Head and Neck Medicine by Alexandros G.Sfakianakis: 09/06/18

Πέμπτη 6 Σεπτεμβρίου 2018

The effect of antioxidants on Helicobacter pylori eradication: A systematic review with meta‐analysis

Helicobacter, EarlyView.

https://ift.tt/2MRBna6

Pemphigus vulgaris as the first manifestation of multiple myeloma: a case report

The association between pemphigus and malignancy has been well documented for decades but an association between pemphigus vulgaris and multiple myeloma is unusual. We report a case of pemphigus vulgaris revea...

https://ift.tt/2MTrrN7

Untersuchung der Qualität der Hörgeräteversorgung bei Senioren unter Berücksichtigung kognitiver Einflussfaktoren

Laryngo-Rhino-Otol
DOI: 10.1055/a-0671-2295

In der Gruppe der über 65-Jährigen ist die Hörminderung eines der häufigsten gesundheitlichen Probleme. Um die Kommunikationsfähigkeit in dieser Population aufrecht zu erhalten, ist eine adäquate Hörgeräteversorgung essentiell. Das Ziel der vorliegenden Studie war die Überprüfung der Qualität der Hörgeräteversorgung bei Senioren in Bezug auf die Wiederherstellung der Sprachdiskrimination. Weiterhin sollte der Einfluss des Alters und einiger kognitiver Parameter auf das Sprachverstehen betrachtet werden. Es wurden 40 Probanden im Alter von 66 bis 88 Jahren mit ein- oder beidseitiger Hörgeräteversorgung untersucht. Es wurde der gemittelte Hörverlust der Frequenzen 0,5–1-2–4 kHz und der gemittelte Hochton-Hörverlust bei den Frequenzen 2–4-6 kHz sowie das maximale Einsilberverstehen (mEV) und das hörgeräteversorgte Sprachverstehen bei 65 dB betrachtet. Um mögliche kognitive Einflussfaktoren zu ermitteln, wurden ein Demenzscreening-Verfahren (DemTect-Test) und ein Test zur Prüfung des Arbeitsgedächtnisses angewendet. Zwar zeigte sich ein Gewinn durch die Hörgeräteversorgung in 82 % der untersuchten Fälle, die nach Hilfsmittelrichtlinie geforderte Verbesserung von mindestens 20 % gegenüber der unversorgten Situation wurde jedoch in 56 % der Fälle nicht erreicht. Weiterhin wurde das individuelle mEV mit Abweichung von höchstens zehn Prozentpunkten von 81 % aller Fälle nicht erreicht. Signifikante Korrelationen zwischen Zahlenfolgen-Merkspanne bzw. DemTect-Ergebnis und mEV konnten nicht festgestellt werden. Im untersuchten Probandenkollektiv ergaben sich auch keine Hinweise für eine Abhängigkeit des Ergebnisses der Hörgeräteversorgung vom Lebensalter oder von (milder) kognitiver Beeinträchtigung sowie reduzierter Arbeitsgedächtnisleistung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

https://ift.tt/2CrbuJj

Gap Arthroplasty or Interpositional Arthroplasty for the Management of TMJ Ankylosis? A Prospective Randomized Comparative Multicenter Clinical Trial

Abstract

Aim

The main aim of this study is to compare the gap arthroplasty with interpositional gap arthroplasty for the management of TMJ ankylosis.

Methodology

A prospective randomized multicenter clinical trial had been performed, on 60 patients diagnosed with TMJ ankylosis from August 2005 to June 2015. Patients were equally divided into two groups: Group I patients were treated with gap arthroplasty, while patients in Group II were treated with interpositional arthroplasty.

Results

The mean age in Group I was 27.9 years and in Group II was 25.6 years. Trauma was the common etiological factor in both the groups. The mean postoperative mouth opening after 1 month, 6 months and 24 months was found to better in Group II. Open bite after 24 months was present in six patients in Group I and in one case in Group II. Permanent facial nerve palsy was present in one patient in both the groups. Frey's syndrome was present in one patient from Group I and none from Group II. Reoccurrence occurred in eight cases from Group I (26.6%) and none from Group II.

Conclusion

This study concluded that interpositional arthroplasty is better than gap arthroplasty in terms of mouth opening and reankylosis.

https://ift.tt/2NlUgkS

Tofacitinib for the Treatment of Alopecia Areata in Preadolescent Children

https://ift.tt/2M7P3IZ

Reply to MS#JAAD-D-18-01527

https://ift.tt/2NlILKe

Ruxolitinib for the treatment of severe alopecia areata

https://ift.tt/2wMx8Sr

Lightening Becker’s nevus: Role of topical therapies

https://ift.tt/2NpP6Ev

Trichloroacetic acid as a treatment for persistent oral mucosal lesions in pemphigus vulgaris

https://ift.tt/2wPvBuP

Previously undiagnosed Darier disease complicated by bilateral ecthyma gangrenosum masquerading as a vasculopathy with retiform eschar formation

We present the case of a 57-year-old incarcerated man with a history of hepatitis C and life-long presumed atopic dermatitis who presented with a two month history of painful, progressive, ulcerations with overlying eschars on his bilateral lower extremities. He had been treated unsuccessfully with oral trimethoprim-sulfamethoxazole and clindamycin before admission. Upon admission, he was found to have leukocytosis but was otherwise hemodynamically stable and afebrile. On exam, he had erythematous hyperkeratotic papules coalescing into plaques on the neck, chest, abdomen, back, and extremities, with a flexural predominance, and retiform ulcerations with overlying eschars on the bilateral lower legs.

https://ift.tt/2NlIHtY

Onychogryphosis: A case report and review of the literature

Patient history: A 67-year-old man presented with a 30-year history of severe thickening, curving, and yellow discoloration of his left great toenail. He stated that the nail broke off midway and regrew every six months. It had become more painful recently and was impinging on his second toe, making it difficult to walk and put on socks. There is no history of trauma, tinea pedis or family history of onychomycosis. Physical examination was notable for thickening and lateral deviation of the left first toenail.

https://ift.tt/2M5aTNa

Peristomal pyoderma gangrenosum in a patient with chronic ulcerative colitis: Case report

Introduction: Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that could be difficult to diagnose and treat. A painful necrotic ulcer surrounding an area of abdominal stoma with rapidly progression is the clinical hallmark. It is almost exclusively associated with inflammatory bowel disease (IBD). In this report, we present a 63-year-old man previously diagnosed of chronic ulcerative colitis (CUC) that develop a peristomal pyoderma gangrenosum 2 years after surgery.

https://ift.tt/2MW7HZl

Necrotisans erythema nodosum leprosum with systemic manifestations

Introduction: Erythema nodosum leprosum (ENL) is an acute reaction that generally occurs during the treatment of multibacillary leprosy. Severe cases can lead to necrotic ulcers and cause extra cutaneous manifestations. One case of necrotisans erythema nodosum leprosum (NENL) is reported to show that leprosy late diagnosis and treatment can cause severe cutaneous and systemic manifestations.

https://ift.tt/2wNqivJ

Pruritus in patients under targeted anticancer therapy: Multidimensional analysis using the 5-D itch scale

Background: Pruritus is very common symptom in patients under anticancer therapy. However, the characteristics of pruritus according to anticancer agents have not been known well.

https://ift.tt/2Nuf4qF

Platelet-rich plasma for skin rejuvenation: A systematic review of the clinical evidence

Background: Recently, platelet-rich plasma (PRP) has been used as an off-label treatment for a variety of clinical conditions including skin rejuvenation (SR). The effectiveness of PRP for SR is unclear due to lack of standardization for PRP administration. We aimed to assess the level of evidence (LOE) for safety and efficacy of PRP for SR.

https://ift.tt/2wPx7x0

Patient experience of the “two-week wait” cancer referral pathway in a large secondary care department in England

Background: The 2-week wait (2WW) system has been implemented across the NHS in England to enable rapid referral of patients with squamous cell carcinoma and malignant melanoma from primary to secondary care. Patients are told that the referral is to exclude skin cancer. In our secondary care dermatology department, a 2-week lag between referral and dermatology consultation represents a 19-week reduction in wait time (WT) from a standard referral. Little is currently known about the patients' perception of this streamlining, how WT impacts patient quality of life, and how appropriate patients consider this WT when being referred for suspected malignancy.

https://ift.tt/2MUBKki

Nonmelanoma skin cancer in HIV-positive patients: A six-year single-institution retrospective review

Background: HIV-positive (HIV+) patients have been demonstrated to have an increased incidence of nonmelanoma skin cancer (NMSC) at 2.1-2.8 times the rate found in HIV negative (HIV-) populations. Rates of NMSC with aggressive subclinical extension (ASE), defined as extensive subclinical tumor spread revealed during Mohs micrographic surgery (MMS), have not been found to be significantly different in HIV+ and HIV− populations in a previous study. However, HIV disease progression (CD4 and CD8 levels and viral load) and NMSC characteristics and their relationship to presence of NMSC with ASE within the HIV+ population remain unclear.

https://ift.tt/2M50e4U

Process of standardized postoperative telephone follow-up implementation for Mohs micrographic surgery

Mohs micrographic surgery (MMS) is an effective outpatient procedure for skin cancer removal with low reported complication rates. Identifying both major and minor postoperative complications is necessary to improve the quality of Mohs-based surgical care. There are currently no established standards for regular patient follow-up after MMS. Therefore, there exists a need to determine standardized, cost-effective, and reproducible follow-up strategies. The objective of this study was to determine whether routine telephone follow-up is an effective tool to capture postoperative complications and other patient-reported concerns.

https://ift.tt/2NovQXW

Predicting therapy outcome by HLA-Cw6 genotyping in psoriasis patients treated with secukinumab

Introduction: A possible correlation of genetic markers and response to treatment has been proclaimed. The strongest association has been shown between HLA-Cw6 and ustekinumab. So far it is unclear whether this effect can be also found in IL-17.

