Genetics of perioperative pain management

Purpose of review The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. Recent findings Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes. Clinical Pharmacogenetics Implementation Consortium has put forth recommendations on CYP2D6 genotype-based opioid selection and dosing. The list of drug–gene pairs studied continue to expand. Summary Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings. Correspondence to Senthilkumar Sadhasivam, MD, MPH, Gopal Krishna Professor and Chief of Anesthesia, Department of Anesthesia, Riley Hospital for Children at Indiana University Health, RH 2835, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA. Tel: +1 317 948 3845; fax: +1 317 944 0282; e-mail: ssadhasivam@iuhealth.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

Pelvic binders are routinely used in the prehospital setting for stabilization of pelvic injuries in patients with trauma. Emergency department trauma management relies on primary and secondary survey assessme...

https://ift.tt/2OIojkc

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Treatment-free survival, which is living without the need for treatment for recurrent cancer, is an important outcome for thyroid cancer patients. The goal of this study was to understand factors associated with treatment-free survival in the general population, because this will enable the care teams to tailor long term follow up to a particular situation, and, many times, help decrease patient worry. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

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Is skip metastases associated with tumor thickness and tumor size in tongue carcinoma patients?

Abstract

Objective

To assess the correlation of skip metastases associated with increase in tumor thickness and size of the tumor.

Material and methods

A retrospective analysis was carried out from August 2009 to August 2015. In this study, a total number of 33 carcinoma tongue patients having T1, T2, and T3 sizes with N0 and N+ clinical necks who were treated by supraomohyoid neck dissection, extended supraomohyoid neck dissection, and modified radical neck dissection were analyzed. The data was assessed using Shapiro-Wilk W test, Nagelkerke R² regression model, mean, and standard deviation.

Results

Metastasis to lymph nodes was present in 75% of patients. Level I and level II were the commonest sites to be involved, i.e., 20 patients. Three patients had skip metastasis out of which two patients had metastasis at level III (6%), and one patient had skip metastasis at level IV (3%).

Conclusion

The incidence of skip metastasis increases with tumor thickness and tumor size in tongue carcinoma patients.

Clinical relevance

The article reveals the positive relationship between tumor thickness, tumor size, and skip metastasis. The analysis shows tumor thickness as a higher predictor for skip metastasis with odds ratio of 5.5 compared to the tumor size having odd ratio 2.

https://ift.tt/2QOyYvk

Surgical management of oral submucous fibrosis using buccal fat pad: a retrospective study of 30 cases

Abstract

The aim of our study was to evaluate the effectiveness of buccal fat pad (BFP) in the management of oral submucous fibrosis (OSMF). Retrospective records of 30 patients of OSMF treated with BFP with atleast a year of follow-up were analyzed. Patients were divided into groups based on the stages of OSMF. Surgical management consisted of resection of fibrous bands, bilateral temporalis myotomy, and coronoidectomy followed by grafting with BFP. There were 17 patients of stage III (mouth opening 16–25 mm) and 13 patients of stage IV OSMF (mouth opening less than 16 mm). The mean mouth opening of stage III group pre-operatively was 19.94 ± 2.19 mm which increased to a mean of 35.12 ± 5.69 mm (p < 0.0001). For patients with stage IV OSMF, the mouth opening increased from a pre-operative of 10.23 ± 4.07 mm to a post-operative of 31.46 ± 6.78 mm (p < 0.0001). No intra-operative complications were noted in any patient. Relapse was seen in 1 patient (5.8%) of stage III while 3 patients (23.07%) had relapse in stage IV group. Our results indicate that BFP is a good flap owing to its benefits which are easy to harvest and entails minimal morbidity for management of OSMF.

https://ift.tt/2xyT8R0

Surgical management of oral submucous fibrosis using buccal fat pad: a retrospective study of 30 cases

Abstract

The aim of our study was to evaluate the effectiveness of buccal fat pad (BFP) in the management of oral submucous fibrosis (OSMF). Retrospective records of 30 patients of OSMF treated with BFP with atleast a year of follow-up were analyzed. Patients were divided into groups based on the stages of OSMF. Surgical management consisted of resection of fibrous bands, bilateral temporalis myotomy, and coronoidectomy followed by grafting with BFP. There were 17 patients of stage III (mouth opening 16–25 mm) and 13 patients of stage IV OSMF (mouth opening less than 16 mm). The mean mouth opening of stage III group pre-operatively was 19.94 ± 2.19 mm which increased to a mean of 35.12 ± 5.69 mm (p < 0.0001). For patients with stage IV OSMF, the mouth opening increased from a pre-operative of 10.23 ± 4.07 mm to a post-operative of 31.46 ± 6.78 mm (p < 0.0001). No intra-operative complications were noted in any patient. Relapse was seen in 1 patient (5.8%) of stage III while 3 patients (23.07%) had relapse in stage IV group. Our results indicate that BFP is a good flap owing to its benefits which are easy to harvest and entails minimal morbidity for management of OSMF.

https://ift.tt/2xyT8R0

Induction of innate immune memory: the role of cellular metabolism

Jorge Domínguez-Andrés | Leo AB Joosten | Mihai G Netea

https://ift.tt/2xEoc1S

Thyroid® High-Impact Articles

FREE ACCESS through October 2, 2018.

Read now:

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

Impact of Hypothyroidism and Heart Failure on Hospitalization Risk
Kevin Ro, Alexander D. Yuen, Lin Du, Clarissa C. Ro, Christian Seger, Michael W. Yeh, Angela M. Leung, and Connie M. Rhee

Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies
Shinje Moon, Min Joo Kim, Jae Myung Yu, Hyung Joon Yoo, and Young Joo Park 

Cardiovascular Morbidity and Mortality After Treatment of Hyperthyroidism with Either Radioactive Iodine or Thyroidectomy
Ryödi Essi, Metso Saara, Huhtala Heini, Välimäki Matti, Auvinen Anssi, and Jaatinen Pia 

Decreasing Disease-Specific Mortality of Differentiated Thyroid Cancer in Korea: A Multicenter Cohort Study
Min Ji Jeon, Hee Kyung Kim, Eun Heui Kim, Eun Sook Kim, Hyon-Seung Yi, Tae Yong Kim, Ho-Cheol Kang, Young Kee Shong, Won Bae Kim, Bo Hyun Kim, and Won Gu Kim  

Incidence and Survival of Thyroid Cancer in Children, Adolescents, and Young Adults in Denmark: A Nationwide Study from 1980 to 2014
Jakob Schmidt Jensen, Christian Grønhøj, Christian Mirian, David Hebbelstrup Jensen, Jeppe Friborg, Christoffer Holst Hahn, Tina Klitmøller Agander, and Thomas Hjuler 

Sonographically Estimated Risks of Malignancy for Thyroid Nodules Computed with Five Standard Classification Systems: Changes over Time and Their Relation to Malignancy
Giorgio Grani, Livia Lamartina, Marco Biffoni, Laura Giacomelli, Marianna Maranghi, Rosa Falcone, Valeria Ramundo, Vito Cantisani, Sebastiano Filetti, and Cosimo Durante 

Sobetirome and its Amide Prodrug Sob-AM2 Exert Thyromimetic Actions in Mct8-Deficient Brain
Soledad Bárez-López, Meredith D. Hartley, Carmen Grijota-Martínez, Thomas S. Scanlan, and Ana Guadaño-Ferraz  

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

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Resorption behaviour of the articular surface dome and functional outcome after open reduction and internal fixation of mandibular condylar head fractures using small-fragment positional screws

The aim of the study was to evaluate the resorption of the mandibular condylar head after open reduction and internal fixation of fractures with small-fragment screws and to evaluate the functional outcome.

https://ift.tt/2xEY0E3

The association with variables of fibular reconstructed mandible and bite force in oral cancer patients with dental implant rehabilitation

The aim of this study was to investigate how the physical variables of fibular reconstructed mandibles with dental implants affects the relative bite force in oral cancer patients.

https://ift.tt/2QSvLuG

Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results

Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndrome explain why treating orbital vascular malformations can be challenging and technically demanding.In this study, two institutions have retrospectively collected their cases, consisting in a total of 69 vascular malformations of the orbit.

https://ift.tt/2xEXVAf

Cleft palate formation after palatal fusion occurs due to the rupture of epithelial basement membranes

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) induces cleft palate and hydronephrosis in the mouse embryo. Cleft palate occurs due to failure in palatal grow, but the underlying mechanisms are unclear. We investigated the mechanisms of cleft palate development in TCDD-exposed mouse embryos. We administered olive oil (control group) or TCDD diluted in olive oil (40 μg/kg) via gastric tubes to pregnant mice on gestational day (GD) 12. Embryos of control and TCDD-exposed groups were removed from pregnant mice on GD 14 and GD 15, respectively.

https://ift.tt/2QKhqjH

Effects of Systemic Erythropoietin Treatment and Heterogeneous Xenograft in Combination on Bone Regeneration of a Critical-Size Defect in an Experimental Model

