Social Factors in the Development of Chronic Rhinosinusitis: a Systematic Review

Abstract

Purpose of Review

In an era where prevention is paramount, understanding social factors for chronic rhinosinusitis (CRS) may facilitate preventive interventions that mitigate risk factors associated with the initiation or progression of the disease.

Recent Findings

Both passive and active smoking are clearly and unequivocally associated with both the incidence and the severity of rhinosinusitis, while there an increasing body of evidence linking social deprivation and low socioeconomic status with rhinosinusitis and its complications. However, overall, only a handful of studies were longitudinal, while the available studies suffer from lack of standardized definitions of rhinosinusitis.

Summary

In this systematic review, we assessed the available evidence linking CRS with social factors, such as socioeconomic status and class, educational status, family status, living and working location and conditions, and use of toxins or recreational drugs as well as exercise and diet. Thirty studies from 1995 onwards fulfilled our inclusion criteria and were used for this review. Social deprivation and low socioeconomic level seem to be directly associated with rhinosinusitis, as there are pollutants in living or working environment. A clear and direct association between smoking (both active and passive) and rhinosinusitis was also shown. However, the link between rhinosinusitis and education level, and exercise and diet, if any, seems to be more complex.

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Systematic Reviews and Meta-analysis in Rhinosinusitis: a Critical Review of the Reviews

Abstract

Purpose of Review

There has been an explosion in the number of published systematic reviews on chronic rhinosinusitis in the last decade.

Recent Findings

While the aim of these reviews in facilitating evidence-based practice is laudable, poor quality reviews may contain significant bias that can mislead a non-discerning reader.

Summary

Attention therefore must be given to review methodology before implanting findings. Organisations such as the Cochrane Collaboration promote high-quality reviews, but are limited in chronic sinus disease by heterogeneous outcomes and a paucity of randomised trials.

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Neurotrophins in Asthma

Abstract

Purpose of Review

Asthma is a chronic airway disease that affects more than 300 million people worldwide. Current treatment focuses on symptomatic relief by temporally dampening inflammation and relaxing the airway. Novel combative strategies against asthma and hopefully a cure are yet to be developed. The goal of this review is to summarize recent literature on neurotrophins (NTs) in experimental models and clinical settings of asthma research.

Recent Findings

We highlight studies of early phases of asthma that collectively reveal a profound impact of elevated NT levels following initial detrimental insults on long-term airway dysfunction.

Summary

We hope this review will foster insights into the complex interaction between NTs, nerves, immune cells, and airway structural cells during a critical time window of development and disease susceptibility. Future studies are required to better understand the role of NTs in asthma pathophysiology and to evaluate whether NTs and their receptors may serve as new drug targets.

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Modified Allergens for Immunotherapy

Abstract

Purpose of Review

During the past few decades, modified allergens have been developed for use in allergen-specific immunotherapy (AIT) with the aim to improve efficacy and reduce adverse effects. This review aims to provide an overview of the different types of modified allergens, their mechanism of action and their potential for improving AIT.

Recent Findings

In-depth research in the field of allergen modifications as well as the advance of recombinant DNA technology have paved the way for improved diagnosis and research on human allergic diseases. A wide range of structurally modified allergens has been generated including allergen peptides, chemically altered allergoids, adjuvant-coupled allergens, and nanoparticle-based allergy vaccines. These modified allergens show promise for the development of AIT regimens with improved safety and long-term efficacy. Certain modifications ensure reduced IgE reactivity and retained T cell reactivity, which facilities induction of immune tolerance to the allergen. To date, multiple clinical trials have been performed using modified allergens. Promising results were obtained for the modified cat, grass and birch pollen, and house dust mite allergens.

Summary

The use of modified allergens holds promise for improving AIT efficacy and safety. There is however a need for larger clinical studies to reliably assess the added benefit for the patient of using modified allergens for AIT.

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Occupational Animal Allergy

Abstract

Purpose of Review

This review explores animal allergen exposure in research laboratories and other work settings, focusing on causes and prevention.

Recent Findings

(1) Consistent with the hygiene hypothesis, there is new evidence that early childhood exposure to pets produces changes in the gut microbiome that likely lead to a lower risk of allergy. (2) Anaphylaxis from laboratory animal bites occurs more frequently than suggested by prior literature. (3) Animal allergens represent an occupational hazard in a wide variety of work settings ranging from fields that work with animals to public settings like schools and public transportation where allergens are brought into or are present in the workplace.

Summary

Exposure to animal allergens can result in allergy, asthma, and anaphylaxis. Animal allergy has been most studied in the research laboratory setting, where exposure reduction can prevent the development of allergy. Similar prevention approaches need to be considered for other animal work environments and in all settings where animal allergens are present.

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Optimizing the induction chemotherapy regimen for patients with locoregionally advanced nasopharyngeal Carcinoma: A big-data intelligence platform-based analysis

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Hao Peng, Ling-Long Tang, Bin-Bin Chen, Lei Chen, Wen-Fei Li, Yan-Ping Mao, Xu Liu, Yuan Zhang, Li-Zhi Liu, Li Tian, Ying Guo, Ying Sun, Jun Ma
ObjectivesThis study aimed at identifying the optimal induction chemotherapy regimen for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy.Materials and methodsWe identified eligible patients with newly-diagnosed stage III-IVA NPC (excluding T3N0) between September 2009 and May 2015. Survival outcomes and grade 3–4 toxicities were compared between different IC regimen groups.ResultsIn total, 3738 patients were eligible for this study, with 1572 (42.1%), 1085 (29.0%) and 1081 (28.9%) receiving TPF, PF and TP, respectively. In the whole population, multivariate analysis found that TPF seems to be better than PF and TP. Howerver, subgroup analysis revealed TPF and TP had same effectiveness in patients receiving a cumulative cisplatin dose (CCD) ≥200mg/m² in concurrent chemotherapy, while TPF shows relatively better survival benefit in patients receiving CCD<200mg/m². Grade 3–4 toxicities were similar between TPF and TP groups, but were relatively higher than that in PF group.ConclusionsOur study concluded that induction TP regimen may be enough for patients receiving a CCD≥200mg/m², while TPF may be superior to TP and PF for patients receiving a CCD<200mg/m², although grade 3–4 toxic events were more common but tolerable. Further studies are needed to validate our findings.



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Aquagenic pruritus successfully treated with omalizumab

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Association of clinicopathological features of melanoma with total naevus count and a history of dysplastic naevi: a cross-sectional retrospective study within an academic centre

Summary

Background

High naevus count (HNC) (≥ 50 naevi) and presence of dysplastic naevi (DN) are risk factors for malignant melanoma (MM); however, MMs also occur in patients with low naevus count (LNC) (< 50 naevi) and in patients without DN. Little is known about differences between MMs in these groups.

Aim

To characterize the clinicopathological differences between MMs in patients with HNC and those in patients with LNC, with or without biopsy-proven DN.

Methods

This was a cross-sectional retrospective chart review of 281 patients with MM seen between April 2013 and March 2014 at an academic pigmented lesion clinic (Boston, MA, USA).

Results

Patients with LNC MMs were diagnosed at an older age (51 vs. 41 years, P < 0.001, OR = 0.95, 95% CI 0.93–0.97), with more aggressive MM features, including greater Breslow thickness (1.1 vs. 0.8 mm, P = 0.01), more mitoses (2 vs. 1 mitoses/mm², P < 0.001), lower rate of superficial spreading subtype (58 vs. 78%, P < 0.01, OR = 2.57, 95% CI 1.31–5.03) and higher MM stage (P < 0.001), compared to patients with HNC. Patients with DN had similar trends as those in patients with HNC described above, and in addition, were more likely to have a truncal MM (55 vs. 39%, P < 0.01, OR = 1.97, 95% CI 1.22–3.18) with less ulceration (13 vs. 29%, P < 0.01, OR = 0.36, 95% CI 0.19–0.71). Patients without DN were more likely to have a history of a non-MM skin cancer (32 vs. 19%, P = 0.01, OR = 0.49, 95% CI 0.28–0.85) and an amelanotic MM (33 vs 21%, P = 0.03, OR = 0.55, 95% CI 0.31–0.96).

Conclusions

Patients with LNC may develop MMs with more aggressive features at an older age than patients with HNC. A history of biopsy-proven DN reveals distinct MM differences compared to patients without DN.

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Preoperative Clinical and Sonographic Predictors for Lateral Cervical Lymph Node Metastases in Sporadic Medullary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Diagnostik von AVWS bei Erstklässlern: Welche Tests trennen auffällige von unauffälligen Kindern?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-101836

Hintergrund Im kontrollierten Gruppenvergleich wurde für 2., 3. und 4.-Klässler gezeigt, dass eine Trennung von Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) von solchen ohne (Non-AVWS) durch 3 bzw. 4 Untersuchungsinstrumente möglich ist mit einer Zuordnungsrichtigkeit von 93,6 % bzw. 97,5 % 1, 2. Die vorliegende Studie erfolgte mit der Fragestellung, ob auch für Erstklässler eine Trennung der Gruppen gelingt. Material und Methoden Leistungen von 77 Kindern (n = 40 mit AVWS, mittl. Alter: 6,93, SD 0,53 Jahre; n = 37 Non-AVWS, mittl. Alter: 6,90, SD 0,52 Jahre) im 1. Regelgrundschuljahr wurden in 8 spezifisch auditiven Tests einer eklektischen AVWS-Testbatterie miteinander verglichen: Uttenweiler-Test zum Dichotischen Wortverstehen; Subtests Lautdifferenzierung u. Kinästhetik (Heidelberger Lautdifferenzierungstest- HLAD); Göttinger Sprachaudiometrie II im Störgeräusch; Hannoverscher Binauraler Summationstest; Zahlenfolgen-Gedächtnis u. Laute Verbinden (Psycholinguistischer Entwicklungstest); Mottier-Test. Ergebnisse Kinder mit AVWS wurden von unauffälligen Kindern (Non-AVWS) der gleichen Schuljahrgangsstufe in 94,8 % aller Fälle (kreuzvalidiert: in 92,2 %) statistisch signifikant durch vier Testvariablen getrennt: (1) PET-Zahlenfolgen-Gedächtnis; (2) HLAD-Lautdifferenzierung; (3) Mottier-Test; (4) Sprachaudiometrie im Störgeräusch. Schlussfolgerungen Die Qualität der diagnostischen A-Priori-Gruppierung mittels einer multivariaten Statistik konnte für das 1. Regelgrundschuljahr bestätigt werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The Effect of Unfocused Extracorporeal Shock Wave Therapy on Bone Defect Healing in Diabetics

