Upon publication of the original article [1], the authors reported the following funding information was omitted: Publication supported by Wroclaw Centre of Biotechnology, programme The Leading National Resear...
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Παρασκευή 5 Οκτωβρίου 2018
Correction to: Passive blood anaphylaxis: subcutaneous immunoglobulins are a cause of ongoing passive anaphylactic reaction
A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report
Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria...
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Effectiveness of photopolymerization in composite resins using a novel 445-nm diode laser in comparison to LED and halogen bulb technology
Abstract
Challenges especially in the minimal invasive restorative treatment of teeth require further developments of composite polymerization techniques. These include, among others, the securing of a complete polymerization with moderate thermal stress for the pulp. The aim of this study is to compare current light curing sources with a blue diode laser regarding curing depth and heat generation during the polymerization process. A diode laser (445 nm), a LED, and a halogen lamp were used for polymerizing composite resins. The curing depth was determined according to the norm ISO 4049. Laser output powers of 0.1, 0.5, 1, and 2 W were chosen. The laser beam diameter was adapted to the glass rod of the LED and the halogen lamp (8 mm). The irradiation time was fixed at 40 s. To ascertain ΔT values, the surface and ground area temperatures of the cavities were simultaneously determined during the curing via a thermography camera and a thermocouple. The curing depths for the LED (3.3 mm), halogen lamp (3.1 mm) and laser(0.5/1 W) (3/3.3 mm) showed no significant differences (p < 0.05). The values of ΔTsurface as well as ΔTground also showed no significant differences among LED, halogen lamp, and laser(1 W). The ΔTsurface values were 4.1LED, 4.3halogen lamp, and 4.5 °C for the laser while the ΔTground values were 2.7LED, 2.6halogen lamp, and 2.9 °C for the laser. The results indicate that the blue diode laser (445 nm) is a feasible alternative for photopolymerization of complex composite resin restorations in dentistry by the use of selected laser parameters.
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Prevention of oral carcinogenesis in rats by Dracaena cinnabari resin extracts
Abstract
Objectives
In vivo study was performed to determine the chemopreventive efficacy of the DC resin methanol extract on a 4-nitroquinoline-1-oxide (4NQO) oral cancer animal model.
Materials and methods
This study involves administration of 4NQO solution for 8 weeks alone (cancer induction) or with Dracaena cinnabari (DC) extract at 100, 500, and 1000 mg/kg. DC extract administration started 1 week before exposure until 1 week after the carcinogen exposure was stopped. All rats were sacrificed after 22 weeks, and histological analysis was performed to assess any incidence of pathological changes. Immunohistochemical expressions of selected tumor marker antibodies were analyzed using an image analyzer computer system, and the expression of selected genes involved in apoptosis and proliferative mechanism related to oral cancer were evaluated using RT2-PCR.
Results
The incidence of OSCC decreased with the administration of DC extract at 100, 500, and 1000 mg/kg compared to the induced cancer group. The developed tumor was also observed to be smaller when compared to the induced cancer group. The DC 1000 mg/kg group inhibits the expression of Cyclin D1, Ki-67, Bcl-2, and p53 proteins. It was observed that DC 1000 mg/kg induced apoptosis by upregulation of Bax and Casp3 genes and downregulation of Tp53, Bcl-2, Cox-2, Cyclin D1, and EGFR genes when compared to the induced cancer group.
Conclusions
The data indicated that systemic administration of the DC resin methanol extract has anticarcinogenic potency on oral carcinogenesis.
Clinical relevance
Chemoprevention with DC resin methanol extract may significantly reduce morbidity and possibly mortality from OSCC.
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Effect of intermittent teriparatide (PTH 1-34) on the alveolar healing process in orchiectomized rats
Abstract
Objective
To evaluate intermittent teriparatide therapy's influence on the alveolar healing process in rats with induced osteoporosis.
Materials and methods
Fifty-four male rats were divided into three groups: fictitious surgery (SHAM), bilateral orchiectomy (ORQ NT), and bilateral orchiectomy treated with teriparatide (ORQ TERI). Right upper incisor extraction was performed. After 14 and 42 days, the rats were euthanized. Immunolabeling analysis was performed in order to characterize bone turnover through Wnt, alcaline phosphatase, osteocalcin, and TRAP presence in tissue; micro-CT analysis was performed in order to determine the bone volume fraction (BV/TV), trabecular thickness, separation, and number (Tb.Th, Tb.Sp, Tb.N). For the micro-CT data, statistical analysis was performed through one-way ANOVA and Tukey post-test, for parametrical data, with significance level adopted in p < 0.05. Days, Wnt, alkaline phosphatase, and osteocalcin revealed more labeling for ORQ TERI and less for TRAP. For the Tb.N in the ORQ NT group was 0.496 mm, a significant statistical difference was observed between the groups of ORQ NT and ORQ TERI (p < 0.05). For the BV/TV, Tb.Sp, and Tb.Th parameters, no significant statistical difference was observed among the three experimental groups (p > 0.05).
Conclusions
Treatment with intermittent teriparatide reverted impairment in the metabolism of repairing bone tissue in orchiectomized animals.
Clinical relevance
Cases of decreased bone density such as osteoporosis can lead to delayed alveolar repair process. PTH 1-34 has been shown to be a medication that improves this repair, making bone of low quality into one with normal features.
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Phytochemical screening and antityrosinase activity of carvacrol, thymoquinone, and four essential oils of Lebanese plants
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2yetzoG
Photobiomodulation on critical bone defects of rat calvaria: a systematic review
Abstract
Bone defects following trauma represent a high impact on the quality of life of millions of people around the world. The aim of this study was to review photobiomodulation (PBM) action in the treatment of bone critical defects in rat calvaria, related to evaluation of the current protocols applied. One hundred and forty-seven articles related to the subject were found by searching the main databases (Pubmed, Lilacs, Web of Science, and Scopus) considering the period of publication until the year 2017, and only 14 corresponded the inclusion criteria established for this systematic review. The main parameters of the PBM were expressed in Table 1. In addition, it was possible to observe the use of two different wavelengths (red and infrared), which are considered therapeutic. Most of the evaluated articles presented positive results that describe a greater amount of neoformed bone, an increase in collagen synthesis, and a contribution to microvascular reestablishment. However, two studies report no effect on the repair process when the PBM was used. In addition, we observed considerable variations between the values of power, fluence, and total energy, which make it difficult to compare the results presented between the selected studies. It was possible to conclude that the infrared laser was more effective in positively stimulating the bone repair process of critical defects. Furthermore, a discrepancy was found in the parameter values used, which made it difficult to choose the best protocol for the treatment of this type of lesion.
https://ift.tt/2E13mAc
To treat or not to treat: The minimally symptomatic EoE patient
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder in which a mixed inflammatory cell infiltrate leads to symptoms of esophageal dysfunction. While great strides have been made to understand the pathophysiology and natural history of eosinophilic esophagitis over the last 30 years, there still does not exist an FDA-approved therapy.
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Multidisciplinary Tracheostomy Care
There have been reports of successful quality-improvement initiatives surrounding tracheostomy care for more than a decade, but widespread adoption of best practices has not been universal. Five key drivers have been found to improve the quality of care for tracheostomy patients: multidisciplinary synchronous ward rounds, standardization of care protocols, appropriate interdisciplinary education and staff allocation, patient and family involvement, and use of data to drive improvement. The Global Tracheostomy Collaborative is a quality-improvement collaborative dedicated to improving the care of tracheostomy patients worldwide through communication, dissemination, and implementation of proven strategies based on these 5 key drivers.
https://ift.tt/2QCkjT5
Rethinking Morbidity and Mortality Conference
This article will discuss the importance of an effective morbidity and mortality (M&M) conference toward supporting a proactive and preventative approach to patient safety and quality improvement (PSQI). Key characteristics will be discussed that enhance this process for being a mechanism for driving positive PSQI culture change that permeates the department. The focus of this article will be on how to approach the structure and process of this conference for maximal benefit.
https://ift.tt/2OH9YHO
Publicly Available Databases in Otolaryngology Quality Improvement
The historical context for quality improvement is provided. Important differences are described between the two overarching types of databases: clinical registries and administrative databases. The pros and cons of each are provided as are examples of their utilization in otolaryngology–head and neck surgery.
https://ift.tt/2Qx9yRJ
Management of Flaccid Facial Paralysis of Less Than Two Years’ Duration
Flaccid facial paralysis results in disfiguring facial changes. The treatment of flaccid facial paralysis is complex and treatment approaches should be determined based on duration and the causes of paralysis, status and accessibility of the affected facial nerve, medical comorbidities, and patient-specific goals. Although primary nerve repair is the preferred treatment strategy when possible, nerve substitution procedures are the mainstay of treatment for patients with flaccid facial paralysis of less than 2 years duration.
https://ift.tt/2ODIgvS
Medical Management of Acute Facial Paralysis
Acute facial paralysis (FP) describes acute onset of partial or complete weakness of the facial muscles innervated by the facial nerve. Acute FP occurs within a few hours to days. The differential diagnosis is broad; however, the most common cause is viral-associated Bell Palsy. A comprehensive history and physical examination are essential in arriving at a diagnosis. Medical treatment for acute FP depends on the specific diagnosis; however, corticosteroids and antiviral medications are the cornerstone of therapy. Lack of recovery after 4 months should prompt further diagnostic workup.
https://ift.tt/2QxKD0h
Delivering Otolaryngologic Care Safely and Successfully
In 2000, when the Institute of Medicine published To Err Is Human,1 the focus of the patient safety movement was on convincing both providers and patients that we had a safety problem. Currently, most people understand that patient safety is a real issue. Unfortunately, there are still an estimated 251,000 deaths2 and over 1,000,000 nonfatal injuries3 from medical errors annually in the United States. The focus now is on how to implement the best practices that we know exist. An additional challenge is creating a culture around safety, with leadership engagement.