The aim of the present study was to evaluate the effects of systemic EPO treatment alone or in combination with xenogenic bone graft augmentation on bone regeneration. Eleven adult male Sprague-Dawley rats were used in the present study. Rats were subjected to bilateral 5 mm critical size bone defects on the parietal bones under general anaesthesia. Right parietal bone defects were augmented with xenogenic bone graft and left parietal bone defect was left empty. Rats were randomly assigned for one of the two groups.

https://ift.tt/2xBS8LR

Relapse tendency after BSSO surgery differs between 2D and 3D measurements: a validation study

Bilateral sagittal split ramus osteotomy (BSSO) surgery is used to correct various dento-skeletal deformities. Clinical outcomes are critically dependent on accurate and proper positioning of skeletal units created by BSSO. Monitoring skeletal changes postoperatively is a major part of follow-up. Between January 2015 and December 2015, 24 patients underwent BSSO surgery without any other segmental osteotomy (mean age, 29.9 ± 14.2 [range, 17–67] years; 18 females). Cephalometric X-rays and cone-beam computed tomography scans were performed 6 weeks and 12 months postoperatively.

https://ift.tt/2QHF9RA

Nodular Mass in the Upper Lip

A man presents with a firm, painless, slow-growing mass in his upper lip. What is your diagnosis?

https://ift.tt/2v7nB7v

September 2018 Issue Highlights

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Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity

This laboratory analysis of synthetic femurs investigates the association of anterolateral thigh osteomyocutaneous flap harvest, with and without prophylactic fixation, with femur structural integrity as measured by 4-point bend and torsional biomechanical testing.

https://ift.tt/2vfHBVN

Reversible Auricular Necrosis Secondary to Systemic Thrombosis

This report describes a woman diagnosed with a rare case of concomitant heparin-induced thrombocytopenia and antiphospholipid antibody syndrome that presented with auricular necrosis.

https://ift.tt/2o4vTtG

Dornase Alfa Ototoxic Effects in Animals and Efficacy for Clogged Tympanostomy Tubes in Children

This pilot study investigates the ototoxic effects of dornase alfa in a chinchilla model and its efficacy vs ofloxacin in a randomized clinical trial of children with clogged tympanostomy tubes.

https://ift.tt/2LLE10w

Prevalence and Risk Factors for Olfactory Hallucinations in the United States

Olfactory dysfunction can result in substantial reductions in quality of life if left untreated. The presence of phantom smells, or phantosmia, is a clinically distinct olfactory dysfunction where patients sense odors when no odor source is present. The cause of phantosmia is not completely understood and has been most commonly associated with head trauma, psychiatric conditions, chronic rhinosinusitis, epilepsy, and a number of neurologic and neurodegenerative disorders.

https://ift.tt/2BiN18s

Effect of Nitrous Oxide as a Treatment for Subjective, Idiopathic, Nonpulsatile Bothersome Tinnitus

This randomized clinical trial investigates whether inhaled nitrous oxide and oxygen vs inhaled nitrogen and oxygen can reduce bothersome tinnitus among adults with subjective, idiopathic, nonpulsatile tinnitus of 6 months' duration or longer.

https://ift.tt/2O3f1OY

Physician Adherence to Guidelines for Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings

This cohort study uses data from the National Ambulatory Medical Care Survey to evaluate the prevalence of patient visits to ambulatory care clinics for benign paroxysmal positional vertigo and whether physicians' diagnostic and treatment recommendations adhered to clinical practice guidelines over time.

https://ift.tt/2MuqKZD

Association of Cytologically Indeterminate Thyroid Nodule Size With Histologic and Clinical Outcomes

This study assesses the association of indeterminate thyroid nodule size among adults with histologic and clinical outcomes such as cancer rates and response to therapy in considering a surgical approach.

https://ift.tt/2LtulqI

Errors in Figure 2 and Figure 3

In the Original Investigation titled "Effect of Nitrous Oxide as a Treatment for Subjective, Idiopathic, Nonpulsatile Bothersome Tinnitus: A Randomized Clinical Trial," published online August 2, 2018, there was an error the x-axis label and caption of Figure 2 and the key in Figure 3. In the x-axis, the labels read "Nitrous Oxide First" and "Placebo First." They should have been "Nitrous Oxide" and "Placebo." The caption included expansions of GBS and PI, which should not have been included. In Figure 3, the key indicates 'Nitrous oxide first" and "Placebo first." The key should have been "Nitrous oxide" and "Placebo." This article was corrected online.

https://ift.tt/2PPz04D

Safety of Drilling 3-Dimensional–Printed Temporal Bones

This occupational safety assessment evaluates a surgeon's exposure to volatile organic compounds when drilling 3 commonly used materials in 3-dimensional–printed temporal bone implants using a standard Office of Safety and Health Administration protocol.

https://ift.tt/2o23Eff

Revisiting the 2015 American Thyroid Association Guidelines in the NIFTP Era

The incidence of thyroid cancer and subsequent thyroid surgery has increased significantly during the past decade in the United States. Mortality rates have remained unchanged, supporting the widely accepted hypothesis that this finding can, in part, be explained by increased detection of small, nonaggressive nodules, resulting in potential overdiagnosis and treatment.

https://ift.tt/2LtutGI

Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States

This cross-sectional study examines the presence and activity of otolaryngology residency programs on social media sites.

https://ift.tt/2BDQDlS

Bilateral Painless Cervical Lymphadenopathy in a Child

A child younger than 10 years presented with an 8-week history of bilateral cervical lymphadenopathy unresponsive to a 10-day course of drug treatment and no relevant medical history. What is your diagnosis?

https://ift.tt/2uOrwG1

Factors Associated With Phantom Odor Perception Among US Adults

This cross-sectional study of data from the National Health and Nutrition Examination Survey examines the prevalence of phantom odor perception among US adults and evaluates differences by age, sex, socioeconomic position, health status, health behaviors, smell function, and oral and sinonasal symptoms.

https://ift.tt/2MAub0W

Management of Hoarseness

This guideline summary presents American Academy of Otolaryngology–Head and Neck Surgery recommendations for assessing and treating patients with hoarseness (dysphonia).

https://ift.tt/2Ln04ul

Preoperative Tranexamic Acid for Rhinoplasty

This systematic review and meta-analysis of randomized clinical trials evaluates the preoperative use of tranexamic acid for reduction of bleeding, eyelid edema, and periorbital ecchymosis in patients undergoing rhinoplasty.

https://ift.tt/2vvLuXo

Cocaine-Induced Midline Destructive Lesions and Erosion of the Eustachian Tube

This case report describes a 43-year-old woman with eustachian tube erosion associated with cocaine use.

https://ift.tt/2MxcTih

Artificial Saliva vs Saline Solution and Suture Degradation in Oropharyngeal Surgery

This in vitro study examines artificial saliva vs saline solution and their association with the strength of common types of absorbable sutures used in oral surgery.

https://ift.tt/2MuaMis

Pleomorphic Adenoma of the Nasolacrimal Duct

This study describes the case of a man in his 60s with a 2-year medical history of right epiphora with recent 6-week onset of hemolacrima who presented with an incidental soft tissue lesion along the left inferior turbinate with associated nasolacrimal duct dilatation above the mass.

https://ift.tt/2LtQRAA

Device Safety

Medical devices are essential in the diagnosis and treatment of otolaryngologic disease. The US Food and Drug Administration (FDA) is tasked with assuring the safety and effectiveness of these devices. Otolaryngologists, in turn, are often responsible for helping patients understand risks, benefits, and alternatives when deciding whether to rely on devices in their care. To best counsel patients, otolaryngologists should be aware of the strengths and limitations of device regulation by the FDA. This article reviews the FDA regulatory framework for medical devices, premarket evidentiary standards for marketing devices, and postmarket methods of safety surveillance.

https://ift.tt/2xtaLCC

Systems Science

In the 21st century, most medical care is not delivered by a single physician but rather, by a team. A team is a type of system, a set of people and things interacting together for a defined aim. The discipline of systems science concerns itself with how complex teams or organizations function. The application of systems science has had a major positive impact on safety and quality in such diverse disciplines as auto manufacturing, airline safety, and nuclear power generation. A modest understanding of how systems science applies to medical care can help improve safety and quality of care.

https://ift.tt/2PR8qs0

The Impact of Cognitive and Implicit Bias on Patient Safety and Quality

Humans use cognitive shortcuts, or heuristics, to quickly assess and respond to situations and data. When applied inappropriately, heuristics have the potential to redirect analysis of available information in consistent ways, creating systematic biases resulting in decision errors. Heuristics have greater effect in high-pressure, high-stakes decisions, particularly when dealing with incomplete information, in other words, daily medical and surgical practice. This article discusses 2 major categories: cognitive biases, which affect how we perceive and interpret clinical data; and implicit biases, which affect how we perceive and respond to other individuals, and also discusses approaches to recognize and alleviate bias effects.

https://ift.tt/2xv5nih

A Critical Need: Increasing Interest in the Field of Allergy and Immunology in Medical Students and Residents

