Head and Neck Medicine by Alexandros G.Sfakianakis: 07/11/18

Τετάρτη 11 Ιουλίου 2018

Condylar changes after orthognathic surgery for class III dentofacial deformity: a systematic review

Evaluation of the therapeutic effect of micro-plasma radio frequency on hypertrophic scars in rabbit ears

Abstract

To evaluate the therapeutic effect of micro-plasma radio frequency on hypertrophic scars in rabbit ears to provide an experimental basis and theoretical foundation for the treatment of hypertrophic scars. Hypertrophic scars were established on the ventral surface of the ears of six New Zealand white rabbits. Left and right ears were randomly divided into two groups: experimental group treated with micro-plasma radio frequency and control group with no treatment. H&E staining and CD34 labeling of microvessels were performed to analyze ear specimens, and immunohistochemical staining was conducted to detect IL-8 and MCP-1 in the scars. Compared with the control group, scar tissue in the experimental group was improved by color and texture. H&E-stained collagen fiber bundles were more organized after treatment as assessed by optical microscopy. The number of microvessels in the experimental group was decreased compared with that in the control group. Microvascular density was significantly reduced in the experimental group compared with the control group (27.16 ± 5.64 and 48.75 ± 8.25 mm², respectively; P < 0.01). The mean optical densities of IL-8 and MCP-1 were significantly reduced in the experimental group compared with the control group (IL-8 0.016 ± 0.011 and 0.078 ± 0.023, respectively; MCP-1 0.018 ± 0.016 and 0.054 ± 0.038, respectively; both P < 0.01). The micro-plasma radio-frequency technique has a therapeutic effect on hypertrophic scars in rabbit ears.

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Condylar changes after orthognathic surgery for class III dentofacial deformity: a systematic review

Publication date: Available online 12 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A.-S. Vandeput, P.-J. Verhelst, R. Jacobs, E. Shaheen, G. Swennen, C. Politis

Abstract

After orthognathic surgery for class II dentofacial deformity, remodelling of the mandibular condyle will take place. In a number of cases, this may evolve towards a phenomenon of condylar resorption. Yet, studies on the occurrence of this complication after the correction of a class III deformity are scarce. A systematic review of the literature was performed with the aim of identifying reports on condylar resorption or remodelling after orthognathic surgery for class III dentofacial deformity. A search of the international databases yielded 12 eligible studies. Eight studies reported some degree of postoperative condylar remodelling, while symptoms of condylar resorption were only described in a limited group of patients. Thus, the literature may show evidence of condylar remodelling after orthognathic treatment of class III patients, and anecdotal reports of condylar resorption exist. The small sample sizes, heterogeneity in methods and outcomes, and use of two-dimensional radiographs indicate the need for updated long-term research. In the future, the use of cone beam computed tomography data for volumetric and morphological condylar analysis in combination with three-dimensional cephalometry may provide the opportunity to further elucidate this phenomenon and better characterize its aetiology.

https://ift.tt/2ubQgc4

Superficial siderosis misdiagnosed as idiopathic bilateral neurosensorial deafness

Superficial siderosis (SS) is a rare condition resulting from different sources of bleeding into the subpial space. The most common symptoms are: hypoacusia, ataxia, incontinence, dementia and parkinsonism. Since several neurodegenerative disorders may present with same clinical features, SS is often misdiagnosed. Here we present a case of SS misdiagnosed as idiopathic bilateral neurosensorial deafness.

https://ift.tt/2KR239V

Multiple intestinal perforations due to blister pill pack ingestion

A 72-year-old woman with morbid obesity and history of psychosis attended the emergency room due to abdominal pain. CT scan revealed a mesenteric infiltration surrounding a thickened wall bowel agglomeration; inside, a dense 2 cm foreign body with no pneumoperitoneum or peritoneal effusion. Surgery revealed four contained bowel perforations due to a blister pill pack inside the ileum; consequently, a 30 cm bowel resection was performed. Ingestion was restarted on day 2, a superficial wound infection was evacuated on day 4 and the patient was discharged 6 days after surgery. Foreign body ingestion is relatively common in paediatric patients. Adult cases are usually related to vision problems, intellectual disability and psychiatric or cognitive disorders. Mostly, no consequences are reported, but some cases (<1%) can lead to complications such as perforations or gastrointestinal (GI) bleeding. Endoscopic extraction may be considered when placed in the upper GI tract, but surgery remains imperative if perforation is established.

https://ift.tt/2N93ZY5

A challenging case of primary amenorrhoea

The differential diagnosis of a girl presenting with primary amenorrhoea includes numerous conditions. Often, patients of 46XY disorder of sex development (DSD) are reared as girl and present with primary amenorrhoea. Their further evaluation to reach the final diagnosis is often a great challenge. In this article, we report a challenging case of 46XY DSD presented with primary amenorrhoea. Patient had spontaneous breast development which initially confused the diagnosis to complete androgen insensitivity syndrome. However, low testosterone suggested against this possibility and further evaluation revealed hormonal findings consistent with 17α hydroxylase/17,20 lyase (CYP17A1) deficiency. Patient had 46XY karyotype and in consistence with hormonal findings patient was found to have a likely pathogenic homozygous c.1345C>T (p.Arg449Cys) variation in exon 8 of CYP17A1.

https://ift.tt/2KP07Po

Squamous cell carcinoma arising in hypertrophic lichen planus

Hypertrophic lichen planus (HLP) is a chronic T-cell-mediated inflammatory disease characterised by pruritic hypertrophic or verrucous plaques on the lower limbs. We report a case of an 87-year-old woman with a 12-year history of HLP on both lower legs presenting with malignant transformation of one lesion into a squamous cell carcinoma (SCC). Malignancy developing in cutaneous lichen planus is rare, with less than 50 cases reported in the literature. This case highlights the need to be aware of suspicious changes in long-standing HLP to allow early detection of a developing SCC.

https://ift.tt/2L9230W

Vesicovaginal fistula and vesicocutaneous fistula in a patient having pelvic ectopic kidney with pyonephrosis: a unique therapeutic challenge

Patients with ectopic kidney require special considerations in their management due to the anatomic characteristics predisposing the kidney to obstruction and related complications. Pelvic ectopic kidneys have the added disadvantage of being confined in the bony pelvis giving less manoeuvrability during surgery of that unit. Vesicovaginal fistulas are usually managed surgically and careful surgical dissection has to be carried out because the highest success rates are usually seen at the first operation. It is rare to find a combination of such challenging diseases in a single patient. We present the case of a young woman who developed iatrogenic vesicovaginal and vesicocutaneous fistulae during an attempt to surgically manage a pyonephrotic ectopic pelvic kidney.

https://ift.tt/2L24xl8

Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolisation

Uterine artery pseudoaneurysm (UAP) is a rare cause of delayed postpartum haemorrhage. Early diagnosis and endovascular management are effective in treating this condition. We present the case of a 36-year-old gravida 3, para 2 woman with delayed postpartum haemorrhage and endometritis following a spontaneous vaginal delivery. Ultrasound and catheter angiogram demonstrated a UAP arising from the distal aspect of the left uterine artery. Significant bleed persisted despite selective bilateral uterine artery embolisation. A repeat angiogram confirmed complete occlusion of bilateral uterine arteries, but abdominal aortogram demonstrated that the left ovarian artery was now feeding the pseudoaneurysm. A repeat embolisation procedure was performed to occlude the left ovarian artery. The patient was discharged the following day. Selective arterial embolisation is effective in the management of UAP. Persistent bleeding despite embolisation should raise the suspicion of anastomotic vascular supply and may require repeat embolisation.

https://ift.tt/2Jg9qlM

Visible-free cholesterol crystal emboli adjacent to microinfarcts in myocardial capillaries and arterioles on H&E-stained frozen sections of an autopsied patient

The number of released free cholesterol crystal emboli (fCCE) and their role during percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have not been documented yet. Furthermore, fCCE manifesting in the coronary lumen following plaque rupture has been historically overlooked owing to the standard tissue preparation for light microscopy which uses ethanol as a dehydrating agent that can dissolve fCCE, leaving behind empty tissue. In this case report, we evaluated fCCE released during PCI for ACS and their relationship with myocardial injury and coronary artery obstruction on the H&E-stained sections by using polarised light microscopy. To our knowledge, there has been no mention of the visibility of fCCE on H&E-stained frozen polarised sections before.

https://ift.tt/2KZZa5U

Metastatic Merkel-cell carcinoma: the dawn of a new era

Merkel-cell carcinoma (MCC) is a rare but aggressive cutaneous malignancy arising most often in sun-exposed Caucasians who are immunosuppressed or the elderly. Patients with metastatic disease treated with chemotherapy have a median progression-free survival of just 3 months. This report describes a 58-year-old man with a background history of psoriasis treated with immunosuppressive therapy and subsequently diagnosed with metastatic MCC. Chemotherapy produced a partial response. Then, a novel immunotherapy agent, pembrolizumab, induced a complete response maintained for at least 19 months. Quality of life was unaffected, and toxicity from immunotherapy was minimal. At the time of writing, there was no clinical or radiological evidence of recurrence and treatment is ongoing.

https://ift.tt/2JfnJqy

Secondary spindle cell sarcoma following external beam radiotherapy for prostate cancer: a rare but devastating complication

We report a case of rapidly growing sarcoma that resulted in mortality only 6 years after radiotherapy for low-grade prostate cancer.

At the age of 69 years and a prostate-specific antigen (PSA) that had risen to 9.0 µg/L, transrectal ultrasound-guided biopsy of the prostate found a single core of Gleason 3+3 disease involving 4 mm of a 10 mm core. The patient declined active surveillance and completed 78 Gy of external beam radiotherapy over 39 fractions to a prostate volume of 46 mL.

His PSA nadir was 0.62 µg/L 1-year postradiation; however, in April 2017, his PSA began to rise satisfying the definition of biochemical recurrence. He underwent cystoscopy, biopsy favoured an undifferentiated pleomorphic sarcoma. Restaging scans (CT/bone scan) were completed showing no metastasis, and repeat MRI showed rapid growth of the lesion in 3 months.

