Three-dimensional imaging assessment of anatomic invasion and volumetric considerations for chemo/radiotherapy-based laryngeal preservation in T3 larynx cancer

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Mona Kamal, Sweet Ping Ng, Salman A. Eraj, Crosby D. Rock, Brian Pham, Jay A. Messer, Adam S. Garden, William H. Morrison, Jack Phan, Steven J. Frank, Adel K. El-Naggar, Jason M. Johnson, Lawrence E. Ginsberg, Renata Ferrarotto, Jan S. Lewin, Katherine A. Hutcheson, Carlos E. Cardenas, Mark E. Zafereo, Stephen Y. Lai, Amy C. Hessel, Randal S. Weber, G. Brandon Gunn, Clifton D. Fuller, Abdallah S.R. Mohamed, David I. Rosenthal
ObjectivesTo investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies.Materials and MethodsThe pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes.ResultsThe median TV was 6.6 cm³. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis.ConclusionThe extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer.



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Comments on “Compositional and functional variations of oral microbiota associated with the mutational changes in oral cancer” by Yang et al.

Publication date: Available online 10 February 2018
Source:Oral Oncology
Author(s): Divya Gopinath, Rohit Kunnath Menon




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Closed-Eye Visualizations in the Setting of Hyponatremia

Purpose. To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies. Methods. Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained. Results. Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte replenishment. There has been no recurrence of the symptoms. Conclusion. This patient had hallucinations exclusively with the eyes closed, which must be differentiated from the release hallucinations seen with the eyes open in Charles Bonnet syndrome. This patient had no visual loss or retinal disease, which should be suspected in open eye hallucinations.

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Alloplastic temporomandibular joint replacement systems: a systematic review of their history

Publication date: Available online 9 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. De Meurechy, M.Y. Mommaerts
This systematic review provides an overview of the historical evolution of the prosthetic temporomandibular joint and addresses the challenges and complications faced by engineers and surgeons, in an effort to shed light on why only a few systems remain available. A better understanding of the history of temporomandibular joint prostheses might also provide insights into the origin of the negative public opinion of the prosthesis, which is based on outdated information. A computerized search using the PubMed Central, ScienceDirect, Wiley Online, Ovid, and Cochrane Library databases was performed following the PRISMA guidelines. Out of 7122 articles identified, 41 met the inclusion criteria for this systematic review. Although several historical reviews have been published previously, none has covered such an extensive time period or has described all designs. Furthermore, besides providing a historical overview, this review discusses the rationale behind the evolution in design and biomaterials, which have largely contributed to the outcomes of the prosthetic systems.



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Diagnosis and Management of Pemphigus: recommendations by an International Panel of Experts

Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management,

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Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib: a 32-week open label extension study with optional narrow-band ultraviolet B

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Global Burden of Urticaria: Insights from the 2016 Global Burden of Disease Study

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Whole-exome sequencing reveals differences between nail apparatus melanoma and acral melanoma

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Impact of a Smartphone Application on Skin Self-Examination Rates in Patients that are New to Total Body Photography: A Randomized Controlled Trial

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The staining of clothing by sunscreens: a pilot study

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Rapid improvement of prurigo nodularis with cyclosporine treatment

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Patient satisfaction and preference of absorbable versus non-absorbable sutures for linear repairs

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Rethinking Biotin Therapy for Hair, Nail, and Skin Disorders

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Commentary: Skin cancer in the military

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A technique for more precise distinction between catagen and telogen human hair follicles ex-vivo

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In-office compounding of lidocaine-epinephrine: an option for anesthesia preparation prior to skin biopsy

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The impact of underlying disease state on outcomes in patients with pyoderma gangrenosum: A national survey

It is unclear if the underlying disease affects the outcomes in pyoderma gangrenosum.

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Comparative Effectiveness of Targeted Immunomodulators for the Treatment of Moderate-to-Severe Plaque Psoriasis: A Systematic Review and Network Meta-Analysis

The comparative effectiveness of available targeted immunomodulators for moderate-to-severe psoriasis has not been evaluated.

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Incidence and morphometry of sellar bridges and related foramina in dry skulls: Their significance in middle cranial fossa surgery

The current study investigated the incidence, morphology and morphometry of the ossified ligaments expanding between petrous bone and posterior clinoid processes and in between the anterior, middle and posterior clinoid processes. Side symmetry, gender dimorphism and age influence were also studied.

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Re: Acrylic stent to aid placement of footplate of palatal distractor during surgically-assisted rapid palatal expansion

I read with interest the recent paper by Payne et al1 and commend them on their use of a stent to indicate the position of the abutment plates of the transpalatal distractor.2 I would, however, like to raise two important points.

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Re: Wrong tooth extraction: an examination of “Never Event” data

I read the recent article by Pemberton et al1 with interest and would like to draw attention to a recent experience in our department.

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Comments on “Compositional and functional variations of oral microbiota associated with the mutational changes in oral cancer” by Yang et al.

We read with great interest the article titled "Compositional and functional variations of oral microbiota associated with the mutational changes in oral cancer" by Yang et al. [1]. We greatly appreciate the author's efforts for exploring the association between mutations in oral cancer and microbiome, thus opening up an interesting avenue in oral microbiome research. Host genetics has already been demonstrated to influence the gut microbiome [2] and the authors of this paper have reported an association between mutations seen in oral cancer with the salivary microbiome.

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Control of B-1a cell development by instructive BCR signaling

Taras Kreslavsky | Jason B Wong | Maria Fischer | Jane A Skok | Meinrad Busslinger

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The regulation of lymphocyte activation and proliferation

Susanne Heinzel | Julia M Marchingo | Miles B Horton | Philip D Hodgkin

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Natural killer cell education in human health and disease

Jeanette E Boudreau | Katharine C Hsu

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Auditory and language development in Mandarin-speaking children after cochlear implantation

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Xing Lu, Zhaobing Qin
ObjectiveTo evaluate early auditory performance, speech perception and language skills in Mandarin-speaking prelingual deaf children in the first two years after they received a cochlear implant (CI) and analyse the effects of possible associated factors.MethodsThe Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS)/Meaningful Auditory Integration Scale (MAIS), Mandarin Early Speech Perception (MESP) test and Putonghua Communicative Development Inventory (PCDI) were used to assess auditory and language outcomes in 132 Mandarin-speaking children pre- and post-implantation.ResultsChildren with CIs exhibited an ITMAIS/MAIS and PCDI developmental trajectory similar to that of children with normal hearing. The increased number of participants who achieved MESP categories 1–6 at each test interval showed a significant improvement in speech perception by paediatric CI recipients. Age at implantation and socioeconomic status were consistently associated with both auditory and language outcomes in the first two years post-implantation.ConclusionMandarin-speaking children with CIs exhibit significant improvements in early auditory and language development. Though these improvements followed the normative developmental trajectories, they still exhibited a gap compared with normative values. Earlier implantation and higher socioeconomic status are consistent predictors of greater auditory and language skills in the early stage.