It is vital for any field in medicine to attract the best and brightest learners to ensure that the specialty continues to provide outstanding clinical care and cutting-edge research. This is especially true for the field of Allergy and Immunology (AI) as graduates of AI training programs have a very large depth and breadth of environments in which to practice, from private practice to faculty at a large tertiary care medical center to working in industry, integrated healthcare organizations, or for the government.

https://ift.tt/2xEWamD

Omalizumab as single-dose therapy for vernal keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a bilateral inflammatory ocular condition often brought on by an allergic response. Patients with VKC commonly exhibit ocular symptoms such as photophobia, redness of the eyes, itching, discharge, and lacrimation, which can have profound effects on quality of life. The pathogenesis of the disease is both immunoglobulin E (IgE) and non-IgE mediated, invoking several hypersensitivity mechanisms. The treatment for VKC is mainly centered on symptom control with the use of antihistamines, calcineurin inhibitors, and corticosteroids.

https://ift.tt/2O1iMYI

Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 119-131, September 2018.


https://ift.tt/2PQFL6o

Diagnostic Approach to Chronic Eosinophilic Pneumonia in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 184-185, September 2018.


https://ift.tt/2xrMtc1

Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 199-203, September 2018.


https://ift.tt/2PP9Y5J

Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 180-183, September 2018.


https://ift.tt/2xsIWtX

Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 158-165, September 2018.


https://ift.tt/2PTBVt3

Minocycline-Induced Eosinophilic Pneumonia in a Pediatric Patient

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 194-198, September 2018.


https://ift.tt/2xtLfNo

Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 119-131, September 2018.


https://ift.tt/2NoGIG2

Diagnostic Approach to Chronic Eosinophilic Pneumonia in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 184-185, September 2018.


https://ift.tt/2DiqGZL

Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 180-183, September 2018.


https://ift.tt/2DeFMzi

Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 199-203, September 2018.


https://ift.tt/2NoGGxU

Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 158-165, September 2018.


https://ift.tt/2Nuq8Vc

Minocycline-Induced Eosinophilic Pneumonia in a Pediatric Patient

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 194-198, September 2018.


https://ift.tt/2DhdULa

JESREC score and mucosal eosinophilia can predict endotypes of chronic rhinosinusitis with nasal polyps

Publication date: Available online 19 September 2018

Source: Auris Nasus Larynx

Author(s): Tsuguhisa Nakayama, Naoki Sugimoto, Naoko Okada, Tadao Tsurumoto, Ryoto Mitsuyoshi, Shinya Takaishi, Daiya Asaka, Hiromi Kojima, Mamoru Yoshikawa, Yasuhiro Tanaka, Shin-ichi Haruna

Abstract

Objective

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.

Methods

A cross-sectional study involving 71 consecutive patients with CRS with nasal polyps (CRSwNP) and 13 control patients was performed. Nasal polyp tissues from CRSwNP patients and uncinate process tissues from control patients were collected for analysis of inflammatory cells by immunohistochemistry and measurement of cytokines and chemokines by ELISA and quantitative real-time PCR. We compared the differences between subtypes according to JESREC score and mucosal eosinophil count and investigated the subgroups with different endotypes by cluster analysis and principal component analysis.

Results

In the 71 CRSwNP patients, 9 patients had JESREC score <11 and mucosal eosinophil count <70/HPF (Group A), 20 patients had JESREC score ≥11 and mucosal eosinophil count <70/HPF (Group C), and 42 patients had JESREC score ≥11 and mucosal eosinophil count ≥70/high-power field (HPF) (Group D). Semiquantitative analysis of inflammatory cells showed that eosinophils, neutrophils, macrophages, mast cells, and basophils differed significantly between the subgroups. At the mRNA level, CLC, IL5, IL13, CCL11, CCL24, CCL26, POSTN, CSF3, and IL8 showed significant differences. At the protein level, eotaxin-2/CCL24, eotaxin-3/CCL26, and G-CSF had significant differences. Cluster analysis using gene expression levels in 55 CRS patients and 11 control patients revealed that the patients could be classified into five clusters. Cluster 1 (n = 27) contained all patients with Group D. Cluster 2 (n = 11) comprised all control patients. Cluster 3 (n = 4) included mixed subtypes: one with Group A and three with Group D. Cluster 4 (n = 7) and Cluster 5 (n = 17) contained all patients with Groups A and C, respectively. Furthermore, the principal component analysis revealed that the subtypes had different characteristics.

Conclusion

CRS subtypes based on JESREC score and mucosal eosinophil count showed different inflammatory patterns, and unsupervised statistical analyses supported the classification that can predict endotypes. From these results, we concluded that the classification based on JESREC score and mucosal eosinophil count was useful for predicting CRS endotypes.

https://ift.tt/2Dja9F7

The Masked ABR (mABR): a New Measurement Method for the Auditory Brainstem Response

Abstract

The auditory brainstem response (ABR) is relatively non-invasive, and in many species, the only practical way to assess auditory sensitivity. The two main methods for measuring ABR are using either transients or tone bursts as a stimulus. The transient stimulus produces strong neural responses that contain no frequency information. In contrast, tone bursts stimulate only a small part of the auditory system, eliciting weaker neural responses but supplying frequency information. Furthermore, short tone bursts become less and less frequency specific with increasing stimulus wavelength, making them unsuitable for testing low-frequency hearing. Here, we develop a method that can measure sensitivity to both low and high-frequency stimuli. The method is based on masking of a transient response by long-duration sinusoids. The measurement system is developed as a highly portable system that runs on battery power. It has been used in a variety of animals in our lab and in the field, including squid (Mooney et al. in J Exp Biol 213: 3748–3759, 2010), lungfish (Christensen-Dalsgaard et al. in J Neurophys 105: 1992–2004, 2011b), alligators (Bierman et al. in J Exp Biol 217: 1094–1107, 2014), and mink (Brandt et al. in J Exp Biol 216: 3542–3550, 2013). Here, we present data recorded from Tokay geckos and compare the results with tone burst ABR measurements. This method produces results comparable to tone burst stimulations at higher frequencies (above 1 kHz) but has several advantages: it is relatively insensitive to fluctuations in neural signal level, it allows measurements at very low frequencies, it allows constant monitoring of the state of the animal, and can be used to measure directional hearing.

https://ift.tt/2NWjeaR

Editorial Board

Publication date: October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 5

Author(s):

https://ift.tt/2xA9Ort

Contents

Publication date: October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 5

Author(s):

https://ift.tt/2QMHlHG

The Masked ABR (mABR): a New Measurement Method for the Auditory Brainstem Response

Abstract

The auditory brainstem response (ABR) is relatively non-invasive, and in many species, the only practical way to assess auditory sensitivity. The two main methods for measuring ABR are using either transients or tone bursts as a stimulus. The transient stimulus produces strong neural responses that contain no frequency information. In contrast, tone bursts stimulate only a small part of the auditory system, eliciting weaker neural responses but supplying frequency information. Furthermore, short tone bursts become less and less frequency specific with increasing stimulus wavelength, making them unsuitable for testing low-frequency hearing. Here, we develop a method that can measure sensitivity to both low and high-frequency stimuli. The method is based on masking of a transient response by long-duration sinusoids. The measurement system is developed as a highly portable system that runs on battery power. It has been used in a variety of animals in our lab and in the field, including squid (Mooney et al. in J Exp Biol 213: 3748–3759, 2010), lungfish (Christensen-Dalsgaard et al. in J Neurophys 105: 1992–2004, 2011b), alligators (Bierman et al. in J Exp Biol 217: 1094–1107, 2014), and mink (Brandt et al. in J Exp Biol 216: 3542–3550, 2013). Here, we present data recorded from Tokay geckos and compare the results with tone burst ABR measurements. This method produces results comparable to tone burst stimulations at higher frequencies (above 1 kHz) but has several advantages: it is relatively insensitive to fluctuations in neural signal level, it allows measurements at very low frequencies, it allows constant monitoring of the state of the animal, and can be used to measure directional hearing.

https://ift.tt/2NWjeaR

Outcomes of Open vs Endoscopic Skull Base Surgery in Older Patients

This cohort study compares outcomes of endoscopic and open skull base surgery to investigate associations between surgical approaches, patient age, disease process, and intraoperative and postoperative complications among patients 70 years or older.

https://ift.tt/2QNgUlg

Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Oropharyngeal Squamous Cell Carcinoma

This cohort study examines the differences in overall survival and toxic effects in patients with oropharyngeal squamous cell carcinoma treated with radiotherapy vs primary surgery.

https://ift.tt/2xBDt3w

Three-Dimensional Printing Technology for Patients With Nasal Septal Deformities

This multicenter study examines the clinical application of a 3-D printed biomaterial implant in septoplasty for patients with caudal septal deviations.

https://ift.tt/2QNgHhY

An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy

A farmer in his 50s had bilateral periauricular swelling with no fever, weight loss, or loss of appetite. What is your diagnosis?

https://ift.tt/2xxoXti

Immune response mediated by Th1 / IL-17 / caspase-9 promotes evolution of periodontal disease

Publication date: Available online 19 September 2018

Source: Archives of Oral Biology

Author(s): M.E.L. Sommer, R.A. Dalia, A.V.B. Nogueira, J.A. Cirelli, M.A.R. Vinolo, J.L. Fachi, C.A. Oliveira, T.A.M. Andrade, F.A.S. Mendonça, M. Santamaria, M. Felonato

Abstract

Introduction

Periodontitis is characterized by inflammatory mediators beyond T lymphocyte function and phenotype (Th1/Th2/Th17). The clinical diversity in periodontitis makes it difficult to characterize the immune response in patients. This study evaluated the profile of the adaptive immune response in the periodontal disease model.