He underwent palliative pelvic exenteration, however, 1 month later presented with large volume tumour recurrence and was subsequently palliated and died.

https://ift.tt/2KZZ6mG

Combination therapy for systemic sclerosis-associated pneumatosis intestinalis

We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.

https://ift.tt/2JfnCv8

Neutropaenia and splenomegaly without arthritis: think rheumatoid arthritis

Felty syndrome(FS) is an uncommon, but severe, extra-articular manifestation of rheumatoid arthritis (RA). It occurs in patients with longstanding RA. It is extremely rare for RA to present as FS or develop after initially presenting as neutropaenia and splenomegaly. We describe a case of 47-year-old woman who was diagnosed simultaneously with FS and possible RA after testing positive for anticyclic citrullinated peptide antibody, but a negative rheumatoid factor. She had an excellent response to methotrexate. We review the existing literature of such cases and emphasise the importance of serological testing for RA in patients presenting with neutropaenia and splenomegaly, even in the absence of joint symptoms or prior diagnosis of RA.

https://ift.tt/2KZZ3Hw

Azathioprine-induced pancytopenia with normal TPMT activity presenting with HSV oral ulcers

A 65-year-old man with treatment-resistant psoriatic arthritis, hypertension, dyslipidaemia and benign prostatic hyperplasia (BPH) presented with herpes simplex virus (HSV) oral ulcers and a recent 15 lb weight loss due to reduced consumption. Five weeks previously, his methotrexate was tapered and he had begun taking azathioprine. The patient's thiopurine S-methyltransferase (TPMT) activity level was normal prior to starting azathioprine. He was found to have pancytopenia with normal folate levels and azathioprine was discontinued. His pancytopenia worsened, with a nadir 8 days after stopping azathioprine, before returning to normal levels. His oral ulcers improved and he was able to tolerate solid food. This case illustrates that decreased TPMT activity is not the only risk factor for pancytopenia as an adverse reaction to azathioprine. Furthermore, HSV stomatitis may be the presenting symptom of pancytopenia. The timeline of improvement in cell counts illustrated in this patient has implications for the management of suspected azathioprine-induced pancytopenia.

https://ift.tt/2Lb7sF1

Giant pituitary incidentaloma

Description

A 78-year-old woman, independent, with medical history of hypertension, dyslipidaemia and bilateral cataract surgery. The patient underwent a head CT after a traumatic brain injury where a giant pituitary incidentaloma of 60 mm in the largest diameter was found. The patient mentioned decreased left eye acuity for the past 20 years, with no complaints of headaches or diplopia. The physical examination was unremarkable with no stigmata of endocrine disease. Anterior pituitary hormonal profile was normal. Additional MRI showed an extensive infiltrative lesion, 60x40 mm, with cavernous and sphenoidal sinus invasion, suprasellar extension and left optic nerve encapsulation (figures 1 and 2). Visual field campimetry revealed left amaurosis and right inferior temporal quadrantanopia. A nasal endoscopic biopsy was performed and the histopathology was compatible with pituitary adenoma with rare cells staining positive for adrenocorticotropic hormone and alpha subunit. Cytological atypia was absent and the Ki67 index...

https://ift.tt/2KZcKqj

Small bowel perforation by toothpick

Toothpick ingestion is a rare but potentially fatal condition which may cause bowel perforation and rare complications if it migrates out of the gastrointestinal tract. This case report describes a delayed presentation of toothpick-induced small bowel injury leading to abdominal wall abscess and spondylodiscitis. A 51-year-old man was admitted twice with fever and loin pain, but repeated non-contrast CT was reported to be unremarkable. However, 5 months later, he presented with a left lower quadrant abdominal wall abscess and back pain. An updated CT showed a linear hyperdensity which was already present in previous scans, causing small bowel perforation, abdominal wall abscess and spondylodiscitis. Emergency laparotomy identified a toothpick causing small bowel perforation. The abdominal wall abscess was incised and drained, and small bowel was repaired.

https://ift.tt/2Lc3jke

Acute upper gastrointestinal bleeding in a patient with malignant melanoma

Description

The patient is a 73-year-old woman who was diagnosed with nodular melanoma of the calf almost 2 years prior to presentation. The melanoma was treated with wide-margin surgical resection (pT4b, 21 mitoses/high power field, 8 mm depth), followed by sentinel lymph node biopsy, which was negative. However, surveillance CT scan done less than a year after the original excision showed metastases to the liver, bone, lungs and adrenal glands. After oncological assessment, the patient had decided not to proceed with chemotherapy. The gastroenterology service was consulted when the patient presented with melena and significant anaemia (haemoglobin 54 g/L, haematocrit 0.17 L/L). Her haemoglobin level was normal 1 year prior (128 g/L). She also had mild renal impairment (creatinine 135 μmol/L, urea 11.4 mmol/L, glomerular filtration rate 32 mL/min/1.73 m²). She was resuscitated, including blood transfusions, and underwent urgent gastroscopy.

The gastroscopy showed multiple lesions in the fundus and body of the stomach (figure 1). The lesions were nodular with central...

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Syncope: An Atypical Presentation of Pulmonary Embolism Secondary to Occult Uterine Malignancy

All syncopal patients who present to the emergency department should be considered for pulmonary embolism (PE) as part of their differential diagnosis. PE presenting as a syncopal episode and associated with occult uterine malignancy is uncommon. Review of the literature indicates that up to 10% of patients with unprovoked venous thromboembolism (VTE) are diagnosed with cancer in the year following that first episode of VTE. In patients suspected of having a PE who do not manifest any source of an embolism require eventual workup to screen for an occult malignancy. Here, we report a 74-year-old female who presented to the emergency department following an unexplained sudden loss of consciousness and eventually was found to have a massive saddle embolus caused by a uterine malignancy-induced VTE.

https://ift.tt/2um9Xgg

Blood-brain barrier (BBB) and the complement landscape

Publication date: Available online 12 July 2018

Source: Molecular Immunology

Author(s): Jessy J. Alexander

Abstract

The brain is an immune privileged organ, uniquely placed in the body. Two systems involved in maintaining brain homeostasis and in protecting the brain are the blood-brain barrier (BBB) and the complement system. The BBB is present in the vasculature of the brain and is the dynamic interface between brain and body that regulates what enters and leaves the brain, thereby maintaining the brain microenvironment optimal for brain function. The complement system is ubiquitous, being present systemically and in the brain, both membrane bound and in circulation. It is an important arm of the body's defense that helps maintain homeostasis by eliminating debris and damaged cells, participating in destroying pathogens, promoting inflammation and conveying 'danger signals'. Recent studies reveal that the complement system plays an important role in normal brain development. However, when the complement system is overwhelmed, complement activation could contribute to loss of BBB integrity resulting in brain pathology. Studies support an association between complement proteins and BBB dysfunction, with the mechanisms being slowly unraveled. This review will provide an overview of both these systems, how they intersect and interact with each other.

https://ift.tt/2ulcEii

A prospective cohort study assessing the clinical utility of the Cottle maneuver in nasal septal surgery

Low-level laser therapy (830 nm) on orthodontic pain: blinded randomized clinical trial

Abstract

The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I—laser on the right side; group II—placebo on the right side; group III—laser on the left side; group IV—placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).

The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser's and placebo's group.

https://ift.tt/2ztPJHj

Tinnitus perception in patients after vagal nerve stimulator implantation for epilepsy

Publication date: Available online 11 July 2018

Source: American Journal of Otolaryngology

Author(s): Helena Wichova, Sameer A. Alvi, James Lin, Keith Sale, Christopher Larsen, Hinrich Staecker

Abstract

Purpose

Vagal nerve stimulation in conjunction with sound therapy has been proposed as a treatment for subjective tinnitus. The purpose of this study is to retrospectively review the effect of VNS on perception of tinnitus in epilepsy patients. We explore the incidence of tinnitus and its perceived reduction in patients requiring implantation of VNS for medically refractory seizures.

Materials and methods

A phone survey was conducted in adult patients with prior VNS implantation. A questionnaire including the visual analog scale (VAS) of tinnitus loudness was used to determine the presence and severity of tinnitus.

Results

Out of the 56 patients who had completed the phone survey, 20 (35%) reported the presence of pre-operative tinnitus. The tinnitus positive group was significantly older (p = 0.019). Of the 20 pre-operative tinnitus positive patients, all patients continued to have tinnitus post-operatively. Four (20%) noted no changes in VAS of tinnitus loudness while 16 (80%) had at least a one-point decrease. The mean difference between pre- and post-operative VAS of loudness was 2.05, with a standard deviation of 1.84 and this was statistically significant (p < 0.001).

Conclusions

In this study, we evaluate the potential of vagal nerve stimulation to alter the perception of tinnitus in patients with refractory epilepsy. Eighty percent of patients noted some level of subjective tinnitus improvement after VNS implantation. Given this finding, there may be a potential additional benefit to the use of VNS in patients with epilepsy.

https://ift.tt/2JfhKSs

Is human papillomavirus and p16 expression associated with survival outcomes in nasopharyngeal cancer?: A systematic review and meta-analysis

Publication date: Available online 11 July 2018

Source: American Journal of Otolaryngology

Author(s): Tristan Tham, Sushma Teegala, Yonatan Bardash, Saori Wendy Herman, Peter Costantino

Abstract

Introduction

Human papillomavirus (HPV) is a known prognostic indicator in oropharyngeal cancer. Not much is known about the prognostic role of HPV in Nasopharyngeal cancer (NPC). Here, we performed a systematic review and meta-analysis of the literature to investigate if HPV status was a prognostic factor for NPC.

Methods

PubMed (via the web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled Hazard Ratios (HR) for Overall Survival (OS).

