Publication date: Available online 2 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Erica Jackson Mayland, Anna M. Pou
Salivary gland tumors are an uncommon heterogeneous group of neoplasms that vary in their anatomic site, histology and biologic behavior. Pleomorphic adenoma is the most common benign tumor and mucoepidermoid and adenoid cystic carcinoma are the most common malignant tumors. Evaluation and diagnosis of these tumors includes not only a complete history and head and neck exam, but also biopsy and imaging of the tumors. Controversy remains regarding the necessity and type of biopsy to be performed and the usefulness of imaging. This manuscript describes the utility of different diagnostic procedures in evaluating salivary gland neoplasms.
https://ift.tt/2IMrljJ
Δευτέρα 2 Ιουλίου 2018
Evaluation and Diagnosis of Salivary Gland Neoplasms
Four Japanese Patients with Congenital Nephrogenic Diabetes Insipidus due to the AVPR2 Mutations
Almost 90% of nephrogenic diabetes insipidus (NDI) is caused by mutations in the arginine vasopressin receptor 2 gene (AVPR2) on the X chromosome. Herein, we reported clinical and biochemical parameters in four cases of three unrelated Japanese families and analyzed the status of the AVPR2. Two of the four patients had poor weight gain. However, in the male and female sibling cases, neither had poor weight gain while toddlers, but in the male sibling, episodes of recurrent fever, polyuria, and polydipsia led to the diagnosis of NDI at 4 years of age. Analysis of AVPR2 identified two nonsense mutations (c.299_300insA; p.K100KfsX91 and c.296G > A; p.W99X) and one missense mutation (c.316C > T; p.R106C). These mutations were previously reported. The patient with c.316C > T; p.R106C had milder symptoms consistent with previous reports. Of the familial cases, the sister was diagnosed as having NDI, but a skewed X-inactivation pattern in her peripheral blood lymphocytes was not identified. In conclusion, our study expands the spectrum of phenotypes and characterized mutations in AVPR2 in NDI.
https://ift.tt/2lR2UbP
Antimicrobial susceptibilities of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis strains from periodontitis patients in Morocco
Abstract
Background and objective
Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been frequently isolated in periodontitis patients in Morocco. Its persistence after the subgingival debridement of the biofilm has been correlated with worse clinical outcomes. The aim of this study was to evaluate the antimicrobial susceptibilities of A. actinomycetemcomitans and P. gingivalis, to amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. In addition, microbiological profiles of patients harbouring A. actinomycetemcomitans, P. gingivalis, or both were compared.
Material and methods
In 45 consecutive periodontitis Moroccan patients, subgingival samples were taken and processed by culture. Twenty-four A. actinomycetemcomitans and 30 P. gingivalis colonies were isolated (54 strains) and susceptibility tests, using the epsilometric method, were run for amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. Minimum inhibitory concentrations for 50 (MIC50) and 90% (MIC90) of the organisms were calculated.
Results
The prevalence of A. actinomycetemcomitans and P. gingivalis was 79.5 and 84.4%, respectively. A. actinomycetemcomitans showed susceptibility to amoxicillin, amoxicillin plus clavulanate, while 28% of the isolated strains were resistant to azithromycin and 61.7% towards metronidazole. No P. gingivalis resistance towards amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin was found.
Conclusion
A. actinomycetemcomitans and P. gingivalis were frequently detected in Moroccan patients with periodontitis, while antimicrobial resistance was only detected for A. actinomycetemcomitans to metronidazole and azithromycin.
Clinical relevance
A. actinomycetemcomitans resistance against some antimicrobials in periodontitis patients in Morocco can influence the selection of the therapeutic approaches.
https://ift.tt/2tXSBWZ
Recurrent FPIES to wheat after multiple tolerant exposures in a male infant
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated reaction to food that typically presents in infancy and manifests as repetitive vomiting, lethargy and hypotension 1 to 4 hours after ingestion, occasionally followed by delayed diarrhea. Due to lack of a diagnostic biomarker, oral food challenge (OFC) remains the gold standard for diagnosis of FPIES and to monitor for resolution. Supervised introduction of high-risk foods has also been recommended given the high rate of cross-reactivity of some foods.
https://ift.tt/2KrfZHF
Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report
Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5–11.6% of patients with primary spontaneous pneumothorax. Sp...
https://ift.tt/2lR6yCw
Intraoperative thermal safety of endoscopic ear surgery utilizing a holder
Despite the ever-growing popularity of endoscopic ear surgery (EES), there are still concerns regarding the potential thermal risk associated with the use of light sources and also questions raised about the thermal safety of extended stationary applications of endoscopes with holders that allow the use of both hands in the middle ear. The temperature changes witnessed during EES when using different calipers on static endoscopes fitted with camera holders during true operations were measured, and effects of varying light source intensities, as well as the cooling effect of irrigation and suction, were investigated.
