The etiology of scrotal pain is clinically classified in terms of the necessity for emergency surgery. Lately, color Doppler ultrasonography has reduced unnecessary surgeries, but there are still some cases that require immediate exploration because of an uncertain diagnosis. Here, we describe the case of a 14-month-old boy, who could not deliver his complaint accurately, presenting with a grumpy mood and a red swollen scrotum. Emergency surgery revealed that the cause was intense inflammation of the hydrocele wall, which typically does not cause acute scrotum. We also reviewed rare etiologies of scrotal pain for general physicians to develop the differential diagnosis.
http://ift.tt/2C3oG1M
Τετάρτη 7 Φεβρουαρίου 2018
Unusual Cause of Acute Scrotal Pain-Inflammatory Noncommunicating Hydrocele: A Pediatric Case Report
Imatinib-induced diffuse hyperpigmentation of the oral mucosa, the skin, and the nails in a patient affected by chronic myeloid leukemia: report of a case and review of the literature
Abstract
Background
Imatinib mesylate is a tyrosine-kinase inhibitor used as the first-line treatment in chronic myeloid leukemia patients, but it is also indicated for other hematological diseases and solid tumors. Imatinib treatment is often associated with hypopigmentation, but only a few cases of hyperpigmentation are described in literature.
Methods
We are reporting the first case of imatinib-related hyperpigmentation involving the oral mucosa, skin, and nails in a patient affected by chronic myeloid leukemia and treated with imatinib since 2002. A review of all the available literature regarding the imatinib-related hyperpigmentation was performed, and one additional case was analyzed. Due to the possibility of a post-inflammatory hyperpigmentation, all cases of pigmentary changes previously characterized by a rash and/or pruritus in the same body areas were excluded.
Results
Thirty cases of well-documented imatinib-related hyperpigmentation were described in literature. In our case, imatinib therapy was well tolerated for several years, and it led to an excellent hematological and cytogenetic response. However, the patient gradually developed a blue-gray pigmentation that involved the nose, fingernails, toenails, pretibial regions, posterior axillary folds, and hard palate. Other causes of pigmentary changes were excluded, and histopathological examination confirmed the clinical suspicion of imatinib-related hyperpigmentation.
Conclusions
Hyperpigmentation induced by imatinib is an adverse reaction rarely described in literature. The underlying pathogenetic mechanisms are not yet completely clear, and further studies are necessary to elucidate them. Currently, no treatment is required for this condition, and there is no indication to discontinue imatinib treatment.
http://ift.tt/2nRWGZP
Treatment efficacy of probiotics on atopic dermatitis, zooming in on infants: a systematic review and meta-analysis
Abstract
Probiotic treatment of atopic dermatitis is widely studied with controversial results. The objective of this study is to review the efficacy of probiotics for the treatment of atopic dermatitis in infants. PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, and reference lists were searched up to July 2017. Double-blinded randomized clinical trials were included. The primary outcome was the Scoring Atopic Dermatitis index. Subgroups analyses were conducted on probiotic species, treatment duration, participant age, and disease severity. Eight clinical trials (741 infants) were included in the quantitative synthesis. The overall pooled change in Scoring Atopic Dermatitis index (95% CI) in infants was −5.71 (−8.37, −3.04), P < 0.01. Subgroup analysis revealed that the effect was protective in moderate-to-severe patients −8.32 (−16.35, −0.28), with preparations containing Lactobacillus −5.76 (−9.21, −2.30). Probiotics for the treatment of infantile atopic dermatitis is beneficial.
http://ift.tt/2nO10Kn
Toxicity and growth inhibition potential of vetiver, cinnamon, and lavender essential oils and their blends against larvae of the sheep blowfly, Lucilia sericata
Abstract
Background
Myiasis induced by the sheep blowfly, Lucilia sericata, represents a public health problem widely distributed throughout the world. L. sericata larval stages feed on both humans and animals. L. sericata adults and larvae can play a role in spreading agents of mycobacterial infections.
Objectives
It is critical to establish new and safe alternative methods of controlling L. sericata.
Methods
The insecticidal effectiveness and growth inhibition potential of three commercially available essential oils (EOs), vetiver (Chrysopogon zizanioides), cinnamon (Cinnamomum zeylanicum), and lavender (Lavandula angustifolia), as well as their blends, were tested against the second (L2) and third (L3) larval stages of L. sericata. Sunflower (Helianthus annuus) oil was used as a carrier and tested on L2 and L3 larvae. To the best of our knowledge, all applied essential oils, except lavender, and oil blends were tested against L. sericata for the first time.
Results
All applied oils did not repel L2 from the treated liver but adversely affected their development. Contact treatments on L. sericata L3 indicated that vetiver and cinnamon oils significantly affected treated larvae. Total mortality rates were 93.33 and 95.56%, respectively. Furthermore, oil blends tested through contact assays killed larvae when used at higher concentrations; adult emergence was eliminated post-treatment with doses >30% for oil blend 1 and >10% for oil blend 2.
Conclusion
Overall, cinnamon and vetiver oils (5%) were selected as reliable and cheap biopesticides for controlling larvae of L. sericata. The tested oils are inexpensive and represent new promising botanical insecticides in the fight against blowflies causing myiasis.
http://ift.tt/2nS20w8
Effects of a sodium fluoride- and phytate-containing dentifrice on remineralisation of enamel erosive lesions—an in situ randomised clinical study
Abstract
Objective
The objective of this work was to evaluate effects of a dentifrice containing sodium fluoride (1150 ppm F) and the organic polyphosphate phytate (0.85% w/w of the hexa-sodium salt) on in situ remineralisation of early enamel erosive lesions and resistance to subsequent demineralisation.
Materials and methods
Subjects (n = 62) wore palatal appliances holding eight bovine enamel specimens with pre-formed erosive lesions. They brushed their natural teeth with the phytate test dentifrice (TD); a positive control dentifrice (PC, 1150 ppm fluoride as NaF); a reference dentifrice (RD, disodium pyrophosphate + 1100 ppm fluoride as NaF) or a negative control dentifrice (NC, fluoride-free) in a randomised, double-blind, crossover design. Specimens were removed at 2, 4 and 8 h post-brushing and exposed to an ex vivo acid challenge. Surface microhardness (Knoop) was measured at each stage. The primary efficacy variable was relative erosion resistance (RER); other variables included the surface microhardness recovery (SMHR), acid resistance ratio (ARR) and enamel fluoride uptake (EFU).
Results
After 4 h, the results for RER, ARR and EFU were in the order PC > TD = RD > NC with PC > TD = RD = NC for SMHR. Results at 2 and 8 h were generally consistent with the 4 h data. Mineralisation progressed over time. Dentifrices were generally well-tolerated.
Conclusions
In this in situ model, addition of phytate or pyrophosphate to a fluoride dentifrice inhibited the remineralising effect of fluoride. Both formulations still delivered fluoride to the enamel and inhibited demineralisation, albeit to a lesser extent than a polyphosphate-free dentifrice.
Clinical relevance
Addition of phytate or pyrophosphate to a fluoride dentifrice may reduce its net anti-erosive properties.
http://ift.tt/2GXVsF7
Correction to: Cone beam computed tomography and ultrasonography imaging of benign intraosseous jaw lesion: a prospective radiopathological study
Abstract
In the original version of this article, '123 lytic intraosseous jaw lesions diagnosed in 112 patients' was incorrectly presented as '123 lytic intraosseous jaw lesions diagnosed in 121 patients' and 'an average age of 31.7 ± 15.4 (range, 6–72)' was incorrectly presented as 'average age of 15.4 ± 31.7 (range, 6–72)'.
http://ift.tt/2Ed3xEg
Postoperative chemoradiotherapy in patients with head and neck cancer aged 70 or older with positive margins or extranodal extension and the influence of nodal classification
Abstract
Background
Postoperative concomitant chemoradiotherapy (CRT) improves outcomes for younger adults with head and neck squamous cell carcinoma (HNSCC) and positive margins or extranodal extension (ENE), but its benefit for older adults is not well established.
Methods
Patients from the National Cancer Data Base (NCDB) with HNSCC undergoing curative-intent resection, neck dissection, and postoperative radiation with positive margins or ENE were identified.
Results
This analysis included 1199 patients aged ≥ 70 years with median follow-up of 42.6 months. Postoperative concurrent CRT was associated with improved overall survival (OS; hazard ratio [HR] 0.752; 95% confidence interval [CI] 0.638-0.886) compared to radiation alone in multivariable analysis. Three-year OS was 52.4% with CRT versus 43.4% with radiation (P = .012) in propensity-score matched cohorts. The survival impact of CRT varied by N classification (P = .002 for interaction), with benefit seen only in those with N2 to N3 disease.
Conclusion
Postoperative concurrent CRT may benefit older patients with HNSCC with positive margins or ENE, particularly those with higher nodal burden.
http://ift.tt/2E9tJiY
Prevalence of adverse pathological features in 1 to 4 cm low-risk differentiated thyroid carcinoma
Abstract
Background
The American Thyroid Association (ATA) recommends thyroid lobectomy for 1 to 4 cm tumors without adverse features. We studied the prevalence of adverse pathological features in patients eligible for unilateral lobectomy.
Methods
We conducted a retrospective study of patients who underwent total thyroidectomy. Patients with differentiated thyroid cancer (DTC) with tumors measuring 1 to 4 cm with no known preoperative adverse features were included in this study. Patients with nodal and distant metastasis, tumors <1 cm to > 4 cm, age < 17 years old, and gross extrathyroidal extension were excluded. Patients with bilateral nodularity on imaging were excluded from the final analysis on adverse features.
Results
There were 59.1% of patients undergoing thyroidectomy with tumors measuring 1 to 4 cm and no preoperatively known adverse features who were eligible for lobectomy under current ATA guidelines who would have needed a completion thyroidectomy after pathological analysis of the index tumor.
Conclusion
Two thirds of the patients may require a completion thyroidectomy if unilateral lobectomy is done in tumors measuring 1 to 4 cm based on adverse pathological features.
http://ift.tt/2ELgSEB
Quality of life during the first year after partial laryngectomy: Longitudinal study
Abstract
Background
This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.
