Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?

Abstract

Cervical lymphadenopathy frequently poses a diagnostic challenge as neither clinical nor imaging assessment can reliably differentiate between benign and malignant lymphadenopathy. Non-invasive differentiation between the two may help to reduce the number of FNAC or biopsy. The purpose of this study was to evaluate whether the new ARFI technique (Virtual Touch Quantification), in conjunction with gray scale sonography and Doppler, can help in the characterization and differentiation of benign from malignant cervical lymphadenopathy. Fifty adult patients with cervical lymphadenopathy were included in the study and sonoelastography was done. Sonoelastographic findings were compared to the gold standard histopathology or cytopathology. ARFI measurements in benign and malignant enlarged lymph nodes were compared using the Student t test and ROC curve was used to arrive at the Youden index, sensitivity, specificity, PPV, NPV and diagnostic accuracy. Sonographic patterns indicative of malignancy includes heterogenous echopattern, short axis/long axis ratio > 0.5, absent echogenic fatty hilum and mixed vascular pattern. Sensitivity, specificity, PPV, NPV and accuracy in differentiation between the benign and malignant lymph nodes using ARFI elastography was 79.17, 100, 100, 83.9 and 89.9% respectively. ROC curve analysis of SWVs for differentiation between the malignant and benign lymph nodes gave a cut-off value of 2.8 m/s with an area under curve of 0.892. ARFI imaging technique quantifies the tissue stiffness of the cervical lymph nodes non-invasively and aids in characterisation and differentiation of benign from malignant cervical lymphadenopathy in conjunction with conventional sonography.

http://ift.tt/2HF51YZ

Cochlear Implantation in Children with Otitis Media

Abstract

One of the concerns during the cochlear implant candidacy process is the presence of chronic otitis media which could delay the implantation process. The aim of this study was to evaluate the surgical difficulties and the long-term complications in children with otitis media and to examine whether it is necessary to delay the implantation until the infection is resolved. The study used a comparative retrospective design based on chart review of all patients who received their implant(s) from January to December of 2012. A total of 200 patients were identified and were followed for 4 years post surgery. Patients were divided into three groups based on their history of otitis media (non-otitis media, chronic otitis media with effusion, and acute otitis media). Data included long-term complications, operative time and duration from first clinical visit to the time until implantation was received. None of study participants had long-term complications during the study period. The operative time was longer in the acute otitis media group with a difference of 45 min. The average delay in cochlear implantation due to the presence of otitis media in chronic group was more than 5 months. Pediatric patients with otitis media could be implanted in one stage safely and effectively.

http://ift.tt/2pofyBp

BRAF and RAS Mutational Status in Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and Invasive Subtype of Encapsulated Follicular Variant of Papillary Thyroid Carcinoma in Korea

Thyroid, Ahead of Print.


http://ift.tt/2HIdHhr

A Nomogram Based on the Characteristics of Metastatic Lymph Nodes to Predict Papillary Thyroid Carcinoma Recurrence

Thyroid, Volume 28, Issue 3, Page 301-310, March 2018.


http://ift.tt/2pjfVwK

Mild Maternal Hypothyroxinemia During Pregnancy Induces Persistent DNA Hypermethylation in the Hippocampal Brain-Derived Neurotrophic Factor Gene in Mouse Offspring

Thyroid, Volume 28, Issue 3, Page 395-406, March 2018.


http://ift.tt/2HGmsZ8

Acknowledgment of Reviewers

Thyroid, Volume 28, Issue 3, Page 422-426, March 2018.


http://ift.tt/2plj3bq

Effect of Thyroglobulin Autoantibodies on the Metabolic Clearance of Serum Thyroglobulin

Thyroid, Volume 28, Issue 3, Page 288-294, March 2018.


http://ift.tt/2HEYNs6

Ionizing Radiation Deregulates the MicroRNA Expression Profile in Differentiated Thyroid Cells

Thyroid, Volume 28, Issue 3, Page 407-421, March 2018.


http://ift.tt/2FEQsIx

Future Meetings

Thyroid, Volume 28, Issue 3, Page 427-428, March 2018.


http://ift.tt/2HGdeMC

Clinicopathologic and Prognostic Significance of Programmed Cell Death Ligand 1 Expression in Patients with Non-Medullary Thyroid Cancer: A Systematic Review and Meta-Analysis

Thyroid, Volume 28, Issue 3, Page 349-361, March 2018.


http://ift.tt/2piR5gI

Temporal Trends in the Presentation, Treatment, and Outcome of Medullary Thyroid Carcinoma: An Israeli Multicenter Study

Thyroid, Volume 28, Issue 3, Page 369-376, March 2018.


http://ift.tt/2HCZD8E

Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?

Abstract

Cervical lymphadenopathy frequently poses a diagnostic challenge as neither clinical nor imaging assessment can reliably differentiate between benign and malignant lymphadenopathy. Non-invasive differentiation between the two may help to reduce the number of FNAC or biopsy. The purpose of this study was to evaluate whether the new ARFI technique (Virtual Touch Quantification), in conjunction with gray scale sonography and Doppler, can help in the characterization and differentiation of benign from malignant cervical lymphadenopathy. Fifty adult patients with cervical lymphadenopathy were included in the study and sonoelastography was done. Sonoelastographic findings were compared to the gold standard histopathology or cytopathology. ARFI measurements in benign and malignant enlarged lymph nodes were compared using the Student t test and ROC curve was used to arrive at the Youden index, sensitivity, specificity, PPV, NPV and diagnostic accuracy. Sonographic patterns indicative of malignancy includes heterogenous echopattern, short axis/long axis ratio > 0.5, absent echogenic fatty hilum and mixed vascular pattern. Sensitivity, specificity, PPV, NPV and accuracy in differentiation between the benign and malignant lymph nodes using ARFI elastography was 79.17, 100, 100, 83.9 and 89.9% respectively. ROC curve analysis of SWVs for differentiation between the malignant and benign lymph nodes gave a cut-off value of 2.8 m/s with an area under curve of 0.892. ARFI imaging technique quantifies the tissue stiffness of the cervical lymph nodes non-invasively and aids in characterisation and differentiation of benign from malignant cervical lymphadenopathy in conjunction with conventional sonography.

http://ift.tt/2HF51YZ

Cochlear Implantation in Children with Otitis Media

Abstract

One of the concerns during the cochlear implant candidacy process is the presence of chronic otitis media which could delay the implantation process. The aim of this study was to evaluate the surgical difficulties and the long-term complications in children with otitis media and to examine whether it is necessary to delay the implantation until the infection is resolved. The study used a comparative retrospective design based on chart review of all patients who received their implant(s) from January to December of 2012. A total of 200 patients were identified and were followed for 4 years post surgery. Patients were divided into three groups based on their history of otitis media (non-otitis media, chronic otitis media with effusion, and acute otitis media). Data included long-term complications, operative time and duration from first clinical visit to the time until implantation was received. None of study participants had long-term complications during the study period. The operative time was longer in the acute otitis media group with a difference of 45 min. The average delay in cochlear implantation due to the presence of otitis media in chronic group was more than 5 months. Pediatric patients with otitis media could be implanted in one stage safely and effectively.

http://ift.tt/2pofyBp

Immune signatures predicting responses to immunomodulatory antibody therapy

Graham Pawelec

http://ift.tt/2tUCGff

Yet Another Absolute Indication for Rapid Sequence Intubation

No abstract available

http://ift.tt/2phVNdK

The ASA Committee for Neuroanesthesia and Anesthesia Quality Institute: Report for Demographic Patterns for Neurosurgical Anesthesia Practice in the United States

No abstract available

http://ift.tt/2IxPXgW

Neuroanesthesiology Update

We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. We cover the following broad topics: general neurosurgery, spine surgery, stroke, traumatic brain injury, monitoring, and anesthetic neurotoxicity.

http://ift.tt/2pk7pNs

Neuroanesthesia

No abstract available

http://ift.tt/2Iw6e6d

Dexmedetomidine Reduces Perioperative Opioid Consumption and Postoperative Pain Intensity in Neurosurgery: A Meta-analysis

