Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Παρασκευή 27 Ιουλίου 2018

Epidermal growth factor receptor peptide vaccination induces cross-reactive immunity to human EGFR, HER2, and HER3

Abstract

Current treatments for tumors expressing epidermal growth factor receptor (EGFR) include anti-EGFR monoclonal antibodies, often used in conjunction with the standard chemotherapy, radiation therapy, or other EGFR inhibitors. While monoclonal antibody treatment is efficacious in many patients, drawbacks include its high cost of treatment and side effects associated with multiple drug infusions. As an alternative to monoclonal antibody treatments, we have focused on peptide-based vaccination to trigger natural anti-tumor antibodies. Here, we demonstrate that peptides based on a region of the EGFR extracellular domain IV break immune tolerance to EGFR and elicit anti-tumor immunity. Mice immunized with isoforms of EGFR peptide p580–598 generated anti-EGFR antibody and T-cell responses. Iso-aspartyl (iso-Asp)-modified EGFR p580 immune sera inhibit in vitro growth of EGFR overexpressing human A431 tumor cells, as well as promote antibody-dependent cell-mediated cytotoxicity (ADCC). Antibodies induced by Asp and iso-Asp p580 bound homologous regions of the EGFR family members HER2 and HER3. EGFR p580 immune sera also inhibited the growth of the human tumor cell line MDA-MB-453 that expresses HER2 but not EGFR. Asp and iso-Asp EGFR p580 induced antibodies were also able to inhibit the in vivo growth of EGFR-expressing tumors. These data demonstrate that EGFR peptides from a region of the EGFR extracellular domain IV promote anti-tumor immunity, tumor cell killing, and antibodies that are cross reactive with ErbB family members.



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Impact of Hypothyroidism and Heart Failure on Hospitalization Risk

Thyroid, Ahead of Print.


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Effect of Tumor Size and Minimal Extrathyroidal Extension in Patients with Differentiated Thyroid Cancer

Thyroid, Ahead of Print.


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The Association of Reactive Oxygen Species Levels on Noise Induced Hearing Loss of High Risk Workers in Dr. Soetomo General Hospital Surabaya, Indonesia

Abstract

Excessive noise exposure could increase the production of reactive oxygen species in the cochlea, thus causing the risk of noise-induced hearing loss (NIHL). Noise is commonly found in the industrial sites. However, public places like hospital also can have noisy location which risk the workers of NIHL. To analyzed the correlation of reactive oxygen species and hearing impairment to employees at risk in the hospital. Participants were obtained by identifying the employees in hospital from 3813. They were examined for baseline characteristics, hearing loss and reactive oxygen species. Hearing loss was defined as audiometry and tympanometry level. The statistical test that used in this study is Chi square test (p < 0.05). The proportion of participant was 42.43 ± 10.72 years old in women (58.33%) and noise levels at Dr. Soetomo General Hospital was 98.15 ± 8.16 dB in range 85.39–112.90 dB. The prevalence of NIHL was 47.92% (audiometry) and 70.83% (otoacoustic emission). Reactive oxygen species estimated 5.55 ± 4.39 ng/ml. Statistical analysis of reactive oxygen species to audiometry (p = 0.993) and reactive oxygen species to otoacoustic emission (p = 0.647). Increased production of reactive oxygen species that cause hearing loss, but there was no correlation between reactive oxygen species and hearing loss in risk worker at the hospital.



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The Association of Reactive Oxygen Species Levels on Noise Induced Hearing Loss of High Risk Workers in Dr. Soetomo General Hospital Surabaya, Indonesia

Abstract

Excessive noise exposure could increase the production of reactive oxygen species in the cochlea, thus causing the risk of noise-induced hearing loss (NIHL). Noise is commonly found in the industrial sites. However, public places like hospital also can have noisy location which risk the workers of NIHL. To analyzed the correlation of reactive oxygen species and hearing impairment to employees at risk in the hospital. Participants were obtained by identifying the employees in hospital from 3813. They were examined for baseline characteristics, hearing loss and reactive oxygen species. Hearing loss was defined as audiometry and tympanometry level. The statistical test that used in this study is Chi square test (p < 0.05). The proportion of participant was 42.43 ± 10.72 years old in women (58.33%) and noise levels at Dr. Soetomo General Hospital was 98.15 ± 8.16 dB in range 85.39–112.90 dB. The prevalence of NIHL was 47.92% (audiometry) and 70.83% (otoacoustic emission). Reactive oxygen species estimated 5.55 ± 4.39 ng/ml. Statistical analysis of reactive oxygen species to audiometry (p = 0.993) and reactive oxygen species to otoacoustic emission (p = 0.647). Increased production of reactive oxygen species that cause hearing loss, but there was no correlation between reactive oxygen species and hearing loss in risk worker at the hospital.



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Harnessing CRISPR to combat human viral infections

Hendrik de Buhr | Robert Jan Lebbink

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Analysis of stromal mucin in oral epithelial dysplasia & oral squamous cell carcinoma- A histochemical study

Publication date: Available online 27 July 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Ankita Sahni, Shweta Rehani, Priyanka Kardam, Sneha Sethi, Rashmi Kumari, Yulia Mathias

Abstract
Background

Mucins are glycoproteins that act as a selective molecular barrier and its alterations usually accompany the carcinogenesis.

Aim

To evaluate the transition of mucins in the grades of oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) using histochemical stains.

Materials & Method

A total of 66 samples of variable grades of OED and OSCC and each section was stained with PAS, Alcian blue- PAS (AB-PAS) and Aldehyde fuschin – Alcian blue (AF-AB). Mucins pattern and intensity were examined at 5 randomly selected fields on 10x magnification.

Results

1. PAS stain – Predominantly OED and OSCC showed a diffuse pattern with a gradual decrease in intensity in OED and overall a weak intensity in OSCC. 2. AB-PAS stain – Neutral mucins showed gradual increase in its intensity in grades of OED and OSCC with no predominant pattern. The intensity for the acid mucins remains weak in all the grades of OED and OSCC with diffuse distribution, except in higher grades of OED and OSCC. 3. AF- AB stain - For sulphated mucins, in OED a focal and diffuse pattern was observed in OSCC with minimal intensity. The carboxylated mucin was absent in both.

Conclusion

Mucins undergo change in its pattern and intensity in varying grades of OED/OSCC. Although in GIT and other mucosa, the expression of altered mucin is a recognized factor, seldom research has been done in OED and OSCC. Thus, the present study could be the stepping stone in the exploration of mucinous alteration in OED and OSCC.



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Reconstruction with submental flap for aggressive orofacial cancer- an updated series

Publication date: Available online 27 July 2018

Source: American Journal of Otolaryngology

Author(s): Tam-Lin Chow, Wilson W.Y. Kwan, Siu-Chung Fung, Lai-In Ho, Ka-Lai Au

Abstract
Purpose

Submental flap is gaining popularity for head and neck reconstruction. We have reported in 2007 our early experience of using submental flap for aggressive orofacial malignancy. Novel flap design and application is described in this updated series.

Materials and Methods

15 patients who had received submental flap reconstruction after extirpation of newly diagnosed aggressive orofacial lesions were retrieved. The details of the flap harvest was studied for flap size, inclusion of mylohyoid muscle, antegrade versus retrograde blood supply, and compared with our previous series.

