A hyperpigmented rash on face and chest

http://ift.tt/2EF54Gt

Using a Dihydrofolate Reductase-Based Strategy for Producing the Biosimilar Version of Pertuzumab in CHO-S Cells

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2soT07a

Asymptomatic facial nodules

http://ift.tt/2EYuRqJ

Role of solid lipid nanoparticles as photoprotective agents in cosmetics

Summary

Background

Novel drug delivery systems have gained popularity since last two decades because of its advantages over conventional dosage forms. Effect of UV radiation on skin can cause either acute or chronic damage to our skin. Solid lipid nanoparticles (SLNs) were developed as novel carrier over the conventional carrier systems like liposomes and emulsions. The SLNs were selected as a carrier for the formulation because of its ability to protect the labile drug particles, the ability to make the drug release in a controlled manner, and occlusive property of the SLNs.

Objective

The current review is an attempt to focus on the characteristics of solid lipid nanoparticles, methods for the preparations, and their cosmetic applications along with some future perspectives of the nanodrug delivery systems.

Methods

A review of the current literature of solid lipid nanoparticles (SLNs) as novel carrier showed better photoprotection in sunscreens.

Results and conclusions

The disadvantages of conventional sunscreens can be overcome by incorporation of solid lipid nanoparticles. On comparing the lipid nanobased systems with traditional cosmetic products, the occlusion can be achieved without the use of paraffin and other greasy oils. The film formed by lipid nanoparticles will be smooth as compared to the inflexible films formed by the paraffin. Newer approaches may lead to even better results. They also possess excellent UV-blocking activity and showed better photoprotection.

http://ift.tt/2BqOqIu

Avoiding the Trap of Misdiagnosis: Valuable Teaching Points Derived from a Case of Longstanding Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES), a condition predominantly affecting young individuals, is a rare clinical entity that can result in significant morbidity. The presence of lower limb pain and claudication in young, physically active individuals should prompt consideration for PAES. Early diagnosis and management is crucial to prevent long-term complications; however, diagnosis is fraught with challenges due to the rarity of the disease and its similar clinical presentation with more common conditions. We present a case of a young female with PAES who was misdiagnosed and underwent a tarsal tunnel release for suspected tarsal tunnel syndrome and subsequent fasciotomies for presumed chronic exertional compartment syndrome (CECS) without any relief. We outline the insidious undiagnosed course of her condition over a period of 12 years, discuss teaching points of how to recognize key differences of PAES and associated conditions, and provide recommendations for how to make the right diagnosis.

http://ift.tt/2BZmGvT

Bronchoalveolar Lavage Fluid in Children: Comparative Proteomic Analysis in Infectious and Non-Infectious Lung Disease

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2o3KdCl

Cribriform plate width is highly variable within and between subjects

All successful endonasal surgery, including functional endoscopic sinus surgery (FESS), depends on knowledge of both anatomy and the specific variations that can occur between and within patients. Familiarity with these structures is a critical component in preventing complications from these procedures, and failure to understand subtle variation can have disastrous results. The aim of this study was to characterize the anatomical variations (if any) of the cribriform plate using a large cadaveric sample set.

http://ift.tt/2HceXd6

Randomized clinical trial on condylar fractures: ‘open or closed’?

Publication date: Available online 13 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.V.J. Rozeboom, L. Dubois, J. de Lange




http://ift.tt/2CiwFbf

Genetic and epigenetic alterations in the tumour, tumour margins, and normal buccal mucosa of patients with oral cancer

Publication date: Available online 12 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Eljabo, N. Nikolic, J. Carkic, D. Jelovac, M. Lazarevic, N. Tanic, J. Milasin
Despite adequate surgical resection, oral squamous cell carcinoma (OSCC) shows a high rate of recurrence and metastasis, which could be explained by the presence of molecular alterations in seemingly normal tumour margins and the entire oral mucosa. The aims of this study were (1) to assess the presence of gene amplification (c-Myc and HER2) and promoter methylation (p14 and p16) in the tumours, tumour margins, and unaffected oral mucosa of 40 OSCC patients, and (2) to evaluate the possibility of using these alterations as prognostic markers. c-Myc and HER2 genes were quantified by means of real-time PCR (qPCR), and p14 and p16 methylation status was determined by methylation-specific PCR (MSP PCR). All tissues examined exhibited molecular alterations in various proportions. Tumour tissues, as expected, showed the highest prevalence of alterations, while oral mucosa showed the lowest. Multiple alterations (co-alterations) in tumours and tumour margins were significantly more frequent than in unaffected oral mucosa (P<0.001 and P=0.027, respectively). HER2 amplification in margin tissue (P<0.001) and swabs (P=0.013), as well as the existence of three co-alterations in margins (P=0.001) and macroscopically unaffected oral mucosa (P<0.001) were correlated with shorter disease-specific survival.



http://ift.tt/2EqfhaB

Base of tongue cancer—is it tongue cancer located at the base of the tongue, or is it a type of lingual tonsil cancer? The perspective from a genomic analysis

The aim of this study was to determine whether base of tongue (BOT) cancer is tongue cancer located at the base of the tongue or lingual tonsil cancer originating from tonsil tissue. This was a retrospective study using data from The Cancer Genome Atlas (TCGA). The genomic patterns of three primary cancers (BOT, oral tongue, and tonsil) were compared to determine their similarities and differences. Gene expression data (n=193; 26 BOT, 125 oral tongue, and 42 tonsil cases), copy number alteration data (n=142; 19 BOT, 96 oral tongue, and 27 tonsil cases), and somatic mutation data (n=187; 25 BOT, 122 oral tongue, and 40 tonsil cases) were analyzed using the t-test, heatmap analysis, and OncoPrint, respectively.

http://ift.tt/2EkkA79

Randomized clinical trial on condylar fractures: ‘open or closed’?

This letter concerns a major controversy in maxillofacial trauma care: whether to perform open or closed treatment of a mandibular condyle fracture. A randomized clinical trial (RCT) on this subject has been underway since 2013 at the Academic Medical Centre in Amsterdam, University Medical Centre in Groningen, Erasmus Medical Centre in Rotterdam, Spaarne Hospital in Haarlem, and Isala Clinics in Zwolle. Other researchers have tried to do this before1,2. Until now, no research group has succeeded in executing a RCT with sufficient power to answer the question as to whether one should perform surgery on a mandibular condyle fracture or not.

http://ift.tt/2F0ZcoJ

The highs and lows of marijuana use in allergy

In November 2012, Colorado and Washington became the first states to pass initiatives legalizing marijuana use. Since then, voters in 8 states and the district of Columbia have passed similar legislation and Vermont recently announced plans to do so. It is likely that this trend will continue since marijuana sales in legalized states have added significant revenue to state economies. This rapid expansion highlights the need for studies that measure health effects of marijuana use in the population.

http://ift.tt/2su9iMg

Real world evaluation of a mobile health application in children with asthma

Asthma is one of the most prevalent chronic pediatric conditions, affecting approximately 9% of children in the United States.1 Asthma morbidity is significant as exacerbations are a leading cause of emergency department (ED) visits and hospitalizations.2,3 Successful management of asthma, including prevention of ED visits, requires proper diagnosis and treatment, comprehensive patient and family education, and development and utilization of self-management skills. Children and parents must learn to identify and avoid triggers, remain adherent to daily controller therapy, ensure access to rescue medications, and recognize and treat symptoms promptly and appropriately.

http://ift.tt/2BYvVwb

Shifting the Focus: The Primary Role of IL-23 in Psoriasis and other Inflammatory Disorders

Abstract

Insights into the pathophysiology of autoimmune inflammatory diseases including psoriasis have advanced considerably in recent years, and in parallel, so too have the available treatment options. Current clinical paradigms for the treatment of psoriasis have evolved to include targeted biologic therapies, starting with tumor necrosis factor-alpha (TNF-α) inhibitors and later, agents targeting interleukin (IL)-12/23 and IL-17. The most recent evidence suggests that IL-23 might be an even more potent target for the effective treatment of psoriasis and other autoimmune inflammatory disorders. This review will describe recent developments leading to the current understanding of the key role of IL-23 as a 'master regulator' of autoimmune inflammation, and the clinical evidence for agents that specifically target this modulator in the context of treating psoriasis, spondyloarthropathy, and inflammatory bowel disease.

