AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Kealan C. Hobelmann, Michael C. Topf, Voichita Bar-Ad, Adam J. Luginbuhl, William M. Keane, Joseph M. Curry, David M. Cognetti
ObjectiveTo assess the pathological outcomes of surgically-managed human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) using the 8th Edition of the American Joint Committee on Cancer Staging Manual (AJCC-8ed).Materials and methodsA retrospective review was conducted of 156 patients with previously untreated OPSCC who underwent primary TORS between March 2010 and February 2015 to evaluate the impact of the new AJCC-8ed pathologic staging system. Only patients who had complete pathologic staging with neck dissection and at least 2 years of follow-up records or disease recurrence within 2 years were included for analysis.Results and conclusionsOf the 156 patients, 116 patients had neck dissections and adequate follow-up data. There were 10 total recurrences, including 2 regional recurrences and 1 local recurrence. Lymph node size, number of positive lymph nodes, and presence of any positive nodes were not associated with recurrence for HPV-positive patients. The presence of extranodal extension approached significance. Pathologic N-stage was not predictive of recurrence under the AJCC-7ed or the AJCC-8ed systems. Cancer staging under the AJCC-8ed, but not the AJCC-7ed system was significantly associated with recurrence. In conclusion, pathologic node status as defined in the AJCC-8ed pathologic staging system does not appear to drive prognosis for surgically managed patients. While the new AJCC-8ed staging is an improvement in prognostication, the use of T-stage alone is still a better predictor of recurrence. TORS with adjuvant therapy determined by pathologic findings provides excellent locoregional control for HPV-positive OPSCC.



https://ift.tt/2IVVP7y

Gene signatures and expression of miRNAs associated with efficacy of panitumumab in a head and neck cancer phase II trial

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Marco Siano, Vittoria Espeli, Nicolas Mach, Paolo Bossi, Lisa Licitra, Michele Ghielmini, Milo Frattini, Silvana Canevari, Loris De Cecco
ObjectivePlatinum-based chemotherapy plus the anti-EGFR monoclonal antibody (mAb) cetuximab is used to treat recurrent/metastatic (RM) head-neck squamous cell carcinoma (HNSCC). Recently, we defined Cluster3 gene-expression signature as a potential predictor of favorable progression-free survival (PFS) in cetuximab-treated RM-HNSCC patients and predictor of partial metabolic FDG-PET response in an afatinib window-of-opportunity trial. Another anti-EGFR-mAb (panitumumab) was used as the treatment agent in RM-HNSCC patients in the phase II PANI01trial. PANI01 tumor samples were analyzed using functional genomics to explore response predictors to anti-EGFR therapy.Materials and methodsWhole-gene expression and real-time PCR analyses were applied to pre-treatment samples from 25 PANI01 patients. Three gene signatures (Cluster3 score, RAS onco-signature, microenvironment score) and seven selected miRNAs were separately analyzed for association with panitumumab efficacy.ResultsCluster3 expression levels had a profile with a significant bimodal separation of samples (P =  3.08 E−13). Higher RAS activation, microenvironment score, and miRNA expression were associated with low-Cluster3 patients. The same biomarkers were separately associated with PFS. Patients with high-Cluster3 had significantly longer PFS than patients with low-Cluster3 (median PFS: 174 versus 51 days; log-rank P = 0.0021). ROC analysis demonstrated accuracy in predicting PFS (AUC = 0.877).ConclusionsDespite differences in clinical settings and anti-EGFR inhibitors used for treatment, response prediction by the Cluster3 signature and selected miRNAs was essentially the same. Translation into a useful clinical assay requires validation in a broader setting.



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Modular MLV-VLPs co-displaying ovalbumin peptides and GM-CSF effectively induce expansion of CD11b+ APC and antigen-specific T cell responses in vitro

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Patricia Gogesch, Stefan Schülke, Stephan Scheurer, Michael D. Mühlebach, Zoe Waibler
The development of novel vaccination strategies is a persistent challenge to provide effective prophylactic treatments to encounter viral infections. In general, the physical conjugation of selected vaccine components, e.g. antigen and adjuvant, has been shown to enhance the immunogenicity and hence, can increase effectiveness of the vaccine. In our proof-of-concept study, we generated non-infectious, replication deficient Murine Leukemia Virus (MLV)-derived virus-like particles (VLPs) that physically link antigen and adjuvant in a modular fashion by co-displaying them on their surface. For this purpose, we selected the immunodominant peptides of the model antigen ovalbumin (OVA) and the cytokine granulocyte macrophage-colony stimulating factor (GM-CSF) as non-classical adjuvant. Our results show that murine GM-CSF displayed on MLV-VLPs mediates expansion and proliferation of CD11b⁺ cells within murine bone marrow and total spleen cells. Moreover, we show increased immunogenicity of modular VLPs co-displaying OVA peptides and GM-CSF by their elevated capacity to induce OVA-specific T cell-activation and -proliferation within OT-I and OT-II splenocyte cultures. These enhanced effects were not achieved by using an equimolar mixture of VLPs displaying either OVA or GM-CSF. Taken together, OVA and GM-CSF co-displaying MLV-VLPs are able to target and expand antigen presenting cells which in turn results in enhanced antigen-specific T cell activation and proliferation in vitro. These data suggest MLV-VLPs to be an attractive platform to flexibly combine antigen and adjuvant for novel modular vaccination approaches.

