Head and Neck Medicine by Alexandros G.Sfakianakis: 08/31/18

Παρασκευή 31 Αυγούστου 2018

Rhomboid Intercostal and Subserratus Plane Block: A Cadaveric and Clinical Evaluation

Background and Objectives Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy. Methods For the cadaveric portion of the study, bilateral ultrasound-guided RISS blocks were performed on 6 fresh cadavers with 30 mL of 0.5% methylcellulose with india ink. For the retrospective case series, we present 15 patients who underwent RISS block or RISS catheter insertion for heterogeneous indications including abdominal surgery, rib fractures, chest tube–associated pain, or postoperative incisional chest wall pain. Results In the cadaveric specimens, we identified staining of the lateral branches of the intercostal nerves from T3 to T9 reaching the posterior primary rami deep to the erector spinae muscle medially. In the clinical case series, dermatomal coverage was observed in the anterior hemithorax with visual analog pain scores less than 5 in patients who underwent both single-shot and continuous catheter infusions. Conclusions Our preliminary cadaveric and clinical data suggest that RISS block anesthetizes the lateral cutaneous branches of the thoracic intercostal nerves and can be used in multiple clinical settings for chest wall and upper abdominal analgesia. Accepted for publication March 10, 2018. Address correspondence to: Hesham Elsharkawy, MD, MBA, MSc, Department of General Anesthesia and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code E31, Cleveland, OH 44195 (e-mail: elsharh@ccf.org). H.E. has received unrestricted educational funding from PAJUNK (Norcross, GA) and consultant fees from Pacira Pharmaceuticals, Inc. Those companies had no input into any aspect of the present project design or manuscript preparation. The authors declare no conflict of interest. All images are created and used with permission of Cleveland Clinic Center for Medical Art and Photography. 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 Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Noninvasive measures in atopic dermatitis

Purpose of review To summarize the current knowledge on the morphology, functionality and biochemical composition of the skin in allergic reactions. We address novel noninvasive techniques that promise to disclose intimate mechanisms of skin allergy in vivo. Epidermal barrier is not just a static wrap of the organism but rather a dynamic field for immunological, biophysical and biochemical processes and serves as a bio-sensor for exogenous danger signals. Recent findings Classical biophysical methods are amended by novel in-vivo techniques, such as Raman spectroscopy, analysing the skin microcomposition and develop epidermal profiles. Visualization techniques, such as reflectance spectroscopy and optical coherence tomography (OCT) are employed in studying the micro-morphological changes in the skin of allergic patients. Summary The noninvasive assessment of skin functions, micro-morphology and biochemical as well as immunological pathways will help to better understand skin allergies. They will allow to detect subtypes, for example in atopic dermatitis and to develop specific treatment modalities.

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Editorial introductions

No abstract available

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Globalization and anaphylaxis

Purpose of review To understand the impact of globalization in the management of anaphylaxis and identify potential strategies to improve patients' care and prevention. Recent findings Developments in the field of anaphylaxis have been consistently following these globalization trends offering possibilities of collaborations of the allergy community and integrated international initiatives to reach quality care of allergic patients worldwide. Summary Globalization is the process of interaction and integration between people, companies, and governments worldwide. Developments in the field of anaphylaxis have been following these globalization trends offering possibilities of collaborations and integrated international initiatives to reach quality care of allergic patients worldwide. Complex disorders, such as anaphylaxis, have called for complex integrative strategies, leading to a new acceptance of outside traditions. Allergy is encouraging us to accept holistic and integrative medical practices as viable options. With the dissolution of multinational boundaries and the universal free access to information, the notion of holistic and global-based care is emerging as the new reality of the medicine. We strongly believe that the integrated action plan to the management and prevention of anaphylaxis, just possible through the globalization, is a key health, political and economical move that advocates for the best practice of allergology.

https://ift.tt/2N6VrEx

Cosmetics and ocular allergy

Purpose of review The purpose of this review was to explore recent developments in the study of ocular cosmetics, as they pertain to adverse reactions that can be attributed to them. Recent findings Immunologically mediated adverse reactions to cosmetics are most commonly the result of sensitization to preservatives, fragrances and dyes used in these products. Metals such as nickel, cobalt, chromium and lead are used in products such as eye shadows and eye liners as well as toy makeup sets in amounts greater than the recommended amount of 1 ppm. Cosmetics make up the majority of fragrance-induced contact dermatitis. Recently, a free smartphone app was developed by American Contact Dermatitis Society that holds promise in better enabling patients to utilize their patch test data while shopping for cosmetics. Summary Both immediate and delayed hypersensitivity reactions linked to cosmetics are often the result of sensitization to preservatives, fragrances and additives in the products themselves. Despite significant advances in our understanding of these reactions, further research will be necessary to elucidate the mechanisms behind these reactions and bring this knowledge to the bedside as to improve patient care with potential cosmetic-based related allergic disorders.

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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.

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Novel systemic drugs in treatment of atopic dermatitis: results from phase II and phase III studies published in 2017/2018

Purpose of review The present review will give an update of recently published clinical studies on novel systemic treatment approaches in atopic dermatitis. Recent findings Until 2017 immunosuppressive drugs such as cyclosporine had to be used in atopic dermatitis when the disease could not sufficiently be treated with topical drugs. Several new substances specifically targeting inflammation in atopic dermatitis are currently studied. In 2017, dupilumab was approved in the United States and in Europe for first-line biologic treatment of moderate to severe atopic dermatitis in adults. The antibody blocks a subunit of the interleukin (IL)-4 and IL-13 receptor, thus inhibiting effects of two key cytokines in type 2 polarized inflammation. In addition to the studies on dupilumab recent clinical investigations on the effects on anti-IL-13 (lebrikizumab, tralokinumab), anti-IL-31 receptor (nemolizumab), anti-IL-22 (fezakinumab), and on small molecules targeting the histamine-4-receptor (ZPL389) and the Janus kinase inhibitor baricitinib have been published as full papers in the last 2 years. Summary A couple of promising novel therapeutical targets have recently been investigated and published in clinical trials on atopic dermatitis.

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Adults and children with anaphylaxis in the emergency room: why it is not recognized?

Purpose of review Despite many international guidelines have been published in the last 10 years, anaphylaxis continues to be underdiagnosed, undernotified, and undertreated. Anaphylactic reactions in adults and children in emergency departments are frequently not recognized, leading to underutilization of epinephrine, and a higher risk of death. Recent findings A few studies have been recently published showing that educational intervention for both physicians and other healthcare professionals improve diagnosis and treatment of anaphylaxis. Moreover, the new International Classification of Diseases, 11th edition improved classification of anaphylaxis, making it easier to be notified. Summary Anaphylaxis is a life-threatening hypersensitivity reaction that is most frequently seen by emergency physicians and nurses than allergists or immunologists. Education seems to be best strategy to improve management of this severe condition.

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Ocular allergy as a risk factor for dry eye in adults and children

Purpose of review To provide an overview of the pathogenic mechanisms underlying the correlation between ocular allergy and dry eye disease (DED), highlighting how the first condition may be a risk factor for the second one. Recent findings Recent advances in our comprehension of the pathogenesis of ocular allergy and DED allow identifying several pathways of interaction between these two conditions. A growing body of evidence supports the role of ocular allergy as a risk factor for DED. Ocular allergy, particularly the severe forms of keratoconjunctivitis, can impact on different key mechanisms of the DED vicious cycle, including tear film instability, ocular surface inflammation and damage, and neurosensory abnormalities. Summary Ocular allergy and DED are two common, relevant, symptomatic, not mutually exclusive conditions affecting the ocular surface. They share some clinical and biochemical features. To better understand the complex interactions between these two conditions, it's essential to consider the very wide spectrum of clinical conditions included in the term ocular allergy and the still largely unexplored peculiarities of the pediatric ocular surface physio-pathology and DED.

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Pitfalls in anaphylaxis

Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events.

