Sleeping beauty syndrome presenting with insomnia

A young man previously diagnosed with Kleine-Levin syndrome (KLS) presented with abnormal behaviour over the last 8 days. This included decreased sleeping hours and appetite, hypersexuality, aggressiveness and visual hallucinations. All blood tests and investigations in the emergency department yielded normal results. A preliminary diagnosis of a KLS episode with psychosis was made and the patient was started on a regimen of aripiprazole 10 mg once daily along with lorazepam 2 mg intravenously in two divided doses in the event of agitation or insomnia. On discharge 5 days later, the patient had returned to his premorbid level of functioning and was willing to follow up in the neurology clinic. He was discharged on aripiprazole 10 mg once daily and lorazepam 2 mg two times daily as needed for 2 weeks to help with his agitation and insomnia, as well as lithium carbonate 400 mg at night.

https://ift.tt/2RMAyOr

Takotsubo syndrome with severe bradycardia initiated by seizure: Is the implantation of a permanent pacemaker necessary?

Although arrhythmias are frequent in patients with Takotsubo syndrome (TTS), data on sick sinus syndrome remain elusive. Here, we report a case of TTS initiated by a seizure as a physical trigger that led to sinus arrest. The patient presented with cardiogenic shock and bradycardia which required intensive cardiovascular care. However, in the subacute phase of TTS, the sinus function recovered significantly, and pacemaker implantation was deferred.

https://ift.tt/2Eg1l2Y

Living donor renal transplant in a patient with end-stage renal disease due to Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome (HPS) is a rare genetic disorder characterised by oculocutaneous albinism, bleeding diathesis and end-stage renal disease (ESRD), due to interstitial deposition of ceroid lipofuscin. Renal transplantation is potentially a definitive treatment option for patients with ESRD due to HPS. Herein, we describe the case of a 55-year-old male patient with HPS that successfully underwent a living donor kidney transplant. We also emphasise the importance of multidisciplinary input during the preoperative, perioperative and postoperative phases in this high-risk clinical scenario.

https://ift.tt/2RLPNav

Living donor liver transplantation and situs inversus totalis: cutting the Gordian knot

Liver transplantation for biliary atresia splenic malformation syndrome associated with situs inversus totalis is a challenging task due to the complexity of associated malformations and the technical proficiency required to overcome them. We present the case of a 6-month-old infant who underwent liver transplantation for biliary atresia. A reduced left lateral segment liver graft from a live donor (his mother) was implanted. The postoperative period was uneventful, and the child remained well on follow-up. Thus, such rare congenital anomalies no longer prove to be a deterrent for successful liver transplantation.

https://ift.tt/2EfGpt2

Unusual case of unilateral conductive hearing loss: chronic lymphocytic leukaemia

This presentation reports a novel case of chronic lymphocytic leukaemia (CLL), presenting with an early cutaneous lesion within the external auditory canal, in a patient being assessed for conductive hearing loss. It has previously been reported that infiltrative CLL can involve the head and neck; however, isolated external ear canal involvement is rare. Given that the incidence of CLL in Australia is rising, this case highlights the importance of considering CLL as a differential diagnosis for presentations of unilateral conductive hearing loss.

https://ift.tt/2RMAuyb

Corneal ulcer as the presenting feature of type 2 diabetes mellitus

A 60-year-old woman, with no significant medical or ophthalmic history, presented with a unilateral large corneal ulcer and hypopyon. Despite a severely injected conjunctiva and large corneal epithelial defect, the patient denied any discomfort in the eye. The ulcer was extremely slow to heal requiring prolonged treatment with topical and systemic broad-spectrum antibiotics. Due to the corneal opacification, fundal examination was not possible. Subsequent examination of the fellow eye revealed an appearance consistent with proliferative diabetic retinopathy. She was given treatment with panretinal laser photocoagulation. There was no history of diabetes and the patient denied experiencing any of the classical symptoms of hyperglycaemia. With blood tests revealing a raised plasma glucose and Haemoglobin A1c (HbA1c), a new diagnosis of diabetes mellitus was made. With the commencement of treatment for diabetes, there were signs of improvement in the corneal appearance.

https://ift.tt/2EjtOVF

Mesenteric panniculitis: diagnostic precision

A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.

https://ift.tt/2RMArT1

Bilateral congenital eventration of diaphragm: keep in mind, the other side

Eventration of diaphragm is an uncommon disorder in which diaphragmatic muscle is replaced by fibroelastic tissue, either partially or completely. Bilateral eventration is even rarer. We present a case of bilateral eventration of diaphragm in newborn with a fibroelastic sac on left side and diaphragmatic eventration with good muscular lips on right side. The right-sided diaphragmatic eventration was not evident initially, but manifested after surgical repair of the left-sided eventration.

https://ift.tt/2EqQWBY

Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt

A 6-month-old boy presented with painless right hemiscrotal swelling. The scrotal ultrasound revealed a cerebrospinal fluid hydrocele caused by the migration of a ventriculoperitoneal shunt (VPS) catheter tip into the right hemiscrotum and associated undescended left testis. Earlier, he underwent a VPS placement for hydrocephalus secondary to neonatal bacterial meningitis and ventriculitis. The patient was treated with bilateral herniotomy, left-sided orchidopexy and repositioning of VPS into the peritoneal cavity.

https://ift.tt/2RFDjBn

Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor

We report a case of Staphylococcus aureus endocarditis, with large vegetation, in a 17-month-old male infant, complicated with meningitis, ischaemic strokes and osteoarthritis leading to haemorrhagic stroke by aneurysm rupture. He did not present any risk factor for endocarditis. The final course was favourable through, after valve replacement. The strain was sensible to methicillin and belongs to complex clonal 398, with accessory gene regulator I. We did not found immunodeficiency.

https://ift.tt/2Eg0Cig

Unilateral localized extraocular muscle metastasis by lobular breast carcinoma

Here is a case of an isolated orbital metastasis in a previously diagnosed metastatic breast cancer of a 46-year-old woman presenting diplopia and pain in her left eye. The magnetic resonance showed a suspected metastatic localisation in the upper left oblique muscle, which was confirmed by the fine-needle aspiration biopsy. The systemic therapy with liposomal doxorubicin as well as local stereotactic radiotherapy showed a gradual improvement of the local symptoms and signs.

https://ift.tt/2RMAn5J

A snotty nose: more than just a cold

Description 

A healthy 3-year-old girl presented with a 5-day history of right-sided cheek and eye swelling and pain, associated with right-sided green nasal discharge. Examination revealed diffuse erythematous swelling around the right cheek, jawline and eye. Oral antibiotics for suspected periorbital cellulitis were ineffective. Blood inflammatory markers and ultrasound of her neck and parotid glands were normal. She was discharged as having viral parotitis. Antibiotics and nasal drops were later restarted for clinical sinusitis; however, she showed no improvement, now having 3 weeks of right-sided facial swelling with thick green and intermittently bloody nasal discharge. Further history revealed possible squint, mastication pain and breathing difficulty through the right nostril.

Cranial imaging (figure 1) demonstrated a large central but predominantly right-sided nasopharyngeal tumour, extending into the ethmoid sinuses and orbits (with medial recti distortion), infratemporal fossa and pterygoid muscles and anterior and middle cranial fossae. There was...

https://ift.tt/2Eg0y20

Disseminated nocardiosis with infective endocarditis of a transplanted heart

Nocardiosis is caused by various species of Nocardia and typically occurs as an opportunistic infection. It frequently disseminates, most often involving the lungs, subcutaneous tissues and central nervous system. It has rarely been reported to affect native heart valves. We report the case of a 64-year-old man with disseminated nocardiosis involving the brain, lungs, muscle and tricuspid valve of a transplanted heart. Following antimicrobial therapy, the patient improved clinically and there was no evidence of residual infection on follow-up imaging. This case highlights the presentation of nocardiosis, current therapeutic guidelines and the question of prophylaxis against Nocardia in immunocompromised patients.

https://ift.tt/2RMAjTx

Toxic epidermal necrolysis: the red eye and red herrings in casualty

A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review revealed an erythematous facial and skin rash, mildly swollen lips and mild swallowing difficulties. The patient was referred for an urgent medical assessment, by which time she was found to have erythema affecting 54% of her body surface area and diagnosed with suspected toxic epidermal necrolysis (TEN). She rapidly deteriorated over 24 hours with a spreading blistering skin rash and airway compromise requiring urgent intubation and admission to the intensive treatment unit (ITU). Subsequent skin biopsies confirmed the diagnosis of TEN, attributed to recent use of ibuprofen. Treatment included broad-spectrum antibiotics and high-dose corticosteroids. The patient had a prolonged hospital stay and developed severe scarring of the ocular surface. She was discharged home and remains under continuing outpatient follow-up with ophthalmology and dermatology teams.

https://ift.tt/2Eg0tLK

Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

https://ift.tt/2RMAgqP

Acute pancreatitis-induced takotsubo cardiomyopathy and cardiogenic shock treated with a percutaneous left ventricular assist device

A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.

https://ift.tt/2Eg0q2w

Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

https://ift.tt/2RMAeiH

Stage III Kienböcks disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition

Kienböck's disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck's disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck's disease treated with hyperbaric oxygen.

https://ift.tt/2Eg0n6Q

Case of newly diagnosed bilateral anorchia in a 42-year-old male patient

A 42-year-old African man presented with hypogonadic phenotypical features, including gynoid body distribution, gynaecomastia, absent facial and truncal hair and micropenis. He denied ever experiencing development of male secondary sex characteristics. Endocrine testing revealed hypergonadotropic hypogonadism and undetectable AMH. Human chorionic gonadotropin (hCG) stimulation test failed to increase testosterone levels. Peripheral blood karyotype was 46, XY. Clinical examination and abdominal/pelvic/scrotal ultrasound and MRI failed to identify any testicular structures/remnants. Given the clinical course and the biochemical–radiological presentation, the diagnosis of bilateral anorchia was made (after more than four decades of its probable onset), and surgical exploration was decided against. The patient was subsequently started on monthly intramuscular testosterone experiencing progressive normal virilisation.

https://ift.tt/2RMA7DN

Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO₂) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO₂ ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

https://ift.tt/2Eg0T4M

IgE Test in Secretions of Patients with Respiratory Allergy

Abstract

Purpose of Review

IgE is a key player in multiple inflammatory airway diseases. Ample literature demonstrates its presence in mucosa of patients with allergic rhinitis (AR), local allergic rhinitis (LAR), asthma, or chronic rhinosinusitis with nasal polyposis (CRSwNP).

