Αρχειοθήκη ιστολογίου

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

Τετάρτη 1 Αυγούστου 2018

Le syndrome « ichtyose-prématurité » : deux nouveaux cas

Publication date: Available online 1 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Severino-Freire, A.-C. Bing Lecointe, E. Bourrat, M. Pichery, N. Jonca, C. Chiaverini, J. Mazereeuw-Hautier

Résumé
Introduction

Le « syndrome ichtyose-prématurité » est très rare ; il appartient au groupe des ichtyoses syndromiques. Il est dû à des mutations du gène FATP4, lequel joue un rôle clé dans le transport et l'activation des acides gras de l'épiderme et dans la fonction barrière cutanée. Malgré une présentation clinique stéréotypée en période néonatale, l'affection est peu connue des cliniciens. Nous en rapportons deux nouveaux cas.

Observations

Cas no 1 : il s'agissait d'un enfant de sexe masculin, d'origine française, né de parents non apparentés à 33 semaines de gestation. À la naissance, l'enfant présentait une détresse respiratoire prise en charge en réanimation néonatale. Sur le plan cutané, on notait un aspect de vernix caseosa épais atteignant principalement le cuir chevelu, les sourcils et les quatre membres. L'évolution était favorable, avec un examen cutané normal à 4 ans. Cas no 2 : il s'agissait d'un enfant de sexe masculin, d'origine marocaine, né de parents apparentés à 34 semaines de gestation. À la naissance, il présentait une détresse respiratoire aiguë prise en charge en réanimation néonatale. À l'examen clinique, il avait un aspect épaissi de la peau mimant un vernix caseosa, blanchâtre, localisé principalement sur le cuir chevelu, le front, les quatre membres et l'abdomen. L'évolution était favorable, avec un examen cutané normal à 2 ans.

Conclusion

Nos deux patients illustrent la présentation clinique caractéristique de ce syndrome, qui mérite d'être connu des cliniciens pédiatres et dermatologues afin de poser le diagnostic, de réaliser un conseil génétique et de prévoir une prise en charge adaptée de la période périnatale en cas de future grossesse.

Summary
Background

Ichthyosis prematurity syndrome is a rare syndromic form of ichthyosis caused by mutations in FATP4, which plays a central role in the transport and activation of fatty acids in the epidermis and in epidermal barrier function. Despite stereotypical clinical presentation in the neonatal period, the diagnosis is not well known by clinicians. Herein we report two new cases.

Patients and methods

Case no. 1: a boy born prematurely (33 weeks of gestation) to non-consanguineous French parents presented at birth with respiratory distress necessitating admission to intensive care. His skin was covered by a thick caseous vernix, especially on the scalp, eyebrows and 4 limbs. At the age of 4 years, the boy's skin appeared normal. Case no. 2: a boy born prematurely to consanguineous Moroccan parents (34 weeks of gestation) presented at birth with respiratory distress requiring admission to intensive care. At clinical examination, he had a whitish thick skin giving an impression of vernix caseosa, with involvement of the scalp, forehead, 4 limbs and abdomen. At the age of 2 years, his skin was normal.

Conclusion

The clinical presentation of this syndrome is typical. It is important to make the diagnosis to enable genetic counseling and planning of adequate neonatal care in the event of future pregnancies.



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Sialendoscopy and Minimally Invasive Salivary Gland Surgery

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Michael D. Turner, Maria J. Troulis



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Intracorporeal Lithotripsy

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Jack Kolenda



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Ultrasound-Guided Salivary Gland Techniques and Interpretations

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Henry T. Hoffman, Nitin A. Pagedar



https://ift.tt/2LJMzot

Surgical Retrieval of Submandibular Stones

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Joseph P. McCain, Jose Montero



https://ift.tt/2vuPOVQ

Surgical Techniques for the Management of Parotid Salivary Duct Strictures

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Erica M. Jackson, Rohan R. Walvekar



https://ift.tt/2LLJoNm

Surgical Armamentarium for Sialendoscopy

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Michael D. Turner



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Forthcoming Issues

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s):



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Contents

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s):



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Contributors

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s):



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Copyright

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s):



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Extracorporeal Lithotripsy

Publication date: September 2018

Source: Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 26, Issue 2

Author(s): Oded Nahlieli



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Preferential interaction of MHC class I with TAPBPR in the absence of glycosylation

Publication date: Available online 1 August 2018

Source: Molecular Immunology

Author(s): Andreas Neerincx, Louise H. Boyle

Abstract

We recently discovered that TAPBPR promotes reglucosylation of the N-linked glycan on MHC class I molecules, a modification that restores their recognition by calreticulin and reincorporation into the peptide-loading complex. We wondered whether TAPBPR displayed some degree of glycan specificity, as is known to be the case for tapasin via its interaction with calreticulin & ERp57, or whether its interaction with MHC class I was glycan independent. Here, we explored this by comparing the ability of TAPBPR to bind to MHC class I containing either an intact or disrupted NxS/T glycosylation consensus sequence. In contrast to tapasin, TAPBPR bound strongly to MHC class I molecules that lacked N-linked glycosylation, suggesting that the TAPBPR:MHC class I interaction is glycan independent. Furthermore, we found that glycosylated HLA-A2 preferentially interacts with tapasin rather than TAPBPR, possibly explaining, in part, why MHC class I molecules bind efficiently to tapasin in the face of an alternative chaperone. The distinction in glycan specificity between the two peptide editors suggests that TAPBPR may bind to MHC class I molecules that are associated with a broader diversity of oligosaccharides attached compared with tapasin. This may explain, to some extent, the ability of TAPBPR to interact with MHC class I molecules outside of the ER.

Graphical abstract

Graphical abstract for this article



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Management of epistaxis in patients with ventricular assist device: a retrospective review

Patients with a ventricular assist device (VAD) are at risk for epistaxis due to the need for anticoagulation. Additionally, these patients develop acquired von Willebrand syndrome (AvWS) due to these devices....

https://ift.tt/2AyFHoU

Mucocutaneous leishmaniasis in a patient with rheumatoid arthritis treated with adalimumab

Introduction: Human leishmaniasis is an infection caused by flagellated protozoa of the genus Leishmania. They are obligate intracellular parasites that selectively infect dendritic cells and macrophages. Development of cutaneous, mucocutaneous, or visceral disease depends on the Leishmania species involved and on the immune response of the host. Tumor necrosis factor alpha (TNF-α) cytokine has been implicated in macrophage activation and tissue granuloma formation, two activities linked to control of intracellular infection caused by Leishmania spp.

https://ift.tt/2vnz9DM

Motivations to use, and to stop use of, tanning beds among sexual-minority men: A qualitative study

Background: Sexual-minority men, defined as gay, bisexual, and other men who have sex with men, are more likely than heterosexual men to report using tanning beds in the past 12 months. Furthermore, self-reported lifetime prevalence of melanoma is twice as high among sexual minority men compared with heterosexual men. A recent study of 14–35-year-old sexual-minority men in San Diego, California, assessed motivations to, and not to, indoor tan using an online survey methodology. Motivations to indoor tan in that study included appearance reasons, sociocultural pressures, and affect regulation.

https://ift.tt/2LLy3wM

Secukinumab demonstrates high sustained efficacy and a favorable safety profile through five years of treatment in moderate-to-severe psoriasis

Background: Secukinumab, a fully human monoclonal antibody that neutralizes IL-17A, has been shown to have significant efficacy in the treatment of moderate to severe psoriasis and psoriatic arthritis, demonstrating sustained high levels of efficacy with a favorable safety profile. Here we report secukinumab's long-term sustainability and safety through 5 years of continuous treatment at the approved dose.

https://ift.tt/2vnz5nw

The link between psoriasis, psoriatic arthritis, and the onset of diabetes

Background: Psoriasis currently affects >125 million people in the world. Approximately, 30% of patients with psoriasis will develop psoriatic arthritis and are also at a higher risk of developing diabetes. The aim of this project was to determine whether patients with psoriasis and diabetes are at a higher risk for developing psoriatic arthritis than those who do not have diabetes.