Aim: The purpose of this study was to evaluate the effect of the unfocused extracorporeal shock wave therapy (ESWT) on healing of mandible ramus defects in diabetic rats. Material and method: Forty male Wistar albino rats were used in the experiment. All animals were randomly divided into 2 main groups, nondiabetic and diabetic. Critical-sized defects were created on ramus in all rats. ESWT was performed to half of rats in each group at 3 sessions after surgery. Animals were euthanized at either fourth or eighth week. Stereological and radiologic examination was performed. Data were statistically analyzed by one-way variance analysis and Tukey post-hoc test. Results: Hounsfield Unit (HU) values were higher in D−E+ group than D−E− group in both 8-week and 4-week groups (P > 0.05). In both 4-week and 8-week diabetic groups, higher value was observed when compared with nondiabetic groups (P > 0.05). According to stereological results, in 4-week groups, there was a higher NB, CT, and NV volume in D−E− group than D−E+ group and in D+E− group than D+E+ group. These results are similar for the 8-week groups except NV volume. Conclusion: It was found that ESWT application has no positive effect on the healing of critical-sized bone defects in nondiabetics whereas promising effects in diabetics were observed. Address correspondence and reprint requests to Enes Özkan, DDs, PhD, Bafra Oral and Dental Health Hospital, 55400, Samsun, Turkey; E-mail: drenesozkan@gmail.com Received 28 April, 2017 Accepted 10 November, 2017 This experimental study was supported by Project Management Office Coordinatorship of Ondokuz Mayis University with PYO.DIS.1904.12.006 project code. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Alternatives to Autologous Bone Graft in Alveolar Cleft Reconstruction: The State of Alveolar Tissue Engineering

Alveolar cleft reconstruction has historically relied on autologous iliac crest bone grafting (ICBG), but donor site morbidity, pain, and prolonged hospitalization have prompted the search for bone graft substitutes. The authors evaluated bone graft substitutes with the highest levels of evidence, and highlight the products that show promise in alveolar cleft repair and in maxillary augmentation. This comprehensive review guides the craniofacial surgeon toward safe and informed utilization of biomaterials in the alveolar cleft. A literature search was performed to identify in vitro human studies that fulfilled the following criteria: Level I or Level II of evidence, ≥30 subjects, and a direct comparison between a autologous bone graft and a bone graft substitute. A second literature search was performed that captured all studies, regardless of level of evidence, which evaluated bone graft substitutes for alveolar cleft repair or alveolar augmentation for dental implants. Adverse events for each of these products were tabulated as well. Sixteen studies featuring 6 bone graft substitutes: hydroxyapatite, demineralized bone matrix (DBM), β-tricalcium phosphate (TCP), calcium phosphate, recombinant human bone morphogenic protein-2 (rhBMP-2), and rhBMP7 fit the inclusion criteria for the first search. Through our second search, the authors found that DBM, TCP, rhBMP-2, and rhBMP7 have been studied most extensively in the alveolar cleft literature, though frequently in studies using less rigorous methodology (Level III evidence or below). rhBMP-2 was the best studied and showed comparable efficacy to ICBG in terms of volume of bone regeneration, bone density, and capacity to accommodate tooth eruption within the graft site. Pricing for products ranged from $290 to $3110 per 5 mL. The balance between innovation and safety is a complex process requiring constant vigilance and evaluation. Here, the authors profile several bone graft substitutes that demonstrate the most promise in alveolar cleft reconstruction. Address correspondence and reprint requests to Fan Liang, MD, Division of Plastic Surgery, Keck School of Medicine of USC, 1510 San Pablo Street, Suite 415 Los Angeles, CA 90033; E-mail: fan.liang@med.usc.edu Received 16 January, 2017 Accepted 10 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Long-Term Skeletal Changes After Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip/Palate

Purpose: To systematically evaluate the skeletal changes after maxillary distraction osteogenesis (DO) in growing patients with cleft lip with or without cleft palate (CL/P). Materials and methods: Electronic databases, gray literature, and reference list searches were conducted. Articles reporting prospective and retrospective studies that included patients 1 year were reviewed. The original articles were evaluated by 2 investigators to ensure that they met the selection criteria. A methodologic quality assessment tool was used to evaluate the quality of selected studies. Twenty-six studies met the initial search criteria, and 9 articles included 101 growing patients with maxillary hypoplasia due to CL/P who received DO surgery were finally selected and analyzed. Results: The results showed that long term after maxillary advancement with DO, the horizontal relapse in A-point was 40% in 1 study. Totally, the range of horizontal relapse in A-point was 11.9% to 45.9%. Similarly, the relapse in SNA angle was 40% in 2 studies. Totally, the range of relapse in SNA was 25.7% to 77%. Two studies showed that the vertical relapse in A-point were 137% and 208%, and in the PNS point were 65% and 62.7%. Conclusion: Although findings demonstrated that DO is an effective treatment method for severe maxillary hypoplasia in growing patients with CL/P, there is a relatively high amount of skeletal relapse both in horizontal and vertical dimension. Thus, the first proposed alternative for CL/P patients would be to select the correct primary procedure to decrease damage and avoid unnecessary scars. Then appropriate preoperative and postoperative care is necessary to prevent postoperative relapse. In addition, overcorrection also may be a possible alternative for compensation of postoperative relapse. Address correspondence and reprint requests to Nuo Zhou, MD, Department of Oral and Maxillofacial Surgery, College of Stomatology, GuangXi Medical University, 10 Shuangyong Road, Nanning 530021, Guangxi, China; E-mail: Briannuo@hotmail.com Received 4 August, 2017 Accepted 10 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Natural History of Cranial Morphology in Sagittal Craniosynostosis

Background: Children with craniosynostosis have abnormal head shapes. Parents frequently ask whether the abnormal head shape will get worse with time. However, there is no information in the literature to indicate whether the deformity gets worse. Objective: To assess the progression of cranial morphology in children with unoperated craniosynostosis. Methods: A retrospective review of all children with unoperated sagittal craniosynostosis who were referred to the Craniofacial Clinic at the Hospital for Sick Children (SickKids) was conducted. Serial 3D photographs of patients with sagittal craniosynostosis who have not undergone surgical correction were included in the study. There were 14 cases included, with 9 males and 5 females. Ages at time of scans ranged from 3 months to 5 years of age (mean = 28.3 months, SD = 28.2 months). Nine patients had the first scan at age of

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Safety Outcomes in Endoscopic Versus Open Repair of Metopic Craniosynostosis

Background: Premature fusion of the metopic suture leads to a range of clinical presentations, with more severe patients presenting characteristically with trigonocephaly. Endoscopic-assisted correction of craniosynostosis is emerging as an alternative to the gold-standard open cranial vault remodeling. While there are several documented benefits of endoscopic correction, the management of craniosynostosis varies widely in the literature with little consensus as to the preferred timing and surgical technique for repair. The purpose of this study was to investigate the safety outcomes of endoscopic versus open surgery at our institution. Methods: This retrospective cohort study included all patients diagnosed with metopic craniosynostosis who underwent open or closed surgical management and received at least 6 months of follow-up. Data extraction was performed via chart review and included demographic information and safety outcome variables. Results: During the study period, 17 patients who met our inclusion criteria were treated by the multidisciplinary craniofacial team at our institution. Eight patients underwent endoscopic surgery and 9 underwent open surgery. The mean age at surgery was significantly higher in the open surgery group than the endoscopic surgery group (13.7 months versus 2.3 months, respectively). Estimated blood loss, percent estimated blood volume lost, transfusion volume, procedure length, hospital length of stay, and intensive care unit (ICU) length of stay were all significantly higher in the open surgery group compared with the endoscopic group. Conclusions: In our patient population, endoscopic surgery for metopic craniosynostosis had an improved safety profile versus open surgery based on reduced procedure length, estimated blood loss, volume of blood transfusion, and length of stay in the ICU and hospital. Address correspondence and reprint requests to Dr Laura A. Monson, MD, Baylor College of Medicine, 6701 Fannin Street, Suite 610, Houston, TX 77030; E-mail: Laura.Monson@bcm.edu). Received 18 September, 2017 Accepted 10 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reevaluation of Mandibular Morphometry According to Age, Gender, and Side

Aim: This study aims to reevaluation the linear and angular measurements of mandibles with multidetector computed tomography (MDCT) that is a new method and used frequently in recent years. Materials and Methods: The archived MDCT images of 100 adult patients (age range, 15–74 years) without mandibular operation and trauma history were evaluated retrospectively. Mandibular ramus heights, maximal mandibular length, mandibular symphysis height, mandibular angles, and mandibular foramen distance measurements were performed on MDCT images. All measurement parameters were analyzed by gender, age groups, and sides. Results: Mandibular linear length measurements were higher in males than in females (P 

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Nasal Cavity Actinomycosis Mimicking Rhinolith

Actinomycosis is a subacute-to-chronic bacterial infection caused by filamentous, gram-positive, non-acid-fast, anaerobic-to-microaerophilic bacteria. It is characterized by continuous spread, suppurative and granulomatous inflammation, and formation of multiple abscesses and sinus tracts that may discharge sulfur granules. Although the most common clinical forms of actinomycosis are cervicofacial, involvement of the nose and paranasal sinuses are extremely rare. Furthermore, nasal cavity actinomycosis mimicking rhinolith has not been reported in the literature previously. This article reports a patient of nasal cavity actinomycosis causing symptoms similar to those of a rhinolith, which was successfully treated by surgical debridement and antibiotic therapy. Address correspondence and reprint requests to Kyu-Sup Cho, MD, PhD, Department of Otorhinolaryngology, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea; E-mail: choks@pusan.ac.kr Received 12 September, 2017 Accepted 18 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Facial Artery as a Recipient Vessel for Extensive Scalp Reconstruction With Free Omental Flap Without Vein Graft