Background: Dexmedetomidine (DEX) has been administered to patients during neurosurgery. Some studies have found that DEX could reduce perioperative opioid consumption and postoperative pain intensity. However, no firm conclusions have been reached. The purpose of this meta-analysis was to assess the efficacy of DEX for managing pain in neurosurgical patients. Materials and Methods: A comprehensive literature review was conducted to identify randomized controlled trials (RCTs) focusing on the effects of DEX on perioperative opioid consumption and postoperative pain intensity in patients undergoing neurosurgery. PubMed, the Web of science, the Cochrane Library, and Scopus were searched. The resulting data were combined to calculate the pooled mean differences (MDs), standard MDs or odds ratios (ORs), and 95% confidence intervals (CIs), as appropriate. Heterogeneity and potential publication bias were assessed. Furthermore, a trial sequential analysis was performed to improve the precision of our findings. Results: A total of 11 published RCTs involving 674 patients undergoing neurosurgery (335 patients, 339 controls) were included in this meta-analysis. There were significant differences in postanesthesia care unit (PACU) visual analog scale scores between the groups (MD=−1.54, 95% CI, −2.33 to 0.75, I2=87%, P=0.0001). In addition, there were significant differences in PACU opioid requirements between the treatment and control groups (standard MD=−0.88, 95% CI, −1.74 to 0.02, I2=91%, P=0.05). Furthermore, intraoperative opioid consumption was significantly reduced in the treatment group (MD=−127.75, 95% CI, −208.62 to 46.89, I2=98%, P=0.002). Conclusions: DEX could reduce perioperative and PACU opioid consumption as well as postoperative pain intensity.

http://ift.tt/2phVFeg

Patient, Surgeon, and Anesthesiologist Satisfaction: Who has the Priority?

No abstract available

http://ift.tt/2Iw6fqN

Injury and Liability Associated With Spine Surgery

Background: Although spine surgery is associated with significant morbidity, the anesthesia liability profile for spine surgery is not known. We examined claims for spine procedures in the Anesthesia Closed Claims Project database to evaluate patterns of injury and liability. Materials and Methods: A retrospective cohort study was performed. Inclusion criteria were anesthesia claims provided for surgical procedures in 2000 to 2014. We compared mechanisms of injury for cervical spine to thoracic or lumbar spine procedures using χ2 and the Fisher exact test. Univariate and multivariate logistic regression analyses were used to determine factors associated with permanent disabling injury in spine surgery claims. Results: The 207 spine procedure (73% thoracic/lumbar; 27% cervical) claims comprised >10% of claims. Permanent disabling injuries to nerves, the spinal cord, and the eyes or visual pathways were more common with spine procedures than in nonspine procedures. Hemorrhage and positioning injuries were more common in thoracic/lumbar spine claims, whereas difficult intubation was more common in cervical spine claims. Multiple logistic regression demonstrated prone positioning (odds ratio=3.50; 95% confidence interval, 1.30-9.43) and surgical duration of ≥4 hours increased the odds of severe permanent injury in spine claims (odds ratio=2.73; 95% confidence interval, 1.11-6.72). Conclusions: Anesthesia claims related to spine surgery were associated with severe permanent disability primarily from nerve and eye injuries. Prone positioning and surgical duration of ≥4 hours were associated with permanent disabling injuries. Attention to positioning, resuscitation during blood loss, and reducing length of surgery may reduce these complications.

http://ift.tt/2phVAY0

Editorial

No abstract available

http://ift.tt/2IvyxBN

Effects of Hypertonic Saline and Sodium Lactate on Cortical Cerebral Microcirculation and Brain Tissue Oxygenation

Background: Hyperosmolar solutions have been used in neurosurgery to modify brain bulk. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of hypertonic saline (HTS) and sodium lactate (HTL) on cerebral cortical microcirculation and brain tissue oxygenation in a rabbit craniotomy model. Methods: Rabbits (weight, 1.5 to 2.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=9), half-molar sodium lactate (group HTL, n=10), or normal saline (group C, n=9). Brain tissue partial pressure of oxygen (PbtO2) and microcirculation in the cerebral cortex using sidestream dark-field imaging were evaluated before, 20 and 40 minutes after 15 minutes of hyperosmolar solution infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of sidestream dark-field image recording. Results: No differences in the microcirculatory parameters were observed between the groups before and after the use of osmotherapy. Brain tissue oxygen deteriorated over time in groups C and HTL, this deterioration was not significant in the group HTS. Conclusions: Our findings suggest that equivolemic, equiosmolar HTS and HTL solutions equally preserve perfusion of cortical brain microcirculation in a rabbit craniotomy model. The use of HTS was better in preventing the worsening of brain tissue oxygen tension.

http://ift.tt/2phVxLO

Prone Position, Cerebral Oximetry, and Delirium

No abstract available

http://ift.tt/2IxZmVN

Comparison of 3% Hypertonic Saline and 20% Mannitol for Reducing Intracranial Pressure in Patients Undergoing Supratentorial Brain Tumor Surgery: A Randomized, Double-blind Clinical Trial

Background: In the present study, we hypothesized that 3% hypertonic saline (HS) is more effective than 20% mannitol to reduce intracranial pressure (ICP) and to modify brain bulk in patients undergoing an elective supratentorial craniotomy. Materials and Methods: After institutional review board approval, patients scheduled to undergo supratentorial craniotomy were enrolled into this prospective, randomized, double-blind study. The patients were monitored for routine hemodynamic parameters, depth of anesthesia, and ICP. They received 5 mL/kg 20% mannitol (n=20) or 3% HS (n=19) as infusion for 15 minutes. The patients' ICP values were monitored during hypertonic fluid infusion and throughout 30 minutes after infusion as a primary outcome. Secondary outcomes were hemodynamic variables, serum sodium value, blood gases, and surgeon brain relaxation assessment score (1=relaxed, 2=satisfactory, 3=firm, 4=bulging). In addition, the length of intensive care unit and hospital stay were recorded. Results: Demographic and tumor characteristics were similar between groups. The basal (before hypertonic infusion, ICPT0) and last (30 min after hypertonic infusion finished, ICPT45) ICP values were 13.7±3.0 and 9.5±1.9 mm Hg, respectively, for the M group, which were comparable with the corresponding levels of 14.2±2.8 and 8.7±1.1 mm Hg in the HS group (P>0.05). The median amount of ICP reduction between T0 and T45 timepoints were 4 (1 to 7) and 5 (1 to 9) mm Hg for group M and group HS, respectively (P=0.035). Baseline central venous pressure, pulse pressure variation, and serum sodium and lactate values were similar between groups, but the last measured pulse pressure variation and lactate value were lower, and sodium value was higher in group HS than in group M (P

http://ift.tt/2phVwaI

A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery: An Untouched Aspect of the Meta-Analysis

No abstract available

http://ift.tt/2Iw1A89

Comparison of Anesthetic Management and Outcomes in Patients Having Either Transnasal or Transoral Endoscopic Odontoid Process Surgery

Background: Endoscopic neurosurgical procedures involving the upper cervical vertebrae are challenging due to a narrow operating field and close proximity to vital anatomical structures. Historically, transoropharyngeal (transoral) endoscopy has been the preferred approach. More recently, however, an endoscopic transnasal approach was developed as an alternative method in hopes to reduce postoperative dysphagia, a common complication following transoral neurosurgery. Methods: Twenty-two endoscopic neurosurgical cases involving the odontoid or C1 vertebra were reviewed between January 1, 2005 and December 31, 2015 (17 and 5 through transoral and transnasal approaches, respectively). Patient demographics, anesthetic technique, intraoperative course, and postoperative outcomes such as were recorded. Results: Patients who underwent transnasal odontoidectomy had a shorter length of stay and lower rates of tracheostomy compared with those having similar surgery via the transoral route. In those having transoral surgery, no patient presented to the operating room with a preexisting tracheostomy. In 16 of 17 patients within the transoral group, a tracheostomy was performed. In those having transnasal surgery, 2 of 5 patients had a preexisting tracheostomy. In the remaining 3 of 5 patients, orotracheal intubation was performed and patients were extubated after the procedure. Conclusions: The transnasal odontoid resection technique may become a more popular surgical approach without increasing rates of complications compared with those having transoral surgery. Ultimately, a larger, study is needed to further clarify these relationships.

http://ift.tt/2phVtvy

Spectrogram Analysis as a Monitor of Anesthetic Depth in a Pediatric Patient

No abstract available

http://ift.tt/2IxZmFh

Journal Club

No abstract available

http://ift.tt/2phVoIg

2017 SNACC Annual Meeting Report

No abstract available

http://ift.tt/2IyAkpQ

Association between odontogenic conditions and maxillary sinus mucosal thickening: a retrospective CBCT study

Abstract

Objectives

This study aimed to assess the maxillary sinus mucosal thickening and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images.