Methods

72 rats (Wistar) were divided into a control group (CTL/day 0) and periodontitis (PD15/15 days and PD60/60 days). In the PD15 and PD60 groups, periodontal disease was induced by ligature with a silk thread placed in the cervical region of the upper first molar. After euthanasia, the periodontal tissue was analyzed by flow cytometry (CD4, CD8, CD25, CD44), semi-quantitative RT-PCR (T-bet, GATA-3, RORγt), semi-quantitative RT-PCR and ELISA IFN-γ, TNF-α, IFN-γ, IL-4, IL-6, IL-10, IL-17) and by Western blotting (Caspase-9, PCNA).

Results

The number of CD4⁺CD25⁺, CD4⁺CD44⁺, CD8⁺CD25⁺ and CD8⁺CD44⁺ cells and expression levels of T-bet and GATA-3 are increased in the PD60 group compared to PD15 and CTL. The RORγ-t gene transcript increased in the PD15 group in relation to PD60 and CTL. The cytokines IFN-γ, TNF-α and IL-17 increased in the PD60 group in relation to PD15. The expression of Caspase-9 was higher in the PD60 group than in PD15.

Conclusions

The results suggest that the evolution of gingivitis to periodontitis is related to the accumulation of activated Th1 cells (IFN-γ and TNF-α) associated with the presence of increased IL-17. Studies with inhibitors of these cytokines in periodontal disease may lead to therapy directed at blocking the inflammatory process in this pathology, interrupting bone loss.

https://ift.tt/2MNPEzD

Immune response mediated by Th1 / IL-17 / caspase-9 promotes evolution of periodontal disease

Publication date: Available online 19 September 2018

Source: Archives of Oral Biology

Author(s): M.E.L. Sommer, R.A. Dalia, A.V.B. Nogueira, J.A. Cirelli, M.A.R. Vinolo, J.L. Fachi, C.A. Oliveira, T.A.M. Andrade, F.A.S. Mendonça, M. Santamaria, M. Felonato

Abstract

Introduction

Periodontitis is characterized by inflammatory mediators beyond T lymphocyte function and phenotype (Th1/Th2/Th17). The clinical diversity in periodontitis makes it difficult to characterize the immune response in patients. This study evaluated the profile of the adaptive immune response in the periodontal disease model.

Methods

72 rats (Wistar) were divided into a control group (CTL/day 0) and periodontitis (PD15/15 days and PD60/60 days). In the PD15 and PD60 groups, periodontal disease was induced by ligature with a silk thread placed in the cervical region of the upper first molar. After euthanasia, the periodontal tissue was analyzed by flow cytometry (CD4, CD8, CD25, CD44), semi-quantitative RT-PCR (T-bet, GATA-3, RORγt), semi-quantitative RT-PCR and ELISA IFN-γ, TNF-α, IFN-γ, IL-4, IL-6, IL-10, IL-17) and by Western blotting (Caspase-9, PCNA).

Results

The number of CD4⁺CD25⁺, CD4⁺CD44⁺, CD8⁺CD25⁺ and CD8⁺CD44⁺ cells and expression levels of T-bet and GATA-3 are increased in the PD60 group compared to PD15 and CTL. The RORγ-t gene transcript increased in the PD15 group in relation to PD60 and CTL. The cytokines IFN-γ, TNF-α and IL-17 increased in the PD60 group in relation to PD15. The expression of Caspase-9 was higher in the PD60 group than in PD15.

Conclusions

The results suggest that the evolution of gingivitis to periodontitis is related to the accumulation of activated Th1 cells (IFN-γ and TNF-α) associated with the presence of increased IL-17. Studies with inhibitors of these cytokines in periodontal disease may lead to therapy directed at blocking the inflammatory process in this pathology, interrupting bone loss.

https://ift.tt/2MNPEzD

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2OMaYXW

Effectiveness of preanesthetic administration of gabapentin on sedative action during intravenous sedation with propofol

Abstract

Purpose

There are no sufficient evidences for the sedative effect of gabapentin during anesthesia, especially intravenous sedation (IVS). The purpose of this study was to evaluate the sedative effect of gabapentin as preanesthetic medication during the IVS with propofol.

Methods

10 volunteer subjects joined this study. They underwent propofol IVS three times on separate days. On the first day, the IVS without gabapentin was performed as a control. On the second and the third day, gabapentin 200 mg and 400 mg were administered before the IVS, respectively. The target blood concentration (C_T) of propofol was gradually increased, and the bispectral index (BIS) value and Ramsay sedation score (RSS) were evaluated at each propofol C_T. Postanesthetic complications and influences on vital signs were also evaluated.

Results

Compared to the control group, the propofol C_Ts in the gabapentin 400 mg group significantly reduced at the BIS values of 60 and 70 (p = 0.031 and p = 0.043, respectively), and at RSS 3, 4, 5 and 6 (p = 0.040, p = 0.004, p = 0.001 and p = 0.004, respectively). There was no significant difference in propofol C_Ts between the control group and the gabapentin 200 mg group. There were no abnormality and no deterioration in circulation and respiration in all groups. There were no significant increases in complications with the administration of gabapentin.

Conclusion

The oral administration of 400 mg dose of gabapentin reduced the propofol C_Ts for achieving an adequate sedation level on IVS.

https://ift.tt/2OzSTfD

Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis

Abstract

Objectives

The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths.

Materials and methods

Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0.

Results

After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63).

Conclusions

Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.

Clinical relevance

Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.

https://ift.tt/2DesL8V

Longevity, effectiveness, safety, and impact on quality of life of low-concentration hydrogen peroxides in-office bleaching: a randomized clinical trial

Abstract

Objective

The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides.

Materials and methods

Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p < 0.05).

Results

The group HP15% presented significant color change (ΔE) from T1 to T4 (p = 0.002) and T1 to T5 (p < 0.001). Parameters L, a*, and b* differed significantly at T3, T4, and T5 compared T1 for both groups. At 6-month follow-up, 57.1% of HP6 and 43.7% of HP15% participants migrated from B1 to a darker color. No significant differences were observed between the groups in tooth sensitivity, gingival irritation, or impact on quality of life.

Conclusions

Both agents showed bleaching effectiveness, but HP15% presented greater color stability than HP6%, at 6-month follow-up. The agents showed low levels of tooth sensitivity, gingival irritation, and did not affect the oral health-related quality of life of the participants.

Clinical relevance

Despite the greater presence of sensitivity during treatment compared with 6% hydrogen peroxide, 15% hydrogen peroxide demonstrated better bleaching effectiveness, and greater color stability at the end of bleaching and at 6-month follow-up. The use of 15% hydrogen peroxide presents more suitable results.

https://ift.tt/2NoCM8c

Does Preemptive administration of IV ibuprofen (Caldolor®) IV acetaminophen (Ofirmev®) reduce postoperative pain and subsequent narcotic consumption following third molar surgery?

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Archana Viswanath, Daniel Oreadi, Matthew Finkelman, Gustavo Klein, Maria Papageorge

Purpose

Preemptive analgesia is known to reduce postoperative pain following third molar removal. The purpose of this study was to compare postoperative pain in subjects receiving either preoperative IV ibuprofen or IV acetaminophen for third molar surgery.

Methods

This study was a randomized single blinded clinical study conducted in subjects undergoing surgical extraction of two or more impacted third molars under deep sedation. This study compared two interventions 800 mg Caldolor (IV ibuprofen) and 1000 mg Ofirmev (IV acetaminophen). The primary outcome variable was postoperative pain measured at different time points on the visual analog scale (VAS). The secondary outcome variable was amount of postoperative analgesic (narcotic and over the counter) medications taken in both the groups. Mann-Whitney U test were used to compare groups, outcomes Chi-square test was used to assess associations between nominal variables, and the Spearman correlation was used to assess associations between continuous variables. Significance was set at P < .05

Results

The study sample consisted of 58 (female 39 male 19) subjects. Forty-one subjects (IV ibuprofen n=19, IV acetaminophen n=22) completed the study. There was equal distribution of age, gender, number of impacted teeth between the groups. At 4 hours postoperative period pain levels in the ibuprofen group was significantly lower than acetaminophen group (p=0.004). This trend continued at 24 hours (p=0.019), 48 hours (p=0.017).The average amount of narcotic medications taken in the ibuprofen (2.68±2.26) group was lower than the acetaminophen (7.32±6.68) group and the results were statistically significant (p=0.005).

