

This database analysis uses the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample to measure the incidence of primary palate trauma visits to US emergency departments and to determine frequency and factors associated with head and neck imaging.

http://ift.tt/2GzQP3Q

Specific IgE to gelatin as a cause of anaphylaxis to zoster vaccine

Publication date: Available online 1 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Maya K.C. Retterer, Lisa J. Workman, John R. Bacon, Thomas A.E. Platts-Mills




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Age-dependent Effect of Ambient Ozone on Emergency Asthma Hospitalizations in Hong Kong

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuanrong Dai, Hong Qiu, Shengzhi Sun, Yang Yang, Hualiang Lin, Linwei Tian




http://ift.tt/2DUzQr8

CCL19-producing fibroblastic stromal cells restrain lung carcinoma growth by promoting local antitumor T cell responses

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Hung-Wei Cheng, Lucas Onder, Jovana Cupovic, Maximilian Boesch, Mario Novkovic, Natalia Pikor, Ignazio Tarantino, Regulo Rodriguez, Tino Schneider, Wolfram Jochum, Martin Brutsche, Burkhard Ludewig
BackgroundA particular characteristic of non-small cell lung cancer (NSCLC) is the composition of the tumor microenvironment with a very high proportion of fibroblastic stromal cells (FSC).ObjectiveLapses in our basic knowledge of fibroblast phenotype and function in the tumor microenvironment make it difficult to define whether FSC subsets exist that exhibit either tumor-promoting or tumor-suppressive properties.MethodsWe employed gene expression profiling of lung versus tumor FSC from NSCLC patients. Moreover, CCL19-expressing FSCs were studied in transgenic mouse models utilizing a lung cancer metastasis model.ResultsCCL19 mRNA expression in human tumor FSC correlates with immune cell infiltration and intratumoral accumulation of CD8⁺ T cells. Mechanistic dissection in murine lung carcinoma models revealed that CCL19-expressing FSC form perivascular niches to promote accumulation of CD8⁺ T cells in the tumor. Targeted ablation of CCL19-expressing tumor FSC reduced immune cell recruitment and resulted in unleashed tumor growth.ConclusionThese data suggest that a distinct population of CCL19-producing FSC fosters the development of an immune-stimulating intratumoral niche for immune cells to control cancer growth.

Graphical abstract

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Mentoring: an art and a responsibility

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): K. Frank Austen




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Human Th17 cell development requires processing of dendritic cell-derived CXCL8 by neutrophil elastase

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuri Souwerm, Tom Groot Kormelink, Esther W. Taanman-Kueter, Femke J. Muller, Toni M.M. van Capel, Domonkos V. Varga, Yotam E. Bar-Ephraim, Marcel B.M. Teunissen, S. Marieke van Ham, Taco W. Kuijpers, Diana Wouters, Linde Meyaard, Esther C. de Jong




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Incidence and sociodemographic characteristics of eczema diagnosis in children: a cohort study

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Lu Ban, Sinéad M. Langan, Katrina Abuabara, Kim S. Thomas, Alyshah Abdul Sultan, Tracey Sach, Emma McManus, Miriam Santer, Sonia Ratib




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Group-2 innate lymphoid cells promote airway hyperresponsiveness through production of VEGFA

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Xiaofei Shen, Muhammad Asghar Pasha, Kelsi Hidde, Adil Khan, Mingwei Liang, Wenxian Guan, Yitao Ding, Angela Haczku, Qi Yang




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An unexpected protective role of low affinity allergen-specific IgG via the inhibitory receptor FcγRIIb

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Martin Bachmann, Monique Vogel, Lisha Zha, Fabiana Leoratti, Lichun He, Mona O. Mohsen, Federico Storni, Mark Cragg
BackgroundInduction of allergen-specific IgG antibodies is a critical parameter for successful specific immunotherapy (SIT). IgG antibodies may inhibit IgE-mediated mast cell activation by direct allergen-neutralization or via the inhibitory receptor FcγRIIb. The affinity of IgE antibodies to the allergen has been shown to be critical for cellular activation.ObjectiveHere we addressed the question of the affinity thresholds of allergen-specific IgG antibodies for inhibition of mast cell activation by using 2 different monoclonal antibodies against the major cat allergen, Fel d 1, both in vitro and in vivo in mice.MethodsThe sequences of the two high-affinity mAbs were back-mutated to germ-line, resulting in low affinity (10^-7M) antibodies of the exact same specificity.ResultsUsing these newly generated recombinant antibodies, we demonstrate that low affinity antibodies are still able to inhibit mast cell activation via FcγRIIb but fail to neutralize the allergen.ConclusionAntibody affinity dictates the mechanism of mast cell inhibition and IgG antibodies triggering the inhibitory FcγRIIb-pathway may show a broader cross-reactivity pattern than previously thought. This indicates that SIT generates a larger protective umbrella of inhibitory IgG antibodies than previously appreciated.

Graphical abstract

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Activation of Protease-Activated Receptor 2 leads to impairment of keratinocyte tight junction integrity

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Peter Nadeau, Mason Henehan, Anna De Benedetto




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Home Sweet Home

In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. A 25-year-old woman presented to the emergency…

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'This Mole Looks Strange'

How would you approach a patient who presents to primary care with worries about a changing mole?
Medscape Family Medicine

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Cyclic fatigue using severely curved canals and torsional resistance of thermally treated reciprocating instruments

Abstract

Objectives

To evaluate the cyclic fatigue using severely curved canals and torsional resistance of ProDesign R (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil), Reciproc Blue (VDW, Munich, Germany), and WaveOne Gold (Dentsply Maillefer, Ballaigues, Switzerland) reciprocating instruments

Materials and methods

Twenty instruments of the ProDesign R (25/0.06) system, 20 instruments of the Reciproc Blue (25/0.08v) system, and 20 instrument of the WaveOne Gold (25/0.07v) system were used. Cyclic fatigue resistance was tested measuring the time to fracture and the number of cycles to fracture in an artificial stainless steel severely curved canal with 80° angle and a 3-mm radius of curvature (n = 10). Torque and angle of rotation at failure of new instruments (n = 10) were measured according to ISO 3630-1. The fracture surfaces of all fragments were examined with a scanning electron microscope. Results were statistically analyzed using one-way ANOVA and Tukey's test at a significance level of p < 0.05.

