Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. ...
https://ift.tt/2xsiNeQ
Τετάρτη 19 Σεπτεμβρίου 2018
Surgically assisted rapid maxillary expansion in lingual orthodontics – optimizing of coupling and timing
The anti-inflammatory effect of milk and dairy products on periodontal cells: an in vitro approach
Abstract
Objective
Milk can reduce intestinal tissue damage in colitis models, and protects infants against necrotizing enterocolitis. However, whether milk can decrease inflammation related to peri-implantitis and oral mucosal dehiscence remains unclear. We therefore investigated whether or not milk and fermented by-products have any anti-inflammatory effects on the cells of the oral cavity.
Material and methods
Human gingival fibroblasts and the human oral epithelial cell line HSC2 were exposed to pasteurized human milk, pasteurized cow's milk, dairy products, and powdered milk. An inflammatory response was then provoked with IL1 and TNFα. The expression changes of IL1, IL6, and IL8 were detected by reverse transcriptase PCR and immunoassay.
Results
We can report that pasteurized human milk and pasteurized cow's milk as well as yoghurt, buttermilk, sour milk, whey, and powdered milk can lower the expression of inflammatory cytokines in gingival fibroblasts being stimulated by IL1 and TNFα. A similar anti-inflammatory response to pasteurized milk and dairy products was observed with the human oral epithelial cell line HSC2.
Conclusion
These data suggest that pasteurized and powdered milk, as well as fermented dairy products, display an anti-inflammatory effect on oral fibroblasts and oral epithelial cells.
Clinical relevance
Our in vitro findings provide the scientific basis to extend this research towards testing the anti-inflammatory effects of milk in a pre-clinical periodontitis and peri-implantitis model.
https://ift.tt/2xnx1Ok
An unusual case of extensive truncal cutaneous larva migrans in a Cameroonian baby: a case report
Cutaneous larva migrans is a neglected zoonotic helminthic disease which is paradoxically underreported in low-income and middle-income countries from where a majority of the cases emanate. It presents as migr...
https://ift.tt/2xABrk7
The American Thyroid Association Sonographic Classification System Can Stratify the Risk of Malignancy for Indeterminate Thyroid Nodules
Clinical Thyroidology, Volume 30, Issue 9, Page 426-428, September 2018.
https://ift.tt/2NtdKVJ
Patients with Benign Thyroid Disorders Report Impairments in Sex Life
Clinical Thyroidology, Volume 30, Issue 9, Page 405-407, September 2018.
https://ift.tt/2Daqw6C
Needle Biopsy of Thyroid Nodules Is Best Performed Using Capillary Action Techniques Rather than Suction
Clinical Thyroidology, Volume 30, Issue 9, Page 418-421, September 2018.
https://ift.tt/2NtAG7n
Therapy-Induced Hypothyroidism Reduces Long-Term Post-treatment Cardiovascular Morbidity and Mortality in Graves’ Disease and Toxic Multinodular Goiter
Clinical Thyroidology, Volume 30, Issue 9, Page 408-411, September 2018.
https://ift.tt/2DdmOcm
If High Circulating Levels of Biotin Are Commonly Affecting Thyroid-Function Tests, Shouldn't Something Be Done About It?
Clinical Thyroidology, Volume 30, Issue 9, Page 401-404, September 2018.
https://ift.tt/2Nrz7Xa
Some Patients Do Not Undergo Subsequent Evaluation Following an Abnormally Suppressed TSH
Clinical Thyroidology, Volume 30, Issue 9, Page 412-414, September 2018.
https://ift.tt/2DeZhIc
Integrating AJCC-TNM, ATA-IRS, and Patient Age Improves Survival Predictions for Thyroid Cancer
Clinical Thyroidology, Volume 30, Issue 9, Page 422-425, September 2018.
https://ift.tt/2Npy3TH
Quantitative Uptake of Sestamibi Differentiates Type 1 from Type 2 Amiodarone-Induced Thyrotoxicosis
Clinical Thyroidology, Volume 30, Issue 9, Page 415-417, September 2018.
https://ift.tt/2DcVwTr
Is Survival the Optimal End Point for Determining Appropriate Extent of Surgery in Medullary Thyroid Cancer?
Clinical Thyroidology, Volume 30, Issue 9, Page 429-432, September 2018.
https://ift.tt/2NsgW3S
Tumor Regression and Cure Depends on Sustained Th1 Responses
While immunomodulatory monoclonal antibodies (mAbs) have therapeutic efficacy against many tumors, few patients are cured. Attempting to improve their therapeutic efficacy we have applied the TC1 mouse lung carcinoma model and injected established subcutaneous tumors intratumorally with 3 weekly doses of various combinations of mAbs. Combinations of mAbs to CTLA4/PD1/CD137 (the 3 mAb combination) and to CTLA4/PD1/CD137/CD19 (the 4 mAb combination) were most efficacious to induce complete regression of both the injected tumor and an untreated tumor in the same mouse. Tumor cure was consistently associated with shifting a Th2 to a Th1 response in tumor-draining lymph nodes and spleen and it involved epitope specific and long-lived memory T cells as well as M1 macrophages. This shift and accompanying tumor rejection was harder to achieve as the treated tumors increased in size. Relapse of tumors which had initially regressed following treatment with immunomodulatory mAbs was associated with return of a Th2 microenvironment in tumors, tumor-draining lymph nodes and spleens rather than the emergence of immune-resistant tumor cells. While mAbs to CTLA4 plus PD-1 were therapeutically ineffective, combining the 2 of them with intraperitoneal cisplatin, 10 mg/kg, induced long-term complete tumor regression in most mice with small TC1 tumors and the therapeutic efficacy against larger tumors improved by administrating cisplatin together with the 3 or 4 mAb combination.https://ift.tt/2QKQ1OP
Understanding Microbiome Effect on Immune Checkpoint Inhibition in Lung Cancer: Placing the Puzzle Pieces Together
Over the past couple of years, human microbiome has received increasing attention as a regulator and predictor of response to the therapies of various diseases. It is speculated that manipulating gut microbiome can modify response to cancer immunotherapies as well. Through this review, we have critically analyzed our current understanding of gut microbiome as a modulator of immunotherapies in lung cancer, explained conflicting data, evaluated current gaps and extrapolated our present knowledge to generate directions for future investigations.
https://ift.tt/2xACIrq
https://ift.tt/2xACIrq
Cancer Stem Cell Vaccination With PD-L1 and CTLA-4 Blockades Enhances the Eradication of Melanoma Stem Cells in a Mouse Tumor Model
Immune checkpoint inhibitors and monoclonal antibodies reinvigorate cancer immunotherapy. However, these immunotherapies only benefit a subset of patients. We previously reported that ALDHhigh tumor cells were highly enriched for cancer stem cells (CSCs), and ALDHhigh CSC lysate-pulsed dendritic cell (CSC-DC) vaccine was shown to induce CSC-specific cytotoxic T lymphocytes. In this study, we investigated the CSC targeting effect of the CSC-DC vaccine combined with a dual blockade of programmed death-ligand 1 and cytotoxic T-lymphocyte-associated protein (CTLA-4) in B16-F10 murine melanoma tumor model. Our data showed that animals treated with the dual blockade of programmed death-ligand 1 and CTLA-4 and CSC-DC vaccine conferred significantly more tumor regression than the CSC-DC vaccine alone. Importantly, the triple combination treatment dramatically eliminated ALDHhigh CSCs in vivo. We observed that CSC-DC vaccine in combination with anti-PD-L1 and anti-CTLA-4 administration resulted in ∼1.7-fold fewer PD-1+CD8+ T cells and ∼2.5-fold fewer CTLA-4+CD8+ T cells than the populations observed following the CSC-DC vaccination alone. Moreover, significant antitumor effects and dramatically eliminated ALDHhigh CSCs following the triple combination treatment were accompanied by significantly enhanced T-cell expansion, suppressed transforming growth factor β secretion, enhanced IFN-γ secretion, and significantly enhanced host specific CD8+ T-cell response against CSCs. Collectively, these data showed that administration of a-PD-L1 and a-CTLA-4 combined with CSC-DC vaccine may represent an effective immunotherapeutic strategy for cancer patients in clinical.https://ift.tt/2QK4BWI
Nivolumab Treatment for Cancers in the HIV-infected Population
Nivolumab is a standard treatment option in several advanced malignancies, but safety and efficacy are still unknown in patients with human immunodeficiency virus (HIV) infection. We describe a case series of people living with HIV (PLWH) receiving nivolumab in the Veterans Health Administration (VA) and report responses and toxicities. We identified all PLWH who received nivolumab at any VA facility since 2000 in the Corporate Data Warehouse (CDW), which provides nationwide research access to VA electronic medical records. We identified 16 HIV-infected nivolumab recipients. The median number of nivolumab doses received was 6 (range, 1–32). Changes in CD4 count during therapy were variable, with 70% (7/10) of patients experiencing increases. Half of PLWH were treated for non–small-cell lung cancer; 2 for Hodgkin lymphoma (HL), 2 for renal cell carcinoma, and 4 for off-label cancers. For non–small-cell lung cancer, 7 patients had evaluable responses. Although 5 of 7 patients immediately progressed, 1 had a partial response and 1 had stable disease, which were both durable. Two of 16 (14%) PLWH had complete responses; both with HL (2/2 HL, 100%). The prevalence of immune-related adverse effects was 40% overall (6/15); 27% (4/15) had pneumonitis. To our knowledge, this is the largest case series reporting outcomes with nivolumab in PLWH. Outcomes were comparable with those seen in studies of HIV-uninfected patients, and particularly interesting for HL. The reason for the high proportions of immune-related adverse effects is unclear, but needs to be confirmed in larger studies.https://ift.tt/2xxDipV
JESREC score and mucosal eosinophilia can predict endotypes of chronic rhinosinusitis with nasal polyps
Recently, JESREC score and mucosal eosinophil count have been used to diagnose eosinophilic chronic rhinosinusitis (ECRS) in Japan. However, it remains unknown whether the subtypes of CRS diagnosed by these criteria have different endotypes. In the present study, we investigated whether JESREC score and mucosal eosinophil count were appropriate for classification of CRS subgroups into endotypes.