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Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Ahmad Daneshi, Marjan Mirsalehi, Seyed Basir Hashemi, Mohammad Ajalloueyan, Mohsen Rajati, Mohammad Mahdi Ghasemi, Hesamaldin Emamdjomeh, Alimohamad Asghari, Shabahang Mohammadi, Mohammad Mohseni, Saleh Mohebbi, Mohammad Farhadi
ObjectivesTo evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated.MethodsCochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects >24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed.ResultsThe median CAP scores improved significantly after the cochlear implantation in all the patients (p value < 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value < 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003).ConclusionThe auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.



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Treatment of extensive post tonsillectomy oropharyngeal stenosis secondary to fibromatosis

Publication date: Available online 2 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Brian Chang, Jennifer F. Ha, David Zopf
Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy. We demonstrate that surgical resection with a clear margin allowed for alleviation of stenosis without recurrences reported since the procedure.



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Granulomatosis with polyangiitis presenting as facial nerve palsy in a teenager

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): James C. Wang, Brittany A. Leader, Ryan A. Crane, Bernadette L. Koch, Matthew M. Smith, Stacey L. Ishman
Granulomatosis with polyangiitis (GPA, previously known as Wegener's granulomatosis) is an autoimmune systemic small-vessel vasculitis, associated with the presence of anti-neurophil cytoplasmic antibodies with a cytoplasmic staining pattern (c-ANCA). It is characterized by necrotizing granulomas, usually affecting the airways and kidneys. GPA should be considered when patients do not improve despite adequate treatment of otologic symptoms, when patients have unspecific symptoms suggesting systemic disease (e.g. fever, malaise), or when other organs are involved (kidney, lungs, etc.). We present an interesting case of a 14-year-old female with eight-weeks of bilateral otalgia, unilateral facial nerve palsy, decreased appetite, and fatigue refractory to steroid, anti-viral, and antibiotic treatment ultimately diagnosed with GPA.



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Volume relationships between cricoid and main stem bronchi in children using three-dimensional computed tomography imaging

Publication date: Available online 5 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Tariq M. Wani, Ayman Mohammad AlAhdal, Mohammed Hakim, Tanveer Hussein, Abdul Basit Mir, Ravees Jan, Dmitry Tumin, Joseph D. Tobias
BackgroundThere are limited data to guide the selection of the appropriate sized endobronchial tube for main stem intubation to provide one-lung ventilation in children. The relationship between the cricoid and the main bronchi (right and left) has been previously evaluated using two-dimensional computed tomography (CT) imaging and video-bronchoscopic images. The present study defines the three-dimensional, CT-derived volume-based relationships between the right main-stem bronchus (RMB), left main-stem bronchus (LMB), and the cricoid ring.MethodsThe three-dimensional CT images of 35 children, less than 8 years of age, undergoing radiological evaluation unrelated to airway or mediastinal symptomatology were examined. The images of the airway column were evaluated at the level of the cricoid and main stem bronchi (right and left). Volumes were calculated and comparisons made between these levels.ResultsThere was no statistically significant difference based on gender for the cricoid and main stem bronchi volumes. A statistically significant difference was observed between the cricoid and left main stem bronchi volumes as well as between the right and left main stem bronchi.ConclusionThe relationship (ratio) between the volumes of the cricoid and main stem bronchi remains constant by age. The cricoid dimensions can be used to predict the main stem bronchi dimensions.



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Bony cochlear nerve canal stenosis in pediatric unilateral sensorineural hearing loss

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Chae-Hyun Lim, Ji Hyung Lim, Doyoun Kim, Ho sung Choi, Dong-Hee Lee, Dong-Kee Kim
ObjectivesThis study was performed to evaluate the frequency of bony cochlear nerve canal (BCNC) stenosis and its clinical significance in pediatric patients with unilateral sensorineural hearing loss (SNHL) of unknown etiology.Materials and methodsWe analyzed the medical records and temporal bone computed tomography (CT) results of patients less than 13 years of age with a diagnosis of unilateral SNHL of unknown etiology between July 2007 and July 2017. We compared the BCNC diameter between both sides and analyzed the age at diagnosis, degree of hearing loss, and accompanying inner ear anomalies.ResultsIn 42 patients, the mean age at diagnosis was 7.4 ± 3.6 years, and the average hearing level in the affected ear was 87.9 ± 20.0 dB HL (decibels hearing level). The average diameter of the BCNC was 1.22 ± 0.75 mm on the affected side and 1.96 ± 0.52 mm on the normal side. The most suitable criterion for BCNC stenosis appeared to be a diameter of 1.2 mm by the recursive partitioning procedure. With application of this criterion, the rate of BCNC stenosis was significantly greater on the affected side than on the normal side (52.4% vs. 4.8%, respectively; P < 0.05). A narrow internal acoustic canal was found in two patients, and vestibular and cochlear anomalies were found in three patients each.ConclusionsOur results suggest that it is reasonable to set a diameter of 1.2 mm as a cutoff for BCNC stenosis, and also that BCNC stenosis is a common cause of unilateral SNHL of unknown etiology in childhood.



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Emberger syndrome: A rare association with hearing loss

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Faisal Zawawi, Meirav Sokolov, Thomas Mawby, Karen A. Gordon, Blake C. Papsin, Sharon L. Cushing
Emberger Syndrome (ES) is a rare genetic disorder characterized by lymphedema and myelodysplasia. It is also associated with hearing loss. The genetic mutations associated with ES are not part of the comprehensive 80 gene next generation sequencing (NGS) panel. As a result, the otolaryngologist should maintain an index of suspicion for ES in any child with SNHL who presents repeatedly with recurrent infections, lymphedema and/or cutaneous warts. This paper describes the clinical evolution and management of two children who were followed up for hearing loss and eventually were diagnosed with ES.



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Pattern of allergic rhinitis among children in Ekiti, Nigeria

