Pitfalls in anaphylaxis

Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events. Correspondence to Massimo Triggiani, MD, PhD, Division of Allergy and Clinical Immunology University of Salerno, Via S. Allende Baronissi, Fisciano, Salerno, Italy. Tel: +39 089 965056; fax: +39 089 965056; e-mail: mtriggiani@unisa.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2uR91ko

Intrathoracic scapular dislocation following lung cancer resection

Abstract

A 64-year-old man underwent right upper lobectomy combined resection with third-fifth rib for lung cancer and reconstruction of chest wall using Dual Mesh. Six days after surgery, he experienced acute severe pain in the right shoulder. The purulent drainage through the drainage tube was also found. Chest CT showed that the inferior angle of the scapula protruded into the right intrathoracic cavity. We performed a removal of Mesh. Although we did not want to use synthetic materials because of infection, we performed titanium plate fifth rib fixation to avoid the recurrent dislocation of the scapula. After the redo surgery, continuous lavages with physiologic saline of the thoracic cavity was also performed. Patient is now doing well without recurrences of cancer, infection and scapular dislocation, 14 months after the redo surgery.

https://ift.tt/2uSoIIa

Concomittant fibrous dysplasia with aneurysmal bone cyst formation within the skull, humerus and rib

Abstract

Polyostotic fibrous dysplasia (FD) is a rare pathology characterized by the abnormal and gradual replacement of normal bone (calcium hydroxylapatite of osteoid matrix) with fibrous connective tissue. Aneurysmal bone cyst (ABC) is a tumor-like benign lesion with blood-filled cavities that can affect virtually any bone in the body. We report on a 20-year-old male presenting with an extremely rare pathology of FD with ABC formation of the skull, fourth rib and humerus. Our case report represents a novel literary addition to rare FD with ABC pathologies. Optimal diagnosis of this rare pathology can be achieved by a full body evaluation for clinical and radiographic FD with or without ABC, and optimal treatment for this rare pathology is the maximum surgical excision of the tumor and/or soft tissue.

https://ift.tt/2LmMFld

Case report: irreducible medial subtalar dislocation with incarcerated anterior talar head fracture in a young patient

Abstract

Subtalar dislocations are rare injuries that typically occur from high-energy injuries. All subtalar dislocations should be attempted to be closed reduced, however, ~32% are irreducible requiring open reduction. We present an irreducible medial subtalar dislocation following a motor vehicle accident with no associated fractures demonstrated on radiograph. However, open reduction revealed an incarcerated anterior talar head fracture that was reduced and stabilized with retrograde K-wires.

https://ift.tt/2JG9Wtt

Food protein-induced eosinophilic enteritis with intestinal stricture in a neonate: a case report and review of the literature

Abstract

The case of a 21-day-old boy with eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy is reported herein. For the first 4 days of life, he was both breast-fed and formula-fed, after which he was exclusively breast-fed. At the age of 24 days, he underwent laparotomy to investigate the possibility of intestinal obstruction for bilious vomiting, and an ileal stricture was detected and resected. Pathologic analysis showed the presence of eosinophil accumulation in the lesions presented more than 20 eosinophils per high-power field and the eosinophils were oriented towards the epithelium and diffusely distributed throughout the tissue, but the margins of resection showed a few infiltration of eosinophiles. Allergen-specific lymphocyte stimulation testing showed a markedly increased lymphocyte response to lactoferrin. He was finally diagnosed as eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy. The patient remained asymptomatic during a follow-up period of 12 months.

https://ift.tt/2LxrPQh

Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report

Abstract

We report a case of total arch replacement in a patient who suffered repeated cerebral infarctions due to unstable plaque simultaneously in the innominate and left subclavian arteries.

https://ift.tt/2JI35Q9

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency program...

https://ift.tt/2Lt657K

Absence of host NF-κB p50 induces murine glioblastoma tumor regression, increases survival, and decreases T-cell induction of tumor-associated macrophage M2 polarization

Abstract

High-grade gliomas harbor abundant myeloid cells that suppress anti-tumor immunity and support tumor growth. Targeting transcription factors, such as NF-κB p50, that mediate suppressive myeloid M2 polarization may prove therapeutic. GL261-Luc glioblastoma cells were inoculated into wild-type and p50^−/− mice, followed by analysis of tumor growth, survival, tumor myeloid cells, and T cells. The absence of host p50 slows tumor growth and enables regression in 30% of recipients, leading to prolonged survival. Tumors developing in p50^−/− mice possess a greater concentration of tumor-infiltrating myeloid cells (TIMs) than those in wild-type mice. TIMs are predominantly F4/80^hi macrophages which, along with tumor-associated microglia, express increased pro-inflammatory M1 and reduced immune-suppressive M2 markers. In p50^−/− mice, total tumor CD4 T cells are threefold more abundant, whereas CD8 T-cell numbers are unchanged, and both produce increased IFNγ and Granzyme B. Naïve splenic p50^−/− CD8 T cells manifest increased activation, whereas naïve p50^−/− and WT CD4 T cells show similar Th1, Th2, and Th17 polarization. Antibody targeting CD4, but not CD8, fully obviates the p50^−/− survival advantage. Combined CD4 and CD8 T-cell depletion reverses myeloid M2 polarization in wild-type hosts, without affecting myeloid M1 polarization in p50^−/− hosts. Finally, gliomas grow similarly in p50(f/f) and p50(f/f);Lysozyme-Cre mice, the latter having reduced p50 specifically in myeloid cells and tumor microglia. Thus, high-grade glioma T cells play a key role in directing M2 polarization of tumor myeloid cells, and reducing NF-κB p50 in both tumor myeloid cells and T cells may contribute to glioma therapy.

https://ift.tt/2O7Vmyb

Recurring acute urticaria and abdominal pain: Consider a diagnosis of alpha-galactose anaphylaxis

Publication date: Available online 20 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Deschamps Huvier, F. Tetart, O. Bauvin, J. Martinet, P. Joly

Summary

Background

Food urticaria is common and generally benign, and it may be of viral or idiopathic aetiology. A food origin of the allergy is frequently sought but rarely found. Mammalian meat anaphylaxis, or alpha-galactose (α-gal) anaphylaxis, is a rare and recently discovered entity.

Patients and methods

Herein, we report a case of alpha-galactose (α-gal) anaphylaxis in a 60-year-old woman presenting four episodes of acute urticaria with signs of anaphylaxis occurring a few hours after meals containing mammalian meat (beef meat, pork meat and offal). The diagnosis was confirmed by a positive gelatine prick-test and the presence of α-gal IgE.

Discussion

In the event of acute urticaria associated with systemic symptoms, in particular gastrointestinal signs, allergy to α-galactose should be considered.

Résumé

Introduction

L'urticaire aiguë est fréquente et le plus souvent bénigne, d'étiologie virale ou idiopathique. Une origine allergique alimentaire est souvent cherchée et rarement trouvée. L'allergie aux viandes de mammifères, ou allergie à l'alpha-galactose (α-gal), est une entité rare de découverte récente.

Observation

Nous rapportons une observation d'allergie à l'α-galactose chez une femme de 60 ans ayant présenté quatre épisodes d'urticaire aiguë avec signes d'anaphylaxie apparus à distance des repas, après l'ingestion de viande de mammifères (viande de bœuf, viande et abats de porc). Le diagnostic a été confirmé par la positivité du prick-test à la gélatine et la présence d'IgE α-gal.

Discussion

Devant une urticaire aiguë associée à des symptômes systémiques, notamment signes digestifs, il faut savoir évoquer une allergie à l'α-galactose.

https://ift.tt/2NtVPtx

Th17 activation by dendritic cells stimulated with gamma-irradiated Streptococcus pneumoniae

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hyun Young Kim, Sun Kyung Kim, Ho Seong Seo, Soyoung Jeong, Ki Bum Ahn, Cheol-Heui Yun, Seung Hyun Han

Abstract

Dendritic cells (DCs) play an important role in antigen presentation, which is an essential step for the induction of antigen-specific adaptive immunity. Inactivated bacterial whole cell vaccines have been widely used to prevent many bacterial infections because they elicit good immunogenicity due to the presence of various antigens and are relatively inexpensive and easy to manufacture. Recently, gamma-irradiated whole cells of nonencapsulated Streptococcus pneumoniae were developed as a broad-spectrum and serotype-independent multivalent vaccine. In the present study, we generated gamma-irradiated S. pneumoniae (r-SP) and investigated its capacity to stimulate mouse bone marrow-derived DCs (BM-DCs) in comparison with heat-inactivated and formalin-inactivated S. pneumoniae (h-SP and f-SP, respectively). r-SP showed an attenuated binding and internalization level to BM-DCs when compared to h-SP or f-SP. r-SP weakly induced the expression of CD80, CD83, CD86, MHC class I, and PD-L2 compared with h-SP or f-SP. Furthermore, r-SP less potently induced IL-6, TNF-α, and IL-23 expression than h-SP or f-SP but more potently induced IL-1β expression than h-SP or f-SP in BM-DCs. Since Th17-mediated immune responses are known to be important for the protection against pneumococcal infections, r-SP-primed DCs were co-cultured with splenocytes or splenic CD4⁺ T cells. Interestingly, r-SP-sensitized BM-DCs markedly induced IL-17A⁺ CD4⁺ T cells whereas h-SP- or f-SP-sensitized BM-DCs weakly induced them. Collectively, these results suggest that r-SP could be an effective pneumococcal vaccine candidate eliciting Th17-mediated immune responses by stimulation of DCs.

https://ift.tt/2JGrWUp

Harare children’s hospital airway symposium and pentafrica conference 2018

Publication date: Available online 20 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Clemence Chidziva, Titus Dzongodza, Cameline Nyamarebvu, Shazia Peer, Christopher Prescott, Naboth Matinhira, Peter J. Koltai

https://ift.tt/2NuuOGe

Botulinum toxin A treatment of epiphora secondary to autologous submandibular gland transplantation

Publication date: Available online 20 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): X.F. Shan, L. Lv, Z.-G. Cai, G.-Y. Yu

Abstract

The aim of this study was to explore whether botulinum toxin A (BTXA) injection treats epiphora secondary to submandibular gland (SMG) transplantation for severe keratoconjunctivitis sicca.