Results

A total of 7 studies from 2014 to 2018, reporting data on 2646 patients (range 43–1328) were included in this meta-analysis. The pooled data showed that HPV/p16 status was not associated with OS in NPC with HR of 0.77 (95% CI: 0.55–1.09, p = 0.14). The test for heterogeneity showed little to no heterogeneity of results (I² = 4%, p = 0.38). Subgroup analysis showed that in large sample sizes, HPV was significantly associated with survival.

Conclusion

Despite the finding in the pooled HR, we could not draw a definitive conclusion as to the prognostic significance of HPV in NPC. Recommendations for future research are given.

https://ift.tt/2NKfG8P

Walking hyponatremia syndrome of inappropriate antidiuretic hormone secretion secondary to carbamazepine use: a case report

Severe hyponatremia is rare when carbamazepine is used as monotherapy. It is common to encounter this imbalance in the hospital setting, but rare in the ambulatory one. Here, we present a case of hyponatremia ...

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8q22.1 Microduplication Syndrome: Why the Brain Should Be Spared? A Literature Review and a Case Report

Microduplication of chromosome 8q22.1 is mainly associated to Leri's pleonosteosis syndrome phenotype, an extremely rare autosomal dominant disease encompassing the GDF6 and SDC2 genes. To date, most of the authors focus their attention only on skeletal symptoms of the disease, and they do not systematically research or describe the co-occurrence of psychiatric illnesses or mental disorders with these muscular-skeletal diseases. In this report, we provide a description of an 8-year-old girl, with a positive family history for both skeletal malformations and bipolar disorders (BD). We suggest a possible association between Leri's pleonosteosis features and psychiatric symptoms. Furthermore, our report could be added to the large amount of reports that describe the correlation between genetic regions and disease risk for both psychiatric and rheumatological disorders.

https://ift.tt/2NIbcPS

Metastasis of Ewing's Sarcoma to the Thyroid Gland: A Case Report

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Swathi Appachi, Joseph B. Meleca, Paul Krakovitz

Abstract

Ewing's sarcoma (ES) is an aggressive pediatric malignancy. We present a case of ES with thyroid metastasis. The patient was diagnosed with ES at age 8. Despite aggressive treatment, she suffered disease progression. Surveillance demonstrated a left thyroid lesion. This grew rapidly within 2 months, causing tracheal compression. She underwent hemi-thyroidectomy to prevent airway compromise. Due to her refractory ES, she was enrolled in the Vigil immunotherapy vaccine trial; thus, the specimen was used for vaccine development. This is the first reported case of skeletal ES with metastasis to the thyroid, requiring hemithyroidectomy to prevent airway compromise.

https://ift.tt/2zvn8kZ

Palliation in Pediatric Otorhinolaryngology

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Udayan K. Shah, Elissa G. Miller, Carly Levy

Abstract

Palliation in pediatric otorhinolaryngology is a rarely discussed but important aspect of care. This review encapsulates current thinking on pediatric palliative care (PC) and demonstrates, through one case, the impact of integrating PC into clinical care. We encourage early consideration of pediatric palliative care approaches for children with complex otorhinolaryngologic disorders.

https://ift.tt/2ubdmQ4

Multiple surgeries in pediatric otolaryngology patients and associated anesthesia risk

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Melissa A. Scholes, Emily L. Jensen, David M. Polaner, Dexiang Gao

Abstract

Objectives

To determine the risk of healthy children undergoing tympanostomy tubes of an additional surgery prior to age three and associated risk factors.

Methods

A retrospective chart review of pediatric patients at a tertiary metropolitan children's hospital who underwent tympanostomy tube insertion procedure before age of three from January 2010 through March 2015. We determined patient demographics, indication for tympanostomy tube insertion, as well as information about additional procedures requiring general anesthesia before the age of three years. A prospective telephone interview was also performed on a portion of the study population to assess if there were additional surgeries before the age of three that did not occur at our institution.

Results

: In our institution there was a 13% risk of getting an additional surgery after tympanostomy tubes in children who are otherwise healthy. The most common second procedure was an otolaryngologic procedure in 77.8% of the cases. Children with a diagnosis of recurrent acute otitis media had a threefold greater chance of getting an additional surgery than those with a diagnosis of chronic otitis media with effusion. Patients that identified as Black or African American were 3.2 times more likely to have additional surgery. With every year increase at age of surgery, the odds of an additional surgery decreased by 77%.

Conclusions

In healthy children undergoing tympanostomy tube insertion at our institution, the incidence of additional procedures under general anesthesia (GA) is low at 13%. Although there is evidence of possible deleterious effects of anesthesia on the developing brain, it is generally accepted that one short (< 1 h) anesthetic exposure under the age of three has not been associated with adverse neurodevelopmental outcomes. As a specialty that regularly performs procedures on young children, we need to be aware of the possible effects of anesthetic agents on our patients. However, this study shows that that the exposure risk is low and should help reassure patient's families.

https://ift.tt/2zwcJFM

Experimental model of temporomandibular joint arthritis: evaluation of contralateral joint and masticatory muscles

Publication date: Available online 11 July 2018

Source: Archives of Oral Biology

Author(s): George Azevedo Lemos, Pâmela Lopes Pedro da Silva, André Ulisses Dantas Batista, Evanisi Teresa Palomari

Abstract

Objective

To investigate morphological and biochemical changes in an experimental model of temporomandibular joint (TMJ) arthritis, as well as examine contralateral joint involvement and morphometric aspects of masticatory muscles in affected animals.

Design

Forty Wistar rats were allocated into three groups, as follows: a healthy control group (HG); and a group with arthritis induced in the left TMJ (IG); and a contralateral group with noninflamed right TMJ (CG). Arthritis was induced by intra-articular injection of 50 µL of Complete Freund's Adjuvant (CFA). Morphological analysis was performed using histological sections of TMJs stained with hematoxylin-eosin, picrosirius and toluidine blue. In addition, histomorphometric analyses of the articular cartilage, articular disc and masticatory muscles, were performed. Biochemical analysis of TMJ tissues included dosage of sulfated glycosaminoglycans (GAGs), zymography of the Matrix Metalloproteinases (MMPs) 2 and 9 and ELISA for the cytokines IL-6, TNF-α and IL-1β. The data were analyzed by paired and unpaired t-tests, with a p < 0.05.

Results

IG animals presented morphological and biochemical changes in their TMJ, including synovial membrane hyperplasia; chronic inflammatory infiltrate; collagen fiber disorganization in the disc; reduced proteoglycans in the cartilage; greater disc thickness; lower cartilage thickness; lower feed intake; higher activity of MMP-9 and MMP-2, and higher concentration of IL-6, TNF-α, and IL-1β, as compared to HG. CG animals showed posterior disc thickening; reduced proteoglycans in the cartilage; lower collagen fiber organization of the disc; active MMP-9, and higher concentration of IL-6 and TNF-α compared to HG animals. Articular inflammation reduced the area and diameter of fibers of the temporal (right), medial pterygoid (left), and lateral pterygoid (right and left) muscles as compared to HG animals.

Conclusion

TMJ arthritis reduced the area and diameter of masticatory muscle fibers and caused morphological and molecular changes in the contralateral joint.

https://ift.tt/2zwTdJ9

CORRELATION BETWEEN CRESTAL ALVEOLAR BONE LOSS WITH INTRACANAL BACTERIA AND APICAL LESION AREA IN NECROTIC TEETH

Publication date: Available online 11 July 2018

Source: Archives of Oral Biology

Author(s): Francisco Wilker M.G. Muniz, Francisco Montagner, Rogério C. Jacinto, Cassiano K. Rösing, Brenda P.F.A. Gomes

Abstract

Objective

This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth.

Design

Data from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3 mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria.

Results

No statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (p > 0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (p = 0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area.

Conclusions

It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.

https://ift.tt/2me81D4

Experimental model of temporomandibular joint arthritis: evaluation of contralateral joint and masticatory muscles

Publication date: Available online 11 July 2018

Source: Archives of Oral Biology

Author(s): George Azevedo Lemos, Pâmela Lopes Pedro da Silva, André Ulisses Dantas Batista, Evanisi Teresa Palomari

Abstract

Objective

Design

Results

Conclusion

TMJ arthritis reduced the area and diameter of masticatory muscle fibers and caused morphological and molecular changes in the contralateral joint.

https://ift.tt/2zwTdJ9

CORRELATION BETWEEN CRESTAL ALVEOLAR BONE LOSS WITH INTRACANAL BACTERIA AND APICAL LESION AREA IN NECROTIC TEETH

Publication date: Available online 11 July 2018

Source: Archives of Oral Biology

Author(s): Francisco Wilker M.G. Muniz, Francisco Montagner, Rogério C. Jacinto, Cassiano K. Rösing, Brenda P.F.A. Gomes

Abstract

Objective

This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth.

Design

Results

Conclusions

It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.

https://ift.tt/2me81D4

Erythropoietin alleviates hyperglycaemia-associated inflammation by regulating macrophage polarization via the JAK2/STAT3 signalling pathway

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Jinjin Cui, Fengyun Zhang, Wei Cao, Yongshun Wang, Jingjin Liu, Xinxin Liu, Tao Chen, Ling Li, Jinwei Tian, Bo Yu

Abstract

Background

Erythropoietin (EPO), which is clinically used for renal anaemia, reportedly exerts beneficial pleiotropic effects in atherosclerosis. This aim of this study was to investigate the effects of EPO on macrophage inflammation and polarization under hyperglycaemic conditions and to identify the effects of EPO-treated macrophage supernatants (SNs) on endothelial cell (EC) function.

Methods

Peritoneal macrophages (pMΦs) were isolated from normal, diabetic or EPO-injected mice. Pro-inflammatory factors were detected by qRT-PCR and ELISA, and macrophage phenotype markers were evaluated by flow cytometry. High glucose culture was used to mimic the hyperglycaemic microenvironment of diabetes mellitus (DM) in vitro. After exposure to various doses of stimuli, macrophage inflammation and phenotype were detected via ELISA, qRT-PCR and flow cytometry. The underlying mechanism was investigated through western blotting. To examine the communication between macrophages and ECs, ECs were cultured with the SN of macrophages treated with different stimuli, and the tube formation ability of ECs was detected using Matrigel. The VEGF, ICAM-1 and VCAM-1 protein expression levels were determined by western blotting, and the nitric oxide (NO) and endothelin-1 (ET-1) expression levels were measured with a nitric oxide indicator and by ELISA, respectively.