Materials and methods

CBCT images of 294 patients (143 female, 151 males; age range 18–78 years) with 588 maxillary sinuses were evaluated retrospectively. The anatomic relationship between maxillary sinuses and teeth was determined and classified. The presence of root canal fillings and the periapical lesions of these teeth was also recorded. Sinus mucosal thickenings were classified as grade 1 (normal) (< 2 mm), grade 2 (moderate) (2–10 mm), and grade 3 (severe) (> 10 mm). Alveolar bone loss was measured on all maxillary premolar/M teeth.

Results

More than 2-mm mucosal thickening (grade 2 and grade 3) in either one or both maxillary sinuses was found in 172 (58.5%) of the patients. The prevalence of mucosal thickening (> 2 mm) for maxillary sinuses with and without any periapical lesions was 42.1 and 53.6%, respectively (p < 0.05). The prevalence of mucosal thickening increased in patients with periodontal alveolar bone loss (p < 0.05). There was a significant correlation between mucosal thickening with age, gender and missing teeth (p < 0.05).

Conclusions

Multiple conditions, including periapical infection, root canal treatment, and close relationship maxillary teeth and sinus, may have a precursor effect on the occurrence of mucosal thickening in the maxillary sinus. Periodontal status and its role as a risk factor in triggering maxillary sinus infections should be also considered by not only dental professionals but also the medical professionals to plan for the treatment of maxillary sinus lesions.

Clinical relevance

Maxillary sinuses are significantly influenced by various odontogenic conditions, including periodontal bone loss, periapical lesions, and missing teeth, which may result in thickening of the maxillary sinus mucosa.

http://ift.tt/2FZRMVx

Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study

This study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI.

http://ift.tt/2plIqZV

Antidromic neurogenic activity and cutaneous bacterial flora

Abstract

By its size and diversity, the cutaneous microbial flora is the second of the human body and there is a growing body of research showing its key role in cutaneous homeostasis. However, skin is also the first neuroendocrine organ and it is now demonstrated that bacteria can sense a multitude of human hormones and neurotransmitters. Then, besides of the intrinsic effect of their virulence factors on cutaneous neurogenic activity, recent data demonstrate that the virulence, invasion potential, and biofilm formation activity of some of the principal species of the cutaneous bacteria flora are directly controlled by neuropeptides released by sensory nerve endings including substance P and calcitonin gene-related peptide. Other factors involved in skin inflammation, such as atrial natriuretic peptides, vasoactive intestinal peptide, neuropeptide Y, and histamine should also directly and indirectly participate to the control of the cutaneous microbial flora. Herein, we highlight some of the more recent studies showing that the skin bacteria are interfering at multiple levels with cutaneous neurogenic inflammation. Understanding this mechanism was leading to the development of new cosmetic products, but this is also a promising route for novel therapeutic strategies for the care of cutaneous inflammatory diseases.

http://ift.tt/2G0CKyM

Environmental exposure to peanut and the risk of an allergic reaction

• Data have shown that peanut butter vapors and smeared peanut butter on skin do not cause systemic reactions; that peanut can be abated from hands and surfaces using appropriate cleaning agents; and that shelled peanut dust does not become airborne• Recent data have suggested that a dose of 1.5mg peanut protein would be generally tolerated by about 95% of the peanut allergic population based on objective symptoms in challenge-based studies• Restrictive policies that focus on bans (or restricted presence in certain areas) of peanuts or peanut-containing products in environments such as schools or on commercial aircraft are not backed by evidence that such measures work

http://ift.tt/2IvL3kB

The multidimensional burden of atopic dermatitis: an update

Atopic dermatitis (AD) is a chronic, inflammatory skin disease affecting 11% of children1 and 5-7% of adults 2,3 in the United States. Consequences of AD include itching, sleep disturbances, and impairment in physical activity and social functioning, affecting both patients and their families 4. AD may also impact academics and choice of occupation. The total annual burden of AD in 2004 USD was estimated to be $4.228 billion, combining direct and indirect costs of care, but this is likely an underestimate of present day costs 5.

http://ift.tt/2pkk1nw

Mycoplasma pneumoniae induces allergy by producing p1-specific IgE

Our previous study found that most of MPP patients had elevated serum total IgE levels.

http://ift.tt/2IvKXcJ

Influence of venous stasis on survival of epigastric flaps in rats

Venous congestion results in tissue damage and remains the most common reason for failure of transfer of microvascular free flaps if it is not recognised early. The purpose of this study was to measure the critical duration of venous congestion and the resultant survival of flaps according to the duration of venous stasis. A standard epigastric flap was raised and repositioned in 35 rats, seven of which acted as controls. The superficial inferior epigastric vein was fully occluded for four, five, six, or seven hours in the rest (n=7 each group).

http://ift.tt/2FRrIIT

Idiopathic condylar resorption

Idiopathic condylar resorption is a well-documented but poorly-understood pathological entity that predominantly affects young women, particularly during the pubertal growth spurt. Several theories have been proposed to explain its aetiopathogenesis, the most favoured of which are the hormonally mediated theory, the theory of avascular necrosis, and the dysfunctional remodelling theory. The condition is diagnosed by a combination of clinical and radiological data as well as elements from the patient's history.

http://ift.tt/2pkLt5q

Early experience of a nurse-led clinic in a tertiary centre

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the "two-week wait" referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of "fast-track" referrals and their potential effect on the overall volume of work.

http://ift.tt/2HCGJyX

NIR laser pointer for in vivo photothermal therapy of murine LM3 tumor using intratumoral China ink as a photothermal agent

Abstract

The photothermal effect is one of the most promising photonic procedures currently under development to successfully treat several clinical disorders, none the least some kinds of cancer. At present, this field is undergoing a renewed interest due to advances in both photothermal materials and better-suited light sources. However, scientific studies in this area are sometimes hampered by the relative unavailability of state-of-art materials or the complexity of setting up a dedicated optical facility. Here, we present a simple and affordable approach to do research in the photothermal field that relies on a commercial NIR laser pointer and a readily available everyday pigment: China ink. A proof-of-concept study is presented in which mice bearing intradermal LM3 mammary adenocarcinoma tumors were successfully treated in vivo employing China ink and the laser pointer. TUNEL and Ki-67 post-treatment tissue assessment clearly indicates the deleterious action of the photothermal treatment on the tumor. Therefore, the feasibility of this simple approach has been demonstrated, which may inspire other groups to implement simple procedures to further explore the photothermal effect.

http://ift.tt/2FMuvmF

Survival of dental implants placed in HIV-positive patients: a systematic review

No consensus has been reached on the use of dental implants in human immunodeficiency virus (HIV)-positive patients. This systematic review evaluated dental implants in HIV-positive patients in terms of implant survival and success rates, marginal bone loss, and complications. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until October 2017.

http://ift.tt/2IxQMGM

Assessing the potential role of scaffold-mediated local chemotherapy in oral cancer

Chemotherapy entails a fine balance between inducing cytotoxicity in cancer cells while preserving the integrity of the normal cells. Chemotherapy, unlike surgery or radiotherapy, is not precisely targeted and leads to non-selective accumulation of drugs in healthy tissues. The past decade has seen the invent of several targeted therapy systems to minimize cytotoxic effects on healthy tissues [1–3]. The nanoparticle-mediated delivery system has gained popularity in the past two decades. Although nanoparticles aid in the targeted delivery of the chemotherapeutic agents, the nanoparticles (Doxil, gold, silver, etc.) themselves have shown to have cytotoxic effects [4–7], thus restricting their use in cancer therapy.

http://ift.tt/2IvKmrD

Myringoplasty in Children for Tympanic Membrane Perforation: Indications, Techniques, Results, Pre- and Post-Operative Care, and Prognostic Factors

Abstract

Purpose of the Review

The aim of this report is to identify the current relevant literature data on myringoplasty for chronic tympanic membrane perforation in children; to expose the different surgical techniques, traditional and recent techniques and to report their indications and results; and to address controversies of age in terms of timing of surgery and as a prognostic factor among many other factors.

Recent Findings

Myringoplasty is an easy and reliable surgery when performed in children in order to repair tympanic membrane perforation. Reported success rate is classically between 32 and 95% while some series have 100% rates. Timing of surgery in terms of age is still controversial and varies among teams related to their own experience.