https://ift.tt/2LK8nRc

6143—Botulinum toxin type A treatment for Raynaud’s phenomenon: Experience and 3-year follow-up

Introduction: Raynaud's phenomenon consists of vasospastic disease of the digital arteries after exposure to cold or stress and may appear in isolation or in the context of a systemic disease. When severe, it causes an important reduction in a patient's quality of life. The available treatments do not always offer good results, making it necessary to look for therapeutic alternatives.

https://ift.tt/2vqqK2z

Pigmented fungiform papillae of the tongue: An incidental finding in a patient with mycosis fungoides

A 28-year-old Hispanic man with a history of stage IA mycosis fungoides presented with "new dark spots on the tongue." He was not taking any medications and had never been prescribed minocycline. He also denied pain, pruritus, and systemic symptoms. His skin disease had been clinically stable for the past five years with home, narrowband UVB phototherapy twice a month. Physical examination of the oral cavity was significant for multiple dark-brown structures on the distal tongue. Dermoscopic evaluation showed several fungiform papillae with pigmented borders in a rose petal pattern.

https://ift.tt/2LLy0B6

7124—Direct immunofluorescence and correlates of systemic disease in adult Henoch-Schönlein purpura

Introduction: IgA vasculitis, formerly called Henoch-Schönlein purpura (HSP), is a systemic vasculitis caused by the deposition of IgA in multiple organ systems, commonly leading to renal, gastrointestinal, and joint manifestations. In adults, renal disease is more severe and occurs more often. The primary objective of this study was to characterize clinical and direct immunofluorescence (DIF) findings with systemic disease in adults with HSP.

https://ift.tt/2vu5RDx

Subungual melanoma: The attitudes, knowledge, and referral patterns of nail technicians

Background: Subungual melanoma (SM) accounts for 2%-10% of all melanomas and cannot be distinguished from benign conditions such as longitudinal melanonychia by inspection alone. Low ten-year survival in SM has been attributed to delayed diagnosis, thus early detection may improve outcomes. Early specialist referral and dermatoscopy is useful for proper diagnosis and care. A mnemonic to educate the lay population on findings concerning for SM was created in 2000, but dissemination to the public has been poor.

https://ift.tt/2LK8jAW

6774—The role of shave biopsy and electrodesiccation in the overall treatment of keratinocyte carcinoma

The mainstay of treatment for nonmelanoma skin cancer (NMSC) remains surgical. Surgical literature shows that biopsy of keratinocyte carcinoma may clear tumors. This prospective study sought to determine the role of biopsy by means of the shave technique and electrodesiccation in the clearance of nonmelanoma skin cancer. Biopsies performed on highly probable skin cancers were performed with the use of the shave technique and treated with electrodesiccation. Suspected cancers were shaved in a manner that encompassed the entire lesion.

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Rare presentation of a primary cutaneous well differentiated liposarcoma

A 61-year-old man with a history of malignant melanoma in-situ presented with a 1-year history of a large firm nodule on his back. Physical exam revealed a 3 × 2 cm firm, nontender, mobile nodule on his right back. A punch biopsy was obtained revealing subcuticular adipose tissue with a lobular architecture that contained enlarged, markedly pleomorphic, and hyperchromatic nuclei at the periphery of the fat lobules and was interpreted as a well differentiated liposarcoma. Liposarcomas of the skin are exceedingly rare and represent a diagnosis of exclusion regarding histopathologic mimics, metastases, and direct extensions from deeper tumors.

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6349—Cellular mechanism of compulsive behavior in a mouse model of trichotillomania

Introduction and objectives: Dysfunction of the striatum of the brain is implicated in compulsive behavior such as trichotillomania. Sapap3-mutant (Sapap3−/−) mice lack a post-synaptic scaffolding protein linked to trichotillomania in genetic studies and mice exhibit compulsive grooming leading to severe skin wounds. Yet the cellular basis of this compulsive behavior remains unknown.

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Ninety-nine percent response rate in 586 radiation treatments for cutaneous T-cell lymphoma

Background: Cutaneous T-cell lymphoma (CTCL) is a skin tropic lymphoid neoplasm. Relapse is very common; particularly for advanced disease for which there is no cure despite an array of treatment modalities. Skin directed radiation therapy is effective for CTCL. This retrospective study was undertaken to assess response rates and toxicity in patients who received skin directed radiation therapy.

https://ift.tt/2LOyoyQ

7445—Hospital readmissions for skin disease in the United States

Background: Hospital readmissions represent a potentially preventable form of hospitalization; however, hospital readmissions for dermatologic conditions remain poorly characterized.

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Telogen effluvium with dysesthesia has lower B12 levels and may respond to B12 supplementation

The pathogenesis of telogen effluvium with dysesthesia (TED) is not well understood and treatment options are limited. We investigated a subtype of telogen effluvium (TE) associated with dysesthesia (TED), which is defined as the presence of TE with severe itch, pain, soreness, burning, or formication in the absence of any inflammatory scalp disorder or medication associated with TE/dysesthesia. A retrospective chart review of 45 patients with telogen effluvium with dysesthesia (TED) and a control group of 45 patients with TE were evaluated for B12 levels.

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Effect of adding a diet with index and low glycemic load for 12 weeks in the treatment of moderate acne: Randomized clinical trial

Background: Acne is a self-limiting disorder of the pilosebaceous unit that is observed mainly in adolescents and young adults. It affects the self-esteem and quality of life of those who suffer from it, mainly because of the scars that it leaves as a sequel in cases of inflammatory acne. As the main reason for dermatologic consultation, it is extremely important to investigate new therapeutic options. Recent studies have suggested that dietary factors, specifically glycemic load, may be involved in the pathogenesis of acne.

https://ift.tt/2vnyPF4

Social media usage relating to dermatology. #dermatology: Its users, popularity, and content on Twitter and Instagram

Background: Information technology advances and the Internet have given rise to radical changes in how medicine is practiced. With Web 2.0, characterized by the change from static web pages to user-generated content and the growth of social media, this may change further still. Presently, 2.34 billion people already use social media. We aimed to understand how social media is currently used with relation to dermatology.

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“Dermohscopy” mapping: Correlating dermoscopic findings with histology in Mohs micrographic surgery

Mapping is an essential step during Mohs micrographic surgery (MMS) since it allows tumors seen on histology to be tracked during surgery. Histologic findings are typically correlated to the clinical photo or to the hand-drawn map. Despite the increasing use of dermoscopy as an adjuvant tool to help identify basal cell carcinoma, mapping the dermoscopic findings before MMS has not been described to the author's knowledge. The author describes the "dermohscopy" mapping to better correlate dermoscopic findings with histology in MMS.

https://ift.tt/2vnyKRM

Risk of depression among patients with acne: A population-based cohort study using The Health Improvement Network (THIN) database

Background: Acne has been associated with decreased self-esteem and many reports have suggested a high prevalence of depressive symptoms among these patients. Despite this, the population-level risk of physician-diagnosed major depressive disorder (MDD) among patients with acne is not known.

https://ift.tt/2LOyfLO

1% antraline: Treatment of alopecia areata in children

Introduction: Alopecia areata is a clinical entity with difficult therapeutic management, and in the case of children we have few treatment options. Anthralin or dithranol (1,8-dihydroxyantrone) is a synthetic derivative of anthracene that acts on keratinocytes in the skin and increases its ability to generate free radicals with antiinflammatory effect. It is used topically once a day for psoriasis and alopecia areata. The main benefit is its good tolerance and rare side-effects, which include local irritation and temporary hyperpigmentation of the scalp.