Recent Findings

Current evidence shows that high-affinity IgE in blood stream of allergic individuals derives mainly from the mucosae. Also, mucosal synthesis of IgE can occur in the absence of systemic atopy, and may be relevant in atopic and non-atopic phenotypes of rhinitis as demonstrated in LAR. Specific IgE (sIgE) detection varies depending on technique used for sample collection and its measurement. sIgE detection is highly specific for diagnosis of LAR. Moreover, measurement of sIgE in secretions could be useful in monitoring response to allergen-specific immunotherapy in both AR and LAR phenotypes.

Summary

This review will focus on recent developments in the role of IgE in respiratory diseases, and the clinical implications of its measurement in secretions.

https://ift.tt/2IRCxwT

Möglichkeiten und Grenzen der Eigenfetttransplantation

Mithilfe der autologen Transplantation von abgesaugtem subkutanem Fettgewebe lassen sich gute Ergebnisse zum Beispiel bei der Brustvergrößerung erzielen. Der folgende Beitrag beschreibt verschiedene Möglichkeiten, wie Patientinnen und Patienten erfolgreich mit der sogenannten BEAULI™-Methode behandelt werden können.

https://ift.tt/2IWBITS

Aus dem Nähkästchen: fünf Tipps und Tricks für Eingriffe an der Haut

https://ift.tt/2OpHvXZ

FOBI präsentiert breites Spektrum der ästhetischen Medizin

Die 26. Fortbildungswoche für praktische Dermatologie und Venerologie bot ihren Besuchern in München Ende Juli auch eine Vielzahl ästhetischer Fortbildungsthemen an. Einige der Highlights finden Sie im folgenden Kongressbericht.

https://ift.tt/2IWBGeI

Sklerosierung statt Operation

https://ift.tt/2Opg4gM

Neues Verfahren gegen Cellulite

https://ift.tt/2IWBE6A

Pflege bei irritierender Aknetherapie

https://ift.tt/2Opg00w

Symptomorientierte Therapie der Rosazea

https://ift.tt/2IWBzQk

Allergan benennt neue Führungskräfte für Deutschland

https://ift.tt/2OpfYpq

Was brennt Ihren Patienten unter den Nägeln?

Nägel dienen dem Schutz und der Stabilität der Finger- und Zehenkuppen sowie der taktilen Sensibilität und fungieren an den Fingern als Greifwerkzeuge. Gleichzeitig stellen kranke Nägel eine kosmetische Einschränkung dar. Nagelerkrankungen verdienen daher ausreichende Beachtung und eine intensive Behandlung.

https://ift.tt/2IWBmww

Zusatz zur Lokalanästhesie und Notfallmedikation

https://ift.tt/2OpfKyA

Lifestyle und der Einfluss auf die ästhetische Medizin

Jennifer Ceaser ist eine US-amerikanische Journalistin mit Sitz in Berlin. Seit über 15 Jahren veröffentlicht sie regelmäßig in Print- und Online-Publikationen wie New York Magazine, New York Post, The Independent, London Evening Standard, Conde Nast Traveler. Mit dem Experten Dr. Dirk Gröne spricht sie über den Einfluss der modernen Medien auf das Patientenverhalten.

https://ift.tt/2IWBvA4

Inhaltsverzeichnis

https://ift.tt/2Ojlvhc

Auf stürmischer See

https://ift.tt/2IWBtYY

Therapie der androgenetischen Alopezie

https://ift.tt/2OkzyTQ

Alopecia androgenetica der Frau

Zusammenfassung

Aufgrund der Vielgestaltigkeit der Ausfallsmuster und der zahlreichen möglichen Ursachen betrachten viele Ärzte Haarausfall bei Frauen als crux medicorum. Doch das Problem ist beherrschbar. Grundsätzlich ist zu unterscheiden, ob der Haarausfall durch hormonelle oder nicht hormonelle Ursachen bedingt ist und ob im Fall einer androgenetischen Alopezie eine manifeste Hyperandrogenämie oder nur eine erhöhte Sensitivität der Haarfollikel gegenüber Androgenen vorliegt.

https://ift.tt/2IWBfB6

Speicherung und Aufbewahrung von Patientendaten vs. DSGVO

Die Datenschutzgrundverordnung (DSGVO) hat nicht nur der Ärzteschaft umfassende neue Verpflichtungen auferlegt, sondern auch den Patienten neue Auskunfts- und Löschungsansprüche eingeräumt. Diese Ansprüche stehen nun neben den bisherigen gesetzlichen Regelungen im Raum, sodass zu beleuchten ist, welche Rangordnung unter den Normen besteht. Nur dadurch lässt sich klären, ob die neuen Regelungen der DSGVO die Verpflichtungen der Ärzteschaft auch an dieser Stelle erweitern und was künftig zu beachten ist.

https://ift.tt/2OpfOOQ

Laserlipolyse zur selektiven Fettzerstörung und Fettgewinnung

In der letzten Zeit sorgt die Laserlipolyse als minimalinvasives Verfahren für einen Aufwärtstrend dieser operativen Technik, wobei diese vorrangig zur Fettreduktion und Straffung der Haut eingesetzt werden kann. Neuerdings wird die Laserlipolyse auch für die Gewinnung von vitalen kleinzelligen Fettzellen und „stromal vascular fraction"(SVF)-Zellen gezielt verwendet, welche anschließend für den regenerativen Gewebeaufbau im Rahmen eines autologen Lipotransfers zur Verfügung stehen.

https://ift.tt/2IWBdsY

Narbenbehandlung mit Radiofrequenz-Needling

https://ift.tt/2Opykqs

Epstein–Barr Virus and Grave's Disease

Viral Immunology, Volume 31, Issue 8, Page 539-539, October 2018.


https://ift.tt/2IUvUdx

Zika Virus Alters the Expression Profile of microRNA-Related Genes in Liver, Lung, and Kidney Cell Lineages

Viral Immunology, Volume 31, Issue 8, Page 583-588, October 2018.


https://ift.tt/2OpBHxF

Diabetes Is Associated with Cognitive Decline in Middle-Aged Patients

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2A7A52Q

The Prevalence and Psychological Impact of Cyberbullying on Undergraduate Students at an HBCU

Violence and Gender, Ahead of Print.


https://ift.tt/2OnrUYH

Claudin‐1 expression decreases with increasing pathological grade in actinic keratosis and may be a marker of high‐risk actinic keratosis

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2EiEvrL

2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD

2018 Van Meter Lectureship "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAFV600E thyroid cancer" presented by Carmelo Nucera, MD, PhD

October 11, 2018—The American Thyroid Association (ATA) announces with pleasure that the 2018 Van Meter Award has been presented to Dr. Carmelo Nucera, currently Assistant Professor in the Department of Pathology and at the Cancer Center and Cancer Research Institute of Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. He is also an Associate Member at the Broad Institute of Harvard and MIT and Faculty member at the Center for Vascular Biology Research (CVBR) at BIDMC, which is dedicated to "improve human health by using genomics to advance our understanding of the biology and treatment of human disease, and to help lay the groundwork for a new generation of therapies."

The Van Meter Award recognizes outstanding contributions to research on the thyroid gland or related subjects by an investigator who is age 45 or under. Dr. Nucera has given the prestigious Van Meter Lecture on October 4 at 8:05 am, during this year's ATA Annual Meeting in Washington, DC from October 3 to 7. The award winner and the title of his lecture are kept secret until the time of the presentation.  Dr. Nucera spoke on "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAF^V600E thyroid cancer".

Dr. Nucera was born in Reggio Calabria (Italy), and received his MD summa cum laude in 2000 from the Medical and Surgery School at the University of Messina, Italy, where he also spent his residency in Endocrinology and Metabolic Diseases. During his residency he coordinated a local unit doing ultrasound screening of thyroid nodules, for the Ministry of Italian Scientific and Technological Research. He was also a Research Fellow and Coinvestigator at the Regina Elena Cancer Institute and Gemelli Medical School University Hospital in Rome, where he studied cloning techniques, molecular and cellular biology techniques, and transgenic mouse models for maternal thyroid hormone action during embryo-fetal development. At the Institute of Endocrinology of the University of Catania, he studied DNA automated sequencing and RNA extraction techniques for human thyroid tumors.

