APRT deficiency: the need for early diagnosis

Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder which leads to accumulation of poorly soluble 2,8-dihydroxyadenine in kidneys resulting in nephrolithiasis as well as chronic kidney disease from crystal nephropathy. This report describes a 55-year-old previously fit man who presented with shortness of breath and the investigative pathway that eventually led to a diagnosis of APRT deficiency. Early diagnosis has aided in timely institution of allopurinol, thereby improving his renal function and possibility of weaning off renal replacement therapy. Genetic testing has enabled early identification of other family members at risk and prevention of renal failure by commencing xanthine oxidoreductase (XOR) inhibitors. The issues surrounding kidney donation by a member of this family are also discussed. This case represents the importance of awareness and recognition of the signs and symptoms of this rare condition, complications of which can be easily prevented by early institution of XOR inhibitor therapy.

https://ift.tt/2EIgmep

Congenital hypoplasia of depressor anguli oris muscle (CHDAOM): an uncommon cause of asymmetric crying facies in childhood

Description 

A 2-year-old developmentally normal girl presented to us with a history of deviation of angle of mouth to right only during crying, persisting from neonatal period. She was born at term by normal vaginal delivery to a primigravida mother with a birth weight of 2.2 kg and smooth perinatal transition. Parents noticed asymmetry of face from neonatal period visible only during crying, which disappeared when she was consoled, without any drooling, regurgitation of feeds or poor sucking. There is no history suggestive of any other neurological or systemic abnormality in index case or in family.

Local examination revealed thinning of lower lip near left angle of mouth on palpation. There was no facial asymmetry while the child was calm (figure 1A), however, on crying there was deviation of the angle of mouth downwards and towards right side (figure 1B). There was no evidence of hypoplasia...

https://ift.tt/2OMfHgk

Brazilian experience with atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis

The aim of this study was to evaluate the positivity rates of atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in patients with respiratory diseases such as ast...

https://ift.tt/2O2dlF3

A paediatric case of cutaneous larva migrans acquired in the UK

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2q8QRIM

Sturz bei der Gartenarbeit mit asymptomatischer penetrierender Halsverletzung

Laryngo-Rhino-Otol
DOI: 10.1055/a-0756-9714

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2D3rh0H

Aerobe Belastung bei Mundatmung verändert die Wahrnehmungsschwelle für H2S nicht

Laryngo-Rhino-Otol
DOI: 10.1055/a-0753-0367

Hintergrund Während aerober körperlicher Belastung verschlechterte sich in einer früheren Studie bei Nasenatmung die Wahrnehmungsschwelle für H2S. Die Ursache blieb offen. Es soll in dieser Studie geprüft werden, wie sich die Wahrnehmungsschwelle bei alleiniger Mundatmung verändert. Material und Methoden Während einer Ruhephase einer aeroben Belastung und nachfolgender Erholungsphase wurden unterschiedliche H2S-Konzentrationen mittels eines Fluss-Olfaktometers im staircase Verfahren inspirationssynchron intranasal appliziert. Die fehlende Nasenatmung wurde online und offline objektiviert. Es wurden die Reaktionszeiten bestimmt. Parallel sind verschiedene Vitalparameter gemessen worden. Ergebnisse Die passiven Wahrnehmungsschwellen zwischen den Belastungs- und der Erholungsphasen differierten nicht. In der Ruhephase war die H2S Schwelle am höchsten. Die Reaktionszeiten waren in den drei Versuchsphasen nicht different. Schlussfolgerung Eine etwa halbstündige aerobe Belastung veränderte die passive Riechschwelle für H2S bei Mundatmung im Vergleich zur nachfolgenden Erholungsphase nicht. Die hohe Riechschwelle in der Ruhephase wird mit anfänglichen Anpassungsschwierigkeiten an die Versuchsbedingungen erklärt.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2PRmhyS

Dear Dr. Dermatoethicist: Erection Ethics

https://ift.tt/2Rcv2Ux

Surgical Pearl: Reverse Beveling to Improve Wound Edge Apposition

https://ift.tt/2q7OeHv

The Cost of an Itch: A Nationally Representative Retrospective Cohort Study of Pruritus-Associated Healthcare Expenditure in the United States

https://ift.tt/2R9Y32S

Association between atopic dermatitis, depression and suicidal ideation: A systematic review and meta-analysis

This meta-analysis found that atopic dermatitis was associated with increased odds of clinical depression, depressive symptoms, anti-depressant use, suicidality and parental depression. Presence of depression and suicidality should be incorporated into clinical decision-making of atopic dermatitis patients.

https://ift.tt/2q8UVc7

Treatment of primary non-metastatic melanoma at high-volume academic facilities is associated with improved long-term patient survival

Volume-outcome relationships in cancer care have motivated calls for regionalization of care. We demonstrate that high-volume academic facilities achieve improved outcomes for melanoma patients. Increased utilization of those aspects of these centers that increase patient survival, whether by regionalization of care or dissemination of these practices, may improve patient outcomes.

https://ift.tt/2R5u2RQ

High-Throughput Sequencing of the T-cell receptor beta chain gene distinguishes two subgroups of cutaneous T-cell lymphoma

https://ift.tt/2qfqt0h

Perspectives on Dexmedetomidine Use for Neurosurgical Patients

The α2-adrenergic receptor agonist dexmedetomidine has sedative, anxiolytic, analgesic, and sympatholytic effects. The potential advantages of neuroprotection, minimal impact on neuronal function, stable hemodynamics, opioid and anesthesia sparing effects, and minimal respiratory depression during awake procedures render it an effective anesthetic adjuvant in various neurosurgical settings. However, both the benefits and drawbacks of the use dexmedetomidine in neuroanesthesia should be considered. This narrative review will summarize the applications of dexmedetomidine in various neurosurgical settings, highlighting evidence regarding both its common and controversial uses. Supported by Beijing Municipal Administration of Hospitals' Youth Program (QML20160503) and by the National Natural Science Foundation of China (Grant No.1701038). The authors have no funding or conflicts of interest to disclose. Address correspondence to: Adrian W. Gelb, MB, ChB, Department of Anesthesia & Perioperative Care, University of California San Francisco, 500 Parnassus Ave., MUE 408, San Francisco, CA 94143 (e-mail: adrian.gelb@ucsf.edu). Received March 27, 2018 Accepted September 6, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

https://ift.tt/2CZG0JS

A novel hydroxyapatite-binding antimicrobial peptide against oral biofilms

Abstract

Objectives

Novel synthetic antimicrobial peptides which consist of a new immunomodulatory peptide 1018 and two different modifications with hydroxyapatite-binding affinity were developed. We compared the effect(s) of these peptides against oral plaque biofilms and measured their effectiveness in killing biofilm microbes and in reducing biofilm volume.