https://ift.tt/2OH9QYQ
The use of topical rapamycin in the treatment of superficial lymphatic malformations
Rapamycin can be useful in the treatment of vascular malformations, but the value of its topical application to superficial lymphatic malformations has not been established .Topical rapamycin improves the clinical appearance of superficial lymphatic malformations and alleviates associated symptoms.
https://ift.tt/2pEJZTA
Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments
Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines.
https://ift.tt/2Pg2ys6
Predictors of mucosal melanoma survival in a population-based setting
This population-based study underscores that extracutaneous melanomas are rare and aggressive neoplasms. Poorer survival in patients with mucosal melanoma was observed in relation to stage and anatomic site, but not tumor thickness (i.e., Breslow depth) or patient race/ethnicity. Due to the poor prognosis for all stages of mucosal melanoma, dermatologists should consider incorporating examination of the oropharynx and genitalia in the full body skin exam.
https://ift.tt/2PeVdcB
Relative efficacy of systemic treatments for atopic dermatitis
Systemic treatments are common for severe atopic dermatitis and biologic medications represent recent advances in the field. Dupilumab and cyclosporine are both effective at improving clinical severity of atopic dermatitis, as are newer biologic medications lebrikizumab and tralokinumab. Long term efficacy and safety results are needed for biologic medications.
https://ift.tt/2Pf2Rnc
Future considerations for clinical dermatology in the setting of 21st century American policy reform: corporatization and the rise of private equity in dermatology
Within the last two decades, for-profit financial groups have become increasingly involved in health care. Outlier dermatology practices with high volumes of well-reimbursed procedures are attractive to consolidation backed by private equity. With fewer choices for independent or group private practice, junior dermatologists are increasingly seeking employment without ownership in private equity-backed corporate groups, whose primary fiscal responsibility lies with investors. Medicare's response to corporatization and consolidation has already changed the practice of dermatopathology.
https://ift.tt/2PekJhX
Analysis of cutaneous Merkel Cell Carcinoma outcomes after different surgical interventions
Despite current recommendation of 1-2 cm excision margin for merkel cell carcinoma, we compared different surgical option for better outcome. We did not recommend local destruction and confirmed superior survival with excision margin of more than 2 cm in patients younger than 60 years having T1/T2 tumors or adjuvant radiotherapy.
https://ift.tt/2pzTyTI
Characteristics, treatment and outcome of bleeding after tooth extraction in patients on DOAC and phenprocoumon compared to non-anticoagulated patients—a retrospective study of emergency department consultations
Abstract
Objectives
Bleeding after tooth extraction range from minor bleeding to life-threating haemorrhagic shock and are among the leading complications in patients under oral anticoagulation with direct oral anticoagulants (DOACs) or phenprocoumon. Little is known about how anticoagulation in patients under DOAC or phenprocoumon alters the characteristics, treatment or outcome of bleeding events, in comparison to non-anticoagulated patients.
Methods
Patients admitted to a tertiary ED in Bern, Switzerland, from June 1st 2012 to 31st May 2016 with bleeding related to tooth extraction under DOAC, phenprocoumon or without anticoagulation, were compared.
Results
Out of 161,458 emergency consultations, 64 patients with bleeding from tooth extraction were included in our study. In anticoagulation groups, we found significantly more delayed bleeding events than in patients without anticoagulation (9 (81.3%) DOAC, 19 (86.4%) phenprocoumon, 8 (30.8%) no anticoagulation, p < 0.001). Anticoagulated patients had to stay longer in the ED than non-anticoagulated patients, with no significant difference between DOAC or phenprocoumon (hours: 4.8 (3.2–7.6 IQR) DOAC, 3.0 (2.0–5.5 IQR) phenprocoumon, p = 0.133; 2.7 (1.6–4.6) no anticoagulation; p = 0.039). More patients with anticoagulation therapy needed surgery than patients without anticoagulant therapy (11 (68.8%) DOAC, 12 (54.6%) VKA, p = 0.506; 7(26.9%) no anticoagulation; p = 0.020).
Conclusions
Delayed bleeding occur more often in anticoagulated patients with both DOAC and phenprocoumon compared to patients without anticoagulation. Bleeding events in anticoagulated patients with DOAC and phenprocoumon equally need longer ED treatment and more frequent surgical intervention.
Clinical relevance
Caution with delayed bleeding in anticoagulated patients with DOACs and phenprocoumon is necessary and treatment of bleeding is resource-demanding.
https://ift.tt/2E2uNJP
To treat or not to treat: The minimally symptomatic EoE patient
Publication date: Available online 5 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Amanda Muir, Hillary Moore, Jonathan Spergel
https://ift.tt/2PfBOrI
Lupin: An Emerging Food Allergen in the United States
Publication date: Available online 4 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Theresa A. Bingemann, Carah B. Santos, Anne F. Russell, Aikaterini Anagnostou
https://ift.tt/2y3NhUT
Sensitization Profiles to Hazelnut Allergens across the United States of America
Publication date: Available online 4 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Andre Valcour, Jonas Lidholm, Magnus P. Borres, Robert G. Hamilton
https://ift.tt/2QxlEKx
Level of competence of primary and secondary school teachers in the management of anaphylaxis
Publication date: Available online 4 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Silvia F Cantariño, Silvia Novío
https://ift.tt/2zUjj77
Transoral vertical ramus osteotomy fixed with Kirschner pins
Publication date: Available online 5 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): T.-T. Huang, K.-H. Cheng, C.-J. Chang, K.-C. Chen, J.-K. Liu, T.-Y. Wong
Abstract
Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9 mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa. This is followed by a brief period of maxillomandibular fixation. We have reviewed the records of 95 patients who had unilateral or bilateral vertical ramus osteotomy fixed with K pins, after which the mean (SD) period of fixation was 19 (11) days. Fixation failed in two patients because excursion of the jaw was either too heavy or too early. The fixations were redone. All other fixations remained stable, including the 20 dual-jaw procedures in which VRO preceded maxillary osteotomy. The mean (SD) maximal mouth opening at final follow-up was 44 (7) mm, and in only one patient was it less than 30 mm. Numbness of the lip or chin developed in seven patients, five of whom had other anterior mandibular procedures. Four patients had discomfort on palpation of the site of the pins, and one required removal. The new method was effective, and resulted in few complications within its limitations.
https://ift.tt/2Pc8SRt
Distribution of metastatic regional lymph nodes in squamous cell carcinoma of the oral commissure and its implications for treatment in the neck
Publication date: Available online 5 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Laith Mukdad, Jose E. Alonso, Albert Han, Edward C. Kuan, Maie A. St. John
https://ift.tt/2y1EN0u
Impact of reconstructive microsurgery on patients with cancer of the head and neck: a prospective study of quality of life, particularly in older patients
Publication date: Available online 4 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): E. Segna, A.R. Bolzoni, A.B. Giannì, A. Baj, G.A. Beltramini
Abstract
Treatment of cancer of the head and neck often requires extended resection and major reconstructive surgery, both of which can have great functional and emotional impact. It is fundamental to evaluate the outcome with respect not only to the clinical aspects but also to the quality of life (QoL) perceived by the patients. In the light of the reported increasing incidence of oral cancer in older patients, we decided to see if there was an association between QoL and age. Between June 2015 and December 2016 we submitted the Italian version of the 36-item Short Form Health Survey (SF-36) to 30 patients (mean (range) age 65.5 (23–87) years) who had had resection and microsurgical reconstruction at the Ospedale Maggiore Policlinico of Milan. The questionnaires were completed before operation, and 12 months afterwards, and clinical and personal data were also collected. From the results of SF-36 we obtained the Short Form 12 (SF-12), Physical Health Composite Score (PCS), and Mental Health Composite Score (MCS) and looked at how age influences the variation in QoL scores. The variation between SF-36 and SF-12 results (preoperatively and postoperatively) did not seem to correlate with age. Our study confirmed that reconstructive microsurgery can be realistically proposed to older as well as younger patients because, according to the QoL index, older patients are able to manage (and therefore take advantage of) this complex surgical technique.
https://ift.tt/2IHpzls
Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs
Publication date: Available online 4 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): M. Tang, C. Yu, P. Hu, C. Wang, J. Sheng, S. Ma
Abstract
The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).
https://ift.tt/2pCoYJ9
Accuracy of a CAD/CAM surgical template for mandibular distraction: a preliminary study
Publication date: Available online 4 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): B. Li, H. Sun, F. Zeng, T. Zhang, X. Wang
Abstract
We have assessed the accuracy and clinical validation of virtual planning using a surgical template in 16 patients with hemifacial microsomia being treated by mandibular distraction osteogenesis. Virtual planning and simulation were first done on three-dimensional models. Distraction was simulated on the virtual model and the new morphology of the mandible was previewed. Both the position and direction of the distractor were calculated to achieve the optimal morphology. The templates were designed based on the virtual planning, and manufactured using a 3-dimensional printing technique. The template was designed to assist the surgeon to make the osteotomy and predrill the screw-holes to guide the distractor into position. The outcome was evaluated by comparing planned with postoperative outcomes. The osteotomy was made and the distractor implanted successfully under the guidance of the template in all patients. The linear and angular differences for the distractor were measured and reported using the root mean square deviation. There was no difficulty in using the templates. The largest linear root mean square deviation between the planned and the postoperative distractors was 0.93 mm in the anteroposterior direction, and the largest in the horizontal plane was 4.64°. We suggest that the preoperative plan can be transferred accurately to a patient using the template.