Dr. Nucera received his PhD in Experimental Endocrinology and Metabolic Diseases funded through the Italian Ministry of Scientific Research and Education, and completed his thesis on "novel mechanisms of BRAF^V600E-driven thyroid cancer progression" at the Division of Endocrine Surgery at Massachusetts General Hospital (MGH), and at BIDMC at Harvard Medical School.

He was also a post-doctoral research fellow at the same Division at MGH/Harvard. In the years following, Dr. Nucera acted as Attending Physician-Scientist at courses, workshops, and symposia, primarily at Harvard Medical School but also at the ATA.

His academic appointments have included Instructor in the Division of Cancer Biology and Angiogenesis in the Department of Pathology at BIDMC and, for the past five years, Assistant Professor in the Division of Experimental Pathology at the same institution at Harvard Medical School.

Dr. Nucera is primarily engaged in translational thyroid cancer research, as well as in teaching and tutoring medical students, post-docs, PhD students, and College students. He currently focuses on biomarker discovery such as regulatory long intergenic non-coding RNAs (LincRNA) and murine preclinical and co-clinical trials for targeted therapies for super-precision medicine. He is actively developing an independent research program at the BIDMC/Harvard, focused on a preclinical/translational model of patient-derived thyroid cancers and the role of the BRAF^V600E gene mutation in metastatic thyroid cancer. Since his residency, Dr. Nucera has investigated the cellular details of thyroid tumors. His goals have been, among others, to:

• Determine the role of the BRAF gene mutation in human thyroid cancer microenvironment
• Understand the autocrine and paracrine pathways by which BRAF^V600E (serine/threonine-protein kinase) and tyrosine kinase VEGFR2 (one of the vascular endothelial growth factors) promote aggressiveness in papillary thyroid cancer
• Assess the role of stem-cell like pericytes in the mechanisms of drug resistance to targeted therapies in BRAF^V600E thyroid cancer
• Unravel the clonal evolution of BRAF^V600E thyroid cancer treated with targeted therapies

Among the many mentees he has formally supervised are several post-doctoral research fellows, with whom he has collaborated on research studies and papers. For the past decade, Dr. Nucera has given presentations to his medical colleagues, nationally and internationally, concerning the details of his cellular research, thyroid cancer research, tumor modeling, targeted gene therapies, and clinical trials. As principal investigator (PI), he has successfully advanced many basic and clinical-translational projects and collaborations. His research expertise has been enhanced by his teaching experience at Harvard Medical School, resulting in his obtaining major grants as PI from the NIH and National Cancer Institute.

Dr. Nucera has served on the ATA Research and Internet Communications Committees and is a member of the Annual Thyroid Congress Program for the ATA. He has been recently nominated basic research Chair of the ATA Research Committee for 2018.

He is a reviewer for dozens of medical journals, including the New England Journal of Medicine, Frontiers in Oncology, the Journal of the National Cancer Institute, and the ATA's Thyroid. He is an Associate Editor for both Frontiers in Endocrinology and Discoveries. And he has received frequent honors and prizes for his research since medical school.

In his relatively brief career, Dr. Nucera has achieved much more in his research into thyroid oncology and gene therapy than many people over a lifetime. That commitment makes him a very worthy recipient for the prestigious 2018 Van Meter Award from the American Thyroid Association.

 ###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

•  The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

 The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post 2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD appeared first on American Thyroid Association.

https://ift.tt/2ISoE1y

Blood clot stability and bone formation following maxillary sinus membrane elevation and space maintenance by means of immediate implant placement in humans. A computed tomography study

The present controlled clinical pilot study proposed to assess blood clot contraction and bone neo-formation following maxillary sinus lift (MSL) with immediate implant placement without using grafts using cone beam tomography exams.

https://ift.tt/2QPq4wJ

Olopatadine/Mometasone Combination Nasal Spray Improves Seasonal Allergic Rhinitis Symptoms in an Environmental Exposure Chamber Study

GSP301 nasal spray is a fixed-dose combination of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate intended for seasonal allergic rhinitis (SAR) treatment.

https://ift.tt/2EgogLD

Assessment of clinical ability in the removal of teeth among undergraduate dental students: a longitudinal comparative study

To evaluate the clinical ability of undergraduate students to remove teeth, we have developed a new, structured, and objective assessment scale including 11 items that measure the various skills required on a visual analogue scale (VAS). We did a pilot study to validate the new format and included 10 students, each one of whom was rated by three examiners. The assessment form was then used to evaluate the ability of students taking teeth out throughout the academic year 2017–2018. Results showed high inter-examiner reliability, significant correlation of mean scores (p<0.001), and high internal validity of the assessment form (Cronbach's α from 0.8257 to 0.9191).

https://ift.tt/2CduzNx

Usefulness of dermoscopy/dermatoscopy to improve the clinical and histopathologic diagnosis of skin cancers

Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared to naked-eye examination. Dermoscopy can also lead to the detection of thinner and smaller cancers. Furthermore, dermoscopy leads to more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, since most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers.

https://ift.tt/2RNKV4y

Dermoscopy/dermatoscopy and dermatopathology correlates of cutaneous neoplasms

Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc.) to inform clinical management decisions. Dermoscopic findings and/or images provided to pathologists offer an important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form will provide little value to pathologists.

https://ift.tt/2EjwHpI

Comparative evaluation of different fixation techniques of the sagittal split ramus osteotomy in 10 mm advancements: Mechanical testing and screw insertion torque

To compare the mechanical characteristics of five techniques for the functionally stable fixation of simulated sagittal split ramus osteotomy with 10 mm of advancement and to evaluate the screw insertion torque.

https://ift.tt/2NEabHw

Case 31-2018: A 37-Year-Old Man with a Self-Inflicted Gunshot Wound

Presentation of Case. Dr. Jordan P. Bloom (Surgery): A 37-year-old man was admitted to the surgical intensive care unit (ICU) of this hospital because of a self-inflicted gunshot wound. The patient had been in his usual state of health until 2 days before admission. That evening, while he was at…

https://ift.tt/2Ef2JTu

A Tricky Diagnosis

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. Stage. A 70-year-old man…

https://ift.tt/2NyvWIF

Case 29-2018: A 31-Year-Old Woman with Infertility

Presentation of Case. Dr. Caitlin Sacha (Obstetrics and Gynecology): A 31-year-old woman with infertility was referred to the fertility center of this hospital by a surrogate parenting agency to discuss the possibility of family building with an oocyte donor and a gestational carrier. The patient…

https://ift.tt/2NDOE1E

The prevalence of benign paroxysmal positional vertigo in patients with osteoporosis

Abstract

Background

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. There is some evidence that osteoporosis is a risk factor for BPPV.

Objective

To determine the prevalence of BPPV in patients with proven osteoporosis.

Materials and methods

We examined 187 new consecutive patients who attended our osteoporosis clinic. All patients had proven osteoporosis (DEXA scan resulting in a T score ≤ − 2.5). Patients completed a screening questionnaire assessing the presence of episodic vertigo provoked by changes in head position. When we suspected the presence of BPPV, we performed a Dix–Hallpike manoeuvre and a supine roll test. If the diagnostic procedure was positive, a (therapeutic) canalith repositioning manoeuvre (CRM) was performed.

Results

Twelve out of 187 patients had a history of typical vertigo compatible with BPPV. In four patients, the presence of BPPV was confirmed by means of a positive Dix–Hallpike manoeuvre. The prevalence of BPPV in this population of patients with osteoporosis was 2.1% (95% CI 0.8–5.4%).

Conclusion

The prevalence of BPPV in patients with osteoporosis is low. Based on this study, we suggest that there does not seem to be a relation between osteoporosis and BPPV.

https://ift.tt/2EeoGlW

Age-dependent loss of induced regulatory T cell function exacerbates liver ischemia-reperfusion injury

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Rui Liu, Shaopeng Zhang, Wenxuan Ma, Hao Lu, Ji Gao, Xiaojie Gan, Zheng Ju, Jian Gu, Ling Lu

Abstract

Previous studies demonstrate that the number of induced regulatory T cells (iTregs) increases in aged mice. However, these studies do not characterize iTregs across different ages or how these immune modulators contribute to the dysregulation of immunity in murine disease models. Therefore, this study aimed to examine the relationship between age and iTreg function using a mouse model of hepatic ischemia-reperfusion injury (IRI). In this model, aged-mice suffered more serious injury than Young-mice, with higher serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and higher histological scores from liver biopsies. iTregs isolated from Young-mice exhibited stronger immunosuppressive ability in vitro and had a greater response during IRI in vivo. In addition, aged-mice that were pretreated with iTregs generated in Young-mice (Y-iTregs) had alleviated injury compared with mice pretreated with iTregs from aged-mice (A-iTregs) or no treatment group. Adoptive transfer of iTregs ameliorated liver IRI and promoted liver recovery with decreased levels of interferon-γ (IFN-γ) and interleukin-17 (IL-17). These results demonstrate that the exacerbated IRI observed in aged-mice is a result of decreased iTreg function. Therefore, improving iTreg function is important for disease treatment in elder patients.