Materials and methods

The high affinity hydroxyapatite (HA)-binding peptide 1018 (SHABP), the mild affinity HA-binding peptide 1018 (MHABP), and peptide 1018 without additional amino acid sequence (peptide 1018) were synthesized. Oral multispecies biofilms were grown anaerobically for 3 days. The biofilms were exposed to three peptides at two different concentrations (0.65 and 3.25 μmol/L) for 24, 48, and 72 h. The biofilms were also treated for 3 or 9 min with the peptides (3.25 μmol/L). The percentage of killed biofilm bacteria and biofilm volume were determined by using LIVE/DEAD viability staining and confocal laser scanning microscopy.

Results

SHABP was superior to MHABP and peptide 1018 in its killing efficacy of the pre-formed biofilms, especially at concentration of 3.25 μmol/L (p < 0.05). SHABP performed also better than MHABP and peptide 1018 in reducing the overall biofilm volume at both concentrations (p < 0.05). During the 3 days of long-term exposure, MHABP and peptide 1080 killed more bacteria in the top half of the biofilms, compared to bottom half. SHABP killed more bacteria in the bottom half (39%) of the biofilms than in the top half (29%) at day 1 (p < 0.05), whereas more bacteria were killed in the upper layers on days 2 and 3. SHABP killed a much higher percentage of plaque biofilm bacteria when used on 3-day-old biofilms for one or three times for 3 min than MHABP or peptide 1018 at high concentration (p < 0.05).

Conclusions

The modified peptide 1018 with high HA-binding affinity had higher antimicrobial activity against biofilm microbes and reduced biofilm volume more than the other peptides tested.

Clinical relevance

Modified peptide 1018 with high hydroxyapatite-binding affinity is a promising agent for use in oral antibiofilm strategies in the future.

https://ift.tt/2PkKDnm

Androgen-dependent immune modulation in parasitic infection

Abstract

Parasitic infections modulate the immune system of the host, resulting in either immune tolerance or the induction of pro-inflammatory defense mechanisms against the pathogen. In both cases, sex hormones are involved in the regulation of the immune response, as they are present in the systemic circulation and can act on a wide variety of cell types, including immune cells. Men and women have a different milieu of sex hormones, and these hormones play a role in determining immune responses to parasitic infections. Men, who have higher plasma levels of androgens than women, are generally more susceptible to parasitic infections. Many immune cells express the androgen receptor (AR), and the immunologic functions of these cells can be modulated by androgens. In this review, we will highlight the immune cell types that are sensitive to male steroid hormones and describe their roles during three parasitic diseases, amebiasis, leishmaniasis, and helminthiasis.

https://ift.tt/2PMCFR7

Lésions auto-provoquées dans un contexte d’hidradénite suppurée : un cas de pathomimicrie

Publication date: Available online 22 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Marzouki-Zerouali, A. Schoeffler, A.-L. Liegeon, P. Le Vaou, F. Truchetet

Résumé

Introduction

Les troubles factices constituent un domaine complexe de la pathologie. Si le diagnostic est souvent évoqué, il est difficile à poser et la thérapeutique est délicate. La pathomimie cutanée est une expression somatique cutanée d'un désordre psychiatrique souvent grave, provoquée dans un état de conscience claire par le malade lui-même sur son revêtement cutanéomuqueux mais dont la motivation est inconsciente, sans recherche de bénéfices secondaires ; elle se distingue donc de la simulation. Les pathomimicries représentent une entité particulière proche de la pathomimie : il s'agit de l'induction de poussées d'une maladie connue déclenchées par l'exposition volontaire à l'agent responsable. Nous rapportons un cas de pathomimicrie dans un contexte d'hidradénite suppurée.

Observation

Une adolescente ayant pour antécédents principaux une obésité de grade 2 et un épisode d'abcès pubien était vue en consultation pour des lésions axillaires. Elle arrivait dans un état d'incurie, méfiante, agressive et refusait de se déshabiller. Après mise en confiance, l'examen clinique montrait de larges ulcérations à distance des plis sur les zones axillaires, à contours géographiques et à fond propre et bourgeonnant, associées à des lésions typiques d'hidradénite suppurée de grade 2 (Hurley), avec des pertuis purulents et des cicatrices en corde des plis inguinaux. Une hospitalisation était proposée et l'évolution était favorable sous antibiothérapie par doxycycline et soins locaux par pansements alginates et hydrocellulaires. L'avis psychiatrique concluait à une faille narcissique ancienne à type de dysmorphophobie probablement réactionnelle à un harcèlement scolaire récurrent depuis l'enfance. Sous couvert d'une relation de confiance difficilement établie, la patiente reconnaissait la manipulation de ses lésions. Devant les données anamnestiques, cliniques, la négativité du bilan paraclinique, le diagnostic de pathomimicrie était retenu.

Discussion

Plusieurs cas de pathomimicrie de dermatoses (auto-entretien d'un ulcère de cause connue, contact avec un allergène identifié dans l'eczéma ou reprise d'un médicament incriminé dans une toxidermie) ou de maladies systémiques (injections d'insuline chez un patient diabétique) ont été rapportés. Ce cas est le premier décrit, à notre connaissance, de pathomimicrie dans le cadre d'une hidradénite suppurée. Sur le plan thérapeutique, le suivi doit être multidisciplinaire. Il faut éviter l'affrontement avec le patient et ne pas forcer son aveu, ce qui risquerait d'induire une décompensation psychiatrique grave. Une attitude rassurante permet le recours au psychiatre une fois la confiance durablement établie. Le dermatologue a donc une place primordiale dans la prise en charge de ces patients.

Summary

Background

Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent. Herein we report on a case of pathomimicry in a context of hidradenitis suppurativa.

Patients and methods

A teenage girl whose main previous medical history consisted of grade-2 obesity and an episode of pubic abscess was seen at our clinic for axillary lesions. She presented in a state of negligence, was suspicious and aggressive, and refused to undress. After gaining her trust, clinical examination revealed prominent ulcerations (each with a granulated base) at a distance from the folds in the axillary areas, as well as typical hidradenitis lesions of Hurley Grade 2 with purulent openings and rope-like scars from the inguinal folds. Hospitalization was recommended and a positive outcome was achieved under antibiotic therapy with doxycycline, topical alginate and hydrocellular dressings. A psychiatric evaluation concluded that the patient was presenting dysmorphophobic narcissistic weakness, probably in reaction to recurrent harassment at school since childhood. Once she developed trust with us, which was difficult to establish, the patient admitted to having caused the lesions herself. Given the history and clinical data, as well as the negative laboratory tests, a diagnosis of pathomimicry was made.