Results

The dimension of flap skin paddle was 30cm2 (range 20–72). Retrograde pedicle flow was used in 2(13.3%) patients. Mylohyoid muscle was included in the flap in 6(40%) patients. There was no total flap necrosis while partial flap necrosis occurred in 1 patient(6.7%). There was a significant increase of inclusion of mylohyoid muscle to the flap in this series (p = 0.02). Novel techniques including double-paddled flap skin to resurface full-thickness defect and chimeric osteocutaneous mandible submental flap for maxillary defect were successfully performed.

Conclusions

Submental flap is a viable reconstructive option in selected patients with aggressive orofacial malignancy. The indications are expanding and its technical modification is evolving and resulting in more innovative applications.



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Involvement of orexin in lipid accumulation in the liver

Publication date: Available online 27 July 2018

Source: Journal of Oral Biosciences

Author(s): Ayako Mochizuki, Kiyomi Nakayama, Shiro Nakamura, Masanori Dantsuji, Ryutaro Kamijo, Seiji Shioda, Takeshi Sakurai, Masahiko Ozeki, Tomio Inoue

Abstract
Objectives

Orexin, a hypothalamic neuropeptide, is involved in energy homeostasis and regulates motivated behaviors, including feeding and the awake-sleep cycle. Orexin-knockout (OX-KO) mice exhibit greater weight gain than wild-type (WT) mice, despite similar food intake, suggesting that OX-KO mice may have an altered metabolism for weight gain. However, the actual effects of orexin on the metabolism of mice remain unclear.

Methods

We compared the lipid metabolism of OX-KO and WT mice, with a focus on lipid metabolism in the liver.

Results

The livers of OX-KO mice were significantly larger than those of WT mice and were yellowish in appearance. Oil red O staining revealed that lipid accumulation in the livers of OX-KO mice was higher than that in WT mice. Hepatic triglyceride content in OX-KO mice was higher than that in WT mice. The total cholesterol level in the peripheral blood was higher in OX-KO mice than in WT mice, although no significant differences in free fatty acid and serum triglyceride levels were observed. In comparison with WT mice, OX-KO mice showed higher transcript levels of hepatic lipogenic genes encoding sterol regulatory element binding protein 1 and Cd36 and lower transcript levels of genes encoding fatty acid transporter protein 2/5, peroxisomal proliferator-activated receptor α, STAT-induced suppressor of cytokine signaling 3, and hormone-sensitive lipase. Moreover, tumor necrosis factor (TNF) α mRNA levels in the liver were significantly higher in OX-KO mice than in WT mice.

Conclusions

Orexin likely contributes to the regulation of lipid metabolism in the liver.



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Diagnostic Algorithm for Evaluating Nasal Airway Obstruction

Nasal obstruction is a common symptom and can have a large impact on patient quality of life. There are numerous causes, including anatomic, congenital, inflammatory, infectious, neoplastic, toxic, and systemic. An algorithmic approach can aid in ensuring all pertinent patient information is incorporated into the final diagnosis and treatment plan. Key components include a thorough history, physical examination including modified Cottle and Cottle maneuver, patient-reported outcome measures and/or quality of life questionnaires, examination with and without decongestion, and nasal endoscopy. The resultant information can then be effectively used to narrow the differential and guide the next steps in management.

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Small airway function in children with mild-to-moderate asthmatic symptoms and healthy controls

Background: Clinical significance of small airway obstruction in mild pediatric asthma is unclear.Objective: To evaluate small airway properties in children with mild-tomoderate asthmatic symptoms, and the association of small airway function with asthma control and exercise-induced bronchoconstriction (EIB).Methods: Children (5-10 years) with either recurrent wheezing (n=42) or persistent troublesome cough (n=16), and healthy controls (n=19) performed impulse oscillometry (IOS), spirometry, and multiple-breath nitrogen washout (MBNW) test.

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Management of anaphylaxis and allergies in patients with long QT syndrome - review of current evidence

Long QT syndrome (LQTS) represents a diverse group of inherited and acquired disorders of ventricular repolarization characterized by prolongation of the QT interval associated with an increased risk of life-threatening Torsades de Pointes (TdP) ventricular tachycardias. Symptoms of TdP ventricular tachycardia range from syncope, when TdP stops spontaneously, to cardiac arrest, when TdP deteriorates to ventricular fibrillation. The diagnosis of inherited LQTS (iLQTS) relies on prolonged QT interval in the electrocardiogram (ECG) or prolongation of the heart beat corrected QT interval (QTc) respectively, clinical and family history and/ or genetic testing 1.

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Direct oral amoxicillin challenge without antecedent penicillin skin testing in low-risk patients

Temino et al recently described outcomes of an outpatient penicillin skin testing initiative in an allergy clinic.1 Consistent with other studies, >90% of patients labeled as penicillin (PCN) allergic were found to be tolerant of PCN. This is in accordance with current guidelines encouraging routine PCN allergy verification in all comers with this diagnosis, in view of the substantial clinical and economic consequences of a PCN allergy label.

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Use of Biomarkers to Identify Phenotypes and Endotypes of Severe Asthma

Severe asthma is a complex, heterogeneous set of diseases. The European Respiratory Society and American Thoracic Society Task Force define severe asthma as asthma that requires or remains uncontrolled despite treatment with systemic corticosteroids or high dose inhaled corticosteroids plus another controller such as a long acting beta agonist1. Lack of control can be determined by symptoms, lung function, or exacerbations, accounting for inter-individual variability in disease state and outcomes.

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Small airway function in children with mild-to-moderate asthmatic symptoms and healthy controls

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Hanna Knihtilä, Anne Kotaniemi-Syrjänen, Anna S. Pelkonen, Mika J. Mäkelä, L Pekka Malmberg

Abstract

Background: Clinical significance of small airway obstruction in mild pediatric asthma is unclear.

Objective: To evaluate small airway properties in children with mild-tomoderate asthmatic symptoms, and the association of small airway function with asthma control and exercise-induced bronchoconstriction (EIB).

Methods: Children (5-10 years) with either recurrent wheezing (n=42) or persistent troublesome cough (n=16), and healthy controls (n=19) performed impulse oscillometry (IOS), spirometry, and multiple-breath nitrogen washout (MBNW) test. Exhaled nitric oxide (NO) was measured at multiple flow rates to determine alveolar NO concentration (CALV). Asthma control was evaluated with the Childhood Asthma Control Test (C-ACT), short-acting beta2-agonist (SABA) use within the past month, and asthma exacerbations within the past year.

Results: IOS, spirometry, and exhaled NO indices which are related to small airway function differed between children with recurrent wheezing and healthy controls, whereas only forced expiratory flow at 25-75% of the forced vital capacity (FEF25-75) was associated with persistent cough. MBNW indices showed no difference between the groups. Among symptomatic children, conducting airway ventilation inhomogeneity (Scond) and CALV were associated with asthma exacerbations (p=0.028 and p=0.002, respectively), and lung clearance index (LCI) and CALV were associated with EIB (p=0.044 and p=0.004, respectively). None of the proposed small airway indices was associated with the C-ACT score or SABA use.

Conclusion: Subtle changes were observed in the proposed small airway indices of IOS, spirometry, and exhaled NO among children with mild-tomoderate recurrent wheezing. Small airway dysfunction, expressed as ventilation inhomogeneity indices and CALV, was also associated with asthma exacerbations and EIB.