https://ift.tt/2lOF0NV
Chronic Deafness Degrades Temporal Acuity in the Electrically Stimulated Auditory Pathway
Abstract
Electrical stimulation of the auditory nerve with a penetrating intraneural (IN) electrode in acutely deafened cats produces much more restricted spread of excitation than is obtained in that preparation with a conventional cochlear implant (CI) as reported by Middlebrooks and Snyder (J Assoc Res Otolaryngol 8:258–279, 2007). That suggests that a future auditory prosthesis employing IN stimulation might offer human patients greater frequency selectivity than is available with a present-day CI. Nevertheless, it is a concern that the electrical field produced by an IN electrode might be too restricted to produce adequate stimulation of the partially depopulated auditory nerve of a deaf patient. We evaluated this by testing responses to IN and CI stimulation in adult-deafened cats. Activation of the auditory pathway was monitored by recording from the central nucleus of the inferior colliculus (ICC). Cats deaf for 153–277 days exhibited a ~ 30 % loss of auditory nerve fibers compared to cats deaf for < 18 h. Contrary to our concern, measures of thresholds and dynamic ranges showed no significant deafness-related impairment of excitation by IN or CN stimulation. Surprisingly, however, temporal acuity decreased dramatically in these adult-deafened cats, as demonstrated by a marked decrease in the maximum rate of electrical cochlear stimulation to which ICC neurons synchronized to IN or CI stimulation. For instance, half of ICC neurons synchronized to IN stimulation up to 203 pulses per second (pps) in acute deafness, whereas that number dropped to 79 pps for chronic deafness. Such a loss of temporal acuity might contribute to the poor sensitivity to temporal fine structure that has been reported in human CI users. Seemingly, the degraded temporal acuity that we observed in cats was even worse than the fine-structure sensitivity of human CI users, suggesting that most patients experience some improvement of temporal acuity resulting from restoration of patterned auditory nerve stimulation by a CI.
https://ift.tt/2lNpMsH
A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010–2014
Previous reports on anaphylaxis in Asia are limited to relatively small-scale studies. We performed this study to identify the nationwide prevalence of anaphylaxis and epinephrine prescription rates by age gro...
https://ift.tt/2IJoIz6
Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study
Abstract
Objective
To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10–13 years in individuals between 60 and 96 years.
Materials and methods
Baseline (2001–2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3–C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014.
Results
Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ2 = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60–72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ2 = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60–72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ2 = 10.7, p = 0.001).
Conclusions
Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60–96-year-old individuals.
Clinical relevance
Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.
https://ift.tt/2z4Wi2T
Reflection- and Distortion-Source Otoacoustic Emissions: Evidence for Increased Irregularity in the Human Cochlea During Aging
Abstract
Previous research on distortion product otoacoustic emission (DPOAE) components has hinted at possible differences in the effect of aging on the two basic types of OAEs: those generated by a reflection mechanism in the cochlea and those created by nonlinear distortion (Abdala and Dhar in J Assoc Res Otolaryngol 13:403–421, 2012). This initial work led to the hypothesis that micromechanical irregularity ("roughness") increases in the aging cochlea, perhaps as the result of natural tissue degradation. Increased roughness would boost the backscattering of traveling waves (i.e., reflection emissions) while minimally impacting DPOAEs. To study the relational effect of aging on both types of emissions and address our hypothesis of its origin, we measured reflection- and distortion-type OAEs in 77 human subjects aged 18–76 years. The stimulus-frequency OAE (SFOAE), a reflection emission, and the distortion component of the DPOAE, a nonlinear distortion emission, were recorded at multiple stimulus levels across a four-octave range in all ears. Although the levels of both OAE types decreased with age, the rate of decline in OAE level was consistently greater for DPOAEs than for SFOAEs; that is, SFOAEs are relatively preserved with advancing age. Multiple regression analyses and other controls indicate that aging per se, and not hearing loss, drives this effect. Furthermore, SFOAE generation was simulated using computational modeling to explore the origin of this result. Increasing the amount of mechanical irregularity with age produced an enhancement of SFOAE levels, providing support for the hypothesis that increased intra-cochlear roughness during aging may preserve SFOAE levels. The characteristic aging effect—relatively preserved reflection-emission levels combined with more markedly reduced distortion-emission levels—indicates that SFOAE magnitudes in elderly individuals depend on more than simply the gain of the cochlear amplifier. This relative pattern of OAE decline with age may provide a diagnostic marker for aging-related changes in the cochlea.