https://ift.tt/2M8A6WO

Pigmented eccrine poroma: A clinical dermoscopy challenge

Eccrine poroma is a benign neoplasia originated from the intraepidermal portion of the sweat gland duct. It is characterized by a papule, plaque or nodule, normochromic or erythematous, exophytic or hyperkeratotic. Although its pathogenesis is still unknown, it seems to be related to radiation, trauma or scars. The pigmented variant, more frequent in blacks and affecting mainly nonacral areas, is responsible for 17% of the cases. Various clinical-dermatoscopic features have been described, directing its differential diagnosis to other benign and malignant neoplasia, such as seborrheic keratosis, epithelized pyogenic granuloma, basal-cell and squamous-cell carcinoma, angiofibroma, and melanoma.

https://ift.tt/2MUBIZI

Pediatric melanoma immunotherapy: A retrospective examination of a decade of clinical experience at a tertiary care center

Background: Pediatric or adolescent melanoma, defined as melanoma in patients below age 20, is an infrequent occurrence that represents 0.4% of the approximately 87,110 new cases of melanoma diagnosed in the United States annually. As a result, few data exist to guide therapy that prolong survival, in particular with more recently developed immune therapies, such as immune checkpoint inhibitors. This lack of data is especially important as there is growing evidence that pediatric melanoma differs in its presentation, gene expression, and behavior from adult melanoma, and that response to therapy may vary by age.

https://ift.tt/2wS5cwe

Painful subcutaneous lesions in a patient with metastatic melanoma

Introduction: We present the case of a patient with metastatic melanoma (MM) treated with combined therapy (vemurafenib + cobimetinib), who develops painful subcutaneous lesions compatible with secondary panniculitis.

https://ift.tt/2MUwAos

Old is gold—Revisiting the efficacy of topical psoralen–ultraviolet A phototherapy for palmoplantar dermatoses

Palmoplantar involvement of dermatoses such as atopic dermatitis and psoriasis has significant impact on quality of life. While systemic treatment options have increased in recent years, topical psoralen ultraviolet A (tPUVA) therapy remains a viable option when topical treatments have failed and potential systemic adverse events outweigh benefits. Literature on tPUVA efficacy is sparse. Our objectives were to report the efficacy of tPUVA after an initial treatment course and to identify associated clinical factors.

https://ift.tt/2M7nnDK

Nicolau syndrome appears after filling hyaluronic acid with the use of blanching technique

A 34-year-old woman was treated in our clinic for mild acne and scars. Two years before, oral isotretinoin was given to the patient with a complete healing of the acne but numerous 2–3-mm scars remained in both cheeks. Two sessions of a nonablative CO2 laser was performed one year after the termination of the isotretinoin treatment with partial improvement of the scars. After that, a blanching technique with hyaluronic acid was offered to the patient. She was injected with a low reticulated hyaluronic acid with lidocaine using a 30 Gy needle doing a blanching technique to fill the scars presented in her cheeks.

https://ift.tt/2MSvedV

Precise control of maxillary multidirectional movement in Le Fort I osteotomy using a surgical guiding device

We introduced a surgical protocol to achieve accurate maxillary multidirectional movement in Le Fort I osteotomies. This comprised a way of controlling precision and a guiding device together with prebent titanium plates. We evaluated the protocol using a semiautomated 3-dimensional assessment in 22 patients with maxillary multidirectional movement (movement in three or more of six directions). Operations were all done between October 2015 and April 2017 by the same surgeon, who followed the protocol strictly.

https://ift.tt/2Qc0SRB

Noise-Induced Hypersensitization of the Acoustic Startle Response in Larval Zebrafish

ABSTRACT

Overexposure to loud noise is known to lead to deficits in auditory sensitivity and perception. We studied the effects of noise exposure on sensorimotor behaviors of larval (5–7 days post-fertilization) zebrafish (Danio rerio), particularly the auditory-evoked startle response and hearing sensitivity to acoustic startle stimuli. We observed a temporary 10–15 dB decrease in startle response threshold after 18 h of flat-spectrum noise exposure at 20 dB re·1 ms⁻². Larval zebrafish also exhibited decreased habituation to startle-inducing stimuli following noise exposure. The noise-induced sensitization was not due to changes in absolute hearing thresholds, but was specific to the auditory-evoked escape responses. The observed noise-induced sensitization was disrupted by AMPA receptor blockade using DNQX, but not NMDA receptor blockade. Together, these experiments suggest a complex effect of noise exposure on the neural circuits mediating auditory-evoked behaviors in larval zebrafish.

https://ift.tt/2NSJ1O1

The Stress Response in the Non-sensory Cells of the Cochlea Under Pathological Conditions—Possible Role in Mediating Noise Vulnerability

Abstract

Various stressors, such as loud sounds and the effects of aging, impair the function and viability of the cochlear sensory cells, the hair cells. Stressors trigger pathophysiological changes in the cochlear non-sensory cells as well. We have here studied the stress response mounted in the lateral wall of the cochlea during acute noise stress and during age-related chronic stress. We have used the activation of JNK/c-Jun, ERK, and NF-κB pathways as a readout of the stress response, and the expression of the FoxO3 transcription factor as a possible additional player in cellular stress. In the aging cochlea, NF-κB transcriptional activity was strongly induced in the stria vascularis of the lateral wall. This induction was linked with the atrophy of the stria vascularis, suggesting a role for NF-κB signaling in mediating age-related strial degeneration. Acutely following noise exposure, the JNK/c-Jun, ERK, and NF-κB pathways were activated in the spiral ligament of the lateral wall of CBA/Ca mice. This activation was concomitant with the morphological transformation of macrophages, suggesting that the upregulation of stress signaling leads to macrophage activation. In contrast, C57BL/6J mice lacked these responses. Only the combination of noise exposure and a systemic stressor, lipopolysaccharide, exceeded the threshold for the activation of stress signaling in the lateral wall of C57BL/6J mice. In addition, we found that, at the young adult age, outer hair cells of CBA/Ca mice are much more vulnerable to loud sounds compared to these cells of C57BL/6J mice. These results suggest that the differential stress response in the lateral wall of the two mouse strains underlies, in part, the differential noise vulnerability of their outer hair cells. Together, we propose that the molecular stress response in the lateral wall modulates the outcome of the stressed cochlea.

https://ift.tt/2wQcoKm

The RNA-Specific Adenosine Deaminase ADAR1 Inhibits Human Protein Kinase R Activation

Viral Immunology, Volume 31, Issue 7, Page 537-538, September 2018.

https://ift.tt/2CtLlcQ

Interaction of S17 Antibody with the Functional Binding Region of the Hepatitis B Virus Pre-S2 Epitope

Viral Immunology, Volume 31, Issue 7, Page 492-499, September 2018.

https://ift.tt/2wQOf6d

Noise-Induced Hypersensitization of the Acoustic Startle Response in Larval Zebrafish

ABSTRACT

https://ift.tt/2NSJ1O1

Improved Neural Coding of ITD with Bilateral Cochlear Implants by Introducing Short Inter-pulse Intervals

Abstract

Bilateral cochlear implant (CI) users have poor perceptual sensitivity to interaural time differences (ITDs), which limits their ability to localize sounds and understand speech in noisy environments. This is especially true for high-rate (> 300 pps) periodic pulse trains, which are used as carriers in CI processors. Here, we investigate a novel stimulation strategy in which extra pulses are added to high-rate periodic pulse trains to introduce short inter-pulse intervals (SIPIs). We hypothesized that SIPIs can improve neural ITD sensitivity similarly to the effect observed by randomly jittering IPIs (Hancock et al., J. Neurophysiol. 108:714–28, 2012). To test this hypothesis, we measured ITD sensitivity of single units in the inferior colliculus (IC) of unanesthetized rabbits with bilateral CIs. Introducing SIPIs into high-rate pulse trains significantly increased firing rates for ~ 60 % of IC neurons, and the extra spikes tended to be synchronized to the SIPIs. The additional firings produced by SIPIs uncovered latent ITD sensitivity that was comparable to that observed with low-rate pulse trains. In some neurons, high spontaneous firing rates masked the ITD sensitivity introduced by SIPIs. ITD sensitivity in these neurons could be revealed by emphasizing stimulus-synchronized spikes with a coincidence detection analysis. Overall, these results with SIPIs are consistent with the effects observed previously with jittered pulse trains, with the added benefit of retaining control over the timing and number of SIPIs. A novel CI processing strategy could incorporate SIPIs by inserting them at selected times to high-rate pulse train carriers. Such a strategy could potentially improve ITD perception without degrading speech intelligibility and thereby improve outcomes for bilateral CI users.

https://ift.tt/2M0yX3G

The Stress Response in the Non-sensory Cells of the Cochlea Under Pathological Conditions—Possible Role in Mediating Noise Vulnerability

Abstract

https://ift.tt/2wQcoKm

Surface Motion of Tympanic Membrane in a Chinchilla Model of Acute Otitis Media

Abstract

The conductive hearing loss caused by acute otitis media (AOM) is commonly related to a reduction of the tympanic membrane (TM) mobility in response to sound stimuli. However, spatial alterations of the TM surface motion associated with AOM have rarely been addressed. In this study, the TM surface motion was determined using scanning laser Doppler vibrometry (SLDV) in a chinchilla model of AOM. The AOM was established by transbullar injection of nontypeable Haemophilus influenzae. The TM surface vibration was measured in control (uninfected) animals and two AOM groups of animals: 4 days (4D) and 8 days (8D) post inoculation. To quantify the effect of middle ear pressure in those infected ears, the SLDV measurement was first conducted in unopened AOM ears and then in middle ear pressure released ears. Results showed that middle ear infection generally reduced the TM displacement across the entire surface, but the reduction in the umbo displacement over the time course, from 4 to 8 days post inoculation, was less than the reduction in the displacement at the center of each quadrant. The presence of middle ear fluid shifted the occurrence of traveling-wave-like motion on the TM surface to lower frequencies. The observation of the spatial variations of TM surface motion from this study will help refine our understanding of the middle ear sound transmission characteristics in relation to AOM.

https://ift.tt/2MToV9X

Does the King Airway system signal the end of intubation skills?