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The Effects of Maxillary Expansion on Late Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate

Publication date: Available online 27 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Aslıhan Uzel, M. Emre Benlidayı, Mehmet Kürkçü, Erol Kesiktaş

Abstract
Objective

The purpose of this study was to answer the research question of whether maxillary expansion provides enough postgraft stimulation to decrease the volume loss of alveolar bone grafts in patients with cleft lip and palate (CLP) who missed the appropriate treatment time

Methods

This study was designed as a prospective controlled clinical trial. Thirty patients in permanent dentition with unilateral CLP (UCLP) were divided into two groups. In Group I (mean age 19.33±5.16 years), slow maxillary expansion was performed before secondary alveolar bone grafting; in Group II (mean age 19.93±3.99 years), slow maxillary expansions were performed six weeks after secondary alveolar bone grafting (SABG). The iliac crest was preferred as a donor site for autogenous bone graft harvesting. Cone-beam computerized tomography images were taken one week (T1), 6 months (T2) and 12 months (T3) postoperatively. The volume and density of the alveolar bone graft were calculated using Mimics 13.1 software, and SPSS 19.0 was used for statistical analysis.

Results

The bone graft volume loss was significantly higher in Group I than in Group II after 6 months of healing (p=0.003). The increase in bone density was significantly higher in Group II than in Group I after 6 months of healing (p=0.017). Although the mean loss of volume was lower and the mean density of the bone graft was higher in Group II, there was no significant difference between the two groups in terms of mean graft volume and mean bone density 12 months after the operation. The mean bone graft volume loss was 46.3 and 34.6% and the mean increase in bone density was 16 and 49% for Groups I and II, respectively, after 12 months of healing.

Conclusions

Maxillary expansion after late secondary alveolar bone grafting may be taken into consideration as a treatment choice in selected UCLP patients to provide bone graft stimulation.



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Increased Presence of Perineural Invasion At the Tongue and Floor of Mouth; Could It Represent A More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Publication date: Available online 27 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Roderick Y. Kim, Joseph I. Helman, Thomas M. Braun, Brent B. Ward

Abstract
Purpose

Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between perineural invasion, location of tumor, and other known histopathologic characteristics used to define aggressive disease.

Material and Methods

This was a retrospective cohort study of adult subjects with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded subjects whose neck was previously treated with surgery or radiation. Demographic and histopathological variables of interest were obtained from the patient chart. The primary outcome of interest was perineural invasion, and predictors of interest included location of tumor, histopathologic tumor characteristics and cervical lymph node status. For continuous variables, mean differences were compared with a t-test. For categorical variables, the differences in the distribution of the proportions were analyzed with a chi-squared test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at a p-value less than 0.05.

Results

Three hundred and seventy-three subjects met the study criteria. Perineural invasion showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. Perineural invasion was more likely seen in tumors located at the tongue or floor of the mouth. Tumors with PNI had deeper depth of invasion 15.9±10.9mm versus 10.2±10.0 mm (p<0.001). Tumors with PNI had higher mean total number of positive nodes, 2.85±5.23versus 0.83±1.80 (p<0.001).

Conclusions

Perineural invasion is statistically correlated with tongue and floor of the mouth subsites within the oral cavity, as well as, larger tumors, deeper tumors, and disease which has progressed to the lymph nodes. Whether this correlation represents causation in any either direction remains unknown.



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Condyle Fractures: Impact of Surgical and Conservative Approaches on Oral Health

The aim of this study is to assess the impact of oral health on the quality of life of patients who underwent conservative or surgical treatment for mandibular condylar fracture. A retrospective study was conducted, and 24 patients with condylar fracture were selected and underwent surgical or conservative treatment. Oral Health Impact Profile-14 (OHIP-14) was utilized to evaluate the patients. The angles of condylar fracture were measured in panoramic and Towne radiographs using the ImageJ software, and the results were compared to the results of the OHIP-14 questionnaire. Condylar fractures had a negative impact on the patients' quality of life in pretreatment assessment. After conservative and surgical treatments, the condylar fracture had a low impact on the patients' quality of life. Greater fracture alignment was obtained in patients treated by open reduction. A low level of correlation was observed between fracture alignment and changes in OHIP-14 of the patients studied. In conclusion, the study showed a significant improvement in the quality of life in the post-treatment period of the sample assessed. However, in patients selected for this study, no difference was found in the quality of life between the surgically and conservatively treated groups. Address correspondence and reprint requests to Abrahão Cavalcante Gomes de Souza Carvalho, DDS, MSc, Department of Oral Surgery, UNICHRISTUS, João Adolfo Gurgel Street, 133, Cocó, Fortaleza, Ceará 60.192-345, Brazil; E-mail: abrahao_cav@yahoo.com.br Received 8 January, 2018 Accepted 21 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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22q11.2 Deletion: Surgical and Speech Outcomes of Patients With Velopharyngeal Insufficiency Treated With a Superiorly Based Pharyngeal Flap as the Primary Surgery

The most frequent palate diagnoses in patients with chromosome 22q11.2 deletion syndrome are a classic submucous cleft, occult, and velopharyngeal insufficiency without cleft, which generates alterations in speech that require surgery. Surgical protocols are controversial owing to syndrome characteristics that make their handling more complex. Pharyngeal flap pharyngoplasty is effective for this type of patient. The objective of this study is to examine the surgical management of velopharyngeal insufficiency in patients with chromosome 22 deletion, using a pharyngeal flap as the primary surgery. The clinical records of patients with chromosome 22 deletion and velopharyngeal insufficiency between 2015 and 2017 were analyzed retrospectively. Eight patients underwent pharyngeal flap pharyngoplasty as a primary surgery, including 1 with velopharyngeal insufficiency without a cleft, 1 with a classic submucous cleft, and 6 with occult submucous cleft. The pre- and postoperative protocol performed by speech therapists and surgeons included clinical evaluation of the oral cavity; perceptual, video recording, and nasometry speech evaluation; and videonasopharyngoscopy. All perceptual parameters and nasometry results significantly changed. Of the cases, 88% achieved a flap with the expected width and height and complete closure of the velopharyngeal sphincter. One patient required flap revision. Four of the 8 patients achieved normal resonance, and 2 of 8 showed mild hypernasality. Using the pharyngeal flap pharyngoplasty as a primary technique to correct velopharyngeal insufficiency in patients with chromosome 22 deletion provides satisfactory outcomes and decreases the number of surgeries. Preoperative planning must be conducted carefully and needs to be individualized to be successful. Address correspondence and reprint requests to Drina C. Álvarez Carvajal, SLP, PGDip, Alfredo Gantz Mann Foundation, El Lazo 8545, Pudahuel, Santiago, Chile; E-mail: drina.alvarez@gmail.com Received 18 March, 2018 Accepted 24 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Nonsurgical Management of Orbital Dystopia Using Refractive Lenses and Prosthetic Shells

Surgical rehabilitation of orbital dystopia can be challenging. The authors demonstrate the effective use of spectacle lenses to visually correct misalignments of the globe and the orbit. Presented is a retrospective review of 4 patients undergoing aesthetic rehabilitation through use of spectacle lenses and in a number patients a cosmetic shell. Two patients with neurofibromatosis presented with inferior dystopia of the globe and orbit. A base-down prismatic lens applied to the spectacles in conjunction with a prosthetic shell successfully visually corrected the facial asymmetry and improved patients' aesthetic appearance. One patient with a history of traumatic retinal detachment, who did not want any surgical intervention, a "plus" (hypermetropic) lens was used to magnify the perceived image of an enophthalmic and phthisical globe, to enhance appearance and improve symmetry. In the fourth patient, with Goldenhar syndrome, the appearance of a hypotropia and concurrent esotropia was successfully treated with a Fresnel prism and a prosthetic shell. This case series illustrates the successful role of various refractive lenses often in conjunction with prosthetic shells in patients with reduced vision and orbital dystopia to improve facial symmetry. This conservative treatment is especially useful when surgery is not a desired or not considered a suitable option for the patient. Address correspondence and reprint requests to Jonathan H. Norris, MSc, FRCOphth, Oxford Eye Hospital, Headington, Oxford OX3 9DU, UK; E-mail: jonathan.norris@ouh.nhs.uk Received 20 December, 2017 Accepted 2 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Developing an In-house Interdisciplinary Three-Dimensional Service: Challenges, Benefits, and Innovative Health Care Solutions

