Thyroid, Ahead of Print.
https://ift.tt/2CIDQNJ
Παρασκευή 26 Οκτωβρίου 2018
Anlotinib for the Treatment of Patients with Locally Advanced or Metastatic Medullary Thyroid Cancer
Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study
Thyroid, Ahead of Print.
https://ift.tt/2qd4K95
Progestogen Hypersensitivity: presentation and natural history
To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens.
https://ift.tt/2SjtNnI
Associations of unsafe, unsupportive and underdeveloped neighborhoods with atopic dermatitis in US children
Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting 12.97% of US children1 and 7% of US adults.2 Emotional factors, e.g. anxiety and stress, can also exacerbate AD flares and influence the course of disease.3,4 AD also poses a significant financial burden on society and negatively impacts patient and family quality of life.5,6 However, the relationship between childhood AD and neighborhood conditions has yet to be examined.
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Co-existent TBX1 Mutation and Chromosomal 20q13.13-q13.2 Duplication in an Infant with Abnormal TREC Newborn Screening
An eight day old male, term infant of a diabetic mother with patent ductus arteriosus was transferred from an outlying facility for surgical management of truncus arteriosus (TA), coarctation of the aorta, hypoplastic aortic arch, and anomalous origin of the right subclavian artery. The newborn also had absent thymic shadow on chest radiograph, hypocalcemia, and abnormal newborn screening (NBS) for severe combined immunodeficiency (SCID) measuring T cell receptor rearrangement circles (TRECs); threshold cycle (Ct) was 36.86 (Normal <36).
https://ift.tt/2Sl15CU
Markers of systemic involvement and death in hospitalized cancer patients with severe cutaneous adverse reactions
Cancer patients have increased risk of severe cutaneous adverse reactions, without reliable biomarkers to identify predisposition for associated morbidity and mortality. In hospitalized cancer patients with morbilliform rash, elafin, IL-6, TNF-α were associated with mortality. IL-6, IL-10 were associated with drug-related systemic involvement. These biomarkers may guide future therapeutic research.
https://ift.tt/2PZSZhE
A Phase 2, Randomized Dose-Finding Study of Tapinarof (GSK2894512 Cream) for the Treatment of Plaque Psoriasis
Novel topical treatments for psoriasis have not been developed for many years. Tapinarof, a therapeutic AhR modulating agent, is a potential new treatment option for psoriasis patients. Tapinarof, delivered in a 1% cream, achieved ≥75% improvement in Psoriasis Area and Severity Index in 60% of patients treated once daily.
https://ift.tt/2O6XpRT
Validation of a novel method for localization of parathyroid adenomas using SPECT/CT
Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations reg...
https://ift.tt/2yDknv8
Establishment of Monoclonal Antibody PMab-202 Against Horse Podoplanin
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 233-237, November 2018.
https://ift.tt/2PY8eYa
The Augmenting Effects of the tDNA Insulator on Stable Expression of Monoclonal Antibody in Chinese Hamster Ovary Cells
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 200-206, November 2018.
https://ift.tt/2D3TggJ
Detection of Tiger Podoplanin Using the Anti-Cat Podoplanin Monoclonal Antibody PMab-52
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 224-228, November 2018.
https://ift.tt/2PSRRw2
Novel Monoclonal Antibodies Against Native Human Collectin L1, Using the Heteromeric Complex CL-LK as Immunogen
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 207-211, November 2018.
https://ift.tt/2D5rRed
Generation of a Monoclonal Antibody Against Staphylococcal Superantigen-Like Protein 5 (SSL5) That Discriminates SSL5 from Other SSL Proteins
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 212-217, November 2018.
https://ift.tt/2PXRTCZ
DgMab-6: Antihuman DGKγ Monoclonal Antibody for Immunocytochemistry
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 229-232, November 2018.
https://ift.tt/2D6AUM2
Establishment of P38Bf, a Core-Fucose-Deficient Mouse-Canine Chimeric Antibody Against Dog Podoplanin
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 218-223, November 2018.
https://ift.tt/2PSRNfM
Failure to Accurately Disclose Conflicts of Interest in Article Published in JAMA Otolaryngology–Head & Neck Surgery
To the Editor I write to take full responsibility for failing to report appropriate conflict of interest disclosures in articles published in JAMA Otolaryngology–Head & Neck Surgery and the JAMA Network journals between 2015 and 2018, including "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: A Secondary Analysis of a Randomized Clinical Trial," published online on April 9, 2016, and in the September 2016 issue of JAMA Otolaryngology–Head & Neck Surgery. In that article, I had reported nothing to disclose. In the interest of full disclosure, I now report the following financial interests and activities that I had been involved in from 2013 to the present, regardless of potential relevance:
https://ift.tt/2RbWWQc
https://ift.tt/2RbWWQc
Missing Conflict of Interest Disclosure
In the Original Investigation titled "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: a Secondary Analysis of a Randomized Clinical Trial," published in the September 2016 issue of JAMA Otolaryngology–Head & Neck Surgery, conflict of interest disclosures were not reported accurately by José Baselga, MD, PhD. Dr Baselga has written a Letter to the journal explaining this inconsistent reporting of potential conflict of interest disclosures. This article was corrected online.
https://ift.tt/2ORlMs3
https://ift.tt/2ORlMs3
Rural and urban differences in orthognathic surgical patients in the north east of Scotland
Publication date: Available online 25 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): S.J.W. Kent, R. Morrison
Abstract
We have previously identified differences in the presentation and treatment of cancer between patients who live in rural compared with urban areas, but have not yet seen differences in those treated by orthognathic surgery. We hypothesised that patients from areas further away from the hospital face higher costs to attend and may not present with minor problems as often as those who live nearby. We therefore retrospectively reviewed all those (n = 216) who had presented for orthognathic surgery over a six-year period (May 2011 to May 2017). The severity of malocclusion and facial asymmetry was established by combining measurements of intraoperative movements. Rurality was measured as the distance from home to the hospital at the time of operation. Those with smaller intraoperative movements (less than 7 mm combined movement) lived significantly closer to the hospital as the crow flies (mean difference 15.13 miles, 95% CI 0.20 to 30.48, p=0.05) and could travel there more quickly (mean difference 65 minutes 95% CI 9.8 to 121.7, p=0.02) than those with larger movements. Our results suggest that patients with small malocclusions and slight facial asymmetry who live further away from the hospital, may be less likely to present for operation than those who live closer. We explain why socioeconomic class is unlikely to confound our results, and suggest potential ways to minimise the effect observed.
https://ift.tt/2ELsMlz
Re: Knowledge of final-year medical students about oral and maxillofacial surgery: a two-centre study
Publication date: Available online 25 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): M.J. Evans, G. Pike, D. Jaikaransingh, A. Antony
https://ift.tt/2D6C2PJ
Loss of Gimap5 promotes pathogenic CD4+ T cell development and allergic airway disease
Publication date: Available online 25 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Andrew R. Patterson, Paige Bolcas, Kristin Lampe, Rachel Cantrell, Brandy Ruff, Ian Lewkowich, Simon P. Hogan, Edith M. Janssen, Jack Bleesing, Gurjit K. Khurana Hershey, Kasper Hoebe
Abstract
Background
The GTPase of immunity-associated protein 5 is essential for lymphocyte homeostasis and survival. Recently, human GIMAP5 SNPs have been linked with an increased risk for asthma, while the loss of Gimap5 in mice has been associated with severe CD4+ T cell-driven immune pathology.
Objective
To identify the molecular and cellular mechanisms by which Gimap5-deficiency predisposes to allergic airway disease.
Methods
CD4+ T cell polarization and the development of pathogenic CD4+ T cells were assessed in Gimap5-deficient mice and a human patient with a GIMAP5 loss-of-function (LOF) mutation. House dust mite (HDM)-induced airway inflammation was assessed using a complete Gimap5 LOF (Gimap5sph/sph) and conditional Gimap5fl/flCd4Cre/ert2 mice.
Results
GIMAP5 LOF mutations in both mice and humans are associated with spontaneous polarization towards pathogenic TH17 and TH2 cells in vivo. Mechanistic studies in vitro reveal that impairment of Gimap5-deficient TH cell differentiation is associated with increased DNA damage, particularly during TH1 polarizing conditions. The DNA damage in Gimap5-deficient CD4+ T cells could be controlled by TGFβ, thereby promoting TH17 polarization. When challenged with HDM in vivo, Gimap5-deficient mice displayed an exacerbated asthma phenotype (inflammation and airway hyperresponsiveness) with increased development of TH2, TH17, and pathogenic TH17/ TH2 cells.