https://ift.tt/2IEfkhK
Outcome of salvage procedures for recurrent oral and oropharyngeal cancer
Publication date: Available online 4 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): R. Smirk, P. Kyzas
Abstract
Despite advances in the primary treatment of oral and oropharyngeal cancer, many patients develop local or regional recurrence, or both, and when radiotherapy has already been used, operation provides the best chance of salvage for these patients. We have looked at the outcomes of salvage procedures in a single unit, including improved survival, morbidity, and treatment-related quality of life. Patients treated with salvage procedures were identified from a prospectively-completed database. Overall and disease-free survival were analysed using Kaplan–Meier curves and logrank tests. Functional, social, and emotional outcomes were assessed using the University of Washington Quality of Life Questionnaires. Twenty-nine patients were identified, of whom 24 had free flap reconstructions, and their estimated mean overall survival was 25 months (95% CI 20.4 to 29.2). Disease-free survival was significantly worse in patients with stage IV recurrences or in whom resection margins were close or invaded. Permanent gastrostomy was required in 15/29 patients, and four/29 needed a permanent tracheostomy. Answers to questionnaires showed that a large proportion of patients had considerable problems with speech, chewing, swallowing, and appearance. The decision on whether to treat recurrent head and neck cancer is a balance between improving survival and poor functional outcomes. The extent of disease and whether clear surgical margins can be achieved should be considered when treatment is recommended.
https://ift.tt/2pALbao
Total virtual workflow in CAD-CAM bony reconstruction with a single step free fibular graft and immediate dental implants
Publication date: Available online 4 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): D. Zweifel, M.G. Bredell, H. Essig, T. Gander, M. Lanzer, C. Rostetter, M. Rücker, S. Studer
Abstract
The Surgical reconstruction of defects of the face is challenging. Local and regional flaps have an important part to play, but large defects of bone and soft tissue are a greater problem. Microvascular tissue transfer has become the standard for such patients, and preoperative planning of bony reconstructions is now common. To use these preplanning tools best the implants should be placed in the prosthetically ideal place, and the bone positioned to surround the implants – that is, truly backward planning of the position of the bone. The buccolingual angulation and the actual position of the implants during operation can be difficult to verify. Using commonly available software and 3-dimensional printing solutions, therefore, we have constructed an algorithm to optimise the position of these implants during the operation, and to get their position as close to the planned outcome as possible. This algorithm is adaptable to any implant system and is potentially possible in any implant or preplanning software unit.
https://ift.tt/2IEeMbG
Ultrasound-guided quadratus lumborum block in pediatrics: trans-muscular versus intra-muscular approach
Abstract
Purpose
Quadratus lumborum (QL) block has four approaches. However, there is difference between the four approaches regarding efficacy, safety and adverse effects. The primary objective of this study is to compare the analgesic effect between trans-muscular and intra-muscular approaches of the QL block in pediatric patients for elective lower abdominal surgery.
Methods
54 patients aged between 1 and 6 years were enrolled. Patients of both genders were selected. The patients were randomly classified into two groups: Group TQL includes patients (27 patients) in whom bilateral QL block was performed using trans-muscular approach, and Group IQL (27 patients), which underwent bilateral QL block using an intra-muscular approach. The primary outcome measure was the number of patients who require rescue analgesia in the first 24 h. The secondary outcome measures were FLACC score, heart rate, non-invasive blood pressure at 2, 4, 6, 12, and 24 h postoperatively, and postoperative complications (e.g., quadriceps muscle weakness, local hematoma).
Results
In the first 24 h after surgery, 13 patients in the IQL group (48.1%) required rescue analgesia, whereas only five patients in the TQL group (18.5%) required rescue analgesia. The FLACC score was lower in the TQL group than the IQL group at all time intervals up to 24 h postoperatively. In the TQL group, eight patients (29.6%) developed quadriceps weakness; whereas, only one patient (3.7%) in the IQL group developed quadriceps weakness.
Conclusion
TQL is better than IQL in the analgesic efficacy following the pediatric lower laparotomy.
https://ift.tt/2pzwioS
Leptin impairs the therapeutic effect of ionizing radiation in oral squamous cell carcinoma cells
Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NpG46w
Role of synovium‐derived fibrous cartilage in TMJ synovial chondromatosis
Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OCYLIn
Atopic dermatitis in cats and dogs: a difficult disease for animals and owners
The purpose of this review article is to give an overview of atopic dermatitis in companion animals and of recent developments including knowledge on immunological background, novel treatment options and diffi...
https://ift.tt/2RtcJew
Effect of preparation design on marginal and internal adaptation of translucent zirconia laminate veneers
European Journal of Oral Sciences, EarlyView.
https://ift.tt/2RtLIHK
CAIX and pax-8 Commonly Immunoreactive in Endolymphatic Sac Tumors: A Clinicopathologic Study of 26 Cases with Differential Considerations for Metastatic Renal Cell Carcinoma in von Hippel-Lindau Patients
Abstract
Endolymphatic sac tumors (ELSTs) are rare, slowly growing temporal bone neoplasms which show a high association with von Hippel-Lindau (VHL) syndrome. The immunohistochemistry evaluation of these papillary-cystic neoplasms frequently raises the differential diagnosis with renal cell carcinoma, among other metastatic neoplasms, whether in VHL patients or not. A cohort of 26 patients with ELSTs were evaluated for histologic features, immunohistochemistry findings, and association with VHL. Standard immunohistochemistry evaluation was performed. Sixteen females and 10 males ranging in age from 10 to 69 years (mean 44; VHL mean: 32) at initial presentation, comprised the cohort of patients. Most (86%) experienced hearing changes or inner ear symptoms (vertigo, dizziness), with an average duration of symptoms for 39 months (range 2–240 months). The tumors were an average of 2.9 cm (range 0.4–8 cm), with 14 left, 11 right sided and one bilateral tumor. Nine patients had documented VHL, with 3 patients having a concurrent or subsequent clear cell renal cell carcinoma. Patients were followed an average of 6.2 years (available in 24 patients): 19 alive without disease, 7.5 years; 2 dead without disease, 1.2 years; and 3 alive with disease, 3.1 years. The neoplastic cells show the following immunohistochemistry findings: AE1/AE3, EMA, CK7, CAIX, GLUT1, VEGF: 100% of cases tested were positive; pax-8: 85% of cases positive; CD10 and RCC: 0% of cases reactive. Based on this cohort of 26 patients with ELST, 9 of whom had VHL, the strong pax-8 and CAIX should be used in conjunction with negative CD10 and RCC to help exclude a metastatic renal cell carcinoma. As CAIX is an enzyme overexpressed in hypoxia and hypoxia inducible factor is what VHL protein regulates, this is an expected, although previously unreported finding. Whether part of VHL or not, VHL mutations may be a somatic rather than germline finding in the tumors, a possible further explanation for the CAIX reaction.
https://ift.tt/2yiefaH
Paediatric auditory brainstem implantation: The South Asian experience
Publication date: Available online 4 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Raghunandhan, K. Madhav, A. Senthilvadivu, K. Natarajan, M. Kameswaran
Abstract
Introduction
Paediatric Auditory Brainstem Implantation (ABI) is indicated for children with congenital cochlear aplasia, absent/hypoplastic vestibulocochlear nerve, for whom cochlear implantation is not possible. Knowledge of the anatomical landmarks and variants in anatomy of the brainstem is vital for ABI surgery.
Method
Study was done at Auditory implant centre in Madras ENT research foundation, which includes 24 children who had undergone ABI surgery and are being followed up for 1 year, post operatively. Aims were to study the anatomical variants and the outcomes of ABI implantation. To determine if different anatomical variants effect placement of ABI electrode. To assess the patient outcomes by Categories of auditory Performance (CAP) scores and Speech Intelligibility Ratings (SIR) scores.
Results
All the candidates showed gradual improvement in audiological and verbal outcomes after the ABI. The mean CAP and SIR scores after 6 months of AVHT were 2.07 and 1.37 respectively. After 1 year of auditory verbal rehabilitation therapy CAP was 3.42 and SIR was 2.33. Flocculus of the cerebellum can be of different grades. Though, there was difficulty in insertion of the electrode in subjects with anatomical variants, the outcomes were comparable with other subjects.
Conclusion
ABI surgery involves frequent anatomical variations surrounding the lateral recess which makes the positioning of the auditory prosthesis difficult. Variants during the surgery can make the placement of ABI electrodes difficult, but promising results were seen all the implantees.
https://ift.tt/2QxdH8l
Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications
Publication date: Available online 4 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J.-Q. Chen, H.-Y. Tan, Z.-Y. Wang, W.-D. Zhu, Y.-C. Chai, H. Jia, H. Wu
Abstract
Objective
Classical surgical management of jugular foramen (JF) tumors usually requires facial nerve rerouting which results in permanent facial palsy in most patients. The purpose of the article is to study the outcomes of different rerouting techniques, and to discuss their indications.
Material and methods
We retrospectively reviewed 98 patients with JF tumors operated at our center between January 2008 and December 2016 using different surgical approaches with the following procedures for facial nerve management: total anterior rerouting (TR), partial anterior rerouting (PR), and fallopian bridge (FB) technique. The data for facial nerve management, surgical outcome and postoperative facial nerve function were collected from the medical records.
Results
In the study, there were 48 males and 50 females. Of them, 61 (62.2%) were jugular paragangliomas, 22 (22.4%) schwannomas, and 15 (15.3%) meningiomas. Total tumor removal was achieved in 95 (96.9%) patients, while near-total removal was achieved in 3 (3.1%) paragangliomas. TR was applied in 31 (31.6%) patients with PR in 26 (26.5%) patients, and FB in 41 (41.8%) patients. The mean follow-up duration was 39.4 ± 22.6 months, and 2 recurrences of paragangliomas were observed. Seventy-five patients (76.5%) had good facial function (HB I-II) at 1 year after surgery, the patients who received a TR approach presented significantly less HB I-II FN function (48.4%) than those with PR (82.6%, P < 0.05) or those with FB technique (95.1%, P < 0.001). 21 patients (21.4%) presented new-onset lower cranial nerve dysfunction of which 13 recovered at 1 year after surgery.