Graphical abstract

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Dendritic cells with increased expression of suppressor of cytokine signaling 1(SOCS1) gene ameliorate lipopolysaccharide/d-galactosamine-induced acute liver failure

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Shan-Shan Li, Min Yang, Yong-Ping Chen, Xin-Yue Tang, Sheng-Guo Zhang, Shun-Lan Ni, Nai-Bin Yang, Ming-Qin Lu
Acute liver failure is a devastating clinical syndrome with extremely terrible inflammation reaction, which is still lack of effective treatment in clinic. Suppressor of Cytokine Signaling 1 protein is inducible intracellular negative regulator of Janus kinases (JAK)/signal transducers and activators of transcription (STAT) pathway that plays essential role in inhibiting excessive intracellular signaling cascade and preventing autoimmune reaction. In this paper, we want to explore whether dendritic cells (DCs) with overexpression of SOCS1 have a therapeutic effect on experimental acute liver failure. Bone marrow derived dendritic cells were transfected with lentivirus encoding SOCS1 and negative control lentivirus, thereafter collected for costimulatory molecules analysis, allogeneic Mixed Lymphocyte Reaction and Western blot test of JAK/STAT pathway. C57BL/6 mice were randomly separated into normal control and treatment groups which respectively received tail vein injection of modified DCs, negative control DCs and normal saline 12 h earlier than acute liver failure induction. Our results indicated that DCs with overexpression of SOCS1 exhibited like regulatory DCs (DCregs) with low level of costimulatory molecules and poor allostimulatory ability in vitro, which was supposed to correlate with block of JAK2/STAT1 signaling. In vivo tests, we found that infusion of modified DCs increased survival rate of acute liver failure mice and alleviate liver injury via inhibition of TLR4/HMGB1 pathway. We concluded that DCs transduced with SOCS1 gene exhibit as DCregs through negative regulation of JAK2/STAT1 pathway and ameliorated lipopolysaccharide/d-galactosamine induced acute liver failure via inhibition of TLR4 pathway.



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Costunolide promotes the proliferation of human hair follicle dermal papilla cells and induces hair growth in C57BL/6 mice

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xo7siq

Pigmented transverse nasal band: A distinct presentation

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2srsgQz

A 9-year analysis of transoral laser microsurgery (TLM) of head and neck cancer on their potential suitability for transoral robotic surgery (TORS) for estimation of future TORS-specific caseload

OBJECTIVE: After that the establishment of transoral robotic surgery (TORS) for head and neck cancer has been adopted in North America, it has also recently been adopted in Europe. In these parts, transoral laser microsurgery (TLM) is widely applied. The aim of the study was to identify the absolute number of operations amenable to TORS at a TORS initiating institution on the basis of all former TLM cases.

PATIENTS AND METHODS: All laser surgery procedures from May 2004 to April 2013 (108 months) were initially retrospectively registered; after that, all stage pT1 and pT2 squamous cell carcinomas of the oropharynx, hypopharynx, and larynx were selected.

RESULTS: Over a period of nine years out of all TLM cases, there were 45 cases of pT1 and pT2 orohypopharyngeal and supraglottic squamous cell carcinomas, which could have been considered for TORS surgery. With the inclusion of a nowadays-typical TORS indication such as tonsil cancer, 142 cases would have been amendable to TORS.

CONCLUSIONS:  The indication for TORS would have been made in five of the TLM cases per year. Institutions initiating TORS, which own an intensive TLM experience, are encouraged to TORS indications in more than solely typical TLM indications. By indicating TORS instead of handheld surgery, a higher caseload of more than 15 cases per year can be achieved for TORS indications.

L'articolo A 9-year analysis of transoral laser microsurgery (TLM) of head and neck cancer on their potential suitability for transoral robotic surgery (TORS) for estimation of future TORS-specific caseload sembra essere il primo su European Review.

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Hepatic Abscess in a Returning Traveler with Crohn’s Disease: Differentiating Amebic from Pyogenic Liver Abscess

Liver abscess is a rare but serious complication of Crohn's disease. Patients with Crohn's disease are at risk for pyogenic liver abscesses due to immunosuppressive therapy, fistulous disease, and intraabdominal abscesses. Inflammatory bowel disease patients are also known to have a greater prevalence of amebiasis compared to the rest of the population; however, a higher incidence of amebic liver abscess has not been reported. We describe a case of a liver abscess in a patient with Crohn's disease that was initially presumed pyogenic but later determined to be amebic in origin. Epidemiology, clinical presentation, diagnosis, and treatment of amebic and pyogenic liver abscesses are discussed.

https://ift.tt/2kvWk9P

Goldenhar syndrome (oculo-auriculo-vertebral spectrum – OAVS): findings on cone beam computed tomography – three case reports

Publication date: Available online 7 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Igor Maryanchik, Madhu K. Nair
BackgroundGoldenhar syndrome, also known as oculo-auriculo-vertebral spectrum (OAVS), is a variant of hemifacial microsomia, a congenital condition affecting primarily aural, oral, and mandibular development, with vertebral anomalies, ocular abnormalities, and epibulbar dermoids. As a complex and heterogeneous condition, this disorder varies from mild to severe, and involvement is unilateral in many cases, but bilateral involvement is also known to occur. It presents several complex problems in treatment, requiring an integrated, multidisciplinary approach.Clinical and Radiographic FindingsOAVS has a wide range of clinical manifestations. This report describes radiographic features of the syndrome in three patients, as visualized on maxillofacial cone beam computed tomography (CBCT). Pertinent radiographic findings include multiple substantial unilateral anomalies affecting the skull, cervical vertebrae, orbit, ear, maxilla, mandible, and teeth.Definitive InterpretationRadiographic features are consistent with those previously reported in the literature for OAVS.ConclusionThe relevance of imaging diagnosis and characterization of the syndrome and the significance of coordinated diagnosis and management approaches between oral and maxillofacial radiologists and medical/dental specialists must be emphasized in order to allow for planning and implementation of inter-disciplinary intervention at an early stage.



https://ift.tt/2sdF9OG

Asymptomatic subcutaneous swelling of lower face

Publication date: Available online 10 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Stephanie Joana Roman Martelli, Felipe Martins Silveira, Pedro Henrique de Azambuja Carvalho, Ana Paula Neutzling Gomes, Ana Carolina Uchoa Vasconcelos




https://ift.tt/2JachAt

Oral cancer early detection: What will it take?