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Topical antihistamines, mast cell stabilizers, and dual-action agents in ocular allergy: current trends

Purpose of review To address the current trends of therapeutic mechanisms for treatment of allergic conjunctivitis (AC), based on topical antihistamines and mast cell stabilizers (MCS). Recent findings The antihistamine drug alcaftadine has H4 receptor inverse agonism, anti-inflammatory and MCS activities. The antihistamines levocabastine and azelastine are more effective than placebo in treatment of AC symptoms in randomized controlled trials (RCTs). The topical dual-action antihistamines/MCS olopatadine, azelastine, ketotifen, and epinastine are commonly used in Europe and in the United States for mild subtypes of AC. For the main symptoms of AC, ocular itch and conjunctival hyperemia, epinastine 0.05% was superior to placebo, but equal or more effective than olopatadine 0.1%, while the later was more effective than ketotifen. High concentration olopatadine 0.77% had longer duration of action, better efficacy on ocular itch, and a similar safety profile to low-concentration olopatadine 0.2%. The new formulas of topical dual-action agents present longer duration of action, leading to a decreased frequency of use. Summary The topical dual-action agents are the most effective agents treating signs and symptoms of mild forms of AC. There is superiority to the high-concentration olopatadine drug over other agents on ocular itch, with prolonged effect when used once-daily.

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Seasonal ocular allergy and pollen counts

Purpose of review The purpose of the article is to provide a historical overview of literature regarding pollen sensitization and ocular allergy with an emphasis on developments that have occurred over the past 5 years. Recent findings Currently, pollen studies have examined the molecular and cellular pathways involved in initiating allergic conjunctivitis to find targets for therapeutics. Studies have also documented the threshold, linear increase and plateau point in the relationship between pollen levels and allergic conjunctivitis symptoms. Summary Traditionally, intact pollen grains are counted as a means of correlating patient symptoms to allergen exposure. However, establishing a dose–response relationship between pollen grain exposure and allergic conjunctivitis has proven to be difficult. It has been observed that ocular allergies induce a two-fold response including early-phase and late-phase IgE-mediated reactions. Sensitization itself is a combination of pollen exposure over time in genetically predisposed individual. However, symptoms appear to reach an asymptotic point at which clinical severity plateaus. More studies are needed to clearly define differences in pollen sensitization by plant species.

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New biologics in the treatment of urticaria

Purpose of review Symptomatic management of chronic spontaneous urticaria (CSU) basically depends on second-generation H1 antihistamines and omalizumab. Omalizumab is a game changer in the management, but still there is a need for new targets and new biologics targeting new pathways in the treatment which will provide long-lasting remission, which will be given orally and which will be cheaper. This review will focus on new biologics that are underway of production or are already under use for different disorders but could be beneficial for the treatment of Chronic urticaria. Recent findings In this review, the treatment targets are classified according to the cells which are involved in the pathogenesis of CSU. Those are mast cells/basophils, B cells, T cells and eosinophils. The treatments that are under clinical trials for CSU are anti-IgE treatments such as ligelizumab, molecules targeting intracellular signaling pathways such as spleen tyrosine kinase inhibitors, surface inhibitory molecules such as siglec-8, anti-IL-1s such as canakinumab, Bruton kinase (BTK) inhibitors such as GDC-0853 and anti-IL-5s such as benralizumab and mepolizumab. Summary The ongoing clinical trials on new targets of treatment hold new hopes not only for a better care of the disease but also a better understanding of the pathomechanisms lying underneath.

https://ift.tt/2NHzGZm

Conjunctival provocation tests: prediction of seasonal allergy

Purpose of review The conjunctival provocation test (CPT) is often used to clearly identify the specific allergen causing the symptoms of allergic rhinoconjunctivitis but also to assess the clinical efficacy of an allergen immunotherapy (AIT). As there is no consensus about its predictive value, the aim of this publication is to evaluate under which conditions the CPT can predict the symptom severity during the allergy season after previous AIT. Recent findings Three out of four randomized controlled trials (RCTs) showed a correlation between CPT reactivity and symptoms occurring under natural allergen exposure after previous AIT. Furthermore, one RCT found that performing the CPT 4 weeks after initiating AIT can identify early responders who also show a benefit during the season. Another RCT suggested that conducting the CPT prior to starting AIT can be used to identify patients who may benefit more from treatment than others. Summary The assessment of the reviewed literature led us to the conclusion that the CPT has a predictive value and can consequently be used to assess the efficacy of an administered AIT if performed according to a standardized challenge protocol with high-quality allergen extracts.

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Precision medicine in food allergy

Purpose of review To familiarize the reader with the concept of precision medicine in food allergy through the most recent insights in the diagnosis, prognosis, and management of the disease. Recent findings With the advent of omics sciences, a new era is commencing. Food protein allergens characterization and quantification together with the immunoglobulin E epitope mapping will contribute to the diagnosis/prognosis of food allergy and will lead to a better safety assessment of foods. The characterization of biomarkers able to identify specific phenotypes and endotypes will improve the diagnostic accuracy. This together with a better understanding of mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient. Summary In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the development of a personalized treatment tailored on the specific patient' profile.

https://ift.tt/2NIYVtW

Novel ethosomal gel of clove oil for the treatment of cutaneous candidiasis

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2NCUe56

A retrospective intercenter comparison of two surgical protocols through the dental arch relationship of 5- to 6-year-old unilateral cleft patients

Abstract

Objectives

The objectives of this retrospective equivalence trial were to assess the dental arch relationship of 5- to 6-year-old patients with unilateral cleft lip and palate (UCLP) treated in two specialized cleft centers with a different surgical protocol using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system, and to determine the correlation between these two scoring indices.

Materials and methods

The dental arch relationship of seventy-three 5- to 6-year-old patients with complete UCLP was evaluated on plaster casts using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. The sagittal occlusion, overbite, and overjet were also recorded. Inter- and intra-examiner agreement was determined using Intraclass Correlation Coefficients.

Results

A good to very good inter- and intra-examiner agreement was found. No significant mean difference in outcome based on the 5-Year-Olds' Index, the modified Huddart/Bodenham scoring system, overjet, or overbite was detected. For mean difference in sagittal occlusion, the hypothesis that both centers are clinically equivalent was confirmed. A strong negative correlation (r_s = − 0.832) between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system was found.

Conclusions

The dental arch relationship of 5- to 6-year-old unilateral cleft patients treated in two Belgian cleft centers is clinically equivalent based on sagittal occlusion, despite substantial differences in their treatment protocol. Clinical equivalence for other parameters was not confirmed. There is a strong correlation between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system.

Clinical relevance

A well-implemented treatment protocol for cleft patients is of the utmost importance, but case load and skill of the surgeon are also important factors for the quality of the results.

https://ift.tt/2NBMpN7

Dengue fever in a kidney transplant recipient with complicated clinical course: a case report

Dengue fever is the commonest mosquito-borne illness in the tropics and subtropics. Renal transplantation is one of the ever expanding modes of treatment of end-stage renal disease. Hepatitis B is a common inf...

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Successful treatment of out-of-hospital cardiopulmonary arrest due to streptococcal toxic shock syndrome – effectiveness of extracorporeal membrane oxygenation and the rapid antigen group A streptococcus test: a case report

Streptococcal toxic shock syndrome caused by Streptococcus pyogenes, a group A streptococcus, infection is a rare condition that rapidly progresses to multiple organ failure, shock, and death. It is thus importan...

https://ift.tt/2NdK8Lb

Age-related hearing loss and cognitive decline — The potential mechanisms linking the two

The amount of attention to age-related hearing loss (ARHL) has been growing, not only from the perspective of being one of the most common health conditions affecting older adults, but also from the perspective of its relation to cognition. Results from a number of epidemiological and laboratory studies have demonstrated a significant link between ARHL and cognitive decline. The Lancet International Commission on Dementia, Prevention, Intervention, and Care has estimated that mid-life hearing loss, if eliminated, might decrease the risk of dementia by nine percent, since hearing loss is a modifiable age-associated condition linked to dementia.