Conclusion
Facial nerve management in JF tumors should be tailored individually. No-rerouting methods, such as the fallopian bridge technique, bring significantly better results in terms of facial nerve function, which might be performed first during surgery; its indication is based mainly on the tumor type and extent.
https://ift.tt/2zT9oyK
CAIX and pax-8 Commonly Immunoreactive in Endolymphatic Sac Tumors: A Clinicopathologic Study of 26 Cases with Differential Considerations for Metastatic Renal Cell Carcinoma in von Hippel-Lindau Patients
Abstract
Endolymphatic sac tumors (ELSTs) are rare, slowly growing temporal bone neoplasms which show a high association with von Hippel-Lindau (VHL) syndrome. The immunohistochemistry evaluation of these papillary-cystic neoplasms frequently raises the differential diagnosis with renal cell carcinoma, among other metastatic neoplasms, whether in VHL patients or not. A cohort of 26 patients with ELSTs were evaluated for histologic features, immunohistochemistry findings, and association with VHL. Standard immunohistochemistry evaluation was performed. Sixteen females and 10 males ranging in age from 10 to 69 years (mean 44; VHL mean: 32) at initial presentation, comprised the cohort of patients. Most (86%) experienced hearing changes or inner ear symptoms (vertigo, dizziness), with an average duration of symptoms for 39 months (range 2–240 months). The tumors were an average of 2.9 cm (range 0.4–8 cm), with 14 left, 11 right sided and one bilateral tumor. Nine patients had documented VHL, with 3 patients having a concurrent or subsequent clear cell renal cell carcinoma. Patients were followed an average of 6.2 years (available in 24 patients): 19 alive without disease, 7.5 years; 2 dead without disease, 1.2 years; and 3 alive with disease, 3.1 years. The neoplastic cells show the following immunohistochemistry findings: AE1/AE3, EMA, CK7, CAIX, GLUT1, VEGF: 100% of cases tested were positive; pax-8: 85% of cases positive; CD10 and RCC: 0% of cases reactive. Based on this cohort of 26 patients with ELST, 9 of whom had VHL, the strong pax-8 and CAIX should be used in conjunction with negative CD10 and RCC to help exclude a metastatic renal cell carcinoma. As CAIX is an enzyme overexpressed in hypoxia and hypoxia inducible factor is what VHL protein regulates, this is an expected, although previously unreported finding. Whether part of VHL or not, VHL mutations may be a somatic rather than germline finding in the tumors, a possible further explanation for the CAIX reaction.
https://ift.tt/2yiefaH
CAIX and pax-8 Commonly Immunoreactive in Endolymphatic Sac Tumors: A Clinicopathologic Study of 26 Cases with Differential Considerations for Metastatic Renal Cell Carcinoma in von Hippel-Lindau Patients
Abstract
Endolymphatic sac tumors (ELSTs) are rare, slowly growing temporal bone neoplasms which show a high association with von Hippel-Lindau (VHL) syndrome. The immunohistochemistry evaluation of these papillary-cystic neoplasms frequently raises the differential diagnosis with renal cell carcinoma, among other metastatic neoplasms, whether in VHL patients or not. A cohort of 26 patients with ELSTs were evaluated for histologic features, immunohistochemistry findings, and association with VHL. Standard immunohistochemistry evaluation was performed. Sixteen females and 10 males ranging in age from 10 to 69 years (mean 44; VHL mean: 32) at initial presentation, comprised the cohort of patients. Most (86%) experienced hearing changes or inner ear symptoms (vertigo, dizziness), with an average duration of symptoms for 39 months (range 2–240 months). The tumors were an average of 2.9 cm (range 0.4–8 cm), with 14 left, 11 right sided and one bilateral tumor. Nine patients had documented VHL, with 3 patients having a concurrent or subsequent clear cell renal cell carcinoma. Patients were followed an average of 6.2 years (available in 24 patients): 19 alive without disease, 7.5 years; 2 dead without disease, 1.2 years; and 3 alive with disease, 3.1 years. The neoplastic cells show the following immunohistochemistry findings: AE1/AE3, EMA, CK7, CAIX, GLUT1, VEGF: 100% of cases tested were positive; pax-8: 85% of cases positive; CD10 and RCC: 0% of cases reactive. Based on this cohort of 26 patients with ELST, 9 of whom had VHL, the strong pax-8 and CAIX should be used in conjunction with negative CD10 and RCC to help exclude a metastatic renal cell carcinoma. As CAIX is an enzyme overexpressed in hypoxia and hypoxia inducible factor is what VHL protein regulates, this is an expected, although previously unreported finding. Whether part of VHL or not, VHL mutations may be a somatic rather than germline finding in the tumors, a possible further explanation for the CAIX reaction.
https://ift.tt/2yiefaH
Three dimensional evaluation of soft tissue after orthognathic surgery
Abstract
Background
To evaluate the nasolabial soft tissue change three-dimensionally after orthognathic surgery, using a structured light scanner.
Methods
Thirty-two malocclusion patients, who underwent orthognathic surgery, were evaluated. CBCT and 3D facial scans were obtained before surgery and 3 months after surgery. The 3D changes in the 26 landmarks, and the relative ratio of the soft tissue movement to the bony movement, were evaluated.
Results
In the Le Fort I advancement patients, the nasal tip moved 17% forward, compared to the maxillary bony movement, but the nasal prominence decreased 15%. The alar width increased 4 mm after the advancement, and the width decreased 4.7 mm after Le Fort I setback. The relative ratio of the soft tissue movement to the bony movement after bilateral sagittal split osteotomy was about 66% at the Li point in the anteroposterior direction, and it was 21% in the Le Fort I advancement and 14% in Le Fort I setback at the Ls point.
Conclusion
Alar cinch suturing may not be sufficient to overcome the effect of the maxilla advancement compressing the nasal complex. Alar width widening was prevented in Le Fort I setback. However, it is uncertain that the alar cinch suturing was solely responsible. The soft tissue around the mandible tends to accompany the bony movement more than the maxillary area. In addition, structured light scanning system proved to be a useful tool to evaluate the nasolabial soft tissue.
https://ift.tt/2BY6fyT
Bite injuries caused by transcranial electrical stimulation motor-evoked potentials’ monitoring: incidence, associated factors, and clinical course
Abstract
Purpose
The incidence of bite injuries associated with transcranial electrical stimulation motor-evoked potentials monitoring reportedly ranges from 0.13 to 0.19%. However, in clinical practice, bite injuries appear to occur more frequently than previously reported. Our aim was to identify the incidence of and perioperative risk factors associated with bite injuries caused by transcranial electrical stimulation motor-evoked potential monitoring.
Methods
Patients who underwent elective surgery with transcranial electrical stimulation motor-evoked potential monitoring at a single tertiary hospital in Japan between June 2017 and December 2017 were included in this study. All patients were assessed by oral surgeons preoperatively and postoperatively. The associated factors with bite injuries were explored by the univariate analysis.
Results
12 of 186 patients experienced 13 bite injuries, including three lip, six oral mucosa, and four tongue injuries. No patient required suture repair. 11 of 12 patients had uneventful postoperative courses and were cured within 12 postoperative days. One patient with a tongue ulcer and a hematoma had difficulty in oral intake and persistent dysgeusia. Patient severe movement during transcranial electrical stimulation motor-evoked potential monitoring was associated with bite injuries (p = 0.03).
Conclusions
The incidence of bite injuries assessed by oral surgeons was 6.5% in patients with transcranial electrical stimulation motor-evoked potential monitoring, and the patients with severe movement during the monitoring tended to incur bite injuries. In rare cases, transcranial electrical stimulation motor-evoked potential monitoring may cause difficulty in oral intake and dysgeusia.
https://ift.tt/2QwltPU
Navigation-guided resection of maxillary tumours: can a new volumetric virtual planning method improve outcomes in terms of control of resection margins?
Publication date: Available online 4 October 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Francesco Ricotta, Laura Cercenelli, Salvatore Battaglia, Barbara Bortolani, Gabriella Savastio, Emanuela Marcelli, Claudio Marchetti, Achille Tarsitano
Summary
Introduction
In the present study, our aim was to confirm the role of navigation-guided surgery in reducing the percentage of positive margins in advanced malignant pathologies of the mid-face, by introducing a new volumetric virtual planning method for resection.
Materials and Methods
Twenty-eight patients were included in this study. Eighteen patients requiring surgery to treat malignant midface tumors were prospectively selected and stratified into two different study groups. Patients enrolled in the Reference Points Resection group (RPR - 10 patients) underwent resection planning using the anatomical landmarks on CT scan; patients enrolled in the Volume Resection group (VR - 8 patients) underwent resection using the new volumetric virtual planning method. The remaining 10 patients (Control group) were treated without the use of a navigation system.
Results
In total, 127 margins were pathologically assessed in the RPR group, 75 in the VR group, and 85 in the control group. In the control group, 16% of the margins were positive, while in the RPR group the value was 9%, and in the VR group 1%.