https://ift.tt/2xjXKez
Osteogenic capacity of diluted platelet-rich plasma in ectopic bone-forming model: benefits for bone regeneration
Platelet-rich plasma (PRP) with normal and below-normal physiological concentrations of platelets is designated as diluted PRP (dPRP).The aims of this study are to evaluate whether bone mineral matrix in combination with dPRP possesses osteogenic capacity; and whether the differences in dynamics and osteogenic process pattern depend on different platelet concentrations, to what extent, and also what could be benefits for bone regeneration in clinical practice.Three types of implants were made: BMM-bone mineral matrix alone; dPRP/10-bone mineral matrix mixed with dPRP (concentration of platelets 10 times lower than physiological level) and dPRP/3-bone mineral matrix mixed with dPRP (concentration of platelets 3 times lower than physiological level).
https://ift.tt/2xn1PPe
Comparison of the bactericidal effect of cold atmospheric pressure plasma (CAPP), antimicrobial photodynamic therapy (aPDT), and polihexanide (PHX) in a novel wet surface model to mimic oral cavity application
Cold atmospheric pressure plasma (CAPP) is increasingly used for medical applications. The first devices are available from commercial manufactures, promising to improve wound healing and disinfection. The underlying antimicrobial mechanisms of CAPP are discussed, while the first results on its bactericidal efficiency against common bacterial species have already been published, with promising results. Most of the plasma sources used in these studies were built by the investigators themselves, and are not commercially available or licensed for clinical use.
https://ift.tt/2PSBSxN
Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap
Virtual surgical planning (VSP) has become established as a practical aid in reconstructive surgery. Benefits include improved planning options, simplified osteosynthesis through optimized cut surfaces, improved restoration of facial symmetry, and reduced surgery times (Hirsch et al., 2009; Roser et al., 2010; Metzler et al., 2014; Stirling Craig et al., 2015; Zweifel et al., 2015; Ritschl et al., 2017; Ren et al., 2018). On the other hand, disadvantages are the considerable additional costs and a lack of flexibility in intraoperative strategy changes (Deek et al., 2016; Weitz et al., 2016).
https://ift.tt/2xnWOpo
The impact of harvest length and detachment of the interosseous membrane on donor-site morbidity following free fibula flap surgery—a biomechanical experimental study
The fibula flap has been established for orofacial reconstruction following ablative surgery. Donor-site morbidity of the lower leg may be explained by the harvest technique and particularly by detachment of the M. extensor halluces longus (EHL) and M. extensor digitorum longus (EDL).
https://ift.tt/2POVa76
Impact of voxel size and scan time on the accuracy of three-dimensional radiological imaging data from cone-beam computed tomography
Three-dimensional (3D) radiological imaging plays an important role in surgical planning used in modern dentistry. The aim of this study was to optimize imaging parameters with a special focus on voxel size and scan time.
https://ift.tt/2xpoGcW
A Provider Global Assessment Quality Measure for Clinical Practice for Inflammatory Skin Disorders
Current quality measures in dermatology have limited feasibility and validity for demonstrating value of care provided. Expert consensus was reached on a global severity metric for incorporation into a quality measure for inflammatory dermatoses. This effort will facilitate standardized data collection and may better demonstrate quality of care in dermatology.
https://ift.tt/2NUM1wA
Clinical and dermoscopic features of cutaneous BAP1 inactivated melanocytic tumors: results of a multicenter case-control study by the International Dermoscopy Society (IDS)
Multiple BAP-1 inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer-syndrome involving germline mutations in BAP1. We have identified 5 dermoscopic patterns present in BIMT. Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise suspicion for BIMT associated with BAP1 germline mutations.
https://ift.tt/2OAQwJC
Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone
Various factors are linked to poor outcomes in squamous cell carcinoma, but poor differentiation and invasion beyond subcutaneous fat may greater predict risk of locoregional disease and disease-specific death., Mohs surgery alone provides excellent marginal control of high-risk squamous cell carcinoma and may lower rates of measured poor outcomes.
https://ift.tt/2NTKQNQ
A population-based registry study on relative survival from melanoma in Germany stratified by tumor thickness for each histological subtype
Melanoma relative survival varies by histology. However, differences were strongly alleviated after adjustment for tumor thickness. Increased 5-year relative survival between the periods 2002-2005 and 2010-2013 is explained by a decrease in tumor thickness. Prevention and awareness should be encouraged as prognosis of thick melanoma is still poor.
https://ift.tt/2NY60Kw
Management of nasopharyngeal teratomas associated with cleft palate
Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association.We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft.
https://ift.tt/2MPC1jw
Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition
According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10mm and a tumour diameter >4cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10mm and a tumour diameter <4cm (55 patients who did not receive PORT).
https://ift.tt/2plYZWf
Treatment of skeletal open bite using a navigation system: CAD/CAM osteotomy and drilling guides combined with pre-bent titanium plates
Severe skeletal open bite associated with posterior vertical maxillary excess and mandibular deformity is considered a difficult problem in orthodontic and surgical treatment. This study used a navigation system for the correction of severe skeletal open bite in order to accurately transfer the virtual plan to the actual operation and achieve precise rigid internal fixation in bimaxillary osteotomies of the jaws. Twelve patients with a severe skeletal open bite associated with vertical maxillary excess and mandibular deformity were recruited.
https://ift.tt/2MSf0N2
Rosacea: 5 Things to Know
These five things include some lesser known, but critically important, facts about rosacea and its management.
Medscape Dermatology
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“Chronic Urticaria”: Recommendations From an Allergist and Immunologist
No abstract availablehttps://ift.tt/2QJMShW
EMPACT Syndrome in a Patient Treated With Phenobarbital
No abstract availablehttps://ift.tt/2xC0PWw
Allergic Contact Dermatitis of the Vulva
Allergic contact dermatitis is an important diagnostic consideration in the evaluation of patients presenting with vulvar complaints. The high prevalence of contact sensitization in the vulvar region is likely multifactorial. We review the extant literature regarding key predisposing factors in the pathogenesis of vulvar allergic contact dermatitis, as well as the most commonly implicated allergens as identified by a number of retrospective studies and case series. On the basis of our findings, we provide diagnostic and therapeutic recommendations for practicing clinicians.https://ift.tt/2QJMLD2
Effective Use of Dupilumab in Managing Systemic Allergic Contact Dermatitis
Allergic contact dermatitis to metals has become increasingly recognized in patients with endovascular implants. The ACD can lead to in-stent restenosis as well as a prominent eczematous reaction overlying the implant, often necessitating its removal. We present a case of refractory allergic contact dermatitis to nickel in a 44-year-old man with numerous endovascular stents and vascular clips. He developed numerous adverse effects of systemic therapy to manage his symptoms including recurrent infections leading to frequent hospitalizations. He was effectively transitioned to dupilumab, a monoclonal antibody against the IL-4α subunit currently approved by the Food and Drug Administration in the management of atopic dermatitis, with an improvement in symptoms and a reduction in infection rate.https://ift.tt/2xxzHbq
Contact Dermatitis to Carmine
Carmine is a widely used "natural" food additive that has been reported to provoke both an immediate hypersensitivity and a delayed systemic response with cutaneous expression. Systemic contact dermatitis describes the hypersensitivity reaction following systemic re-exposure of the inciting allergen in previously sensitized individuals. In individuals with recalcitrant dermatitis and a positive carmine intolerance history and/or patch test, it is important to consider a trial topical and dietary elimination of carmine-associated products and foods.https://ift.tt/2QIbFmL
Allergy Alert Test for p-Phenylenediamine–Allergic Hair Dye Users
Background Contact dermatitis to hair dyes remains a health concern. Regulations in many countries require consumer self-testing for hair dyes, but no standardized procedure exists. Objective The aim of this study was to develop a self-test protocol for an allergy alert test (AAT) that can elicit a self-noticeable alert signal in p-phenylenediamine (PPD)–allergic consumers. Methods Simulating consumer use conditions (open application for 45 minutes after mixing with a developer), PPD-positive hair dye–allergic subjects and PPD-negative control subjects were tested on the forearm and behind the ear with experimental products containing 0.05%, 0.25%, 0.75%, and 2% PPD. Reactions were self-evaluated by subjects and independently assessed by dermatologists. Conclusions The AAT caused a reaction self-noticeable on the forearm in 90.5% (38/42) and behind the ear in 93% (39/42) of the PPD-positive subjects. This was objectified by a dermatological evaluation. The strength of the AAT response and the number of responding subjects increased with increasing PPD concentrations. Allergy alert test responses were also dependent on the reaction strength of the diagnostic patch test to PPD before the study; in subjects with (+++) patch test reactions, 19 of 19 were positive. All 48 control subjects were negative to the AAT. Therefore, the AAT protocol provides a signal indicative of an allergic reaction in PPD-allergic hair dye consumers.https://ift.tt/2QIbCr5
Excipient and Dose per Unit Area Affect Sensitivity When Patch Testing With Gold Sodium Thiosulfate
Background Dose/area and reading paradigms for gold patch testing are controversial and not standardized worldwide. Objectives The aims of this study were to determine the optimum patch test dose of gold sodium thiosulfate (GST) in a hydrogel (HYD) and to establish GST HYD safety/efficacy and further characterize normal morphology and time course of GST reactions. Methods Twenty gold-allergic patients were patch tested with a dilution series of GST HYD and with GST 2% petrolatum (pet). Furthermore, this previously determined optimal dose was compared with GST 0.5% pet in 19 known-allergic and 216 consecutive subjects. Results The optimal GST HYD dose was 0.075 mg/cm2, not statistically different from GST 2% pet (P = 0.4795). Gold sodium thiosulfate HYD outperformed GST 0.5% pet in both known-allergic subjects (79% vs 63%, P = 0.2482) and consecutive subjects (30% vs 9%, Phttps://ift.tt/2QGD8W1