Three-dimensional printing (3DP) technologies have been employed in regular medical specialties. They span wide scope of uses, from creating 3D medical models to design and manufacture of Patient-specific implants and guidance devices which help to optimize medical treatments, patient education, and medical training. This article aims to provide an in-depth analysis of factors and aspects to consider when planning to setup a 3D service within a hospital serving various medical specialties. It will also describe challenges that might affect 3D service development and sustainability and describe representative cases that highlight some of the innovative approaches that are possible with 3D technology. Several companies can offer such 3DP service. They are often web based, time consuming, and requiring special call conference arrangements. Conversely, the establishment of in-house specialized hospital-based 3D services reduces the risks to personal information, while facilitating the development of local expertise in this technology. The establishment of a 3D facility requires careful consideration of multiple factors to enable the successful integration with existing services. These can be categorized under: planning, developing and sustaining 3D service; 3D service resources and networking workflow; resources and location; and 3D services quality and regulation management. Address correspondence and reprint requests to Muhanad M. Hatamleh, MSc, PhD, Clinical Scientist, King's College Hospital NHS Foundation Trust SE59RS; 3D Facility Service Manager, Great Ormond Street Hospital for Children WC1N 3JH, London, UK; Department of Allied Medical Sciences, Luminus Technical University College, Amman, Jordan; E-mail: Muhanad.hatamleh@gmail.com Received 25 March, 2018 Accepted 16 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Individualized Treatment for Infantile Hemangioma

Infantile hemangioma can grow dramatically or typically locate on the face, which may lead to functional impairment, cosmetically disfiguring and exhibiting complications such as ulceration, bleeding, or infection. Early intervention is necessary. In this study, the authors chose individual treatment for different patients. From January 2012 to December 2016, 185 patients with hemangioma were enrolled into this study. Lesion area ranged from 0.5 cm × 0.5 cm to 9 cm × 12 cm. The initial treatment age ranged from 1 to 7 months with an average age of 3.9 months. Thirty-five children achieved the treatment of Intralesional Compound Betamethasone, 134 children achieved the treatment of oral propranolol, and 16 children achieved the treatment of topical carteolol. In the follow-up, the treatment could be repeated or switched to oral propranolol if the tumor tended to grow again. At the end of follow-up, 89% of the patients' tumors shrinked or involuted completely, 5 patients switched to oral propranolol. The adverse effects included soft tissue atrophy, moon face, diarrhea, heart rate reduction, and liver enzyme abnormalities. All of the patients recovered in a short period. Early treatment for hemangioma can achieve good results and avoid functional impairment. For different patients, the authors suggest individualized treatment according to the tumors' size and location. Address correspondence and reprint requests to Si-Ming Yuan, MD, Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China; E-mail: yuansm@163.com Received 27 March, 2018 Accepted 17 May, 2018 M-nX and MZ are co-first authors. This work was supported by National Natural Science Foundation of China (No. 81272989, awarded to Dr. Si-Ming Yuan). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Introduction of Meglumine Diatrizoate into the Middle Cranial Fossa: A Rare Fatal Complication of Temporomandibular Joint Arthrography

The authors here report a rare fatal complication of temporomandibular joint (TMJ) arthrography. A 57-year-old woman suddenly exhibited spasm and dizziness during TMJ arthrography. A multislice CT scanning of head demonstrated a defect in the roof of the glenoid fossa and unanticipated introduction of meglumine diatrizoate into the middle cranial fossa, which should account for neurotoxic symptoms of the patient and could be fatal if not appropriately treated in time. As TMJ puncture is widely performed in clinical practice and generally considered a safe technique, this case might serve as a reminder of the potential risk of the anatomical variation—a defect in the roof of the glenoid fossa—to TMJ clinical practitioners. Address correspondence and reprint requests to Yong Cheng, PhD, DDS and Bo Li, PhD, DDS, School and Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei 430079, PR China; E-mail: wb003142@whu.edu.cn (Yong Cheng); libocn@whu.edu.cn (Bo Li). Received 5 April, 2018 Accepted 21 May, 2018 YC and BL are co-corresponding authors in this paper. This study was supported by the Fundamental Research Funds for the Central Universities (Grant No. 2042016kf0071) and the National Natural Science Foundation of China (Grant No. 81570995). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Pitfalls in Carotid Endarterectomy: A New Step-By-Step Approach

Carotid endarterectomy (CEA) is a surgical intervention that may prevent stroke in asymptomatic and symptomatic patients. Our aim was to examine the microsurgical anatomy of carotid artery and other related neurovascular structures to summarize the CEA that is currently applied in ideal conditions. The upper necks of 2 adult cadavers (4 sides) were dissected using ×3 to ×40 magnification. The common carotid artery, external carotid artery (ECA), and internal carotid artery were exposed and examined. The surgical steps of CEA were described using 3-D cadaveric photos and computed tomography angiographic pictures obtained with help of OsiriX imaging software program. Segregating certain neurovascular and muscular structures in the course of CEA significantly increased the exposure. The division of facial vein allowed for internal jugular vein to be mobilized more laterally and dividing the posterior belly of digastric muscle resulted in an additional dorsal exposure of almost 2 cm. Isolating the ansa cervicalis that pulls hypoglossal nerve inferiorly allowed hypoglossal nerve to be released safely medially. The locations of the ECA branches alter depending on their anatomical variations. The hypoglossal nerve, glossopharyngeal nerve, and accessory nerve pierce the fascia of the upper part of the carotid sheath and they are vulnerable to injury because of their distinct courses along the surgical route. Surgical exposure in CEA requires meticulous dissection and detailed knowledge of microsurgical anatomy of the neck region to avoid neurovascular injuries and to determine the necessary surgical maneuvers in cases with neurovascular variations. Address correspondence and reprint requests to Emine Seyma Denli Yalvac, MD, Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Medeniyet University, Kadiköy, Istanbul 34722, Turkey; E-mail: seyma.denli@hotmail.com Received 5 April, 2018 Accepted 21 May, 2018 The authors report no conflicts of interests. © 2018 by Mutaz B. Habal, MD.