Summary

Myringoplasty in children has high rates of anatomical and functional success when well indicated. Age has not been found to affect surgery results.

http://ift.tt/2Gzhn5J

Table of Contents (Pantone 286 C)

Publication date: April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 4





http://ift.tt/2tYYkiE

Society Page (Headings are Pantone 286 C; logos are 4/color)

Publication date: April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 4





http://ift.tt/2phEVVb

Information for Readers (Pantone 286 C)

Publication date: April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 4





http://ift.tt/2Dyh5cg

Editorial Board (Pantone 286 C)

Publication date: April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 4





http://ift.tt/2phLTJL

Sound energy absorbance characteristics of cartilage grafts used in type 1 tympanoplasty

Publication date: Available online 16 March 2018
Source:Auris Nasus Larynx
Author(s): Nesibe Gül Yüksel Aslıer, Selhan Gürkan, Mustafa Aslıer, Günay Kirkim, Enis Alpin Güneri, Ahmet Ömer Ikiz
ObjectiveThe purpose of this prospective case-control study is to evaluate the sound energy absorbance characteristics of cartilage grafts in patients, who have undergone type 1 cartilage tympanoplasty.MethodsThirty-four operated ears of 32 patients and 70 ears of 35 control subjects were included. Differences of pure-tone audiometry thresholds and wideband ambient-pressure absorbance ratios with respect to the graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery were analyzed. Receiver operating characteristics curve was generated to detect the absorbance level at which the reconstructed tympanic membrane behaves as 'near-normal tympanic membrane'.ResultsIn the surgical group, wideband energy absorbance ratios at all 1/2-octave band frequencies were significantly worse than normal ears. Energy absorbance ratios at 2000 and 2828Hz frequencies were higher in patients with tragal cartilage grafts. Higher absorbance ratios at 250–750Hz range were obtained in patients with 400μm cartilage graft thickness, <50% cartilage surface area ratio and ≥5 years since surgery. A multivariate generalized linear model revealed common effects of the independent variables at 8000Hz. The receiver operating characteristics analysis generated a cut-off level of 63.20% of sound energy absorbance at 1400Hz with 83% sensitivity and 88% specificity.ConclusionEven though no differences in hearing thresholds were observed; graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery affected the course of sound energy absorbance after type 1 cartilage tympanoplasty as evidenced by wideband tympanometry.



http://ift.tt/2phvzbV

Management Strategies for Oral Potentially Malignant Disorders

Clinicians involved in screening, diagnosing, referring, and/or managing patients with OPMDs should be well versed in the latest standards of care. Joel Laudenbach reviews a recent report.
Medscape Dental & Oral Health

http://ift.tt/2pgtsp8

Keratinocyte Growth Factor (KGF) Modulates Epidermal Progenitor Cell Kinetics through Activation of p63 in Middle Ear Cholesteatoma

Abstract

The basal stem/progenitor cell maintains homeostasis of the epidermis. Progressive disturbance of this homeostasis has been implicated as a possible cause in the pathogenesis of epithelial disease, such as middle ear cholesteatoma. In many cases of stem/progenitor cell regulation, the importance of extracellular signals provided by the surrounding cells is well-recognized. Keratinocyte growth factor (KGF) is a mesenchymal-cell-derived paracrine growth factor that specifically participates in skin homeostasis; however, the overexpression of KGF induces middle ear cholesteatoma. In this study, two kinds of thymidine analogs were transferred at different time points and we investigated the effects of overexpressed KGF on the cell kinetics of stem/progenitor cells in vivo. As a result, BrdU(+)EdU(+) cells (stem/progenitor cells) were detected in the thickened epithelium of KGF-transfected specimens. The use of a high-resolution microscope enabled us to analyze the phosphorylated level of p63 in individual nuclei, and the results clearly demonstrated that BrdU(+)EdU(+) cells are regarded as progenitor cells. In the overexpression of KGF, the stimulation of progenitor cell proliferation was inhibited by SU5402, an inhibitor for tyrosine kinase of KGFR. These findings indicate that KGF overexpression may increase stem/progenitor cell proliferation and block terminal differentiation, resulting in epithelial hyperplasia, which is typical in middle ear cholesteatoma.

http://ift.tt/2pekWqz

Introducing Short Interpulse Intervals in High-Rate Pulse Trains Enhances Binaural Timing Sensitivity in Electric Hearing

Abstract

Common envelope-based stimulation strategies for cochlear implants (CIs) use relatively high carrier rates in order to properly encode the speech envelope. For such rates, CI listeners show poor sensitivity to interaural time differences (ITDs), which are important for horizontal-plane sound localization and spatial unmasking of speech. Based on the findings from previous studies, we predicted that ITD sensitivity can be enhanced by including pulses with short interpulse intervals (SIPIs), to a 1000-pulses-per-second (pps) reference pulse train. We measured the sensitivity of eight bilateral CI listeners to ITD while systematically varying both the rate at which SIPIs are introduced ("SIPI rate") and the time interval between the two pulses forming a SIPI ("SIPI fraction"). Results showed largely enhanced ITD sensitivity relative to the reference condition, with the size of the improvement increasing with decreasing SIPI rate and decreasing SIPI fraction. For the lowest SIPI fraction, insertion of extra pulses brought ITD sensitivity to the level measured for low-rate pulse trains with rates matching the SIPI rates. The results appear promising for the goal of enhancing ITD sensitivity with envelope-based CI strategies by inserting SIPI pulses at strategic times in speech stimuli.

http://ift.tt/2HFidgJ

42 The Epidemiology of Asthma

Publication date: 2019
Source:Kendig's Disorders of the Respiratory Tract in Children
Author(s): Alexander John Henderson
Epidemiology is the study of populations to discover modifiable factors that contribute to disease occurrence and natural history with a view to reducing disease burden through prevention. Asthma is a complex, polygenic disease with heterogeneous manifestations making it difficult to define precisely in population studies. Despite this, global efforts to harmonize outcome definitions have led to detailed understanding of the temporal and spatial variations of asthma prevalence in children. Asthma prevalence notably increased in high-income countries during the final three decades of the 20th century, but the cause for this has never been fully established.Early life has been implicated as a critical period for the development of asthma. Many environmental influences have been considered as potential risk factors for asthma, but few have been associated with more than modest increases in risk. One barrier to identifying causal risk factors is the clustering of environmental factors with consequent confounding of relationships between environment and disease. Thus even strong and reproducible associations can seldom be regarded as causal without experimental evidence, which is generally lacking.Despite these difficulties, new approaches to asthma classification, meticulous observations in birth cohorts, technological advances that enable assignment or genetic risk and identification of biomarkers for disease pathways, and analytical advances have contributed to real advances in understanding asthma pathogenesis. The interaction of allergic sensitization with respiratory viral infections offers a promising target for the development of preventative interventions.



http://ift.tt/2FQf2C6

Stachybotrychromenes A–C: novel cytotoxic meroterpenoids from Stachybotrys sp.

Abstract

In the course of gaining new insights into the secondary metabolite profile of various Stachybotrys strains, in particular concerning triprenyl phenol-like compounds, so far, unknown metabolites with analogous structural features were discovered. Three novel meroterpenoids containing a chromene ring moiety, namely stachybotrychromenes A–C, were isolated from solid culture of the filamentous fungus Stachybotrys chartarum DSMZ 12880 (chemotype S). Their structures were elucidated by means of comprehensive spectroscopic analysis (1D and 2D NMR, ESI-HRMS, and CD) as well as by comparison with spectroscopic data of structural analogues described in literature. Stachybotrychromenes A and B exhibited moderate cytotoxic effects on HepG2 cells after 24 h with corresponding IC₅₀ values of 73.7 and 28.2 μM, respectively. Stachybotrychromene C showed no significant cytotoxic activity up to 100 μM. Moreover, it is noteworthy that stachybotrychromenes A–C are produced not only by S. chartarum chemotype S but also S. chartarum chemotype A and Stachybotrys chlorohalonata.

http://ift.tt/2IuH08v

Smurf1 regulates macrophage proliferation, apoptosis and migration via JNK and p38 MAPK signaling pathways

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Jing Guo, Xiao Qiu, Luo Zhang, Rongfei Wei
Smad ubiquitylation regulatory factor 1 (Smurf1) has been identified to play a critical role in bone homeostasis, development, cell cycle regulation and tumorigenesis. However, the role of Smurf1 in macrophage proliferation, apoptosis and migration is still unclear. Here, we show that Smurf1 expression was elevated in LPS-induced RAW264.7 macrophage and mouse embryonic fibroblasts (MEFs). And we found that knockdown of Smurf1 suppresses macrophage proliferation but promotes apoptosis and migration. Furthermore, JNK and p38 MAPK signaling were upregulated in Smurf1-depleted cells. And inhibition of JNK and p38 MAPK signaling in Smurf1 knockdown cells rescue the phenotypes of macrophage proliferation, apoptosis and migration. Therefore, our study suggests that Smurf1 is a new positive regulator for macrophage proliferation and apoptosis, but a negative regulator for macrophage migration.