Seeing Double: Allergic Contact Dermatitis to para-Amino Compounds
No abstract availablehttps://ift.tt/2xA3FLQ
Clinical Profile and Allergens in Pigmented Cosmetic Dermatitis and Allergic Contact Dermatitis to Cosmetics in India
Background Pigmented cosmetic dermatitis (PCD) is frequently encountered in dark-skinned individuals as gradual hyperpigmentation on the face without preceding erythema or itching. Little is known about the allergen profile in PCD. Objectives The aim of the study was to describe the clinical profile and common allergens in PCD and allergic contact dermatitis (ACD) to cosmetics in Delhi. Methods Records of patients suspected of PCD and ACD to cosmetics were analyzed. All patients were patch tested with the Indian standard series, Indian cosmetic and fragrance series, and personal cosmetics and, in relevant cases, hairdresser series. Results One hundred six patients were analyzed. Patch test was positive in 77 cases (72.6%). Cetrimonium, gallate mix, thiomerosal, and skin lightening creams were more frequently positive in cases of PCD (P = 0.019–0.003), whereas p-phenylenediamine, toluene-2,5 diamine sulfate, p-aminophenol, m-aminophenol, and nitro-p-phenylenediamine were predominantly positive in ACD to cosmetics (Phttps://ift.tt/2QGD5cN
Transparent Film Dressings for Patch Testing Leads to Better Adhesion and Patient Comfort
No abstract availablehttps://ift.tt/2xAeL3l
Sleep Disturbance and Sleep-Related Impairment in Adults With Atopic Dermatitis: A Cross-sectional Study
Background Little is known about the impact of sleep disturbances (SD) or sleep-related impairment (SRI) in adults with AD or their relationship with severity of AD and itch and other predictors. Objective The aim of this study was to determine the relationship between AD severity, SD, and SRI. Methods We conducted a prospective online questionnaire-based study of 287 adults with AD, including assessment of AD severity by Patient-Oriented Eczema Measure, self-reported global AD severity, Self-Assessed Eczema Area and Severity Index and visual analog scale–itch, Patient-Reported Outcome Measurement Information System SD and SRI individual items, and T scores. Results Adults with AD commonly endorsed all SD and SRI symptoms examined; only 58 (21.8%) reported having good or very good sleep quality in the past week. However, only a minority of adults with AD endorsed a more profound impact from these individual aspects of SD and SRI in the past week or Patient-Reported Outcome Measurement Information System T scores greater than 55. In particular, SD and SRI were associated with severe or very severe AD (Patient-Oriented Eczema Measure, self-reported severity, visual analog scale–itch, and/or Self-Assessed Eczema Area and Severity Index). Sleep-related impairment was also associated with comorbid hay fever and/or anxiety. Conclusions This study suggests that SD and SRI are common in adults with AD, particularly those with severe diseases. Sleep disturbances and SRI should be considered when assessing burden of AD and therapeutic decisions.https://ift.tt/2QIbnwb
Pain and Itch Are Dual Burdens in Atopic Dermatitis
Background Despite being widely reported by patients with atopic dermatitis (AD), pain symptoms, unlike itch, have not been widely assessed. Objective The aim of the study was to understand the distinct pain symptoms in patients with AD. Methods Responses from an anonymous questionnaire were collected from our eczema clinic (in-person survey) and collaboration with Global Parents for Eczema Research Group and the National Eczema Association (online survey) to assess skin pain among patients with AD 5 years and older. Eczema Area and Severity Index was measured in the clinic cohort to correlate with pain symptoms. Conclusions In our international cohort of 103 patients with AD, 78% reported concomitant pain and itch. The greatest pain burden occurred on the hands (odds ratio [OR], 0.77), perioral region (OR, 0.74), and toes (OR, 0.7), corresponding to regions with the greatest sensory nerve density. Pain was most commonly described as "burning" and "stinging," particularly when lesions were red, cracked, and dry. Its presence significantly interfered with sleep, leisure activities, and activities of daily living. Among the clinic cohort, we observed a strong Spearman correlation between objective Eczema Area and Severity Index score and subjective skin pain. It is imperative that clinicians understand patients' unique pain burden to best evaluate clinical severity and quality-of-life interference.https://ift.tt/2QIbhEP
Giant craniopharyngioma in an adult presenting with new onset seizure
Description
A 43-year-old man presented to the emergency department after experiencing a first episode seizure. No further information was available at presentation as the patient was confused on his arrival. On physical examination, vital signs were normal. The patient was confused, and his Glasgow Coma Score was 12(E3V4M5). Initial workup included complete blood count, electrolytes and ECG were normal. Thyroid function tests, insulin growth factor-1 and plasma random cortisol level were within the normal range. Testosterone levels were low, and luteinising hormone was inappropriately normal. CT demonstrated a cystic mass with peripheral calcification measuring 6.0x4.5x3.9 cm. The lesion originated from the pituitary fossa and expanded superiorly distorting the third ventricle and the left lateral ventricle causing hydrocephalus (figure 1). A pituitary MRI confirmed these findings (figure 2). The patient underwent a craniotomy with mass resection. The procedure was uneventful. Pathology demonstrated nodular whorls and...
https://ift.tt/2QJpTnh
Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner
This case presents symptom resolution for a long-distance runner with chronic Achilles tendinopathy (AT), following a partial tear of his Achilles tendon. The patient reported a sudden pain during a morning run, with preserved function. Three hours postinjury, he was reviewed in a musculoskeletal clinic. An ultrasound scan confirmed a partial Achilles tear, associated with significant Doppler activity. His index of AT severity The Victorian Institute of Sports Assessment - Achilles Questionnaire (VISA-A) 4 hours postinjury was markedly higher compared with 2 weeks preinjury, indicating reduced symptom severity. A follow-up scan 4 weeks postinjury showed minimal mid-portion swelling and no signs of the tear. His VISA-A score showed continued symptom improvement. This case represents resolution of tendinopathic symptomatology post partial Achilles tear. While the natural histories of AT and Achilles tears remain unknown, this case may indicate that alongside the known role of loading, inflammation may be a secondary mediator central to the successful resolution of AT pain.
https://ift.tt/2xACG2v
87-year-old woman with improved pulmonary function following accidental long-term inhalation therapy with dabigatran
Accidental long-term dabigatran etexilate inhalation was associated with subtherapeutic dabigatran serum concentrations in an elderly female patient with restrictive lung disease. A significant improvement in her pulmonary function was noted without other therapy directed towards her bronchopulmonary disease.
https://ift.tt/2QJpQI7
Unusual case of levamisole-induced dual-positive ANCA vasculitis and crescentic glomerulonephritis
Cocaine adulterated levamisole is an increasingly reported cause of skin necrosis, arthralgia and systemic vasculitis, but renal involvement is uncommon. We present a case of a 40-year-old Hispanic man with a history of cocaine abuse who presented with acute kidney injury to the rheumatology clinic where he was being treated for chronic inflammatory arthritis. He was found to have a serum creatinine of 2.5 mg/dL, microscopic haematuria and subnephrotic proteinuria, along with positive proteinase 3, myeloperoxidase, anticardiolipin antibodies and an elevated antinuclear antibody titre. The renal pathology revealed focal necrotising glomerulonephritis with crescentic features and mild immune type deposition. The patient was treated with cocaine abstinence, pulse dose steroids followed by maintenance prednisone, rituximab and cyclophosphamide. His renal function subsequently improved but did not normalise. We believe that his incomplete improvement was due to the degree of kidney injury on presentation as well as recidivism with cocaine use.
https://ift.tt/2xwkVl7
Microangiopathic haemolytic anaemia with thrombocytopenia induced by vitamin B12 deficiency long term after gastrectomy
Microangiopathic haemolytic anaemia with thrombocytopenia, called pseudo-thrombotic microangiopathy (TMA), is a clinically important complication in patients with vitamin B12 deficiency. We herein present a case of an 80-year-old woman with pseudo-TMA after gastrectomy. She was initially suspected with thrombotic thrombocytopenic purpura based on rapid progression of anaemia with schistocytes and thrombocytopenia; however, her anaemia and thrombocytopenia were improved by vitamin B12 supplementation alone, with a single session of plasma exchange. Vitamin B12 deficiency was finally confirmed by low vitamin B12 levels from the patient's initial blood sample. In addition, normal ADAMTS13 activity was proven, lowering the likelihood of thrombotic thrombocytopenic purpura. Therefore, this patient was diagnosed with pseudo-TMA caused by vitamin B12 deficiency. Pseudo-TMA can occur in patients with vitamin B12 deficiency post-gastrectomy.
https://ift.tt/2QJpMIn
Herpes simplex virus keratitis mimicking Acanthamoeba keratitis: a clinicopathological correlation
A 36-year-old male, soft contact lens wearer was referred by his primary ophthalmologist for corneal ulcer of the right eye (OD), which was persistent despite topical fluoroquinolone therapy for 1 month. A ring-shaped infiltrate typically seen in Acanthamoeba infection was noted, and topical therapy with chlorhexidine and polyhexamethylene biguanide was initiated. However, the patient's condition deteriorated over the next several weeks; thus, diagnostic and therapeutic penetrating keratoplasty was performed. The postoperative immunohistochemical analysis suggested a diagnosis of herpes simplex virus (HSV) keratitis. The patient ultimately improved after initiation of oral valacyclovir following penetrating keratoplasty. We report a case of a commonly encountered clinical entity, HSV keratitis, with an atypical clinical presentation, masquerading as Acanthamoeba keratitis.
https://ift.tt/2xyjy5j
Acute testicular pain secondary to a leaking abdominal aortic aneurysm (AAA)
We present the case of a 56-year-old male smoker with a background of hypertension who presented with acute onset right testicular pain secondary to a leaking abdominal aortic aneurysm. Following urgent surgical repair and a complicated intensive care recovery, the patient was discharged with no residual disability. This case highlights an atypical presentation of what is a devastating illness.
