Micro-computed tomography-based anatomical study of the branch canals in mandibular anterior teeth in a Chinese population

Abstract

Objectives

To analyze the incidence and distribution of branch canals in mandibular anterior teeth.

Materials and methods

Three hundred mandibular anterior teeth, comprising 100 central incisors, 100 lateral incisors, and 100 canines, were scanned using a micro-computed tomography (micro-CT) system. Three-dimensional (3-D) visualization reconstruction of the root canal system and its branch canals was performed on each specimen. Data regarding the number of branch canals, the distance from the anatomical apex to the branch canal, and the orientation of each branch orifice were collected and analyzed.

Results

One hundred and fifty-three primary branch canals and 35 secondary branch canals were detected in the specimens overall. The incidence of branch canals in mandibular anterior teeth was 34%, with the highest incidence (50%) exhibited in mandibular canines, followed by lateral incisors (29%). Of the 153 primary branch canals found in the mandibular anterior tooth samples investigated, 82.35% appeared within 3 mm of the apical region, while 71.90% were labial and lingual canals.

Conclusions

There was regularity in the distribution and orientation of branch canals in mandibular anterior teeth.

Clinical relevance

This knowledge may be employed as a guide in clinical endodontic therapy.

http://ift.tt/2GP7JvK

FDA Clears Tildrakizumab (Ilumya) for Plaque Psoriasis

Tildrakizumab-asmn, a selective interleukin-23 p19 inhibitor given by subcutaneous injection, was shown to be effective for chronic plaque psoriasis in two phase 3 trials.
FDA Approvals

http://ift.tt/2puzZwu

The Use Of Buccal Fat Pad In Surgical Treatment Of ‘Krokodil’ Drug-Related Osteonecrosis Of Maxilla

Publication date: Available online 20 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Koryun Hakobyan, Yuri Poghosyan, Aram Kasyan
'Krokodil' is the street name of a new synthetic drug mixture. It is a light brown liquid that is used intravenously without previous purification. Osteonecrosis of the jaw (ONJ) is a common complication among Krokodil users. Krokodil drug-related ONJ presents as alveolar process exposure in the oral cavity.Surgery is the main method for treatment of Krokodil drug-related ONJ patients. In a study by Poghosyan et al., no cases of recurrence were seen after surgery on the maxilla, but 38% of cases (8/21) developed an oroantral communication after surgical treatment for maxillary osteonecrosis (Poghosyan et al., 2014).The aim of this study is to report on the results of buccal fat pad use in closure of maxillary sinus floor defects after partial maxillary resection in Krokodil drug-related ONJ patients.Six male patients with Krokodil drug-related distal maxillary osteonecrosis were included in this retrospective study. All patients underwent surgical treatment, which included surgical removal of necrotic bone, and closure of formed maxillary sinus floor defects with buccal fat pad and local mucoperiosteal flaps.In all patients the postoperative period was uneventful. After suture removal small areas of buccal fad pad exposure were found in all patients, which epithelialized successfully over the following month. During the postoperative follow-up period (8–12 months) no signs of recurrence were found.



http://ift.tt/2u6ZcSh

Supportive topical tranexamic acid application for hemostasis in oral bleeding events – retrospective cohort study of 542 patisents

Publication date: Available online 20 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Zirk, Max Zinser, Johannes Buller, Viktor Bilinsky, Timo Dreiseidler, Joachim E. Zöller, Matthias Kreppel
PurposeTranexamic acid (TXA) is widely used in the prevention of postsurgical oral bleeding. Tranexamic acid in addition to further surgical measures is widely utilized in prevention of post-surgical oral bleeding. The aim of the present study was to investigate: Can oral hemostasis be achieved by merely compression and topical application of tranexamic acid in different anticoagulant regimes among patients attending a general emergency department? Where are the limits to this procedure? Which has the greater impact on surgeons' choice for an invasive hemostatic approach—bleeding quality or oral anticoagulant therapy?Materials and methodsA retrospective cohort study of 542 patients who consecutively received treatment for oral bleeding was performed. We surveyed the values of the diverse hemostatic approaches. Special attention was granted to patient anticoagulant regimen and quality of the oral bleeding event.ResultsA total of 199 of 542 (36.7%) oral bleeding events were stopped by compression with a gauze or gauze soaked with TXA (4.8%). Stopping an oral bleeding event with wound compression can be improved by factor 1.6 if the gauze is soaked with tranexamic acid (4.8%), p ≤ 0.05. LMWH presented significantly more moderate bleeding than bloody oozing of the wound, p<0.05. The quality of bleeding had a strong influence on oral surgeons' decisions to apply further surgical means. Sutures and native collagen fleeces were the favored methods to stop moderate and severe bleeding (p<0.05).ConclusionTopical application of TXA aids as a useful supportive tool to stop mild bleeding events such as the bloody oozing of an oral wound. The quality of an oral bleeding episode should be considered in the choice of hemostatic measure. Hemostatic approaches should begin with the least invasive procedure. TXA is a helpful tool.



http://ift.tt/2IIvru6

Wheat amylase/trypsin inhibitors exacerbate intestinal and airway allergic immune responses in humanized mice

Publication date: Available online 21 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Iris Bellinghausen, Benno Weigmann, Victor Zevallos, Joachim Maxeiner, Sonja Reißig, Ari Waisman, Detlef Schuppan, Joachim Saloga
BackgroundAmylase-trypsin inhibitors (ATIs) in wheat and related cereals are potent activators of myeloid innate immune cells via engagement of TLR4. Furthermore, ATIs have been shown to serve as adjuvants in experimental intestinal inflammatory diseases.ObjectiveThe aim of this study was to analyze whether ATIs are also modifiers of allergic inflammation.MethodsTherefore, CD4⁺ T cells from grass or birch pollen sensitized donors were stimulated with autologous allergen-pulsed dendritic cells in the presence or absence of ATIs or the control storage protein zein from corn. To analyze allergen-induced gut and lung inflammation, immunodeficient mice were engrafted with PBMC from these allergic donors plus the respective allergen, and fed with selected diets. Three weeks later, inflammation was induced by rectal or intranasal allergen challenge and monitored by mini-endoscopy or airway hyperreactivity (AHR), respectively.ResultsAllergen-specific T cell proliferation and cytokine production was significantly exacerbated by ATIs and not by zein. In vivo, allergen-specific human IgE was strongly elevated in sera of mice receiving an ATI-containing diet compared to mice that were fed gluten- and thus ATI-free. Importantly, allergen-induced IgE-dependent colitis and AHR were also enhanced in ATI-fed mice. Gut inflammation was further increased in mice receiving an additional ATI injection and even detectable in the absence of the aeroallergen, while zein had no such effect. Injection of anti-human TLR4 mAbs or the anti-human IgE mAb omalizumab completely abolished ATI-induced allergic inflammation.ConclusionThese results underline that wheat ATIs are important nutritional activators and adjuvants of allergy which might be exploited for nutritional therapeutic strategies.Clinical ImplicationsAllergen-induced IgE-mediated inflammation of the intestine and the lung is exacerbated by ATIs which might be important for future therapies.

Graphical abstract

http://ift.tt/2FYBSri

Wheat amylase/trypsin inhibitors exacerbate intestinal and airway allergic immune responses in humanized mice

Publication date: Available online 21 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Iris Bellinghausen, Benno Weigmann, Victor Zevallos, Joachim Maxeiner, Sonja Reißig, Ari Waisman, Detlef Schuppan, Joachim Saloga
BackgroundAmylase-trypsin inhibitors (ATIs) in wheat and related cereals are potent activators of myeloid innate immune cells via engagement of TLR4. Furthermore, ATIs have been shown to serve as adjuvants in experimental intestinal inflammatory diseases.ObjectiveThe aim of this study was to analyze whether ATIs are also modifiers of allergic inflammation.MethodsTherefore, CD4⁺ T cells from grass or birch pollen sensitized donors were stimulated with autologous allergen-pulsed dendritic cells in the presence or absence of ATIs or the control storage protein zein from corn. To analyze allergen-induced gut and lung inflammation, immunodeficient mice were engrafted with PBMC from these allergic donors plus the respective allergen, and fed with selected diets. Three weeks later, inflammation was induced by rectal or intranasal allergen challenge and monitored by mini-endoscopy or airway hyperreactivity (AHR), respectively.ResultsAllergen-specific T cell proliferation and cytokine production was significantly exacerbated by ATIs and not by zein. In vivo, allergen-specific human IgE was strongly elevated in sera of mice receiving an ATI-containing diet compared to mice that were fed gluten- and thus ATI-free. Importantly, allergen-induced IgE-dependent colitis and AHR were also enhanced in ATI-fed mice. Gut inflammation was further increased in mice receiving an additional ATI injection and even detectable in the absence of the aeroallergen, while zein had no such effect. Injection of anti-human TLR4 mAbs or the anti-human IgE mAb omalizumab completely abolished ATI-induced allergic inflammation.ConclusionThese results underline that wheat ATIs are important nutritional activators and adjuvants of allergy which might be exploited for nutritional therapeutic strategies.Clinical ImplicationsAllergen-induced IgE-mediated inflammation of the intestine and the lung is exacerbated by ATIs which might be important for future therapies.