Publication date: Available online 18 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lauren L. Patton




https://ift.tt/2IWuyht

Frequency and type of ponticulus posticus in a longitudinal sample of non-orthodontically treated subjects: relationship with gender, age, skeletal maturity, and skeletal malocclusion.

Publication date: Available online 9 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Antonino Lo Giudice, Gianluigi Caccianiga, Salvatore Crimi, Costanza Cavallini, Rosalia Leonardi
Objectives. To assess the frequency and type of ponticulus posticus (PP) and to evaluate its relationship with gender, chronological age, skeletal maturity, and skeletal malocclusion. Study Design. The sample included longitudinal lateral cephalograms of 734 subjects (378 males and 356 females) retrieved from the American Association of Orthodontists Craniofacial Growth Legacy Collection. The presence of PP (complete and partial forms) was assessed by visual inspection and the cervical maturation method (CVM) was used to determine the skeletal maturation stage. The presence and type (complete or partial) of PP were assessed by gender, age at first appearance of PP, skeletal maturation stage as determined by the cervical maturation method (CVM), and skeletal malocclusion. Results. The overall prevalence of PP was 12.6% (93/734) with complete and partial forms observed respectively in 8.7% (64/734) and 3.9% (29/734) of the sample. Both forms of PP occurred mainly in the age range between 7-13 years old (p=0.04). No differences were found between gender, skeletal maturity stages, or skeletal malocclusion groups (p > 0.05). However, approximately 90% of PP occurred before and after the circumpubertal stage. Conclusion. PP should be expected mainly during childhood and pubertal age. This may support the theory of a genetic cause of this vertebral anomaly.



https://ift.tt/2Jac9AZ

An unusual microscopic pattern of foreign body reaction as a complication of dry socket management

Publication date: May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 5
Author(s): Jason Tasoulas, Argyrios Daskalopoulos, Christos Droukas, Afroditi Nonni, Nikolaos G. Nikitakis
Foreign body reactions in the oral cavity are relatively common, frequently resulting from iatrogenic causes. Depending on the nature of the foreign material, various microscopic patterns may be observed, causing diagnostic difficulties. Recognition of the ensuing unusual microscopic pattern, especially for cases in which the possibility of a foreign body reaction is not entertained in the clinical differential diagnosis, necessitates sufficient degree of suspicion, familiarization with the spectrum of microscopic appearances, and careful clinicopathologic correlation. Medicated dressings of various compositions are commonly placed for prevention or management of dry socket (or alveolar osteitis, a common postoperative complication of tooth extraction) and may be a cause of foreign body reaction. Here, we report a foreign body reaction to a medical dressing material in a postextraction socket, with an unusual microscopic pattern bearing resemblance to parasitic infestation.



https://ift.tt/2IZiNqk

Intraoperative three-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit

Publication date: Available online 7 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Thomas Gander, Michael Blumer, Claudio Rostetter, Maximilian Wagner, Daniel Zweifel, Paul Schumann, Daniel B. Wiedemeier, Martin Rücker, Harald Essig
ObjectiveFractures of the zygoma and orbit are common facial skeleton injuries. Inadequate reduction and internal fixation may result in functional and esthetic impairment. Herein, the use of intraoperative three-dimensional (3D) cone beam computed tomographic (CBCT) imaging for determining the intraoperative revision rate and need for additional reconstruction of the orbit were assessed.Study DesignA retrospective analysis was conducted of 48 consecutive patients (15 females, 33 males) suffering from simple or complex zygomatic fractures seen between June 2015 and October 2016. Intraoperative 3D CBCT imaging (Xoran Technologies, Ann Arbor, MI, USA) was performed and the intraoperative result was overlaid on the preoperative plan using iPlan software (Brainlab, Feldkirchen, Germany) for quality control. Categorical variables were cross-tabulated and compared using Fisher's exact test. P-values and 95% confidence intervals were assessed.ResultsIn 6 out of 48 patients, intraoperative revision was necessary based on the superimposition with the preoperative planning. Five of these six patients had comminuted fractures (p=0.001). In seven patients, the indication for orbital reconstruction was revised after the intraoperative 3D CBCT imaging.ConclusionsIntraoperative 3D CBCT imaging allows for immediate revision and prevents unnecessary orbital reconstruction.



https://ift.tt/2sfIEUG

Occurrence and associated factors of carotid artery calcification detected by digital panoramic radiography in chronic kidney disease patients undergoing hemodialysis

Publication date: Available online 24 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paulo R.L. Maia, Ana M.C. Medeiros, Hallissa S.G. Pereira, Kenio C. Lima, Patrícia T. Oliveira
ObjectivesTo investigate the occurrence and associated factors of carotid artery calcification (CAC) in chronic kidney disease (CKD) patients undergoing hemodialysis.Study DesignA total of 309 panoramic radiographs of CKD patients (180 men and 129 women with a mean age of 43.7 years) undergoing hemodialysis were evaluated by a single radiologist to evaluate the frequency of CAC. An evaluation of the associated factors of age, gender, time spent in hemodialysis, arterial hypertension, diabetes mellitus, biochemical parameters, and other systemic diseases was also performed.ResultsThe occurrence of CAC detected by the panoramic radiographs of these patients was 15.9% The chi-squared test found that there was a statistically significant association between age, gender, and diabetes mellitus and the presence of CAC (p<0.05). Multivariate analysis demonstrated that time spent in hemodialysis was significantly associated with the occurrence of CAC.ConclusionThere was a significant presence of CAC detected on digital panoramic radiographs in CKD patients undergoing hemodialysis. Calcification was more frequent in older patients, women, individuals with diabetes mellitus, and patients who had undergone hemodialysis for longer periods.