Conclusions

Preemptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.

https://ift.tt/2xybLpd

Evaluation of postoperative mandibular positional changes after mandibular setback surgery in a surgery-first approach: Isolated mandibular surgery versus bimaxillary surgery

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jeong Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook

ABSTRACT

Purpose

The aim of this study was to compare postoperative positional changes in the mandible after isolated mandibular surgery (IMS) or bimaxillary surgery (BMS) in a surgery-first approach (SFA).

Materials and Methods

The investigators designed and implemented a retrospective cohort study composed of patients who underwent mandibular setback surgery using the SFA. Surgical and postoperative changes were evaluated using lateral cephalograms taken 1 month before surgery (T0), 1 week after surgery (T1), and immediately after the debonding of orthodontic appliances (T2, 16.6 ± 8.7 months after surgery). To predict postoperative mandibular positional changes due to the increase in vertical dimension (VD) in surgical occlusion, the mandible was rotated counterclockwise to the preoperative VD on the lateral cephalogram at T1, and resultant mandibular positional changes were measured. To evaluate actual postoperative mandibular positional changes between each time point and compare them between the two groups, an independent t test, a paired t test, and repeated measures analysis of variance were performed.

Results

Thirty patients were evaluated (16 in the IMS group and 14 in the BMS group). Both groups showed significant time-course mandibular positional changes from T0 to T1 and from T1 to T2 within each group (point B, P < 0.001), although no statistically significant differences were observed between the groups. There was no statistically significant difference between groups in the predicted and actual postoperative rotational movements. In addition to the mandibular forward movement that resulted from the postoperative mandibular counterclockwise rotation, additional horizontal relapse occurred.

Conclusion

The present findings suggest that the mandible exhibits significant postoperative forward movement during the postoperative orthodontic treatment, regardless of the extent of the orthognathic surgery in the SFA, and it is necessary to consider mandibular forward movement due to the VD increase in surgical occlusion and additional relapse during the treatment planning stage.

https://ift.tt/2PU1OJn

Dysphagia Requiring Nasogastric Feeding Following Orthognathic Surgery: An Unusual Complication, Case Report ,Literature Review and Recommendations

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bryant A. Salmon, Ali Dawlatly, Joseph E. Van Sickels

https://ift.tt/2xsq7qT

Updated review of traumatic dislocation of the mandibular condyle into the middle cranial fossa

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): João Luiz Gomes Carneiro Monteiro, José Alcides Almeida de Arruda, Amanda Regina Silva de Melo, Ricardo Jorge Vasconcelos Barbosa, Suzana Célia de Aguiar Soares Carneiro, Belmiro Cavalcante do Egito Vasconcelos

Abstract

Purpose

Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event following maxillofacial trauma. Treatment may be a closed or open reduction (with or without craniotomy) and arthroplasty procedures might be necessary for long-standing cases. The aim of the present study was to perform an integrative review of traumatic DMCCF cases reported in an electronic database, and to report a case in which cerebrospinal fluid (CSF) leakage occurred after open treatment.

Patients and Methods

The study was carried out in two phases. In the first part, an electronic search was undertaken in Medline (via PubMed) in April/2018, with 52 articles being included. In the second, we report a case in which CSF leakage occurred trough the external auditory canal following open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months.

Results

A total of 59 cases were included. Most patients were females (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. A closed treatment was ideally performed within 2 weeks of intrusion. An open treatment was required for cases with ≥2 weeks of impaction. Types of open treatment were: open reduction, condylectomy, condylotomy or temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications include persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus.

Conclusion

Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurological surgeons. Close monitoring is extremely important to mitigate complications.

https://ift.tt/2PU1FWl

Does Open Rhinoplasty Alter Voice Quality?

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Majid Nemati, Arash Tahmasebi, Hassan Mohajerani, Reza Tabrizi

Abstract

Purpose

Voice change may happen after upper airway manipulation. The current study aimed to evaluate voice change after open rhinoplasty.

Materials and Methods

The current cross sectional study was conducted on subjects undergoing open rhinoplasty. Three acoustic parameters (frequency, bandwidth, and amplitude) were evaluated before open rhinoplasty, three, seven, and ten months after the operation. Subjects' sounds in pronouncing M/N/A were examined. The acoustic factors were measured in the first and second nasal murmurs. Time is a predictive factor and multiple acoustic parameters were the outcome of the study.

Results

Twenty-five subjects were studied. Amplitude and bandwidth decreased for the vowel A after rhinoplasty. However, frequency increased for pronouncing A. In constants, M and N, amplitude decreased after rhinoplasty. Unlike vowels, bandwidth increased in consonants. As vowels, frequency increased in consonants.

Conclusion

It seems that open rhinoplasty affects voice quality. Open rhinoplasty altered frequency, amplitude, and bandwidth of vowels and consonants during 10 months.

https://ift.tt/2xpSBBK

Reconstruction of full thickness lower lid defects using Texier’s procedure: retrospective assessment of the indications

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarra Cristofari, Kessara Rem, Marc Revol, Michael Atlan, Alessio Stivala

Abstract

Purpose

Lower-lid defects involving more than 75% of lid's length or attaining the cheek are usually reconstructed by a Mustardé rotational cheek flap. This solution often induces a postoperative ectropion. Texier's procedure (upper lid myocutaneous flap and a chondro-mucosal alar graft) is usually indicated for one-step reconstruction of less than 50% long full thickness defects of the lower lid. This retrospective study aimed to evaluate larger indications of Texier's procedure for full thickness defects of the lower lid, and the results on defects longer than 50% or even 75% of the length of the lid, in combination with a chondromucosal nasal septal graft for over 75% length-defects.

Materials and Methods

All lower lid reconstructions using Texier's procedure over a period of 29 months were retrospectively included. Data regarding post-operative complications, and patients' satisfaction were collected.

Results

Fifteen patients were included, of which one third had a 50% or less defect of the lower lid, one third presented with a defect from 50 to 75%, and one third had a defect of 75% or more. In this last group, reconstruction included a septal graft. The mean follow-up was 35 months. Transitory palpebral edema was present in 100% of patients, and lasted 8 months on average. No postoperative ectropion, nor nasal alar retraction on the graft donor site were observed. Mean satisfaction score was 2,86/3.

Conclusions

Texier's procedure can be used at first-line to reconstruct most full thickness defects of the lower lid, including subtotal lid-length defects.

https://ift.tt/2PNXnjd

Intratumoral heterogeneity in recurrent metastatic squamous cell carcinoma of the oral cavity: New perspectives afforded by multiregion DNA sequencing and mtDNA analysis

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Andrea Gabusi, Davide Bartolomeo Gissi, Achille Tarsitano, Sofia Asioli, Claudio Marchetti, Lucio Montebugnoli, Maria Pia Foschini, Luca Morandi

Abstract

Purpose

Improvements in sequencing technologies have revealed that genetic differences among neoplastic cells may reflect clonal expansion. Intratumor heterogeneity (ITH) has been suggested to explain differences in prognosis and treatment response, indicating that personalized medicine is the goal of the future. Here, we evaluated ITH in five patients with recurrent metastatic oral squamous cell carcinoma (OSCC) and tracked the evolution from non-neoplastic tissue to neoplastic events developing after primary tumor formation.

Patients and Methods

Representative regions were macrodissected from specimens obtained from patients with OSCC of the tongue (n=4) and mouth floor (n=1). ITH and tumor evolution were explored by analyzing DNA mutations revealed by next-generation sequencing of specific driver genes combined with changes in the mtDNA D-loop hypervariable region. Phylogenetic trees were generated employing MAFFT tool with UPGMA/Jukes-Cantor serving as the substitute model.

Results

High levels of heterogeneity were observed within and among tumors. ITH emerged as metastatic/recurrent events progressed, but the evolutionary patterns differed. In some patients, specific subclones persisted during tumor relapse. Neighboring tissue was also heterogeneous at the pre-malignant level.

Conclusions

A multiregion approach yielded more representative data than did single samples when tumors were subjected to molecular investigation. Persistent mutations that might be targeted by individualized medicine were thus unveiled. mtDNA is a useful adjunct tool when studying the phylogenetic evolution of subclones. The clinical implications of "field" heterogeneity should be studied in depth.

https://ift.tt/2xpSu9i

Leptin levels in the synovial fluid of patients with temporomandibular disorders

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Haofei Xiong, Wei Li, Jin Ke, Wei Fang, Bo Li, Lili Wei

Purpose

This study was conducted to measure the concentrations of leptin and IL-6 in the synovial fluid (SF) of 38 patients with temporomandibular disorders (TMD) and 7 healthy controls, and analyze the correlation between leptin and IL-6.

