Review of “Who Makes It to the End? A Novel Predictive Model for Identifying Surgical Residents at Risk for Attrition” by Yeo HL, Abelson JS, Mao J, Lewis F, Michelassi F, Bell R, Sedrakyan A, Sosa JA in Ann Surg 266: 499–507, 2017

No abstract available

http://ift.tt/2tg1a2b

Factors Influencing Perception of Facial Attractiveness: Gender and Dental Education

Purpose: This study was conducted to investigate the gender- and dental education-specific differences in perception of facial attractiveness for varying ratio of lower face contour. Methods: Two hundred eleven students (110 male respondents and 110 female respondents; aged between 20–38 years old) were requested to rate facial figures with alterations to the bigonial width and the vertical length of the lower face. We produced a standard figure which is based on the "golden ratio" and 4 additional series of figures with either horizontal or vertical alterations to the contour of lower face. The preference for each figure was evaluated using a Visual Analog Scale. The Kruskal Wallis test was used for differences in the preferences for each figure and the Mann–Whitney U test was used to evaluate gender-specific differences and differences by dental education. Results: In general, the highest preference score was indicated for the standard figure, whereas facial figure with large bigonial width and chin length had the lowest score. Male respondents showed significantly higher preference score for facial contour that had a 0.1 proportional increase in the facial height-bigonial width ratio over that of the standard figure. For horizontal alterations to the facial profiles, there were no significant differences in the preferences by the level of dental education. For vertically altered images, the average Visual Analog Scale was significantly lower among the dentally-educated for facial image that had a proportional 0.22 and 0.42 increase in the ratio between the vertical length of the chin and the lip. Conclusion: Generally, the standard image based on the golden ratio was the most. Slender face was appealed more to males than to females, and facial image with an increased lower facial height were perceived to be much less attractive to the dentally-educated respondents, which suggests that the dental education might have some influence in sensitivity to vertical changes in lower face.

http://ift.tt/2Fk6giH

Re-Engineering the Cleft Craft Surgery: Function is an Essential Element of the Repair

No abstract available

http://ift.tt/2tdEpMi

Mucosal Dehiscence After Alveolar Bone Graft in Cleft

Cleft lip and palate patient represent a challenging experience for the surgeon. This kind of patients had to be followed by a multidisciplinary team from the beginning to the end to avoid the deformation sequelae. During the several surgical procedures, the bone graft represents a possible procedure that, through the new procedure, could be avoided. Unfortunately, patient treated following the previous procedure must be submitted to alveolar bone graft to coordinate the arch, to restore the maxillary integrity, to allow the correct dentition.

http://ift.tt/2FmqgRV

Critical Appraisal in Plastic Surgery: Nullius in Verba

No abstract available

http://ift.tt/2Fm17qA

Repair of the Nasal Floor by the Cleft Margin Flap in Bilateral Complete Cleft Lip

Bilateral complete cleft lip deformity has been the most challenging to plastic surgeons, and lots of methods of repair have been described in the literature. The basic principles are to achieve continuity of the orbicularis oris muscle, a balanced Cupid's bow with nasal ala, and a complete reconstruction of the nasal floor. The last one is, however, easily neglected. A well-reconstructed nasal floor serves as a good support of the nasal cartilage, which minimizes secondary deformity. In addition, a nasal floor with sufficient soft tissue and minimal contracture makes bone grafting easier in the future. The cleft margin flap was first introduced by Tajima in 1983 and used for the nasal floor repair in the unilateral complete cleft lip. The authors have used this technique in bilateral complete cleft lip repair, and from our practice, tension-free repairs of the nasal floors could easily be achieved by the cleft margin flaps. The results were satisfying and no significant scar contracture or deformity of the nasal floor was observed during follow-up. The authors conclude that the cleft margin flaps are viable and alternative choices for the repair of the nasal floors in bilateral complete cleft lip without major complications.

http://ift.tt/2tivedQ

Cell Polarity and PAR Complex Likely to Be Involved in Dexamethasone-Induced Cleft Palate

Accumulating studies demonstrated that PAR complex contributed to the establishment and maintenance of cell polarity which was fundamental to many aspects of cell and developmental biology. The purpose of this study was to investigate whether dexamethasone (DEX) could downregulate the PAR complex and disrupt cell polarity in palatal epithelium during palatal fusion in mice. The C57BL/6J mice were selected for the experiment. Pregnant mice in control group and DEX-treated group were injected intraperitoneally with 0.9% sodium chloride 0.1 mL, which contained DEX 6 mg/kg respectively, every day from E10 to E12. The palatal epithelia morphology was observed with hematoxylin and eosin and scanning electron microscopy. Immunofluorescence staining, western blot, and real-time polymerase chain reaction were performed to detect the expression of PAR3/PAR6/aPKC. After being treated with DEX, the palatal shelves showed delayed development and became shorter and smaller. During the process of palatogenesis, PAR3 and PAR6 expressed in the palatal epithelium, and aPKC expressed in both the epithelium and the mesenchyme. Dexamethasone could downregulate the expression levels of PAR3/PAR6/aPKC in both protein and gene level. In conclusions, DEX affected the PAR complex of mouse embryonic palate, and could perturb the PAR complex and the cell polarity of medial edge epithelium cells, and caused the failure of palatal fusion.