Results

EPO treatment increased the M2 macrophage population and decreased the number of M1 macrophages. EPO decreased the secretion of pro-inflammatory factors, including TNF-α, iNOS and IL-6. The JAK2/STAT3 signalling pathway was also identified as being involved in the M1 macrophage transition. The SN of macrophages treated with EPO (SN-EPO) presented increased NO and ET-1 levels and decreased ICAM-1 and VCAM-1 levels. Tube formation assays revealed that the SN-EPO promoted the ability of ECs to form capillary-like structures in vitro. In contrast, AZD1480, a JAK2 inhibitor, abolished this SN-EPO effect.

Conclusion

EPO treatment alleviated the inflammatory reaction in DM mice and inhibited M1 polarization through the JAK2/STAT3 pathway. Moreover, EPO treatment promoted the tube formation ability of ECs in a VEGF-dependent manner and decreased the production of adhesion molecules, a vasodilator and a vasoconstrictor.

https://ift.tt/2KY1drl

Thrombotic risk assessment and analytical performance of the chemiluminescent analyzer IDS-Isys for the detection of anti-cardiolipin and anti-beta 2 glycoprotein I autoantibodies

Publication date: Available online 11 July 2018

Source: Clinical Immunology

Author(s): Nafai Salma, Lemerle Julie, Bendaoud Boutahar, Le Nuz Sylvie, Eléonore Bettacchioli, Le Ny Fabien, Elisabeth Pasquier, Jousse-Joulin Sandrine, Francis Couturaud, Hillion Sophie, Renaudineau Yves

Abstract

Patients with antiphospholipid antibodies (APLA) are predisposed to develop thrombosis, however the standardization of anti-cardiolipin (aCL) and anti-beta 2 glycoprotein I (β2-GPI) Ab assays are challenging. Therefore we decided to test the performance of a new chemiluminescent assay (CLIA), and assayed aCL and aβ2-GPI IgG/M in serum from 120 healthy individuals, 108 patients with idiopathic venous thrombosis, 78 patients with antiphospholipid syndrome (APS), and 64 non-thrombotic APLA-carriers using CLIA IDS-Isys. Very good (aCL/aβ2-GPI IgG) to moderate (aCL/aβ2-GPI IgM) agreement with a commercial and an in house ELISA assay were observed and, in particular, CLIA demonstrated the highest sensitivity in aβ2-GPI IgG detection. Finally, aCL/aβ2-GPI Ab capacity to predict the thrombotic risk was tested showing for CLIA a significant odds ratio (OR) when considering double positivity for aCL/aβ2-GPI IgG, aCL IgG at high levels, and aβ2-GPI IgG at high levels. In conclusion, CLIA improves aβ2-GPI IgG detection and thrombotic risk assessment.

https://ift.tt/2NGgvPQ

Primary small bowel adenomas and adenocarcinomas—recent advances

Abstract

The small intestine represents 75% of the length and 90% of the absorptive surface area of the gastrointestinal tract (GIT), yet only 2% of digestive system cancers occur at this site. Adenocarcinoma accounts for half of small bowel malignancies. There have been a number of important recent advances in our understanding, classification and treatment of small bowel tumours. Over recent years, ampullary tumours have become recognised as a form of small bowel carcinoma, distinct from head of pancreas and lower biliary tract tumours. This is reflected in separate TNM systems and increasing interest in separating intestinal from pancreatobiliary subtypes. The recognition of the importance of microsatellite (MSI) status and the advent of molecular pathology has also changed our approach to these neoplasms.

https://ift.tt/2m7W2aa

Physical property investigation of contemporary glass ionomer and resin-modified glass ionomer restorative materials

Abstract

Objectives

The objective of this study was to investigate selected physical properties of nine contemporary and recently marketed glass ionomer cement (GIC) and four resin-modified glass ionomer cement (RMGI) dental restorative materials.

Materials and methods

Specimens (n = 12) were fabricated for fracture toughness and flexure strength using standardized, stainless steel molds. Testing was completed on a universal testing machine until failure. Knoop hardness was obtained using failed fracture toughness specimens on a microhardness tester, while both flexural modulus and flexural toughness was obtained by analysis of the flexure strength results data. Testing was completed at 1 h, 24 h, 1 week, and then at 1, 3, 6, and 12 months. Mean data was analyzed with Kruskal-Wallis and Mann-Whitney (p = 0.05).

Results

Physical properties results were material dependent. Physical properties of the GIC and RMGI products were inferior at 1 h compared to that at 24 h. Some improvement in selected physical properties were noted over time, but development processes were basically concluded by 24 h. A few materials demonstrated improved physical properties over the course of the evaluation.

Conclusions

Under the conditions of this study:

GIC and RMGI physical property performance over time was material dependent;
Polyalkenoate maturation processes are essentially complete by 24 h;
Although differences in GIC physical properties were noted, the small magnitude of the divergences may render such to be unlikely of clinical significance;
Modest increases in some GIC physical properties were noted especially flexural modulus and hardness, which lends support to reports of a maturing hydrogel matrix;
Overall, GIC product physical properties were more stable than RMGI;
A similar modulus reduction at 6 months for both RMGI and GIC produced may suggest a polyalkenoate matrix change; and
Globally, RMGI products demonstrated higher values of flexure strength, flexural toughness, and fracture toughness than GIC materials.

Clinical relevance

As compared to RMGI materials, conventional glass ionomer restorative materials demonstrate more stability in physical properties.

https://ift.tt/2um3FgX

Advances in Influenza Research

Viral Immunology, Volume 31, Issue 6, Page 405-406, July/August 2018.

https://ift.tt/2N2sGFm

Double-Stranded Ribonucleic Acid-Mediated Antiviral Response Against Low Pathogenic Avian Influenza Virus Infection

Viral Immunology, Volume 31, Issue 6, Page 433-446, July/August 2018.

https://ift.tt/2KO1LQZ

Contributions of Influenza Virus Hemagglutinin and Host Immune Responses Toward the Severity of Influenza Virus: Streptococcus pyogenes Superinfections

Viral Immunology, Volume 31, Issue 6, Page 457-469, July/August 2018.

https://ift.tt/2N2sExe

Efficacy of Nd-YAG laser for treatment of pyogenic granuloma on the fingers and toes

Abstract

Pyogenic granuloma (PG) is a common benign vascular proliferation which often occurs on the head, neck, hands, and feet. Among the various treatment options for PG, surgical excision is the most effective treatment which offers the lowest overall recurrence rates and also provides the exact diagnosis. However, it could have difficulties to do the surgery when lesions are located on the fingers and toes, especially very near to the nails, so laser may be a very good alternative choice. In this article, we evaluated the clinical efficacy and safety of neodymium-yttrium aluminum garnet (Nd:YAG) laser for treatment of PG located on the fingers and toes. Twenty-one patients with 21 PGs located on the fingers and toes were treated by multispot Nd-YAG laser. We chose monopulse (pulse width 10.5–13.5 ms; energy 100–125 J/cm²); treatment interval was 3–4 weeks. All lesions disappeared after one or two treatments. There was no apparent scar formation, no impact on the function of the fingers and toes, no damage to nail growth, and no recurrence in more than 12-month follow-up. Nd-YAG is an effective and safety treatment option for treatment of PG located on the fingers and toes.

https://ift.tt/2L9zlNu

Darier's sign in urticaria pigmentosa–significance of perivascular eosinophilic infiltration

Publication date: Available online 11 July 2018

Source: Allergology International

Author(s): Eriko Maehara, Makiko Kido-Nakahara, Takamichi Ito, Hiroshi Uchi, Masutaka Furue

https://ift.tt/2LcOA8I

Three cases of adult-onset atopic dermatitis after hematopoietic stem cell transplantation

Publication date: Available online 11 July 2018

Source: Allergology International

Author(s): Nobutoshi Take, Takeshi Nakahara, Makiko Kido-Nakahara, Masutaka Furue

https://ift.tt/2NJXFHE

Six natural ways to whiten teeth

Teeth inevitably begin to yellow with age, but a range of strategies can slow the process and even reverse it. In this article, learn how to whiten teeth naturally at home using baking soda, oil pulling, hydrogen peroxide, and other techniques. We also look at which strategies to avoid to prevent damage to the teeth.

https://ift.tt/2N31lmH

L’érysipèle du pénis et du scrotum

Publication date: Available online 11 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J.-N. Dauendorffer, P. Mongiat Artus, M. Janier, M. Bagot, S. Fouéré

https://ift.tt/2uln0ic

Tesla and the Violet Ray

The beginnings of electrotherapy can be traced back to the Victorian era in the late 19th century. During this period, physicians experimented with applying electrical currents to the human body. Among the early pioneers of electrotherapy were the French physician Jacques Arsène d'Arsonval and the genius inventor and engineer, Nikola Tesla. The electrotherapy circuits produced from Tesla's research were not initially intended for medical applications. Tesla publicized the product during his various lectures and captured the attention of 2 French physicians, Paul Marie Oudin and Jacques-Arsène d'Arsonval.

https://ift.tt/2u9jUyE

Revised Mohs Surgery Appropriate Use Criteria for Superficial BCC

This Viewpoint discusses the process of reevaluating Mohs surgery appropriate use criteria for primary superficial basal cell carcinoma.

https://ift.tt/2I8LOQE

Osteopenia and Multiple Fractures in an Infant With Harlequin Ichthyosis

This case report describes the occurrence of osteopenia and multiple fractures in an infant with harlequin ichthyosis.

https://ift.tt/2vxV0Mj

Framework for Caring for Older Patients With Skin Disease

This Viewpoint describes principles of geriatric science that allow for more appropriate dermatological care for the US population of patients older than 65 years.

