The purpose of this study was to assess host-derived parameters around dental zirconia and titanium implants and natural teeth during the occurrence of mucositis. After 4 weeks of perfect oral hygiene, 16 clinically profiled patients were asked to refrain from oral hygiene for 2 weeks, resulting in experimental plaque accumulation. This was followed by 4 weeks of perfect oral hygiene to reverse the inflammation. Immunological samples were analyzed for interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α), and interleukin 1β (IL-1β).
https://ift.tt/2D5lkPG
Δευτέρα 5 Νοεμβρίου 2018
Experimental peri-implant mucositis around titanium and zirconia implants in comparison to a natural tooth: part 1—host-derived immunological parameters
An assessment and comparison of nasolabial aesthetics in bilateral clefts using the anatomical subunit-based scale: a nasoalveolar moulding versus non-nasoalveolar moulding study
Nasoalveolar moulding is a presurgical orthopaedic technique used to improve the outcomes of bilateral clefts. However, the lack of a validated scale tailored to bilateral clefts makes it difficult to quantify the merits of nasoalveolar moulding and compare it to other techniques. In this study, a recently published anatomical subunit scale was used to evaluate and compare the early effects of nasoalveolar moulding. Two groups of similarly treated bilateral cleft patients were included: one in which patients underwent presurgical nasoalveolar moulding and one in which they did not.
https://ift.tt/2PbKtiZ
An Unusual Position of Retromandibular Vein in Relation to Facial Nerve: A Rare Case Report
Knowledge of different anatomical structures is very important in parotid surgery to preserve facial nerve. Retromandibular vein is one of the landmarks used to identify facial nerve. So, the relation of the vein with facial nerve is very important in parotid surgery. The typical position of RMV is deep to facial nerve in almost 88% of cases reported in various literatures. Here, we present an unusual position of RMV found during parotid surgery for pleomorphic adenoma.
https://ift.tt/2D4kAdI
American Thyroid Association: Dr. Elizabeth Pearce to Lead 2018-2019 Board of Directors
October 17, 2018—The American Thyroid Association (ATA) announces with pleasure that Elizabeth Pearce, MD, MSc, began a one-year term as president of the Board of Directors at the close of the Annual Meeting, October 7 in Washington, DC. Dr. Pearce has served for the past year as President-Elect.
Newly elected board members are:
Martha Zeiger, MD, President-Elect
Jacqueline Jonklaas, MD, Secretary-Elect
Joshua Klopper, MD, Director
Angela Leung, MD, MSc, Director
Elizabeth Pearce, MD, MSc, Board President
Dr. Pearce is professor of medicine in the Endocrinology, Diabetes, and Nutrition Section at Boston University School of Medicine. She received her undergraduate and medical degrees from Harvard and a masters' degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at Boston University under the mentorship of Dr. Lewis Braverman. Her research interests include: the sufficiency of dietary iodine in the U.S. and globally; thyroid function in pregnancy; thyroidal effects of exposure to environmental endocrine disruptors; and the cardiovascular effects of subclinical thyroid dysfunction. She has been part of the leadership of the Iodine Global Network (IGN; formerly ICCIDD) since 2009. She is a member of the AACE Thyroid Disease State Network and serves as faculty for the Endocrine Society's annual board review course. She has served on multiple editorial boards, including those for Endocrine Practice, Journal of Clinical Endocrinology and Metabolism, Clinical Endocrinology, European Journal of Clinical Nutrition, and Lancet Diabetes & Endocrinology.
Dr. Pearce has been a member of the American Thyroid Association since 2000. She has chaired both the ATA's Publications and Public Health Committees. She cochaired the 2012 Annual Meeting Program Committee and the 2009 and 2016 Spring Symposia and was a member of the Program Committee for the 2015 International Thyroid Congress. Dr. Pearce has also served as a member of the ATA Finance Committee and the Guidelines Policy Task Force. She was one of the leaders in establishing the ATA's Braverman Lectureship and cochaired the task force for the 2017 Pregnancy Guidelines. She is associate editor for both Thyroid and Clinical Thyroidology journals. She served as a member of the Board of Directors from 2009 to 2013 and again as president-elect for the past year. Dr. Pearce was the 2011 recipient of the Van Meter Award for outstanding contributions to research on the thyroid gland.