Conclusion
Activation of Gimap5-deficient CD4+ T cells is associated with increased DNA damage and reduced survival that can be overcome by TGFβ. This leads to a selective survival of pathogenic TH17 cells, but also TH2 in humans and mice, ultimately promoting allergic airway disease.
https://ift.tt/2PrivPu
Advances in Food Allergy in 2017
Publication date: Available online 25 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Corinne A. Keet, Katrina J. Allen
Abstract
This review highlights research and policy advances in food allergy that were published in 2017 in the Journal and beyond. In 2017, many important studies on the treatment of food allergy were published, bringing us ever closer to a standardized treatment for food allergy. Other important advancements included research into other management strategies, including thresholds for avoidance and management of food allergies in schools were published, and development of new guidelines for prevention of food allergy. There were several important epidemiological studies helping us understand the phenotypes of allergic disease, and new hypotheses proposed for how best to prevent food allergy. Finally, there was a welcome increased attention to non-IgE mediated food allergies.
https://ift.tt/2JgDmzx
Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders
Publication date: Available online 25 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jennie Yoo, Meghan C. Halley, E. Anne Lown, Veronica Yank, Katherine Ort, Morton J. Cowan, Morna J. Dorsey, Heather Smith, Sumathi Iyengar, Christopher Scalchunes, Christina Mangurian
Abstract
Background
Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process.
Objectives
This study aims to understand caregiver challenges and identify areas for healthcare system-level improvements to enhance caregiver well-being.
Methods
In this mixed-methods study, caregivers of children with PIDs were contacted in August to November 2017 via on-line and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an on-line survey assessing sociodemographic variables, child's medical characteristics, psychosocial support use, and WHO-5 Well-Being Index. Open-ended questions about healthcare system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes.
Results
Among the 80 caregiver respondents, caregivers had a median age of 34 years (range 23-62 years), were predominantly female, white, and married with male children diagnosed with SCID. In the adjusted regression model, lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling(s), managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, on-line connections to other PID caregivers, and bedside mental health services.
Conclusions
Certain high-risk sub-populations of caregivers may need more targeted psychosocial support to reduce long-term impact of the HCT experience upon their wellbeing. Caregivers suggested several organizational-level solutions for provision of this support.
https://ift.tt/2PsKYEE
“Electrochemotherapy – a loco regional therapy with well-established palliative effect in patient with large recurrent lesion of Head and Neck”
Publication date: Available online 26 October 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Barbara Pichi, Raul Pellini, Giuseppe Spriano
https://ift.tt/2CHuCRV
Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking
Publication date: Available online 26 October 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Sang-Jeong Lee, Hoon Joo Yang, Min-Hyuk Choi, Sang-Yoon Woo, Kyung-Hoe Huh, Sam-Sun Lee, Min-Suk Heo, Soon-Chul Choi, Soon Jung Hwang, Won-Jin Yi
Abstract
It is essential to reposition the mandibular proximal segment (MPS) as close to its original position as possible during orthognathic surgery. Conventional methods cannot pinpoint the exact position of the condyle in the fossa in real time during repositioning. In this study, based on an improved registration method and a separable electromagnetic tracking tool, we developed a real-time, augmented, model-guided method for MPS surgery to reposition the condyle into its original position more accurately.
After virtual surgery planning, using a complex maxillomandibular model, the final position of the virtual MPS model was simulated via 3D rotations. The displacements resulting from the MPS simulation were applied to the MPS landmarks to indicate their final postoperative positions. We designed a new registration body with 24 fiducial points for registration, and determined the optimal point group on the registration body through a phantom study. The registration between the patient's CT image and physical spaces was performed preoperatively using the optimal points.
We also developed a separable frame for installing the electromagnetic tracking tool on the patient's MPS. During MPS surgery, the electromagnetic tracking tool was repeatedly attached to, and separated from, the MPS using the separable frame. The MPS movement resulting from the surgeon's manipulation was tracked by the electromagnetic tracking system. The augmented condyle model and its landmarks were visualized continuously in real time with respect to the simulated model and landmarks.
Our method also provides augmented 3D coronal and sagittal views of the fossa and condyle, to allow the surgeon to examine the 3D condyle–fossa positional relationship more accurately. The root mean square differences between the simulated and intraoperative MPS models, and between the simulated and postoperative CT models, were 1.71 ± 0.63 mm and 1.89 ± 0.22 mm respectively at three condylar landmarks. Thus, the surgeons could perform MPS repositioning conveniently and accurately based on real-time augmented model guidance on the 3D condyle positional relationship with respect to the glenoid fossa, using augmented and simulated models and landmarks.
https://ift.tt/2qfuRvT
Double Puncture Versus Single Puncture Arthrocentesis For The Management Of Unilateral Temporomandibular Joint Disc Displacement Without Reduction: A Randomized Controlled Trial
Publication date: Available online 26 October 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Fernanda Stefani Folle, Rodrigo Lorenzi Poluha, Enio Tadashi Setogutti, Eduardo Grossmann
Summary
Purpose
To compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR).
Materials and Methods
Twenty-six patients with DDWOR were randomly and blindly allocated into two treatment groups (N=13): Group 1, conventional double puncture arthrocentesis; Group 2, single puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID – mm), and pain intensity self-reported with a visual analogue scale (VAS; 0-10) were collected. VAS scores and MID were measured before (baseline) and 6 months after arthrocentesis (final).
Results
Both techniques resulted in significantly reduced VAS scores and increased MID (p=0.001) after 180 days. However, there were no statistically significant differences between techniques (p>0.05).
Conclusions
The two arthrocentesis methods tested were effective in reducing VAS scores and increasing MID in patients with DDWOR.
https://ift.tt/2CIiOyX
Validation of a novel method for localization of parathyroid adenomas using SPECT/CT
Abstract
Background
Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations regarding localization of superior versus inferior adenomas. We proposed a novel method for localization using SPECT/CT by determining the anterior-posterior relationship of the adenoma to a horizontal line in the coronal plane through the tracheoesophageal groove. Our objective was to determine the accuracy, validity, and inter-rater reliability of this method.
Method
This was a retrospective review of patients who underwent parathyroidectomy for a single adenoma between 2010-2017. SPECT/CT images were reviewed by two staff Otolaryngologists, a Radiologist, an Otolaryngology fellow and Otolaryngology resident. Results were compared using intra-operative report as the gold standard.
Overall accuracy in determining superior/inferior and right/left adenomas was calculated, as well as Cohen's Kappa to determine agreement with operative report and inter-rater reliability. The performance was compared to that of the original radiology report.
Results
One hundred thirty patients met criteria and were included. Our method correctly identified the location of the adenoma in terms of both side and superior/inferior position in 80.4% [76 - 84%] of patients, which considerably outperformed the original radiology report at 48.5% [4-78%] accuracy. The agreement level between our method and operative report was high (Kappa=0.717 [0.691-0.743]), as was the inter-rater reliability (Kappa=0.706 [0.674-0.738]).
Conclusion
We report a novel method for localization of parathyroid adenomas using SPECT/CT which outperforms standard radiology reporting. This tool can be used by surgeons and radiologists to better inform and plan for minimally invasive parathyroidectomy.
https://ift.tt/2PrfwGM
CA209-891: Neoadjuvant and Adjuvant Nivolumab as Immune Checkpoint Inhibition in Oral Cavity Cancer
Condition: Squamous Cell Carcinoma of the Oral Cavity
Interventions: Biological: Nivolumab, Surgery, Radiotherapy; Biological: Nivolumab, Surgery, Chemoradiotherapy
Sponsors: The Clatterbridge Cancer Centre NHS Foundation Trust; University of Liverpool; Bristol-Myers Squibb
Not yet recruiting
https://ift.tt/2PVgTKY
Interventions: Biological: Nivolumab, Surgery, Radiotherapy; Biological: Nivolumab, Surgery, Chemoradiotherapy
Sponsors: The Clatterbridge Cancer Centre NHS Foundation Trust; University of Liverpool; Bristol-Myers Squibb
Not yet recruiting
https://ift.tt/2PVgTKY
Regorafenib Combined With Irinotecan as Second-line in Patients With Metastatic Gastro-oesophageal Adenocarcinomas
Conditions: Adenocarcinoma of the Stomach; Adenocarcinoma of the Gastroesophageal Junction
Interventions: Combination Product: Regorafenib and Irinotecan; Drug: Irinotecan
Sponsor: UNICANCER
Not yet recruiting
https://ift.tt/2AsBt07
Interventions: Combination Product: Regorafenib and Irinotecan; Drug: Irinotecan
Sponsor: UNICANCER
Not yet recruiting
https://ift.tt/2AsBt07
News and Announcements
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s):
https://ift.tt/2JiFJBZ
Characteristics and Management of Free Flap Compromise Following Internal Jugular Venous Thrombosis
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Yu-ming Xu, Jiang Liu, Xiao-wen Qiu, Chang Liu, Han-jiang Wu, Zhao-jian Gong
Purpose
Free flap compromise after internal jugular venous thrombosis (IJVT) occurs fairly infrequently in oral and maxillofacial rehabilitation and reconstruction but could seriously affect the patient's postoperative recovery. The aim of this study was to analyze and discuss the characteristics and management of such flap compromise.