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Issue Information

International Forum of Allergy &Rhinology, Volume 8, Issue 9, Page 971-973, September 2018.

https://ift.tt/2PkPotI

Poor patient compliance with instructions for continuous sialogogues after 131I therapy

Oral Diseases, Volume 0, Issue ja, -Not available-.

https://ift.tt/2N6XTuQ

Vitamin D Deficiency in Patients with Aggressive Periodontitis

Oral Diseases, Volume 0, Issue ja, -Not available-.

https://ift.tt/2wELaFI

Discovery and preclinical validation of proteomic biomarkers in saliva for early detection of OSCC

Oral Diseases, Volume 0, Issue ja, -Not available-.

https://ift.tt/2otwXrk

Myofibroblastic lesions in the oral cavity: Immunohistochemical and ultrastructural analysis

Oral Diseases, Volume 0, Issue ja, -Not available-.

https://ift.tt/2C5Px2d

Hyperglycemia and periodontitis: possible mechanisms of interaction

Oral Diseases, Volume 0, Issue ja, -Not available-.

https://ift.tt/2oqzbI3

Assessment of endothelial function during the loading phase of infliximab in psoriasis: a potential predictor of its drug survival

International Journal of Dermatology, EarlyView.

https://ift.tt/2N8wXe4

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero‐American patients

International Journal of Dermatology, EarlyView.

https://ift.tt/2wz5sjz

Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review

International Journal of Dermatology, EarlyView.

https://ift.tt/2N4c83M

Controversies in off‐label prescriptions in dermatology: the perspective of the patient, the physician, and the pharmaceutical companies

International Journal of Dermatology, EarlyView.

https://ift.tt/2wAAMyJ

Percutan nasal septal retraction technique for dorsal cartilagenous deviations

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2C4B9Y3

The Effect of Ventilation Tube Insertion to the Health‐Related Quality of Life in a Group of Children in Southeast Anatolia

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PVsN7U

Fluoroscopic Balloon Diameter Measurement at Different Pressures during Eustachian Balloon Dilation

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2LLgQhY

Atopic Dermatitis and Cancer in Solid Organs: a Systematic Review and Meta‐Analysis

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2C4er2r

Creation and pilot test results of the dermatology‐specific proxy instrument the Infants and Toddlers Dermatology Quality of Life

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PTN0ek

Evaluation of a non‐ablative, fractional 1565 nm laser for the improvement of striae distensae albae

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2NEkThJ

Investigation of the Predisposing Factor of Pemphigus and its clinical subtype through a Genome‐wide association and next generation sequence analysis

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PU9jR5

Chromoblastomycosis: an autochthonous case of a tropical disease

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2NyhZLn

Bier's spots

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2wqMzjN

The impact of atopic dermatitis on sexual health

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2NGrZmc

Manipulating mindsets to improve patient outcomes: Is it ethical? Can it be avoided?

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PWrtlB

Does the Dermatology Life Quality Index (DLQI) underestimate the disease‐specific burden of psoriasis patients?

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2NGrOaw

Vancomycin‐induced red man syndrome presentation in a preterm infant

Pediatric Dermatology, EarlyView.

https://ift.tt/2orpn0g

Sinecatechins ointment for the treatment of warts in children

Pediatric Dermatology, EarlyView.

https://ift.tt/2wDlAk8

The value of full‐body skin examination: Poland syndrome diagnosed as an incidental finding

Pediatric Dermatology, EarlyView.

https://ift.tt/2wwZGQn

An atypical presentation of herpes simplex virus infection in Harlequin ichthyosis

Pediatric Dermatology, EarlyView.

https://ift.tt/2NB8hbk

Remission of seizures with immunosuppressive therapy in Parry‐Romberg syndrome and en coup de sabre linear scleroderma: Case report and brief review of the literature

Pediatric Dermatology, EarlyView.

https://ift.tt/2wuZiSj

Localized infantile hemangiomas of the face and scalp: Predilection for the midline and periorbital and perioral skin

Pediatric Dermatology, EarlyView.

https://ift.tt/2wwmXBe

Terminal osseous dysplasia presenting with intracytoplasmic inclusion bodies in digital fibromas

Pediatric Dermatology, EarlyView.

https://ift.tt/2oqzr9R

Ulcerated congenital plexiform fibrohistiocytic tumor: Case report and literature review

Pediatric Dermatology, EarlyView.

https://ift.tt/2NB7Z4e

Chronic urticaria in infants as the first manifestation of autoinflammatory disease

Pediatric Dermatology, EarlyView.

https://ift.tt/2wwMETb

Segmental Hailey‐Hailey disease of the vulva

Pediatric Dermatology, EarlyView.

https://ift.tt/2NBXOMC

Pediatric ocular lichen planus and lichen planopilaris: One new case and a review of the literature

Pediatric Dermatology, EarlyView.

https://ift.tt/2wwMsmV

Intracochlear Sound Pressure Measurements in Normal Human Temporal Bones During Bone Conduction Stimulation

Abstract

Bone conduction (BC) is heavily relied upon in the diagnosis and treatment of hearing loss, but is poorly understood. For example, the relative importance and frequency dependence of various identified BC sound transmission mechanisms that contribute to activate the cochlear partition remain unknown. Recently, we have developed techniques in fresh human cadaveric specimens to directly measure scalae pressures with micro-fiberoptic sensors, enabling us to monitor the input pressure drive across the cochlear partition that triggers the cochlear traveling wave during air conduction (AC) and round-window stimulation. However, BC stimulation poses challenges that can result in inaccurate intracochlear pressure measurements. Therefore, we have developed a new technique described here that allows for precise measurements during BC. Using this new technique, we found that BC stimulation resulted in pressure in scala vestibuli that was significantly higher in magnitude than in scala tympani for most frequencies, such that the differential pressure across the partition—the input pressure drive—was similar to scala vestibuli pressure. BC (stimulated by a Bone Anchored Hearing Aid [Baha]) showed that the mechanisms of sound transmission in BC differ from AC, and also showed the limitations of the Baha bandwidth. Certain kinematic measurements were generally proportional to the cochlear pressure input drive: for AC, velocity of the stapes, and for BC, low-frequency acceleration and high-frequency velocity of the cochlear promontory. Therefore, our data show that to estimate cochlear input drive in normal ears during AC, stapes velocity is a good measure. During BC, cochlear input drive can be estimated for low frequencies by promontory acceleration (though variable across ears), and for high frequencies by promontory velocity.

https://ift.tt/2PlFl7O

Effects of 3,3′-Iminodipropionitrile on Hair Cell Numbers in Cristae of CBA/CaJ and C57BL/6J Mice

Abstract

This study examines absolute hair cell numbers in the cristae of C57BL/6J mice and CBA/CaJ mice from weaning to adulthood as well as the dose required for 3,3′-iminodiproprionitrile (IDPN)-injury of the cristae in C57BL/6J mice and CBA/CaJ mice, the two mouse strains most commonly used by inner ear researchers. In cristae of CBA/CaJ and C57BL/6J mice, no loss of hair cells was observed up to 24 weeks. In both strains, dose-dependent loss of hair cells was observed 7 days after IDPN treatment of 2-month-old mice (IC₅₀ = 16.1 mmol/kg in C57BL/6J mice vs. 25.21 mmol/kg in CBA/CaJ mice). Four-month-old C57BL/6J mice exposed to IDPN developed dose-dependent vestibular dysfunction as indicated by increased activity and circling behavior in open field tests and by failure to swim 7 days after treatment. IDPN-hair cell injury in C57BL/6J mice and CBA/CaJ mice represents a fast and predictable experimental model for the study of vestibular degeneration and a platform for the testing of vestibular therapies.

https://ift.tt/2wwpw7j

The Laryngoscope, Volume 128, Issue 8, Page iii-vi, August 2018.

https://ift.tt/2LLEL0N

Masthead

The Laryngoscope, Volume 128, Issue 8, Page i-ii, August 2018.

https://ift.tt/2wvAuKd

Micromammal taphonomy and site formation process of Nutria Mansa 1 archaeological site (Buenos Aires, Argentina)

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

https://ift.tt/2N7Z39A

Intracochlear Sound Pressure Measurements in Normal Human Temporal Bones During Bone Conduction Stimulation

Abstract

https://ift.tt/2PlFl7O

Effects of 3,3′-Iminodipropionitrile on Hair Cell Numbers in Cristae of CBA/CaJ and C57BL/6J Mice

Abstract

https://ift.tt/2wwpw7j

A Milroy case with FLT4/VEGFR3 mutation and an unusual skin biopsy

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2N8d3Qo

Induction of protective cellular immune responses against experimental visceral leishmaniasis mediated by dendritic cells pulsed with the N-terminal domain of Leishmania infantum elongation factor-2 and CpG oligodeoxynucleotides