Our co-hosts tackle the topic of supraglottic airways, and the best way to approach them in the field

https://ift.tt/2Ma8roI

Improved Neural Coding of ITD with Bilateral Cochlear Implants by Introducing Short Inter-pulse Intervals

Abstract

https://ift.tt/2M0yX3G

Surface Motion of Tympanic Membrane in a Chinchilla Model of Acute Otitis Media

Abstract

https://ift.tt/2MToV9X

Inflammation cutanée de contiguïté : situations diverses et contours flous

Publication date: Available online 5 September 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): P. del Giudice

https://ift.tt/2NNVd2m

Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures

This observational study compares postoperative use of opioids between the United States and Hong Kong in patients undergoing head and neck surgery.

https://ift.tt/2wOZHiO

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation—Reply

In Reply In their analysis of our study, Dr Favier and colleagues suggest improvements in methodology to focus on haptic feedback fidelity through mechanical testing. We appreciate this thoughtful commentary and agree that both subjective and quantifiable measures are needed to optimally evaluate surgical simulators. As seen in their study evaluating mechanical characteristics of 3-dimensionally (3D)-printed material for skull base procedures, certain 3D-printed materials may differ in mechanical forces compared with human cadaver bone. Further, cadaver bone may not realistically represent in vivo sinus lamellae. Accordingly, although objective measurements of mechanical force are ideal, the intended audience of the simulator must also participate in the evaluation to assist in determining realism of the haptic feedback. Although we acknowledge that study participants were mostly resident physicians, surgical trainees are frequently the intended audience for surgical simulation and should be included in the development of such simulators. One method for evaluating the qualifications of study participants would be to choose a set number of live surgical experiences and statistically evaluate whether surgical experience affects participant rating of haptic feedback. Unfortunately, given the small sample size in our study, meaningful conclusions would be difficult to draw with these limited data.

https://ift.tt/2CqpEdD

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation

To the Editor In the field of rhinology and skull base surgery, many 3-dimensionally (3D)-printed simulators have been described. In their study, Hsieh and colleagues consider a material, VeroWhite, for endoscopic sinus and skull base surgical model 3D-printing. The aim was to study the anatomical accuracy and haptic feedback of the model to validate its use for surgical learning. Its anatomical accuracy was scientifically determined, thanks to a double comparison: segmentation of real patient anatomy compared with segmentation of the 3D-printed model; image-guided navigation on the model using the patient's original computed tomographic (CT) findings, to assess the accuracy of 13 important surgical landmarks. The authors concluded that VeroWhite was suitable to print accurate anatomical 3D models of the skull base and sinuses.

https://ift.tt/2oLDDBa

Association of Cognition and Age-Related Hearing Impairment

This cohort study investigates the link between age-related hearing impairment and cognitive decline and explores untreated hearing loss and social isolation as potential explanations in a cohort of individuals 50 years or older from the United Kingdom.

https://ift.tt/2wO2Sql

Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors

This cross-sectional survey study of oropharyngeal cancer survivors investigates the association of late lower cranial neuropathy with severity of cancer treatment–related symptoms and general functional impairment.

https://ift.tt/2oJj8VM

Preoperative Imaging in Primary Hyperparathyroidism

This narrative review describes the advantages and disadvantages of current and emerging preoperative imaging technologies for primary hyperparathyroidism.

https://ift.tt/2Cptwvv

Invisible Empire of Hate: Gender Differences in the Ku Klux Klan's Online Justifications for Violence

Violence and Gender, Ahead of Print.

https://ift.tt/2wNYMhX

Regulatory T cell deficiency and autoimmune skin disease: beyond scurfy mouse and IPEX

Publication date: Available online 6 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Takashi Hashimoto, Hayato Takahashi, Shimon Sakaguchi

https://ift.tt/2NoWb8e

RhoA/ROCK Signaling Modulates Lineage Commitment of Mesenchymal Stem Cells in Asthma through Lef1

Publication date: Available online 5 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Xia Ke, Danh C. Do, Changjun Li, Yilin Zhao, Marian Kollarik, Qingling Fu, Mei Wan, Peisong Gao

ABSTRACT

Rationale

Mesenchymal stem cells (MSCs) are increased in the airways after allergen challenge. RhoA/ROCK signaling is critical in determining the lineage fate of MSCs in tissue repair/remodeling.

Objectives

To investigate the role of RhoA/ROCK signaling in lineage commitment of MSCs during allergen-induced airway remodeling and delineate the underlying mechanisms.

Methods

Active RhoA expression in asthmatic lung tissues and its role in cockroach allergen-induced airway inflammation and remodeling were investigated. The RhoA/ROCK signaling-mediated MSC lineage commitment was assessed in an asthma mouse model using MSC lineage tracing mice (nestin-Cre; ROSA26-EYFP). The role of RhoA/ROCK in MSC lineage commitment was also examined by MSCs expressing constitutively active RhoA (RhoA-L63) or dominant negative RhoA (RhoA-N19). Downstream RhoA-regulated genes were identified using the stem cell signaling array.

Results

Lung tissues from asthmatic mice showed increased expression of active RhoA when compared with those from controls. Inhibition of RhoA/ROCK signaling with fasudil, a RhoA/ROCK inhibitor, reversed established cockroach allergen-induced airway inflammation and remodeling as assessed by more collagen deposition/fibrosis. Furthermore, fasudil inhibited MSC differentiation into fibroblasts/myofibroblasts, but promoted MSC differentiation into epithelial cells in asthmatic nestin-Cre; ROSA26-EYFP mice. Consistently, expression of RhoA-L63 facilitated the differentiation of MSCs to fibroblasts/myofibroblasts, whereas expression of RhoA-19 switched the differentiation toward epithelial cells. Gene Array identified the Wnt signaling effector Lef1 as the most up-regulated gene in RhoA-L63-transfected MSCs. Knockdown of Lef1 induced MSC differentiation away from fibroblasts/myofibroblasts but towards epithelial cells.

Conclusions

These findings uncover a previously unrecognized role of RhoA/ROCK signaling in MSC-involved airway repair/remodeling in asthma.

https://ift.tt/2PGtMYM

Consensus approach for the management of severe combined immune deficiency caused by adenosine deaminase deficiency

Publication date: Available online 5 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Donald B. Kohn, Michael S. Hershfield, Jennifer M. Puck, Alessandro Aiuti, Annaliesse Blincoe, H. Bobby Gaspar, Luigi D. Notarangelo, Eyal Grunebaum

Abstract

Inherited defects in adenosine deaminase (ADA) cause a subtype of severe combined immunodeficiency (SCID), known as ADA-SCID. Most affected infants can be diagnosed while still asymptomatic by a SCID newborn screening test, allowing early initiation of therapy. We reviewed the evidence currently available and propose a consensus management strategy. In addition to the treatment of the immune deficiency of ADA-SCID, patients should be followed for specific non-infectious respiratory, neurological and biochemical complications associated with ADA deficiency. All patients should initially receive enzyme replacement therapy (ERT), followed by definitive treatment with either of two equal first line options. If an HLA matched sibling donor (MSD) or matched family donor (MFD) is available, allogeneic hematopoietic stem cell transplantation (HSCT) should be pursued. The excellent safety and efficacy observed in over 100 ADA-SCID patients who received gamma-retrovirus or lentivirus mediated autologous hematopoietic stem cell gene therapy (HSC-GT) since 2000 now positions HSC-GT as an equal alternative. If MSD/MFD HSCT or HSC-GT are not available or have failed, ERT can be continued or re-instituted, and HSCT using alternative donors should be considered. The outcomes of novel HSCT, ERT and HSC-GT strategies should be evaluated prospectively in "real life" conditions to further inform these management guidelines.

https://ift.tt/2MTPSdx

Dupilumab progressively improves systemic and cutaneous abnormalities in atopic dermatitis patients

Publication date: Available online 5 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Emma Guttman-Yassky, Robert Bissonnette, Benjamin Ungar, Mayte Suárez-Fariñas, Marius Ardeleanu, Hitokazu Esaki, Maria Suprun, Yeriel Estrada, Hui Xu, Xiangyu Peng, Jonathan I. Silverberg, Alan Menter, James G. Krueger, Rick Zhang, Usman Chaudhry, Brian Swanson, Neil M.H. Graham, Gianluca Pirozzi, George D. Yancopoulos, Jennifer D.D. Hamilton

ABSTRACT

Background

Dupilumab is an IL-4Rα monoclonal antibody inhibiting signaling of IL-4/IL-13, key drivers of Type 2-driven inflammation, as demonstrated by its efficacy in atopic/allergic diseases.

Objective

This placebo-controlled, double-blind trial (NCT01979016) evaluated efficacy, safety, and effects of dupilumab on molecular/cellular lesional and nonlesional skin phenotypes and systemic Type 2 biomarkers of moderate-to-severe atopic dermatitis (AD) patients.

Methods

Skin biopsies and blood were evaluated from 54 patients randomized 1:1 to weekly subcutaneous 200 mg dupilumab or placebo for 16 weeks.

Results

Dupilumab (versus placebo) significantly improved AD clinical signs and symptoms, was well tolerated, and progressively shifted the lesional transcriptome toward a nonlesional phenotype (weeks 4–16). Mean improvements in a meta-analysis-derived AD transcriptome (genes differentially expressed between lesional and nonlesional skin) were 68.8% and 110.8% with dupilumab and −10.5% and 55.0% with placebo (weeks 4 and 16, respectively; P<0.001). Dupilumab significantly reduced expression of genes involved in Type 2 inflammation (IL-13/IL-31/CCL17/CCL18/CCL26), epidermal hyperplasia (K16/MKi67), T-cells, dendritic cells (ICOS/CD11c/CTLA4), and Th17/Th22 activity (IL-17A/IL-22/S100As) and concurrently increased expression of epidermal differentiation, barrier, and lipid-metabolism genes (FLG/LOR/claudins/ELOVL3). Dupilumab reduced lesional epidermal thickness versus placebo (week 4, P=0.001; week 16, P=0.0002). Improvements in clinical and histological measures correlated significantly with modulation of gene expression. Dupilumab also significantly suppressed Type 2 serum biomarkers, including CCL17, CCL18, periostin, and total and allergen-specific IgEs.