Discussion

Several cases of dermatological pathomimicry (sustainment by the patient of an ulcer with a known cause, contact with an allergen found in eczema, or renewed use of a medication implicated in toxiderma) or systemic disease (insulin injection in a diabetic patient) have been reported. To the best of our knowledge, this is the first description of pathomimicry associated with hidradenitis suppurativa. Regarding therapy, aftercare should be multidisciplinary. Confessions should not be forced and confrontations, which risk serious psychiatric collapse, should be avoided. A reassuring attitude enables psychiatry to be applied once trust has been sustainably established, hence the crucial role of the dermatologist.

https://ift.tt/2S9uDU9

Sinking Skin Flap Syndrome: Phenomenon of Neurological Deterioration after Decompressive Craniectomy

Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. Management is largely conservative. We here present a case of a patient with large craniectomy who was admitted to our hospital with pneumonia. Later on, he developed worsening mental status and CT head revealed sinking skin flap with significant midline shift. This is a very rare case of neurological deterioration after craniectomies, commonly known as sinking skin flap syndrome. To our knowledge, only few cases have been reported so far.

https://ift.tt/2CBjzK9

Comparison of miRNA expression profiles in individuals with chronic or aggressive periodontitis

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


https://ift.tt/2O0Xuq7

Multi‐ethnic variations in the practice of oral cancer risk habits in a developing country

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


https://ift.tt/2OG126o

Adjuvant De-Escalated Radiation + Adjuvant Nivolumab for Intermediate-High Risk P16+ Oropharynx Cancer

Conditions:   Carcinoma, Squamous Cell of Head and Neck;   Oropharynx Squamous Cell Carcinoma
Interventions:   Drug: Nivolumab Injection;   Radiation: Radiotherapy (RT)
Sponsors:   Robert Ferris;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2z0kzUn

Hyaluronic acid gel based on CPM® technology with and without lidocaine: Is there a difference?

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2D1BZ7P

Effects of isotretinoin on the hair cycle

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2PU7oMl

Autologous pure platelet‐rich plasma injections for facial skin rejuvenation: Biometric instrumental evaluations and patient‐reported outcomes to support antiaging effects

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2D2qJYX

Mr John Jago 05 June 1940–07 September 2018

Publication date: Available online 22 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): N.A. Nasser

https://ift.tt/2q5lSxh

Multicentre approach to epidemiological aspects of craniosynostosis in Germany

Publication date: Available online 22 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): C. Neusel, D. Class, A.W. Eckert, R. Firsching, P. Göbel, D. Götz, R. Haase, G. Jorch, A. Köhn, S. Kropf, L. Patzer, I. Schanze, C. Zahl, A. Rissmann

Abstract

We know of no current published data on the prevalence of craniosynostosis in Germany, so our objective in this study was to contribute to the limited knowledge of its epidemiology by assessing time trends, the frequency of prenatal diagnosis, and the timing of diagnosis and treatment. Data were collected in Saxony-Anhalt during the period 2000–17, and we designed a retrospective multicentre cohort study. The prevalence was 4.8 cases of craniosynostosis/10 000 births, and did not increase during that time. We compared the data of 91 patients with those of 273 controls. There were 75 boys and 16 girls (ratio 4.7:1). Fifty-one children had isolated craniosynostosis, consisting of 46 with a single-suture, and five with a multisuture, synostosis. Twenty-nine were associated with other congenital malformations, and 11 were syndromic. Three cases had been diagnosed prenatally, and 34 had skull deformities diagnosed immediately after birth at a mean (SD) age of 3.4 (4.7) months. The mean (SD) age at the time of first admission to hospital in one of the three surgical centres of Saxony-Anhalt was 5.9 (5.5) months, and 65 patients were operated on at a mean age of 9.1 (6.3) months. In contrast to published reports we found a prevalence of 4.8 cases of craniosynostosis/10 000 births that did not increase during the period 2000–16. Although we found a low prenatal detection rate, the diagnosis and treatment in this cohort study seemed timely.

https://ift.tt/2R8GrEz

Anatomical characteristics of maxillary sinus septa visualized by cone beam computed tomography

Publication date: Available online 22 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. Hungerbühler, C. Rostetter, H.-T. Lübbers, M. Rücker, B. Stadlinger

Abstract

Proper implant positioning in the posterior region of the edentulous maxilla commonly requires sinus floor elevation. Maxillary sinus septa increase the risk of membrane perforation during sinus floor elevation. The purpose of this retrospective, cone beam computed tomography (CBCT)-based study was to examine the frequency, number, location, and orientation of antral septa in the maxillary sinus. Further, possible associated factors were assessed. Measurements were performed on CBCT scans of 301 patients (602 sinuses). The data were analysed statistically with respect to patient age, sex, and dentition type. One or more septa were detected in 117 patients (38.9%). A total of 188 septa were found in the 602 sinuses (31.2%). Septa were most often coronally oriented (53.2%), followed by sagittal (24.5%) and transverse (22.3%) orientations. Septa were most often found in the region of the first and second molar (37.2%), followed by the posterior region of the third molar (33.0%) and the anterior region of the premolars and canines (29.8%). A significant association was found between edentulism and the presence of septa. For edentulous patients, the septa were most often transversally oriented. Maxillary sinus septa are encountered in every third patient. This may have an influence on the performance of sinus floor elevation.

https://ift.tt/2JcuuuP

Histologic pattern of invasion and epithelial-mesenchymal phenotype predict prognosis in squamous carcinoma of the head and neck

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Gregory T. Wolf, William Winter, Emily Bellile, Ariane Nguyen, C.R. Donnelly, Jonathan B. McHugh, Dafydd Thomas, Lahin Amlani, Laura Rozek, Yu L. Lei, the Head and Neck SPORE Program

Abstract

Introduction

Disruption of E-cadherin function and increased expression of vimentin and the transcriptional oncogene, SOX2, are thought to characterize epithelial to mesenchymal transition (EMT) in HNSCC that contributes to invasive and metastatic behavior. To determine if such changes relate to prognosis or host immune response, expression of these markers and correlations with clinical characteristics, histologic worst pattern of invasion (WPOI) and tumor infiltrating lymphocytes (TIL) and survival were assessed.

Methods

Immunohistologic expression of markers was determined in tissue microarrays from 274 previously untreated HNSCC patients. Expression was correlated with levels of TILs in microcores and WPOI in biopsy specimens. Correlations were assessed by Kruskal-Wallis testing and Spearman correlation coefficients where appropriate. Overall and relapse-free survival were analyzed with Cox proportional hazards models. Median follow up was 60.0 months.