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Maria Agallou, Eleni Pantazi, Elisavet Tsiftsaki, Dimitra K. Toubanaki, Catherine Gaitanaki, Despina Smirlis, Evdokia Karagouni

Abstract

Leishmania elongation factor 2 (EF-2) has been previously identified as a T_H1-stimulatory protein. In this study, we assayed the protective potential of the N-terminal domain of EF-2 (N-LiEF-2, 1–357 aa) that has been predicted to contain several overlapping MHC class I and II-restricted epitopes injected in the form of dendritic cell (DC)-based vaccine. Ex vivo pulsing of DCs with the recombinant N-LiEF-2 domain along with CpG oligodeoxynucleotides (ODNs) resulted in their functional differentiation. BALB/c vaccinated with CpG-triggered DCs pulsed with N-LiEF-2 were found to be the most immune-reactive in terms of induction of DTH responses, increased T cell proliferation and IL-2 production. Moreover, vaccination induced antigen-specific T_H1 type immune response as evidenced by increased IFN-γ and TNFα levels followed by a significant increase of nitrite (NO) and reactive oxygen species (ROS) in splenocyte cultures. Vaccinated mice showed a pronounced decrease in parasite load in spleen and liver when challenged with L. infantum, increased expression of Stat1 and Tbx21 mRNA transcripts versus reduced expression of Foxp3 transcripts and were able to produce significantly elevated levels of IL-2, IFN-γ and TNFα but not IL-10 compared to non-vaccinated mice. Both antigen and parasite-specific CD4⁺ T and CD8⁺ T cells contributed to the IFN-γ production indicating that both subtypes contribute to the resistance to infection and correlated with robust nitrite generation, critical in controlling Leishmania infection. Together, these findings demonstrated the immunogenic as well as protective potential of the N-terminal domain of Leishmania EF-2 when given with CpG-triggered DCs representing a basis for the development of rationalized vaccine against leishmaniasis.

https://ift.tt/2onQWrc

Interleukin-33 deficiency exacerbated experimental autoimmune encephalomyelitis with an influence on immune cells and glia cells

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Yifan Xiao, Lin Lai, Huoying Chen, Junyu Shi, FanFan Zeng, Jun Li, Huiting Feng, Jie Mao, Feng Zhang, Naming Wu, Yong Xu, Zheng Tan, Feili Gong, Fang Zheng

Abstract

Interleukin (IL)-33, a member of the IL-1 cytokine family, is highly expressed in central nervous system (CNS), suggesting its potential role in CNS. Although some studies have focused on the role of IL-33 in multiple sclerosis (MS) / experimental autoimmune encephalomyelitis (EAE), an autoimmune disease characterized by demyelination and axonal damage in CNS, the exact role of IL-33 in MS/EAE remains unclear and controversial. Here, we used IL-33 knockout mice to clarify the role of endogenous IL-33 in EAE by simultaneously eliminating its role as a nuclear transcription factor and an extracellular cytokine. We found that the clinical score in IL-33 knockout EAE mice was higher accompanied by more severe demyelination compared with the wild-type (WT) EAE mice. As for the main immune cells participating in EAE in IL-33 knockout mice, pathogenic effector T cells increased both in peripheral immune organs and CNS, while CD4⁺FOXP3⁺ regulatory T cells decreased in spleen and lymph nodes, Th2 cells and natural killer (NK) cells decreased in CNS. Additionally, the populations of microglia/macrophages and CD11C⁺CD11B⁺ dendritic cells (DCs) increased in CNS of IL-33 knockout mice with EAE, among which iNOS-producing microglia/macrophages increased. Moreover, resident astrocytes/microglia were more activated in IL-33 knockout mice with EAE. In vitro, after blocking the IL-33, the proliferation of primary astrocytes, the production of MCP-1/CCL2 and TNF-α by astrocytes, and the production of TNF-α by primary microglia stimulated by the homogenate of the peak stage of EAE were increased. Our results indicate that IL-33 plays a protective role in EAE and exerts extensive influences on multiple immune cells and neural cells involved in EAE.

https://ift.tt/2NBPLj7

rhPLD2 inhibits airway inflammation in an asthmatic murine model through induction of stable CD25+ Foxp3+ Tregs

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Chuan-Xing Yu, Ling-Yu Bai, Jun-Jin Lin, Song-Bo Li, Jun-Ying Chen, Wen-Juan He, Xiu-Ming Yu, Xi-Ping Cui, Hui-Li Wang, Yi-Zhong Chen, Ling Zhu

Abstract

Our previous studies have shown that recombinant human phospholipase D2 (rhPLD2) plays a modulator role on NF-κB and PKC signaling pathways. It also inhibits IL-5-induced inflammatory response in chronic asthmatic guinea pigs. Additionally, increasing evidence also has revealed that the adoptive transfer of induced regulatory T cells (Tregs) may be a therapeutic solution to airway allergic diseases. To investigate the epigenetic, transcriptomic and phenotypic variability of Treg population in an ovalbumin (OVA)-induced airway inflammation model derived from the induction of rhPLD2, OVA-induced asthmatic murine model is used in this study. The lung inflammation, eosinophil infiltration, the differentiation and proliferation of T helper cells and the amplification of Tregs were examined in this mouse model with and without rhPLD2 induction. Our data showed that rhPLD2 administration in asthmatic mice significantly increases CD4⁺CD25⁺ Foxp3⁺ Treg cell numbers and alleviates lung inflammation. The addition of rhPLD2 in vitro enhanced the demethylation of Treg-specificdemethylated region (TSDR) in iTregs, suggesting that rhPLD2 protein may be involved in improving the quality and quantity of Treg cells that eventually significantly reduces lung inflammation in asthmatic murine model. These results suggest that rhPLD2 could have a clinical impact treating patients with allergic airway inflammation via promoting and stabilizing iTreg differentiation and function.

https://ift.tt/2oscUJS

TET mediated epigenetic regulation of iNKT cell lineage fate choice and function

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Ageliki Tsagaratou

Abstract

During the last years, intensive research has shed light in the transcriptional networks that shape the invariant NKT (iNKT) cell lineage and guide the choices towards functionally distinct iNKT cell subsets (Constantinides and Bendelac, 2013; Engel and Kronenberg, 2014; Gapin, 2016; Kim et al., 2015). However, the epigenetic players that regulate gene expression and orchestrate the iNKT cell lineage choices remain poorly understood. Here, we summarize recent advances in our understanding of epigenetic regulation of iNKT cell development and lineage choice. Particular emphasis is placed on DNA modifications and the Ten Eleven Translocation (TET) family of DNA demethylases.

https://ift.tt/2NyNVPX

‘Chronic traumatic ulcer of lateral tongue’- An underestimated ‘oral potentially malignant disorder’?

Publication date: Available online 30 August 2018

Source: Oral Oncology

Author(s): Prashanth Panta, Sachin C. Sarode, Gargi S. Sarode, Shankargouda Patil

https://ift.tt/2LIVWAd

Inflammatory markers in palatine tonsils of children with obstructive sleep apnea syndrome

Publication date: Available online 31 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Vitor Guo Chen, Viviane Maria Guerreiro da Fonseca, Jônatas Bussador Amaral, Cíntia Meirelles Camargo-Kosugi, Gustavo Moreira, Eduardo Macoto Kosugi, Reginaldo Raimundo Fujita

Abstract

Introduction

Obstrutive sleep apnea syndrome is characterized by repeated episodes of upper airway obstruction, associated with intermittent hypoxia and hypercapnia, and the main risk factor in childhood is adenotonsillar hypertrophy. The lymphocytes in these structures are responsible for local and systemic immune responses.

Objective

Verify the levels of the inflammatory markers, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, CRP and α1-GP, in the tonsils of children with and without obstructive sleep apnea syndrome.

Methods

This cross-sectional prospective study included 34 children with complains of snoring, difficulty breathing during sleep or recurrent tonsillitis. Patients underwent to a complete otorhinolaryngological examination, nasal endoscopy and polysomnography and were divided into two groups with 17 children each: obstructive sleep apnea syndrome group and control group. All underwent an adenotonsillectomy. Cytokines were measured in the collected tonsils (ELISA and Multiplex methods).