http://ift.tt/2Fmq9FZ

Surgical Management of Migraine Headache

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P 

http://ift.tt/2tecnQT

Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance

The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P 

http://ift.tt/2Fmq5WL

Nontraumatic Intradiploic Epidermoid Cyst and Older Age: Association or Causality?

Background: Intradiploic epidermoid cysts (IEC) are rare, benign lesions derived from ectodermal remnants during neural tube closure. Their origin is still debated or unknown. Objective: Analyzing of the patients with intradiploic epidermoid cysts operated in the authors' department. Methods: The patients with IEC who were operated in the authors' department between January 2014 and December 2015 were investigated from data file. Results: Six patients with IEC were found, reviewed the literature, and noted that these cysts usually occur in adults. There are only 3 young cases that occurred after head injury. Conclusion: It was shown that the nontraumatic IEC are more frequent in older ages. In youngs, it can generally be embryologic or rarely of mechanical origin following trauma. Cranial trauma may be important for developing of IEC. Trauma may lead to inclusion of epidermal cells into the diploe of the skull and may be a reason of intradiploic epidermoid cyst in older age. The effect of older age, and gender difference on occurrence should be investigated.

http://ift.tt/2telSQa

Nasopharyngoscopic Analyses through Anterior Maxillary Distraction Osteogenesis for Adolescent Patients With Cleft Palate

Anterior maxillary distraction osteogenesis (AMDO) is a novel technique for correcting hypoplastic maxilla by sagittal expansion of the maxilla. Recent reports suggest that AMDO does not have an effect on fragile velopharyngeal function in patients with cleft palate. Furthermore, no studies have evaluated the impact of AMDO on velopharyngeal function. We adopted AMDO to correct severe hypoplastic maxilla in adolescent patients with cleft palate and evaluated its impact on velopharyngeal space and function in 8 patients aged 12 to 21 years who underwent AMDO from 2006 to 2014. All the patients had received treatment for cleft palate; however, they still exhibited marginal velopharyngeal insufficiency. The mean activation of the distractor was 10.9 ± 0.9 mm. We determined changes in velopharyngeal closure ratio and closure pattern via nasopharyngoscopy. Additionally, skeletal changes were evaluated using lateral cephalograms. The mean horizontal advancement in the cephalogram obtained 1 year after the distraction was +6.4 mm. Nasopharyngoscopic examination revealed that no deterioration of velopharyngeal gap had occurred after AMDO in all 8 patients. The velopharyngeal closure pattern changed from coronal to circular in 1 patient. Our results indicate that AMDO achieved correction of hypoplastic maxilla without deterioration in velopharyngeal gap and function. Therefore, AMDO is an effective and optimal approach for correcting hypoplastic maxilla especially in patients with fragile velopharyngeal function, such as those with cleft palate.

http://ift.tt/2Fmq1X1

Surgical Treatment of Synovial Chondromatosis in the Inferior Compartment of the Temporomandibular Joint With Articular Disc Involvement

The authors report an unusual case of painful synovial chondromatosis originated in the inferior compartment of the temporomandibular joint (TMJ) with articular disc involvement in a 56-year-old woman with complaint of severe pain in the right preauricular region. Magnetic resonance images showed advanced destruction of the right articular disc anteriorly displaced, condylar erosion, and distinct nodules within an extremely expanded inferior joint compartment with large amount of fluid, as well as a large TMJ effusion. A scintigraphy showed elevated bone uptake in the right TMJ, demonstrating intense bone remodeling activity in the region. After a right internal maxillary artery embolization, the patient underwent open surgery. The intraoperative procedures, including articular disc removal, condylar remodeling, and replacement of the articular disc, are described in detail. Synovial chondromatosis of the TMJ is a rare disease, especially when it affects the inferior compartment and the articular disc. Initial diagnosis is challenging and imaging techniques (magnetic resonance imaging and scintigraphy) play an important role in identifying signs, making accurate diagnosis, and offering additional information not available with conventional imaging, such as TMJ inflammation or remodeling. In these patients, open surgery may be considered a definitive treatment, since the postoperative recurrence rate is very low.