Patients and Methods
The authors performed a retrospective case series of 13 patients who underwent reconstruction of oral and maxillofacial defects with anterolateral thigh flaps and developed flap compromise from IJVT from July 2014 through December 2016 at the Second Xiangya Hospital of Central South University (Changsha, China). The clinical features of flap compromise are described, and the precautions and improvement measures are reported.
Results
All 13 patients were men with an average age of 50.3 years. Flap compromise caused by IJVT occurred on postoperative days 3 to 7, of which 2 flaps were salvaged (15.4%) and 11 flaps failed completely after immediate urgent re-exploration. Four patients presented with orocutaneous fistula after salvage surgery that healed well after a period of wound dressing.
Conclusions
Because of the late occurrence and low salvage rate of flap compromise caused by IJVT, intensive flap monitoring after reconstruction surgery is necessary for patients with free flap transfer.
https://ift.tt/2Pnrtxf
Safety and Efficacy of Outpatient Parotidectomy
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Andrea Ziegler, Gina Lazzara, Eric Thorpe
Purpose
Given the increasing costs of medical care, there has been a shift to outpatient elective surgeries in certain patient populations among all surgical specialties. The goal of this study was to compare the safety and efficacy of outpatient parotidectomy with traditional inpatient parotidectomy.
Materials and Methods
This is a retrospective chart review of all patients who underwent a parotidectomy at a single tertiary academic center from 2007 through 2017.
Results
There were 568 patients who met the inclusion criteria. There was no difference in demographics or patient comorbidities between the inpatient and outpatient groups. There was no increased incidence of postoperative complications or extent of postoperative care in patients who underwent outpatient parotidectomy. On average at the authors' institution, the direct outpatient parotidectomy cost was $1,200 less than the inpatient equivalent.
Conclusion
Outpatient parotidectomy can be performed safely and cost effectively with no increased risk of complications.
https://ift.tt/2JhhGDD
More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Satu Kainulainen, Patrik Lassus, Anna-Liisa Suominen, Tommy Wilkman, Jyrki Törnwall, Hanna Thoren, Anna-Maria Koivusalo
Purpose
Prospective studies on the effect of dexamethasone after microvascular reconstructive head and neck surgery are sparse despite the widespread use of dexamethasone in this setting. The aim of this study was to clarify whether perioperative use of dexamethasone would improve the quality and speed of recovery. The authors hypothesized that dexamethasone would enhance recovery and diminish pain and nausea.
Materials and Methods
Ninety-three patients with oropharyngeal cancer and microvascular reconstruction were included in this prospective double-blinded randomized controlled trial. Patients in the study group (n = 51) received dexamethasone 60 mg over 3 perioperative days; 42 patients did not receive dexamethasone and served as controls. Patient rehabilitation, postoperative opioid and insulin consumption, postoperative nausea and vomiting (PONV), and C-reactive protein (CRP), leukocyte, and lactate levels were recorded.
Results
There was significantly less pain in the study group (P = .030) and the total oxycodone dose for 5 days postoperatively was lower (P = .040). Dexamethasone did not significantly lessen PONV for 5 days postoperatively (P > .05). There were no differences between groups in intensive care unit or hospital stay or in other clinical measures of recovery. Patients receiving dexamethasone required significantly more insulin compared with patients in the control group (P < .001). Lactate and leukocyte levels were significantly higher (P < .001) and CRP levels were significantly lower in the study group.
Conclusion
The only benefit of perioperative dexamethasone use was lower total oxycodone dose; however, the disadvantages were greater. Because dexamethasone can have adverse effects on the postoperative course, routine use of dexamethasone as a pain or nausea medication during reconstructive head and neck cancer surgery is not recommended.
https://ift.tt/2Pnrp0t
Effect of Laser Bio-Stimulation on Mandibular Distraction Osteogenesis: An Experimental Study
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Said K. Taha, Salah Abd El Fattah, Ehab Said, Mohmed Ayad Abdel-Hamid, Amany H. Nemat, Hanaa El Shenawy
Purpose
The aim of this study was to evaluate the osseous response to laser bio-stimulation clinically and histologically during distraction osteogenesis (DO) induced in the mandibles of mongrel dogs.
Materials and Methods
Thirty dogs were divided into 3 groups of 10 (5 with and 5 without laser treatment) according to sacrifice periods (2, 4, and 8 weeks after distraction). DO was performed between the mandibular second and third premolars using an internal linear distractor. After a 7-day latency period, the distractor was activated at the rate of 1 mm per day for 10 days followed by a consolidation period during which the right mandibular side was irradiated with a diode laser (wavelength [λ], 970 nm; power, 2 W; spot size, 320 μm; total energy [E], 840 J), whereas the control group was not irradiated, after distraction. Histologic specimens were prepared and histomorphometric analysis of specimens was performed.
Results
Clinical examinations showed that the low-intensity laser diode had a pronounced effect on the quality and quantity of newly formed bone in the DO regenerate in the laser groups compared with the control groups. Histopathologic sections from laser groups I, II, and III displayed the bio-stimulatory effect of laser on new bone through an increased rate of osteoblast proliferation and differentiation, an accelerated rate of intramembranous ossification, and increased neoangiogenesis compared with the control groups. Moreover, the histomorphometric results showed that mean bone trabecular size, bone trabecular total area, and bony area fraction of the regenerate were larger and statistically significant (P < .05) especially in laser groups I and II (early stages of bone formation) compared with the control groups.
Conclusion
The low-level diode laser had a positive role as a potential bio-stimulator and local inducer in enhancing bone formation during DO and resulted in early stability of the bone regenerate, a shorter total treatment time, and improved new bone quality and quantity.
https://ift.tt/2JhhBQl
Lip Morphology in Patients With Facial Asymmetry Can Be Corrected by 2-Jaw Surgery
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Iyo Aoyama, Takashi Oikawa, Kazutoshi Nakaoka, Toshiko Sekiya, Yoshiki Hamada, Yoshiki Nakamura
Purpose
Surgical orthodontic patients with facial asymmetry frequently show asymmetry of the lips, and this is often a major complaint of patients. This study investigated whether lip asymmetry associated with the maxilla and mandible was improved when 2-jaw surgery was performed in surgical orthodontic treatment.
Materials and Methods
Inclusion criteria for this retrospective cohort study were 1) an anteroposterior maxillary relation defined as skeletal Class I; 2) menton (Me) tranverse deviation greater than 5.0 mm; 3) maxillary cant greater than 3.0°; and 4) 2-jaw surgery. Primary predictor variables in this study were skeletal morphologic measurements (Me deviation, maxillary cant, and maxillary distance ratio) before and after treatment. Outcome variables were lip morphology measurements (labial commissure distance, lip angle, and lip area). Additional variables included age and gender. Vertical distances, angles, and area of the upper and lower lips were measured and compared before and after treatment. Hard tissues were measured using posteroanterior cephalograms. Paired t test and correlation coefficients were calculated.
Results
Fourteen patients (4 men [28.5%] and 10 women [71.5%]; mean age, 29 yr) were included. Meaningful changes were observed in distance and angle measurements of the lips from before to after treatment. In area measurement, ratios of the area on the deviated side to that on the contralateral side for the upper and lower lips changed markedly and were close to 1.0 compared with before treatment. A relevant correlation was found between change in Me deviation and change in ratio of the height of the labial commissure.
Conclusion
In cases of facial asymmetry caused by deviation of the maxilla and mandible, lip asymmetry can be adequately corrected by leveling the canted occlusal plane and positioning the Me toward the midline with 2-jaw surgery.
https://ift.tt/2PqCHRH
Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Farhad Ghorbani, Hamed Gheibollahi, Saeid Tavanafar, Hamid Reza Eftekharian
Purpose
The objectives of this study were to evaluate the effect of orthognathic surgery on the long-term quality of life of patients who received this treatment and to delineate the common reasons for dissatisfaction.