Most patients with reconstruction for extensive scalp defects require the use of a free flap. The suitability of the recipient vessel has a major impact on the surgery and postoperative outcome. Flaps that can be used to reconstruct the total scalp with a single flap include the latissimus dorsi (LD) and omental flaps; the LD flap is generally preferred since the omental flap results in relatively larger donor site morbidity. The recipient vessel most commonly used for scalp defect reconstruction is the superficial temporal vessel. The authors report a patient with successful total scalp reconstruction using a free omental flap on a patient whose bilateral superficial temporal arteries could not be used and who did not have available LD on both sides due to previous LD free flap surgeries for recurrent scalp angiosarcoma. In this patient, direct anastomosis of the flap to the right facial artery was performed without pedicle lengthening, such as vein graft or arteriovenous loops, and favorable outcome was achieved in terms of facial contour after recovery. The free omental flap is useful for reconstruction of extensive scalp defects without additional complex surgical procedures when other flaps are not viable or when the recipient vessel is located at a far distance. Address correspondence and reprint requests to Han Koo Kim, MD, PhD, Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, 102, Heuksuk-Ro, Dongjak-Gu, Seoul 06973, Korea; E-mail: hkkiim@cau.ac.kr Received 10 October, 2017 Accepted 11 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Standard Operating Procedure of Clean and Fast Craniotomy Without Application of Raney Clips

Clean and fast craniotomy and closure (CAC) is a fundamental part of modern microneurosurgery, and is an essential technique that young neurosurgeons shall master. The hemostatic instruments of CAC have evolved from forceps to raney clips. Thanks to the wide application of bipolar coagulation, local infiltration anesthesia combined with cauterization is become an effective method of hemostasis. The authors worked out a standard operating procedure (SOP) of CAC assisted by fishhooks without the application of raney clips. According to the authors' experience, the average time spent on CAC decreased from more than 1 hour to

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Single Session Facial Lipostructure by Using Autologous Fat Mixed With Platelet-Rich Fibrin Injected by Using Facial Autologous Muscular Injection Technique

Aim: This study was designed to evaluate the role of single session autologous facial fat grafting in correcting facial asymmetries after mixing it with platelet-rich fibrin (PRF) and injecting them into rich vascular facial muscular plane. Materials and Methods: Fifteen patients (12 females and 3 males) with age ranging from 18 years to 40 years were included in this study and followed up during 6 months, all the patients were treated in the Al-Shaheed Ghazi Al-Hariri for specialized surgeries hospital (Medical City, Baghdad, Iraq). Autologous fat with PRF injected in facial muscular plane was the standardized method in the treatment of acquired and congenital facial defects. Results were evaluated by 2 plastic surgeons using visual analogue scale. Interexaminer and intraexaminer calibration of the visual analogue scale were carried out by using paired t test. Results: This prospective study showed that the majority of patients (73.3%) needed only a single session for creating a noticeable improvement in facial volumes and contours. Conclusions: Mixing fat with PRF and injecting them by using facial autologous muscular injection technique offers better graft survival by utilizing the growth factors and cytokines in PRF clot together with rich vascular plexus in the muscular layer consequently. Address correspondence and reprint requests to Ahmed Fadhil Al-Quisi, BDS, FIBMS, Lecturer in Oral and Maxilloficial Department, Collage of Dentisty, Baghdad University, Baghdad, Alshaab, 0964, Iraq; E-mail: ahmedquisi@gmail.com Received 27 November, 2016 Accepted 11 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Crushed Cartilage: A Rescue Procedure in Rhinoplasty

While the use of crushed cartilage is now universally recognized as a valid procedure in rhinoplasty to mask irregularities and eliminate slight deficits, there is still no consensus as to the optimal degree of crushing and the rate of graft resorption over time. With a view to casting light on these 2 important aspects and providing some guidelines, the authors present a study of 123 patients subjected to grafts of cartilage with different degrees of crushing in the different areas of the nasal pyramid: upper third (45 patients), middle third (40), and lower third (38). The degree of crushing was medium for 95 patients and high for 28 who presented thinner and less elastic skin. Comparison of the performance over time of the cartilage grafts inserted in the same areas but with different degrees of crushing provides important indications as regard the best way of preparing the material. The results proved satisfactory with improvements for all of the 95 patients subjected to grafts of moderately crushed cartilage. The initial defect was instead still present, albeit with some partial improvement, at a distance of 12 months in 17 of the 28 patients where highly crushed cartilage was used. The study suggests that a moderate degree of crushing offers better results as regard flexibility and stability over time. Address correspondence and reprint requests to Tito M. Marianetti, MD, Viale delle Provincie 55/18, 00162 Rome, Italy; E-mail: titomatteo.marianetti@tin.it Received 3 May, 2017 Accepted 26 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Parotid Mucoepidermoid Carcinoma Mimicking a Large Mucocele

Mucoepidermoid carcinoma is a malign tumor involving the parotid gland and minor salivary glands. Parotid pure cystic mucoepidermoid carcinoma can also masquerade mucocele, and hence, histopathological examination is crucial to distinguish the 2. Herein, the authors report a patient of mucoepidermoid carcinoma presenting as an asymptomatic mucocele-like cystic parotid mass. A 69-year-old female presented with cystic parotid mass; her examination findings and diagnostic imaging were consistent with that of mucocele. Histological examination revealed mucoepidermoid carcinoma. This case indicates that parotid mucocele-like cysts should be included in the differential diagnosis of malign salivary gland tumors. Address correspondence and reprint requests to Nurdoğan Ata, MD, Department of Otorhinolaryngology, Gaziantep 25 Aralik State Hospital, Sarigüllük Mah. Fevziçakmak bulvari PK: 27060 Şehitkamil, Gaziantep, Turkey; E-mail: nurdoganata@mynet.com Received 5 October, 2017 Accepted 24 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Modified Unilateral Pedicled V-Y Advancement Flap for Scalp Defect Repair

Reconstruction of scalp defects caused by tumor resection or trauma is very challenging. A majority of the surgeons prefer to use local flap rather than skin graft or free flap for scalp defects repair. The aim of this study is to investigate the technique of modified unilateral pedicled V-Y advancement flap for the reconstruction of scalp defect. A retrospective review was performed in a series of 18 patients who had a modified unilateral pedicled V-Y advancement flap to restore scalp defect from May 2013 to January 2017. Their mean age is 58 (24–78) years. These patients suffered from basal cell carcinoma, seborrhoeic keratosis, squamous cell carcinoma, or trauma on the scalp. All of them underwent preoperative Doppler scanning to identify the scalp arteries and then individually designed. The flap size ranged from 33 × 50 mm to 68 × 105 mm. Patients were followed for an average of 12 months postoperatively (ranged from 6 to 37 months). No major complications occurred, only 2 cases had a minor distal epidermal necrosis or obstruction of venous backflow observed for the first 3 days of the surgery, and they both healed well. Modified unilateral pedicled V-Y flap technique with fairly rapid recovery and acceptable reorientation of hair follicles leads to esthetical outcome and patient satisfaction. Most importantly, no tumor recurrence at the original site during the follow-up period was seen. The modified unilateral pedicled V-Y advancement flap is a simple but efficient technique, particularly suitable for the repair of small and medium size scalp defects with advantages including the safety of the procedure and overall esthetic results like hairline preservation and less scarring when compared to other local flap techniques. Address correspondence and reprint requests to Hua Shen, MD and Zhengdong Cai, MD, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Haining Road, Hongkou District, Shanghai 200080, People's Republic of China; E-mails: samwells@sina.com; caizdvip@163.com Received 20 October, 2017 Accepted 24 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Total Lower Lip Reconstruction With Functional Gracilis Free Muscle Flap

Free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss. Therefore, dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested. In this study, we present a case of a successful total lower lip repair with this flap. In a 78-year-old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip, bilateral modified radical neck dissection and full-thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side. After microvascular anastomoses, the motor nerve of the flap was coapted to the marginal mandibular branch of the fascial nerve. The entire intra- and extraoral surfaces of the flap were covered with a partial-thickness skin graft which was taken from the right thigh. There was no any intra- or early postoperative complication. The skin graft and flap survived without any problem. In the controls of the patient who was followed-up for 8 postoperative months, it was observed that the gracilis muscle flap was well-adapted to its place, gained a very good tonus, its volume reduced over time and reached to ideal dimensions, and the overlying skin graft provided a good color and texture match with the surrounding tissues. The motor activity of the muscle was monitored with the Tinel's test. The speech and facial expressions of the patient were very clear. Despite the patient has an edentulous mandible and was not using prosthesis, her feeding with fluid and solid foods was free of problems, oral competence was highly sufficient, and there was no any drooling. Esthetic appearance was very good and intraoral vestibular depth was sufficient. The mouth opening was 3 cm. When comparing with upper orbicularis oculi muscle on the electroneuromyography (ENMG) ordered at the 8th month, a similar nerve conduction time (3.3 versus 3.8 ms) and contraction amplitude (0.5 versus 0.4 mV) values were obtained from the gracilis muscle. Follow-up of the patient is still continued with no tumor recurrence observed during this period. Being the real dynamic flap and its tonus of the functional gracillis free muscle flap in opposite to the static methods provides a significant superiority over the other options in terms of oral functions; moreover, the overlying skin graft presents a very good color and texture harmony aesthetically. This method is a candidate to be an exclusive surgical technique in the repair of total or close to total lip losses in the future. Address correspondence and reprint requests to Dr Mehmet Akif Cakmak, MD, Ataturk Universitesi Tip Fakultesi, Yakutiye Arastirma Hastanesi, Plastik Rekonstruktif ve Estetik Cerrahi A.D., 25240 Erzurum, Turkey; E-mail: makifcakmak@gmail.com Received 20 October, 2017 Accepted 26 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2o7HNCI