http://ift.tt/2tfvom0

Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders

The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1; standard deviation [SD] = 7.4) underwent subtotal Le Fort I osteotomy and pterygomaxillary disjunction following surgically assisted rapid maxillary expansion (SARME) carried out using HAAS (n = 29; 48.3% male and 51.7% female; mean age = 27: SD = 7.7) and HYRAX (n = 61; 44.3% male and 55.7% female; mean age = 26; SD = 7.2) expanders. Post-SARME dento-gingival, radiographic, and clinical undesired outcomes were evaluated. A total of 16 (17.8%) patients experienced at least 1 undesired outcome—7 (7.8%) and 9 (10.0%) in HAAS and HYRAX group, respectively. The most common undesired outcomes were radiographic asymmetric expansion—2 (2.2%) and 3 (3.3%) in HAAS and HYRAX group, respectively—followed by pain during out-of-clinic expansion 4 (4.4%) in HAAS group only—dental darkening 5 (5.5%) in HYRAX group, only, requiring root canal treatment, and local infection—2 (2.2%), 1 in each HAAS and HYRAX groups. Excepting for complications arising from the acrylic stop plate in HAAS expander, the number and severity of complications observed in the current study did not differ due to the use of HAAS and HYRAX appliances to perform maxillary expansion. Hygiene issues do not rule out the use of HAAS. The wider maxillary expansion performed, the more frequent are the cases of asymmetric expansion.

http://ift.tt/2Fmqx7p

Age-Related Volumetric Changes in Mandibular Condyles

A precise knowledge of the condylar changes with advancing age may improve understanding of pathophysiological alterations of the mandibular condyles. However, the majority of studies focusses on morphological changes, although volumetric analysis based upon cone beam computerized tomography may provide important additional data to characterize mandibular condyles. Therefore, we aimed to provide and compare volumetric data of mandibular condyles of a young and old patient group. This is a retrospective chart review of 195 patients with cone beam computerized tomography between 2007 and 2016. Student t test, analysis of variance, and Pearson correlation test were performed to analyze associations between categorical and continuous variables. P values

http://ift.tt/2tepMbN

Evaluating Resident Perspectives on International Humanitarian Missions

Background: Opportunities for international missions are highly sought after by medical students, residents, and attending plastic surgeons. The educational benefits and ethical considerations of trainees participating in these ventures have been extensively debated. At the time of this writing, many surgical training programs lack the necessary infrastructure or funds to support missions of this sort. Despite the increasing interest, the perceived benefit of international work has not yet been well studied. The authors seek to evaluate residents' perspectives on the personal and educational benefits of international mission work. Methods: A 24-item online questionnaire was designed to measure residents' perspectives on humanitarian missions. Residents' perceptions on how participation in these missions may have influenced their career path were also evaluated. This questionnaire was disseminated to the plastic surgery residents in Accreditation Council for Graduate Medical Education (ACGME) accredited programs in the United States during the 2015 to 2016 academic year. Results: Of the 123 responses collected, 49 (40%) indicated that they had participated in international mission work prior to beginning residency, while 74 (60%) had not. Fifty-seven percent (n = 25) of those who had participated agreed that this experience impacted their choice to pursue plastic surgery as a specialty. Twenty-nine (24%) participated in 1 or more missions during residency. The most common type of mission work focused on cleft lip/palate repairs (n = 24) followed by nonsurgical medical relief (n = 18) and general plastics/combined (n = 6). Most respondents reported trips lasting 6 to 8 days (n = 29, 48%), though several reported trips lasting 9 to 10 days (n = 6, 10%) and 11 days or more (n = 16, 27%). When asked about the volume of procedures performed, 32 (65%) reported participating in more than 15 procedures, with 15 (31%) residents reporting participation in 26 procedures or more. When asked to evaluate the educational benefits in light of the 6 core competencies from the ACGME, there was an overwhelmingly positive response. Conclusions: Residents perceive international mission experiences to be valuable for professional development as well as an effective tool for surgical education, particularly in the setting of competency-based education goals and these ventures should be supported by training programs. An appropriately planned mission experience can impact the professional and educational development of the trainee.

http://ift.tt/2FhpeXv

Ecthyma Gangrenosum in the Eyelid

No abstract available

http://ift.tt/2tiZepS

Comparison of Postoperative Outcomes Between Monitored Anesthesia Care and General Anesthesia in Closed Reduction of Nasal Fracture