Materials and Methods
In this retrospective cohort study, patients who underwent orthognathic surgery were studied. One hundred thirty-two patients who had undergone orthognathic surgery from 2007 to 2017 in the oral and maxillofacial surgery department participated in this study. They were divided based on their dentofacial deformity into those with Class II malocclusion and those with Class III malocclusion. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery.
Results
The rate of esthetic improvement in orthognathic surgery patients was 91.7%. No significant difference between male and female patients was found regarding the changes in social, esthetic, and functional aspects before and after orthognathic surgery. Both genders recommended orthognathic surgery for patients with similar problems. One in four patients was dissatisfied with the nasal appearance after the surgical procedure (25.8%).
Conclusions
In this study the patients' satisfaction from the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and then functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance.
https://ift.tt/2JiFff9
Growth and Development of Craniofacial Structures in Patients at Different Ages With Unrepaired Submucous Cleft Palate
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Congcong Cao, Xue Xu, Qian Zheng, Bing Shi, Jingtao Li, Yan Wang
Purpose
Submucous cleft palate (SMCP) is a particular subtype of cleft palate deformity; research related to the craniofacial features of patients with SMCP is comparatively rare. The study objective was to perform a cephalometric comparison of the craniofacial features of patients with SMCP and non-cleft controls at different ages.
Materials and Methods
The sample in this cross-sectional study was composed of 2 groups: SMCP patients and non-cleft controls. The primary predictor variables were study group (cleft and non-cleft) and age. Age was divided into 3 groups. The outcome variables of interest were craniofacial measurements. The measurements used reflect cranial length, cranial angle, maxillary sagittal length and protrusion, maxillary vertical height, pharyngeal depth, facial height, mandibular length and protrusion, mandibular plane angle, and intermaxillary relation. Adjusted cephalometric craniofacial measurements between the groups were compared in 3 age groups using generalized linear models after being adjusted for age and gender.
Results
The study included 60 SMCP patients and 60 non-cleft controls. SMCP patients and non-cleft controls were divided into 3 subgroups: those aged 5 to 7 years, those aged 9 to 11 years, and those aged 18 to 30 years. Patients with SMCP at age 5 to 7 years showed a shortened cranial base length, maxillary sagittal length and height, and bony pharynx depth. Patients with SMCP at age 9 to 11 years showed a smaller maxillary sagittal length and bony pharynx depth and an inharmonious jaw relationship. Patients with SMCP at age 18 to 30 years showed a smaller maxillary sagittal length and height and an inharmonious jaw relationship.
Conclusions
SMCP is associated with progressive maxillary retrognathism and reduced profile convexity from childhood to adulthood.
https://ift.tt/2Pnr8ut
Does C-Arm Guidance Improve Reduction of Zygomatic Arch Fractures?—A Randomized Controlled Trial
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Akash Menon, Arvind Karikal, Vikram Shetty
Purpose
Traditionally, in the assessment of the reduction of zygomatic arch fractures, the surgeon uses subjective measures such as palpation of a bony step deformity, the anecdotal "pop" sounds, and visual confirmation of symmetry. In the present study, we sought to objectively assess the accuracy of reduction and improvement in form and function after C-arm–guided reduction of isolated zygomatic arch fractures (IZAFs) and to compare these results with those obtained conventionally.
Patients and Methods
A prospective, randomization of patients scheduled for surgical closed reduction of IZAF was performed. The test group underwent C-arm–guided reduction of the fracture until the arch contour was re-established and visualized on fluoroscopic images. In the control group, palpation, auditory cues, and visualization of symmetry determined the adequacy of the reduction. The patients and evaluator were both unaware of the treatment technique used. The primary outcome measures were the maximum interincisal distance (IID), standardized measurements on computed tomography (CT), and measures of symmetry on facial photographs. Variables such as intragroup differences and patient–evaluator agreement were also studied. The data were analyzed using SPSS software, version 21.
Results
The study sample consisted of 20 patients (10 each in the test and control groups). Significant improvement in facial symmetry was observed in all 20 patients (P < .001) from preoperatively to 30 days postoperatively. The CT measurements confirmed acceptable symmetry, with insignificant differences between the 2 groups (C-arm group, P < .001; vs control group, P = .004 for intragroup improvement in symmetry). The IID had improved significantly (P < .001) at the end of follow-up in both groups.
Conclusions
Although significantly superior outcomes were not inferred in the symmetry-related and CT measurements, C-arm–guided reduction provided an opportunity to instantaneously confirm the accuracy of bony reduction. Thus, the need for postoperative imaging and secondary surgery can be overcome, enabling even inexperienced surgeons to attain precise and reproducible results.
https://ift.tt/2JiF8QL
Primary Assessment of the Patient With Orbital Fractures Should Include Pupillary Response and Visual Acuity Changes to Detect Occult Major Ocular Injuries
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Jeffrey Chow, Krishnan Parthasarathi, Patrick Mehanna, Eline Whist
Purpose
Sight-threatening injuries associated with orbital fractures are of major concern to maxillofacial surgeons whom are often the first asked to assess these patients. Eliciting signs and symptoms that are predictive of these injuries would allow expedited ophthalmic consultation and appropriate management. We hypothesized that abnormal pupillary response is predictive of major ocular injuries.
Patients and Methods
A retrospective cohort study of patients with facial fractures was instituted with review of all associated ophthalmic injuries. The primary predictor variables were the presence or absence of post-traumatic ocular symptoms and signs (visual acuity change, diplopia, flashes and floaters, pain on globe movement, abnormal pupillary response, restriction of eye movement, and visual field defects). Secondary predictors were pattern of fracture and mechanism of fracture. The primary outcome variable was the presence or absence of major ocular injury assessed during formal ophthalmology consultation. Descriptive statistics were calculated as categorical values. Correlation between the presence or absence of predictors and outcome (major ocular injury) was calculated using χ2 analysis, with the significance value set at P ≤ .01.
Results
The study included 75 patients (25% of whom were female patients) with a mean age of 41 ± 22 years. We recorded 165 minor ocular injuries and 43 major ocular injuries. The mechanisms of injury included assault (48%, n = 36), motor vehicle accident (21%, n = 16), fall (17%, n = 13), sport (11%, n = 8), and occupational (3%, n = 2). The fracture pattern included zygomaticomaxillary (36%, n = 27), isolated orbital floor (25%, n = 19), complex (20%, n = 15), and isolated orbital nonfloor (19%, n = 14). Of the primary outcome predictors, only abnormal pupillary response (odds ratio, 36; P < .001) and subjective visual acuity changes (odds ratio, 10; P < .001) were predictive of major ocular injury. The mechanism of injury and pattern of fracture were not predictive of major ocular injury.
Conclusions
During primary assessment of the patient with orbital fractures, abnormal pupillary response and subjective visual acuity changes are key predictors of occult major ocular injury.
https://ift.tt/2PpL683
The Utility of Polyether-Ether-Ketone Implants Adjacent to Sinus Cavities After Craniofacial Trauma
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Visakha Suresh, Rachel Anolik, David Powers
Purpose
Polyether-ether-ketone (PEEK) implants have become increasingly popular for use in reconstructive procedures. It is imperative to understand the consequences of using this biomaterial in anatomic sites that can pose a risk of infection. Specifically, the use of PEEK in paranasal sinus cavity reconstruction is not well documented. This study examined postoperative complications, namely surgical site infection and implant loss, in patients who underwent paranasal sinus cavity reconstruction using PEEK implants.
Materials and Methods
This study is a single-center case series. Patients who underwent craniomaxillofacial reconstruction with a custom-made PEEK implant in intimate contact with a functional paranasal sinus from June 2013 to May 2017 were included. Baseline characteristics and preoperative and postoperative variables were collected by retrospective chart review.
Results
Eight patients were included in this study. Average patient age was 45.75 ± 19.36 years. Average follow-up duration was 300 ± 263 days. Mean operative time for PEEK implantation was 214.13 ± 66.03 minutes. Implant size ranged from 5 to nearly 100 cm2. No patients were diagnosed with acute or chronic sinusitis postoperatively. One patient underwent explantation of his PEEK implant secondary to breakdown of overlying skin that separated from the site of the frontal sinus because of coagulase-negative Staphylococcus epidermis infection.