Results

ProDesign R instruments showed a significantly longer cyclic fatigue life than the other tested instruments (p < 0.05). Reciproc Blue showed longer cyclic life than WaveOne Gold (p < 0.05). Reciproc Blue showed the higher torsional strength, followed by WaveOne Gold and ProDesign R instruments (p < 0.05). Moreover, Reciproc Blue showed significantly higher angular rotation to fracture than ProDesign R (p < 0.05). WaveOne Gold showed intermediary results regarding angular rotation to fracture with no differences when compared to Reciproc Blue or ProDesign R instruments (p < 0.05).

Conclusions

ProDesign R presented the highest cyclic fatigue resistance in severely curved canals when compared with Reciproc Blue and WaveOne Gold. However, Reciproc Blue showed the higher torsional strength overall and higher angular rotation to fracture when compared to ProDesign R.

Clinical relevance

Despite the numerous advantages of reciprocating instruments, these instruments still have some risk of fracture during its use, especially in severely curved canals. The present study evaluated the cyclic fatigue and torsional resistance of thermally treated reciprocating instruments.

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Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Hole following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Purpose: To report a case of macular hole (MH) secondary to a retinal arterial macroaneurysm (RAMA) which was successfully treated with an autologous transplantation of internal limiting membrane (ILM). Case Report: An 87-year-old female presented with a sudden decrease in central vision in the right eye. A fundus examination revealed a RAMA in the superonasal macular region, a subretinal hemorrhage (SRH), involving the macula, and a sub-ILM hemorrhage. A pars plana vitrectomy (PPV) was performed. Intraoperatively, an MH filled with coagulum was detected. We tried to blow off and drain the SRH with a current of BSS and a gentle suction with a 27-gauge vitreous cutter from the MH, but some amount of SRH at the bottom of the MH remained. The ILM was peeled off for 2 disc diameters around the MH. The vitreous cavity was filled with air at the end of the operation. Two weeks after the surgery, the MH was not closed. One month following the initial PPV, a second PPV was performed to achieve closure of the MH. Results: An autologous transplantation of ILM was performed as second PPV. Six months after the final surgery, the MH was successfully closed and the best-corrected decimal visual acuity was 0.6. Conclusions: Autologous ILM transplantation can be an effective treatment option for MH closure following RAMA rupture.
Case Rep Ophthalmol 2018;9:113–119

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A Case of Fundus Oculi Albinoticus Diagnosed as Angelman Syndrome by Genetic Testing

Purpose: To report a case of fundus oculi albinoticus diagnosed as Angelman syndrome (AS) via genetic testing. Case Report: This study reports on a 4-year-old boy. Since he had been having respiratory disturbance since birth, he underwent a complete physical examination to investigate the cause. The results indicated that he had various brain congenital abnormalities, such as a thin corpus callosum, as well as hydronephrosis, an atrial septal defect, and skin similar to patients with fundus oculi albinoticus. Examination revealed bilateral fundus oculi albinoticus, mild iridic hypopigmentation, optic atrophy, and poor visual tracking. Genetic testing revealed a deletion in the Prader-Willi syndrome/AS region on chromosome 15, and together with the results of methylation analysis, his condition was diagnosed as AS. Follow-up examinations revealed no change in the fundus oculi albinoticus and optic atrophy, nor did they indicate poor visual tracking. Conclusions: When fundus oculi albinoticus and optic atrophy are observed in patients with multiple malformations, AS should be considered as a differential diagnosis.
Case Rep Ophthalmol 2018;9:102–107

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Alternating Hypotropia with Pseudoptosis: A New Phenotype of Congenital Cranial Dysinnervation Disorder

Congenital cranial dysinnervation disorders, also known as CCDDs, are characterized by aberrant innervation to extraocular and facial muscles resulting in unusual forms of incomitant strabismus. Anomalous innervation to extraocular muscles can result in a wide variety of phenotypes causing various clinical conditions such as Duane syndrome, congenital fibrosis of the extraocular muscles, and Möbius syndrome. We report a case of bilateral dysinnervation disorder causing atypical ocular movements in both eyes as the patient changes fixation from one eye to the other and from right gaze to left gaze that fits with the wider diagnosis of CCDDs.
Case Rep Ophthalmol 2018;9:96–101

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Tracheal advancement with myomucosal island flap for partial laryngopharyngectomy defect reconstruction

Abstract

Background

Restoring the anatomy and function of a partial laryngopharyngectomy with hemicricoid defect is an extremely challenging area in head and neck cancer surgery. Procedures such as tracheal autotransplantation described for these defects are complex and attempted in very few centers. Therefore, the purpose of this article was to share our technique of reconstructing such defects with tracheal advancement with myomucosal island flap for laryngopharyngeal defect (TAMMIL), which allows functional reconstruction of the larynx.

Method

A 49-year-old man with carcinoma of the right pyriform sinus, postneoadjuvant chemotherapy with progressive disease underwent vertical partial laryngopharyngectomy. The resultant defect was reconstructed with tracheal advancement and islanded facial artery myomucosal (FAMM) flap.

Result

The patient is 1-year postsurgery, free of disease, decannulated, and taking oral feeds. Video fluoroscopy showed no evidence of aspiration.