Graphical abstract

http://ift.tt/2FYBSri

Evaluation of selective attention in patients with misophonia

Publication date: Available online 21 March 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fúlvia Eduarda da Silva, Tanit Ganz Sanchez
IntroductionMisophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet.ObjectiveTo characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention.MethodsWe evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients).ResultsThe dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p=0.027) and between misophonia and tinnitus (without misophonia) (p=0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p≥0.452).ConclusionThe misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition.



http://ift.tt/2IEGq80

Maxillary tumour-induced osteomalacia

Publication date: Available online 21 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): O. Emodi, A. Rachmiel, D. Tiosano, R.M. Nagler
Tumour-induced osteomalacia (TIO) is a rare paraneoplastic form of renal phosphate wasting that results in severe hypophosphatemia, defective vitamin D metabolism, and osteomalacia. In the case reported here, maxillary TIO was not diagnosed for 6years, although initial complaints were reported when the patient was 12years old. Meanwhile she suffered from profound growth limitation, pain, weakness, and spontaneous multiple bone fractures, culminating in complete loss of ambulatory ability and severe limitation in daily activities. At age 18years, she finally received an accurate diagnosis and definitive treatment was administered. She underwent a partial maxillectomy with complete removal of the tumour, resulting in a full cure. Shortly afterwards the patient regained the ability to walk, no longer needing the wheelchair to which she had been confined. This definitive diagnosis was based on three modalities: (1) fibroblast growth factor 23 analysis (high levels of the secreted hormone were found on the left side of the maxilla in the facial vein and pterygoid plexus, pinpointing the tumour location), (2) octreotide scan, and (3) ⁶⁸Ga-DOTA-NOC-PET/CT. TIO removal via partial maxillectomy led to a complete reversal of this patient's health condition, restoring her ability to walk and function. The importance of prompt employment of these diagnostic modalities and the high level of clinical suspicion required in such cases are clear.



http://ift.tt/2pyGRIv

Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis

The present systematic review and meta-analysis aimed to test the hypothesis that no facial soft tissue changes occur after nonsurgical rapid maxillary expansion (RME), in order to provide a reference for orth...

http://ift.tt/2IIXz0u

Vascular Malformations and Health-Related Quality of Life

This systematic review and meta-analysis uses validated health-related quality-of-life instruments to compare the health-related quality of life of patients with vascular malformations with that of the US general population.

http://ift.tt/2ptFJGK

Favre-Racouchot Syndrome Following Long-term Exposure to Infrared Waves

This case report describes a patient with monolateral Favre-Racouchot syndrome following long-term exposure to infrared waves.

http://ift.tt/2pvNV8q

Quality of Life and the Dermatologist

This Editorial discusses factors that affect quality of life in those with vascular malformations, and dermatologists' goal of improving these aspects for patients.

http://ift.tt/2ptLTqd

Urticaria and Episcleritis in a Woman With Chronic Cough

A woman in her 30s presented with a 10-month history of painful pruritic eruption and painful red eyes; the eruption was exacerbated by stress but unrelated to time of day, ambient temperature, or sunlight exposure. She also reported recent worsening of a chronic cough. What is your diagnosis?

http://ift.tt/2FX3hd7

Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

To the Editor We applaud the important research findings by Patel et al regarding pediatric onychomycosis. In this study, the authors appropriately conclude that routine laboratory monitoring of children during treatment with terbinafine may be unnecessary, considering (1) the low incidence of clinically significant adverse effects; (2) the costs of laboratory tests; (3) workup of spurious laboratory abnormalities; and (4) patient discomfort.

http://ift.tt/2puIDuZ

Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis—Reply

In Reply We appreciate the comments of Li and Mostaghimi regarding our study. While we generally agree that baseline monitoring of laboratory values in children prior to systemic therapy for onychomycosis may not be cost-effective or informative in otherwise healthy children, we would like to emphasize that, in our opinion, clinicians should be adherent to medication-use directives and current guidelines for patient safety, which at this time are unambiguous with regard to the recommendation for pretreatment laboratory screening for terbinafine. The package insert, which was last revised in January 2017, states "before prescribing Lamisil Tablets, perform liver function tests because hepatotoxicity may occur in patients with and without preexisting liver disease." Furthermore, the US Food and Drug Administration medication guide for terbinafine, which was last issued in August 2016, states "your doctor should do a blood test to check you for liver problems before you start treatment with LAMISIL Tablets." With these guidelines in place, we currently do not feel comfortable, based on this one study, to advise clinicians to dismiss these recommendations. Importantly, this study does give us the opportunity to open up lines of communication with the US regulatory bodies to consider altering the terbinafine medication guidance specifically for pediatric patients and consider additional studies that would help solidify these data. We want to maintain the highest standard of care and safety for the treatment of pediatric patients while continuing to practice cost-effective and evidence-based medicine.

http://ift.tt/2G2sJOI

Chronic Urticaria Associated With Methylisothiazolinone Type IV Hypersensitivity

This case report describes a patient with chronic urticaria associated with methylisothiazolinone type IV hypersensitivity.

http://ift.tt/2ptpyJh

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

http://ift.tt/2FQto9B

Nationwide questionnaire-based survey of oral immunotherapy in Japan

Publication date: Available online 20 March 2018
Source:Allergology International
Author(s): Sakura Sato, Chizuko Sugizaki, Noriyuki Yanagida, Komei Ito, Yusei Ohshima, Naoki Shimojo, Takao Fujisawa, Motohiro Ebisawa
BackgroundClinical trials on oral immunotherapy (OIT) have been increasing for nearly a decade; however, several national guidelines do not recommend OIT as a standardized procedure. The aim of this study was to obtain insights into the current use and practice of OIT in Japan.MethodsA first questionnaire was mailed to 524 training and teaching facilities of the Japan Pediatric Society. The first survey requested information on the implementation of OIT, whereas the second survey aimed to gather more detailed information on OIT, such as its safety.ResultsIn total, 360 facilities (69%) responded to the survey; among them, 102 (28%) provided OIT to 7973 patients [1544 received OIT while hospitalized (inpatient OIT), whereas 6429 received OIT without hospitalization (outpatient OIT)]. Approval for OIT was obtained from an ethics committee or institutional review board in 89% and 31% of facilities for inpatient and outpatient OIT, respectively. In inpatient OIT, immediate allergic reactions requiring treatment occurred in 68% of patients while hospitalized, and in another 56%, following discharge. In contrast, 11% of patients developed immediate allergic reactions in outpatient OIT. Adrenaline injections at home were required in 2%. Sixteen patients developed adverse reactions other than immediate allergic reactions, among which eosinophilic gastroenteritis was most common.ConclusionsOIT is widely provided not only as clinical research but also as general practice in Japan. However, because there is a high risk of developing anaphylaxis at home, OIT should be conducted carefully as in a clinical research setting taking safety into consideration.



http://ift.tt/2FRs4DE

Individuality of masticatory performance and of masticatory muscle temporal parameters

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Claire D. Tewksbury, Kathryn X. Callaghan, Brent A. Fulks, Geoffrey E. Gerstner
ObjectiveMammalian mastication serves to improve intra-oral food reduction. Insufficient food reduction creates potential swallowing problems, whereas over-reduction may accelerate tooth wear and increase feeding time. Either extreme has consequences. The study's objectives were: (1) to study the relationship between food reduction, number of chews in a sequence, and chewing rate, (2) to study how controlling the number of chews and chewing rate variability affects food reduction, and (3) to assess how dentoskeletal morphological and electromyographical (EMG) characteristics impact food reduction.DesignTwenty-three healthy, fully-dentate adults chewed a standardized test food under three conditions: (1) no control, (2) number of chews controlled, and (3) number of chews and chewing rate controlled. EMG activity was sampled from masseter and temporalis muscles bilaterally. Demographic, occlusal contact area in maximum intercuspation, and cephalometric data were obtained.ResultsIn uncontrolled conditions, food reduction and bout duration varied more than expected across subjects. Subjects with poor reduction under controlled conditions were those with poor reduction under uncontrolled conditions. Only occlusal contact area correlated with chewing performance under uncontrolled conditions. Chewing cycle duration, EMG burst duration, and EMG peak onset latency increased when the number of chews was restricted. EMG amplitude, a surrogate for bite force, increased in tasks controlling the number of chews and chewing rate. Chewing rate variability was difficult to diminish below individual-specific levels.ConclusionsResults: provided evidence that bite force, chewing rate, chewing performance and chewing bout duration reflected individual preferences. Future work will determine whether similar findings occur among other mammals.