Results

Loss of E-cadherin expression was significantly associated with low or absent SOX2 expression (R = 0.433, p < 0.0001). SOX2 expression and low grade WPOI were significantly associated with favorable overall (OS) and relapse free (RFS) survival in multivariable analysis. E-cadherin expression did not correlate with TILs, however WPOI score correlated indirectly with CD4, CD8, and FoxP3 levels. When grouped by primary treatment, lower grades (1, 2) of WPOI predicted improved RFS and OS in patients treated with primary surgery but not for patients treated with chemoradiation.

Conclusion

The findings suggest that SOX2 expression and WPOI are significant prognostic factors and that WPOI correlates with decreased T cell infiltration. The combination of markers and TILs might be useful in selecting patients for primary surgery.

https://ift.tt/2PQknyu

Treatment outcomes of squamous cell carcinoma of the oral cavity in young adults

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Mauricio E. Gamez, Ryan Kraus, Michael L. Hinni, Eric J. Moore, Daniel J. Ma, Stephen J. Ko, Jean Claude M. Rwigema, Lisa A. McGee, Michele Y. Halyard, Matthew R. Buras, Robert L. Foote, Samir H. Patel

Abstract

Objectives

The natural history of squamous cell carcinoma (SCC) of the oral cavity (OC) in young adults is unknown. We sought to provide an updated report on treatment outcomes of patients with OC SCC who were 40 years or younger.

Materials and methods

We performed a retrospective analysis of 124 consecutive patients with primary OC SCC treated at Mayo Clinic (1980–2014). Patient and tumor characteristics and treatment approach were abstracted from patient charts.

Results

Median patient age was 35 years (range, 19–40 years). The most common primary site was oral tongue (107 patients; 86.3%). Most patients (101; 81.5%) underwent wide local excision. Surgery alone was curative in 77 patients (62.1%); 47 (37.9%) received radiotherapy, and 26 (21%) received chemotherapy. Five-year overall survival (OS) was 78.1%; 10-year OS was 76.9%. Five-year disease-free survival (DFS) was 66.6%; 5-year local control was 87.6%; and 5-year locoregional control was 78.5%. On multivariable analysis, factors associated with worse OS and DFS were higher pathologic T stage (P = .008), lymph node positivity (P < .001), and disease recurrence (P < .001).

Conclusion

Young adults with primary OC SCC may be treated with a similar treatment approach as older adults.

https://ift.tt/2D3RVGy

Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma

Publication date: Available online 23 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sumita Khatri, Wendy Moore, Peter G. Gibson, Richard Leigh, Arnaud Bourdin, Jorge Maspero, Manuel Barros, Roland Buhl, Peter Howarth, Frank C. Albers, Eric S. Bradford, Martyn Gilson, Robert G. Price, Steven W. Yancey, Hector Ortega

Abstract

Background

Mepolizumab has demonstrated favorable safety and efficacy profiles in placebo-controlled trials ≤12 months' duration; however, long-term data are lacking.

Objective

To evaluate the long-term safety and efficacy of mepolizumab in patients with severe eosinophilic asthma (SEA).

Methods

COLUMBA (NCT01691859) was an open-label extension study in patients with SEA previously enrolled in DREAM (NCT01000506). Patients received 100mg subcutaneous mepolizumab every 4 weeks plus standard of care, until a protocol-defined stopping criterion was met. Safety endpoints included frequency of adverse events (AEs), serious AEs (SAEs), and AEs of special interest. Efficacy endpoints included annualized exacerbation rate, changes from baseline in Asthma Control Questionnaire (ACQ)-5 score, and blood eosinophil counts. Immunogenicity was also assessed.

Results

Overall, 347 patients were enrolled for an average of 3.5yrs (maximum: 4.5yrs; total exposure: 1201 patient-years). On-treatment AEs were reported in 94% of patients (exposure-adjusted rate: 3688 events/1000 patient-years). The most frequently reported on-treatment AEs were respiratory tract infection, headache, bronchitis, and asthma worsening. Seventy-nine (23%) patients experienced ≥1 on-treatment SAE; there were 6 deaths, none assessed as related to mepolizumab. For patients with ≥156 weeks enrollment, the exacerbation rate was 0.74 events/year (Weeks 0–156), a 56% reduction from the off-treatment period between DREAM and COLUMBA. For all patients, at the first post-baseline assessment, the mean ACQ-5 score was reduced by 0.47 points and blood eosinophil counts by 78%, with similar improvements maintained throughout the study. The immunogenicity profile (8% anti-drug antibodies) was consistent with previous studies.

Conclusion

These data support the long-term safety and efficacy of mepolizumab in patients with SEA.

Clinical Implications

Following long-term use in patients with severe eosinophilic asthma, mepolizumab maintains clinical effectiveness and continues to demonstrate a favorable safety profile, with no evidence of inducing neutralizing antibodies.

Graphical abstract

https://ift.tt/2CAuCDl

Advances in Atopic Dermatitis in 2017

Publication date: Available online 22 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Katie Kennedy, Jennifer Heimall, Jonathan M. Spergel

Synopsis

This review encompasses relevant scientific and clinical advances in atopic dermatitis published in 2017. These include articles from the Journal as well as other prominent publications that have contributed to the emerging field of the microenvironment of the skin and molecular patterns guiding biologic treatment strategies. The most commonly questioned and explored themes of the year included the impact of the microbiome on atopic dermatitis development as well as cell signaling and severity of symptoms. Topics also included the description of patient specific molecular endotypes within the larger atopic dermatitis population. All of these factors will create potential opportunities to guide personalized therapy with the broadening array of topical and systemic interventions currently available, as well as provide new insights to guide development of novel, molecularly targeted therapeutics. With recent FDA approval of the first wave of new, targeted therapies for atopic dermatitis (AD), additional information exploring the safety profiles and long-term effects of these medications was also at the forefront of 2017.

https://ift.tt/2AmHQSn

Elevated IgE M1 prime transcripts in nasal tissues in patients with nasal polyps and asthma

Publication date: Available online 22 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Heleen Scheerens, Ashley Smith, Olga Li, Lee Honigberg, Jeffrey M. Harris, Gabriele Holtappels, Claus Bachert

https://ift.tt/2CxTcES

Assessing the effect of multibracket appliance treatment on tooth color by using electronic measurement

The purpose of this study was to investigate how tooth color is affected by multibracket appliance (MBA) treatment.

https://ift.tt/2O1VdLw

Lingual cavernous hemangioma in a Nepalese boy—‘A Difficult Associate!!!’

Abstract

Hemangiomas are benign tumors comprising of ectatic blood vessels. Although common in the head and neck region, those occurring within the oral cavity and tongue are exceedingly rare. We report a 5-year-old boy with a swelling over the anterior third of tongue post failed conservative therapy eventually treated with surgical excision and confirmed histologically as a cavernous hemangioma probably first of its kind reported from Nepal.

https://ift.tt/2EEljoh

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):861

Authors:

PMID: 30347055 [PubMed - in process]

https://ift.tt/2EEs6OX

Timely Adjuvant Postoperative Radiotherapy: Racing to a PORT in the Storm.