Conclusion

This technique is single-staged, easier compared to existing techniques, aids "like-for-like" reconstruction, and allows surgical organ preservation in selected laryngeal and hypopharyngeal cancers.

http://ift.tt/2nvTFhq

Validation of nomograms for overall survival, cancer-specific survival, and recurrence in carcinoma of the major salivary glands

Abstract

Background

The purpose of this study was to investigate the performance of the Memorial Sloan Kettering Cancer Center salivary carcinoma nomograms predicting overall survival, cancer-specific survival, and recurrence with an external validation dataset.

Methods

The validation dataset comprised 123 patients treated between 2010 and 2015 at our institution. They were evaluated by assessing discrimination (concordance index [C-index]) and calibration (plotting predicted vs actual probabilities for quintiles).

Results

The validation cohort (n = 123) showed some differences to the original cohort (n = 301). The validation cohort had less high-grade cancers (P = .006), less lymphovascular invasion (LVI; P < .001) and shorter follow-up of 19 months versus 45.6 months. Validation showed a C-index of 0.833 (95% confidence interval [CI] 0.758-0.908), 0.807 (95% CI 0.717-0.898), and 0.844 (95% CI 0.768-0.920) for overall survival, cancer-specific survival, and recurrence, respectively.

Conclusion

The 3 salivary gland nomograms performed well using a contemporary validation dataset, despite limitations related to sample size, follow-up, and differences in clinical and pathology characteristics between the original and validation cohorts.

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Comparison the clinical outcomes with altered versus conventional fractionated radiotherapy plus concurrent chemotherapy for advanced nasopharyngeal carcinoma

Abstract

Background

The purpose of this study was to compare the long-term survivals between altered fractionated and conventional fractionated radiotherapy with the same concurrent chemoradiotherapy (concurrent CRT) for patients with advanced nasopharyngeal carcinoma (NPC).

Methods

We retrospectively reviewed 203 patients with NPC who received radiotherapy (RT) by either a conventional fractionated (70-74 Gy/35-37 fractions/7-8 weeks) or altered fractionated (72-75 Gy/45 fractions/6 weeks) schedule plus the same concurrent CRT.

Results

The patient characteristics between conventional fractionated and altered fractionated groups showed similar distribution. The 5-year rates of nasopharyngeal failure-free, neck failure-free, and distant metastasis failure-free survival between conventional fractionated and altered fractionated groups were 88% versus 86% (P = .7781), 95% versus 93% (P = .4176), and 76% versus 73% (P = .4029), respectively. The overall survival (OS; 5-year rates were 64% versus 62%; P = .4812) and progression-free survival (PFS; 5-year rates were 67% versus 63%; P = .3829) rates also showed no significant differences. The acute and late toxicities were similar between both groups.

Conclusion

Altered fractionated and conventional fractionated RT achieved similar survival outcome when concurrent CRT strategy was used for advanced NPC.

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Intraoperative monitoring of marginal mandibular nerve during neck dissection

Abstract

Background

The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection.

Methods

This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor.

Results

The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy.

Conclusion

In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection.

http://ift.tt/2DSpo7x

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Abstract

Background

Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia.

Methods

One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH.

Results

A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%.

Conclusion

Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy.

http://ift.tt/2ny3Hih

Clinical Evaluation of the Patient with Otosclerosis

Otosclerosis is a disorder presenting most commonly with unilateral conductive hearing loss. It can present as a mixed hearing loss also. Evaluation for otosclerosis relies on a specific history and physical examination, including tuning fork assessment and audiometric testing. Otosclerosis differs from other etiologies in that symptoms of imbalance are rare, and the ear most commonly appears normal on otoscopy.

http://ift.tt/2BI2Osl

Culture of human dental pulp cells at variable times post-tooth extraction

Abstract The aim of this study was to investigate the viability of human dental pulp cells from extracted teeth kept at standard room temperature and atmospheric pressure for different periods of time. Twenty-one healthy permanent teeth were used. They were divided into five groups according to the expected time from extraction to processing. One group was tested immediately after extraction; the other groups were each tested at one of the following time points: 30 minutes, 1 hour, 2 hours, and 5 hours post-extraction. Cell morphology was analysed by light microscopy; cell proliferation was analysed using MTT assay and by counting the viable cells in a haemocytometer. Similar results were observed in all groups (p < 0.05). A delay of up to five hours for tooth processing and tissue collection does not preclude the establishment of dental pulp cell cultures, affect the morphology of these cells, or reduce their proliferative potential.

http://ift.tt/2s1pkNi

Evaluation of adaptation of ceramic inlays using optical coherence tomography and replica technique

Abstract Optical coherence tomography (OCT) has generally been used as a nondestructive technique to evaluate integrities of composite restorations. We investigated marginal and internal adaptations of ceramic inlay restorations with OCT and compared them to results with the silicone replica technique. Round-shaped class I cavities were prepared on 16 human maxillary first premolar teeth. Ceramic inlays were fabricated. Silicone replicas from inlays were obtained and sectioned to measure marginal and internal adaptations with a stereomicroscope (Leica Dfc 295, Bensheim, Germany). Inlays were cemented on respective teeth. Marginal and internal adaptations were then measured with the OCT system (Thorlabs, New Jersey, USA) in 200- μm intervals. Replica and OCT measurements were compared with independent samples t-tests. A paired t-test was used to evaluate the marginal and internal adaptations of each group (p < 0.05). Marginal and internal adaptations were 100.97 ± 31.36 and 113.94 ± 39.75 μm, respectively, using the replica technique and 28.97 ± 17.86 and 97.87 ± 21.83 μm, respectively, using OCT. The differences between the techniques were significant (p = 0.00 and p = 0.01, respectively). On evaluation within the groups, internal adaptation values were found to be significantly higher than the marginal adaptation values for the replica technique (p = 0.00) and OCT (p = 0.00). Therefore, the replica and OCT techniques showed different results, with higher values of marginal and internal adaptation found with the replica technique. Marginal and internal adaptation values of ceramic inlays, whether measured by replica or OCT techniques, were within clinically acceptable limits.