Methods
The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance.
Results
Most subscales worsened 1 week postprocedure, but many recovered to baseline level after 1 year. Dyspnea and cognitive functioning deteriorated over time, with worst scores recorded after 1 year. Financial difficulties and fatigue increased after surgery and maintained that level throughout the follow-up period; sticky saliva remained worse than at baseline, despite some improvements over time.
Conclusion
The discovered limitations of QOL should be observed more closely during follow-up treatment, and patients should be informed about these potential effects before partial laryngectomy.
http://ift.tt/2E9tCUA
Thyroidectomy in patients who have undergone gastric bypass surgery
Abstract
Background
Morbid obesity is a chronic condition that may be challenging to treat. Gastric bypass surgery is used to treat morbid obesity and its complications. Hypocalcemia, a known complication after thyroidectomy, is usually transient and treatable. There is a growing body of literature indicating that patients with previous gastric bypass surgery are at an increased risk for recalcitrant, symptomatic hypocalcemia after thyroidectomy. The management of hypocalcemia in patients with prior gastric bypass surgery may be exceedingly difficult.
Methods
Relevant articles published between 2008 and January 2017 were reviewed by topic. The review of literature was conducted using a systematic search of database resources, such as PubMed and EMBASE.
Results
Prior gastric bypass surgery may be an independent risk factor for developing profound hypocalcemia after thyroid surgery.
Conclusion
Refractory hypocalcemia in patients who have undergone gastric bypass surgery is underreported. Careful consideration should be given to performing staged thyroidectomy and, in some cases, reversal of the bariatric surgery.
http://ift.tt/2ENyi3p
Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis
Abstract
Background
The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).
Methods
Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.
Results
Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124).
Conclusion
In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
http://ift.tt/2E8JbvO
Nekrotisierende zervikale Lymphadenopathie mit unklaren Hautläsionen
Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-101433
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2C3bhqn
Hörsturz mit Surditas, Schwindel und Tinnitus - eine 12-jährige Odyssee
Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-100517
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2E9uSuU
Antibody response of growing German Holstein bulls to a vaccination against bovine viral diarrhea virus (BVDV) is influenced by Fusarium toxin exposure in a non-linear fashion
Abstract
The Fusarium toxin deoxynivalenol (DON) is a frequent contaminant of feedstuffs and is supposed to interfere with immune responses. As the relevance for growing bulls is less clear than for other livestock, the trial was designed according to the dose-response principal with a control group fed a diet with background contamination (CON, 0.36 mg DON per kilogram dry matter [DM]) and three groups with increasing concentrations of DON (mg/kg DM); FUS I, 3.01; FUS II, 5.66; FUS III, 8.31. Half of each treatment group was vaccinated against BVDV at days 1 and 21 of the 70 days lasting experiment. Sequential blood samples were collected for determination of antibody titers to BVDV and for hematological and clinical-chemical traits. Antibody response was strongest in group FUS II while group FUS III responded weakest. This group showed the lowest proportion of CD4+ T cells, but also the highest levels of liver lesion indicating enzyme activities in blood. BVDV-vaccination induced a pronounced decrease in red blood count indices, which occurred dose-dependently at a higher level in the FUS-fed groups. The obvious interactions between DON exposure and BVDV-vaccination require further elucidation.
http://ift.tt/2EQe5de
Prognostic significance of HPV status in the re-irradiation of recurrent and second primary cancers of the head and neck
To evaluate the prognostic significance of human papillomavirus (HPV) status among patients treated by salvage radiation therapy for local-regional recurrences and second primary cancers of the head and neck arising in a previously irradiated field.
http://ift.tt/2GZrKiX
Forehead reduction and orbital contouring in facial feminisation surgery for transgender females
Forehead reduction and orbital contouring form a considerable component of the procedures available to feminise the face in transgender females. In this paper I shall discuss the history and development of techniques to reduce bossing of the forehead and contour the orbits, and describe their classification, assessment, surgical approach, and complications.
http://ift.tt/2C33Sr5
Use of ultrasound-activated resorbable sheets and pins in the management of fractures of the condylar neck of the mandible: a case series
The need to treat fractures of the mandibular condyle remains controversial, but when the decision to operate has been made, then multiple forms of fixation are advocated. Traditionally, metal plates and screws have been used, but this is thought to have several disadvantages, particularly in the growing skeleton. Resorbable fixation for maxillofacial fractures has not gained widespread acceptance because of technical difficulties with the materials and concern about inflammatory reactions during their resorption.
http://ift.tt/2EcwTqg
Survival in patients with submandibular gland carcinoma — Results of a multi-institutional retrospective study
Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.
http://ift.tt/2nUwCgO
A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan
We used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.
http://ift.tt/2nK5Ecf
The gray scale value of ear tissues undergoing volume-rendering high-resolution cone-beam computed tomography
When the thresholds for VR reconstruction from multi-slice CT images are changed, problems develop when assessing pathologies in the absence of standardized thresholds. The advantages of CBCT include lower radiation exposure compared with other techniques and better visualization of small ear structures. However, a disadvantage is that the scanner provides unstandardized gray scale values, thus not CT numbers (Hounsfield units, HU).
http://ift.tt/2nTNROW
Experiences with a modified preauricular mini INCISION with subdermally dissection in condylar and subcondylar fractures of the mandible
Condylar and subcondylar fractures (CSFs) are among the most common mandible fractures. If reduction of these fractures is not carried out correctly, serious complications can result, including infection, damage to temporomandibular joint (TMJ) function, malocclusion, nonunion, malunion, and ankylosis of the TMJ.
http://ift.tt/2nJJ6bD
Food protein-induced enterocolitis syndrome: a review of the new guidelines
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergy that presents with delayed vomiting after ingestion primarily in infants. While the pathophysiology of FP...
http://ift.tt/2BMJe2Q
Estimating the health care costs associated with recurrent cellulitis managed in the outpatient setting
Recurrent cellulitis is diagnosed in 22% to 49% of all cellulitis cases, but little is known about the costs associated with these cases.
http://ift.tt/2nRstdf
Long-term outcomes of craniofacial implants for the restoration of facial defects
The aim of this study was to evaluate the long-term survival of craniofacial implants and prostheses and to identify factors associated with failure in a cohort of patients. A 25-year retrospective analysis was conducted at Royal Melbourne Hospital. Data included demographic characteristics, age, site and cause of the deformity, and number and survival of implants. Odds ratios were calculated and event-to-time Kaplan–Meier analyses performed. One hundred and ten patients were included (341 implants); their mean age was 46.2 years.
http://ift.tt/2BKlU5E
Coexistence of frontal sinus hypoplasia with maxillary sinus hypoplasia: a radiological study
Abstract
The goal of this study was to determine whether frontal sinus hypoplasia coexists with maxillary sinus hypoplasia. Analyzing paranasal CT scans retrospectively, we included 86 patients who had a hypoplastic maxillary sinus at least on one side and 80 patients with bilateral normal maxillary sinuses (control group). We classified hypoplastic maxillary sinuses using the classification system previously defined by Bolger et al. (Otolaryngol Head Neck Surg 103(5):759–765, 1990). We classified the frontal sinuses as aplastic, hypoplastic, medium-sized, and hyperplastic; as previously defined by Guerram et al. (Am J Phys Anthropol 154(4):621–627, 2014). We compared the presence of frontal sinus hypoplasia using Chi-square test between the groups. The mean age of the maxillary sinus group was 43.2 (range 18–84) years. Of 86 patients, 33 (38.4%) had unilateral and 53 (61.6%) had bilateral maxillary sinus hypoplasia. Of 139 maxillary sinuses totally included, 73 (52.5%) were type 1, 51 (36.7%) were type 2 and 15 (10.8%) were type 3 hypoplastic maxillary sinuses. Of 332 frontal sinuses totally included, 25 (7.5%) were aplastic, 32 (9.6%) were hypoplastic, 172 (51.9%) were medium-sized, and 103 (31%) were hyperplastic. Of 86 patients with a hypoplastic maxillary sinus at least on one side, 29 (33.7%) had a hypoplastic and/or aplastic frontal sinus, while 10 (12.5%) had a hypoplastic and/or aplastic frontal sinus at least on one side in control group. Incidence of frontal sinus hypoplasia and/or aplasia was significantly higher in patients with maxillary sinus hypoplasia compared to the patients with bilaterally normal maxillary sinuses (χ2 = 10.384, P = 0.001). Maxillary sinus hypoplasia has a significantly higher coexistence with frontal sinus hypoplasia. This study may have an implication for anatomical studies about the development of the paranasal sinuses and paranasal sinus surgery as well as further morphological studies.
http://ift.tt/2nK5mSW
l-Methionine anti-biofilm activity against Pseudomonas aeruginosa is enhanced by the cystic fibrosis transmembrane conductance regulator potentiator, ivacaftor
Background
Biofilms may contribute to refractory chronic rhinosinusitis (CRS), as they lead to antibiotic resistance and failure of effective clinical treatment. l-Methionine is an amino acid with reported biofilm-inhibiting properties. Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator with mild antimicrobial activity via inhibition of bacterial DNA gyrase and topoisomerase IV. The objective of this study was to evaluate whether co-treatment with ivacaftor and l-methionine can reduce the formation of Pseudomonas aeruginosa biofilms.
Methods
P aeruginosa (PAO-1 strain) biofilms were studied in the presence of l-methionine and/or ivacaftor. For static biofilm assays, PAO-1 was cultured in a 48-well plate for 72 hours with stepwise combinations of these agents. Relative biofilm inhibitions were measured according to optical density of crystal violet stain at 590 nm. Live/dead assays (BacTiter-Glo™ assay, Promega) were imaged with laser scanning confocal microscopy. An agar diffusion test was used to confirm antibacterial effects of the drugs.