Timely Adjuvant Postoperative Radiotherapy: Racing to a PORT in the Storm.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 18;:

Authors: Teng MS, Gupta V

PMID: 30347023 [PubMed - as supplied by publisher]

https://ift.tt/2OHEEK0

Association of Facility Volume With Positive Margin Rate in the Surgical Treatment of Head and Neck Cancer.

Association of Facility Volume With Positive Margin Rate in the Surgical Treatment of Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 18;:

Authors: Nocon CC, Ajmani GS, Bhayani MK

Abstract
Importance: The achievement of complete tumor resection with tumor-free margins is one of the main principles of oncologic surgery for head and neck squamous cell carcinoma (HNSCC). The negative prognostic influence of a positive margin (PM) across all head and neck subsites has been well established. National guidelines recommend the use of adjuvant chemoradiation therapy (CRT) in the setting of PM.
Objective: To determine the incidence of PM in HNSCC across multiple subsites, as well as the factors associated with its occurrence.
Design, Setting, and Participants: This retrospective cohort study used the National Cancer Database to identify patients diagnosed with HNSCC between 2010 and 2014 and who underwent surgical resection (n = 28 840).
Main Outcomes and Measures: Predictors of PM rate and likelihood to receive adjuvant CRT.
Results: Among the 28 840 patients included in this study, 19 727 (68.4 %) were men, and the average age was 62.4 years (range, 40 to ≥90 years). In univariable analysis, a lower PM rate was associated with higher facility volume (26.3% for the lowest volume quartile, 16.5% for the middle 2 quartiles, and 10.8% for the highest volume quartile) and treatment at academic vs nonacademic facilities (14.0% vs 22.7%). In multivariate analysis, those treated at higher-volume facilities remained significantly less likely to have PM (adjusted odds ratio, 0.85; 95% CI, 0.83-0.88). The trend of decreasing PM rate with increasing facility volume was observed in both academic (aOR, 0.88 per 10-case volume increase [95% CI, 0.85-0.91]) and nonacademic (aOR, 0.73 per 10-case volume increase [95% CI, 0.68-0.80]) facilities. There was no association between facility volume and patient likelihood of receiving adjuvant CRT in the setting of PM (compared with CCPs: aOR, 0.98 per 10-case volume increase [95% CI, 0.84-1.14] for CCCPs; and aOR, 1.24 [95% CI, 0.99-1.55] for INCPs).
Conclusions and Relevance: These findings suggest that high-volume facilities are associated with lower rates of PM in the surgical treatment of HNSCC in both academic and nonacademic settings. Facility volume for head and neck oncologic surgeries may be considered a benchmark for quality of care.

PMID: 30347018 [PubMed - as supplied by publisher]

https://ift.tt/2EEs5dR

Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma.

Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 18;:

Authors: Janz TA, Kim J, Hill EG, Sterba K, Warren G, Sharma AK, Day TA, Hughes-Halbert C, Graboyes EM

Abstract
Importance: Delays in initiation of postoperative radiotherapy (PORT) after surgery for head and neck squamous cell carcinoma (HNSCC) are common, predominantly affect racial minorities, and are associated with decreased survival. Details regarding the care processes that contribute to timely, equitable PORT remain unknown.
Objective: To determine care processes associated with timely, equitable PORT.
Design, Setting, and Participants: This retrospective cohort study included patients 18 years or older undergoing surgery for HNSCC at the Medical University of South Carolina (MUSC), Charleston, followed by PORT (at MUSC or elsewhere) with or without chemotherapy from January 1, 2014, through December 31, 2016. Data were analyzed from September 15, 2017, through June 28, 2018.
Main Outcomes and Measures: The main outcome measure was the proportion of timely, guideline-adherent initiation of PORT (≤6 weeks postoperatively). Secondary outcome measures included care processes associated with timely PORT. The association between process variables with timely PORT was explored using multivariable logistic regression analysis. Effect modification of the association between receipt of care processes and timely PORT by race was explored using interaction effects.
Results: A total of 197 patients were included in the analysis; they were predominantly white (157 [79.7%]) and male (136 [69.0%]) with a mean age of 59 years (range, 28-89 years). Overall, 89 patients (45.2%) experienced a delay initiating PORT. African American patients had a 13.5% absolute increase in the rate of delayed PORT relative to white patients (21 of 37 [56.8%] vs 68 of 157 [43.3%]). The adjusted multivariable regression showed that the following care processes were associated with timely PORT: preoperative radiotherapy consultation (odds ratio [OR], 8.94; 95% CI, 1.64-65.53), PORT at MUSC (OR, 6.21; 95% CI, 1.85-24.75), pathology report within 7 postoperative days (OR, 4.14; 95% CI, 1.21-15.86), time from surgery to PORT referral of no longer than 10 days (OR, 12.14; 95% CI, 3.14-63.00), time from PORT referral to consultation of no longer than 10 days (OR, 10.76; 95% CI, 3.01-49.70), and time from PORT consultation to its start of no longer than 21 days (OR, 4.80; 95% CI 1.41-18.44). Analysis of interactions revealed no statistically significant differences between African American and white patients in receipt of key processes associated with timely PORT.
Conclusions and Relevance: Specific care processes are associated with guideline-adherent initiation of PORT. Novel strategies appear to be needed to ensure that these processes are performed for all patients with HNSCC, thereby facilitating timely, equitable PORT.

PMID: 30347012 [PubMed - as supplied by publisher]

https://ift.tt/2OEYYM9

Andrologie bei onkologischen Erkrankungen

Zusammenfassung

In der dermatoonkologischen Behandlung findet sich eine Vielzahl gonadotoxischer Interventionen. Insbesondere alkylierende und hormonell aktive Substanzen sowie gonadale Bestrahlungen sind bekannt für eine fertilitätseinschränkende Wirkung beim Mann. Die zertifizierten Hautkrebszentren in Deutschland haben deshalb seit 2017 die Auflage zur Umsetzung von Beratungen zum Fertilitätserhalt. Gestützt wird dies durch die S2k-Leitlinie zur Fertilitätserhaltung bei onkologischen Therapien. Da die verschiedenen Interventionen von den dermatoonkologischen Leitlinien stadienabhängig empfohlen werden, befürworten die Autoren mindestens die Frage „Ist Kinderwunsch ein Thema für Sie?", wenn Patienten ein entsprechendes Stadium erreichen. Die Fertilitätsprotektion des Mannes über eine Kryokonservierung von Ejakulat oder Hodenmaterial ist dann eine einfache und sichere Möglichkeit. Das Verfahren ist standardisiert und häufig verfügbar. Zudem bietet sich über das neue Projekt Androprotect jetzt die Möglichkeit zur Kryokonservierung von Hodenmaterial präpubertärer männlicher Kinder und Säuglinge. Treten unter Therapie Zeichen eines Hypogonadismus auf, kann in Abwägung der Testosteronwirkungen eine Behandlung erwogen werden, wichtig ist, hier die anabolen und immunmodulierenden Effekte zu beachten.