Hemodynamic Assessment with SPY-Indocyanine Green Angiography in Expansion Period: A Study for Expansion Capsule Pressure Optimization

Tissue expansion-related severe complication exists, and the poor blood supply is one of the causes. After decades of negative correlation between capsule pressure and blood flow was verified, the widely recognized expansion capsule pressure is still absent. A prospective randomized controlled trial was performed to explore the optimal expanding capsule pressure. Thirty subjects were randomly divided into 5 groups, received a weekly expanding on 60-, 70-, 80-, 90-, and 100-mm Hg capsule pressure, respectively. All patients achieved 8-week follow-up; hemodynamic assessment by SPY-indocyanine green (ICG) angiography was taken every 2 weeks. Standardized indexes from SPY-ICG angiography were used to assess the blood supply, in which the ratio of ingress rate and the ingress rate of normal skin (IR/NIR) reflects the arterial perfusion level, and the ratio of Engress Rate and IR (ER/IR) indicates the venous reflux level. The expansion-related adverse events during the trial were recorded. The IR/NIR and the ER/IR are both obviously negatively correlated to the capsule pressure of tissue expander (P ≤ 0.05, the ER/IR's correlation coefficient = −0.453; the IR/NIR's correlation coefficient = −0.482). The post-expansion IR/NIR increased significantly after 8 weeks of expansion (P ≤ 0.05) in 90-mm Hg group. And the post-expansion ER/IR was significantly elevated (P ≤ 0.05) in 80 and 90-mmHg groups. There were 2 expansion-related complications reported in 100-mm Hg group, whereas no complication occurred in 4 other lower groups. SPY-ICG angiography is an objective measurement for tissue expansion hemodynamic monitoring. The expanding capsule pressure of 80 to 90 mm Hg is a reasonable upper limit. Address correspondence and reprint requests to Tao Zan, MD, PhD, Department of Plastic and Reconstructive Surgery, the Ninth Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China; E-mail: zantaodoctor@yahoo.com; zantaodoctor@gmail.com; QingFeng Li, MD, PhD, Department of Plastic and Reconstructive Surgery, the Ninth Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China; E-mail: dr.liqingfeng@shsmu.edu.cn; dr.liqingfeng@yahoo.cn Received 2 June, 2017 Accepted 29 October, 2017 Q.L. and T.Z. contributed equally to the article, and Q.L. should be considered as the co-correspondent author. This work was supported by grants from the National Natural Science Foundation of China (81471857), Shanghai Pujiang Program (15PJD022). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2o3Sffv

Transcriptional and epigenetic regulation of innate-like T lymphocyte development

Mihalis Verykokakis | Barbara L Kee

http://ift.tt/2Hh1Sz8

Chemical sensing in development and function of intestinal lymphocytes

Luisa Cervantes-Barragan | Marco Colonna

http://ift.tt/2GgcHjF

Dysphagia and Pharyngeal Obstruction in a Nonsmoker

A man in his 60s presented with a 6-month history of dysphagia and a 3-month history of a 5-pound weight loss and a right neck mass; physical examination, including flexible nasolaryngoscopy, was notable for a large smooth nonulcerated right base of tongue mass. What is your diagnosis?

http://ift.tt/2AlOgmI

February 2018 Issue Highlights

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Granulomatosis With Polyangiitis

This Viewpoint examines the continued use of the name Wegner granulomatosis despite the 2011 consensus to change the name of the disease to granulomatosis with polyangiitis.

http://ift.tt/2zKDBkJ

Addition to Funding/Support

In the Original Investigation titled "Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes," published online April 13, 2017, and in the July 2017 print issue, a funding source and grant information were missing from the Funding/Support section. University of Minnesota Cancer Center (grant P30CA077598) was added. This article has been corrected online.

http://ift.tt/2kV00BP

First-Generation Deescalation Trials in HPV-Positive Oropharyngeal Cancer

This Viewpoint discusses the limitations of precision medicine in patients with human papillomavirus–positive oropharyngeal cancer.

http://ift.tt/2iH0LhL

Sensory Changes and the Hearing Loss–Cognition Link

The UK National Institute of Health and Care Excellence (NICE) and the US National Institutes of Health (NIH) identified peripheral age-related hearing loss (ARHL) and social isolation as potentially modifiable dementia risk factors. A growing body of evidence suggested that ARHL and cognition in older age are interrelated and that midlife ARHL may be a risk factor for the development of Alzheimer disease (AD) and dementia in older adults. In a recent meta-analysis of only 3 selected studies with follow-up periods of 9 to 17 years, Livingstone and colleagues found that peripheral ARHL was a significant risk factor for incident dementia, calculating a pooled risk ratio of 1.94. At early stage of ARHL, part of the hearing problems are not related to the peripheral deficit of the auditory system but also to the central auditory processing (CAP) dysfunction, with considerable difficulty in understanding speech in presence of a background noise. Both peripheral and central auditory dysfunctions are therefore relevant to assess a possible influence of ARHL on late-life cognitive disorders.

http://ift.tt/2nEsvZj

Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia

This study characterizes audiologic and otologic manifestations in a cohort of individuals with fibrous dysplasia and/or McCune-Albright syndrome and investigated potential mechanisms of hearing loss.

http://ift.tt/2Bz3gKL

Hypercoagulability and Severe Obstructive Sleep Apnea

To the Editor I read with interest the study by Hong et al, which assessed the association between hypercoagulability and severe obstructive sleep apnea (OSA). The authors measured several coagulation tests, including platelet count, bleeding time, prothrombin time (PT) in seconds and as international normalized ratio, and activated partial thromboplastin time and their association with severity of OSA. They found that patients with moderate to severe OSA had elevated blood coagulability markers compared with healthy individuals.

http://ift.tt/2kXZ5AS

Association of Lymph Node Density With Survival in Papillary Thyroid Cancer

This cohort study assesses the association of lymph node density—the ratio of the number of positive lymph nodes to the total number of nodes excised—with survival in patients with papillary thyroid cancer.

http://ift.tt/2kd5ew5

Missing Acknowledgment

In the article titled "Asymptomatic Septal Mass," an acknowledgement that was omitted has been added to thank Jonathan B. McHugh, MD, for his consultation on the case presented. The article was corrected online.

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Age-Related Hearing Loss, Cognitive Function, and Dementia

This meta-analysis examines the association between age-related hearing loss and cognitive function, cognitive impairment, and dementia in epidemiologic studies from 12 countries.

http://ift.tt/2AlO7Qc

Prevalence of Laryngeal Cleft in Patients With Esophageal Atresia

This study uses data from the Esophageal and Airway Treatment Center at Boston Children's Hospital to assess the prevalence of laryngeal cleft in pediatric patients with esophageal atresia with or without tracheoesophageal fistula.

http://ift.tt/2kBG2g7

Association of Sudden Sensorineural Hearing Loss With Cardiocerebrovascular Disease

This cohort study uses Korea National Health Insurance Service data to investigate the association between sudden sensorineural hearing loss and cardiocerebrovascular disease.

http://ift.tt/2kUF8KU

Asymptomatic Septal Mass

A woman in her 40s presented with a 2-month history of an enlarging asymptomatic anterior septal mass; she denied a history of localized trauma, and examination revealed an 8-mm pink-red, soft fleshy growth posterior to the membranous septum near the nostril apex. What is your diagnosis?

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Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments

This cross-sectional analysis of cases from a national survey system reports the mechanism of injury for traumatic tympanic membrane perforation among patients who presented to the emergency department.

http://ift.tt/2DqInT5

Cerebrospinal Fluid Rhinorrhea and a Lytic-Appearing Lesion

A man with a recent history of meningitis presented with a 1-month history of intermittent clear drainage from his left naris during activity; temporal bone computed tomography demonstrated a lytic-appearing lesion of the posterior fossa and partial opacification of the mastoid air cells. What is your diagnosis?

http://ift.tt/2j1XUzz

Association of GERD With Cancer of the Upper Aerodigestive Tract in Elderly Patients

This case-control study uses a database of population-based tumor registries to investigate the association of gastroesophageal reflux disease with the risk of malignancy in the upper aerodigestive tract in elderly patients.

http://ift.tt/2DqIcqT

Hypercoagulability and Severe Obstructive Sleep Apnea—Reply

In Reply We appreciate the interest of Dr Ghadami in our recently published study titled "Association Between Hypercoagulability and Severe Obstructive Sleep Apnea." The comments raised by the reader can be summarized as follows: The frequent arousals in sleep might be one of the reasons for elevated coagulability markers in patients with obstructive sleep apnea (OSA).

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Outcomes Following Cordotomy by Coblation for Bilateral Vocal Fold Immobility

This case series of 19 patients examines outcomes of coblation in cordotomy for treatment of patients with bilateral vocal fold immobility.

http://ift.tt/2zdoI8X

Errors in Figures 1, 2, and 3

In the Original Investigation titled "Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis," published online December 7, 2017, in Figure 1, the total number of studies included in quantitative synthesis (meta-analysis) should have been 36 instead of 40; in Figure 2, the r value for reasoning should have been −0.18 instead of −0.17; and in Figure 3, the numbers of participants and events for all categories were incorrect. This article has been corrected online.