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The Modified Socket-Shield Technique

No abstract available

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Orbital Emphysema: A Rare Postoperative Complication

Orbital emphysema can be a rare and severe postoperative complication. Fast and critical diagnosis is essential to avoid permanent visual loss to the patient. Therefore, a case of a male patient victim of a motorcycle accident with a postoperative complication of orbital emphysema has been presented. The immediate diagnosis and treatment of the orbital emphysema revealed to be the main success factors for the resolution of this complication. Address correspondence and reprint requests to Breno dos Reis Fernandes, DDS, Department of Surgery and Integrated Clinic, Araçatuba School of Denstistry, São Paulo State University (UNESP), Araçatuba 16015-050, Brazil; E-mail: brenofernandesctbmf@hotmail.com Received 20 April, 2018 Accepted 21 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Modification, Refinement, and Transformation of Craniofacial Surgery in Japan

No abstract available

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Reconstruction of Contracted Eye Socket With Autogenic Dermal Sphere Connected to Epidermis

Background: Because of the deficiency of blood circulation and soft tissue, reconstruction of the eye socket for severe conjunctival sac stenosis in anophthalmic patients is very difficult. In this article, the authors report an innovative technique for conducting a 1-stage operation to reconstruct the contracted eye socket with an autogenic dermal sphere connected to the epidermis (ADSE). Methods: Five patients, each having a single severely contracted eye socket and conjunctival sac, were included in this study. An ADSE was transplanted into the contracted eye socket and conjunctival sac. After the operation, several observation indexes were evaluated, such as the survival and stability of implanted autologous tissue, the improvement of the contracted eye socket, and the degree of patients' satisfaction with their appearance. Results: All of the implanted epidermal and dermal tissues survived well after 6 months' observation. Although somewhat absorbed, the transplanted dermal ball was plump in the eye socket, and the epithelial tissues merged well with the residual conjunctival epithelium. Moreover, the transplanted epidermis assumed a mucosal appearance in 4 of 5 patients. After reconstruction of the eye socket, the size of the conjunctival sac and depth of the eye socket were corrected sufficiently for patients to wear an ocular prosthesis. Conclusions: The implantation of an ADSE can reconstruct a severely contracted eye socket in anophthalmic patients. Because of the high survival rate and limited absorption ratio, this 1-stage operation satisfied both patients and their ophthalmologists. Address correspondence and reprint requests to Yuanyuan Du, MD, Mylike Medical Cosmetic Hospital, Shanghai, China; E-mail: 18686623812@163.com Received 13 June, 2017 Accepted 10 November, 2017 This work was supported by the Key Projects of Science and Technology Development Plan of Jilin Province (Grant No 20150414032GH). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomical basis for simultaneous block of greater and third occipital nerves, with an ultrasound-guided technique

Abstract

Purpose

In some headache disorders, for which the greater occipital nerve block is partly effective, the third occipital nerve is also suggested to be involved. We aimed to establish a simple technique for simultaneously blocking the greater and third occipital nerves.

Methods

We performed a detailed examination of dorsal neck anatomy in 33 formalin-fixed cadavers, and deduced two candidate target points for blocking both the greater and third occipital nerves. These target points were tested on three Thiel-fixed cadavers. We performed ultrasound-guided dye injections into these points, examined the results by dissection, and selected the most suitable injection point. Finally, this target point was tested in three healthy volunteers. We injected 4 ml of local anesthetic and 1 ml of radiopaque material at the selected point, guided with a standard ultrasound system. Then, the pattern of local anesthetic distribution was imaged with computed tomography.

Results

We deduced that the most suitable injection point was the medial head of the semispinalis capitis muscle at the C1 level of the cervical vertebra. Both nerves entered this muscle, in close proximity, with little individual variation. In healthy volunteers, an anesthetic injected was confined to the muscle and induced anesthesia in the skin areas innervated by both nerves.

Conclusions

The medial head of the semispinalis capitis muscle is a suitable landmark for blocking the greater and third occipital nerves simultaneously, by which occipital nerve involvement in various headache disorders may be rapidly examined and treated.



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The history and progress of local anesthesia: multiple approaches to elongate the action

Abstract

Analgesia and temporary inhibition of motor activity without interfering with central nervous function have been the essential merits of local anesthesia. Local anesthetics originated from cocaine have played a major role in local analgesia. However, the relatively short duration of action of local anesthetics has been a concern in intra- and post-operative analgesia. From the early age of modern local anesthesia, physicians and medical scientists had been struggling to control the active duration of local anesthetics. Such approach includes: development of long-acting local anesthetics, with physical tourniquet techniques, co-administration of other medicines such as vaso-constrictive agents or analgesics, development of mechanical devices to continuously or intermittently administer local anesthetics, and utilization of pharmaceutical drug delivery systems. In this review, the historical sequence of studies that have been performed in an effort to elongate the action of local anesthetics is presented, referring to epoch-making medical and scientific studies.



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Preface to the Special issue for the 27th International complement workshop

Publication date: Available online 27 July 2018

Source: Molecular Immunology

Author(s): Andrea J. Tenner, John P. Atkinson, V. Michael Holers



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Hyperhidrosis: Five Things to Know

Public awareness of this medical condition is driving many patients out of the woodwork and into their provider's offices. Be ready to discuss the treatment options.
Medscape Dermatology

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Thyroid® High-Impact Articles

thyroid-cover-july-2018.png

FREE ACCESS through August 9, 2018.
Read now:

Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association®

American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults
Lisa A. Orloff, Sam M. Wiseman, Victor J. Bernet, Thomas J. FaheyIII, Ashok R. Shaha, Maisie L. Shindo, Samuel K. Snyder, Brendan C. StackJr., John B. Sunwoo, and Marilene B. Wang

Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory
Robert L. Schmidt, Jonathan S. LoPresti, Michael T. McDermott, Suzanna M. Zick, and Joely A. Straseski

Needle Biopsy of Routine Thyroid Nodules Should Be Performed Using a Capillary Action Technique with 24- to 27-Gauge Needles: A Systematic Review and Meta-Analysis
William J. Moss, Andrey Finegersh, John Pang, Joseph A. Califano, Charles S. Coffey, Ryan K. Orosco, and Kevin T. Brumund

Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation
Antonio Matrone, Francesco Latrofa, Liborio Torregrossa, Paolo Piaggi, Carla Gambale, Alessio Faranda, Debora Ricci, Laura Agate, Eleonora Molinaro, Fulvio Basolo, Paolo Vitti, and Rossella Elisei

Neoadjuvant BRAF- and Immune-Directed Therapy for Anaplastic Thyroid Carcinoma
Maria E. Cabanillas, Renata Ferrarotto, Adam S. Garden, Salmaan Ahmed, Naifa L. Busaidy, Ramona Dadu, Michelle D. Williams, Heath Skinner, G. Brandon Gunn, Horiana Grosu, Priyanka Iyer, Marie Claude Hofmann, and Mark Zafereo

The post <i>Thyroid<sup>®</sup></i> High-Impact Articles appeared first on American Thyroid Association.



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Accuracy of identifying the cricothyroid membrane in children using palpation

Abstract

Accurate identification of the cricothyroid membrane (CTM) has paramount importance in the event of a 'cannot intubate, cannot oxygenate' scenario. We sought to determine the ability of anesthesiologists to correctly identify the CTM in obese and non-obese children. Anesthesiologists were asked to mark the entry point of the cricothyroidotomy device with an ultraviolet invisible pen on obese and non-obese (BMI < 95th percentile for age and sex) children aged 7–12 years. A correct estimation was defined as a mark made between the upper and lower borders of the CTM and within the 3-mm midline. Twenty anesthesiologists palpated 30 obese and 50 non-obese children. The CTM was accurately identified with digital palpation in a total 55% of children, and there were no differences inaccurate identification rates of the CTM between obese and non-obese children [57 vs. 54%, respectively; median difference 3%; 95% confidence interval (− 20 to 25%); p = 0.82]. Accuracy was not correlated with any demographic or morphometric features of the children. Percutaneous identification of the CTM in children aged 7–12 years was poor and not significantly different for obese and non-obese children. Pre-procedural ultrasonography may help to identify the landmarks for cricothyroidotomy.