http://ift.tt/2GBhc9w

Effect on adhesion of a nanocapsules-loaded adhesive system

Abstract This study aimed to evaluate the in situ degree of conversion, contact angle, and immediate and long-term bond strengths of a commercial primer and an experimental adhesive containing indomethacin- and triclosan-loaded nanocapsules (NCs). The indomethacin- and triclosan-loaded NCs, which promote anti-inflammatory and antibacterial effects through controlled release, were incorporated into the primer at a concentration of 2% and in the adhesive at concentrations of 1, 2, 5, and 10%. The in situ degree of conversion (DC, n=3) was evaluated by micro-Raman spectroscopy. The contact angle of the primer and adhesive on the dentin surface (n = 3) was determined by an optical tensiometer. For the microtensile bond strength µTBS test (12 teeth per group), stick-shaped specimens were tested under tensile stress immediately after preparation and after storage in water for 1 year. The data were analyzed using two-way ANOVA, three-way ANOVA and Tukey's post hoc tests with α=0.05. The use of the NC-loaded adhesive resulted in a higher in situ degree of conversion. The DC values varied from 75.07 ± 8.83% to 96.18 ± 0.87%. The use of NCs in only the adhesive up to a concentration of 5% had no influence on the bond strength. The contact angle of the primer remained the same with and without NCs. The use of both the primer and adhesive with NCs (for all concentrations) resulted in a higher contact angle of the adhesive. The longitudinal μTBS was inversely proportional to the concentration of NCs in the adhesive system, exhibiting decreasing values for the groups with primer containing NCs and adhesives with increasing concentrations of NCs. Adhesives containing up to 5% of nanocapsules and primer with no NCs maintained the in situ degree of conversion, contact angle, and immediate and long-term bond strengths. Therefore, the NC-loaded adhesive can be an alternative method for combining the bond performance and therapeutic effects. The use of an adhesive with up to 5% nanocapsules containing indomethacin and triclosan and a primer with no nanocapsules maintained the long-term bond performance.

http://ift.tt/2rYrXj5

Erratum: Health-related quality of life of patients with squamous cell carcinoma: a comparison according to tumor location. Braz Oral Res. 2017;31:e105.

Abstract This study aimed to evaluate the in situ degree of conversion, contact angle, and immediate and long-term bond strengths of a commercial primer and an experimental adhesive containing indomethacin- and triclosan-loaded nanocapsules (NCs). The indomethacin- and triclosan-loaded NCs, which promote anti-inflammatory and antibacterial effects through controlled release, were incorporated into the primer at a concentration of 2% and in the adhesive at concentrations of 1, 2, 5, and 10%. The in situ degree of conversion (DC, n=3) was evaluated by micro-Raman spectroscopy. The contact angle of the primer and adhesive on the dentin surface (n = 3) was determined by an optical tensiometer. For the microtensile bond strength µTBS test (12 teeth per group), stick-shaped specimens were tested under tensile stress immediately after preparation and after storage in water for 1 year. The data were analyzed using two-way ANOVA, three-way ANOVA and Tukey's post hoc tests with α=0.05. The use of the NC-loaded adhesive resulted in a higher in situ degree of conversion. The DC values varied from 75.07 ± 8.83% to 96.18 ± 0.87%. The use of NCs in only the adhesive up to a concentration of 5% had no influence on the bond strength. The contact angle of the primer remained the same with and without NCs. The use of both the primer and adhesive with NCs (for all concentrations) resulted in a higher contact angle of the adhesive. The longitudinal μTBS was inversely proportional to the concentration of NCs in the adhesive system, exhibiting decreasing values for the groups with primer containing NCs and adhesives with increasing concentrations of NCs. Adhesives containing up to 5% of nanocapsules and primer with no NCs maintained the in situ degree of conversion, contact angle, and immediate and long-term bond strengths. Therefore, the NC-loaded adhesive can be an alternative method for combining the bond performance and therapeutic effects. The use of an adhesive with up to 5% nanocapsules containing indomethacin and triclosan and a primer with no nanocapsules maintained the long-term bond performance.

http://ift.tt/2GB6PCH

Acute lymphoblastic leukemia/lymphoma of the oral and maxillofacial region

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Celeste Sánchez Romero, Hélder Antônio Rebelo Pontes, Flávia Sirotheau Corrêa Pontes, André Caroli Rocha, Román Carlos, Javier C. Rendón, Oslei Paes de Almeida, Felipe Paiva Fonseca
ObjectiveTo describe the clinicopathological and immunohistochemical features of acute lymphoblastic leukemia/lymphoma (ALL/LBL) of the oral and maxillofacial region (OMF).Study designCases diagnosed as ALL/LBL of the OMF region were retrieved from the files of two Brazilian and one Guatemalan oral pathology services from 2005 to 2017. Microscopic and immunohistochemical features of each case were reviewed and fully described, whereas clinical data were retrieved from the pathology reports.ResultsDuring the period considered, six cases were identified. Males were the most affected (4:2), with a mean age of 19 years old. The mandible was involved in two cases, the maxilla in two, the cheek mucosa in one and the parotid gland in one case. A painful swelling was the most common presentation, and three patients also had systemic complaints. Microscopically, tumors revealed solid infiltrations of small to medium sized immature cells. The "puzzle-like" and "starry-sky" patterns were observed, and "single lane" growth was also identified. Immunohistochemically, two cases were diagnosed as T-cell ALL/LBL with the LCA+/cCD3+/CD79a+focal/CD20-/PAX5-/CD99+/CD34-/CD10+/TdT+ phenotype and four as B-cell ALL/LBL with the LCA+/CD3-/CD20-/CD79a+/CD10+/CD34variable/TdT+ predominant phenotype. The Ki67 index ranged from 80 to 99%.ConclusionOMF ALL/LBL is rare, but its microscopic features and immunohistochemical profile CD3+orCD79a+/CD10+/CD34+variable/CD99+/TdT+ contribute to the correct diagnosis.