Conclusion

Dupilumab-mediated inhibition of IL-4/IL-13 signaling via IL-4Rα blockade significantly and progressively improved disease activity, suppressed cellular/molecular cutaneous markers of inflammation and systemic measures of Type 2 inflammation, and reversed AD-associated epidermal abnormalities.

https://ift.tt/2PIpu34

Paraben exposures and asthma-related outcomes among children from the U.S. general population

Publication date: Available online 5 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Lesliam Quirós-Alcalá, Nadia N. Hansel, Meredith C. McCormack, Elizabeth C. Matsui

ABSTRACT

Background

Parabens are synthetic preservatives present in many consumer products. Their antimicrobial and endocrine disrupting properties have raised concerns that they may play a role in respiratory and allergic diseases; however, studies exploring these associations are scarce.

Objective

We examined the cross-sectional association between parabens and asthma morbidity among 450 children with asthma and with asthma prevalence among 4,023 children in the U.S. general population, participating in the National Health and Nutrition Examination Survey (2005-2014).

Methods

We conducted multivariable logistic regression to examine associations between urinary paraben biomarker concentrations (butyl-BP, ethyl-EP, methyl-MP, and propyl-PP) and asthma attacks and emergency department (ED) visits among children with asthma, and with current asthma diagnosis among all children. We also examined heterogeneity of associations by sex.

Results

We observed an increased prevalence odds of reporting ED visits for every 10-fold increase in MP and PP concentrations among boys with asthma (adjusted prevalence odds ratio, aPOR:2.61, 95% confidence interval, CI:1.40, 4.85 and aPOR:2.18, 95%CI:1.22, 3.89, respectively; p_{interaction-MP}=0.002; p_{interaction-PP}=0.003); associations remained after adjusting for other phenolic compounds previously linked to respiratory outcomes. No other dimorphic effects of exposure by sex were observed. Among children in the general population, no overall associations with current asthma were observed, although there was a positive trend with PP and current asthma diagnosis.

Conclusion

We identified differential effects of exposure to select parabens by sex on asthma morbidity. Further studies are needed to replicate these findings, and elucidate mechanisms by which parabens could impact respiratory health and elicit dimorphic effects by sex.

https://ift.tt/2MTPMmb

Acute respiratory infections in early childhood and risk of asthma at 7 years of age

Publication date: Available online 5 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Laura Toivonen, Ville Forsström, Matti Waris, Ville Peltola

https://ift.tt/2PK90aN

Midostaurin in patients with indolent systemic mastocytosis: An open-label phase 2 trial

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Bjorn van Anrooij, Joanne N.G. Oude Elberink, Lambert F.R. Span, Jan G.R. de Monchy, Stefano Rosati, André B. Mulder, Johanna C. Kluin-Nelemans

https://ift.tt/2MP8fQN

Insulin decreases expression of the proinflammatory receptor proteinase-activated receptor-2 on human airway epithelial cells

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Vivek D. Gandhi, Nami Shrestha Palikhe, Shereen M. Hamza, Jason R.B. Dyck, Jean Buteau, Harissios Vliagoftis

https://ift.tt/2NPl2ip

Paradoxical psoriasis following anti–TNF therapy in ankylosing spondylitis: A population-based cohort study

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Jung Min Bae, Hyuck Sun Kwon, Gyong Moon Kim, Kyung-Su Park, Ki-Jo Kim

https://ift.tt/2MP1j6h

Deconstructive somatic cell nuclear transfer reveals novel regulatory T-cell subsets

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Manching Ku, Eugene Ke, Mohsen Sabouri-Ghomi, Justin R. Abadejos, Brent Freeman, Amy Nham, Nathaniel Phillips, Kevin Y. Yang, Kathy O. Lui, Oktay Kirak

https://ift.tt/2PK8WI5

Aspergillosis, eosinophilic esophagitis, and allergic rhinitis in signal transducer and activator of transcription 3 haploinsufficiency

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Mukil Natarajan, Amy P. Hsu, Michael A. Weinreich, Yuan Zhang, Julie E. Niemela, John A. Butman, Stefania Pittaluga, Janyce Sugui, Amanda L. Collar, Jean K. Lim, Tirdad Zangeneh, Tara Carr, Andrew J. Oler, Morgan Similuk, Lindsey B. Rosen, Jigar V. Desai, Alexandra F. Freeman, Steven M. Holland, Kyung J. Kwon-Chung, Joshua D. Milner

https://ift.tt/2MTzFVM

Association of ST2 polymorphisms with atopy, asthma, and leukemia

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Melissa H. Bloodworth, Mark Rusznak, Lisa Bastarache, Janey Wang, Joshua C. Denny, R. Stokes Peebles

https://ift.tt/2PK2fps

Detection of IL-36γ through noninvasive tape stripping reliably discriminates psoriasis from atopic eczema

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Anna Berekméri, Anne Latzko, Adewonuola Alase, Tom Macleod, Joseph S. Ainscough, Philip Laws, Mark Goodfield, Andrew Wright, Philip Helliwell, Sara Edward, Gordon D. Brown, Delyth M. Reid, Joerg Wenzel, Martin Stacey, Miriam Wittmann

https://ift.tt/2MUtCA0

Context matters: TH2 polarization resulting from pollen composition and not from protein-intrinsic allergenicity

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Lorenz Aglas, Stefanie Gilles, Renate Bauer, Sara Huber, Galber R. Araujo, Geoffrey Mueller, Sandra Scheiblhofer, Marie Amisi, Hieu-Hoa Dang, Peter Briza, Barbara Bohle, Jutta Horejs-Hoeck, Claudia Traidl-Hoffmann, Fatima Ferreira

https://ift.tt/2PHshtn

Micro RNAs are required for Langerhans cell, skin- and lung-resident macrophage ontogeny

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Yi Yao, Carly Martin, Congcong Yin, Chunyuan Guo, Zheng Dong, Li Zhou, Qing-Sheng Mi

https://ift.tt/2MRlYXf

AllergoOncology: Generating a canine anticancer IgE against the epidermal growth factor receptor

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Judit Fazekas-Singer, Josef Singer, Kristina M. Ilieva, Miroslawa Matz, Ina Herrmann, Edzard Spillner, Sophia N. Karagiannis, Erika Jensen-Jarolim

https://ift.tt/2PK8Joh

Reference values for peripheral blood lymphocyte subsets of healthy children in China

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Yuan Ding, Lina Zhou, Yu Xia, Wei Wang, Ying Wang, Li Li, Zhongxiang Qi, Linqing Zhong, Jinqiao Sun, Wenjing Tang, Fangfang Liang, Haijuan Xiao, Tao Qin, Ying Luo, Xuezhen Zhao, Zhou Shu, Ying Ru, Rongxin Dai, Hong Wang, Yanping Wang

https://ift.tt/2NnpE2j

Ozone exposure induces respiratory barrier biphasic injury and inflammation controlled by IL-33

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Chloé Michaudel, Claire Mackowiak, Isabelle Maillet, Louis Fauconnier, Cezmi A. Akdis, Milena Sokolowska, Anita Dreher, Hern-Tze Tina Tan, Valérie F. Quesniaux, Bernhard Ryffel, Dieudonnée Togbe

Background

IL-33 plays a critical role in regulation of tissue homeostasis, injury, and repair. Whether IL-33 regulates neutrophil recruitment and functions independently of airways hyperresponsiveness (AHR) in the setting of ozone-induced lung injury and inflammation is unclear.

Objective

We sought to examine the role of the IL-33/ST2 axis in lung inflammation on acute ozone exposure in mice.

Methods

ST2- and Il33–deficient, IL-33 citrine reporter, and C57BL/6 (wild-type) mice underwent a single ozone exposure (1 ppm for 1 hour) in all studies. Cell recruitment in lung tissue and the bronchoalveolar space, inflammatory parameters, epithelial barrier damage, and airway hyperresponsiveness (AHR) were determined.

Results

We report that a single ozone exposure causes rapid disruption of the epithelial barrier within 1 hour, followed by a second phase of respiratory barrier injury with increased neutrophil recruitment, reactive oxygen species production, AHR, and IL-33 expression in epithelial and myeloid cells in wild-type mice. In the absence of IL-33 or IL-33 receptor/ST2, epithelial cell injury with protein leak and myeloid cell recruitment and inflammation are further increased, whereas the tight junction proteins E-cadherin and zonula occludens 1 and reactive oxygen species expression in neutrophils and AHR are diminished. ST2 neutralization recapitulated the enhanced ozone-induced neutrophilic inflammation. However, myeloid cell depletion using GR-1 antibody reduced ozone-induced lung inflammation, epithelial cell injury, and protein leak, whereas administration of recombinant mouse IL-33 reduced neutrophil recruitment in Il33–deficient mice.

Conclusion

Data demonstrate that ozone causes an immediate barrier injury that precedes myeloid cell–mediated inflammatory injury under the control of the IL-33/ST2 axis. Thus IL-33/ST2 signaling is critical for maintenance of intact epithelial barrier and inflammation.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2NTJSOk

Efficacy of lentivirus-mediated gene therapy in an Omenn syndrome recombination-activating gene 2 mouse model is not hindered by inflammation and immune dysregulation

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Valentina Capo, Maria Carmina Castiello, Elena Fontana, Sara Penna, Marita Bosticardo, Elena Draghici, Luigi P. Poliani, Lucia Sergi Sergi, Rosita Rigoni, Barbara Cassani, Monica Zanussi, Paola Carrera, Paolo Uva, Kerry Dobbs, Nicolò Sacchetti, Luigi D. Notarangelo, Niek P. van Til, Gerard Wagemaker, Anna Villa

Background

Omenn syndrome (OS) is a rare severe combined immunodeficiency associated with autoimmunity and caused by defects in lymphoid-specific V(D)J recombination. Most patients carry hypomorphic mutations in recombination-activating gene (RAG) 1 or 2. Hematopoietic stem cell transplantation is the standard treatment; however, gene therapy (GT) might represent a valid alternative, especially for patients lacking a matched donor.