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Non-obese type 2 diabetes patients present intestinal B cell dysregulations associated with hyperactive intestinal Tfh cells

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Jingjing Zhou, Yiran Wang, Yifei He, Ye Gao, Renhui Wan, Mengxi Cai, Wenwen Li, Rong Chen, Emma Walker, Xiao Zhai, Qijin Wang
Most current studies of type 2 diabetes (T2D) focus on obesity in the pathogenesis of the disease. However, many individuals develop T2D at non-obese body mass index (BMI) level. It is yet unclear whether certain etiological mechanisms discovered in these obese models can apply to non-obese T2D patients. In the present study, we focused on one aspect that was potentially involved in T2D development, the intestinal inflammation, and examined the difference between non-obese T2D patients and BMI-matched healthy controls. We found that non-obese T2D patients presented significantly higher levels of fecal IgG than BMI-matched controls. Compared to active Crohn's disease patients, both T2D and healthy controls presented lower levels of fecal IgG. In the mucosal biopsies, the B cells and plasmablasts from T2D patients presented a slight but significant increase in the frequencies of cells with surface IgG expression compared to those from healthy individuals. The potential mechanism resulting in increased IgG expression was then examined. The CD4⁺CXCR5⁺ T cells (Tfh) from non-obese T2D patients were highly enriched in IFN-γ-producing cells and depleted in IL-4- and IL-17-producing cells. Presence of mucosal CD4⁺CXCR5⁺ T cells significantly increased IgG production from mucosal samples. Interestingly, when stimulated with E. coli, a common intestinal microbe, the CD4⁺CXCR5⁺ T cells from T2D patients presented significantly higher IFN-γ expression than CD4⁺CXCR5⁺ T cells from BMI-matched controls Together, these results demonstrated that non-obese T2D patients presented a low-grade inflammation in the intestinal tract, possibly supported by bacteria-responding CD4⁺CXCR5⁺ T cells.



http://ift.tt/2pjDUuZ

Keratinocyte Growth Factor (KGF) Modulates Epidermal Progenitor Cell Kinetics through Activation of p63 in Middle Ear Cholesteatoma

Abstract

The basal stem/progenitor cell maintains homeostasis of the epidermis. Progressive disturbance of this homeostasis has been implicated as a possible cause in the pathogenesis of epithelial disease, such as middle ear cholesteatoma. In many cases of stem/progenitor cell regulation, the importance of extracellular signals provided by the surrounding cells is well-recognized. Keratinocyte growth factor (KGF) is a mesenchymal-cell-derived paracrine growth factor that specifically participates in skin homeostasis; however, the overexpression of KGF induces middle ear cholesteatoma. In this study, two kinds of thymidine analogs were transferred at different time points and we investigated the effects of overexpressed KGF on the cell kinetics of stem/progenitor cells in vivo. As a result, BrdU(+)EdU(+) cells (stem/progenitor cells) were detected in the thickened epithelium of KGF-transfected specimens. The use of a high-resolution microscope enabled us to analyze the phosphorylated level of p63 in individual nuclei, and the results clearly demonstrated that BrdU(+)EdU(+) cells are regarded as progenitor cells. In the overexpression of KGF, the stimulation of progenitor cell proliferation was inhibited by SU5402, an inhibitor for tyrosine kinase of KGFR. These findings indicate that KGF overexpression may increase stem/progenitor cell proliferation and block terminal differentiation, resulting in epithelial hyperplasia, which is typical in middle ear cholesteatoma.

http://ift.tt/2pekWqz

Introducing Short Interpulse Intervals in High-Rate Pulse Trains Enhances Binaural Timing Sensitivity in Electric Hearing

Abstract

Common envelope-based stimulation strategies for cochlear implants (CIs) use relatively high carrier rates in order to properly encode the speech envelope. For such rates, CI listeners show poor sensitivity to interaural time differences (ITDs), which are important for horizontal-plane sound localization and spatial unmasking of speech. Based on the findings from previous studies, we predicted that ITD sensitivity can be enhanced by including pulses with short interpulse intervals (SIPIs), to a 1000-pulses-per-second (pps) reference pulse train. We measured the sensitivity of eight bilateral CI listeners to ITD while systematically varying both the rate at which SIPIs are introduced ("SIPI rate") and the time interval between the two pulses forming a SIPI ("SIPI fraction"). Results showed largely enhanced ITD sensitivity relative to the reference condition, with the size of the improvement increasing with decreasing SIPI rate and decreasing SIPI fraction. For the lowest SIPI fraction, insertion of extra pulses brought ITD sensitivity to the level measured for low-rate pulse trains with rates matching the SIPI rates. The results appear promising for the goal of enhancing ITD sensitivity with envelope-based CI strategies by inserting SIPI pulses at strategic times in speech stimuli.

http://ift.tt/2HFidgJ

Quick Take: Examining pediatric intubation

DALLAS — At the 20th EMS State of the Science, a Gathering of Eagles Conference, RJ Frascone, medical director for Regions Hospital EMS in Minnesota asked the audience whether or not it's important to intubate kids, particularly those that are not in cardiac arrest. Frascone discussed his agency's experiences involving pediatric intubation as the organization switched from direct laryngoscope ...

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Ewing sarcoma of the adrenal gland: a case report and review of the literature

Ewing sarcoma/primitive neuroectodermal tumor is a family of highly malignant proliferation of neuroectodermal origin, most often skeletal, adrenal localization is extremely rare. Only few cases have been repo...

http://ift.tt/2G1SVMk

Primary failure of eruption (PFE): a systematic review

Primary failure of eruption (PFE) is a rare disease defined as incomplete tooth eruption despite the presence of a clear eruption pathway. Orthodontic extrusion is not feasible in this case because it results ...

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Epidemiology of asthma-chronic obstructive pulmonary disease overlap (ACO)

Publication date: Available online 15 March 2018
Source:Allergology International
Author(s): Akifumi Uchida, Kohta Sakaue, Hiromasa Inoue
The term "asthma-COPD overlap" (ACO) has been applied to the condition in which a person has persistent airflow limitation with clinical features of both asthma and COPD. The certain definition and diagnostic criteria for ACO have not yet been established, and ACO prevalence has varied widely in studies: from 0.9% to 11.1% in the general population, from 11.1% to 61.0% in asthma patients, and from 4.2% to 66.0% in COPD patients. Furthermore, the frequency of exacerbations and prognosis in ACO patients have not been clearly demonstrated. Although ACO consists with several subgroups of patients with distinct clinical and pathophysiological features, it would be important to propose a standardized definition of and/or diagnostic criteria for ACO based on biomarkers and objective measures, even if it is tentative. It may lead cohort studies with large population or clinical trials around the world.



http://ift.tt/2HGR10V

Asthma and COPD overlap pathophysiology of ACO

Publication date: Available online 15 March 2018
Source:Allergology International
Author(s): Mari Hikichi, Shu Hashimoto, Yasuhiro Gon
Asthma and COPD appear as a result of different mechanisms triggered by different pathogeneses and although they present different features and symptoms of airway inflammation and airway obstruction, there are also cases that present the features of both asthma and COPD. This type of pathology is known as asthma-COPD overlap syndrome (ACOS). Asthma-COPD overlap is identified in clinical practice by the features that it shares with both asthma and COPD. This is not a definition, but a description for clinical use, as asthma-COPD overlap includes several different clinical phenotypes and there are likely to be several different underlying mechanisms". In this paper, the disease that shares several features of both asthma and COPD will be referred to as asthma-COPD overlap (ACO). In this article, we describe the pathogenesis of ACO for understanding the mechanism in asthma and COPD overlap.