Conclusions
The volumetric tumor resection planning associated to the navigation-guide resection appeared to be an improvement in terms of control of surgical margins in advanced tumours involving the mid-face.
https://ift.tt/2RsJYi4
Thoracic spinal cord injury without radiologic abnormality in a pediatric patient case report
Abstract
Spinal Cord Injury Without Radiologic Abnormality (SCIWORA) accounts for up to 19% of spinal cord related lesions in pediatric population, mostly comprising the cervical spine. A 2-year-old patient is presented, who suffered a motor-vehicle accident. After being admitted, neither X-Ray nor spinal TC scan showed any structural abnormalities. Neurological examination showed complete sensory and motor loss under T7 as well as bladder and bowel dysfunction. Magnetic resonance imaging (MRI) showed spinal cord lesion extending from T7 to T10. The patient was treated with external immobilization and physical therapy. Thoracic SCIWORA is an uncommon diagnosis that should be considered in pediatric patients who suffer spinal trauma. Spinal cord MRI has proven to be the most accurate modality for diagnosis.https://ift.tt/2y1iKH9
Ectopic jejunal pancreas with pancreatitis mistaken for a post-transplant lymphoproliferative disease in an immunosuppressed kidney transplant patient
Abstract
An ectopic pancreas, also known as pancreatic rest or heterotopic pancreas, consists of pancreatic tissue found in a location with no continuity with the anatomic pancreas. This lesion can occasionally cause gastrointestinal obstruction, ulceration or become inflamed and cause ectopic pancreatitis. We present the case of a 29-year-old immunocompromised female patient due to a previous kidney transplant. She presented with nausea and vague abdominal discomfort and was admitted for investigation and treatment of an acute kidney injury. A small bowel mass of unknown etiology was incidentally found on abdominal computed tomography imaging. Due to the high suspicion of a post-transplant lymphoproliferative disease, a surgical exploration took place and revealed the presence of a pancreatic rest with chronic pancreatitis. Ectopic pancreas diagnosis is challenging and surgical exploration is warranted when a neoplastic process is suspected.https://ift.tt/2PcacDT
Adenocarcinoma arising in a colonic interposition after esophagectomy for benign stricture and review of the literature
Abstract
Colon interposition in oesophageal replacement after oesophagectomy for benign strictures is associated with significant perioperative complications that carry high morbidity and mortality. Long-term sequelae such as further strictures and colonic redundancy are frequent. Adenocarcinoma in the colonic graft is rare. A 70-year-old female presented to our clinic with symptoms of dysphagia. When she was 51 years, she underwent left colonic oesophageal interposition for an oesophageal stricture caused by caustic ingestion. Studies revealed colonic adenocarcinoma in interposed colonic graft, with latero-cervical lymph nodes. She was proposed to neoadjuvant chemotherapy. Although long-term risk analysis is lacking, it's not unreasonable to propose endoscopic screening according to general colonic cancer guidelines in patients with colonic interposition in oesophageal replacement after oesophagectomy.https://ift.tt/2y2UnZX
A Case series of candy cane limb syndrome after laparoscopic Roux-en-Y gastric bypass
Abstract
Candy cane syndrome is a rare complication reported in bariatric patients following Roux-en-Y gastric bypass. It occurs when there is an excessive length of roux limb proximal to gastrojejunostomy, creating the possibility for food particles to lodge and remain in the blind redundant limb. Patients present with non-specific symptoms such as abdominal pain associated with nausea and vomiting. Most remain undiagnosed as the disease process is poorly described. We report three cases of candy cane syndrome treated successfully at our institution.https://ift.tt/2PeE5Dw
Aortic valve reconstruction with autologous pericardium in a patient with osteogenesis imperfecta
Abstract
Cardiac valve surgery for patients with osteogenesis imperfecta is associated with a high incidence of complications such as perioperative bleeding and valve detachment. In this report, we present a patient who was diagnosed with osteogenesis imperfecta and severe aortic insufficiency and also discussed treatment options.https://ift.tt/2y0WcGO
Renal clear cell carcinoma metastasis to submandibular gland: case report and review of the literature
Abstract
Metastases from renal clear cell carcinoma (RCCC) to the head and neck (HN) region are rare, representing 8–14% of all RCCC metastases, with the thyroid gland being the most common site of RCCC metastasis in the HN. Metastatic tumors that are located in the salivary glands have a prevalence of 5%, while the submandibular gland is only involved in 1% of the cases. We present the case of a 74-year-old female patient with metastasis to the submandibular gland, 11 years after radical nephrectomy for a RCCC.https://ift.tt/2P8Jzj7
Ascaris lumbricoides and its almost deadly complication
Abstract
Parasitic infections are still a burden in developing countries. The lack of sanitation and hygiene measures can result in an increase in morbidity and mortality due to parasitic infections. Surgery may be needed to treat serious complications caused by some of these parasites. Ascaris lumbricoides is one of the most common parasites and although infections are usually mild, severe complications, although rare, still exist. We present a case of a patient from the Ecuadorean Amazon region with limited access to drinking water. She presented to the emergency room with abdominal pain and a mass in the abdomen. After surgery, a mass with a perforation due to Ascaris was discovered. After discharge and due to lack of follow up and self-care, she became infected again, this time making her prognosis more complex and her clinical presentation more difficult. However, after proper clinical and surgical management, patient fully recovered.https://ift.tt/2y0Dyif
Continuing Medical Education Calendar
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s):
https://ift.tt/2OHPyOY
Information for Readers
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
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Editorial Board
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
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Table of Contents
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s):
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Brief Overview of This Month's JACI
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s):
https://ift.tt/2OyPAJ9
Cover 1
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s):
https://ift.tt/2NoLKh6
Correction
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s):
https://ift.tt/2OIPgY6
GM-CSF therapy in human caspase recruitment domain–containing protein 9 deficiency
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Rebecca A. Drummond, Fatema Tuz Zahra, Mukil Natarajan, Muthulekha Swamydas, Amy P. Hsu, L. Joseph Wheat, Christina Gavino, Donald C. Vinh, Steven M. Holland, Constantinos M. Mikelis, Michail S. Lionakis
https://ift.tt/2NpTOhv
Nuclear factor (erythroid-derived 2)-like-2 pathway modulates substance P–induced human mast cell activation and degranulation in the hair follicle
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Laura Jadkauskaite, Rajia Bahri, Nilofer Farjo, Bessam Farjo, Gail Jenkins, Ranjit Bhogal, Iain Haslam, Silvia Bulfone-Paus, Ralf Paus
https://ift.tt/2OFZdWc
Evolution of IgE responses to multiple allergen components throughout childhood
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Rebecca Howard, Danielle Belgrave, Panagiotis Papastamoulis, Angela Simpson, Magnus Rattray, Adnan Custovic
Background
There is a paucity of information about longitudinal patterns of IgE responses to allergenic proteins (components) from multiple sources.
Objectives
This study sought to investigate temporal patterns of component-specific IgE responses from infancy to adolescence, and their relationship with allergic diseases.
Methods
In a population-based birth cohort, we measured IgE to 112 components at 6 follow-ups during childhood. We used a Bayesian method to discover cross-sectional sensitization patterns and their longitudinal trajectories, and we related these patterns to asthma and rhinitis in adolescence.
Results
We identified 1 sensitization cluster at age 1, 3 at age 3, 4 at ages 5 and 8, 5 at age 11, and 6 at age 16 years. "Broad" cluster was the only cluster present at every follow-up, comprising components from multiple sources. "Dust mite" cluster formed at age 3 years and remained unchanged to adolescence. At age 3 years, a single-component "Grass" cluster emerged, which at age 5 years absorbed additional grass components and Fel d 1 to form the "Grass/cat" cluster. Two new clusters formed at age 11 years: "Cat" cluster and "PR-10/profilin" (which divided at age 16 years into "PR-10" and "Profilin"). The strongest contemporaneous associate of asthma at age 16 years was sensitization to dust mite cluster (odds ratio: 2.6; 95% CI: 1.2-6.1; P < .05), but the strongest early life predictor of subsequent asthma was sensitization to grass/cat cluster (odds ratio: 3.5; 95% CI: 1.6-7.4; P < .01).
Conclusions
We describe the architecture of the evolution of IgE responses to multiple allergen components throughout childhood, which may facilitate development of better diagnostic and prognostic biomarkers for allergic diseases.
https://ift.tt/2NpTL5j
PD-1 blocks lytic granule polarization with concomitant impairment of integrin outside-in signaling in the natural killer cell immunological synapse
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Yu Huang, Zhiying Chen, Joon Hee Jang, Mirza S. Baig, Grant Bertolet, Casey Schroeder, Shengjian Huang, Qian Hu, Yong Zhao, Dorothy E. Lewis, Lidong Qin, Michael Xi Zhu, Dongfang Liu
Background
The inhibitory receptor programmed cell death protein 1 (PD-1) is upregulated on a variety of immune cells, including natural killer (NK) cells, during chronic viral infection and tumorigenesis. Blockade of PD-1 or its ligands produces durable clinical responses with tolerable side effects in patients with a broad spectrum of cancers. However, the underlying molecular mechanisms of how PD-1 regulates NK cell function remain poorly characterized.
Objective
We sought to determine the effect of PD-1 signaling on NK cells.
Methods
PD-1 was overexpressed in CD16-KHYG-1 (a human NK cell line with both antibody-dependent cellular cytotoxicity through CD16 and natural cytotoxicity through NKG2D) cells and stimulated by exposing the cells to NK-sensitive target cells expressing programmed death ligand 1 (PD-L1).
Results
PD-1 engagement by PD-L1 specifically blocked NK cell–mediated cytotoxicity without interfering with the conjugation between NK cells and target cells. Further examination showed that PD-1 signaling blocked lytic granule polarization in NK cells, which was accompanied by failure of integrin-linked kinase, a key molecule in the integrin outside-in signaling pathway, to accumulate in the immunological synapse after NK–target cell conjugation.
Conclusion
Our results suggest that NK cell cytotoxicity is inhibited by PD-1 engagement, which blocks lytic granule polarization to the NK cell immunological synapse with concomitant impairment of integrin outside-in signaling. This study provides novel mechanistic insights into how PD-1 inhibition disrupts NK cell function.
Graphical abstract
https://ift.tt/2OFZatu
ORAI1 mutations abolishing store-operated Ca2+ entry cause anhidrotic ectodermal dysplasia with immunodeficiency
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Jayson Lian, Mario Cuk, Sascha Kahlfuss, Lina Kozhaya, Martin Vaeth, Frédéric Rieux-Laucat, Capucine Picard, Melina J. Benson, Antonia Jakovcevic, Karmen Bilic, Iva Martinac, Peter Stathopulos, Imre Kacskovics, Thomas Vraetz, Carsten Speckmann, Stephan Ehl, Thomas Issekutz, Derya Unutmaz, Stefan Feske
Background
Store-operated Ca2+ entry (SOCE) through Ca2+ release–activated Ca2+ channels is an essential signaling pathway in many cell types. Ca2+ release–activated Ca2+ channels are formed by ORAI1, ORAI2, and ORAI3 proteins and activated by stromal interaction molecule (STIM) 1 and STIM2. Mutations in the ORAI1 and STIM1 genes that abolish SOCE cause a combined immunodeficiency (CID) syndrome that is accompanied by autoimmunity and nonimmunologic symptoms.