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Properties of sunscreen influence its application

Background: Skin cancer is associated with significant rates of morbidity and mortality, and one preventative measure against skin cancer is the use of sunscreen. A better understanding of which sunscreen attributes are most important to the public, and which may account for their use or disuse, may help health practitioners and public health initiatives to promote the sun protection methods that are most appealing to the public.

https://ift.tt/2LOycj6

Decreased CD4+CD25+CD127dim/− Regulatory T Cells and T Helper 17 Cell Responsiveness to Toll-Like Receptor 2 in Chronic Hepatitis C Patients with Daclatasvir Plus Asunaprevir Therapy

Viral Immunology, Ahead of Print.


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Management of epistaxis in patients with ventricular assist device: a retrospective review

Abstract

Background

Patients with a ventricular assist device (VAD) are at risk for epistaxis due to the need for anticoagulation. Additionally, these patients develop acquired von Willebrand syndrome (AvWS) due to these devices. Management is complicated by the risk of thrombosis if anticoagulation is reversed. This study sought to characterize the clinical features and management of epistaxis in this high-risk population.

Methods

Retrospective review of adults with VAD and epistaxis necessitating inpatient consultation with the otolaryngology service were included.

Results

49 patients met inclusion criteria. All patients had a presumed diagnosis of AvWS. An elevated INR (> 2.0) was present in 18 patients (36.7%). Anticoagulation was held in 14 (28.6%) patients, though active correction was not necessary. Multiple encounters were required in 16 (32.7%) patients. Spontaneous epistaxis was associated with multiple encounters (p = 0.02). The use of hemostatic material was associated with a lower likelihood of bleeding recurrence (p = 0.05), whereas cauterization with silver nitrate alone was associated with a higher likelihood of re-intervention (p = 0.05). Surgery or embolization was not required urgently for any patient. Endoscopy under general anesthesia was performed for one patient electively. Mean follow up time was 16.6 months (σ = 6.3). At six months, 18 (36.7%) patients were deceased.

Conclusion

While these patients are at risk for recurrent spontaneous epistaxis, nonsurgical treatment without active correction of INR or AvWS was largely successful. Placement of hemostatic material, as opposed to cautery with silver nitrate, should be considered as a first-line treatment in this group. Multidisciplinary collaboration is critical for successful management.



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A Novel Surgical Treatment for Posterior Glottic Stenosis Using Thyroid Ala Cartilage – A Case Report and Literature Review

Publication date: Available online 1 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Megan M. Gaffey, Ravi Sun, Gresham T. Richter

Abstract

Posterior glottic stenosis (PGS) describes a laryngeal disorder in which worsening degrees of scarring limit abduction of the vocal folds and/or arytenoids. It can be congenital or acquired. Generally, the acquired form is the result of chronic endotracheal tube trauma to the posterior larynx.

Symptoms of acquired PGS usually begin four to eight weeks after extubation, and present as gradually worsening stridor and shortness of breath as the laryngeal obstruction becomes more severe. Without intervention, PGS can cause total obstruction and respiratory failure. The mainstay of treatment for PGS is surgery.

We present a case in which an infant patient with PGS was treated with a posterior cricoid split and insertion of a thyroid ala graft. The graft was bolstered in place with an appropriately-sized endotracheal tube during a six-day period of postoperative intubation. We report this as a novel surgical approach, as a literature review did not uncover that this technique has been previously described. Our patient has had excellent airway and voice outcomes. His swallow outcomes have been difficult to assess, as the patient has shown signs of global delay.



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The Effects of Elevated Fibroblast Growth Factor 23 on Mandibular Growth in Rats

Publication date: Available online 1 August 2018

Source: Archives of Oral Biology

Author(s): Yanan Wu, Jinkai Zhang, Fengshan Chen

Abstract
Objective

The aim of this study is to elucidate the local effects of fibroblast growth factor 23 (FGF23) in on mandibular condylar growth in growing rats.

Design

Growing Sprague–Dawley rats received intra-temporomandibular joint injections of phosphate buffer solution (PBS), adenovirus-mediated green fluorescent protein (Ad-GFP) or adenovirus-mediated fibroblast growth factor 23 (Ad-FGF23), which were marked as groups A, B, and C, respectively. In vitro, we treated rat mandibular cartilage chondrocytes with PBS, Ad-GFP, and Ad-FGF23.

Results

The mandibular condyles in group C grew smaller sizes than those in the other control groups due to significant differences among the experimental and control groups with the value of C-D, Q-R (P ≤ 0.05), accompanied by diminished bone mass of sub-cartilage condyles via micro CT analysis. Histologically, the length of the hypertrophic zone was diminished and was associated with decreasing chondrocyte proliferation in group C. Quantitative real-time PCR indicated significant decreases in the expression of chondrogenesis marker genes, including Type X collagen (Col X) and SRY-type box 9 (Sox 9). Moreover, elevated Ad-FGF23 suppressed chondrocyte proliferation and the expression of the chondrogenic differentiation markers Col X and Sox 9 of in vitro.

Conclusions

Local injection of FGF23 suppressed the development and decreased the bone mass of condyles through the decreasing the formation of condylar cartilage, specifically by regulating condylar cartilage cell viability and chondrogenesis expression.



https://ift.tt/2O5DWBF

The Effects of Elevated Fibroblast Growth Factor 23 on Mandibular Growth in Rats

Publication date: Available online 1 August 2018

Source: Archives of Oral Biology

Author(s): Yanan Wu, Jinkai Zhang, Fengshan Chen

Abstract
Objective

The aim of this study is to elucidate the local effects of fibroblast growth factor 23 (FGF23) in on mandibular condylar growth in growing rats.

Design

Growing Sprague–Dawley rats received intra-temporomandibular joint injections of phosphate buffer solution (PBS), adenovirus-mediated green fluorescent protein (Ad-GFP) or adenovirus-mediated fibroblast growth factor 23 (Ad-FGF23), which were marked as groups A, B, and C, respectively. In vitro, we treated rat mandibular cartilage chondrocytes with PBS, Ad-GFP, and Ad-FGF23.

Results

The mandibular condyles in group C grew smaller sizes than those in the other control groups due to significant differences among the experimental and control groups with the value of C-D, Q-R (P ≤ 0.05), accompanied by diminished bone mass of sub-cartilage condyles via micro CT analysis. Histologically, the length of the hypertrophic zone was diminished and was associated with decreasing chondrocyte proliferation in group C. Quantitative real-time PCR indicated significant decreases in the expression of chondrogenesis marker genes, including Type X collagen (Col X) and SRY-type box 9 (Sox 9). Moreover, elevated Ad-FGF23 suppressed chondrocyte proliferation and the expression of the chondrogenic differentiation markers Col X and Sox 9 of in vitro.

Conclusions

Local injection of FGF23 suppressed the development and decreased the bone mass of condyles through the decreasing the formation of condylar cartilage, specifically by regulating condylar cartilage cell viability and chondrogenesis expression.



https://ift.tt/2O5DWBF

Epitope mapping of anti-ALK antibodies in children with anaplastic large cell lymphoma

Publication date: Available online 1 August 2018

Source: Clinical Immunology

Author(s): Fabian Knörr, Simone Weber, Vijay K. Singh, Karen Pulford, Alfred Reiter, Wilhelm Woessmann, Christine Damm-Welk

Abstract

Patients with Nucleophosmin (NPM)-Anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) mount ALK autoantibodies. The titer of these autoantibodies inversely correlates with the risk of relapse.

The epitopes recognized by these autoantibodies in NPM-ALK might be associated with different ALK-antibody levels. We used overlapping peptide microarray technology to analyze epitope-binding to NPM-ALK by plasma or serum from 129 ALK-positive ALCL patients and 21 controls. Antibodies present in sera from ALCL patients bound to epitopes mainly in the C-terminal region of the ALK portion of NPM-ALK (amino acid positions 469–496, 561–588, 617–644). Patients with higher ALK antibody titers detected the epitope 561–588 more frequently as well as three further epitopes at the N-terminus of the kinase domain compared to patients with intermediate and low titers.