Results
l-Methionine (0.5 μM) significantly reduced PAO-1 biofilm mass (32.4 ± 18.0%; n = 4; p < 0.001) compared with controls. Low doses of ivacaftor alone (4, 8, and 12 μg/mL) had no effect on biofilm formation. When combined with ivacaftor (4 μg/mL), a synergistic anti-biofilm effect was noted at 0.05 μM and 0.5 μM of l-methionine (two-way analysis of variane, p = 0.0415) compared with corresponding concentrations of l-methionine alone.
Conclusion
Ivacaftor enhanced the anti-biofilm activity of l-methionine against the PAO-1 strain of P aeruginosa. Further studies evaluating the efficacy of ivacaftor/l-methionine combinations for P aeruginosa sinusitis are planned.
http://ift.tt/2FWoy6t
Otolaryngologist adherence to the AAO-HNSF Allergic Rhinitis Clinical Practice Guideline
Background
In February 2015, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNSF) published the Allergic Rhinitis Clinical Practice Guideline (AR-CPG). The objective of this study was to assess otolaryngologists' perception of the accuracy and adherence to the AR-CPG.
Methods
A survey was distributed to fellows of the American Academy of Otolaryngic Allergy and members of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. A total of 601 otolaryngologists responded. The survey evaluated otolaryngologists' demographic data, perception of the accuracy of the guideline, and adherence to the guideline action statements.
Results
The majority of respondents were actively practicing (544 [90.5%]), for a duration of 11–30 years (308 [51.2%]), in a private practice setting (387 [64.4%]). The cohort was largely fellowship trained (348 [57.9%]) and had reviewed the guideline (428 [71.2%]). Most respondents perceived the guideline as being correct "a great deal" (295 [69.7%]) and deviated from the guideline "only a little" (302 [71.6%]). High rates of adherence to the strong guideline recommendations were observed. Respondents "always/most of the time" recommended intranasal steroids (581 [97.6%]), and oral antihistamines (439 [74%]) as primary therapy. Otolaryngologists in practice for longer were more likely to deviate from the guideline recommendations by obtaining sinonasal imaging (p = 0.007) and recommending oral leukotriene receptor antagonists as primary therapy (p = 0.0001).
Conclusion
Overall perception of the correctness of and adherence to the AR-CPG was high in this cohort. Targeted education resources should be provided to otolaryngologists in practice for longer in efforts to reduce harmful or unnecessary variations in care.
http://ift.tt/2GXAVR2
Potential COIs in Dermatology Clinical Practice Guidelines
This Viewpoint discusses the importance of achieving balance between the practical and the ideal in clinical practice guideline development.
http://ift.tt/2E9BKV2
http://ift.tt/2E9BKV2
A New Severity Assessment for Hidradenitis Suppurativa
This study examines the accuracy and clinical relevance of a newly developed scoring system for hidradenitis suppurativa severity.
http://ift.tt/2EMSin3
http://ift.tt/2EMSin3
Evaluating Industry Payments Among Dermatology Clinical Practice Guideline Authors
To the Editor The article by Checketts et al regarding industry payments among dermatology clinical practice guideline (CPG) authors was accompanied by an editorial by Katz highlighting some of the problems with the study's methodology. We have significant additional concerns regarding its conclusions.
http://ift.tt/2E7Oxr1
http://ift.tt/2E7Oxr1
Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population
This cross-sectional study characterizes the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries.
http://ift.tt/2EOm22L
http://ift.tt/2EOm22L
Evaluating Industry Payments Among Dermatology Clinical Practice Guideline Authors—Reply
In Reply We appreciate the opportunity to respond to Glazer et al regarding our recent publication on financial conflicts of interest (COIs). This issue is timely, important, and needs addressing. We will respond to their 2 primary criticisms. First, they proffer that research payments should not be considered COIs owing to the importance of physician-industry relationships in advancing medical knowledge. Second, they contend that the Open Payments Database (OPD) is "flawed," and thus our findings lack merit. We address these criticisms herein.
http://ift.tt/2E8zBZU
http://ift.tt/2E8zBZU
Erosive Patches on Bilateral Nipples
A young woman presented with painless erythematous erosive patches on both nipples 3 months after a bite during sexual intercourse. What is your diagnosis?
http://ift.tt/2EOAdVI
http://ift.tt/2EOAdVI
Efficacy and Safety of Guselkumab for Palmoplantar Pustulosis
This randomized clinical trial evaluates the safety and efficacy of guselkumab compared with placebo for the treatment of palmoplantar pustulosis.
http://ift.tt/2E9oxeK
http://ift.tt/2E9oxeK
Evaluation of treatment outcomes in patients with supraglottic laryngeal cancer in Ontario, Canada: A population-based study
Abstract
Background
Supraglottic laryngeal carcinoma has an entirely different etiology, clinical presentation, and prognosis compared to glottis cancer but the only evidence for the use of concurrent chemotherapy with radiotherapy (CRT) is the 5.4% 5-year improvement in overall survival (OS) for the combined laryngeal site.
Method
We conducted a retrospective population-based study using administrative data to compare OS, disease-specific survival (DSS), laryngectomy-free survival, and laryngoesophageal dysfunction-free survival over time and by treatment for all patients with supraglottic laryngeal carcinoma diagnosed between January 1, 1990, and December 31, 2014, in Ontario, Canada.
Results
There was no improvement over time in OS (hazard ratio [HR] 1.006; P = .90), DSS (HR 1.031; P = .65), or laryngoesophageal dysfunction-free survival (P = .39). The patients selected for CRT had similar OS (HR 1.04; P = .66), laryngectomy-free survival (HR 0.95; P = .23), and laryngoesophageal dysfunction-free survival (P = .79) compared with patients undergoing radiotherapy.
Conclusion
The addition of CRT by head and neck oncologists in Ontario, Canada, did not improve outcomes for the "real world" patients with supraglottic laryngeal carcinoma.
http://ift.tt/2C2j4om
The association and potentially destructive role of Th9/IL-9 is synergistic with Th17 cells by elevating MMP9 production in local lesions of oral lichen planus
Abstract
Background
The present study was to investigate association and potentially destructive role of Th9/IL-9 and their synergistic interaction with Th17 cells in elevating MMP9 production in local lesions of oral lichen planus (OLP) patients.
Methods
Oral mucosal tissues were obtained from OLP patients and healthy controls (HC) and then divided into an epithelial part (EP) or a lamina propria part (LP). Both EP and LP subsets were assessed for IL-9 and MMP9 mRNA levels by real-time quantitative PCR (qPCR). Flow cytometry was used to detect the CD4+ T helper subset Th9 (IL-9+IL-17-CD4+) and Th17 (IL-9-IL-17+CD4+) in co-cultured CD4+ Th cells and oral keratinocytes of OLP. IL-9, IL-17 and MMP9 in co-culture supernatant were detected by ELISA.
Results
The qPCR results demonstrated that IL-9 and MMP9 mRNA levels were positively correlated in OLP lesions, and both significantly elevated in EP and LP lesions of erosive type OLP. Th9 and Th17 cells were significantly elevated in co-cultures of CD4+ Th cells and keratinocytes, and MMP9, IL-9 and IL-17 levels were simultaneously increased. In vitro, recombinant human IL-17 treatment significantly enhanced MMP9 protein and mRNA levels, while a synergistic effect of IL-9 and IL-17 was not observed. However, further results showed Th17 cells, IL-17 and MMP9 were increased significantly when recombinant IL-9 was added to the cultured CD4+ T cells.
Conclusion
This study demonstrated that Th9/IL-9 can induce elevated levels of MMP9 to aggravate OLP disease severity, which may occur directly through increasing Th17 levels or indirectly through a synergistic role with Th17.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Bfz1dZ
Farm dust reduces viral load in human bronchial epithelial cells by increasing barrier function and antiviral responses
Publication date: Available online 7 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Luciën E.P.M. van der Vlugt, Katrien Eger, Christoph Müller, Dennis K. Ninaber, Maria C. Zarcone, Gimano D. Amatngalim, Franz Bracher, Erika von Mutius, Hermelijn H. Smits, Pieter S. Hiemstra
http://ift.tt/2E9Kj2j
Severe Asthma is Associated with Metabolic Syndrome in Brazilian Adolescents
Publication date: Available online 7 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Fábio Chigres Kuschnir, Mara Morelo Rocha Felix, Maria Cristina, Caetano Kuschnir, Erica Azevedo de Oliveira Costa Jordão, Dirceu Solé, Antônio José Ledo Alves da Cunha, Moyses Szklo
http://ift.tt/2ENrq6k
Germline Gain-of-Function MYD88 Mutation in a Child with Severe Arthritis
Publication date: Available online 7 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Keith A. Sikora, Joshua R. Bennett, Laurens Vyncke, Zuoming Deng, Wanxia Li Tsai, Ewald Pauwels, Gerlinde Layh-Schmitt, April Brundidge, Fatemeh Navid, Kristien J.M. Zaal, Eric Hanson, Massimo Gadina, Louis M. Staudt, Thomas A. Griffin, Jan Tavernier, Frank Peelman, Robert A. Colbert
http://ift.tt/2E9K5rZ
New mechanism underlying IL-31-induced atopic dermatitis
Publication date: Available online 7 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jianghui Meng, Masaki Moriyama, Micha Feld, Joerg Buddenkotte, Timo Buhl, Attila Szöllösi, Jingming Zhang, Paul Miller, Andre Ghetti, Michael Fischer, Peter W. Reeh, Chunxu Shan, Jiafu Wang, Martin Steinhoff
BackgroundT helper type 2 cell-released interleukin 31 (IL-31) is a critical mediator in atopic dermatitis (AD), a prevalent and debilitating chronic skin disorder. Brain-derived natriuretic peptide (BNP) has been described as a central itch mediator. The importance of BNP in peripheral (skin-derived) itch and its functional link to IL-31 within the neuro-immune axis of the skin is unknown.ObjectiveTo investigate the function of BNP in the peripheral sensory system and skin in IL-31-induced itch and neuro-epidermal communication in AD.MethodsCa2+-imaging, immunohistochemistry, quantitative real-time PCR, RNA-Seq, knockdown, cytokine/phosphor-kinase arrays, enzyme immune assay and pharmacological inhibition were subjected to examine the cellular basis of the IL-31-stimulated, BNP-related itch signaling in human DRG neurons (hDRG) and skin cells, transgenic AD-like mouse models, and human skin of AD and healthy subjects.ResultsIn hDRG, we confirmed expression and co-occurrence of OSMRβ and IL-31 receptor A in a small subset of neuronal population. Furthermore, IL-31 activated ∼50% of endothelin-1-responsive neurons, and half of the latter also responded to histamine. In murine DRGs IL-31 upregulated Nppb and induced SNARE-dependent BNP release. In the Grhl3PAR2/+mice, house dust mite-induced severe AD-like dermatitis was associated with Nppb upregulation. Lesional IL-31Tg mice also exhibited increased Nppb transcripts in DRGs and skin; accordingly, skin BNP receptor was elevated. Importantly, expression of BNP and its receptor were increased in AD patient skin. In human skin cells, BNP stimulated a pro-inflammatory, itch-promoting phenotype.ConclusionOur findings show, for the first time, that BNP is implicated in AD and that IL-31 regulates BNP in both DRGs and skin. IL-31 enhances BNP release and synthesis, and orchestrates cytokine and chemokine release from skin cells, thereby coordinating the signaling pathways involved in itch. Inhibiting peripheral BNP function may be a novel therapeutic strategy for AD and pruritic conditions.
http://ift.tt/2ENQ0Uq
Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment
Abstract
Objective
To evaluate the effect of preventive dental management on reducing the incidence and delaying the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients treated with intravenous zoledronic acid (ZA).