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Waheed Atilade Adegbiji, Gabriel Toye Olajide, Anthony Oyebanji Olajuyin, Shuaib Kayode Aremu, Akanbi Ganiyu Olusola
BackgroundAllergic rhinitis is a chronic and recurrent nasal condition. It is often neglected in children with late presentation. This study aimed at determining the prevalence, sociodemographic features, comorbid illnesses, complications and quality of life in children with allergic rhinitis in the study institution.Materials and methodsThis is a prospective hospital based study of children with allergic rhinitis in Ekiti state university teaching hospital, Ado Ekiti. The study was carried out in ENT department over a period of two years (between June 2015 to May 2017). Informed consent was obtained from the parents/guardian/patients and consented patients were enrolled into the study. Data were obtained by pretested interviewers assisted questionnaire. Details of their history, physical examination and investigations were carried out and findings were documented. All data obtained were descriptively analysed using SPSS version 18.0 and presented in simple tables and charts. Ethical clearance was sought for and obtained from the ethical committee of the hospital.ResultsA total of 4341 patients were seen out of which 265 were children with allergic rhinitis. Prevalence of allergic rhinitis in children in this study was 6.1%. There were 63.0% males with male to female ratio of 2:1. Allergic rhinitis was peaked at preschool age group (1–5 years) accounted for 47.9%.A total of 42.3% participants were living in urban setting while 57.7% were from rural setting. Majorities (40.4%) of the patients were in nursery and parent's major occupation was mainly farming in 27.2%.There was positive family history of allergy in 54.7% patients. Perennial allergic rhinitis were noted in 63.8% patients while seasonal allergic rhinitis were noted in 36.2% patients. Major form of allergens was inhalant 81.8% and the least form of allergen was ingestant 5.7%.The commonest identified trigger factors among the study population were as follows: dust, cold weather and smoke which were accounted for 59.6%, 37.4% and 18.9% of the study patients respectively. Other noted triggering factors were soap and perfume which accounted for 4.2% and 1.1% respectively.Major associated comorbid illnesses among the patients were tonsils hypertrophy, adenoid hypertrophy and inferior turbinate hypertrophy which accounted for 55.5%, 46.4% and 40.4% respectively. Clinical presentations of allergic rhinitis in this study were mainly 75.8% nasal blockage, 65.3% runny nose and 8.5% recurrent sneezing.Commonest complications of allergic rhinitis were 35.1% pharyngitis, 32.1% otitis media and 28.3% headache.Treatment of allergic rhinitis leads to improvement on the clinical features in 90.1% patients. No significant improvement in clinical features were noticed in 9.8% patients. None of the studied patients reported worse clinical condition after treatment of allergic rhinitis. No mortality was recorded from allergic rhinitis in this study.ConclusionAllergic rhinitis affect all paediatric age group and there were delayed presentation in the participants. There were associated comorbid illnesses, complications and affectation of quality of life at presentation in majority of the patients.



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Healthcare and psychosocial experiences of individuals with craniofacial microsomia: Patient and caregivers perspectives

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Daniela V. Luquetti, Michelle R. Brajcich, Nicola M. Stock, Carrie L. Heike, Alexis L. Johns
ObjectiveCraniofacial microsomia (CFM) is primarily characterized by underdevelopment of the ear and mandible, with several additional possible congenital anomalies. Despite the potential burden of care and impact of CFM on multiple domains of functioning, few studies have investigated patient and caregiver perspectives. The objective of this study was to explore the diagnostic, treatment-related, and early psychosocial experiences of families with CFM with the aim of optimizing future healthcare delivery.MethodsForty-two caregivers and nine adults with CFM responded to an online mixed-methods survey. Descriptive statistics and qualitative methods were used for the analysis.ResultsSurvey respondents reported high rates of subspecialty evaluations, surgeries, and participation in therapies. Some participants reported receiving inaccurate or incomplete information about CFM and experienced confusion about etiology. Communication about CFM among family members included mostly positive messages. Self-awareness of facial differences began at a mean age of three years and teasing at mean age six, with 43% of individuals four years or older reporting teasing. Teasing often involved name-calling and frequent reactions were ignoring and negative emotional responses. Participants ranked "understanding diagnosis and treatment" as a top priority for future research and had the most questions about etiology and treatment guidance.ConclusionsThe survey results on the healthcare and psychosocial experiences from birth through adulthood of individuals with CFM reinforce the need for ongoing psychological assessment and intervention. Healthcare provision could be improved through establishing diagnostic criteria and standardized treatment guidelines, as well as continued investigation of CFM etiology.



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Challenges and outcomes of cholesteatoma management in children with Down syndrome

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Saied Ghadersohi, Bharat Bhushan, Kathleen R. Billings
IntroductionThe high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging.ObjectiveTo describe management strategies for cholesteatoma diagnosis, surgical treatment, and post-operative management in children with Down syndrome.MethodsRetrospective case series of 14 patients (17 total ears) with Down syndrome diagnosed with cholesteatoma over a 9-year period.ResultsA total of 14 patients with cholesteatoma (3 with bilateral disease) were analyzed. Thirteen ears (76.5%) had ≥2 tympanostomy tubes insertions prior to cholesteatoma diagnosis, and otorrhea and hearing loss were the most common presenting symptoms. Common pre-operative CT scan findings included mastoid sclerosis and ossicular erosion. The average age at first surgery was 9.8 years, and the average follow-up was 4.3 years. For acquired cholesteatoma, most ears were managed with canal wall up (CWU) approaches, but ultimately 6/15 (40.0%) required canal wall down (CWD) approaches. Postoperatively, 3 (20.0%) ears developed new tympanic membrane retraction pockets, but no recurrent cholesteatoma. Four (26.7%) ears developed recurrent disease, and 3 (20.0%) had residual disease at secondary procedures. Ossiculoplasty was performed in 4 ears. Twelve (70.6%) ears were rehabilitated with hearing aids or FM systems.ConclusionsThe diagnosis of cholesteatoma in Down syndrome was associated with otorrhea, hearing loss, and CT scan findings of ossicular erosion and mastoid sclerosis. Most cases were managed with CWU surgical approaches. Hearing aid use was common post-operatively.



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Tracheal paraganglioma presenting as stridor in a pediatric patient, case report and literature review

Publication date: Available online 7 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Amy L. Dimachkieh, Allison Dobbie, Damon R. Olson, Mark A. Lovell, Jeremy D. Prager
ObjectiveTo review tracheal paragangliomas and describe the clinical presentation, radiologic findings, operative management, and histologic findings of a pediatric patient who presented with stridor refractory to traditional asthma therapy.MethodsChart review of an 8-year-old male who presented to a tertiary care pediatric hospital and literature review of tracheal paragangliomas.ResultsWe present the case of an 8-year-old male who presented with new-onset of wheezing and dyspnea on exertion. He was given a new diagnosis of asthma and treated with bronchodilators that failed to improve his symptoms, which progressed over 3 months until he presented urgently with biphasic stridor. Bedside flexible laryngoscopy failed to reveal an etiology. Computed tomography (CT) imaging demonstrated 17 × 12 × 16 mm exophytic mass arising from the posterior membranous trachea with extension of the mass to the border of the thyroid gland and separate from the esophagus. Magnetic resonance imaging (MRI) angiography confirmed vascular supply from the right thyrocervical trunk and inferior thyroid artery. Rigid microlaryngoscopy revealed a friable vascular polypoid mass 2 cm distal to the vocal folds with 75% obstruction of the airway from which a small biopsy was taken. Pathology confirmed paraganglioma with neuroendocrine cells arranged in "zellballen" architecture and strong immunopositivity for chromogranin and synaptophysin in the neuroendocrine cells and S100 immunopositivity in the sustentacular cells. The patient underwent complete open resection of the tumor including three tracheal rings with primary anastomosis. Final pathology confirmed paraganglioma and negative margins. Genetic screening revealed a succinate dehydrogenase complex subunit C (SDHC) germline mutation, confirming hereditary paraganglioma/pheochromocytoma syndrome. He remains well at 3 month follow up without dyspnea or stridor.ConclusionTracheal paragangliomas are exceptionally rare, with 12 reported cases. This is the only pediatric case reported. In pediatric patients with persistent airway complaints, subglottic and tracheal masses and obstruction should be considered. Due to the vascularity and endotracheal component of tracheal paragangliomas, a detailed surgical plan should consider embolization, endotracheal laser photocoagulation and electrocautery, and open surgical resection. Additionally, pediatric patients benefit from a multidisciplinary approach including radiology, endocrinology, and genetic counseling.