These results identify new potential target epitopes for immunotherapy in ALK-positive ALCL. The methodology can be adapted for more reproducible analyses of tumor antigen detection.



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The hi-tech way to handle the new gen kind in the procedure room



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Bactericidal efficacy of three parameters of Nd:YAP laser irradiation against Enterococcus faecalis compared with NaOCl irrigation

Abstract

The success of endodontic treatment depends on the thorough removal of microorganisms from the root canal system. The search for new ways to eliminate the microorganisms is therefore justified. Nd:YAP is a laser that uses yttrium aluminum perovskite, doped with neodymium crystal, as active laser medium. We used the Nd:YAP laser in an in vitro experiment to evaluate the bactericidal effect of three parameters of Nd:YAP laser-activated irrigation on biofilms of Enterococcus faecalis in root canals. The canals of 45 extracted human single-root teeth were prepared on a #35 Mtwo instrument and contaminated with E. faecalis for 14 days. Forty infected single-root teeth were then randomly divided into four groups according to the irrigation agitation protocols as follows: 5.25% sodium hypochlorite (NaOCl), Nd:YAP laser (180 mJ) + NaOCl, Nd:YAP laser (280 mJ) + NaOCl, and Nd:YAP laser (360 mJ) + NaOCl. The remaining bacteria were counted immediately using the cell count method. Teeth were firstly spilt and one half examined by scanning electron microscopy (SEM). The other half involved examination of bacterial colonization in dentinal tubules using confocal laser scanning microscopy (CLSM). Nd:YAP laser (280 mJ) + NaOCl and Nd:YAP laser (360 mJ) + NaOCl completely removed the E. faecalis biofilms from the root canal walls and made it the cleanest among the treatment groups. Bacterial reductions in the treatment groups for dentinal tubules are presented in a descending order as follows: Nd:YAP laser (360 mJ) (53.7%), Nd:YAP laser (280 mJ) (51.5%) > Nd:YAP laser (180 mJ) (45.3%) > 5.25% NaOCl (31.9%) > control (19.3%) (p < 0.05). Nd:YAP laser of 280 mJ and 360 mJ showed effective bactericidal effect in removing E. faecalis biofilm from the root canal walls and dentinal tubules.



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MicroRNA dysregulation in adenoid cystic carcinoma of the salivary gland in relation to prognosis and gene fusion status: a cohort study

Abstract

Adenoid cystic carcinoma (ACC) is among the most frequent malignancies of the salivary gland, and is notorious for its prolonged clinical course characterized by frequent recurrences often years after initial treatment. No molecular marker has been shown to have independent prognostic value in ACC, including characteristic gene fusions involving MYB, MYBL1, and NFIB. MicroRNA has been shown to be associated with clinical outcome in numerous malignancies, including one study of ACC, warranting further validation of this class of markers in this disease. Here, we investigate the prognostic value of microRNA in two ACC cohorts: a training cohort (n = 64) and a validation cohort (n = 120) with microarray and qPCR. In the training cohort, multivariate analysis of microarray data found high expression of hsa-miR-6835-3p to be associated with reduced recurrence-free survival (RFS) (p = 0.016). Measuring the highest ranking microRNAs identified in survival analysis in the same cohort, qPCR identified high expression of hsa-miR-4676 to be associated with reduced overall survival (OS) and high expression of hsa-mir-1180 to be associated with improved RFS. This was not confirmed in the validation cohort, in which qPCR identified high expression of hsa-mir-21, hsa-mir-181a-2, and hsa-mir-152 to be associated with reduced OS and high expression of hsa-miR-374c to be associated with improved RFS. Interestingly, two distinct subsets of ACC separated in microRNA expression irrespective of gene fusion status, but without significant difference in outcome. Collectively, qPCR identified several microRNAs associated with OS and RFS, and different subsets of ACC separated according to microRNA expression, suggestive of ACC being a heterogeneous group of malignancies in its microRNA profile.



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Whole exome sequencing approach to analysis of the origin of cancer stem cells in patients with head and neck squamous cell carcinoma

Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.


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Association of Low SES With Hidradenitis Suppurativa

This cohort analysis evaluates the association of low socioeconomic status with hidradenitis suppurativa among patients in the United States.

https://ift.tt/2LSHzNP

Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata

This systematic review and meta-analysis uses standardized criteria and prognostic factors to examine the clinical hair regrowth outcomes of contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester for patients with alopecia areata.

https://ift.tt/2vlWQwe

An Atypical Figurate Erythema With Seasonal Recurrences

A woman had a large annular erythematous plaque on her back that had centrifugally expanded. She had mild pruritus that had not responded to antihistamine therapy or topical steroids and reported a 20-year history of the plaques recurring every summer and resolving by autumn. What is your diagnosis?

https://ift.tt/2LHsjnv

Comparison of Course and Outcome for Patients With Disseminated or Localized Lyme Borreliosis

This cohort study compares the development and treatment outcome of disease among European patients with Lyme borreliosis manifested as either multiple erythema migrans or as erythema migrans as well as controls without a history of the disease.

https://ift.tt/2vvDlBE

Machine Learning and Health Care Disparities in Dermatology

This viewpoint discusses the limitations of machine learning in diagnostics involving skin of color.

https://ift.tt/2LLoJsz

Association Between Severe Acute Contact Dermatitis Due to N sativa Oil and Epidermal Apoptosis

This case series describes the clinical and histologic features of severe acute contact dermatitis due to Nigella sativa oil and investigates the components responsible for such eruptions.

https://ift.tt/2vvD81k

Rezidivierende frontale Schwellung beim Kind



https://ift.tt/2vpCBhm

Laryngologie, Phoniatrie



https://ift.tt/2LLybvY

Pseudo-pneumothorax: skin fold is an excellent imitator

Description

A 79-year-old hospitalised woman underwent central venous catheterisation for high-calorie infusion. Chest radiography to check the position of the catheter showed a curvilinear line at the lateral zone of the right lung (figure 1A). We suspected pneumothorax and performed CT of the chest. However, it revealed the absence of pneumothorax; the curvilinear mimicked pneumothorax was revealed to be a skinfold (figure 1B).

Figure 1

(A) Initial chest radiograph showed a curvilinear line at the right lateral zone of the right lung. (B) CT of the chest revealed the absence of pneumothorax.

The lateral margin of the skinfold artefact, caused by compression of flaccid back skin against the film, can be sharply outlined by a lucent line.1 This line is an edge enhancement phenomenon at the margin between objects with different contrast or luminance (Mach band effect).



https://ift.tt/2LLt4fg

Diagnostic dilemma of micropapillary variant of mucinous breast cancer

An elderly woman presented with an enlarging left breast lump. Breast imaging revealed a large suspicious mass associated with cystic components. Core biopsy however was non-diagnostic and only revealed necrotic papillary tissue. The patient then underwent excision of the lesion that revealed a large area of intracystic papillary ductal carcinoma in situ with a focus of micropapillary variant of mucinous cancer. This case describes how this rare subtype could present as necrotic papillary tissue on core biopsy, resulting in a diagnostic dilemma, which had not been previously reported. A literature review of this rare subtype was performed too.



https://ift.tt/2vpgXtv

EGFR inhibitor-induced cut-like skin lesions of the fingers

Cetuximab and osimertinib are epidermal growth factor receptors (EGFRs) inhibitors used in the treatment of several malignancies. These agents have been associated with several skin lesions, the most common being papulopustular acneiform rash involving the face, neck, chest and back. Herein, we describe a unique toxic effect of these agents involving the fingertips and lateral aspects of fingers in a small patient series. The lesions presented approximately 4 weeks into treatment were cut-like and caused local discomfort/pain. Application of a colloidal solution allowed for partial resolution of these lesions in one patient, while discontinuation of the drug led to the disappearance of the lesions in another. Thus, we call for awareness of this unique skin toxicity with the use of EGFR inhibitors in patients with cancer.