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Rethinking isolated cleft lip and palate as a syndrome

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mine Koruyucu, Yelda Kasimoğlu, Figen Seymen, Merve Bayram, Asli Patir, Nihan Ergöz, Elif B. Tuna, Koray Gencay, Kathleen Deeley, Diego Bussaneli, Adriana Modesto, Alexandre R. Vieira
ObjectiveThe goal of the present work was to use dental conditions that have been independently associated with cleft lip and palate (CL/P) as a tool to identify a broader collection of individuals to be used for gene identification that lead to clefts.Study designWe studied 1,573 DNA samples combining individuals that were born with CL/P, or had tooth agenesis, or supernumerary teeth, or molar incisor hypomineralization (MIH), or dental caries with the goal to identify genetic associations. We tested two single nucleotide polymorphisms that were located in the vicinity of regions suggested to contribute to supernumerary teeth. Over-representation of alleles were determined for combinations of individuals as well as for each individual phenotypic group with an alpha of 0.05.ResultsWe determined that the allele C of rs622260 was over-represented in all individuals studied when compared with a group of unrelated individuals that did not present any of the conditions described above. When subgroups were tested, associations were seen for individuals with MIH.ConclusionsAlthough we did not test this hypothesis directly here, based on associations reported previously, we believe that CL/P is actually a syndrome of alterations of the dentition and considering it that way may allow for the identification of genotype-phenotype correlations that may be useful for clinical care.



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Magnetic resonance imaging (MRI) – a diagnostic tool for postoperative evaluation of dental implants. a case report.

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Laura Wanner, Ute Ludwig, Jan-Bernd Hövener, Katja Nelson, Tabea Flügge
Objective.Compared to cone beam computed tomography (CBCT), magnetic resonance imaging (MRI) might be superior for the diagnosis of nerve lesions associated with implant placement.Study Design.A patient presented with unilateral pain associated with dysesthesia in the region of the right lower lip and chin after implant placement. Conventional orthopantomography couldn't show an association between the position of the inferior alveolar nerve and the implant. For three-dimensional display of the implant in relation to the surrounding anatomy, CBCT was compared to MRI.Results.MRI enabled the precise depiction of the implant position and its spatial relation to the inferior alveolar nerve, whereas the nerve position and its exact course within the mandible couldn't be directly displayed in CBCT.Conclusion.MRI may be a valuable, radiation-free diagnostic tool for the visualization of intraoral hard and soft tissues, offering an objective assessment of nerve injuries by a direct visualization of the inferior alveolar neurovascular bundle.



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Loss of heterozygosity (LOH) of MIR15A/MIR16-1, negative regulators of the anti-apoptotic gene BCL2, is not frequent in odontogenic keratocysts

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Taynara Asevedo Campos de Resende, Vanessa de Fátima Bernardes, Jéssica Carolina da Silva, Luiz Armando De Marco, Ricardo Santiago Gomez, Carolina Cavalieri Gomes, Marina Gonçalves Diniz
Objectives The odontogenic keratocyst (OKC) is an aggressive odontogenic cyst that shows high recurrence rate. Apart from PTCH1 mutations, few molecular alterations are described in OKCs. Low expression of microRNAs (miRNAs) miR-15a and/or miR-16-1 in association with increased expression of their target, Bcl-2, have been previously shown in OKC. In humans, MIR15A and MIR16-1 are clustered at chromosome position 13q14, and loss of heterozygosity (LOH) at this locus occurs in different tumors. We aimed to determine whether deletion at 13q14 is the potential mechanism leading to miR-15a/16-1 aberrant expression in OKC. Methods Genomic DNA was extracted from 15 formalin fixed paraffin embedded microdissected OKC cases. The polymorphic DNA markers D13S272 and D13S273 on chromosome 13q14.3, around MIR15A/MIR16-1, were amplified by PCR. LOH was examined by capillary electrophoresis DNA-fragment analysis. Results D13S272 marker showed no LOH in 12 informative cases, while 2/9 (22%) informative cases showed LOH at D13S273 marker. Conclusions LOH event at MIR15A/MIR16-1 locus is not frequent in OKC. The mechanism underlining the regulation of miR-15a and miR-16-1 expression in OKC remains to be determined.



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Prognostic indicators of improved survival and quality of life in surgically treated oral cancer.

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): G. Tirelli, A. Gatto, P. Bonini, M. Tofanelli, A. Piccinato, Z.M. Arnež
OBJECTIVENo published study has analysed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyse postoperative QoL in relation to survival in order to identify which parameters can predict the long-term outcome allowing the best QoL.STUDY DESIGNThis retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery.RESULTSThe 5-year overall survival rate was equal to 68.1% while the 5-year disease-specific-survival (DSS) was 77.8%. In this sample, 32% of patients also underwent adjuvant radio-chemotherapy. On stepwise Cox regression, the best predictors of DSS were the N stage (p<0.001) and tumor depth of invasion (DOI)(p<0.001). QoL was affected by N stage, DOI, invasive surgical approach, radiotherapy and neck dissection (p<0.05).CONCLUSIONThe prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage and the DOI, all of which can be minimized by early diagnosis.