https://ift.tt/2lPPYTo
Health-Related Quality of Life of Community Thyroid Cancer Survivors in Hangzhou, China
Thyroid, Ahead of Print.
https://ift.tt/2NhsdQI
Persistent buccopharyngeal membrane: a rare entity
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
Author(s): A. Rai, A. Jain, M.M. Khan, V. Gupta
https://ift.tt/2lQGAz8
Editorial Board
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
https://ift.tt/2tZuHdA
Surgical guide and CAD/CAM prebent titanium plate for sagittal split ramus osteotomy in the correction of mandibular prognathism
Publication date: Available online 2 July 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C. Xue, Y. Tian, L. Wang, X. Yang, E. Luo, D. Bai
This study was designed to introduce and evaluate the clinical use of a surgical guide and a CAD/CAM prebent titanium plate for sagittal split ramus osteotomy (SSRO) in the correction of mandibular prognathism. We studied 14 patients who had been diagnosed, and treated by bilateral SSRO with the guide, during the period July 2015–January 2016. Surface deviations of distal segments from simulation until the end of the operation were measured on a coloured map. Deviations of position and orientation of the condyle and proximal segment from before to after operation, and those from simulation until the end of the operation, were measured with a 3-dimensional vector. All patients were followed up for at least a year. The coloured map showed that the mean (SD) distances were 0.40 (0.25)mm between the simulated and postoperative distal segments. The 3-dimensional vector showed that the mean values of mediolateral, anteroposterior, and superior-inferior translations of the condyles were less than 1mm (p<0.02) from before the operation until the end, and from simulation to the end of the operation, and the mean value of pitching for proximal segments was less than 1° (p<0.02) from simulation to the end of the operation. At the one year follow-up, the occlusions were stable. Based on accurate diagnosis and simulation, this guide takes the distal segment precisely to its planned position, and the condyle and proximal segment are well-controlled. This is a useful tool, which is comparatively easy to make and operate.
https://ift.tt/2lMP5er
Application of a resin handle for preparation of lamina for osteo-odontokeratoprosthesis
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
Author(s): A. Enomoto, K. Matsunaga, M. Fukuda, Y. Shimomura, S. Hamada
https://ift.tt/2tWZ7x7
Re: Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
Author(s): A. Pellatt, J. Collin, C.W. Hughes
https://ift.tt/2lPDStm
Perioperative risk factors that predict complications of radial forearm free flaps in oral and maxillofacial reconstruction
Publication date: July 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
Author(s): C. Wang, G. Fu, F. Liu, L. Liu, M. Cao
The aim of the study was to find out what perioperative risk factors predicted complications in patients having reconstructions with radial forearm free flaps (RFFF). We organised a retrospective study of 169 patients (mean (range) age 54 (22–86) years, 100 of whom were female) who had oral and maxillofacial tumours resected, and reconstructed with RFFF, from January 2011–December 2016. We recorded predictive variables, subdivided into: personal and clinical (sex, age, weight, coexisting conditions, history of smoking, radiotherapy, and primary lesions); haemodynamic (perioperative concentrations of haemoglobin and albumin, blood loss, blood transfusion, urinary output (ml), and rate (ml/kg/hour), and infusion rates for crystalloids and colloids (ml/kg/hour, and volumes given intraoperatively and postoperatively for 24hours); and anaesthetic and surgical (American Society of Anesthesiologists(ASA) grade, visual analogue pain score (VAS), and duration of tourniquet and operation). The primary outcome was the presence of a postoperative complication, and the secondary outcome the types of complications (medical and surgical). The significance of differences among the variables was assessed by univariate and multivariate analysis, and probabilities of less than 0.05 were accepted as significant. There were 26 complications, of which 15 were surgical and 11 medical. Risk factors were: preoperative radiotherapy, postoperative haemoglobin and albumin concentrations, VAS for pain, and volume of crystalloids transfused during the first 24hours. Although reconstruction with a RFFF is a common and safe treatment for patients with oral and maxillofacial tumours, regulating perioperative risk factors, particularly those related to anaesthesia (including VAS and management of fluids) is important in the reduction of the number of complications.
https://ift.tt/2u2kFJ0
Training Groups
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
https://ift.tt/2lPIGzi
Refinement of the approach in virtual surgical planning of osseous genioplasty
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 6
Author(s): G.W. Jenkins, R. Banks, D. Keith
https://ift.tt/2z2B6up
Objective measures of physical activity in patients with chronic unilateral vestibular hypofunction, and its relationship to handicap, anxiety and postural stability
Dizziness is one of the most common symptoms in the general population. Patients with dizziness experience balance problems and anxiety, which can lead to decreased physical activity levels and participation in their daily activities. Moreover, recovery of vestibular function from vestibular injury requires physical activity. Although there are reports that decreased physical activity is associated with handicap, anxiety, postural instability and reduced recovery of vestibular function in patients with chronic dizziness, these data were collected by self-report questionnaires.