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Geographic health disparities in the Los Angeles pediatric esophageal foreign body population

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Kevin Hur, Varun Angajala, Dennis Maceri, Christian Hochstim
ObjectiveTo assess geographical sociodemographic differences in the pediatric esophageal foreign body population of Los Angeles.MethodsWe retrospectively reviewed the medical records of 128 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a retained foreign body in the esophagus removed by rigid or flexible esophagoscopy. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariable logistic regression.ResultsThe average age of patients with a retained esophageal foreign body in this study was 2.5 years old, 52.3% were male, 91.4% had no past medical history, 53.1% were Hispanic, 82.0% had public health insurance, and 63.3% were transfers from an outside hospital. The most common foreign body removed was a coin. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus farther than 10 miles. On multivariable analysis, zip codes with a high volume of esophageal foreign bodies were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not risk factors for zip codes with a high volume of esophageal foreign bodies.ConclusionGeographic areas in the greater Los Angeles community with a high volume of retained esophageal foreign bodies requiring endoscopic removal at our institution are associated with lower income neighborhoods. Further studies should be performed to better understand health disparities within the U.S. pediatric esophageal foreign body population.



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Meta-analysis of the comorbidity rate of allergic rhinitis and asthma in Chinese children

Publication date: Available online 5 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Wei Kou, Xuelei Li, Hongbing Yao, Ping Wei
ObjectivesAllergic rhinitis (AR) and asthma often occur concomitantly and are the two most common inflammatory conditions of the airways in children. Large-scale studies investigating the comorbidity of asthma and AR in children are rare. So, we performed a meta-analysis to describe the comorbidity rate of asthma and AR in Chinese children.MethodsWe retrieved related studies from Pubmed, Science, Springer, Elsevier, Embase, BMJ, and four Chinese biomedical databases, including Wanfang Data, VIP, CBM, and CNKI. From these individual studies, the comorbidity rate of asthma and AR in Chinese children was extracted and pooled to generate summary effect estimates in R version 3.2.3.ResultsThe meta-analysis included 25 cross-sectional studies. The results indicated that in China, the incidence of asthma in children with AR is 35.01% (95% CI: 32.32%–37.70%) and the incidence of AR in children with asthma is 54.93% (95% CI: 53.05%–56.80%).ConclusionsThe comorbidity of AR and asthma is high in Chinese children. Statistically, the prevalence of AR was higher in children with asthma, as opposed to the prevalence of asthma in children with AR. The comorbidity rate of AR and asthma signifies the importance of improving the recognition and treatment under both conditions by respiratory physicians and otolaryngologists.



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Microbiology and antibiotic therapy of subperiosteal orbital abscess in children with acute ethmoiditis

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): A. Coudert, S. Ayari-Khalfallah, P. Suy, E. Truy
ObjectiveThe objective of this study was to investigate the microbiological cultures and the management of acute ethmoiditis complicated by subperiosteal orbital abscess (SPOA) in a pediatric population.MethodsThe medical records of children under 18 years old was performed in a tertiary referral pediatric center from January 2009 to April 2017. Clinical examination, computed tomography scans, medical and surgical treatments were reviewed and compared to other studies in literature.ResultsOne hundred and twenty-nine children were hospitalized for acute ethmoiditis. Among them, forty eight were complicated by SPOA. The mean age of these children were 7 years (range 10 months–16 years). Thirtyfour underwent surgical drainage; for the others the medical treatment was sufficient. Microbiological samples were obtained during the surgical intervention and were contributive in 91% of cases. Streptococcus spp was the most frequently encountered bacteria (60% of cases). We also found anaerobic bacteria (12%), and Staphylococcus aureus (12%). 94% of children received two intravenous antibiotics (a third-generation cephalosporin and metronidazole) for a mean duration of four days. Then the oral treatment was based on amoxicillin-clavulanate during about 8.5 days. All children were cured without sequelae.ConclusionsFor five years Streptococcus milleri, Staphylococcus spp and anaerobic bacteria are on the rise in acute ethmoiditis complicated by SPOA. That is why antibiotics must be adapted to these bacteria even in children under ten years old.



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Human beta defensin-1 is involved in the susceptibility to adenotonsillar hipertrophy

Publication date: Available online 5 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Luisa Zupin, Fulvio Celsi, Martina Bresciani, Eva Orzan, Domenico Leonardo Grasso, Sergio Crovella
IntroductionInnate immunity molecules are known to play a pivotal role in the homeostasis of the oral mucosa, permitting the presence of commensal microflora and, at the same time, providing a first line of defense against pathogens attempting to invade the oral cavity.Tonsils represent the local immune tissue in oral cavity, being able to provide a non-specific response to pathogens; however, in the presence of microbes or foreign materials present in the mouth tonsils could became infected and develop chronic inflammation, thus leading to hypertrophy.The etiology of the disease is multifactorial depending upon environmental and host factors, the latter including molecules of mucosal innate immunity.MethodsNinety-five children with adeno-tonsillar hypertrophy subjected to adeno-tonsillectomy were recruited at the pediatric otorhinolaryngology service of the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste (Italy).The specimen discard from the surgery were used for genomic DNA extraction and genotyping, for mRNA extraction and gene expression analysis, finally the samples were cut and used to prepare slides to perform immunohistochemistry.ResultsFunctional polymorphisms within DEFB1 gene, encoding the human beta defensin-1 (hBD-1), were analyzed finding association between DEFB1 rare haplotypes and susceptibility to adenotonsillar hypertrophy. DEFB1 mRNA expression was detected in the tonsils and the hBD-1 protein was localized at the epithelia of tonsils mainly in the proximity of the basal lamina.ConclusionOur findings lead us to hypothesize an involvement of hBD-1 mediated innate immunity in the modulation of the susceptibility towards adenotonsillar hypertrophy development.



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Hospital cost analysis of children with preseptal cellulitis

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): İlknur Çağlar, Cansu Kafes, Mine Korcum, Mine Düzgöl, Ahu Kara, Süleyman Nuri Bayram, Hurşit Apa, İlker Devrim
ObjectiveHospitalization of the children with preseptal cellulitis creates a burden on healthcare costs. This study aimed to analyze the hospital costs for preseptal cellulitis and determine the factors contributing.MethodsChildren, between 1 and 18 years old, who were admitted to hospital for preseptal cellulitis from May 2013 to December 2016 were included in the study. Patients were divided into groups by age (under or equal to five years and older than five years) and by the presence of sinusitis. Demographics, length of stay and total and categorical hospital costs were evaluated retrospectively.ResultsThe study included 54 patients with a mean age of 5 years. Thirty one of the patients were under five years of age. The most common symptoms were swelling (94.4%) and redness (83.3%) around eye. Among the predisposing factors, sinusitis was the most common one (37%). The average length of stay was 4.5 days. Total hospital cost of all patients was $11,841. Antibiotic costs (37%) and inpatient floor costs (36%) were the greatest expenditures. Between age groups, length of stay was longer, and inpatient floor and antibiotic costs were significantly higher in the group of >5 years (p = 0.007, p = 0.004 and p = 0.001, respectively). In the group with sinusitis, length of stay was longer, and all hospital costs were significantly higher compared to the group without sinusitis (p < 0.001). There was a strong, positive correlation between length of stay and hospital costs (r = 0.854, n = 53, p < 0.001). Sinusitis was a significant factor (p < 0.001) for longer length of stay, but age was not (p = 0.841).ConclusionSinusitis was found to be an important factor contributing to longer length of stay and higher hospital costs for preseptal cellulitis. Oral or ambulatory intravenous antimicrobial treatment strategies might decrease the hospital expenditure in these patients; however care should be taken in the presence of sinusitis.