Fifteen patients with epiphora after SMG transplantation were separated to three groups, and received 15 U, 20 U and 25 U BTXA injection in the transplanted SMG, respectively. Secretion of transplanted SMG was assessed subjectively by visual analogue scale (VAS) regarding epiphora, and objectively by Schirmer test.

There were no significant differences in the 15-U BTXA group regarding the values of the VAS on epihora before and 1 month after BTXA injection. While in 20-U group and 25-U group, the values of VAS on epihora decreased significantly after BTXA injection, and lasted for 6 months. Under resting conditions, the secretion of transplanted SMG decreased 64.4%, 73.0% and 78.0% in 15-U, 20-U and 25-U groups, respectively (P < 0.01), in 1 month after BTXA injection; significant secretion decreasing lasted 3 months only in the 25-U BTXA group.

BTXA injection can decrease the secretion of transplanted SMG significantly, relieving the symptoms of epiphora; 25 U BTXA is a suitable dose to treat 'opportunistic epiphora' after SMG transplantation.

https://ift.tt/2uE4x1j

Urinary polycyclic aromatic hydrocarbons and allergic sensitization in a nationwide study of children and adults in the U.S.

Publication date: Available online 20 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Franziska Rosser, Yueh-Ying Han, Erick Forno, Juan C. Celedón

https://ift.tt/2Lo1uDT

Dental implant imaging: when the good and the bad make the ugly

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Galal Omami

https://ift.tt/2zWdOqr

Letter to the editor on “Magnetic resonance imaging (MRI) - a diagnostic tool for postoperative evaluation of dental implants: a case report”

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Laura Wanner, Ute Ludwig, Jan-Bernd Hövener, Katja Nelson, Tabea Flügge

https://ift.tt/2uCW527

New surgical method of tongue reduction for Macroglossia

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Gardon Marc-Antoine, Andre Charles-Victor, Ernenwein Didier, Teissier Natacha, Bennaceur Selim

ABSTRACT

Objective

We hereby describe a new surgical technique, which allows efficient tongue reduction with satisfactory appearance and avoids complications due to tip excision.

Study Design

This is a retrospective case review that includes 6 patients who underwent a tongue reduction for macroglossia using our new central V shape technique. 3 subjects were operated at early age because of significant macroglossia with permanent tongue protrusion, cosmetics disorder and speech delay. For the other 3 subjects, surgery was undertaken at teenage because medical treatment was unsuccessful. We assessed tongue shape, mobility, taste and sensitivity.

Results

The post-operative follow-up period ranged from 2 months to 16 years with an average of 7 years. On subjective evaluation, all patients were satisfied with their tongue' appearance and reported no sensitive nor sensory difficulties. They had normal food progression in the oral cavity. Objectively, their tongue had normal mobility, taste and sensitivity. Postoperatively, in these patients, there was no residual tongue protrusion, cosmetics disorder and nor speech-delay. No patient needed revision surgery.

Conclusion

This central V-shaped excision offers good surgical results with efficient tongue reduction and none of the complications due to other tongue reduction techniques such as tongue's tip amputation nor anterior-wedge resection.

https://ift.tt/2LEE9KY

Case 22-2018: A 64-Year-Old Man with Progressive Leg Weakness, Recurrent Falls, and Anemia

Presentation of Case. Dr. Molly E. Wolf (Medicine): A 64-year-old man was admitted to this hospital because of progressive leg weakness, recurrent falls, and anemia. The patient had been in his usual state of health until 8 months before this admission, when fatigue on exertion and subjective leg…

https://ift.tt/2mwo67a

Case 21-2018: A 61-Year-Old Man with Grandiosity, Impulsivity, and Decreased Sleep

Presentation of Case. Dr. Samuel J. Boas (Psychiatry): A 61-year-old man was brought to the emergency department of this hospital by his family because of concerns about grandiosity, impulsivity, decreased sleep, and increased alcohol use. The patient had a history of alcohol-use disorder; he had…

https://ift.tt/2uuSrXi

CD4 T cell loss and Th2 and Th17 bias are associated with the severity of severe fever with thrombocytopenia syndrome (SFTS)

Publication date: Available online 20 July 2018

Source: Clinical Immunology

Author(s): Meng-Meng Li, Wen-Jing Zhang, Xiu-Fang Weng, Ming-Yue Li, Jia Liu, Yan Xiong, Shu-E Xiong, Cong-Cong Zou, Hua Wang, Meng-ji Lu, Dong-Liang Yang, Cheng Peng, Xin Zheng

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease caused by a novel bunyavirus with high mortality. Immune suppression is thought to be crucial in disease progression. However, data on immune responses during SFTS are scarce. This study aimed to evaluate the changes in CD4 T-cell subsets throughout the entirety of infection and analyse their relationships with disease severity in SFTS patients. In parallel with CD4 T-cell depletion, decreased Th1, Th2 and Treg numbers, but comparable Th17-cell numbers, were observed in deceased patients compared with those in surviving patients. Additionally, increased Th2 and Th17-cell percentages in the residual CD4 T-cell population led to aberrant Th2/Th1 and Th17/Treg ratios, which were positively correlated with disease severity. Collectively, our data indicated that CD4 T-cell deficiency, Th2 and Th17 bias were closely correlated with the severity of SFTS, indicating therapeutic potential of early immune interventions to ameliorate disease severity.

https://ift.tt/2NxiLIb

Socioeconomics of Atopic Dermatitis-Can We Afford New Treatments?

To get a grasp of the socioeconomics of atopic dermatitis (AD), we need to understand its prevalence in the population, its burden, co-morbidities, and costs, both direct and indirect. Only then can we extrapolate whether it makes sense for society to cover new, more costly treatments in the management of this condition. AD affects a large percentage of the pediatric and adult population in the United States. 1 Generally, this chronic inflammatory condition of the skin has no mortality, which has to weigh into assessing the socioeconomics of this disorder.

https://ift.tt/2Nu47Bw

Atopic dermatitis in US adults - epidemiology, association with marital status and atopy

Atopic Dermatitis (AD) prevalence and risk factors in the US-population are not fully elucidated. A study from the 2010 National Health Interview Survey (NHIS) found that 10.2% of US adults reported having "dermatitis, eczema, or any other red, inflamed skin rash"1 in the past 12 months, likely overestimating AD prevalence by including other rashes. Further, 3.2% reported having rash with asthma and/or hay fever1, likely underestimating AD prevalence by excluding intrinsic AD or those with remote history of atopic disease.

https://ift.tt/2O6Jf4y

Differences in egg and milk food challenge outcomes based on tolerance to the baked form

Previous studies suggest inclusion of baked egg and milk in the diet of egg or cow's milk (CM) allergic children may positively impact native tolerance. Differences in native food reactivity based on historical baked tolerance, however, is not fully understood. Objective: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form.

https://ift.tt/2NtATmn

Characterization of the mature form of a β-defensin-like peptide, Hoa-D1, in the lobster Homarus americanus

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Giap H. Vu, Daniel Do, Cindy D. Rivera, Patsy S. Dickinson, Andrew E. Christie, Elizabeth A. Stemmler

Abstract

We report on the characterization of the native form of an American lobster, Homarus americanus, β-defensin-like putative antimicrobial peptide, H. americanus defensin 1 (Hoa-D1), sequenced employing top-down and bottom-up peptidomic strategies using a sensitive, chip-based nanoLC-QTOF-MS/MS instrument. The sequence of Hoa-D1 was determined by mass spectrometry; it was found to contain three disulfide bonds and an amidated C-terminus. The sequence was further validated by searching publicly-accessible H. americanus expressed sequence tag (EST) and transcriptome shotgun assembly (TSA) datasets. Hoa-D1, SYVRScSSNGGDcVYRcYGNIINGAcSGSRVccRSGGGYamide (with c representing a cysteine participating in a disulfide bond), was shown to be related to β-defensin-like peptides previously reported from Panulirus japonicas and Panulirus argus. We found Hoa-D1 in H. americanus hemolymph, hemocytes, the supraoesophageal ganglion (brain), eyestalk ganglia, and pericardial organ extracts, as well as in the plasma of some hemolymph samples. Using discontinuous density gradient separations, we fractionatated hemocytes and localized Hoa-D1 to hemocyte sub-populations. While Hoa-D1 was detected in semigranulocytes and granulocytes using conventional proteomic strategies for analysis, the direct analysis of cell lysates exposed evidence of Hoa-D1 processing, including truncation of the C-terminal tyrosine residue, in the granulocytes, but not semigranulocytes. These measurements demonstrate the insights regarding post-translational modifications and peptide processing that can be revealed through the MS analysis of intact peptides. The identification of Hoa-D1 as a widely-distributed peptide in the lobster suggests the possibility that it may be pleiotropic, with functions in addition to its proposed role as an antimicrobial molecule in the innate immune system.

https://ift.tt/2zXiv3f

Bone-anchored maxillary protraction to correct a class III skeletal relationship: a multicenter retrospective analysis of 218 patients

This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients.

https://ift.tt/2mzfVHm

TGF-β activity in cow milk and fermented milk products: An in vitro bioassay with oral fibroblasts

Publication date: November 2018

Source: Archives of Oral Biology, Volume 95

Author(s): Layla Panahipour, Alexandra Stähli, Nadja Haiden, Reinhard Gruber

Abstract

Objective

Milk is a rich source of transforming growth factor (TGF)-β which supports intestinal mucosal homeostasis of infants. Milk may also have beneficial effects on the integrity of the oral cavity, its being part of the gastrointestinal tract. However, it is unclear if milk and fermented milk products provoke a TGF-β response in oral cells.