https://ift.tt/2JmxP9q

Prevalence of Skin Cancer Examination Among Indoor Tanning Bed Users

This study uses weighted national survey data to examine the prevalence of skin cancer examinations among users of indoor tanning beds.

https://ift.tt/2IW6IGB

The Future of JAMA Dermatology

I am deeply humbled to be selected to serve as Editor in Chief of JAMA Dermatology. The fundamental role of an editor in chief is to review, select, and publish the articles that best help clinicians practice more safely and effectively. The opportunity to illuminate the aspects of our field that deserve spotlight is a task both daunting and delightful. I am committed to do a deep dive into dermatology to identify what is most significant, what is most fascinating, what is most problematic, and to find opportunities to improve and elevate the practice of dermatologists. My ultimate goal is to ensure that dermatologists deliver the best patient care possible, and I consider it an incredible honor to be able to contribute to the specialty through this work.

https://ift.tt/2tStKEW

Missing Affiliation

In the Brief Report titled "Early Genetic Diagnosis of Neurofibromatosis Type 2 From Skin Plaque Plexiform Schwannomas in Childhood," published in the March 2018 issue of JAMA Dermatology, Dr Plana's affiliation at Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain, was missing. This article has been corrected online.

https://ift.tt/2u9JvaK

Topical Sirolimus to Treat Tuberous Sclerosis Complex

Tuberous sclerosis complex (TSC) causes the formation of hamartomatous tumors in multiple organs. Facial angiofibromas frequently arise during childhood and can be a source of patient distress owing to bleeding and effects on appearance. The standard treatment is surgical, delivered by multiple modalities, including lasers, shave excision, dermabrasion, electrosurgery, or cryosurgery. These approaches are effective but can create concerns about the potential for scarring, pain, anesthesia risk, postoperative recovery, and the need for repeated procedures delivered in the office or operating room. Consequently, there has been interest in the development of a topical therapy for home use that is painless and nonscarring. In this issue, Koenig and collaborators show that topical 0.1% or 1.0% sirolimus (rapamycin) applied once daily is safe and effective for treating facial angiofibromas. This is welcome news for many with TSC. Furthermore, these results are expected to fuel investigations into other uses for sirolimus in dermatology. The story of how topical sirolimus became a treatment option for TSC is based in scientific discoveries of its molecular target and that target's role in relevant diseases.

https://ift.tt/2s70uIU

Disseminated Asymptomatic Papules Over the Body

A woman in her 30s had a 15-year history of generalized asymptomatic papules on her arms, trunk, legs, neck, and face; examination revealed skin-colored to red-brown papules distributed over her trunk, extremities, neck, forehead, and periocular regions. What is your diagnosis?

https://ift.tt/2HzZ5Rh

2018 Update of Hyaluronidase Use in Aesthetic Dermatology

Hyaluronidase has become an essential tool in cosmetic dermatology as an eraser of unwanted hyaluronic acid (HA) filler. The purpose of this Editorial is to update the reader on the evidence supporting the use of hyaluronidase in (1) the emergency treatment of vascular occlusion from accidental injection of HA into a blood vessel and (2) the more common case of removing small amounts of HA that are simply unwanted, which is the purpose of the study published by Alam and colleagues in this issue of JAMA Dermatology.

https://ift.tt/2Fjvj1C

Demographic, Academic, and Publication Factors Associated With Academic Dermatology Career Selection

This cohort study examines associations between demographic, academic, and publication factors and dermatology trainees' initial choice of academic vs private practice careers.

https://ift.tt/2KPiwYn

Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules

This parallel-group, randomized clinical trial assesses the effectiveness and dose-related effect of small quantities of hyaluronidase vs saline to treat hyaluronic acid filler nodules in healthy women.

https://ift.tt/2KbXMKa

Problematic End Points in a Keratinocyte Carcinoma Chemoprevention Trial

To the Editor Treatment with topical fluorouracil, 5%, compared with placebo reduced risk of surgically treated squamous cell carcinoma (SCC) and Mohs surgery for keratinocyte carcinoma (KC) for 1 year, according to a randomized clinical trial (RCT) report. However, because neither of these outcomes was prespecified, these findings should be interpreted very cautiously and should not sway clinical practice.

https://ift.tt/2y8mCIY

Topical Rapamycin in Patients With Facial Angiofibromas

This randomized clinical trial examines the efficacy and safety of topical rapamycin therapy for treatment of patients with tuberous sclerosis complex–related facial angiofibromas.

https://ift.tt/2IDKCZb

Striking White Hair

Poliosis is a patch of white hair with decreased or absent melanin located in areas with hair growth, such as the scalp and eyebrows. This condition most commonly occurs on the scalp. If poliosis occurs on the scalp, it is referred to as a mallen streak. The term mallen streak originated from author Catherine Cookson's The Mallen Trilogy book series, which had characters in the same family with this trait. In addition, poliosis has also been depicted in movies as a sign of malice and sin. In the 1939 film The Return of Doctor X, the main character has a mallen streak that further characterizes his deceitfulness. Other films that have characters with poliosis include Bride of Frankenstein and Sweeney Todd: The Demon Barber of Fleet Street.

https://ift.tt/2u9J6Fg

Sirolimus Gel vs Placebo for Facial Angiofibromas in Patients With Tuberous Sclerosis Complex

This randomized clinical trial assesses the efficacy and safety of sirolimus gel, 0.2% vs placebo for treatment of angiofibromas and skin lesions in adult and pediatric patients with tuberous sclerosis complex.

https://ift.tt/2k8001l

July 2018 Issue Highlights

https://ift.tt/2ub0wkG

Contributions by MC1R Variants to Melanoma Risk in Males and Females

This case-control study evaluates the association of melanocortin-1-receptor (MC1R) with melanoma risk in males vs females, adjusting for risk factors such as age, pigmentation, phenotype, signs of skin damage, and sun exposure.

https://ift.tt/2y47494

Microenvironmental derived factors modulating dendritic cell function and vaccine efficacy: the effect of prostanoid receptor and nuclear receptor ligands

Abstract

Dendritic cells (DCs) are widely used in DC-based immunotherapies because of their capacity to steer immune responses. So far treatment success is limited and more functional knowledge on how DCs initiate and stably drive specific responses is needed. Many intrinsic and extrinsic factors contribute to how DCs skew the immune response towards immunity or tolerance. The origin and type of DC, its maturation status, but also factors they encounter in the in vitro or in vivo microenvironment they reside in during differentiation and maturation affect this balance. Treatment success of DC vaccines will, therefore, also depend on the presence of these factors during the process of vaccination. Identification and further knowledge of natural and pharmacological compounds that modulate DC differentiation and function towards a specific response may help to improve current DC-based immunotherapies. This review focuses on factors that could improve the efficacy of DC vaccines in (pre-)clinical studies to enhance DC-based immunotherapy, with a particular emphasis on compounds acting on prostanoid or nuclear receptor families.

https://ift.tt/2NJ67XK

Association of Lichen Planopilaris With Dyslipidemia

This cohort study evaluates the association between lichen planopilaris, hyperlipidemia, and metabolic syndrome.

https://ift.tt/2KQODuE

Dermatology Procedures Billed by Advanced Practice Professionals, 2012-2015

This longitudinal study uses Medicare data from 2012 through 2015 to review the trends in scope and volume of dermatology procedures performed by advanced practice professionals such as nurse practitioners and physician assistants.

https://ift.tt/2N9f0ZB

Skin Cancer Detection In Vivo With Reflectance Confocal Microscopy Performed by a Novice Reader

This study evaluates the learning curve, diagnostic accuracy, and challenges for a novice reader of reflectance confocal microscopy for determining a diagnosis of skin cancer.

https://ift.tt/2KRf6rS

Economic Analysis of a Noninvasive Molecular Pathologic Assay for Pigmented Skin Lesions

This economic analysis assesses the costs of use of the pigmented lesion assay vs visual and histopathologic assessment in model inputs of patients with primary pigmented lesions suggestive of melanoma.

https://ift.tt/2N8UgRD

Myths, Truths, and Clinical Relevance of Comedogenicity Product Labeling

This Viewpoint evaluates the meaning of the noncomedogenic label and the need for an objective assay for assessment of facial products.

https://ift.tt/2KNqRj4

An Atrophic and Spiny Eruption of the Palms

A woman presented with a pruritic and burning hyperpigmented eruption on the bilateral palms; examination revealed well-marginated brown atrophic patches on the bilateral palms extending focally onto the volar aspect of the wrist and surmounted by spiny keratotic pits in the palmar creases. What is your diagnosis?

https://ift.tt/2N8U30N

Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review

Abstract

Purpose

Septic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. However, these rates are based on old series. We question whether the prognosis of CST is currently still as devastating. The primary purpose of this study is to assess the mortality and morbidity of CST.

Methods

Using the databases of all relevant specialties in our tertiary referral hospital, we collected all the patients treated for CST in the period 2005–2017. In addition, a PubMed search, using the mesh term 'cavernous sinus thrombosis', was performed.

Results

We found 12 patients with CST in the study period. Of the 12 patients, 11 survived and 9 recovered without any permanent deficits. Seven patients were treated with anticoagulation, and in none of the patients we saw hemorrhagic complications. In literature, older articles describe higher mortality rates (14–80%), but more recent articles report mortality and morbidity rates similar to our results.

Conclusions

The prognosis of CST nowadays is more favorable than previously described. Anticoagulation seems to be a safe addition to antibiotic and surgical treatment, at least in patients without central nervous system infection.

https://ift.tt/2Lbt4Bf

Mandibular Myalgia and Miniscule Meckel’s Caves

983981

Trigeminal neuropathy manifests as episodic sharp, shooting pain in the maxillofacial region. Contributory etiologies are myriad, ranging from central pathology affecting its origin in the brainstem to peripheral processes affecting their distal-most insertion sites. We present a case of bilateral hypoplastic Meckel's caves in an adult patient leading to the clinical symptomology of trigeminal neuralgia. To the best of our knowledge, this is the only report of its kind highlighting this anatomic variant.
ORL 2018;80:103–107

https://ift.tt/2ztlMHz

Combination Therapies for Obesity

Metabolic Syndrome and Related Disorders, Ahead of Print.

https://ift.tt/2N4LIv0

What Can Diabetes-Associated Genetic Variation in TCF7L2 Teach Us About the Pathogenesis of Type 2 Diabetes?