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Analysis of risk factors associated with unilateral hearing loss in children who initially passed newborn hearing screening

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Eric N. Appelbaum, Jessica B. Howell, Derek Chapman, Arti Pandya, Kelley M. Dodson
ObjectiveTo analyze 2007 Joint Committee on Infant Hearing (JCIH) risk factors in children with confirmed unilateral hearing loss (UHL) who initially passed newborn hearing screening.MethodsRetrospective record review of 16,108 infants who passed newborn hearing screening but had one or more JCIH risk factors prompting subsequent follow-up through the universal newborn hearing screening (UNHS) program in Virginia from 2010 to 2012. The study was reviewed and qualified as exempt by the Virginia Commonwealth University Institutional Review Board (IRB) and the Virginia Department of Health.ResultsOver the 2-year study period, 14896 (4.9% of total births) children passed UNHS but had the presence of one or more JCIH risk factor. Ultimately, we identified 121 babies from this group with confirmed hearing loss (0.7%), with 48 babies (0.2%) showing UHL. The most common risk factors associated with the development of confirmed UHL after passing the initial screen were neonatal indicators, craniofacial anomalies, family history, and stigmata of syndrome associated with hearing loss.ConclusionNeonatal indicators and craniofacial anomalies were the categories most often found in children with confirmed unilateral hearing loss who initially passed their newborn hearing screen. While neonatal indicators were also the most common associated risk factor in all hearing loss, craniofacial abnormalities are relatively more common in children with UHL who initially passed newborn hearing screening. Further studies assessing the etiology underlying the hearing loss and risk factor associations are warranted.



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Tympanostomy tubes for serous otitis media and risk of recurrences

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Nathalie Klopp-Dutote, Catherine Kolski, Vladimir Strunski, Cyril Page
ObjectivesTo determine the value of tympanostomy tubes (TTs) in the management of serous otitis media (SOM) and the risk factors for SOM recurrence.MethodThis single-centre cohort study was performed in the University hospital of Amiens, France; and concerned 215 under-12 children having undergone at least one bilateral TT (Shepard grommet-type) placements for SOM.ResultsThe mean TT retention time was 10 months. SOM recurred in 79 children (62.79%) and thus required a second TT placement (bilaterally in 90% of these cases). Overall, 29.3% of the patients underwent a total of two TT placements, 5.58% underwent three placements and 0.93% underwent four placements. After their first-ever TT placement, 17 children had complications: 10 cases of otorrhoea (4.6%), 4 cases of retraction pocket (1.9%) and 3 perforations of the tympanic membrane (1.4%). At last follow-up, the most common complications were tympanosclerosis (6.9%) and perforation of the tympanic membrane (6.5%). In a multivariate analysis, the only significant risk factors for SOM recurrence were age below 48 months at the time of TT placement, and a TT retention time below 9 months. In contrast, a history of allergy, gastro-oesophageal reflux, prematurity or passive smoking were not significantly associated with recurrence.ConclusionAge at the time of TT placement and the TT retention time were significantly associated with SOM recurrence. The TT retention time and the number of TT placements were not associated with the risk of long-term complications.



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Cochlear implantation in pediatric patients with Cockayne Syndrome

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Renae D. Van Wyhe, Claudia V. Emery, Robert A. Williamson
Cockayne Syndrome (CS) is a rare, autosomal recessive disorder characterized by a spectrum of phenotypic abnormalities, including progressive sensorineural hearing loss (SNHL) that involves both peripheral and central components. To date, a single series of CS patients undergoing cochlear implant (CI) placement has been reported; this study reports on additional previously unreported pediatric CI recipients. Subjective benefits were noted early after activation in both patients, and speech perception scores improved over time as well, varying from 42 to 70% (versus 0–12% previously). Thus, we report that cochlear implantation in pediatric patients with CS can be effective in the management of progressive SNHL.



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Acute external otitis as debut of acute myeloid leukemia - A case and review of the literature

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Joachim Slengerik-Hansen, Therese Ovesen
Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis.



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Ascertainment of Asthma Prognosis Using Natural Language Processing from Electronic Medical Records

Publication date: Available online 10 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Sunghwan Sohn, Chung-Il Wi, Stephen T. Wu, Hongfang Liu, Euijung Ryu, Elizabeth Krusemark, Alicia Seabright, Gretchen A. Voge, Young J. Juhn
NLP algorithm successfully determined asthma prognosis (i.e., no remission, long-term remission, and intermittent remission) by taking into account asthma symptoms documented in EMR, and addressed the limitations of billing code-based asthma outcome assessment.



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Lumen area change (Delta Lumen) between inspiratory and expiratory CT as a measure of severe outcomes in asthma

Publication date: Available online 10 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Sung Shine Shim, Mark L. Schiebler, Michael D. Evans, Nizar Jarjour, Ron L. Sorkness, Loren Denlinger, Alfonso Rodriguez, Sally Wenzel, Eric A. Hoffman, Ching-Long Lin, David S. Gierada, Mario Castro, Sean B. Fain
BackgroundQuantitative computed tomography (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthma.ObjectiveWe sought to determine if the change of airway lumen area between TLC and FRC lung volumes measured from CT imaging data was correlated with severe outcomes in asthma patients.MethodsWe studied 152 asthma patients (90 female and 62 male) and 33 normal subjects (12 female and 21 male) with QCT. Post-processing of airways at generations 1-5 (1 = trachea) was performed for wall area percent (WA%), wall thickness percent (WT%), lumen area at baseline TLC (LATLC) and FRC (LAFRC) and low attenuation area at FRC. A new metric (reflecting remodeling and/or distal air trapping), Delta Lumen, was determined from the percent normalized difference in lumen area defined as (LATLC - LAFRC ) / LATLC x 100.ResultsPost-processing of 4501 airway segments was performed (3681 segments in the 152 subjects with asthma and 820 segments in the 33 normal subjects, range 17-28 segments per subject). Delta Lumen was negatively correlated with WT% and low attenuation area (p<0.01) in asthma subjects. Delta Lumen was significantly lower for airway generations 3-5 (segmental airways) in subjects undergoing hospitalization due to exacerbation and in refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively, and Delta Lumen was negatively, associated with systemic corticosteroid treatment (p<0.05) suggesting reduced Delta Lumen is a potential outcomes biomarker in severe asthma.ConclusionReduced Delta Lumen of the central airways measured on QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.