https://ift.tt/2ITcZyQ

Does the orthognathic surgery improve myofacial pain in individuals with skeletal class III? one year follow-up

Publication date: Available online 16 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Aline Monise Sebastiani, Paola Fernanda Cotait de Lucas Corso, Daniel Bonotto, Juliana Feltrin de Souza, Delson João da Costa, Rafaela Scariot, Nelson Luis Barbosa Rebellato
Objective: The objective of the present study was to evaluate the effect of orthognathic surgery on temporomandibular disorder (TMD) in patients with skeletal class III malocclusion. Study design: Forty-seven patients undergoing surgery were evaluated using Axis I of the Research Diagnostic Criteria/TMD index by a trained examiner, consecutively, at three different periods: 1 week before operation (T0), 6 months after operation (T1), and 1 year after operation (T2). Bivariate analyses were performed to compare the evaluation periods (p<0.05). Results: The prevalence of TMD in the sampled patients from T0 to T1 decreased from 30 (63.8%) to 22 (46.8%) (p=0.021). Even in T2, the prevalence of TMD remained lower than that in T0, at 21 (44.7%) diagnosed patients (p=0.049). The reported frequencies of myofascial pain and headache were lower in T1 and T2 than in T0 (p<0.001). A decrease in the frequency of joint pain and joint sound was observed only from T0 to T1 (p=0.039 and p=0.021, respectively). The mean maximum mouth-opening diameter decreased from T0 to T1 (p<0.001) and increased again at T2 (p<0.001). Conclusion: Orthognathic surgery promoted a reduction in the frequencies of myofascial pain and headache reported by patients with skeletal class III malocclusion.



https://ift.tt/2xhlwds

A multimodal analgesic protocol may reduce opioid use after 3rd molar surgery, a pilot study

Publication date: Available online 3 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Caitlin B.L. Magraw, Matthew Pham, Timothy Neal, Barry Kendell, Glenn Reside, Ceib Phillips, Raymond P. White
ObjectiveThis study was designed to assess the number of opioid doses available to patients from filled prescriptions after adoption of a multimodal analgesic protocol which included opioid prescribing to manage pain post-surgery in 2017.Study DesignData were retrieved from records of the first 24 patients having 3^rd molar surgery in 2017 identified from appointment schedules.Inclusion Criteria: American Society of Anesthesiologists risk classification I or II, age 18-35 years, and at least two lower 3^rd molars removed.Exclusion criteria: patients being treated for opioid addiction/abuse.The primary outcome variable was the number of opioid doses filled by prescriptions at each patient's discretion. The primary predictor variable was the multimodal analgesic protocol.ResultsData from records of 24 consecutive patients were analyzed. 83% were female. Median age was 25 years. (IQR 12,29y). Median surgery time was 35 min.(IQR 27, 32 min.). The median number of opioid doses filled in 2017 was 4 (IQR 0,4).ConclusionsThe outcomes from this pilot study suggest that implementation of a multimodal analgesic protocol to manage post-surgery pain while limiting the number of opioid doses available to the patient may be an effective strategy for a wider range of patients and procedures.



https://ift.tt/2JaoZzk

A call to study orphan diseases

Publication date: Available online 22 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Faizan Alawi




https://ift.tt/2xhlthM

Comparison of fractal dimension analysis and panoramic-based radiomorphometric indices in the assessment of mandibular bone changes in patients with type 1 and type 2 diabetes mellitus

Publication date: Available online 3 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Emine Şebnem Kurşun-Çakmak, Seval Bayrak
ObjectivesThis study compared the fractal dimension (FD) and radiomorphometric indices in the assessment of mandibular bone of patients with type 1 (T1 DM) and type 2 diabetes mellitus (T2 DM).Study DesignPanoramic radiographs of 104 patients were evaluated to calculate FD, mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) in the mandible.ResultsNo statistically significant differences were found in FD when T1 DM and T2 DM groups were compared with controls (P ≥ .168). Patients with T1 DM had significantly lower MCW (P < .001) and PMI (P = .030) compared with controls. Patients with T2 DM had no significant differences in MCW (P = .228) or PMI (P = .137) compared with controls. No significant differences were observed between patients with T1 DM and those with T2 DM for FD, MCW, and PMI (P > .05). In the T1 DM and T2 DM groups, there was a significant correlation between MCW and FD (P ≤ .011). No correlation was observed between FD and PMI in either the T1 DM group or the T2 DM group (P ≥ .142). No significant differences in MCI were observed between the DM groups and controls (P = .740) or between the T1 DM and T2 DM groups (P = 1.000).ConclusionsThe cortical and trabecular bone architectures of patients with T1 DM and T2 DM were not different. Patients with T1 DM had lower cortical measurements compared with controls.



https://ift.tt/2JabVK9

Atypical presentation of blastic plasmacytoid dendritic cell neoplasm: a potential diagnostic pitfall in nasal cavity

Publication date: Available online 3 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Fang Yu, Ke Sun, Zhaoming Wang
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease with an aggressive clinical course resulting in median survival times of 12-14 months¹. It represents approximately 0.8% of primary cutaneous lymphomas². According to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissue in 2008, BPDCN is defined as an acute myeloid leukemia related precursor neoplasm, derived from precursors of the plasmacytoid dendritic cell. It is characterized microscopically by its dense monomorphous infiltrates of medium-sized blastoid morphology and expression of CD4 and CD56 as well as the absence of any common myeloid, T-lymphoid, B-lymphoid, and NK-lymphoid lineage markers³. A few series of BPDCN have been reported in the literature, but very few cases of BPDCN have been described with lack of skin manifestation at the time of diagnosis⁴. Here we report a rare BPDCN that happened in nasal cavity.



https://ift.tt/2ITcPHK

The Anatomage Table and the placement of titanium mesh for the management of orbital floor fractures