Martha Zeiger, MD, President-Elect
Dr. Martha Zeiger is the S. Hurt Watts professor and chair of surgery at the University of Virginia School of Medicine. Regarded as a world leader in endocrine surgery, she is also an expert in the molecular aspects of thyroid cancer and an experienced academic leader. Her surgical training includes a surgical oncology fellowship, focused on endocrine surgery, at the National Cancer Institute, NIH, prior to joining the faculty at Johns Hopkins University School of Medicine in 1993. There, she built her endocrine surgery practice, established an endocrine surgery fellowship program, and directed an NIH-funded molecular biology laboratory for over 20 years. Today, her research team continues at Johns Hopkins, focusing on the molecular aspects of thyroid cancer.
While at John Hopkins, Dr. Zeiger took the lead as: associate dean for postdoctoral affairs; professor of surgery, oncology, cellular and molecular medicine; associate vice chair of surgery faculty development; and medical director of business development, strategic alliance, and venture technology. While associate dean for postdoctoral affairs, she oversaw 1,200 research fellows in the School of Medicine. She also established a formal program for international postdoctoral fellows.
Dr. Zeiger has held numerous leadership positions in national medical societies: the American Association of Endocrine Surgeons, the American Association of Clinical Endocrinologists, and the ATA. Through AAES, she founded Endocrine Surgery University, an annual course for all endocrine surgery fellows in North America.
She has served on the ATA Board of Directors and many ATA committees, including publications, membership, conflict of interest task force. She co-chaired the annual meeting program committee in 2011.
Jacqueline Jonklaas, MD, Secretary-Elect
Dr. Jonklaas is currently a professor in the endocrinology division at Georgetown University in Washington, DC, where she completed her medical degree, residency, and fellowship training. As a clinical researcher in the thyroid field, her time is divided between research, clinical activities, and teaching. Dr. Jonklaas's research has focused on the management of hypothyroidism and thyroid cancer. Current research involves examining patient-reported outcomes after radioiodine therapy. Her recent publications address topics such as how to optimize the treatment of hypothyroidism and the outcomes of thyroid cancer patients based on their treatment, age, and gender.
She is the program director of the Georgetown University Clinical Research Unit. She is involved in translational research and the activities of the Georgetown University's Clinical and Translational Science Award. She recently directed the endocrinology courses for Georgetown University Medical School's first- and second-year medical students. She currently teaches in these courses.
She serves on the editorial board of the Journal of Clinical Endocrinology and Metabolism. She is involved in teaching at the national level as a member of the Endocrine Society Self-Assessment Committee.
Dr. Jonklaas has been a member of the ATA since 1999. She has served on several past ATA committees, including the Patient Education and Advocacy Committee, the Surgical Task Force Committee, and the Awards Committee. She was cochair of the ATA Task Force on Thyroid Hormone Replacement, whose guidelines were published in 2014. She previously served on the Board of Directors from 2013–2017, and recently completed a term as the cochair of the Guidelines and Statement Committee. Currently she serves on the Program Committee. She also serves on the editorial board of the ATA journal Thyroid.
Joshua Klopper, MD, Director (Endocrinologist in Community Practice)
D
r. Klopper joined the Colorado Permanente Medical Group (CPMG) of Kaiser Permanente in July 2015 and was appointed chief of the department in April 2016. He was appointed associate clinical professor of medicine in the Division of Endocrinology, Metabolism, and Diabetes at the University of Colorado School of Medicine in October 2015.
He earned a B.S. in psychology in 1995 from Indiana University in Bloomington, Indiana. In 1999 he received his medical degree from the Emory University School of Medicine in Atlanta, Georgia. He completed his internship and residency in internal medicine at the University of Colorado Health Sciences Center in 2002. Dr. Klopper then completed a postdoctoral research fellowship in the Endocrinology Division, prior to starting his endocrinology fellowship at the University of Colorado at Denver Health Sciences Center, completed in 2006.