Material and methods
This single-center clinical study included 255 cancer patients monitored over a 6-year period. Patients received dental treatment prior (Group A) or after (Group B) the initiation of ZA therapy. Dental treatments performed, incidence proportion (IP) and incidence rate (IR) in both groups were analyzed using significance tests. BRONJ onset were estimated using the Kaplan–Meier estimator and log-rank test. Independent risk factors to develop BRONJ were evaluated using Cox regression analysis models.
Results
37 patients suffered from BRONJ (IP=14.5%), 7.3% in group A and 36.5% in group B (p=0.000). The IR was 0.007 patients/month in group B and 0.004 in group A. BRONJ free survival at 3 years were 97% in group A and 66% in group B. Survival curves were significant (p=0.056) according to log-rank test. Multivariate Cox models showed that dental extractions (p=0.000) were significant.
Conclusions
BRONJ occurred significantly in patients who underwent dental extractions after the initiation of ZA and did not accomplish a preventive dental program.
This article is protected by copyright. All rights reserved.
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Complete resection of a rectus abdominis muscle invaded by desmoid tumors and subsequent management with an abdominal binder: a case report
Desmoid-type fibromatosis is characterized by desmoid tumors, which are benign soft tissue tumors that can be locally aggressive but typically do not metastasize. Desmoid tumors can manifest anywhere in the bo...
http://ift.tt/2C05FwV
Influence of peanut matrix on stability of allergens in gastric-simulated digesta: 2S albumins are main contributors to the IgE-reactivity of short digestion resistant peptides
Abstract
Background
Most food allergens sensitizing via the gastrointestinal tract are stable proteins that are resistant to pepsin digestion, in particular major peanut allergens, Ara h 2 and Ara h 6. Survival of their large fragments is essential for sensitizing capacity. However, the immunoreactive proteins/peptides to which the immune system of the gastrointestinal tract is exposed during digestion of peanut proteins is unknown. Particularly, the IgE-reactivity of short digestion-resistant peptides (<10 kDa) released by gastric digestion under standardized and physiologically relevant in vitro conditions has not been investigated.
Objective
The aim of this study was to investigate and identify digestion products of major peanut allergens and in particular to examine IgE reactivity of short digestion-resistant peptides released by pepsin digestion of whole peanut grains.
Methods
Two-dimension gel-based proteomics and shotgun peptidomics, immunoblotting with allergen-specific antibodies from peanut sensitised patients, enzyme-linked immunosorbent inhibition assay and ImmunoCAP tests, including far ultraviolet-circular dichroism spectroscopy were used to identify and characterize peanut digesta.
Results
Ara h 2 and Ara h 6 remained mostly intact, and short digestion-resistant peptides from Ara h 2 were more potent in inhibiting IgE binding than Ara h 1 and Ara 3. Ara h 1 and Ara h 3 exhibited sequential digestion into a series of digestion-resistant peptides with preserved allergenic capacity. A high number of identified short digestion-resistant peptides from Ara h 1, Ara h 2 and Ara h 3 were part of short continuous epitope sequences and possessed substantial allergenic potential.
Conclusion and Clinical Relevance
Peanut grain digestion by oral and gastric phase enzymes generates mixture of products, where the major peanut allergens remain intact and their digested peptides have preserved allergenic capacity highlighting their important roles in allergic reactions to peanut.
This article is protected by copyright. All rights reserved.
http://ift.tt/2C574Te
Advancing the management of Obstructive Airways Diseases through Translational Research
Abstract
Obstructive airways diseases (OAD) represent a huge burden of illness worldwide, and in spite of the development of effective therapies, significant morbidity and mortality related to asthma and COPD still remains. Over the past decade, our understanding of OAD has improved vastly, and novel treatments have evolved. This evolution is the result of successful translational research, which has connected clinical presentations of OAD and underlying disease mechanisms, thereby enabling the development of targeted treatments. The next challenge of translational research will be to position these novel treatments for OAD for optimal clinical use. At the same time, there is great potential in these treatments providing even better insights into disease mechanisms in OAD, by studying the effects of blocking individual immunological pathways. To optimise this potential, there is a need to ensure that translational aspects are added to randomised clinical trials, as well as Real World studies, but also to use other trial designs such as platform studies, which allow for simultaneous assessment of different interventions. Furthermore, demonstrating clinical impact, i.e. research translation, is an increasingly important component of successful translational research.
This review outlines concepts of translational research, exemplifying how translational research has moved management of Obstructive Airways Diseases into the next century, with the introduction of targeted, individualised therapy. Furthermore, the review describes how these therapies may be used as research tools, to further our understanding of disease mechanisms in OAD, through translational, mechanistic studies. We underline the current need for implementing basic immunological concepts into clinical care, in order to optimise the use of novel targeted treatments, and to further the clinical understanding of disease mechanisms. Finally, potential barriers to adoption of novel targeted therapies into routine practice are described, and how these may be overcome.
This article is protected by copyright. All rights reserved.
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Tumors of the parapharyngeal space: the VU University Medical Center experience over a 20-year period
Abstract
Background
Tumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. This series of 99 PPS tumors provides an overview of the clinical course and management of PPS tumors.
Materials and methods
This retrospective study included clinical data from patients treated for PPS tumors from 1991 to 2012 (warranting at least a 4-year follow-up) at the VU University Medical Center, Amsterdam, The Netherlands.
Results
Fifty percent were salivary gland tumors, 41% were neurogenic and 9% had a different origin. 18.2% of the PPS tumors were malignant. The most reported symptom at presentation was swelling of the neck and throat. In 14%, the PPS tumor was an accidental finding following imaging for other diagnostic reasons. Cytology showed an accuracy rate of 73.1% (19/26). The positive predictive value of a malignant cytology result was 86% (95% CI 42.1–99.6%). Surgery was performed in 55 patients (56%). The most frequently performed approach (56%) was the cervical–transparotid approach, followed by the cervical (25%), transmandibular (16%) and transoral (2%) approach. Nine patients died of the disease, of which seven patients had a malignant salivary gland tumor, one patient had a pleomorphic adenoma at first diagnosis which degenerated into carcinoma ex pleomorphic adenoma and one patient died of metastatic renal cell carcinoma.
Conclusion
This large single-centre report on PPS tumors shows that careful diagnostic work up and proper surgical planning are important in this specific and rare group of head and neck tumors. Surgery was the main treatment (56%) for parapharyngeal tumors. Management of parapharyngeal neurogenic neoplasms generally consists of active surveillance due to peri-operative risk for permanent cranial nerve damage. The histopathological diagnoses were consistent with previous reports.
http://ift.tt/2nFuOZK
Validation of the second version of the LittlEARS ® Early Speech Production Questionnaire (LEESPQ) in German-speaking children with normal hearing
Abstract
Introduction
The introduction of neonatal hearing screening and the increasingly early age at which children can receive a cochlear implant has intensified the need for a validated questionnaire to assess the speech production of children aged 0‒18. Such a questionnaire has been created, the LittlEARS® Early Speech Production Questionnaire (LEESPQ). This study aimed to validate a second, revised edition of the LEESPQ.
Methods and materials
Questionnaires were returned for 362 children with normal hearing. Completed questionnaires were analysed to determine if the LEESPQ is reliable, prognostically accurate, internally consistent, and if gender or multilingualism affects total scores.
Results
Total scores correlated positively with age. The LEESPQ is reliable, accurate, and consistent, and independent of gender or lingual status. A norm curve was created.
Discussion
This second version of the LEESPQ is a valid tool to assess the speech production development of children with normal hearing, aged 0‒18, regardless of their gender. As such, the LEESPQ may be a useful tool to monitor the development of paediatric hearing device users.