Conclusions
Literature review indicates that this is the largest case series reported to date documenting the use of PEEK implants in reconstruction of the region of the paranasal sinuses. Specific biologic, or alloplastic, barriers outside the formation of native scar tissue or regional fasciocutaneous tissues at the sites of reconstruction were not used in these reconstructions, although consideration for placement of these barriers can be at the discretion of the operative surgeon. The authors conclude that PEEK implants can be used in complex craniomaxillofacial reconstructive procedures to achieve near anatomic reconstruction not easily attainable through conventional means. Defects that involve the paranasal sinus cavities with a functional ostium or obliterated sinus cavity can be reconstructed with PEEK implants without increasing the risk of infection and need for explantation. Long-term follow-up and continued outcome results of this treatment modality will be necessary to verify its clinical usefulness in the future.
https://ift.tt/2JiEToP
Retrospective Study of 383 Cases of Fibro-Osseous Lesions of the Jaws
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Camila de Nazaré Alves de Oliveira Kato, Laiz Fernandes Mendes Nunes, Loliza Luiz Figueiredo Houri Chalub, Adriana Etges, Tarcília Aparecida Silva, Ricardo Alves Mesquita
Purpose
The aims of this study were to describe the clinical and radiologic features of 383 fibro-osseous lesions (FOLs) from an oral pathology reference service in Brazil and to compare the findings with previous studies. The hypothesis of the study was that the most common type of FOL would differ from other investigations.
Materials and Methods
We conducted a descriptive and retrospective study with review of the records of the clinical and biopsy services (1990 to 2015). All records of the patients included showed a definitive diagnosis of FOL. The primary outcome variable was the type of FOL, and the predictor variables were gender, age, ethnicity, location, and clinical and radiologic characteristics. Descriptive analyses and χ2 tests were performed. The P value was set at .05.
Results
From the 27,998 records available, 383 showed FOLs, with 187 (48.8%) being cemento-osseous dysplasias (CODs), 103 (26.9%) being fibrous dysplasias (FDs), and 93 (24.3%) being ossifying fibromas (OFs). The mean age of the patients was 38.5 ± 17.5 years. CODs presented a predilection for female gender (n = 314, 82.0%), African descent (n = 134, 71.6%), and the mandible (n = 248, 64.6%). The most common radiologic feature was a mixed radiolucent-radiopaque image (n = 149, 51.7%). FDs and OFs were commonly diagnosed during the first and second decades of life (P < .001), whereas CODs were more frequently diagnosed beyond the third decade (P < .001). Secondary osteomyelitis was more significantly observed in CODs (P < .001) than in FDs and OFs. Swelling was more frequently reported for FDs and OFs than for CODs (P < .001).
Conclusions
CODs were the most frequently observed FOLs in this Brazilian population. Female patients, patients of African descent, and patients with mandibular localization were most commonly affected by these conditions. The most common type of FOL differed from that in similar case reports or series from various geographic locations. It is believed that the data source (clinical and/or biopsy services) can directly influence the outcome.
https://ift.tt/2Pjt1IT
Nonsurgical Management of Medication-Related Osteonecrosis of the Jaws Using Local Wound Care
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Danny Hadaya, Akrivoula Soundia, Earl Freymiller, Tristan Grogan, David Elashoff, Sotirios Tetradis, Tara L. Aghaloo
Purpose
Medication-related osteonecrosis of the jaws (MRONJ) is a known complication of antiresorptive medications with surgical and nonsurgical treatment options. The aim of this study was to evaluate the effectiveness of nonsurgical therapy using local wound care on management of MRONJ lesions.
Materials and Methods
The authors conducted a retrospective cohort study of patients who presented to the University of California–Los Angeles School of Dentistry Oral and Maxillofacial Surgery Clinic for evaluation and treatment of MRONJ. The primary predictor variable was wound care score; secondary predictors were demographics (age, gender), anatomic location, primary condition, and type and time of antiresorptive treatment. Outcomes assessed were disease resolution and time to disease resolution. Statistical analysis was carried out using the Spearman correlation for continuous and ordinal variables or the χ2 test for categorical variables. Time-to-event statistics and Cox proportional hazards models were calculated; a Kaplan-Meier plot was generated to assess time to healing.
Results
One hundred six patients with 117 MRONJ lesions were treated using local wound care; complete disease resolution was observed 71% of lesions, with an additional 22% of lesions undergoing disease improvement. Wound care score was statistically associated with disease resolution and time to resolution, whereas demographics, anatomic site, condition, and type and time of antiresorptive treatment had no effect on resolution.
Conclusion
Local wound care increased the likelihood of MRONJ resolution and decreased the time to disease resolution. This strategy can be used in patients who cannot undergo surgery and should be implemented in all patients with MRONJ lesions who are managed nonsurgically.
https://ift.tt/2Jj2rKa
Bilateral Dislocation of the Temporomandibular Joint in Children
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Ludovic Sicard, Diane O'Hana, Roman Hossein Khonsari, Abdelkhaled Kaddour Brahim
Purpose
Bilateral nontraumatic temporomandibular joint (TMJ) dislocation is an acute situation that can lead to a chronic and recurrent condition. Few pediatric cases have been reported in the literature and no standardized care protocol has been established to date.
Materials and Methods
Two cases of chronic bilateral dislocation of the TMJ in young children are reported and their medical management is discussed based on data from the literature.
Results
A 26 months-old child and a 19-months old child were included. Both had chronic bilateral TMJ dislocation managed using a combination of reduction under nitrous oxide sedation, reduction under general anesthesia, chin-to-vertex bandage and orthodontic headgear.
Conclusion
TMJ dislocations in children raise specific concerns such as the need for screening for underlying congenital disorders of connective tissues. Furthermore, surgical options in children are very limited. The authors propose a standardized management protocol for recurrent joint dislocation in pediatric populations based on 2 new cases and data from the literature.
https://ift.tt/2PnqIEp
Does Accurate Positioning of the Temporomandibular Joint Titanium Condylar Prosthesis Prevent Complications?
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Yoh Sawatari, Hisham Marwan, Shadi Alzahrani, Michael Peleg, Robert Marx
Purpose
Reconstruction of the temporomandibular joint defect is challenging. The purposes of this study were to identify factors associated with the accuracy of positioning of a titanium condylar prosthesis and to measure the association between the accuracy of the condylar prosthesis position and postoperative complications.
Materials and Methods
We designed a retrospective cohort study and enrolled a sample of patients whose condyle was reconstructed with an alloplastic condylar prosthesis. The primary predictor variable was the accurate positioning of the prosthesis in the fossa in comparison with the native condyle. The primary outcome variable was the development of postoperative complications related to the inaccurate positioning of the condylar prosthesis. Other variables were included and discussed in detail in the article. In addition, the postoperative pain level was assessed with a visual analog scale score. Because of the small sample size, we elected to use a descriptive data analysis for the research.
Results
The final sample was composed of 40 patients, with a mean age of 38 years. A postoperative complication developed in 6 patients (15%), including cutaneous plate exposure after radiation therapy, erosion through the tympanic plate of the condylar fossa, and erosion into the temporal bone. The average displacement of the condylar prosthesis in the patients in whom complications developed was 5.04 mm in the vertical and 1.5 mm in the lateral dimension, which was less than the average of all other patients in the study. Seven patients reported higher levels of pain represented by the visual analog scale score, and this was associated with increased deviation of the condylar prosthesis position by 4.4% and 16.6% in the vertical and lateral dimensions, respectively.
Conclusions
This retrospective study showed that the amount of displacement of the temporomandibular joint prosthesis did not correlate with the incidence of complications or postoperative pain.
https://ift.tt/2JgZolL
Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Ashkan Mobini, Pushkar Mehra, Radhika Chigurupati
Purpose
The purpose of this study was to determine the effect of individual characteristics, such as age, gender, and type of surgery, on postoperative pain intensity and opioid analgesic consumption after orthognathic surgery.
Patients and Methods
This prospective observational study was conducted at a single academic medical center during a 12-month period from 2015 to 2016. Thirty of 125 patients 18 to 65 years of age who had American Society of Anesthesiologists status I and II and were admitted to the hospital after orthognathic surgery were recruited. The main outcome variable was opioid analgesic consumption measured in morphine milligram equivalents (MME) during the patients' hospital stay. Secondary outcome variables were postoperative pain intensity measured using the numeric rating scale (0 to 10) and length of hospital stay. Data on age, gender, type of surgery, postoperative pain intensity, and opioid and nonopioid analgesic consumption for each 24-hour period during hospitalization were collected. The analgesic regimen consisted of oxycodone, hydromorphone, and acetaminophen. Differences in postoperative pain and opioid requirements between men and women, older and younger, and 1- and 2-jaw surgery were assessed using unpaired Student t test for statistical analysis. A P value less than .05 was considered statistically significant.