Publication date: Available online 2 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Matteo Brucoli, Francesca Boccafoschi, Paolo Boffano, Emanuele Broccardo, Arnaldo Benech
ObjectiveThe anatomy of the head and neck region is complex as are its implications for maxillofacial pathologic conditions and their surgical treatments. We hypothesize that the assessment of the surgical management of orbital floor fractures by using titanium mesh could represent an appropriate first experimental field for the use of the Anatomage Table in maxillofacial surgery.Study DesignPatients with unilateral orbital floor fractures were searched for in the hospital database of Novara University Hospital, Novara, Italy. The Digital Imaging and Communications in Medicine data of preoperative and postoperative computed tomography examinations were retrieved and were uploaded in the Anatomage Table device. Then, a workstation was used to create anatomic dissection coronal and sagittal images together with the corresponding computed tomography scans. Finally, 10 maxillofacial surgery residents and young surgeons were involved in the assessment of the images.ResultsThe young surgeons reported a higher clarity of anatomic dissection images in comparison with computed tomography scans both in preoperative and postoperative images.ConclusionsThe fields of application of this new technology are wide and promising, ranging from the education, to the follow-up, to patient informed consent.



https://ift.tt/2sgziYV

Giant dentinogenic ghost cell tumor: A case report

Publication date: Available online 18 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ciro Dantas Soares, Roman Carlos, Thayná Melo de Lima Morais, Oslei Paes de Almeida
Dentinogenic ghost cell tumor (DGCT), a rare, benign odontogenic tumor with aggressive behavior, causes bone destruction and cortical expansion. We report here a case of DGCT in a 38-year-old male, presenting with enormous extraoral protrusion, which radiographically was predominantly radiolucent with radiopaque areas. Microscopically, it was observed to be a solid ameloblastomatous proliferation with pseudoglandular structures associated with clusters of ghost cells. Abundant dentinoid material adjacent to the epithelial sheets containing entrapped epithelial tumor cells was also evident. Immunohistochemistry revealed positivity for pan-cytokeratin (CK), CK-14, CK-7, and CK-19; CD138; and β-catenin. The Ki-67 proliferative index was very low (<1%). The clinical, histopathologic, and immunohistochemical features led to the diagnosis of DGCT. The patient underwent partial mandibulectomy, and no recurrences have occurred. To our knowledge, this is the largest DGCT described in the English language literature.



https://ift.tt/2ISgKEC

Editorial Board

Publication date: May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 5





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Letter to the Editor on Chronic fibrosing osteomyelitis of the jaws: an important cause of recalcitrant facial pain. A clinicopathologic study of 331 cases in 227 patients by Goldblatt LI, Adams WR, Spolnik KJ, Deardorf KA, Parks ET

Publication date: Available online 17 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Gary D. Klasser, Daniel M. Laskin, Charles S. Greene, James C. Burns




https://ift.tt/2IZ1nKv

Table of Contents

Publication date: May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 5





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Society Page

Publication date: May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 5





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Information for Readers

Publication date: May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 5





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Corrigendum to “Clinical and pathological analyses of tuberculosis in the oral cavity: report of 11 cases” [Oral Surgery oral medicine oral pathology oral radiology 2018;125: 44-51]

Publication date: Available online 23 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology





https://ift.tt/2L4YloN

Magnifying endoscopy with narrow-band imaging to assist the linear stapler closure of the pharynx during total laryngectomy

This study aimed to present a novel technique for stapler-assisted laryngectomy under direct visualization using a videoendoscope with narrow-band imaging (NBI-endoscopy).

https://ift.tt/2kxJ7xu

Interactions médicamenteuses entre méthotrexate et antibiotiques

Publication date: Available online 28 May 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




https://ift.tt/2kAghw9

Where Does Health Communication Technology Fit Into Allergy Practice?,

Over the past three decades, health and communication technologies (HCT) have evolved and joined forces to improve asthma management. Initially, technology was focused on the electronic measurement of patient adherence (Figure 1). As adherence-measurement devices improved, investigators began to use them as interventions to boost adherence, first by giving feedback directly to patients and later by adding communication technology. The more recent upsurge of available communication technology has introduced the role of smart phones, mobile apps, and interactive voice recognition (IVR) technology into healthcare.

https://ift.tt/2ITm76r

Giant intrascrotal embryonal rhabdomyosarcoma in an adult: a case report and review of the literature

Intrascrotal embryonal rhabdomyosarcoma in adults is a rare tumor with high aggression and a poor prognosis. We report our patient's case and review the relevant literature to improve the understanding of this...

https://ift.tt/2xkGMiz

Editorial Board

Publication date: June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 3





https://ift.tt/2J6Xl6r

Contents

Publication date: June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 3





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Laryngeal papillomatosis in Senegal: A ten-year experience

Publication date: June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 3
Author(s): S. Maïga, C. Ndiaye, M. Diouf, B.K. Diallo, M. Ndiaye, M.S. Diouf, I.C. Ndiaye, R. Diouf
ObjectivesThe objectives of this study were to describe the epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis in the Fann teaching hospital ENT department in Dakar, Senegal.Patients and methodsWe retrospectively reviewed all cases of laryngeal papillomatosis managed in the Fann teaching hospital ENT department between 1st January 2006 and 31st December 2015. Epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis were studied. Statistical analysis was performed with SPSS 18 software.ResultsThe median age at diagnosis was 11 years and the sex ratio was 1.88. The mean time to consultation was 4.5 years. The predominant symptom was dysphonia, present in all cases, followed by laryngeal dyspnoea in 64.6% of cases. The glottic area was involved in all patients. Tracheostomy was performed in 20.8% of cases. All patients in our study underwent endoscopic excision of the lesions.ConclusionLaryngeal papillomatosis is the most common benign tumor in children, but it can also occur in adults. Treatment has been revolutionized by progress in endoscopy and antiviral therapy. However, tracheostomy still occupies an important place in our practice.