Conclusion
The second version of the LEESPQ is a valid instrument for assessing early speech production of children aged 0‒18 months.
http://ift.tt/2nQKhFh
The immunopathogenic and immunomodulatory effects of interleukin-12 in periodontal disease
Interleukin 12 (IL-12) is an inflammatory cytokine that promotes the response of the immune system. This cytokine has been implicated as a potent stimulator of several diseases characterized by inflammatory-induced bone destruction, such as rheumatoid arthritis and periodontitis. Yet, the exact role of IL-12 in the development and progress of periodontitis has not been clarified. Several studies have demonstrated a positive correlation between the level of IL-12 and the severity of periodontal destruction. Deletion of IL-12 in mice with periodontitis significantly suppressed the level of bone destruction. Interestingly, next to a role in modulating the pathogenesis, IL-12 also has immunological-regulatory properties. This cytokine induces expression of immunosuppressive molecules, such as indoleamine-pyrrole 2,3-dioxygenase (IDO). Thus, these findings suggest both negative and positive influences of IL-12 in periodontal disease. It is currently proposed that the diversity of action of cytokines is a molecular key which regulates biological development and homeostasis. Accordingly, the actions of IL-12 might be one of the mechanisms that regulate homeostasis of periodontal tissue during and following inflammation. Therefore, this article aims to review both destructive and protective functionalities of IL-12 with an emphasis on periodontal disease.
http://ift.tt/2nQwI98
Giant colonic diverticulum—a rare cause of acute abdomen
Abstract
Giant colonic diverticulum (GCD), defined as diverticulum larger than 4 cm, is a rare entity. It is generally a manifestation of colonic diverticular disease and can have dramatic complications such as perforation, abscess, volvulus, infarction and adenocarcinoma. This report documents the case of a 63-year-old man coming to the Emergency Department with acute abdomen due to a perforation of a GCD. In the plain abdominal X-ray the 'Balloon-sign' was revealed, computed tomography scan and Hartmann's procedure were performed. Acute abdomen can occur as a manifestation of a complication of a GCD, and this report highlights the fact that GCD should be considered for patients with a high risk of diverticular disease and abdominal pain.http://ift.tt/2ENHvZL
Medullary-like hepatocellular carcinoma
Abstract
Hepatocellular carcinoma (HCC) is the most frequent primary hepatic cancer. Pathological features can define the biological behavior and prognosis. Medullary-like HCC is a very rare variant that has been described only twice in literature. In the present study, we report the case of a non-cirrhotic 72-year-old man, who presented two HCC lesions on routine screening for hepatitis C virus liver disease. Radiological imaging and biopsy showed two different subtypes: one classic HCC, which was treated with chemoembolization, and a second PET/CT-positive carcinoma with a PET/CT-positive metastatic coeliac lymph node, which was resected laparoscopically with a left lateral sectionectomy and extended lymphadenectomy. Histopathology revealed a medullary-like HCC; lymph node analysis confirmed the metastatic nature of the PET/CT-positive coeliac node and showed an incidental B-cell lymphoma in the hepatic pedicle lymph nodes. To the best of our knowledge this is the third case of medullary-like HCC described in the literature, and the first associated to a concomitant typical HCC.http://ift.tt/2E89geq
After a punch: recurrence of compartment syndrome following minor trauma
Abstract
Acute compartment syndrome (ACS) is a diagnosis that requires high-clinical suspicion especially in cases when the initial causal event could be considered insignificant. We present a novel case presentation of ACS associated with minor trauma in a patient with a previous history of compartment syndrome in the same extremity from a motor vehicle accident 10 years prior to presentation. To the best of our knowledge, this is the first reported case of recurrent ACS. Due to the possibility of significant morbidity, including loss of limb, it is imperative to recognize the presentation quickly so proper surgical intervention can occur. This case shows compartment syndrome can occur after a low impact mechanism of injury and previous compartment syndrome may be a risk factor, lowering the threshold for a re-occurrence. Serial exams and compartment pressure measurements should be used to aid recognition in ambiguous clinical presentations.http://ift.tt/2EJRWgN
Comparison of Endonasal DCR Surgery Using Cautery and Surgical Blade Technique in Cases of Chronic Dacryocystitis
Abstract
Dacryocystitis is defined as inflammation of lacrimal sac. This can be congenital or acquired. Congenital dacryocystitis is commonly chronic while acquired dacryocystitis is acute and chronic both. Endonasal DCR surgery is the most commonly used treatment in chronic DCR but recent use of cautery technique in endonasal DCR surgery rather than traditional surgical blade technique has emerged with promising results with good success rate and fewer complications.
http://ift.tt/2nKStrq
Radiological comparison of inferior turbinate hypertrophy between allergic and non-allergic rhinitis: does allergy really augment turbinate hypertrophy?
Abstract
Background
Inferior turbinate hypertrophy could be a result of allergic rhinitis (AR) that leads to nasal congestion and nasal airway obstruction, which is the most bothersome complaint in patients with AR. However, evidence regarding whether patients with AR have a more hypertrophied inferior turbinate than do patients with non-AR is lacking.
Objective
We aimed to evaluate the degree of inferior turbinate hypertrophy according to the presence of AR using radiological measurements of the inferior turbinate.
Methods
For evaluating the inferior turbinate, which contributes to nasal obstruction in patients with AR, we enrolled 90 adult patients with septal deviation and divided them into two groups (AR group: n = 49; non-AR group: n = 41). Allergic rhinitis was diagnosed according to the presence of an allergic history, positive multiple allergen simultaneous test, and serological total immunoglobulin E level (≥ 100 kU/L). We analyzed the minimal cross-sectional area on acoustic rhinometry for both groups. The bilateral total width as well as medial mucosa and nasal cavity space in the anterior and posterior portions of the inferior turbinate were measured using computed tomography.
Results
We could not find any significant differences in the anterior and posterior dimensions of the inferior turbinate, intranasal space, and choanal spaces between the AR and non-AR groups. Instead, the anterior part of the inferior turbinate in both the groups showed significant differences between the deviated and contralateral sides. The contralateral side had a larger width than did the deviated side, but no significant difference was noted in the posterior portion of the inferior turbinate.
Conclusion
The degree of inferior turbinate hypertrophy showed no difference between patients with and without AR. Therefore, we suggest that surgical treatment for reducing the size of the inferior turbinate hypertrophy should be considered when performing septoplasty in patients with symptoms of nasal obstruction, regardless of the presence of AR.
http://ift.tt/2EaErpa
Comparison of Endonasal DCR Surgery Using Cautery and Surgical Blade Technique in Cases of Chronic Dacryocystitis
Abstract
Dacryocystitis is defined as inflammation of lacrimal sac. This can be congenital or acquired. Congenital dacryocystitis is commonly chronic while acquired dacryocystitis is acute and chronic both. Endonasal DCR surgery is the most commonly used treatment in chronic DCR but recent use of cautery technique in endonasal DCR surgery rather than traditional surgical blade technique has emerged with promising results with good success rate and fewer complications.
http://ift.tt/2nKStrq
Wide skin markings pattern - melanoma descriptor or patient-related factor?: reply from authors
We read with great interest the letter by Rishpon and Colleagues on our paper titled "Uncovering the diagnostic dermoscopic features of flat melanomas located on the lower limbs" (1). In the current letter, we investigated a series of 247 lesions, including 71 thin melanomas, located on lower limbs with the aim to identify diagnostic specific dermoscopic criteria for melanoma diagnosis. Furthermore, a new dermoscopic descriptor, namely wider skin markings was introduced.
This article is protected by copyright. All rights reserved.
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Posterior Nasal Pack After Transpalatal Excision of Juvenile Nasopharyngeal Angiofibroma: Can It be Avoided?
Abstract
The evolution of the packing of postnasal space following transpalatal excision of JNA in the last 7 decades is described and a modification is presented for minimizing the immediate postoperative morbidity.
http://ift.tt/2C2wAIp
Preliminary experience in transoral laryngeal surgery with a flexible robotic system for benign lesions of the vocal folds
Abstract
Purpose
This purpose of this case series is to present the first four cases utilizing micro-phonosurgical instrumentation designed specifically for use with a semi-flexible 'robotic' system—the Medrobotics Flex system and to evaluate the accessibility and feasibility of this platform in the context of transoral robotic surgery (TORS) for laryngeal surgery.
Methods
Four patients (3 female, 1 male; age range 49–79 years) were operated by the senior author at CHL—a tertiary hospital centre between 2016 and 2017. The 'robot' was deployed in all cases to assess its accessibility and ability to perform surgery in the larynx.
Results
All four patients were successfully treated using the system along with newly developed instrumentation specifically focused on phonosurgery.
Conclusion
This series has demonstrated accessibility and ability for laryngeal surgery using a novel semi-rigid operator-controlled 'robotic' system. We encountered no device failures and were able to perform all the selected cases uneventfully.
http://ift.tt/2EaqlnK
Basophils from allergic rhinitis patients show allergen-specific upregulation of thymic stromal lymphopoietin receptor
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Tomoyuki Arai, Daiju Sakurai, Tomohisa Iinuma, Takuya Nakagawa, Syuji Yonekura, Yoshitaka Okamoto
BackgroundAn allergic rhinitis (AR) diagnosis is based on typical nasal symptoms and allergen sensitization testing. However, it is sometimes difficult to distinguish AR from non-AR, and it is especially difficult to identify the causal allergen for immunotherapy of patients with AR.ObjectiveTo identify differences among patients with AR, subjects with asymptomatic sensitization (AS), and subjects without sensitization (NS) that could facilitate the diagnosis of AR.MethodsWe used RNA sequencing to examine differential gene expression in unstimulated and allergen-stimulated peripheral basophils from participants with NS, AS, and AR. We selected genes that were upregulated after allergen stimulation and showed differences in expression in patients with AR compared with subjects with AS and NS. Basophil surface expression of 1 gene product was examined by flow cytometry. The usefulness of gene expression in the diagnosis of AR was examined with receiver operating characteristic curves.ResultsExpression of cytokine receptor-like factor 2 and its product, thymic stromal lymphopoietin receptor (TSLPR), was significantly increased in basophils of patients with AR after allergen stimulation. A significantly larger percentage of TSLPR-positive cells was observed after allergen-specific stimulation of basophils from patients with AR compared with subjects with AS. Basophil TSLPR expression was as good as or better than CD203c expression in discriminating between patients with AR and subjects with AS, as judged by receiver operating characteristic curves.ConclusionOur data suggest that TSLPR expression on basophils was specifically upregulated by allergen stimulation and might be useful for the identification of the causative allergen in patients with AR.
http://ift.tt/2FUbaQ6
Patterns of electronic cigarette use in youth with asthma: Results from a nationally representative sample
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Elise Turner, David A. Fedele, Lindsay Thompson, Ramzi G. Salloum
http://ift.tt/2GUj6Cl
Author's response to ‘fractional exhaled nitric oxide: signaling lung function changes in obstructive lung diseases.’