Results
Thirty patients (14 men, 16 women) with an average age of 26.3 years (18 to 50 yr) were admitted to the hospital for an average of 61 hours (24 to 170 hours) after orthognathic surgery. Twenty-three of 30 patients (77%) had bimaxillary surgery. The average postoperative pain score was 6.0 (2 to 8.5) on a scale of 0 to 10 and average opioid consumption was 106 MME (range, 0 to 407 MME). Women reported more postoperative pain (6.3 vs 5.3) and consumed more opioid analgesic than men (131 vs 78 MME). Patients younger than 25 years required 112 MME of opioid compared with 98 MME for those older than 25 years, although the 2 age groups reported similar pain scores. Patients who had 2-jaw surgery and mandibular (1-jaw) surgery reported more pain and required more opioid analgesics than those who had only maxillary surgery.
Conclusion
Based on these study results, there appears to be a trend for increased opioid analgesic requirement in women and younger patients during the immediate postoperative period after orthognathic surgery.
https://ift.tt/2Pnqu01
The Impact of Genetics and Environmental Factors on the Position of the Upper Third Molars
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Giedrė Trakinienė, Antanas Šidlauskas, Tomas Trakinis, Irena Andriuškevičiūtė, Loreta Šalomskienė
Purpose
The purpose of this study was to estimate the importance of heredity in the position of the upper third molars.
Materials and Methods
Panoramic radiographs and lateral cephalograms of same-gender twins were analyzed. The determination of zygosity was performed by means of DNA tests with polymerase chain reaction for the amplification of short tandem repeats and 15 specific DNA markers. Data were estimated by the relative influence of additive genetic factors (A), nonadditive genetic factors (D), the common or shared environment (C), and unique environmental factors (E).
Results
The study sample consisted of 212 twins: 80 dizygotic and 132 monozygotic twins. The genetic analysis showed that the best-fitting model for the size of the molars and their angulations was AE (additive genetic factors and unique environmental factors), in which the additive genetic factors had up to 84% influence and specific environment had up to 40%. Therefore, the ACE (additive genetic factors, common or shared environment, and unique environmental factors) model showed higher significance for the tooth eruption level. The heritability estimates were up to 59%, specific environment contributed up to 16%, and common environment reached 30%.
Conclusions
Genetic factors play a key role in the position of the upper third molars.
https://ift.tt/2JhSi0y
Advancements in Maxillofacial Trauma: A Historical Perspective
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): Patrick J. Louis, Anthony B. Morlandt
For the 75th anniversary of the Journal of Oral and Maxillofacial Surgery, the authors were asked to review the past and examine advancements in the management of facial trauma. Several important advances in the management of maxillofacial trauma have resulted in improved outcomes. These include the development of high-resolution computed tomography, improved classification schemes, rigid fixation techniques, improved biomaterials, soft tissue resuspension, and primary bone grafting. Further advances in outcomes have occurred with the use of microsurgical techniques, free tissue transfer techniques, virtual surgical planning, endoscopic techniques, and surgical navigation. Historic treatments and these important advances are discussed.
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Be Careful What You Don't Ask For
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s): James R. Hupp
https://ift.tt/2JhShtw
AAOMS Author Disclosure forms
Publication date: November 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 11
Author(s):
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Lateral pharyngotomy
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, A. Villeneuve, F. Rubin, F.C. Holsinger
Abstract
Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.
https://ift.tt/2At98H6
Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert
Abstract
Objective
Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.
Material and method
A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.
Results
Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04).
Conclusion
Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.
https://ift.tt/2RfZuwU
Impact of cochlear implantation on peripheral vestibular function in adults
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. Colin, P. Bertholon, S. Roy, A. Karkas
Abstract
Objective
Cochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues.
Material and methods
A prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)].
Results
Twenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n = 11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P = NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P = NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P = NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P = NS). There were no significant associations (P > 0.05) between test results and symptoms.
Conclusions
In the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.
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Haploidentical Hematopoietic Stem Cell Transplant complicated by Atypical Hemolytic Uremic Syndrome and Kidney Transplant from the same donor with no Immunosuppression but C5 Inhibition
Background Atypical hemolytic uremic syndrome (aHUS) is life-threatening condition particularly when complicating allograft hematopoietic stem cell transplant (HSCT). In the past, the outcome was very poor with the majority of patients reaching end stage renal disease (ESRD) or dying with little or no chances of kidney transplant (KTx) due to the high risk of relapse. The availability of C5 inhibition has opened up significant therapeutic opportunities and has improved the outcome particularly if complement dysregulation (CD) is the underlying pathogenetic mechanism. Methods: We describe a peculiar case of a girl with aHUS complicating HSCT and her subsequent successful KTx received from the same donor thus performed without immunosuppression but anti C5 inhibition. Results Soon after HSCT performed for acute lymphoblastic leukemia, the patient developed a thrombotic microangiopathy (TA-TMA) due to CD and reached ESRD. After 2 years on dialysis the patient received a KTx from her father who was already the HSCT donor. Given the full chimerism, no immunosuppressive agent was prescribed except a short (2 days) course of steroids and eculizumab to prevent aHUS relapse. Nine months after the KTx the patient is well with normal renal function, no immunosuppression and continues eculizumab prevention of aHUS (1 infusion every 21 days). Conclusions All patients with TA-TMA should be screened for the causes of CD. C5 inhibition with eculizumab is an important therapeutic resource to manage this complication. When KTx is necessary, immunosuppression can be safely withhold in case of same donor for both grafts and documented full chimerism. Correspondence information: Ardissino Gianluigi, Center for HUS Control, Prevention and Management, Fondazione, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 9, 20122 Milan, Italy, e-mail: ardissino@centroseu.org Authorship page Authorship: Ardissino Gianluigi: participated in the writing of the paper Cresseri Donata: participated in the writing of the paper Giglio Fabio: participated in the writing of the paper Onida Francesco.: participated in the writing of the paper Iannuzzella Francesco: participated in the writing of the paper Tel Francesca: participated in the writing of the paper Giussani Antenore: participated in the writing of the paper Messa Piergiorgio: participated in the writing of the paper Longhi Selena: participated in the writing of the paper Vincenti Daniele: participated in the writing of the paper Tedeschi Silvana: participated in the writing of the paper Cugno Massimo: participated in the writing of the paper Ciceri Fabio: participated in the writing of the paper Disclosure: The authors declare no conflicts of interest Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2z56yF3
Everolimus and Long-term Clinical Outcomes in Kidney Transplant Recipients: A Registry-based 10-year Follow-up of Five Randomized Trials
Background Data regarding the long-term efficacy of everolimus-based immunosuppression for kidney transplantation are lacking. Existing randomised controlled trials are limited by short follow-up duration which limits capacity to assess impact on graft and patient survival. Methods We linked individual trial participants to the Australian and New Zealand Dialysis and Transplant Registry. Using a one-step meta-analysis approach, we investigated the ten-year risk of graft loss, mortality and graft function in 349 participants from five randomised-trials of everolimus-based immunosuppression. Results Two-hundred and forty-two patients randomised to everolimus and 107 control patients were followed for a median of 9-years (IQR 7.1, 9.8 years). There were no significant differences in the risk of all-cause graft loss [adjusted HR (95% confidence interval) 1.16 (0.69-1.94)], mortality [adjusted HR 1.51 (0.78-2.93)] and death-censored graft loss in everolimus versus control [adjusted HR 1.00 (0.50-2.01)). For patients in the early initiation (de novo or
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https://ift.tt/2z3c2QD
Evolution of robotic systems for transoral head and neck surgery
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Howard Poon, Changsheng Li, Wenchao Gao, Hongliang Ren, Chwee Ming Lim
Abstract
Oropharyngeal tumor is traditionally resected from an open approach, often necessitating the need of a midline mandibulotomy in order to remove tumor safely with oncologic margins. The limitations imposed by a transoral route include poor visualization of the inferior extent of the oropharynx, rigid instrumentation, and inability to resect tumor that extends caudally into the supraglottis. While visualization with angled endoscopes, coupled with flexible laser development and microscopic magnification may overcome some of these limitations, this technique suffers from linear trajectory of the instruments which hampers expedient surgical resection in a 3-dimensional fashion. With development of the Da Vinci Surgical System, the safety and oncologic feasibility of removing oropharyngeal tumors are made possible because it provides a 3-dimensional magnification of the surgical field and wristed maneuverability of the surgical instruments which enable surgeons to operate around tight anatomical confines. Nevertheless, this first-generation robot is continually being modified with more flexibility and maneuverability through the development of robots like the FLEX Robotic System and more recently the Da Vinci Single Port System (SP). In this review, we will discuss the historic developments of robots for transoral applications, present the current approved robotic systems, and highlight the upcoming robots for transoral robotic surgery (TORS). Finally, we will also propose an ideal TORS surgical robot by highlighting the engineering technologies to accomplish these challenges.