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The efficacy of sublingual immunotherapy for allergic diseases in Asia

Publication date: Available online 16 March 2018
Source:Allergology International
Author(s): Xuandao Liu, Chew Lip Ng, De Yun Wang
Sublingual immunotherapy (SLIT) has been proven to be safe and effective from an abundance of Western literature, but data from Asia is less complete. This review aims to examine the basic science, safety and efficacy of SLIT in Asian patients, and to determine future research needs in Asia. We performed a literature search on PUBMED, Scopus, and Cochrane Library database for articles on SLIT originating from Asian countries through Nov 2017. There were 18 randomized, double-blind, placebo-controlled trials, of which 9 involved solely paediatric subjects. Overall, sublingual immunotherapy is safe and is efficacious in Asian populations in allergic rhinitis (AR) and asthma. House dust-mite SLIT is effective in both mono- and polysensitized AR patients. Efficacy of SLIT is comparable to subcutaneous immunotherapy. Data on long term efficacy is lacking. A disproportionate majority of research originates from China and Japan, reflecting an asymmetry of access to SLIT within Asia. Significant disparities exist in the development of the allergy speciality, prescription patterns of SLIT, and pharmacological potencies of different SLIT products within and between Asian nations. We conclude that current available evidence suggests SLIT is efficacious in Asians but data quality of evidence is hampered by non-placebo controlled studies with methodological limitations. More data is needed in South and Southeast Asian populations. Future efforts may be directed towards improving access to SLIT in developing countries, standardization of SLIT dosage, and evaluating long term clinical outcomes.



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Paediatric asthma treatment: what to do when international guidelines' recommendations don't agree?

Publication date: Available online 15 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Désirée E.S. Larenas Linnemann, Margarita Fernández Vega, Jorge Agustín Luna Pech, Jimena Villaverde Rosas, José Antonio Ortega Martell, Blanca Estela del Río Navarro, María del Carmen Cano Salas, Jade Romero Lombard, Erika del Carmen López Estrada, Monica Rodriguez-González, José Luis Mayorga Butrón, Jorge Salas Hernández, Juan Carlos Vázquez García, Ignacio Ortiz Aldana, Mario Humberto Vargas Becerra, Martín Bedolla Barajas, Noel Rodríguez Pérez, Ambrocio Aguilar Aranda, Carlos Adrián Jiménez González, Carlos García Bolaños, Claudia Garrido Galindo, David Alejandro Mendoza Hernández, Enrique Mendoza López, Gerardo López Pérez, Guillermo Hideo Wakida Kuzonoki, Héctor Hernán Ruiz Gutiérrez, Héctor León Molina, Héctor Martínez de la Lanza, Héctor Stone Aguilar, Javier Gómez Vera, Jorge Olvera Salinas, José Joel Oyoqui Flores, José Luis Gálvez Romero, José Santos Lozano Saenz, Juan Ignacio Salgado Gama, Marcos Alejandro Jiménez Chobillon, Martha Angélica García Avilés, Martha Patricia Guinto Balanzar, Miguel Alejandro Medina Ávalos, Robert Camargo Angeles, Rogelio García Torrentera, Saraí Toral Freyre, Gabriel Montes Narvaez, Héctor Solorio Gómez, Juan Rosas Peña, Sergio Jesús Romero Tapia, Adela Reyes Herrera, Francisco Cuevas Schacht, Joaquín Esquer Flores, José Antonio Sacre Hazouri, Lorenzo Compean Martínez, Pablo Julián Medina Sánchez, Sergio Garza Salinas, Carlos Baez Loyola, Iraís Romero Alvarado, José Luis Miguel Reyes, Laura Elizabeth Huerta Espinosa, Manuel Ángel Correa Flores, Ricardo Castro Martínez




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Systematic review of professional liability when prescribing beta-lactams for patients with a known penicillin allergy

Publication date: Available online 15 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Meghan N. Jeffres, Elizabeth A. Hall-Lipsy, S. Travis King, John D. Cleary
ObjectiveTo describe medical negligence and malpractice cases in which a patient with a known penicillin allergy received a beta-lactam and experienced an adverse reaction related to the beta-lactam.Data SourcesLexis-Nexus, Westlaw, and Google Scholar were searched.Study SelectionsMedical negligence and malpractice cases were eligible for inclusion if they met the following criteria: the plaintiff had a known penicillin allergy, received a beta-lactam, and experienced an adverse event. All United States federal and state cases were eligible.ResultsTwenty-seven unique cases met inclusion criteria. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient or representative) prevailed or settled in three cases and defendants (providers) prevailed in seven cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians prior to trial in one case and defendants prevailed in three cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in one case and the legal outcome of the other case is unknown. In cases where the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating a cephalosporin or carbapenem was contraindicated for a patient with a penicillin allergy.ConclusionThe cases with published legal outcomes found limited professional liability for clinicians who prescribed either cephalosporins or carbapenems to a patient with a known penicillin allergy. These results may decrease the litigation fears of providers and risk managers within healthcare systems.



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Soft Tissue Changes Following Combined Anterior Segmental Bimaxillary Orthognathic Procedures

Abstract

Aims & objectives

To analyze the soft tissue response in patients treated by combined anterior segmental bimaxillary procedures.

Methods

A  Prospective, observational and analytical study was carried out for a period of 2 years involving 37 patients with predefined inclusion and exclusion criteria; lateral cephalograms were taken by the same operator on the standardized unit immediately before and 6 months after surgery; hard and soft tissue landmarks were measured in millimeters to both horizontal and vertical reference lines; any differences in distances were recorded as a surgical change; appropriate statistical test was carried; level of significance was p < 0.05.

Results

All patients underwent anterior maxillary osteotomy with 34 anterior mandibular osteotomies, 2 advancement genioplasties and 1 reduction genioplasty. Analysis showed significant angular, horizontal and vertical change. The significant differences in skeletal variables were observed in N–Pg distance, overjet, overbite, U1–NF angle, L1–Mp angle and soft tissue variables like labiomental angle, upper–lower lip protrusion, upper–lower lip length and lower incisor to labrale inferius distance. Nasolabial angle, interlabial gap and upper incisor exposure were extremely significant.

Conclusion

Soft tissue response to surgery is perhaps more predictable after 6 months, so this may be a treatment modality of choice in adult bimaxillary/dentoalveolar protrusion patients who need instant esthetic facial results.

http://ift.tt/2FG5aPt

Adapalene 0.3% Gel Shows Efficacy for the Treatment of Atrophic Acne Scars

Abstract

Introduction

Scarring is an unfortunate clinical outcome of acne. Current treatment options for atrophic acne scars are dominated by non-pharmacological, invasive procedures which may not be suitable or affordable to all patients. This phase II, single-center, open-label, exploratory study assessed the efficacy, safety and subject-reported outcomes of adapalene 0.3% gel in the treatment of atrophic acne scars.

Methods

The study included subjects aged 18–50 years with past history of acne and moderate to severe facial atrophic acne scars. Subjects received adapalene 0.3% gel once daily for the first 4 weeks and twice daily for the following 20 weeks. Assessments were performed at baseline, day 10 and weeks 4, 8, 16 and 24, and at post-treatment follow-ups (weeks 36 and 48–72).

Results

At week 24, investigator and subject assessments reported improvement in skin texture/atrophic scars in 50% and > 80% of subjects, respectively. Subjects were satisfied with the treatment and reported improvements in quality of life.

Conclusion

Daily use of adapalene 0.3% gel for the treatment of atrophic acne scars showed promising clinical efficacy, a favorable tolerability profile, and improvement in quality of life.

Funding

Nestlé Skin Health–Galderma R&D.

Trial Registration

ClinicalTrials.gov Identifier NCT01213199.

http://ift.tt/2GzfzK0

Evaluation of Full-field Coherence Tomography for ex Vivo Staging and Assessment of Superficial Esophageal Squamous Carcinoma: a Pilot Study

Condition:   Esophagus Cancer
Intervention:   Other: Non interventional study
Sponsors:   Nantes University Hospital;   LLTech
Not yet recruiting

http://ift.tt/2HEDEya

Raman Probe for In-vivo Diagnostics (During Oesophageal) Endoscopy

Conditions:   Barrett Esophagus;   Esophageal Cancer
Intervention:   Diagnostic Test: endoscopy
Sponsors:   University of Exeter;   University of Bristol;   Gloucestershire Hospitals NHS Foundation Trust
Not yet recruiting

http://ift.tt/2pfIBae

Pembrolizumab & Cabozantinib in Patients With Head and Neck Squamous Cell Cancer Who Have Failed Platinum Based Therapy

