Induced surface proteins of Streptococcus epidermidis adhering to titanium implant substrata

Abstract

Objective

Staphylococcus epidermidis, as a primary colonizer, is strongly associated with infections of (dental) implants (i.e., peri-implantitis), but little is known about the surface proteome of this bacterium. For the identification of bacterial adhesins, this study investigated the surface proteome of S. epidermidis adhering directly to titanium implant substrata.

Materials and methods

S. epidermidis strain ATTC 35984 was cultured either planktonically or on titanium implant specimens. The surface proteomes were isolated by mutanolysin digestion, and proteins were separated by 2D gel electrophoreses to reveal highly expressed proteins only. Protein spots were visualized by silver staining and proteins were identified by mass spectrometry.

Results

Surface proteome analyses of S. epidermidis on titanium identified six expressed proteins. Three proteins were highly expressed on the titanium implants including accumulation-associated protein Q8CQD9. These specific proteins could be potential pathogenicity factors of bacteria in peri-implant biofilms.

Conclusion

For the first time, our study identified S. epidermidis surface proteins, which are expressed after adhesion to titanium implant materials.

Clinical relevance

Our study reveals possible candidates for a newly protein-based vaccine against peri-implantitis.

https://ift.tt/2HJgZ3A

Analysis of factors associated with cedar pollen sensitization and development of pollinosis in a young Japanese adult population

Publication date: Available online 13 June 2018
Source:Allergology International
Author(s): Satoshi Nakamura, Sachiko Tsunoda, Hiroshi Sakaida, Sawako Masuda, Ahamad Shah Said, Kazuhiko Takeuchi
BackgroundGenetic and environmental factors are proposed to be involved in cedar pollen allergy sensitization and onset. The impact of these factors will provide key information for the prevention of cedar pollen sensitization and allergy onset, which we investigated in this cross-sectional study.MethodsSubjects were 382 young adult volunteers who completed a self-administered questionnaire on self-reported subjective symptoms of pollinosis, physician-diagnosed pollinosis, and background factors. We also measured their serum IgE antibody titers specific for cedar, cypress, and mites. Factors associated with subjective symptoms, physician diagnosis, and the three specific antigens were determined using both univariate and multivariate analyses.ResultsSensitization to cedar, cypress, and mites, defined as specific IgE levels of class 1 or above, was found in 78.8%, 64.4%, and 56.0% of subjects, respectively. The prevalence of cedar pollinosis was 41.2% based on subjective symptoms and 22.2% based on physician diagnosis. Factors associated with increased cedar pollen sensitization were mite sensitization, comorbid allergic rhinitis, and family history of cedar pollinosis. Risk-reducing factors for cedar pollen sensitization were keeping a cat, number of common colds, and hours of sleep. Risk-increasing factors for both subjective pollinosis symptoms and physician-diagnosed pollinosis were comorbid allergic rhinitis and family history of cedar pollinosis.ConclusionsSensitization to cedar pollen in this population was extremely high. Both common and distinct factors were associated with sensitization to pollen and with the development of pollinosis. The distinct factors were associated with sensitization to cedar and cypress antigens.



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Hypofractionated Radiotherapy Is Superior to Conventional Fractionation in an Orthotopic Model of Anaplastic Thyroid Cancer

Thyroid, Volume 28, Issue 6, Page 739-747, June 2018.


https://ift.tt/2JN1QU2

NFE2-Related Transcription Factor 2 Coordinates Antioxidant Defense with Thyroglobulin Production and Iodination in the Thyroid Gland

Thyroid, Volume 28, Issue 6, Page 780-798, June 2018.


https://ift.tt/2LK25MJ

Thyroid Incidentalomas Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography: Malignant Risk Stratification and Management Plan

Thyroid, Volume 28, Issue 6, Page 762-768, June 2018.


https://ift.tt/2JPLSYY

Future Meetings

Thyroid, Volume 28, Issue 6, Page 823-824, June 2018.


https://ift.tt/2LMqiCi

Theo J. Visser, PhD (September 17, 1949–March 21, 2018)

Thyroid, Volume 28, Issue 6, Page 687-689, June 2018.


https://ift.tt/2JRgx8r

Excessive Iodine Intake and Subclinical Hypothyroidism in Children and Adolescents Aged 6–19 Years: Results of the Sixth Korean National Health and Nutrition Examination Survey, 2013–2015

Thyroid, Volume 28, Issue 6, Page 773-779, June 2018.


https://ift.tt/2HGM5sB

RSS Story 01

RSS Story 01 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus dignissim dapibus erat, non hendrerit tortor tempus sed....

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Zygomatico-coronoid ankylosis as sequel of inadequate treatment

Vikas Dhupar, Francis Akkara, Pulkit Khandelwal, Archana Louis

Annals of Maxillofacial Surgery 2018 8(1):158-161

Temporomandibular joint ankylosis may be true or false. Most commonly, trauma and inflammatory conditions lead to this condition. Zygomatico-coronoid ankylosis is a rare extra-articular (false) form of ankylosis of the jaw. This condition may follow treated or untreated midface fractures. Coronoid process locking may be overlooked because attention is generally focused on temporomandibular joint. A review of literature has reported 16 cases of this disorder. The true incidence of this condition may be even higher. In this paper, we present an unusual case of posttraumatic bony ankylosis of the right coronoid process of the mandible with the zygomatic arch in a 30-year-old male. This bony ankylosis was produced by a mass of heterotopic bone formed, following inadequate treatment of midfacial fracture. Extra-oral ostectomy of the ankylotic mass followed by immediate postsurgical aggressive physiotherapy produced good long-term functional outcome.

https://ift.tt/2Jx71YJ

Odontome, cyst, impacted tooth, and space infection in a single patient: All-in-one diagnostic dilemma

Lakshmi Shetty, Khushal Gangwani, Deepak Kulkarni, Uday Londhe

Annals of Maxillofacial Surgery 2018 8(1):127-130

This case report analyzes the clinical and radiographic features of odontogenic infection with underlying pathology. Systematic approach leads to narrow the differential diagnosis on the basis of exclusion. This results in correct diagnosis, proper treatment, and avoiding unnecessary treatment. This case report highlighted an unusual case of odontogenic infection involving adjacent fascial spaces with underlying pathology which was mimicking a cyst, tumor, and odontome. Systematic approach helped us achieve accurate diagnosis, treatment, and avoiding complications.

https://ift.tt/2HL739v

Unilateral subcondylar and condylar neck fractures: Randomized clinical study

Tajamul Ahmad Hakim, Ajaz Ahmed Shah, Shahid Farooq, Shamina Kosar, Sumaira Gul, Nida Mehmood

Annals of Maxillofacial Surgery 2018 8(1):3-9

Aims and Objectives: The aim of the present study was to compare closed treatment with open reduction internal fixation (ORIF) for subcondylar and condylar neck fractures. Materials and Methods: This randomized prospective study was conducted on thirty patients who visited the Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, with condylar fractures. All fractures were displaced; either angulated between 10° and 45° and the ascending ramus was shortened by >2 mm to <15 mm. Patients were divided into two groups after satisfying the inclusion and exclusion criteria – Group I (closed treatment) and Group II (open reduction) (15 implants in each group). In Group I, patients were treated by mandibulo-maxillary fixation using arch bar and elastics for 4 weeks, and in Group II, patients were treated by ORIF using two 1.5-mm miniplates. Follow-up was done at 1 month, 3 months, and 6 months. Our postoperative evaluation included five parameters – maximal interincisal opening, protrusion, lateral excursion on fractured and nonfractured sides, anatomical reduction, and pain and malocclusion. Nonparametric data were compared for statistical significance with Chi square test and parametric data with an independent sample's t-test (P < 0.05). Results: Correct anatomical position of the fragments was achieved significantly more accurately in the operative group in contrast to the closed treatment group. Regarding mouth opening/lateral excursion on fractured and nonfractured sides/protrusion, significant (P < 0.05) differences were observed between both groups (open 39.73/7.50/8.17/7.87 mm vs. closed 36.87/6.07/7.23/7.13 mm). Pain also revealed significant (P = 0.025) difference with less pain in the operative treatment group. Conclusion: Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment was superior in all objective and subjective functional parameters except occlusion.

https://ift.tt/2JAdUIM

Osteosynthesis using the uncalcined and unsintered hydroxyapatite / Poly-L-Lactic acid system

Hiroyuki Nakano, Kazuya Inoue, Tomoki Sumida, Tomohiro Yamada, Yoshihide Mori

Annals of Maxillofacial Surgery 2018 8(1):116-117

The poly-L-lactic acid mini-plate system accomplished rapid development. However, the system still has a variety of problems. One such problem is the breakage of screws. In this technical report, we develop the temporary fixing screws made from stainless with hexagon steel that exhibit a hexagonal head and thread part that also features a tapping function.

https://ift.tt/2LNC4wf

Soft tissue healing and bony regeneration of impacted mandibular third molar extraction sockets, following postoperative incorporation of platelet-rich fibrin

Priya Esther Jeyaraj, Ashish Chakranarayan

Annals of Maxillofacial Surgery 2018 8(1):10-18

Introduction: Surgical removal of impacted mandibular third molars is one of the most commonly performed dentoalveolar surgeries by dental surgeons around the globe. It is known to be associated with clinically significant postoperative morbidity including swelling, pain, trismus, fever, and infection. In addition, the residual bony defect takes 7 months to 1 year to gradually fill with bone and to reossify. Aims and Objective: (1) To carry out a prospective study to evaluate differences in soft tissue healing and bony regeneration of impacted mandibular third molar extraction sites, with and without the incorporation of autologous platelet-rich fibrin (PRF) within the surgical wounds. (2) To also compare the incidence of short- and long-term posttreatment complications in both cases. Materials and Methods: Sixty patients were randomly inducted into two groups, consisting of 30 patients each. The first group, which served as the study group, consisted of patients in whom fresh autologous PRF were placed within the extraction site immediately following the surgical removal of the impacted mandibular third molar, before suturing of the mucoperiosteal flap. The second group, which served as the control froup, included those patients in whom the mucoperiosteal flaps were closed without incorporation of PRF within site.Both groups were evaluated and compared for postoperative pain, swelling, trismus, soft tissue healing, as well as bone fill of the extraction socket. Results: It was found that the study group in which autologous PRF had been incorporated into the operative site exhibited quick and complication-free soft tissue healing as well as a much quicker reossification and bone fill of the extraction socket, as compared to the control group in which no PRF was used. Conclusion: Incorporation of PRF within extraction sockets of impacted third molars proved to be beneficial for patients, yielding a quicker postoperative recovery with fewer complications such as postoperative swelling and edema, pain, and trismus; better overall postoperative results in terms of faster soft tissue healing as well as an earlier bony regeneration.