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Opioids, gliosis and central immunomodulation

Abstract

Neuropathic pain is a common health problem that affects millions of people worldwide. Despite being studied extensively, the cellular and molecular events underlying the central immunomodulation and the pathophysiology of neuropathic pain is still controversial. The idea that 'glial cells are merely housekeepers' is incorrect and with respect to initiation and maintenance of neuropathic pain, microglia and astrocytes have important roles to play. Glial cells differentially express opioid receptors and are thought to be functionally modulated by the activation of these receptors. In this review, we discuss evidence for glia-opioid modulation of pain by focusing on the pattern of astrocyte and microglial activation throughout the progress of nerve injury/neuropathic pain. Activation of astrocytes and microglia is a key step in central immunomodulation in terms of releasing pro-inflammatory markers and propagation of a 'central immune response'. Inhibition of astrocytes before and after induction of neuropathic pain has been found to prevent and reverse neuropathic pain, respectively. Moreover, microglial inhibitors have been found to prevent (but not to reverse) neuropathic pain. As they are expressed by glia, opioid receptors are expected to have a role to play in neuropathic pain.



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Management of anaphylaxis and allergies in patients with long QT syndrome - review of current evidence

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tatjana Welzel, Victoria C. Ziesenitz, Stefanie Seitz, Birgit Donner, Johannes N. van den Anker



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Direct oral amoxicillin challenge without antecedent penicillin skin testing in low-risk patients

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Merin Kuruvilla, Jamie Thomas



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Use of Biomarkers to Identify Phenotypes and Endotypes of Severe Asthma

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tara F Carr, Monica Kraft



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SHR-1210 in Combination With Apatinib and Chemotherapy in Patients With Advanced Esophageal Squamous Cell Cancer

Condition:   Esophageal Squamous Cell Carcinoma
Interventions:   Drug: SHR-1210;   Drug: Apatinib;   Drug: Irinotecan Injection;   Drug: Paclitaxel liposome;   Drug: Nedaplatin
Sponsor:   Chinese Academy of Medical Sciences
Not yet recruiting

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SUV Accuracy of PET/MR

Condition:   Positron Emission Tomography-Magnetic Resonance (PET-MR)
Interventions:   Diagnostic Test: Positron Emission Test / Magnetic Resonance (PET/MR);   Diagnostic Test: Positron Emission Test / Computed Tomography (PET/CT)
Sponsors:   Case Comprehensive Cancer Center;   National Institutes of Health (NIH)
Not yet recruiting

https://ift.tt/2LTH7f0

A Comparison of NETSPOT Imaging Versus F-FDG-PET in Head and Neck Cancer Patients

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: The isotope 68Ga, NETSPOT and 18F-FDG-PET/CT
Sponsor:   West Virginia University
Not yet recruiting

https://ift.tt/2uUoJMF

Pembrolizumab in Treating Participants With Leukoplakia

Conditions:   Erythroleukoplakia;   Leukoplakia;   Verrucous Oral Leukoplakia
Intervention:   Biological: Pembrolizumab
Sponsors:   Jonsson Comprehensive Cancer Center;   National Cancer Institute (NCI);   Merck Sharp & Dohme Corp.
Not yet recruiting

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Evaluation of HPV OncoTect ™ for the Etiological Diagnosis of HPV-induced Oropharyngeal Cancers

Condition:   Oropharyngeal Cancer
Intervention:   Diagnostic Test: HPV OncoTect™
Sponsor:   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting

https://ift.tt/2LGZTt2

Pilonidal disease, hidradenitis suppurativa and follicular occlusion syndrome: a diagnostic challenge

L'articolo Pilonidal disease, hidradenitis suppurativa and follicular occlusion syndrome: a diagnostic challenge sembra essere il primo su European Review.



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Underestimation of house dust mite-specific IgE with extract-based ImmunoCAPs compared to molecular ImmunoCAPs

Publication date: Available online 27 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Huey-Jy Huang, Yvonne Resch-Marat, Azahara Rodriguez-Dominguez, Kuan-Wei Chen, Renata Kiss, Petra Zieglmayer, René Zieglmayer, DI, Patrick Lemell, Friedrich Horak, Rudolf Valenta, Susanne Vrtala

Summary

We identified 6 house dust mite (HDM) allergen molecules to comprising the majority of HDM IgE-binding components and show that molecular ImmunoCAPs based on these six allergens are superior to allergen extract-based ImmunoCAPs for quantifying HDM-specific IgE.



https://ift.tt/2mKD5dI

Expression of Corticosteroid Regulated Genes By Peripheral Blood Mononuclear Cells in Children with Asthma

Publication date: Available online 27 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Elena Goleva, Denise C. Babineau, Michelle A. Gill, Leisa P. Jackson, Baomei Shao, Zheng Hu, Andrew H. Liu, Cynthia M. Visness, Christine A. Sorkness, Donald Y.M. Leung, Alkis Togias, William W. Busse

Abstract
Background

Variability in response to inhaled corticosteroids may result in less than optimal asthma control and development of biomarkers assessing therapeutic efficacy of corticosteroids is important.

Objective

To examine whether in vitro peripheral blood mononuclear cell (PBMC) responses to corticosteroids relate to the clinical inhaled corticosteroid response.

Methods

PBMC were collected from 125 children with asthma (6-17 years) at enrollment (Visit 0, V0) and after one year of bimonthly guidelines-based management visits (Visit 6, V6). Difficult- versus easy-to-control asthma were defined as requiring daily therapy with ≥500 μg of fluticasone propionate (FLU) with/without a long-acting beta-agonist versus requiring ≤100 μg of FLU in at least 4 visits. mRNA levels of glucocorticoid receptor alpha (GRalpha), corticosteroid transactivation (FK binding protein 5 (FKBP5)) and transrepression markers (IL-8, TNFalpha) were measured by RT-PCR in freshly isolated cells and in response to 10-8 M FLU.

Results

Compared to easy-to-control, PBMC of difficult-to-control asthma had significantly lower GRalpha at V0 (p=0.05). A 30% increase in IL-8 suppression by FLU (p=0.04) and a trend for increased TNFalpha suppression by FLU between V0 and V6 (p=0.07) were observed in easy-to-control asthma. In contrast, no changes between V0 and V6 in the IL-8 and TNFalpha suppression by FLU were observed in difficult-to-control asthma. Corticosteroid-mediated transactivation (FKBP5 induction by FLU) increased in the PBMC of difficult- and easy-to-control asthma between V0 and V6 (p=0.05 and p=0.03 respectively).

Conclusions

PBMC of children with difficult-to-control asthma treated with guidelines-based therapy and requiring high dose inhaled corticosteroids had reduced in vitro responsiveness to corticosteroids.



https://ift.tt/2Ac83oY

A Single-Arm, Open-Label, Phase IV Study to Evaluate the Efficacy of a Topical Formulation for Hyperkeratotic Actinic Keratosis Lesions

Abstract

Introduction

Actinic keratosis (AKs) are epidermal lesions that commonly occur in skin exposed to chronic cumulative UV irradiation. Untreated AK lesions can advance to squamous cell carcinoma. Current treatments of AK have many shortcomings; for instance, not all treatments can be used for the hyperkeratotic form of AK. The aim of this study was to test the efficacy and tolerability of a topical product containing 2,4,6-octatrienoic acid and urea for the treatment of hyperkeratotic AK lesions.

Methods

Forty male and female subjects with at least two hyperkeratotic AK lesions were enrolled in this single-arm, open-label phase IV study. The product was applied twice daily for two consecutive months. The efficacy endpoints were the reductions in the mean number of AK lesions per subject from baseline (T0) to the end of the trial (T1) and to three months after the end of the treatment period (T2).