Objective

We sought to determine the efficacy of lentiviral vector (LV)–mediated GT in the murine model of OS (Rag2^R229Q/R229Q) in correcting immunodeficiency and autoimmunity.

Methods

Lineage-negative cells from mice with OS were transduced with an LV encoding the human RAG2 gene and injected into irradiated recipients with OS. Control mice underwent transplantation with wild-type or OS-untransduced lineage-negative cells. Immunophenotyping, T-dependent and T-independent antigen challenge, immune spectratyping, autoantibody detection, and detailed tissue immunohistochemical analyses were performed.

Results

LV-mediated GT allowed immunologic reconstitution, although it was suboptimal compared with that seen in wild-type bone marrow (BM)−transplanted OS mice in peripheral blood and hematopoietic organs, such as the BM, thymus, and spleen. We observed in vivo variability in the efficacy of GT correlating with the levels of transduction achieved. Immunoglobulin levels and T-cell repertoire normalized, and gene-corrected mice responded properly to challenges in vivo. Autoimmune manifestations, such as skin infiltration and autoantibodies, dramatically improved in GT mice with a vector copy number/genome higher than 1 in the BM and 2 in the thymus.

Conclusions

Our data show that LV-mediated GT for patients with OS significantly ameliorates the immunodeficiency, even in an inflammatory environment.

https://ift.tt/2NnpCHJ

An actin cytoskeletal barrier inhibits lytic granule release from natural killer cells in patients with Chediak-Higashi syndrome

Publication date: September 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 3

Author(s): Aleksandra Gil-Krzewska, Mezida B. Saeed, Anna Oszmiana, Elizabeth R. Fischer, Kathryn Lagrue, William A. Gahl, Wendy J. Introne, John E. Coligan, Daniel M. Davis, Konrad Krzewski

Background

Chediak-Higashi syndrome (CHS) is a rare disorder caused by biallelic mutations in the lysosomal trafficking regulator gene (LYST), resulting in formation of giant lysosomes or lysosome-related organelles in several cell types. The disease is characterized by immunodeficiency and a fatal hemophagocytic lymphohistiocytosis caused by impaired function of cytotoxic lymphocytes, including natural killer (NK) cells.

Objective

We sought to determine the underlying biochemical cause of the impaired cytotoxicity of NK cells in patients with CHS.

Methods

We generated a human cell model of CHS using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technology. We used a combination of classical techniques to evaluate lysosomal function and cell activity in the model system and super-resolution microscopy to visualize F-actin and lytic granules in normal and LYST-deficient NK cells.

Results

Loss of LYST function in a human NK cell line, NK92mi, resulted in inhibition of NK cell cytotoxicity and reproduced other aspects of the CHS cellular phenotype, including the presence of significantly enlarged lytic granules with defective exocytosis and impaired integrity of endolysosomal compartments. The large granules had an acidic pH and normal activity of lysosomal enzymes and were positive for the proteins essential for lytic granule exocytosis. Visualization of the actin meshwork openings at the immunologic synapse revealed that the cortical actin acts as a barrier for secretion of such large granules at the cell-cell contact site. Decreasing the cortical actin density at the immunologic synapse or decreasing the lytic granule size restored the ability of LYST-deficient NK cells to degranulate and kill target cells.

Conclusion

The cortical actin and granule size play significant roles in NK cell cytotoxic function. We present evidence that the periodicity of subsynaptic actin is an important factor limiting the release of large lytic granules from NK cells from patients with CHS and could be a novel target for pharmaceutical intervention.

https://ift.tt/2NSvpCm

Prognostic significance of cell cycle-associated proteins p16, pRB, cyclin D1 and p53 in resected oropharyngeal carcinoma

Abstract

Background

Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has an improved outcome and may allow for treatment de-escalation. High-risk HPV (HR-HPV) infection is associated with deregulated expression of the cell cycle-associated proteins p16^INK4, pRB, cyclin D1 and p53. The objective of this study was to assess cell cycle proteins as potential surrogate markers for HR-HPV DNA testing to identify OPSCC with favorable prognosis after resection.

Methods

Tissue microarray cores of 313 surgically treated OPSCC were stained for p16^INK4a, pRB, cyclin D1 and p53 using immunohistochemistry. Protein expression was scored as high or low based on the proportion of positive carcinoma cells. Tumor samples were analysed for HR-HPV DNA with polymerase chain reaction-based testing. Associations between cell cycle protein expression and HR-HPV DNA status were evaluated by calculating sensitivity, specificity, predictive values, and diagnostic odds ratios (DOR). Kaplan-Meier and Cox regression analysis were applied to evaluate associations between cell cycle protein expression and patient outcome.

Results

High expression of p16^INK4a, cyclin D1, pRB and p53 in tumor cells were observed in 51.8%, 51.4%, 41.9% and 33.5% of OPSCC, respectively. HR-HPV DNA positive were 158/313 (50.5%) tumor samples (HPV16: 147, HPV18: 1, HPV33: 5, HPV35: 2, HPV56: 2, and HPV59: 1). P16^INK4a showed a higher DOR to predict HR-HPV DNA positivity than pRB, cyclin D1 and p53. Both the p16^INK4a/pRB and the p16^INK4a/pRB/cyclin D1/p53 signatures had lower DOR than p16^INK4a alone. Improved 5-year overall and disease-specific survival were associated with HR-HPV DNA positivity, high p16^INK4a, low pRB, low cyclin D1, and low p53 expression. Associations with improved outcome were also observed for the marker combinations high p16^INK4a/positive HR-HPV DNA, high p16^INK4a/low pRB and high p16^INK4a/low pRB/low cyclin D1/low p53. In a multivariate analysis adjusted for age, smoking history, pT and pN category, high p16^INK4a expression showed the lowest hazard ratio for death.

Conclusions

High p16^INK4a expression is a reliable marker for survival prognostication in surgically treated OPSCC patients. Protein signatures including the pRB, cyclin D1 and p53 proteins do not further increase the prognostic performance of p16^INK4a as a single marker.

https://ift.tt/2NTEn2j

Epstein–Barr Virus-Positive Large Cell Neuroendocrine Carcinoma of the Nasopharynx: Report of One Case and Review of the Literature

Abstract

Epstein–Barr Virus (EBV)-positive neuroendocrine carcinoma (NEC) of the nasopharynx is exceedingly rare, only two cases have been reported in the literature. While EBV infection is strongly associated with nasopharyngeal carcinoma, which is carcinoma with squamous differentiation, the link between EBV and NEC is not well known, and can be diagnostically challenging. In this study, we report the third case of EBV-positive large cell NEC of nasopharynx with neck lymph node metastasis. The patient was treated with combined radiation and chemotherapy and showed complete clinical and radiological response. Similar treatment response has been reported in another patient with high stage EBV-positive large cell NEC, suggesting that EBV status is an important prognostic factor. Recognition of this rare tumor is important for disease management and patient prognosis. We also review the literature about the clinical and pathologic presentation of neuroendocrine tumors of nasopharynx.

https://ift.tt/2M3hFTi

Moderately Hypofractionated Conformal Radiation Combined With Cisplatin for Esophageal Squamous Cell Carcinoma

Condition: Esophageal Squamous Cell Carcinoma
Intervention: Combination Product: Moderately hypofractionated conformal radiation combined With cisplatin
Sponsor: Sun Yat-sen University
Recruiting

https://ift.tt/2CrNi9X

Efficacy of Pediatric Manual Therapy in the Positional Plagiocephaly

Conditions: Plagiocephaly; Plagiocephaly, Nonsynostotic; Plagiocephaly, Positional
Interventions: Procedure: Pediatric Manual Therapy; Procedure: Educational Physical Therapy
Sponsor: Universidad de Zaragoza
Recruiting

https://ift.tt/2NkDx1h

The Effect of EMT on Anxiety Levels and Perception of Waiting Time in the Radiation Oncology Waiting Room

Condition: Cancer
Intervention: Other: Environmental Music Therapy
Sponsor: Icahn School of Medicine at Mount Sinai
Recruiting

https://ift.tt/2M5BFVo

Two successful cases of DIEP flaps for breast reconstruction in patients with Factor V Leiden

m_rjy231f01.png?Expires=2147483647&Signa

Abstract

Factor V Leiden (FVL) is the most common inherited hypercoagulable condition. It is a genetic disorder caused by a missense mutation that prevents inactivation of Factor V in the clotting cascade, leading to overproduction of thrombin and excess clotting. This pathophysiological process is especially unfavorable in patients undergoing free tissue transfer. Many authors have noted a propensity for both venous and arterial thrombosis leading to partial or complete flap loss. To date, there have been no published reports of patients with FVL undergoing deep inferior epigastric perforator flap reconstruction without flap complications. Here, the authors present two cases of successful free tissue transfer for breast reconstruction in patients with diagnosed FVL. The perioperative thromboelastography lab values are evaluated to help guide anticoagulation regimen for these high-risk procedures.

https://ift.tt/2Q70Muh

Femoral neuropathy following direct anterior total hip arthroplasty: an anatomic review and case series†

m_rjy171f01.png?Expires=2147483647&Signa

Abstract

The popularity of the direct anterior approach for total hip arthroplasty (THA) has dramatically increased in recent years. Many patients request this muscle sparing approach for the theorized benefits of quicker recovery and reduced post-operative pain. Femoral nerve injury is a rare, yet serious complication following the anterior approach for THA. During the 7-year period from 2008 to 2016, 1756 patients underwent primary THA with a direct anterior approach by a single senior surgeon for end-stage osteoarthritis. Six (0.34%) of these patients had a post-operative femoral nerve palsy. We aim to discuss anatomic considerations, risk factors, and a timeline of severity and recovery for femoral nerve palsy following direct anterior THA in six patients.