Objective
We performed molecular and immunologic analysis of patients with CID, anhidrosis, and ectodermal dysplasia of unknown etiology.
Methods
We performed DNA sequencing of the ORAI1 gene, modeling of mutations on ORAI1 crystal structure, analysis of ORAI1 mRNA and protein expression, SOCE measurements, immunologic analysis of peripheral blood lymphocyte populations by using flow cytometry, and histologic and ultrastructural analysis of patient tissues.
Results
We identified 3 novel autosomal recessive mutations in ORAI1 in unrelated kindreds with CID, autoimmunity, ectodermal dysplasia with anhidrosis, and muscular dysplasia. The patients were homozygous for p.V181SfsX8, p.L194P, and p.G98R mutations in the ORAI1 gene that suppressed ORAI1 protein expression and SOCE in the patients' lymphocytes and fibroblasts. In addition to impaired T-cell cytokine production, ORAI1 mutations were associated with strongly reduced numbers of invariant natural killer T and regulatory T (Treg) cells and altered composition of γδ T-cell and natural killer cell subsets.
Conclusion
ORAI1 null mutations are associated with reduced numbers of invariant natural killer T and Treg cells that likely contribute to the patients' immunodeficiency and autoimmunity. ORAI1-deficient patients have dental enamel defects and anhidrosis, representing a new form of anhidrotic ectodermal dysplasia with immunodeficiency that is distinct from previously reported patients with anhidrotic ectodermal dysplasia with immunodeficiency caused by mutations in the nuclear factor κB signaling pathway (IKBKG and NFKBIA).
Graphical abstract
https://ift.tt/2NpTKhL
Loss-of-function nuclear factor κB subunit 1 (NFKB1) variants are the most common monogenic cause of common variable immunodeficiency in Europeans
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Paul Tuijnenburg, Hana Lango Allen, Siobhan O. Burns, Daniel Greene, Machiel H. Jansen, Emily Staples, Jonathan Stephens, Keren J. Carss, Daniele Biasci, Helen Baxendale, Moira Thomas, Anita Chandra, Sorena Kiani-Alikhan, Hilary J. Longhurst, Suranjith L. Seneviratne, Eric Oksenhendler, Ilenia Simeoni, Godelieve J. de Bree, Anton T.J. Tool, Ester M.M. van Leeuwen
Background
The genetic cause of primary immunodeficiency disease (PID) carries prognostic information.
Objective
We conducted a whole-genome sequencing study assessing a large proportion of the NIHR BioResource–Rare Diseases cohort.
Methods
In the predominantly European study population of principally sporadic unrelated PID cases (n = 846), a novel Bayesian method identified nuclear factor κB subunit 1 (NFKB1) as one of the genes most strongly associated with PID, and the association was explained by 16 novel heterozygous truncating, missense, and gene deletion variants. This accounted for 4% of common variable immunodeficiency (CVID) cases (n = 390) in the cohort. Amino acid substitutions predicted to be pathogenic were assessed by means of analysis of structural protein data. Immunophenotyping, immunoblotting, and ex vivo stimulation of lymphocytes determined the functional effects of these variants. Detailed clinical and pedigree information was collected for genotype-phenotype cosegregation analyses.
Results
Both sporadic and familial cases demonstrated evidence of the noninfective complications of CVID, including massive lymphadenopathy (24%), unexplained splenomegaly (48%), and autoimmune disease (48%), features prior studies correlated with worse clinical prognosis. Although partial penetrance of clinical symptoms was noted in certain pedigrees, all carriers have a deficiency in B-lymphocyte differentiation. Detailed assessment of B-lymphocyte numbers, phenotype, and function identifies the presence of an increased CD21low B-cell population. Combined with identification of the disease-causing variant, this distinguishes between healthy subjects, asymptomatic carriers, and clinically affected cases.
Conclusion
We show that heterozygous loss-of-function variants in NFKB1 are the most common known monogenic cause of CVID, which results in a temporally progressive defect in the formation of immunoglobulin-producing B cells.
Graphical abstract
https://ift.tt/2OFZ8So
Autonomous role of Wiskott-Aldrich syndrome platelet deficiency in inducing autoimmunity and inflammation
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Lucia Sereni, Maria Carmina Castiello, Francesco Marangoni, Achille Anselmo, Dario di Silvestre, Sara Motta, Elena Draghici, Stefano Mantero, Adrian J. Thrasher, Silvia Giliani, Alessandro Aiuti, Pierluigi Mauri, Luigi D. Notarangelo, Marita Bosticardo, Anna Villa
Background
Wiskott-Aldrich syndrome (WAS) is an X-linked immunodeficiency characterized by eczema, infections, and susceptibility to autoimmunity and malignancies. Thrombocytopenia is a constant finding, but its pathogenesis remains elusive.
Objective
To dissect the basis of the WAS platelet defect, we used a novel conditional mouse model (CoWas) lacking Wiskott-Aldrich syndrome protein (WASp) only in the megakaryocytic lineage in the presence of a normal immunologic environment, and in parallel we analyzed samples obtained from patients with WAS.
Methods
Phenotypic and functional characterization of megakaryocytes and platelets in mutant CoWas mice and patients with WAS with and without autoantibodies was performed. Platelet antigen expression was examined through a protein expression profile and cluster proteomic interaction network. Platelet immunogenicity was tested by using ELISAs and B-cell and platelet cocultures.
Results
CoWas mice showed increased megakaryocyte numbers and normal thrombopoiesis in vitro, but WASp-deficient platelets had short lifespan and high expression of activation markers. Proteomic analysis identified signatures compatible with defects in cytoskeletal reorganization and metabolism yet surprisingly increased antigen-processing capabilities. In addition, WASp-deficient platelets expressed high levels of surface and soluble CD40 ligand and were capable of inducing B-cell activation in vitro. WASp-deficient platelets were highly immunostimulatory in mice and triggered the generation of antibodies specific for WASp-deficient platelets, even in the context of a normal immune system. Patients with WAS also showed platelet hyperactivation and increased plasma soluble CD40 ligand levels correlating with the presence of autoantibodies.
Conclusion
Overall, these findings suggest that intrinsic defects in WASp-deficient platelets decrease their lifespan and dysregulate immune responses, corroborating the role of platelets as modulators of inflammation and immunity.
Graphical abstract
https://ift.tt/2NpdfXU
CCL19-producing fibroblastic stromal cells restrain lung carcinoma growth by promoting local antitumor T-cell responses
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Hung-Wei Cheng, Lucas Onder, Jovana Cupovic, Maximilian Boesch, Mario Novkovic, Natalia Pikor, Ignazio Tarantino, Regulo Rodriguez, Tino Schneider, Wolfram Jochum, Martin Brutsche, Burkhard Ludewig
Background
A particular characteristic of non–small cell lung cancer is the composition of the tumor microenvironment with a very high proportion of fibroblastic stromal cells (FSCs).
Objective
Lapses in our basic knowledge of fibroblast phenotype and function in the tumor microenvironment make it difficult to define whether FSC subsets exist that exhibit either tumor-promoting or tumor-suppressive properties.
Methods
We used gene expression profiling of lung versus tumor FSCs from patients with non–small cell lung cancer. Moreover, CCL19-expressing FSCs were studied in transgenic mouse models by using a lung cancer metastasis model.
Results
CCL19 mRNA expression in human tumor FSCs correlates with immune cell infiltration and intratumoral accumulation of CD8+ T cells. Mechanistic dissection in murine lung carcinoma models revealed that CCL19-expressing FSCs form perivascular niches to promote accumulation of CD8+ T cells in the tumor. Targeted ablation of CCL19-expressing tumor FSCs reduced immune cell recruitment and resulted in unleashed tumor growth.
Conclusion
These data suggest that a distinct population of CCL19-producing FSCs fosters the development of an immune-stimulating intratumoral niche for immune cells to control cancer growth.
Graphical abstract
https://ift.tt/2OIQd2Y
A Jagged 1–Notch 4 molecular switch mediates airway inflammation induced by ultrafine particles
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Mingcan Xia, Hani Harb, Arian Saffari, Constantinos Sioutas, Talal A. Chatila
Background
Exposure to traffic-related particulate matter promotes asthma and allergic diseases. However, the precise cellular and molecular mechanisms by which particulate matter exposure acts to mediate these effects remain unclear.
Objective
We sought to elucidate the cellular targets and signaling pathways critical for augmentation of allergic airway inflammation induced by ambient ultrafine particles (UFP).
Methods
We used in vitro cell-culture assays with lung-derived antigen-presenting cells and allergen-specific T cells and in vivo mouse models of allergic airway inflammation with myeloid lineage-specific gene deletions, cellular reconstitution approaches, and antibody inhibition studies.
Results
We identified lung alveolar macrophages (AM) as the key cellular target of UFP in promoting airway inflammation. Aryl hydrocarbon receptor–dependent induction of Jagged 1 (Jag1) expression in AM was necessary and sufficient for augmentation of allergic airway inflammation by UFP. UFP promoted TH2 and TH17 cell differentiation of allergen-specific T cells in a Jag1- and Notch 4–dependent manner. Treatment of mice with an anti–Notch 4 antibody abrogated exacerbation of allergic airway inflammation induced by UFP.
Conclusion
UFP exacerbate allergic airway inflammation by promoting a Jag1-Notch 4–dependent interaction between AM and allergen-specific T cells, leading to augmented TH cell differentiation.