This article is protected by copyright. All rights reserved.

http://ift.tt/2GbwvF2

Large-scale total synthesis of 13 C 3 -labeled citrinin and its metabolite dihydrocitrinone

Abstract

The analysis of the nephrotoxic mycotoxin citrinin in food, feed, and physiological samples is still challenging. Nowadays, liquid chromatography coupled with mass spectrometry is the method of choice for achieving low limits of detection. But matrix effects can present impairments for this method. Stable isotope dilution analysis can prevent some of these problems. Therefore, a stable isotopically labeled standard of citrinin for use in stable isotope dilution analysis was synthesized on large scale. The improved diastereoselective total synthetic strategy offered the possibility to introduce three ¹³C-labels in two steps by ortho-toluate anion chemistry. This led to a mass difference of 3 Da, sufficient for preventing spectral overlap. Additionally, a stable isotopically labeled form of dihydrocitrinone, the main urinary metabolite of citrinin, was synthesized with the same mass difference. This was achieved by a sequence of cyclisation, oxidation, deprotection, and carboxylation reactions starting from a protected intermediate of the labeled citrinin synthesis. Thus, this method also offers a complete way to synthesize dihydrocitrinone from citrinin on large scale.

http://ift.tt/2EpaIJD

Editorial Board

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106





http://ift.tt/2Cimq6K

In Memoriam: Jun-Ichi Suzuki, MD, PhD, 1929 to 2017

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Kimitaka Kaga




http://ift.tt/2EsLHAY

Whole exome sequencing identifies a pathogenic mutation in WFS1 in two large Chinese families with autosomal dominant all-frequency hearing loss and prenatal counseling

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Hongbo Cheng, Qin Zhang, Wenbin Wang, Qingxia Meng, Fuxin Wang, Minjuan Liu, Jun Mao, Yichao Shi, Wei Wang, Hong Li
ObjectivesTo identify the pathogenic mutation and provide prenatal counseling and diagnosis in two large Chinese families with autosomal dominant all-frequency hearing loss.MethodsWhole exome sequencing technology was used to identify the pathogenic mutation of the two families. In addition, 298 patients with sporadic hearing loss and 400 normal controls were studied to verify the mutation/polymorphism nature of the identified variant. Prenatal diagnosis was carried out.ResultsA rare missense mutation c.2389G > A (p.D572N) in the Wolframin syndrome 1 (WFS1) gene was identified. It was reported in only one previous Chinese study, and never in other populations/ethnicities. The mutation was also found in one patient with sporadic hearing loss (1/298, 0.3%). A healthy baby was born after prenatal diagnosis.ConclusionOur findings strongly suggest that the c.2389G > A mutation in WFS1 is associated with all-frequency hearing loss, rather than low- or high-frequency loss. So far, the mutation is only reported in Chinese. Prenatal diagnosis and prenatal counseling is available for these two Chinese families.



http://ift.tt/2ChOmrq

Total congenital sternal cleft isolated in a newborn of 20 days: Rare case

Publication date: March 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 106
Author(s): Dounia Basraoui, Badia Bannar, Mohamed Ouladsaiad, Hicham Jalal
Sternal clefts are rare malformations, especially in their complete form, which results from a lack of fusion of the sternal bars, which is normally done at the 9th week of intra uterine life. The incomplete form is often associated with other malformations of the chest wall, or falling within the framework of a polymalformative syndrome, the diagnosis is easy, being done with the inspection and the palpation, the paraclinical examinations are useful for confirming the diagnosis. We report the case of a total congenital sternal cleft isolated in an asymptomatic 20-day-old newborn. Thoracic CT, with threedimensional reconstructions, without injection of the contrast product confirmed the diagnosis, showing the presence of two hemistonids hypoplastic.The aim of our work is to draw attention to this pathology from birth because surgery must be undertaken during the first weeks of life to protect the heart and large vessels from any trauma, to improve respiratory dynamics and for aesthetic reasons.



http://ift.tt/2Eozr4B

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO 2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

Abstract

Purpose

 CO₂ laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated.

Methods

This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO₂ laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses.

Results

The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO₂ laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci's classification) experienced worse local control rates, despite free surgical margins confirmed by histology.

Conclusions

 CO₂ laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.

http://ift.tt/2Hb7g75

Damage-regulated autophagy modulator 1 in oral inflammation and infection

Abstract

Objectives

Damage-regulated autophagy modulator (DRAM) 1 is a p53 target gene with possible involvement in oral inflammation and infection. This study sought to examine the presence and regulation of DRAM1 in periodontal diseases.

Material and methods

In vitro, human periodontal ligament fibroblasts were exposed to interleukin (IL)-1β and Fusobacterium nucleatum for up to 2 days. The DRAM1 synthesis and its regulation were analyzed by real-time PCR, immunocytochemistry, and ELISA. Expressions of other autophagy-associated genes were also studied by real-time PCR. In vivo, synthesis of DRAM1 in gingival biopsies from rats and patients with and without periodontal disease was examined by real-time PCR and immunohistochemistry. For statistics, ANOVA and post-hoc tests were applied (p < 0.05).

Results

In vitro, DRAM1 was significantly upregulated by IL-1β and F. nucleatum over 2 days and a wide range of concentrations. Additionally, increased DRAM1 protein levels in response to both stimulants were observed. Autophagy-associated genes ATG3, BAK1, HDAC6, and IRGM were also upregulated under inflammatory or infectious conditions. In vivo, the DRAM1 gene expression was significantly enhanced in rat gingival biopsies with induced periodontitis as compared to control. Significantly increased DRAM1 levels were also detected in human gingival biopsies from sites of periodontitis as compared to healthy sites.

Conclusion

Our data provide novel evidence that DRAM1 is increased under inflammatory and infectious conditions in periodontal cells and tissues, suggesting a pivotal role of DRAM1 in oral inflammation and infection.

Clinical relevance

DRAM1 might be a promising target in future diagnostic and treatment strategies for periodontitis.

http://ift.tt/2F1nlvh

Open access: is there a predator at the door?

http://ift.tt/2EDx65a

INDEX

http://ift.tt/2srOdSt

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Background

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

Methods

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

Results

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

Conclusion

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

http://ift.tt/2EG2bVR

Issue Information

http://ift.tt/2suHw2a

International consensus statement on allergy and rhinology: allergic rhinitis—executive summary

Background

The available allergic rhinitis (AR) literature continues to grow. Critical evaluation and understanding of this literature is important to appropriately utilize this knowledge in the care of AR patients. The International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has been produced as a multidisciplinary international effort. This Executive Summary highlights and summarizes the findings of the comprehensive ICAR:AR document.

Methods

The ICAR:AR document was produced using previously described methodology. Specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

Results

Over 100 individual topics related to AR diagnosis, pathophysiology, epidemiology, disease burden, risk factors, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR were addressed in the comprehensive ICAR:AR document. Herein, the Executive Summary provides a synopsis of these findings.