Patients and Methods

Patients with TMD were divided into three subgroups according to imaging and clinical findings: displaced disc with reduction (DDR, n=12), displaced disc without reduction (DDNR, n=13), and osteoarthritis (OA, n=13). SF samples were collected, and leptin and IL-6 levels were measured by ELISA.

Results

No significant difference in leptin level was found between the control group and the DDR or DDNR group, whereas the OA group presented a higher leptin concentration than all other groups. IL-6 concentrations were significantly higher in all patient groups than in the control group. The levels were significantly higher in the OA group than in the DDR or DDNR group, but no significant differences were found between the DDR and DDNR groups. No significant correlation was found between the leptin and IL-6 concentrations.

Conclusion

Distinct changes in leptin and IL-6 concentrations in the SF occurred at the different stages of TMD, suggesting their potential implication in the pathogenesis of TMD.

https://ift.tt/2PRjkxD

Takotsubo Syndrome Following Surgical And Non-Surgical Oral And Maxillofacial Events: Review Of Published Cases

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): John K. Brooks, Gary Warburton, Brian C. Clark

Abstract

Purpose

Takotsubo syndrome (TS) is an acute and potentially serious cardiac disorder and often attributed to an exuberant catecholaminergic response to a severely physical or emotional event. There is a paucity of information in the dental literature on TS, therefore, this article will provide an overview of this uncommon syndrome, including clinical presentation, demographics, etiopathogenesis, diagnosis, management, and recovery, particularly emphasizing its occurrence with oral and maxillofacial procedures.

Methods

A PubMed search with the keyword takotsubo, published from 1991 through May 2018, yielded 3,778 articles. Cases reports and case series of TS associated with surgical and nonsurgical procedures of the oral and maxillofacial region were reviewed. Other cases were identified using a defined search strategy.

Results

The literature search identified 28 documented episodes of TS that occurred with head and neck surgeries, mostly sinus, carotid, nasal, cancer reconstruction surgeries, and, notably, 3 cases were concurrent with dental extractions. All of the featured patients developed some degree of cardiovascular impairment and demonstrated phenotypic overlap with acute occlusive coronary disease. The majority of patients recovered within 2 weeks and the remainder extended up to 3 months.

Conclusion

On rare occasions, TS has been reported in association with oral and maxillofacial procedures. As stress appears to be a precipitating factor in the development of TS, perioperative efforts should be instituted to reduce an adrenergic cascade.

https://ift.tt/2xpSoOY

“How Important are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors”

Publication date: Available online 19 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Daniel M. Laskin, Arsalan Bhatti, Caroline K. Carrico

ABSTRACT

Purpose

Letters of recommendation are currently a part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in decision-making process.

Materials and Methods

In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared to other application attributes through a visual analog scale that ranged from 0 to 100, with 0 labeled as "Not Important" and 100 "Very Important." Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of both applicant attributes and components of recommendations were compared using random effects models to adjust for multiple responses from the same respondent. Post-hoc pairwise comparisons were performed using Tukey's adjustment.

Results

Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon, and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents.

Conclusions

Despite some of the deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.

https://ift.tt/2PS2DCu

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

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).

https://ift.tt/2O0UmyA

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

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N. Subramaniam, D. Balasubramanian, S. Murthy, P. Rathod, S. Vidhyadharan, K. Thankappan, S. Iyer

Abstract

According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10 mm 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 >10 mm and a tumour diameter >4 cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10 mm and a tumour diameter <4 cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10 mm with tumour diameter below or above 4 cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10 mm may not be warranted in the absence of other risk features such as nodal disease or close margins.

https://ift.tt/2poPCVP

Management of nasopharyngeal teratomas associated with cleft palate

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): C. Diakité, H. Bénateau, S. Dakpé, P. Guerreschi, P. Galinier, A. Veyssière

Abstract

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. The diagnosis of the teratoma was confirmed by histological analysis.

Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence.

Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.

https://ift.tt/2MPNiAa

Treatment of skeletal open bite using a navigation system: CAD/CAM osteotomy and drilling guides combined with pre-bent titanium plates

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): W. Du, G. Chen, D. Bai, C. Xue, W. Fei, E. Luo

Abstract

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. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with the guidance of this navigation system. Computed tomography and cephalometric examinations were performed to evaluate the correction of the deformity. Deviations between the simulated plan and actual postoperative outcome were measured to determine the precision of the surgery. Satisfactory and stable results were achieved in all patients postoperatively, without complications or relapse during follow-up. Photographs and cephalometric evaluations showed that the facial profile and occlusion were improved. Assessment of the deviations between the simulated plan and actual postoperative outcome showed that the navigation system can precisely transfer the virtual plan to the actual operation. The results suggest that the navigation system can accurately transfer the virtual plan to the actual operation during bimaxillary jaw osteotomies, without relapse, in patients with a severe skeletal open bite.

https://ift.tt/2pnh99Z

The impact of harvest length and detachment of the interosseous membrane on donor-site morbidity following free fibula flap surgery—a biomechanical experimental study

Publication date: Available online 19 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Samer George Hakim, Ali Shakery Tehrany, Robert Wendlandt, Hans-Christian Jacobsen, Thomas Trenkle, Peter Sieg

Summary

Purpose

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).

Material and Methods

On cadaveric lower leg specimens, the tendons of the EHL and EDL were dissected at the proximal phalanges and loaded with corresponding weights. The average displacement of the muscle was evaluated during the harvesting procedure.

Results

Cumulative detachment of the interosseous membrane caused considerable displacement of the EHL but less impairment of the EDL. Segmental and cumulative osteotomy of the fibula implicated significant displacement of both EHL and EDL.

Conclusion

A recommendation can be given for cautious selection of osteotomy site of the fibula and for limited sacrifice of the fibula and adjacent attachments of the extensors to keep local-site morbidity at a minimum.

https://ift.tt/2OCpRw0

Impact of voxel size and scan time on the accuracy of three-dimensional radiological imaging data from cone-beam computed tomography

Publication date: Available online 19 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Eva Dach, Bastian Bergauer, Anna Seidel, Cornelius von Wilmowsky, Werner Adler, Michael Lell, Manfred Wichmann, Ragai-Edward Matta

Summary

Purpose

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.

Material and Methods

A virtual 3D master model of a macerated human skull was generated using an industrial optical noncontact white light scanner. The skull was X-rayed with cone-beam computed tomography that was applied using different settings for voxel size and acquisition time (voxel edge length of 0.3 mm, scan times 4.8 s and 8.9 s; voxel edge length of 0.2 mm, scan times 14.7 s and 26.9 s). The scan was repeated 10 times at each setting. The CBCT scans were converted into 3D virtual models (actual value), which were superimposed with the 3D master model (reference value) to detect absolute differences.

Results

The mean value of deviation increased with increasing voxel size and decreasing scan time. For a voxel edge length of 0.3 mm, the mean values of deviation were 0.33 mm and 0.22 mm with scan times of 4.8 s and 8.9 s, respectively. For a voxel edge length of 0.2 mm, the mean deviations were 0.16 mm and 0.14 mm with scan times of 14.7 s and 26.9 s, respectively.

Conclusions

When using small voxel sizes, the scan time does not have a significant impact on image accuracy and therefore the scan time can be shortened. However, for larger voxel sizes, shorter scan times can lead to increased inaccuracy.

https://ift.tt/2NSRFiL

Osteogenic capacity of diluted platelet-rich plasma in ectopic bone-forming model: benefits for bone regeneration

Publication date: Available online 19 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Marija Đ. Vukelić-Nikolić, Stevo J. Najman, Perica J. Vasiljević, Tatjana M. Jevtović-Stoimenov, Vladimir J. Cvetković, Milica N. Andrejev, Žarko J. Mitić

Summary

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). A subcutaneous implantation model in Balb/c mice was used. The implants were analyzed using expression analysis of bone-related genes, histochemical, immunohistochemical and histomorphometrical analysis.

All types of implants induced creation of necessary preconditions for supporting osteogenic processes, but did not induce visible young bone growth. Implant types dPRP/10 and dPRP/3 showed very similar and significantly better stimulatory effects on osteogenic processes than bone matrix alone. In this study, significant ectopic osteogenic potential of concentration of platelets in PRP that are lower than physiological level in blood plasma in combination with bone mineral matrix was demonstrated. Diluted platelet-rich plasma could be a promising and useful adjuvant therapeutic agent in bone regeneration.

https://ift.tt/2OEvJoG

Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap

Publication date: Available online 19 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Jochen Weitz, Klaus-Dietrich Wolff, Marco Rainer Kesting, Christopher-Philipp Nobis

https://ift.tt/2NUm8wV

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

Publication date: Available online 19 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): S. Hafner, M. Ehrenfeld, A. Neumann, A. Wieser

Abstract

Purpose

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. To evaluate the postulated bactericidal effects in clinical practice, we studied a commercially available, ready-to-use CAPP-device, which is also designed to be used in the field of dental, oral, and maxillofacial treatment.