Graphical abstract
https://ift.tt/2NniRlf
Pathogenic TH17 inflammation is sustained in the lungs by conventional dendritic cells and Toll-like receptor 4 signaling
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Karim H. Shalaby, Miranda R. Lyons-Cohen, Gregory S. Whitehead, Seddon Y. Thomas, Immo Prinz, Hideki Nakano, Donald N. Cook
Background
Mechanisms that elicit mucosal TH17 cell responses have been described, yet how these cells are sustained in chronically inflamed tissues remains unclear.
Objective
We sought to understand whether maintenance of lung TH17 inflammation requires environmental agents in addition to antigen and to identify the lung antigen-presenting cell (APC) types that sustain the self-renewal of TH17 cells.
Methods
Animals were exposed repeatedly to aspiration of ovalbumin alone or together with environmental adjuvants, including common house dust extract (HDE), to test their role in maintaining lung inflammation. Alternatively, antigen-specific effector/memory TH17 cells, generated in culture with CD4+ T cells from Il17a fate-mapping mice, were adoptively transferred to assess their persistence in genetically modified animals lacking distinct lung APC subsets or cell-specific Toll-like receptor (TLR) 4 signaling. TH17 cells were also cocultured with lung APC subsets to determine which of these could revive their expansion and activation.
Results
TH17 cells and the consequent neutrophilic inflammation were poorly sustained by inhaled antigen alone but were augmented by inhalation of antigen together with HDE. This was associated with weight loss and changes in lung physiology consistent with interstitial lung disease. The effect of HDE required TLR4 signaling predominantly in lung hematopoietic cells, including CD11c+ cells. CD103+ and CD11b+ conventional dendritic cells interacted directly with TH17 cells in situ and revived the clonal expansion of TH17 cells both ex vivo and in vivo, whereas lung macrophages and B cells could not.
Conclusion
TH17-dependent inflammation in the lungs can be sustained by persistent TLR4-mediated activation of lung conventional dendritic cells.
https://ift.tt/2OEE135
Tripartite motif-containing (TRIM) 21 negatively regulates intestinal mucosal inflammation through inhibiting TH1/TH17 cell differentiation in patients with inflammatory bowel diseases
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Guangxi Zhou, Wei Wu, Lin Yu, Tianming Yu, Wenjing Yang, Ping Wang, Xiaoping Zhang, Yingzi Cong, Zhanju Liu
Background
Tripartite motif-containing (TRIM) 21 has been implicated in the pathogenesis of several types of autoimmune diseases.
Objective
We sought to elucidate TRIM21 expression in patients with inflammatory bowel diseases (IBDs) and its role in regulating intestinal mucosal inflammation.
Methods
TRIM21 expression was analyzed in the inflamed mucosa of patients with IBDs by means of quantitative RT-PCR and immunohistochemistry. Peripheral blood CD4+ T cells were transfected with lentivirus-expressing TRIM21 (LV-TRIM21) or LV-sh-TRIM21, and cytokine expression was determined by using quantitative RT-PCR and ELISA. TRIM21−/− mice were generated, and trinitrobenzene sulfonic acid– and CD45RBhighCD4+ T cell–induced colitis models were established to determine its role in induction of intestinal inflammation.
Results
TRIM21 was expressed predominantly in CD4+ T cells and decreased markedly in the inflamed mucosa of patients with IBDs compared with healthy control subjects. Ectopic expression of TRIM21 inhibited IBD CD4+ T cells to differentiate into TH1 and TH17 cells, whereas downregulation of TRIM21 had the opposite effects. TRIM21−/− mice had more severe colitis after administration of trinitrobenzene sulfonic acid compared with wild-type mice, which was characterized by increased expression of IFN-γ, TNF-α, and IL-17A in the colon. TRIM21−/−CD45RBhighCD4+ T cells reconstituted into recombination-activating gene (Rag1)−/− mice induced more severe colitis than in wild-type control mice. Mechanistically, interferon regulatory factor 3 was identified as a functional downstream target of TRIM21 in that silencing of interferon regulatory factor 3 suppressed TRIM21−/−CD4+ T-cell differentiation into TH1 and TH17 cells.
Conclusions
TRIM21 plays a protective role in mucosal inflammation through inhibiting TH1 and TH17 cell differentiation. Thus TRIM21 might serve as a potential therapeutic target for the treatment of IBDs.
https://ift.tt/2NkaVkR
Cysteinyl leukotriene receptor 1 expression identifies a subset of neutrophils during the antiviral response that contributes to postviral atopic airway disease
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Dorothy S. Cheung, Jerome A. Sigua, Pippa M. Simpson, Ke Yan, Syed-Rehan A. Hussain, Jennifer L. Santoro, Erika J. Buell, Desire A. Hunter, Michelle Rohlfing, Deepa Patadia, Mitchell H. Grayson
Background
Viral respiratory tract infections increase the risk of development and exacerbation of atopic disease. Previously, we demonstrated the requirement for a neutrophil (PMN) subset expressing CD49d to drive development of postviral atopic airway disease in mice.
Objective
We sought to determine whether human CD49d+ PMNs are present in the nasal mucosa during acute viral respiratory tract infections and further characterize this PMN subset in human subjects and mice.
Methods
Sixty subjects (5-50 years old) were enrolled within 4 days of acute onset of upper respiratory symptoms. Nasal lavage for flow cytometry and nasal swabs for viral PCR were performed at enrollment and during convalescence. The Sendai virus mouse model was used to investigate the phenotype and functional relevance of CD49d+ PMNs.
Results
CD49d+ PMN frequency was significantly higher in nasal lavage fluid during acute respiratory symptoms in all subjects (2.9% vs 1.0%, n = 42, P < .001). In mice CD49d+ PMNs represented a "proatopic" neutrophil subset that expressed cysteinyl leukotriene receptor 1 (CysLTR1) and produced TNF, CCL2, and CCL5. Inhibition of CysLTR1 signaling in the first days of a viral respiratory tract infection was sufficient to reduce accumulation of CD49d+ PMNs in the lungs and development of postviral atopic airway disease. Similar to the mouse, human CD49d+ PMNs isolated from nasal lavage fluid during a viral respiratory tract infection expressed CysLTR1.
Conclusion
CD49d and CysLTR1–coexpressing PMNs are present during symptoms of an acute viral respiratory tract infection in human subjects. Further study is needed to examine selective targeting of proatopic neutrophils as a potential therapeutic strategy to prevent development of postviral atopic airway disease.
Graphical abstract
https://ift.tt/2OArptT
Treating insect-bite hypersensitivity in horses with active vaccination against IL-5
Publication date: October 2018
Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 4
Author(s): Antonia Fettelschoss-Gabriel, Victoria Fettelschoss, Franziska Thoms, Christoph Giese, Michelle Daniel, Florian Olomski, Jivko Kamarachev, Katharina Birkmann, Maya Bühler, Martin Kummer, Andris Zeltins, Eliane Marti, Thomas M. Kündig, Martin F. Bachmann
Background
Insect-bite hypersensitivity is the most common allergic dermatitis in horses. Excoriated skin lesions are typical symptoms of this seasonal and refractory chronic disease. On a cellular level, the skin lesions are characterized by massive eosinophil infiltration caused by an underlying allergic response.
Objective
To target these cells and treat disease, we developed a therapeutic vaccine against equine IL-5 (eIL-5), the master regulator of eosinophils.
Methods
The vaccine consisted of eIL-5 covalently linked to a virus-like particle derived from cucumber mosaic virus containing the tetanus toxoid universal T-cell epitope tt830-843 (CMVTT). Thirty-four Icelandic horses were recruited and immunized with 400 μg of eIL-5–CMVTT formulated in PBS without adjuvant (19 horses) or PBS alone (15 horses).
Results
The vaccine was well tolerated and did not reveal any safety concerns but was able to induce anti–eIL-5 autoantibody titers in 17 of 19 horses. This resulted in a statistically significant reduction in clinical lesion scores when compared with previous season levels, as well as levels in placebo-treated horses. Protection required a minimal threshold of anti–eIL-5 antibodies. Clinical improvement by disease scoring showed that 47% and 21% of vaccinated horses reached 50% and 75% improvement, respectively. In the placebo group no horse reached 75% improvement, and only 13% reached 50% improvement.
Conclusion
Our therapeutic vaccine inducing autoantibodies against self IL-5 brings biologics to horses, is the first successful immunotherapeutic approach targeting a chronic disease in horses, and might facilitate development of a similar vaccine against IL-5 in human subjects.
Graphical abstract
https://ift.tt/2NoeZAv
Histiocytome fibreux angiomatoïde de la gouttière du pouls radial
Publication date: Available online 4 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): L. Jelti, M. Alorini, C. Boivin, P. Courville, X. Balguerie, A. Bonmarchand, E. Angot
Résumé
Introduction
L'histiocytome fibreux angiomatoïde (HFA) est une tumeur rare des tissus mous, de malignité intermédiaire, à évolution lente, touchant principalement les enfants et les adultes jeunes, localisée préférentiellement aux extrémités. Sa rareté et sa présentation clinique non spécifique rendent son diagnostic difficile.
Observation
Un adolescent de 16 ans présentait depuis plusieurs années un nodule isolé, d'apparition spontanée, au sein de la gouttière du pouls radial droit. Une exérèse chirurgicale épargnant les structures anatomiques nobles était effectuée. L'examen histologique mettait en évidence une lésion tumorale d'architecture plurinodulaire, limitée par une pseudo-capsule fibreuse, constituée de cellules histiocytoïdes ou fusiformes disposées en faisceaux courts. Il s'y associait une réaction lympho-plasmocytaire d'architecture nodulaire en périphérie. Les cellules tumorales exprimaient la desmine, l'actine muscle lisse, le CD99 et l'antigène de membrane épithéliale EMA. Un transcrit de fusion EWSR1-ATF1 était mis en évidence.