Conclusion

In the ICAR:AR critical review of the literature, several strengths were identified. In addition, significant knowledge gaps exist in the AR literature where current practice is not based on the best quality evidence; these should be seen as opportunities for additional research. The ICAR:AR document evaluates the strengths and weaknesses of the AR literature. This Executive Summary condenses these findings into a short summary. The reader is also encouraged to consult the comprehensive ICAR:AR document for a thorough description of this work.

http://ift.tt/2EGuYJZ

Neutrophils drive type-I interferon production and autoantibodies in Wiskott-Aldrich syndrome

Publication date: Available online 13 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): K.E. Cervantes-Luevano, N. Caronni, M.C. Castiello, E. Fontana, G. Piperno, A. Naseem, P. Uva, M. Bosticardo, G.E. Marcovecchio, L.D. Notarangelo, M.P. Cicalese, A. Aiuti, A. Villa, F. Benvenuti
BackgroundWiskott-Aldrich syndrome (WAS) is a rare primary immunodeficiency caused by mutations in WASp, a key regulator of cytoskeletal dynamics in hematopoietic cells. A high proportion of patients develop autoimmunity due to a breakdown in T and B cell tolerance. Moreover, excessive production of type-I interferon by plasmacytoid DCs contribute to autoimmune signs, however, the factors that triggers excessive innate activation have not been defined.ObjectiveNeutrophils extracellular traps (NETs) emerged as major initiating factors in diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In this study, we explored the possible involvement of aberrant neutrophil functions in WAS.MethodsWe evaluated the expression of a set of granulocyte genes associated with NETs in a cohort of WAS patients and the presence of NET-inducers in sera. Using a mouse model of WAS, we analyzed NET release by WASp-null neutrophils, and we evaluated the composition and homeostasis of neutrophils in vivo. By means of depletion experiments, we assessed the impact of neutrophils in promoting inflammation and reactivity against auto-antigens.ResultsTranscripts of genes encoding neutrophil enzymes and antimicrobial peptides were elevated in granulocytes of WAS patients, and serum soluble factors triggered NET release. WASp-null neutrophils showed increased spontaneous NETosis, induced type-I interferon production by plasmacytoid DCs (pDCs), and activated B cells via BAFF. Consistently, their depletion abolished constitutive pDCs activation, normalized circulating IFN-I levels and, importantly, abolished production of autoantibodies directed against dsDNA, nucleosomes and MPO.ConclusionsThese findings reveal that neutrophils are involved in the pathogenic loop that causes excessive activation of innate cells and autoreactive B cell, thus identifying novel mechanisms that contribute to the autoimmunity of WAS.

Graphical abstract

http://ift.tt/2HepIvG

Diagnostic flexible pharyngo-laryngoscopy: development of a procedure specific assessment tool using a Delphi methodology

Abstract

Purpose

Proper training and assessment of skill in flexible pharyngo-laryngoscopy are central in the education of otorhinolaryngologists. To facilitate an evidence-based approach to curriculum development in this field, a structured analysis of what constitutes flexible pharyngo-laryngoscopy is necessary. Our aim was to develop an assessment tool based on this analysis.

Methods

We conducted an international Delphi study involving experts from twelve countries in five continents. Utilizing reiterative assessment, the panel defined the procedure and reached consensus (defined as 80% agreement) on the phrasing of an assessment tool.

Results

Fifty panelists completed the Delphi process. The median age of the panelists was 44 years (range 33–64 years). Median experience in otorhinolaryngology was 15 years (range 6–35 years). Twenty-five were specialized in laryngology, 16 were head and neck surgeons, and nine were general otorhinolaryngologists. An assessment tool was created consisting of twelve distinct items.

Conclusion

The gathering of validity evidence for assessment of core procedural skills within Otorhinolaryngology is central to the development of a competence-based education. The use of an international Delphi panel allows for the creation of an assessment tool which is widely applicable and valid. This work allows for an informed approach to technical skills training for flexible pharyngo-laryngoscopy and as further validity evidence is gathered allows for a valid assessment of clinical performance within this important skillset.

http://ift.tt/2EGh8XQ

A comparison of Dysphonia Severity Index and Acoustic Voice Quality Index measures in differentiating normal and dysphonic voices

Abstract

Purpose

The aim of the study was to investigate and compare the feasibility and robustness of the Acoustic Voice Quality Index (AVQI) and the Dysphonia Severity Index (DSI) in diagnostic accuracy, differentiating normal and dysphonic voices.

Methods

A group of 264 subjects with normal voices (n = 105) and with various voice disorders (n = 159) were asked to read aloud a text and to sustain the vowel /a/. Both speech tasks were concatenated, and perceptually rated for dysphonia severity by five voice clinicians. They rated the Grade (G) and the overall dysphonia severity with a visual analog scale (VAS). All concatenated voice samples were acoustically analyzed to receive an AVQI score. For DSI analysis, the required voice parameters were obtained from the sustained phonation of the vowel /a/.

Results

The results achieved significant and marked concurrent validity between both auditory-perceptual judgment procedures and both acoustic voice measures. The DSI threshold (i.e., DSI = 3.30) pertaining to G_mean obtained reasonable sensitivity of 85.8% and specificity of 83.4%. For VAS_mean, the DSI threshold of 3.30 was determined also with reasonable sensitivity of 70.3% and excellent specificity of 93.9%. Also, the AVQI threshold (i.e., AVQI = 3.31) pertaining to G_mean demonstrated reasonable sensitivity of 78.1% and excellent specificity of 92.0%. For VAS_mean, an AVQI threshold of 3.33 was determined with excellent sensitivity of 97.0% and reasonable specificity of 81.8%.

Conlusion

The outcomes of the present study indicate comparable results between DSI and AVQI with a high level of validity to discriminate between normal and dysphonic voices. However, a higher level of accuracy was yielded for AVQI as a correlate of auditory perceptual judgment suggesting a reliable voice screening potential of AVQI.

http://ift.tt/2o7cKqS

Medical Cannabis During Chemoradiation for Head and Neck Cancer

Condition:   Head and Neck Cancer
Intervention:   Other: Certification of medical cannabis
Sponsor:   Albert Einstein College of Medicine, Inc.
Not yet recruiting

http://ift.tt/2o4aXCF

TAK228 With Carbo and Taxol in Advanced Malignancies

Conditions:   Malignant Neoplasm of Breast;   Malignant Neoplasms of Bone and Articular Cartilage;   Malignant Neoplasms of Digestive Organs;   Malignant Neoplasms of Eye Brain and Other Parts of Central Nervous System;   Malignant Neoplasms of Female Genital Organs;   Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites;   Malignant Neoplasms of Independent (Primary) Multiple Sites;   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Malignant Neoplasms of Male Genital Organs;   Malignant Neoplasms of Mesothelial and Soft Tissue;   Malignant Neoplasms of Respiratory and Intrathoracic Organs;   Malignant Neoplasms of Thyroid and Other Endocrine Glands;   Malignant Neoplasms of Urinary Tract;   Malignant Neoplasms Stated as Primary Lymphoid Haematopoietic
Interventions:   Drug: TAK-228;   Drug: Paclitaxel;   Drug: Carboplatin
Sponsors:   M.D. Anderson Cancer Center;   Takeda
Not yet recruiting

http://ift.tt/2nWsHAI

A Study of BGB-A317 Versus Chemotherapy as Second Line Treatment in Patients With Advanced Esophageal Squamous Cell Carcinoma

Condition:   Esophageal Squamous Cell Carcinoma (ESCC)
Interventions:   Drug: BGB-A317;   Drug: Paclitaxel, or Docetaxel, or Irinotecan
Sponsor:   BeiGene
Recruiting

http://ift.tt/2o2CMeP

Study of REGN2810 in Adults With Cervical Cancer

Condition:   Recurrent or Metastatic, Platinum-refractory Cervical Cancer
Interventions:   Drug: REGN2810;   Drug: Investigator Choice (IC) Chemotherapy
Sponsors:   Regeneron Pharmaceuticals;   Sanofi
Recruiting

http://ift.tt/2nUcA6P

SNOT-22–based clusters in chronic rhinosinusitis without nasal polyposis exhibit distinct endotypic and prognostic differences

Background

Endotypic and prognosticating features of chronic rhinosinusitis without nasal polyposis (CRSsNP) are poorly understood. Our objectives were to use an unbiased symptom-based approach to: (1) study symptoms, clinical and endotypic features; and (2) identify features predicating outcomes from endoscopic sinus surgery (ESS).

Methods

Clinical, computed tomography (CT), histopathology, and 22-item Sino-Nasal Outcome Test (SNOT-22) data was collected on 146 adult CRSsNP patients who underwent ESS. Unsupervised network modeling of presurgical SNOT-22 scores was performed to classify symptom-based clusters. Subject characteristics and post-ESS SNOT-22 scores were compared between clusters.