https://ift.tt/2LFFRjo

Rare breast metastasis from adenoid cystic carcinoma of the submandibular gland

Adenoid cystic carcinomas (ACCs) are rare malignant neoplasms of exocrine glands, most commonly found in salivary glands. This report describes a 67-year-old woman with metastatic ACC to the breast, only the third reported case of its kind. The salivary gland ACC was first diagnosed 5 years prior. Routine mammogram identified a Breast Imaging and Reporting Systems (BIRADS) 4 lesion. Core breast biopsy demonstrated findings consistent with metastatic ACC to the breast. The patient ultimately underwent local excision but suffered a recurrence of disease less than 2 months later despite chemotherapy. She passed away 15 months after excision due to complications associated with a small bowel obstruction and decompensated respiratory status from pulmonary metastases. While metastatic salivary ACC to the breast is rare, it is important to be able to distinguish metastatic salivary ACC to the breast from primary ACC of the breast as the treatment considerations for the two disease processes differ significantly.



https://ift.tt/2O4f8tQ

Cervical spinal cord stimulation for the treatment of essential tremor

A patient with refractory essential tremor of the hands and head/neck refused deep brain stimulation and requested consideration for spinal cord stimulation (SCS). Trial of a cervical SCS system using a basic tonic waveform produced positive outcomes in hand tremor, head-nodding and daily functioning. The patient proceeded to implant and received regular programming sessions. Outcomes were recorded at follow-ups (1, 3, 6, 12, 23 months postimplant) and included patient self-reported changes, clinical observations, handwriting assessments and The Essential Tremor Rating Assessment Scale scores. Trial of a paraesthesia-free burst waveform programme produced a small improvement in head-nodding, without uncomfortable paraesthesias. With continued programming, the patient reported further improvements to tremor and functionality, with minimal tremor remaining at 12–23 months. No major side effects were reported.



https://ift.tt/2OADmwx

Delayed presentation of bilateral central hip protrusio acetabuli: evidence-based management

This is a case of a previously healthy 51-year-old man who sustained bilateral central hip dislocations following a sudden presentation of epileptic seizures. The patient was initially treated conservatively for a period of 9 months. On presentation, he had gross disability due to stiffness in both hips and left peroneal nerve paresis. Through minimally invasive direct anterior approaches, bilateral total hip arthroplasties were performed using tripolar head articulations. These were cemented into a biologic acetabular buttress constructed out of autologous bone graft. The femoral heads and necks were used as plugs and pressed into the acetabular defects, putting the medial acetabular walls under tension. At 24 months' follow-up, there was a good clinical outcome, and the acetabular walls remodelled bilaterally. In conclusion, in traumatic protrusio acetabuli, a functional, biologic reconstruction of the acetabular wall can be facilitated with the application of distraction osteogenesis (tension-stress) principles while using minimally invasive surgical techniques.



https://ift.tt/2O2XiaB

Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

We report a case of a 63-year-old woman who was presented to the emergency department with an occipital haemorrhage secondary to a pancreatic cerebral metastasis. Pancreatic cancer is the ninth most common cancer in women in Australia, and distant disease is present in 70% of patients with pancreatic cancer at the time of diagnosis. However, metastases to the brain are rare, accounting for only 0.33%–0.57% cases antemortem. Herein, we discuss the management of this unusual case to highlight the importance of recognising unusual central nervous system involvement of cancers, a problem which may be increasing in prevalence.



https://ift.tt/2LLGvvO

Post-extracorporeal shockwave lithotripsy perirenal haematoma

Description

A previously healthy 50-year-old man presented with intermittent left flank pain for 3 months. The patient denied any history of diabetes and hypertension. On evaluation with X-ray Kidney-Ureter-Bladder and ultrasound (USG) of abdomen, he was found to have left upper ureteric calculus (size: 13 mm) with left mild hydronephrosis and normal right kidney. He subsequently underwent uneventful extracorporeal shockwave lithotripsy (ESWL) with Dornier compact alpha electromagnetic lithotripter for the calculus. Three thousand shockwaves were delivered to the stone. The procedure was uneventful and the patient was discharged. Twenty-four hours later, the patient presented with severe left flank pain. On clinical examination, he had tachycardia (pulse rate: 100/min), normal blood pressure (138/76 mm Hg) and tenderness in the left flank region. Laboratory examination revealed the following parameters:

Haemoglobin: 10.2 g/dL.

Haematocrit: 30.6%.

Total leucocyte count: 7500 /mm3.

Platelet count: 3.5 lacs /mm3.

Blood urea: 44 mg/dL.

Serum creatinine:...



https://ift.tt/2vpgOWZ

Unusual Monteggia type 1 variant in adult: a rare finding in a rare fracture

Description 

A 56-year-old female patient presented to the orthopaedic outpatient department with alleged history of slip from stairs about 10–12 in number and fall on the outstretched hand about 3 weeks ago. Following the injury, she developed severe pain, swelling abnormal mobility of lower arm and restriction of movement of the right elbow. She also admitted that post trauma, she had received treatment from traditional bone setters which had reduced her pain. On examination of her limb, there was a flexion deformity of right elbow along with extra articlar varus deformity of lower arm  which was mobile with tenderness and bony crepitus at both at arm and the elbow. There was no distal neurovascular deficit.

Radiographs of the right arm and forearm with shoulder, elbow and wrist joints revealed fractures of the lower shaft humerus and proximal ulna (metaphyseal with intra-articular fragment and coronal split from metaphyio-diaphysis junction extending up to half of...



https://ift.tt/2OxdyBL

Introduction to Ear and Temporal Bone Special Issue



https://ift.tt/2mYjLtQ

Effect of Cervical Collar on Intracranial Pressure

Conditions:   Optic Nerve Sheath Diameter;   Ultrasonography
Interventions:   Device: Ambu Perfect ACE;   Device: Philly One-Peace Collar;   Device: Necloc Collar;   Device: NexSplit Plus;   Device: NECKLITE
Sponsors:   Lazarski University;   Wroclaw Medical University;   The Cleveland Clinic
Recruiting

https://ift.tt/2NXGt0D

Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study

Publication date: Available online 1 August 2018

Source: American Journal of Otolaryngology

Author(s): Danielle R. Trakimas, Judith Kempfle, Katherine L. Reinshagen, Daniel Lee, Elliott D. Kozin, Aaron K. Remenschneider

Abstract
Purpose

Effective operative approaches for the treatment of refractory vertigo in Meniere's disease are invasive. Vestibular neurectomy can preserve hearing and has been shown to be effective; however, current approaches require an extensive craniotomy. Transcanal endoscopic approaches to the internal auditory canal (IAC) with cochlear preservation have been recently described and may offer a minimally invasive approach to selectively sectioning the distal vestibular nerves while preserving residual hearing.

Materials and methods

Three cadaveric human heads were imaged using high resolution computed tomography (CT). Anatomic analysis of preoperative CT scans showed adequate diameters (>3 mm) of the infracochlear surgical corridor for access to the IAC. A transcanal endoscopic approach was attempted to section the vestibular nerve. Post-operative CT scans were assessed to define the operative tract, determine cochlear preservation and assess cochlear and facial nerve preservation.

Results

Transcanal endoscopic approach was successfully performed (n = 3) using 3 mm-diameter, 14 cm-length 0°, 30°, and 45° endoscopes and microsurgical drills. In all cases the tympanomeatal flap and ossicular chain remained intact. Internal auditory canalotomy was performed using angled instruments and confirmed in real time via lateral skull base navigation. The vestibular nerves were readily identified and sectioned with preservation of the facial and cochlear nerves. Post-procedure CT showed no violation of the cochlea.