Dr. Klopper was a full-time faculty member in the Division of Endocrinology at the University of Colorado School of Medicine from 2006–2015, where he specialized in the evaluation and management of thyroid nodules and thyroid cancer, including advanced thyroid cancer. During his academic career, he received grant funding at the local, state, and national level including from the American Cancer Society. He has published original research on the evaluation and management of thyroid nodules and advanced thyroid cancer and has written several book chapters and reviews. Additionally, he participated as an original member of the Thyroid Cancer Care Collaborative development committee. He has served on the Clinical Affairs and Development committees of the ATA as well as on the Endocrine Society Annual Meeting Steering committee. Currently, Dr. Klopper is on the Medical Specialty Peer Review Committee for CPMG and has been codirector of the Endocrine Society's Introductory Hands-On Thyroid Ultrasound Workshop since 2014.
Angela Leung, MD, MSc, Director (Endocrinologist in Academic Practice)
Angela M. Leung, MD, MSc, is an assistant professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism at the UCLA David Geffen School of Medicine and in the VA Greater Los Angeles Healthcare System, and an associate program director of the UCLA/VA endocrinology fellowship program.
She received her undergraduate degree at Occidental College in Los Angeles, her medical degree from the Boston University School of Medicine, and a masters' degree in epidemiology from the Boston University School of Public Health. She completed her internal medicine residency and a clinical and research endocrine fellowship at Boston University Medical Center. Her research areas of interest include iodine deficiency and excess, thyroid toxicant exposures, and maternal-child thyroid health. She is a member of the AACE Thyroid Disease State Network and the editorial board of Endocrine Practice, has participated in the AACE Endocrine Training Support Committee, and was a recipient of the Endocrine Society Early Investigator Award. She has reviewed for several NIH standing and early-career award endocrine study sections; for the U.S. EPA's Biologically-Based Dose Response model to guide perchlorate regulation in U.S. drinking water; and for the EPA's draft toxicity assessments of the thyroid disruptors GenX and perfluorobutane sulfonate. Through the Endocrine Society, she participates in reviewing the effects of thyroid toxicants for the Organization for Economic Cooperation and Development, a global initiative focused on the regulatory policies of endocrine disruptors.
Dr. Leung has been involved in multiple ATA programs and initiatives. She serves on the editorial boards of three ATA journals: Thyroid, Clinical Thyroidology, and Clinical Thyroidology for the Public. She is past Chair of the ATA Public Health Committee (2012–16), during which she led the publication of the ATA's statements on iodine excess and the use of potassium iodide in nuclear accidents; was a member of the Program Committee for the 2016 ATA Annual Meeting; and served as clinical cochair for the 2017 ATA Annual Meeting in Victoria, British Columbia.
The ATA thanks this year's Nominating Committee, chaired by David Steward, and the Secretary-Elect Selection Task Force, chaired by John Morris. We are extremely grateful to all who serve on the Board of Directors. Special thanks go to those who will retire from the Board this year: Regina Castro, MD, Christine Spitzweg, MD, and outgoing Past-President John C. Morris, MD.
###
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:
- The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
- Annual scientific meetings
- Biennial clinical and research symposia
- Research grant programs for young investigators
- Support of online professional, public, and patient educational programs
- Development of guidelines for clinical management of thyroid disease and thyroid cancer
The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).
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https://ift.tt/2zsSx4l
Surgical management of recurrent dislocation of the temporomandibular joint: a new treatment protocol
Recurrent dislocation of the temporomandibular joint (TMJ) is rare. It is distinct from acute or chronic dislocation and is associated with considerable morbidity and deterioration in quality of life. To formulate a practical surgical treatment algorithm, we retrospectively reviewed the management and long-term outcomes of 14 patients who presented to a single hospital department over a period of six years (2010–2016), and collected data on demographics, clinical features, operation, and outcome.