Results

Baseline characteristics of the subject population were as follows: females, 56.2%; revision ESS status in 35%; asthma prevalence, 32.6%; median Lund-Mackay CT score, 8; and median SNOT-22 total score, 43. Network mapping and unsupervised clustering of preoperative SNOT-22 scores revealed 4 clusters: (A) severely burdened with high scores in all 4 subdomains; (B) moderately burdened with high scores in the rhinologic subdomain; (C) moderately burdened with high scores in psychological-sleep subdomains; and (D) mildly burdened. The number of previous ESS and asthma prevalence differed significantly between clusters; CT scores were similar. Asthma burden and tissue eosinophilia were greatest in cluster A (p = 0.03). All groups showed significant improvement at 3 months post-ESS (p < 0.0001). At 6 months, patients in cluster C tended to worsen.

Conclusion

SNOT-22–based network modeling of CRSsNP patients yielded 4 clusters with distinct features. Asthma prevalence and tissue eosinophilia were highest in the cluster with highest SNOT-22 scores. All patients showed significant improvement from ESS at 3 months; those with high sleep-psychosocial symptoms tended to show worsening at 6 months.

http://ift.tt/2G9Dzlo

Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting

Abstract

Background

The American Society of Anesthesiologists (ASA) physical status is a universal classification system that helps clinicians to categorize their patients preoperatively. However, there is a lack of both inter-rater and intra-rater reliability among clinicians for the ASA physical status classification. Our study focuses on testing these reliabilities within pediatric anesthesia providers in the cancer setting.

Methods

In our retrospective observational study, a total of 1177 anesthesia records were reviewed. The cohort included all pediatric patients (≤ 18 years old) diagnosed with either retinoblastoma or neuroblastoma who had two or more anesthesia procedure within a 14-day time period.

Results

Overall, the ASA physical status score among two different anesthesia providers for the same patient treated at different times had very little inter-rater reliability, κ = − 0.042 (95% CI − 0.17; 0.09). Of the 1177-patient anesthesia records, only 25% had two or more ASA physical status score assigned by the same anesthesiologist within a 14-day time period. There was moderate intra-rater reliability κ = 0.48 (95% CI 0.29; 0.68) for patients who were assigned an ASA physical status score by the identical anesthesia provider at different times points within a 14 day period.

Conclusion

In contrast to observations in earlier studies, findings indicate poor agreement in inter-rater reliability. Although there was moderate agreement in intra-rater reliability, one would expect to find stronger, even perfect, intra-rater reliability. These findings suggest the need to develop a specific physical status classification system directed toward patients with a systemic illness such as cancer in both young and adult patients.

http://ift.tt/2nWWAAT

Plasma N-acylethanolamine and endocannabinoid levels in burning mouth syndrome: potential role in disease pathogenesis

Abstract

Objective

The objective was to measure endocannabinoid (eCB) ligands and non-cannabinoid N-acylethanolamine (NAE) molecules in plasma from individuals with burning mouth syndrome (BMS), and to determine if plasma eCB/NAE levels correlated with pain, inflammation and depressive symptomatology in this cohort.

Study design

Plasma content of the eCBs, anandamide (AEA) and 2-arachidonoyl-glycerol (2-AG), and the NAE molecules, palmitoylethanolamide (PEA) and oleolylethanolamide (OEA), were assessed in healthy subjects (n=8) and in a cohort of newly diagnosed BMS patients (n=9) using liquid chromatography-tandem mass spectrometry. Plasma eCBs and NAE profiles were correlated with self-rated oral cavity pain intensities, depressive symptomatology and plasma IL-8 levels.

Results

Plasma levels of PEA, but not OEA, AEA or 2-AG, were significantly elevated in patients with BMS, when compared to plasma from healthy individuals. Plasma PEA, OEA and AEA levels correlated with depressive symptomatology.

Conclusions

This is the first evidence to indicate that circulating eCB/NAE levels are altered in BMS.

This article is protected by copyright. All rights reserved.

http://ift.tt/2o3oYkd

Anterosuperior anchoring myringoplasty using cyanoacrylate glue can prevent packing gelfoam in the middle ear cavity

Publication date: Available online 12 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): Y. Li, J. Liang, Y. Cheng, Q. Zhang, X. Ren, Y. Sheng
ObjectivesAlthough a number of methods have been attempted to improve securing the graft, packing gelfoam in the middle ear cavity cannot be avoided, which could obstruct the tympanic ostium of the Eustachian tube and affect inner ear function. Myringoplasty using tissue adhesive has gained traction because tissue adhesives can effectively stabilise the graft and act as scaffolding to improve the graft uptake. The aim of this prospective study was to explore myringoplasty using cyanoacrylate glue with no packing in the middle ear cavity for the repair of subtotal tympanic membrane (TM) perforations.MethodsBetween March 2014 and November 2015, 71 patients with subtotal TM perforations were randomly and prospectively divided into a glue group and a control group. Two securing techniques were performed using only cyanoacrylate glue or using only filling gelfoam in the middle ear cavity, respectively, during an anterosuperior anchoring myringoplasty operated by a single surgeon.ResultsAt a 6-month follow-up, the graft uptake rate was 87% in the glue group and 89% in the control group. A significant hearing improvement was found in both groups postoperatively when compared to the preoperative values (P<0.05 for both). There was no significant difference in the graft uptake rate and hearing improvement between the 2 groups (P>0.05). Similar complications were found in each group.ConclusionCyanoacrylate glue is a helpful material for graft stabilisation and can substitute for filling gelfoam in the middle ear cavity during anterosuperior anchoring myringoplasty for subtotal TM perforation.



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Photobiomodulation improves motor response in patients with spinal cord injury submitted to electromyographic evaluation: randomized clinical trial

Abstract

Photobiomodulation is a treatment that has been widely used in neurotrauma and neurodegenerative diseases. In the present study, low-level laser therapy was administered to patients with spinal cord injury. Twenty-five individuals were divided into two groups: placebo photobiomodulation plus physiotherapy and active photobiomodulation plus physiotherapy. Electromyographic evaluations were performed before and after 12 sessions of phototherapy as well as 30 days after the end of treatment. In the active phototherapy group, median frequency values of the brachial biceps and femoral quadriceps muscles were higher at rest and during isotonic contraction 30 days after photobiomodulation (p = 0.0258). No significant results were found regarding the rest and isotonic conditions in the pre-photobiomodulation period (p = 0.950) or immediately following photobiomodulation (p = 0.262). The data provide evidence that phototherapy improves motor responses in individuals with spinal cord injury, as demonstrated by differences in the EMG signal before and after treatment. Trial registration: NCT 03031223

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Effect of multiple autoclave cycles on the surface roughness of HyFlex CM and HyFlex EDM files: an atomic force microscopy study

Abstract

Aim

To compare the effect of autoclave cycles on the surface topography and roughness of HyFlex CM and HyFlex EDM instruments using atomic force microscopy (AFM) analysis.

Methodology

Eight new files of each brand were subdivided into four subgroups (n = 2/each subgroup). One group was allocated as the control group and not subjected to autoclave sterilization. The other three groups were subjected to different numbers (1, 5, and 10) of autoclave sterilization cycles. After the cycle instruments were subjected to AFM analysis. Roughness average (Ra) and the root mean square (RMS) values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way ANOVA and post hoc Tamhane tests at 5% significant level.

Results

The lowest Ra and RMS values were observed in the HyFlex EDM files that served as the control and in those subjected to a single cycle of autoclave sterilization (P < 0.05). The highest Ra and RMS values were observed in the HyFlex CM and HyFlex EDM files that were subjected to 10 cycles of autoclave sterilization (P < 0.05). The surface roughness values of the HyFlex CM group showed a significant increase after ten autoclave cycles, whereas those of the HyFlex EDM group exhibited a significant change after five autoclave cycles (P < 0.05).