Material and Methods

Human gingival fibroblasts were exposed to pasteurized cow milk, yoghurt, sour milk, buttermilk and whey, followed by a reverse transcriptase polymerase chain reaction of the TGF-β target genes interleukin11 (IL11), proteoglycan4 (PRG4), and NADPH oxidase 4 (NOX4). Immunoassays were performed for IL11 and TGF-β in cell culture supernatant and milk products, respectively. Signaling was investigated with the TGF-β receptor type I kinase inhibitor SB431542.

Results

We report here that pasteurized cow milk and the aqueous fractions of yoghurt, sour milk, buttermilk and whey enhanced the expression of IL11, NOX4 and PRG4 in gingival fibroblasts. Moreover, IL11 protein levels in the respective supernatant were significantly increased. Cow milk, yoghurt, sour milk and buttermilk contain approximately 1–2 ng TGF-β1, whereas active TGF-β1 is hardly detectable in whey. SB431542 reduced the response of gingival fibroblasts to pasteurized cow milk and fermented milk products based on IL11 release into the supernatant.

Conclusions

These results demonstrate that gingival fibroblasts respond to pasteurized cow milk and to fermented milk products with an increased expression of TGF-β target genes.

https://ift.tt/2uAXqqk

TGF-β activity in cow milk and fermented milk products: An in vitro bioassay with oral fibroblasts

Publication date: November 2018

Source: Archives of Oral Biology, Volume 95

Author(s): Layla Panahipour, Alexandra Stähli, Nadja Haiden, Reinhard Gruber

Abstract

Objective

Milk is a rich source of transforming growth factor (TGF)-β which supports intestinal mucosal homeostasis of infants. Milk may also have beneficial effects on the integrity of the oral cavity, its being part of the gastrointestinal tract. However, it is unclear if milk and fermented milk products provoke a TGF-β response in oral cells.

Material and Methods

Human gingival fibroblasts were exposed to pasteurized cow milk, yoghurt, sour milk, buttermilk and whey, followed by a reverse transcriptase polymerase chain reaction of the TGF-β target genes interleukin11 (IL11), proteoglycan4 (PRG4), and NADPH oxidase 4 (NOX4). Immunoassays were performed for IL11 and TGF-β in cell culture supernatant and milk products, respectively. Signaling was investigated with the TGF-β receptor type I kinase inhibitor SB431542.

Results

We report here that pasteurized cow milk and the aqueous fractions of yoghurt, sour milk, buttermilk and whey enhanced the expression of IL11, NOX4 and PRG4 in gingival fibroblasts. Moreover, IL11 protein levels in the respective supernatant were significantly increased. Cow milk, yoghurt, sour milk and buttermilk contain approximately 1–2 ng TGF-β1, whereas active TGF-β1 is hardly detectable in whey. SB431542 reduced the response of gingival fibroblasts to pasteurized cow milk and fermented milk products based on IL11 release into the supernatant.

Conclusions

These results demonstrate that gingival fibroblasts respond to pasteurized cow milk and to fermented milk products with an increased expression of TGF-β target genes.

https://ift.tt/2uAXqqk

Botulinum toxin A treatment of epiphora secondary to autologous submandibular gland transplantation

The aim of this study was to explore whether botulinum toxin A (BTXA) injection treats epiphora secondary to submandibular gland (SMG) transplantation for severe keratoconjunctivitis sicca.Fifteen patients with epiphora after SMG transplantation were separated to three groups, and received 15U, 20U and 25U BTXA injection in the transplanted SMG, respectively. Secretion of transplanted SMG was assessed subjectively by visual analogue scale (VAS) regarding epiphora, and objectively by Schirmer test.

https://ift.tt/2LtmVn4

The effect of intratympanic steroid injection frequency in idiopathic sudden sensorineural hearing loss

Publication date: Available online 20 July 2018

Source: American Journal of Otolaryngology

Author(s): Eric M. Sugihara, Michel A. Evans, Miles Neumann, Seilesh C. Babu

Abstract

Purpose

To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss.

Materials and methods

A retrospective chart review was performed from 2007 to 2015 at a neurotology tertiary referral center. Adults who met academy criteria for idiopathic sudden sensorineural hearing loss within two months of onset and negative imaging were grouped based on injection frequency. Injection schedules were every 1–4 (group 1), 5–10 (group 2), or 11–30 (group 3) days. All patients had at least two injections with Dexamethasone 10 mg/ml. All patients had pre- and post-injection audiograms.

Results

Seventy patients met inclusion criteria (group 1, n = 21; group 2, n = 29; group 3, n = 20). There was no significant difference between group demographics or baseline audiometric data. Mean gains were significant and similar between groups for pure tone average (group 1 = −23.6 ± 22.0 dB; group 2 = −19.7 ± 18.4 dB; group 3 = −24.9 ± 24.7 dB; p = 0.67) and word recognition score (group 1 = +26.3 ± 34.8%; group 2 = +23.3 ± 29.9%; group 3 = +33.4 ± 28.9%; p = 0.53).

Conclusions

Frequency of intratympanic steroid injections does not significantly affect hearing outcomes. Following injection therapy, hearing outcomes improved regardless of prior or concomitant oral steroid regimen. Earlier time to initiating injections yielded a higher rate of hearing improvement. Long term hearing outcomes >6 months did not show significant additional improvement.

https://ift.tt/2NtY6EW

Topical micronutrients in atopic dermatitis—An evidence‐based review

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFrJg

Highly‐focused ultrasound in non‐invasive body contouring: Long‐term follow‐up in Korean patients

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6nkui

The 13th International Pan Arab League of Dermatology Conference Held Jointly with the Ninth Dermopolitan Congress Jordan at the Dead Sea, Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFm8q

Oral Isotretinoin for the treatment of Aripiprazol‐induced acneiform rash

Dermatologic Therapy, EarlyView.


https://ift.tt/2O3xBao

PDT and BF‐200 ALA: The therapy option for the treatment of Poikiloderma of Civatte

Dermatologic Therapy, EarlyView.


https://ift.tt/2NuFchk

10th International Conference of Jordanian Society of Dermatology, Venereology, Dermatosurgery & Laser, Amman, Kingdom of Jordan

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6EgRx

Intralesional 5‐fluorouracil to treat extensive molluscum contagiosum in an immunocompromised patient: A novel therapeutic modality

Dermatologic Therapy, EarlyView.


https://ift.tt/2L9D2qE

Scoring the tumor-stroma ratio in colon cancer: procedure and recommendations

Abstract

The tumor-stroma ratio (TSR) has been reported as a strong, independent prognostic parameter in colon cancer as well as in other epithelial cancer types, and may be implemented to routine pathology diagnostics. The TSR is an easy technique, based on routine hematoxylin and eosin stained histological sections, estimating the amount of stroma present in the primary tumor. It links tumors with high stromal content to poor prognosis. The analysis time is less than 2 min with a low inter-observer variation. Scoring of the TSR has been validated in a number of independent international studies. In this manuscript, we provide a detailed technical description of estimating the TSR in colon cancer, including examples, pitfalls, and recommendations.

https://ift.tt/2uRCx9w

Ein neu entwickeltes Biofeedbackprogramm zum Gesichtsmuskeltraining für Patienten mit Fazialisparese

Zusammenfassung

Hintergrund

Patienten mit einer Fazialisparese sind in ihrer Lebensqualität deutlich eingeschränkt. Ist kein irreversibler Nervenschaden erkennbar, wird zunächst neben einer medikamentösen Therapie mit Kortison ein intensives Training der Gesichtsmuskulatur empfohlen. Dazu haben die Autoren einen digitalen Biofeedbackspiegel mit Bewegungsverstärkung entwickelt, um das vegetative Nervensystem indirekt zu beeinflussen.

Fragestellung

Ziel dieser Arbeit war es, die Zuverlässigkeit des Biofeedbackprogramms im Vergleich zur klinischen Einteilung nach House-Brackmann zu evaluieren.

Methoden

Das Biofeedbacksystem ähnelt einem Spiegel und nutzt den Vorteil der Steigerung der körperlichen Selbstkontrolle. Es spiegelt nicht nur das Bild des Patienten wider, sondern potenziert die Bewegung durch Videoverarbeitung und eine Lupenfunktion. Die Gesichtsbewegungen des Patienten werden gefilmt und in Echtzeit verstärkt. Kleinste Bewegungen können sichtbar gemacht und gemessen werden, sodass der Patient ein direktes Feedback über Nervenregenerationen erhält. Dies kann die Motivation zum täglichen Gesichtsmuskeltraining steigern und die Compliance verbessern.

Ergebnisse

Die Einschränkung der Lebensqualität wurde mithilfe der Fragebögen Facial Clinimetric Evaluation Scale (FaCE) und Facial Disability Index (FDI) evaluiert und objektiviert und belegte, dass die Selbstwahrnehmung der Patienten mit einer schlechten Lebensqualität assoziiert war.