https://ift.tt/2QJpJwb
Isolated Fourniers gangrene of the penis with penile autoamputation
Description
A 65-year-old non-diabetic man presented to us with blackish discolouration of his penile shaft for 10 days (figures 1 and 2). He had undergone total thyroidectomy for follicular carcinoma of the thyroid gland 2 weeks previously. Intraoperatively, failed attempts were made to catheterise the patient. These attempts were traumatic, and a suprapubic catheter was hence placed. Following this, he developed inflammation and oedema on his penile shaft which then gradually started turning black for which he came to us. A diagnosis of isolated Fournier's gangrene of penis was made. Debridement was done, and the patient was advised regular dressings. During the initial debridement, the tunica albuginea and corpus cavernosa were not excised although the patient had slight gangrenous changes over the cavernosa. Later, gradually, a line of demarcation developed, and there was autoamputation of the involved shaft, 2 weeks after the initial debridement. The patient...
https://ift.tt/2xwkPtL
Positron emission tomography and reframing vasculitis as a spectrum of disease when investigating a patient with a fever of unknown origin
A retired businessman presented to the infectious diseases department with a history of ongoing fevers and myalgia and raised inflammatory markers. This continued despite adequate antibiotic treatment of an epididymo-orchitis. Extensive investigations, including bone marrow and liver biopsies and a positron emission tomography, did not reveal a cause but showed reactive change in the bone marrow. Later, he developed a vasculitic rash and vision loss due to non-arteritic anterior ischaemic optic neuropathy. High-dose steroids were immediately initiated. A temporal artery biopsy was performed, which confirmed a healing large vessel vasculitis, possibly giant cell arteritis. He has responded very well to therapy. We must better appreciate the limitations of positron emission tomography in investigating a fever of unknown origin. The case also encourages awareness of autoimmune disorders as the leading category of causative diseases for this in older age groups.
https://ift.tt/2QJpGjZ
Rare cause of ovarian mass
Pelvic actinomycosis is a rare entity that occurs almost exclusively in women, the presentation of which is usually non-specific and variable. Pelvic actinomycosis is almost always associated with the use of an intrauterine contraceptive device (IUD). Pelvic actinomycosis unrelated to IUD use is almost always associated with previous surgical procedures. The symptoms, clinical signs and radiological findings are usually non-specific, mimicking an ovarian malignancy. So an awareness of this rare condition and a proper diagnosis can avoid unnecessary surgeries because these cases can be treated with a prolonged course of antibiotics. We present a case of pelvic actinomycosis which masqueraded as an ovarian malignancy.
https://ift.tt/2xwkKGt
Brain-Resident T Cells Following Viral Infection
Viral Immunology, Ahead of Print.
https://ift.tt/2xnmliu
Evaluation of Possible Effects of a Potassium Channel Modulator on Temporal Processing by Cochlear Implant Listeners
Abstract
Temporal processing by cochlear implant listeners is degraded and is affected by auditory deprivation. The fast-acting Kv3.1 potassium channel is important for sustained temporally accurate firing and is also susceptible to deprivation, the effects of which can be partially restored in animals by the molecule AUT00063. We report the results of a randomised placebo-controlled double-blind study on psychophysical tests of the effects of AUT00063 on temporal processing by CI listeners. The study measured the upper limit of temporal pitch, gap detection, and discrimination of low rates (centred on 120 pps) for monopolar pulse trains presented to an apical electrode. The upper limit was measured using the optimally efficient midpoint comparison (MPC) pitch-ranking procedure; thresholds were obtained for the other two measures using an adaptive procedure. Twelve CI users (MedEl and Cochlear) were tested before and after two periods of AUT00063 or placebo in a within-subject crossover study. No significant differences occurred between post-drug and post-placebo conditions. This absence of effect occurred despite high test-retest reliability for all three measures, obtained by comparing performance on the two baseline visits, and despite the demonstrated sensitivity of the measures to modest changes in temporal processing obtained in other studies from our laboratory. Hence, we have no evidence that AUT00063 improves temporal processing for the doses and patient population employed.
https://ift.tt/2MIuses
Clinical evaluation of non-surgical cleaning modalities on titanium dental implants during maintenance care: a 1-year follow-up on prosthodontic superstructures
Abstract
Objectives
To investigate tissue health around implants with newly attached superstructures over 12 months of preventive maintenance appointments and instrumentation when necessary.
Material and methods
In a randomized, split-mouth study 32 implants (8 participants with 4 implants each) received followed-up care every 3 months after superstructure attachment. Implants and superstructures were randomly assigned to four treatment groups and treated if necessary: (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) rubber cup polishing (CON). Probing depths (PDs), bleeding on probing (BOP), modified gingival (mucosal) bleeding index (GBI) around implants, and full-mouth Plaque Control Record (PCR) were measured every 3 months. Clinical attachment levels (CALs) and height of keratinized mucosa (KM)/gingival margins (GMs) for implants/teeth and PD, BOP, and GBI for teeth were documented at baseline, 6 months, and 12 months. Matrix metalloproteinase 8 (MMP-8) and periopathogens were measured at baseline and 12 months.
Results
Participants exhibited minimal signs of periodontal inflammation with statistically significant PD improvement (3.0 ± 0.2 to 2.8 ± 0.3 mm; p = 0.022) and overall CAL (4.3 ± 0.8 to 4.0 ± 0.7 mm; p = 0.048) after 1 year. Implants showed no statistically significant differences (p > 0.05) between or within groups at baseline or 12 months for any parameter, except MMP-8 decreased significantly for PS (14.50 ± 17.58 to 4.63 ± 7.56 ng; p = 0.044), and after 12 months, PCR showed a significant difference between TC and PS (p = 0.018).
Conclusions
Treatment was necessary as inflammation was observed around newly placed superstructures within the first year of maintenance care. All tested treatment modalities yielded comparable clinical improvements.
Clinical relevance
Early assessment and diagnosis of mucositis and regular maintenance can promote long-lasting implant health.
https://ift.tt/2plLMMU
Severe Bronchiolitis Profiles and Risk of Developing Recurrent Wheezing by Age 3 Years
Publication date: Available online 18 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Orianne Dumas, Kohei Hasegawa, Jonathan M. Mansbach, Ashley F. Sullivan, Pedro A. Piedra, Carlos A. Camargo
Abstract
Background
A better understanding of bronchiolitis heterogeneity may help clarify its relationship with the development of recurrent wheezing and asthma.
Objectives
To identify severe bronchiolitis profiles by a clustering approach, and to investigate for the first time their association with allergy/inflammatory biomarkers; nasopharyngeal microbiota; and development of recurrent wheezing by age 3 years.
Methods
We analyzed data from a prospective, 17-center U.S. cohort study of 921 infants (age <1 year) hospitalized with bronchiolitis (2011-2014 winters) with post-hospitalization follow-up. Severe bronchiolitis profiles at baseline (hospitalization) were determined by latent class analysis, based on clinical factors and viral etiology. Blood biomarkers and nasopharyngeal microbiota profiles were determined using samples collected within 24h of hospitalization. Recurrent wheezing by age 3 years was defined based on parental report of breathing problem episodes post-discharge.
Results
Three severe bronchiolitis profiles were identified: profile A (15%), characterized by history of breathing problems/eczema during infancy and non-RSV (mostly rhinovirus) infection; profile B (49%) with the largest probability of RSV infection and which resembled classic RSV-bronchiolitis; and profile C (36%), the most severely ill group. Profile A infants had higher eosinophil counts, higher cathelicidin levels, and elevated proportions of Haemophilus-dominant or Moraxella-dominant microbiota profile. Compared to profile B, we observed significantly increased risk of developing recurrent wheezing in children with profile A (hazard ratio 2.64; 95% CI 1.90-3.68), and, to a lesser extent, with profile C (1.51; 1.14-2.01).
Conclusion
Although longer follow-up is needed, our results may help identify, among children hospitalized for bronchiolitis, subgroups with particularly elevated risk of developing asthma.
https://ift.tt/2xzBKM4
Effect of photobiomodulation on neural differentiation of human umbilical cord mesenchymal stem cells
Abstract
Photobiomodulation therapy (PBMT) can enhance the mesenchymal stem cell (MSC) proliferation, differentiation, and tissue repair and can therefore be used in regenerative medicine. The objective of this study is to investigate the effects of photobiomodulation on the directional neural differentiation of human umbilical cord mesenchymal stem cells (hUC-MSCs) and provide a theoretical basis for neurogenesis. hUC-MSCs were divided into control, inducer, laser, and lasers combined with inducer groups. A 635-nm laser and an 808-nm laser delivering energy densities from 0 to 10 J/cm2 were used in the study. Normal cerebrospinal fluid (CSF) and injured cerebrospinal fluid (iCSF) were used as inducers. The groups were continuously induced for 3 days. Cellular proliferation was evaluated using MTT. The marker proteins nestin (marker protein of the neural precursor cells), NeuN (marker protein of neuron), and GFAP (glial fibrillary acidic protein, marker proteins of glial cells) were detected by immunofluorescence and western blot. We found that irradiation with 635-nm laser increased cell proliferation, and that with 808 nm laser by itself and combined with cerebrospinal fluid treatment generated significant neuron-like morphological changes in the cells at 72 h. Nestin showed high positive expression at 24 h in the 808 nm group. The expression of GFAP increased in the 808-nm combined inducer group at 24 h but decreased at 72 h. The expression of neuN protein increased only at 72 h in both the 808-nm combined inducer group and inducer group. We concluded that 808 nm laser irradiation could help CSF to induce neuronal differentiation of hUC-MSCs in early stage and tend to change to neuron rather than glial cells.