https://ift.tt/2u2foRI
Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection
Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated.
https://ift.tt/2yZJU4h
Common polymorphism in the glycine N-methyltransferase gene as a novel risk factor for cleft lip with or without cleft palate
The objective of this study was to identify new environmental and genetic risk factors for orofacial clefts that arise during early foetal development. In this retrospective, case–control, mother–child pair study, 172 orofacial clefts cases and 199 healthy controls, and their respective mothers, were genotyped for common variants in relevant genes obtained by text and database mining using STRING 10.0. Exposure to environmental risk factors was evaluated using questionnaires. Variant glycine N-methyltransferase (odds ratio (OR) 2.1, 95% confidence interval (95% CI) 1.0–4.4) and dihydrofolate reductase (OR 2.4, 95% CI 1.3–4.5) genotypes were identified as risk factors for cleft lip with or without cleft palate formation.
https://ift.tt/2lLg7Tw
Complete spontaneous regression of a metastatic melanoma of the mandible: a case report and follow-up recommendations
Regression of metastatic melanoma is very rare and occurs in only 0.23% of cases. Metastasis to the oral cavity is particularly uncommon and accounts for only 1–3% of all oral malignancies. This report presents a case of spontaneous and complete regression of a metastatic melanoma in the mandibular ramus. The patient remains asymptomatic more than 2 years after diagnosis. The patient was followed up regularly. It is recommended that further surveillance imaging be performed in asymptomatic patients following discussion with the surgical and oncological teams.
https://ift.tt/2z9BN50
Surgical guide and CAD/CAM prebent titanium plate for sagittal split ramus osteotomy in the correction of mandibular prognathism
This study was designed to introduce and evaluate the clinical use of a surgical guide and a CAD/CAM prebent titanium plate for sagittal split ramus osteotomy (SSRO) in the correction of mandibular prognathism. We studied 14 patients who had been diagnosed, and treated by bilateral SSRO with the guide, during the period July 2015–January 2016. Surface deviations of distal segments from simulation until the end of the operation were measured on a coloured map. Deviations of position and orientation of the condyle and proximal segment from before to after operation, and those from simulation until the end of the operation, were measured with a 3-dimensional vector.
https://ift.tt/2KFepxM
Postoperative temporomandibular dysfunction in patients with fractures of the zygomatic complex: a prospective follow-up study
The aim of this prospective follow-up study was to clarify the incidence and characteristics of dysfunction of the temporomandibular joint (TMJ) in patients treated surgically for fractures of the zygomatic complex. Patients were evaluated on presentation and six months after injury to assess the function of the masticatory system using the Helkimo index, which incorporates two complementary subindices: the subjective symptomatic (anamnestic) index (Ai) and the objective clinical dysfunction index (Di).
https://ift.tt/2tOZzyh
Banana fruit: An “appealing” alternative for practicing suture techniques in resource-limited settings
Suturing is an important core surgical competency that requires continued practice. The purpose of this study was to evaluate bananas as a medium for practicing suture techniques in resource-limited settings.
https://ift.tt/2KBN3vI
Ixekizumab provides superior efficacy compared to ustekinumab over 52-weeks of treatment: results from IXORA-S, a phase 3 study
The IL-17 antagonist ixekizumab is effective in the clearance of plaque psoriasis. The superior efficacy of ixekizumab over ustekinumab observed at earlier time points is maintained through Week 52 and is associated with greater quality of life improvements. Over 52 weeks, the overall safety of ixekizumab and ustekinumab was comparable.
https://ift.tt/2IP3kZ8
Natural History of Disease Activity and Damage in Patients with Cutaneous Lupus Erythematosus
There are few longitudinal studies characterizing disease activity and damage of CLE patients. This study utilizes the CLASI to delineate the disease course of CLE patients on standard-of-care treatments. Having high baseline disease activity, minority race, or CLE disease duration <1 year predict CLE activity improvement.