Schlussfolgerung

In der vorliegenden Studie zeigte die Messung der Gesichtsbewegungen eine gute Übereinstimmung mit der klinischen Einteilung nach House-Brackmann. Das Biofeedbacksystem ist eine zuverlässige Unterstützung im Rahmen der Regenerationsphase bei Patienten mit Fazialisparese.

https://ift.tt/2muWi39

Mechanics of antigen extraction in the B cell synapse

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Katelyn M. Spillane, Pavel Tolar

Abstract

B cell encounter with antigen displayed on antigen-presenting cells leads to B cell immune synapse formation, internalisation of the antigen, and stimulation of antibody responses. The sensitivity with which B cells detect antigen, and the quality and quantity of antigen that B cells acquire, depend upon mechanical properties of the immune synapse including interfacial tension, the strength of intermolecular bonds, and the compliance of the molecules and membranes that participate in antigen presentation. In this review, we discuss our current understanding of how these various physical parameters influence B cell antigen extraction in the immune synapse and how a more comprehensive understanding of B cell mechanics may promote the development of new approaches to stimulate the production of desired antibodies.

https://ift.tt/2Loi4ng

CD11c + MHCII lo GM-CSF-bone marrow-derived dendritic cells act as antigen donor cells and as antigen presenting cells in neoepitope-elicited tumor immunity against a mouse fibrosarcoma

Abstract

Dendritic cells play a critical role in initiating T-cell responses. In spite of this recognition, they have not been used widely as adjuvants, nor is the mechanism of their adjuvanticity fully understood. Here, using a mutated neoepitope of a mouse fibrosarcoma as the antigen, and tumor rejection as the end point, we show that dendritic cells but not macrophages possess superior adjuvanticity. Several types of dendritic cells, such as bone marrow-derived dendritic cells (GM-CSF cultured or FLT3-ligand induced) or monocyte-derived ones, are powerful adjuvants, although GM-CSF-cultured cells show the highest activity. Among these, the CD11c⁺ MHCII^lo sub-set, distinguishable by a distinct transcriptional profile including a higher expression of heat shock protein receptors CD91 and LOX1, mannose receptors and TLRs, is significantly superior to the CD11c⁺ MHCII^hi sub-set. Finally, dendritic cells exert their adjuvanticity by acting as both antigen donor cells (i.e., antigen reservoirs) as well as antigen presenting cells.

https://ift.tt/2zVunD7

Low-Level EMF Stimulation for Paroxysmal Atrial Fibrillation

Conditions:   Atrial Fibrillation;   Catheter Ablation;   Autonomic Imbalance
Interventions:   Device: Low-level Pulsed EMF;   Device: Sham Stimulation
Sponsor:   Daniel Sohinki
Not yet recruiting

https://ift.tt/2msMpD0

Study to Evaluate Safety & Tolerability of AGI-134 in Solid Tumour

Conditions:   Superficial, Palpable, Unresectable/Metastatic Solid Tumour;   Metastatic Colorectal Cancer;   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: AGI-134;   Drug: AGI-134 + Pembrolizumab
Sponsor:   Agalimmune Ltd.
Not yet recruiting

https://ift.tt/2uPn61K

A Study to Assess the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of AZD8233 in Healthy Male Subjects With Increased Elevated LDL-C Levels.

Condition:   Hypercholesterolemia
Intervention:   Drug: AZD8233
Sponsors:   AstraZeneca;   Parexel
Not yet recruiting

https://ift.tt/2mvStdR

Atopic dermatitis in US adults - epidemiology, association with marital status and atopy

Publication date: Available online 20 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tammy Hua, Jonathan I. Silverberg

https://ift.tt/2JEoqtI

Bone-anchored maxillary protraction to correct a class III skeletal relationship: a multicenter retrospective analysis of 218 patients

Publication date: Available online 20 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Van Hevele Jeroen, Nout Erik, Scheerlinck Jan, Meyns Joeri, Claeys Thomas, Politis Constantinus

Abstract

This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients. Elastic traction was performed for 22.9 months, on average. The miniplate survival rate was 93.6%; 25.7% of the patients suffered failure of one of the miniplates. Postoperative antibiotics and placement of the neck of the miniplate in the attached gingiva significantly improved the success rate. Miniplate failure was six times higher in the maxilla and occurred more in younger patients. Self-drilling screws were significantly better than self-tapping screws for fixing the miniplate. Small cephalometric changes were seen: SNA (+1.9°), SNB (+0.4°), ANB (+1.4°), Wits analysis (+1.3 mm). In conclusion, bone-anchored maxillary protraction on four miniplates is an effective method for correcting a class III relationship, but has less skeletal effect than previously reported in the literature.

https://ift.tt/2NwvVFs

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

Abstract

Background

An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates.

Methods

Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded.

Results

There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as 'otology' (42%), 'general otolaryngology' (35%), 'rhinology' (17%) and 'head and neck' (4%). The most common procedure codes were categorized as 'general otolaryngology' (45%), 'otology' (23%), 'head and neck' (13%) and 'rhinology' (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon.

Conclusion

This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of 'otology', 'general' and 'rhinology' based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.

https://ift.tt/2uCq6zd

Delayed bone healing by collagen membrane in early phase of four weeks

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Jungtae Lee, Dajung Lee, Seo-Eun Oh, Kyeong-Mee Park, Sungtae Kim

Abstract

Objective

Barrier membranes are important in maintaining a space for the epithelium or connective tissues to grow in guided bone regeneration procedure. In this study, the effects of resorbable membranes during the early stages of bone regeneration and in subjects with impaired bone healing capacity were investigated.

Study Design

Twenty-eight rats were selected for this study. Half of all animals were selected for radiation therapy before surgical procedure. Four groups were assigned (G1∼G4). One circular defect was created in the center parietal bones. This was covered with resorbable membrane in group G2, G4. After 4 weeks, the animals were sacrificed.

Results

At week 4, the new bone formation was observed in the margins of old bone boundaries in the all groups except G3. Osteoclast was the most abundant in the G1 group (18.3±7.7) and the least in the G4 group (7.9±4.7). The mean of osteocalcin levels in blood was the highest in the G2 group and lowest in the G3 group. Runx2 levels were only significant difference in the G4 group when compared before and after treatment.

Conclusions

Bone healing is adversely affected after radiation therapy. In addition, resorbable membranes can delay healing in the early stages of bone regeneration.

https://ift.tt/2mx5Bj7

Enlarging Growth of the Mental Region in a 48-year-old Man

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Jacqueline Cox, Jerrold E. Armstrong, Sachin Pandey, Bret Wehrli, King Chong Chan, Christina McCord

Abstract

 

https://ift.tt/2A4UV51

Pain Management and the Healthcare Provider – Opioids, Cannabinoids and the Drug Abuse Epidemic

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Joshua E. Lubek

https://ift.tt/2mtfYEm

Impact of Salivary Hypofunction on Incidence of Orofungal Infections with use of Topical Steroids for Management of Patients with Oral Lichen Planus and Xerostomia

Publication date: Available online 20 July 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Mary Hil Edens, Michael D. Carpenter, Joel J. Napeñas, Michael T. Brennan

Abstract

Objectives

To determine if salivary hypofunction increases the incidence of oral fungal infections (OFI) after topical steroid use for the management of oral lichen planus (OLP).

Study Design

Patients with a diagnosis of OLP, treatment for at least 2 weeks with topical steroids, baseline salivary flows completed and had a follow-up visit within 5 weeks of steroids being prescribed were assessed. Patients were evaluated for clinical signs of fungal infection at follow-up visits.

Results

Forty-Seven patients (91% female) met the inclusion criteria with 21.3% developing an OFI following topical steroid use. Demographics, type of OLP, steroid used, and antifungal used did not impact the development of an OFI. The mean stimulated salivary flow was significantly lower in the group that developed an OFI compared to the group that did not develop an OFI (8.31 ml/15min vs 15.4 ml/15min, respectively; p=0.0006). A higher incidence of OFI occurred in the low stimulated flow group vs. the normal flow group (39% vs 4%, respectively). Most patients in the OFI group received a preventative antifungal (90%).

Conclusions

OFIs increased following steroid treatment in OLP patients with low stimulated salivary flows. Preventative antifungals (90%) were not effective to prevent OFIs in OLP patients with salivary hypofunction treated with topical steroids.

https://ift.tt/2uQmVDz

Optic Neuritis Possibly Induced by Anti-PD-L1 Antibody Treatment in a Patient with Non-Small Cell Lung Carcinoma

Background: Recent immune therapy with checkpoint inhibitors (CPIs) has demonstrated remarkable antitumor effects on specific tumors, such as malignant lymphoma and non-small cell lung carcinoma. By contrast, CPIs cause an imbalance in the immune system, triggering a wide range of immunological side effects termed immune-related adverse effects (irAEs). Here, we report a rare case of optic neuritis and hypopituitarism during anti-programmed death-ligand 1 (PD-L1) antibody treatment. Case Presentation: A patient with non-small cell lung carcinoma received anti-PD-L1 antibody treatment every 3 weeks; however, the patient started experiencing headaches, general fatigue, anorexia, and diarrhea approximately 1 year after the initiation of the treatment. Moreover, sudden visual loss of the right eye occurred 1 week after the interruption of the anti-PD-L1 antibody treatment. MRI findings showed gadolinium enhancement in the left optic nerve, but no enlargement of the pituitary gland and stalk. Laboratory data showed decreased serum adrenocorticotropic hormone (ACTH), cortisol, and free T₄ levels, and a hormone tolerance test indicated hypopituitarism, hypothyroidism, and hypoadrenocorticism. The central scotoma caused by optic neuritis completely disappeared immediately after a course of steroid pulse therapy, and no recurrence occurred up to 2 years after initiation of the steroid pulse therapy while replacement therapy for hypothyroidism and hypoadrenocorticism was continued. Conclusions: The patient presented with optic neuritis and hypopituitarism, possibly due to irAEs of the anti-PD-L1 antibody treatment. Steroid pulse therapy was effective for optic neuritis, suggesting underlying immunological mechanisms. Neurological complications including optic neuritis should be considered when examining patients with cancer undergoing CPI treatment.
Case Rep Ophthalmol 2018;9:348–356

https://ift.tt/2muLfaf

The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council

No abstract available

https://ift.tt/2Lrmx8w

The Radial Forearm Flap: A Technique Modification for Oral Cavity Composite Defects Involving a Marginal Mandibulectomy