Materials and Methods

Standardized bacterial cultures of two different pathogens (Acinetobacter baumannii and Staphylococcus aureus) were produced with defined colony-forming unit concentrations. Dilutions of these cultures were treated with a commercially available CAPP product according to the manufacturer's instructions in order to evaluate the antimicrobial activity of the technique. This in vitro study compared the CAPP treatment with established clinical therapies like polihexanide (PHX) and antimicrobial photodynamic therapy (aPDT).

Results

The bactericidal effect was evaluated in terms of reduction in colony-forming units after treatment of the bacterial samples with a defined dose of plasma, aPDT, or PHX. For CAPP, the bactericidal effect was found to be stronger in the Gram-negative isolate (A. baumannii) than in the Gram-positive S. aureus. A strong depth dependency was observed, especially with the Gram-negative isolate. Good bactericidal effects, with a reduction in bacterial load of more than 2 × log₁₀, could only be observed in conditions of 0.3 mm of water-film thickness or less. Such a significant reduction in bactericidal effect depending on depth was not observed using aPDT or PHX in the studied depth range of 0.3–1.8 mm.

Conclusion

CAPP treatment performed by the device (Plasma ONE) and configuration we used in this study seems to be ill suited for sufficiently killing Acinetobacter baumannii or Staphylococcus aureus in a moist infection site, as would be expected in the oral cavity. Established local antimicrobial therapies using PHX or aPDT showed better disinfectant properties. The clinical effect of improved wound healing, described by the manufacturer and some scientists, could not be investigated using this model. Given the results, however, it seems unlikely to be a direct consequence of bactericidal effects of CAPP in a wet environment. Further development of CAPP devices, or a different configuration (e.g. with a higher output, resulting in reactive nitrogen species-dominated, gas-phase chemistry), may enhance antibacterial effects in future, while tissue compatibility of such techniques remains to be elucidated further.

https://ift.tt/2OEHHyo

Angioedema is an unfavorable factor for the response to omalizumab in chronic spontaneous urticaria: a retrospective study

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xrS1mX

Recurrent merkel cell carcinoma of the gluteal region: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PRpj5A

Atopic‐like dermatitis after Secukinumab injection: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xpFJLM

A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PPVKRQ

New therapeutic vision of Nutrition in dermatology: Integrative Nutrition

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xpFFf0

ANGIOTENSIN‐CONVERTING‐ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS INDUCED PEMPHIGUS: A CASE SERIES AND LITERATURE REVIEW

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PMFZvc

Pomegranate chitinase III: Identification of a new allergen and analysis of sensitization patterns to chitinases

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Lisa Tuppo, Ivana Giangrieco, Claudia Alessandri, Teresa Ricciardi, Chiara Rafaiani, Michela Ciancamerla, Rosetta Ferrara, Danila Zennaro, Maria Livia Bernardi, Maurizio Tamburrini, Adriano Mari, Maria Antonietta Ciardiello

Abstract

Allergy to pomegranate is often associated with severe symptoms. Two allergens have previously been described: 9k-LTP Pun g 1 and pommaclein Pun g 7. This study describes the isolation of a chitinase III, identified by direct protein sequencing and mass spectrometry. It is a 29-kDa protein showing 69% sequence identity with the latex hevamine and IgE binding in dot blotting, immunoblotting and FABER^®test. Chitinase-specific IgE were detected in 69 of 357 patients sensitized to one or more pomegranate allergenic preparations present on the FABER^®test. Using this test, 19.2% of the patients sensitized to kiwifruit chitinase IV were also sensitized to pomegranate chitinase III, rather than to latex chitinase I (7.2%) with which it shares the N-terminal hevein-like domain. In conclusion, a new allergen has been identified, contributing to improving food allergy diagnosis. This study reveals the important role of chitinases III and IV as allergy sensitizers and prompts further investigations.

Graphical abstract

https://ift.tt/2xBTLcC

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

Publication date: Available online 19 September 2018

Source: American Journal of Otolaryngology

Author(s): Di Deng, Jintao Du, Feng Liu, Bing Zhong, Yixin Qiao, Yafeng Liu

Abstract

Background

Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.

Objective

This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus.

Methods

Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017.

Results

The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients.

Conclusion

ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

https://ift.tt/2NSNyTR

Au-delà des kératoses actiniques, le champ de cancérisation cutané

Publication date: Available online 20 September 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): P. Reygagne, G. Rostain

Résumé

Les kératoses actiniques (KA) forment des papules érythémateuses, squameuses et kératosiques apparaissant sur la peau chroniquement exposée au soleil sous l'effet des rayons ultraviolets. Elles correspondent à une prolifération de kératinocytes atypiques limitée à l'épiderme et sont susceptibles de progression vers le carcinome épidermoïde in situ et le carcinome épidermoïde cutané (CEC). S'il est faible, le risque métastatique associé au CEC ne doit pas pour autant être négligé. Le concept de champ de cancérisation a été introduit en 1953 à la suite d'études de lésions néoplasiques de la muqueuse buccale. Il est défini comme une zone prétumorale d'aspect normal, comportant des anomalies infracliniques multifocales qui peuvent faire le lit de nouvelles lésions néoplasiques. De tels champs sont fréquents dans les zones cutanées photo-exposées et en périphérie des KA et des CEC. Dans cette situation, le traitement ne devrait pas se limiter aux lésions visibles ou palpables de KA et, en cas de suspicion de champ de cancérisation, un traitement visant à la destruction physique ou à l'élimination des kératinocytes atypiques de la totalité de la zone devrait être envisagé. Une telle approche pourrait en théorie améliorer le pronostic à long terme en diminuant l'émergence de nouvelles lésions, voire diminuer le coût économique global lié à la prise en charge des KA et optimiser l'aspect cosmétique du champ de cancérisation ; cela mérite, cependant, d'être confirmé.

Summary

Lesions occurring in actinic keratoses (AK) form erythematous, squamous, crusty and keratotic papules that appear on skin chronically exposed to the sun due to ultraviolet radiation. They are formed by the proliferation of atypical keratinocytes limited to the epidermis and may progress to squamous cell carcinoma in situ and to cutaneous squamous cell carcinoma (CEC). Although low, the metastatic risk associated with the CEC is not negligible. The concept of field cancerization was introduced in 1953 following studies of neoplastic lesions of the oral mucosa. A cancer field is a normal-looking pre-tumoral zone with subclinical, multifocal anomalies, which may constitute a base for new neoplastic lesions. Such fields are frequently seen in areas of photo-exposed skin and around the edges of AK and CEC. In this event, treatment should not be limited to visible or palpable AK lesions, and if a cancer field is suspected, treatment involving the physical destruction or elimination of atypical keratinocytes from the entire area should be considered. Such an approach may improve the long-term prognosis, reduce treatment costs and ensure optimal cosmetic outcome.

https://ift.tt/2DdKjlG

Non-smoking, non-drinking elderly females, a 5 year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Adrian DeAngelis, Omar Breik, Kendrick Koo, Tim Iseli, Alf Nastri, Tsien Fua, Danny Rischin, Michael McCullough, David Wiesenfeld

Abstract

Objectives

To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma.

Materials & methods

Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded.

Results

Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.

Conclusions

The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.

https://ift.tt/2pv1XI9

Aurora kinases are a novel therapeutic target for HPV-positive head and neck cancers

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Mushfiq H. Shaikh, Adi Idris, Newell W. Johnson, Sora Fallaha, Daniel T.W. Clarke, David Martin, Iain M. Morgan, Brian Gabrielli, Nigel A.J. McMillan

Abstract

Objectives

Human papilloma virus (HPV) is the main culprit in cancers of the cervix, penis, anus, skin, eye and head and neck. Current treatments for HPV cancers have not altered survival outcomes for 30 years and there is a significant lack of targeted therapeutic agents in the management of advanced HPV-related HNSCC. Here we show that survival and maintenance of HPV-positive HNC cells relies on the continuous expression of the major HPV oncogene, E7, and that Aurora kinases are critical for survival of high-risk HPV-positive HNC cells.

Materials and methods

To assess the role of HPV E7 on HNC cell survival, RNA interference (RNAi) of the E7 gene was initially performed. Using an Aurora kinase inhibitor, Alisertib, the role of Aurora kinases in the carcinogenesis of HPV E7 positive HNC tumour lines was then investigated. An in vivo HNC xenograft model was also utilised to assess loss of tumour volume in response to RNAi E7 gene silencing and Alisertib treatment.

Results

RNAi silencing of the HPV E7 gene inhibited the growth of HPV-positive HNC cells and in vivo tumour load. We show that HPV E7 oncogene expression confers sensitivity to Alisertib on HNC cells where Alisertib-mediated loss in in vitro cell viability and in vivo tumour load is dependent on E7 expression. Moreover, Aurora kinase inhibition induced degradation of MCL-1 in HPV E7-expressing HNC cells.