Source:Annals of Allergy, Asthma & Immunology
Author(s): Suguru Sato, Junpei Saito
http://ift.tt/2FUb3nE
The atopic march
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): David A. Hill, Jonathan M. Spergel
http://ift.tt/2GVdFTB
Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Anna Kaarina Kukkonen, Anna Susanna Pelkonen, Sanna Marika Edelman, Paula Maria Kauppi, Mika Juhani Mäkelä
BackgroundVenom immunotherapy is effective in preventing systemic allergic reactions (SARs), but the diagnosis of venom allergy is problematic.ObjectiveTo compare the performance of component-resolved diagnosis and conventional tests in patients referred for venom immunotherapy.MethodsWe measured serum-specific immunoglobulin E to yellowjacket and honeybee venoms (Ves v 1 and Ves v 5 and Api m 1), cross-reactive carbohydrate determinants, serum basal tryptase (ImmunoCAP, ThermoFisher Scientific, Uppsala, Sweden), and skin prick test reactions in 84 patients referred to receive venom immunotherapy. History of SAR and its severity were evaluated.ResultsOf the 78 patients with suspected yellowjacket venom (YJV) allergy, a history of SAR was confirmed in 47 (60%) and 31 (40%) had a non-SAR reaction. The most accurate tests to confirm venom allergy after a SAR were serum-specific immunoglobulin E to yellowjacket whole-venom extract spiked with Ves v 5 (area under the curve 0.87, 95% confidence interval 0.77–0.97, P < .001) and Ves v 5 (area under the curve 0.86, 95% confidence interval 0.76–0.96, P < .001). Sensitization to Ves v 1 was infrequent and its area under the curve was low (0.62, 95% confidence interval 0.47–0.76, P = .106). Sensitivity of the YJV skin prick test was 86%, but its specificity was low at 54%. Double sensitization to yellowjacket and honeybee occurred frequently in skin prick tests. Of the patients without a SAR, 26% showed a positive reaction to YJV in any serum test and 46% showed a positive reaction in skin tests.ConclusionSpecific immunoglobulin E to the YJV spiked with Ves v 5 confirmed the allergy after a SAR. A history of SAR should be confirmed before testing, because venom sensitization is frequent in other types of reactions.
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Tribute to albert sheffer MD and sheldon spector MD
Source:Annals of Allergy, Asthma & Immunology
Author(s): Richard Nicklas
http://ift.tt/2GVdzvd
The skin as a target for prevention of the atopic march
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Adrian J. Lowe, Donald Y.M. Leung, Mimi L.K. Tang, John C. Su, Katrina J. Allen
ObjectiveAllergic diseases have increased dramatically in the developed world during the past few decades, yet the understanding of risk factors and effective prevention approaches remain limited. In this review, we summarize the evidence supporting the hypothesis that skin-barrier impairment and early-life atopic dermatitis (AD) could play a causal role in the development of sensitization and subsequent food allergies and allergic airways disease (allergic asthma and rhinitis). We further discuss the potential to target the skin barrier as a means to lower the incidence of allergic disease.Data SourcesReview of published literature.Study SelectionsNarrative.ResultsThere is a strong link between AD and sensitization, food allergy, asthma, and allergic rhinitis, particularly AD that is severe and commences in the first 6 months of life. There also is emerging evidence that regular use of prophylactic emollients can significantly decrease the expression of AD, at least while treatment continues. Studies are exploring whether decreased AD expression might modulate the allergic response at a more fundamental level and potentially alter the association between early-life AD and subsequent development of food allergy and allergic airways disease.ConclusionAlthough at this point there is only indirect evidence that early-life emollient use might prevent AD and food allergy, early studies are encouraging. The results of high-quality prevention trials that are in progress are eagerly anticipated. If found to be effective, then neonatal emollient use could be a simple public health measure to lower the incidence of AD, food allergies, and allergic airways disease in future generations.
http://ift.tt/2FQSqRu
Allergic asthma is associated with increased risk of infections requiring antibiotics
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Christian Woehlk, Anna von Bülow, Margit Kriegbaum, Vibeke Backer, Celeste Porsbjerg
BackgroundViral infection and allergy have been identified as major risk factors for exacerbation in asthma, especially in the presence of both. However, whether patients with allergic asthma are more susceptible to respiratory infections requiring antibiotics remains unknown.ObjectiveTo investigate allergy as a risk factor for respiratory infections requiring antibiotics based on register data from a nationwide population of patients with asthma.MethodsA register-based prospective follow-up study was performed using the Danish prescription database. In the inclusion period from 2010 through 2011, we identified patients with allergic asthma 18 to 44 years old. Patients were investigated during the follow-up period from 2012 through 2013, depending on their prescription drug use of antiallergic medication and antibiotics. Odds ratios were adjusted for age, sex, asthma severity, education, and urban vs rural residence.ResultsIn a nationwide population we identified 60,415 patients with asthma. Based on prescriptions fillings for antiallergic medication, patients were subdivided into (1) nonallergic asthma (n = 35,334, 51.5%) and (2) allergic asthma (n = 25,081, 48.5%). Allergic asthma was associated with an increased risk of filling at least 2 antibiotic prescriptions per year compared with nonallergic asthma (odds ratio 1.28, 95% confidence interval 1.24–1.33, P < .0001). Interestingly, a subgroup analysis showed a protective effect of immunotherapy against the risk of requiring antibiotics (odds ratio 0.76, 95% confidence interval 0.66–0.87, P = .0001).ConclusionPatients with allergic asthma have an increased risk of being prescribed antibiotics for respiratory infections compared with those with nonallergic asthma. Treatment with allergen immunotherapy appears to have a protective effect against this risk.
http://ift.tt/2GUuQoh
Home-based subcutaneous immunoglobulin therapy vs hospital-based intravenous immunoglobulin therapy: A prospective economic analysis
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Lisa W. Fu, Christine Song, Wanrudee Isaranuwatchai, Stephen Betschel
BackgroundHome-based subcutaneous immunoglobulin (SCIg) administration used for immunoglobulin replacement therapy for patients with primary immunodeficiency has been demonstrated to have benefits compared with hospital-based intravenous immunoglobulin (IVIg) therapy.ObjectiveTo estimate the cost savings associated with treating eligible patients with primary immunodeficiency with home-based SCIg compared with hospital-based IVIg in a prospective study.MethodsThis study was a 12-month prospective observational study that collected information from patient charts, directly from the nurse for time spent with patients and materials used, and directly from the physicians for billing. Data were collected on case report forms at each follow-up. Data were entered in a web-based REDCap database and statistical comparisons were performed.ResultsThe average hospital (including hospital personnel such as nurses) and physician costs were significantly lower in the SCIg group ($1,836 and $84, respectively) than in the IVIg group ($4,187 and $744, respectively), which supported the findings in the number of hospital and physician visits in each group. The total cost was reported from the hospital's (only hospital-related costs) and the health system's (hospital- and physician-related costs) perspectives. For the 2 perspectives, the SCIg group reported significantly lower average total costs than the IVIg group.ConclusionThis is the first prospective analysis of the cost savings associated with home-based SCIG therapy compared with hospital-based IVIG therapy. These findings could help justify provision of home-based therapy training to suitable patients to lower health care costs or improve the capacity of care.
http://ift.tt/2FTeMSG
Penicillin skin testing without minor determinate mixture and amoxicillin challenge in the Appalachian region
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Nicolas Mungo, Keerthi Reddy, Jan Gutierrez-Sereno, Sonia Lopez-Alvarez, Alexei Gonzalez-Estrada
http://ift.tt/2GVZvls
Allergic sensitization and sleep in children with asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Tomoyuki Kawada
http://ift.tt/2FVuH2N
Recent advances in asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Bradley E. Chipps, Chitra Dinakar, Stanley M. Fineman, Stephen A. Tilles
http://ift.tt/2GWboHW
What can we learn about predictors of atopy from birth cohorts and cord blood biomarkers?
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Mallory J. Gallant, Anne K. Ellis
http://ift.tt/2FVPjrQ
Information for Readers
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
http://ift.tt/2GRoQwB
Current insights in allergen immunotherapy
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Giovanni Passalacqua, Diego Bagnasco, Matteo Ferrando, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica
ObjectiveAllergen-specific immunotherapy (AIT) in its subcutaneous and sublingual forms is currently a well-established and experimentally supported treatment for respiratory allergy and hymenoptera venom allergy. There have been advances in its use linked strictly to the advancement in the knowledge of the molecular mechanisms of allergy, the production of well-characterized extracts, and diagnostic techniques. The use of AIT in asthma and the application of new approaches are expanding. We briefly review the advances and concerns in the use of AIT.Data SourcesPubMed and Scopus.Study SelectionsThe most recent and clinically relevant literature was selected and reviewed.ResultsThe introduction of high-quality products supported by large dose-finding trials has yielded better defined indications, contraindications, and modalities of use. Some specific products in tablet form have recently been approved in the United States. Sublingual immunotherapy has been found to be effective in asthma, which until recently had been a matter of debate. Another promising therapy is oral and sublingual desensitization for food allergy, for which encouraging results have recently been reported. In the near future, other options will be available, including new routes of administration (intralymphatic and epicutaneous), allergoids, engineered allergens, and peptides. The use of component-resolved diagnosis techniques will further refine and target AIT prescriptions.ConclusionThis condensed and updated review shows that AIT remains a viable treatment option, especially after the introduction of standardized tablets for some allergens. Food allergy and new administration routes represent a promising expansion.
http://ift.tt/2FVuuwx
Table of Contents
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
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Instructions for Authors
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
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Editorial Board
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
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Clinical and economic burden of hospitalizations with registration of penicillin allergy
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Bernardo Sousa-Pinto, António Cardoso-Fernandes, Luís Araújo, João Almeida Fonseca, Alberto Freitas, Luís Delgado
BackgroundPenicillin allergy is commonly reported, but only a minority of claimants has a confirmed diagnosis. Nevertheless, patients labeled as having penicillin allergy are treated with second-line antibiotics, which are more expensive and less effective, possibly increasing the risk of drug-resistant infections.ObjectiveTo compare hospitalizations with and without registration of penicillin allergy concerning their morbidity and hospital resource use.MethodsWe analyzed a national administrative database containing a registration of all Portuguese hospitalizations from 2000 to 2014. All episodes occurring in adults with a penicillin allergy registration were compared with an equal number of hospitalizations without such registration and matched for inpatients' age, sex, and main diagnosis. We compared those episodes concerning their length of stay, hospital price charges, comorbidities, and frequency of drug-resistant infections. Differences between medical and surgical hospitalizations were explored.ResultsHospitalizations with registration of penicillin allergy (n = 102,872) had a longer average length of stay than the remainder episodes (8 vs 7 days; P < .001) and higher hospital charges (3,809.0 vs 3,490.0 USD; P < .001). Inpatients with penicillin allergy registration also had a higher mean Charlson Comorbidity Index (0.91 vs 0.76; P < .001) and a significantly higher frequency of infections by several agents, including methicillin-resistant Staphylococcus aureus, Enterococcus species, and Escherichia coli. Among surgical episodes, septicemia was 1.2-fold more frequent among penicillin allergy cases.ConclusionHospitalizations with registration of penicillin allergy are associated with increased economic costs and frequency of infections by drug-resistant agents, reinforcing the need to establish a correct diagnosis of penicillin allergy.