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Physiological distribution of PSMA-ligand in salivary glands and seromucous glands of the head and neck on PET/CT

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Thomas J.W. Klein Nulent, Matthijs H. Valstar, Bart de Keizer, Stefan M. Willems, Laura A. Smit, Abrahim Al-Mamgani, Ludwig E. Smeele, Robert J.J. van Es, Remco de Bree, Wouter V. Vogel
ObjectivesProstate-specific membrane antigen (PSMA) PET/CT is used for detection and (re)staging of prostate cancer. However, healthy salivary, seromucous, and lacrimal glands also show high PSMA-ligand uptake. This study aimed to describe physiological PSMA-ligand uptake distribution characteristics in the head and neck, to aid in PSMA PET/CT interpretation and to identify possible new clinical applications for PSMA-ligand imaging.Study designThirty consecutive patients who underwent PSMA PET/CT for prostate cancer were evaluated. Tracer maximum standardized uptake values (SUVmax) in the salivary, seromucous, and lacrimal glands were determined visually and quantitatively. Overall and intra-individual variations were reported.ResultsAll gland locations showed increased tracer uptake. The mean SUVmax (±SD) varied: parotid 12.3±3.9; submandibular 11.7±3.5; sublingual 4.5±1.9; soft palate 2.4±0.5; pharyngeal wall 4.3±1.3; nasal mucosa 3.4±0.9; supraglottic larynx 2.7±0.7; and lacrimal 6.2±2.2. The parotid showed the largest overall variation in SUVmax (5.2-22.9), the sublingual glands the largest mean intra-individual difference (18.1%).ConclusionsMajor and minor salivary and seromucous glands consistently show high PSMA-ligand uptake. Minor gland locations can be selectively visualized by this technique for the first time. This provides potential new applications such as quantification of present salivary gland tissues and individualization of radiotherapy for head and neck cancer or ¹⁷⁷Lu-PSMA radionuclide treatment.



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Prevalence of primary open-angle glaucoma among patients with obstructive sleep apnea

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Arthur H. Friedlander, Lindsay L. Graves, Tina I. Chang, K. Karl Kawakami, Urie K. Lee, Shannon C. Grabich, Zhuang T. Fang, Michelle R. Zeidler, JoAnn A. Giaconi
ObjectiveDetermine primary open angle glaucoma (POAG) prevalence among obstructive sleep apnea (OSA) patients because perioperative environment risks further damaging the optic nerve.Study designAnalyzed "convenience sample" referred by Sleep Medicine for oral appliances because of continuous positive pressure (CPAP) intolerance. Determined aggregate prevalence of the 3 POAG subtypes: ("classic" open angle glaucoma (COAG), normal tension glaucoma (NTG), open angle glaucoma suspect (OAGS); among the index population and compared it to that of same hospital's general population. Similarly determined were associations between OSA severity levels (apnea-hypopnea index; AHI) and POAG subtypes.ResultsAmong the study sample of 225 patients with OSA (96.4% male; mean age 58.5 ± 12.3 years), 47 (20.9%) had POAG; with subtype distribution: (COAG: 12(25.5%), NTG: 8 (17.0%), OAGS: 27 (57.4%)). The POAG prevalence rate among medical center's general population was 2.5% which was significantly less (P < .00001) than among those with comorbid OSA. Severity of the breathing disorder (AHI) failed to demonstrate a significant correlation to any POAG subtype (P > .05).ConclusionThe significant prevalence of POAG among OSA sufferers, suggests need for preoperative consultations from an ophthalmologist to determine eye health and possibly an anesthesiologist to avoid potential vision loss.



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Ectopic Intratracheal Thyroid Tissue Leading to Stridor

Abstract

Ectopic thyroid is a condition in which the thyroid tissue is present outside its normal anatomical position. Usually the ectopic thyroid is present along the line of its migration. The presence of ectopic thyroid tissue within the trachea is a very rare condition. Surgery is appropriate treatment for patients with ectopic thyroid tissue with clinical signs of upper airway obstruction. Here we present such a case where an ectopic intratracheal thyroid was causing airway obstruction.

http://ift.tt/2E7Bjhk

Functional Outcome After Treatment for Oropharyngeal Squamous Cell Carcinoma

Conditions:   Oropharynx Cancer;   Pain;   Swallowing Disorder;   Quality of Life;   Saliva Altered;   Human Papilloma Virus
Intervention:  
Sponsor:   Rigshospitalet, Denmark
Recruiting

http://ift.tt/2rZbQ4D

HPV Anti-CD40 RNA Vaccine

Conditions:   Carcinoma, Squamous Cell;   Head and Neck Neoplasm;   Cervical Neoplasm;   Penile Neoplasms Malignant
Intervention:   Drug: HPV vaccine
Sponsors:   University of Southampton;   Biontech AG
Recruiting

http://ift.tt/2GEtNJg

Functional Sparing of Salivary Glands Using MRI Sialography for Patients Undergoing Definitive Radiation Therapy for Head and Neck Cancers of the Oropharynx

Conditions:   Head and Neck Cancer;   Oropharynx Cancer;   Xerostomia Due to Radiotherapy
Intervention:   Other: MRI Sialogram
Sponsor:   UNC Lineberger Comprehensive Cancer Center
Not yet recruiting

http://ift.tt/2rYqB7Z

The Vertebral Vector in a Horizontal Plane. A Simple Way to See in 3D.

Condition:   Scoliosis
Intervention:   Other: Medical File data analysis
Sponsor:   Tamas Illes
Not yet recruiting

http://ift.tt/2GEtIFs

Prehabilitation in Patients With Esophageal or Gastric Cancers

Conditions:   Esophageal Cancer;   Gastric Cancer
Intervention:   Behavioral: Prehabilitation group
Sponsor:   Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Not yet recruiting

http://ift.tt/2rXyDhl

The Oral Microbiome as a Prognostic Tool in Oral Malignant and Premalignant Lesions and in Medication Related Osteonecrosis of the Jaw

Conditions:   Oral Squamous Cell Carcinoma;   Medication Related Osteonecrosis of the Jaw;   Oral Epithelial Dysplasia
Intervention:   Diagnostic Test: Buccal mucosa samples for Extraction of BACTERIAL DNA
Sponsor:   Barzilai Medical Center
Recruiting

http://ift.tt/2GEtBtw

Ectopic Intratracheal Thyroid Tissue Leading to Stridor

Abstract

Ectopic thyroid is a condition in which the thyroid tissue is present outside its normal anatomical position. Usually the ectopic thyroid is present along the line of its migration. The presence of ectopic thyroid tissue within the trachea is a very rare condition. Surgery is appropriate treatment for patients with ectopic thyroid tissue with clinical signs of upper airway obstruction. Here we present such a case where an ectopic intratracheal thyroid was causing airway obstruction.