Results

Statistically significant increasing were observed between IL-8 and IL-10 cytokines of patients with obstructive sleep apnea when compared to the control group; also between c-reactive protein and α1-GP of the tonsils cortical region in children with obstructive sleep apnea syndrome when compared with the medullary region. There were no statistically significant differences for the remaining inflammatory mediators.

Conclusion

After the analysis of the levels of pro and anti-inflammatory markers (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, CRP, α1-GP) in the tonsils, we observed higher levels of markers IL-8 and IL-10 in pediatric patients with obstructive sleep apnea syndrome.

Resumo

Introdução

A síndrome da apneia obstrutiva do sono é caracterizada por episódios repetidos de obstrução das vias aéreas superiores, associados a hipóxia intermitente e hipercapnia, e o principal fator de risco na infância é a hipertrofia adenotonsilar. Os linfócitos nessas estruturas são responsáveis por respostas imunes locais e sistêmicas.

Objetivo

Dosar os marcadores inflamatórios, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, PCR e α1-GP, nas tonsilas de crianças com e sem síndrome da apneia obstrutiva do sono.

Método

Estudamos prospectivamente 34 crianças que se queixavam de ronco, dificuldade para respirar durante o sono ou tonsilites recorrentes. Os pacientes foram submetidos a exame otorrinolaringológico completo, endoscopia nasal e polissonografia e foram divididos em dois grupos com 17 crianças cada: síndrome de apneia obstrutiva do sono e controle. Todos foram submetidos à adenotonsilectomia. As citocinas foram medidas nas tonsilas coletadas (métodos ELISA e Multiplex).

Resultados

Com diferenças estatisticamente significantes, observou-se aumento das citocinas IL-8 e IL-10 em pacientes com apneia obstrutiva do sono em comparação ao grupo controle, assim como aumento dos níveis de proteína C reativa. e de α1-GP na região cortical das tonsilas de crianças portadoras de síndrome da apneia obstrutiva do sono em comparação com a região medular. Não houve diferenças estatisticamente significantes para o restante dos mediadores inflamatórios.

Conclusão

Após a análise dos níveis de marcadores pró e anti-inflamatórios (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, PCR, α1-GP) nas tonsilas, observamos níveis mais altos de marcadores IL-8 e IL-10 em pacientes pediátricos com síndrome da apneia obstrutiva do sono.

https://ift.tt/2Ncsast

Cross-cultural adaptation of the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese

Publication date: Available online 30 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Sthella Zanchetta, Humberto Oliveira Simões, Pamela Papile Lunardelo da Silva Lunardelo, Marina de Oliveira Canavezi, Ana Cláudia Mirândola Barbosa Reis, Eduardo Tanaka

Abstract

Introduction

Patient-reported outcome measures, inventory and or questionnaire, allow patients to present their perspective of the impact of their individual condition on a day-to-day basis, independent of the analysis of test results by the expert clinician. Outcome measures are recommended when there is evidence showing their reliability, validity and sensitivity. There are standardized patient-reported outcome measures for hearing in English language; however, other languages lack these instruments.

Objective

Adapt the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese and analyze its validation measures.

Methods

We conducted two studies. In Study 1, we translated and adapted the Amsterdam inventory for auditory disability and handicap to Brazilian Portuguese according to good practice guidelines; this included the pre-test stage. In Study 2, we administered the Portuguese version to adults with and without hearing loss (n = 31 and 18, respectively) and analyzed the measures of instrument validation, reliability, and reproducibility. Moreover, we calculated the correlation between pure tone thresholds and scores on the questionnaire.

Results

The results obtained in Study 1 demonstrated the feasibility of the translation process and the instrument's cultural adaptation, as well as its applicability, resulting in the Portuguese version of the Amsterdam inventory for auditory disability and handicap. In Study 2, the results revealed construct values for the questions and domains, as well as for the total reliable score. The intra-interviewer test–retest condition showed excellent reproducibility (ICC = 0.97). Finally, there was a strong positive correlation (r = 0.83) between the mean pure tone threshold and the hearing difficulties values, as measured by the instrument's scores.

Conclusion

The English version of the Amsterdam inventory for auditory disability and handicap could be translated and adapted to Brazilian Portuguese. An analyses of the validation process yielded reliable, consistent, and stable results.

Resumo

Introdução

Medidas de resultados relatados pelo paciente, inventários e/ou questionários, permitem que os pacientes apresentem suas perspectivas do impacto de sua condição no dia-a-dia, independente da análise dos resultados dos testes realizados pelo especialista. Esses instrumentos são recomendados quando há evidências mostrando sua confiabilidade, validade e sensibilidade. Existem medidas de resultados relatados pelo paciente padronizadas para a audição em língua inglesa; no entanto, esses instrumentos não existem em outras línguas.

Objetivo

Adaptar o Amsterdam Inventory for Auditory Disability and Handicap para o português brasileiro e avaliar suas medidas de validação.

Método

Realizamos dois estudos. No estudo 1, traduzimos e adaptamos o Amsterdam Inventory for Auditory Disability and Handicap para o português brasileiro de acordo com as diretrizes de boas práticas; incluindo a fase de pré-teste. No estudo 2, aplicamos a versão em português em adultos com e sem perda auditiva (n = 31 e 18, respectivamente) e analisamos as medidas de validação, confiabilidade e reprodutibilidade do instrumento. Além disso, calculamos a correlação entre os limiares de tons puros e os escores do questionário.

Resultados

Os resultados obtidos no estudo 1 demonstraram a viabilidade do processo de tradução e adaptação cultural do instrumento, assim como sua aplicabilidade, resultando na versão em português da Amsterdam Inventory for Auditory Disability and Handicap. No estudo 2, os resultados revelaram valores de constructo para as questões e domínios, bem como para o escore total confiável. A condição de teste-reteste intra-entrevistador mostrou excelente reprodutibilidade (CCI = 0,97). Por fim, houve forte correlação positiva (r = 0,83) entre o limiar médio de tom puro e os valores das dificuldades auditivas, medidos pelos escores do instrumento.

Conclusão

A versão em inglês do Amsterdam Inventory for Auditory Disability and Handicap foi traduzida e adaptada para o português brasileiro. Uma análise do processo de validação produziu resultados confiáveis, consistentes e estáveis.

https://ift.tt/2NBjjNA

Does a strong IgG response precede allergic sensitization?

Allergy, Volume 73, Issue 9, Page 1924-1925, September 2018.

https://ift.tt/2onyU8u

Very rarely chronic urticaria can be caused by cancer and if so, resolves with its cure

Allergy, Volume 73, Issue 9, Page 1925-1926, September 2018.

https://ift.tt/2wCinl3

In this Issue: Graphical Abstracts

Allergy, Volume 73, Issue 9, Page 1759-1761, September 2018.

https://ift.tt/2opwWon

Issue Information ‐ TOC

Allergy, Volume 73, Issue 9, Page 1757-1758, September 2018.

https://ift.tt/2NFziKU

Issue Information ‐ Cover and Editorial Board

Allergy, Volume 73, Issue 9, Page 1755-1755, September 2018.

https://ift.tt/2ww7W3c

Corrigendum

Allergy, Volume 73, Issue 9, Page 1929-1929, September 2018.

https://ift.tt/2NyWJ8o

Comparison Between a Standard Tube and the Ultra-thin Tritube for Intubation of the Trachea and for Maintaining Access to the Trachea After Anaesthesia, in Patients With an Expected Difficult Direct Laryngoscopy

Conditions: Oral Neoplasm; Pharynx Cancer; Larynx Cancer
Interventions: Device: Tritube; Device: Standard enditracheal tube
Sponsor: Michael Seltz Kristensen
Not yet recruiting

https://ift.tt/2LDrhEl

Abemaciclib + Nivolumab in Patients With Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma That Progressed or Recurred Within Six Months After Platinum-based Chemotherapy

Condition: Head and Neck Squamous Cell Carcinoma
Interventions: Drug: Abemaciclib; Drug: Nivolumab; Procedure: Tumor biopsy; Procedure: Peripheral blood; Other: EORTC QLQ-30
Sponsors: Washington University School of Medicine; Eli Lilly and Company
Not yet recruiting

https://ift.tt/2NaJPAM

Apatinib Combined With S-1 for the Treatment of Recurrent/Metastatic Head and Neck Malignancies

Condition: Head and Neck Cancer
Intervention: Drug: Apatinib
Sponsors: China International Medical Foundation; Chinese Society of Clinical Oncology
Not yet recruiting

https://ift.tt/2LKrFke

Do Changes in ctDNA Predict Response for Patients With Oesophageal Cancer Receiving Duvalumab

Condition: Oesophageal Cancer
Intervention: Drug: Durvalumab
Sponsors: Simon C Pacey, MD; AstraZeneca
Not yet recruiting

https://ift.tt/2N30Kox

Long term effectiveness of electrochemotherapy for the treatment of lower lip squamous cell carcinoma

Publication date: Available online 31 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): M. Gargiulo, J.M. Serra Mestre, A. Cortese, D.C. Murphy, S. Parascandolo, Razzano S

Summary

Purpose

Electrochemotherapy (ECT) is a therapeutic approach based on the local application of electrical pulses that permeabilize cell membranes to enhance the uptake of low-permeant chemotherapeutic agents, thus increasing their cytotoxic effects.