https://ift.tt/2xlLgDa
Photobiomodulation is associated with a decrease in cell viability and migration in oral squamous cell carcinoma
Abstract
The treatment of squamous cell carcinoma (SCC) involves surgery, chemotherapy, and/or radiotherapy, which can cause mucositis (inflammation of the oral mucosa that causes considerable pain and can compromise the continuity of oncological treatment). Photobiomodulation (PBM) has been successfully used in the treatment of mucositis, but doubts arise regarding the use of laser for areas in which tumor cells may remain. In this study, the effect of PBM on the viability, mitochondrial activity, proliferation, apoptosis, and migration of cells derived from oral SCC was evaluated. SCC9 cells were irradiated with laser (660 and 780 nm, using 11 dosimetric parameters) and submitted to mitochondrial and caspase 3 activity tests after 1 and 3 days. Based on the results, cell viability (neutral red assay), proliferation (BrdU assay), and migration (scratch-wound assay) were evaluated using only the dosimetric parameters recommended for mucositis. Non-irradiated cells served as the control. The experiments were performed in triplicate. The 11 parameters diminished mitochondrial activity and induced tumor cell apoptosis. Using the parameters recommended for mucositis, irradiation with 780 nm (70 mW, 4 J/cm2) proved to be the safest and led to a reduction in cell viability, the induction of apoptosis, and a reduction in the migration capacity of the tumor cells.
https://ift.tt/2MMywKt
Evaluation of Possible Effects of a Potassium Channel Modulator on Temporal Processing by Cochlear Implant Listeners
Abstract
Temporal processing by cochlear implant listeners is degraded and is affected by auditory deprivation. The fast-acting Kv3.1 potassium channel is important for sustained temporally accurate firing and is also susceptible to deprivation, the effects of which can be partially restored in animals by the molecule AUT00063. We report the results of a randomised placebo-controlled double-blind study on psychophysical tests of the effects of AUT00063 on temporal processing by CI listeners. The study measured the upper limit of temporal pitch, gap detection, and discrimination of low rates (centred on 120 pps) for monopolar pulse trains presented to an apical electrode. The upper limit was measured using the optimally efficient midpoint comparison (MPC) pitch-ranking procedure; thresholds were obtained for the other two measures using an adaptive procedure. Twelve CI users (MedEl and Cochlear) were tested before and after two periods of AUT00063 or placebo in a within-subject crossover study. No significant differences occurred between post-drug and post-placebo conditions. This absence of effect occurred despite high test-retest reliability for all three measures, obtained by comparing performance on the two baseline visits, and despite the demonstrated sensitivity of the measures to modest changes in temporal processing obtained in other studies from our laboratory. Hence, we have no evidence that AUT00063 improves temporal processing for the doses and patient population employed.
https://ift.tt/2MIuses
Management of Complex Arteriovenous Malformations Using a Novel Combination Therapeutic Algorithm
This case series assesses the efficacy and tolerability of sirolimus as an adjuvant therapy for endovascular embolization in the management of complicated extracranial head and neck arteriovenous malformations.
https://ift.tt/2xpldet
https://ift.tt/2xpldet
Translating Data on Trends in Disease Management to Decisions
Quantifying health care utilization is an important first step in understanding how to efficiently and effectively deliver health care to patients. Actinic keratoses (AKs) are among the most common clinical diagnoses encountered by dermatologists, and treatment aims to reduce patient discomfort and potential for malignant transformation. Given an aging population, disease burden will likely increase, highlighting the need for understanding trends in AK treatment and reimbursement.
https://ift.tt/2PPtpLB
https://ift.tt/2PPtpLB
Antiphospholipid Syndrome Following Pembrolizumab Treatment of Stage IIIB Unresectable Melanoma
The case report describes the occurrence of antiphospholipid syndrome following pembrolizumab treatment of stage IIIB unresectable melanoma.
https://ift.tt/2xpkCtf
https://ift.tt/2xpkCtf
Use of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population
This billing claims analysis uses the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data to evaluate trends in the use and costs of actinic keratosis destruction.
https://ift.tt/2PPrI0N
https://ift.tt/2PPrI0N
Comparison of hospital based and home based exercise on quality of life, and neck and shoulder function in patients with spinal accessary nerve injury after head and neck cancer surgery
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Jung Hwa Do, In Jin Yoon, Young Ki Cho, Jun Su Ahn, Jung Kyo Kim, JaeYong Jeon
Abstract
Objectives
The purpose of this study was to compare the effects of hospital-based and home-based exercise programs on quality of life (QOL) and neck and shoulder function of patients who underwent head and neck cancer (HNC) surgery.
Methods
This clinical trial included 40 patients with neck and shoulder dysfunction after HNC. The exercise program included range of motion (ROM) exercises, massage, stretching, and strengthening exercises. Twenty patients who were assigned to the hospital-based exercise group performed physical therapy for 40 min three times a week for four weeks, and the remaining 20 patients were assigned to the home-based group. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck Questionnaire (EORTC QLQ-H&N), the Neck and Shoulder Disability Index (NDI), ROM, and numeric rating scale (NRS) were assessed before and after the exercise program. The program consisted of a 10-minute ROM to the neck and shoulder, a 10-minute massage, and 15 min of progressive resistance exercises, followed by a five-minute stretching exercise.
Results
There were statistically significant differences in the changes of neck and shoulder disability index (p < .05). Additionally, there were significant differences in neck extension and rotation ROM and NRS in the hospital-based group compared with the home-based group (p < .05). QOL was not significantly different between the two groups.
Conclusions
Home-based exercise was effective for improving QOL, shoulder function, and pain relief. Hospital-based exercise had better effects on physical function of the neck and shoulder and reduced pain.
https://ift.tt/2pnfK38
Bone grafting in orthognathic surgery: a systematic review
Publication date: Available online 18 September 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): A. Alyahya, G.R.J. Swennen
Abstract
Bone grafting has been used in orthognathic surgery to fill the gaps created by jaw repositioning, with the intention of improving healing and stability. Since the majority of orthognathic cases have a satisfactory result, the decision to graft or not is a clinical dilemma. A systematic review of the literature was performed on the use of bone grafts in orthognathic surgery. A search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials yielded 1927 articles published up until 2018. An additional 10 articles were retrieved through manual searching of the reference lists and citations. After title and abstract screening, 58 articles were potentially eligible; full-text screening excluded 10 of these. Thus 48 articles were included in this review. The present literature highlights the benefits of grafting bony gaps during orthognathic surgery in terms of healing, stability, and aesthetic outcomes. Generally, there was no difference between the various types of bone graft, although calcium phosphate cement and hydroxyapatite were found to increase the rate of infection. The conclusion of this review is that there remains a lack of evidence in the literature regarding the grafting of osteotomy sites in orthognathic surgery. Guidelines are proposed based on the present evidence; however, future research is needed to validate these.
https://ift.tt/2NqiGKI
Risk factors and prognosis for the primary intraosseous carcinoma of the jaw
Publication date: Available online 18 September 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): K. Li, L. Yang, Y.-J. Qiao, Y.-J. Liang, X. Wang, G.-Q. Liao
Abstract
Primary intraosseous carcinoma (PIOC) is a rare but aggressive type of odontogenic tumour arising within the jawbone. Diagnosis criteria and treatment strategy remain difficult and controversial. The present study aimed to clarify the clinicopathological features and determine prognostic factors in management of PIOC. A retrospective study of 30 patients with PIOC, treated at the Hospital of Stomatology of Sun Yat-sen University between 2009 and 2017, was conducted. Clinical, histopathological and treatment modality data were collected. Follow-up data were recorded to determine prognostic factors. There were 19 males and 11 females with a mean age of 52.3 years. The most common location of the tumour was the mandible (90%). Having a history of tooth extraction or tooth mobility was the major characteristic symptom (63.3%), jaw swelling coming in second (53.3%). Half of the patients underwent surgery alone. The estimated 2-year overall survival rate (OS) and recurrence-free survival rate (RFS) were 61.3% and 40.1%, respectively. Higher histological grade was an independent risk factor for poor OS (hazard ratio (HR) 0.233 [0.059–0.915], P = 0.037), while at pN+ stage for RFS, HR = 5.627 [1.199–26.409], P = 0.029. Because of its rarity and intrabony site, the classification, staging and treatment guidelines for PIOC should be further studied and established.
https://ift.tt/2Db6DfD
Japanese guidelines for the management and treatment of generalized pustular psoriasis: The new pathogenesis and treatment of GPP
The Journal of Dermatology, EarlyView.
https://ift.tt/2PMGTrG
Making a difference providing equitable renal care globally
In their report, Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala, Moore et al describe a 42-year old indigenous Maya man who loses his job after being diagnosed with complicated diabetes. He later develops renal failure of unknown etiology. The patient originally presents to a non-profit clinic, then goes to a "higher-level laboratory in the regional capital," and finally to "The National Centre for Chronic Renal Disease (UNAERC)" The patient is given two options for renal replacement therapy, either twice-weekly haemodialysis or continuous ambulatory peritoneal dialysis (CAPD). Due to his limited mobility and finances, the patient chose CAPD as management of his renal failure.
Chronic Kidney Disease (CKD) is a common effect of many non-communicable disease processes, including hypertension, diabetes, and iatrogenic causes. The burden of this disease, "is significant and rising." CKD in general, and end-stage renal disease (ESRD) in particular are illnesses which have profound impact on the family, social, economic and psychological well-being of patients. As described by the authors, the patient's wife "cannot hold a regular job…as primary caregiver…. The patient and his family have subsided on donations…as well as meagre wages…. The patient… worries constantly about the future. His chronic diseases have caused him to feel distress, helplessness and shame." The patient is not alone in feeling this way. While studies in the developing world regarding quality of life on dialysis patients are lacking, those that do exist support the psychosocial detriment that dialysis is to many.[1] According to one patient, "In many ways… dialysis is the end of hope." [2] This reveals the importance of a multidisciplinary approach to renal replacement in the developing world, with a special emphasis on social work and mental health services.