https://ift.tt/2sT5qSQ

Numb chin as signal for malignancy-primary intraosseous diffuse large B-Cell lymphoma of the mandible

Marc Anton Fuessinger, Pit Voss, Marc Christian Metzger, Claudia Zegpi, Wiebke Semper-Hogg

Annals of Maxillofacial Surgery 2018 8(1):143-146

Malignant lymphomas are about 5% of all malignant tumors. Extranodal non-Hodgkin's lymphomas (NHLs) are found in 26% of these cases. Lymphomas of the head-and-neck area occur in 2%–3% of all malignancies, with 28% with an extranodal manifestation. Extranodal NHLs in the oral cavity are usually found in the maxilla, and rarely in the mandible. Their symptoms and clinical manifestation have no pathognomonic features; therefore, the expression of this uncommon entity can be diagnosed with an odontogenic inflammatory process, leading to a misdiagnosis. Delay in the decision for a biopsy, and adequate treatment for the patient directly impairs the prognosis of this neoplasm. This study reports a case of a patient with discomfort in the right mandible and paresthesia of the right lower lip and chin without any dental focus. After performing further diagnostic examinations including a subsequent biopsy, the final diagnosis was a diffuse large B-cell lymphoma (DLBCL). Intraosseous DLBCLs are uncommon in the daily clinical routine, but emphasize the need for careful examination by the clinicians also considering the differential diagnosis of sensory neuropathy. Neurological symptoms with no apparent cause should raise the suspicion of malignancy until the opposite is proven.

https://ift.tt/2HLq2kn

Condylar fractures: Review of 40 cases

Mohamed Ali Mahgoub, Ahmed Hassan El-Sabbagh, Ehab Atef Abd El-Latif, Mohamed Radwan Elhadidy

Annals of Maxillofacial Surgery 2018 8(1):19-27

Purpose: To put an algorithmic approach for the treatment of condylar fractures according to the condition of occlusion. Patients and Methods: This study had been carried out between May 2016 and April 2017. Forty patients were included (6 females and 34 males) with their ages ranged between 3 and 60 years. Patients were managed through two approaches as follows: maxillomandibular fixation (MMF) only regimen and MMF with open reduction and internal fixation regimen. The operated cases were 12 with bilateral condylar/subcondylar fractures, and the rest were unilateral 28 cases. Results: Data were assessed demographically, time lapse before the intervention, surgically, functionally, and radiologically. In general, there were no significant differences between closed and open methods. Conclusion: Retromandibular approach was convenient for internal fixation of condylar fracture with a good outcome. In our work, there were no significant differences between closed and open methods in the treatment of condylar fractures.

https://ift.tt/2JyCn1i

Critical appraisal --- The response

Ritesh Garg, Mohan Alexander

Annals of Maxillofacial Surgery 2018 8(1):174-175



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Wound healing and bone regeneration in postextraction sockets with and without platelet-rich fibrin

Baratam Srinivas, Pradipta Das, Moumita Maity Rana, Abdul Qahar Qureshi, Kedar C Vaidya, Shaikh Junaid Ahmed Raziuddin

Annals of Maxillofacial Surgery 2018 8(1):28-34

Context and Aim: In today's world of advanced dentistry, there are various aspects of restorative, esthetic, and surgical processes. Healing of an extraction socket comprises of bone as well as soft-tissue remodeling with maximum dimensional changes occurring during the first 3 months. Platelet-rich fibrin (PRF) was first developed in France as a therapeutic alternative to platelet-rich plasma to overcome many of its limitations. The present study was planned to evaluate and compare wound healing and bone regeneration in extraction sockets with and without PRF. Materials and Methods: The present study was carried out on 30 patients selected from the outpatient department over a period of 2½ years starting from May 2013 undergoing extraction of maxillary or mandibular teeth simultaneously to conduct a split-mouth study. The research protocol was approved by the Institutional Ethics Committee governing the use of human subjects in clinical experimentation. Statistical Analysis Used: Descriptive and analytical statistics were calculated using Statistical Package for Social Sciences version 19. Chi-square test was used to assess wound healing score in the two groups while paired t-test was used to compare the bone density in the socket and periapical regions at different time intervals, and unpaired t-test was used for the intergroup comparisons. P < 0.05 was considered to be significant while P < 0.001 was considered highly significant. Results: Patients in PRF group had better healing index when compared to without PRF group. Use of PRF showed a comparable increase in bone density too. Conclusion: An appreciable wound healing and bone regeneration was seen in the experimental group when compared to the control sites where no PRF was used substantiating the use of PRF as an inexpensive autologous material for socket preservation and future rehabilitation. The present study, also, showed that minimal operator expertise was required to conduct the procedure of PRF preparation and grafting when compared to bone harvesting from distant sites. The shorter duration between extractions and further rehabilitation obviates the need for a second procedure.

https://ift.tt/2JzGpGH

Neurofibromatosis Type 1 in the Mandible

Yuka Uchiyama, Tetsuro Sumi, Keisuke Marutani, Hiroo Takaoka, Shumei Murakami, Hiroyasu Kameyama, Yoshiaki Yura

Annals of Maxillofacial Surgery 2018 8(1):121-123

Neurofibromatosis type 1 (NF1) was first described in 1882 as a hamartomatous disorder of neural crest derivation. We present the imaging of a 65-year-old woman with NF1. Computed tomography revealed that there were three major findings presented: skeletal deformity, an area of fat (probably related to mesodermal dysplasia), and benign neoplasm within the masticator space. Moreover, masticatory muscles were hypoplastic.

https://ift.tt/2HKuCzs

Evaluation of laser tissue welding and laser-tissue soldering for mucosal and vascular repair

Yusuf Abbas Mistry, Srivalli S Natarajan, Suraj A Ahuja

Annals of Maxillofacial Surgery 2018 8(1):35-41

Context: Laser tissue bonding (LTB) is believed to have certain advantages over conventional sutures such as fluid-tight closure and minimal scarring and fibrosis. Aim: The aim of the present study was to evaluate the bond strength of laser tissue welding and laser tissue soldering in mucosal and vascular repair. Materials and Methods: A total of 85 samples of bovine oral mucosa and 85 bovine aortas were bonded using a CO2laser and different laser powers. Human serum albumin was used as solder. The breaking load for mucosal samples and the bursting pressure for aorta samples were evaluated. Few specimens were evaluated histologically for thermal damage and other microscopic changes. Statistical Methods: Two-way ANOVA was performed as the data were normally distributed and analyzed for significant differences between the groups. This was followed by Simple Main effects (Tuckey's post hoc test) to determine the individual variation between groups and also the significant differences within the groups. Results: Significantly higher values of breaking load (44.2 ± 3.03 g) and bursting pressure (70.8 ± 12.33 mmHg) were noted when 50% albumin was used. When reinforcing sutures were given the bond strength was further increased (68.0 ± 4.0 g for breaking load) (108.0 ± 12.56 mmHg for bursting pressure). Microscopically, a bridge of solder coagulum formed across the wound. Thermal damage was restricted to the top layers only although it did extend much more laterally adjacent to the wound edges. Few areas of vacuolization and carbonization were seen. Conclusion: LTB seems to be a promising new method of wound closure and warrants further evaluation in the form of in vivo and clinical studies.

https://ift.tt/2sSX3Xr

Sebaceous cyst in the oral cavity

Matias Garcia Blanco, Sebastian Ariel Puia

Annals of Maxillofacial Surgery 2018 8(1):137-139

Sebaceous glands are reported to be normally located in the oral region in the vermilion of the upper lip and on the buccal mucosa. They are small yellowish bodies located immediately beneath the mucosa, and although numerous pathologies of these tissues have been described, very few clinical reports have been made. Pathologies such as ectopic location, hyperplasia, adenomas, carcinomas, and cysts have been described. If an excretory duct suffers a dilatation which does not regress of its own accord, it may originate a cyst. The purpose of this clinical report is to describe a free sebaceous cyst located in the upper lip.

https://ift.tt/2HJWCmE

Anthropometric assessment of the normal adult human ear

Sharanbasappa R Japatti, Priyanka J Engineer, Manjunatha Reddy B, Akash U Tiwari, Chidambar Y Siddegowda, Reshma B Hammannavar

Annals of Maxillofacial Surgery 2018 8(1):42-50

Purpose: Knowledge of anthropometric measurements of the external ear is important as variations exist based on gender, age and ethnicity. This study has derived anthropometric data pertaining to the external ear in the Maharashtrian population. Materials and Methods: Nine variables of the external ear were measured in 505 Maharashtrian adults (aged 18–64 years) using photoanthropometric methods. Results: Descriptive data and the left-right symmetry for the study population were obtained. Conclusion: These data have applications in screening for or monitoring diseases, otoplastic surgery, forensics, industrial design, apparel design and ergonomics.

https://ift.tt/2JxYvsw

Hemangiopericytoma/Solitary fibrous tumor of the buccal mucosa

Nisha Raghani, Manish J Raghani, Sruthi Rao, Santhosh Rao

Annals of Maxillofacial Surgery 2018 8(1):151-153

Hemangiopericytomas (HPCs)/Solitary fibrous tumor are rare neoplasms of vascular origin that occur in head-and-neck region. These tumors arise from capillary pericytes and are difficult to distinguish from other tumors of vascular origin. HPC, initially described by Stout and Murray in 1942, usually occur in the fifth decade of life and account for 3%–5% of all soft-tissue sarcomas and 1% of all vascular tumors. The tumors usually occur in limbs, pelvis, or head-and-neck region; 15%–30% of all HPCs occur in head and neck. We report a case of HPC located in the right buccal area of a 60-year-old man.

https://ift.tt/2HJaDRG

Facial nerve injury in temporomandibular joint approaches

Ayesha Moin, Akshay D Shetty, TS Archana, Saurabh G Kale

Annals of Maxillofacial Surgery 2018 8(1):51-55

Facial paralysis can be a devastating consequence resulting from blunt and penetrating trauma to the head and neck, as well as surgical injury, either accidental or due to involvement by tumor. In addition, the etiology can be attributed to a variety of other causes, ranging from infectious to metabolic, and is frequently idiopathic in nature. The incidence of facial nerve injury during temporomandibular joint (TMJ) surgeries varies among surgeons. There are many factors that could contribute to the injury of the temporal and zygomatic branches of the facial nerve. These nerves lie in a confluence of superficial fascia, temporalis fascia, and periosteum and may be injured by any dissection technique that attempts to violate the integrity of these regions. Excessive or heavy-handed retraction causes compression and/or stretching of nerve fibers resulting in neuropraxia. The facial nerve then enters the parotid gland, where the main trunk branches into the upper and lower divisions at the pes anserinus. The nerve further divides into five main branches: the temporal, zygomatic, buccal, marginal mandibular, and cervical. The temporal branch lies within the superficial muscular aponeurotic system at the level of the zygomatic arch. In this paper, we evaluate the facial nerve function based on the House–Brackmann grading index after the preauricular approach for the treatment of condylar fractures, pathologies, and TMJ ankylosis cases. The nerve functional regeneration postfacial nerve injury has been evaluated and reported in this retrospective study.