Results

At T0, the mean (SD) number of lesions per subject was 3.65 (1.25). At the end of the treatment period (T1), this number had dropped (significantly, p < 0.0001) by 83.56%. The mean number of lesions per subject then decreased by 41.47% (p < 0.0001) between T1 and the three-month follow-up visit (T2). Complete elimination of lesions had occurred in 57.5% of the subjects at T1, and 82.5% (55% who had remained completely clear of lesions since T1, and 27.5% who had fully eliminated their lesions during the period from T1 to T2) at T2. No side effects were reported.

Conclusion

The application of a topical combination of 2,4,6-octatrienoic acid and urea twice daily for 60 consecutive days is a safe and effective treatment for hyperkeratotic AK lesions.

Funding

Giuliani SpA.



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Editorial Board w/barcode



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Table of Contents



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Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor

Publication date: Available online 27 July 2018

Source: American Journal of Otolaryngology

Author(s): Zheng-Cai Lou, Wei Hong, Zihan-Lou

Abstract
Objective

The use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF.

Design and participants

This was a retrospective cohort study of 95 TMPs who were observed for at least 6 months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses.

Interventions

Each traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time.

Results

A total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6 months, and the mean closure time was 10.5 ± 4.8 days. The closure rate was not significantly different according to the duration of perforation ≤3 days and >3 days (P = 0.816). However, the mean closure time was significantly different according to the duration of perforation (P < 0.001). The perforation size did not affect the closure rate (P = 0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P = 0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P = 0.001). Multivariate logistic regression analyses showed that the duration of perforation (P = 0.011), size of perforation (P < 0.001), and involvement of the malleus in perforation (P = 0.005) were factors independently correlated with closure time.

Conclusions

Daily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time.



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Stimulation bei Schlafapnoe

Zusammenfassung

Zur Behandlung der obstruktiven Schlafapnoe (OSA) wird primär die Positivdrucktherapie eingesetzt. Aufgrund von Nebenwirkungen ist die Therapieadhärenz jedoch limitiert, daher ist eine erhebliche Anzahl an Patienten nicht oder nicht ausreichend behandelt. Aufgrund häufig auftretender Folgeerkrankungen, wie arterielle Hypertonie, koronare Herzkrankheit oder Diabetes mellitus, sowie der Folgen von regelmäßig auftretender Tagesschläfrigkeit ist eine Therapie der OSA dringend erforderlich. Neben der Unterkieferprotrusionsschiene oder Lagerungshilfen zur Verhinderung der Rückenlage stehen chirurgische Verfahren als Alternativtherapien zur Verfügung. Als weiteres Verfahren wird seit einigen Jahren die Hypoglossusnervstimulation bei ausgewählten Patienten eingesetzt. Hierbei handelt es sich um ein funktionell chirurgisches Verfahren, bei dem durch Stimulation des N. hypoglossus eine Aktivierung der Muskulatur des oberen Atemwegs erreicht wird.



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High-grade glioma associated immunosuppression does not prevent immune responses induced by therapeutic vaccines in combination with T reg depletion

Abstract

High-grade gliomas (HGG) exert systemic immunosuppression, which is of particular importance as immunotherapeutic strategies such as therapeutic vaccines are increasingly used to treat HGGs. In a first cohort of 61 HGG patients we evaluated a panel of 30 hematological and 34 plasma biomarkers. Then, we investigated in a second cohort of 11 relapsed HGG patients receiving immunomodulation with metronomic cyclophosphamide upfront to a DC-based vaccine whether immune abnormalities persisted and whether they hampered induction of IFNγ+ T-cell responses. HGG patients from the first cohort showed increased numbers of leukocytes, neutrophils and MDSCs and in parallel reduced numbers of CD4+/CD8+ T-cells, plasmacytoid and conventional DC2s. MDSCs and T-cell alterations were more profound in WHO IV° glioma patients. Moreover, levels of MDSCs and epidermal growth factor were negatively associated with survival. Serum levels of IL-2, IL-4, IL-5 and IL-10 were altered in HGG patients, however, without any impact on clinical outcome. In the immunotherapy cohort, 6-month overall survival was 100%. Metronomic cyclophosphamide led to > 40% reduction of regulatory T cells (Treg). In parallel to Treg-depletion, MDSCs and DC subsets became indistinguishable from healthy controls, whereas T-lymphopenia persisted. Despite low T-cells, IFNγ-responses could be induced in 9/10 analyzed cases. Importantly, frequency of CD8+VLA-4+ T-cells with CNS-homing properties, but not of CD4+ VLA-4+ T-cells, increased during vaccination. Our study identifies several features of systemic immunosuppression in HGGs. Metronomic cyclophosphamide in combination with an active immunization alleviates the latter and the combined treatment allows induction of a high rate of anti-glioma immune responses.



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A Comprehensive Study of Oxidative Stress in Tinnitus Patients

Abstract

Oxidative stress is considered to be one of the molecular changes that are the underlying causes of tinnitus. The aim of this study was to investigate the dynamic thiol/disulphide homeostasis as a new oxidative stress parameter in tinnitus patients as well as to investigate the lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) parameters and compare the results with the results of the healthy control group. A prospective controlled trial was performed on tinnitus patients in Harran University hospital. A total of 70 subjects, including 35 tinnitus patients and 35 healthy individuals participated in this study. Their total thiol, native thiol levels and LOOH, TAS, TOS levels were measured in plasma of all tinnitus patients and healthy volunteers participants. TOS and OSI levels were significantly increased, and TAS levels were significantly lower in the patient groups compared with the control group (p < 0.01). Native thiol levels and Native thiol/total thiol ratios were significantly lower in the tinnitus group compared to the control group (p < 0.01). Disulphide level and disulphide/native thiol and disulphide/total thiol ratios were significantly higher in the patients (p < 0.01). Also, LOOH ratios were significantly higher in the tinnitus group (p < 0.01). The results of this study reveal that in tinnitus cases, the oxidative stress and antioxidant enzyme imbalance were more significant than in healthy control group. The nature of the relationship between oxidative stress and tinnitus should be clarified with larger studies.



https://ift.tt/2JZ9zdu

Cutis laxa autosomique récessive : de nouveaux gènes identifiés

Publication date: Available online 26 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure



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Multiple capillary malformations of progressive onset: Capillary malformation–arteriovenous malformation syndrome (CM-AVM)

Publication date: Available online 26 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): G. Gourier, S. Audebert-Bellanger, P. Vourc'h, S. Fraitag, K. L'Hérondelle, A. Labouche, L. Misery, C. Abasq-Thomas

Summary
Background

Capillary malformation–arteriovenous malformation syndrome (CM-AVM) is an autosomal dominant disorder first described in 2003.

Patients and methods

An 8-year-old girl was referred for the progressive appearance of multiple capillary malformations in childhood, evocative of CM-AVM syndrome. Molecular analysis of the RASA1 gene revealed a mutation but further examinations did not show arteriovenous malformation.

Discussion

CM-AVM syndrome is an autosomal dominant disease caused by RASA1 gene mutations. More than 100 mutations have been identified to date. The EPHB4 gene may also be involved. Capillary malformations with particular characteristics are described. High-flow vascular malformations are associated in 18.5% of cases, with 7.1% being intracerebral.

Conclusion

CM-AVM syndrome is a recent diagnostic entity. Diagnosis should be considered in the presence of multifocal capillary malformations. This diagnosis may lead to the detection of high-flow arteriovenous malformation and raises the question of specific management for these patients.