https://ift.tt/2IQynsx

Memory responses of innate lymphocytes and parallels with T cells

Abstract

Natural killer (NK) cells are classified as innate immune cells, given their ability to rapidly respond and kill transformed or virally infected cells without prior sensitization. Recently, accumulating evidence suggests that NK cells also exhibit many characteristics similar to cells of the adaptive immune system. Analogous to T cells, NK cells acquire self-tolerance during development, express antigen-specific receptors, undergo clonal-like expansion, and can become long-lived, self-renewing memory cells with potent effector function providing potent protection against reappearing pathogens. In this review, we discuss the requirements for memory NK cell generation and highlight the similarities with the formation of memory T cells.

https://ift.tt/2GYBado

Foaming of blood in endovenous laser treatment

Abstract

This work is dedicated to a challenging issue of modern phlebology—establishment of a physical mechanism of the endovenous laser treatment (EVLT) against great saphenous vein incompetence (protuberant varicosities). Using optical and acoustical methods, we have studied the laser-induced formation of microbubbles in an aqueous solution of surface-active substances, serum, and blood directly in patients while conducting EVLT of the great saphenous vein in a clinical setting. We have used lasers with wavelengths 0.97 and 1.47 μm. Their radiation was transmitted through a quartz-quartz polymer fiber 600 μm in diameter. It has been found that in all cases, the laser beam with moderate power (1–10 W) supplied through an optical fiber leads to the formation of micro-bubbled foam. It has been shown that laser exposure during EVLT induces blood boiling, which results in heating of the venous walls (thermal destruction of the intima) and provides effective foam occlusion of the blood vessels (hemostasis). Necessary and sufficient conditions for a successful EVLT are associated with the thermal destruction of intima and laser-induced foam hemostasis.

https://ift.tt/2ISAZlD

Effect of photobiomodulation therapy on oxidative stress markers of gastrocnemius muscle of diabetic rats subjected to high-intensity exercise

Abstract

This study aimed to determine whether photobiomodulation therapy (PBMT) in diabetic rats subjected to high-intensity exercise interferes with the expression of the oxidative stress marker in the gastrocnemius muscle. Twenty-four male Wistar rats were included in this study comprising 16 diabetic and eight control rats. The animals were allocated into three groups—control, diabetic fatigue, and diabetic PBMT fatigue groups. Diabetes was induced via the intraperitoneal administration of streptozotocin (50 mg/kg). We subsequently assessed blood lactate levels and PBMT. The animals of the diabetic fatigue group PBMT were irradiated before the beginning of the exercises, with dose of 4 J and 808 nm, were submitted to treadmill running with speed and gradual slope until exhaustion, as observed by the maximum volume of oxygen and lactate level. The animals were euthanized and muscle tissue was removed for analysis of SOD markers, including catalase (CAT), glutathione peroxidase (GPx), and 2-thiobarbituric acid (TBARS) reactive substances. CAT, SOD, and GPx activities were significantly higher in the diabetic PBMT fatigue group (p < 0.05) than in the diabetic fatigue group. Outcomes for the diabetic PBMT fatigue group were similar to those of the control group (p > 0.05), while their antioxidant enzymes were significantly higher than those of the diabetic fatigue group. PBMT mitigated the TBARS concentration (p > 0.05). PBMT may reduce oxidative stress and be an alternative method of maintaining physical fitness when subjects are unable to perform exercise. However, this finding requires further testing in clinical studies.

https://ift.tt/2LCetPJ

Merkel cell carcinoma and cellular cytotoxicity: sensitivity to cellular lysis and screening for potential target antigens suitable for antibody-dependent cellular cytotoxicity

Abstract

The recent success of checkpoint inhibitors in the treatment of Merkel cell carcinoma (MCC) confirms that MCC tumors can be immunogenic. However, no treatment directly targeting the tumor is available for use in combination with these checkpoint inhibitors to enhance their efficacity. This study was carried out to characterize MCC line sensitivity to cellular lysis and to identify cell surface antigens that could be used for direct targeting of this tumor. For five representative MCC lines, the absence or low expression of MICA, MICB, HLA-I, and ICAM-1 was associated with low level of recognition by NK cells and T lymphocytes. However, expression of HLA-I and ICAM-1 and sensitivity to cellular lysis could be restored or increased after exposure to INFγ. We tested 41 antibodies specific for 41 different antigens using a novel antibody-dependent cellular cytotoxicity (ADCC) screening system for target antigens. Anti-CD326 (EpCAM) was the only antibody capable of inducing ADCC on the five MCC lines tested. Because MCC tumors are often directly accessible, local pharmacologic manipulation to restore HLA class-I and ICAM-1 cell surface expression (and thus sensitivity to cell lysis) can potentially benefit immune therapeutic intervention. In line with this, our observation that ADCC against EpCAM can induce lysis of MCC lines and suggests that therapeutic targeting of this antigen deserves to be explored further.

https://ift.tt/2LCOIi5

Otoacoustic emission suppression in children diagnosed with central auditory processing disorder and speech in noise perception deficits

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Vasiliki (Vivian) Iliadou, Jeffrey Weihing, Gail D. Chermak, Doris Eva Bamiou
ObjectiveThe present study was designed to test the hypothesis that medial olivocochlear system functionality is associated with speech recognition in babble performance in children diagnosed with central auditory processing disorder.MethodChildren diagnosed with central auditory processing disorder who specifically demonstrated speech in noise deficits were compared to children diagnosed with central auditory processing disorder without these deficits. Suppression effects were examined across 15 time intervals to examine variability. Analysis of right and left ear suppression was performed separately to evaluate laterality.Study sample52 children diagnosed with central auditory processing disorder, aged 6–14 years were divided into normal or abnormal groups based on SinB performance in each ear. Cut-off value was set at SNR = 1.33 dB. Transient otoacoustic emissions suppression was measured.ResultsThe abnormal Speech in Babble Right Ear group showed significant negative correlations with suppression levels for 7 of the 15 time intervals measured. No significant correlations with SinBR performance were observed for the remaining time intervals, as was the case for the typically evaluated R8-18 time interval and the Speech in Babble Left Ear.ConclusionsResults indicate that suppression is influenced by the time window analysed, and ear tested, and is associated with speech recognition in babble performance in children with central auditory processing disorder.