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Is the better part of valor truly discretion?
Source:Annals of Allergy, Asthma & Immunology, Volume 120, Issue 2
Author(s): Matthew Greenhawt, John J. Oppenheimer
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Posterior Nasal Pack After Transpalatal Excision of Juvenile Nasopharyngeal Angiofibroma: Can It be Avoided?
Abstract
The evolution of the packing of postnasal space following transpalatal excision of JNA in the last 7 decades is described and a modification is presented for minimizing the immediate postoperative morbidity.
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The effect of low-level laser therapy (660 nm) on the gene expression involved in tissue repair
Abstract
The effect of low-level laser therapy (LLLT) on the healing of skin lesions has been evaluated in many studies; however, the molecular mechanisms involved in the biostimulatory effects resulting from this treatment need to be better understood. The paper aims to analyze the effects of LLLT (660 nm) at doses of 1 and 5 J/cm2 on cell viability and expression of vascular endothelial growth factor (VEGF) and interleukin (IL6) genes in L929 fibroblast cells. The dose-response curve was performed with the GaInAlAs (660 nm) laser-treated cells at energy rates of 1 and 5 J/cm2. Cell viability was quantified at 24, 48, and 72 h after irradiation and the effects of TLBP on the cytoskeleton and endoplasmic reticulum were evaluated by fluorescence microscopy and the RT-qPCR method was used for the analysis of gene expression. It was observed that the 72 h group had a statistically significant increase in cell viability compared to the 48 h group (p < 0.01) and when compared to the 72 h control (p = 0.03). In 72 h, a greater distribution of the cytoskeleton filaments and the more evident endoplasmatic reticulum was verified, indicating an increase in the protein synthesis when compared with the control group. In the expression of the VEGF gene, a significant increase of 1.98 times (p < 0.05) in the number of transcripts was observed; whereas for the IL6 gene, a decrease of the transcripts was 4.05 times (p < 0.05), both occurring within 72 h after irradiation at 5 J/cm2. The LLLT (660 nm) at the dose of 5 J/cm2 should modulate cellular viability, upregulated VEGF, and downregulated IL6 expression of messenger RNA in culture of L929 fibroblast cells.
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Cardiac autonomic responses and number of repetitions maximum after LED irradiation in the ipsilateral and contralateral lower limb
Abstract
The aim of this study was to verify the maximum number of repetitions, fatigue index, blood lactate concentration ([Lac]), and cardiac autonomic responses after LED irradiation (LEDI) in the ipsilateral and contralateral limb. Twelve male subjects (22.0 ± 3.86 years; weight 82.94 ± 12.58 kg; height 1.77 ± 0.05 m), physically active, took part in this study. The subjects underwent a one repetition maximum (1RM) test and performed four randomly experimental sessions in the horizontal leg press exercise, which consisted in four sets of maximum repetitions at 80% of 1RM. The subjects performed two experimental sessions applying LED active or placebo on ipsilateral limb and two experimental sessions applying LED active or placebo on contralateral limb prior exercise and in the interval of sets on quadriceps and hamstrings muscles. A number of repetitions and fatigue index were verified. [Lac] and heart rate variability (HRV) were collected during post-exercise recovery and analyzed. It was observed that active LEDI promoted an increase in maximal number of repetitions (LEDI = 44.4 ± 9.0 vs placebo = 39.9 ± 11.4; p < 0.05) and decreases the fatigue index (LEDI = 34.3 ± 21.8% vs placebo = 50.0 ± 26.6%; p < 0.05) comparing to placebo situation, only in the ipsilateral application. There were no differences on [Lac] and in HRV parameters comparing LEDI vs placebo on post-exercise recovery in both applications (p > 0.05). The LEDI improves performance only in the ipsilateral application, but there were no differences on [Lac] and cardiac autonomic responses after exercise for both the applications.
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Critical reviews of 1470-nm laser vaporization on benign prostatic hyperplasia
Abstract
Benign prostatic hyperplasia (BPH) is recognized as the common chronic disease that affect majority of men in their elder ages. Nevertheless, there are no effective documents for BPH treatment. Even though great progression has been made on BPH by laser surgery, it also faces several challenges. In this study, our aims were to explore the effects of 1470-nm laser vaporization on BPH. For the research, a total of 170 BPH patients were enrolled. A 1470-nm laser vaporization apparatus was purchased for the surgery. The indicators such as serum sodium, international prostate symptom score (IPSS), Quality of life (QOL), maximum flow rate (Qmax), prostate specific antigen (PSA), and average Post-void Residual Volume (PVR) were detected for evaluating the prostate function. The operation was successful in all 170 patients, neither of whom converted to transurethral resection of the prostate (TURP) nor to open surgery. The surgery time was 52.3 ± 5.6 min, the laser emission time was 35.6 ± 3.2 min, the energy consumption was 254.1 ± 19.3 kJ. The level of serum sodium showed no significant difference between the pre- and post-operation. Qmax was significantly increased in post-operation, while IPSS, QOL, PVR, and PSA were significantly decreased in the post-operation. The 1470-nm laser vaporization treatment protected patients against BPH, indicating that 1470-nm laser vaporization might be important on treating BPH, which provided solid foundation for further clinical treatment.
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Investigation of arginine A-specific cysteine proteinase gene expression profiling in clinical Porphyromonas gingivalis isolates against photokilling action of the photo-activated disinfection
Abstract
Porphyromonas gingivalis is a significant root canal pathogen capable of causing endodontic infections, which during their treatment may receive sub-lethal doses of photo-activated disinfection (sPAD). As sPAD can influence microbial virulence, this study was designed to evaluate the effect of sPAD on gene expression level of arginine A-specific cysteine proteinase (rgpA), as one of the underlying virulence factors involved in the development of endodontic infection via P. gingivalis strains. To find out the sPAD against 16 clinical isolates of PAD-resistant P. gingivalis that were isolated in vivo, we used toluidine blue O (TBO), methylene blue (MB), and indocyanine green (ICG) as the photosensitizers, which were excited with specific wavelength of light in vitro. Quantitative real-time PCR (qRT-PCR) was then applied to monitor gene expression of rgpA in P. gingivalis isolates to characterize its virulence agent and understand the effect of sPAD on its pathogenicity. Maximal sPAD that could not decrease the count of P. gingivalis isolates were 6.25, 15.6, and 25 μg/mL at fluencies of 171.87, 15.6, and 93.75 J/cm2 for TBO, ICG, and MB, respectively. ICG-sPAD could suppress the rgpA gene expression about 14-fold, while MB and TBO-mediated sPAD could cause the attenuation of rgpA expression about 4.9- and 11.6-fold, respectively. ICG-sPAD with the maximum ability to reduce rgpA gene expression compared with other photosensitizers can be an appropriate candidate for the treatment of endodontic infections.
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Low-level laser therapy with 940 nm diode laser on stability of dental implants: a randomized controlled clinical trial
Abstract
Low-level laser therapy (LLLT) is a non-invasive modality to promote osteoblastic activity and tissue healing. The aim of this study was to evaluate the efficacy of LLLT for improvement of dental implant stability. This randomized controlled clinical trial was performed on 80 dental implants placed in 19 patients. Implants were randomly divided into two groups (n = 40). Seven sessions of LLLT (940 nm diode laser) were scheduled for the test group implants during 2 weeks. Laser was irradiated to the buccal and palatal sides. The same procedure was performed for the control group implants with laser hand piece in "off" mode. Implant stability was measured by Osstell Mentor device in implant stability quotient (ISQ) value immediately after surgery and 10 days and 3, 6, and 12 weeks later. Repeated measures ANOVA was used to compare the mean ISQ values (implant stability) in the test and control groups. Statistical test revealed no significant difference in the mean values of implant stability between the test and control groups over time (P = 0.557). Although the mean values of implant stability changed significantly in both groups over time (P < 0.05). Although the trend of reduction in stability was slower in the laser group in the first weeks and increased from the 6th to 12th week, LLLT had no significant effect on dental implant stability.
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Non-invasive high-intensity focused ultrasound for UV-induced hyperpigmentation in Fitzpatrick skin types III and IV: a prospective, randomized, controlled, evaluator-blinded trial
Abstract
Skin hyperpigmentation is a frequently encountered problem, particularly in darker skin types. Unfortunately, standard treatments for this condition have shown disappointing results. High-intensity focused ultrasound (HIFU) is commonly indicated for skin laxity, but recently was used to treat UV-induced hyperpigmentation in animal models. This study is aimed to evaluate the efficacy and safety of high-intensity focused ultrasound for UVB-induced hyperpigmentation in human subjects. A randomized, evaluator-blinded pilot study was conducted on 20 subjects. Each subject was induced three hyperpigmentary spots by local broadband UVB. After 2 weeks, each spot was randomly allocated to control, low-energy, and high-energy HIFU. Subjects were instructed to follow up weekly for a duration of 1 month. Lightness index measurements, mean improvement scores, subjects' satisfaction, pain scores, and side effects were evaluated. All 20 subjects completed the study. Fourteen subjects had Fitzpatrick (FPT) skin type III and six subjects had FPT skin type IV. Twelve subjects showed greater improvement at control sites while eight subjects showed greater improvement at HIFU-treated sites. In FPT skin type III, HIFU appeared to be inferior to control in both lightness index and mean improvement scores, but in FPT skin type IV, HIFU had greater lightness index improvement and higher improvement scores than control. Side effects were more frequent in high-energy-treated areas. Focused ultrasound may be offered in some patients with hyperpigmentary conditions. More research is needed to determine proper energy settings for optimal outcome.