Publication date: Available online 20 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Baber Khatib, Ashish Patel, Eric J. Dierks, Allen Cheng

https://ift.tt/2uOWHBa

Papillary Thyroid Carcinoma Incidentally Found in Cervical Lymph Nodes During Neck Dissection for Patients with Tongue Squamous Cell Carcinoma: A Three-Case Report and Literature Review

Publication date: Available online 20 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yu-ming Xu, Zhao-jian Gong, Han-jiang Wu

Abstract

The incidence of papillary thyroid carcinoma incidentally found in cervical lymph nodes during neck dissection for patients with tongue squamous cell carcinoma is infrequent, with the coexistence of papillary thyroid carcinoma and squamous cell carcinoma in the same cervical lymph node be the rarest. Some of these patients presented with primary lesion in their thyroid gland, the others have no obviously malignant thyroid lesion. The reasons behind this kind of clinical phenomenon and the relationship between tongue squamous cell carcinoma and papillary thyroid carcinoma found in cervical lymph nodes are unclear. Moreover, for surgeons, it is still a clinical dilemma to make a choice between thyroid surgery and follow-up. Of the 956 patients who underwent neck dissection due to maxillofacial tumors from January 2011 through December 2017 at Second Xiangya Hospital of Central South University, 3 patients with tongue squamous cell carcinoma presented with papillary thyroid carcinoma in their cervical lymph nodes. Neither preoperatively physical examination nor ultrasonography after surgery showed significant nodule in the thyroid gland of these patients, so none of them underwent thyroid surgery or chemoradiotherapy. At follow-up（1 year to 6.5 years）, we found no obviously malignant lesion in their thyroid gland or relatedly metastatic disease. Our study suggests that tongue squamous cell carcinoma may not affect the occurrence and development of papillary thyroid carcinoma in cervical lymph nodes. For patients with tongue squamous cell carcinoma presenting with papillary thyroid carcinoma in cervical lymph nodes, it is not necessary to carry out thyroid surgery immediately if ultrasonography showed no significantly malignant lesion in thyroid gland. Nevertheless, conducting periodic follow-up is very important.

https://ift.tt/2LjXXqr

Protective effects of SIRT6 against lipopolysaccharide (LPS) are mediated by deacetylation of Ku70

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Lin Zhang, Li Bai, Qihui Ren, Guohui Sun, Yajing Si

Abstract

Progression of pulpitis is facilitated by the immune system's response to bacteria, enhancing the production of inflammatory regulators. Bacterial lipopolysaccharide (LPS) is the major structural component of the outer wall of all Gram-negative bacteria and a potent activator of the immune system. Apoptosis is believed to play an important role in the inflammatory process of pulpitis. SIRT6 is a member of class III of histone deacetylases (HDACs), also called sirtuins (SIRTs). The role of SIRT6 in apoptosis in pulpitis is unknown. In this study, we found that the expression of SIRT6 in human dental pulp cells (hDPCs) was down-regulated by treatment with LPS. MTT and LDH assays revealed that overexpression of SIRT6 in hDPCs attenuated cell death induced by LPS. Consistently, our results demonstrated that SIRT6 was able to protect hDPCs from apoptosis. We found that SIRT6 could interact with Ku70, an important apoptosis regulator, by the immunoprecipitation (IP) experiment. SIRT6 physically binds to Ku70. Overexpression of SIRT6 reduced acetylation of Ku70 and promoted interaction of Ku70 with the proapoptotic protein Bax. These studies underscore an essential role of SIRT6 in the survival of hDPCs in stress situations.

https://ift.tt/2uO80JP

HMBOX1 in hepatocytes attenuates LPS/D-GalN-induced liver injury by inhibiting macrophage infiltration and activation

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hengli Zhao, Qiuju Han, Nan Lu, Dongqing Xu, Zhigang Tian, Jian Zhang

Abstract

The HMBOX1 (Homeobox Containing 1) gene was first isolated from the human pancreatic cDNA libraries and is widely expressed in many tissues. Previously, we detected high expression of HMBOX1 in the liver, but its function was unclear. In this study, hepatocyte-specific HMBOX1 knockout mice (Hm^△hep mice) were generated and used to characterize the function of HMBOX1 in the LPS/D-GalN-induced acute liver failure model. HMBOX1-knockout exhibits exacerbated liver injury induced by LPS/D-GalN, accompanied with high levels of inflammatory cytokines both in the liver and in circulation. Further investigation demonstrated that HMBOX1 negatively regulates NF-κB signal transduction. Therefore, HMBOX1-knockout in hepatocytes promotes CCL2 expression through the activation of NF-κB signaling, which enhanced the infiltration of macrophages into the liver. In addition, the decrease of HMBOX1 in hepatocytes promotes the activation of macrophages, upregulating CD80 and MHCⅡ, as well as inflammatory factors TNF-α and IL-6. Importantly, overexpression of HMBOX1 rescued liver injury in Hm^△hep mice. These findings indicate that HMBOX1 in hepatocytes acts as a key immunosuppressive factor for inflammation and plays a critical protective role in LPS/D-GalN-induced liver injury.

https://ift.tt/2LmeSbF

Polymorphisms in the DAD1 and OXA1L genes are associated with asthma and atopy in a South American population

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Anaque de Oliveira Pires, Gerson de Almeida Queiroz, Milca de Jesus Silva, Raimon Rios da Silva, Hugo Bernardino Ferreira da Silva, Norma Vilany Queiroz Carneiro, Héllen Freitas Fonseca, Maria Borges Rabelo de Santana, Regina Santos Nascimento, Neuza Maria Alcântara-Neves, Gustavo Nunes de Oliveira Costa, Ryan dos Santos Costa, Maurício L. Barreto, Camila Alexandrina Figueiredo

Abstract

Atopic asthma, which is characterized by the chronic inflammation and morbidity of airways, is a disease of great complexity, and multiple genetic and environmental factors are involved in its etiology. In the first genome-wide association study (GWAS) conducted in Brazil for asthma, a positive association was found between atopic asthma and a variant (rs1999071), which is located between the DAD1 and OXA1L genes, although neither gene has previously been reported to be associated with asthma or allergies. The DAD1 gene is involved in the regulation of programmed cell death, and OXA1L is involved in biogenesis and mitochondrial oxidative phosphorylation. This study aimed to evaluate how polymorphisms in DAD1 and OXA1L are associated with asthma and markers of atopy in individuals from the Salvador cohort of the SCAALA (Social Change Asthma and Allergy in Latin America) program. The DNA of 1220 individuals was genotyped using the Illumina 2.5 Human Omni Bead chip. Logistic regression analyses were performed with PLINK 1.9 software to verify the association between DAD1 and OXA1L polymorphisms and asthma and atopic markers, adjusted for sex, age, helminth infections and ancestry markers, using an additive model. The DAD1 and OXA1L genes were associated with some of the evaluated phenotypes, such as asthma, skin prick test (SPT), specific IgE for aeroallergens, and Th1/Th2-type cytokine production. Using qPCR, as well as in silico gene expression analysis, we have demonstrated that some of the polymorphisms in both genes are able to affect their respective gene expression levels. In addition, DAD1 was over-expressed in asthmatic patients when compared with controls. Thus, our findings demonstrate that variants in both the DAD1 and OXA1L genes may affect atopy and asthma in a Latin American population with a high prevalence of asthma.

https://ift.tt/2uM64BH

Regenerative Medicine 3.TX: What Can We Learn About Organ Regeneration From Organ Replacement

No abstract available

https://ift.tt/2LBCs1f

A clinical decision support system can help facilitate living kidney donor assessments

No abstract available

https://ift.tt/2LalnPt

Deep Profiling of the CD8+ T cell Compartment identifies Activated cell subsets and Multifunctional Responses Associated with Control of Cytomegalovirus Viremia

Background Human cytomegalovirus (HCMV) is a common opportunistic pathogen in transplant recipients. Patterns of viremia and reactivation are influenced by the host immune response, including CD8+ T cells. However, the cellular deficits or phenotypic differences that account for differential outcomes during HCMV viremia are incompletely understood. Methods PBMCs were collected from 20 transplant recipients (10 viremia controllers and 10 noncontrollers) at onset of HCMV viremia and 4-weeks post. We utilized mass cytometry to perform in-depth characterization of cell-surface and intracellular CD8+ T cell markers and to compare frequencies of these cells between groups. Results Deep profiling identified 2 TCM subsets at onset and 5 TEMRA subsets at 4 weeks that were associated with control of HCMV viremia, in addition to 6 TEMRA subsets at onset and 4 weeks associated with relapsing or remitting HCMV viremia. In general, CD8+ T cell clusters associated with poorly controlled HCMV viremia lacked markers of activation or terminal differentiation including CD38, CD69, CD25, CD57 and HLA-DR. We also measured the production of 8 HCMV-specific effector molecules (TNFα, IFNγ, IL2, granzyme B, perforin, MIP1β, IL10 and CD107a) in CD8+ T cells. Viremia controllers had greater diversity of HCMV-specific multi-functional responses at both time points, including significantly higher frequencies of HCMV-specific TNFα+IFNγ+ CD8+ T cells at onset. These multifunctional cells had a phenotype consistent with activated TEM/TEMRA cells. Conclusions Uncontrolled CMV viremia is associated with specific clusters of memory T cell subsets and lower frequencies of HCMV-specific multifunctional CD8+ T cells. *Indicates joint senior authorship. Corresponding Author: Atul Humar MD MSc FRCPC, PMB 11-175, 585 University Avenue, Toronto, Canada M5G 2N2; tel: (416) 340-4241; fax (416) 340-4043; email: atul.humar@uhn.ca AUTHORSHIP PAGE Authors: Victor H. Ferreira – victor.ferreira@uhnresearch.ca Deepali Kumar – deepali.kumar@uhn.ca Atul Humar – atul.humar@uhn.ca Author Contributions: V.H.F. - participated in performance of the research, data analysis, and writing of the paper. D.K. – participated in research design, data interpretation, data collection, and writing of the paper. A.H. – participated in research design, data interpretation, data collection, and writing of the paper. Disclosure: A.H. has received a research grant from Roche and Qiagen, consulting fees from Astellas and Chimerix. D.K. has received research grants from Roche, Qiagen and Oxford Immunotec and consulting fees from Qiagen and Oxford Immunotec. Funding: This study was funded by the Canadian National Transplant Research Program (CNTRP). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LBCk1L