Fracture of nasal bone is among the most common facial bone fractures. Reduction of nasal bone fracture is able to be performed under local or general anesthesia. The aim of this study is to compare monitored anesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures. The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture between January 1, 2016 and December 31, 2016. Patients are divided into an MAC group (n = 17) or GA group (n = 28). A sore throat, postoperative pain scores, nausea, vomiting, hospital stay, operation time, and the result of surgery are compared between the groups. All the patients have interviewed their satisfaction of aesthetic and functional outcome. The operation time and hospital stay were lower in the MAC group. There is no difference in a sore throat, postoperative pain score, and the result of surgery significantly. In the MAC and GA groups, there was no statistically significant difference in the postoperative cosmetic and functional satisfaction scores. Closed reduction of nasal bone fracture using MAC is as safe and efficient as GA. However, MAC anesthesia may not be feasible if airway discomfort due to bleeding is expected, or fracture is severe and multiple manipulations are required. Therefore, MAC is considered to be a good alternative when patients undergoing short-term or small operations do not prefer general anesthesia.

http://ift.tt/2Fl7k5T

Maxillary Osteomyelitis Caused by Kocuria Species in a Patient Who Is on Long-Term Uncontrolled Use of Methylprednisolone

Uncontrolled use of medicines bring with it serious health problems. Long-term and uncontrolled use of steroids, without the supervision of a healthcare professional, may cause unexpected infections due to immunosuppression. The authors present a patient with maxillary osteomyelitis caused by Kocuria species in a 41-year-old male who has been receiving methylprednisolone without control for 1.5 years.

http://ift.tt/2tiZ7dW

The Impact of Type-D Personality on Oral Health-Related Quality of Life in Cleft Lip and Palate Adolescents

The purpose of this study was to investigate the oral health-related quality of life and type-D personality in cleft lip/palate (CLP) patients and the relationship between type-D personality and oral health-related quality of life (OHRQoL) in CLP patients. Fifty patients with CLP within age range from 8 to 15 years were chosen and asked to complete both Child Oral Health Impact Profile (COHI) and Type-D scale (DS14) questionnaire. Moreover, the participants of a control group matched with CLP patients were asked to complete the DS14 questionnaire. A significant difference between boys and girls on the subscale "emotional well-being" of COHIP (P = 0.001) and a positive significant correlation between "oral symptoms" and age (P = 0.029) were found among CLP patients. The prevalence of type-D personality was equal between clefts and nonclefts groups. However, there was a significant relationship between type-D personality and OHRQoL in CLP patients regarding mean scores of overall COHIP and its subscales (P

http://ift.tt/2FigX5E

Mandibular Reconstruction by Osteogenic Distraction Due to Two Different Injuries

Varied factors, whether intrinsic or extrinsic, may lead to a decrease in the bone volume of the jaws. Trauma and pathology can be listed as examples of such factors. The aim of this study is to present the osteogenic distraction technique as alternative to augmentation of low mandibular bone volume caused by different etiologies. The first case reports a mandibular marginal resection of ameloblastoma and the second one reports a male patient presenting mandibular fracture sequelae. Both cases were treated according to the osteogenic distraction technique. Several factors have influence on the decision of treatment management of these conditions. Although autogenous bonegraft is considered criterion standard for alveolar reconstruction, its high rates of resorption and the morbidity associated to donor sites lead surgeons to seek for other surgical alternatives such as osteogenic distraction. Therefore, it also aims to expose the advantages and benefits of this technique as well as the satisfactory results achieved.

http://ift.tt/2tiYYqU

Innate immunity gene expression by epithelial cells of upper respiratory tract in children with adenoid hypertrophy

A major role of the innate immunity in the defence of mucosal tissue is well established. However, a balance between the main components of the immunity such as toll-like receptors (TLRs) and defensins in the pathology of upper respiratory tract in children has not been addressed yet. Our aim was to investigate the gene expression of some TLRs as well as alpha and beta-defensins in children suffered from adenoid hyperthrophy in comparison with healthy children.

http://ift.tt/2FchbaS

Treatment of pediatric esthesioneuroblastoma with smell preservation

Olfactory neuroblastoma is a rare malignant tumor of neuroectodermal origin and represents the most common cancer of the nasal cavity in pediatric age. The gold standard of treatment consists of en bloc resection, numerous studies have shown as the endoscopic approaches permit good control of the disease improving the quality of life after the treatment. Herein we describe the case of a 13-year-old patient referred to our outpatient clinic with a polypoid multi-lobed lesion occupying the left nasal cavity and imaging that confirmed a left-sided nasal mass without cribriform plate involvement (Kadish B).

http://ift.tt/2FPks14

Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study

Numerous studies have reported that various environmental factors during early life are key determinants for developing allergic disease. Herein, we aimed to investigate the impact of environmental factors on allergic rhinitis.

http://ift.tt/2Fa33za

Combined Diagnosis of Systemic Lupus Erythematosus and Tuberculosis in an Irish Adolescent Female

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown aetiology, which can affect any organ system. Tuberculosis (TB) is a common infection in SLE because of immune dysregulation associated with the latter. We report a case of an adolescent female who presented with a year's history of polyarticular arthralgia and fever. Physical examination revealed a large left effusion that needed drainage. Investigations revealed a combined diagnosis of SLE and TB. Management comprised quadruple anti-TB therapy and SLE treatment. She made a steady recovery and has maintained a stable state from the lupus perspective.