http://ift.tt/2GdomUb

Expression and localization of phosphodiesterase 2A in the submandibular gland of mice

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Kannika Adthapanyawanich, Hiroki Nakata, Shoichi Iseki
ObjectivesPhosphodiesterases comprise a superfamily of enzymes that hydrolyze and inactivate cyclic AMP (cAMP) and/or cyclic GMP (cGMP), thereby regulating cellular signaling mechanisms. We herein investigated the production of phosphodiesterase 2A (PDE2A) in the mouse submandibular gland.DesignThe expression and localization of the mRNA and protein of PDE2A were examined in the submandibular gland of male and female mice using the reverse transcription-polymerase chain reaction, in situ hybridization, Western blotting, and immunohistochemistry.ResultsAmong the different species of phosphodiesterases examined in the mouse submandibular gland, PDE2A, which hydrolyzes cAMP and cGMP, exhibited a marked sexual difference; it was more abundantly expressed in females. The mRNA and protein signals for PDE2A were intense in all acinar and duct portions, including the striated duct, in females, whereas in males, these signals were markedly weaker in the granular convoluted duct, the counterpart of the female striated duct, than in acini and other duct portions. Furthermore, the signals for protein kinases A and G1, which are intracellular effectors of cAMP and cGMP, respectively, were markedly weaker in the male granular convoluted duct.ConclusionsThese results suggest that cyclic nucleotide-dependent signaling mechanisms function poorly in granular convoluted duct cells in the mouse submandibular gland.



http://ift.tt/2uaCitg

Editorial Board

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89





http://ift.tt/2GdoanV

Surface free energy of enamel treated with sodium hexametaphosphate, calcium and phosphate

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): José Guilherme Neves, Marcelle Danelon, Juliano Pelim Pessan, Leonardo Raniel Figueiredo, Emerson Rodrigues Camargo, Alberto Carlos Botazzo Delbem
ObjectiveThis study evaluated the capacity of sodium hexametaphosphate (HMP) at different concentrations to alter the surface properties of dental enamel in order to increase calcium and phosphate adsorption.DesignBovine enamel blocks (4 mm x 4 mm, n = 144, 12/group) were divided: 0%; 0.25%; 0.5%; and 1% HMP, followed or not by application of solutions containing Ca or Ca-PO4, totaling 12 groups. The treatments were performed for 2 min, and the surface free energy (mN/m) was calculated by measuring the contact angles of three probing liquids (deionized water, diiodomethane and ethylene glycol), which was used to determine the polar and nonpolar components of the enamel surface. Calcium (Ca), phosphate (PO4) and HMP in the solutions treatment solutions were analyzed before and after treatment. The data presented normal and homogeneous distribution and then were subjected to ANOVA, followed by Student-Newman Keuls' test (p<0.05).ResultsThe higher the % of HMP in the solutions, the greater HMP adsorption and more electron-donor sites on enamel surface were achieved (p < 0.05). Also, Ca adsorption was higher with increasing % HMP in the solutions (p < 0.05), which in turn reduced electron-donor sites on enamel surface. Increased Ca and PO4 adsorption occurred at 0.5% and 1% HMP after treatment with Ca-PO4 solution, resulting in a less electron-donor sites on surface when compared to the other treatments (P<0.05).ConclusionsHMP leads to a more electron-donor sites on enamel surface, what promotes greater adsorption of Ca and PO4 ions.



http://ift.tt/2u8ESA6

Individuality of masticatory performance and of masticatory muscle temporal parameters

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Claire D. Tewksbury, Kathryn X. Callaghan, Brent A. Fulks, Geoffrey E. Gerstner
ObjectiveMammalian mastication serves to improve intra-oral food reduction. Insufficient food reduction creates potential swallowing problems, whereas over-reduction may accelerate tooth wear and increase feeding time. Either extreme has consequences. The study's objectives were: (1) to study the relationship between food reduction, number of chews in a sequence, and chewing rate, (2) to study how controlling the number of chews and chewing rate variability affects food reduction, and (3) to assess how dentoskeletal morphological and electromyographical (EMG) characteristics impact food reduction.DesignTwenty-three healthy, fully-dentate adults chewed a standardized test food under three conditions: (1) no control, (2) number of chews controlled, and (3) number of chews and chewing rate controlled. EMG activity was sampled from masseter and temporalis muscles bilaterally. Demographic, occlusal contact area in maximum intercuspation, and cephalometric data were obtained.ResultsIn uncontrolled conditions, food reduction and bout duration varied more than expected across subjects. Subjects with poor reduction under controlled conditions were those with poor reduction under uncontrolled conditions. Only occlusal contact area correlated with chewing performance under uncontrolled conditions. Chewing cycle duration, EMG burst duration, and EMG peak onset latency increased when the number of chews was restricted. EMG amplitude, a surrogate for bite force, increased in tasks controlling the number of chews and chewing rate. Chewing rate variability was difficult to diminish below individual-specific levels.ConclusionsResults: provided evidence that bite force, chewing rate, chewing performance and chewing bout duration reflected individual preferences. Future work will determine whether similar findings occur among other mammals.



http://ift.tt/2GdomUb

Expression and localization of phosphodiesterase 2A in the submandibular gland of mice

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Kannika Adthapanyawanich, Hiroki Nakata, Shoichi Iseki
ObjectivesPhosphodiesterases comprise a superfamily of enzymes that hydrolyze and inactivate cyclic AMP (cAMP) and/or cyclic GMP (cGMP), thereby regulating cellular signaling mechanisms. We herein investigated the production of phosphodiesterase 2A (PDE2A) in the mouse submandibular gland.DesignThe expression and localization of the mRNA and protein of PDE2A were examined in the submandibular gland of male and female mice using the reverse transcription-polymerase chain reaction, in situ hybridization, Western blotting, and immunohistochemistry.ResultsAmong the different species of phosphodiesterases examined in the mouse submandibular gland, PDE2A, which hydrolyzes cAMP and cGMP, exhibited a marked sexual difference; it was more abundantly expressed in females. The mRNA and protein signals for PDE2A were intense in all acinar and duct portions, including the striated duct, in females, whereas in males, these signals were markedly weaker in the granular convoluted duct, the counterpart of the female striated duct, than in acini and other duct portions. Furthermore, the signals for protein kinases A and G1, which are intracellular effectors of cAMP and cGMP, respectively, were markedly weaker in the male granular convoluted duct.ConclusionsThese results suggest that cyclic nucleotide-dependent signaling mechanisms function poorly in granular convoluted duct cells in the mouse submandibular gland.



http://ift.tt/2uaCitg

Editorial Board

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89





http://ift.tt/2GdoanV

Surface free energy of enamel treated with sodium hexametaphosphate, calcium and phosphate

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): José Guilherme Neves, Marcelle Danelon, Juliano Pelim Pessan, Leonardo Raniel Figueiredo, Emerson Rodrigues Camargo, Alberto Carlos Botazzo Delbem
ObjectiveThis study evaluated the capacity of sodium hexametaphosphate (HMP) at different concentrations to alter the surface properties of dental enamel in order to increase calcium and phosphate adsorption.DesignBovine enamel blocks (4 mm x 4 mm, n = 144, 12/group) were divided: 0%; 0.25%; 0.5%; and 1% HMP, followed or not by application of solutions containing Ca or Ca-PO4, totaling 12 groups. The treatments were performed for 2 min, and the surface free energy (mN/m) was calculated by measuring the contact angles of three probing liquids (deionized water, diiodomethane and ethylene glycol), which was used to determine the polar and nonpolar components of the enamel surface. Calcium (Ca), phosphate (PO4) and HMP in the solutions treatment solutions were analyzed before and after treatment. The data presented normal and homogeneous distribution and then were subjected to ANOVA, followed by Student-Newman Keuls' test (p<0.05).ResultsThe higher the % of HMP in the solutions, the greater HMP adsorption and more electron-donor sites on enamel surface were achieved (p < 0.05). Also, Ca adsorption was higher with increasing % HMP in the solutions (p < 0.05), which in turn reduced electron-donor sites on enamel surface. Increased Ca and PO4 adsorption occurred at 0.5% and 1% HMP after treatment with Ca-PO4 solution, resulting in a less electron-donor sites on surface when compared to the other treatments (P<0.05).ConclusionsHMP leads to a more electron-donor sites on enamel surface, what promotes greater adsorption of Ca and PO4 ions.



http://ift.tt/2u8ESA6

Can too little be as bad as too much?