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Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): C.L. Werker, M.T.A. van den Aardweg, S. Coenraad, A.B. Mink van der Molen, C.C. Breugem
ObjectiveAdopted children with cleft lip and/or cleft palate form a diverse group of patients. Due to increased age at palatal repair, adopted children have a higher risk of velopharyngeal insuffiency and poor speech outcome. Delayed palate repair may also lead to longer lasting Eustachian tube dysfunction. Decreased function of the Eustachian tube causes otitis media with effusion and recurrent acute otitis media, which can lead to other middle ear problems and hearing loss.MethodsOne-hundred-and-thirty-two adopted children treated by the Cleft palate team in Wilhelmina Children's Hospital during January 1994 and December 2014 were included. Retrospectively, middle ear findings, the need for ventilation tube insertion and hearing during childhood were assessed. Findings were compared with 132 locally born children with cleft lip and/or cleft palate.ResultsAdopted children had a mean age of 26.5 months old when they arrived in our country. After the age of two the total number of otitis media with effusion episodes and the need for ventilation tube placement did not significantly differ among adopted and non-adopted children. Adopted children had significantly more tympanic membrane perforations. Hearing threshold levels normalized with increasing age. Although within normal range, adopted children showed significantly higher pure tone averages than locally born children when they were eight to ten years old.ConclusionIn general, adopted patients with cleft lip and/or cleft palate did not have more middle ear problems or ventilation tubes during childhood. However, theyhave more tympanic membrane perforations.



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Implementing a standardised discharge analgesia guideline to reduce paediatric post tonsillectomy pain

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Fenella R. Shelton, Hirotaka Ishii, Sophie Mella, Dylan Chew, Jemma Winterbottom, Hussein Walijee, Rachel Brown, Edward J. Chisholm
ObjectivesTo reduce readmission for pain control post-paediatric tonsillectomy.IntroductionPaediatric tonsillectomy is a common procedure in the UK. Uncontrolled pain at home is a common reason for re-admission and therefore adequate analgesic control following paediatric tonsillectomy is vital for a smooth post-operative recovery. Analgesic regimens at a district general hospital in England were audited and a standardised protocol was subsequently implemented.MethodsA retrospective audit from September 2014 to August 2015 was completed. Discharge analgesic regimens and readmission rates post-tonsillectomy for recurrent tonsillitis in 2–17 year-old children were studied in a large general hospital in the United Kingdom. A standardised weight-based algorithm was used to dose scheduled regular paracetamol for 2 weeks. Second cycle prospective audit ran from December 2015 to November 2016.ResultsIn cycle 1, 151 children (mean age, 7.9 years) underwent tonsillectomy for tonsillitis, 25 (16.6%) of whom were readmitted. 12 (7.9%) experienced postoperative haemorrhage, 13 (8.6%) required pain control, and one (1.2%) had infection. The discharging analgesic regimen varied widely and often included purchase of over-the-counter ibuprofen and paracetamol. In cycle 2, 118 children (mean age, 8.8 years) underwent tonsillectomy, 17 (14.4%) were readmitted; 12 (10.2%) had post-operative haemorrhage, 0 needed pain control, 5 (4.2%) had other problems. There was a significant reduction in readmission for pain control (p = 0.0027) from 7.3% to 0% in the study. There was no significant change in overall readmission rate (16.6%–14.4%) or postoperative haemorrhage rate (8.9% overall).DiscussionAnalgesia prescription post tonsillectomy varies widely and over the counter prescriptions of ibuprofen and paracetamol is based on age rather than weight with patients receiving inadequate analgesic doses. A readily available standardised postoperative analgesic protocol can significantly reduce readmission rates for pain control following paediatric tonsillectomy.



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Occurrence of type 1 and type 2 diabetes in patients treated with immunotherapy (anti-PD-1 and/or anti-CTLA-4) for metastatic melanoma: a retrospective study

Abstract

Anti-PD-1 and anti-CTLA-4 antibodies cause immune-related side effects such as autoimmune type 1 diabetes (T1D). It has also been suggested that by increasing TNF-α, IL-2 and IFN-γ production, anti-PD-1 and/or anti-CTLA-4 treatment could affect pancreatic beta cell function and insulin sensitivity. This study was based on a retrospective observational analysis from 2 July 2014 to 27 June 2016, which evaluated the occurrence of T1D and changes in glycemia and C-reactive protein (CRP) plasma concentrations in patients undergoing anti-PD-1 and/or anti-CTLA-4 treatment for melanoma at the Saint Louis Hospital. All cases of T1D that developed during immunotherapy registered in the French Pharmacovigilance Database (FPVD) were also considered. Among the 132 patients included, 3 cases of T1D occurred. For the remaining subjects, blood glucose was not significantly affected by anti-PD-1 treatment, but CRP levels (mg/l) significantly increased during anti-PD-1 treatment (p = 0.017). However, 1 case of type 2 diabetes (T2D) occurred (associated with a longer therapy duration). Moreover, glycemia of patients pretreated (n = 44) or concomitantly treated (n = 8) with anti-CTLA-4 tended to increase during anti-PD-1 therapy (p = 0.068). From the FPVD, we obtained 14 cases of T1D that occurred during immunotherapy and were primarily characterized by the rapidity and severity of onset. In conclusion, in addition to inducing this rare immune-related diabetes condition, anti-PD-1 treatment appears to increase CRP levels, a potential inflammatory trigger of insulin resistance, but without any short-term impact on blood glucose level.

https://ift.tt/2siOcNv

Nalbuphine as an adjuvant to 0.25% levobupivacaine in ultrasound-guided supraclavicular block provided prolonged sensory block and similar motor block durations (RCT)

Abstract

Purpose

Prolonged postoperative analgesia with early motor recovery for early rehabilitation is a challenge in regional block. The purpose of this study is to evaluate the effect of adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular brachial plexus block.