http://ift.tt/2FQNEon

Total Plasma Exchange in Hypertriglyceridemia-Induced Pancreatitis: Case Report and Literature Review

Objective. To emphasize the role of apheresis in management of pancreatitis. Methods. The clinical course of a patient admitted for hypertriglyceridemia-induced pancreatitis (HTGP) complicated by multiorgan dysfunction is described, who demonstrated dramatic improvement in his clinical status after total plasma exchange (TPE). In addition, the current guidelines for TPE and the alternative treatment options for HTGP are also presented. Results. A patient presenting with pancreatitis associated with severe systemic inflammatory response was admitted to our hospital with an initial triglyceride level of 1181 mg/dL. Given the patient's worsening clinical condition, he was started on TPE with a rapid fall in his serum TG levels, in turn leading to early clinical recovery. Conclusion. Though various therapeutic options for the treatment of HTGP are described in literature, there are no set guidelines available to tackle this difficult clinical situation. TPE, albeit not very well known in this context, is one of the many therapies available. Though it leads to a rapid, precipitous fall in the TG levels and early symptom resolution, the data about the long-term morbidity as well as the effectiveness of this therapy is still lacking.

http://ift.tt/2teSlFT

Infective Endocarditis in a Young Adult due to Lactococcus lactis: A Case Report and Review of the Literature

Infective endocarditis (IE) is a condition mainly associated with valvular disease or prosthetic valve and intravenous drug use as a risk factor. Here, we describe a rare case of a previously healthy patient with endocarditis due to Lactococcus lactis associated with cattle contact, where antibiotic treatment resulted in full recovery.

http://ift.tt/2FhIiVx

A Seizure and Hemiplegia following Contrast Exposure: Understanding Contrast-Induced Encephalopathy

Contrast-induced encephalopathy is a rare, reversible phenomenon known to occur after intravenous or intra-arterial contrast exposure. This report describes a case involving a 73-year-old female admitted for an elective thoracic aortic aneurysm repair. During the procedure, a large volume of nonionic iodinated contrast was necessary for arteriography. Postoperatively, the patient developed seizure activity followed by left-sided hemiplegia. Computed tomography (CT) of the brain without contrast and magnetic resonance imaging (MRI) were negative for acute stroke but did show residual contrast surrounding the brain. Antiepileptic medications were administered with resolution of the seizure activity. The patient was treated with supportive management and improved to baseline over the next seven days. This case demonstrates a rare, nonionic iodinated contrast-induced encephalopathy with seizure activity and transient hemiplegia. The unique imaging findings differentiate it from other neurologic conditions.

http://ift.tt/2taIXTI

Detection of GSK-3β activation index in pediatric chronic tonsillitis is an indicator for chronic recurrent inflammation

Chronic tonsillitis (TC) is among the most common bacterial diseases in pediatric otolaryngology. We aimed to evaluate the expression of glycogen synthase kinase 3β (GSK-3β) in a cohort of children with chronic tonsillitis (TC), and the correlation between GSK-3β activity index and inflammatory profiles of TC.

http://ift.tt/2GXN6wn

Dynamic imaging with sialography combined with sialendoscopy to manage a foreign body in Stensen's duct

We describe sialography as a dynamic imaging modality useful in establishing the diagnosis and planning for treatment of a parotid gland ductal foreign body.

http://ift.tt/2F9sCo7

Transoral robotic excision of laryngeal papillomas with Flex® Robotic System — A novel surgical approach

Recurrent respiratory papillomatosis results in hoarseness, stridor and airway obstruction. Management is surgical, with most surgeons using microdebrider or laser. Transoral robotic surgery (TORS) has been successfully utilised for the excision of oropharyngeal malignancies and paediatric airway surgery. This is the first case report of TORS being used for the excision of laryngeal papillomas.

http://ift.tt/2CXbf3E

Does blindness affect ocular vestibular evoked myogenic potentials?

The aim of the present study was to investigate the influence of blindness on ocular vestibular evoked myogenic potentials (oVEMP) responses.

http://ift.tt/2FbspjY

Support device for percutaneous endoscopic gastrostomy tube

During the treatment for head and neck cancer patients often require a percutaneous endoscopic gastrostomy (PEG) to maintain adequate nutritional intake.1 Complications associated with a PEG include leakage,2 widening of the stoma, and dislodgement of the tube.3 These complications may in turn result in the need for placement of a new tube.

http://ift.tt/2CWWPR9

Placement of an arch bar for intermaxillary fixation using two wires for each dental arch