By Madhava Sai Sivapuram

"Any substance which is taken too much or too little is poisonous to our body whether it is a drug or a diet". These were the exact words told by my pharmacology professor when I was studying pharmacology. I thought yes, if there is excessive use of drugs, it is going to cause adverse drug reactions, whereas too little may not help us recover. With regards to the human diet, too much can cause obesity which is a risk for many diseases, whereas too little will make you undernourished. I never thought that a person's diet could be a cause of a life-threatening situation.

I faced such a situation during my BMJ Case Reports elective period[1] It was a completely new environment for me where hospital experiences a very good outpatient and inpatient flow. It was the 3rd or 4th day of my electives where I was still trying to understand the workflow of the hospital. I came across a middle-aged lady waiting outside the ward for my professor, as he was the attending physician of her father, who was admitted due to sudden fall on the ground, following a decrease in blood pressure. He had been taking medication for diabetes and hypertension for the past 10 years.

My professor had asked me to take the patient history and find out the reason for the fall in the blood pressure, but I could not do that as the patient was discharged on the same day.

It was a 3-week elective and I enjoyed working alongside my professor, who always gave me a new prospect to think about. Two days before my departure from the hospital, I got a chance to meet the patient and the family again; they had come in for a follow-up. This time the patient load in the OPD was not as high. My professor spends a lot of time with patients discussing their history and always tells me the cause of the problem is always in the patient's history. If we could figure this out, we would solve the puzzle, which is the beauty of medicine.

The lady told us that her father was having a problem with his blood pressure and during her recent visit to the family doctor, she was told that he should reduce his salt intake. She misunderstood the instruction to be that he should eat no salt at all, and she started cooking dishes exclusively for him without salt in them and was taking extra care that he was not eating any food that contained salt.

From this, we learned that her misunderstanding had cost them a lot of money and precious time. We explained to them what had gone wrong with the patient and suggested they increase his salt intake to a certain threshold.

This BMJ Case Reports elective experience has led me to remember my pharmacology professor's words practically in a real-life scenario. It also made me understand how important it is to fully inform the patient and their attendants, and also the necessity of checking their understanding.  Any misunderstanding with our health education comes at a huge price for the patients and their attendants.

I acknowledge Professor Rakesh Biswas under whom I did this elective.

References:

1. http://promotions.bmj.com/jnl/bmj-case-reports-student-electives-2/

Competing Interests

None Declared

 

 

 

 

http://ift.tt/2DK9OGa

Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart

Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach.

http://ift.tt/2FVNA5Z

Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

http://ift.tt/2prLyV4

Serpentine thrombus in the heart: a rare case of trapped thrombus in patent foramen ovale

A 77-year-old Caucasian woman with recent abdominal surgery was diagnosed with multiple paradoxical systemic emboli in the mesenteric and renal circulation. Diagnosis was made by direct visualisation of a serpentine thrombus traversing both atria through patent foramen ovale (PFO) by transesophageal echocardiogram (TEE). Concomitantly, the patient was found to have deep venous thrombosis and pulmonary embolism. A decision was made to pursue cardiothoracic surgery preceded by inferior vena cava filter placement. She was started on intravenous anticoagulation. Repeat TEE was negative for thrombus and the patient did not present any new clinical signs of embolisation by this time. Consequently, the treatment plan was modified and the patient received oral systemic anticoagulation followed by PFO closure with the use of St. Jude Amplatzer Cribriform septal occluder device. During the outpatient follow-up the patient was asymptomatic and there was no significant flow through the device on transthoracic echocardiogram.

http://ift.tt/2FZGI7V

Self-harm scar revision

This report discusses in detail the case of a patient who underwent a scar revision procedure to have her characteristic self-harm scars altered. A detailed insight into the patient's perspective was gained through semistructured interviews conducted at 6 weeks and 6 months postoperatively. The interviews found that an equally if not more conspicuous scar that was distinct from those created from self-harm had a pronounced psychological benefit for the patient. This article calls for more active management of the psychological sequelae of self-harm scars, with the need to facilitate access to surgical treatment in certain cases.

http://ift.tt/2ptYrOi

Metastatic primary anorectal melanoma developing in a patient treated for multicentric glioblastoma multiforme: two rare malignancies presenting in synchronicity

Description

A 66-year-old woman presented with complaints of dizziness, headache and forgetfulness, which had been worsening over the last 2 months. General physical examination revealed weakness in the left upper and lower limbs (power 4/5) with spasticity (deep tendon reflexes 3+ on left side). A non-contrast MRI brain revealed a mass lesion involving the right thalamus and another lesion in the right cerebellar peduncle. Both lesions were hyperintense on T2 and hypointense on T1 sequences (figure 1). A stereotactic biopsy from the thalamic lesion revealed glioblastoma multiforme (WHO Grade IV) on histopathological evaluation and immunohistochemistry (Ki67 index: 15%–20%). Due to financial constraints, O(6)-methylguanine-DNA methyltransferase(MGMT) promoter methylation status was not determined.

Figure 1

Pretreatment non-contrast MRI images of multicentric glioma. (A) T1-weighted axial image reveals a hypointense space-occupying lesion in the right thalamus involving the right basal ganglia (red arrow). (B) T1-weighted axial image reveals a hypointense space-occupying lesion in the...

http://ift.tt/2FVNUBJ

Renal injury in a patient with lumbar scoliosis

Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.

http://ift.tt/2ptYoSC

FAST examination diagnosing bladder rupture following blunt pelvic trauma

Description

A 52-year-old man presented as a level 2 trauma notification after a plywood fell on him from 15 feet. On presentation, he was evaluated according to Advanced Trauma Life Support (ATLS) protocol. Secondary survey was significant for suprapubic tenderness and abrasions to bilateral hips. A focused assessment with sonography in trauma (FAST) examination was performed, showing echogenic fluid filling the bladder (video 1).

Video 1

Focused assessment with sonography in trauma examination performed in the trauma bay showing echogenic fluid filling the bladder.

A Foley catheter was placed, and gross haematuria was noted. X-ray in the trauma bay showed fractures of the left superior and inferior pubic rami (figure 1). Subsequently, a CT cystogram was performed which showed large clot within the bladder with small extraperitoneal extravasation (figure 2). The injury was managed with transurethral Foley and gentle...

http://ift.tt/2FZn8sq

Severe autosomal dominant polycystic kidney disease

Description 

A 61-year-old man with a known history of autosomal dominant polycystic kidney disease (ADPKD) and stage IV chronic kidney disease presented with a 6-month history of abdominal pain, nausea, vomiting and fatigue. In addition to the ADPKD, the right kidney had a 4.4 cm inferior pole mass concerning for renal cell carcinoma (RCC). Preoperative imaging (figure 1), a coronal CT of abdomen and pelvis, demonstrates bilateral ADPKD. His total kidney volume was calculated to be 9980.5 mL, which in combination with his age made him a '1E' (most severe) based on the Mayo Clinic risk stratification schema. The following aggregate of issues led the patient to undergo bilateral open nephrectomies: the suspicion for malignancy associated with the right renal mass, a slight increase in malignancy risk associated with polycystic kidney disease in general, and the likely need for postoperative dialysis if left with only a single poorly...

http://ift.tt/2psh4T4

Multiple Inhibitory Mechanisms of Lidocaine on Bradykinin Receptor Activity in Model Sensory Neurons