https://ift.tt/2Juh6FM

Unusual cause for maxillofacial injury

Balasundaram Thanneermalai, Prabodh Kumar Chattopadhyay, K Kamalpathey, Ravinder Singh Semi, Ajay Premanand Desai, Rahul P Menon

Annals of Maxillofacial Surgery 2018 8(1):166-170

Penetrating facial injuries are potentially dangerous and may require emergency management because of the presence of vital structures in the face, and it may be life-threatening especially when the injury involves airway, major blood vessels, spinal cord, and cervical spines. Penetrating injuries of the facial region can occur due to missile injuries, blast injuries, motor vehicle accidents, and accidental fall on sharp objects. However, injury to face caused by the shattering of a protective helmet itself is extremely rare. Primary management is targeted to deal with life-threatening conditions and stabilize the patient followed by subsequent care in a well-equipped setting. We present a case of a 30-year-old male, who suffered extensive soft and hard tissue injury of the maxillofacial region due to shattering of a protective helmet causing a ballistic effect.

https://ift.tt/2LKHzLW

Management of the frontoethmoidal encephalomeningocele

Priya Jeyaraj

Annals of Maxillofacial Surgery 2018 8(1):56-60

Introduction: The Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube anomaly, with herniation of intracranial material such as the brain and leptomeninges through a defect of the dura and anterior skull base at the junction of the frontal and ethmoidal bones. It may result not only in neural defects, sensorimotor deficits, neurological morbidities, visual impairment, impaired nasal function, and a potential risk of intracranial infection, but also in significant craniofacial disfigurement with complex deformities in the frontal, orbital, and nasal regions. Materials and Method: The standard two-staged surgical protocol comprises of the first stage performed by a neurosurgeon, which aims at correcting the neural defect by a formal craniotomy; then the second stage performed by a craniomaxillofacial or plastic and reconstructive surgeon, to correct craniofacial hard and soft tissue deformities. The case discussed was managed using a modified intracranial-transcranial single stage approach, achieving both the desired objectives. Results and Conclusion: This protocol elucidates the importance and value of teamwork between the Neurosurgeon and Craniomaxillofacial surgeon, in comprehensively and efficiently managing small to moderately sized FEEMs, assuring their complete elimination, satisfactory defect closure, effective functional treatment as well as esthetic correction and reconstruction of the attendant craniofacial deformities by means of a single-stage definitive surgical approach.

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On the negative outcomes of craniofacial surgery

SM Balaji

Annals of Maxillofacial Surgery 2018 8(1):1-2



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Medial sural artery perforator flap for head and neck reconstruction

Gunjan Agrawal, Ashutosh Gupta, Vivek Chaudhary, Fiza Qureshi, Amit Choraria, Hitesh Dubey

Annals of Maxillofacial Surgery 2018 8(1):61-65

Aim: The aim is to study the assessment of feasibility of medial sural artery perforator (MSAP) free flap for head and neck reconstruction at our center. Materials and Methods: Oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa, and floor of mouth cancer attending our center were reconstructed using MSAP flap after oncologic resection. Handheld 8 MHz Doppler was used to identify the perforator preoperatively. Results: We reconstructed 10 patients using MSAP flap. The flap was designed according to defect and donor site was primarily closed in all cases. Excellent results were seen in nine patients reconstructed with MSAP flap without any postoperative complication. Flap failure occurred in one patient due to venous thrombosis. The thickness of flap ranged from 4 to 8 mm. The vascular pedicle length ranged from 9 to 13 cm. Conclusion: The MSAP flap is appropriate for medium-sized oral defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor-site morbidity which makes it comparable to other microvascular free flaps such as radial artery free flap (RAFF) and anterolateral thigh flap.

https://ift.tt/2JyVwjx

Acceleration of intruding anterior tooth by alveolar corticotomy

MK Karthikeyan, Ruby Mathews, Ramachandra Prabhakar, R Saravanan, M Ramasamy, N Raj Vikram

Annals of Maxillofacial Surgery 2018 8(1):118-120

True intrusion is one of the difficult and complex goals to achieve which requires clinical judgment, skills, and experience. Intrusion requires less force level than other tooth movement, but it requires delicacy since the entire stress is concentrated in the apex of the root. Although true intrusion alone is not challenging, eliminating the adverse effect while intruding requires tedious skills of the clinician. A 17-year-old male patient with Class I malocclusion with open bite has a prominent maxillary cortical bone. He had a convex profile with an unpleasant smile. To reduce the bulkiness of cortical bone and to intrude the upper anterior, so the decision was made to perform corticotomy.

https://ift.tt/2HIaGNN

Current and future challenges of subcutaneous and sublingual allergy immunotherapy for allergists in the United States

Publication date: Available online 12 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Harold S. Nelson




https://ift.tt/2Mm1YYZ

The widening spectrum of immunological memory

Colleen M Lau | Joseph C Sun

https://ift.tt/2t4qhSb

A Rapidly Fatal Case of Low-Dose Methotrexate Toxicity

An 82-year-old female presented with multiple oral ulcers and malena for 1 week. Her laboratory tests revealed pancytopenia and acute renal failure. She had history of rheumatoid arthritis for which she was taking 7.5 mg methotrexate weekly and stage 4 chronic kidney disease from diabetic nephropathy. During the hospital stay, she developed pneumonia and septic shock requiring norepinephrine and vasopressin. She underwent continuous venovenous hemodiafiltration. Leucovorin, filgrastim, and multiple packed red blood cell and platelet transfusions were given. She remained hypotensive and pancytopenic despite all interventions. She died on day 6 of hospital stay from acute hypoxic respiratory failure due to septic shock.

https://ift.tt/2sRkgJs

Sleep quality and psychosocial characteristics of patients with painful post-traumatic trigeminal neuropathies

Publication date: Available online 12 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Eduardo Vazquez-Delgado, Marta Viaplana-Gutierrez, Charles Carlson, Rui Figueiredo, Eduard Valmaseda-Castellon
ObjectivesTo explore how pain and psychological distress influence the sleep quality of patients with painful post-traumatic trigeminal neuropathy (PPTN).Study designThirty-two patients with a diagnosis of PPTN according to the International Classification for Headache Disorders of the International Headache Society were enrolled. All patients completed a battery of questionnaires that examined sleep quality, psychological distress, and quality of life.ResultsThe global Pittsburg Sleep Quality Index (PSQI) score was "5" or greater in 75% of the patients. Additionally, the Symptom Check List-90-Revised (SCL-90-R) global severity score (GSI) revealed that 71.9% of the study sample reported values of psychological distress over the level of clinical significance. Sleep quality was analyzed through a linear regression model of global PSQI (dependent variable) that included gender, age, pain intensity, and pain duration (independent variables). This model revealed a significant positive association between the PSQI global score and the SCL-90-R GSI that was independent of age, gender, pain intensity and duration.ConclusionsPPTN patients present higher levels of sleep disturbance and psychological distress than the general population. Sleep quality disturbances and levels of psychological distress are strongly associated and seem to be independent of age, gender, medication use, pain intensity and duration.



https://ift.tt/2l3M74R

MRI assessment and histopathological evaluation of subchondral bone remodeling in temporomandibular joint osteoarthritis: A retrospective study

Publication date: Available online 12 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lingzhi Li, Huimin Shi, Han Xie, Lizhen Wang
ObjectiveThe aim was to characterize subchondral bone remodeling using magnetic resonance imaging (MRI) and histopathological assessment of temporomandibular joint osteoarthritis (TMJOA), and to analyze their correlations.Study DesignThe retrospective study was based on 153 joints of 100 patients. These patients had undergone MRI and had been diagnosed with temporomandibular joint internal derangement (TMJID) Wilkes stage IV-V followed by the failure of conservative or arthroscopic/anchorage treatment. We evaluated and compared 136 joints based on MRI and histopathological observation. According to the modified Osteoarthritis Research Society International (OARSI) system and Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) system, the scores of histopathology and MRI were compared using kappa categorical agreement analysis.ResultsMRI showed subchondral bone changes in 153 joints, 136 of which underwent surgical treatment and histopathological assessment. Statistical tests revealed substantial agreement between MRI and histopathology (kappa value: 0.779).ConclusionMRI is an effective technique to evaluate the pathological changes of TMJOA. Our histopathological grading criteria contributed to the clarification of the occurrence and developmental process of TMJOA. Therefore, the evidence of MRI should be seen as a reference standard for the choice of non-surgical or surgical therapy in the management of TMJOA.



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Embracing early recovery after surgery (ERAS) protocols: Is it time for otolaryngology to join the parade?

As an academic, clinical and/or investigative surgical specialist, one must embrace the ethical imperative for health care professionals to promulgate refinements in perioperative care that would improve patient outcomes. This editorial comment has been provided to the American Journal of Otolaryngology because clinical and research interactions with the U.S. Department of Defense have demonstrated an interface between nutritional science and hearing disorders [1–3] at a time when there are important changes occurring in the perioperative environment.

https://ift.tt/2t4pOzo

Current and future challenges of subcutaneous and sublingual allergy immunotherapy for allergists in the United States

Both subcutaneous and sublingual allergy immunotherapy (SCIT and SLIT, respectively) for inhalant allergens have proven efficacy for allergic rhinitis and allergic asthma, with limited support for efficacy in selected patients with atopic dermatitis.1 Both SCIT and SLIT have been shown to modify the immunologic defect underlying the allergic respiratory diseases,2 an effect that is clinically manifest by suppression of new sensitization in monosensitized patients, reduction in the development of asthma in those only having allergic rhinitis, and persistence of clinical improvement for years after an adequate course of treatment.

https://ift.tt/2l3AsmB

Perioperative safety and complications in treatment of oral and maxillofacial surgery patients under general anesthesia with obstructive sleeping disorders

Patients with sleeping disorders, such as obstructive sleep apnea, (OSA) have a higher risk for postoperative complications after maxillofacial surgery under general anesthesia. The aim of this study was to detect specific complications after oral and maxillofacial surgery.Sixty-nine cases of patients with middle or severe sleep apnea who underwent an operation under general anesthesia in the oral and maxillofacial region were retrospectively analyzed. This group was compared with an age and diagnosis matched group without sleep apnea receiving the same operative treatment.

https://ift.tt/2HIiOh9

Cystic masses of the lateral neck – proposition of an algorithm for increased treatment efficiency