If a single long wire is used for each dental arch it may loosen as the wire stretches,1 and several wires take more time to fix to the arch bars.2 We describe a alternative method of placement using a wire 20–25cm long for each side of each dental arch. This prevents loosening of the arch bar and reduces the time taken to do it.

http://ift.tt/2F8E2rW

Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal

Publication date: Available online 8 February 2018
Source:Autoimmunity Reviews
Author(s): Maurizio Cutolo, Karin Melsens, Sara Wijnant, Francesca Ingegnoli, Kristof Thevissen, Filip De Keyser, Saskia Decuman, Ulf Müller-Ladner, Yves Piette, Valeria Riccieri, Nicola Ughi, Els Vandecasteele, Amber Vanhaecke, Vanessa Smith
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.



http://ift.tt/2GXGTR9

Prefabricated fibula free flap with dental implants for mandibular reconstruction

Publication date: Available online 2 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Pauchet, J.-L. Pigot, F. Chabolle, C.-A. Bach
Free fibula transplant is routinely used for mandibular reconstruction in head and neck cancer. Dental rehabilitation, the objective of mandibular reconstruction, requires the use of dental implants as supports for fixed or removable dentures. Positioning of fibular bone grafts and implants determines implant osseointegration and the possibilities of dental rehabilitation.Prefabrication of a fibula free flap with dental implants prior to harvesting as a free flap can promote implant osseointegration. The position of the implants must then be precisely planned.Virtual surgery and computer-assisted design and prefabrication techniques are used to plan the reconstruction and then reproduce this planning by means of tailored fibula and mandible cutting guides, thereby ensuring correct positioning of fibular bone fragments and implants.The prefabricated fibula free flap technique requires two surgical procedures (prefabrication and flap transfer) and precise preoperative planning.Prefabricated fibula free flap with dental implants, by improving the quality of osseointegration of the implants before flap transfer, extends the possibilities of prosthetic rehabilitation in complex secondary mandibular reconstructions.



http://ift.tt/2H2odjb

Age-associated distribution of normal B-cell and plasma cell subsets in peripheral blood

Publication date: Available online 2 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Elena Blanco, Martín Pérez-Andrés, Sonia Arriba-Méndez, Teresa Contreras-Sanfeliciano, Ignacio Criado, Ondrej Pelak, Ana Serra-Caetano, Alfonso Romero, Noemí Puig, Ana Remesal, Juan Torres Canizales, Eduardo López-Granados, Tomas Kalina, Ana E. Sousa, Menno Van Zelm, Mirjam Van der Burg, Jacques J.M. van Dongen, Alberto Orfao
BackgroundHumoral immunocompetence develops stepwise throughout life and contributes to individual susceptibility to infection, immunodeficiency, autoimmunity and neoplasia. Immunoglobulin heavy chain (IgH)-isotype serum levels can partly explain such age-related differences, but their relationship with the IgH-isotype distribution within memory B-cell (MBCs) and plasma cell (PCs) compartments remains to be investigated.ObjectiveWe studied the age-related distribution of MBCs and PCs expressing different IgH-isotypes, in addition to the immature/transitional and naive B-cell compartments.MethodsB-cell and PC subsets, and plasma IgH-isotype levels, were studied in cord blood (CB, n=19) and peripheral blood (n=215) from healthy donors aged 0-90y by flowcytometry and nephelometry, respectively.ResultsIgH-switched MBCs expressing IgG1,2,3 and IgA1,2 were already detected in CB and newborns at very low counts, while CD27⁺ IgM⁺⁺D⁺ MBCs only became detectable at 1-5months(m), remaining stable until 2-4y, and IgD MBCs peaked at 2-4y, both populations decreasing thereafter. MBCs expressing IgH-isotypes of the second IGH-constant (IGHC) gene-block (IgG1, IgG3 and IgA1) peaked later during childhood (2-4y), while MBCs expressing third IGHC gene-block Ig-isotypes (IgG2, IgG4 and IgA2) reached their maximum during adulthood. PCs were already detected in newborns, increasing until 6-11m for IgM, IgG1-3 and IgA1-2, until 2-4y for IgD and until 5-9y for IgG4, decreasing thereafter. For most IgH-isotypes (except IgD and IgG4), maximum plasma levels were reached after PCs and MBCs peaked.ConclusionsPCs reach maximum values early in life, followed by MBCs and plasma IgH-isotypes. Importantly, IgH-isotypes from different IGHC gene-blocks show different patterns, probably reflecting consecutive cycles of IgH-isotype-switch recombination through life.