Conclusions

Although the initial surface roughness values of the HyFlex EDM files were lower than those of the HyFlex CM files, the surface roughness values of the EDM files showed a statistically significant increase after 5 cycles of autoclave sterilization. In contrast, the surface roughness values of the HyFlex CM files did not increase until 10 cycles of autoclave sterilization.

Clinical relevance

Present study indicated that autoclave sterilization negatively affected the surface roughness of the tested NiTi files.

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Cover Image

The cover image, by Eleni-Marina Kalogirou et al., is based on the Original Article Ductal cells of minor salivary glands in Sjögren's syndrome express LINE-1 ORF2p and APOBEC3B, DOI 10.1111/jop.12656.

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Pregnancy outcome in a pregnant patient with idiopathic Pulmonary Arterial Hypertension: a case report and review of the literature

Idiopathic pulmonary arterial hypertension is a rare and progressive condition which is aggravated by the physiologic changes during pregnancy. Because of high mortality rate, most physicians recommend early t...

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Definition and diagnosis of asthma–COPD overlap (ACO)

Publication date: Available online 9 February 2018
Source:Allergology International
Author(s): Satoru Yanagisawa, Masakazu Ichinose
It is now widely recognized that asthma and COPD can coexist as asthma–COPD overlap (ACO), but the preliminary attempts at providing universal guidelines for the diagnosis of ACO still need to be improved. We believe that a case can be made for devising guidelines for the diagnosis of this increasingly common disease that are specific to Japan. In this paper, we present our consensus-based description of ACO which we believe is realistic for use in our country. In addition, we cite the scientific evidence for our own "objective" features used to develop the criteria for COPD and asthma diagnosis. We acknowledge that they will need to be validated and updated over time, but hope the results will encourage further research on the characteristics and treatment of this commonly encountered clinical problem.



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A case of contact dermatitis and contact urticaria syndrome due to multiple allergens observed in a professional baseball player

Publication date: Available online 1 February 2018
Source:Allergology International
Author(s): Kaoru Nishiwaki, Yuka Matsumoto, Kosuke Kishida, Muneaki Kaku, Ryoji Tsuboi, Yukari Okubo




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The optimal age for epicutaneous sensitization following tape-stripping in BALB/c mice

Publication date: Available online 10 February 2018
Source:Allergology International
Author(s): Masato Tamari, Keisuke Orimo, Kenichiro Motomura, Ken Arae, Akio Matsuda, Susumu Nakae, Hirohisa Saito, Hideaki Morita, Kenji Matsumoto
BackgroundDirect contact of food proteins with eczematous lesions is thought to be the main cause of epicutaneous sensitization. To further investigate the development and pathogenesis of food allergy in vivo, a good mouse model of epicutaneous sensitization is needed. However, a fundamental problem in that regard is that the optimal age for epicutaneous sensitization of mice is unknown. In this study, we attempted to elucidate that optimal age.MethodsDorsal skin of wild-type BALB/c female mice (1, 3, 8 and 24 weeks old) was shaved, depilated and tape-stripped. A Finn chamber containing a 20-μl-aliquot of 20-mg/ml (OVA) was applied to the tape-stripped skin on 3 consecutive days/week, for 3 weeks. The body temperature was measured after intraperitoneal OVA challenge. Serum OVA-specific IgE titers and OVA-induced cytokine production by spleen cells were measured by ELISA. Dendritic cells (DCs) that migrated to the draining lymph nodes were quantified by FITC-labeled OVA and flow cytometry. The mRNA expression levels in the dorsal skin were measured by qPCR.ResultsA significant age-dependent body temperature decline was observed after OVA challenge. The serum OVA-specific IgE titer, OVA-induced cytokine production (i.e., IL-4, IL-5 and IL-13) by spleen cells, and number of FITC-OVA-engulfing DCs increased with age. In addition, mRNA for IL-33, but not TSLP or IL-25, was significantly induced in the skin by tape-stripping and increased with age.ConclusionsTwenty-four-week-old mice showed the greatest DC migration, Th2 polarization, IgE production and body temperature decline. Skin-derived IL-33 is likely to play key roles in those changes.



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Spontaneous alveolar bone loss after 4NQO exposure in Wistar rats

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Harry J.R. Oballe, Francisco Wilker M.G. Muniz, Cheyenne C. Bueno, Isadora P. Klein, Vinicius C. Carrard, Cassiano K. Rösing, Eduardo J. Gaio
ObjectiveThis study evaluated the effect of an experimental carcinogenic, 4-Nitroquinoline 1-oxide (4NQO), in the spontaneous alveolar bone loss (ABL) in an animal model.DesignTwenty-two male Wistar rats were included in this study. They were randomly divided into two groups: the control group (n = 10) received food and water ad libitum, and the test group (n = 12) receive the same food; however, 25 ppm of 4NQO was diluted in the drinking water. All animals were euthanized after 20 weeks, and the tongues were removed and analyzed macroscopically to determine the presence of oral mucosal lesions. All specimens were paraffin-embedded and histological sections were obtained. The microscopic analysis was based on routine procedure (haematoxylin and eosin stain). The analysis of spontaneous ABL was performed by a calibrated examiner using standardized photographs and imaging software. Differences in spontaneous ABL were assessed among the three resulting groups: control, 4NQO with oral squamous cell carcinoma (OSCC), and 4NQO without OSCC.ResultsIn the 4NQO-treated group, nine animals developed OSCC. The animals in the 4NQO with OSCC group presented significantly more spontaneous ABL (0.65 ± 0.21 mm) than the control group (0.34 ± 0.05) (p < 0.001). The animals in the 4NQO without OSCC group showed a mean spontaneous ABL of 0.47 ± 0.13 mm, which was not statistically significant different when compared to the control group (p = 0.096).ConclusionsIt was concluded that the presence of OSCC enhanced spontaneous ABL in Wistar rats when compared to control animals. Additionally, it was shown that, solely, administration of 4NQO may not be considered responsible for alveolar bone destruction.



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Spontaneous alveolar bone loss after 4NQO exposure in Wistar rats

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Harry J.R. Oballe, Francisco Wilker M.G. Muniz, Cheyenne C. Bueno, Isadora P. Klein, Vinicius C. Carrard, Cassiano K. Rösing, Eduardo J. Gaio
ObjectiveThis study evaluated the effect of an experimental carcinogenic, 4-Nitroquinoline 1-oxide (4NQO), in the spontaneous alveolar bone loss (ABL) in an animal model.DesignTwenty-two male Wistar rats were included in this study. They were randomly divided into two groups: the control group (n = 10) received food and water ad libitum, and the test group (n = 12) receive the same food; however, 25 ppm of 4NQO was diluted in the drinking water. All animals were euthanized after 20 weeks, and the tongues were removed and analyzed macroscopically to determine the presence of oral mucosal lesions. All specimens were paraffin-embedded and histological sections were obtained. The microscopic analysis was based on routine procedure (haematoxylin and eosin stain). The analysis of spontaneous ABL was performed by a calibrated examiner using standardized photographs and imaging software. Differences in spontaneous ABL were assessed among the three resulting groups: control, 4NQO with oral squamous cell carcinoma (OSCC), and 4NQO without OSCC.ResultsIn the 4NQO-treated group, nine animals developed OSCC. The animals in the 4NQO with OSCC group presented significantly more spontaneous ABL (0.65 ± 0.21 mm) than the control group (0.34 ± 0.05) (p < 0.001). The animals in the 4NQO without OSCC group showed a mean spontaneous ABL of 0.47 ± 0.13 mm, which was not statistically significant different when compared to the control group (p = 0.096).ConclusionsIt was concluded that the presence of OSCC enhanced spontaneous ABL in Wistar rats when compared to control animals. Additionally, it was shown that, solely, administration of 4NQO may not be considered responsible for alveolar bone destruction.