Preoperative discrimination of solitary cervical branchial cleft cysts from cystic lymph node metastasis often is challenging. Surgical excision of the cystic formation and consecutive histopathological examination of tissue specimens are the only means resulting in the correct diagnosis. However, in case of malignancies surgery on the lateral neck prior to the definitive treatment is considered to negatively influence the patients' outcome. The rate of cystic lymph node metastasis in patients presenting with a lateral branchial cleft cyst, localization of the primary tumour and oncological outcome were investigated.

https://ift.tt/2JPhMEY

Scleral exposure alterations following Le Fort I osteotomy (with and without maxillary impaction) in skeletal class III patients: A before-and-after clinical trial

Exposure of sclera below the iris in natural head positions is aesthetically undesirable. Studies on post-surgical changes in inferior scleral exposure following orthognathic surgery are scarce and mostly retrospective. The aim of this clinical trial is to examine the effect of Le Fort I osteotomy, a procedure for correction of malocclusion and maxillo-mandibular deformities, on the inferior scleral exposure and overall scleral surface area in skeletal class III patients.

https://ift.tt/2HMpqLk

The ethical issue of “cherry picking” patients

https://ift.tt/2JFqzGl

Circulating anti-bullous pemphigoid 180 autoantibody can be detected in a wide clinical spectrum: A cross-sectional study

https://ift.tt/2JwIcfw

Hair cross sectioning in uncombable hair syndrome: an easy tool for a complex diagnosis

https://ift.tt/2y7jInY

Reply to comment on “Drug survival of apremilast for psoriasis in a real-world setting”

https://ift.tt/2sR5z9g

Health-related quality of life in patients with malignant melanoma by stage and treatment status

https://ift.tt/2JwI8MO

Soft tissue assessment before and after mandibular advancement or setback surgery using three-dimensional images: systematic review and meta-analysis

The aim of this systematic review was to evaluate the effects of mandibular advancement or setback surgery on the facial soft tissue assessed using three-dimensional images. An electronic search was performed in the MEDLINE, Cochrane Library, Scopus, Virtual Health Library (VHL), Web of Science, and OpenGrey databases. Inclusion criteria comprised studies that evaluated the soft tissues of adult patients before and after mandibular advancement or setback surgery using computed tomography or magnetic resonance imaging.

https://ift.tt/2Mlm9pV

Management of the airway in maxillofacial surgery: part 2

Prediction of the difficulty of an airway is unreliable, and failure of one technique of management increases the likelihood of failure of subsequent interventions. Part 2 of this review describes strategies to avoid or mitigate the impact of failure, and the associated airway-related morbidity and mortality.

https://ift.tt/2JAKJoQ

Management of the airway in maxillofacial surgery: part 1

In part 1 of this review of management of the airway in maxillofacial surgery we discuss preoperative assessment of the airway, and the practical means to deal with difficulties. We review the evidence for videolaryngoscopy and flexible indirect laryngoscopy, together with surgical access to the airway including tracheostomy, cricothyroidotomy, and submental intubation.

https://ift.tt/2JDGOUj

Measuring health-related benefit and quality of care in oral and maxillofacial surgery: British Association of Oral and Maxillofacial Surgeons Outcomes Project

There is widespread recognition that the trajectory of increase in expenditure on healthcare in developed economies is not sustainable, and this has manifested as an acute squeeze on NHS funding since the financial crisis of 2008. Policy-makers and the public have also recognised that surgical outcomes vary. Commissioners of services are under increasing pressure to ensure that expenditure is directed towards care that delivers a demonstrable benefit in health-related wellbeing to patients and, in choosing providers, commissioners seek to direct funding to those services that provide the highest quality of care ("value-based purchasing").

https://ift.tt/2MnAsKP

Idelalisib in a patient with refractory Waldenström’s macroglobulinemia complicated by anuric renal failure: a case report

Waldenström's macroglobulinemia is a rare B-cell lymphoma. The gold standard treatment for Waldenström's macroglobulinemia is an anti-CD20 antibody (rituximab) in combination with alkylating agents and dexamet...

https://ift.tt/2l95rNX

Does enamel matrix derivative application improve clinical outcomes after semilunar flap surgery? A randomized clinical trial

Abstract

Objectives

To evaluate the treatment of gingival recessions by semilunar coronally positioned flap plus enamel matrix derivative (SCPF + EMD).

Materials and methods

Thirty patients with class I localized gingival recession were included. They were randomly allocated in two groups: SCPF + EMD and SCPF. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 6 and 12 months post-surgery. Patient/professional evaluation of esthetics and root sensitivity was performed.

Results

After 12 months, mean root coverage was 1.98 ± 0.33 mm for SCPF + EMD (90.86 ± 14.69%) and 1.85 ± 0.41 mm (79.76 ± 17.44%) for SCPF (p > 0.05). The esthetic evaluation by the patient showed preference for SCPF + EMD. According to the professional evaluation (QCE), the use of EMD decreases the appearance of postoperative scar tissue line. There was a significant reduction in root hypersensitivity with no further complaints by the patients.

Conclusions

The addition of EMD provides significantly better esthetics to SCPF, according to patient and professional assessments. SCPF + EMD is effective but not superior to SCPF for root coverage, after 12 months.

Clinical relevance

Previous clinical trials showed that the combination of EMD with coronally advanced flaps may enhance the outcome of root coverage. There is a lack of studies testing the combination of EMD with SCPF. The combination SCPF + EMD provides better esthetics when compared to the SCPF and is effective, but not superior, to SCPF for root coverage, after 12 months.

Trial registration: NCT02459704

https://ift.tt/2HI0hS7

Locally applied statins as adjuvants to non-surgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

Abstract

Objective

This review aimed at evaluating the effects of chronic periodontitis (CP) treatment with local statins as adjuncts to scaling and root planing (SRP), compared with SRP alone or with placebo.

Methods

Electronic and hand searches were conducted in three databases to select randomized controlled trials (RCTs) comparing SRP + statins versus SRP alone. Random effects models were conducted to determine the clinical attachment level (CAL) gain as the primary outcome variable, and probing pocket depth (PPD) reduction, modified sulcus bleeding index (mSBI), and intrabony defect depth (IBD) as the secondary outcomes.

Results

Of the 526 papers identified, 15 articles met the criteria for inclusion in this systematic review, and 13 in the meta-analysis. The meta-analysis showed a statistically significant CAL gain (mean differences [MD] = 1.84 mm, 95% confidence interval [CI] = 1.45 to 2.23; p = 0.000), PPD reduction (MD = 1.69 mm, 95% CI = 1.37 to 2.04; p = 0.000), mSBI change (MD = 0.70, 95% CI = 0.57 to 0.84; p = 0.000), and IBD (MD = 1.48, 95% CI = 1.30 to 1.67; p = 0.000) attributed to SRP + statin treatment (6 months).

Conclusion

Within the limitations of this study, the collective evidence emerging from this systematic review and meta-analysis may support the use of locally applied statins as adjuncts to SRP in CP treatment, based on being an easy, low-cost alternative, with lesser adverse effects on bacterial resistance. These results should be interpreted with caution.

Clinical relevance

Clinicians might consider the use of SRP + statins as an adjunct over other alternative approaches, based on the results of the present review. The informed decision should be taken, considering the patient's values and preferences, and the intervention to be implemented by the clinician.

https://ift.tt/2sPIK60

Role of sublingual immunotherapy in the treatment of asthma: An updated systematic review

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2l9r8hf

Nasal physiology: improving our understanding in the health and disease

International Forum of Allergy &Rhinology, Volume 8, Issue 6, Page 666-667, June 2018.


https://ift.tt/2t25miJ

Issue Information

International Forum of Allergy &Rhinology, Volume 8, Issue 6, Page 659-661, June 2018.


https://ift.tt/2l84UMq

Mucus T helper 2 biomarkers predict chronic rhinosinusitis disease severity and prior surgical intervention

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2t25iiZ

Accessory maxillary ostium repair using middle turbinate flap: a case series of 116 patients with chronic rhinosinusitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2l3H8RB

Size of septectomy does not affect distribution of nasal irrigation after endoscopic modified Lothrop procedure

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2y603Vr

Combined effect of parathyroid hormone and strontium ranelate on bone healing in ovariectomized rats

Oral Diseases, EarlyView.


https://ift.tt/2sYnji4

A novel 4q25 microdeletion encompassing PITX2 associated with Rieger syndrome

Oral Diseases, EarlyView.


https://ift.tt/2MjnzRI

Saliva in the “Omics” era: A promising tool in paediatrics

Oral Diseases, EarlyView.


https://ift.tt/2JIrUvZ

Response to Dr. Nimisha Divakar

Oral Diseases, EarlyView.


https://ift.tt/2sQF8jV

Biodiversity of the human oral mycobiome in health and disease

Oral Diseases, EarlyView.


https://ift.tt/2JFtdMk

Mass spectrometry in the palm of your hand: Future applications of in vivo tissue analysis

Oral Diseases, EarlyView.


https://ift.tt/2Mn2hTd

Image cytometry DNA ploidy analysis: Correlation between two semi‐automated methods

Oral Diseases, EarlyView.


https://ift.tt/2JIrEx1

Tooth Loss and Dental Implant Outcomes—Where is dentistry going? A Survey by SIdP, the Italian Society of Periodontology and Implantology

Oral Diseases, EarlyView.


https://ift.tt/2MmH6Rb

Noninferiority trials in oral medicine

Oral Diseases, EarlyView.


https://ift.tt/2sZH5Kg

Gingival tissue reaction to direct adhesive restoration: A preliminary study

Oral Diseases, EarlyView.


https://ift.tt/2MkusCl

Oral yeast colonization in patients with primary and secondary Sjögren's syndrome

Oral Diseases, EarlyView.


https://ift.tt/2JFRL7O

Abnormal bone remodelling activity of dental follicle cells from a cleidocranial dysplasia patient

Oral Diseases, EarlyView.


https://ift.tt/2sSoNex

Chronic mucocutaneous candidiasis due to gain‐of‐function mutation in STAT1

Oral Diseases, EarlyView.


https://ift.tt/2sX04oK

Human papillomavirus prevalence in a Mid‐European oral squamous cell cancer population: A cohort study

Oral Diseases, EarlyView.


https://ift.tt/2MosBN0

Detection of distant metastasis and prognostic prediction of recurrent salivary gland carcinomas using 18F‐FDG PET/CT

Oral Diseases, EarlyView.


https://ift.tt/2sZH4WI

Evaluating the effect of nicotinic cholinergic receptor genes on the risk of nonsyndromic cleft lip with or without cleft palate

Oral Diseases, EarlyView.


https://ift.tt/2sS9G53

A novel splicing mutation of ectodysplasin A gene responsible for hypohidrotic ectodermal dysplasia

Oral Diseases, EarlyView.


https://ift.tt/2JD0Ga1

Odontogenic myxoma: An updated analysis of 1,692 cases reported in the literature

Oral Diseases, EarlyView.