Graphical abstract

http://ift.tt/2F9r5OB

Support device for percutaneous endoscopic gastrostomy tube

Publication date: Available online 3 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Dunn, B. Hamilton, A. Burns




http://ift.tt/2FhwOBs

Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex

Publication date: Available online 2 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Nigel R. Johnson, Navin R. Singh, Mehmet Oztel, Venkat N. Vangaveti, Benjamin B. Rahmel, Lakshmi Ramalingam
Our aim was to evaluate ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex that required operative treatment, and we collected data retrospectively over a period of five years (2012-2016 inclusive). Of the 190 patients, 162 were male with a median age of 31 (IQR 25 -39) years. Assault was the most common mechanism of injury (125/190, 66%). Minor ophthalmic injuries (those unlikely to cause permanent visual disturbance) and major ophthalmic injuries (those with the potential to cause permanent visual disturbance) were recorded. The common minor ophthalmic injuries were: diplopia, enophthalmos, proptosis, subconjunctival haemorrhage, and restriction of the extraocular muscles. Commotio retinae, traumatic mydriasis, retro-orbital haemorrhage, and hyphaema were the common major ophthalmic injuries. All 13 different major ophthalmic injuries were recorded in the group who had had orbital fractures reconstructed, which suggested that more intraocular damage can be caused by this type of fracture than by others. Visual acuity was reduced in 26/190 patients with only four having persistent postoperative changes at six weeks. The odds ratio for those patients who had a major ophthalmological injury and were unable to drive was 0.07 (95% CI 0.02 to 0.21, p=0.001), which was highly significant. Ophthalmological assessment is strongly recommended for patients with fractures of the orbitozygomaticomaxillary complex.



http://ift.tt/2tbmYfB

Retrobulbar abscess: rare complication after repair of an oroantral communication

Publication date: Available online 2 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Mahmood, H. Flora, C. Murphy, D. Sutton
We present the case of a retrobulbar abscess that developed secondary to the repair of an oroantral communication. Orbital abscesses have been described in relation to odontogenic infections, facial injury, sinusitis, and after dental extractions but, to the best of our knowledge, none has been reported in these circumstances. Retrobulbar abscess is a rare complication, but early clinical and radiological diagnosis, and urgent decompression are vital because it comes with considerable risk of irreversible visual impairment.



http://ift.tt/2FnaNRP

Placement of an arch bar for intermaxillary fixation using two wires for each dental arch

Publication date: Available online 3 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ashwant Kumar Vadepally




http://ift.tt/2tgOVT8

Detection of GSK-3β activation index in pediatric chronic tonsillitis is an indicator for chronic recurrent inflammation

Publication date: Available online 3 March 2018
Source:American Journal of Otolaryngology
Author(s): Gao Yunfei, Mi Jiaoping, Chen Fenghong, Liao Zhenpeng, Feng Xiaoshan, Lv Minghui, He Haixin, Cao Yujie, Yan Yan, Zhu Zhe, Fan Yunping, Hong Haiyu
PurposeChronic tonsillitis (TC) is among the most common bacterial diseases in pediatric otolaryngology. We aimed to evaluate the expression of glycogen synthase kinase 3β (GSK-3β) in a cohort of children with chronic tonsillitis (TC), and the correlation between GSK-3β activity index and inflammatory profiles of TC.Materials and methodsThe expression of GSK-3β was comparably evaluated between children with TC (n = 26) and tonsillar hypertrophy (TH, n = 26). GSK-3β expression was detected by immunohistochemistry, RT-qPCR, and Western blot. The inflammatory profiles between the TC and TH groups were also evaluated.ResultsWe found that while GSK-3β was highly expressed in both TC and TH groups, no significant difference were detected at mRNA and protein levels between groups. The protein level of p-GSK-3β was significantly lower in the TC group as compared to the TH group. Additionally, the inflammatory markers, including NF-κB, T-bet, and IFN-γ were higher in the TC group compared to TH group. The GSK-3β activation index was positively correlated with the levels of NF-κB, T-bet, and IFN-γ in the TC group.ConclusionsOur findings suggested that GSK-3β activation index was demonstrated to be a clinically applicable indicator for chronic recurrent inflammation in pediatric TC.



http://ift.tt/2thAiiC

Comparison between burning mouth syndrome patients with and without psychological problems

Publication date: Available online 2 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.-J. Kim, J. Kim, H.-S. Kho
The purpose of this study was to compare clinical and socio-demographic characteristics between burning mouth syndrome (BMS) patients with and without psychological problems. Of 644 patients with symptoms of oral burning, 224 with primary BMS were selected on the basis of laboratory testing, medical history, and psychometric tests: 39 with psychological problems (age 62.5±11.5years) and 185 without psychological problems (age 58.4±11.4years). Comprehensive clinical and socio-demographic characteristics, including psychological profiles and salivary flow rates, were compared between the two groups. No significant difference in sex ratio, duration and diurnal pattern of symptoms, unstimulated whole saliva flow rate, or marital status was found between the groups. The patients with psychological problems had a significantly higher mean age, reduced stimulated whole saliva flow rate, and lower level of education than those without psychological problems. The patients with psychological problems also displayed higher rates and greater severity of various types of BMS-related symptom in most parts of the oral mucosa, higher rates of stress-related symptoms, and greater difficulties in daily activities. The severity of taste disturbance was the factor most significantly correlated with the level of psychometry. In conclusion, psychological problems in BMS patients are associated with an aggravation of BMS symptoms.