https://ift.tt/2wLLeDC

Protracted diagnosis of ACNES: a costly exercise

m_rjy230f01.png?Expires=2147483647&Signa

Abstract

This case report summarizes the course of events leading to diagnosis and eventual repair of anterior cutaneous nerve entrapment syndrome (ACNES) in a 58-year-old female. The time period elapsing from initial symptoms to final operative repair was 9 months. The diagnosis was missed by both medical and surgical specialists despite multiple outpatient appointments, investigative procedures and a battery of laboratory tests. The diagnosis of ACNES was first considered when reviewed by a hernia surgeon and subsequently confirmed following open exploration of the anterior abdominal wall. The nerve was released and pain symptoms resolved. Access to the NHS Scotland ISD register permitted an economic analysis of the diagnostic services utilized for this patient and these totalled nearly £11 500. At a time when the NHS is focused on cost effectiveness, this particular sequence of investigations illustrates a protracted and costly diagnostic pathway.

https://ift.tt/2QaBCev

Diagnostic criteria in Pai syndrome: results of a case series and a literature review

Publication date: Available online 6 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. Morice, E. Galliani, J. Amiel, M. Rachwalski, C. Neiva, C. Thauvin-Robinet, M.-P. Vazquez, A. Picard, N. Kadlub

Abstract

Pai syndrome was originally described as the association of a midline cleft lip, midline facial polyps, and lipoma of the central nervous system. However, only a few patients present with the full triad, and most exhibit a wide spectrum of phenotypic variability. The aim of this study was to phenotypically delineate Pai syndrome and to propose new criteria to facilitate a clinical diagnosis in the future. The study cohort consisted of seven case patients and an additional 60 cases diagnosed with Pai syndrome identified in a literature review. Only 23 of 67 patients presented the full triad as historically described by Pai et al. (1987). A congenital facial midline skin mass was always encountered, particularly affecting the nasal structures (60/67). A midline facial cleft was reported in 45 of 67 patients and a pericallosal lipoma in 42 of 67 patients. The proposed definition of Pai syndrome is the association of (1) a congenital nasal and/or mediofrontal skin mass and/or a mid-anterior alveolar process polyp as a mandatory criterion, and at least one of the following criteria: (2) midline cleft lip and/or midline alveolar cleft, and/or (3) a pericallosal lipoma or interhemispheric lipoma in the case of corpus callosum dysgenesis.

https://ift.tt/2MRMEXL

Intraoperative factors associated with free flap failure in the head and neck region: a four-year retrospective study of 216 patients and review of the literature

Publication date: Available online 6 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Lin, J.-f. He, X. Zhang, H.-m. Wang

Abstract

The aim of this study was to identify intraoperative factors associated with free flap failure. The outcomes of 216 patients (220 flaps) were analyzed retrospectively. A statistical analysis was performed to determine the association of flap failure with the intraoperative factors of prolonged operation time, flap type, vascular pedicle at the recipient site, and use of vasoactive medication. A review of the recent literature was also conducted to identify other intraoperative risk factors. Univariate regression analysis revealed that a prolonged operative time (P = 0.013) and the vascular pedicle at the recipient site (P = 0.027) were primary risk factors for flap failure. Furthermore, the intraoperative use of papaverine improved the success rate of free flap transfer (P = 0.015). Multivariate regression analysis showed that only the application of papaverine remained statistically significant (P = 0.011). The results confirmed that the choice of flap type had no influence on free flap survival (P = 0.583). In addition, the literature review showed that excessive intraoperative fluid administration is a risk factor for free flap failure. These conclusions may provide microvascular surgeons with information to reduce the failure rate. Also, microvascular surgeons should always consider the details of intraoperative fluid management.

https://ift.tt/2PDBVNE

Blue laser imaging with acetic acid enhancement improved the detection rate of gastric intestinal metaplasia

Abstract

Our aim was to evaluate the ability of blue laser imaging (BLI) combined with acetic acid (BLI-AA) to detect gastric intestinal metaplasia (GIM). Participants undergoing gastroscopy from July 2017 to February 2018 in our hospital were enrolled prospectively. The abilities of white light imaging endoscopy, BLI endoscopy, and BLI-AA to detect GIM were compared. One hundred six patients undergoing gastroscopy met the inclusion criteria. GIM was diagnosed in 41 patients. For BLI-AA, the sensitivity, specificity, positive predictive, and negative predictive values were 85.4%, 84.6%, 77.8%, and 90.2% respectively. The diagnostic accuracy rate for BLI-AA was 84.9%, which was higher than that of white light imaging endoscopy and BLI endoscopy. For target biopsy, the GIM detection rate for the BLI-AA mode was significantly higher (77.8%, 105/135) than that for the BLI mode (58.3%, 84/144) or the white light endoscopy mode (40.4%, 57/141) (p < 0.05). BLI-AA is an efficient and simple method for the detection of GIM.

https://ift.tt/2PLerq7

Is conservative surgery a better choice for the solid/multicystic ameloblastoma than radical surgery regarding recurrence? A systematic review

Abstract

Purpose

Determine if conservative surgery of primary solid/multicystic ameloblastoma (SMA) is capable of decreasing the recurrence rate as effectively as radical surgery.

Methods

We searched in MEDLINE, Web of Science, Scopus and Cochrane Library for original studies reporting on the conservative or radical treatment of primary SMA and the related recurrence rate. All selected data were independently assessed. Meta-analysis was performed and the Relative Risk (RR) of recurrence with a confidence interval of 95% was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant.

Results

The 2647 records retrieved were reduced to 7 studies to be qualitatively assessed and 4 studies were included in the meta-analysis. RR of 1.88 [0.59, 5.95] of the pooled values pointed that recurrence rate after the conservative surgery is neither comparable nor lower than the radical surgery (P = 0.28).

Conclusions

Conservative surgery does not reduce the recurrence rate as efficiently as radical surgery for primary SMA. However, there is not enough evidence to support this statement.

https://ift.tt/2MRxAtb

Epstein–Barr Virus-Positive Large Cell Neuroendocrine Carcinoma of the Nasopharynx: Report of One Case and Review of the Literature

Abstract

https://ift.tt/2M3hFTi

The Effect of Nonsurgical Periodontal Treatment on Gingival Crevicular Fluid Stress Hormone Levels: A Prospective Study

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

https://ift.tt/2wIbqii

Is conservative surgery a better choice for the solid/multicystic ameloblastoma than radical surgery regarding recurrence? A systematic review

Abstract

Purpose

Determine if conservative surgery of primary solid/multicystic ameloblastoma (SMA) is capable of decreasing the recurrence rate as effectively as radical surgery.

Methods

Results

Conclusions

Conservative surgery does not reduce the recurrence rate as efficiently as radical surgery for primary SMA. However, there is not enough evidence to support this statement.

https://ift.tt/2MRxAtb

A clinicopathologic study on central odontogenic fibroma: with special reference to amyloid variant

Publication date: Available online 6 September 2018

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

Author(s): Chuan-Xiang Zhou, Tie-Jun Li

Abstract

Objective

. To clarify the clinicopathological features of central odontogenic fibroma (OF), especially the amyloid variant, and to discuss its relationship with Langerhans cell variant of calcifying epithelial odontogenic tumor (CEOT).

Study design

. The clinicopathological features and immuophenotypes of 17 OFs, including six amyloid variants, were analyzed. The Langerhans cell variant of CEOT is reviewed and its relationship with OF is discussed.

Results

. Most OFs (13/17) were located at the anterior region of the jaws, often with root resorption. The amyloid variant exhibited typical clinicopathological features of OFs characterized by dispersed small epithelial nests embedded in fibrous stroma. Immunohistochemically, the epithelial component in all central OFs, including amyloid variants, exhibited dispersed staining for CK10/13 but was negative for CK7 and CK8/18. Langerhans cells were positive for S-100 and Langerin in the epithelium of OFs including the amyloid variants.

Conclusions

. The amyloid variant of OF is a rare benign tumor exhibiting typical clinicopathological features of conventional OFs, which should not be diagnosed as CEOT even with the amyloid deposits. Previously reported cases described as "Langerhans cell variant of CEOT" should be classified as the "amyloid variant of OF" given that it shares features more in common with OFs than with CEOTs.

https://ift.tt/2wNFJnR

Molecular therapy for genetic and degenerative vestibular disorders

Purpose of review The primary purpose of this review is to summarize current literature in the field of vestibular regeneration with a focus on recent developments in molecular and gene therapies. Recent findings Since the discovery of limited vestibular hair cell regeneration in mammals in the 1990s, many elegant studies have improved our knowledge of mechanisms of development and regeneration of the vestibular system. A better understanding of the developmental pathways of the vestibular organs has fueled various biological strategies to enhance regeneration, including novel techniques in deriving vestibular hair cells from embryonic and induced pluripotent stem cells. In addition, the identification of specific genetic mutations responsible for vestibular disorders has opened various opportunities for gene replacement therapy. Summary Vestibular dysfunction is a significant clinical problem with limited therapeutic options, warranting research on biological strategies to repair/regenerate the vestibular organs to restore function. The use of gene therapy appears promising in animal models of vestibular dysfunction.

https://ift.tt/2MS2im7

Editorial: the middle cranial fossa approach

No abstract available

https://ift.tt/2NNcFnE

Pediatric free flap reconstruction for head and neck defects

Purpose of review The aim of this study was to review recent literature on the use of pediatric free flap reconstruction for head and neck defects with focus on skull base, congenital deformities, mandibular reconstruction and operative considerations. Recent findings Reconstruction of the skull base depends on the defect size, location, bony involvement, and pedicle length with a variety of flaps to choose from. Free flaps may be used to correct congenital anomalies due to facial clefts and syndromic causes requiring bony and tissue bulk. Preservation of the condyle together with free flap mandibular reconstruction has better growth potential. Delayed repair of mandibular defects may be an option especially for patients with malignancy. Chemotherapy and radiation therapy may inhibit the growth potential of the mandible. The use of running or coupled arterial anastomosis is associated with an increased immediate complication. Summary Pediatric free flap reconstruction is a reasonable option for various head and neck defects such as skull base, congenital, and mandibular defects.