Metabolic Syndrome and Related Disorders, Ahead of Print.

https://ift.tt/2KSxe4U

A prospective cohort study assessing the clinical utility of the Cottle maneuver in nasal septal surgery

Abstract

Background

A nasal septal deviation can have a significant detrimental effect on a patient's quality of life. Nasal valve collapse (NVC) often co-exists with a septal deviation. The Cottle maneuver is one of the most common methods to diagnose NVC; however, no study has assessed the efficacy of this physical exam finding. This study tests the hypothesis that patients with nasal obstruction due to a septal deviation with a negative pre-operative Cottle maneuver will demonstrate a greater improvement in their Nasal Obstruction Symptom Evaluation (NOSE) score, compared to patients who demonstrate a positive pre-operative Cottle maneuver, when assessed at 12 months following a septoplasty with turbinate diathermy.

Methods

This was a prospective Cohort Study. The population was 141 patients with nasal obstruction due to a septal deviation with or without nasal valve collapse, excluding patients with bilateral complete nasal valve collapse. Patients were placed in cohorts according to the results of the Cottle maneuver (positive or negative). A NOSE questionnaire was administered at baseline and 12-months after a septoplasty with turbinate diathermy. Non-adjusted NOSE scores were used (score out of 20). An ANOVA was used to compare if there was a difference in outcomes between patient cohorts.

Results

One hundred and forty-one patients completed 12-month follow-up with 71.5% of patients demonstrating a positive Cottle maneuver at baseline. The mean (95% C.I.) difference in NOSE score at 12 months between patients with a positive Cottle versus a negative Cottle was 0.18 (− 1.6 to 1.92; p = 0.38).

Conclusion

In a univariate, single surgeon study, a positive Cottle Maneuver does not appear to influence outcomes in the described patient population compared to those with a negative Cottle Maneuver when undergoing a septoplasty.

https://ift.tt/2mb0Vzl

Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Rodney A. Gabriel, Brian M. Ilfeld

https://ift.tt/2u9wvli

Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Thomas Kyle Harrison, Howard Kornfeld, Anuj Kailash Aggarwal, Anna Lembke

https://ift.tt/2zv7wOy

Update on Selective Regional Analgesia for Hip Surgery Patients

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Dario Bugada, Valentina Bellini, Luca F. Lorini, Edward R. Mariano

https://ift.tt/2u8RHb2

Updates on Multimodal Analgesia for Orthopedic Surgery

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Darsi N. Pitchon, Amir C. Dayan, Eric S. Schwenk, Jaime L. Baratta, Eugene R. Viscusi

https://ift.tt/2zAcCcq

Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Lisa Kumar, Amanda H. Kumar, Stuart A. Grant, Jeff Gadsden

https://ift.tt/2u9QDUm

Cervical-Cranial Dry Needling vs. Orthopedic Manual Therapy for Cervicogenic Headache

Condition: Cervicogenic Headache
Interventions: Other: Cervical-cranial dry needling; Other: Orthopedic manual therapy; Other: Thoracic Manipulation; Other: Exercise; Other: Patient Education
Sponsors: Youngstown State University; Franklin Pierce University
Not yet recruiting

https://ift.tt/2LbaKrE

Efficacy of Physiotherapy in Patients With Bruxism.

Condition: Temporomandibular Dysfunction (TMD)
Interventions: Other: Manual therapy; Other: Regular treatment control.
Sponsor: University of Valencia
Recruiting

https://ift.tt/2NKz6do

Increased risk of incident psoriasis in end‐stage renal disease patients on chronic hemodialysis: A nationwide population‐based cohort study

The Journal of Dermatology, EarlyView.

https://ift.tt/2L8TUJW

Fulminant onset of insulin-dependent diabetes with positive anti-GAD antibody titers during treatment with nivolumab in a patient with NSCLC

Abstract

Programmed cell death-1 (PD-1) and programmed cell death-ligand-1 (PD-L1) inhibitors have been highlighted in the field of cancer treatment. The interaction between PD-1 and PD-L1 is thought to play an important role in the regulation of the self-immune tolerance mechanism, so blocking these molecules may cause serious immune-related adverse events (IrAE), including fulminant insulin-dependent (type 1) diabetes. Here, we describe a patient with fulminant type 1 diabetes induced by nivolumab, an anti-PD-1 antibody. The patient, a 78-year-old man, was being treated with nivolumab as a third-line treatment for squamous cell carcinoma of the lung. After three cycles, he experienced an abrupt flare-up of the blood glucose within half a day. His blood glucose further increased without clinical symptoms until his hospital visit. Laboratory data showed the complete exhaustion of intrinsic insulin and the elevation of serum antibody titer to glutamic acid decarboxylase (GAD). Although the patient was previously diagnosed with non-insulin-dependent (type 2) diabetes, his disease activity had been well controlled with oral medication and low-dose insulin therapy until just before the flare-up. Because of the laboratory findings and the extremely rapid onset of hyperglycemia, a diagnosis of fulminant, rather than the rapid onset, type 1 diabetes related to nivolumab therapy was strongly suspected. Our case study indicates that fulminant hyperglycemia can occur extremely rapidly. The blood glucose of patients receiving PD-1 antibody therapy should be closely monitored.

https://ift.tt/2N77L4a

ACPA mediates the interplay between innate and adaptive immunity in rheumatoid arthritis

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Xiwen Dong, Zhaohui Zheng, Yue Zhai, Yan Zheng, Jin Ding, Jianli Jiang, Ping Zhu

Abstract

The production of anti-citrullinated peptide antibodies (ACPAs) requires the participation of both innate immunity and adaptive immunity. On the one hand, activated innate immunity is able to produce citrullinated auto-antigens that fuel autoimmunity and provide an inflammatory environment that facilitates the breach of self-tolerance, proliferation of self-reactive T/B cells and the production of ACPAs. On the other hand, after their production by plasma B cells, ACPAs are also able to interact with innate immunity to exacerbate the manifestation and chronicity of rheumatoid arthritis (RA). This article discusses the roles of citrullinated peptides and ACPA played in innate immunity and autoimmunity. In addition, we emphasise the relationships between environmental factors and innate immunity, as well as the pathogenic function of ACPAs per se. In doing so, we hope to provide fundamental knowledge of RA pathogenesis and reveal potential therapeutic targets in RA treatment.

https://ift.tt/2mbadeE

Support of precision medicine through risk-stratification in autoimmune liver diseases – histology, scoring systems, and non-invasive markers

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Lars Bossen, Alessio Gerussi, Vasiliki Lygoura, George F. Mells, Marco Carbone, Pietro Invernizzi

Abstract

Autoimmune liver diseases (AILDs) are complex conditions, which arise from the interaction between a genetic susceptibility and unknown environmental triggers. They represent a relevant cause of liver failure and liver transplantation worldwide. As a testimony of our progress in understanding the biology of AILDs and the disease progression is the overall median survival which has increased over the last decade. However, there are still major challenges such as the lack of therapies and surveillance strategies in primary sclerosing cholangitis (PSC), the management and treatment of non-responders to first-line therapies in primary biliary cholangitis (PBC) and the need for tailoring immunosuppressive drugs in autoimmune hepatitis (AIH). The different disease course and treatment response in patients with AILDs might be related to a heterogeneous genetic background between individuals which translates in a heterogeneous clinical phenotype. Thus, it becomes essential to personalise management and treatment based on specific risk profiles, e.g. low-risk and high-risk, based on genetic and molecular signatures.

It is now possible, thanks to the development of large-scale AILDs patient cohorts, that such diseases can be analysed using various high-throughput methods like gene expression profiling, next generation sequencing and other omics technologies to identify unique fingerprints based on which a personalised or tailor-made management and therapy can be developed. The final aim being to facilitate treatment decision-making that balances patient-specific risks and preferences. This is critical especially now with the current and forthcoming availability of more efficacious medications. To reach this point we need specific interventions such as creating bigger biobanks, sequencing more genomes and linking biological information to health-related data.

We have already identified subsets of patients with different risk profiles among patients with PBC, PSC and AIH by using clinical tools such as liver histology, laboratory investigation and non-invasive methods. In this manuscript, we review the clinical features and investigations that already enable us to individualize the care of PBC patients and that might support the development of precision medicine (PM) in AILDs.

https://ift.tt/2zzZZOa

‘Cervical spine fractures associated with maxillofacial trauma: a 3-year-long study in the greek population’

Publication date: Available online 11 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): C. Mourouzis, O. Schoinohoriti, C. Krasadakis, G. Rallis

https://ift.tt/2uhqGCz

Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital floor fractures

Publication date: Available online 11 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Gesche Frohwitter, Stephan Wimmer, Carolin Goetz, Jochen Weitz, Michael Ulbig, Karsten U. Kortuem, Julia Dangelmaier, Lucas Ritschl, Christian Doll, Oliver Ristow, Marco R. Kesting, Steffen Koerdt

Summary

Introduction

Treatment decisions for fractures of the orbital floor are based on clinical appearance, ophthalmological examination, and computed tomography (CT) scans. In extensive fractures, decisions are easily made between conservative and surgical treatment. However, objective parameters are rare in inconclusive cases.

Materials and Methods

Our retrospective study included 106 patients with unilateral isolated orbital floor fractures. Correlations between preoperative ophthalmological examinations and specific CT parameters were performed.

Results

The defect size of the fracture appeared to be significantly associated with the presence of diplopia. CT-morphological parameters and preoperative ophthalmological results showed statistical significance for diplopia and incarceration of inferior rectus muscle (IRM), diplopia and displacement of IRM, decreased mobility and incarceration of IRM, and decreased mobility and displacement of IRM.