https://ift.tt/2ILrmo6
Peripheral monocytes and neutrophils predict response to immune checkpoint inhibitors in patients with metastatic non-small cell lung cancer
Abstract
We carried out a retrospective cohort study on patients with metastatic non-small cell lung cancer (mNSCLC) to identify the peripheral blood count parameters associated with response to immune checkpoint inhibitors (ICIs). There were 17 males and 15 females. Their median age was 64.5 years (range 20–84). History of smoking was present in 25/32 (78%) patients. Twelve patients received pembrolizumab, 19 patients nivolumab, and one patient nivolumab followed by pembrolizumab. Responses were observed in 19/32 (59%) patients, all partial responses. There was no difference in the distribution of sex, age, and smoking status between responders and non-responders. The median time to response (TTR) was 12 weeks (range 6–24) and the median duration of response (DoR) was 24 weeks (range 7–112). Higher pre-therapy absolute monocyte counts (AMCs) correlated to shorter TTR (p = 0.03), but not to response rate or DoR. Within the group of responders, those with AMCs > 700/mm3 had a significantly shorter median TTR than those with AMCs ≤ 700/mm3 (8 weeks vs 12 weeks; p = 0.048). Although baseline absolute neutrophil counts (ANCs) did not have any prognostic value, ANCs after first dose predicted response to ICI (p = 0.02). Patients with ANCs ≤ 4200/mm3 after first dose were more likely to respond than those with ANCs > 4200/mm3 (OR = 6.8; 95% CI 1.1–41.8; p = 0.05). Analysis of AMC and ANC before and during therapy may, therefore, provide an easy method to identify those mNSCLC patients most likely to benefit from ICI therapy.
https://ift.tt/2z1JvhD
Successful desensitization in a pediatric patient with acetazolamide allergy
Acetazolamide is an uncommon cause of IgE-mediated drug allergy. Classified as a sulfonamide, acetazolamide differs in chemical structure from sulfonamide antibiotics as it does not have an amine moiety at the N4 position. As a result, acetazolamide is infrequently a cause of IgE-mediated drug reactions and is less-likely to be cross-reactive in those with IgE-mediated allergy to sulfonamide antibiotics.1,2 Acetazolamide is reported to trigger non-IgE mediated reactions including pulmonary edema, delirium, acute generalized exanthematous pustulosis, and even Steven Johnsons syndrome.
https://ift.tt/2Kox2d7
Mechanisms of allergen-specific immunotherapy: diverse mechanisms of immune tolerance to allergens
Successful AIT induces establishment of long-term clinical tolerance against allergens resulting in reduction of symptoms and decrease in the need for pharmacotherapy, ultimately improving quality of life for patients suffering from IgE-mediated diseases.1
https://ift.tt/2KFQSg7
Health Literacy and Asthma Among Hispanic and African American Urban Adolescents with Undiagnosed Asthma
Asthma has high prevalence among adolescents, urban youth, and Hispanic and African American youth.1, 2 A large proportion of youth experience asthma symptoms, but are not diagnosed.3 Understanding more about undiagnosed asthma is an essential first step in increasing the likelihood of adolescents obtaining a diagnosis and treatment, and in preventing detrimental outcomes.
https://ift.tt/2KoMdTM
Specific-IgE to galactose-alpha-1,3-galactose (alpha-gal) has limited utility in diagnosing meat allergy in a tick-endemic population
Sensitization to galactose-alpha-1,3-galactose (alpha-gal) is considered a prerequisite to mammalian meat allergy (MMA), and can occur through tick bites, which is due to the paralysis tick, Ixodes holocyclus in Australia.1 The onset of symptoms is typically 3-6 hours following ingestion of mammalian meat, but immediate reactions are also described.2
https://ift.tt/2IKfpiq
Efficacy of C1Inhibitor concentrate in hereditary angioedema with C1Inhibitor deficiency: analysis in the French Cohort
Hereditary angioedema (HAE) is a rare genetic disease characterized by transitory recurrent subcutaneous and/or submucosal swelling episodes, which mainly affect skin, gastrointestinal tract and upper airways1. It should be divided into 2 forms according to the level of C1 inhibitor: HAE with C1 inhibitor deficiency (C1INH-HAE)1, and with a normal C1-Inhibitor level2, C1INH-HAE being the most frequent1. C1INH-HAE can be life-threatening especially when it affects upper airways3.
https://ift.tt/2Kt5kvS
Combo-VAS: an integrated outcome for assessing the perception of allergen immunotherapy effectiveness in clinical practice.