Discussion
Les lésions d'HFA sont peu spécifiques et de diagnostic anatomopathologique. L'exérèse élargie recommandée a été, chez notre patient, limitée par la localisation complexe de la lésion, au contact de structures anatomiques majeures vasculo-nerveuses et fonctionnelles. L'examen histologique de la pièce d'exérèse chirurgicale, associé à la recherche du gène de fusion, a permis de porter le diagnostic. Après discussion en réunion de concertation pluridisciplinaire, une surveillance au long cours a été décidée.
Summary
Background
Angiomatoid fibrous histiocytoma (AFH) is a slowly progressing rare soft-tissue tumour of moderate malignant potential. It is most commonly seen in children and young adults. Clinically, the lesion is easily confused with a haematoma or soft-tissue haemangioma, and the radiological aspects are not specific.
Patients and methods
A 16-year-old male patient presented with a nodular lesion situated very close to the right radial artery, vein and nerve and which had been developing for several years. Surgical resection was carried out with sparing of vasculonervous and functional structures. Histological examination revealed a tumour of plurinodular architecture, surrounded by a fibrous pseudocapsule consisting of histiocytoid or fusiform cells in short bundles associated with a mononuclear inflammatory reaction of nodular architecture. The tumour cells expressed the following immunomarkers: desmin, smooth muscle actin, CD99, and epithelial membrane antigen. Fusion transcript EWSR1-ATF1 was found.
Discussion
In this case, as occurs in the literature, a diagnosis of AFH was not made on clinical examination or imaging. The enlarged excision normally recommended was greatly restricted in our patient due to the complex localization of the lesion, which was in contact with major anatomical structures. The diagnosis was based on histological examination of the surgical excision and identification of the fusion gene. Long-term follow-up is required to detect local recurrence or metastasis. Management is decided in multidisciplinary meetings.
https://ift.tt/2QtV5G8
Odontogenic tumours and lesions from 1992-2016 in a single specialist Oral and Maxillofacial Pathology Unit in the United Kingdom
Publication date: Available online 5 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): B.S.M.S. Siriwardena, Hannah Crane, Niall O'Neill, Rasha Abdelkarim, Daniel J. Brierley, Christopher D. Franklin, Paula M. Farthing, Paul M. Speight, Keith D. Hunter
Abstract
Objectives
Odontogenic tumours (ODTs) are a heterogeneous group of lesions derived from elements of the tooth-forming tissues. There are no published detailed data on the incidence of odontogenic tumours in the UK.
Aim
to retrospectively describe the range and incidence of odontogenic tumours from 1992-2016 in a single specialist unit and to compare this with other populations.
Study Design
Using the Oral and Maxillofacial Pathology database, Sheffield, both local and referred consultation cases were included. A proportion of diagnoses were re-classified in accordance with the 2017 WHO classification.
Results
In total, 559 odontogenic tumours were diagnosed. Overall, the most common lesions were ameloblastoma (196; 33.8%), odontome (148; 25.5%) and odontogenic myxoma (37; 6.3%), but this varied between local and referral case populations, with odontomes most common in the local population (43%). The sites affected, gender and age of patients were similar to other western populations. Malignant ODTs comprised 33 cases (5.7%), of which nine (27.3%) were ameloblastic carcinoma. The majority of the malignant ODTs were referral cases.
Conclusions
These are the first detailed data on odontogenic tumours within a UK population and the pattern of incidence from the local population is similar to other western populations. The exceptional rarity of malignant ODTs emphasises the need for specialist centres in order to gain diagnostic experience.
https://ift.tt/2yk5UmI
Is splint therapy required after arthrocentesis to improve outcome in the management of temporomandibular joint disorders? A systematic review and meta-analysis
Publication date: Available online 5 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Shakil Ahmed Nagori, Anson Jose, Sanjay Kumar Roy Chowdhury, Ajoy Roychoudhury
Abstract
Objective
The aim of this systematic review was to assess the efficacy of splint therapy in improving outcomes after arthrocentesis for the management of temporomandibular joint disorders.
Study design
A comprehensive electronic search was conducted to search for randomised control trials (RCTs), controlled clinical trials (CCTs) and retrospective studies comparing arthrocentesis and splint therapy with arthrocentesis alone.
Results
Six studies were included in this review. There was no statistical significant difference in pain reduction with or without the use of splint after arthrocentesis at 1 month (fixed: WMD= -0.01, 95% CI -0.46 to 0.44; P= 0.96, I2=0%) and 6 months (fixed: WMD= -0.08, 95% CI -0.27 to 0.42; P= 0.66, I2=0%). Similarly, no difference was seen in improvement in maximal mouth opening at 1 month (fixed: WMD= -0.16, 95% CI -1.75 to 1.42; P= 0.84, I2=44%) and 6 months (fixed: WMD= -0.83, 95% CI -0.52 to 2.18; P= 0.23, I2=0%).
Conclusions
Within the limitation of this review, there is some evidence that, splint therapy may not improve outcomes after arthrocentesis. There is a need of well-designed RCT evaluating the additional benefit of splint therapy after arthrocentesis for managing temporomandibular joint disorders.
https://ift.tt/2RrPz8e
The use of radiation therapy in the definitive management of ameloblastic carcinoma: A case report
Publication date: Available online 5 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Takayuki Aoki, Takeshi Akiba, Yusuke Kondo, Masashi Sasaki, Hiroshi Kajiwara, Yoshihide Ota
Abstract
Although rare, ameloblastic carcinoma (AC), is one of the most common malignant tumors that arises from odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radio-resistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an elderly patient with maxillary AC and underlying medical problems who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. Based on our findings, RTx for AC might represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely.
https://ift.tt/2yixBML
HIF-1α, NOTCH1, ADAM12 and HB-EGF are overexpressed in mucoepidermoid carcinoma
Publication date: Available online 5 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Dimitra Castelo Branco, Natacha Malu Miranda da Costa, Caio Tadashi Saab Abe, Maria Sueli da Silva Kataoka, João de Jesus Viana Pinheiro, Júnior Sérgio de Melo Alves
Abstract
Objective
Intratumoral hypoxia (IH) occurs during cellular proliferation of malignant tumors. This phenomenon is characterized by a decrease in oxygen levels in the neoplastic microenvironment. Throughout this condition, HIF-1α, NOTCH1, ADAM12, and HB-EGF proteins can be activated, triggering signaling pathways associated with tumor invasiveness through invadopodia formation. This study aimed to evaluate the immunostaining of HIF-1α, NOTCH1, ADAM12, and HBEGF in 19 cases of mucoepidermoid carcinoma (MEC) and 10 samples of salivary glands (control group).
Study Design
The immunoperoxidase technique was employed to detect the proteins of interest. A Student´s t-test was used to compare immunoexpression between MEC samples and the control group
Results
Protein immunostaining was statistically significantly higher in MEC samples than in the control group (p < 0.01), and the proteins were especially overexpressed in epidermoid cells of MEC
Conclusion
We suggest an association between the NOTCH1 signaling pathway activated by IH and the biologic behavior of MEC.
https://ift.tt/2Rv3ASW
In Memoriam: Ines Velez, DDS, MS
Publication date: Available online 5 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael A. Siegel
https://ift.tt/2ygpMr4
A Review of the Microbiology of Submandibular Space Infections
Abstract
Introduction
The submandibular space is part of the deep neck fascial spaces. Infection within these spaces can cause significant mortality and morbidity.
Materials and methods
The study is a review of the microbiology of the submandibular space infections seen at the tertiary academic referral hospitals, University of the Witwatersrand. The period of the study is from January 1, 2006, to December 31, 2006. Ninety-three patients were reviewed of which 52 had aspirates taken. The predominant microorganisms were the gram-positive anaerobic cocci. A literature search for this category of infection was also conducted.
Conclusion
The most commonly isolated microorganisms were the gram-positive cocci.
https://ift.tt/2NtJG7C
Pre-treatment with MELAMIL TRIPTO® induces sleep in children undergoing Auditory Brain Response (ABR) testing
Publication date: Available online 4 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): A. Della Volpe, L. Dipietro, G.P. Ricci, V. Pastore, M. Paccone, C. Pirozzi, A. Di Stadio
Abstract
Objectives
Previous studies have shown that tryptophan and vitamin B6 used in conjunction with melatonin induce sleep more effectively than melatonin alone. This study aims at evaluating the efficacy of different dosages and timings of administration of a solution containing melatonin, tryptophan, and vitamin B6 for inducing sleep in children undergoing ABR testing.
Methods
294 children scheduled for Auditory Brain Response (ABR) evaluation were administered a solution containing melatonin, tryptophan, and vitamin B6 to induce sleep before the exam. Two different administration timings (pre-treatment and single shot treatment) and three dosages (0.5 ml in pre-treatment, 1.5 ml in pre-treatment, and 3 ml in single shot) were tested. The following parameters were evaluated: time needed for the subject to fall asleep before ABR testing, subject sl'eep features during ABR testing (quality, stability, duration), recorded ABR quality (including presence of abnormalities in amplitude and latency), subject waking up modality, and time needed for the subject to wake up at the end of the ABR exam.
Results
Quality of ABR signals was similar across treatments, and subjects responded in a similar manner in terms of time needed to wake-up and wake-up modality. However, pretreatment with the1.5 ml dose induced sleep faster than the two other dosages, and the length of the induced sleep was longer than that induced by pre-treatment with 0.5ml. In general, the pre-treatment with 1.5 ml led to a shorter ABR exam, because reduces the time for inducing sleep, allows a long sleeping phase with a good quality, without variation in the wakening up times.
Conclusions
Melamil Tripto® is an alternative to sedative drugs for inducing spontaneous sleep in pediatric subjects undergoing ABR testing. A pre-medication with 1.5 ml of MT 1 week before ABR testing further improves the strength of the solution.
https://ift.tt/2OIHe1o
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