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Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Shearwood McClelland, Janna Z. Andrews, Huma Chaudhry, Sewit Teckie, Anuj Goenka
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
https://ift.tt/2Pjlqdl
The existence of early stage oral mucosal melanoma: A 10-year retrospective analysis of 170 patients in a single institute
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Yunteng Wu, Lizheng Wang, Xuhui Ma, Wei Guo, Guoxin Ren
Abstract
Background
Oral mucosal melanoma (OMM) is an aggressive tumor with an extremely low incidence, and the current TNM Staging System has classified all OMMs as high stage. However, controversy remains regarding the existence of early stage OMMs.
Patients and methods
The clinical and pathological features, treatments and outcomes of 170 OMM patients treated in a single institution from January 2007 to July 2017 were retrospectively analyzed. Multivariate analysis was performed to identify significant prognostic factors for overall survival (OS).
Results
Multivariate analysis identified positive cervical lymph nodes (p < 0.0001), nodular OMMs (p < 0.0001), ulceration (p = 0.002), and level III or level IV invasion (p < 0.0001) as independent poor prognostic factors for OS. Nodular OMM patients with a tumor size ≤1 cm had a better outcome than those with a tumor size >1 cm (p < 0.0001). Twenty-two patients with superficial invasion had a favorable survival without the need of adjuvant therapy (postoperative chemotherapy or radiotherapy), and the current TNM Staging System was not suitable for those patients. Patients with deep invasion were more likely to suffer from recurrence and distant metastasis.
Conclusions
Tumor size ≤1 cm and OMM in situ, although extremely rare, do exist. It is advisable for AJCC to consider tumor size ≤1 cm and OMM in situ as the early stage of OMM when updating the new Oral Melanoma Staging System.
https://ift.tt/2JgNOXW
Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up
Publication date: Available online 25 October 2018
Source: Allergologia et Immunopathologia
Author(s): M. Alves-Correia, Â. Gaspar, L.-M. Borrego, J. Azevedo, C. Martins, M. Morais-Almeida
Abstract
Introduction
Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary.
Objective
We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA.
Materials and methods
The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells).
Results
The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200 mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127−/dim regulatory T cells were increased after OIT.
Conclusions
OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.
https://ift.tt/2AstSi7
Considerations on the ‘corseting’ or ‘strangling’ technique to treat large venous malformations
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): Margherita Dessy, Federica Giovanditto, Marco Cucurullo, Ambra Dionisio, Carlotta Liberale, Giacomo Colletti
https://ift.tt/2PSamke
Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): Q. Wu, B. Yang, S. Gao, P. Gong, L. Xiang, Y. Man, Y. Qu
Abstract
The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery. Pairwise comparisons of changes in ridge width gain, marginal bone loss, and pink aesthetic score were performed; correlations with pristine ridge morphology were investigated. The results showed similar marginal bone loss in the two groups. The overall ridge width gains in the new technique group (2.56 ± 1.92 mm) and GBR group (0.73 ± 1.21 mm) differed significantly (P < 0.05). The pink aesthetic score was higher for the new technique group (11.75 ± 1.22) than for the GBR group (9.25 ± 1.86) (P < 0.01). The morphology of the concavity had different impacts on regeneration in the two groups. The apical U-shape splitting technique, as a safe and effective alternative to GBR, provided a significant increase in bone volume gain where labial fenestration was inevitable during implant placement.
https://ift.tt/2AsTviy
‘Corseting’ and ‘strangling’—two techniques sharing similar concepts to treat large venous malformations in the head and neck region
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. Nair, J.P. Chawla, S.S. Shroff, B. Kumar, A. Shah
https://ift.tt/2PVoNnB
Editorial Board
Publication date: November 2018
Source: Autoimmunity Reviews, Volume 17, Issue 11
Author(s):
https://ift.tt/2CD4tUp
CD84 cell surface signaling molecule: An emerging biomarker and target for cancer and autoimmune disorders
Publication date: Available online 26 October 2018
Source: Clinical Immunology
Author(s): Marta Cuenca, Jordi Sintes, Árpád Lányi, Pablo Engel
Abstract
CD84 (SLAMF5) is a member of the SLAM family of cell-surface immunoreceptors. Broadly expressed on most immune cell subsets, CD84 functions as a homophilic adhesion molecule, whose signaling can activate or inhibit leukocyte function depending on the cell type and its stage of activation or differentiation. CD84-mediated signaling regulates diverse immunological processes, including T cell cytokine secretion, natural killer cell cytotoxicity, monocyte activation, autophagy, cognate T:B interactions, and B cell tolerance at the germinal center checkpoint. Recently, alterations in CD84 have been related to autoimmune and lymphoproliferative disorders. Specific allelic variations in CD84 are associated with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. In chronic lymphocytic leukemia, CD84 mediates intrinsic and stroma-induced survival of malignant cells. In this review, we describe our current understanding of the structure and function of CD84 and its potential role as a therapeutic target and biomarker in inflammatory autoimmune disorders and cancer.
https://ift.tt/2Sicbsx
SLAMF1/CD150 in hematologic malignancies: Silent marker or active player?
Publication date: Available online 25 October 2018
Source: Clinical Immunology
Author(s): Inna Gordiienko, Larysa Shlapatska, Larysa Kovalevska, Svetlana P. Sidorenko
Abstract
SLAMF1/CD150 receptor is a founder of signaling lymphocyte activation molecule (SLAM) family of cell-surface receptors. It is widely expressed on cells within hematopoietic system. In hematologic malignancies CD150 cell surface expression is restricted to cutaneous T-cell lymphomas, few types of B-cell non-Hodgkin's lymphoma, near half of cases of chronic lymphocytic leukemia, Hodgkin's lymphoma, and multiple myeloma. Differential expression among various types of hematological malignancies allows considering CD150 as diagnostical and potential prognostic marker. Moreover, CD150 may be a target for antibody-based or measles virus oncolytic therapy. Due to CD150 signaling properties it is involved in regulation of malignant cell fate decision and tumor microenvironment in Hodgkin's lymphoma and chronic lymphocytic leukemia. This review summarizes evidence for the important role of CD150 in pathogenesis of hematologic malignancies.
https://ift.tt/2z2V459
Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe
Publication date: Available online 26 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Naboth Matinhira, Nyarai D. Soko, Tsitsi Bandason, Ramon G. Jenson, Titus Dzongodza, Christian von Buchwald, Clemence Chidziva
Abstract
Objective
Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting.
Methods
We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types.
Results
A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed.
Conclusion
HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.
https://ift.tt/2Q2BcXa
Is chemotherapy the best option for chronic lymphocytic leukemia associated Wells’ syndrome? Reply to “Case of Wells’ syndrome: A rare association with the clinical course of chronic lymphocytic leukemia”
The Journal of Dermatology, EarlyView.
https://ift.tt/2D5dtmc
Itching, chloroquine, and malaria: a review of recent molecular and neuroscience advances and their contribution to mechanistic understanding and therapeutics of chronic non‐histaminergic pruritus
International Journal of Dermatology, EarlyView.
https://ift.tt/2PYIM4L
Exercise-Induced Anaphylaxis: Literature Review and Recent Updates
Abstract
Purpose of Review
This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.
Recent Findings
Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.
Summary
EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.
https://ift.tt/2ONge1L
Potential new targets for drug development in severe asthma
In recent years there has been increasing recognition of varying asthma phenotypes that impact treatment response. This has led to the development of biological therapies targeting specific immune cells and cy...
https://ift.tt/2AsoyuX
Exercise-Induced Anaphylaxis: Literature Review and Recent Updates
Abstract
Purpose of Review
This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.
Recent Findings
Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.