Conditions:   Metastatic Head and Neck Carcinoma;   Paranasal Sinus Squamous Cell Carcinoma;   Recurrent Head and Neck Squamous Cell Carcinoma;   Recurrent Hypopharyngeal Squamous Cell Carcinoma;   Recurrent Laryngeal Squamous Cell Carcinoma;   Recurrent Oral Cavity Squamous Cell Carcinoma;   Recurrent Oropharyngeal Squamous Cell Carcinoma;   Stage IV Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IV Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IV Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IV Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVC Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVC Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IVC Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVC Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Unresectable Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Cabozantinib;   Biological: Pembrolizumab
Sponsors:   Emory University;   Exelixis
Not yet recruiting

http://ift.tt/2HEEPxF

A huge pleomorphic adenoma of the submandibular salivary gland

The most common tumour of salivary gland is pleomorphic adenoma (PA). They are benign, painless, can grow into big tumours but usually do not affect nerves or lymph nodes. PA most commonly occurs in the parotid gland but it may involve submandibular, lingual and minor salivary glands also. They can attain giant proportions and weigh several kilograms. We report a giant PA arising in the submandibular gland and treated by complete surgical excision without any complication. A female patient presented with a tumour in the submandibular region and front of neck with a history of more than 18 years. The weight of the resected mass was 4.35 kg. Patient's fear of surgery and lack of awareness were the main reasons for her long-standing swelling. Such giant PAs of the submandibular gland are very rare in medical literature.

http://ift.tt/2GxELAw

Sequential cataract surgeries in a patient with a left ventricular assist device (LVAD)

The population of patients on left ventricular assist devices (LVADs) has increased significantly since the 1990s, and with it, need for non-cardiac elective surgeries. Presence of an LVAD or heart failure, however, can cause physicians to perceive these patients to be at prohibitively high risk for elective surgery. Nevertheless, as one of the most common causes of poor vision in the elderly, cataracts can significantly limit improvements in quality of life that a patient may have otherwise gained from LVAD support. We describe the case of a 62-year-old man with an LVAD who underwent two uncomplicated sequential cataract surgeries following extensive cardiology evaluations and intraoperative monitoring by anaesthesia without intravenous sedation. The patient reported significant improvement in visual acuity and quality of life. Our case demonstrates the potential benefits of conducting cataract surgery relatively early in the disease course in patients with LVAD devices.

http://ift.tt/2tTKu0Q

Chyluria in young child: a rare presentation

Chyluria, a chronic manifestation of lymphatic filariasis, is rare in children. Clinicians must have a high index of suspicion to diagnose this condition in children as it mimics nephrotic syndrome. We present an unusual case in which a 7-year-old boy hailing from a filarial endemic region presented with a passage of milky urine, which on evaluation was diagnosed as parasitic chyluria. The child showed remission after medical management that persisted until 1 year of follow-up.

http://ift.tt/2GxDYzy

Subscapularis pyomyositis: a rare presentation of shoulder pain

We present a rare case of a subscapularis pyomyositis in a 38-year-old woman and examine the diagnostic and surgical challenges posed. History and examination features were similar to that of septic shoulder arthritis without overlying features of warmth or erythema. Serological markers revealed a C-reactive protein of 221 mg/L and white cell count of 11.1x10⁹/L. A dry shoulder aspirate was obtained. Contrast-enhanced MRI demonstrated a peripheral rim-enhancing lesion within the subscapularis muscle belly with lack of central enhancement. These features are consistently seen with an infective aetiology. A deltopectoral approach to surgical drainage was utilised and subsequent fluid cultures grew Panton–Valentine Leukocidin positive Staphylococcus aureus species. This rare bacterium is associated with an increased risk of osteomyelitis and despite making a full recovery, the patient was advised to reattend if any future shoulder pain was encountered.

http://ift.tt/2tPfSgW

Successful treatment of concomitant metastatic prostate cancer and B-cell non-Hodgkins lymphoma with R-EPOCH chemotherapy regimen and antiandrogen therapy

A 70-year-old man presented with left loin pain without urinary symptoms. Initial investigations with CT showed enlarged para-aortic, mediastinal lymph nodes, right-side renal mass and enlarged prostate. A prostatic-specific antigen (PSA) was alarmingly high at 4750 μg/L (normal <4.0 μg/L). Further investigations included positron emission tomography (PET); both prostate-specific membrane antigen and 18-fluorodeoxyglucose as well as bone scan and bone marrow examination confirmed dual malignancies with B-cell non-Hodgkin's lymphoma (B-NHL) and wide spread metastatic prostatic adenocarcinoma (PA) to the skull, spine, pelvis, liver and lungs. The patient was treated with six cycles of rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin(R-EPOCH) containing regimen for B-NHL and goserelin hormonal therapy for PA. Restaging with PET scans thereafter showed complete remission of NHL with disappearance of his metastatic PA and normalisation of PSA levels. R-EPOCH regimen and antiandrogen therapy resulted in a good outcome and remission of both malignancies.

http://ift.tt/2FWomrw

Intracranial haemangiopericytoma: a rare case presenting with haemorrhage

Description

Haemangiopericytomas (HPCs) are rare intracranial tumours. Until 1993 HPC was considered as an angioplastic variant of meningioma.1 The recently published WHO classification of central nervous system (CNS) tumours classifies HPCs as mesenchymal non-meningothelial tumours combined with solitary fibrous tumours (SFTs), graded 1–3, and it is likely that this nomenclature will further evolve in the future.2 While these are highly vascular tumours, they often present with mass effect. Presentation with haemorrhage is also well described, but not commonly seen in clinical practice; this is partly due to the rarity of these tumours.3 This is only the 14th case presenting with intracranial haemorrhage and only the second case presenting with haemorrhage in the posterior fossa.

A 58-year-old right-handed woman, without significant medical history, presented with sudden-onset occipital headache. Initially she was fully conscious with no neurological deficits, but her clinical status deteriorated quickly, with increasing headache, nausea, vomiting...

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Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children.

Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Lawlor CM, Riley CA, Carter JM, Rodriguez KH

Abstract
Importance: The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Pediatric Otolaryngology Committee recommended that children younger than 3 years be admitted following tonsillectomy. Recommendations for hospital observation were not included as a key action statement in the 2011 AAO-HNS Clinical Practice Guidelines for Tonsillectomy in Children.
Objective: To examine the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery.
Design, Setting, and Participants: This was a multicenter case series study with medical record review of 2139 consecutive children ages 3 to 6 years who underwent tonsillectomy at 1 tertiary care academic center and 5 acute care centers in New Orleans, Louisiana, between 2005 and 2015. Children with moderate to severe developmental delay, bleeding disorders, and other major medical comorbidities were excluded.
Main Outcomes and Measures: Complications examined included respiratory distress, dehydration requiring intravenous fluids, and bleeding.
Results: Of the 2139 patients, 1817 met inclusion criteria. A total of 1011 (55.6%) were male. The mean (SD) age at the time of the procedure was 46 (14) months (range, 12-72 months). The mean weight at the time of the procedure was 17 (5) kg (range, 9-43 kg). A total of 95 patients (5.2%) had a postoperative complication. Of the 455 children younger than 3 years in the study, 32 (7.0%) had complications compared with 63 (4.6%) of the 1362 patients 3 years or older. The odds of having a complication in children younger than 3 years was 1.5 times greater than it was in children 3 years or older (odds ratio [OR], 1.56; 95% CI, 1.00-2.42). When examining total complications, children younger than 3 years were more likely to experience a complication within the first 24 hours after surgery than children 3 years or older (25% vs 9.5%; OR, 3.17; 95% CI, 1.00-10.11). The children admitted to the hospital had a greater risk of complication than those treated as an outpatient, independent of age (6.9% vs 93.0%; OR, 3.49; 95% CI, 2.0.18-6.05). No association between weight and complications was found on logistic regression (area under the curve = 0.5268; P = .66).
Conclusions and Relevance: Healthy children younger than 3 years may be at an increased risk for complication following tonsillectomy. Those children may also be at increased risk for complications within the first 24 hours after surgery compared with children 3 years or older. Our data suggest that complications are independent of weight in these patients. In our cohort, those patients selected for overnight observation were associated with an increased number of adverse events following tonsillectomy, suggesting that clinician judgment is crucial in determining which patients are safe for outpatient tonsillectomy.

PMID: 29543971 [PubMed - as supplied by publisher]

http://ift.tt/2pjHXs7

Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery.

Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Ambrose SE, Ongkasuwan J, Dedhia K, Diercks GR, Anne S, Shashidharan S, Raol N

Abstract
Importance: Vocal fold motion impairment (VFMI) is a known risk factor following congenital heart surgery (CHS). The impact of this diagnosis on utilization and outcomes is unknown.
Objective: To evaluate the cost, postprocedure length of stay (PPLOS), and outcomes for neonates with VFMI after CHS.
Design, Setting, and Participants: A cross-sectional analysis of the 2012 Kids' Inpatient Database (KID) of neonates who underwent CHS was carried out. The KID is an administrative data set of patients, aged 20 years or younger, and contains data on more than 10 million hospitalizations from 44 states. The KID is limited to inpatient hospitalization and contains discharge summary level of data. Patients were limited to those who were born during the hospitalization and those who were aged 28 days or younger at the time of admission for CHS. A weighted total of 4139 neonates who underwent CHS were identified, of which 3725 survived. The proportion of neonates diagnosed with VFMI was 264 (6.92%) of 3725.
Exposures: Congenital heart surgery.
Main Outcomes and Measures: Cost of inpatient hospital stay, postprocedure length of stay, odds of pneumonia, gastrostomy tube placement, and tracheostomy tube placement. Risk-adjusted generalized linear models examined differences in cost and PPLOS between neonates who underwent CHS and were diagnosed with VFMI and those who were not. Risk-adjusted logistic regression compared the odds of selected outcomes (gastrostomy, tracheostomy, pneumonia). Models were weighted to provide national estimates.
Results: Of 3725 neonates (aged 0-28 days), 2203 (59.1%) were male and 1517 (40.7%) were female. Neonates diagnosed with VFMI had significantly higher total cost by $34 000 (95% CI, 2200-65 000) and PPLOS by 9.1 days (95% CI, 4.6-13.7) compared with those who did not. When PPLOS was included as a covariate in the model for cost, presence of VFMI was no longer significant. There were no differences in odds of pneumonia, gastrostomy, or tracheostomy.
Conclusions and Relevance: Vocal fold motion impairment after CHS was associated with significant increases in cost owing to increased PPLOS. These findings provide a foundation to further investigate standardized screening for VFMI following CHS; early identification and treatment may decrease cost and PPLOS.

PMID: 29543970 [PubMed - as supplied by publisher]

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JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 01;144(3):184

Authors:

PMID: 29543968 [PubMed - in process]

http://ift.tt/2DxBqyd

An Aggressive Sinonasal Mass With Parameningeal Extension.

An Aggressive Sinonasal Mass With Parameningeal Extension.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Davis RJ, Allison DB, Mydlarz WK

PMID: 29543960 [PubMed - as supplied by publisher]

http://ift.tt/2phPrvT

Single-Stage Mastoid Obliteration in Cholesteatoma Surgery and Recurrent and Residual Disease Rates: A Systematic Review.

Single-Stage Mastoid Obliteration in Cholesteatoma Surgery and Recurrent and Residual Disease Rates: A Systematic Review.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: van der Toom HFE, van der Schroeff MP, Pauw RJ

Abstract
Importance: The ideal surgical treatment of cholesteatoma has been subject to discussion for years because both traditional surgical techniques (canal wall down [CWD] and canal wall up [CWU] tympanoplasty) have their own advantages and disadvantages. A more recently propagated surgical approach, to combine the CWD or CWU tympanoplasty technique with obliteration of the mastoid and epitympanum, is showing promising results.
Objective: To systematically review the literature on recurrent and residual cholesteatoma rates after single-stage CWU and CWD tympanoplasty with mastoid obliteration.
Evidence Review: A systematic search of literature was performed to identify relevant publications in multiple electronic databases. The initial search was conducted in December 2016 and was updated in July 2017. Each study was reviewed by 2 independent reviewers on predetermined eligibility criteria. The methodological quality was determined using the methodological index for nonrandomized studies (MINORS) scale, and the relevance to the current topic was determined using a 4-criterion checklist.
Findings: The searches identified a total of 336 potentially relevant publications; 190 articles were excluded based on title and abstract. The full-text articles of the remaining 146 citations were assessed for eligibility, resulting in 22 articles. After assessing these remaining articles for methodological quality and relevance to the current topic, another 8 studies were excluded, and a total of 13 studies (1534 patients) were included. Of the 1534 patients who underwent CWD or CWU tympanoplasty with mastoid obliteration, the rate of recurrent disease was 4.6%, and the rate of residual disease was 5.4%. In CWU tympanoplasty with mastoid obliteration, these rates were 0.28% and 4.2%, respectively and in CWD tympanoplasty with mastoid obliteration, 5.9% and 5.8%, respectively.
Conclusions and Relevance: We show the recurrent and residual disease rates after either CWU or CWD tympanoplasty with mastoid obliteration to be qualitatively similar to, if not better than, previously reported rates of for nonobliterative techniques. In this study, the lowest recurrent and residual rates were reported when combining the CWU tympanoplasty with mastoid obliteration, on average 0.28 and 4.2%, respectively.

PMID: 29543959 [PubMed - as supplied by publisher]

http://ift.tt/2GC81pW

Multidisciplinary Clinical Treatment of Head and Neck Cancer.

Multidisciplinary Clinical Treatment of Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Mark JR, Kelly WK, Gomella LG

PMID: 29543958 [PubMed - as supplied by publisher]

http://ift.tt/2HExoqt

Multidisciplinary Clinical Treatment of Head and Neck Cancer-Reply.

Multidisciplinary Clinical Treatment of Head and Neck Cancer-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Townsend M, Nussenbaum B

PMID: 29543957 [PubMed - as supplied by publisher]

http://ift.tt/2pg7hPx

Injectable Soft-Tissue Augmentation for the Treatment of Tracheoesophageal Puncture Enlargement.

Injectable Soft-Tissue Augmentation for the Treatment of Tracheoesophageal Puncture Enlargement.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Tjoa T, Bunting G, Deschler DG

PMID: 29543950 [PubMed - as supplied by publisher]

http://ift.tt/2HGAz0P

JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2017.

JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2017.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 15;:

Authors: Piccirillo JF

PMID: 29543945 [PubMed - as supplied by publisher]

http://ift.tt/2FZsreE

Can I get rid of a mole by myself?

Some people use home remedies to get rid of their moles. However, these remedies have not been proven to be safe or effective. Read on to find out more.

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Biosimilar Drugs for Psoriasis: Principles, Present, and Near Future

Abstract

Psoriasis is a chronic, inflammatory, lifelong disease with a high prevalence (afflicting approximately 1–5% of the population worldwide) and is associated with significant morbidity. The introduction of biologic therapies has improved the management of this disease. Multiple biologic medicines that block cytokine signaling, including tumor necrosis factor (TNF) antagonists (adalimumab, etanercept, and infliximab) and inhibitors of interleukin (IL)-17 (brodalumab, ixekizumab, and secukinumab), IL-23 (guselkumab), or IL-12/23 (ustekinumab), are approved for the treatment of psoriasis. Despite the clinical benefits associated with use of biologics in psoriasis, many patients are not treated with biologic therapy, and access to treatment may be limited for various reasons, such as high treatment costs. Patents for many biologics have expired or will soon expire, and biosimilar versions of these agents are available or in development. A biosimilar is a biological product that is highly similar to an approved biologic (i.e., originator or reference) product, and has no clinically meaningful differences in safety, purity, or potency when compared with the reference product. Biosimilars may offer less expensive treatment options for patients with psoriasis; they also may increase access to and address problems with underutilization of biologic therapy. Biosimilar development and approval follows a well-regulated process in many countries, with guidelines developed by the European Medicines Agency, US Food and Drug Administration, and World Health Organization. Currently, several anti-TNF biosimilars are available for use in patients with psoriasis, and other monoclonal antibodies are in development. This review provides dermatologists and those who treat and/or manage psoriasis with a working knowledge of the scientific principles of biosimilar development and approval. It also examines real-world experience with biosimilars available for or used in dermatology that will enable physicians to make informed treatment decisions for their patients with psoriasis.

Funding: Pfizer Inc.

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Aortic pseudocoarctation: a very rare finding

Description

A 52-year-old Caucasian woman with a history of hypertension since age 30 was referred to cardiology department due to aortic stenosis. She had exertional dyspnoea, without thoracic pain or syncope. There was no blood pressure gradient between upper and lower extremities. Transthoracic echocardiography revealed bicuspid aortic valve, severe valvular aortic stenosis and dilation of ascending aorta (figure 1). There was also a tapering of the descending aorta, with turbulent flow and a systolic peak gradient of 19 mm Hg (figure 2). To assess the thoracic aorta, the patient underwent CT angiography, which revealed elongation of the distal aortic arch, a focal kinking at the aortic isthmus, and absence of significant stenosis and enlarged collateral arteries, consistent with aortic pseudocoarctation (figure 3).

Figure 1

Transthoracic echocardiography. (A) Bicuspid aortic valve with fusion of the right and left cusps and superimposed calcific changes....

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