https://ift.tt/2CdnH2r

Prostaglandin E2 facilitates Hepatitis B virus replication by impairing CTL function

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Xiaoyan Li, Tingting Xie, Lifen Gao, Chunhong Ma, Xiaoyun Yang, Xiaohong Liang

Abstract

Reversal of T cell dysfunction is a novel and promising approach for the treatment of chronic diseases. PGE2, one of most studied Prostaglandins, exhibits strong and versatile immunoregulation activity on different immune cells including T cells, and has become a promising therapeutic target. Here we found that compared to healthy donors, patients with chronic Hepatitis B virus (HBV) infection had significantly elevated serum PGE2 level. Importantly, serum PGE2 concentration correlated with viral load and liver damage in Chronic hepatitis B(CHB)patients. In AAV-HBV1.2 mouse model, administration of PGE2 analogue promoted HBV replication, while antagonists for EP2 and EP4, two important receptors for PGE2, inhibited virus replication. However, PGE2 analogue had no significant effect on the growth and virus replication in cultured HBV-harboring hepatocyte cell line. Further analysis showed that high PGE2 level in CHB patients correlated with high Tim-3 expression and low level of perforin and granzme B in CD8 + T cells. In parallel, blockade of PGE2 signaling restored the function of CD8 + T cells and controls HBV infection. Depletion of CD8 + T cells almost abrogated the effects of PGE2 on HBV replication. These findings identify PGE2 as a negative regulator for CD8 + T cells contributing to HBV persistence and the intervention of PGE2 signaling might be of potentially translational significance.

https://ift.tt/2CFGDrM

Introduction to the Special Issue: The tumor microenvironment and molecular regulation of innate immune cells

Publication date: Available online 11 October 2018

Source: Molecular Immunology

Author(s): Sandra E. Nicholson, Stephanie S. Watowich

https://ift.tt/2CdXwZO

Related Biomarkers of Neurocognitive Impairment in Children with Obstructive Sleep Apnea

Publication date: Available online 12 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yewen Shi, Huanan Luo, Haiqin Liu, Jin Hou, Yani Feng, Jinwei Chen, Liang Xing, Xiaoyong Ren

Abstract

Objectives

Different experiment approaches have demonstrated that children with obstructive sleep apnea (OSA) exhibit neurocognitive and behavioral deficits. This review summarized the potential biomarkers of OSA-associated neurocognitive impairment in children.

Methods

A scoping review of studies on children with OSA that evaluated the potential value of different markers in identifying neurocognitive impairment was undertaken. Additionally, the biomarkers were categorized according to the different research methods, including brain imaging studies, serological indicators and urine markers.

Results

Majority of the studies that evaluated blood biomarkers, plasma insulin growth factor-1 (IGF-1) and Alzheimer's disease (AD)-related biomarkers appeared to exhibit a favorable profile, and could discriminate between OSA children with or without neurocognitive impairments. Brain imaging studies and urinary neurotransmitters could also be helpful for screening OSA cognitive morbidity in children.

Conclusion

Due to limited research methods available in children, the cognitive susceptibility of children with OSA has been rarely studied. The main reason for this may be the limited research methods in children. Numerous study populations of children and complex psychological tests are required, which involve major labor and costs.Multi-center prospective studies are needed to identify suitable biomarkers for the timely prediction and effective intervention to prevent neurocognitive impairment in children with OSA and to explore futuer opportunities in this arena.

https://ift.tt/2QM6wZU

Clinical Validation and Reproducibility of Endoscopic Airway Measurement in Pediatric Aerodigestive Evaluation

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Christian R. Francom, Cameron A. Best, Ryan G. Eaton, Victoria Pepper, Amanda J. Onwuka, Christopher K. Breuer, Meredith N. Merz Lind, Jonathan M. Grischkan, Tendy Chiang

ABSTRACT

Background

Endoscopic airway measurement (EAM) combines optical endoscopic instruments with open source image processing to accurately obtain airway dimensions. Preclinical models have demonstrated EAM as an accurate technique of airway measurement with the added advantage of characterizing multilevel stenosis, non-circular lesions, and distal obstruction. The aim of this prospective clinical study was to compare EAM to airway measurements obtained from endotracheal tube approximation (ETTA) during pediatric aerodigestive evaluation and to evaluate reproducibility of EAM across practitioners.

Methods

Thirty-seven pediatric patients undergoing routine microlaryngoscopy and bronchoscopy at a single tertiary care children's hospital were prospectively recruited. Patients undergoing emergent procedures were excluded. Two blinded reviewers performed airway measurements using ImageJ (NIH) as previously described and average values were compared to ETTA measurements. Additional EAMs were obtained from an ex vivo airway model by 28 separate clinicians and were analyzed by the same reviewers to evaluate reproducibility.

Results

EAM and ETTA measurements were themselves significantly different (p = 0.0003); however, the average absolute difference between the two methods was small (Mean: 0.5 mm, 95%CI: -2.6 to 1.6 mm). There were notable differences between raters such that estimates of raters with more experience were more similar to ETTA. Despite observed differences between EAM and ETTA, endoscopic airway measurement was highly correlated with ETTA (p = 0.0002, Spearman r = 0.4185), and strong agreement was observed (Bias: -0.4974 ± 1.083 mm, 95% LOA: -2.62 to 1.625 mm).

Conclusion

Clinical use of EAM is a valid and precise approach for quantification of airway luminal dimensions. This method may provide advantages over traditional ETTAs for evaluation of asymmetric airway morphology in the pediatric population.

https://ift.tt/2A6Mow7

Findings from Aetiological Investigation of Auditory Neuropathy Spectrum Disorder in Children referred to Cochlear Implant Programs

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): K. Rajput, M. Saeed, J. Ahmed, M. Chung, C. Munro, S. Patel, C. Leal, D Jiang, R. Nash

Abstract

Objectives

Auditory neuropathy spectrum disorder (ANSD) is an audiological diagnosis characterised by hearing dysfunction in the presence of intact outer hair cell function in the cochlea. ANSD is thought to account for 7-10% of all childhood permanent hearing impairment, and can result from a range of pathological processes. This paper describes the rationale, methods and findings from the aetiological investigation of ANSD.

Methods

Retrospective audit of four cochlear implant programmes.

Results

97 patients were identified. 79% of patients were identified before the age of one. Prematurity and jaundice were the most frequently identified aetiological factors. 33 patients had cochlear nerve deficiency on imaging. Genetic diagnoses identified included otoferlin, SX010 gene, connexin 26 and A1FM1 gene mutations. ANSD was seen in conjunction with syndromes including Kallman syndrome, CHARGE syndrome, X-linked deafness, SOTOS syndrome, Brown Vieletto Van Laere syndrome, and CAPOS syndrome.

Discussion

We present a two-level system of aetiological investigation that is clinically practical. Patients with ANSD sufficiently severe to consider cochlear implantation are generally identified at an early age. Aetiological investigation is important to guide prognosis and identify comorbidity.

Conclusion

Prematurity and jaundice are the most commonly identified aetiological factors in ANSD. Imaging findings identify crucial factors in a significant minority. An important minority may have genetic and syndromic diagnoses that require further management.

https://ift.tt/2QMM37n

Child development skills and language in toddlers with cleft lip and palate

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maria Gabriela Cavalheiro, Dionísia Aparecida Cusin Lamônica, Simone Rocha de Vasconsellos Hage, Luciana Paula Maximino

Abstract

Introduction

Children born with cleft lip and palate (CLP) are exposed to several risk factors for developmental delay.

Methods

This cross-sectional and descriptive study compared the performance of gross motor, adaptive fine motor, social-personal and language skills in children with non-syndromic cleft lip and palate (age = 36 to 47 months, n = 30) matched as to chronological age and gender. The evaluation instruments were Denver Developmental Screening Test II and MacArthur Communicative Development Inventory – part D, employed for the receptive and expressive vocabulary checklist. Intergroup comparisons were performed using t tests and Chi-square tests. The Pearson correlation coefficient was used to verify the inter-category correlation (p≤0.05).

Results

There was statistically significant difference in gross motor, adaptive fine motor, and language skills, both in receptive and expressive aspects, in the comparison between groups. In the personal-social area, children with CLP presented performance below the expected, without statistically significant difference between groups.

Conclusions

Children with CLP are at risk for developmental disorders and should be monitored from early childhood to minimize the deleterious effects of this risk condition.

https://ift.tt/2A6HeAe

Improvement in diagnostic delays over time in patients with hereditary angioedema: findings from the Icatibant Outcome Survey

The objective of this analysis was to evaluate the change over time in age at first symptoms, age at diagnosis, and delay in diagnosis using data from the Icatibant Outcome Survey (IOS). Patients with a diagno...

https://ift.tt/2OTShVB

Effect of TiF 4 varnish on microbiological changes and caries prevention: in situ and in vivo models

Abstract

Objective

The aim of this study was to evaluate microbiological changes, oral soft tissue toxicity, and caries-preventive effect of an experimental titanium tetrafluoride (TiF₄) varnish compared with a commercially available fluoride varnish (NaF), using in situ and in vivo models.