Development of a clinical decision support system for living kidney donor assessment based on national guidelines

Background Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. Methods We developed a clinical decision support system (CDSS), based upon national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. Results The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations and predicted operation side in our patient cohort. 17/45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. Conclusions We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks. Corresponding Author, Mr Simon R Knight, Senior Clinical Lecturer and Honorary Consultant Transplant Surgeon, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Old Road, Oxford OX3 7LE. Tel: +44 1865 227 131, Mob: +44 7909 921 103. E-mail: simon.knight@nds.ox.ac.uk Authorship All authors made a significant contribution to the content of this manuscript, as per ICMJE recommendations. SRK conceived the study idea, participated in study design, provided clinical input to the decision support system (CDSS), coded the CDSS, entered and analysed patient data and wrote the manuscript. KNC participated in study design, coded the clinical decision support system and reviewed the manuscript. MS participated in study design, developed the openclinical.net platform, advised on the technical development of the clinical decision support system, provided the tools required for data analysis and reviewed the manuscript. NH provided clinical input to the content of the clinical decision support system and reviewed the manuscript JPH participated in study design, provided clinical input to the content of the clinical decision support system and reviewed the manuscript JF developed the openclinical.net concept, participated in study design, advised on the technical development of the clinical decision support system and reviewed the manuscript. Disclosures JF is a shareholder and Chief Scientific Officer of Deontics Ltd., a commercial company that makes use of the technologies described in this paper. He is also a cofounder of OpenClinical CIC. MS is a cofounder of both Deontics Ltd and OpenClinical CIC. KNC is a Medical AI advisor for OpenClinical CIC. SK, JH and NH have no conflicts of interest in relation to this work. Funding This work did not receive funding from any external sources. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2L8xoVD

Rethinking Regenerative Medicine From a Transplant Perspective (and Vice Versa)

No field in health sciences has more interest than organ transplantation in fostering progress in regenerative medicine (RM) because the future of no other field more than the future of organ transplantation will be forged by progress occurring in RM. In fact, the most urgent needs of modern transplant medicine - namely, more organs to satisfy the skyrocketing demand and immunosuppression-free transplantation -, cannot be met in full with current technologies and are at risk of remaining elusive goals. Instead, in the past few decades, groundbreaking progress in RM is suggesting a different approach to the problem. New, RM-inspired technologies among which decellularization, 3D printing and interspecies blastocyst complementation, promise organoids manufactured from patients' own cells and bear potential to render the use of currently used allografts obsolete. Transplantation, a field that has traditionally been immunology-based, is therefore destined to become a RM-based discipline. However, the contours of RM remain unclear, mainly due to the lack of a universally accepted definition, the lack of clarity of its potential modalities of application and the unjustified and misleading hype that often follows the reports of clinical application of RM technologies. All this generates excessive and unmet expectations and an erroneous perception of what RM really is and can offer. In this manuscript, we will (i) discuss these aspects of RM and transplant medicine, (ii) propose a definition of RM, and (iii) illustrate the state of the art of the most promising RM-based technologies of transplant interest. Disclosure: authors have no conflicts of interest to disclose Authorship Giuseppe Orlando conceived the work and the design of the manuscript, was responsible for its undertaking and completion, wrote the introduction, the paragraph on decellularization technology and the conclusions and approved the final draft Sean Murphy participated to the design of the manuscript, wrote the part on 3D printing and approved the final draft Benedetta Bussolati participated to the design of the manuscript, wrote the part on stem cells, regeneration and blastocyst complementation, and approved the final draft Marc Clancy participated to the design of the manuscript, wrote the part on ischemia-reperfusion and approved the final draft Paolo Cravedi wrote the part on the regenerative immunology. and approved the final draft Giovanni Migliaccio wrote the part on product development and translation, and approved the final draft Patricia Murray participated to the design of the manuscript, wrote the part on stem cells, regeneration and blastocyst complementation, and approved the final draft Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LBrsk7

Production of a mouse monoclonal IgM antibody that targets the carbohydrate Thomsen-nouveau cancer antigen resulting in in vivo and in vitro tumor killing

Abstract

The construction of a tumor-associated carbohydrate antigen-zwitterionic polysaccharide conjugate, Thomsen-nouveau-polysaccharide A1 (Tn-PS A1, where Tn = d-GalpNAc), has led to the development of a carbohydrate binding monoclonal antibody named Kt-IgM-8. Kt-IgM-8 was produced via hybridoma from Tn-PS A1 hyperimmunized Jackson Laboratory C57BL/6 mice, splenocytes and the murine myeloma cell line Sp2/0Ag14 with subsequent cloning on methyl cellulose semi-solid media. This in-house generated monoclonal antibody negates binding influenced from peptides, proteins, and lipids and preferentially binds monovalent Tn antigen as noted by ELISA, FACS, and glycan array technologies. Kt-IgM-8 demonstrated in vitro and in vivo tumor killing against the Michigan Cancer Foundation breast cell line 7 (MCF-7). In vitro tumor killing was observed using an LDH assay that measured antibody-induced complement-dependent cytotoxicity and these results were validated in an in vivo passive immunotherapy approach using an MCF-7 cell line-derived xenograft model. Kt-IgM-8 is effective in killing tumor cells at 30% cytotoxicity, and furthermore, it demonstrated approximately 40% reduction in tumor growth in the MCF-7 model.

https://ift.tt/2uCgGnj

Small bowel obstruction SBO after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report

Abstract

A 50-year-old man underwent laparoscopic hernia repair for a groin hernia, presenting acute abdominal pain and bowel obstruction syndrome 1 day post surgery. Diagnostic laparoscopy was performed at postoperative the day after the hernioplasty and a volvulus was found. The residual end of the barbed V-LOC adopted in the peritoneal closure was incidentally hooked to the mesentery and caused a small bowel obstruction as a volvulus. The redundant V-LOC strand was released and cut superficial to the peritoneum. A detorsion of volvulus was preformed. Neither bowel ischemia nor significant bowel injury was noted. The following day he was discharged without complication. The residual 'free' barbel suture in the peritoneal cavity invited adhesion formations and subsequently the Bowel obstruction.

https://ift.tt/2Lrizgq

Acute oesophageal necrosis: a rare but potentially fatal association of cocaine use

Acute oesophageal necrosis (AON), also known as 'black oesophagus', is a rare condition characterised by the necrosis of the oesophagus usually involving the distal part. It has been associated with various conditions, and the pathogenesis is thought to involve hypovolaemia combined with decreased function of oesophageal protective mucosal barriers and may be compounded by the effect of gastric secretions on oesophageal mucosa. The hallmark of this condition is characteristic circumferential black discolouration of the distal oesophagus that may extend proximally. We present a case of a man who presented with haematemesis associated with cocaine abuse. Oesophagogastroduodenoscopy confirmed black oesophagus. The patient was managed with intravenous fluids, packed red blood cell transfusions, proton pump inhibitors and sucralfate suspension; however, he failed to recover. We have also reviewed the previous reported cases of AON in association with cocaine use.

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Presentation of papillary fibroelastoma of the aortic valve with atypical symptoms

Papillary fibroelastomas are rare benign tumours arising from the cardiac endothelium. The rationale behind the treatment of fibroelastomas is to eliminate the risk of embolic events and the associated morbidity and mortality. These tumours present predominantly in males during the seventh decade of life and most commonly affect the aortic valve. We report a case of aortic valve papillary fibroelastoma with an atypical clinical presentation, treated with valve-sparing surgical excision. Our case highlights the management of this rare but serious condition and emphasises the need to develop clear guidelines regarding the treatment of asymptomatic patients with a papillary fibroelastoma.

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Unusual cause of sinusitis and cough

Description

A 60-year-old woman with chronic lymphocytic leukaemia (CLL) previously treated with ofatumumab was referred for evaluation of worsening productive cough, sinus pain and nasal congestion. She had received multiple courses of antibiotics, antifungals and steroids with partial symptomatic improvement. CT of the chest demonstrated bilateral bronchial wall thickening and bronchial dilatation associated with patchy opacities (figure 1A). An open lung biopsy revealed a dense monotonous lymphocytic infiltrate in a bronchiolocentric distribution sparing the lung parenchyma with associated vague non-caseating granulomatous inflammation and focal areas of organising pneumonia. These findings suggested pulmonary involvement by CLL (figure 1B, C). Nasal and paranasal sinus biopsies were also consistent with CLL. She was started on salvage therapy with ibrutinib. Sinus, nasal and pulmonary symptoms resolved completely after 4 months without the need for additional antibacterial or antifungal medication. Repeat imaging showed resolution of opacities (figure 1D). The...