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Laparoscopic endoscopic combined surgery for removal of migrated coil after embolization of ruptured splenic artery aneurysm

Abstract

Splenic artery aneurysm is the most common visceral arterial aneurysm. Rupture of aneurysm is a rare event but associated with a high mortality. Endovascular coil embolization of bleeding splenic artery aneurysm has emerged as a promising minimal invasive treatment and considered safer than open surgery in selected patients. Nevertheless, several complications related to coils have been reported, the rarest being coil migration and erosion. We report a case of splenic artery coil migration into the stomach and its successful removal by laparoscopic endoscopy combined surgery.

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Solitary pancreatic head metastasis from tibial adamantinoma: a rare indication to pancreaticoduodenectomy

Abstract

Pancreatic metastases are rare, <2% of all pancreatic neoplasia. This is the first case of pancreatic metastasis from adamantinoma, a rare, low grade and slow growing tumor which is frequently localized in long bones. We describe a case of a 45-year-old woman presenting with increased bilirubin level. Computed tomography and ecoendoscopic ultra sonography revealed a pancreatic head mass. Fine-needle aspiration biopsy was consistent with metastatic adamantinoma. The patient was submitted to a standard pancreaticoduodenectomy. As in the case presented, standard pancreatic resections are safe and feasible options to treat non-pancreatic primary tumor improving patient's survival and quality of life.

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A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

Abstract

Ischemic heart disease presents with various symptoms, and chest pain is a chief complaint. Occlusion of the left main trunk often results in serious symptoms such as cardiogenic shock. However, while extremely rare, left main trunk occlusion can present with only slight chronic symptoms. In the present case, a 62-year-old woman with few risk factors for ischemic heart disease visited our hospital complaining of exertional chest pain, which had gradually intensified over the past several years. Coronary artery computed tomography revealed total occlusion of the left main trunk, which was examined closely using coronary angiography. Coronary angiography showed that the left coronary artery was perfused by collateral pathways from the right coronary artery. The patient was thus diagnosed with chronic occlusion of the left main trunk. She underwent off-pump coronary artery bypass grafting, which proved to be an effective treatment.

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Asthma mobile applications: are they ready for prime time?

Publication date: Available online 12 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michael S. Blaiss




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Face-to-face anti-tobacco intervention lowered cotinine level in asthmatic children

Publication date: Available online 12 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stelmach Włodzimierz, Mitał Marcin, Stelmach Iwona, Jerzyńska Joanna, Krakowiak Jan




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Interleukin-25 and eosinophils progenitor cell mobilization in allergic asthma

Eosinophil-lineage committed progenitor cells (EoP) migrate from the bone marrow and differentiate locally to provide an ongoing source of mature eosinophils in asthmatic inflammatory responses in the airways....

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A review of the role of estrogen in dermal aging and facial attractiveness in women

Summary

Estrogens are known to have protective and favorable influences on skin health; conversely, androgens oppose the actions of estrogens. Estrogen's chemical messages are transmitted via the classical nuclear hormone estrogen receptors (ER) alpha and beta and the rapid-acting G-coupled membrane estrogen receptor. Androgens [both testosterone and 5α-dihydrotestosterone (5α-DHT)] bind the same androgen receptor. Estrogen levels peak in the mid- to late 20s in women and then decline by 50% by 50 years of age and dramatically decrease further after menopause. The loss of estrogens with aging contributes to diminished dermal health, whereas estrogen hormone therapy [eg, oral conjugated equine estrogens (CEE)] restores skin health. Several reports suggest positive correlations between the levels of circulating estrogens and: (1) perceived age, (2) attractiveness, (3) enhanced skin health, and (4) facial coloration in women. Based upon a psychological dermato-endocrine perspective, the positive correspondence of high estrogens levels with perceived age and facial attractiveness in women especially with aging demonstrates the importance of hormonal influences on observed dermal health and youthful appearance.

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Postural assessment in class III patients before and after orthognathic surgery

Abstract

Purpose

This study aimed to assess body posture before and after bimaxillary orthognathic surgery by photogrammetry in skeletal class III patients.

Methods

Thirty-one patients with skeletal class III dentofacial deformities (14 men, 17 women) who underwent orthodontic preparation for surgery were included in this non-randomized controlled trial. Of these, 15 who did not undergo orthognathic surgery during the period of this study served as controls. Postural assessment was performed by photogrammetry using SAPO® (Postural Assessment Software) based on anterior-, posterior-, and lateral-view images taken 1 month before and 4 months after bimaxillary orthognathic surgery with internal rigid fixation (or 4 months after the initial assessment, for the control group). The study was approved by PUCRS Research Ethics Committee, and written informed consent was obtained from all individual participants prior to their inclusion in the study.

Results

There was no significant difference between groups for age, gender, and GAP. In the intervention group, the right leg/hindfoot angle, which initially indicated a valgus deformity, normalized after intervention (P < 0.048). Posterior displacement of the head (P < 0.005) and trunk (P < 0.004) were observed after intervention.

Conclusions

These results suggest that correction of class III dentofacial deformities by bimaxillary orthognathic surgery can produce systemic postural adjustments, especially posterior displacement of the head and trunk and knee and ankle valgus.

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Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy

Sinus fungal ball is defined as noninvasive chronic rhino-sinusitis with a clump of mold in the paranasal sinuses, typically affecting the maxillary sinus. Fairly good outcomes of endoscopic surgery have been reported where the ball is removed through the antrostomy. However, the affected sinus tends to have a smaller cavity and thicker bony walls. As such, it is often challenging to maintain a window size that is sufficient to control possible recurrence. The endoscopic modified medial maxillectomy procedure was applied to a 61-year old and a 70-year old female patient with maxillary sinus fungal ball. Using this method, we created a much larger inferior meatal antrostomy without difficulty. The window provided us with an endoscopic view of the whole sinus and complete eradication of the lesion. Endoscopic modified medial maxillectomy is useful as a surgical procedure for maxillary sinus fungal ball and should be considered for better outcomes. Address correspondence and reprint requests to Kazuhiro Nomura, MD, PhD, Department of Otolaryngology, Tohoku Rosai Hospital, 4-3-21 Dainohara Aoba-ku, Sendai, Miyagi 981-8563, Japan; E-mail: kazuhiroe@gmail.com Received 17 June, 2017 Accepted 5 December, 2017 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Does Periosteal Graft Combined With Platelet-Rich Plasma Enhance the Healing of Bone Defect?

Introduction: This study investigated the effect of periosteal graft + platelet-rich plasma (PRP) combination on facial bone defect healing. Methods: Five-millimeter critical sized defects in zygomatic arches of 12 adult New Zealand rabbits were created. Rabbits were randomly divided into 3 groups: First group (control group): bone defects of left zygomatic arches of 6 rabbits were wrapped with a silicone tube. Second group (periosteal graft group): bone defects of left zygomatic arches of 6 rabbits were wrapped with periosteal graft. Third group (experimental group): bone defects of right zygomatic arches of 12 rabbits were wrapped with periosteal graft–PRP combination. New bone formation was evaluated at 8th and 16th weeks. One rabbit was sacrificed at 8th week. Remaining 11 rabbits were imaged with 3-dimensional computed tomography (CT) at 16th week; then, zygomatic arches were removed for micro-CT and histologic examinations. Results: Three-dimensional CT analysis at 16th week revealed no significant difference between groups regarding new bone formation (P = 0.232). Micro-CT analysis of new regenerated bone at 16th week displayed significant differences between groups 1 and 3 regarding mean bone volume (BV, mm3) (P = 0.028) and mean bone mineral density (BMD, mm2) (P = 0.001). There was no difference between groups 2 and 3 or between groups 1 and 2, regarding BV or BMD. Histological Bone Regeneration Scorings at 16th week displayed significant difference between groups (P = 0.015). Negative correlation between 3-dimensional CT and histologic results (r = 0.120); positive correlations between BV/BMD values in micro-CT and histologic results (r = 0.524 and r = 0.456) were found. Conclusions: By enhancing bone formation capacity of periosteal grafts, periosteal graft–PRP combination provided bone formation having more volume and density comparing with silicone tube application. Address correspondence and reprint requests to Arzu Türkseven, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Kadiköy, Istanbul, Turkey; E-mail: arzuturkseven@gmail.com Received 14 June, 2017 Accepted 28 September, 2017 This study has been presented at the Turkish Plastic, Reconstructive and Aesthetic Surgery Society 36th National Conference in Istanbul, Turkey. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Effects of Hyaluronic Acid and Hydroxyapatite/Beta-tricalcium Phosphate in Combination on Bone Regeneration of a Critical-size Defect in an Experimental Model