Materials and Methods

Twenty-one patients with SCC of the lower lip were treated according to the European Standard Operating Procedures of Electrochemotherapy. Bleomycin (15,000 IU/m² body surface area) was administered intravenously over a 1-minute period. Eight electrical pulses (amplitude, 1000 V/cm; duration, 100 μs) were generated and delivered at a repetition frequency of 5 kHz. Changes in tumor volume were used to assess treatment response.

Results

Objective response (OR), complete response (CR), and partial response (PR) rates of 100%, 71.4%, and 28.6% respectively were demonstrated following a single session of ECT. ECT was well tolerated, and no adverse events occurred.

Conclusions

Intravenous bleomycin-based ECT is a safe and effective therapy for SCC of the lower lip. ECT improves the quality-of-life of patients by preserving the function and the aesthetic appearance of the affected area. ECT provides a therapeutic option for elderly and frail patients who, due to their state of health, are not suitable for, or refuse surgical interventions.

https://ift.tt/2PoJ58p

Three-dimensional evaluation of mandibular midline distraction: a systematic review

Publication date: Available online 31 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Atilla Gül, Jan P. de Gijt, Stephen T.H. Tjoa, Eppo B. Wolvius, Maarten J. Koudstaal

Abstract

Objective

To provide a literature overview on mandibular midline distraction (MMD) using three-dimensional (3D) imaging analysis techniques. Regarding different distractor types, the focus was on changes in position and/or morphology of the mandibular condyle and temporomandibular joint (TMJ), skeletal effects, dental effects, soft tissue effects, and biomechanical and masticatory effects, specifically on the mandible and TMJ.

Methods

Studies up to March 27 2017 were included, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, using Embase, Medline OvidSP, Web-of-science, Scopus, Cochrane, and Google Scholar.

Results

Thirty-one full-text papers were assessed for eligibility and 15 met the inclusion criteria: prospective (2), retrospective (2), case-report (1) and computational analysis (10). All included studies were graded low (level 4–5) for quality of evidence, using the Oxford Centre for Evidence-Based Medicine criteria.

Conclusion

There is a limited number of studies available, with low levels of evidence and small sample sizes. Bone-borne distraction seems preferable when taking skeletal effects into account. Tooth-borne distraction leads to significant dental tipping. Hybrid distractors combined with parasymphyseal step osteotomy seem to be the most stable under functional masticatory loads. The effects of chewing appeared to be marginal during the latency period. No permanent TMJ symptoms were reported, and little is known about soft tissue effects.

Systematic review registration

International Prospective Register of Systematic Reviews, PROSPERO CRD42014010010.

https://ift.tt/2wwvUex

Current practice trends in microvascular free flap reconstruction by fellowship-trained otolaryngologists

Publication date: Available online 30 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Yarah M. Haidar, Sartaaj Walia, Tjoson Tjoa, Edward C. Kuan, Julie A. Goddard

Summary

Purpose

In the field of head and neck microvascular surgery, there are currently no clear, universally accepted recommendations on the intraoperative, preoperative, and postoperative management of these patients.

Materials and Methods

A 23-question cross-sectional survey was distributed to otolaryngologists who perform microvascular reconstruction. Information about practice setting, fellowship training background, intraoperative practice, postoperative practice, and surgical complications were analyzed.

Results

Complete survey responses were received from 102 (32.8% response rate) of surveyed otolaryngologists who perform microvascular surgery. A great degree of variability was noted in intraoperative and postoperative care of free flap patients. Overall, self-reported free flap survival-rates were relatively high, despite the variability in practice, with the majority of surgeons (74%) reporting flap survival rate of 96-100%. Complication rates requiring return to the operating room were low; all respondents reported <20% overall complications with <10% re-operation rates due to vascular complications.

Conclusion

An increasing number of microvascular-trained otolaryngologists are performing free flaps. Self-reported free flap survival rates are high and complication rates are low, despite significant variability in intraoperative and postoperative practices among otolaryngologists performing microvascular flap reconstruction. By identifying these differences among surgeons, we hope to provide the impetus for further academic dialogue and prospective trials.

https://ift.tt/2NDrMQn

Nodal metastases distribution in laryngeal cancer requiring total laryngectomy: Therapeutic implications for the N0 Neck

Publication date: Available online 31 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): D. Riviere, J. Mancini, L. Santini, A. Loth bouketala, A. Giovanni, P. Dessi, N. Fakhry

Abstract

Objectives

Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck.

Material and methods

Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015.

Results

Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n = 11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P = 0.03).

Conclusions

Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.

https://ift.tt/2NaFj5i

Familial acanthosis nigricans with the FGFR3 mutation: Differences of pigmentation between male and female patients

The Journal of Dermatology, EarlyView.

https://ift.tt/2NAUoKb

Hinführung zum Thema – Schmerzen bei an Krebs erkrankten Menschen

https://ift.tt/2PQHnxE

Aktuelle pathophysiologische Entwicklungen bei fibrosierenden Erkrankungen: Ansatzpunkte für neue Konzepte in der Therapie

Zusammenfassung

Die Fibrose ist ein häufiges Symptom zahlreicher Hauterkrankungen unterschiedlicher Genese. Die Pathogenese fibrosierender Veränderungen der Haut und anderer Organsysteme ist bisher nicht ausreichend verstanden, und die derzeitigen Therapiemöglichkeiten sind unzureichend. Fibrosierende Erkrankungen der Haut führen zu einer Gewebeverhärtung und zu einem Funktionsverlust, die in der Folge mit schwerwiegenden Einschränkungen der Lebensqualität, gesteigerter Morbidität und letztlich einer erhöhten Mortalität einhergehen können. Epidemiologische Studien weisen darauf hin, dass in den westlichen Industrienationen bis zu 45 % aller Todesursachen auf Erkrankungen zurückzuführen sind, die mit einer Gewebefibrose in unterschiedlichen Organen einhergehen. Aktuell stehen nur wenige spezifisch für fibrosierende Erkrankungen zugelassene Medikamente zur Verfügung. Die Entwicklung neuer, ursachenbasierter und damit effizienter Therapieansätze ist dringend erforderlich. Dies stellt einerseits eine große Herausforderung dar, eröffnet zugleich aber auch die Möglichkeit, einen besonderen Beitrag zur Aufklärung dieses medizinisch ungelösten Problems zu leisten. Im Folgenden sind ausgewählte Erkenntnisse der letzten Jahre mit Fokus auf der Rolle der Immunantwort in der Fibrogenese dargestellt.

https://ift.tt/2NAfUyK

Update: Asthma Yardstick: Practical recommendations for a sustained step-up in asthma therapy for poorly controlled asthma

Publication date: Available online 30 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): John J. Oppenheimer, Larry Borish

https://ift.tt/2LJlWeH

Biologics and Small Molecule Agents in Allergic and Immunologic Skin Diseases

Abstract

Purpose of Review

Biologics and small molecules are key therapeutic options in the treatment of chronic immunologic and allergic skin conditions. By directly targeting innate and inflammatory responses within the skin, including pro-inflammatory cytokines and cellular signaling pathways, these new agents have the potential to counteract the inflammatory cascade responsible for various conditions, including psoriasis and atopic dermatitis. Over the past decade, groundbreaking research identifying key cytokines and receptors involved in the pathogenesis of these diseases has allowed for the development of highly efficacious biologics and small molecules that are associated with unprecedented rates of skin clearance and favorable adverse event profiles.