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Effect of different power settings of Er,Cr:YSGG laser before or after tribosilicatization on the microshear bond strength between zirconia and two types of cements
Abstract
The aim of this study was to evaluate the effect of different output powers of Er,Cr:YSGG laser and the association with tribochemical silica coating on the bond strength between zirconia ceramic and two resin cements. One hundred ninety-two zirconia ceramic bars (IPS e-max ZirCAD Ivoclar Vivadent-) were sectioned (6 × 6 × 4 mm), sintered, and randomly divided into 12 groups for each cement system according to the surface treatment (n = 8): C—without treatment (control); R—tribochemical coating + resin cement (control); 2L—laser (2.0 W) + resin cement; 2LR—laser (2.0 W) + tribochemical coating + resin cement; R2L—tribochemical coating + laser (2.0 W) + resin cement; 2.5L—laser (2.5 W) + resin cement; 2.5LR—laser (2.5 W) + tribochemical coating + resin cement; R2.5L—tribochemical coating + laser (2.5 W) + resin cement; 3L—laser (3.0 W) + resin cement; 3LR—laser (3.0 W) + tribochemical coating + resin cement, R3L—tribochemical coating + laser (3.0 W) + resin cement; and RPHO—tribochemical + resin cement + photoactivation (control). After the surface treatment, the respective primers were applied, and resin cements, Multilink N, Ivoclar Vivadent (M), and Panavia F 2.0, Kuraray Medical Inc. (P), were inserted into Tygon molds which were bonded to the zirconia bars. Each specimen received two cements bars. After 24 h of storage in a relative humidity (100%) at 37 °C, they were evaluated by the microshear test speed of 1 mm/min. The microshear values were analyzed by one-way ANOVA and Tukey's test (α = 0.05). ANOVA showed statistically significant differences among the evaluated groups. The highest bond strength was observed in RPHO, which statistically differed from all groups. The lowest bond strength was observed in M2.5L (Multilink N) and in P3LR (Panavia F 2.0). It can be concluded that the lowest power output tested was suitable and showed bond strength values similar to tribochemical silica deposition. The light curing is important to adhesion and the tribosilicatizated surface achieves similar microshear values to untreated surface in absence of light.
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Dispersion of near-infrared laser energy through radicular dentine when using plain or conical tips
Abstract
The aim of this study was to investigate the influence of tip design on patterns of laser energy dispersion through the dentine of tooth roots when using near-infrared diode lasers. Diode laser emissions of 810 or 940 nm were used in combination with optical fiber tips with either conventional plain ends or conical ends, to irradiate tooth roots of oval or round cross-sectional shapes. The lasers were operated in continuous wave mode at 0.5 W for 5 s with the distal end of the fiber tip placed in the apical or coronal third of the root canal at preset positions. Laser light exiting through the roots and apical foramen was imaged, and the extent of lateral spread calculated. There was a significant difference in infrared light exiting the root canal apex between plain and conical fiber tips for both laser wavelengths, with more forward transmission of laser energy through the apex for plain tips. For both laser wavelengths, there were no significant differences in emission patterns when the variable of canal shape was used and all other variables were kept the same (plain vs conical tip, tip position). To ensure optimal treatment effect and to prevent the risks of inadvertent laser effects on the adjacent periapical tissues, it is important to have a good understanding of laser transmission characteristics of the root canal and root dentine. Importantly, it is also essential to understand transmission characteristics of plain and conical fibers tips.
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Rapid analysis of pharmaceutical drugs using LIBS coupled with multivariate analysis
Abstract
Type 2 diabetes drug tablets containing voglibose having dose strengths of 0.2 and 0.3 mg of various brands have been examined, using laser-induced breakdown spectroscopy (LIBS) technique. The statistical methods such as the principal component analysis (PCA) and the partial least square regression analysis (PLSR) have been employed on LIBS spectral data for classifying and developing the calibration models of drug samples. We have developed the ratio-based calibration model applying PLSR in which relative spectral intensity ratios H/C, H/N and O/N are used. Further, the developed model has been employed to predict the relative concentration of element in unknown drug samples. The experiment has been performed in air and argon atmosphere, respectively, and the obtained results have been compared. The present model provides rapid spectroscopic method for drug analysis with high statistical significance for online control and measurement process in a wide variety of pharmaceutical industrial applications.
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Application of Digital Diagnosis and Treatment Technique in Benign Mandibular Diseases
Purpose: To explore the feasibility of preoperative planning for treatment of benign mandibular lesions (BML) using digital technologies such as three-dimensional (3D) reconstruction, measurement, visualization as well as image contrast and design of neural positioning protection template (NPPT) in combination with 3D printing technology in the BML diagnosis and treatment. Methods: The 3D models of BML and inferior alveolar nerves (IAN) of 10 BML patients were reconstructed based on their digital imaging and communications in medicine (DICOM) data using MIMICS16.0 software. The models were used to visualize lesions and nerve contrast measurement and guide design of personalized NPPT and osteotomy after operation modality was determined in order to achieve accurate, minimally invasive operation with shortened intraoperative time. Results: Intraoperative NPPT application could accurately locate lesions and their scope and assist osteotomy. The measurement results were consistent with those of preoperative reconstruction and measurement. The BML were curetted completely without damage IAN. The 10 BML patients had no numbness and other discomforts in the lower lip and mandibular teeth after operation. Conclusions: The digital diagnosis and treatment technology is an effective method for functional treatment of BML patients and its application could achieve personalized, minimally invasive and precise treatment and save intraoperation time. Address correspondence and reprint requests to Wei Tang, MD, PhD, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, NO. 14 3rd Section, Renmin South Road. Chengdu 610041. PR China; E-mail: mydrtw@vip.sina.com Received 25 August, 2017 Accepted 23 September, 2017 This study was supported by the Program of Science and Technology Department of Sichuan Province (2014SZ0157-2). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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http://ift.tt/2EavUGQ
Comparison of Three Methods Used for Estimating Area of Foramen Magnum
Objective: To compare whether there are any differences between the 3 methods used for measure area of foramen magnum (FM) in skulls. Methods: The FMs of 150 skulls were examined. Antero-posterior diameter, transverse diameter were measured using by Vernier caliper. The area of the FM was calculated by using 2 different formulas as described previously by Radinsky and Teixeira. The authors also applied stereological assessment method for estimating the surface area of FMs. The area was calculated 3 times manually using stereological point grid system for each skull. The authors compared the mean surface area of FMs obtained from each of these 3 methods estimating surface area of FMs whether there were any significant differences in between their results. Results: The mean areas of the FMs estimated according to Teixeria formula, Radinsky formula, and Cavalieri stereological method were respectively as follows: 790.47 ± 99.86 mm2, 783.66 ± 99.34 mm2, and 748.06 ± 100.19 mm2. The authors observed significant differences (P
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Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation
Objective: Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging. Methods: The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age. Results: No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05). Conclusion: A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum. Address correspondence and reprint requests to Gülbahar Ustaoğlu, Faculty of Dentistry, Abant Izzet Baysal University, Gölköy, Bolu, Turkey; E-mail: gulbaharustaoglu@hotmail.com Received 8 June, 2017 Accepted 5 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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Heritability of Facial Skeletal and Dental Characteristics of Monozygotic and Dizygotic Twins Using Cephalometric Analysis and Falconer's Method
The purpose of this study was to investigate the heritability of facial skeletal and dental characteristics of the monozygotic (MZ) and dizygotic (DZ) twins. The samples consisted of Korean MZ and DZ twins (n = 13 pairs/each twin; 7 pairs of males and 6 pairs of females; mean age, 39 years, respectively). The linear, angular, and ratio variables, which could describe the size and shape of the facial horizontal and vertical, dental, mandible and cranial base structure, were measured. The Falconer's method was used to calculate the heritability (h2; close to or below 0, low heritability; close to or above 1, high heritability). In the facial horizontal and vertical aspects, the highest h2 values were shown at SNA (degree, 1.53), SNB (degree, 2.12), SN-Pog (degree, 2.19), SN-palatal plane angle (degree, 1.29), SN-mandibular plane angle (degree, 1.59), N-ANS/ANS-Me (1.66), and ANS-Me/N-Me (1.62). In the dental aspects, although L1-occlusal plane angle (degree, 1.38) and SN-occlusal plane angle (degree, 2.09) showed high h2 values, most of the dental variables showed low h2 values. In the mandible and cranial base, lower gonial angle, mandibular body length, and cranial base angle showed high h2 values (N-Go-Gn [degree], 1.07; Go-Pog [mm], 0.92; N-S-Ba [degree], 1.51). The descending order of the overall mean h2 values was the facial horizontal (1.10), facial vertical (0.71), mandible (0.59), cranial base (0.37), and dental characteristics (−0.11). The shape of facial skeletal structure and location of the occlusal plane within skeletal framework was more influenced by genetic factors than environmental factors. Address correspondence and reprint requests to Dr Seung-Hak Baek, DDS, PhD, Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Daehak-no #101, Jongro-gu, Seoul, Republic of Korea; E-mail: drwhite@unitel.co.kr; Dr Young Ho Kim, DDS, PhD, Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea; E-mail: ajouorthod@naver.com Received 19 May, 2017 Accepted 11 November, 2017 EK and JS contributed equally to this work as co-first authors. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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