https://ift.tt/2MfTcM9

Dental implications in Hajdu–Cheney syndrome: A novel case report and review of the literature

Oral Diseases, EarlyView.


https://ift.tt/2t30km1

Impact of farnesol and Corsodyl® on Candida albicans forming dual biofilm with Streptococcus mutans

Oral Diseases, EarlyView.


https://ift.tt/2sRZj1b

New observations regarding Helicobacter pylori and gastric cancer in Mongolia

Helicobacter, EarlyView.


https://ift.tt/2l6iTCi

The effect of light intensity on image quality in endoscopic ear surgery

Clinical Otolaryngology, EarlyView.


https://ift.tt/2JE4FTM

Circulating human papillomavirus DNA as a surveillance tool in head and neck squamous cell carcinoma: A systematic review and meta‐analysis

Clinical Otolaryngology, EarlyView.


https://ift.tt/2MmDuio

Cochlear implantation using a custom guide catheter in 14 patients with incomplete partition type III

Clinical Otolaryngology, EarlyView.


https://ift.tt/2y5SCNR

Intralesional steroid injection as an alternative treatment for 57 patients of vocal fold mucus retention cysts

Clinical Otolaryngology, EarlyView.


https://ift.tt/2JxWLzt

Biofilm in voice prosthesis: A prospective cohort study and laboratory tests using sonication and SEM analysis

Clinical Otolaryngology, EarlyView.


https://ift.tt/2y5StKj

Thymol inhibits oral squamous cell carcinoma growth via mitochondria‐mediated apoptosis

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2t12xP6

Prognostic significance of elevated serum CD44 levels in patients with oral squamous cell carcinoma

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2l6nGDG

Clinicopathological significance of chemokine receptor (CCR1, CCR3, CCR4, CCR5, CCR7 and CXCR4) expression in head and neck squamous cell carcinomas

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2t0mJkb

Rapid progression to gummatous tertiary syphilis in a patient with HIV

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2Jw61nI

Postoperative wound infection rates following diagnostic skin biopsies in dermatology patients at an Australian tertiary hospital

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JJ0zd2

Issue Information ‐ TOC

Allergy, Volume 73, Issue 6, Page 1149-1150, June 2018.


https://ift.tt/2t3tbXo

Issue Information ‐ Cover and Editorial Board

Allergy, Volume 73, Issue 6, Page 1147-1147, June 2018.


https://ift.tt/2l4GuDq

The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): A consensus on practical guidance

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2JFvyab

Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S2, Page 5-14, June 2018.


https://ift.tt/2l7aHSy

Two important novelties in etiopathogenesis and therapy of acne

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S2, Page 3-4, June 2018.


https://ift.tt/2yeEKBd

Characterisation of Cutibacterium acnes phylotypes in acne and in vivo exploratory evaluation of Myrtacine®

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S2, Page 15-23, June 2018.


https://ift.tt/2l9bylL

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S2, Page 1-2, June 2018.


https://ift.tt/2y4TPFn

Dyschromatosis symmetrica hereditaria with chilblains due to a novel two‐amino‐acid deletion in the double‐stranded RNA‐binding domain of ADAR1

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l3l9dF

Mucosal melanoma: clinical and genetic profile

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2t1NLHF

A review of non‐invasive imaging in extramammary Paget's disease

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l3kWXV

Inflammatory cytokines and peripheral mediators in the pathophysiology of pruritus in cutaneous T‐cell lymphoma

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2ybojFo

The Jarisch–Herxheimer reaction in syphilis: could molecular typing help to understand it better?

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l6bfYU

Which acne treatment has the best influence on health‐related quality of life? Literature review by the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2t1NjZZ

Response: field cancerization and koebnerized skin tumours

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l9bvX7

Longitudinal subungual acanthoma: one denomination for various clinical presentations

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2t2AU8m

Reply to mucosal melanoma: clinical and genetic profile

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l6Npfu

Reply to Gambichler T et al.: Altered epigenetic pathways and cell cycle dysregulation in healthy appearing skin of patients with koebnerized squamous cell carcinomas following skin surgery

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2y6sLFr

Prurigo Activity Score (PAS): validity and reliability of a new instrument to monitor chronic prurigo

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l6b67O

Evaluation of the appropriate surgical margin for pigmented basal cell carcinoma according to the risk factors for recurrence: a single‐institute retrospective study in Japan

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2t2Rc0T

Teledermatology‐driven topical therapy of actinic keratosis: a comparative study of clinical effectiveness and compliance

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2l6aW0c

Metastatic tubercular gummas and splenic tuberculoma secondary to tubercular lymphadenitis in an immunocompetent female

International Journal of Dermatology, EarlyView.


https://ift.tt/2t2qo0V

The global prevalence and correlates of skin bleaching: a meta‐analysis and meta‐regression analysis

International Journal of Dermatology, EarlyView.


https://ift.tt/2l66i1Y

A large shagreen patch with overlying verrucous epidermal naevus: a curious case of colocalization

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JvIoMe

Acquired reactive perforating collagenosis associated with mediastinal synovial sarcoma

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2y4pSFh

A dog's life: an unfamiliar and lethal side effect of topical 5‐fluorouracil

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2y4JsB8

Borst–Jadassohn phenomenon arising from a seborrhoeic keratosis and its characteristic dermoscopic features

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JvIfIG

Idiopathic thrombocytopenic purpura in a patient with IgG4‐related disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2ybRhW2

Biologic therapy: a boon for hidradenitis suppurativa‐like lesions complicating naevus comedonicus in a prepubertal child

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JvteWZ

A novel frameshift SERPINB7 mutation in a Chinese case with Nagashima‐type palmoplantar keratosis: case report and review of the literature

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JCBQHj

Genetic association between the NLRP3 gene and acne vulgaris in a Chinese population

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2MmIFPg

pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

The Laryngoscope, EarlyView.


https://ift.tt/2JIUQYh

First case of chronic cutaneous chromoblastomycosis by Rhinocladiella similis aquired in Europe

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2MiFwQq

Utility of tissue elafin as an immunohistochemical marker for diagnosis of acute skin graft‐versus‐host disease: a pilot study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2ybR7xU

Novel treatment of painful plantar keratoderma in pachyonychia congenita using topical sirolimus

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JySITu

Confirmation of the role of a KRT5 mutation and successful management of skin lesions in a patient with Galli–Galli disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JE3XpG

Axillary web syndrome following epidermal inclusion cyst: a case report and literature review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JzZzvO

Permanent alopecia as a manifestation of chronic graft‐versus‐host disease of the scalp: clinical, dermoscopic and histopathological observations

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JDuOlH

A case of gamasoidosis caused by Dermanyssus gallinae, misdiagnosed as delusional parasitosis

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Jv1Okd

An unusual eruption following herpes zoster infection

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2y5AIef

Benefit of electron beam therapy in combination with medium‐dose systemic corticosteroid as a palliative treatment for elderly patients with blastic plasmacytoid dendritic cell neoplasm: case report and review of the literature

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JzZd8s

Dermoscopic patterns of early‐stage mycosis fungoides in a Chinese population

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2y4pDKn

Treatment of halo naevus with the topical Janus kinase inhibitor tofacitinib 1.5%

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Mivxui

Why a randomized melanoma screening trial is not a good idea

British Journal of Dermatology, EarlyView.


https://ift.tt/2JJ8YR8

T helper 17 cell/regulatory T‐cell imbalance in hidradenitis suppurativa/acne inversa: the link to hair follicle dissection, obesity, smoking and autoimmune comorbidities

British Journal of Dermatology, EarlyView.


https://ift.tt/2HIbr9A

New additions to the bookshelf: Vulval Disease

British Journal of Dermatology, EarlyView.


https://ift.tt/2JJ8HxA

Erythropoietic protoporphyria and solar urticarial

British Journal of Dermatology, EarlyView.


https://ift.tt/2LMLYyf

Diagnostic accuracy of dermatofluoroscopy in cutaneous melanoma detection: results of a prospective multicentre clinical study in 476 pigmented lesions

British Journal of Dermatology, EarlyView.


https://ift.tt/2JRROkB

Widespread regular sunscreen application deemed not useful in the U.S.A.: reply from authors

British Journal of Dermatology, EarlyView.


https://ift.tt/2HHoOqr

Widespread regular sunscreen application deemed not useful in the U.S.A.

British Journal of Dermatology, EarlyView.


https://ift.tt/2JRRC4R

Issue Information

Dermatologic Therapy, Volume 31, Issue 3, May/June 2018.


https://ift.tt/2LHMk94

Sensitization to various minor house dust mite allergens is greater in patients with atopic dermatitis than in those with respiratory allergic disease

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2l2NqB8

Insights in particulate matter‐induced allergic airway inflammation: Focus on the epithelium

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2y3QTZh

Subcutaneous immunotherapy suppresses Th2 inflammation and induces neutralizing antibodies, but sublingual immunotherapy suppresses airway hyperresponsiveness in grass pollen mouse models for allergic asthma

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2l6CPFj

Phase 2a, randomized, double‐blind, placebo‐controlled, multicentre, parallel‐group study of an H4R‐antagonist (JNJ‐39758979) in adults with uncontrolled asthma

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2y3QLsL

IgE sensitization to food allergens and airborne allergens in relation to biomarkers of type 2 inflammation in asthma

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2l745Ue

Sputum‐to‐serum hydrogen sulphide ratio as a novel biomarker of predicting future risks of asthma exacerbation

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2t0b3On

The roles for innate lymphoid cells in the human immune system

Abstract

From constituting a novel and obscure cell population, innate lymphoid cells (ILCs) are now accepted as a self-evident part of the immune system, contributing with unique and complementary functions to immunity by production of effector cytokines and interaction with other cell types. In this review, we discuss the redundant and complementary roles of the highly plastic human ILCs and their interaction with other immune cells with the ultimate aim of placing ILCs in a wider context within the human immune system.

https://ift.tt/2sTLHCk

Wet and wounded: Pediatric facial trauma from swimming and diving

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Nicholas P. Guys, Ahsan Mir, Peter F. Svider, Anthony Sheyn
ObjectivesSwimming has been reported as the most common recreational activity among American youths, while diving remains a popular youth activity as well. We characterize the most common facial injuries occurring during these activities and evaluate facial fracture mechanisms and demographic trends, as this information may be helpful in preventative counseling as well as diagnosis.MethodsThe National Electronic Injury Surveillance System was assessed for swimming- and diving-related facial injuries in children from 2007 to 2016. Estimates of national injury incidence were recorded, and patient diagnoses, demographics, and injury mechanisms were evaluated.ResultsIn the 10-year period assessed, 789 NEISS entries extrapolated to an estimated 27,709 patients nationwide were analyzed. The yearly incidence fluctuated but steadily rose from 2013 to 2016. Males comprised a majority of injuries (58%), and laceration was the most common diagnosis (65%), followed by abrasion/contusion (22%) and fracture (9%). Facial fractures were most likely to involve the nasal bones (87%). Swimming injuries were more numerous overall (74%), but a greater proportion of diving injuries resulted in fracture (12% vs. 7%). Teenagers were also more likely to suffer fractures than were younger children involved in the same activities.ConclusionMost analyses of swimming and diving injuries have focused on spinal and orthopedic trauma. Nevertheless, the nature of headfirst diving and swim strokes suggest facial trauma is an underappreciated concern for clinicians. These findings reinforce the need for safer swimming and diving practices and serve as a useful resource for physicians managing pediatric facial injuries.