CKD and ESRD also target vulnerable populations. The authors speak convincingly of a "sickness-poverty cycle… he became too sick to work, then too poor to pay for quality healthcare and medications and consequently he became even sicker." The inability of patients to access care and the inequity created by the care delivered can be devastating for patients who do not possess social capital to protect themselves. This can include the indigenous Maya in Guatemala, others of poor socioeconomic status in Latin America, or even undocumented immigrants in a country with a well-developed healthcare system, such as the United States. [3] Comprehensive, universally accessible healthcare is necessary for the protection of these patients, and may help prevent CKD from transitioning to ESRD. The delivery of this care will be one of the challenges of the future as non-communicable diseases continue to increase in the developing world.
BMJ Case Reports invites authors to submit global health case reports that describe the delivery of renal care for vulnerable patients. These cases could focus on:
-Unique models of delivery in the developing world
-Successful interventions for providing access to vulnerable patients worldwide
-Challenges and complications of renal care in low-resource settings
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at casereports.bmj.com. For more information, review our guidance on how to write a global health case report and look through our online collection.
To read more about renal care globally at BMJ Case Reports, please review:
–Acute peritoneal dialysis in a Jehovah's Witness post laparotomy
–Renal failure: unusual clinical presentation of an isolated intracranial hydatid cyst
To read more about kidney disease globally from other cited sources, please review:
[1] Awuah KT, Finkelstein SH, Finkelstein FO. Quality of life of chronic kidney disease patients in developing countries. Kidney international supplements. 2013 May 1;3(2):227-9.
[2] Russ AJ, Shim JK, Kaufman SR. "Is there life on dialysis?": time and aging in a clinically sustained existence. Medical anthropology. 2005 Oct 1;24(4):297-324.
[3] Campbell GA, Sanoff S, Rosner MH. Care of the undocumented immigrant in the United States with ESRD. American Journal of Kidney Diseases. 2010 Jan 1;55(1):181-91.
The post Making a difference providing equitable renal care globally appeared first on BMJ Case Reports blog.
https://ift.tt/2QIOHf1
Surgically assisted rapid maxillary expansion in lingual orthodontics – optimizing of coupling and timing
Abstract
Background
Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. Treatment times in such cases are often long with adult patients usually requesting invisible appliances. Lingual appliances can provide the mechanical control required as well as fulfil the aesthetic demands in such cases. However lingual appliances are usually custom made and indirectly bonded. Due to tooth movement following surgery there is usually a long delay before impressions can be made for customized lingual appliances. This results in a long delay before alignement and leveling can be commenced post-surgery.
Case presentations
Three cases are presented here demonstrating the simultaneous placement of bone anchored expansion devices for surgically assisted rapid maxillary expansion with customized lingual appliances.
Conclusions
The combination of the two procedures allows the alignement and leveling to commence very soon after surgery significantly reducing treatment times. The design of the appliances and the clinical procedures are described and discussed.
https://ift.tt/2DcZzPL
Effective antimicrobial activity of rifabutin against multidrug‐resistant Helicobacter pylori
Helicobacter, EarlyView.
https://ift.tt/2pokaXr
Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial—2-year results
Abstract
Objectives
Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations.
Materials and methods
Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24.
Results
At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations.
Conclusions
Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria.
Clinical significance
Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years.
Trial registration
https://ift.tt/2QISmtl
Metallic crown-induced occlusal trauma as a protocol to evaluate inflammatory response in temporomandibular joint and periodontal tissues of rats
Abstract
Objectives
The goal of this study is to propose a standard protocol of experimental occlusal trauma to evaluate the inflammatory hyperalgesia induced by metallic crowns on orofacial tissues of rats.
Materials and methods
Thirty animals were randomly divided into six groups (n = 5 per group). Detailed methodology on the manufacturing of metallic crowns is described. The inflammatory hyperalgesia induced by occlusal interference was evaluated by intra-articular injection of a low dose of 0.5% formalin (30 μl) or vehicle (saline) into temporomandibular joint, 21 or 28 days after metallic crown cementation. Posteriorly, pro-inflammatory cytokines were evaluated by enzyme-linked immunosorbent assay to assess the effect of occlusal interference on periodontium.
Results
The cementation of metallic crowns with dental anatomy on the lower molar of rats does not show signs of stress and lack of feeding. Metallic crown-induced occlusal trauma results in a temporomandibular joint inflammatory hyperalgesia (P < 0.05: ANOVA, Tukey's test). Otherwise, it was observed that occlusal trauma results in the increase of protein level of pro-inflammatory cytokines TNF-alpha and IL-1beta in the gingival tissues (P < 0.05).
Conclusion
This study demonstrates in detail a methodology of occlusal trauma resulting from the cementation of metallic crowns in the lower molars of rats, mimicking occlusal interferences commonly evaluated in the dental clinic. This methodology makes new studies to better understand the mechanisms involved in the occlusal trauma of orofacial tissues possible.
Clinical relevance
The standardization of an experimental occlusal interference model will allow us to understand the deleterious effect and mechanisms that affect the orofacial tissues.
https://ift.tt/2xsNzU0
Effect of cold plasma on periodontal wound healing—an in vitro study
Abstract
Objectives
Cold atmospheric plasma (CAP), a room temperate ionized gas, seems to be a possible way to enhance tissue recovery. An in vitro study was conducted to investigate the influence of medical CAP on the regenerative capacity of human periodontal ligament (PDL) cells.
Material and methods
Human PDL cells were subjected to CAP at various intensities, distances, and durations. The effects of CAP on a number of specific markers were studied at transcriptional level using real-time PCR. Additionally, an in vitro wound healing assay was applied to PDL cell monolayers either in the presence or absence of CAP by using JuLI™ Br Live Cell Analyzer and software. Finally, cell viability of CAP-treated cells was analyzed by an XTT assay.
Results
CAP treatment enhanced significantly the expression of the cytokines tumor necrosis factor (TNF)α, cyclooxygenase (COX)2, interleukin (IL)-1β, IL-6, IL-8, collagen (COL)1α, and matrix metalloproteinase (MMP)1, as well as the proliferation markers Ki67 and proliferating cell nuclear antigen (PCNA), but downregulated apoptotic markers Apaf1 and p53. Additionally, the in vitro wound healing rate was significantly enhanced after CAP application. Moreover, CAP treatment resulted in a significantly increased cell viability in the XTT assay.
Conclusion
This in vitro study shows that CAP has regulatable effects on markers of periodontal wound healing thereby underlining the potential use of CAP as a benefit treatment strategy.
Clinical relevance
Our study demonstrates the application of CAP in the treatment of oral pathologies suggesting a promising future treatment approach.
https://ift.tt/2QJ2iTS
Perforation of appendiceal adenocarcinoma ex goblet cell carcinoid: a rare case
Abstract
Goblet cell carcinoid tumor is a rare form of carcinoid tumor of the appendix. It behaves more aggressively than classical carcinoid tumor of the appendix. Thus, special attention must be given to its disease course and treatment. Our case presentation is of a 68-year-old female who presented with abdominal pain. Computed tomography of her abdomen and pelvis showed a perforated appendicitis. She underwent an ileocectomy with pathological report showing a goblet cell carcinoid tumor of the appendix with negative lymph nodes. A subsequent colonoscopy done 5 months later showed no synchronous lesions and a healthy anastomosis. Given the limited amount of data available about goblet cell carcinoid tumors of the appendix, it is important to report all findings in an effort to improve our understanding and treatment approaches of this rare disease.https://ift.tt/2xn4vw6
The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction
Abstract
Background
To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC).
Methods
A retrospective review of a prospectively collected database of all patients with OPSCC diagnosed and treated from 1998 to 2009. Speech, swallowing, and quality of life data were gathered at 3 different evaluation points. HPV status was determined using p16 positivity as a surrogate marker. Univariate and multivariate statistical analyses were performed to identify whether p16 status is a significant predictor of functional outcome and QOL.
Results
One hundred twelve patients with OPSCC and known p16 status were treated with primary surgery between 1998 and 2009, with mean age of 56 years. Out of those patients 63 (56%) were p16 positive. Speech intelligibility remained high at 1-year post operation (95.4%). Only 11.5% of the patients required a feeding tube at 1 year after surgery to maintain their daily caloric requirements and the risk of aspiration after surgery was not significant (p = 0.097). There was no statistically or clinically significant difference in speech, swallowing ability, swallowing safety and QOL outcomes between p16-positive and negative OPSCC.
Conclusions
Surgically treated OPSCC patients demonstrate excellent swallowing function and can achieve excellent speech perception. P16 status may not be predictive of functional outcomes or QOL in surgically treated OPSCC.
https://ift.tt/2NVXeNe
The role of CCR5 in directing the mobilization and biological function of CD11b + Gr1 + Ly6C low polymorphonuclear myeloid cells in cancer
Abstract
Bone marrow (BM) cells of the hematopoietic system, also known as BM-derived leukocytes (BMD), are mobilized from the BM to the blood and then colonize tumor sites. These cells then become key players in either promoting or regulating the development and progression of tumors. Among the cells that suppress anti-tumor immunity are regulatory T cells (Tregs), tumor-associated macrophages (TAMS) and myeloid-derived suppressor cells (MDSC). MDSC comprise CD11b+Gr1+Ly6Clow polymorphonuclear myeloid cells (PMN-MDSC), and CD11b+Gr1+Ly6Chigh monocytic myeloid cells (Mo-MDSC). Several studies including ours have identified the CCR2–CCL2 axis as the key driver of the mobilization of monocytic cells from the BM to the blood and later their colonization at the tumor site. The current review focuses on the mechanisms by which PMN-MDSC are mobilized from the BM to the blood and later to the tumor site, and their clinical implications.