https://ift.tt/2CAkzhB

Resveratrol Represses Tumor Necrosis Factor α/c-Jun N-terminal Kinase Signaling via Autophagy in Human Dental Pulp Stem Cells

Publication date: Available online 22 October 2018

Source: Archives of Oral Biology

Author(s): Feng-Ming Wang, Zhiai Hu, Xiaohua Liu, Jian Q. Feng, Robert. A. Augsburger, James L. Gutmann, Gerald N. Glickman

Abstract

Objectives

To study the effects of polyphenol resveratrol on TNFα-induced inflammatory signaling as well as the underlying mechanism in human dental pulp stem cells (DPSCs).

Materials and Methods

Human DPSCs were cultured and treated by TNFα in the presence or absence of resveratrol. NF-κB and mitogen-activated protein kinase (MAPK) signaling pathways were analyzed by Western blotting and immunofluorescence staining. Interleukin 6 (IL6) and interleukin 8 (IL8) mRNA levels were analyzed by reverse transcription polymerase chain reaction. For the mechanistic study, autophagy was examined and further manipulated by gene silencing of Atg5 using siRNAs. Statistical analysis was performed by Student's t- test, and values of p < 0.05 were considered significant.

Results

Upon TNFα treatments, neither degradation of IκBα nor the phosphorylation and nuclear translocation of p65 NF-κB were inhibited by resveratrol at different concentrations. In contrast, resveratrol dramatically inhibited TNFα-induced phosphorylation of c-Jun N-terminal kinase (JNK) MAPK. Furthermore, resveratrol activated autophagy, as evidenced by the accumulated autophagic puncta formed by lipid bound LC3B in resveratrol-treated cells. Intriguingly, both resveratrol and JNK inhibitor SP600125 suppressed TNFα-induced IL6 and IL8 mRNA expression (P < 0.05). Silencing autophagy gene Atg5 led to the hyper-activation of JNK and augmented TNFα-induced IL6 and IL8 mRNA expression (P < 0.05).

Conclusions

The results suggest that resveratrol suppresses TNFα-induced inflammatory cytokines expressed by DPSCs through regulating the inhibitory autophagy-JNK signaling cascade. Resveratrol might be beneficial to ameliorate pulpal damage during the acute phase of inflammation in vital pulp therapy.

https://ift.tt/2ScoKpd

Poorly differentiated plasmacytoid squamous cell carcinoma: Case report of a rare malignancy

Publication date: Available online 23 October 2018

Source: American Journal of Otolaryngology

Author(s): Gabrielle Rieth, Arminé Kocharyan, Akina Tamaki, Jason Thuener, Freedom Johnson

Abstract

Plasmacytoid squamous cell carcinoma is an especially aggressive variant of squamous cell carcinoma that has previously been described in the literature as a variant of oral cancers and most extensively, in vulvular [3], transitional cell, and urothelial carcinomas [2,13,15–20]. In this case report, we present a 36-year-old man with 6 to 8 weeks of a progressively enlarging mass over the lateral third of his clavicle, acromion process, and deltoid. The mass was resected, and the supraclavicular defect was reconstructed using an anterolateral thigh free flap. Final pathology determined the specimen was an invasive poorly differentiated squamous cell carcinoma with spindle cell and plasmacytoid features of cutaneous origin. Plasmacytoid squamous cell carcinomas have previously been described in the oral cavity, but in no other subsite of the head and neck. This article describes the patient's case and provides a literature review of the available reports related to plasmacytoid variant of squamous cell carcinoma.

https://ift.tt/2SeEjwH

The fragility of statistically significant results in otolaryngology randomized trials

Publication date: Available online 22 October 2018

Source: American Journal of Otolaryngology

Author(s): Mason Skinner, Daniel Tritz, Clayton Farahani, Andrew Ross, Tom Hamilton, Matt Vassar

Abstract

Objectives

The American Academy of Otolaryngology–Head and Neck Surgery regards randomized controlled trials as class A evidence. A novel method to determine the robustness of outcomes in trials is the fragility index. This index represents the number of patients whose status would have to change from a non-event to an event to make a statistically significant result non-significant.

Methods

Investigators included otolaryngology journals listed in the top 10 of one or both of Google Scholar Metrics and Clarivate Analytics' Journal rankings. For inclusion, a randomized controlled trial needed to report a one-to-one random assignment of participants to condition, contain two parallel arms or have used a two-by-two factorial design, and report at least one statistically significant dichotomous outcome.

Results

Sixty-nine trials met inclusion criteria. The median fragility index was three events (interquartile range 1–7.5). Median sample size was 72 (interquartile range 50–102.5). Modest correlations were observed between fragility index and total sample size (r = 0.27) and fragility index and event rate (r = 0.46). Investigators found no correlation between fragility index and impact factor or Science Citation Index. In 39% (27/69) of trials, the number lost to follow-up was equal to or greater than the fragility index.

Conclusion

A median fragility index of 3 indicates that three people, on average, are needed to alter the outcomes in otolaryngology trials. This indicates that the results of two-group randomized controlled trials reporting binary endpoints published in otolaryngology journals may frequently be fragile.

https://ift.tt/2yXzkaL

Analysis of the role of thyroidectomy and thymectomy in the surgical treatment of secondary hyperparathyroidism

Publication date: Available online 22 October 2018

Source: American Journal of Otolaryngology

Author(s): Mateus R. Soares, Graziela V. Cavalcanti, Ricardo Iwakura, Leandro J. Lucca, Elen A. Romão, Luiz C. Conti de Freitas

Abstract

Purpose

Parathyroidectomy can be subtotal or total with an autograft for the treatment of renal hyperparathyroidism. In both cases, it may be extended with bilateral thymectomy and total or partial thyroidectomy. Thymectomy may be recommended in combination with parathyroidectomy in order to prevent mediastinal recurrence. Also, the occurrence of thyroid disease observed in patients with hyperparathyroidism is poorly understood and the incidence of cancer is controversial. The aim of the present study was to report the experience of a single center in the surgical treatment of renal hyperparathyroidism and to analyse the role of thyroid and thymus surgery in association with parathyroidectomy.