Hyaluronic acid (HyA) is an outstanding new product in the field of oral and maxillofacial surgery. The aim of this study was to evaluate the effects of HyA on bone regeneration in critical-size calvarial defects. Twenty-four female Sprague-Dawley rats were used in the present study. In each rat, 4 critical-size defects received different treatments: no treatment (control); HyA; Graft; and HyA + Graft combination. New bone formation, defect closure, inflammation, vascular proliferation, immature bone formation, mature bone formation, and bone marrow existence were investigated based on histological findings. The healing parameters related to bone formation (new bone formation, defect closure, immature bone formation) were significantly higher in the HyA group compared with the control group. However, HyA alone was unable to induce sufficient bone regeneration compared with treatments involving graft materials (Graft and HyA + Graft). In the Graft and HyA + Graft groups, prominent enhancement of all healing parameters was noted. The present results demonstrate that HyA alone did not adequately enhance bone regeneration in critical-size defects. Moreover, addition of HyA to a biphasic alloplastic graft material did not result in improved regeneration compared with the graft material alone. Address correspondence and reprint requests to Nurettin Diker, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, 82. Sokak No: 26 06490 Bahcelievler, Ankara 06490, Turkey; E-mail: dikernurettin7tp@gmail.com Received 8 June, 2017 Accepted 26 November, 2017 This research was funded by the Baskent University Research Fund. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluation of Postoperative Stability After Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures Using Cone Beam Computed Tomography Analysis

The aim of this study was to evaluate whether the amount of fracture displacement affects postoperative stability of isolated zygomaticomaxillary complex fractures and to determine whether the 1-point fixation method is as stable as 2- or 3-point fixation methods. The authors investigated 14 patients with 1-point fixation in the zygomaticomaxillary area (group A), 14 patients with 2-point fixation in the zygomaticomaxillary and frontozygomatic area (group B), and 13 patients with 3-point fixation in the zygomaticomaxillary, frontozygomatic, and infraorbital rim area (group C). Stability of the reduced zygomaticomaxillary complex was assessed by comparing immediate postoperative cone beam computed tomography images with those obtained at least 3 months later. Preoperatively, the total mean displacement was 3.79 ± 1.36 mm in group A, 3.43 ± 0.89 mm in group B, and 3.86 ± 1.57 mm in group C. The total postoperative orbital and screw changes were 0.91 ± 0.18 and 0.72 ± 0.08 mm, respectively, in group A; 0.92 ± 0.19 and 0.68 ± 0.09 mm, respectively, in group B; and 0.91 ± 0.11 and 0.66 ± 0.10 mm, respectively, in group C. There were no significant relationships between postoperative stability and amount of fracture displacement in any of the 3 groups, or between the 3 groups (P > 0.05). There was little difference in postoperative stability between the 3 groups. Hence, the amount of displacement is not a very important consideration when deciding the fixation method, including the number and location of miniplates applied for fixation. Address correspondence and reprint requests to Jang-Ho Son, DDS, PhD, Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea; E-mail: ribosome@hanmail.net Received 1 May, 2017 Accepted 5 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Outcome After Less “Rigid” Fixation in Open Cranial Vault Remodeling for Craniosynostosis

Open cranial vault remodeling techniques require rigid fixation with hardware such as plates and screws; however, complications can occur. The purpose of this study was to assess the surgical outcome after open reconstruction for craniosynostosis with less rigid fixation using nonabsorbable suture. Methods: Retrospective review of patients who underwent open craniofacial reconstruction for craniosynostosis at the Hospital Kuala Lumpur between January 2011 and December 2016 were performed. Demographic data, surgical complications, and postoperative aesthetic outcomes and reoperations were evaluated using Whitaker classification. Statistical analyses were performed using SPSS. Results: Thirty-four (n = 34) cases were included in this review consisting of 16 males and 18 females (ratio 1:1.25). Sixteen patients were syndromic with multiple suture synostoses: Apert syndrome (n = 8), Crouzon syndrome (n = 6), and Muenke's syndrome (n = 2). Eighteen patients were nonsyndromic: isolated single-suture craniosynostosis (n = 12) and multiple suture involvement (n = 6). Mean age of presentation was 17.4 months (4–16 months) with mean age of surgery of 23.8 months (6–68 months). Mean length of surgery was 6.1 hours (range 3–10 hours) and mean length of hospital stay was 10 days (mean 7–20 days). Mean duration of follow-up was 2.2 years (6 month–4 years). There were a total of 9 complications postoperatively: massive blood loss (n = 4), seroma (n = 2), exposure keratitis (n = 1), hand extravasation (n = 1), and occipital sore (n = 1). Analysis showed multiple suture craniosynostoses were associated with longer operative times (4.3 hours vs 6.5 hours, P = 0.0082 24 months of age, P = 0.00059). Patients were categorized as 88.2% (n = 30) Whitaker I and II and 11.8% (n = 4) Whitaker III and IV. Reoperation rates were 2.9% (n = 1). Whitaker III and IV class were higher among patients with syndromic synostosis, unicoronal and multiple suture synostoses. Conclusions: Our technique of open cranial reconstruction with nonabsorbable suture nylon 2/0 as sole method of fixation has resulted in good aesthetic outcome with low reoperations and complications rate. Longer follow-up is needed to ascertain our long-term results. Address correspondence and reprint requests to Khai Luen Koh, MRCS, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia; E-mail: kkhailuen@hotmail.com Received 29 April, 2017 Accepted 1 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Facial Fracture-Associated Blindness

Introduction: Yet uncommon, blindness is a potential associated injury of facial fractures. Methods: Epidemiology, mechanisms, fracture types, and outcome of facial fractures-associated blindness in a 10-year period are retrospectively reviewed. Results: Out of 907 facial fractures patients, 10 had blindness, giving a frequency of 1.1%. There were 9 men and 1 woman whom age range was 6 to 59 years (mean: 31.2 years). Intentional injury patients were significantly the most at risk of blindness (P = 0.02). In all the patients, the fracture involved at least 1 of the orbit walls. Risk of blindness was significantly higher in naso-fronto-orbito-ethmoidal complex fractures (P = 0.03). The vision loss was recorded in 13 eyes (unilateral in 7 patients and bilateral in 3). Its predominant mechanism was a globe rupture or perforation, recorded in 8 eyes. A treatment with intention to improve the vision was attempted in 1 patient only. None of the patients had vision recovery. Discussion: The findings of this study commend comprehensive ophthalmologic evaluation in any patient with an orbit wall fracture. Address correspondence and reprint requests to Rasmané Béogo, MD, Department of Stomatology and Maxillofacial Surgery, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso 01, Burkina Faso; E-mail: rbeogo@yahoo.fr Received 10 February, 2017 Accepted 4 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Power-Assisted Particulate Bone Grafting Effectively Prevents Osseous Defects After Cranial Vault Reconstruction