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Erratum: Frontal Fibrosing Alopecia and Cutaneous Comorbidities: A Potential Relationship with Rosacea

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Sensing Danger after Kidney Transplantation

No abstract available

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3D Endoscopic Donor Nephrectomy Versus Robot-Assisted Donor Nephrectomy: a Detailed Comparison of 2 Prospective Cohorts

AbstractBackgroundThere are 2 endoscopic surgical techniques that implement 3D vision to overcome visual misperception: 3D endoscopy and the da Vinci surgical system. 3D endoscopy has several advantages, such as the presence of tactile feedback and easy implementation, at lower costs. We aimed to assess whether 3D endoscopy could be an alternative to the robot during living donor nephrectomy (LDN).MethodsBetween April 2015 and April 2016 we prospectively collected data on 40 patients undergoing 3D endoscopic LDNs in 1 center, performed by a da Vinci certified surgeon. Data on donors' perioperative results and recipient and graft survival were collected. These data were compared to 40 robot-assisted donor nephrectomies (RADNs) performed in the same center (between January 2012 and May 2014).ResultsBaseline characteristics for both groups were comparable. Intraoperative results showed a significantly shorter median skin-to-skin time (STS-time) of 138.5 min. (125.8-163.8) versus 169.0 (141.5-209.8) min. in favour of the 3D group (P=0.001). Warm ischemia time ([WI-time], P=0.003) and hilar phase for both single- (1 artery and vein) and multiple anatomies (≥1 artery and/or vein [P=0.002 and P=0.010, respectively]) were also significantly reduced in favour of the 3D group, with a flat learning curve. Follow-up demonstrated no readmissions, nor significant differences for donors, recipients and graft survival.Conclusions3D endoscopy may be a good alternative to RADN, since morbidity, graft and recipient survival were comparable, with a significantly shorter median STS-time, WI-time and hilar dissection phase. Furthermore, implementation was easy and at lower costs, whilst tactile feedback was preserved. Background There are 2 endoscopic surgical techniques that implement 3D vision to overcome visual misperception: 3D endoscopy and the da Vinci surgical system. 3D endoscopy has several advantages, such as the presence of tactile feedback and easy implementation, at lower costs. We aimed to assess whether 3D endoscopy could be an alternative to the robot during living donor nephrectomy (LDN). Methods Between April 2015 and April 2016 we prospectively collected data on 40 patients undergoing 3D endoscopic LDNs in 1 center, performed by a da Vinci certified surgeon. Data on donors' perioperative results and recipient and graft survival were collected. These data were compared to 40 robot-assisted donor nephrectomies (RADNs) performed in the same center (between January 2012 and May 2014). Results Baseline characteristics for both groups were comparable. Intraoperative results showed a significantly shorter median skin-to-skin time (STS-time) of 138.5 min. (125.8-163.8) versus 169.0 (141.5-209.8) min. in favour of the 3D group (P=0.001). Warm ischemia time ([WI-time], P=0.003) and hilar phase for both single- (1 artery and vein) and multiple anatomies (≥1 artery and/or vein [P=0.002 and P=0.010, respectively]) were also significantly reduced in favour of the 3D group, with a flat learning curve. Follow-up demonstrated no readmissions, nor significant differences for donors, recipients and graft survival. Conclusions 3D endoscopy may be a good alternative to RADN, since morbidity, graft and recipient survival were comparable, with a significantly shorter median STS-time, WI-time and hilar dissection phase. Furthermore, implementation was easy and at lower costs, whilst tactile feedback was preserved. Corresponding author: T.C.K. Tran, MD, Erasmus MC, Department of Surgery's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Email: t.tran@erasmusmc.nl. Tel. number: 00317031810. Fax number: 00317032396 Authorship Page Participated in research design: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Participated in the writing of the paper: Mulder, Janki, Tran Participated in the performance of the research: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Participated in data analysis: Mulder, Janki, Klop, IJzermans, Tran Critical revision: Mulder, Janki, Terkivatan, Klop, IJzermans, Tran Disclosure The study was supported by Olympus Netherlands B.V., who provided all necessary equipment for free, and the Erasmus MC Efficiency Research grant. E.E.A.P. Mulder, S. Janki, T. Terkivatan, K.W.J. Klop, J.N.M. IJzermans and T.C.K. Tran declare no conflicts of interest or financial ties; neither the investigators nor subjects received compensation for the performance of the study, and the investigators had control of the presentation of the data. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Ganja, No Barrier for Liver Transplantation?

No abstract available

http://ift.tt/2F2U3fL

Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study

Abstract

Objectives

The aim of this study is to evaluate the effect of operators experience and skill on treatment results of initial non-surgical periodontal therapy.

Materials and methods

Initial periodontal treatment was carried out by either second-year periodontal residents (PR) or last year dental students (DS). From the treatment records of patients in each group, plaque and bleeding indices, and pocket depth (PD) at baseline and at re-evaluation were collected retrospectively on each tooth at six locations. Data were separated according to tooth type, area, and probing depth categories, sub-grouped to 1–3, 4–5, and ≥ 6 mm.

Results

Fifty and 49 records of DS and PR patients, accordingly, were analyzed. Initial periodontal treatment improved patient compliance in both groups and reduced signs of inflammation with significantly superior results in the PR group. Significant change in percentage of pockets was recorded in each category. The increase in percentage of sites with PD 1–3 mm and decrease in percentage of PD ≥ 6 mm pockets was significantly (p ≤ 0.001) superior in patients treated by PR. Percentage of 4–5 mm pockets was significantly reduced in both groups (p ≤ 0.01), with a significantly greater reduction in the mandibular molar and anterior teeth in the PR group.

Conclusions

Experience and skill significantly affect the outcome of non-surgical periodontal therapy, with more positive improvement in patient compliance and clinical parameters when performed by a more qualified operator.

Clinical relevance

Improvement of operator skills may decrease the number of residual pockets and increase patient compliance following non-surgical periodontal treatment.

http://ift.tt/2C1fMGa

Radiographic study of mandibular third molars: evaluation of the position and root anatomy in Brazilian population

Abstract

Objectives

The root anatomy and position of mandibular third molars are important factors in assessing the level of difficulty of surgical removal procedures. In this light, this study aims to identify the most frequent position and the root anatomy of mandibular third molars.

Methods

The study sample comprised 1205 mandibular third molars from 710 panoramic radiographs evaluated. Regarding the position, all of them were based on Pell and Gregory's and Winter's classifications. The root anatomy was classified according to the type and number of roots, as well as the presence of laceration, fusion, or divergence. Gender and the quadrant were also considered. Following an interexaminer analysis, a statistical analysis was performed using the Kappa test.

Results

The results showed that the IA (40.3%) and mesioangular (53.8%) position was predominant in mandibular third molars. Regarding the anatomy, the most common were two roots (98.3%), of the conical simple type (88.9%), with absence of laceration (89.2%), divergence (84%), and fusion (80%).

Conclusion

The present study showed that the most prevalent mandibular third molar type in Brazilian patients was the IA and mesioangular position, with simple root anatomy. The result of this study can assist oral surgeons to better plan and assess the level of difficulty of surgical removal procedures.

http://ift.tt/2Buye98

Chronic lymphocytic leukemia cells acquire regulatory B-cell properties in response to TLR9 and CD40 activation

Abstract

Circulating chronic lymphocytic leukemia (CLL) cells share phenotypic features with certain subsets of regulatory B-cells (Bregs). The latter cells have been reported to negatively regulate immune cell responses, mostly by provision of IL-10. The purpose of the current study was to identify and delineate Breg properties of CLL cells. B-cells and T-cells were obtained from the peripheral blood of untreated CLL patients diagnosed according to the 2008 Guidelines of the International Workshop on Chronic Lymphocytic Leukemia. Co-culture assays were used to examine the ability of CLL cells to suppress autologous T-cell immune responses. IL-10 potency of CLL cells was assessed following stimulation with activators of the toll-like receptor 9 (TLR9) or CD40 and was correlated with the inhibitory activity of the cells. TLR9-activated CLL cells were found to increase the frequency of CD4⁺CD25^hiFOXp3⁺ regulatory T-cells (Tregs) and to inhibit autologous CD4⁺ T-cell proliferation. This signaling cascade proved to control IL-10 generation in CLL cells, which in turn promoted the inhibition of T-cell proliferation by CLL cells. However, CD40 activation of CLL cells, while exhibiting a similar ability to augment Treg frequency, did not either affect IL-10 generation or T-cell proliferation. In conclusion, CLL cells demonstrate a unique clonal quality of adopting Breg properties which promote modulation of T-cell characteristics. TLR9 appears to be a potent activator of regulatory abilities in CLL cells, possibly contributing to preferential immune escape of TLR9-responsive cells.

http://ift.tt/2C2PB29

Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care: a cross sectional study

Abstract

Objective

To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care.

Materials and methods

For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed.

Results

One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72–85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all.

Conclusions

Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly.

Clinical relevance

Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

http://ift.tt/2EJ2W0o

Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction

Abstract

Objective

The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction.

Materials and methods

The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18–30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes).

Results

VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia.

Conclusions

Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery.

Clinical relevance

These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.

Trial registration

ACTRN12617001138370

http://ift.tt/2sBYFqQ

Laugier–Hunziker Syndrome Presenting with Metachronous Melanoacanthomas

Abstract

Laugier–Hunziker syndrome (LHS, also termed idiopathic lenticular mucocutaneous hyperpigmentation) is an unusual condition characterized by progressive pigmentation of the mucous membranes. LHS displays a benign course and is not associated with malignancy. Here we present a case of LHS with a 7-year follow-up. We document metachronous oral melanoacanthomas in this individual. In addition, we found that the oral melanotic macules in this patient waxed and waned in a cyclical manner. To our knowledge, this is the first report of these findings in the context of LHS. Finally, we provide an overview of other conditions that can present with mucosal hyperpigmentation. It is critical to distinguish LHS from other conditions characterized by mucosal pigmentation in order to facilitate optimal patient care.

http://ift.tt/2EvojD6

Effects of 915 nm laser irradiation on human osteoblasts: a preliminary in vitro study