Materials and methods

We analysed parathyroid surgery data, considering patient demographics, such as age and gender, and surgical procedure data, such as type of hyperparathyroidism, associated thyroid or thymus surgery, surgical duration and mediastinal recurrence. Histopathological results of thyroid and thymus samples were also analysed.

Results

Medical records of 109 patients who underwent parathyroidectomy for secondary hyperparathyroidism were reviewed. On average, thymectomy did not have impact on time of parathyroidectomy (p = 0.62) even when thyroidectomy was included (p = 0.91). Intrathymic parathyroids were detected in 7.5% of the thymuses removed and papillary carcinoma was detected in 20,8% of thyroid tissue samples. Two patients showed recurrence of supernumerary intrathymic parathyroids and a single case of mediastinitis was observed.

Conclusions

Parathyroidectomy with thymectomy and/or thyroidectomy has an important role in the treatment of renal hyperparathyroidism since thyroid cancer can frequently occur and require surgery. Thymectomy should be considered to avoid recurrence and a risky re-operation.

https://ift.tt/2S9qDml

Resveratrol Represses Tumor Necrosis Factor α/c-Jun N-terminal Kinase Signaling via Autophagy in Human Dental Pulp Stem Cells

Publication date: Available online 22 October 2018

Source: Archives of Oral Biology

Author(s): Feng-Ming Wang, Zhiai Hu, Xiaohua Liu, Jian Q. Feng, Robert. A. Augsburger, James L. Gutmann, Gerald N. Glickman

Abstract

Objectives

To study the effects of polyphenol resveratrol on TNFα-induced inflammatory signaling as well as the underlying mechanism in human dental pulp stem cells (DPSCs).

Materials and Methods

Human DPSCs were cultured and treated by TNFα in the presence or absence of resveratrol. NF-κB and mitogen-activated protein kinase (MAPK) signaling pathways were analyzed by Western blotting and immunofluorescence staining. Interleukin 6 (IL6) and interleukin 8 (IL8) mRNA levels were analyzed by reverse transcription polymerase chain reaction. For the mechanistic study, autophagy was examined and further manipulated by gene silencing of Atg5 using siRNAs. Statistical analysis was performed by Student's t- test, and values of p < 0.05 were considered significant.

Results

Upon TNFα treatments, neither degradation of IκBα nor the phosphorylation and nuclear translocation of p65 NF-κB were inhibited by resveratrol at different concentrations. In contrast, resveratrol dramatically inhibited TNFα-induced phosphorylation of c-Jun N-terminal kinase (JNK) MAPK. Furthermore, resveratrol activated autophagy, as evidenced by the accumulated autophagic puncta formed by lipid bound LC3B in resveratrol-treated cells. Intriguingly, both resveratrol and JNK inhibitor SP600125 suppressed TNFα-induced IL6 and IL8 mRNA expression (P < 0.05). Silencing autophagy gene Atg5 led to the hyper-activation of JNK and augmented TNFα-induced IL6 and IL8 mRNA expression (P < 0.05).

Conclusions

The results suggest that resveratrol suppresses TNFα-induced inflammatory cytokines expressed by DPSCs through regulating the inhibitory autophagy-JNK signaling cascade. Resveratrol might be beneficial to ameliorate pulpal damage during the acute phase of inflammation in vital pulp therapy.

https://ift.tt/2ScoKpd

Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects: a comparison of quality of life

Publication date: Available online 22 October 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Pei-Pei Zhang, Li Meng, Jun Shen, Hao Liu, Jun Zhang, Xu Xiang, Ying-Bin Yan

Abstract

Objectives

The purpose of the retrospective study was to compare the differences of quality of life (QOL) outcomes 2 or more years postoperatively between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) in reconstruction of defects of a hemiglossectomy.

Methods

Ninety patients who had a lapse ≥ 2 years since the reconstructive flap surgery were evaluated by the University of Washington quality of life scale (UW-QOL), and Performance Status Scale for Head and Neck (PSS-HN).

Results

Patients in the FRFF group reported statistically and clinically significantly better scores in the recreation, swallowing, chewing and speech domains of the UW-QOL compared with those in the ALTF group (P < .05). Similarly, FRFF provided better results in the understandability of speech and normalcy of diet of the PSS-HN, than the ALTF (P < .05).

Conclusions

FRFF had the advantage of oral functions, such as chewing, speech and swallowing, over the ALTF for reconstruction of defect of half of the tongue. These results may provide useful information for surgeons to select a suitable free flap for tongue reconstruction.

https://ift.tt/2yVbnAW

SLAM family receptors in natural killer cells – Mediators of adhesion, activation and inhibition via cis and trans interactions

Publication date: Available online 22 October 2018

Source: Clinical Immunology

Author(s): Maren Claus, Doris Urlaub, Frank Fasbender, Carsten Watzl

Abstract

SLAM family receptors are important for the fine-tuning of immune reactions. Their expression is restricted to cells of hematopoietic origin and most SLAM family receptors are their own ligand. Here we review how these receptors are involved in regulating the functions of Natural Killer (NK) cells. We discuss that promoting cellular adhesion may be a main function of SLAM family receptors in NK cells. The homophilic interactions of SLAM family receptors can not only occur in trans between different cells, but also in cis on the surface of the same cell. This cis interaction additionally modulates the function of the receptors and subsequently affects the activities of NK cells. Finally, SLAM-family receptors can also mediate inhibitory signals under certain conditions. These inhibitory signals can contribute to the functional maturation of NK cells during NK cell education. Therefore, SLAM family receptors are critically involved in many aspects of NK cell functionality.

https://ift.tt/2RbP5T1

Imbalance of two main circulating dendritic cell subsets in patients with myasthenia gravis

Publication date: Available online 22 October 2018

Source: Clinical Immunology

Author(s): Pei Chen, Yingkai Li, Hao Huang, Yan Li, Zhenguang Chen, Xiaoxi Liu, Li Qiu, Changyi Ou, Zhidong Huang, Zhongqiang Lin, Hao Ran, Weibin Liu

Abstract

Although it is well documented that circulating dendritic cells (DCs) have specialized features in many kinds of physiological and pathological condition of human, there is still lack reports about the features of DCs in the peripheral blood of myasthenia gravis (MG) patients. We aimed to investigate the quantitative and component features of DCs and their implication in MG. We collected peripheral blood from different kinds of MG patients and recorded their clinical characteristics. Using flow cytometry, we distinguished circulating DC subsets [plasmacytoid DCs (pDCs) and myeloid DCs (mDCs)] and enumerated their densities in peripheral blood. Absolute numbers of circulating pDCs were significantly decreased in naïve MG patients compared with healthy controls, resulting in a markedly lower ratio of pDCs/mDCs (percentage). Thus, there was an imbalance in the proportions of different circulating DC subsets. We did not find clustered pDCs in the hyperplastic thymus of MG patients. The clinical status of MG patients was improved after drug treatment, together with an increased ratio of pDCs/mDCs. In a longitudinal follow-up, we observed that circulating mDCs were significantly reduced after 1 month of therapy with a steroid and immunosuppressant, resulting in recovery of the pDC/mDC ratio. The ratio of circulating DC subsets might reflect the balance between the autoimmune response and immune tolerance of a patient, and ratio changes during treatment could be a promising marker to predict the efficacy of a specific drug used for MG patients.