Background: Cranial vault reconstruction (CVR) is the gold standard in the operative treatment of craniosynostosis. Full thickness osseous defects (FTOD) of the calvaria have been observed in 5% to 15% patients after CVR, with higher rates cited in the fronto-orbital advancement (FOA) subset. Particulate bone graft (PBG) harvested manually has been shown to decrease FTOD after FOA from 24% to 5.5%. The authors used a modified technique using a powered craniotome, with the hypothesis that the technique would also improve outcomes. Methods: A retrospective review was performed of patients who underwent CVR for craniosynostosis between 2004 and 2014. Patient demographics, diagnosis, age, operative details, and postoperative care were reviewed in detail. Categorical, nonparametric variables were compared by Fisher exact tests. Results: A total of 135 patients met inclusion criteria. The most common diagnoses were metopic (n = 41), sagittal (n = 33), and unilateral coronal craniosynostosis (n = 31); 65% (n = 88) underwent FOA, 29% (n = 39) underwent single-stage total vault reconstruction, and 6% (n = 8) had a posterior vault reconstruction. CVR was performed without PBG in 95 patients and with PBG in 40 patients. Without PBG, FTOD were discovered on clinical examination in 18% of patients (n=17): 11 presented with subcentimeter defects, while 6 had larger defects requiring revision cranioplasty (6% operative revision rate). Among those receiving PBG, 1 patient presented a subcentimeter FTOD (2.5% FTOD incidence and 0% operative revision rate). Conclusion: Particulate bone graft harvested with a powered device decreases the rate of FTOD and reoperation rate after CVR for craniosynostosis. Address correspondence and reprint requests to Jeffrey R. Marcus, MD, Duke Cleft and Craniofacial Center, Chief, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, DUMC 3974, Room 110, Baker House 200 Trent Drive, Durham, NC 27710; E-mail jeffrey.marcus@duke.edu Received 29 January, 2017 Accepted 19 September, 2017 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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An Unusual Complication of Bone Wax Utilization

Bone wax is a commonly used hemostatic agent with minimal complications. Some of the known complications include inflammation, granuloma formation, infection, and impaired osteogenesis. Several clinical reports of bone wax migration have also been reported. In this paper, the authors present a rare patient of bone wax migration intracranially in a 6-year-old patient who initially underwent craniotomy for the evacuation of subdural hematoma and repair of depressed skull fracture. The patient then underwent craniotomy scalp scar revision several months later. Postoperatively he developed short-term memory loss, apraxia, and word finding difficulties. The imaging findings were consistent with the presence of a foreign body centered in the posterior aspect of the left middle temporal gyrus, which was surgically removed and found to be bone wax. The patient recovered well with complete improvement of his neurologic symptoms. Address correspondence and reprint requests to Artur Fahradyan, MD, Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd#96, Los Angeles, CA 90027; E-mail: afahradyan@chla.usc.edu Received 12 September, 2017 Accepted 16 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Hemangioma of the Hard Palate in an Elderly Patient as a Life-Threatening Surgical Emergency

Hemangiomas of the head and neck are common benign tumors usually in childhood. They are rarely seen in hard palate. The authors present a geriatric patient with abundant hemorrhage due to a capillary hemangioma of the hard palate. Management and treatment approaches of this rare, urgent, and life-threatening situation is discussed. Address correspondence and reprint requests to Sinan Uluyol, MD, Department of Otorhinolaryngology, Van Training and Research Hospital, Ipekyolu street, airport junction at 1st km, 65300, Edremit, Van, Turkey; E-mail: sinanuluyol@hotmail.com Received 30 August, 2017 Accepted 17 November, 2017 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Seasonal Variation of Epistaxis in Germany

Aim: The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016. Methods: The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month. A logistic regression model, adjusted for age and sex, was used to calculate the association between epistaxis diagnosis and the month. Results: The authors found a total of 15,523 patients with epistaxis in 114 ENT practices. Of these patients, 55.9% were men and the mean age was 47.8 ± 27.6 years. The highest number of epistaxis patients was found in February (14.89 patients per practice) and the lowest in August (7.22 patients per practice). The age- and sex-adjusted risk of epistaxis was significantly higher in the months of February (OR = 1.32), March (OR = 1.37), April (OR = 1.34), May (OR = 1.35), and December (OR = 1.33) compared with August. Conclusions: The presentation of patients with epistaxis at German ENT practices shows a marked seasonal variation with a low in the summer, an increase in fall and winter, and a peak in February, March, and April. Address correspondence and reprint requests to Karel Kostev, PhD, Department of Epidemiology, QuintilesIMS, Darmstädter Landstraße 108, 60598 Frankfurt am Main, Germany; E-mail: kkostev@de.imshealth.com Received 16 August, 2017 Accepted 4 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It?

Maxillo-mandibular reconstruction in pediatric patients involves particular functional and cosmetic implications. Attention is required for the craniofacial growth over time, involvement of the permanent dentition, facial symmetry, and donor site morbidity. Our aim is to identify the best reconstructive options for maxilla-mandibular defects in children (

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Location of the Septoaponeurosis Junction Relative to the Tarsal Plate in Upper Eyelids

The aim of this study was to measure the location of the septoaponeurosis junction relative to the tarsal plate in the upper eyelids of Koreans through a histologic study. Thirty-four upper eyelids from 34 Korean adult cadavers (mean age, 77.8 years) were used. Sagittal sections on the midpupillary line were made, and 10-μm-thick sections were prepared and stained with hematoxylin-eosin and Masson trichrome. Under a magnifying loupe with a scale, the height of the tarsal plate (HTP), thickness of the tarsal plate (TTP), distance from the lid margin to the septoaponeurosis junction (MJD), and distance from the upper border of the tarsal plate to the septoaponeurosis junction (TJD) were measured. The mean HTP was 8.09 ± 1.68 mm (range: 4.0–0.8 mm). The mean TTP was 1.52 ± 1.56 mm (range: 0.8–3.0 mm). The mean MJD was 9.18 ± 2.69 mm (range: 2.5–13.0 mm). The mean TJD was 1.1 ± 2.6 mm (range: −5.5–7.0 mm). In 25 (73.5%) of the 34 eyelids, the SAJ (1.1 ± 2.6 mm) was above the upper border of the tarsal plate (UTP); however, in 9 (26.5%) of the 34 eyelids, below the UTP. The greater the HTP, the greater the MJD was (y=0.620x+4.166, P = 0.024 [linear regression analysis]). However, there was no significant correlation between the HTP and TJD (P = 0.155 [correlation analysis]). The results of this study provide a useful guide for performing operations involving the orbital septum and levator aponeurosis. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea; E-mail: jokerhg@inha.ac.kr; and Dae Joong Kim, PhD. Department of Anatomy, Inha University School of Medicine, Incheon, Korea; E-mail: djkim@inha.ac.kr Received 5 July, 2017 Accepted 1 December, 2017 This study was supported by a grant from Inha University (Inha Research Grant). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl

Urethral caruncle (UC) is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

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Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma

The laryngeal framework provides a natural barrier preventing tumour spread to extralaryngeal structures. Transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (SCC) may violate these bounda...

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Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery

Abstract

Objective

We aimed to design, build and validate a surgical navigation system which fulfills the accuracy requirements for surgical procedures on the ear and the lateral skull base, and which integrates with the endoscopic workflow and operating room setup.

Materials and Methods

The navigation system consists of portable tablet computer (iPad Pro, Apple Computer, USA) and an optical tracking system (Cambar B1, Axios3D, Germany), both connected via a wireless Bluetooth link and attached directly to the OR table. Active optical tracking references are rigidly fixed to both the patient and surgical tools. Software to support image import, registration and 2D/3D visualization has been developed. Two models were used for targeting accuracy assessment: a technical phantom model and an ex vivo temporal bone model. Additionally, workflow integration and usability of the navigation system during endoscopic lateral skull base procedures was investigated in ex vivo experiments on 12 sides of cadaver head specimens.

Results

The accuracy experiments revealed a target registration error in the technical phantom model of 0.20 ± 0.10 mm (n = 36) and during the ex vivo assessment of 0.28 ± 0.10 mm (n = 21). Navigation was successfully carried out in n = 36 procedures (infracochlear, suprageniculate and transpromontorial approach), with navigated instruments usable without interference with the endoscope. The system aided in the successful and accurate identification of vital anatomical structures.

Conclusions

Useful surgical navigation is, to a large extent, a result of sufficiently accurate tracking technology. We have demonstrated sufficient accuracy and a potentially suitable integration for surgical application within endoscopic lateral skull base procedures.

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