http://ift.tt/2E7Bjhk

An IL-15 superagonist/IL-15Rα fusion complex protects and rescues NK cell-cytotoxic function from TGF-β1-mediated immunosuppression

Abstract

Natural killer (NK) cells are innate cytotoxic lymphocytes that play a fundamental role in the immunosurveillance of cancers. NK cells of cancer patients exhibit impaired function mediated by immunosuppressive factors released from the tumor microenvironment (TME), such as transforming growth factor (TGF)-β1. An interleukin (IL)-15 superagonist/IL-15 receptor α fusion complex (IL-15SA/IL-15RA; ALT-803) activates the IL-15 receptor on CD8 T cells and NK cells, and has shown significant anti-tumor activity in several in vivo studies. This in vitro study investigated the efficacy of IL-15SA/IL-15RA on TGF-β1-induced suppression of NK cell-cytotoxic function. IL-15SA/IL-15RA inhibited TGF-β1 from decreasing NK cell lysis of four of four tumor cell lines (H460, LNCap, MCF7, MDA-MB-231). IL-15SA/IL-15RA rescued healthy donor and cancer patient NK cell-cytotoxicity, which had previously been suppressed by culture with TGF-β1. TGF-β1 downregulated expression of NK cell-activating markers and cytotoxic granules, such as CD226, NKG2D, NKp30, granzyme B, and perforin. Smad2/3 signaling was responsible for this TGF-β1-induced downregulation of NK cell-activating markers and cytotoxic granules. IL-15SA/IL-15RA blocked Smad2/3-induced transcription, resulting in the rescue of NK cell-cytotoxic function from TGF-β1-induced suppression. These findings suggest that in addition to increasing NK cell function via promoting the IL-15 signaling pathway, IL-15SA/IL-15RA can function as an inhibitor of TGF-β1 signaling, providing a potential remedy for NK cell dysfunction in the immunosuppressive tumor microenvironment.

http://ift.tt/2FAQX1z

Correction to: Total analysis of clinical factors for surgical success of adenotonsillectomy in pediatric OSAS

Abstract

The authors would like to publish this erratum to indicate Dr Rayleigh Ping-Ying Chiang as the corresponding author of this article.

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Impacted and transmigrated mandibular canines: an analysis of 3D radiographic imaging data

Abstract

Objectives

Impacted and transmigrated mandibular canines differ greatly in incidence, etiopathology, associated anomalies, and treatment prospects, when compared to their maxillary counterparts. The aim of this study was to provide a detailed analysis of 3D radiographic imaging data of impacted mandibular canines.

Materials and methods

In a retrospective cross-sectional study, CT/CBCT data of 88 patients with a total of 94 impacted mandibular canines were analysed. Evaluated parameters included location, morphology, neighbouring structures, associated anomalies, the influence of those factors on mandibular canine transmigration, as well as applied treatment.

Results

Transmigration was found to occur in 40.4% of impacted mandibular canines. Transmigrated canines were located significantly more basally and horizontally angulated. Further, transmigration was significantly associated with a lack of contact to adjacent teeth and the canine's apex not contacting the mandibular cortical bone. The overall incidence of root resorptions of adjacent teeth related to impacted mandibular canines was 7.3% and was more likely, if the canine was lingually impacted. While about half of the non-transmigrated impacted canines were orthodontically aligned, half of the transmigrated canines were surgically removed. Monitoring was the second most applied treatment strategy for both groups, and no canines were autotransplantated.

Conclusions

Root resorption of adjacent teeth and transmigration are commonly occurring phenomena related to impacted mandibular canines.

Clinical relevance

Treatment often entails the surgical removal of the canine—especially in cases of transmigration. The findings emphasise the importance of early diagnosis and CT/CBCT imaging for further diagnostics and future research of impacted mandibular canines.

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Biomarkers and asthma management: analysis and potential applications

Purpose of review Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations. Recent findings Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed. Summary Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma. Correspondence to Anke H. Maitland-van der Zee, Department of Respiratory Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31 20 566 4356; e-mail: a.h.maitland@amc.nl Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Role of epigenetics in the development of childhood asthma

Purpose of review Epigenetic marks are emerging as mediators of genetics and the environment on complex disease phenotypes, including childhood asthma and allergy. Recent findings Epigenome-wide association studies over the past year have added to the growing body of evidence supporting significant associations of epigenetic regulation of gene expression and asthma and allergy. Studies in children have identified signatures of eosinophils in peripheral blood, Th2 cell transcription factors and cytokines in peripheral blood mononuclear cells, and epithelial dysfunction in the respiratory epithelium. Importantly, studies at birth have begun to decipher the contribution of epigenetic marks to asthma inception. Few studies have also begun to address the contribution of genetics and the environment to these associations. Summary Next generation of epigenome-wide association studies that will deal with confounders, study the influence of the genetics and environment, and incorporate multiple datasets to provide better interpretation of the findings are on the horizon. Identification of key epigenetic marks that are shaped by genetics and the environment, and impact transcription of specific genes will help us have a better understanding of etiology, heterogeneity and severity of asthma, and will also empower us to develop biologically driven therapeutics and biomarkers for secondary prevention of this disease. Correspondence to Ivana V. Yang, University of Colorado Denver 12700 East 19th Avenue, 8611 Aurora, CO 80045. E-mail: ivana.yang@ucdenver.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of allergic sensitization and its relevance to paediatric asthma