https://ift.tt/2Njaz1W

Pearls for the middle fossa approach in acoustic neuroma surgery

Purpose of review To discuss the use of the middle fossa craniotomy for resection of vestibular schwannomas; to present pearls of and modifications to the approach. Recent findings The middle fossa craniotomy allows for hearing preservation in the resection of intracanalicular vestibular schwannomas. Over recent years, the approach has been modified to address larger tumors with a limited cerebellopontine angle component. Positive identification of the superior semicircular canal allows for rapid exposure of the internal auditory canal (IAC). Removal of cerebrospinal fluid from the posterior fossa during exposure of the IAC allows for removal of the middle fossa retractor; reinforced silicone sheeting is used to protect the middle fossa dura during further drilling. The use of the endoscope has allowed for more complete dissection at the fundus of the IAC, including tumors lateral to the transverse crest. Summary Technical modifications to the middle fossa craniotomy have allowed for a shorter duration of temporal lobe retraction intraoperatively and more complete resection of tumors with fundal involvement.

https://ift.tt/2NV0Snd

Advances in computer-aided design for bony free-flap reconstruction

Purpose of review The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques. Recent findings Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions. Summary Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches.

https://ift.tt/2MQGg37

Facial nerve decompression

Purpose of review Facial nerve paralysis is a debilitating condition. Bell's palsy and temporal bone trauma are common causes of acute facial palsy, with recurrent idiopathic paralysis and Melkersson–Rosenthal syndrome accounting for a smaller subset of cases. Properly selected patients may benefit from facial nerve decompression. This article will review the relevant literature on facial nerve decompression. Recent findings The middle cranial fossa approach provides access to the primary site of lesion in Bell's palsy while preserving hearing. Patients with complete facial paralysis secondary to Bell's palsy or temporal bone trauma, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset may benefit from facial nerve decompression. Facial nerve decompression may prevent future occurrences of recurrent forms of facial nerve paralysis. The return of facial nerve function following decompression will occur over weeks to months. Summary Appropriately selected patients with facial paralysis secondary to Bell's palsy or temporal bone trauma may benefit from facial nerve decompression. Patients should be counseled regarding the risks of decompression and that the return of maximal facial nerve function may be delayed up to 12 months.

https://ift.tt/2PFrYPK

Editorial introductions

No abstract available

https://ift.tt/2NlAia1

Comprehensive review of the extended middle cranial fossa approach

Purpose of review To review the current literature on the extended middle cranial fossa (xMCF) approach and to provide a comprehensive description of the relevant anatomy, indications, surgical technique, results, and complications. Recent findings The xMCF approach expands the surgical exposure provided by the sMCF approach, allowing access to the internal auditory canal, cerebellopontine angle, prepontine cistern, anterior petrous apex, petrous carotid artery, Meckel's cave, cavernous sinus, mid and upper clivus, and posterior lesions approaching the jugular foramen. Preservation of serviceable hearing is possible with success rates approximating 50% in vestibular schwannoma and meningioma resection, and facial nerve outcome is excellent. Summary The xMCF is an important approach for difficult to access lesions that additionally offers the possibility of hearing preservation. This approach is also useful for vascular lesions, auditory brainstem implantation, and lesions of mid-brainstem.

https://ift.tt/2NNcyse

The anteromedial thigh free flap: a primary reconstructive option or second best?

Purpose of review This article reviews the recent literature on the anteromedial thigh free flap. Recent findings The anteromedial thigh (AMT) free flap is an excellent reconstructive option for head and neck defects. It is often overshadowed by the anterolateral thigh (ALT) free flap. Lack of familiarity with the anatomy of the AMT likely deters many surgeons from considering it as a reliable option. However, as many as one in 20 patients may not have anatomy suitable for ALT free-flap harvest, and in these cases the AMT provides an ideal alternative as it can be harvested through the same incision without added morbidity. Current areas of research include clinical, anatomic, cadaveric, and radiographic studies evaluating the AMT flap anatomy and utility. Summary The AMT flap has been successfully used to reconstruct the same types of soft tissue head and neck defects as the ALT. However, given that approximately 95% of patients appear to have anatomy favorable to harvest an ALT, the utility of the AMT should be reserved for patients with unfavorable lateral thigh anatomy or when when a chimeric flap is indicated and anatomy permits.

https://ift.tt/2NjIOpW

Combined petrosal approach

Purpose of review The combined petrosal approach to the lateral skull base merges a retrolabyrinthine-presigmoid posterior fossa craniotomy with an adjacent middle fossa craniotomy, which are rendered continuous by division of the tentorium. This is a hearing-preserving approach that affords wide access to the lateral aspect of the clivus, the prepontine space, and the cerebellopontine angle. Recent findings This article details the historical development of the combined petrosal approach alongside a description. In particular, the critically relevant anatomy is reviewed, including the course of the vein of Labbé, with a view toward avoiding the known complications associated with this approach. Outcomes for application of this approach as applied for various lesions are also reviewed as portrayed by the current literature. Summary The combined petrosal approach affords wide access to the lateral skull base in the middle and posterior fossa. The approach and the lesions addressed by this approach involve delicate and sensitive anatomy. We review the evolution of this approach and highlight advancements that have allowed the combined petrosal approach to be a safe addition to the surgeon's armamentarium.

https://ift.tt/2NV0Hbx

Functional considerations in oral cavity reconstruction

Purpose of review The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life. Recent findings Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types. Free flap reconstruction has greatly enhanced the ability to tailor transferred tissue to specific defects. In this review, we describe recent findings in reconstruction of tongue defects, including data from perforator flaps. We also summarize recent evidence regarding reinnervated flaps. Summary When vascularized tissue is needed, it remains unclear how the reconstructive choice impacts postoperative outcome, although in many situations it appears to be dominated by the donor site morbidity rather than the reconstructive technique. Despite numerous case series, the functional impact of motor and sensory reinnervation in vascularized tissue remains unknown. Although perforator flaps have emerged as a promising flap option, with favorable donor site morbidity, their ultimate impact on functional outcomes remains unclear, whereas the success rate appears to be lower than traditional flaps.

https://ift.tt/2MT3VzR

Assessment of vestibular function in elderly patients

Purpose of review Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). Recent findings Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. Summary The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.

https://ift.tt/2PC9iQQ

Reconstructive considerations in low and middle-income countries

Purpose of review Surgical mission trips in head and neck surgery are common. There are an increasing number of surgical groups performing complex reconstructions in low and middle-income countries (LMIC). Consideration of reconstructive options that are location and patient specific are critical for optimum patient care and local physician education. Recent findings The pectoralis muscle regional flap is a versatile and reliable option and has been shown to reconstruct defects in nearly every head and neck subsite. Additional regional flap options described are the supraclavicular island flap and submental island flap. There are 15 published case series describing experience with performing microvascular reconstructions in LMIC. The average success rate was 87.1%. Both loupe and microscope magnification are used. Summary Complex reconstructions are successfully being performed in LMIC. Although microvascular reconstruction is being utilized by some groups, local and patient-specific factors should be carefully considered, as many regional and local flap options available provide the same reconstruction benefit while minimizing operating room time, resources, and postoperative care needs.

https://ift.tt/2NkpWqJ

DNA methylation derived systemic inflammation indices are associated with head and neck cancer development and survival

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Srikant Ambatipudi, Ryan Langdon, Rebecca C. Richmond, Matthew Suderman, Devin C. Koestler, Karl T. Kelsey, Nabila Kazmi, Christopher Penfold, Karen M. Ho, Wendy McArdle, Susan M. Ring, Miranda Pring, Tim Waterboer, Michael Pawlita, Tom R. Gaunt, George Davey Smith, Steve Thomas, Andy R. Ness, Caroline L. Relton

Abstract

Objectives

Head and neck squamous cell carcinoma (HNSCC) is often associated with chronic systemic inflammation (SI). In the present study, we assessed if DNA methylation-derived SI (mdSI) indices: Neutrophil-to-Lymphocyte ratio (mdNLR) and Lymphocyte-to-Monocyte ratio (mdLMR) are associated with the presence of HNSCC and overall survival (OS).

Materials and methods

We used two peripheral blood DNA methylation datasets: an HNSCC case-control dataset (n = 183) and an HNSCC survival dataset (n = 407) to estimate mdSI indices. We then performed multivariate regressions to test the association between mdSI indices, HNSCC development and OS.

Results

Multivariate logistic regression revealed that elevated mdNLR was associated with increased odds of being an HNSCC case (OR = 3.25, 95% CI = 2.14–5.34, P = 4 × 10⁻⁷) while the converse was observed for mdLMR (OR = 0.88, 95% CI = 0.81–0.90, P = 2 × 10⁻³).

In the HNSCC survival dataset, HPV16-E6 seropositive HNSCC cases had an elevated mdLMR (P = 9 × 10⁻⁵) and a lower mdNLR (P = 0.003) compared to seronegative patients. Multivariate Cox regression in the HNSCC survival dataset revealed that lower mdLMR (HR = 1.96, 95% CI = 1.30–2.95, P = 0.0013) but not lower mdNLR (HR = 0.68, 95% CI = 0.46–1.00, P = 0.0501) was associated with increased risk of death.

Conclusion

Our results indicate that mdSI estimated by DNA methylation data is associated with the presence of HNSCC and overall survival. The mdSI indices may be used as a valuable research tool to reliably estimate SI in the absence of cell-based estimates. Rigorous validation of our findings in large prospective studies is warranted in the future.

https://ift.tt/2CpSYkG

Epstein–Barr Virus-Positive Large Cell Neuroendocrine Carcinoma of the Nasopharynx: Report of One Case and Review of the Literature

Abstract

https://ift.tt/2M3hFTi

Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis

Abstract

Objectives

To systematically review the literature in order to investigate association between depression and oral diseases.