Methods

One hundred thirty-five (135) patients scheduled for hand and forearm surgeries with supraclavicular block were randomly allocated into three equal groups. Group L received 25 ml of 0.5% levobupivacaine + 1 ml normal saline; group H received 25 ml of 0.25% levobupivacaine + 1 ml normal saline; and group N received 25 ml of 0.25% levobupivacaine + 1 ml (20 mg) nalbuphine. Onset time and duration of sensory and motor block, and time to first analgesic dose were recorded.

Results

Sensory block onset was comparable between the three groups. Motor block onset in group L and group N was comparable (13.16 ± 3.07 and 13.84 ± 3.05 min, respectively) and was shorter than that in group H (15.71 ± 2 0.91 min). Sensory block duration in group L and group N was comparable (522.22 ± 69.57 and 533.78 ± 66.03 min, respectively) and was longer than that in group H (342.67 ± 92.80 min). Motor block duration in group N and group H was comparable (272.00 ± 59.45 and 249.78 ± 66.01 min, respectively) and was shorter than that in group L (334.67 ± 57.90 min). Time to first analgesic dose was significantly longer in group N (649.78 ± 114.76 min) than that of group L and group H (575.56 ± 96.85 and 375.56 ± 84.49 min, respectively) and longer in group L when compared to group H.

Conclusions

Adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular block provided prolonged duration of sensory block with similar duration of motor block.

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Spinal anesthesia for surgery longer than 60 min in infants: experience from the first 2 years of a spinal anesthesia program

Abstract

Purpose

Spinal anesthesia (SA) is being increasingly used in infants to avoid the potential negative neurocognitive effects of general anesthesia (GA). However, SA has been reported to provide a relatively short duration of surgical anesthesia.

Methods

We retrospectively reviewed SA cases for surgical procedures lasting more than 60 min in children up to 3 years old. All patients received bupivacaine 0.5% (1 mg/kg up to 7 mg) with clonidine 1 µg/kg ± epinephrine. The primary outcome was success of SA without subsequent conversion to GA.

Results

Thirty-five patients met inclusion criteria (all males, age 7 ± 5 months, weight 8 ± 2 kg). Procedures included male genital, groin and multiple site surgeries. Average surgical duration was 71 ± 12 min (range 60–111 min). SA was successful in 31 of 35 patients (89%; 95% confidence interval 78, 99%). The cause of failure was rarely due to the duration of surgery (1 of 4 patients). Six patients with successful SA required sedation with dexmedetomidine ± fentanyl. Differences in procedure duration and patient characteristics were not statistically significant between successful and failed SA.

Conclusions

SA is a highly successful technique and may offer an alternative to GA in children undergoing appropriate surgery expected to last as long as 60–100 min.

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Dependent functional status is associated with unplanned postoperative intubation after elective cervical spine surgery: a national registry analysis

Abstract

Purpose

The impact of preoperative functional status on 30-day unplanned postoperative intubation and clinical outcomes among patients who underwent cervical spine surgery is not well-described. We hypothesized that functional dependence is associated with 30-day unplanned postoperative intubation and that among the reintubated cohort, functional dependence is associated with adverse postoperative clinical outcomes after cervical spine surgery.

Methods

Utilizing the 2007–2016 American College of Surgeons National Surgical Quality Improvement Program database, we identified adult elective anterior and posterior cervical spine surgery patients by Current Procedural Terminology codes. We performed (1) a Cox Proportional Hazard analysis for the following outcomes: reintubation, prolonged ventilator use, and pneumonia and (2) an adjusted logistic regression analysis among patients that required postoperative reintubation to evaluate the association of functional status with adverse postoperative outcomes.

Results

The sample size was 26,263, of which 550 (2.1%) were functionally dependent. The adjusted model suggested that when compared with functionally independent patients, dependent patients were at increased risk of unplanned 30-day intubation (HR 2.05, 95% CI 1.26–3.34; P = 0.003). The adjusted risk of 30-day postoperative pneumonia was significantly higher in patients with functional dependence (HR 1.61, 95% CI 1.02–2.54, P = 0.036). Among patients that required postoperative reintubation, the odds of 30-day mortality was significantly higher in patients with functional dependence (OR 5.82, 95% CI 1.59–23.4, P < 0.001).

Conclusion

Preoperative functional dependence is a good marker for estimating postoperative unplanned intubation following cervical spine surgery.

https://ift.tt/2LzVrcI

Infants Are More Likely Than Older Children to Have Surgery for Cervical Infections

Objectives. To identify differences in cervical infection management in infants versus older children. Methods. Charts of patients 0–18 years, diagnosed with a cervical infection at our institution between 2004 and 2015, were included. Age, gender, presenting symptoms, comorbidities, CT scan findings and management including admission, procedures, antibiotics, cultures, length of stay, readmission rates, and complications were included. Results. 239 patients were included: mean age was 4.6 years, with 55.6% boys and 44.4% girls. Mean length of stay was 3.2 days, with no significant difference between age categories. 12.55% were readmitted within 30 days with no significant difference when stratified for age (p = 0.268). The most common presenting symptoms were fever (74.3%), swelling (71.4%), and neck pain (48.2%). Infants had fewer symptoms documented than older children. 51% has lateral neck infections, and these were more common in younger children (p

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