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Chronic inducible urticaria: a systematic review of treatment options

Publication date: Available online 10 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Corinna Dressler, Ricardo Niklas Werner, Lisa Eisert, Torsten Zuberbier, Alexander Nast, Marcus Maurer
BackgroundChronic inducible urticaria (CindU) is a condition characterized by the appearance of recurrent wheals, angioedema or both, as a response to specific and reproducible triggers.ObjectiveTo systematically assess the evidence on the efficacy and safety of treatment options for CindU. Results were used to inform the 2017 update of "The EAACI/GA²LEN/EDF/WAO Guideline for the definition, classification, diagnosis and management of Urticaria."MethodsRandomised controlled trials (RCTs) and controlled studies (CCTs) were systematically searched in various databases. Included studies were evaluated with the 'Cochrane Risk of Bias tool'. Where possible, results from single studies were meta-analyzed, applying the Mantel-Haenszel approach using a random-effects model (Der Simonian-Laird).ResultsWe identified 30 studies that included patients with cold urticaria, symptomatic dermographism, delayed pressure urticaria, or cholinergic urticaria,. No studies on other forms of CindU were eligible. Risk of bias was often rated as unclear or high. Overall, second generation antihistamines were more effective than placebo and the available data indicate that updosing may be effective. Omalizumab proved to be effective in patients with symptomatic dermographism, who did not respond to antihistamines. Detailed results are given for each type of CindU.ConclusionsThe available evidence is limited by small samples, heterogeneous efficacy outcomes, and poor reporting quality in many of the included studies. The findings are congruent with the suggested stepwise approach to treating CindUs. However, the data do not allow for drawing specific conclusions for specific subtypes of CindU.



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An ulcer on the ventral tip of tongue

Publication date: Available online 9 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hélder Antônio Rebelo Pontes, Lucas Lacerda de Souza, Anderson Mauricio Paiva e Costa, Andreia Aparecida da Silva, Fábio Luiz Neves Gonçalves, Felipe Paiva Fonseca, Flávia Sirotheau Correa Pontes




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Comprehensive review of genetic factors contributing to head and neck squamous cell carcinoma development in low-risk, nontraditional patients

Abstract

Background

The past 2 decades have seen an increased incidence of head and neck squamous cell carcinoma (HNSCC) in a nontraditional, low-risk patient population (ie, ≤45 years of age, no substance use history), owing to a combination of human papillomavirus (HPV) infection and individual genetic variation.

Methods

Articles positing genetic variants as contributing factors in HNSCC incidence in low-risk, nontraditional patients were identified using a PubMed search, reviewed in detail, and concisely summarized herein.

Results

Recent data suggest that common polymorphisms in DNA repair enzymes, cell-cycle control proteins, apoptotic pathway members, and Fanconi anemia-associated genes likely modulate susceptibility to HNSCC development in low-risk, nontraditional patients.

Conclusion

At present, there is a lack of robust, comprehensive data on genetic drivers of oncogenesis in low-risk patients and a clear need for further research on genetic alterations underlying the rising incidence of HNSCC in low-risk, nontraditional patients.

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Time-course change in temporomandibular joint space after advancement and setback mandibular osteotomy with Le Fort I osteotomy

Publication date: Available online 9 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Koichiro Ueki, Akinori Moroi, Takamitsu Tsutsui, Ryota Hiraide, Akihiro Takayama, Yuki Saito, Momoko Sato, Nana Baba, Tatsuya Tsunoda, Asami Hotta, Kunio Yoshizawa
PurposeThe purpose of this study was to compare time-course changes in temporomandibular joint (TMJ) space between mandibular advancement surgery and setback surgery after sagittal split ramus osteotomy (SSRO) and Le Fort I osteotomy.Subjects and MethodsThe subjects were 46 patients (92 joints) who underwent bi-maxillary surgery. The TMJ disc position was assessed by magnetic resonance imaging (MRI) and the anterior, superior, posterior, medial and lateral joint spaces were assessed by computed tomography (CT), preoperatively and at 1 week and 1 year postoperative. The 92 joints were divided into 2 groups, namely class II (n=46 joints), and class III (n=46 joints) (an advanced group vs a setback group). Next, the 92 joints were divided into 2 groups comprising 36 joints with anterior disc displacement joint (ADD group) and 56 joints without (non-ADD group). Time-course changes in the measurements were compared statistically between the advanced and setback groups, and between the ADD and non-ADD groups.ResultsThere were no significant differences between the advance group and setback group regarding time-course change in all the joint spaces. However, there were significant differences between the ADD group and non-ADD group regarding time-course change in the medial, anterior, superior and posterior joint spaces (P<0.05).ConclusionThis study suggested that ADD could affect the time-course change in TMJ space and condylar position after bi-maxillary osteotomy.



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The expression and function of galectins in skin physiology and pathology

Abstract

The galectin family comprises β-galactoside-binding proteins widely expressed in many organisms. There are at least 16 family members, which can be classified into three groups based on their carbohydrate-recognition domains. Pleiotropic functions of different galectins in physiological and pathological processes through extracellular or intracellular actions have been revealed. In the skin, galectins are expressed in a variety of cells, including keratinocytes, melanocytes, fibroblasts, dendritic cells, lymphocytes, macrophages, and endothelial cells. Expression of specific galectins is reported to affect cell status, such as activation or death, and regulate the interaction between different cell types or between cells and the extracellular matrix. In vitro cellular studies, in vivo animal studies and studies of human clinical material have revealed the pathophysiologic roles of galectins in the skin. The pathogenesis of diverse non-malignant skin disorders, such as atopic dermatitis, psoriasis, contact dermatitis, and wound healing, as well as skin cancers, such as melanoma, squamous cell carcinoma, basal cell carcinoma, and cutaneous hematologic malignancy can be regulated by different galectins. Revelation of biological roles of galectins in skin may pave the way to future development of galectin-based therapeutic strategies for skin diseases.

This article is protected by copyright. All rights reserved.

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Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature

Secondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion.

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Modulation of incisor eruption in rats by sympathetic efferents

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): José Johann Chidiac, Ammar Kassab, Khaldoun Rifai, Nayef E. Saadé, Elie D. Al Chaer
IntroductionIntact neural supply is necessary for tooth eruption. Sympathetic denervation accelerates or decelerates the eruption rate depending on the tooth condition (intact or injured). The aim of this study is to reexamine the role of the sympathetic innervation, through the observation of the effects of pre or post ganglionic chemical sympathectomy on the eruption of intact rat incisors.Materials and methodsDifferent groups of rats were subjected to either ganglionic or peripheral chemical sympathectomy and the observed effects on incisor eruption were compared to those made on intact/sham groups or on rats subjected to inferior alveolar nerve (IAN) lesion.ResultsThe total amount of eruption in control/naïve rats, measured over a total period of 144 h, was 3 ± 0.15 mm and decreased to 2.57 ± 0.06 mm (n = 8; p < 0.01) or 2.8 ± 0.10 mm (n = 8; p < 0.05) following treatment with guanethidine and hexamethonium, respectively. This amount decreased to 1.8 ± 0.14 mm (p < 0.001 vs. control, n = 7; or p < 0.01 vs. sham, n = 5) in rats subjected to IAN lesion.ConclusionSympathectomy delayed tooth eruption. Blocking the sympathetic effectors with guanethidine exerted more potent effects than ganglionic block with hexamethonium. Intact sympathetic supply is required for tooth growth under normal conditions.