https://ift.tt/2HF3uBX

Transnasal adenoidectomy in mucopolysaccharidosis

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Rebecca Harrison, Simone Schaefer, Laura Warner, Jean Mercer, Simon Jones, Iain Bruce
BackgroundMucopolysaccharide (MPS) diseases are a heterogeneous group of inherited, metabolic disorders characterized by accumulation of partially degraded glycosaminoglycans (GAG) in multiple organ systems. Due to accumulation in the airway, patients often present with multilevel airway obstruction and obstructive sleep apnoea (OSA). Adenotonsillar surgery leads to a significant improvement in the severity of OSA in MPS patients. However, access to secure the airway and for conventional surgery can be challenging, due to limited neck extension, macroglossia and reduced mouth opening. This study was undertaken to evaluate the role of transnasal microdebridement and radiofrequent plasma ablation (Coblation) in adenoidectomy to treat OSA in patients with MPS and restricted airway access.MethodsA retrospective case review was performed including patients with MPS undergoing adenoidectomy for OSA in the period between June 2015 and March 2017. In all cases, either a microdebrider (Gyrus Diablo) or a Coblation wand (EVAC70, Smith&Nephew) was used via a transnasal approach guided by nasendoscopy. The primary outcome was effect upon OSA, measured by sleep oximetry and parental report of benefit. The secondary outcomes were surgical complications and risk factors for persistent OSA after surgery.ResultsA total of nine patients were identified with a mean age of 9 years (range 3–14 years) at surgery. Post-operative sleep study data was available for eight patients (8/9). Six patients (6/8) had improvement in 4% oxygen desaturation index (ODI-4) with a mean of 8.11 pre-operatively (range 2.69–14.0) and 4.99 postoperatively (range 0.68–8.48). ODI-4 did not improve in two (2/8) patients. Irrespective of sleep oximetry results, improvement in OSA-related symptoms was noted by all parents postoperatively. No risk factors for persistent OSA were identified. Furthermore, no complications were noted in this cohort.ConclusionTransnasal Coblation and Microdebrider adenoidectomy is a safe and effective surgical treatment for OSA in patients with Mucopolysaccharidosis and adenoidal hypertrophy. As lifespan increases for patients with the Mucopolysaccharidoses, greater emphasis is being given to optimising airway management over the longer-term. This technical note describes the novel application of endoscopic techniques for the management of primary adenoidal hypertrophy when transoral access is restricted, or to debulk recurrent disease that would be challenging to remove via the standard transoral route.



https://ift.tt/2JMP0EZ

Margin-Based Vs. Robust Photon Radiotherapy Planning in IMRT of HN-SQCC

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Other: Robust Radiotherapy planning;   Other: Margin-Based Radiotherapy planning
Sponsor:   University of Arkansas
Not yet recruiting

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QUILT-2.025 NANT Neoepitope Yeast Vaccine (YE-NEO-001): Adjuvant Immunotherapy Using a Personalized Neoepitope Yeast-Based Vaccine To Induce T-Cell Responses In Subjects W/ Previously Treated Cancers.

Conditions:   Colorectal Cancer;   Triple Negative Breast Cancer;   Head and Neck Squamous Cell Carcinoma;   Melanoma;   Non Small Cell Lung Cancer;   Pancreatic Cancer;   Liver Cancer;   Hormone Receptor Positive Tumor
Intervention:   Biological: YE-NEO-001
Sponsor:   NantBioScience, Inc.
Not yet recruiting

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Type I Chiari Malformation Presenting in an Adult

Description 

Type I Chiari malformations (CMs) is an acquired or congenital disorder characterised by the presence of the cerebellar tonsils at 5 mm or below of the spinal canal, which can result in abnormal cerebrospinal fluid flow and produce headaches, syrinx or hydrocephalus. CMs are still considered an uncommon disease with a prevalence in the USA of less than 1%.1 2 We present a 44-year-old man with no medical history who presented to the emergency department complaining of nausea, vomiting, vertigo and a 2-day history of headaches exacerbated with Valsalva manoeuvres. He was initially admitted with a working diagnosis of ischaemic stroke and underwent a CT scan of the brain, which was unremarkable. Further work-up with brain MRI disclosed incidental cerebellar herniation 6.5 mm below the foramen magnum (figure 1) and no abnormalities in spinal canal MRIs. The patient was treated symptomatically with oral...

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Marantic endocarditis: incidental infarcts leading to diagnosis of pancreatic cancer

Non-bacterial thrombotic endocarditis (NBTE) is a well-described phenomenon associated with malignancies due to hypercoaguable state. In the setting of pancreatic cancer, NBTE is more commonly diagnosed postmortem. We describe a case of a man who was diagnosed with pancreatic carcinoma after incidental finding of NBTE. Imaging incidentally revealed multiple strokes, bilateral renal and splenic infarcts, while subsequent workup for cardioembolic source demonstrated a 1.1x0.7 cm mitral valve vegetation. As multiple blood cultures were sterile and patient lacked clinical signs of infection, an underlying malignancy was suspected. CT abdomen demonstrated a dilated pancreatic duct, MRI showed a 2.8x2.2 cm pancreatic head mass. Endoscopic biopsy of the mass revealed pancreatic adenocarcinoma. Other than NBTE, there were no other clinical or laboratory findings to clearly suggest pancreatic cancer. Thus, incidental discovery of this mitral valve vegetation led to the diagnosis of pancreatic malignancy.

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Herpes zoster with cutaneous dissemination: a rare presentation of an uncommon pathology in children

Herpes zoster, caused by varicella zoster virus (VZV) reactivation, affects mainly the adult population, although it can occur in children. This happens when primary infection (varicella) has occurred at a very young age or in immunocompromised patients. Complications are rare in healthy individuals. They include VZV cutaneous dissemination, which affects 2%–10% of immunocompromised patients.

We present a previously healthy child, with history of varicella during her first month of life, which presented at age 8 with a severe case of herpes zoster, complicated with cutaneous dissemination. Immunity study was unremarkable. Causes, management and follow-up are discussed.

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Central nervous system blast crisis of chronic myeloid leukaemia misdiagnosed as tubercular meningitis

Chronic Myeloid Leukaemia (CML) presenting with isolated Central Nervous System (CNS) blast crisis is an uncommon entity. A 22-year-old man, diagnosed with chronic phase CML in 2011 and was in haematological and cytogenetic remission until July 2016, had acute onset headache and vomiting with meningeal signs and was admitted elsewhere, investigated by brain imaging and cerebrospinal fluid (CSF) analysis and suspected to have tubercular meningitis, for which steroids and antitubercular medications were started. The patient's sensorium further deteriorated, and Ventriculoperitoneal shunt surgery was done for hydrocephalus by a neurosurgeon. After 2 months of the illness, he was admitted to our hospital with a persistent headache, vomiting and altered sensorium. CSF for cytospin confirmed myeloid blasts. He was still in haematological remission. So, a diagnosis of isolated CNS blast crisis was made. The patient was started on triple intrathecal chemotherapy and cranial radiotherapy. He had improvement with treatment and is still in remission.

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Bilateral Mydriasis Secondary to Propofol Administration in a Patient With Hypertensive Cerebellar Hemorrhage

No abstract available

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Complexity, Variation, and the Ever-moving Cheese

No abstract available

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Journal Club

No abstract available

https://ift.tt/2t0p3aQ

A Narrative Review of Adherence to Subarachnoid Hemorrhage Guidelines

Over the past 2 decades, a large number of guidelines for aneurysmal subarachnoid hemorrhage (aSAH) management have been proposed. The primary aim of these "evidence-based" guidelines is to improve the care of aSAH patients by summarizing and making current knowledge readily available to clinicians. However, an investigation into aSAH guidelines, their changes along time and their successful translation into clinical practice is still lacking. We performed a literature search of historical events and subarachnoid hemorrhage guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to November of 2016. Data were summarized for guidelines on aSAH management and cross-sectional studies of their application. A total of 11 guidelines and 10 cross-sectional studies on aSAH management were analyzed. The use of nimodipine for the treatment of SAH is the only recommendation that remained consistent across guidelines over time (r=0.82; P

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Spurious Hypoxemia During Craniotomy

No abstract available

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General Anesthesia and Young Brain: What is New?

Considering that growing population of very young children is exposed to general anesthesia every year, it is of utmost importance to understand how and whether such practice may affect the development and growth of their very immature and vulnerable brains. Compelling evidence from animal studies suggests that an early exposure to general anesthesia is detrimental to normal brain development leading to structural and functional impairments of neurons and glia, and long-lasting impairments in normal emotional and cognitive development. Although the evidence from animal studies is overwhelming and confirmed across species examined from rodents to non–human primates, the evidence from human studies is inconsistent and not conclusive at present. In this review we focus on new developments in animal studies of anesthesia-induced developmental neurotoxicity and summarize recent clinical studies while focusing on outcome measures and exposure variables in terms of their utility for assessing cognitive and behavioral development in children.

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Epidural Blood Patch in Children Under Anesthesia: Is There an Indication for Neuromonitoring?

No abstract available

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Endovascular Treatment of Acute Ischemic Stroke Under General Anesthesia: Predictors of Good Outcome

Background: The choice of anesthetic technique, general anesthesia (GA) versus Monitored Anesthesia Care, may impact the outcome of patients undergoing endovascular treatment of acute ischemic stroke (AIS). The aim of this study was to identify the factors associated with good discharge outcome in patients receiving GA for AIS. Materials and Methods: Electronic medical records of patients above 18 years old who underwent endovascular treatment of AIS under GA at a Comprehensive Stroke Center from 2010 to 2014 were reviewed. Good outcome was defined as discharge modified Rankin Score 0 to 2 and poor outcome as modified Rankin Score 3 to 6; logistic regression analysis was performed to examine the association between the clinical characteristics and the outcome. Results: In total, 88 patients (56 males), aged 63±15 years with median National Institute of Health Stroke Scale (NIHSS) score 16 (range, 4 to 38) were included. Nineteen (22%) patients had good outcome and 78 (88%) had systolic blood pressure below the guideline recommended 140 mm Hg under GA. After adjusting for age and NIHSS score, the independent predictors of good discharge outcomes were higher maximum end-tidal carbon dioxide (odds ratio [OR], 1.14; confidence interval [CI], 1.02-1.28; P=0.02) and extubation after endovascular treatment (OR, 26.31; CI, 4.80-144.12; P

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Cerebral Sinus Thrombosis in Parturient

No abstract available

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Scheduled Intravenous Acetaminophen Improves Patient Satisfaction With Postcraniotomy Pain Management: A Prospective, Randomized, Placebo-controlled, Double-blind Study

Background: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. Materials and Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared. Results: There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1±0.4 vs. 6.9±0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects. Conclusions: IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.