Allergen Immunotherapy (AIT) is at present indicated for treating respiratory, food, and venom allergy.1 Usually, AIT lasts for some years, but its efficacy is longstanding. These aspects make AIT irreplaceable compared to conventional pharmacological medications. However, AIT presents some disadvantages, including very long duration, high cost, potential side effects, and low compliance, mainly concerning the sublingual route.2 In addition, another limitation of AIT is the lack of simple and reliable criteria of efficacy assessment both considering clinical or laboratory biomarkers.
https://ift.tt/2KFoQl0
Mary Hewitt Loveless, MD, and the origin of venom immunotherapy
If ever there was an allergist whom I wish I had the chance to meet, it was Mary Hewitt Loveless, MD. Regrettably, I didn't, and so my sources for this remembrance are second-hand. Yet the legacy of this truly original investigator continues to grow, now 27 years after her death, at age 92, on June 2, 1991.
https://ift.tt/2KpxUOB
Chronic Tearing Induced by Apremilast
The therapeutic potential of Phosphodiesterase 4 (PDE-4) inhibitors has been studied for various hyperproliferative skin disorders, such as psoriasis and atopic dermatitis. Inhibition of PDE-4 activity leads to elevated levels of intracellular cAMP; this results in anti-inflammatory effects in almost all inflammatory cells.1 Apremilast is an oral PDE-4 inhibitor that is FDA approved for the treatment of psoriatic arthritis in adults as well as patients with moderate to severe plaque psoriasis. The most common adverse reactions to apremilast (≥5%) are diarrhea, nausea, headache, and upper respiratory tract infection.
https://ift.tt/2IKfnai
Radiographic characteristics of chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: a comparison with chronic suppurative osteomyelitis and osteoradionecrosis
Diffuse sclerosing osteomyelitis (DSO) of the mandible is a poorly understood chronic disease. It is assumed to be a form of chronic osteomyelitis. Other forms of chronic osteomyelitis are chronic suppurative osteomyelitis (CSO) and osteoradionecrosis (ORN). This study aimed to investigate radiographic characteristics of DSO and compare these findings with the radiographic characteristics of CSO and ORN in order to radiographically distinguish these three diseases.In this retrospective study, 33 patients were clinically diagnosed with DSO (13), CSO (6), or ORN (14).
https://ift.tt/2tPyzi4
Post-surgical effects on the maxillary segments of children with oral clefts: New three-dimensional anthropometric analysis
This study aimed to use new three-dimensional (3D) anthropometric analyses to verify the post-surgical effects on the maxillary segments of children with unilateral cleft lip and palate. The sample was composed by digitized dental models of 60 children with unilateral complete cleft lip and alveolus (UCLA) and complete unilateral cleft lip and palate (UCLP). The impressions were taken before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). The 3D anthropometric analyses of digitized dental casts were obtained through a specific software.
https://ift.tt/2z2dMgb
The T-win® technology: immune-modulating vaccines
Abstract
The T-win® technology is an innovative investigational approach designed to activate the body's endogenous anti-regulatory T cells (anti-Tregs) to target regulatory as well as malignant cells. Anti-Tregs are naturally occurring T cells that can directly react against regulatory immune cells because they recognize proteins that these targets express, including indoleamine 2,3-dioxygenase (IDO), tryptophan 2,6-dioxygenase, arginase, and programmed death ligand 1 (PD-L1). The T-win® technology is characterized by therapeutic vaccination with long peptide epitopes derived from these antigens and therefore offers a novel way to target genetically stable cells with regular human leukocyte antigen expression in the tumor microenvironment. The T-win® technology thus also represents a novel way to attract pro-inflammatory cells to the tumor microenvironment where they can directly affect immune inhibitory pathways, potentially altering tolerance to tumor antigens. The modification of an immune regulatory environment into a pro-inflammatory milieu potentiates effective anti-tumor T cell responses. Many regulatory immune cells may be reverted into effector cells given the right stimulus. Because T-win® technology is based on the immune-modulatory function of the vaccines, the vaccines activate both CD4 and CD8 anti-Tregs. Of importance, in clinical trials, vaccinations against IDO or PD-L1 to potentiate anti-Tregs have so far proved to be safe, with minimal toxicity.
https://ift.tt/2KFo6zo
Acquired resistance to cancer immunotherapy
Abstract
In recent times, advances in cancer immunotherapy have yielded impressive, durable clinical responses in patients with varied subtypes of cancer. However, a significant proportion of patients who initially demonstrate encouraging tumor regression develop resistance and progress over time. The identification of novel therapeutic approaches to overcome resistance may result in significantly improved clinical outcomes and remains an area of high scientific priority. This review aims to summarize the current knowledge regarding the role of both tumor-intrinsic and tumor-extrinsic factors in the development of resistance to cancer immunotherapy and to discuss current and possible future therapeutic strategies targeting these mechanisms.