Background and Objectives Local anesthetics (LAs) are often infiltrated subcutaneously for localized perioperative numbing. In addition to blocking nerve conduction, LAs act on pathways used by a variety of pain-inducing and inflammatory mediators. We describe the effects in isolated model sensory neurons of LAs on responses to the algogenic and sensitizing peptide, bradykinin (BK). Methods ND/7 sensory neurons were stimulated by different concentrations of BK in the presence or absence of LAs, with transient increases in intracellular calcium (Δ[Ca+2]in) detected fluorometrically in fields of cells. Equilibrium saturable binding of radiolabeled BK also was conducted on the same type of cells, with and without LA. Results Responses to low BK (5 nM) were inhibited by lidocaine at 1 mM (approximately 35% inhibition) and 10 mM (approximately 70% inhibition), whereas responses to high BK (100 nM) were unaffected by 1 mM yet inhibited (approximately 75%) by 10 mM lidocaine. Bupivacaine (1 and 2 mM) did not reduce peak Δ[Ca+2]in (using 5 nM BK). Lidocaine's quaternary derivative, QX-314 (10 mM), also was ineffective on peak Ca+2 (5 nM BK). Saturation binding of BK showed that lidocaine lowered the binding capacity (Bmax) without changing the KD, consistent with noncompetitive inhibition. Conclusions At subclinical concentrations, lidocaine suppresses BK's activation of model sensory neurons. This effect adds to the known analgesic mechanisms of LAs and likely contributes to the reduction of postincisional pain. Accepted for publication November 1, 2017. Address correspondence to: Gary R. Strichartz, PhD, Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, MRB611, 75 Francis St, Boston, MA 02115 (e-mail: gstrichartz@partners.org). Funding for this work was provided in part by the US Public Health Service, National Institutes of Health, from grants NIGMS R01-GM35647 and NIH/NCI R01-CA080153. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2DGIk4p

Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention

Background and Objectives The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule. Methods Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified. Results The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level. Conclusions The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management. Accepted for publication January 15, 2018. Address correspondence to: Philip W.H. Peng, MBBS, Department of Anesthesia, University of Toronto, 399 Bathurst St, McL 2-405 Toronto, Ontario, Canada M5T 2S8 (e-mail: philip.peng@uhn.ca). The authors declare no conflict of interest. Funding was provided through Merit Award in Research, Department of Anesthesia, University of Toronto (to P.W.H.P.) and Physicians' Service Incorporated Foundation award (to P.W.H.P. and K.L.). Interim data from this work were presented at the 2017 Annual Meeting of American Association of Clinical Anatomists in Minneapolis, MN, on July 17 to 21, 2017; at the 2017 World Academy of Pain Medicine Ultrasonography Annual Meeting and Workshop in Miami, FL, on January 13 to 15, 2017; and at the 2017 Study in Multidisciplinary Pain Research—International Symposium of Ultrasound in Regional Anesthesia Congress in Florence, Italy, on March 29 to April 1, 2017. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2GQkvdA

Interfascial Plane Blocks: Back to Basics

Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols. Accepted for publication October 29, 2017. Address correspondence to: Hesham Elsharkawy, MD, MBA, MSc, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, E-31 Cleveland, OH 44195 (e-mail: elsharh@ccf.org). No external funding and no competing interests were declared. H.E. has received unrestricted educational funding from PAJUNK (Norcross, GA) and is consultant for PACIRA (Troy Hills, NJ). A.P. has received honoraria from GE Healthcare, Pittsburgh, PA, for teaching. E.R.M. has received unrestricted educational program funding from Halyard Health (Alpharetta, GA). These companies had no input into any aspect of the present project design or manuscript preparation. Permission to use images was obtained from the Cleveland Clinic Department of Art Photography. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2u7nqMb

Transmission of hepatitis E virus with plasma exchange in kidney-transplant recipients: a retrospective cohort study

Background: After observing a case of plasma exchange-mediated HEV infections in a kidney transplant recipient, we investigated the relationship between plasma exchange and HEV infection after kidney transplantation. Methods: A cohort of 263 patients who underwent kidney transplantation from January 1, 2011 through December 31, 2012 was screened for HEV markers, including anti-HEV IgG and IgM antibodies and HEV RNA, on 3 consecutive blood samples: 1 before, 1 a mean (SD) of 9.5 (9) months and 1 a mean (SD) of 18.2 (6.6) months after transplantation, respectively. Transfusional investigation was performed in patients with detectable HEV RNA. We explored the relationships between plasma exchange, posttransplantation transaminase elevation and HEV markers acquisition. Results: Overall, 24 (9.1%) patients had acquired HEV markers on the first posttransplantation sample, including 2 patients with detectable HEV RNA, and 7 (2.3%) patients had long-term persistent HEV markers on the second posttransplantation sample, including 3 patients with detectable HEV RNA without detectable anti-HEV antibodies. Plasma exchange was an independent risk factor for the acquisition of posttransplantation and long-term persistent HEV markers. Pathogen-reduced plasma-borne transmission of HEV was demonstrated. Plasma exchange and long-term persistent HEV markers were risk factors of posttransplantation transaminase elevation. Conclusion: Plasma exchange, including with pathogen-reduced plasma, is a risk factor for posttransplantation HEV infection and transaminase elevation. Screening for HEV RNA should be carried out in kidney transplant recipients treated with plasma exchange. Corresponding author: Vincent Mallet, MD, PhD, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France; e-mail, vincent.mallet@aphp.fr Role of the funding source The Agence Nationale de la Recherche (ANR) paid for the serological tests. Vincent Mallet is funded by la fondation ARC pour la Recherche sur le Cancer. The Renal Transplant Unit at Necker Hospital belongs to the Fondation Centaure and the Transplantex group, which supports the French network for transplantation research. Conflicts of interest: none Authors Contributions: Conception and design: V. Mallet Analysis and interpretation of the data: V. Mallet, R. Sberro-Soussan, AM Roque-Afonso, L Hauser Drafting of the article: V. Mallet, AM Roque-Afonso, S Pol Critical revision of the article for important intellectual content: V. Mallet, R Sberro-Soussan, AM Roque-Afonso, S Pol Provision of study materials or patients: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol. Final approval of the article: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2G8M3No

Organ Transplantation in the Czech Republic

No abstract available

http://ift.tt/2ptkjbS

Hypothermic Machine Preservation Benefits Deceased Donor Kidneys with Short Cold Ischaemic Times

No abstract available

http://ift.tt/2GebjBY

E-xchange: Hepatitis E and the risk of plasma products for organ transplant recipients

No abstract available

http://ift.tt/2G1yXOv

Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis

Abstract

Background

The present systematic review and meta-analysis aimed to test the hypothesis that no facial soft tissue changes occur after nonsurgical rapid maxillary expansion (RME), in order to provide a reference for orthodontists.

Methods

PubMed, EMBASE, Cochrane Library, OVID, MEDLINE, CINAHL, Scopus, and ScienceDirect databases were electronically and manually searched up to December 2017, and randomized controlled, clinical controlled trials, cohort studies and retrospective studies where soft tissue changes were measured before and after nonsurgical RME were identified. Study appraisal and synthesis were performed by two reviewers who completed the study selection and quality assessment procedures independently and in duplicate. Data from the involved studies were pooled using Revman 5.3.

Results

A total of 1762 articles were identified after the removal of duplicates. After selection and quality assessment, 15 studies met the inclusion criteria for the systematic review, and 13 articles were ultimately included in the meta-analysis. The quality of the involved studies was relatively moderate. Pre-expansion, postexpansion, and postretention data were pooled. The nasal width, alar base width, and distances from the lower lips to the E line showed significant changes after expansion. Moreover, after retention, the nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line showed significant increases relative to the baseline values. Limitations of the present study included the moderate quality of the included studies and the fact that the results were based on short-term observations of patients in the growth phase.

Conclusion

Our findings suggest that RME results in a significantly increased nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line after the retention phase. However, the clinical importance of these findings is questionable.

http://ift.tt/2GNJfDb

Immunohistochemical evaluation of Sonic Hedgehog signaling pathway proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2, and Gli3) in sporadic and syndromic odontogenic keratocysts

Abstract

Aims

The aim of this study was to compare the clinical and demographic features of 62 patients presenting sporadic odontogenic keratocysts (OKCs) or OKCs associated with nevoid basal cell carcinoma syndrome (NBCCS). In conjunction with this, we also evaluated the immunohistochemical expression of Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 and Gli3 proteins in 86 OKCs. By doing this, we add to the understanding of the biology of this type of lesion, providing tools that will help facilitate the early diagnosis of NBCCS in those patients where the first manifestation is that of OKCs.

Methods

This is a retrospective study; patients were classified into two groups: group 1 which consisted of those who were not affected by NBCCS (49 patients and 57 OKCs) and group 2 which consisted of those who were diagnosed with NBCCS (13 patients and 29 OKCs). The clinical and demographic features were studied and the immunohistochemical expression of Sonic Hedgehog proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2, and Gli3) was analyzed in all samples.

Results

There was an increase in the expression of three proteins in the syndromic OKC, when compared to that of sporadic cysts. Shh and Gli1 showed higher cytoplasmic expression, while Smo revealed stronger nuclear and cytoplasmic expressions.