Abstract

Photobiomodulation (PBM) is a non-invasive treatment that uses laser or led devices making its effects a response to light and not to heat. The possibility of accelerating dental implant osteointegration and orthodontic movements and the need to treat refractory bone lesions, such as bisphosphonate related osteonecrosis of the jaws, has led researchers to consider the effects of PBM on bone for dentistry purposes. The aim of our study was to investigate the effects of 915 nm light supplied with a GaAs diode laser on human osteoblasts in vitro. Osteoblasts were isolated from mandibular cortical bone of a young healthy donor. The irradiation parameters were as follows: doses = 5, 15 and 45 J/cm²; power densities = 0.12 and 1.25 W/cm²; and irradiation times = 41.7, 125 and 375 s. We performed one irradiation per day for 3 and 6 days to study proliferation and differentiation, respectively. Microscopic analysis showed a greater amount of bone nodules in samples treated with 5 J/cm² and 0.12 W/cm² compared to controls (56.00 ± 10.44 vs 19.67 ± 7.64, P = 0.0075). Cell growth and quantification of calcium deposition did not show any differences when comparing irradiated and non-irradiated samples. Photobiomodulation, with the parameters investigated in the present study, positively modulated the mineralization process in human osteoblasts, inducing the formation of a greater amount of bone nodules, but did not increase cell proliferation.

http://ift.tt/2F67P1d

Effect of prior application with and without post-injury treatment with low-level laser on the modulation of key proteins in the muscle repair process

Abstract

The aim of the present study was to evaluate the effects of LLLT prior to muscle injury with and without post-injury irradiation on the expression of isoforms of myosin heavy chain (MyHC), calcineurin (CaN), and myostatin during the repair process. Wistar rats were divided into five groups: control (n = 7); injury (n = 21); LLLT + injury (n = 21); injury + LLLT (n = 21), and LLLT + injury + LLLT (n = 21). Cryoinjury was performed on the tibialis anterior (TA) muscle. The injured groups were euthanized at 3, 7, and 14 days after injury. LLLT was performed using an infrared laser (780 nm) with the following parameters: 10 J/cm², 40 mW, 10 s per point, 8 points, and 3.2 J of total energy. At the end of each period, the TA muscle was removed for the analysis of MyHC, CaN, and myostatin gene expression using real-time PCR. The data were tested statistically by Kruskal-Wallis with Dunn's post hoc test (p < 0.05). The results demonstrated that prior irradiation reduced the mRNA expression of all proteins at 3 days. Post irradiation reduced the mRNA expression of MyHC-1, MyHC-2a, MyHC-2b, and CaN at 7 days. Prior irradiation combined with post-injury irradiation reduced the mRNA expression of MyHC-2x and CaN at 14 days and increased the mRNA expression of myostatin in the same period. In conclusion, different protocols of photobiomodulation can modulate the expression of the different isoforms of MyHC, CaN, and myostatin during the repair process. It is noteworthy that the combination of the prior and post-injury irradiation was the protocol that most promoted changes in the final phase of the repair process.

http://ift.tt/2Epk3kn

Vestibulo-ocular reflex gain values in the suppression head impulse test of healthy subjects

Objective

To assess whether there are differences in vestibulo-ocular reflex (VOR) gain for suppression head impulse (SHIMP) and head impulse (HIMP) video head impulse test paradigms, and if so, what are their causes.

Methods

Prospective multicenter observational double-blind nonrandomized clinical study was performed by collecting 80 healthy subjects from four reference hospitals. SHIMP data was postprocessed to eliminate impulses in which early SHIMP saccades were detected. Differences between HIMP and SHIMP VOR gain values were statistically evaluated. Head impulse maximum velocity, gender, age, direction of impulse, and hospital center were considered as possible influential factors.

Results

A small significant statistical difference between HIMP and SHIMP VOR gain values was found on repeated measures analysis of variance (−0.05 ± 0.006, P < 0.001). Optimized linear model showed a significant influence of age variable on the observed differences for HIMP and SHIMP gain values and did not find influence between gain values differences and maximum head impulse velocity. Both HIMP and SHIMP VOR gain values were significant lower (−0.09, P < 0.001) when the impulses were performed to the left side.

Conclusion

We had observed a difference in SHIMP and HIMP gain values not adequately explained by known gain modification factors. The persistence of this slight but significant difference indicates that there are more factors causing lower SHIMP VOR gain values. This difference must to be considered in further studies as well as in the clinical SHIMP testing protocols. We hypothesized that VOR phasic response inhibition could be the underlying cause of this difference.

Level of Evidence

IIb. Laryngoscope, 2018

http://ift.tt/2Bwm3IV

Indicators for imaging in periorbital cellulitis secondary to rhinosinusitis

Abstract

Purpose

Our objective was to identify the clinical indicators for subperiosteal orbital abscess (SPOA) among patients who present with periorbital cellulitis secondary to rhinosinusitis, and to evaluate the need for performing a computerized tomography (CT) scan.

Methods

A retrospective cohort study of all patients admitted to our tertiary care emergency department between 2006 and 2014 was conducted. Included were healthy patients with acute periorbital cellulitis secondary to rhinosinusitis. Variables analyzed included age, gender, duration of symptoms, previous antibiotic therapy, highest recorded temperature, physical examination findings, ophthalmologist's examination results, laboratory results, and interpretation of imaging studies, when performed.

Results

Of the 123 identified patients, 78 (63%) were males, with a mean age of 4 years (range 1–70). 68 patients were categorized as Chandler's 1 disease, 2 as Chandler's 2, and 53 as Chandler's 3. 68 patients underwent a CT scan, of those 53 had SPOA. Proptosis and ophthalmoplegia were strongly associated with the presence of an abscess (P < 0.001). However, 14 patients with no ophthalmoplegia or proptosis who underwent a CT scan were older (mean age, 10 years; P < 0.028), and had higher neutrophil count of 78 versus 59% (P = 0.01). This group of patients had a clinically rapidly progressive disease, receiving wider broad-spectrum antibiotics or had their antibiotic treatment replaced to broader spectrum antibiotics through their course of treatment (48.2% compared to only 6.1%).

Conclusions

We confirmed that patients with proptosis and/or limitation of extraocular movements are at high risk for developing SPOA, yet many do not have these predictors. Other features can identify patients who do not have proptosis and/or limitation of extraocular movements but do have significant risk of SPOA, and in these cases performing an imaging study is strongly suggested.

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AAD 2018

Read clinically focused news coverage of key developments from AAD 2018.
Medscape Dermatology

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Grommet and adenoid pain evaluation (GRAPE) study

Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Lammens F, Boons J, Michiels E, Beckers K, Laureyns G, Indesteege J, Indesteege F, Lemmens W, Lemkens N, Jans F, Jorissen M, Lemkens P
In the GRAPE study an analysis is made of postoperative pain sensation in children between 6 months and 6 years after adenotomy and placement of ear grommets. Intraoperative treatment with paracetamol versus placebo shows no statistically significant difference in pain between both groups indicating that this type of surgery causes little discomfort and does not require specific intraoperative analgesic treatment.



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Management of complex pediatric laryngotracheal stenosis with skin graft reconstruction

Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Sarah N. Bowe, Carissa J. Wentland, G.S. Sandhu, Christopher J. Hartnick
ObjectivesFor pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in a series of two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production.MethodsA chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts. Patient history, bronchoscopic evaluation, intra-operative technique, post-operative management, treatment outcomes, and complications were noted. Harvesting and preparation of the split-thickness skin grafts (STSG) proceeded in a similar manner for each case. Stenting material varied based on the clinical scenario.ResultsUsing this technique, a patient with Type 3 glottic web achieved substantial improvement in exercise tolerance, as well as vocal strength and quality. Furthermore, both nearly aphonic patients could vocalize for the first time since their laryngotracheal injures.ConclusionsTemporary endoluminal stenting with skin graft lining can reproduce epithelial continuity and provide "biological inhibition" to enhance the wound healing process. When previous reconstructive efforts have failed, use of STSG can be considered in the management of complex pediatric laryngotracheal stenosis.



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Genetic mutations in non-syndromic deafness patients in Hainan Province have a different mutational spectrum compared to patients from Mainland China

Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Bangqing Huang, Mingyu Han, Guojian Wang, ShaSha Huang, Jialing Zeng, Yongyi Yuan, Pu Dai
ObjectivesTo provide appropriate genetic testing and counseling for non-syndromic hearing impairment patients in Hainan Province, an island in the South China Sea.Methods299 unrelated students with non-syndromic hearing loss who attended a special education school in Hainan Province were enrolled in this study. Three prominent deafness-related genes (GJB2, SLC26A4, and mtDNA 12S rRNA) were analyzed using Sanger sequencing.ResultsGJB2 mutations were detected in 32.78% (98/299) of the entire cohort; however, only 5.69% (17/299) had two confirmed pathogenic mutations. The most common mutation observed in this population was c.109G > A in the GJB2 gene, with an allelic frequency of 15.05% (90/598), which is significantly higher than that reported in previous cohorts. A total of 16 patients had two confirmed pathogenic SLC26A4 gene mutations, and 16 patients had one. The IVS7-2A > G mutation was the most commonly observed, with an allelic frequency of 3.51% (21/598). Three patients had a m.1555A > G mutation in the mtDNA 12S rRNA gene.ConclusionsThese results reveal that genetic etiology occurred in 11.71% (35/299) of patients, suggesting that Hainan province have a different mutational spectrum compare to Mainland China in non-syndromic deafness patients, which provide useful information to genetic counseling in Hainan province.



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Evaluation of the outcome of CT and MR imaging in pediatric patients with bilateral sensorineural hearing loss

Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): E.A. van Beeck Calkoen, P. Merkus, S.T. Goverts, J.M. van de Kamp, M.F. Mulder, E. Sanchez Aliaga, E.F. Hensen
ObjectiveTo evaluate the clinically relevant abnormalities as visualized on CT and MR imaging in children with symmetric and asymmetric bilateral sensorineural hearing loss (SNHL), in relation to age and the severity of hearing loss.Study designRetrospective cohort study.SettingTertiary referral otology and audiology center.Patients and diagnostic interventionsFrom January 2006 until January 2016, a total of 207 children diagnosed with symmetric and asymmetric bilateral SNHL were included. They underwent CT and/or MR imaging for the evaluation of the etiology of their hearing loss.Main outcome measuresRadiologic abnormalities associated with SNHL.Results302 scans were performed in 207 children (median age of 0.8 years old) with bilateral SNHL. The most frequently identified cause of bilateral SNHL was a malformation of the labyrinth. The combined diagnostic yield of CT and MR imaging was 32%. The diagnostic yield of MR (34%) was considerably higher than that of CT (20%). We found a higher rate of abnormalities in children with profound hearing loss (41%) compared to milder hearing loss (8–29%), and in asymmetric SNHL (52%) compared to symmetric SNHL (30%).ConclusionImaging is essential in the etiologic evaluation of children with bilateral SNHL. The highest diagnostic yield is found in children with bilateral asymmetric SNHL or profound SNHL. Based on our findings, MR is the primary imaging modality of choice in the etiological evaluation of children with bilateral SNHL because of its high diagnostic yield.