https://ift.tt/2q8044i

Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss

Publication date: Available online 23 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Emre Soylemez, Suha Ertugrul, Erkan Doğan

Abstract

Objective

To evaluate the balance skills and falling risk in children with a congenital bilateral profound sensorineural hearing loss (CBPSNHL)

Methods

25 children with CBPSNHL and healthy 25 children with similar age and gender were included in the study. The flamingo balance test, the tandem stance test, and the one-leg standing test were performed to assess the patients' static balance skills. The pediatric balance scale (PBS) was used to evaluate the dynamic balance. Visual analog scale (VAS) was applied to the patients assess the frequency of falls.

Results

The flamingo balance test, the tandem stance test, and the one-leg standing test in the children with CBPSNHL were all significantly worse than the control group. Although the scores of PBS in patients with CBPSNHL were significantly lower than the control group (p <0.001), the results of both groups were consistent with a low risk of falls. There was no significant difference between the VAS scores indicating the frequency of falls among the groups (p = 0.552).

Conclusion

Static and dynamic balance skills of the children with CBPSNHL are significantly impaired compared to their healthy peers. Children with CBPSNHL also have a lower risk of falling just like their healthy peers and there is no significant difference between their falling frequencies. Balance skills of children with CBPSNHL can be assessed quickly and effectively on a hard floor (eyes closed), with a tandem standing test or a one-leg standing test.

https://ift.tt/2EDRUdX

In response to Letter to the Editor entitled “Cortical mastoidectomy with posterior atticotomy as surgical treatment in cases of acute mastoiditis in children”

Publication date: Available online 23 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Józef Mierzwiński, Karolina Haber, Justyna Tyra, Maria Drela, Anna Sinkiewicz, Michael David Puricelli

https://ift.tt/2PjM2uo

Cortical mastoidectomy with posterior atticotomy as surgical treatment in cases of acute mastoiditis in children

Publication date: Available online 22 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Rafal Zielinski

https://ift.tt/2EFMr6o

Hazardous Noise Exposure From Noisy Toys May Increase After Purchase and Removal From Packaging: A Call for Advocacy

Publication date: Available online 22 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Noel Jabbour, Heather M. Weinreich, James Owusu, Marta Lehn, Bevan Yueh, Samuel Levine

Abstract

Objective

Previous studies identified hazardous noise levels from packaged toys. Sound levels may increase when packaging is removed and therefore, complicate the ability to accurately assess noise levels before purchase. The goal of this study was to evaluate how packaging affects the decibel (dB) level of toys by:

Methods

Thirty-five toys were selected from the 2009-2011 Sight and Hearing Association (SHA) based on availability for purchase. Toys' speakers were categorized as Exposed, Partially Exposed, or Covered, based on its packaging. The dB level of each toy was tested at 0 cm and 25 cm from the speaker using a handheld digital sound meter in a standard audiometric booth. T tests and ANOVA were performed to assess mean change in sound level before and after packaging removal.

Results

Significant dB increases were noted after packaging was removed (mean change 11.9 dB at 0 cm; and 2.5 dB at 25 cm, p<0.001). Sixty-four percentage of Covered toys (n=14) had dB greater than 85 dB when packaged and this increased to 100% when unpackaged.

Conclusion

Many manufactured toys have hazardous sound levels. Caregivers and healthcare providers should be aware that toys tested in the store may actually be louder when brought home and removed from their packaging. Limits on and disclosure of dB level of toys should be considered nationally.

https://ift.tt/2PfK0vC

Prevalence of Bifid Uvula in Primary School Children

Publication date: Available online 22 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Pranvera Feka, Jacqueline Banon, Igor Leuchter, Giorgio C. La Scala

Abstract

Background

A bifid uvula is an anatomic variation that can be predictive of sub-mucous cleft palate, which may cause velopharyngeal insufficiency (VPI). Bifid uvula prevalence in the literature ranges from 0.18% to 10.3%, depending on the population studied. The aim of this study is to determine the prevalence of bifid uvula in the Geneva's school children population.

Methods

A cross-sectional study was conducted in Geneva's primary school children, from September 2014 to June 2015. An examination of the uvula was performed by dentists working for the Scholastic Dental Service, after a specific training in diagnosing bifid uvulas. The dentists recorded their findings on a standardized form.

Results

The total number of school children in Geneva in the school year 2014-2015 was 30,375. 23,961 children had their uvula examined, representing 79% of the total population of school children. Among them, a hundred school children had a cleft uvula. One schoolgirl had no uvula. The prevalence of bifid uvula is 0.42%. Sex ratio (M/F) is 0.96.

Discussion

This large study, the second in literature for number of patients examined, identified a prevalence of bifid uvula of 0.42%. This result is in agreement with previous studies.

https://ift.tt/2EFOiIw

Oral peanut immunotherapy ‐ How much is too much? How much is enough?

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


https://ift.tt/2CAcRUH

Delayed granulomatous reaction and cutaneous fistula induced by retained electrodes from a cardiac pacemaker in a child

Pediatric Dermatology, EarlyView.


https://ift.tt/2PdLRkw

Cover Image

Head &Neck, Volume 40, Issue 10, Page C1-C1, October 2018.


https://ift.tt/2CB73KG

Issue Information

Head &Neck, Volume 40, Issue 10, Page 2117-2120, October 2018.


https://ift.tt/2AnNjIQ

Network meta‐analyses of systemic treatments for psoriasis: a critical appraisal

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


https://ift.tt/2An72Zc

Combined THC and CBD to treat pain in epidermolysis bullosa: a report of three cases

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


https://ift.tt/2POE6yp

Tetracycline, nicotinamide, and lesionally administered clobetasol as a therapeutic option to prednisone in patients with bullous pemphigoid: a comparative, retrospective analysis of 106 patients with long‐term follow‐up

International Journal of Dermatology, EarlyView.


https://ift.tt/2CA3qVh

Clinical and molecular evaluation of therapy with the use of cyclosporine A in patients with psoriasis vulgaris

International Journal of Dermatology, EarlyView.


https://ift.tt/2AnmdSg