Conclusion and clinical relevance

Our findings suggest that the expression patterns of important Shh pathway proteins can represent valuable markers for early diagnosis of NBCCS-associated OKCs, as the major criterion for the diagnosis of NBCCS is currently based on the late appearance of basal cellular carcinomas. Thus, standardizing a new diagnostic tool for diagnosis of NBCCS could be of great importance in the identification of therapeutic targets. We therefore suggest, as based on our findings, that OKCs showing high expression of Shh, Smo, and Gli1 are potentially associated with NBCCS.

http://ift.tt/2FWj2kF

How to manage food allergy in nursery or school

Purpose of review The aim of this review is to describe effective management strategies in nursery or school based upon research findings. Recent findings The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. Summary A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families. Correspondence to Julie Wang, MD, Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. Tel: +1 212 241 5548; e-mail: julie.wang@mssm.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2DJn8L4

Nonspecific immunomodulators for recurrent respiratory tract infections, wheezing and asthma in children: a systematic review of mechanistic and clinical evidence

Purpose of review To provide an overview of the mechanistic and clinical evidence for the use of nonspecific immunomodulators in paediatric respiratory tract infection (RTI) and wheezing/asthma prophylaxis. Recent findings Nonspecific immunomodulators have a long history of empirical use for the prevention of RTIs in vulnerable populations, such as children. The past decade has seen an increase in both the number and quality of studies providing mechanistic and clinical evidence for the prophylactic potential of nonspecific immunomodulators against both respiratory infections and wheezing/asthma in the paediatric population. Orally administered immunomodulators result in the mounting of innate and adaptive immune responses to infection in the respiratory mucosa and anti-inflammatory effects in proinflammatory environments. Clinical data reflect these mechanistic effects in reductions in the recurrence of respiratory infections and wheezing events in high-risk paediatric populations. A new generation of clinical studies is currently underway with the power to position the nonspecific bacterial lysate immunomodulator OM-85 as a potential antiasthma prophylactic. Summary An established mechanistic and clinical role for prophylaxis against paediatric respiratory infections by nonspecific immunomodulators exists. Clinical trials underway promise to provide high-quality data to establish whether a similar role exists in wheezing/asthma prevention. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Wojciech Feleszko, Department of Pediatric Respiratory Diseases and Allergy, ul. Zwirki i Wigury 63A, 02-091 Warsaw, Poland. Tel: +48 317 94 19; e-mail: wojciech.feleszko@kliniczny.pl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FQd5tJ

Endotypes in allergic diseases

Purpose of review The precision medicine concept is both appealing and challenging. We review here the recent findings in the endotype-driven approach for major allergic diseases. Recent findings Stratified medicine for different allergic diseases can identify patients who are more likely to benefit or experience an adverse reaction in response to a given therapy and anticipate their long-term outcome and vital risk. In addition, this approach potentially facilitates drug development and prevention strategies. Summary The endotype-driven approach in allergic diseases has tremendous potential, but there are notable barriers in reaching the new world of precision medicine. Multidimensional endotyping integrating visible properties with multiple biomarkers is recommended for both type 2 and nontype 2 allergic diseases to provide evidence that a certain pathway is the key driver for a given patient. Significant healthcare system changes are required to achieve the expected targets. Correspondence to Ioana Agache, Faculty of Medicine, Transylvania University, Theramed Healthcare, Pictor Ion Andreescu 2A, 50051, Brasov, Romania. Tel: +40 728 878386; e-mail: ibrumaru@unitbv.ro Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2HPQ5Hz

Food allergy trends at the crossing among socio-economics, history and geography

Purpose of review The epidemiology of food allergy did inspire theories on the reasons for the recent surge of the disease. We offer here a reasoned review on the relationships between the trajectories of human development and the trend of the food allergy epidemics. Recent findings The exponential trend of the frequency of food allergy paralleled the explosive acceleration of the human development over the last few decades. Dietary factors have been indicated as responsible for these trends and targeted for potential preventive strategies. Other socio-economic factors have been related to this evolution: solar exposure, climate changes, structure of societies, reproductive choices and societal inequalities. Summary The epidemiologic associations of food allergy suggest different causal theories. Future prevention strategies may be predicated not only on dietary interventions, but on wider programmes aimed to restore a human ecology promoting food tolerance. Correspondence to Alessandro Fiocchi, MD, Director of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: allerg@tin.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2pt7M8w

Precision medicine in the area of work-related asthma

No abstract available

http://ift.tt/2ICn4k1

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

Skeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of...

http://ift.tt/2GNWfc3

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Abstract

Background

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

Methods

Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.

Conclusions

Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.

http://ift.tt/2HRSXUk

Wellness interventions for anesthesiologists

Purpose of review The review examines the different preventive measures that have been found to be useful to abolish or decrease the negative effects of burnout and increase resilience in anesthesiologists. Recent findings Studies in anesthesiology cite autonomy, control of the work environment, professional relationships, leadership, and organizational justice as the most important factors in job satisfaction. Factors such as difficulty in balancing personal and professional life, poor attention to wellness, work alcoholism, and genetic factors increase an individual's susceptibility to burnout. Exposure to chronic or repeated stress instigates a spectrum of autonomic, endocrine, immunologic, and behavioral responses that activate the sympathetic-adrenal-medullary and hypothalamic-pituitary-adrenal axis. Investigating the difference in psychobiologic reactivity, as well as defining the psychological symptoms that are characteristic to individuals vulnerable to stress-induced illness, would enable scientists to better look into the modalities to eradicate the negative effects. Recent studies have shown that a combination of individual and structural changes in institutions can increase resilience in physicians. Summary Burnout is a pathological syndrome that is triggered by constant levels of high stress. A combination of individual efforts as well as structural interventions can help to increase wellbeing in physicians. Correspondence to Haleh Saadat, MD, FAAP, Clinical Associate Professor, Department of Anesthesiology, Frank H Netter, MD, School of Medicine, Quinnipiac University, 70 Bassett Rd, North Haven, CT 06473, USA. E-mail: Hsaadat@Quinnipiac.edu, Haleh.saadat@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FPF2lo

Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial

BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A prospective, double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077. Correspondence to Dr Emmanuel Marret, MD, PhD, Department of Anaesthesia and Intensive Care Medicine, American Hospital of Paris, 63 Bd Victor Hugo, Neuilly-sur-Seine, Paris, France E-mail: drmarret@gmail.com © 2018 European Society of Anaesthesiology

http://ift.tt/2FXrAI4

Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura

We present the case of a 19-year-old female with severe hypogammaglobulinemia after having had treatment with rituximab for idiopathic thrombocytopenic purpura requiring intravenous immunoglobulins. She was admitted with the diagnosis of left-sided pneumonia with parapneumonic effusion. The patient was treated with piperacillin/tazobactam after having a poor response to co-amoxiclav. The patient had been tested for immunoglobulin levels, and the levels were very low. She has a history of ITP for which she received steroids. She also received rituximab for the same on four separate occasions, and the last one was about 1 year ago.

http://ift.tt/2GcWRtV

Congenital Aural Atresia prevalence in the Argentinian population

Publication date: Available online 20 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio
IntroductionCongenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world.ObjectiveTo determine the prevalence of microtia, considering the different ethnical structure of the population.MethodsA retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions.ResultsThe incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1).ConclusionThis study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).



http://ift.tt/2FN2cZo

How to manage food allergy in nursery or school

Purpose of review The aim of this review is to describe effective management strategies in nursery or school based upon research findings. Recent findings The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. Summary A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families. Correspondence to Julie Wang, MD, Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. Tel: +1 212 241 5548; e-mail: julie.wang@mssm.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2DJn8L4

Nonspecific immunomodulators for recurrent respiratory tract infections, wheezing and asthma in children: a systematic review of mechanistic and clinical evidence

Purpose of review To provide an overview of the mechanistic and clinical evidence for the use of nonspecific immunomodulators in paediatric respiratory tract infection (RTI) and wheezing/asthma prophylaxis. Recent findings Nonspecific immunomodulators have a long history of empirical use for the prevention of RTIs in vulnerable populations, such as children. The past decade has seen an increase in both the number and quality of studies providing mechanistic and clinical evidence for the prophylactic potential of nonspecific immunomodulators against both respiratory infections and wheezing/asthma in the paediatric population. Orally administered immunomodulators result in the mounting of innate and adaptive immune responses to infection in the respiratory mucosa and anti-inflammatory effects in proinflammatory environments. Clinical data reflect these mechanistic effects in reductions in the recurrence of respiratory infections and wheezing events in high-risk paediatric populations. A new generation of clinical studies is currently underway with the power to position the nonspecific bacterial lysate immunomodulator OM-85 as a potential antiasthma prophylactic. Summary An established mechanistic and clinical role for prophylaxis against paediatric respiratory infections by nonspecific immunomodulators exists. Clinical trials underway promise to provide high-quality data to establish whether a similar role exists in wheezing/asthma prevention. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Wojciech Feleszko, Department of Pediatric Respiratory Diseases and Allergy, ul. Zwirki i Wigury 63A, 02-091 Warsaw, Poland. Tel: +48 317 94 19; e-mail: wojciech.feleszko@kliniczny.pl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FQd5tJ