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Correlation between plaque control and gingival health using short and extended oral hygiene intervals

Abstract

Objectives

To evaluate the correlation between dental plaque formation and gingival health in subjects performing high oral hygiene standards over short or extended intervals.

Materials and methods

Fifty-two non-dental students volunteered for this study. The subjects, trained to perform high oral hygiene standards, were randomized to perform oral hygiene at 12-, 24-, 48-, or 72-h interval over 30 days. The plaque index (PlI) and the gingival index (GI) were evaluated at baseline, 15, and 30 days. For the statistical analysis, oral hygiene intervals were collapsed into daily (12 and 24 h; G12/24) and extended (48 and 72 h; G48/72) intervals. Summary statistics (mean ± SD) and Spearman correlations between the PlI and the GI at baseline, 15, and 30 days were estimated.

Results

At baseline, correlation coefficients between PlI and GI were positive for both groups (r = 0.29 and r = 0.25). At day 15 and 30, correlation was maintained with similar baseline values for the G48/72 group. GI levels did not increase despite an increase in PlI for the G12/24 group, and the correlation was lower than that observed at baseline (r = 0.13 vs. r = 0.29).

Conclusions

In subjects with high oral hygiene standards, the oral hygiene frequency governs the correlation between dental plaque formation and gingival health. Subjects performing high oral hygiene standards at daily intervals will maintain gingival health in difference to subjects using extended hygiene intervals.

Clinical relevance

Subjects performing high oral hygiene standards at daily intervals will maintain gingival health in difference to subjects using extended hygiene intervals.

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N -acetyl- l -cysteine protects dental tissue stem cells against oxidative stress in vitro

Abstract

Objectives

The aim of our study was to investigate whether N-acetyl-l-cysteine (NAC) could protect stem cells from exfoliated deciduous teeth (SHED) against oxidative damage, during in vitro cultivation, to preserve regenerative potential of these cells. Accordingly, we examined the potential of cell culture supplementation with NAC in prevention of lipid peroxidation, unfavorable changes of total lipids fatty acid composition, and the effects on the activity of antioxidant enzymes.

Material and methods

We analyzed the extent of oxidative damage in SHED after 48 h treatment with different NAC concentrations. Cellular lipid peroxidation was determined upon reaction with thiobarbituric acid. All enzyme activities were measured spectrophotometrically, based on published methods. Fatty acid methyl esters were analyzed by gas-liquid chromatography.

Results

Concentration of 0.1 mM NAC showed the most profound effects on SHED, significantly decreasing levels of lipid peroxidation in comparison to control. This dose also diminished the activities of antioxidant enzymes. Furthermore, NAC treatment significantly changed fatty acid composition of cells, reducing levels of oleic acid and monounsaturated fatty acids and increasing linoleic acid, n-6, and total polyunsaturated fatty acid (PUFA) proportions.

Conclusion

Low dose of NAC significantly decreased lipid peroxidation and altered fatty acid composition towards increasing PUFA. The reduced oxidative damage of cellular lipids could be strongly related to improved SHED survival in vitro.

Clinical relevance

Low doses of antioxidants, applied during stem cells culturing and maintenance, could improve cellular characteristics in vitro. This is prerequisite for successful use of stem cells in various clinical applications.

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Mucinous cystic neoplasm of the liver with extrahepatic growth presenting with ascending cholangitis diagnosed by endoscopic ultrasound features: a case report

Mucinous cystic neoplasm of the liver with extrahepatic growth is a rare benign epithelial neoplasm of the biliary system that presents with a mass effect or is incidentally found on imaging. The tumor affects...

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Association of Metabolic Syndrome With Sudden Sensorineural Hearing Loss

This medical record review evaluates the association of the metabolic syndrome with the rate of recovery among adult patients with sudden sensorineural hearing loss.

http://ift.tt/2EtBFj6

Otorhinolaryngological Hazards Related to Diving—Part 1: Compressed Gas Scuba Diving

This review provides an overview of otorhinolaryngological complications during scuba diving.

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Postadenotonsillectomy Blood Pressure Changes in Children With Obstructive Sleep Apnea

This case series investigates disparities in blood pressure changes after adenotonsillectomy in hypertensive and nonhypertensive children with obstructive sleep apnea.

http://ift.tt/2EvDfRJ

Hard Swelling on Inner Cheek

A man had a hard swelling of the left inner cheek, with increasing spontaneous pain and swelling; examination revealed an erythematous lesion of the buccal mucosa, adjacent to the maxillary first molar, which produced a small amount of bleeding with palpation. What is your diagnosis?

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Otorhinolaryngological Fitness for Compressed Gas Scuba Diving—Part 2

This review aims to provide a comprehensive overview of existing otorhinolaryngological fitness guidelines for diving recreationally.

http://ift.tt/2Ewj7Pi

Dimensions of the medial wall of the prelacrimal recess

Background

Addressing anterior maxillary sinus pathology endoscopically that is inaccessible with an endoscopic modified medial maxillectomy requires either a prelacrimal approach (PLA) or an endoscopic Denker's approach (EDA). The PLA involves removing the medial wall of the prelacrimal recess (PLR), which is the bone between the pyriform aperture (PA) and nasolacrimal duct (NLD), from nasal floor to orbital floor. The PLA preserves the inferior turbinate and NLD, whereas both are sacrificed during an EDA. The purpose of this computed tomography (CT)-based study was to determine the anteroposterior and superoinferior dimensions of the medial wall of the PLR.

Methods

One hundred thirty-one triplanar sinus CT scans of patients with various rhinologic diseases, but with intact bony PLR walls, were reviewed to assess dimensions of the medial wall of the PLR. The anteroposterior distances from the PA to the inferior-most, middle, and superior-most aspects of the NLD were measured. The height from the nasal floor to orbital floor was also measured. Combining left and right sides, there were 262 measurements.

Results

The anteroposterior distances between the PA and the NLD were as follows: inferior: mean, 8.4 mm (standard error [SE], 0.2; range, 1.9–14.2); middle: mean, 7.6 mm (SE, 0.2; range, 0–13.6); and superior: mean, 5.5 mm (SE, 2.5; range, 0–11.9). The mean height of the medial wall of the PLR was 26.5 mm (SE, 0.2; range, 18.5–39.9).

Conclusion

The anteroposterior and superoinferior dimensions of the medial wall of the PLR are variable, with the anteroposterior dimension being widest inferiorly. Its dimensions should be evaluated preoperatively when considering endoscopic approaches to or through the anterior maxillary sinus.

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Oral manifestations of lipoid proteinosis in a 10-year-old female: a case report and literature update

Publication date: Available online 14 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kevin C. Lee, Scott M. Peters, Yen Chen Kevin Ko, Timothy C. Kunkle, Michael A. Perrino, Angela J. Yoon, Elizabeth M. Philipone
Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. Herein, we present a case of LP with significant oral, dermatological, and neurological manifestations occurring in a 10 year-old Asian female. In addition to the more typical oral findings of restricted tongue movement and labial and buccal mucosal involvement, this case highlights an unusual pattern of gingival enlargement infrequently reported in the literature. As LP almost always involves the oral cavity, often before the onset of cutaneous lesions, it is important for dental providers to be familiar with the oral manifestations of this disease. Early detection and diagnosis of LP by the dental practitioner can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.



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Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy

Publication date: Available online 14 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ho-Hyun (Brian) Sun, Chan M. Park, Jeffrey A. Elo




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Pentoxifylline, Tocopherol and Clodronate for the treatment of mandibular osteoradionecrosis: A systematic review

Publication date: Available online 14 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Miriam Martos-Fernández, Manel Saez-Barba, Jose López-López, Albert Estrugo-Devesa, Jose María Balibrea-del-Castillo, Coro Bescós-Atín
ObjetiveThe purpose of this article is to evaluate the healing benefit of provided by combining Pentoxifylline-Tocopherol or Pentoxifylline-Tocopherol-Clodronate for treating osteoradionecrosis due to their antioxidant and antifibritic properties.Study designWe searched for relevant literature in PubMed using a combination of "osteoradionecrosis" and the following keywords: "pentoxifillyne", "tocopherol", "vitamin E" or "clodronate". We considered articles in English or Spanish, with no limitations on the publication date.ResultsThe combination of Pentoxifylline plus Tocopherol +/- Clodronate was found to be effective for the treatment of mandibular osteoradionecrosis although data was generally scarce and mostly consisted of retrospective case series.ConclusionThis drug therapy is well tolerated and could be promising for the treatment of mandibular osteoradionecrosis although prospective randomized controlled clinical trials are needed.



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Mast Cells Signal their Importance in Health and Disease

Publication date: Available online 15 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Ana Olivera, Michael A. Beaven, Dean D. Metcalfe
FcεRI is the primary receptor in mast cells that mediate allergic reactions by inducing rapid release of mediators, an adaptive immune response that may have evolved as a host defense against parasites and venoms. Yet, it is apparent that mast cells are also activated via non-IgE receptors whose significance is just beginning to be understood. This includes the Mas-related GPCRs (MRGPRX2) that may contribute to reactions to diverse antimicrobials and polybasic compounds, and ADGRE2, an adhesion GPCR which is activated by mechanical vibration and whose variants are associated with familial vibratory urticaria. Mast cells similarly have long been recognized as the main repository for histamine, heparin and proteases. Recent evidence also points to new functions, modes of delivery and mechanisms of action of mast cell proteases that add new dimensions to the roles of mast cells in human biology. In addition, exposure of mast cells to environmental cues can quantitatively and qualitatively modulate their responses and thus their impact on allergic inflammation. Illustrating this paradigm, we summarize a number of recent studies implicating the injury/tissue damage cytokine IL-33 as a modulator of allergen-induced mast cell responses. We also discuss the discovery of markers associated with transformed mast cells and new potential directions in suppressing mast cell activity.