Conclusion

A transcanal, infracochlear approach to the IAC may permit a minimally invasive approach to distal vestibular neurectomy in cadavers with appropriate anatomy.



https://ift.tt/2Oywn7v

3-Day monocyte-derived dendritic cells stimulated with a combination of OK432, TLR7/8 ligand, and prostaglandin E 2 are a promising alternative for cancer immunotherapy

Abstract

Numerous trials using dendritic cell (DC)-based vaccinations for the treatment of cancer are being carried out. However, an improvement of the quality of DC used is highly warranted. We here generated human monocyte-derived dendritic cells using a 3 day protocol and stimulated the cells using a combination of OK432 (Picibanil), TLR7/8 ligand CL097, and reduced amounts of prostaglandin (PG)E2. We analyzed phenotype, migratory, and T-cell stimulatory capacity compared to a cytokine cocktail consisting of IL-1β, IL-6, TNF, and PGE2. The OK432 cocktail stimulated cells had a similar mature phenotype with upregulated co-stimulatory molecules, HLA-DR and CCR7 as the cytokine cocktail-matured cells and a similar cytokine profile except increased amounts of IL-12p70. Chemotaxis towards CCL19 was reduced compared to the cytokine cocktail, but increased compared to OK432 alone. The T-cell stimulatory capacity was similar to the cytokine cocktail stimulated cells. In conclusion, the OK432 cocktail has the advantage of inducing IL-12p70 production without impairing phenotype or T-cell stimulatory capacity of the cells and might, therefore, be an advantageous alternative to be used in DC-based immunotherapy.



https://ift.tt/2vodUBO

A Third Molar from Rathfarnham, Dublin, and the Patterning Cascade Model

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Mb7jC2

Introduction to Ear and Temporal Bone Special Issue



https://ift.tt/2mYjLtQ

Introduction to Ear and Temporal Bone Special Issue



https://ift.tt/2mYjLtQ

Dermal Filler Linked to Patient Death in Rio de Janeiro

A Brazilian physician known as 'Dr Butt' has been accused of injecting a large amount of polymethyl-methacrylate into the buttocks of a patient during at procedure at his own apartment.
Medscape Medical News

https://ift.tt/2O2aDjd

Ceruminous Neoplasms of the Ear

Abstract

Ceruminous glands are modified apocrine glands located in the external auditory canal (EAC). Neoplastic lesions arising from these glands are rare in humans and constitute a major differential diagnosis for glandular neoplasms of the EAC. Due to anatomic restrictions, benign and malignant neoplasms present with similar symptoms and to some extent even comparable radiologic features, particularly when the tumors are localized. Biopsies are frequently limited by small size, fragmentation and improper anatomic and architectural orientation, thereby hampering our ability to appreciate the relationship of peripheral edges of the tumor to the surrounding tissue. Benign and malignant tumors may also have overlapping histomorphologic features, which further magnifies the challenges in accurate diagnosis and management strategies. This article summarizes the salient clinical, radiologic and histologic features of common ceruminous gland tumors, in addition to discussing features that can aid in differentiating ceruminous tumors from other EAC tumors and to distinguish benign from malignant entities.



https://ift.tt/2OzZdEl

Selected Giant Cell Rich Lesions of the Temporal Bone

Abstract

Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.



https://ift.tt/2vuOX7Y

Squamous Cell Carcinoma of the External Auditory Canal and Temporal Bone: An Update

Abstract

Squamous cell carcinoma (SCC) is the most common primary malignancy to affect the temporal bone, including primary cutaneous SCC of the pinna, external auditory canal, middle and inner ear. This anatomically complex region generates complicated three-dimensional specimens that can be a challenge for macroscopic and microscopic pathologic assessment. A universally accepted staging classification for these malignancies is still to be established. A brief summary of the regional anatomy, etiology and epidemiology, presentation and diagnosis, radiologic assessment and treatment follows with a review of the pathologic assessment of the different types of specimens generated and an update on staging for SCC of the temporal bone.



https://ift.tt/2LGAAIq

Anatomy and Surgical Approach of the Ear and Temporal Bone

Abstract

The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.



https://ift.tt/2vuOR06

Neuroendocrine Neoplasms of the Ear

Abstract

Neuroendocrine neoplasms of the ear are uncommon primary tumors. There is a reported debate in the literature as to the true nature of these tumors and how to classify them. However, there is a kind of consensus that they can represent a spectrum of a common entity with dual glandular and neuroendocrine differentiation. The differential diagnosis of these tumors is broad but their morphologic, immunohistochemical, and radiographic features help to differentiate them from other entities. The tumors have mostly bland histology and indolent biological behavior, yet they may recur and metastasize. It is important to accurately recognize these tumors in order to perform the right management and limit their morbidity. In this article, we review the pathogenesis, histology, immunohistochemical features of neurornedocrine neoplasms of the ear and we discuss their differential diagnosis, clinical behavior and management.



https://ift.tt/2LKLywq

Cross Sectional Imaging of the Ear and Temporal Bone

Abstract

CT and MR imaging are essential cross-sectional imaging modalities for assessment of temporal bone anatomy and pathology. The choice of CT versus MR depends on the structures and the disease processes that require assessment, delineation, and characterization. A thorough knowledge of the two imaging modalities' capabilities and of temporal bone anatomy greatly facilitates imaging interpretation of pathologic conditions.



https://ift.tt/2NXuxfc

Cholesteatoma Pearls: Practical Points and Update

Abstract

The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.



https://ift.tt/2LKLtJ8

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Abstract

Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.



https://ift.tt/2vuOCSK

Ear and Temporal Bone Pathology: Neural, Sclerosing and Myofibroblastic Lesions

Abstract

Neural, sclerosing, and myofibroblastic lesions of the ear and temporal bone present diagnostic challenges for both clinicians and pathologists due to significant overlap in their clinical presentations, histologic appearances, and immunohistochemical profiles. While some of these lesions, such as schwannomas, are relatively common, others are rendered even more difficult because they are encountered very rarely in routine surgical pathology practice. This review is intended to provide an update on the pathology of some of the most commonly encountered primary diagnostic entities for the ear and temporal bone, and includes the following neural lesions: schwannoma, meningioma, and encephalocele/meningocele. Sclerosing lesions that will be discussed include spindle cell and sclerosing rhabdomyosarcoma, sclerosing epithelioid fibrosarcoma, and sclerosing paraganglioma. Finally, myofibroblastic lesions that will be reviewed are nodular fasciitis, IgG4-related disease, and solitary fibrous tumor. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.



https://ift.tt/2OxIfXa

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Abstract

A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.



https://ift.tt/2O2JLzD

Letter to the Editor in response to the article, “The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis”

Dear Editor,

https://ift.tt/2Ke5e6h

Is there a place for FDG-PET-CT in early oral cancer patients?

With interest we read the article 'Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma' by Zhang et al. [1]. They reported on 96 patients diagnosed with cT1 or T2 oral squamous cell carcinoma (OSCC), a palpably negative neck and treated by resection of the primary tumor and elective neck dissection. All patients underwent preoperative CT of the neck with 32 patients having undergone [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET-CT).

https://ift.tt/2n1WSFI

Assessment of the mandibular cortical height in patients of different sexes, skeletal classes, and facial types using cone-beam computed tomography

Some studies have correlated variations in mandibular cortical height with conditions of the bones such as osteoporosis, loss of vertical bone, and fractures.1–3 Because of the differences in craniofacial growth, the facial and skeletal pattern may influence muscular actions that can, in their turn, produce changes in bony morphology.4 We assessed the lower mandibular cortex in patients with different skeletal classes and facial types using cone-beam computed tomography (CT).

https://ift.tt/2OwScnU

Ceruminous Neoplasms of the Ear

Abstract

Ceruminous glands are modified apocrine glands located in the external auditory canal (EAC). Neoplastic lesions arising from these glands are rare in humans and constitute a major differential diagnosis for glandular neoplasms of the EAC. Due to anatomic restrictions, benign and malignant neoplasms present with similar symptoms and to some extent even comparable radiologic features, particularly when the tumors are localized. Biopsies are frequently limited by small size, fragmentation and improper anatomic and architectural orientation, thereby hampering our ability to appreciate the relationship of peripheral edges of the tumor to the surrounding tissue. Benign and malignant tumors may also have overlapping histomorphologic features, which further magnifies the challenges in accurate diagnosis and management strategies. This article summarizes the salient clinical, radiologic and histologic features of common ceruminous gland tumors, in addition to discussing features that can aid in differentiating ceruminous tumors from other EAC tumors and to distinguish benign from malignant entities.