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JNA Editorial – July 2018

No abstract available

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Ventilation With High or Low Tidal Volume With PEEP Does Not Influence Lung Function After Spinal Surgery in Prone Position: A Randomized Controlled Trial

Background: Spinal surgery in the prone position is accompanied by increased intrathoracic pressure and decreased respiratory compliance. This study investigated whether intraoperative lung protective mechanical ventilation improved lung function evaluated with pulmonary function tests in patients at risk of postoperative pulmonary complications (PPCs) after major spinal surgery in the prone position. Methods: Seventy-eight patients at potential risk of PPCs were randomly assigned to the protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H2O positive end-expiratory pressure with recruitment maneuvers) or the conventional group (10 mL/kg predicted body weight, no positive end-expiratory pressure). The primary efficacy variables were assessed by pulmonary function tests, performed before surgery, and 3 and 5 days afterward. Results: Postoperative forced vital capacity (2.17±0.1 L vs. 1.91±0.1 L, P=0.213) and forced expiratory volume in 1 second (1.73±0.08 L vs. 1.59±0.08 L, P=0.603) at postoperative day (POD) 3 in the protective and conventional groups, respectively, were similar. Trends of a postoperative decrease in forced vital capacity (P=0.586) and forced expiratory volume in 1 second (P=0.855) were similar between the groups. Perioperative blood-gas analysis variables were comparable between the groups. Patients in the protective and conventional groups showed similar rates of clinically significant PPCs (8% vs. 10%, P>0.999). Conclusions: In patients at potential risk of developing PPCs undergoing major spinal surgery, we did not find evidence indicating any difference between the lung protective and conventional ventilation in postoperative pulmonary function and oxygenation.

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Safety of Sodium Bicarbonate for Control of ICP (Letter)

No abstract available

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Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial

Background: Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery. Materials and Methods: Our monocentric, double-blind, 1:1 randomized, 2×2 crossover study aimed at studying the effect size and variability of ICP in patients undergoing elective supratentorial brain tumor removal and alternatively ventilated with Vt 9 mL/kg—PEEP 0 mm Hg and Vt 7 mL/kg—PEEP 5 mm Hg. Respiratory rate was adjusted to maintain comparable end-tidal carbon dioxide between ventilation modes. ICP was measured through a subdural catheter inserted before dural opening. Results: Forty patients were enrolled; 8 (15%) were excluded after enrollment. ICP did not differ between traditional and protective ventilation (11.28±5.37, 11 [7 to 14.5] vs. 11.90±5.86, 11 [8 to 15] mm Hg; P=0.541). End-tidal carbon dioxide (28.91±2.28, 29 [28 to 30] vs. 28.00±2.17, 28 [27 to 29] mm Hg; P

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Epidural Injection of Platelet Rich Plasma for Postlumbar Puncture Headaches

No abstract available

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Trends and Outcomes of Early Versus Late Percutaneous Endoscopic Gastrostomy Placement in Patients With Traumatic Brain Injury: Nationwide Population-based Study

Background: Oral intake for traumatic brain injury (TBI) patients is often not an option because of facial trauma, swallowing dysfunctions, altered consciousness, etc. These patients often require percutaneous endoscopic gastrostomy (PEG) placement for nutrition support. To date, there is lack of studies examining the relationship between the timing of PEG placement and patient outcome in the TBI group. Methods: We conducted a population-based study in a retrospective cohort of TBI patients undergoing PEG, using the national inpatient sample for years 2011 to 2013. Results: A total of 96,625 patients were identified for TBI and 3343 of those patients received PEG. TBI patients who undergo an early or late PEG placement had a higher rate of in-hospital mortality, when compared with patients with a standard timing of PEG placement. Late PEG was preferably placed in patients with higher Charlson index and trauma-related comorbidities, and these patients had a higher incidence of complications, that is, sepsis, urinary tract infection, acute respiratory distress syndrome/pneumonia, and deep vein thrombosis/pulmonary embolism. When stratified by mortality-risk groups, early PEG was associated with higher rates of in-hospital mortality while standard PEG was associated with best mortality outcomes in low–mortality-risk group and moderate–mortality-risk group. Conclusions: The results of this study suggest that if a PEG placement is indicated for a TBI patient, a standard (7 to 14 d) timing may be associated with better patient outcomes. However, secondary to limitations associated with the use of administrative databases, further prospective studies are needed to establish clear guidelines regarding the optimal timing of placing PEG in TBI patients.

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A Pediatric Case With Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Due to an Epidural Hemorrhage

No abstract available

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Intraoperative Neurological Monitoring With Evoked Potentials During Carotid Endarterectomy Versus Cooperative Patients Under General Anesthesia Technique: A Retrospective Study

Introduction: The best technique to evaluate contralateral carotid flow during carotid endarterectomy (CEA) is still debated; an accurate detection of efficient contralateral blood flow can avoid unnecessary shunt placement and its complications. The aim of this retrospective observational study was to evaluate and compare the safety and efficacy of general anesthesia with motor-evoked potential and somatosensory-evoked potentials (mSSEP and tcMEP) versus cooperative patients under general anesthesia (CPGA) technique for CEA. Primary outcome was the rate of technical failure. The procedural time and shunt incidence between the 2 neuromonitoring strategies were also analyzed. Patients and Methods: A total of 331 patients who consecutively underwent CEA were included (100 patients in the CPGA group and 231 in the mSSEP+tcMEP group). The anesthesia technique was customized according to the cerebral monitoring needs. Comparison between groups was performed along with risk analysis. Results: Electrophysiological monitoring seems to be a safe and effective strategy of neuromonitoring during CEA. Compared with the CPGA technique, it ensures fewer technical failures, reduces surgical and anesthesiological time and, moreover, it may reduce shunt risk/incidence. The incidence of shunt between the CPGA group and mSSEP+tcMEP was statistically different (CPGA 12%, mSSEP+tcMEP 5.2%; P=0.02), and the relative risk reduction in the mSSEP+tcMEP group, compared with the CPGA group, was 0.57. Conclusions: mSSEP and tcMEP neuromonitoring was associated with less technical failure and procedural time than asleep-awake-asleep strategy. The evoked potential neuromonitoring may be an alternative technique to awake clinical assessment during CEA.

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Life-threatening Tachyarrhythmia Following Intra-Arterial Milrinone for Cerebral Vasospasm

No abstract available

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Effect of Albumin in Combination With Mannitol on Whole-blood Coagulation In Vitro Assessed by Thromboelastometry

Background: Albumin and mannitol may interfere with hemostasis, but their coinfluence is unclear. We aimed to determine the effects of albumin alone and in combination with mannitol or Ringer acetate (RAC) on hemostasis in crossover in vitro study. Materials and Methods: From citrated fresh whole blood withdrawn from 10 volunteers, we prepared 2.5, 5, 10, 15, and 20 vol% dilutions of 4% albumin (Alb group). Each sample was thereafter diluted by 15% mannitol (Alb/Man group) or RAC (Alb/RAC group) at a ratio of 9:1. Using thromboelastometry, FibTEM (fibrinogen ROTEM) and ExTEM (extrinsic ROTEM) tests were performed. Results: A 20 vol%, but not 2.5 to 15 vol% dilution of albumin caused a prolonged clot formation time, α-angle decrease, and maximum clot firmness (MCF) weakening compared with undiluted sample (P

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Epithelial IL-6 trans-signaling defines a new asthma phenotype with increased airway inflammation

Publication date: Available online 11 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Zala Jevnikar, Jörgen Östling, Elisabeth Ax, Jenny Calvén, Kristofer Thörn, Elisabeth Israelsson, Lisa Öberg, Akul Singhania, Laurie C.K. Lau, Susan J. Wilson, Jonathan A. Ward, Anoop Chauhan, Ana R. Sousa, Bertrand De Meulder, Matthew J. Loza, Frédéric Baribaud, Peter J. Sterk, Kian Fan Chung, Kai Sun, Yike Guo, Ian M. Adcock, Debbie Payne, Barbro Dahlen, Pascal Chanez, Dominick E. Shaw, Norbert Krug, Jens M. Hohlfeld, Thomas Sandström, Ratko Djukanovic, Anna James, Timothy S.C. Hinks, Peter H. Howarth, Outi Vaarala, Marleen van Geest, Henric K. Olsson
BackgroundAlthough several studies link high levels of IL-6 and soluble IL-6 receptor (sIL-6R) with asthma severity and decreased lung function, the role of IL-6 trans-signaling (IL-6TS) in asthma is unclear.ObjectiveTo explore the association between epithelial IL-6TS pathway activation and molecular and clinical phenotypes in asthma.MethodsAn IL-6TS gene signature, obtained from air-liquid interface (ALI) cultures of human bronchial epithelial cells stimulated with IL-6 and sIL-6R, was used to stratify lung epithelium transcriptomic data (U-BIOPRED cohorts) by hierarchical clustering. IL-6TS-specific protein markers were used to stratify sputum biomarker data (Wessex cohort). Molecular phenotyping was based on transcriptional profiling of epithelial brushings, pathway analysis and immunohistochemical analysis of bronchial biopsies.ResultsActivation of IL-6TS in ALI cultures reduced epithelial integrity and induced a specific gene signature enriched in genes associated with airway remodeling. The IL-6TS signature identified a subset of IL-6TS High asthma patients with increased epithelial expression of IL-6TS inducible genes in absence of systemic inflammation. The IL-6TS High subset had an overrepresentation of frequent exacerbators, blood eosinophilia, and submucosal infiltration of T cells and macrophages. In bronchial brushings, TLR pathway genes were up-regulated while the expression of tight junction genes was reduced. Sputum sIL-6R and IL-6 levels correlated with sputum markers of remodeling and innate immune activation, in particular YKL-40, MMP3, MIP-1β, IL-8 and IL-1β.ConclusionsLocal lung epithelial IL-6TS activation in absence of type 2 airway inflammation defines a novel subset of asthmatics and may drive airway inflammation and epithelial dysfunction in these patients.

Graphical abstract

Teaser

By cluster analysis of lung epithelium transcriptomics data using an IL-6 trans-signaling gene signature we demonstrate the presence of a poorly controlled asthma patient subset associated with airway inflammation, remodeling and compromised epithelial barrier function.