Materials and methods

The treatment groups were the following: TiF₄ varnish (experimental varnish), Duraphat® (fluoride positive control), placebo varnish (no fluoride), and no treatment (negative control). The varnishes were applied once over the enamel surface using a microbrush. For the in vivo study, 48 Wistar rats were infected with Streptococcus sobrinus 6715, received a treatment, and were submitted to a cariogenic challenge. After 4 weeks, S. sobrinus, oral soft tissue toxicity, presence, and severity of caries were evaluated. For the in situ study, 12 volunteers took part in this randomized crossover, double-blind study performed in four phases of 14 days each. They used intraoral appliances containing four enamel specimens that received the varnish according treatment group. After 24 h, the varnish was removed and plaque accumulation was allowed. A 20% sucrose solution was dripped over the enamel blocks (10×/day for 5 min each). Total streptococci, S. mutans, Lactobacillus, Candida spp. counts, and presence of white spot lesions were evaluated. Lesion depth was also quantified by micro-CT.

Results

For the in vivo study, the fluoride (F-varnishes) showed a statistically significant reduction in the percentage of S. sobrinus compared to the negative control (p < 0.05). Toxicological analysis revealed no abnormalities in oral tissues of rats from all groups, and both F-varnishes reduced the number and severity of caries lesions, without significant differences (p < 0.05). No statistical differences in microbiological counts were seen for the in situ experiment (p > 0.05). However, the specimens treated with TiF₄ exhibited lower percentage of white spot lesions and the lesion depth was significantly reduced by F-varnishes (p < 0.05).

Conclusions

F-varnishes showed reduction in the percentage of S. sobrinus in vivo, no oral soft tissue toxicity, and a caries-preventive effect in vivo and in situ.

Clinical relevance

NaF varnish is largely used due its capacity to form CaF₂-like layer on enamel. Therefore, development of studies focused on other fluoride compounds such as a TiF₄ varnish, which may have greater efficacy than NaF against tooth demineralization, is important.

https://ift.tt/2EeERiY

Dental radiographic findings in 18 individuals with SATB2 -associated syndrome

Abstract

Objective

To characterize the radiographic dental phenotype of individuals with SATB2-associated syndrome (SAS).

Materials and methods

Participants were evaluated by a multidisciplinary team during a concurrent clinic conducted during the 1st international SAS family meeting held in 2017 at a single institution. Whenever possible, panoramic and/or periapical radiographs were obtained in clinic or previously obtained and provided by the caregiver.

Results

Of the 37 individuals evaluated, 18 (12 males, median age 8.5 years) underwent radiographic examination. Dental radiographs revealed anomalies in all individuals starting at 2 years of age. The most consistent finding was delayed development of the mandibular second bicuspids (83%) with other common radiographic findings including delayed development of the roots of the permanent teeth (78%), severely rotated (56%) or malformed teeth (44%), and taurodontism (44%).

Conclusions

Dental anomalies are fully penetrant and can be documented radiographically in all individuals with SAS.

Clinical relevance

Dental radiographic findings of delayed second premolar development and delayed development of permanent root formation, especially concurrent with findings of taurodontism and malformed teeth, support a clinical suspicion for SAS and should help differentiate SAS from other neurodevelopmental syndromes.

https://ift.tt/2QLYeRM

Utility of CD8 score by automated quantitative image analysis in head and neck squamous cell carcinoma

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Douglas J. Hartman, Fahad Ahmad, Robert E. Ferris, David Rimm, Liron Pantanowitz

Abstract

Introduction

In head and neck squamous cell carcinoma (HNSCC) high numbers of tumor infiltrating CD8 T cells in the tumor microenvironment are associated with better outcome. However, no investigators have employed automated image analysis on whole slide images to permit CD8 scores for use in clinical practice. The aim of this study was to develop and validate an image analysis algorithm to automatically quantify CD8 T cells in patients with oropharyngeal HNSCC.

Materials and Methods

Using brightfield image analysis results were cross-validated with fluorescence based quantification (AQUA™). A nuclear image algorithm designed to run on whole slide images was optimized to manual count. The algorithm was locked down and used on a cohort of whole tissue sections from HNSCC patients. Multivariate clinicopathologic parameters and outcomes were statistically correlated with image analysis results.

Results

Linear correlation between manual counts and the customized CD8 algorithm was 0.943. A total of 74 oropharyngeal HNSCC cases were analyzed for CD8 immune cell infiltrate using this image analysis algorithm. A CD8 immune cell density above 136 cells/mm² was associated with median survival of 18 years compared to 5 years. When multivariate modeling was performed, HPV infection was the only predictor of survival; however, when HPV was excluded only CD8 cell density predicts survival.

Conclusions

We report the successful technical development and clinical validation of an image algorithm to automate CD8 immune cell density for oropharyngeal HNSCC. Employing brightfield image analysis on entire tumor sections instead of tumor subcompartments permits this strategy to be widely implemented.

https://ift.tt/2NDayBO

Routine surveillance scanning in HNSCC: Lung screening CT scans have value but head and neck scans do not

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Austin J. Iovoli, Alexis J. Platek, Luke Degraaff, Chong Wang, William D. Duncan, Kimberly E. Wooten, Hassan Arshad, Vishal Gupta, Moni A. Kuriakose, Wesley L. Hicks, Mary E. Platek, Anurag K. Singh

Abstract

Objectives

To examine the utility of computed tomography (CT) imaging during routine surveillance for the detection of recurrent head and neck squamous cell carcinoma (HNSCC).

Materials/methods

Clinical characteristics of HNSCC patients treated between 2008 and 2017 with radiation therapy or concurrent chemoradiation were abstracted from medical records. In patients who achieved a complete response to treatment by positron emission tomography scan, surveillance CT scans were conducted to the maxillofacial area, neck, and chest every 3 months in year 1, every 6 months in year 2, and every 12 months in years 3 and beyond.

Results

Within the entire cohort (n = 534), complete response was achieved in 446 patients (83.5%); of these, 84 (15.7%) patients had a recurrence. Among the 84 patients with disease recurrence, 25 (30%) patients remained alive, of which 15 (18%) underwent successful salvage treatment and became free of disease. Lung screening CT scans detected failure in 8 of these successfully salvaged patients. Among the 8 patients successfully salvaged for locoregional recurrence, 3 failures were asymptomatic at onset and detected by laryngoscope or dental exam. The remaining 5 failures were symptomatic and detected upon work up prompted by symptoms. Maxillofacial and neck surveillance CT imaging failed to detect any successfully salvaged patients.

Conclusions

Routine surveillance for HNSCC patients with lung CT imaging had value but routine head and neck CT scans failed to identify any successfully salvaged patients. Given this finding, routine CT imaging surveillance in HNSCC patients should be restricted to annual lung screening with low-dose chest CT.

https://ift.tt/2OZggmi

EACMFS Prizes & Awards

Publication date: October 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 10

Author(s):

https://ift.tt/2QLhor6

Announcements

Publication date: October 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 10

Author(s):

https://ift.tt/2A6EB1y

IL-33 drives influenza-induced asthma exacerbations by halting innate and adaptive anti-viral immunity

Publication date: Available online 12 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Lara Ravanetti, Annemiek Dijkhuis, Tamara Dekker, Yanaika S. Sabogal Pineros, Abilash Ravi, Barbara S. Dierdorp, Jonas S. Erjefält, Michiko Mori, Stelios Pavlidis, Ian M. Adcock, Navin L. Rao, René Lutter

Abstract

Background

Influenza virus triggers severe exacerbations of asthma for which no adequate treatment is available. It is known that IL-33 levels correlate with exacerbation severity, but its role in the immune-pathogenesis of exacerbations has remained elusive.

Objective

We hypothesized that IL-33 is necessary to drive asthma exacerbations. We intervened with the IL-33 cascade and sought to dissect its role, also in synergy with TSLP, in airway inflammation, anti-viral activity and lung function. We aimed to unveil the major source of IL-33 in the airways and IL-33-dependent mechanisms that underlie severe asthma exacerbation.

Methods

Mild asthmatic patients were experimentally infected with rhinovirus. Mice were chronically exposed to house dust mite (HDM) extract and then infected with influenza to resemble key features of exacerbations in humans. Interventions included anti–IL-33-receptor ST2 and/or anti–TSLP.

Results

We identified bronchial ciliated cells and Type-II alveolar cells as a major local source of IL-33 during virus-driven exacerbation in humans and mice, respectively. By blocking ST2 we demonstrated that IL-33 and not TSLP was necessary to drive exacerbations. IL-33 enhanced AHR and airway inflammation by suppressing innate and adaptive anti-viral responses and by instructing epithelial cells and dendritic cells (DCs) of HDM-sensitized mice to dampen IFN-β expression and prevent the Th1-promoting DCs phenotype. IL-33 also boosted luminal NETosis and halted cytolytic anti-viral activities, but did not affect the Th2-response.

Conclusion

Interventions targeting the IL-33/ST2 axis could prove an effective acute, short-term therapy for virus-induced asthma exacerbation.

Graphical abstract

https://ift.tt/2Pui1Fh

Preoperative Evaluation: Is It Time to View It as a Component of Perioperative Optimization?