Endotypes in allergic diseases

Purpose of review The precision medicine concept is both appealing and challenging. We review here the recent findings in the endotype-driven approach for major allergic diseases. Recent findings Stratified medicine for different allergic diseases can identify patients who are more likely to benefit or experience an adverse reaction in response to a given therapy and anticipate their long-term outcome and vital risk. In addition, this approach potentially facilitates drug development and prevention strategies. Summary The endotype-driven approach in allergic diseases has tremendous potential, but there are notable barriers in reaching the new world of precision medicine. Multidimensional endotyping integrating visible properties with multiple biomarkers is recommended for both type 2 and nontype 2 allergic diseases to provide evidence that a certain pathway is the key driver for a given patient. Significant healthcare system changes are required to achieve the expected targets. Correspondence to Ioana Agache, Faculty of Medicine, Transylvania University, Theramed Healthcare, Pictor Ion Andreescu 2A, 50051, Brasov, Romania. Tel: +40 728 878386; e-mail: ibrumaru@unitbv.ro Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2HPQ5Hz

Food allergy trends at the crossing among socio-economics, history and geography

Purpose of review The epidemiology of food allergy did inspire theories on the reasons for the recent surge of the disease. We offer here a reasoned review on the relationships between the trajectories of human development and the trend of the food allergy epidemics. Recent findings The exponential trend of the frequency of food allergy paralleled the explosive acceleration of the human development over the last few decades. Dietary factors have been indicated as responsible for these trends and targeted for potential preventive strategies. Other socio-economic factors have been related to this evolution: solar exposure, climate changes, structure of societies, reproductive choices and societal inequalities. Summary The epidemiologic associations of food allergy suggest different causal theories. Future prevention strategies may be predicated not only on dietary interventions, but on wider programmes aimed to restore a human ecology promoting food tolerance. Correspondence to Alessandro Fiocchi, MD, Director of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: allerg@tin.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2pt7M8w

Precision medicine in the area of work-related asthma

No abstract available

http://ift.tt/2ICn4k1

SJL-1, a C-type lectin, acts as a surface defense molecule in Japanese sea cucumber, Apostichopus japonicus

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Keisuke Ono, Takuya Alan Suzuki, Youichi Toyoshima, Tomoya Suzuki, Shigeyuki Tsutsui, Tomoyuki Odaka, Toshiaki Miyadai, Osamu Nakamura
The surface defense molecules of aquatic invertebrates against infectious microorganisms have remained largely unexplored. In the present study, hemagglutinins were isolated from an extract of body surface layer of Japanese sea cucumber, Apostichopus japonicus, by affinity chromatography with fixed rabbit erythrocyte membranes. The N-terminal sequence of a 15-kDa agglutinin was almost identical with that of SJL-1, a C-type lectin formerly identified in this species. Because cDNA sequence and tissue distribution of SJL-1 have not been reported, we performed cDNA sequencing, gene expression analysis, and western blotting and immunohistochemical evaluation with anti-recombinant SJL-1 (rSJL-1) antibodies. The hemagglutinin gene was transcribed mainly in the integument, tentacles, and respiratory tree. Western blotting revealed that SJL-I is present in a body surface rinse, indicating that SJL-1 is secreted onto the body surface. SJL-1-positive cells scattered beneath the outermost layer of the integument were detected by immunohistochemistry. Furthermore, rSJL-1 agglutinated Gram-positive and Gram-negative bacteria, and yeast. These results indicate that SJL-1 acts as a surface defense molecule in A. japonicus.



http://ift.tt/2FZ6CbM

Relative antibacterial functions of complement and NETs: NETs trap and complement effectively kills bacteria

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Louiza Azzouz, Ahmed Cherry, Magdalena Riedl, Meraj Khan, Fred G. Pluthero, Walter H.A. Kahr, Nades Palaniyar, Christoph Licht
Neutrophil extracellular traps (NETs) are web-like DNA structures released by activated neutrophils. These structures are decorated with antimicrobial proteins, and considered to trap and kill bacteria extracellularly. However, the exact functions of NETs remain elusive, and contradictory observations have been made with NETs functioning as an antimicrobial or a pathogentrapping mechanism. There is a disconnect in the interpretation of the involvement of other major immune mechanisms, such as the complement system, as effectors of the function of NETs. We have recently shown that NETs activate complement.In this study, we aimed to elucidate the relative antimicrobial roles of NETs in the absence and presence of complement. Using primary human neutrophils, human serum (normal, heat inactivated, and C5-depleted), P. aeruginosa (at multiplicity of infection, MOI, of 1 or 10), S. aureus (MOI of 1), colony-counting assays and confocal microscopy, we demonstrate that most bacteria trapped by NETs remain viable, indicating that NETs have limited bactericidal properties. By contrast, complement effectively killed bacteria, but NETs decreased the bactericidal ability of complement and degrading NETs by DNases restored complement-mediated killing. Experiments with conditions allowing for specific pathway activation showed that the complement classical and lectin, but not the alternative, pathway lead to bacterial killing. NETs under static conditions showed limited killing of bacteria while NETs under dynamic conditions showed enhanced bacteria trapping and reduced killing. Furthermore, NETs incubated with normal human serum depleted complement and reduced the hemolytic capacity of the serum.This report, for the first time, clarifies the relative bactericidal contributions of NETs and complement. We propose that – while NETs can ensnare bacteria such as P. aeruginosa – complement is necessary for efficient bacterial killing.



http://ift.tt/2ppB2xF

Editorial Board

Publication date: April 2018
Source:Molecular Immunology, Volume 96





http://ift.tt/2FXExkV

Expression of complement receptor 3 (CR3) and regulatory protein CD46 on dendritic cells of antiretroviral naïve and treated HIV-1 infected individuals: Correlation with immune activation status

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Nitesh Mishra, Madhav Mohata, Heena Aggarwal, Omkar Chaudhary, Bimal Kumar Das, Sanjeev Sinha, Anjali Hazarika, Kalpana Luthra
During infection and budding, human immunodeficiency virus-1 (HIV-1) acquires regulators of Complement Activation (RCAs) along with the host cell membrane on the viral envelope. Activation of host complement system results in opsonization of virus by complement fragments, however the virus evades complement mediated lysis (CoML) by virtue of the RCAs on the viral envelope. The RCAs on HIV-1 envelope process complement protein C3 into various fragments that promote viral entry and infection of cells through different complement receptors. Complement opsonized HIV-1 has been shown in vitro to infect dendritic cells (DCs) in a CR3 dependent manner, although the role of CR3 and CD46 in natural HIV-1 infection is not clear. Surface expression of CR3 and CD46 on DC subsets of 30 antiretroviral naïve, 31 treated (cART) HIV-1 infected individuals and 30 seronegative controls was measured by flow cytometry and plasma levels of cytokines and complement activity (C3c levels) were quantitated by sandwich ELISA. Significantly lower surface expression of CR3 and CD46 was observed on DC subsets in naïve and treated HIV-1 infected individuals compared to controls. Significantly higher complement activation and plasma levels of IL-4, IL-8, IL-10 and IFN-γ were observed in treatment naïve HIV-1 infected individuals than controls. Significantly lower plasma levels of IL-4, IL-6, IL-8 and IL-10 were observed in treated vs. naïve HIV-1 infected individuals. Our findings suggest that alterations in expression of CR3 and CD46 on DCs along with complement activity could be factors that influence viral persistence and HIV-1 disease progression and need to be further evaluated.



http://ift.tt/2prbJv4

Repair of Lower Canalicular Laceration Using the Mini-Monoka Stent: Primary and Revisional Repairs