https://ift.tt/2pjunEz
Exercise Training Effects on Cognition and Brain Function in Multiple Sclerosis: Project EXACT
Conditions: Multiple Sclerosis; Cognitive Impairment
Interventions: Behavioral: Treadmill Walking Exercise Training; Behavioral: Stretching-and-Toning Exercise Training
Sponsors: University of Alabama at Birmingham; National Institutes of Health (NIH); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Not yet recruiting
https://ift.tt/2NplAiT
Interventions: Behavioral: Treadmill Walking Exercise Training; Behavioral: Stretching-and-Toning Exercise Training
Sponsors: University of Alabama at Birmingham; National Institutes of Health (NIH); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Not yet recruiting
https://ift.tt/2NplAiT
Diagnostic DNA Methylation Signature in Diagnosing Thyroid Cancer After Fine-Needle Aspiration in Patients With Thyroid Nodules
Condition: Thyroid Gland Nodule
Intervention: Other: Diagnostic DNA Methylation Signature
Sponsors: City of Hope Medical Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2DaBc57
Intervention: Other: Diagnostic DNA Methylation Signature
Sponsors: City of Hope Medical Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2DaBc57
Cervico-vestibular Rehabilitation for Mild Traumatic Brain Injury
Conditions: Post-Concussion Syndrome; Mild Traumatic Brain Injury; Vestibular Disorder; Whiplash Injuries; Concussion, Brain
Interventions: Other: Conventional approach; Other: Personalized rehabilitation program
Sponsors: Laval University; Centre interdisciplinaire de recherche en réadaptation et intégration sociale; Université du Québec à Trois-Rivières
Not yet recruiting
https://ift.tt/2Nl34rY
Interventions: Other: Conventional approach; Other: Personalized rehabilitation program
Sponsors: Laval University; Centre interdisciplinaire de recherche en réadaptation et intégration sociale; Université du Québec à Trois-Rivières
Not yet recruiting
https://ift.tt/2Nl34rY
A Prospective Randomized Trial of Capecitabine Treatment in Patients With HNSCC
Condition: Head and Neck Neoplasms
Intervention: Drug: Capecitabine
Sponsor: Zhejiang Cancer Hospital
Recruiting
https://ift.tt/2DdCz3g
Intervention: Drug: Capecitabine
Sponsor: Zhejiang Cancer Hospital
Recruiting
https://ift.tt/2DdCz3g
Oral Dydrogesterone (OD) Versus Micronized Vaginal Progesterone (MVP) for Luteal Phase Support (LPS) in IVF/ICSI
Conditions: Infertility, Female; Infertility; Genital Diseases, Male; Genital Diseases, Female; Progesterone; Dydrogesterone; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Physiological Effects of Drugs; Progestins
Interventions: Drug: Dydrogesterone Oral Tablet; Drug: Micronized progesterone; Drug: Placebo Dydrogesterone oral tablet; Drug: Placebo Micronized progesterone
Sponsors: CRG UZ Brussel; Universitätsklinikum Hamburg-Eppendorf; Abbott; KU Leuven
Not yet recruiting
https://ift.tt/2NqBdXy
Interventions: Drug: Dydrogesterone Oral Tablet; Drug: Micronized progesterone; Drug: Placebo Dydrogesterone oral tablet; Drug: Placebo Micronized progesterone
Sponsors: CRG UZ Brussel; Universitätsklinikum Hamburg-Eppendorf; Abbott; KU Leuven
Not yet recruiting
https://ift.tt/2NqBdXy
Do demographic disparities exist in the diagnosis and surgical management of otitis media?
The Laryngoscope, EarlyView.
https://ift.tt/2xx6jlq
Electronic medical record–based tools aid in timely triage of disc‐shaped foreign body ingestions
The Laryngoscope, EarlyView.
https://ift.tt/2QJjpVF
Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck
Head &Neck, EarlyView.
https://ift.tt/2PJOhE6
Unusual skin manifestations associated with parvovirus B19 primary infection in children
Pediatric Dermatology, EarlyView.
https://ift.tt/2OBGUyq
Pseudoxanthoma elasticum: Dermoscopy and mutation analysis
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2xwVccc
Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid
Publication date: Available online 18 September 2018
Source: Auris Nasus Larynx
Author(s): Wataru Konno, Takashi Kashiwagi, Yasuhiro Tsunemi, Kazuki Goto, Shinichi Haruna
Abstract
Objective
We employed a steroid-eluting, sinus-bioabsorbable device for local treatment after surgery for eosinophilic chronic rhinosinusitis (ECRS). One year later, we investigated its efficacy in suppressing recurrence and reducing the use of oral steroids.
Methods
At one year after ECRS surgery, both 18 cases treated with a postoperative steroid-eluting, sinus-bioabsorbable device (Post-ST group) and 25 cases receiving conventional postoperative therapy (Post-Con group) showed significant improvement in the nasal symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), CT score and threshold test (discrimination test).
Results
The olfactory dysfunction, CT score and threshold test were significantly improved in the Post-ST group compared with the Post-Con group, but the polyp score was not. The mean total number of oral steroid tablets ingested during one year after surgery was 24.3 ± 2.8 tablets in the Post-ST group, which was significant lower than the 36.3 ± 3.7 tablets used in the Post-Con group.
Conclusion
The above results indicate that insertion of a steroid-eluting, sinus-bioabsorbable device after ECRS surgery can reduce the oral steroid intake while maintaining long-term suppression of disease recurrence.
https://ift.tt/2NZUj66
Sphenoidal sinogenic extradural empyema associated with juvenile myelomonocytic leukemia
Publication date: Available online 18 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): N. Guignard, T. Roujeau, L. Saumet, G. Gascou, M. Mondain, M. Akkari
Abstract
Intracranial empyema is a rare but serious complication of sinusitis in children. Myelodysplastic/myeloproliferative syndromes (MMS), including juvenile myelomonocytic leukemia (JMML), can lead to immunosuppression, thus favouring infections. We report the case of a sphenoid sinogenic retro-clival extradural empyema in a 14-year-old female patient associated with JMML. Treatment consisted in an endonasal transphenoidal drainage of the empyema associated with intravenous antibiotherapy. The patient was thereafter enrolled in chemotherapeutic treatment with Azacitidine. The disease progressed to blast phase, indicating bone marrow graft. This is the first reported case of an endocranial complication of bacterial sinusitis associated with MMS in a child.
https://ift.tt/2OIOZRG
Cephalic De-mucosalized Superiorly-Based Pharyngeal Flap: a Modified Mucosa-Preserving Technique for Velopharyngeal Insufficiency
Publication date: Available online 18 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Sherif M. Askar, Mohammed Waheed El-Anwar, Ahmed S. Elaassar, Amal S. Quriba, Ahmed Anany, Ashraf Elmalt, Ahmed I. Elsayed, Mohammed S. Abd EL-Azeem
Abstract
Introduction
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision.
Aim of the work
To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed.
Methods
This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall.
Results
13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ± 1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission.
Conclusions
The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.
https://ift.tt/2NTvQiR
Schmerzhafte Lymphadenopathie nach Insektenstich – ein Fallbericht
Zusammenfassung
Tularämie ist eine bakterielle Zoonose, die meist durch Zecken- und Insektenstiche oder durch Kontakt mit dem Fleisch infizierter Tiere übertragen wird. Wir berichten über einen 36-jährigen Patienten, der nach einem Insektenstich am Abdomen Fieber, Schüttelfrost, Kopfschmerzen und eine einseitige, schmerzhafte, inguinale Lymphadenopathie mit rötlich-livider Verfärbung der umgebenden Haut entwickelte. Die Diagnose einer ulzeroglandulären Tularämie wurde mittels Polymerasekettenreaktion (PCR) und Serologie gestellt. Es wurde eine 21-tägige Therapie mit Doxycyclin durchgeführt, die zur Abheilung führte.
https://ift.tt/2QCdsK5
A rare cause of unilateral facial rash
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2NVI7U0
Inbreeding of house dust mites, a tool for genomic studies and allergy‐related applications
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xzqq2f
Influence of the amplitude of different side-to-side toothbrushes on noncontact biofilm removal
Abstract
Objectives
To investigate the impact of the lateral deflection of toothbrush bristles (amplitude) of three side-to-side toothbrushes for noncontact biofilm removal in an artificial interdental space model.
Materials and methods
A three-species biofilm (Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus sanguinis) was formed in vitro on protein-coated titanium disks. A flow chamber system was combined with a static biofilm growth model. The amplitudes of three commercial side-to-side toothbrushes were evaluated by means of a dose response analysis. The amplitudes were decreased in steps (100%, 85%, 70%, 55%, and 40%). Subsequently, the biofilm-coated substrates were exposed to the toothbrushes. The biofilms were analyzed with confocal laser scanning microscope images and measured using volumetric analyses.
Results
The predictability of interdental biofilm reduction differed among the toothbrushes. A lower variety in the results of repeated experiments occurred in toothbrush C compared to toothbrushes A and B. Toothbrush C obtained highest percentage of biofilm reduction by 85% of amplitude power setting (median biofilm reduction 76%). Decreasing the amplitude from 85 to 40% resulted in reduced biofilm reduction (p = 0.029). In contrast, no significance could be observed for the differences of the tested amplitudes within toothbrushes A and B (p > 0.05). Between the toothbrushes, a significant difference in interdental biofilm reduction was found between C-A (p = 0.029) and C-B (p = 0.029) with amplitude of 85%.
Conclusions
The amplitude of one of the investigated side-to-side toothbrushes affected the biofilm reduction predictably in an interdental space model.