https://ift.tt/2MJ4sjE
Gabapentin, Methadone, and Oxycodone With or Without Venlafaxine Hydrochloride in Managing Pain in Participants With Stage II-IV Squamous Cell Head and Neck Cancer Undergoing Chemoradiation Therapy
Interventions: Drug: Gabapentin; Drug: Methadone; Drug: Oxycodone; Other: Quality-of-Life Assessment; Other: Questionnaire Administration; Drug: Venlafaxine; Drug: Venlafaxine Hydrochloride Extended Release
Sponsors: Roswell Park Cancer Institute; National Cancer Institute (NCI)
Recruiting
https://ift.tt/2MFMiz6
Wearable Sensor for Biometrics During Locoregional Therapy for Head and Neck Cancer
Intervention: Device: wearable sensor
Sponsor: University of Texas Southwestern Medical Center
Recruiting
https://ift.tt/2KpbxsB
Sitravatinib (MGCD516) and Nivolumab in Oral Cavity Cancer Window Opportunity Study
Interventions: Drug: Sitravatinib; Biological: Nivolumab
Sponsors: University Health Network, Toronto; Mirati Therapeutics Inc.
Not yet recruiting
https://ift.tt/2MGV1ky
Nivolumab & IRX-2 With Surgery for Resectable Stage III-IVA Oral Cavity Cancer or HPV-Positive Oropharyngeal Cancer
Interventions: Drug: Cyclophosphamide; Biological: IRX-2; Biological: Nivolumab; Procedure: Surgery
Sponsors: Emory University; Bristol-Myers Squibb; IRX Therapeutics
Not yet recruiting
https://ift.tt/2Ko15BP
TPF Induction Chemotherapy vs PF Adjuvant Chemotherapy Combined With Concurrent Chemoradiotherapy in the Treatment of Locally Advanced NPC
Interventions: Drug: TPF+CCRT; Drug: CCRT+PF
Sponsor: Guiyang Medical University
Recruiting
https://ift.tt/2MH8FEo
mTOR-mediated glycolysis contributes to the enhanced suppressive function of murine tumor-infiltrating monocytic myeloid-derived suppressor cells
Abstract
Immune cell activation occurs concurrently with metabolic reprogramming. As important components of the tumor microenvironment, monocytic myeloid-derived suppressor cells (M-MDSCs) are featured by their potent immunosuppressive abilities on anti-tumor effector cells. However, little is known about the contribution of metabolic adaptations to their suppressive roles. In this study, we found that tumor-infiltrating M-MDSCs had the same phenotype with splenic M-MDSCs. Compared with splenic M-MDSCs, tumor-infiltrating M-MDSCs exhibited stronger suppressive activities which was accompanied by higher glycolysis. Inhibition of glycolysis impaired the suppressive function of tumor M-MDSCs. Meanwhile, the results demonstrated that mTOR was responsible for this function regulation. mTOR inhibition by rapamycin decreased the glycolysis and reduced the suppressive activities of these cells. Furthermore, rapamycin treatment inhibited the tumor growth and reduced the percentage of M-MDSCs in 3LL tumor bearing mice. These results demonstrated that modulation of metabolism in immune cells can be an effective way to enhance anti-tumor effects.
https://ift.tt/2KCyzIQ
Making a Difference by Addressing Social Determinants of Health
"Social Determinants of Health (SDH) are the conditions in which people are born, grow, work, live, and age, and the waiter set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, Social norms, social policies and political systems."1
SDH have a profound impact on our patients. "[T]hey are violent because they cause injury to people…. [C]linicians are not trained to understand such social forces, nor are we trained to alter them. Yet it has long been clear that many medical and public health interventions will fail if we are unable to understand the social determinants of disease."2 These determinants can be addressed at many different levels, helpfully classified as upstream, midstream, and downstream (Figure 1). Downstream determinants after temporally and spatially close to health efffects, upstream determinants are fundamental causes that set in motion causal pathways leading to health effects.3
In the case, "Childhood obesity in Mexico: social determinants of health and other risk factors" by Rodriguez et al, the most obvious aspects are the downstream effects of social determinants of health. A child is diagnosed with gastro-oesophageal reflux (GORD) and obesity. The downstream social determinants are the obvious presentation, and the first priority of the treating clinician. In this case, that can be seen with the lifestyle modifications recommended including changes in diet, exercise and sleeping habits and pharmacological treatment. As noted, these interventions were not very effective, and "The aim of this case report is to demonstrate how childhood obesity is rooted since pregnancy… and how the social determinants of health, like unsafe outdoor conditions, lack of infrastructure to exercise and suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management." (Figure 2)
The midstream effects are also easily seen. Regarding the physical environment, "the family avoids going to the park because of the unsafe outdoor and poor park conditions…. This family lives in a small apartment with a small patio (3x4m), so how much can the patient effectively exercise?" The case is no better when it comes to health behavior, "[T]he total daily caloric intake surpassed her daily caloric requirements by approximately 500 kcal/day…. [And] [i]n the case of our patient, 5 hours of screen use per day clearly exceed the recommended daily screen use hours…which affects the duration of sleep and contribute to the patient's sedentary lifestyle."