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Long term clinical effects of early thymectomy: associations with autoimmune diseases, cancer, infections and atopic diseases

Publication date: Available online 14 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Judith Gudmundsdottir, Jonas Söderling, Håkan Berggren, Sólveig Óskarsdóttir, Martin Neovius, Olof Stephansson, Olov Ekwall




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Identification and analysis of peanut-specific T effector and T regulatory cells in children allergic and tolerant to peanut

Publication date: Available online 15 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Katherine A. Weissler, Marjohn Rasooly, Tom DiMaggio, Hyejeong Bolan, Daly Cantave, David Martino, Melanie R. Neeland, Mimi LK. Tang, Thanh D. Dang, Katrina J. Allen, Pamela A. Frischmeyer-Guerrerio
BackgroundPeanut allergy is potentially life-threatening and generally persists lifelong. Recent data suggests the skin may be an important route of initial sensitization to peanut, while early oral exposure to peanut is protective. In mice, T regulatory cells (Tregs) are central to development of tolerance to food, but their contribution to the pathogenesis of food allergy in humans is less clear.ObjectiveWe sought to quantify and phenotype peanut-specific CD4+ T effector (ps-Teff) and ps-Tregs in children with and without peanut allergy or sensitization.MethodsPs-Teffs and ps-Tregs were identified from peripheral blood of peanut allergic, peanut sensitized, and non-sensitized/non-allergic school-aged children and one year old infants based on upregulation of CD154 or CD137, respectively, following stimulation with peanut extract. Expression of cytokines and homing receptors were evaluated using flow cytometry. Methylation at the FOXP3 locus was measured as a marker of Treg stability.ResultsDifferential upregulation of CD154 and CD137 efficiently distinguished ps-Teffs and ps-Tregs. A greater percentage of ps-Teffs from peanut allergic and sensitized infants expressed the skin homing molecule CLA, suggesting activation following exposure through the skin, compared to non-allergic infants. While ps-Teffs in both school-aged and infant peanut-allergic children produced primarily Th2 cytokines, a Th1-skewed anti-peanut response was only seen in non-allergic school-aged children. The frequency, homing receptor expression, and stability of ps-Tregs in infant and school-aged children were similar regardless of allergic status.ConclusionsExposure to peanut through the skin may prime the development of Th2 ps-Teffs that promote sensitization to peanut, despite the presence of normal numbers of ps-Tregs.

Graphical abstract

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Regarding the Use of the Term “Cementum” in Fibro-Osseous Lesions of the Craniofacial Skeleton

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“Characterization of the Orbital Volume in Normal Population”

Publication date: Available online 14 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Patricio R. Andrades, Pedro E. Cuevas, Rodrigo Hernández, Stefan V. Danilla, Rodrigo Villalobos
IntroductionThe aim of the study was to describe the normal orbital volume and its most important relationships with other clinical variables.MethodsWe designed a correlation study and consecutive normal CTs scans were included. Orbital volume and facial anthropometrics were measured and correlated between them. Two independent and blind observers made all the measurements. Uni and multivariate statistical analysis were performed in order to create a predicting model for orbital volume.ResultsA total of 199 consecutive patients were included in the study (398 orbits). The mean Orbital Volume (OV) was 24.5 ± 3.08 cc. Adequate intra and interobserver reliability was observed. There were no differences between the right and left orbit (p=0.73). The male average OV was 24.9 ± 3.03 cc, the female OV was 23.9 ± 3.08 cc. Age group analysis demonstrated a slow increase in OV beyond thirty years, but these differences were not significant (p=0.98). Only the age, total facial height, facial width and the interorbital distance were significant and were included in the predictive model of OV.ConclusionWe have characterized the normal orbital volume,variations and associations. In order to further advance in the understanding of the clinical implications the abnormal orbital volume must be fully studied.



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Fungal liver abscess in an immunocompetent patient who underwent repeated ERCPs and subtotal cholecystectomy

We report a case of a previously healthy female patient who initially presented with fever, jaundice and right upper quadrant pain three days after dilatation and stenting of a stricture of the common bile duct (CBD). During an earlier admission, the patient had undergone endoscopic retrograde cholangiopancreatography (ERCP) having presented with fevers and biliary dilatation on ultrasound. The ERCP features were more consistent with Mirizzi's Syndrome. The patient subsequently underwent subtotal cholecystectomy and later developed a CBD stricture, requiring repeat ERCP and stent insertion. At presentation, she had moderately deranged liver function tests and significantly elevated inflammatory markers and was found on cross-sectional imaging to have developed a liver abscess. Aspiration of the lesion cultured Candida albicans. She was treated with intravenous antifungals, broad-spectrum antibiotics and further aspiration of abscess, which contributed towards her successful recovery. Fungal liver abscess should be suspected in immunocompetent patients who undergo ERCP and or cholecystectomy.

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“Characterization of the Orbital Volume in Normal Population”

The aim of the study was to describe the normal orbital volume and its most important relationships with other clinical variables.

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Clinical trials in allergen immunotherapy: current concepts and future needs

Abstract

Allergen immunotherapy (AIT) is a safe, effective treatment for allergic rhinoconjunctivitis and allergic asthma. However, AIT's clinical effect is still contested - primarily due to heterogeneity in clinical trial designs, study populations, therapeutic formulations and efficacy criteria. After discussing current concepts and unmet needs, an international panel of experts made several recommendations: (i) explore and validate definitions for [clinical] responders in AIT-trials; (ii) use of well-documented, standardized provocation tests prior to inclusion of subjects with relevant diseases in AIT trials; (iii) monitoring neo-sensitizations and occurrence of new allergy in extended AIT trials, and exclusion of polyallergic participants; (iv) validation of allergen exposure chambers with regard to natural exposure; (v) in studies of seasonal allergies, focus on peak exposure but also consider organising two parallel, geographically distinct but otherwise identical trials; (vi) discuss adaptive trial designs with the regulatory authorities; (vii) use e-health and m-health technologies to capture more information on individual exposure to allergens; (viii) initiate research on potential psychological, biochemical, immune, neural and even genomic markers of the placebo response; (ix) identify trial designs and primary endpoints that will give children with allergies easier, faster access to AIT formulations; and (x) promote and apply standardized methods for reporting systemic and local adverse events. The latest technologies and trial designs may provide novel, ethical ways of reducing bias and heterogeneity in AIT clinical trials. There is scope for physicians, patient organizations, companies and regulators to improve clinical trials in AIT and, ultimately, to provide patients with better treatments.

This article is protected by copyright. All rights reserved.

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Implementation of an Outcomes-Based Curriculum for Dermatology Clerkships and Initial Positive Perceptions from Faculty and Students

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JAK/STAT inhibitors and other small molecule cytokine antagonists for the treatment of allergic disease

To provide an overview of janus kinase (JAK), chemoattractant receptor-homologous molecule expressed on T-helper 2 cells (CRTH2), and phosphodiesterase 4 (PDE4) inhibitors in allergic disorders.

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Rituximab as a therapeutic consideration for refractory eosinophilic fasciitis

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Case 5-2018: A 63-Year-Old Man with Confusion after Stem-Cell Transplantation

Presentation of Case. Dr. Joshua A. Cohen (Medicine): A 63-year-old man was admitted to this hospital with confusion and weakness 5 months after he had undergone allogeneic stem-cell transplantation for chronic lymphocytic leukemia (CLL). The patient had been generally well until 2 years before…

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Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature

Publication date: Available online 11 February 2018
Source:Autoimmunity Reviews
Author(s): Mariana Freschi Bombini, Fernando Augusto Peres, Aline Tamires Lapa, Nailú Angélica Sinicato, Beatriz Ricato Quental, Ágatha de Souza Melo Pincelli, Tiago Nardi Amaral, Caroline Cristina Gomes, Ana Paula del Rio, João Francisco Marques-Neto, Lilian T.L. Costallat, Paula Teixeira Fernandes, Fernando Cendes, Leticia Rittner, Simone Appenzeller
Background/PurposeTo evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes.MethodsConsecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) were obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software.ResultsWe included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups.ConclusionBoth SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.



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The imprint of salivary secretion in autoimmune disorders and related pathological conditions

Publication date: Available online 9 February 2018
Source:Autoimmunity Reviews
Author(s): Kashi Raj Bhattarai, Raghupatil Junjappa, Mallikarjun Handigund, Hyung-Ryong Kim, Han-Jung Chae
Xerostomia is a state of oral dryness associated with salivary gland dysfunction and is induced by stress, radiation and chemical therapy, various systemic and autoimmune diseases, and specific medications. Fluid secretion is interrupted by the stimulation of neurotransmitter-induced increase in cytosolic calcium ([Ca²⁺] i) in salivary gland acinar cells, prompting the mobilization of ion channels and their transporters. Salivary fluid and protein secretion are principally dependent on parasympathetic and sympathetic nerves. Various inflammatory cytokines allied with lymphocytic infiltration cause glandular damage and Sjogren's syndrome, an autoimmune exocrinopathy associated with hyposalivation. A defect in IP3Rs, a major calcium release channel, prompts inadequate agonist-induced [Ca²⁺]i in acinar cells and deters salivary flow. The store-operated calcium entry-mediated Ca²⁺ movement into the acini activates K⁺ and Cl^- channels, which further opens a water channel protein, aquaporin-5, and triggers the release of fluid secretion from the salivary glands. The cellular mechanism of salivary gland dysfunction and hyposalivation has not yet been elucidated. In this review, we focused mainly on the proteins responsible for deficient saliva, the correlation between inflammation and salivation, autoimmune disorders and other ailments or complications associated with hyposalivation.



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