Clinical relevance
Within certain toothbrushes, a specific amplitude power setting may demonstrate beneficial effects on noncontact biofilm removal.
https://ift.tt/2phALfM
“High-grade oncocytic renal tumor”: morphologic, immunohistochemical, and molecular genetic study of 14 cases
Abstract
The spectrum of the renal oncocytic tumors has been expanded in recent years to include several novel and emerging entities. We describe a cohort of novel, hitherto unrecognized and morphologically distinct high-grade oncocytic tumors (HOT), currently diagnosed as "unclassified" in the WHO classification. We identified 14 HOT by searching multiple institutional archives. Morphologic, immunohistochemical (IHC), molecular genetic, and molecular karyotyping studies were performed to investigate these tumors. The patients included 3 men and 11 women, with age range from 25 to 73 years (median 50, mean 49 years). Tumor size ranged from 1.5 to 7.0 cm in the greatest dimension (median 3, mean 3.4 cm). The tumors were all pT1 stage. Microscopically, they showed nested to solid growth, and focal tubulocystic architecture. The neoplastic cells were uniform with voluminous oncocytic cytoplasm. Prominent intracytoplasmic vacuoles were frequently seen, but no irregular (raisinoid) nuclei or perinuclear halos were present. All tumors demonstrated prominent nucleoli (WHO/ISUP grade 3 equivalent). Nine of 14 cases were positive for CD117 and cytokeratin (CK) 7 was either negative or only focally positive in of 6/14 cases. All tumors were positive for AE1-AE3, CK18, PAX 8, antimitochondrial antigen, and SDHB. Cathepsin K was positive in 13/14 cases and CD10 was positive in 12/13 cases. All cases were negative for TFE3, HMB45, Melan-A. No TFEB and TFE3 genes rearrangement was found in analyzable cases. By array CGH, complete chromosomal losses or gains were not found in any of the cases, and 3/9 cases showed absence of any abnormalities. Chromosomal losses were detected on chromosome 19 (4/9), 3 with losses of the short arm (p) and 1 with losses of both arms (p and q). Loss of chromosome 1 was found in 3/9 cases; gain of 5q was found in 1/9 cases. On molecular karyotyping, 3/3 evaluated cases showed loss of heterozygosity (LOH) on 16p11.2-11.1 and 2/3 cases showed LOH at 7q31.31. Copy number (CN) losses were found at 7q11.21 (3/3), Xp11.21 (3/3), Xp11.22-11.21 (3/3), and Xq24-25 (2/3). CN gains were found at 13q34 (2/3). Ten patients with available follow up information were alive and without disease progression, after a mean follow-up of 28 months (1 to 112 months). HOT is a tumor with unique morphology and its IHC profile appears mostly consistent. HOT should be considered as an emerging renal entity because it does not meet the diagnostic criteria for other recognized eosinophilic renal tumors, such as oncocytoma, chromophobe renal cell carcinoma (RCC), TFE3 and TFEB RCC, SDH-deficient RCC, and eosinophilic solid and cystic RCC.
https://ift.tt/2QIdHTG
Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients.
https://ift.tt/2phzc1o
Disease Burden and Treatment Patterns of Psoriasis in Russia: A Real-World Patient and Dermatologist Survey
Abstract
Introduction
Data regarding disease burden and quality of life (QoL) for patients with psoriasis from Russia are limited. The objective of this study was to describe the demographic and clinical characteristics, comorbidities, and treatment patterns of systemic therapy eligible psoriasis patients in Russia in order to assess the impact of psoriasis on the QoL and work productivity of the patients and to evaluate patient/dermatologist concordance on disease severity, signs/symptoms, and satisfaction with psoriasis treatment.
Methods
Data were collected by the Growth from Knowledge Disease Atlas global real-world evidence programme from nine countries. The data from the Russian population are presented here. Adult patients who had a current or prior history of moderate-to-severe psoriasis and were receiving prescription treatment at the time of the survey were included. Dermatologist-reported data on disease severity, symptoms, comorbidities, and treatment as well as patient-reported data on QoL and work productivity were collected. Descriptive analysis of the data was conducted. Patient/dermatologist concordance was assessed using Cohen's κ.
Results
A total of 300 patients from Russia were included. The mean Psoriasis Area and Severity Index score was 9.0 and the mean disease duration was 9.9 years. The proportion of patients with itch, skin pain, and comorbidities increased as current psoriasis severity increased. The disease had a negative impact on patients' QoL (mean Dermatology Life Quality Index score: 7.1) and work productivity (33.2% drop in work productivity), which further deteriorated as disease severity increased. A large proportion of the enrolled patients (60%) were treated with topical agents only. Overall, the level of concordance between patients and their dermatologists regarding psoriasis severity and satisfaction with overall disease control achieved was low.
Conclusion
Results demonstrate a substantial disease burden on psoriasis patients in Russia, despite receiving treatment for their psoriasis, as well as low patient/dermatologist concordance of views on treatment outcomes. These findings also highlight a need to further incorporate the patient's views into treatment decision-making in Russia.
Funding
Novartis Pharma AG, Basel, Switzerland.
https://ift.tt/2DcxbNB
Acral Melanoma: A Patient’s Experience and Physician’s Commentary
Abstract
This article, co-authored by a patient diagnosed with acral melanoma, discusses the patient's experience of being diagnosed with and treated with surgery for this disease. The physician discusses the epidemiology, genetics, diagnosis, treatment, and prognosis of acral melanoma. Follow-up care plans are also discussed.
https://ift.tt/2QFBvrv
TIGIT: a novel immunotherapy target moving from bench to bedside
Abstract
Treatment strategies for patients with advanced solid tumors have traditionally been based on three different paradigms: surgery, cytotoxics (chemotherapy or radiation therapy) and targeted therapies. Immunotherapy has emerged as a novel treatment paradigm in our armamentarium. Unfortunately, most patients still do not benefit from immunotherapy. These patients often have "cold tumors" characterized by a paucity of effector T cells in the tumor microenvironment, low mutational load, low neoantigen burden and often an immunosuppressive tumor microenvironment. TIGIT is an immunoreceptor inhibitory checkpoint that has been implicated in tumor immunosurveillance. Expression of TIGIT has been demonstrated in both NK cells and T cells and plays a role in their activation and maturation. TIGIT competes with immunoactivator receptor CD226 (DNAM-1) for the same set of ligands: CD155 (PVR or poliovirus receptor) and CD112 (Nectin-2 or PVRL2). TIGIT's role in tumor immunosurveillance is analogous to the PD-1/PD-L1 axis in tumor immunosuppression. Both TIGIT and PD-1 are upregulated in a variety of different cancers. Anti-TIGIT antibodies have demonstrated synergy with anti-PD-1/PD-L1 antibodies in pre-clinical models. Currently, there are multiple first-in-man phase I trials hoping to exploit this new pathway and improve response rates with existing immunotherapies.
https://ift.tt/2QCTPRY
Editorial Board
Publication date: November 2018
Source: Archives of Oral Biology, Volume 95
Author(s):
https://ift.tt/2DayKvs
Editorial Board
Publication date: November 2018
Source: Archives of Oral Biology, Volume 95
Author(s):
https://ift.tt/2DayKvs
Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese
Publication date: Available online 18 September 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Thiago Freire Pinto Bezerra, Aldo Stamm, Wilma Teresinha Anselmo-Lima, Marco Aurélio Fornazieri, Nelson D'Ávila Melo, Leonardo Balsalobre, Geraldo Pereira Jotz, Henrique Zaquia Leão, André Alencar Araripe Nunes, Alexandre Felippu, Antonio Carlos Cedin, Carlos D. Pinheiro-Neto, Diego Lima Oliveira, Eulalia Sakano, Eduardo Macoto Kosugi, Elizabeth Araújo, Fabiana Cardoso Pereira Valera, Fábio de Rezende Pinna, Fabrizio Ricci Romano, Francine Grecco de Melo Pádua
Abstract
Introduction
Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language.
Objective
Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese.
Methods
A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith.
Results
The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized.
Conclusion
We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.
Resumo
Introdução
A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa.
Objetivo
Adaptação transcultural dos termos anatômicos do nariz e cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses".
Método
Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith.
Resultados
Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilagionasa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal","recesso frontal" e "processo uncinado".
Conclusão
Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e cavidades paranasais no Brasil.
https://ift.tt/2MLCz9T
Vascular malformation of the sphenoid and temporal bone: A diagnostic dilemma
Publication date: Available online 18 September 2018
Source: American Journal of Otolaryngology
Author(s): Celeste Z. Nagy, Sarah Cantrell, Xin Wu, C. Arturo Solares
Abstract
We present a rare case of a vascular anomaly of the sphenoid and temporal bones causing an expandable mass of the temporal region with dependent patient positioning and characteristic osseous changes on imaging. Initial diagnosis considerations included multiple myeloma (MM), fibrous dysplasia (FD), Paget's disease, lymphoma, meningoencephalocele (MEC), and vascular malformation (VaM). VaMs of the head and neck are rare and typically arise in the mandible and maxilla. However, this case demonstrates a unique finding of a VaM of the sphenoid and temporal bones with important radiological features to distinguish the diagnosis of vascular anomaly from other etiologies.
https://ift.tt/2MNU6P7
Unfinished Business: Evolution of the MHC and the Adaptive Immune System of Jawed Vertebrates
Annual Review of Immunology, Volume 36, Issue 1, Page 383-409, April 2018.
https://ift.tt/2MK7ELq
IgG4-related disease in the head and neck
Purpose of review To summarize current evidence regarding the pathophysiology, diagnostic criteria, and management of IgG4 disease in the head and neck. Recent findings The anti-CD20 antibody, rituximab is being used increasingly as a primary treatment modality in cases with a definitive diagnosis. Despite the favorable prognosis, it is now recognized that the incidence of cancer development within 3 years of diagnosis is higher than that of the general population. Summary IgG4-related disease is a sclerosing, chronic inflammatory disease, that is benign, and usually occurs in middle-aged to elderly individuals. Definitive diagnosis of IgG4-related disease requires radiological confirmation of enlargement of the affected organ, elevated serum IgG4 levels, and characteristic histopathological findings. Treatment is primarily with systemic corticosteroids or the monoclonal anti-CD20 antibody rituximab, surgical excision, or a combination of treatment modalities. Prognosis is good with complete remission in up to 90% of patients. Correspondence to James Johnston, Department of Surgery, University of Auckland, PO Box 99743, Newmarket, Auckland 1149, New Zealand. Tel: +64 21 1716814; e-mail: jj.johnston@auckland.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2xyEE3p
https://ift.tt/2xyEE3p
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