Summary
EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.
https://ift.tt/2ONge1L
Poland syndrome accompanied by internal iliac artery supply disruption sequence: a case report
Poland syndrome is a congenital malformation characterized by ipsilateral hand and chest wall depression, including an absence or hypoplasia of the breast and pectoral muscles. These hypoplastic defects are re...
https://ift.tt/2z2m2K5
Epidemiologic and genetic data suggest the presence of an endemic form of pemphigus foliaceus in Gran Canaria, Spain
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CJasan
Reconstruction of Facial Defects with Three-Stage Frontal Expanded Bipedicled Flaps
Background: The aim of the present study was the therapeutic effect of the frontal expanded bipedicled flaps that are used in the reconstruction of facial defects. Patients were treated with mostly unilateral facial defects which affected temple area and cross the midline with frontal expanded flaps to investigate the therapeutic effect of reconstruction of facial defects with frontal expanded bipedicled flaps from June 2012 to August 2017 and 2 patients were discussed in this study. Methods: The surgery procedure was divided into 3 stages. At the first stage, expanders were implanted and the expanded frontal flaps were transferred at second stage. After that pedicle division was performed and the pedicle skin tissue was used to repair the residue defect at the third stage. Results: All 7 flaps survived completely with satisfactory color and texture. Satisfied results were achieved during the follow-up period of 1 year. Conclusion: The bipedicled frontal expanded flap is very suitable for large facial defect due to its reliable blood supply. Address correspondence and reprint requests to Qinghua Yang, MD, PhD, Plastic Surgery Hospital, Peking Union Medical College, Beijing 100144, China; E-mail: yqh114502@sina.com Received 24 May, 2018 Accepted 18 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2ELZhQK
https://ift.tt/2ELZhQK
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Background: Bromelain belongs to a group of protein-digesting enzymes obtained commercially from the fruit or stem of pineapple. Several studies demonstrated that bromelain exhibits various fibrinolytic, anti-edematous, antithrombotic, and anti-inflammatory activities supporting its application for many therapeutic benefits. The aim of this study was to analyze the effects of bromelain on the pro-wound healing activities and the regenerative properties of mesenchymal stem cells. Methods: Mesenchymal stem cells were treated in vitro with bromelain alone or combined with dexamethasone sodium phosphate. Real-time polymerase chain reaction was performed to profile the expression of extracellular matrix components and remodeling enzymes, and cytokines. Results: The combination of bromelain and dexamethasone sodium phosphate induced a great activation of mesenchymal stem cells with an increase in hyaluronan and collagen production and anti-inflammatory cytokines release. Conclusion: Based on the results of this in vitro study, the combined use of bromelain and dexamethasone sodium phosphate stimulated the pro-wound healing activities and the regenerative properties of mesenchymal stem cells better than bromelain and dexamethasone alone. Address correspondence and reprint requests to Paolo Ghensi, DDS, Clin MSc, Via Chini 101/2, 38123 Trento (TN), Italy; E-mail: dr.ghensi@gmail.com Received 29 April, 2018 Accepted 11 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2D4t8C7
https://ift.tt/2D4t8C7
Characterization of Perinatal Risk Factors and Complications Associated with Nonsyndromic Craniosynostosis
Background: Certain intrauterine risk factors are known to increase the risk of premature cranial suture fusion and may cause complications during birth. Some of these risk factors may be modifiable. Therefore, the authors sought to characterize the institutional patterns of prenatal risk factors and perinatal complications in nonsyndromic craniosynostosis patients compared to normal births from the surrounding area to identify areas for possible intervention or prevention. Methods: The medical records of all infants with nonsyndromic craniosynostosis and full birth records born at Duke University Health System from 2006 to 2017 were retrospectively reviewed. Maternal comorbidities, prenatal risk factors, and perinatal complications were collected. The North Carolina State Center for Health Statistics was queried for perinatal statistics from Durham county and the Northeastern Perinatal Care Region to represent a control cohort of normal births from the same time period and region. The primary outcome investigated was the incidence of prenatal risk factors and complications at birth associated with premature fusion of cranial sutures. Results: Eighty births with nonsyndromic craniosynostosis were included in this study. The majority of these patients were males (61.7%) and born via cesarean section (55.0%). Intrauterine growth restriction occurred in 10.0% and head trauma during delivery occurred in 2.5%. Twinning (14.8% vs 3.6%, P
https://ift.tt/2D5nWxP
https://ift.tt/2D5nWxP
Parent Cognitive Satisfaction and Demand Research of Neonatal Hearing Screening
The primary aim of the present study was to investigate parent cognitive satisfaction and demand by using a valid and reliable questionnaire developed for this purpose (Parent Cognitive Satisfaction and Demand Questionnaire with Neonatal Hearing Screening Program, PCSDQ-NHSP). About 1000 parents whose children received hearing screening participated in this study. The satisfaction questionnaire was found to be a useful instrument for identifying service shortfalls, and the routine use of the PCSDQ-NHSP in other neonatal hearing screening programs is recommended. Overall, parents focused their attention to the neonatal hearing screening results and had high levels of expectations. They also longed for more information about relevant knowledge. Screening ability differed in different areas of Guangdong province where grass-roots hospitals had poor ability to perform this well. More preappointment information leaflets or brochures should be sent to parents. Regular training for neonatal hearing screening test is needed in primary hospitals. We can establish a neonatal hearing screening network to link as many hospitals as possible, and develop a standardized neonatal hearing screening system. Address correspondence and reprint requests to Tao Zhang, PhD, Department of ENT&HN Surgery, The First Affiliated Hospital of Jinan University, No 613, West Whampoa Road, Guangzhou, Guangdong, Tianhe District, 510630, China; E-mail: zhangtao_dr11@163.com Received 13 June, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2EIIPAw
https://ift.tt/2EIIPAw
Accuracy of Three-Dimensional Soft Tissue Prediction in Orthognathic Cases Using Dolphin Three-Dimensional Software
Introduction: Orthodontists and surgeons have been looking for more accurate methods to plan and predict surgical outcomes in patients with skeletal discrepancies. Methods: The sample consisted of 20 subjects from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bisagittal split osteotomy, with or without genioplasty. All subjects had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin three-dimensional (3D) software version 11.9 in digital imaging and communications in medicine format. Three-dimensional voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The differences between Tp and T1 for all patients were measured using linear and angular measurements visualized by surface mapping. Results: Significant differences were found between Tp and T1 in Nasolabial angle, Soft tissue A point, and Subalar area. Conclusions: The soft tissue prediction accuracy after double jaw surgery using Dolphin 3D is limited in some areas, especially upper lip and base of the nose. Address correspondence and reprint requests to Tarek Elshebiny, BDS, MSD, 2124 Cornel Road, Case Western School of Dental Medicine, Cleveland, OH 44106; E-mail: Tme18@case.edu Received 17 April, 2018 Accepted 13 August, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2EMAFHq
https://ift.tt/2EMAFHq
Reverse Anterolateral Thigh Flap for Complex Scalp Reconstruction
It is common for patients diagnosed with severe traumatic brain injury or intracranial tumors to undergo multiple craniotomy and cranioplasty procedures. In the setting of infection, these patients can develop scalp wounds with no local options. A reverse flow anterolateral thigh (ALT) flap for coverage of a complex multifocal scalp wound in a patient with exposed cranioplasty mesh and multiple prior operations without necessitating vein grafts was presented. This might be the first reverse flow free ALT flap to be reported in head and neck reconstruction. Address correspondence and reprint requests to Jamie A. Spitz, MD, Department of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S Wood Street, Suite 515, Clinical Science North Building (M/C 958), Chicago, IL 60612; E-mail: jamiespitzmd@gmail.com Received 29 March, 2018 Accepted 16 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2D4ZCwc
https://ift.tt/2D4ZCwc
Temporal Evaluation of Craniofacial Relationships in Apert Syndrome
Complicated craniofacial malformations interfacing with multiple intracellular regulatory mechanisms, lead to ambiguous growth patterns in Apert syndrome. This study aims to explore the chronology and pathogenesis of the development of craniofacial anatomic relationships and to verify the positional correlates between skull and facial structures in Apert syndrome. Fifty-four computed tomography scans (Apert, n = 18; control, n = 36) were included and divided into 3 age subgroups. Craniofacial 3-dimensional cephalometries were analyzed by Materialize software. The angle between sella-nasion plane and maxillary plane widens 7.74° (P = 0.003) prior to 6 months of age; thereafter, this widening increases by 10.36° (P
https://ift.tt/2ELIihu
https://ift.tt/2ELIihu
Innovations and Contributions to Craniofacial Surgery in Japan
I look back at my decades in the field of plastic and reconstructive and craniofacial surgery, knowing I was the driving force behind its inception in Japan. However, behind me in turn, supporting me, teaching me, and encouraging me during my formative plastic surgery years in the United States and Europe have been many of the true giants in this field, and I will always accord them my total respect and deepest gratitude. Without their knowledge and technique, which they selflessly taught me and my peers, I would certainly never have been able to accomplish so much in the field of plastic and reconstructive surgery, and in particular, craniofacial surgery. Address correspondence and reprint requests to Toyomi Fujino, MD, FACS, Department of Plastic and Reconstructive Surgery, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; E-mail: fujinotsr@polka.ocn.ne.jp Received 30 May, 2018 Accepted 16 June, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2D4ZpsU
https://ift.tt/2D4ZpsU
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