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Modulation of incisor eruption in rats by sympathetic efferents

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): José Johann Chidiac, Ammar Kassab, Khaldoun Rifai, Nayef E. Saadé, Elie D. Al Chaer
IntroductionIntact neural supply is necessary for tooth eruption. Sympathetic denervation accelerates or decelerates the eruption rate depending on the tooth condition (intact or injured). The aim of this study is to reexamine the role of the sympathetic innervation, through the observation of the effects of pre or post ganglionic chemical sympathectomy on the eruption of intact rat incisors.Materials and methodsDifferent groups of rats were subjected to either ganglionic or peripheral chemical sympathectomy and the observed effects on incisor eruption were compared to those made on intact/sham groups or on rats subjected to inferior alveolar nerve (IAN) lesion.ResultsThe total amount of eruption in control/naïve rats, measured over a total period of 144 h, was 3 ± 0.15 mm and decreased to 2.57 ± 0.06 mm (n = 8; p < 0.01) or 2.8 ± 0.10 mm (n = 8; p < 0.05) following treatment with guanethidine and hexamethonium, respectively. This amount decreased to 1.8 ± 0.14 mm (p < 0.001 vs. control, n = 7; or p < 0.01 vs. sham, n = 5) in rats subjected to IAN lesion.ConclusionSympathectomy delayed tooth eruption. Blocking the sympathetic effectors with guanethidine exerted more potent effects than ganglionic block with hexamethonium. Intact sympathetic supply is required for tooth growth under normal conditions.



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Salivary Levels of Angiopoietin 2 in Infants with Infantile Hemangiomas Treated with and without Systemic Propranolol

Abstract

Background

Infantile hemangiomas (IH) with functional or cosmetic concerns necessitate systemictreatment for which propranolol is the preferred treatment. However, the mechanism ofaction is unknown. Mouse models suggest the angiopoietin-2 (Ang2)/Tie-2 system isimplicated. Ang2 can promote endothelial growth or induce apoptosis depending on thepresence of vascular endothelial growth factor (VEGF). This pilot study investigates thesaliva Ang2 levels in infants with IH treated with and without systemic propranolol.

Methods

Patients with clinically confirmed IH were recruited from an academic pediatric.dermatology center. Treatment was based on clinical evaluation. Saliva samples werecollected over six months. An ELISA determined Ang2 levels.

Results

Ang2 levels were detectable in 45% of samples. However, by the late time point only28% had detectable levels. There were no changes of Ang2 over time and there wereno differences in Ang2 levels between groups. However, Ang2 levels were correlatedwith baseline size and changes in size from baseline.

Conclusions

Ang2 is detectable in saliva of affected infants, but does not decrease with propranololtreatment. However, Ang2 levels are positively correlated with size and changes in size.Thus, Ang2 is not the primary factor in the mechanism of propranolol resulting in IHreduction.

This article is protected by copyright. All rights reserved.

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Cryptotanshinone reduces psoriatic epidermal hyperplasia via inhibiting the activation of STAT3

Abstract

The discovery of new therapeutic drugs with the efficacious and safe ability to prevent epidermal hyperplasia is extremely urgent for psoriasis. Cryptotanshinone (CTS), an active component isolated from the root of Salvia miltiorrhiza Bunge, has been reported to have anti-bacterial and anti-tumor effects. However, its effects on psoriasis have not been reported. Here, we investigated the therapeutic effects of CTS on imiquimod (IMQ) induced psoriatic-like skin model and explored the underlying mechanisms. Our results revealed that CTS effectively alleviates IMQ-induced epidermal hyperplasia. In vitro studies also indicated that CTS potently inhibits the growth of keratinocytes. We further found that STAT3, a transcription factor for the cell growth, is the key mediator of CTS on the proliferation of keratinocytes. Taken together, our findings indicated that the curative effects of CTS on psoriasis are accomplished mainly through modulating STAT3, which providing evidences to develop CTS as a potential therapeutic agent for patients with psoriasis.

This article is protected by copyright. All rights reserved.

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Application of an 8% capsaicin patch normalizes epidermal TRPV1 expression but not the decreased intraepidermal nerve fibre density in patients with brachioradial pruritus

Abstract

Background

Topical capsaicin shows efficacy in the treatment of brachioradial pruritus, however its mechanisms of action remain unclear.

Objective

The effect of capsaicin on the epidermis (i.e. peripheral expression of non-neuronal sensory receptors on keratinocytes, morphological changes in innervation) is still unknown. We aimed to investigate the effect of topical capsaicin on keratinocyte expression of TRP channels and on the intraepidermal nerve fibre density (IENFD) in patients with brachioradial pruritus.

Methods

Thirty-one patients with brachioradial pruritus received an 8% capsaicin patch. Biopsies in lesional and non-lesional skin were taken to assess epidermal morphology, keratinocyte expression of TRP channels and IENFD before and 3 weeks after treatment.

Results

Treatment with the capsaicin patch led to a significant decrease in itch and paresthetic symptoms (p<0.05). Keratinocyte morphology is unaltered after capsaicin therapy. Reduced keratinocyte expression of TRPV1 in lesional skin (p=0.009; n=9) normalized three weeks after treatment (p=0.016; n=10), but not the IENFD, which remained reduced in lesional epidermis.

Conclusion

The normalization of the decreased TRPV1 expression may account for the effectiveness of topical capsaicin, which does not reconstitute the reduced IENFD, arguing for a role of epidermal TRPV1 in the maintenance of brachioradial pruritus.

This article is protected by copyright. All rights reserved.