Recent Findings

This narrative review evaluates new and upcoming biologic and small molecule agents for the treatment of two allergic/immunologic skin diseases—atopic dermatitis and psoriasis. Numerous small molecules and biologics targeting TNF-α, IL-12/23, IL-17 and IL-17R, and IL-23 are commercially available for the treatment of psoriasis, and newer agents are in various stages of development. Currently, dupilumab, a monoclonal antibody that blocks IL-4R∝, is the only approved biologic for atopic dermatitis. Antibodies targeting IL-13 and IL-31 and small molecules that inhibit Janus kinase and pruritus-mediating receptors are currently being studied in clinical trials. Further investigations into the pathophysiology of atopic dermatitis will likely yield additional therapeutic options in the future.

Summary

This article reviews recent literature on small molecules and biologics for the treatment of atopic dermatitis and psoriasis.

https://ift.tt/2C5m5tq

Overexpression of T-cadherin inhibits the proliferation of oral squamous cell carcinoma through the PI3K/AKT/mTOR intracellular signalling pathway

Publication date: Available online 30 August 2018

Source: Archives of Oral Biology

Author(s): Qiuju Wang, Xiaoqin Zhang, Xiaoyu Song, Li Zhang

Abstract

Objective

To evaluate T-cadherin gene expression in patients with oral squamous cell carcinoma(OSCC) and explore its effect on the proliferation of OSCC. Additionally, the present study aimed to determine whether the anti-proliferative effect of T-cadherin was associated with the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) signaling pathway.

Design

A reverse transcription-quantitative polymerase chain reaction was performed to detect T-cadherin mRNA expression. A Cell Counting Kit-8 (CCK-8) assay was used to investigate the effect of T-cadherin on cellular proliferation. The survival curves were plotted by Kaplan-Meier method, and the differences between subgroups were determined by log-rank test. The protein expression of phosphorylated (p)-PI3K, total PI3K, p-AKT, total AKT, p-mTOR, total mTOR and cyclin D1was assessed using western blot.

Results

It was revealed that the expression of T-cadherin mRNA was significantly decreased in OSCC samples compared with normal adjacent ones (P = 0.007), and that low T-cadherin expression was correlated with advanced clinical stage (P = 0.0249), higher pathological grade (P = 0.0288) and poor differentiation (P = 0.0295) of OSCC. In addition, T-cadherin negative expression was revealed to be associated with a worse progression‑free survival (PFS) in patients with OSCC. Furthermore, the overexpression of T-cadherin inhibited the proliferation of OSCC cell lines and suppressed the PI3K/AKT/mTOR signaling pathway. Importantly, the combined treatment of T-cadherin with the PI3K inhibitor LY294002 enhanced the inhibitory effect of T-cadherin on cellular proliferation and the PI3K/AKT/mTOR pathway.

Conclusions

The results of the present study suggested that T-cadherin may function as a tumor suppressor gene in OSCC through suppressing the PI3K/AKT/mTOR pathway, and that it may be a potential therapeutic target for OSCC.

https://ift.tt/2wz4Day

Identification of novel genes involved in gingival epithelial cells responding to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis infections

Publication date: Available online 30 August 2018

Source: Archives of Oral Biology

Author(s): Hongguang Zhu, Shouyi Lu, Meirong Wei, Xiaoshan Cai, Guoyou Wang

Abstract

Objective

This study aimed to identify the differentially expressed genes (DEGs) in gingiva epithelial cells responding to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis infections using bioinformatics method.

Study design

GSE9723 dataset was downloaded from Gene Expression Omnibus, and DEGs between the infected cells and controls were identified using unpaired t-test. Overlapping DEGs in responding to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis infections were extracted. Protein-protein interaction networks were constructed and functional modules were isolated using Molecular Complex Detection algorithm. Key genes in protein-protein interaction network and Molecular Complex Detection modules were subjected to functional enrichment analyses. In addition, the transcriptional factors were predicted.

Results

A total of 533 co-up-regulated and 202 co-down-regulated genes were identified. The up-regulated genes, including IL6, CCL19, EDN1, ADCY9, and BCL2 and the down-regulated genes, including CCNB1, PLK1, and CCNA2 were the key genes in the protein-protein interaction network and modules. They were intensively enriched in chemokine signaling pathway, calcium signaling pathway and cell cycle. Finally, two transcriptional factors, E12 and NRSF, targeting to the up-regulated genes and one transcriptional factor, NRP1, targeting the down-regulated genes, were predicted.

Conclusions

CCNB1, PLK1, and CCNA2 might play important roles in the response of host epithelial cells to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

https://ift.tt/2wu4beo

Expanding morphological and clinical aspects of hereditary leiomyomatosis and renal cell carcinoma (HLRCC): a case report in a patient with unusual morphology and clinical presentation

Abstract

Renal cell carcinoma (RCC) accounts for 2–3% of all malignant disease in adults. Hereditary RCC represents 5 to 8% of kidney tumors. Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) represents an autosomal dominant syndrome that results from a germline mutation in fumarate hydratase gene (FH). HLRCC patients typically present with skin or uterine leiomyomas and renal neoplasms. HLRCC was recently recognized as a distinct renal tumor subtype by the WHO 2016 classification. Many morphological patterns such as papillary, solid, tubular, and cystic had been described as part of morphological aspects of HLRCC. In this study, we describe a case of a patient that had a history of persistence of ductus arteriosus (PDA) and cryptorchidism. In addition, the renal tumor showed a very unusual hystiocytoid morphological aspect. We confirmed the presence of a FH germline mutation both in the patient and his mother.

https://ift.tt/2orzG4G

Overexpression of T-cadherin inhibits the proliferation of oral squamous cell carcinoma through the PI3K/AKT/mTOR intracellular signalling pathway

Publication date: Available online 30 August 2018

Source: Archives of Oral Biology

Author(s): Qiuju Wang, Xiaoqin Zhang, Xiaoyu Song, Li Zhang

Abstract

Objective

Design

Results

Conclusions

https://ift.tt/2wz4Day

Identification of novel genes involved in gingival epithelial cells responding to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis infections

Publication date: Available online 30 August 2018

Source: Archives of Oral Biology

Author(s): Hongguang Zhu, Shouyi Lu, Meirong Wei, Xiaoshan Cai, Guoyou Wang

Abstract

Objective

Study design

Results

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CCNB1, PLK1, and CCNA2 might play important roles in the response of host epithelial cells to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

https://ift.tt/2wu4beo

Diagnostic ultrasonography in a child with eosinophilic fasciitis

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2N4qhxP

Biologics and Small Molecule Agents in Allergic and Immunologic Skin Diseases

Abstract

Purpose of Review

Recent Findings

Summary

This article reviews recent literature on small molecules and biologics for the treatment of atopic dermatitis and psoriasis.

https://ift.tt/2C5m5tq

The Evolution of Surgical Enhanced Recovery Pathways: a Review

Abstract

Purpose of Review

Enhanced recovery pathways are a well-defined perioperative health care program utilizing evidence-based interventions in a protocol-like manner designed to standardize techniques including drug selection and dosing to improve results and to reduce overall costs including facilitating earlier discharge from hospitals after surgery.

Recent Findings

A PubMed and World Wide Web search was performed with the following key words: enhanced recovery, surgical enhanced recovery, recovery pathways, and enhanced recovery pathways surgery.

Summary

This introduction to enhanced recovery pathways reflects its 20-year history, worldwide appeal, and ever growing presence in our practices. Many clinical teams have not, as of yet, incorporated enhanced recovery pathway principles to their practices and therefore, continued evolution should include increasing outreach and formalized guidelines in the future.

https://ift.tt/2oruAFC

Von der Schmerzäußerung zur Schmerzbehandlung

https://ift.tt/2LEGFQQ

Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy

Publication date: Available online 30 August 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Rajiv M. Borle, Anendd Jadhav, Nitin Bhola, Pawan Hingnikar, Prafulla Gailkwad

Abstract

Purpose

An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies.