Publication date: Available online 11 October 2018

Source: Anesthesiology Clinics

Author(s): Lee A. Fleisher

https://ift.tt/2yhrppc

Reliability of palatal rugoscopy for sexual dimorphism in forensic dentistry: a systematic literature review and meta-analysis

Publication date: Available online 11 October 2018

Source: Archives of Oral Biology

Author(s): Ramon Nazareno Menezes Andrade, Walbert de Andrade Vieira, Ítalo de Macedo Bernardino, Ademir Franco, Luiz Renato Paranhos

Abstract

Objective

This study aimed to assess the validity of palatal rugoscopy for sexual dimorphism in the casework routine of forensic dentistry.

Design

A systematic literature reviews was established following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Six electronic databases were searched as the primary source of information. "Grey literature" was included to avoid selection and publication bias. As a secondary source of information, the reference lists of the eligible studies were also consulted to increase the search spectrum. Methodological quality and risk of bias were assessed with Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. Statistic tests, namely the meta-analysis of diagnostic accuracy, Cochran Q test, and I2 test, were performed to verify the heterogeneity between the eligible studies.

Results

The systematic search resulted in 263 studies, out of each 8 fulfilled the inclusion criteria. An additional eligible article was included after the search in reference lists. From the 9 studies that underwent qualitative data extraction, six were selected for quantitative analysis. The meta-analysis of grouped sex estimates showed sensitivity and specificity rates of 89% and 83%, respectively. The Area Under the Curve reached 0.93. High heterogeneity and important methodological limitations were detected among the studies.

Conclusion

Palatal rugoscopy seems to have discriminant power for sexual dimorphism. However, the limitations found specifically in each study and the strong heterogeneity across studies suggest that palatal rugoscopy lacks evidence-based confirmation for reliable application as a sole tool for sexual dimorphism in practice.

https://ift.tt/2ISJu0T

Reliability of palatal rugoscopy for sexual dimorphism in forensic dentistry: a systematic literature review and meta-analysis

Publication date: Available online 11 October 2018

Source: Archives of Oral Biology

Author(s): Ramon Nazareno Menezes Andrade, Walbert de Andrade Vieira, Ítalo de Macedo Bernardino, Ademir Franco, Luiz Renato Paranhos

Abstract

Objective

This study aimed to assess the validity of palatal rugoscopy for sexual dimorphism in the casework routine of forensic dentistry.

Design

A systematic literature reviews was established following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Six electronic databases were searched as the primary source of information. "Grey literature" was included to avoid selection and publication bias. As a secondary source of information, the reference lists of the eligible studies were also consulted to increase the search spectrum. Methodological quality and risk of bias were assessed with Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. Statistic tests, namely the meta-analysis of diagnostic accuracy, Cochran Q test, and I2 test, were performed to verify the heterogeneity between the eligible studies.

Results

The systematic search resulted in 263 studies, out of each 8 fulfilled the inclusion criteria. An additional eligible article was included after the search in reference lists. From the 9 studies that underwent qualitative data extraction, six were selected for quantitative analysis. The meta-analysis of grouped sex estimates showed sensitivity and specificity rates of 89% and 83%, respectively. The Area Under the Curve reached 0.93. High heterogeneity and important methodological limitations were detected among the studies.

Conclusion

Palatal rugoscopy seems to have discriminant power for sexual dimorphism. However, the limitations found specifically in each study and the strong heterogeneity across studies suggest that palatal rugoscopy lacks evidence-based confirmation for reliable application as a sole tool for sexual dimorphism in practice.

https://ift.tt/2ISJu0T

Dental pulp stem cells overexpressing stromal-derived factor-1α and vascular endothelial growth factor in dental pulp regeneration

Abstract

Objectives

The current study aimed to investigate the effects of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) overexpressing dental pulp stem cells (DPSCs) in vascularized dental pulp regeneration in vivo.

Materials and methods

Human DPSCs were transfected with VEGF or SDF-1α using premade lentiviral particles. Overexpression was verified by quantitative polymerase chain reaction (q-PCR), enzyme-linked immunosorbent assay (ELISA), and western blot analysis. Effects of SDF-1α and VEGF overexpressing DPSCs on their proliferation (CCK-8 and MTT assays) and endothelial vascular-tube formation (Matrigel assay) were investigated in vitro. Human tooth roots sectioned into 6-mm segments were injected with gene-modified DPSCs encapsulated in PuraMatrix hydrogel and implanted in the dorsum of severe-combined-immunodeficient (SCID) mice. Implants were retrieved after 4 weeks and examined for regenerated pulp-like tissue and vascularization using histology and immunohistochemistry. p < 0.05 was considered statistically significant.

Results

Gene-modified DPSCs expressed significantly high levels (p < 0.05) of SDF-1α and VEGF mRNA and proteins, respectively. Transfected DPSCs showed a significantly higher cell proliferation compared to that of wild-type DPSCs. Furthermore, they enhanced endothelial cell migration and vascular-tube formation on Matrigel in vitro. When injected into tooth root canals and implanted in vivo, DPSCs/SDF-1α + DPSCs/VEGF-mixed group resulted in significantly increased length of regenerated pulp-like tissue within the root canals compared to that of wild-type DPSCs/VEGF and DPSCs/SDF-1α groups. Vessel area density was significantly higher in DPSCs/SDF-1α and mixed DPSCs/SDF-1α + DPSCs/VEGF groups than in DPSCs-VEGF alone or wild-type DPSCs groups.

Conclusion

A combination of VEGF-overexpressing and SDF-1α-overexpressing DPSCs could enhance the area of vascularized dental pulp regeneration in vivo.

Clinical relevance

Enhancing vascularization in pulp regeneration is crucial to overcome the clinical limitation of the limited blood supply to the root canals via a small apical foramen enclosed by hard dentin.

https://ift.tt/2IQUKef

Mixed Reality With Hololens® Exercise Protocol

Condition:   Healthy Volunteers
Interventions:   Other: Mixed reality;   Other: Conventional exercise group
Sponsor:   Centro Universitario La Salle
Not yet recruiting

https://ift.tt/2NCe4MX

Post-radiation Dental Disease Amongst Head and Neck Cancer Patients

Conditions:   Head and Neck Cancer;   Caries, Dental;   Periodontal Diseases;   Radiotherapy Side Effect
Intervention:   Radiation: Radiotherapy (curative) for head and neck cancer
Sponsors:   Belfast Health and Social Care Trust;   Queen's University, Belfast
Not yet recruiting

https://ift.tt/2OSrZDk

Drilling and control of the internal auditory canal by fixed endoscope

Publication date: Available online 11 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): X. Dubernard, J.-C. Kleiber, M. Makeieff, A. Bazin, A. Chays

Abstract

Preservation of vestibular structures, particularly the posterior semicircular canal, is essential to ensure hearing preservation in addition to complete tumour resection during retrosigmoid surgical resection of a vestibular schwannoma. Drilling of the internal auditory canal (IAC) is a delicate step, during which these structures can be accidentally perforated. The orientation of the IAC results in the formation of poorly visible zones that can predispose to perforation of these structures when drilling is performed with a microscope. Hand-held endoscopy exposes all of the operative field, but immobilizes one of the surgeon's hands, making this surgery even more delicate. Fixed endoscopy is a solution that gives the surgeon greater freedom of movement, while ensuring precise control of the surgical procedure. It allows identification and avoidance of vestibular structures, while allowing resection as close as possible to the tumour. The schwannoma can be entirely cleaved when the fundus of the IAC is correctly controlled, while sparing the facial and cochlear nerves.

https://ift.tt/2PwjZF0

French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome: Follow-up protocol for treated children

Publication date: Available online 11 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Akkari, R. Marianowski, F. Chalumeau, P. Fayoux, N. Leboulanger, P.J. Monteyrol, M. Mondain, Groupe de Travail de la SFORL

Abstract

Objectives

The authors present the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) clinical practice guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome (OSAS). This chapter is devoted to the follow-up protocol for children treated for OSAS.

Methods

A multidisciplinary task force was commissioned to carry out a review of the scientific literature on this topic. On the basis of the articles selected and the personal experience of each member of the task force, guidelines were drafted and graded as A, B or C or expert opinion according to a decreasing level of scientific evidence, and were then reviewed by a reading committee, independently of the task force. The final guidelines were established at a consensus meeting.