http://ift.tt/2FOl8E3

Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report

Descending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrot...

http://ift.tt/2FjUAg8

Evaluation of laser therapy and alpha-lipoic acid for the treatment of burning mouth syndrome: a randomized clinical trial

Abstract

The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) and alpha-lipoic acid (ALA) in the treatment of burning mouth syndrome (BMS) and secondary oral burning (SOB) by unstimulated sialometry, symptom assessment, and measurement of salivary TNF-α levels. Forty-four patients were randomized into four treatment groups: BMS/laser (n = 10), BMS/ALA (n = 5), SOB/laser (n = 15), and SOB/ALA (n = 14). The control group consisted of eight healthy female subjects. Unstimulated salivary flow was measured before and after treatment, and the collected saliva was stored at − 20 °C for the analysis of TNF-α. Symptoms were evaluated before and after treatment using a pain visual analog scale. Most patients were women (81.8%) during menopause (72.2%). LLLT and ALA were efficient in increasing salivary flow only in BMS but provided symptom relief in both conditions. TNF-α levels did not differ between patients with BMS and SOB or between those patients and the control group. No differences were observed in posttreatment TNF-α levels in either condition. The results of this study suggest that LLLT and ALA are efficient therapies in reducing burning mouth symptoms, with LLLT being more efficient than ALA.

http://ift.tt/2oLJC8J

Phototherapy suppresses inflammation in human nucleus pulposus cells for intervertebral disc degeneration

Abstract

The etiology of intervertebral disc (IVD) degeneration accompanied by low back pain (LBP) is largely unknown, and there are no curative therapies. Painful IVD degeneration is associated with infiltrated macrophage-mediated inflammatory response of human nucleus pulposus (NP) cells. The present study aimed to address the hypothesis that pro-inflammatory cytokines derived from macrophages lead to the altered molecular phenotype of human NP cells and to investigate the effects of phototherapy (630, 525, 465 nm with 16, 32, 64 J/cm²) on pain-related cytokine interleukin (IL)-6 and chemokine IL-8 under inflammatory conditions in human NP cells. Human NP cells were treated with soluble factors derived from macrophages in an inflammatory microenvironment, similar to that found in degenerative IVD. Human NP cells were also treated with phototherapy (630, 525, 465 nm with 16, 32, 64 J/cm²), and their cytokine and chemokine levels were detected. The soluble factors caused modulated expression of IL-6, IL-8, and matrix metalloproteinases (MMPs) at the gene and protein levels, causing a shift toward matrix catabolism through the expression of MMPs and increased pain-related factors via preferential activation of the nuclear factor-kappa B (NF-κB) p50 protein. Importantly, phototherapy attenuated the protein and gene expression of pain-related factor IL-6 at all doses and wavelengths. Interestingly, phototherapy also modulated the protein and gene expression of IL-8, which is responsible for the anabolic response, at a wavelength of 465 nm at all doses, in human NP cells. These findings suggested that phototherapy, at an optimal dose and wavelength, might be a useful therapeutic tool to treat IVD degeneration.

http://ift.tt/2HX35vY

Tumor-associated myeloid cells promote tumorigenesis of non-tumorigenic human and murine prostatic epithelial cell lines

Abstract

The etiology of prostate cancer is poorly understood, but it is a multi-step process that has been linked to environmental factors that induce inflammation within the gland. Glands of prostate cancer patients frequently contain multiple zones of disease at various stages of progression. The factors that drive disease progression from an indolent benign stage to aggressive disease are not well-defined. Prostate inflammation and carcinoma are associated with high levels of myeloid cell infiltration; these cells are linked to disease progression in other cancers, but their role in prostate cancer is unclear. To determine whether myeloid cells contribute to prostate cancer progression, the ability of prostate tumor-associated CD11b⁺ cells (TAMC) to drive prostate epithelial cell tumorigenesis was tested. Co-culture of CD11b⁺ TAMC with non-tumorigenic genetically primed prostate epithelial cells resulted in stable transformation and induction of tumorigenesis. RNA sequencing identified the IL-1α pathway as a potential molecular mechanism responsible for tumor promotion by TAMC. Inhibition of IL-1α delayed growth of TAMC-induced tumors. Further analysis showed that IL-1α inhibition led to decreased angiogenesis within tumors, suggesting that IL-1α promotes prostate tumor progression, potentially through augmentation of angiogenesis.

http://ift.tt/2oLHvBW