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Genetic variation in the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway affects contact hypersensitivity responses

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Julien M.D. Legrand, Edwige Roy, Batoul Baz, Pamela Mukhopadhyay, Ho Yi Wong, Ramesh Ram, Grant Morahan, Graeme Walker, Kiarash Khosrotehrani




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Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma

Pulmonary adenocarcinoma is one of the major types of lung cancers in which metastasis is very common and it accounts approximately to one-third of all primary pulmonary cancers. Although a minority of patients with lung cancer are asymptomatic, which gets usually detected in routine chest radiography, most of the patients present with some symptoms. Lung cancer metastasis may occur virtually in every organ system. Patients with non-small-cell lung cancer commonly have extrathoracic metastases to the adrenal glands, liver, brain, bones, and lymph nodes at presentation. Approximately one-third of patients with lung cancer will present with symptoms related to extrathoracic spread. Metastasis to the bone is not uncommon in lung cancer; however, osteoblastic bone metastasis is very rare. Here we present a 30-year-old female diagnosed to have pulmonary adenocarcinoma with multiple sclerotic bony lesions in the vertebra.

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ACTH Gel in Resistant Focal Segmental Glomerulosclerosis after Kidney Transplantation

Background Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange and/or rituximab. Methods We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large U.S. transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio (UPCR). Results We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with therapeutic plasma exchange (TPE) and rituximab. Mean± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were Caucasians, and 8 (38%) had previous kidney transplants. Median (IQR) of recurrent and de novo FSGS was 3 (0.75 – 7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis; and 10 (50%) received rituximab as well; which was started before the use of ACTH gel. There was a significant improvement of UPCR from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P=0.004). Ten patients (50%) achieved complete or partial remission. Conclusions Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to therapeutic plasma exchange and rituximab. Corresponding author: Nada Alachkar, MD, Johns Hopkins University School of Medicine, Division of Nephrology, Johns Hopkins Hospital, 600 Wolfe St. Brady 502, Baltimore, MD 21287, Phone: 410-614-9225, Fax: 410-367-2259, nalachk1@jhmi.edu Authorship Page: Tarek Alhamad participated in design of the work, data collection, data analysis and interpretation, drafting the article, final approval of the version to be published John Manllo Dieck participated in data collection and analysis Usman Younus participated in data collection Dany Matar participated in data collection Sami Alasfar participated in data collection Vikas Vujjini participated in data collection Devin Wall participated in data collection Bilal Kanawati participated in data collection Jochen Reiser participated in critical revision of the article Daniel Brennan participated in critical revision of the article Nada Alachkar participated in design of the work, data collection, data analysis and interpretation, drafting the article, final approval of the version to be published Disclosures: TA has a research grant from Mallinckrodt. JR is a cofounder and stockholder of Trisaq; a biotechnological company developing novel therapeutics for chronic kidney diseases and FSGS, and has pending and issued patents in the therapeutic and diagnostic space regarding kidney diseases. The rest of the authors of this manuscript have no conflict of interest to disclose as described by the Transplantation. Sources of support: Research grant from Mallinckrodt, Tarek Alhamad Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Risk factors and clinical course for liver steatosis or nonalcoholic steatohepatitis after living donor liver transplantation

Background Posttransplant liver steatosis occurs frequently and can affect patient outcome. Our aim was to clarify the risk factors for steatosis or steatohepatitis after living donor liver transplantation (LT) through a retrospective examination of recent 100 living donor LT recipients and their liver donors. Methods Liver biopsy was performed at 1-year after LT and each year, thereafter, or as needed due to abnormal liver enzyme levels, with a median follow-up of 4 (2~10) years. Results Liver steatosis (≥5%) was identified in 33 cases, with steatohepatitis identified in 9 of 33 patients with liver steatosis. Recipients with liver steatosis were younger than those without steatosis (53.4±9.5 years versus 57.6±9.9 years, respectively; p=0.045). Of note, the prevalence of steatosis was significantly higher among LT recipients who received a graft from a donor with steatosis than without (60% versus 23%, respectively; p=0.001). Donor steatosis was also associated with steatohepatitis in recipients after LT (steatohepatitis: simple steatosis; 88%: 50%). On multivariate analysis, younger recipient age (p=0.023) and donor steatosis (p=0.005) were independent risk factors of liver steatosis after LT. Among the 33 recipients in our study group, 26 were assessed by serial liver biopsies, with 6 showing progression of the nonalcoholic fatty liver disease activity score (NAS). An increase in body weight was predictive of steatosis progression after LT (p=0.005). Conclusions Age and donor steatosis influence the risk of liver steatosis and steatohepatitis in recipients after LT. The clinical course of steatosis is relatively benign, with only 19% developing NAS and 7.6% significant fibrosis. Received 24 January 2018. Revision received 16 May 2018. Accepted 4 June 2018. Correspondence: Hisamitsu Miyaaki MD, Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Tel: +81-958-19-7481. Fax: +81-958-19-7482 Disclosure Statement of COI;The authors have no conflicts of interest Authors' contribution Hisamitsu Miyaaki; study design, statistical analysis, data interpretation, manuscript preparation, literature search Satoshi Miuma; data collection Naota taura; data collection Hidetaka shibata; data collection Ryu sasaki; data collection Akihiko Soyama; data collection Masaaki Hidaka; data collection Mitsuhisa Takatsuki; data collection Susumu Eguchi; data collection Kazuhiko Nakao; data interpretation  Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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FSGS ACTH gel: part of the answer?

No abstract available

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Vomer Flap: A Golden Tool for the Treatment of Cleft Palate

Despite the lack of consensus regarding the treatment of labio-palatal clefts, each treatment protocol is the expression of an individual perspective that accumulates the experience of each multidisciplinary group, which all pursue the same goal: to achieve adequate language development with the lowest possible impact on facial growth. To achieve this, a management scheme has been developed, this exploits vomer flaps for the closure of palatal clefts and limits dissections in the palatine segments. Modifications are presented in the design and dissection of vomer flaps, so as to use the largest amount of mucosal tissue available, thus facilitating closure of the different clefts, particularly in Veau Group III clefts. Address correspondence and reprint requests to Luz Elena Rueda Gallardo, MD, Calle 3 # 72 - 99 Casa 31, Bogotá, Colombia 110821; E-mail: dra.lrgcirugiaplastica@gmail.com Received 22 October, 2017 Accepted 12 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Investigation of Distances Between the Anterior Nasal Spine and Nasofrontal Beak, Basal Lamella, Skull Base, and Sphenoid Sinus on Paranasal Sinus Computed Tomography

Objective: The aim of this study was to investigate the distances between the anterior nasal spine and basal lamella (BL), skull base, nasofrontal beak (NfB), and the anterior wall of sphenoid sinus on computed tomography (CT) images. Methods: A total of 160 patients who were seen at the otolaryngology clinic of our institution were evaluated with the help of the image processing software of the radiology department. Cases in which bony structures could not be seen clearly because of previous surgery or trauma were excluded. The distance between the anterior nasal spine; and NfB, the closest point of the skull base in the frontal recess (SB1), the closest point of the BL, the intersection of the line with which the distance to the BL was measured with the skull base (SB2) and the closest point of the anterior wall of the sphenoid sinus (Sp) were measured using multiplanar reconstruction. Results: The images of 140 patients were examined. NfB, SB1, BL, SB2, and Sp were 5.14 ± 0.46 (4.15–6.38) cm, 5.70 ± 0.48 (4.31–7.03) cm, 4.84 ± 0.44 (3.86–5.98) cm, 6.23 ± 0.50 (5.13–7.35) cm, and 6.14 ± 0.46 (5.04–7.36) cm, respectively. Conclusion: In our study group, the distances some of which were reported as constant values in the literature were found to have a range of up to 2 cm. Therefore, if distances between structures are to be used for orientation during endoscopic sinus surgery, they should be better measured preoperatively on paranasal sinus CT scan images instead of using predefined constant values. Address correspondence and reprint requests to Yalcin Alimoglu MD, Kulak Burun Boğaz Hastaliklari Kliniği, Haseki Egitim ve Arastirma Hastanesi, Fatih, Istanbul, Turkey; E-mail: alimoglu2001@gmail.com Received 26 October, 2017 Accepted 12 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Objective Assessment of Lingual Nerve Microsurgical Reconstruction

Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery. Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex. All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN. All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery. All patients feeling pain preoperatively experienced complete relief of algic symptoms. The early microsurgical approach is the most suitable choice for the treatment of LN injuries. Address correspondence and reprint requests to Dr. Fabiana Allevi, MD, Via di Rudinì 8, 20142 Milan, Italy; E-mail: fabiana.allevi@gmail.com Received 5 January, 2018 Accepted 12 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Immediate Treatment of Complex Mandible Fracture in a Pediatric Patient

The facial fractures in pediatric patients are rare, and they can need an immediate treatment to recover the function and aesthetic to the young patients. However, the open reduction internal fixation is controversial in pediatrics; it can be effectiveness to treat complex mandible fractures. Therefore, we present a case of a pediatric patient with a complex mandible fracture caused by an auto accident. The immediate treatment was successful with the use of open reduction internal fixation. Address correspondence and reprint requests to Gabriel Mulinari-Santos, MSc, Araçatuba Dental School, José Bonifácil Street, Number 1193, Araçatuba 16015-050, São Paulo, Brazil; E-mail: gabriel_mulinari@hotmail.com Received 6 March, 2018 Accepted 12 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Dimensional Stereophotogrammetric Evaluation of the Efficacy of Autologous Fat Grafting in the Treatment of Parry-Romberg Syndrome

Autologous fat grafting is a surgical procedure used to correct volumetric defects, atrophies, and sclerosis. Three-dimensional (3D) facial photography may enable researchers to quantify the success of surgical procedures through volumetric and surface assessments. Using 3D photography, the authors assessed the results of autologous fat grafting performed in a 15-year-old patient affected by Parry-Romberg syndrome, a rare condition resulting in progressive hemifacial atrophy of skin, subcutaneous tissues and, ultimately, bone. Stereophotogrammetric acquisitions were performed before and 4 months after the surgical intervention. The obtained results were objectively assessed in terms of facial symmetry through calculation of root mean square deviation point-to-point distance between the treated and healthy side, and volume modifications between pre- and postsurgical 3D facial scans. Four months after surgery, 73% of injected adipose tissue was resorbed, whereas facial symmetry increased up to 63%. The proposed method is not invasive and provides quantitative information about the surgical and esthetic outcomes. Clinicians could better plan surgery, and the patients could be more motivated and compliant to the treatment. Address correspondence and reprint requests to Chiarella Sforza, MD, PhD, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; E-mail: Chiarella.sforza@unimi.it Received 19 December, 2017 Accepted 12 April, 2018 Drs CS and ABG contributed equally to this paper. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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