https://ift.tt/2OzZdEl

Selected Giant Cell Rich Lesions of the Temporal Bone

Abstract

Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.



https://ift.tt/2vuOX7Y

Squamous Cell Carcinoma of the External Auditory Canal and Temporal Bone: An Update

Abstract

Squamous cell carcinoma (SCC) is the most common primary malignancy to affect the temporal bone, including primary cutaneous SCC of the pinna, external auditory canal, middle and inner ear. This anatomically complex region generates complicated three-dimensional specimens that can be a challenge for macroscopic and microscopic pathologic assessment. A universally accepted staging classification for these malignancies is still to be established. A brief summary of the regional anatomy, etiology and epidemiology, presentation and diagnosis, radiologic assessment and treatment follows with a review of the pathologic assessment of the different types of specimens generated and an update on staging for SCC of the temporal bone.



https://ift.tt/2LGAAIq

Anatomy and Surgical Approach of the Ear and Temporal Bone

Abstract

The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.



https://ift.tt/2vuOR06

Neuroendocrine Neoplasms of the Ear

Abstract

Neuroendocrine neoplasms of the ear are uncommon primary tumors. There is a reported debate in the literature as to the true nature of these tumors and how to classify them. However, there is a kind of consensus that they can represent a spectrum of a common entity with dual glandular and neuroendocrine differentiation. The differential diagnosis of these tumors is broad but their morphologic, immunohistochemical, and radiographic features help to differentiate them from other entities. The tumors have mostly bland histology and indolent biological behavior, yet they may recur and metastasize. It is important to accurately recognize these tumors in order to perform the right management and limit their morbidity. In this article, we review the pathogenesis, histology, immunohistochemical features of neurornedocrine neoplasms of the ear and we discuss their differential diagnosis, clinical behavior and management.



https://ift.tt/2LKLywq

Cross Sectional Imaging of the Ear and Temporal Bone

Abstract

CT and MR imaging are essential cross-sectional imaging modalities for assessment of temporal bone anatomy and pathology. The choice of CT versus MR depends on the structures and the disease processes that require assessment, delineation, and characterization. A thorough knowledge of the two imaging modalities' capabilities and of temporal bone anatomy greatly facilitates imaging interpretation of pathologic conditions.



https://ift.tt/2NXuxfc

Cholesteatoma Pearls: Practical Points and Update

Abstract

The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.



https://ift.tt/2LKLtJ8

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Abstract

Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.



https://ift.tt/2vuOCSK

Ear and Temporal Bone Pathology: Neural, Sclerosing and Myofibroblastic Lesions

Abstract

Neural, sclerosing, and myofibroblastic lesions of the ear and temporal bone present diagnostic challenges for both clinicians and pathologists due to significant overlap in their clinical presentations, histologic appearances, and immunohistochemical profiles. While some of these lesions, such as schwannomas, are relatively common, others are rendered even more difficult because they are encountered very rarely in routine surgical pathology practice. This review is intended to provide an update on the pathology of some of the most commonly encountered primary diagnostic entities for the ear and temporal bone, and includes the following neural lesions: schwannoma, meningioma, and encephalocele/meningocele. Sclerosing lesions that will be discussed include spindle cell and sclerosing rhabdomyosarcoma, sclerosing epithelioid fibrosarcoma, and sclerosing paraganglioma. Finally, myofibroblastic lesions that will be reviewed are nodular fasciitis, IgG4-related disease, and solitary fibrous tumor. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.



https://ift.tt/2OxIfXa

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Abstract

A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.



https://ift.tt/2O2JLzD

Ceruminous Neoplasms of the Ear

Abstract

Ceruminous glands are modified apocrine glands located in the external auditory canal (EAC). Neoplastic lesions arising from these glands are rare in humans and constitute a major differential diagnosis for glandular neoplasms of the EAC. Due to anatomic restrictions, benign and malignant neoplasms present with similar symptoms and to some extent even comparable radiologic features, particularly when the tumors are localized. Biopsies are frequently limited by small size, fragmentation and improper anatomic and architectural orientation, thereby hampering our ability to appreciate the relationship of peripheral edges of the tumor to the surrounding tissue. Benign and malignant tumors may also have overlapping histomorphologic features, which further magnifies the challenges in accurate diagnosis and management strategies. This article summarizes the salient clinical, radiologic and histologic features of common ceruminous gland tumors, in addition to discussing features that can aid in differentiating ceruminous tumors from other EAC tumors and to distinguish benign from malignant entities.



https://ift.tt/2OzZdEl

Selected Giant Cell Rich Lesions of the Temporal Bone

Abstract

Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.



https://ift.tt/2vuOX7Y

Squamous Cell Carcinoma of the External Auditory Canal and Temporal Bone: An Update

Abstract

Squamous cell carcinoma (SCC) is the most common primary malignancy to affect the temporal bone, including primary cutaneous SCC of the pinna, external auditory canal, middle and inner ear. This anatomically complex region generates complicated three-dimensional specimens that can be a challenge for macroscopic and microscopic pathologic assessment. A universally accepted staging classification for these malignancies is still to be established. A brief summary of the regional anatomy, etiology and epidemiology, presentation and diagnosis, radiologic assessment and treatment follows with a review of the pathologic assessment of the different types of specimens generated and an update on staging for SCC of the temporal bone.



https://ift.tt/2LGAAIq

Anatomy and Surgical Approach of the Ear and Temporal Bone

Abstract

The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.



https://ift.tt/2vuOR06

Neuroendocrine Neoplasms of the Ear

Abstract

Neuroendocrine neoplasms of the ear are uncommon primary tumors. There is a reported debate in the literature as to the true nature of these tumors and how to classify them. However, there is a kind of consensus that they can represent a spectrum of a common entity with dual glandular and neuroendocrine differentiation. The differential diagnosis of these tumors is broad but their morphologic, immunohistochemical, and radiographic features help to differentiate them from other entities. The tumors have mostly bland histology and indolent biological behavior, yet they may recur and metastasize. It is important to accurately recognize these tumors in order to perform the right management and limit their morbidity. In this article, we review the pathogenesis, histology, immunohistochemical features of neurornedocrine neoplasms of the ear and we discuss their differential diagnosis, clinical behavior and management.



https://ift.tt/2LKLywq

Cross Sectional Imaging of the Ear and Temporal Bone

Abstract

CT and MR imaging are essential cross-sectional imaging modalities for assessment of temporal bone anatomy and pathology. The choice of CT versus MR depends on the structures and the disease processes that require assessment, delineation, and characterization. A thorough knowledge of the two imaging modalities' capabilities and of temporal bone anatomy greatly facilitates imaging interpretation of pathologic conditions.



https://ift.tt/2NXuxfc

Cholesteatoma Pearls: Practical Points and Update

Abstract

The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.



https://ift.tt/2LKLtJ8

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Abstract

Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.



https://ift.tt/2vuOCSK

Ear and Temporal Bone Pathology: Neural, Sclerosing and Myofibroblastic Lesions

Abstract

Neural, sclerosing, and myofibroblastic lesions of the ear and temporal bone present diagnostic challenges for both clinicians and pathologists due to significant overlap in their clinical presentations, histologic appearances, and immunohistochemical profiles. While some of these lesions, such as schwannomas, are relatively common, others are rendered even more difficult because they are encountered very rarely in routine surgical pathology practice. This review is intended to provide an update on the pathology of some of the most commonly encountered primary diagnostic entities for the ear and temporal bone, and includes the following neural lesions: schwannoma, meningioma, and encephalocele/meningocele. Sclerosing lesions that will be discussed include spindle cell and sclerosing rhabdomyosarcoma, sclerosing epithelioid fibrosarcoma, and sclerosing paraganglioma. Finally, myofibroblastic lesions that will be reviewed are nodular fasciitis, IgG4-related disease, and solitary fibrous tumor. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.



https://ift.tt/2OxIfXa

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Abstract

A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.



https://ift.tt/2O2JLzD

Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler

Abstract

Purpose of Review

The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6–18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined.