Background: We present our results of primary repair of lower canalicular injury using the Mini-Monoka stent and report our experience with revisional repair of canalicular blocks to treat epiphora following primary repair Methods: We performed primary repair in 169 canalicular laceration patients using Mini-Monoka. The primary repair was defined as the first operation proceeded within 48 hours after injury. Revisional repairs were performed in patients who underwent primary repair of canalicular laceration and subsequently complained of epiphora with canalicular block owing to peripheral scarring. In revisional repair, a Mini-Monoka stent was reinserted to maintain the realigned lacrimal pathway. Results: The primary repair achieved functional success in 94.7% of patients. After primary repair, nine patients complained of epiphora. Two of 9 patients underwent CDCR and 5 underwent revisional repair of canalicular blockage. The revisional repair achieved functional success in 4 of 5 patients. After revisional repair, scar contracture and asymmetry of the medial canthus or malposition of the lower lacrimal punctum were corrected. Cosmetically, all 5 patients were satisfied with the results. Functionally, one patient complained persistent epiphora and was treated with CDCR. Conclusions: We were able to experience simple, safe, and successful primary repair of lower canalicular injuries using the Mini-Monoka stent. If epiphora owing to canalicular block after primary repair and asymmetry of the medial canthus owing to scar contracture or malposition of lacrimal punctum are present, scar release and realignment of the canaliculus with Mini-Monoka insertion at the time of revisional repair are recommended. Address correspondence and reprint requests to Yong-Ha Kim, MD, PhD, Department of Plastic & Reconstructive Surgery, Yeungnam University College of medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea; E-mail: kimyon@ynu.ac.kr Received 1 December, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2FZ72iv

Making a Narrow Path, Then a Road, Through the Snow

No abstract available

http://ift.tt/2IG53RV

A Practical Recommendation for Teaching Neck Anatomy During Neck Dissection in the Operating Room

Anatomy knowledge is not only essential for surgeons but also has importance for anyone who performs an invasive procedure on a patient, and provides examination and diagnosis of patients and sharing of these findings to the patient and other medical professionals. It is accepted that most surgical procedures could facilitate anatomic perception in surgical internships. There is an educational tendency to explore innovative instructional tools and methods that can help support current education styles. This study investigates the effect of a green laser pointer on students' perceptions and educational effectiveness when neck dissection is performed in the operating room. Address correspondence and reprint requests to Mehmet Çelik, MD, Department of Otorhinolaryngology—Head and Neck Surgery, Istanbul University Faculty of Medicine, 34093 Fatih, Istanbul, Turkey; E-mail: mehmetcelik@istanbul.edu.tr Received 3 October, 2017 Accepted 8 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2pvhKpJ

Resolution of Diplopia in Late Repair of Enophthalmos Following Facial Trauma

Posttraumatic enophthalmos due to isolated or complex orbital fractures can contribute to diplopia. Current evidence recommends early repair. However, little is known about the outcome of enophthalmos correction when repair occurs beyond 30 days after trauma. In this systematic review, the authors aim to evaluate the current evidence on functional outcomes after delayed repair of posttraumatic enophthalmos. Two independent assessors undertook a systematic review of the literature using multiple databases. The authors' inclusion criteria identified studies involving patients at least 14 years of age who had surgical correction of persistent enophthalmos 30 days after initial trauma. Each eligible paper was included after critical appraisal using validated guidelines. Data on preoperative and postoperative enophthalmos and diplopia in each study was extracted. The pattern of fracture was also noted. The authors' search for the medical databases yielded 1053 articles, of which 6 eligible papers were included. Meta-analysis was performed. In patients with complex injuries involving orbital and mid-facial fractures, diplopia resolution was calculated to be 53%, and enophthalmos was corrected in 83% of the patients. In patients with isolated orbital fractures, 53% had resolution of their diplopia, and enophthalmos was corrected in 88% of the patients. Enophthalmos can be corrected to within 2 mm of the contralateral eye in both the isolated and complex orbital fractures in patients who present 30 days or greater after injury. Based on the studies reviewed, there is less predictability in diplopia resolution. Address correspondence and reprint requests to Dr Mark McRae, MD, MScCH, St. Joseph's Healthcare, 50 Charlton Ave E, Room G845, Hamilton, ON L8N 4A6, Canada; E-mail: markhmcrae@gmail.com Received 14 October, 2017 Accepted 8 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2IHILzc

Assessment of Atlanto-Axial and Mandibular Rotation by Cone Beam Computed Tomography

The cranial portion of the vertebral segment together with the atlanto-occipital joint represents a very complex area. Since this system could be influenced by different atlas and mandibular position, the aim of this work was to assess atlanto-axial and mandibular rotation. Scanora 3-dimensional cone bean computed tomography images from 205 patients without signs or symptoms of temporomandibular disorder were evaluated. Using a digitalized images analyzer, the axial rotations of atlas and mandible rotation were calculated, measuring the angle with respect to the frontal plane. The same direction for the axial rotation of the mandible and for the atlanto-axial rotation (consistent group) was observed in 80.98% of the patients; opposite directions (inconsistent group) were observed in 19.02%. Among the consistent group, the left rotation was observed in 71.08% of the patients and the right rotation in 28.92%. Absolute values showed a more marked rotation for atlas than mandible and higher values for the left rotation were reported for both. Taking together these data represents important starting points for the knowledge of atlas and mandible relationship and its functional and clinical implication. Address correspondence and reprint requests to Luigi F. Rodella, MD, MSc, Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123 Brescia, Italy; E-mail: luigi.rodella@unibs.it Received 29 November, 2017 Accepted 16 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2FYirix

Improving Postoperative Nasal Airway Patency in Le Fort-Based, Maxillofacial Trauma Patients Via a Modified Nasal Packing Technique

Introduction: Combined mid-face and nasal apparatus trauma injuries pose a significant challenge to airway patency (AW), in the immediate postoperative setting following fracture reduction. As such, the authors describe a modified technique with the goal of maintaining a patent nasal AW, while at the same time, minimizing nasopharyngeal bleeding and nasal AW edema—which can complicate patients requiring intermaxillary fixation (IMF) in the setting of pan-facial trauma. Methods: A modified technique was devised to assist the reconstruction surgeon in avoiding the risks associated with tracheostomy placement. In an effort to avoid surgical AW complications and improve nasal AW patency in the setting of concurrent IMF and nasal trauma, the authors developed a 2-stage technique drawing upon knowledge from the literature and the authors' own experiences. Technique: Following safe extubation, the authors insert open lumen nasal splints in both the nostrils, and suture them together to the nasal septum. If additional inner nasal support is required, polyvinyl alcohol nonabsorbable nasal packing dressing is covered with antibiotic ointment, and then placed within the nasal cavity lateral to the open lumen splints—as a way to further bolster the internal valve and mid-vault anatomy. Discussion: Given the fact that traditional nasal packing with merocele/gauze dressing in concomitant to IMF reduced patients ability to ventilate, the authors felt that a modified technique should be applied. The authors' preferred materials in such patients are open lumen splint, which provides nasal AW patency along with some septum support accompanied by merocele dressing. The authors feel that by applying this technique they achieve dual objectives by supporting the traumatized nose and maintaining nasal AW patency. Address correspondence and reprint requests to Chad R. Gordon, DO, FACS, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 8th floor, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 11 January, 2018 Accepted 29 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2IIfHYo

Does Mixed Conventional/Piezosurgery Implant Site Preparation Affect Implant Stability?

The aim of this study was to compare the effect of conventional implant site preparation technique and a combination of conventional/piezosurgery preparation on implant stability measured at different time intervals, insertion torque, and preparation time. A randomized controlled study was designed, it included 26 patients who received 54 dental implants randomly assigned to 2 groups; in the control group, implants were installed after conventional preparation with drills whereas the study group received implants after mixed conventional/piezosurgery preparation. The outcome variables included: implant stability measured immediately after implant insertion, at 8 weeks and 16 weeks postoperatively, insertion torque and preparation time. All the investigated variables were analyzed statistically using 1 sample Kolmogrov–Simirenov test, Mann–Whitney U test, paired and unpaired Student t test, the Pearson χ2 test, Fisher exact test, and analysis of variance (1-way ANOVA). The differences were considered significant at P ≤ 0.05. Implant stability showed a similar pattern in both the groups which consists of a statistically significant decrease in implant stability quotient values at the 8th week followed by a statistically significant increase at the 16th week, where the implant stability quotient values return close to those of primary stability. The 2 groups revealed a statistically not significant difference in insertion torque and implant stability changes throughout the study period, whereas the preparation time was significantly longer in the study group than the control group. The mixed conventional/piezosurgery method of implant site preparation offers no additional advantage over the conventional drilling method in terms of values of insertion torque and patterns of implant stability change throughout the healing period. Address correspondence and reprint requests to Salwan Yousif Hanna Bede, BDS, FIBMS, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Bab-Almoadham, P.O. Box 1417 Baghdad, Iraq; E-mail: salwan.bede@gmail.com Received 3 December, 2017 Accepted 29 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2pu6QQX