Material and methods

Electronic searches were performed in five databases. Studies testing associations between depression and oral diseases as either exposure or outcome were included. Oral disease variable included any tooth loss or edentulism, periodontal disease, and dental caries.

Results

A total of 2504 articles were identified in the electronic database search. Sixteen studies were included in this systematic review being 14 included in the meta-analyses. Eleven studies considered oral health as outcome, whereas three studies considered depression as an outcome variable. Depression was associated to dental caries, tooth loss, and edentulism. Pooled estimates showed that depression increased the odds of dental caries (OR 1.27; 95% CI 1.13–1.44), tooth loss (OR 1.31; 95% CI 1.24–1.37), and edentulism (OR 1.17; 95% CI 1.02–1.34), respectively. When the oral diseases were tested as independent variable and depression as outcome, associations with both edentulism (OR 1.28; 95% CI 1.06–1.55) and periodontal disease (HR 1.73; 95% CI 1.58–1.89) were found.

Conclusions

The results of our systematic review and meta-analyses show a positive association between depression and oral diseases, specifically dental caries, tooth loss, and edentulism, in adults and elders. More longitudinal studies are required to test causal and temporal relationship between depression and oral health status.

Clinical relevance

Mental and oral health are among the main disabilities worldwide. This article helps to understand more about the relationship between both conditions, highlighting the importance for both clinicians and policy makers of considering individual's psychological status in management of oral health.

https://ift.tt/2MQhWi2

Management of metastatic melanoma: improved survival in a national cohort following the approvals of checkpoint blockade immunotherapies and targeted therapies

Abstract

Background

Immune checkpoint blockade (ICB) and BRAF^V600-targeted therapy have demonstrated substantial clinical efficacy for patients with stage 4 melanoma in clinical trials; however, their impact on survival and barriers to treatment in the "real-life" setting remains unknown.

Methods

Patients who presented with cutaneous melanoma during 2004–2015 using the National Cancer Database, which comprises > 70% of all newly diagnosed cancers in the U.S., were evaluated for predictors of presenting with stage 4 disease and receiving ICB, and for their associated unadjusted and risk-adjusted overall survival (OS).

Results

17,975 patients presented with stage 4 metastatic cutaneous melanoma. Overall, patients who presented after the FDA's initial approvals (starting in 2011) for ICB and BRAF^V600-targeted therapy demonstrated a 31% relative improvement in 4-year OS (p < 0.001), compared to pre-2011. Following the initial approvals in 2011, improved OS was associated in risk-adjusted analyses with ICB (HR 0.57, 95CI 0.52–0.63). ICB demonstrated improved median and 4-year OS of 16.9 months (95CI 15.6–19.3; vs. 7.7 months, 95CI 7.2–8.4) and 32.4% (95CI 29.5–35.3; vs. 21.0%, 95CI 19.6–22.2, all p < 0.001), respectively; improved OS was persistent in unadjusted and risk-adjusted landmark survival analyses. Uninsured patients and management in the community setting were less likely to receive ICB in multivariable analyses.

Conclusions

In a national "real-life" treatment population, we show that the wide availability of the novel treatment modalities ICB and BRAF^V600-targeted therapy has significantly improved the survival of patients with stage 4 melanoma. Our findings additionally suggest that there are opportunities for expanding coverage and access to these novel immunotherapies in community practice.

https://ift.tt/2oJSUlX

The clinical application of BMP for reconstruction of alveolar cleft; 10 years follow up

Publication date: Available online 5 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): A. Ayoub, T. Gillgrass

Abstract

Purpose

To report on a 10-year assessment following the application of rhBMP-7 for reconstruction of alveolar clefts.

Method

This study was conducted as prospective phase II clinical trial on 9 unilateral and two bilateral alveolar clefts which received rhBMP-7 (Osigraft). The mean age of patients at surgery was 10.4 years. Six months postoperatively, occlusal radiographs were taken to evaluate bone formation at the cleft site. Patients were followed with routine cleft care pathway for up to 10 years to monitor the impact of BMP-7 on orthodontic treatments and maxillary growth. Radiographs were taken according to the standard cleft care protocol.

Results

The radiographic assessment of the UCLP cases suggested good bone formation with a Kindelan score at grade 1 or 2. The bilateral alveolar cleft cases had a score of grade 3 or 4 indicating failure or partial failure. The children with successful grafts underwent a routine orthodontic follow-up without incident. The maxillary growth appeared similar to that of cases grafted with autogenous bone. No long-term complications or abnormal pattern of bone formation were detected.

Conclusions

The study provides unique evidence on the long term safety of rhBMP-7 when applied at the area of skeletal immaturity for the reconstruction of alveolar clefts in children.

https://ift.tt/2NWQk7q

Verminderte berufliche Leistungsfähigkeit und Lebensqualität bei Patienten mit moderater bis schwerer Neurodermitis

Zusammenfassung

Hintergrund

Klinische Register tragen zur Evidenzbasierung der Gesundheitsversorgung und zur Umsetzung von Forschungsergebnissen in die Praxis bei. TREATgermany schließt Erwachsene mit moderater bis schwerer Neurodermitis („atopic dermatitis" [AD]) mit prospektiver Beobachtung über mindestens 2 Jahre ein. Der Beitrag zeigt erste Ergebnisse zum Zusammenhang von krankheitsbezogener Lebensqualität und Leistungseinschränkungen im Beruf.

Material und Methoden

Dokumentiert werden objektive und subjektive Outcomes mit validierten Messinstrumenten: klinischer Schweregrad (EASI [Eczema Area and Severity Index], oSCORAD [objective-SCORing Atopic Dermatitis]), Lebensqualität (DLQI [Dermatology Life Quality Index]), Symptome (POEM [Patient-oriented Eczema Measure]), globaler Schweregrad (Investigator Global Assessment [IGA]/Patient Global Assessment [PGA]), Patientenzufriedenheit und berufsbezogene Leistungseinschränkungen (WLQ [Work Limitation Questionnaire]) inklusive Präsentismus (Produktivitätsverlust bei der Arbeit) sowie der Therapieverlauf. Von 06/2016 bis 12/2017 wurden 241 Patienten (Alter 43 ± 15 Jahre; 38,6 % Frauen) in deutschlandweit 19 Zentren eingeschlossen, 69 % waren berufstätig.

Ergebnisse

Erwerbstätige hatten DLQI- und WLQ-Mittelwerte von 10,6 ± 6,9 Punkten bzw. 17,7 ± 18,1 %. Der mittlere Präsentismus betrug 9,2 %. Mit r = 0,39 und 0,33 korrelierten die WLQ- und Präsentismus-Scores signifikant mit dem DLQI (p < 0,001). Eine geringere Lebensqualität war am stärksten mit körperlichen und allgemeinen Leistungseinschränkungen im Beruf assoziiert. Regressionsmodelle zeigten einen Zuwachs von Limitationen bei der Bewältigung von Arbeitsanforderungen um 1,7 % und des Präsentismus um 0,5 % mit der Zunahme des DLQI um 1 Punkt.

Diskussion

Eine moderate bis schwere AD hat negative wirtschaftliche Auswirkungen mit einem mittleren Produktivitätsverlust der Patienten von fast 10 %. Weitere Analysen sollten den Einfluss innovativer Behandlungsmethoden auf Lebensqualität und Arbeitsproduktivität in den Fokus rücken.

https://ift.tt/2Nlqixy

Interleukin-6/STAT3 Signaling is Prominent and Associated with Reduced Overall Survival in p16 Negative Oropharyngeal Squamous Cell Carcinoma

Abstract

This study addresses the hypothesis that IL-6/STAT3 signaling is of clinical relevance in oropharyngeal squamous cell carcinoma (OPSCC). We evaluated relationships between key components of this pathway in tumors from a unique cohort of n = 59 fully annotated, treatment-naïve patients with OPSCC. The multiplex Opal platform was utilized for immunofluorescence (IF) analysis of tissues to detect IL-6 and phosphorylated STAT3 (pSTAT3), taking into consideration its nuclear versus cytoplasmic localization. Abundant staining for both IL-6 and pSTAT3 was evident in tumor-rich regions of each specimen. IL-6 correlated with cytoplasmic pSTAT3 but not nuclear or total pSTAT3 in this cohort of OPSCC tumors, regardless of p16 status (r = 0.682, p < 0.0001). There was a significant association between increased total pSTAT3, nuclear pSTAT3, cytoplasmic pSTAT3 and IL-6 in p16 negative tumors. Our data indicate STAT3 phosphorylation was a key feature in p16-negative OPSCC tumors. When IL-6 data was stratified by median expression in tumors, there was no association with overall survival. In contrast, both total and nuclear pSTAT3 were significant predictors of poor overall and disease free survival. This strong inverse relationship with overall survival was present in p16 negative tumors for both total and nuclear pSTAT3, but not in p16 positive OPSCC tumors. Together these data indicate that activation of the STAT3 signaling pathway is a marker of p16 negative tumors and relevant to OPSCC prognosis and a potential target for treatment of this more aggressive OPSCC sub-population.

https://ift.tt/2M2YOYx

Αρχειοθήκη ιστολογίου

Πέμπτη 6 Σεπτεμβρίου 2018

Abstract

Aim

Methodology

Results

Conclusion

ABSTRACT

Abstract

ABSTRACT

Abstract

Abstract

Abstract

Abstract

Abstract

ABSTRACT

Rationale

Objectives

Methods

Results

Conclusions

Abstract

ABSTRACT

Background

Objective

Methods

Results

Conclusion

ABSTRACT

Background

Objective

Methods

Results

Conclusion

Background

Objective

Methods

Results

Conclusion

Graphical abstract

Background

Objective

Methods

Results

Conclusions

Background

Objective

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusions

Abstract

Abstract

Abstract

Abstract

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Abstract

Purpose

Methods

Results

Conclusions