Purpose of review The purpose of this review is to summarize the recent evidence on the distinct atopic phenotypes and their relationship with childhood asthma. We start by considering definitions and phenotypic classification of atopy and then review evidence on its association with asthma in children. Recent findings It is now well recognized that both asthma and atopy are complex entities encompassing various different sub-groups that also differ in the way they interconnect. The lack of gold standards for diagnostic markers of atopy and asthma further adds to the existing complexity over diagnostic accuracy and definitions. Although recent statistical phenotyping studies contributed significantly to our understanding of these heterogeneous disorders, translating these findings into meaningful information and effective therapies requires further work on understanding underpinning biological mechanisms. Summary The disaggregation of allergic sensitization may help predict how the allergic disease is likely to progress. One of the important questions is how best to incorporate tests for the assessment of allergic sensitization into diagnostic algorithms for asthma, both in terms of confirming asthma diagnosis, and the assessment of future risk. Correspondence to Adnan Custovic, MD, PhD, Department of Paediatrics, Imperial College London, St Mary's Campus Medical School, Room 244, Norfolk Place, London W2 1PG, UK. Tel: +44 20 7594 3274; fax: +44 20 7594 3984; e-mail: a.custovic@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rX2mXF

Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do

Purpose of review Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. Recent findings The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. Summary The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality. Correspondence to Allison J. Burbank, MD, Department of Pediatrics, Division of Allergy, Immunology, & Rheumatology, 104 Mason Farm Road, CB #7310, Chapel Hill, NC 27599-7310, USA. Tel: +1 919 843 2714; fax: +1 919 962 4421; e-mail: allison_burbank@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How to prevent a tragus piercing becoming infected

A look at infected tragus piercings, a condition where a small part of the ear develops an infection. Included is detail on avoiding infection and risks.

http://ift.tt/2EtilPQ

A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage

Background: The recommended cardiac workup of patients with spontaneous intracerebral hemorrhage (ICH) includes an electrocardiogram (ECG) and cardiac troponin. However, abnormalities in other cardiovascular domains may occur. We reviewed the literature to examine the spectrum of observed cardiovascular abnormalities in patients with ICH. Methods: A narrative review of cardiovascular abnormalities in ECG, cardiac biomarkers, echocardiogram, and hemodynamic domains was conducted on patients with ICH. Results: We searched PubMed for articles using MeSH Terms "heart," "cardiac," hypertension," "hypotension," "blood pressure," "electro," "echocardio," "troponin," "beta natriuretic peptide," "adverse events," "arrhythmi," "donor," "ICH," "intracerebral hemorrhage." Using Covidence software, 670 articles were screened for title and abstracts, 482 articles for full-text review, and 310 extracted. A total of 161 articles met inclusion and exclusion criteria, and, included in the manuscript. Cardiovascular abnormalities reported after ICH include electrocardiographic abnormalities (56% to 81%) in form of prolonged QT interval (19% to 67%), and ST-T changes (19% to 41%), elevation in cardiac troponin (>0.04 ng/mL), and beta-natriuretic peptide (BNP) (>156.6 pg/mL, up to 78%), echocardiographic abnormalities in form of regional wall motion abnormalities (14%) and reduced ejection fraction. Location and volume of ICH affect the prevalence of cardiovascular abnormalities. Prolonged QT interval, elevated troponin-I, and BNP associated with increased in-hospital mortality after ICH. Blood pressure control after ICH aims to preserve cerebral perfusion pressure and maintain systolic blood pressure between 140 and 179 mm Hg, and avoid intensive blood pressure reduction (110 to 140 mm Hg). The recipients of ICH donor hearts especially those with reduced ejection fraction experience increased early mortality and graft rejection. Conclusions: Various cardiovascular abnormalities are common after spontaneous ICH. The workup of patients with spontaneous ICH should involve 12-lead ECG, cardiac troponin-I, as well as BNP, and echocardiogram to evaluate for heart failure. Blood pressure control with preservation of cerebral perfusion pressure is a cornerstone of hemodynamic management after ICH. The perioperative implications of hemodynamic perturbations after ICH warrant urgent further examination. A.L. has received research support from Edge Therapeutics for NEWTON-2 study, Aqueduct Critical Care for the ASSESSED clinical trial, and from NIH/NINDS for the ATACH-II clinical trial, none of which are relevant to this study. The remaining authors have no funding or conflicts of interest to disclose. Address correspondence to: Abhijit Lele, MBBS, MD, MS, Department of Anesthesiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, P.O. Box 356540, Seattle, WA 98104 (e-mail: abhijit2@uw.edu). Received October 17, 2017 Accepted December 31, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Issue Information

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ENAP vs LANAP: assessment of revascularization using ultrasound Doppler flowmetry—a split-mouth randomized controlled clinical trial

Abstract

Laser-assisted new attachment procedure (LANAP) is a new protocol that has been proposed for the treatment of periodontitis. However, there is little evidence regarding the rate of revascularization and the clinical efficacy of LANAP over conventional periodontal therapies. Hence, this study is done to evaluate and compare the clinical efficacy of LANAP vs Excisional new attachment procedure (ENAP) and also to assess the blood flow in both the techniques using ultrasound Doppler flowmetry. A split-mouth double-blinded controlled clinical trial was carried out in 15 subjects with chronic periodontitis. In every patient, 2 quadrants were treated with ENAP and the other 2 quadrants with LANAP. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD), clinical attachment level (CAL), and radiographic measurements (RBL) were recorded at baseline and 6, 9, and 12 months, postoperatively. Gingival blood flow assessment was done at baseline and on the ninth day postoperatively. Both the groups showed statistically significant reduction in all the clinical parameters when compared from baseline to subsequent follow-up visits. There was greater reduction in all the parameters in LANAP group than that of ENAP group. The rate of revascularization was higher in ENAP group than that of LANAP group when compared from baseline to the ninth day postoperatively. Although there is a delay in the rate of revascularization in the LANAP group, there was significant improvement in all the clinical and radiographic parameters than that of the ENAP group when compared from baseline to follow-up visits.

http://ift.tt/2DUhyGo