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Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

Anterior megalophthalmos and keratoglobus are characterised by corneal thinning and deep anterior chamber. They are clinically distinguished on the basis of normal to slightly decreased corneal thickness with a large corneal diameter (>13 mm) in case of anterior megalophthalmos, and marked limbus-to-limbus corneal thinning with globular protrusion in keratoglobus. To achieve and maintain a centred and stable intraocular lens (IOL) position in the bag is often difficult in cases of anterior megalophthalmos due to a too large diameter of the capsular bag and ciliary ring. We report a case of a 40-year-old man with features of anterior megalophthalmos with extremely thin cornea. He had spontaneous posterior dislocation of IOL and capsular tension ring (CTR) within the bag after initial successful cataract surgery. The dislocated complex could neither have been repositioned with scleral fixation due to large diameter of ciliary ring nor could it have been explanted through a clear corneal incision due to associated very thin cornea. We performed pars plana vitrectomy and separated the IOL-CTR complex inside the eye and explanted them separately through the sclerotomy, as is done for removal of intraocular foreign body. This avoided incision on the thin cornea. We conclude that this method can be very useful in a similar clinical situation but is complex enough to justify its use in routine cases.

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Total electrical alternans in a patient with malignant pericardial tamponade

We present a case of a 59-year-old man with acute abdominal pain and progressive shortness of breath. A focused assessment with sonography for trauma scan showed free fluid in the hepatorenal recess and in the recto-uterine recess. Later, due to clinical deterioration and the differential possibility of a pulmonary embolism or aortic dissection, a CT scan was performed which revealed large pericardial effusion. This, together with a dilated vena cava inferior and portal system, raised the suspicion of cardiac tamponade. The diagnosis was confirmed by transthoracic echocardiography (TTE). In retrospect, the ECG at admission showed a sinus tachycardia, low-voltage QRS complexes and a total electrical alternans corresponding with the swinging heart seen on TTE. An electrical alternans on ECG is an important diagnostic clue but is often missed, causing an unnecessary delay to proper diagnostic and therapeutic measures.

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Pneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation

Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. A 40-year-old man with 1-year history of dyspepsia and vomiting which was aggravated by 20 kg underweight since 3 months ago, despite medications was presented. His imaging examinations showed partial antral obstruction besides pneumoperitoneum and gas collection in the small intestine wall, which were in favour of PI. Samplings of the small intestine during laparotomy reported simple serosal cysts. Persistence of his symptoms forced him to recourse to another hospital and their new imaging revealed Ladds' band in addition to mentioned findings in previous studies; he underwent subtotal gastrectomy plus Ladds' band division by Braun gastrojejunostomy. PI could be a presentation of antral stenosis and midgut malrotation. PI with pneumoperitoneum needs surgical interventions. Considering that most of the midgut malrotation cases are diagnosed in the first year of life and it is very rare in adults, it may bethat these new findings are due to adhesion band formation after the first surgery in this case.

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Traumatic abdominal wall hernia secondary to seatbelt injury: a case successfully managed by delayed surgical mesh repair and complicated by intervening pregnancy

Traumatic abdominal wall hernia (TAWH) is a rare type of hernia occurring secondary to blunt trauma. We report a case of seatbelt-associated TAWH in a 20-year-old woman who was presented to hospital via ambulance following a road traffic collision with a distended abdomen, peritonitis and free gas, with an associated TAWH identified on CT imaging. The patient underwent delayed surgical repair of her hernia using biological mesh, without recurrence, with a clinical course complicated by pregnancy. We use this report to demonstrate late repair as a safe and effective option for management of TAWH in pregnancy, with active surveillance and a multidisciplinary approach by the obstetric, plastic surgery and trauma teams.

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Genetic testing for a patient with suspected familial hypercholesterolaemia

Familial hypercholesterolaemia (FH) is a genetic condition that results in elevated low-density lipoprotein (LDL) cholesterol (LDL-C) levels with consequent increased risk for premature cardiovascular disease events. Although it is considered an autosomal-dominant genetic condition, the underlying genetic causes of FH can be complex. Currently most guidelines rely on clinical criteria to diagnose FH. But this approach has some pitfalls. We present a patient who was not formally diagnosed with FH using commonly used and well-accepted clinical criteria but via genetic testing was found to have a mutation for this disorder. This case brings to fore the challenges clinicians face in diagnosing and managing such unusual cases optimally. Through this case report, we hope to stimulate a debate among clinicians as well as other stakeholders regarding the need to develop more efficient ways of selecting patients for genetic testing in response to elevated LDL levels.

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Sealing capacity of the ventricular muscle band after iatrogenic left ventricular perforation during transcatheter aortic valve implantation

Left ventricular (LV) perforation accompanied by acute cardiac tamponade is a rare but one of the most feared complication during transcatheter aortic valve implantation. Few cases with the need of emergent surgical repair are described in literature. Handling of this uncommon but possible life-threatening event requires well-considered action by the implanting team and is associated with substantially increased intrahospital mortality. We present a unique case of LV perforation management with percutaneous pericardiocentesis only. As a possible underlying physiological mechanism, we identified the movement of the ventricular muscle band which possibly sealed the perforation side due to transverse and circumferential muscle contractions.

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Correction: Splenic myoid angioendothelioma mimicking metastatic disease in an 8-year-old with Stage IV Wilms tumour

Shah AA, Luca DC, Kane TD, et al. Splenic myoid angioendothelioma mimicking metastatic disease in an 8-year-old with Stage IV Wilms' tumour. BMJ Case Rep 2018. doi: 10.1136/bcr-2018-224550.

The correct full name of the second author is Dragos C Luca.

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Sinusitis Due to the Presence of a Dental Implant Inside the Maxillary Sinus

The migration of a dental implant into the maxillary sinus is an uncommon event of occurrence. Disrespect for concepts of implantology, low alveolar bone density at the site, high incidence of masticatory force in posterior region, and clinical intercurrences predispose to failure in rehabilitation. Address correspondence and reprint requests to Jadison Junio Conforte, MS, Department of Dental Prosthesis, Araçatuba School of Dentistry, UNESP, Rua José Bonifácio, 1193 CEP 16015-050, São Paulo, Brazil; E-mail: junioconforte@yahoo.com.br Received 19 February, 2018 Accepted 2 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reduction of Supraorbital Fractures via a Short Sub-Brow Incision

The authors report a short-incision supraorbital approach through an upper eyebrow skin incision that was used to treat supraorbital rim fractures in 2 patients. With the patient in the supine position, short incision lines were designed. Their length was usually less than 1 cm (1 or 2 mm medial to the frontal nerve and lateral to the supraorbital nerve), and they were designed at the inferior margin of the eyebrow to avoid injuring the frontal, supraorbital, or supratrochlear nerve. The skin was incised and blunt dissection was performed to reach the supraorbital rim. The periosteum was incised and a cleft palate periosteal elevator was introduced below the fracture segments. Gentle forward and upward traction was applied through the elevator and a click could be heard when the segment was reduced into its anatomical position. An intraoperative skull lateral X-ray was taken and the reduction was confirmed. The skin was repaired layer by layer. In supraorbital rim fractures, this short-incision supraorbital approach through an upper eyebrow skin incision could be applied without injuring the supraorbital nerve, instead of the bicoronal approach. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea; E-mail: jokerhg@inha.ac.kr; Dae Joong Kim, PhD, Department of Anatomy, Inha University School of Medicine, 100 Inha-ro, Nam-gu, Incheon 22212, Korea, E-mail: djkim@inha.ac.kr Received 10 April, 2018 Accepted 15 May, 2018 This work was supported by Inha University Research Grant (2018). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Application of Three-Dimensional Simulation Program and Three-Dimensional Printing in Secondary Rhinoplasty

Background: In recent years, efficacy of 3-dimensional (3D) simulation, in preoperative planning of aesthetic and reconstructive surgeries and prediction of the postoperative result, has been reported in many clinical studies. Especially in rhinoplasty, it can be used not only for prediction the outcome but also for fabricating implants that will strictly match with the anatomical needs of patient. Clinical Report: A 30-year-old male after traffic accident visited emergency room complaining on painful swelling and contour deformity of nose. Under the diagnosis of nasal bone fracture and deviated nose, he had been admitted to our hospital. Considering his medical history of rhinoplasty, which was performed in the local aesthetic clinic 6 years ago, the authors decided to perform the operation with 3D simulation program and 3D printed implant. There were no specific complications, such as hematoma, infection, or necrosis. Patient was discharged on fourth postoperation day. Discussion: There is no doubt that creating an ideal dorsal aesthetic line is critically important in rhinoplasty. Therefore creating individual implants for certain patient's anatomical nasal structure is highly significant in the rhinoplasty. Although usefulness of primary rhinoplasty using patient-specific 3D implant is introduced in previous study, the authors successfully applied the patient-specific 3D implant to patient who has fracture of nasal bone and primary rhinoplasty history. It means that the patient-specific implants are stable and can be used not only in primary rhinoplasty patients but also for the patients who had primary rhinoplasty previously. Address correspondence and reprint requests to Eun Soo Park, MD, PhD, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, Republic of Korea; E-mail: peunsoo@schmc.ac.kr Received 20 March, 2018 Accepted 15 May, 2018 This work was supported by the Soonchunhyang University Research Fund. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Horizontal Maxillary Osteotomy Stability Using Mandibular Outer Cortex Bone Grafts in Patients With Cleft Lip and Palate