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Repeatability of nasal allergen challenge results – further validation of the allergic rhinitis clinical investigator collaborative (AR-CIC) protocols

Publication date: Available online 9 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Mena Soliman, Lisa M. Steacy, Jenny Thiele, Dan E. Adams, Helen L. Neighbour, Anne K. Ellis
BackgroundNasal Allergen Challenge(NAC) models have been used to study allergic rhinitis and new therapies. Symptoms and biological samples can be evaluated at time points following allergen exposure.ObjectiveVerification of protocol repeatability and adequate interval between allergen exposures.Methods10 ragweed allergic participants were exposed to incrementally increasing dosages of ragweed allergen intra-nasally until they achieved a Total Nasal Symptom Score(TNSS) of 8/12 and a Peak Nasal Inspiratory Flow(PNIF) >=50% reduction from baseline. 3 weeks later participants were challenged with a cumulative dose equal to the sum of all the allergen doses received at screening. TNSS and PNIF were recorded at regular intervals including a 24h assessment. A repeat visit was conducted after a further 3 weeks. Nasal secretion samples were collected for cytokine and eosinophil quantification.Results9 participants completed all visits. TNSS and PNIF responses followed previous patterns, with an initial peak at 30 minutes followed by a gradual decline. Most participants reported similar patterns at both NAC visits, though some did not demonstrate the same phenotype at both visits. Some experienced a secondary symptom rise 24 hours following NAC. Eosinophil and cytokine sections followed a similar pattern at both NAC visits.ConclusionNAC is an adequate method for modelling AR in humans, demonstrating appropriate repeatability of symptoms, nasal mucosal eosinophil and cytokines. The 24h time point, previously not studied in our model, may be beneficial in evaluation of long acting medications. This 3 week interval NAC model will be beneficial for studies where before and after treatment comparisons are desired.



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Rapid oral desensitization protocol to abiraterone acetate

Publication date: Available online 9 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Miriam Verdu, Virginia Torres-Degayon, Mohamed Hassan-Bennis




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Learnings from a pragmatic pilot trial of text messaging for high risk adolescents with asthma

Publication date: Available online 9 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Cassandra M. Dodds, Maria T. Britto




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Age-related prevalence of chronic rhinosinusitis and nasal polyps and their relationships with asthma onset

Publication date: Available online 9 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Ha-Kyeong Won, Young-Chan Kim, Min-Gyu Kang, Han-Ki Park, Seung-Eun Lee, Min-Hye Kim, Min-Suk Yang, Yoon-Seok Chang, Sang-Heon Cho, Woo-Jung Song
BackgroundChronic rhinosinusitis (CRS) is a major disease condition with high morbidity, and may influence lower airway disease status in adults. However, its associations with adult asthma onset and activity have not been examined in detail in a general adult population.ObjectiveTo investigate the relationships between CRS with nasal polyps and asthma characteristics.MethodsA cross-sectional dataset from 17,506 adult participants (age≥18 years) in the Korean National Health and Nutrition Examination Survey 2010-2012 was analyzed. CRS was defined using structured questionnaires according to the international guideline, and presence of nasal polyps was objectively assessed using nasal endoscope. Presence of asthma and its onset and current activity were asked using structured questionnaires.ResultsCRS was significantly related with asthma, but the relationships were distinct by CRS and asthma status. CRS with nasal polyps (CRSwNP) was significantly associated with adult-onset asthma (onset after 18 years) or late-onset asthma (onset after 40 years), whereas CRS without nasal polyps (CRSsNP) were related to childhood-onset asthma (onset before 18 years) or early-onset asthma (onset before 40 years) in adults. Both CRS subgroups showed significant associations with current asthma but not with past asthma. However, comorbid asthma rate was less than 10% among subjects with CRS.ConclusionThis study found distinct age-related patterns of CRSwNP and asthma and demonstrated their significant associations in a general population. However, low prevalence of asthma in CRSwNP is in sharp contrast to the findings in Western populations, which warrants further investigation for ethnic or regional difference in CRSwNP-asthma relationships.



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Lack of effect of Grastek® on birch pollen-induced allergic rhinoconjunctivitis in the Environmental Exposure Unit

Publication date: Available online 9 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anne K. Ellis, Mark W. Tenn, Lisa M. Steacy, Daniel E. Adams, Andrew G. Day, Terry J. Walker, Hendrik Nolte
BackgroundGrastek® is a standardized sublingual immunotherapy tablet(SLIT-T) approved for the treatment of grass pollen-induced allergic rhinitis(AR) and conjunctivitis. Many grass-allergic patients are also co-sensitized to birch pollen. Whether Grastek® can confer symptomatic benefits for birch pollen-induced AR symptoms is unknown.ObjectiveTo evaluate the treatment effect of Grastek® for birch pollen-induced AR in participants sensitized to both grass and birch pollen using the Environmental Exposure Unit(EEU).MethodsPhase IV, randomized, double-blind, placebo-controlled, parallel-group study enrolling participants aged 18-65 years allergic to both timothy grass and birch pollen. Following a baseline EEU birch pollen challenge where a minimum Total Nasal Symptom Score(TNSS) of 6/12 was required for enrollment, participants were randomized to receive Grastek® or placebo taken once daily for 4 months. No confirmatory grass pollen challenge was performed. The primary endpoint was the change in TNSS averaged from assessments from hours 2 to 5 during the post-treatment birch pollen challenge(PTC) compared to baseline. Secondary/exploratory endpoints included temporally identical changes in Total Ocular Symptom Score(TOSS), Total Rhinoconjunctivitis Symptom Score(TRSS), and individual symptom scores.ResultsThe difference in TNSS reduction following 4 months of therapy between the Grastek® and placebo group was not significant(P=0.83). Reductions in TOSS(P=0.19) and TRSS(P=0.67) were also comparable between groups. Findings between groups for individual symptom scores were similar(all P>0.4) except watery eyes where symptom reduction was slightly better in the placebo arm(P=0.014). Grastek® was well tolerated and no serious AEs occurred.ConclusionA by-stander effect of grass SLIT-T on birch pollen-induced AR symptoms was not detected. Symptomatic benefits of grass SLIT-T are likely allergen specific.



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Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis

Abstract

Objective

The objective of this study was to evaluate the stability of treatment effects of maxillary protraction therapy in Class III children.

Materials and methods

Multiple electronic databases were searched from 01/1996 to 10/2016. Randomized clinical trials, controlled clinical trials, and cohort studies with untreated Class III controls and a follow-up over 2 years were considered for inclusion. The methodological quality of the studies and publication bias were evaluated. Mean differences and 95% confidence intervals (CI) of six variables (SNA, SNB, ANB, mandibular plane angle, overjet, and lower incisor angle) were calculated.

Results

Ten studies were included in the qualitative analysis, and four studies were included in the quantitative analysis. Compared with the control group, after treatment, the treated group showed significant changes: SNA +1.79° (95% CI: 1.23, 2.34), SNB −1.16° (95% CI −2.08, −0.24), ANB +2.92° (95% CI 2.40, 3.44), mandibular plane angle +1.41° (95% CI 0.63, 2.20), overjet +3.94 mm (95% CI 2.17, 5.71) and lower incisor angle −3.07° (95% CI −4.92, −1.22). During follow-up, the changes in five variables reflected significant relapse. Overall, the treated group showed significant changes only in ANB +1.66° (95% CI 0.97, 2.35) and overjet +2.41 mm (95% CI 1.60, 3.23).

Conclusions

Maxillary protraction can be a short-term effective therapy and might improve sagittal skeletal and dental relationships in the medium term. But some skeletal and dental variables showed significant relapse during the follow-up period. Long-term studies are still required to further evaluate its skeletal benefits.

Clinical relevance

The study evaluated the medium-term stability of skeletal and dental effects of maxillary protraction in Class III children and discussed whether the therapy can reduce the need for orthognathic surgery.

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