Recent Findings

Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients.

Summary

This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.



https://ift.tt/2n0fAxx

Long-Term Therapy with Corticosteroids in Nasal Polyposis: A Bone Metabolism Assessment

Abstract

Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the "Gold Standard" treatment for RSCwNP. The present study aimed to evaluate the side effects of prednisone in a group of patients with RSCwNP treated with long-term CS. In particular, attention was focused on bone disorders (osteopenia and osteoporosis) and prospective fracture risk increase. Forty patients (26 females, mean age 55.70 ± 14.03 years) affected by RSCwNP have been enrolled. Control group included 40 healthy subjects (17 females, mean age 56.37 ± 13.03 years). Nasal endoscopy, skin prick tests, nasal cytology, and bone densitometry were evaluated in all subjects. The likelihood of impaired bone metabolism (osteopenia or osteoporosis) was superimposable in both groups. Within RSCwNP group, no parameter was statistically significant in predicting a metabolism alteration.



https://ift.tt/2n08nxl

Case 23-2018: A 36-Year-Old Man with Episodes of Confusion and Hypoglycemia

Presentation of Case. Ms. Sarah J. Grzybinski (Emergency Medicine): A 36-year-old man was admitted to this hospital because of episodes of altered mental status. The patient had been well until 6 years before admission, when his wife observed an episode of unusual behavior. During the episode, the…

https://ift.tt/2vrnunt

The continuing effect of the discovery of IgE by Kimishige Ishizaka

Publication date: Available online 1 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Thomas A.E. Platts-Mills

Sadly, Kimi Ishizaka died on July 6, 2018. I would like to take the opportunity to consider his role in the discovery of IgE and the effect of that discovery. All of us owe an enormous debt to those who established the relevance of IgE and the importance of its receptor on basophils and mast cells. In my own case, I owe a special debt for the pleasure and extraordinary education of working with him at Hopkins between September 1971 and October 1974.



https://ift.tt/2LYdlsy

Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler

Abstract

Purpose of Review

The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6–18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined.

Recent Findings

Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients.

Summary

This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.



https://ift.tt/2n0fAxx

Periodontitis may modulate long-non coding RNA expression

Publication date: Available online 1 August 2018

Source: Archives of Oral Biology

Author(s): Fausto Sánchez-Muñoz, Gustavo Martínez-Coronilla, Ana Gabriela Leija-Montoya, Ulises Rieke-Campoy, Rosa Angelina Lopez-Carrasco, María de Lourdes Montaño-Pérez, Ernesto Beltrán-Partida, Yolanda Bojórquez-Anaya, Nicolas Serafin-Higuera, Javier González-Ramírez

Abstract

Periodontitis is a chronic inflammatory disease that compromises the integrity of the periodontium. Despite extensive research involving periodontitis, the detailed mechanisms underlying periodontal inflammation remain unclear. However, new important expression regulators have been emerging, such as non-coding RNAs, which are important determinants in the molecular control of the inflammatory process. Taking into consideration the vital role of non-coding RNAs, we determined for the first time the expression profiles of different long non-coding RNAs (lncRNAs) that are implicated in inflammation. In this study, we take periodontal samples of healthy subjects, patients with gingivitis and with periodontitis. In both disease groups, the lncRNA OIP5-AS1 expression levels were lower than levels in healthy subjects (P < 0.05). This study reveals new insights into the relative levels of OIP5-AS1 lncRNA in healthy, gingivitis and periodontal tissue, which may have important applications as a potential biomarker with protagonist activity in the development and manifestation of destructive periodontitis.



https://ift.tt/2Oxq3wQ

Long-Term Therapy with Corticosteroids in Nasal Polyposis: A Bone Metabolism Assessment

Abstract

Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the "Gold Standard" treatment for RSCwNP. The present study aimed to evaluate the side effects of prednisone in a group of patients with RSCwNP treated with long-term CS. In particular, attention was focused on bone disorders (osteopenia and osteoporosis) and prospective fracture risk increase. Forty patients (26 females, mean age 55.70 ± 14.03 years) affected by RSCwNP have been enrolled. Control group included 40 healthy subjects (17 females, mean age 56.37 ± 13.03 years). Nasal endoscopy, skin prick tests, nasal cytology, and bone densitometry were evaluated in all subjects. The likelihood of impaired bone metabolism (osteopenia or osteoporosis) was superimposable in both groups. Within RSCwNP group, no parameter was statistically significant in predicting a metabolism alteration.



https://ift.tt/2n08nxl

Periodontitis may modulate long-non coding RNA expression

Publication date: Available online 1 August 2018

Source: Archives of Oral Biology

Author(s): Fausto Sánchez-Muñoz, Gustavo Martínez-Coronilla, Ana Gabriela Leija-Montoya, Ulises Rieke-Campoy, Rosa Angelina Lopez-Carrasco, María de Lourdes Montaño-Pérez, Ernesto Beltrán-Partida, Yolanda Bojórquez-Anaya, Nicolas Serafin-Higuera, Javier González-Ramírez

Abstract

Periodontitis is a chronic inflammatory disease that compromises the integrity of the periodontium. Despite extensive research involving periodontitis, the detailed mechanisms underlying periodontal inflammation remain unclear. However, new important expression regulators have been emerging, such as non-coding RNAs, which are important determinants in the molecular control of the inflammatory process. Taking into consideration the vital role of non-coding RNAs, we determined for the first time the expression profiles of different long non-coding RNAs (lncRNAs) that are implicated in inflammation. In this study, we take periodontal samples of healthy subjects, patients with gingivitis and with periodontitis. In both disease groups, the lncRNA OIP5-AS1 expression levels were lower than levels in healthy subjects (P < 0.05). This study reveals new insights into the relative levels of OIP5-AS1 lncRNA in healthy, gingivitis and periodontal tissue, which may have important applications as a potential biomarker with protagonist activity in the development and manifestation of destructive periodontitis.



https://ift.tt/2Oxq3wQ

FIMARAD : la filière de santé maladies rares en dermatologie

Publication date: Available online 31 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): C. Bodemer, C. Taïeb, D. Vidaud, S. Ingen-Housz-Orob, R. Gène



https://ift.tt/2OwCI3b

Assessing severity of anaphylaxis: a data-driven comparison of 23 instruments

The severity of an allergic reaction can range from mild local symptoms to anaphylactic shock. To score this, a number of instruments have been developed, although heterogeneous in design and purpose. Severity...

https://ift.tt/2mYwuMS

Case report: Long-term survival of a pancreatic cancer patient immunized with an SVN-2B peptide vaccine

Abstract

A 62-year-old woman who underwent surgery to treat pancreatic cancer provided written, informed consent to undergo adjuvant therapy with gemcitabine, tegafur, and uracil. However, this was stopped after only 14 days due to Grade 4 neutropenia. She was then started on vaccine therapy with Survivin 2B peptide (SVN-2B) including IFA and INF-α. Although metastatic lung tumors were identified and resected at 82 months after surgery, the patient has remained free of new or relapsed disease for 12 years thereafter. Tetramer and ELISPOT assays revealed the continuous circulation of SVN-2B-restricted cytotoxic T-lymphocytes (CTLs) in her peripheral blood, and CTL clones had specific activity for SVN-2B at 12 years after surgery. The adverse effects of the peptide vaccination were tolerable and comprised low-grade headache, nausea, and fatigue. A prognosis beyond 10 years in the face of pancreatic cancer with distant metastasis is extremely rare. This experience might indicate the value of cancer vaccination therapy.



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