Résumé
Introduction

Le syndrome malformations capillaires–malformation artérioveineuse (MC-MAV) a été décrit pour la première fois en 2003. Nous rapportons le cas d'une patiente ayant une présentation clinique caractéristique de ce syndrome.

Observation

Une fille de 8 ans nous était adressée en consultation pour l'apparition progressive d'une quinzaine d'angiomes plans au cours de l'enfance. Un syndrome MC-MAV de forme sporadique était évoqué devant l'aspect particulier de ces malformations capillaires. Cette hypothèse était confirmée par la mise en évidence d'une mutation du gène RASA1 à l'analyse génétique. Les explorations complémentaires ne mettaient pas en évidence de malformations artérioveineuses.

Discussion

Le syndrome MC-MAV résulte d'une mutation du gène RASA1, dont plus d'une centaine de mutations différentes ont été identifiées à ce jour. Plus récemment, des mutations du gène EPHB4 ont également été identifiées. Ce syndrome se manifeste chez 90 % des patients par des malformations capillaires multiples de petite taille, roses ou brunes, parfois entourées d'un halo blanc. Elles sont associées dans 18,5 % des cas à des malformations vasculaires à haut débit, dont 7,1 % sont intracérébrales.

Conclusion

Le syndrome MC-MAV est un syndrome récemment découvert, lié à des mutations hétérozygotes des gènes RASA1 ou EPHB4. Il doit être évoqué devant des malformations capillaires multifocales d'apparition progressive. Ce diagnostic peut conduire au dépistage d'une malformation artérioveineuse à flux rapide et soulève la question du suivi à proposer à ces patients.



https://ift.tt/2mOKSaE

A Comprehensive Study of Oxidative Stress in Tinnitus Patients

Abstract

Oxidative stress is considered to be one of the molecular changes that are the underlying causes of tinnitus. The aim of this study was to investigate the dynamic thiol/disulphide homeostasis as a new oxidative stress parameter in tinnitus patients as well as to investigate the lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) parameters and compare the results with the results of the healthy control group. A prospective controlled trial was performed on tinnitus patients in Harran University hospital. A total of 70 subjects, including 35 tinnitus patients and 35 healthy individuals participated in this study. Their total thiol, native thiol levels and LOOH, TAS, TOS levels were measured in plasma of all tinnitus patients and healthy volunteers participants. TOS and OSI levels were significantly increased, and TAS levels were significantly lower in the patient groups compared with the control group (p < 0.01). Native thiol levels and Native thiol/total thiol ratios were significantly lower in the tinnitus group compared to the control group (p < 0.01). Disulphide level and disulphide/native thiol and disulphide/total thiol ratios were significantly higher in the patients (p < 0.01). Also, LOOH ratios were significantly higher in the tinnitus group (p < 0.01). The results of this study reveal that in tinnitus cases, the oxidative stress and antioxidant enzyme imbalance were more significant than in healthy control group. The nature of the relationship between oxidative stress and tinnitus should be clarified with larger studies.



https://ift.tt/2JZ9zdu

Incidence of peri-operative paediatric cardiac arrest: Influence of a specialised paediatric anaesthesia team

BACKGROUND Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN Retrospective cohort study with before-and-after analysis. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. PATIENTS A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016. INTERVENTION Implementation of a specialised paediatric anaesthesia team and training programme occurred in 2014 This included hands-on supervised training in all fields of paediatric anaesthesia, double staffing for critical paediatric cases and a 24/7 emergency team. A logistic regression analysis with risk factors (age, ASA physical status, emergency) was used to evaluate the impact of implementation of the specialised paediatric anaesthesia team. MAIN OUTCOME MEASURES Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention. RESULTS Twelve of 25 paediatric cardiac arrests were classified as anaesthesia-attributable. The incidence of overall peri-operative paediatric cardiac arrest was 8.1/10 000 (95% CI 5.2 to 12.7) in the period 2008 to 2013 and decreased to 4.6/10 000 (95% CI 2.1 to 10.2) in 2014 to 2016. Likewise, the incidence of anaesthesia-attributable cardiac arrest was lower after 2013 [1.6/10 000 (95% CI 0.3 to 5.7) vs. 4.3/10 000 (95% CI 2.3 to 7.9)]. Using logistic regression, children anaesthetised after 2013 had nearly a 70% lower probability of anaesthesia-attributable cardiac arrest (odds ratio 0.306, 95% CI 0.067 to 1.397; P = 0.1263). For anaesthesia-attributable cardiac arrest, young age was the most contributory risk factor, whereas in overall paediatric cardiac arrest, ASA physical statuses 3 to 5 played a more important role. CONCLUSION In this study on incidences of peri-operative paediatric cardiac arrest from a European tertiary care university hospital, implementation of a specialised paediatric anaesthesia team and training programme was associated with lower incidences of peri-operative paediatric cardiac arrest and a reduced probability of anaesthesia-attributable cardiac arrest. Correspondence to Dr Andreas Hohn, MHBA, DESA, EDIC, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany Tel: +49 221 478 82058; fax: +49 221 478 85574; e-mail: andreas.hohn@uk-koeln.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Selecting the Right Biologic for Your Patients with Severe Asthma

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Laurie A. Manka, Michael E. Wechsler

Abstract
Objective

Severe asthma affects 5-10% of the adult asthma population and is associated with increased morbidity, mortality, and consumption of health care resources. Recently, several biologic medications have been approved for use in severe asthma. These medications target the type-2 inflammatory pathway, which is characterized by activation of cytokines including interleukin (IL)-4, IL-5 and IL-13, which results in eosinophilia, high fractional exhaled nitric oxide (FeNO) and atopic features. The objective of this review is to provide clinicians with key points to assist in selecting the best biologic medication for each patient.

Data Sources

A comprehensive literature search was performed, and data were reviewed from basic science articles of inflammatory mediators in type-2 airway inflammation, and clinical trials of biologic medications in patients with severe asthma.

Study Selections

These studies analyzed outcomes of biologic medications in type 2-high severe asthma including clinical biomarkers, exacerbation rates, lung function, and quality of life measures.

Results

Biologic mediations in type 2-high severe asthma improve outcomes including clinical biomarkers, exacerbation rates, lung function, and quality of life measures.

Conclusion

When choosing a biologic medication for patients with severe asthma, asthma endotype, clinical biomarkers, and patient-centered factors should be taken into account.



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Severe Asthma With Eosinophilic Gastroenteritis Effectively Managed by Mepolizumab and Omalizumab

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Duhyun Han, Jason K. Lee



https://ift.tt/2LttzKM

Long-Term Prophylaxis Therapy in Patients with Hereditary Angioedema with C1 Inhibitor Deficiency

Publication date: Available online 27 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Timothy Craig, Paula Busse, Richard G. Gower, Douglas T. Johnston, Jay M. Kashkin, Huamin H. Li, William R. Lumry, Marc A. Riedl, Daniel Soteres



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Phenotypes, endotypes and biomarkers in anaphylaxis: current insights

Purpose of review The aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions. Recent findings Different anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions. Underlying mechanisms differ and biomarkers of cells and systems involved are being identified (tryptase, IL-6, bradykinin etc.) Summary Identifying specific phenotypes/endotypes will allow the application of precision medicine in patients with anaphylaxis, providing insights to the most appropriate approach in each case. Correspondence to Mar Guilarte, Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 932746169; e-mail: mguilarte@vhebron.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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