Results

Short-term, medium-term and long-term clinical follow-up and complementary investigations are necessary in view of the risk of residual OSAS, and the risk of recurrence of OSAS related to adenoid and tonsillar regrowth following adenotonsillectomy, the treatment most commonly performed. The modalities of follow-up after surgery, continuous positive airway pressure (CPAP) ventilation, orthodontic treatment, myofascial rehabilitation, and drug therapy are described. The indications for nasal endoscopy and sleep studies as part of follow-up are specified.

https://ift.tt/2yeptxE

Histamine targets myeloid-derived suppressor cells and improves the anti-tumor efficacy of PD-1/PD-L1 checkpoint blockade

Abstract

Myeloid-derived suppressor cells (MDSCs) are immature monocytes and granulocytes that impede immune-mediated clearance of malignant cells by multiple mechanisms, including the formation of immunosuppressive reactive oxygen species (ROS) via the myeloid cell NADPH oxidase (NOX2). Histamine dihydrochloride (HDC), a NOX2 inhibitor, exerts anti-cancer efficacy in experimental tumor models but the detailed mechanisms are insufficiently understood. To determine effects of HDC on the MDSC compartment we utilized three murine cancer models known to entail accumulation of MDSC, i.e. EL-4 lymphoma, MC-38 colorectal carcinoma, and 4T1 mammary carcinoma. In vivo treatment with HDC delayed EL-4 and 4T1 tumor growth and reduced the ROS formation by intratumoral MDSCs. HDC treatment of EL-4 bearing mice also reduced the accumulation of intratumoral MDSCs and reduced MDSC-induced suppression of T cells ex vivo. Experiments using GR1-depleted and Nox2 knock out mice supported that the anti-tumor efficacy of HDC required presence of NOX2⁺ GR1⁺ cells in vivo. In addition, treatment with HDC enhanced the anti-tumor efficacy of programmed cell death receptor 1 (PD-1) and PD-1 ligand checkpoint blockade in EL-4- and MC-38-bearing mice. Immunomodulatory effects of a HDC-containing regimen on MDSCs were further analyzed in a phase IV trial (Re:Mission Trial, ClinicalTrials.gov; NCT01347996) where patients with acute myeloid leukemia received HDC in conjunction with low-dose IL-2 (HDC/IL-2) for relapse prevention. Peripheral CD14⁺HLA-DR^−/low MDSCs (M-MDSCs) were reduced during cycles of HDC/IL-2 therapy and a pronounced reduction of M-MDSCs during HDC/IL-2 treatment heralded favorable clinical outcome. We propose that anti-tumor properties of HDC may comprise the targeting of MDSCs.

https://ift.tt/2OZm9QM

Orbitale Komplikationen

Zusammenfassung

Als orbitale Komplikation wird eine Erkrankung oder ein Krankheitssymptom bezeichnet, welches von den umgebenden auf die Orbitabinnenstrukturen übergreift. Orbitale Komplikationen können eine entzündliche, traumatische, allergische oder autoimmunologische Ursache haben. Sie kommen bei Kindern häufiger vor als bei Erwachsenen. Zielsetzung des vorliegenden Übersichtsartikels ist die Darstellung der orbitalen Komplikationen, deren Ätiologie, Pathogenese und Therapie unter Würdigung und Diskussion der aktuellen Literatur und Auswertungen des eigenen Patientenkollektivs. Hierbei wird ein besonderes Augenmerk auf die orbitalen Komplikationen entzündlicher Genese und auf die orbitalen Komplikationen aufgrund von Einblutungen in die Orbita gelegt. Der von Allgemeinmedizinern häufig verwendete Begriff der „Orbitaphlegmone" bei entzündlicher Genese der orbitalen Komplikationen ist irreführend und sollte durch eine differenzierte Gradeinteilung ersetzt werden. Die Diagnostik und Therapie der orbitalen Komplikation sollte interdisziplinär erfolgen, wobei hier der Einbeziehung der Ophthalmologen eine besondere Bedeutung zukommt. Die Therapie der orbitalen Komplikation richtet sich nach deren Genese. Im Fall entzündlicher Genese ist bei präseptaler Entzündung eine konservative Therapie indiziert. Kommt es hierunter innerhalb von 24 h zu einer Verschlechterung des Befundes oder liegt eine höhergradige orbitale Komplikation mit Visusminderung oder Einschränkung der Bulbusmotilität vor, so stellt dies eine Indikation für eine operative Intervention dar. Bei akuten Einblutungen in die Orbita stehen Maßnahmen zu Drucksenkungen im Vordergrund (Kanthotomie, Kantholyse, Dekompressionsoperation).

https://ift.tt/2C9MmoO

Titanium mesh associated with rhBMP-2 in alveolar ridge reconstruction

Publication date: Available online 11 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): G.S. Trento, P.H.A. Carvalho, D.V. Macedo, M.A.C. Gabrielli, M.S. Monnazzi, V.A. Pereira-Filho

Abstract

A systematic review of the literature was performed regarding the use of titanium mesh in association with recombinant human bone morphogenetic protein (rhBMP) for alveolar ridge reconstruction. The PubMed, Scopus, and Cochrane databases were searched for articles in English published up until June 2017. The inclusion criteria encompassed studies in humans − randomized clinical trials, prospective and retrospective studies, and case series. The screening and selection process was performed by three independent reviewers, with verification by a senior researcher in the case of disagreement. The initial search identified 92 studies. After removal of duplicates, 70 remained for title and abstract reading. Fifty-four articles were considered non-relevant, resulting in a total of 16 studies. Following application of the inclusion criteria, 10 studies were selected. An additional study was added after the hand search, giving a total of 11 articles. These reported on 106 patients who had undergone alveolar ridge augmentation with rhBMP and titanium mesh. There were 74 maxillary grafts and 22 mandibular grafts, and the success rate of rehabilitation was 93.4% to 100%. The most frequently reported complications were suture dehiscence and mesh exposure, but without graft loss. rhBMP associated with titanium mesh is a viable method for alveolar reconstruction with high success rates and low rates of local complications.

https://ift.tt/2CbGBqv

Response to comments on “Orofacial cleft management by short-term surgical missions in South America: literature review”

Publication date: Available online 11 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H.H. Sung-Hsieh

https://ift.tt/2CGAZpu

Gut microbiome can be restored without adverse events after Helicobacter pylori eradication therapy in teenagers

Helicobacter, EarlyView.


https://ift.tt/2OVjvvd

Dacryocystorhinostomy: Indications and Surgical Technique

Publication date: Available online 12 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Christopher Weller, Ilya Leyngold

Abstract

The following article reviews the clinical presentation, evaluation, and surgical treatment of patients with nasolacrimal duct obstruction, with an emphasis placed on the surgical techniques of external and internal/endoscopic dacryocystorhinostomy.

https://ift.tt/2yhowoc

Imaging of the Human Orbit

Publication date: Available online 12 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): William Pryor, Thomas Zacharia

Abstract

Imaging of the human orbit has significantly improved the diagnosis and management of orbital conditions. Prior to the use of CT and MRI imaging, the value of plain radiographs of the orbit was very limited. Today, modern imaging techniques are an essential adjunct to the physical examination of the eye and orbit, can confidently limit the differential, and in many cases yield a specific diagnosis. In addition, the value of imaging cannot be understated in surgical planning for orbital conditions. This article will review the techniques used in orbital imaging and cover several of the most common conditions encountered within the human orbit.

https://ift.tt/2Pt6uG8

Orbital decompression in thyroid eye disease

Publication date: Available online 12 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Jane S. Kim, Jason Liss

Abstract

Thyroid eye disease is an orbital inflammatory manifestation of autoimmune thyroid disease that results in orbital congestion and can lead to significant cosmetic disfigurement, diplopia, and vision loss. Typically, there is an active, inflammatory phase that transitions into a quiescent, fibrotic state. Management of this condition consists of regulation of the underlying thyroid disease, modulation of risk factors, supportive care for symptoms, and both medical and surgical treatment of ocular sequelae. Orbital decompression is generally indicated in two main subsets of cases: in active disease that includes ulcerative keratitis from severe corneal exposure or compressive optic neuropathy that does not resolve with high-dose corticosteroids, and in quiescent cases with persistent congestive or exposure symptoms and/or cosmetic deformity. Decompression may involve the medial wall, the lateral wall, the orbital floor, and any combination thereof, and this decision is dependent on surgeon preference and the overall goal of decompression. The medial wall is commonly selected due to the ease of approach, the significant potential for orbital volume expansion, and the opportunity for direct decompression of the optic nerve in cases of compressive optic neuropathy. Various surgical approaches to the medial wall have been proposed. The transcaruncular approach offers immediate access to the orbit with direct exposure, excellent visualization of the medial wall and the medial portion of the orbital floor, and absence of cutaneous scars.

https://ift.tt/2yeHtrw

Management of Orbital Fractures

Publication date: Available online 11 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Michael J Wilkinson

Abstract

Fractures of the orbit are a very common injury, and are often treated by multiple facial subspecialties. Many fractures can be asymptomatic and do not require surgical therapy, but for those fractures where intervention is indicated, neglect, delay or inappropriate technique can have permanent consequences on visual function and facial deformity. In this article, the indications and techniques of repair for specific fractures will be discussed, as well as possible risks and complications.

https://ift.tt/2PuouQF

Techniques of Enucleation and Evisceration

Publication date: Available online 11 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Wells T Reinheimer

Abstract

There are many conditions that may require removal of the eye. The most common and obvious reasons involve severe irreversible trauma or potentially life-threatening malignancy. There are, however, other reasons for the therapeutic removal of the eye, including recalcitrant pain and cosmetic deformity. This article will discuss the indications for removal of the eye, as well as describe the alternative techniques of enucleation and evisceration, including their relative advantages.

https://ift.tt/2yh9eQu

Multimodal Approaches in the Management of Malignancies Involving the Orbit

Publication date: Available online 11 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Mitchell Dunklebarger, Vijay A. Patel, Tom Shokri, Neerav Goyal

Abstract

Malignancies involving the orbit comprise heterogeneous pathologies with a variety of ophthalmic and otolaryngic presentations resulting from compression and destruction of native orbital contents. Surgical ablation with negative margins with adjuvant treatment remains a cornerstone for optimal oncologic control and successful operative outcomes. Historically, attempts at tumor extirpation were first performed by neurosurgeons via open craniotomies to access orbital contents. While these approaches remain a mainstay within the superolateral compartment, endoscopic techniques pioneered by otolaryngologists have emerged as a standard in managing inferomedial orbital tumors. Approaches to these tumors remain a multidisciplinary endeavor involving neurosurgeons, ophthalmologists/oculoplastic surgeons, as well as otolaryngology-head and neck surgeons. This chapter will review and illustrate modern approaches to the orbit with special attention given to commonly employed expanded endoscopic and open techniques.

https://ift.tt/2PtR3xx

Radiographic findings in young adults with asymmetric sensorineural hearing loss

Publication date: Available online 11 October 2018

Source: American Journal of Otolaryngology

Author(s): Hiba Z. Khan, Catherine Y. Park, Michelle A. Lim, Amado J. Beltran, Douglas Farquhar, Myron Yencha, Gregory G. Capra

Abstract

Purpose

To evaluate radiographic findings in US Navy recruits found to have asymmetric sensorineural hearing loss (ASNHL) during routine medical screening.