Patients and methods

Between Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c.

Results

Introperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18 ± 1.7 mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively.

Conclusions

When used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.

https://ift.tt/2oqrVfl

Correlation between dermoscopic and histopathological findings of leucoplakia of the tongue: a case report

Publication date: Available online 31 August 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): T. Okamoto, M. Tanaka, N. Kaibuchi, T. Kuwazawa, T. Ando

Abstract

A 75-year-old Japanese man presented at our outpatient clinic with pain on the right side of his tongue. Comparison of histological and dermoscopic images showed that areas with hyperkeratosis were opaque white, areas above the papillary dermis were reddish, and that the lesion looked whiter on dermoscopy the longer the epithelial rete ridges were. A dermatocope shows structural information from the epidermis as well as the upper dermis, and could improve early diagnosis of oral mucosal squamous carcinoma in situ.

https://ift.tt/2NGorA0

Sleep: its importance and the effects of deprivation on surgeons and other healthcare professionals

Publication date: Available online 30 August 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): D.A. Parry, R.S. Oeppen, M.S.A. Amin, P.A. Brennan

Abstract

As clinicians, we sometimes fail to look after ourselves properly and do not regularly eat healthy foods or drink enough. Sleep is another factor that we often neglect. A lack of it can compromise our personal health and performance at work, and the "sleep debt" that results when this is chronic can take far longer to recover from than one might think. Now that junior doctors work more shift rotas and senior colleagues have onerous on-call responsibilities, we all need to be aware of the effects of sleep deprivation, which can lower the mood and motivation, weaken leadership, and result in more clinical errors. In this review we consider what might constitute enough sleep, the consequences of inadequate sleep, and how these might be addressed for surgeons.

https://ift.tt/2osbZcs

Tuberculosis treatment failure in AIDS: vengeance with renal and ocular manifestations

Tuberculosis treatment failure is not uncommon in patients with AIDS. Treatment failure is defined as a positive sputum smear or culture at month 5 or later in the course of the treatment. The clinical presentations in these patients show remarkable heterogeneity. In this report, we chronicle the case of a patient with treatment failure presenting as the disseminated disease, specifically ocular and renal tuberculosis. Additionally, we undertake here a brief literature review highlighting the increased resistance to tuberculosis treatment in patients with AIDS, the rarity of ocular tuberculosis and the importance of tailoring drug regimens on an individual basis in these coinfected patients.

https://ift.tt/2opgkwT

Disseminated tuberculosis masquerading as a neuroendocrine tumour

We describe the case of a 61-year-old man from the Dominican Republic admitted with diarrhoea, fevers and weight loss who was found to have lab studies and imaging (including radiolabeled somatostatin positron emission tomography/CT scan) initially consistent with a metastatic neuroendocrine tumour. However, after weeks of workup and multiple inconclusive biopsies, he was diagnosed with disseminated extrapulmonary tuberculosis. Here we examine the data for neuroendocrine tumour and tuberculosis labs and imaging to delineate where these studies overlap. We also analyse the biases and pitfalls in this case that led to a protracted diagnosis.

https://ift.tt/2PkDgsA

Unilateral renal artery stenosis presenting as acute flaccid paralysis: a rare presentation

Renovascular hypertension is one of the common causes of secondary hypertension. Here we report a case of patient of renal artery stenosis presenting to the emergency department as a case of acute flaccid paralysis. Renal artery stenosis has been associated with hypokalaemia, but rarely reported to be symptomatic. Initial correction of hypokalaemia leads to improvement of weakness and aetiological work up for hypokalaemia with hypertension revealed hypokalaemia due to hyperaldosteronism secondary to unilateral renal artery stenosis. The patient was managed medically with aldosterone antagonist in the anti hypertensive therapy and weakness did not recur despite withdrawal of potassium supplements. On follow-up, the patient was ambulatory with no signs of weakness, controlled blood pressure and normal potassium level.

https://ift.tt/2PO6QYu

Bilateral nasolabial cyst: a rare case

Nasolabial cysts are rare non-odontogenic cysts characterised by their extraosseous appearance and are always located near to ala nasi. They are painless and located beneath the mucosa leading to soft tissue swelling and elevation of nasal ala. Bilateral nasolabial cyst is a rare occurrence. This case report describes the clinical diagnostic features and multimodal imaging appearance of nasolabial cyst with review of literature.

https://ift.tt/2PkDdgo

Severe acute kidney injury due to violent sadomasochistic play

Bondage and discipline, dominance and submission, sadism and masochism (BDSM) refers to a variety of primarily erotic practices. Although safety is crucial for most BDSM practitioners, there are violent forms that may cause serious injury. We present the case of 61-year-old man with no history of chronic kidney disease who developed severe acute anuric kidney injury following violent BDSM play. He had been strapped tightly onto a wooden spanking bench and then received approximately 1000 vigorous hits onto his bare buttocks and thighs. Subsequently, he developed haematuria and became anuric. Laboratory testing revealed strongly elevated serum creatinine levels. Kidney biopsy was unremarkable except mild tubulointerstitial damage. Urinary production increased spontaneously again after 4 days, and serum creatinine normalised over the course of 4 weeks. We believe that a combination of intermittent abdominal compartment syndrome and blunt kidney trauma may have been responsible for this severe acute kidney injury.

https://ift.tt/2orol4E

Blood in a Haab Stria

We describe a case of an asymptomatic and spontaneous intracorneal hemorrhage in an adult with congenital glaucoma and blood collected in a Haab stria.
Case Rep Ophthalmol 2018;9:411–415

https://ift.tt/2PmQpRQ

Case Series of Inappropriate Concentration of Intraocular Sulfur Hexafluoride

Due to high complexity, vitreoretinal surgery presents a higher number of patient safety incidents compared with other ophthalmic procedures. Intraocular gases are one of the most useful adjuncts to vitrectomy and surprisingly, surgeons commonly admit to having occasional problems with incorrect gas concentration. The aim of this study is to present a consecutive case series of patients with improper concentration of sulfur hexafluoride (SF₆) applied during vitrectomy. Three patients underwent 27-gauge vitrectomy and at the end of surgery inappropriate dilution of 100% SF₆ was administered. It was attributed to a calculation error, change in the gas supplier, or increased partial pressure of SF₆ before dilution. Postoperatively, due to IOP increase, two eyes required intravitreal gas-air exchange. Subsequently, cataract surgery was performed in one eye with concomitant vitrectomy and silicone oil tamponade due to retinal detachment. To prevent such complications, we suggest using intraocular gases with great care, training of ophthalmic personnel, and prompting manufacturers to provide SF₆ in a prepared concentration of 20%.
Case Rep Ophthalmol 2018;9:405–410

https://ift.tt/2oqir3J

A Case Report of Intravitreal Bevacizumab for Iris Metastasis of Small Cell Lung Carcinoma with Neovascular Glaucoma

A 79-year-old man who had been diagnosed with small cell lung carcinoma (SCLC) complained of right ocular pain and blurred vision. His right intraocular pressure (IOP) was 30 mm Hg, and anterior chamber cells and multiple grayish white iris masses associated with peripheral anterior synechia (PAS) and neovascularization of the right iris were observed. We presumed that the iris masses were iris metastasis of SCLC. Despite therapy with topical eye drops and oral acetazolamide, the IOP was poorly controlled, so we injected intravitreal bevacizumab into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but the IOP did not improve because of total PAS. To our knowledge, there is only one report of the use of intravitreal bevacizumab for SCLC metastasis in that eye and they reported that intravitreal injection resulted in successful short-term regression of presumed iris metastasis and improved control of secondary neovascular glaucoma, and the case had over one-half PAS. The previous report and our results suggest that secondary neovascular glaucoma with iris metastasis may be controlled by early intravitreal bevacizumab injection.
Case Rep Ophthalmol 2018;9:401–404

https://ift.tt/2PmQfdc

Loss of sterol metabolic homeostasis triggers inflammasomes?—?how and why

Eric V Dang | Jason G Cyster

https://ift.tt/2PoWmxT

Αρχειοθήκη ιστολογίου

Παρασκευή 31 Αυγούστου 2018

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Systematic review registration

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Zusammenfassung