Discussion

Our clinical assessment scheme for CT scans of orbital floor fractures is aimed at facilitating treatment decision making using four CT-based variables. As critical size defects of the orbital floor of ≥ 2 cm² are likely to cause clinically significant posterior displacement of the globe, resulting in enophthalmos, the proposed parameters offer a readily accessible and easy to evaluate scheme that helps to identify patients in need of surgical intervention.

https://ift.tt/2zvyqWs

Endotypes of Chronic Rhinosinusitis Across Ancestry and Geographic Regions

Abstract

Purpose of Review

Preliminary studies have suggested differences in endotypes of chronic rhinosinusitis (CRS) across ancestry/ethnic groups. Eosinophilic CRS (ECRS) is the predominant subtype for Western/European ancestry CRS patients and non-eosinophilic CRS (nECRS) for Asian patients. This review aims to re-analyze CRS endotypes across ancestry populations using one consistent criteria to existing data.

Recent Findings

Although tissue eosinophilia is the most commonly used criterion for ECRS, various cut-off points are suggested. Surrogate markers have been extensively studied. Sixty-six cohorts with study criteria were included with a total of 8557 patients. Raw data from 11 studies 544 patients were re-analyzed using number of tissue eosinophils. At lower cut-off values of ≥ 5 and ≥ 10 cells/HPF, most patients of Asian and Western/European ancestry were classified as ECRS without difference. In contrast, at cut-off points of ≥ 70 and ≥ 120 cells/HPF, the majority of both groups became reclassified as nECRS.

Summary

After applying one consistent criteria to existing data, differences across ancestry and geographic populations in endotypes of CRS were no longer evident.

https://ift.tt/2ujYA8M

Is Allergen Immunotherapy in Children Disease Modifying? A Review of the Evidence

Abstract

Purpose of Review

Although evidence supports a beneficial effect of allergen immunotherapy on the symptoms of allergic respiratory disease and food allergy, it is not clear whether immunotherapy modifies the natural history of these conditions.

Recent Findings

In aeroallergen immunotherapy, studies suggest that prevention of asthma can be attained. Less evident is the ability of immunotherapy to prevent new allergen sensitizations and more studies are needed to test whether immunotherapy can continue suppressing airway symptoms after treatment discontinuation. In food allergen immunotherapy, there is evidence that unresponsiveness to a food challenge can be sustained in some treatment recipients, but little knowledge exists as to the dose and duration of treatment that can optimize this effect.

Summary

Suggestive evidence exists that allergen immunotherapy can modify allergic disease in children, but definitive studies are lacking. More research in the field is required.

https://ift.tt/2N78Gl8

Thyroid-Like Low-Grade Nasopharyngeal Papillary Adenocarcinoma

Abstract

Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is a rare entity. Patients often present with complaints of nasal fullness, obstruction, and epistaxis. It may be confused with metastatic papillary thyroid carcinoma due to its histologic similarity and overlapping immunohistochemical studies, but it is important to distinguish between the two because of differing treatment modalities and prognosis. A significant difference between the two is that despite both entities demonstrating TTF-1 positivity, TL-LGNPPA usually does not stain for thyroglobulin. TL-LGNPPA exhibits indolent growth, with no incidence of metastasis or recurrence after surgical excision.

https://ift.tt/2N3cJyO

Monitoring chemotherapy‐induced alopecia with trichoscopy

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2zsGhnC

The evaluation of psychiatric comorbidity, self‐injurious behavior, suicide probability, and other associated psychiatric factors (lonileness, self‐esteem, life satisfaction) in adolescents with acne: A clinical pilot study

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2uaGMhf

Is Allergen Immunotherapy in Children Disease Modifying? A Review of the Evidence

Abstract

Purpose of Review

Recent Findings

Summary

Suggestive evidence exists that allergen immunotherapy can modify allergic disease in children, but definitive studies are lacking. More research in the field is required.

https://ift.tt/2N78Gl8

A rare case of percutaneous endoscopic gastrostomy causing a small bowel obstruction and subsequent bowel erosion

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Abstract

Gastrostomy tubes can be used to provide long-term nutrition and feeding when oral intake is not adequate. A rare but serious complication includes iatrogenic small bowel injury. The incidence of this is infrequent due to its position of the small bowel beneath the omentum, however, injury leading to obstruction and volvulus has been previously described in the literature. We present an unusual case of gastrostomy tube transection into omental fat causing a kink in the small bowel allowing for a transition point of obstruction and subsequent erosion of the gastrostomy tube into the small bowel.

https://ift.tt/2mb4sO6

Successful use of adipose-derived mesenchymal stem cells to correct a male breast affected by Poland Syndrome: a case report

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Abstract

Poland syndrome is a rare congenital anomaly in which affected persons are born with missing or underdeveloped muscles on one side of the body. In this case study we present the case of a 28-year-old male with absence of all middle phalanges of the right hand and other rare anomalies, who underwent reconstruction with a new method that combines a mixture of adipose-derived mesenchymal stem cells and fat transfer. The patient's restoration of the pectoralis area was aesthetically successful with no complications and remained unchanged even after 3.5 years. The proposed method represents an interesting reconstructive approach for treating Poland's syndrome deformities.

https://ift.tt/2zvpvUY

Repair of gastrocutaneous fistula utilizing thickened fluids: application of Poiseuille’s Law to fistula healing

Abstract

Enterocutaneous fistulas are a rare occurrence after placement of a PEG tube. The key risk factor for their development is the time the PEG tube is in situ, giving time for the fistula tract to mature. Enterocutaneous fistulae are traditionally treated with parenteral nutrition or surgical management. We present a case of a 69-year-old woman who underwent surgical closure of an enterocutaneous fistula with a fibrin plug. The fistula recurred on post-operative Day 5, and the patient was placed on thickened fluids to increase the viscosity of the fluid exiting the fistula tract. This approach decreased the output and lead to subsequent closure of the fistula by outpatient follow up at 4 weeks. This case demonstrates an application of Poiseuille's law to closure of fistula tracts.

https://ift.tt/2m7GaEo

Endotypes of Chronic Rhinosinusitis Across Ancestry and Geographic Regions

Abstract

Purpose of Review

Recent Findings

Summary

After applying one consistent criteria to existing data, differences across ancestry and geographic populations in endotypes of CRS were no longer evident.

https://ift.tt/2ujYA8M

Kardiale Mortalität bei Radio- und/oder Chemotherapie der Brust

https://ift.tt/2N6JDPe

Spätfolgen nach onkologischer Chirurgie

Zusammenfassung

Hintergrund

Die onkologische Chirurgie erfordert oft ausgedehnte und radikale Eingriffe, die mit einem breiten Spektrum möglicher operationsbedingter Spätfolgen einhergehen.

Ziel der Arbeit

Dieser Übersichtsartikel soll wesentliche Spätfolgen onkologischer Chirurgie zusammenfassen und Präventions- und Therapieansätze aufzeigen. Beispielhaft werden Spätfolgen viszeralonkologischer Operationen am oberen und unteren Gastrointestinaltrakt sowie am Pankreas diskutiert.

Methoden

Es erfolgte eine selektive Literaturrecherche und Zusammenfassung der aktuellen Evidenz.

Ergebnisse

Das Erreichen des bestmöglichen onkologischen Ergebnisses geht häufig mit einer erhöhten postoperativen Morbidität sowie bleibenden Funktionseinschränkungen und permanenten Einbußen der Lebensqualität einher. Spätfolgen sind oft spezifisch für den jeweiligen Eingriff, wobei chronische Schmerzsyndrome und eine eingeschränkte gesundheitsbezogene Lebensqualität mit hoher Prävalenz organ- und eingriffsübergreifend auftreten. Häufige Spätfolgen nach onkologischer Chirurgie des oberen Gastrointestinaltrakts sind persistierende Beschwerden bei der Nahrungsaufnahme, postprandiale Störungen sowie respiratorische Einschränkungen. Nach Eingriffen am Pankreas steht aufgrund des Parenchymverlusts die endokrine- und exokrine Pankreasinsuffizienz im Vordergrund. Im Bereich des unteren Gastrointestinaltrakts sind persistierende Stuhlveränderungen, Defäkationsprobleme, Anastomosen- und Stomakomplikationen sowie Störungen der Blasen- und Sexualfunktion von Relevanz.

Schlussfolgerung

Herausforderung der onkologischen Chirurgie ist es, die Balance zwischen erforderlicher Radikalität und postoperativer Morbidität zu finden.

https://ift.tt/2KKnRUy

Thyroid-Like Low-Grade Nasopharyngeal Papillary Adenocarcinoma

Abstract

https://ift.tt/2N3cJyO

Thyroid-Like Low-Grade Nasopharyngeal Papillary Adenocarcinoma

Abstract

https://ift.tt/2N3cJyO

Outcomes of Pancreas Transplant Recipients with de novo Donor Specific Antibodies

Background Development of denovo donor-specific antibodies (dnDSA) has detrimental effects on graft survival in several types of solid organ transplants. But limited information exists about the effect of dnDSA on pancreas transplant graft survival. Methods We report our experience with pancreas recipients transplanted between 01/01/2005 and 08/31/2017. Results We identified 541 pancreas transplant recipients, of which 121 developed dnDSA and 420 did not. 32% developed dnDSA against HLA class I antigens, 56% developed against class II antigens and 12% developed against both. 52% of the patients in the dnDSA+ and 24% in the dnDSA- group underwent pancreas biopsy, mainly due to a rise in pancreatic enzymes. Rejection was found in 42% of the dnDSA+ group, and 20% of the dnDSA- group(p

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Deciphering the Contribution of γδ T Cells to Outcomes in Transplantation