Objective: To investigate horizontal maxillary osteotomy stability after using bone grafts for the treatment of patients with unilateral cleft lip and palate (UCLP). Design: Retrospective cohort study. Setting: Plastic surgery hospital. Patients: Fifty-eight patients with UCLP and maxillary hypoplasia requiring a maxillary Le Fort I advancement of 6 to 9 mm. Interventions: The test group (TG) was comprised of 28 patients who underwent mandibular outer cortex bone grafting in the gaps created by a modified Le Fort I osteotomy. The control group (CG) was comprised of 30 patients who underwent a Le Fort I osteotomy without bone grafts. Main Outcome Measures: Maxillary horizontal advancement (recorded during the operation using a Vernier caliper) and horizontal relapse at 12 months after surgery (based on a manual cephalometric analysis of pre- and postoperative lateral teleradiographs). Results: In the TG, the mean maxillary horizontal advancement was 7.13 ± 0.7 mm (range: 6.01–8.23 mm), and the mean postoperative horizontal relapse was 25.07 ± 6.64%. In the CG, the mean maxillary horizontal advancement was 6.90 ± 0.55 mm (range: 6.05–7.39 mm), and the mean postoperative horizontal relapse was 24.89 ± 4.25%. There were no significant between-group differences in the mean horizontal relapses. Conclusion: The use of mandibular outer cortex bone grafts as physical barriers in patients with UCLP does not increase postoperative stability when the maxillary advancement is 6 to 9 mm. Address correspondence and reprint requests to Tao Song, MD, Center of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; E-mail: songtao2059@163.com Received 3 September, 2017 Accepted 16 May, 2018 This study was supported by Capital Medical Development Fund of China (Z141107002514095). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population

Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects,

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Evaluation of Heart Functions with Detailed Echocardiogram in Patients With Septum Deviation

Background: One of the most important reasons for nasal congestion is septum deviation. Nasal septal deviation increases airway resistance and can cause systemic problems. In this study, echocardiographic findings were compared with the normal population to see how cardiac function was affected in patients with obstructive nasal septum deviation. Methods: This study included a young patient group with 44 obstructive septum deviation patients and 30 healthy individuals with no nasal-related problems. Echocardiography was performed by the same cardiologist and results were compared with normal patients. The authors got permission from the ethics committee of faculty for the study (E. 116795). Results: In the patient group with septum deviation, pulmonary artery pressure was high. In addition, the size of the right heart chambers was also increased. TAPSE, pulmonary acceleration time, ejection fraction, and right ventricular outflow tract-fractional shortening were found to be lower than the normal group. Conclusion: Patients with obstructive septum deviations should be evaluated early for cardiologic functions. Address correspondence and reprint requests to Ozge Caglar, Otorhinolaryngology Department, 18 March University, Medical School, Canakkale, Turkey 00900; E-mail: ozgecaglar@comu.edu.tr Received 8 March, 2018 Accepted 7 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Split-Skin-Graft Wrapped Conformer to Treat Severe Contracted Sockets

This case series present the surgical management of cases with severe contracted sockets using a split-skin-graft wrapped conformer. Eight patients with severely contracted anophthalmic sockets underwent surgery. The surgical technique is described and a chart review was performed to collect patient data pre- and postoperatively. Preoperatively, all patients had grade 3 or 4 contracted sockets with shallow or obliterated fornices and patients were unable to retain an external prosthesis in place. Donor material was harvested from the supraclavicular area. The split-skin-graft was successfully performed in all cases without fornix-deepening sutures. All patients underwent a significant improvement of socket contracture enabling retention of the prosthesis and were satisfied with the outcomes. The split-skin-graft wrapped conformer is a rapid and less surgically challenging option to correct severe contracted anophthalmic sockets. Address correspondence and reprint requests to Alicia Galindo-Ferreiro, MD, PhD, Department of Ophthalmology, Rio Hortega University Hospital, Dulzaina Street, 47012 Valladolid, Spain; E-mail: ali_galindo@yahoo.es Received 26 March, 2018 Accepted 17 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cleft Alveolus Reconstruction Using a Three-Dimensional Printed Bioresorbable Scaffold With Human Bone Marrow Cells

Bone tissue engineering technology based on scaffold has been applied for cleft lip and palate treatment. However, clinical applications of patient-specific three-dimensional (3D) scaffolds have rarely been performed. In this study, a clinical case using patient-specific 3D-printed bioresorbable scaffold with bone marrow stromal cells collected from iliac crest in the operating room has been introduced. At 6-month after transplantation, the bone volume of the newly regenerated bone was approximately 45% of the total defect volume. Bone mineral density of the newly regenerated bone was about 75% compared to the surrounding bone. The Hounsfield unit value was higher than that of cancellous maxillary alveolar bone and lower than that of the cortical maxillary alveolar bone. Bone-marrow-derived mesenchymal stem cells-seeded 3D-printed patient-specific polycaprolactone scaffolds offer a promising alternative for alveolar cleft reconstruction and other bony defects. Address correspondence and reprint requests to Ui-Lyong Lee, DDS, MSD, Department of Oral & Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-ku, Seoul 06973, Republic of Korea; E-mail: davidjoy76@gmail.com, Jin-Hyung Shim, PhD, Department of Mechanical Engineering, Korea Polytechnic University, 237 Sangidaehak-ro, Siheung-si, Gyeonggi-do 15073, Republic of Korea; E-mail: happyshim@kpu.ac.kr Received 15 January, 2018 Accepted 20 May, 2018 Geunseon Ahn and Jeong-Seok Lee contributed equally to this work. This work was supported by Priority Research Centers Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1A6A1A03015562). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anthropometric Analysis of the Dental Arches of Five-Year-Old Children With Cleft Lip and Palate

This study aimed to analyze the dimensional alterations of the dental arches of 5-year-old children with cleft lip and palate and to compare these dimensions with children without oral clefts. One hundred twenty children were divided into the following groups: unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), cleft palate (CP), and control (C). A specific software was used to digitize the dental casts and perform the anthropometric analyses through the measurement of transversal linear intercanine and intermolar distances on the maxilla and mandible. The intergroup comparisons of the maxillary dimensions exhibited that the intercanine distances of groups C and UCL were statistically greater than that of groups UCLP and CP. The intermolar distance was significantly smaller in group UCLP than in the other groups. No statistically significant difference occurred in the mandibular intercanine and intermolar distance among groups. The analysis of the superposition of the maxillary over the mandibular transversal distances showed statistically significant differences among groups. This study showed that at 5-year old, the children with cleft involving the palate had more maxillary dimensional alterations than those without cleft palate. Address correspondence and reprint requests to Thais Marchini Oliveira, PhD, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo 17012-901, Brazil; E-mail: marchini@usp.br Received 22 December, 2017 Accepted 3 June, 2018 Sponsorship: FAPESP process: 2015/26695-0. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Audiological Alterations in Cleft Patients

Introduction: Chronic otitis media with effusion (OME) is a recurrent complication, usually found in cleft palate patients. Conductive hearing loss is the result of the Eustachian tube dysfunction caused by the absence of fusion and the altered insertion of the muscles of the secondary palate. It is also the consequence of an ineffective muscular reconstruction after primary cleft palate repair. Methods: This is a cohort study to compare 4 groups of patients born with isolated cleft lip (ICL), unilateral cleft lip/palate (UCLP), bilateral cleft lip/palate (BCLP), and isolated cleft palate (ICP), received in our hospital between June 2015 to September 2017, operated by the same surgeon, using the same surgical technique and protocol. Complete cleft palate repair was performed, in average, at 10 months, and placement of ventilation tubes, if necessary, was made in the same operatory act. After palate repair, primary or secondary hearing loss was checked, joint to the connection with the type of used ventilation tubes, recurrences and complications also were considered. Results: The study sample was integrated by 69 patients, 2 of 11 patients with ICL (18.18%), 30 of 34 patients with UCLP (88.23%), 17 of 19 patients with BCLP (89.47%), and 4 of 5 patients with ICP (80.00%) were diagnosed with OME requiring ventilation tubes at the time of surgery. It can be established that the average hearing loss in patients with diabolos in the postoperative period is 19.4 db and in those patients with T tubes it is 14.2 db, the difference being statistically significant (P 

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Oral Myiasis in a Patient With HIV Manifestations and Neurologic Toxoplasmosis Treated by Ivermectin

Myiasis has been defined as a pathologic condition where dipterous larvae are lodged in mammalian hosts causing an infestation, which feeds on living or dead tissue for at least a certain period inside the host and develops itself as parasites. In humans, the most commonly affected sites are the nose, eyes, skin wounds, sinuses, lungs, ears, gut, gall bladder, vagina, nasal cavities, and rarely the mouth because the oral tissues are rarely exposed to the external environment. The etiology of oral myiasis is usually related to local factors such as poor oral hygiene, periodontal disease and labial incompetence, and systemic factors such as neurologic deficits. Address correspondence and reprint requests to Willian Ricardo Pires, DDS, MSc, Department of Oral and Maxillofacial Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Rua José Bonifácio, 1193, Araçatuba, São Paulo 16015-050, Brazil; E-mail: willian_ricardo_p@hotmail.com Received 11 April, 2017 Accepted 11 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Optimisation of Medical Management of Chronic Rhinosinusitis

Abstract

Purpose of Review

Chronic rhinosinusitis (CRS) is a common condition and can have a significant impact on quality of life for affected patients. The aetiology is poorly understood leading to the use of a variety of medical treatments to manage the condition, some with little evidence to suggest any benefit.

Recent Findings

Over the last 3 years, research has been carried out investigating alternatives and alterations to many of the current treatment options for CRS. Of these, alternative delivery methods for intranasal corticosteroids and immunomodulation with monoclonal antibodies show the most promise to improve medical treatment of CRS.

Summary

CRS can be a difficult to manage condition with multiple treatment options available; however, many of these have a poor evidence base to support their use. When medical management fails, patients can be subjected to debilitating symptoms and repeated endoscopic sinus operations. New treatments which prevent this cycle could revolutionise current management.

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