Materials and methods

Retrospective analysis of US Navy recruits receiving screening audiometry and medical suitability evaluation from January 2011 to October 2016. Single-institution, institutional review board-approved study of US Navy recruits screened for hearing loss over a six-year period. All recruits with ASNHL were evaluated by an otolaryngologist and received diagnostic radiographic evaluation. Audiometric and imaging results were retrospectively reviewed for this population and compared to common screening criteria.

Results

ASNHL was identified in 674 of 228,504 total recruits screened. This population was 91% male and between 17 and 29 years old (mean age 21.1). Six-hundred fifty-three (97%) met criteria for further ASNHL evaluation. Subjective hearing loss was reported in only 6% of patients. Six-hundred sixty-one (99%) received magnetic resonance imaging of the internal auditory canals. Intracranial pathology was identified in 43 (6.3%) patients and 2 (0.3%) had a causative intracranial lesion corresponding to ASNHL. No patients were found to have a vestibular schwannoma.

Conclusions

In a population of healthy young adults with audiometric proven ASNHL, 0.3% had radiographic proven intracranial pathology explaining the hearing loss. Intracranial masses may be less likely to cause ASNHL in this population; further research is needed to determine appropriate MRI screening methods for young adults with ASNHL.

https://ift.tt/2QMIWMz

Olopatadine/Mometasone Combination Nasal Spray Improves Seasonal Allergic Rhinitis Symptoms in an Environmental Exposure Chamber Study

Publication date: Available online 12 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Piyush Patel, Anne Marie Salapatek, Sudeesh K. Tantry

Abstract

BACKGROUND

GSP301 nasal spray is a fixed-dose combination of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate intended for seasonal allergic rhinitis (SAR) treatment.

OBJECTIVE

Efficacy and safety of GSP301 once-daily (QD) or twice-daily (BID) were evaluated in a ragweed pollen Environmental Exposure Chamber (EEC).

METHODS

In this randomized, double-blind, double-dummy study, adults (18-65 years) with SAR were equally randomized to GSP301 BID (olopatadine 665μg/mometasone 25μg), GSP301 QD (olopatadine 665μg/mometasone 50μg), AzeFlu (FDA-approved azelastine 137μg/fluticasone 50μg BID), Olopatadine (FDA-approved formulation 665μg BID), or placebo (BID). During two visits (baseline and end of 14-day treatment), participants assessed SAR symptoms at specified time points. The primary endpoint—mean change from baseline in instantaneous Total Nasal Symptom Score (iTNSS) for GSP301 BID or QD versus placebo—was analyzed by ANCOVA. Onset of action, ocular symptoms, and adverse events (AEs) were assessed.

RESULTS

A total of 180 participants were randomized. Treatment with GSP301 BID or QD provided statistically significant improvements in Itnss versus placebo (least squares mean difference [95% CI] GSP301 BID: -3.60 [-4.89, -2.30]; QD: -3.05 [-4.35, -1.76]; P<0.0001, both). Significant improvements in iTNSS with GSP301 BID occurred by 10 minutes post-dose (- 1.26 [-2.30, -0.21], P=0.019) and were maintained at all later time points except one (2.5 hours). Treatment-emergent AEs occurred in 22.2%, 30.6%, 25.0%, 22.2%, and 16.7% of participants in GSP301 BID, GSP301 QD, AzeFlu, Olopatadine, and placebo groups, respectively.

CONCLUSION

In an EEC model, GSP301 BID and QD treatments were well tolerated and provided statistically significant and clinically meaningful SAR symptom improvement versus placebo.

https://ift.tt/2OWqi7M

Sclerosing Odontogenic Carcinoma with Local Recurrence: Case Report and Review of Literature

Abstract

Sclerosing odontogenic carcinoma is a rare locally destructive neoplasm with many histologic mimics. Here the diagnostic challenges are presented of a case of sclerosing odontogenic carcinoma with variable histologic features, including unusual and unexpected negative immunostaining for CK19.

https://ift.tt/2QNcb25

Sclerosing Odontogenic Carcinoma with Local Recurrence: Case Report and Review of Literature

Abstract

Sclerosing odontogenic carcinoma is a rare locally destructive neoplasm with many histologic mimics. Here the diagnostic challenges are presented of a case of sclerosing odontogenic carcinoma with variable histologic features, including unusual and unexpected negative immunostaining for CK19.

https://ift.tt/2QNcb25

IgG1+ B‐cell immunity predates IgE responses in epicutaneous sensitization to foods

Allergy, EarlyView.


https://ift.tt/2IQpkoh

Th2 cytokines orchestrate the secretion of MUC5AC and MUC5B in IL‐5‐positive chronic rhinosinusitis with nasal polyps

Allergy, EarlyView.


https://ift.tt/2pOGx8I

Neonates colonized with pathogenic bacteria in the airways have a low‐grade systemic inflammation

Allergy, EarlyView.


https://ift.tt/2ISZKin

Treatable Traits in the European U‐BIOPRED Adult Asthma Cohorts

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2pS6Mep

Atopic diseases and Type I sensitization from adolescence to adulthood in an unselected population (TOACS) with focus on predictors for allergic rhinitis

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2A62eaw

Sclerosing Odontogenic Carcinoma with Local Recurrence: Case Report and Review of Literature

Abstract

Sclerosing odontogenic carcinoma is a rare locally destructive neoplasm with many histologic mimics. Here the diagnostic challenges are presented of a case of sclerosing odontogenic carcinoma with variable histologic features, including unusual and unexpected negative immunostaining for CK19.

https://ift.tt/2QNcb25

Book Review—Diagnostic pathology: cardiovascular, 2nd edition

https://ift.tt/2OTUQqV

Association of IL-36γ with tertiary lymphoid structures and inflammatory immune infiltrates in human colorectal cancer

Abstract

IL-1 family cytokines play a dual role in the gut, with different family members contributing either protective or pathogenic effects. IL-36γ is an IL-1 family cytokine involved in polarizing type-1 immune responses. However, its function in the gut, including in colorectal cancer pathogenesis, is not well appreciated. In a murine model of colon carcinoma, IL-36γ controls tertiary lymphoid structure formation and promotes a type-1 immune response concurrently with a decrease in expression of immune checkpoint molecules in the tumor microenvironment. Here, we demonstrate that IL-36γ plays a similar role in driving a pro-inflammatory phenotype in human colorectal cancer. We analyzed a cohort of 33 primary colorectal carcinoma tumors using imaging, flow cytometry, and transcriptomics to determine the pattern and role of IL-36γ expression in this disease. In the colorectal tumor microenvironment, we observed IL-36γ to be predominantly expressed by M1 macrophages and cells of the vasculature, including smooth muscle cells and high endothelial venules. This pattern of IL-36γ expression is associated with a CD4⁺ central memory T cell infiltrate and an increased density of B cells in tertiary lymphoid structures, as well as with markers of fibrosis. Conversely, expression of the antagonist to IL-36 signaling, IL-1F5, was associated with intratumoral expression of checkpoint molecules, including PD-1, PD-L1, and CTLA4, which can suppress the immune response. These data support a role for IL-36γ in the physiologic immune response to colorectal cancer by sustaining inflammation within the tumor microenvironment.

https://ift.tt/2IOKG5g

Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study

Head &Neck, EarlyView.


https://ift.tt/2CEvM1s

Factors associated with complications in total laryngectomy without microvascular reconstruction

Head &Neck, EarlyView.


https://ift.tt/2Cd2XrX

Prognostic role of extracapsular spread in planned neck dissection after chemoradiotherapy

Head &Neck, EarlyView.


https://ift.tt/2CG6PCM

Risk analysis for tracheostomy dependency in curatively treated laryngeal cancer with organ preservation

Head &Neck, EarlyView.


https://ift.tt/2Cd2WEp

Linagliptin inhibits high glucose‐induced trans‐differentiation of hypertrophic scar derived fibroblasts to myofibroblasts via IGF/Akt/mTOR signaling pathway

Experimental Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Onhto4

Sunscreen applied at ≥ 2mg/cm2 during a sunny holiday prevents erythema; a biomarker of UVR‐induced DNA damage and suppression of acquired immunity

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


https://ift.tt/2OhY4F7

Detection of anti‐type VII collagen IgE antibodies in epidermolysis bullosa acquisita

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


https://ift.tt/2yyIQRp