Conclusion

Overall, we show that Aurora kinases are a novel therapeutic target for HPV-positive HNCs. It might be feasible to combine Aurora kinase and MCL-1 inhibitors for future HNC therapies.

https://ift.tt/2MO6sXo

Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Parul Sinha, Omar A. Karadaghy, Michelle M. Doering, Methodius G. Tuuli, Ryan S. Jackson, Bruce H. Haughey

Abstract

The optimal management of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with primary surgical versus non-surgical treatment is unclear. The objective of this systematic review was to evaluate the literature and compare survival for primary surgical versus non-surgical treatment of HPV-positive OPSCC. We performed a comprehensive literature search of multiple electronic databases for relevant articles up to February, 2017. Studies reporting mortality or hazard ratio (HR) for overall survival (OS) in primary HPV-positive OPSCC patients were eligible. Seventy-three articles were eligible, of which 66 included single-modality (19 surgical, 47 non-surgical), and 7 included both surgical and non-surgical modalities. There were no randomized studies comparing outcomes between both modalities. In a meta-analysis of both-modality studies, OS with surgical treatment was not significantly different from non-surgical treatment (pooled HR 1.12; 95% CI: 0.35, 3.57). There was significant heterogeneity between studies (I² = 82.4%). Among single-modality studies, the mortality rate was lower with surgical [pooled proportion 0.15 (95% CI: 0.09, 0.21)] versus non-surgical treatment [0.20 (95% CI:0.15, 0.24)]. In a subgroup analysis, OS was higher for HPV-positive versus HPV-negative OPSCC, irrespective of the treatment modality. We conclude that there is an absence of high-quality studies that compare survival for HPV-positive OPSCC treated with primary surgical versus non-surgical approach. The available data suggest no statistical or clinically meaningful difference in survival between the two approaches. HPV-positivity was a key prognostic factor irrespective of treatment modality. Further high-quality studies with consistent data reporting are needed to inform the choice for optimal treatment modality for HPV-positive OPSCC.

https://ift.tt/2pnsdnF

Injury, dysbiosis and filaggrin deficiency drive skin inflammation via keratinocyte IL-1α release

Publication date: Available online 19 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Nathan K. Archer, Jay-Hyun Jo, Steven K. Lee, Dongwon Kim, Barbara Smith, Roger V. Ortines, Yu Wang, Mark C. Marchitto, Advaitaa Ravipati, Shuting S. Cai, Carly A. Dillen, Haiyun Liu, Robert J. Miller, Alyssa G. Ashbaugh, Angad S. Uppal, Michiko Oyoshi, Nidhi Malhotra, Sabine Hoff, Luis A. Garza, Heidi H. Kong

Abstract

Background

Atopic dermatitis (AD) is associated with epidermal barrier defects, dysbiosis and skin injury from scratching. In particular, the barrier defective epidermis of AD patients with loss-of-function filaggrin mutations has increased IL-1α and IL-1β levels but the mechanisms by which IL-1α and/or IL-1β are induced and whether they contribute to the aberrant skin inflammation in AD is unknown.

Objective

We sought to determine the mechanisms by which skin injury, dysbiosis and increased epidermal IL-1α and IL-1β contribute to the development of skin inflammation in a mouse model of injury-induced skin inflammation in filaggrin-deficient mice.

Methods

Skin injury of wild-type, filaggrin-deficient (ft/ft), and MyD88-deficient ft/ft mice was performed and ensuing skin inflammation was evaluated by digital photography, histologic analysis and flow cytometry. IL-1α and IL-1β protein expression was measured by ELISA and visualized by immunofluorescence and immuno-electron microscopy. The composition of skin microbiome was determined by 16S rDNA sequencing.

Results

Skin injury of ft/ft mice induced chronic skin inflammation involving dysbiosis-driven intracellular IL-1α release from keratinocytes. IL-1α was necessary and sufficient for skin inflammation in vivo and secreted from keratinocytes by various stimuli in vitro. Topical antibiotics or co-housing of ft/ft mice with unaffected wild-type mice to alter or intermix skin microbiota, respectively, resolved the skin inflammation and restored keratinocyte intracellular IL-1α localization.

Conclusions

Taken together, skin injury, dysbiosis and filaggrin deficiency triggered keratinocyte intracellular IL-1α release that was sufficient to drive chronic skin inflammation, which has implications for AD pathogenesis and for potential therapeutic targets.

Graphical abstract

https://ift.tt/2NUte4s

Trans-maternal Helicobacter pylori exposure reduces allergic airway inflammation in offspring through regulatory T-cells

Publication date: Available online 19 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Andreas Kyburz, Angela Fallegger, Xiaozhou Zhang, Aleksandra Altobelli, Mariela Artola-Boran, Timothy Borbet, Sabine Urban, Petra Paul, Christian Münz, Stefan Floess, Jochen Huehn, Timothy L. Cover, Martin J. Blaser, Christian Taube, Anne Müller

Abstract

Background

The trans-maternal exposure to tobacco, microbes, nutrients and other environmental factors shapes the fetal immune system through epigenetic processes. The gastric microbe Helicobacter pylori represents an ancestral constituent of the human microbiota that causes gastric disorders on the one hand, and is inversely associated with allergies and chronic inflammatory conditions on the other.

Objective

Here, we investigate the consequences of trans-maternal exposure to H. pylori, in utero and/or during lactation, for susceptibility to viral and bacterial infection, predisposition to allergic airway inflammation, and the development of immune cell populations in the lung and lymphoid organs.

Methods

We use experimental models of house dust mite- or ovalbumin-induced airway inflammation and influenza A virus or Citrobacter infection along with metagenomics analyses, multi-color flow cytometry and bilsufite pyrosequencing to study the effects of H. pylori on allergy severity and immunological and microbiome correlates thereof.

Results

Perinatal exposure to H. pylori extract, or its immunomodulator VacA, confers robust protective effects against allergic airway inflammation not only in the first, but also the second offspring generation, but does not increase susceptibility to viral or bacterial infection. Immune correlates of allergy protection include skewing of regulatory over effector T-cells, expansion of Treg subsets expressing CXCR3 or RORγt, and demethylation of the FOXP3 locus. The composition and diversity of the gastrointestinal microbiota is measurably affected by perinatal H. pylori exposure.

Conclusion

We conclude that exposure to H. pylori has consequences not only for the carrier, but also for subsequent generations that may be exploited for interventional purposes.

Graphical abstract

https://ift.tt/2OzBXG5

Radiotherapy‐induced Pemphigus Foliaceous: a rare adverse effect of breast cancer therapy

International Journal of Dermatology, EarlyView.


https://ift.tt/2NVIXjH

Pseudodidymosis: nevus psiloliparus with aplasia cutis congenita, an initial manifestation of Haberland syndrome

International Journal of Dermatology, EarlyView.


https://ift.tt/2ODRTY1

Impact of Climate Change on Pollen and Respiratory Disease

Abstract

Purpose of Review

A warming world will impact everyone and everything. The practice of allergic and respiratory disease will not be excepted. All the impacts will be impossible to anticipate. This review is intended to discuss significant factors related to individuals with allergic and respiratory disease.

Recent Findings

Recent findings include the increased growth of allergenic plants in response to higher carbon dioxide levels and warmer temperatures. This also contributes to the increased production of pollen as well as the appearance of allergenic species in new climactic areas. Stinging insects will extend their ranges into northern areas where they have not previously been a problem. The shift and extension of pollen seasons with warmer springs and later frosts have already been observed. Recent severe hurricanes and flooding events may be just the harbinger of increasing damp housing exposure related to sea level rise. Evidence is accumulating that indicates the expected higher number of ozone alert days and increased pollution in populated areas is bringing increases in pollen potency. Finally, increased exposure to smoke and particles from wild fires, resulting from heat waves, will contribute to the general increase in respiratory disease.

Summary

The practice of allergy being closely aligned with environmental conditions will be especially impacted. Allergists should consider increasing educational activities aimed at making patients more aware of air quality conditions.

https://ift.tt/2MIfGo1

Impact of Climate Change on Pollen and Respiratory Disease

Abstract

Purpose of Review

A warming world will impact everyone and everything. The practice of allergic and respiratory disease will not be excepted. All the impacts will be impossible to anticipate. This review is intended to discuss significant factors related to individuals with allergic and respiratory disease.

Recent Findings

Recent findings include the increased growth of allergenic plants in response to higher carbon dioxide levels and warmer temperatures. This also contributes to the increased production of pollen as well as the appearance of allergenic species in new climactic areas. Stinging insects will extend their ranges into northern areas where they have not previously been a problem. The shift and extension of pollen seasons with warmer springs and later frosts have already been observed. Recent severe hurricanes and flooding events may be just the harbinger of increasing damp housing exposure related to sea level rise. Evidence is accumulating that indicates the expected higher number of ozone alert days and increased pollution in populated areas is bringing increases in pollen potency. Finally, increased exposure to smoke and particles from wild fires, resulting from heat waves, will contribute to the general increase in respiratory disease.

Summary

The practice of allergy being closely aligned with environmental conditions will be especially impacted. Allergists should consider increasing educational activities aimed at making patients more aware of air quality conditions.

https://ift.tt/2MIfGo1