γδ T cells are a subpopulation of lymphocytes expressing heterodimeric T-cell receptors composed of γ and δ chains. They are morphologically and functionally heterogeneous, innate yet also adaptive in behaviour, and exhibit diverse activities spanning immunosurveillance, immunomodulation, and direct cytotoxicity. The specific responses of γδ T cells to allografts are yet to be fully elucidated with evidence of both detrimental and tolerogenic roles in different settings. Here we present an overview of γδ T cell literature, consider ways in which their functional heterogeneity contributes to the outcomes after transplantation, and reflect upon methods to harness their beneficial properties. Correspondence Details: Joanna Hester. Email Address: joanna.hester@nds.ox.ac.uk. Postal Address: Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Level 6, John Radcliffe Hospital, Headington, Oxford, OX3 9DU. Authorship Statement Oliver McCallion: Performed literature review, designed figures and compiled the manuscript. Joanna Hester: Compiled and reviewed the figures and manuscript. Fadi Issa: Compiled and reviewed the figures and manuscript. Disclosure of Interests The authors declare no conflicts of interest. Funding J.H is Kidney Research UK Senior Research Fellow, F.I is an NIHR Academic Clinical Lecturer. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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γδ T Cells in Transplantation: Friend and foe

No abstract available

https://ift.tt/2u9p6T0

Impact of Donor Core Body Temperature on Graft Survival After Heart Transplantation

Background A previous donor intervention trial found that induction of mild therapeutic hypothermia in the brain-dead donor reduced the dialysis requirement after kidney transplantation. Consequences on the performance of cardiac allografts after transplantation were not explored to date. Methods Cohort study investigating 3-year heart allograft survival according to spontaneous core body temperature (CBT) assessed on the day of organ procurement. The study is nested in the database of the randomized trial of donor pretreatment with low-dose dopamine (ClinicalTrials.gov identifier: NCT000115115). Results 99 heart transplant recipients who had received a cardiac allograft from a multiorgan donor enrolled in the dopamine trial were grouped by tertiles of the donor's CBT assessed by a mere temperature reading 4-20 hours before procurement (lowest, 32.0-36.2°C; middle, 36.3-36.8°C; highest, 36.9-38.8°C). Baseline characteristics considering demographics of donors and recipients, concomitant donor treatments, donor hemodynamic and respiratory parameters as well as underlying cardiac diseases in recipients, pretransplant hemodynamic assessments, including pretransplant inotropic / mechanical support, urgency, and waiting-time were similar. A lower CBT was associated with inferior heart allograft survival, hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.31-0.93, per tertile; p=0.02, and HR 0.68, 95% CI 0.50-0.93, per degree Celsius; p=0.02, when CBT was included as continuous explanatory variable in the Cox regression analysis. Conclusions A lower CBT in the brain-dead donor before procurement may associate with an unfavorable clinical course after heart transplantation. More research is required, before therapeutic hypothermia can routinely be used in multiorgan donors when a cardiac transplantation is intended. Address correspondence to: Dr. Peter Schnuelle, Center for Renal Diseases Weinheim, c/o University Medical Center Mannheim, Roentgenstrasse 1, D 69469 Weinheim, Germany, Tel.: 0049 6201 947931, Fax: 0049 6201 947920, e-mail: p.schnuelle@nierenzentrum-weinheim.de Authorship P.S. and U.B. contributed equally. P.S. drafted the manuscript. P.S., U.B., B.K.K., B.A.Y. participated in the study concept and design, statistical analysis and interpretation of data. A.Z., F.W., G.S., M.B., M.K., J.G. participated in the performance of research, acquisition of data, and critical revision of the manuscript for important intellectual content. All authors approved the final version of the manuscript. Disclosure The authors declare no conflicts of interest. Funding The randomized dopamine study was an investigator-driven clinical trial conducted by the University Medical Center Mannheim, Germany. It was partially supported by a medical school grant from Novartis Pharmaceuticals released in November 2002, before the study started recruiting eligible donors. Trial registry ClinicalTrials.gov identifier: NCT000115115 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2upsMPI

Recurrent or De Novo Allograft Steatosis and Long-Term Outcomes After Liver Transplantation

Background Hepatic steatosis is strongly associated with cardiovascular disease in the general population. Whether recurrent or de novo, it can occur in the allograft but the impact on survival and long term clinical outcomes remains unclear. In this study, we aim to determine both the frequency and impact of allograft steatosis on long term posttransplant outcomes. Methods A retrospective review of 588 adult liver transplant (LT) recipients (1999-2006) was performed. Cox regression analysis (time dependent) was used to evaluate differences in time to steatosis post-LT, patient survival and cardiovascular outcomes. Results Mean age 51.9±10.6 years, 64.6% males, underlying NASH (9.4%), previous tobacco (52%), pre-LT diabetes mellitus (30.3%), pre-LT hypertension (23.2%), and known cardiovascular disease (9.7%). Overall, 254 recipients developed allograft steatosis (at 10 years: 77.6% NASH recipients, 44.7% Non-NASH recipients). Risk factors for allograft steatosis were female gender (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.09-2.00, p=0.014), HCV diagnosis (HR 2.49, 95% CI 1.77-3.94, p

https://ift.tt/2uchBe1

Cold-storage injury to rat small-bowel transplants – beneficial effect of a modified HTK solution

Background The small bowel is prone to ischaemic injury during transport prior to transplantation, an injury that endangers the recipient patient. The small-bowel mucosal microcirculation in particular appears to be highly sensitive to injury. Current preservation solutions such as histidine-tryptophan-ketoglutarate (HTK) solution provide some protection to the graft. However, these were developed decades ago and do not address several critical processes, such as hypoxia-induced membrane pores and free radical-mediated hypothermic injury. Methods To protect the graft from cold ischaemic injury, we implemented a modified HTK solution here including glycine, alanine, and iron chelators in a heterotopic, syngeneic small-bowel transplantation model of the rat. The effects of the modified solution and its major components were compared against the conventional HTK solution using intravital microscopy in the early reperfusion period. Results The amino acid glycine, added to HTK solution, slightly improved mucosal perfusion. Both, the modified base solution (without iron chelators) and iron chelators increased functional capillary density of the mucosa during the early reperfusion period. The complete modified solution (with glycine, alanine, and iron chelators) significantly increased the perfusion index, functional capillary density of the mucosa and red blood cell velocity in the grafts following reperfusion in comparison with the grafts preserved with HTK. Conclusions The modified preservation solution improved the microcirculation of the transplants and needs detailed evaluation in further models of small-bowel transplantation. Received 15 December 2017. Revision received 31 May 2018. Accepted 3 June 2018. *deceased Address for correspondence: Dr Gesine Pless-Petig, Institut für Physiologische Chemie, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen. gesine.pless@uni-duisburg-essen.de Authorship statement I. Lautenschläger participated in research design, writing the paper, research work and data analysis G. Pless-Petig participated in writing the paper and data analysis P. Middel participated in research work and data analysis H. de Groot participated in research design U. Rauen participated in research design, writing the paper and data analysis T. Stojanovic participated in research design, writing the paper, research work and data analysis Disclosure U. Rauen obtained consulting fees from Dr Franz Köhler Chemie GmbH, Bensheim, Germany. Dr F. Köhler Chemie holds a patent on a preservation solution covering the modified solution used in this study, and U. Rauen is one of the inventors of the solution. Funding The work was partially funded by Dr F. Köhler Chemie GmbH. However, the study design and data interpretation were nDrever influenced by the company at any point in time, which was also stipulated and agreed upon in the funding contract. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Gender differences in medication adherence among adolescent and young adult kidney transplant recipients

Background Among kidney transplant recipients, gender differences in medication adherence may contribute to the higher graft failure risks observed in girls and young women compared with boys and young men. Our aim was to determine whether adherence differs by gender, and whether gender differences vary by age in adolescent and young adult kidney transplant recipients. Methods We examined data from the 3-month run-in period (no intervention) of the randomized TAKE-IT trial. Adherence was monitored using electronic pillboxes in 136 patients (11-24 y) followed in 8 transplant centers in Canada and USA. We used ordinal logistic regression with generalized estimating equations to estimate the association between gender and each of daily taking (proportion of prescribed doses taken) and timing (proportion of prescribed doses taken on time) adherence, considering effect modification by age (11-16 vs. 17-24 years). Results No difference in taking adherence was observed by gender among participants 11-16 years (OR=0.92 (95%CI 0.55-1.54)), whereas among participants 17-24 years, women had significantly greater odds of higher taking adherence scores (OR=3.03 (95%CI 1.20-7.66)) than men. Results were similar for timing adherence, with no difference among participants 11-16 years (OR=1.03 (95%CI 0.65-1.63)) but a greater odds of higher timing adherence scores in women than in men among participants 17-24 years (OR=3.26 (95%CI 1.43-7.45)). There were no differences in adherence assessed by self-report or SD of tacrolimus trough levels. Conclusions Gender differences in adherence vary by age. Whereas younger adolescents show no adherence differences by gender, young women show much better adherence than young men. Correspondence to: Bethany J Foster, E-mail: bethany.foster@mcgill.ca. 1001 Decarie Blvd, Montreal, QC. H4A 3J1 TAKE-IT registration number: Clinicaltrials.gov registration: NCT01356277 (May 17, 2011) Authorship All authors participated in research design, in the writing of the paper and in data analysis. Disclosure The authors of this manuscript have no relevant conflicts of interest to disclose, except Dr. Foster, who is a co-investigator on 2 investigator-initiated studies funded by Astellas Canada. Funding The study was funded by the American National Institutes of Health, National Institutes of Diabetes, Digestive and Kidney diseases (NIDDK; R01DK092977). The funder had no role in study design, data collection, analysis, interpretation of data, writing the report, or and the decision to submit the report for publication. Dr. Boucquemont, who was a postdoctoral fellow at the Research Institute of the McGill University Health Centre when this study was done, was supported by an RI MUHC – Desjardins Studentship in Child Health Research. Dr. Foster, a member of the Research Institute of the McGill University Health Centre, was supported by a Fonds de recherche du Quebec Santé Chercheur-boursier clinicien award. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Αρχειοθήκη ιστολογίου

Τετάρτη 11 Ιουλίου 2018

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