Finally, the upstream SDH are evident in the "suboptimal physical activity curriculum in government schools." The authors also note that "[M]ost community parks have been built in popular areas that are located far away from the most vulnerable." The authors also mention the social inequalities, "Women and children in low socioeconomic groups are the most vulnerable…. [B]eing a lower middle class family in Mexico and the inequalities this implies clearly affects management."
According to the WHO, "Obesity prevention and treatment requires a whole-of-government approach in which policies across all sectors systematically take health into account, avoid harmful health impacts, and thus improve population health and health equity."4 As clinicians, we see the full weight of SDH on the health of individuals. It is our duty and privilege to report on the harmful effects of policies and infrastructure that wreak havoc on the lives of the vulnerable. Healthcare professionals see the weakest at their most vulnerable, and the authors of this case are examples in not only reporting the facts but offering interventions. In their "Learning points" they include, "Schools must offer more than 60 min of physical activity per week to achieve a negative caloric balance in children. Construction of new parks in vulnerable neighborhoods and tackling crime are priorities to promote outdoor physical activity in Mexico."
BMJ Case Reports invites authors to submit global health case reports that describe the effects of SDH on vulnerable patients and ways to mitigate these effects. These cases could focus on:
- Upstream and midstream interventions and their impact on individual lives
- Downstream effects of SDH on individual patients
- Challenges to instituting SDH interventions as a healthcare professional
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at www.bmjcasereports.com. For more information, review our guidance on how to write a global health case report and look through our online collection
To read more about SDH at BMJ Case Reports, please review:
- Ethiopian-Israeli community
- Social determinants of health: poverty, national infrastructure and investment
- Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective
- A Rohingya refugee's journey in Australia and the barriers to accessing healthcare
To read more about SDH, please review:
[1] World Health Organization. Social determinants of health. What are social determinants of health [internet] available from http://www.who.int/social_determinants/en/ accessed 6/26/2018
[2] Farmer PE, Nizeye B, Stulac S, Keshavjee. Structural violence and clinical medicine. PLoS Med (2006) 3(10):e449
[3] BMJ Case Reports Global Health Curriculum (Available at casereports.BMJ.com/site/about/Global_health_curriculum_slides.pptx
[4] World Health Organization. Report of the commission on ending childhood obesity. World Health Organization; 2016. Geneva, Switzerland
The post Making a Difference by Addressing Social Determinants of Health appeared first on BMJ Case Reports blog.
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Prefrontal modulation during chewing performance in occlusal dysesthesia patients: a functional near-infrared spectroscopy study
Abstract
Objectives
Neuropsychological associations can be considerable in occlusal dysesthesia (OD) patients who routinely complain of persistent occlusal discomfort, and somatization effects in the superior medial prefrontal cortex and the temporal and parietal regions are also present. However, the relationship between physical activity, i.e., chewing, prefrontal cognitive demand, and psychiatric states in OD patients remains unclear. We investigated this relationship in this study.
Materials and methods
OD patients (n = 15) and healthy control (n = 15; HC) subjects were enrolled in this study. Occlusal contact, chewing activities of the masticatory muscles, prefrontal activities, and psychiatric states such as depression and somatization, of the participants were evaluated. Functional near-infrared spectroscopy was used to determine prefrontal hemodynamics and the Symptom Checklist-90-R was used to score the psychiatric states.
Results
We observed a significant association between prefrontal deactivation during chewing and somatization subscales in OD patients. Further, there were no significant differences with regard to the occlusal state and chewing physical activities between the OD patients and HC subjects.
Conclusions
Chewing-related prefrontal deactivation may be associated with somatization severity in OD patients.
Clinical relevance
fNIRS is a functional imaging method that uses the principal of neuro-vascular couplings. It is applicable for evaluation of psychiatric state based on prefrontal cortex blood flow in patients with psychiatric disorders.
https://ift.tt/2tXBTHc
Sinus computed tomography predicts clinical response to corticosteroids in chronic rhinosinusitis with nasal polyps
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy...
https://ift.tt/2KEmenm
Angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) of the external auditory canal, an unusual presentation in an adult female: a case report
https://ift.tt/2KEp7Ys
Complete small bowel obstruction without intussusception due to a submucosal lipoma
https://ift.tt/2MDXts0
Gallstone ileus 1 year after cholecystectomy
https://ift.tt/2KslCVG