https://ift.tt/2JG9M71
Donor sites for radial forearm flaps: a direct comparison of closure with a local “hatchet” flap and split thickness skin grafts in a single patient
We read the article by Pabst et al1 with interest. Morbidity at the donor site of radial forearm flaps (RFF) has been the subject of much discussion, and we would like to describe a direct comparison of two techniques of closure in a single patient (Taylor et al. Radial forearm flap donor sites − A direct comparison of local hatchet flap closure versus split thickness skin grafting in a single patient. Presented at the British Association of Head and Neck Oncologists Annual Scientific Meeting, London, 2018).
https://ift.tt/2DoOoCK
The Mitochondrial Isoform of FASTK Modulates Nonopsonic Phagocytosis of Bacteria by Macrophages via Regulation of Respiratory Complex I [INFECTIOUS DISEASE AND HOST RESPONSE]
Phagocytosis is a pivotal process by which innate immune cells eliminate bacteria. In this study, we explore novel regulatory mechanisms of phagocytosis driven by the mitochondria. Fas-activated serine/threonine kinase (FASTK) is an RNA-binding protein with two isoforms, one localized to the mitochondria (mitoFASTK) and the other isoform to cytosol and nucleus. The mitoFASTK isoform has been reported to be necessary for the biogenesis of the mitochondrial ND6 mRNA, which encodes an essential subunit of mitochondrial respiratory complex I (CI, NADH:ubiquinone oxidoreductase). This study investigates the role and the mechanisms of action of FASTK in phagocytosis. Macrophages from FASTK/ mice exhibited a marked increase in nonopsonic phagocytosis of bacteria. As expected, CI activity was specifically reduced by almost 50% in those cells. To explore if decreased CI activity could underlie the phagocytic phenotype, we tested the effect of CI inhibition on phagocytosis. Indeed, treatment with CI inhibitor rotenone or short hairpin RNAs against two CI subunits (NDUFS3 and NDUFS4) resulted in a marked increase in nonopsonic phagocytosis of bacteria. Importantly, re-expression of mitoFASTK in FASTK-depleted macrophages was sufficient to rescue the phagocytic phenotype. In addition, we also report that the decrease in CI activity in FASTK/ macrophages is associated with an increase in phosphorylation of the energy sensor AMP-activated protein kinase (AMPK) and that its inhibition using Compound C reverted the phagocytosis phenotype. Taken together, our results clearly demonstrate for the first time, to our knowledge, that mitoFASTK plays a negative regulatory role on nonopsonic phagocytosis of bacteria in macrophages through its action on CI activity.
https://ift.tt/2QtgaAQ
Leukocyte CD300a Contributes to the Resolution of Murine Allergic Inflammation [INNATE IMMUNITY AND INFLAMMATION]
CD300a is an inhibitory receptor for mast cells and eosinophils in allergic inflammation (AI); however, the spatiotemporal expression of CD300a and its potential roles in the resolution of AI are still to be determined. In this study, employing a mouse model of allergic peritonitis, we demonstrate that CD300a expression on peritoneal cells is regulated from inflammation to resolution. Allergic peritonitis–induced CD300a–/– mice had a rapid increase in their inflammatory cell infiltrates and tryptase content in the peritoneal cavity compared with wild type, and their resolution process was significantly delayed. CD300a–/– mice expressed lower levels of ALX/FPR2 receptor on peritoneal cells and had higher levels of LXA4 in the peritoneal lavage. CD300a activation on mouse bone marrow–derived mast cells regulated ALX/FPR2 expression levels following IgE-mediated activation. Together, these findings indicate a role for CD300a in AI and its resolution, in part via the specialized proresolving mediator LXA4 and ALX/FPR2 receptor pathway activation.
https://ift.tt/2QmeaKP
Does T Cell Activation Require a Quorum of Lymphocytes? [BRIEF REVIEWS]
Recent reports suggest a quorum of T cells is required to activate T lymphocytes and that this requirement may help explain why scarce lymphocytes, specific for peripheral self-antigen, are rarely activated by Ag. This proposal runs counter to the commonly held framework that the Ag-dependent, but CD4 T lymphocyte–independent, activation of CD8 T lymphocytes, and the activation of CD4 T lymphocytes themselves, can occur when a single CD8 or CD4 T lymphocyte encounters Ag under appropriately dangerous circumstances. We argue that a review of older literature often ignored, as well as of contemporary studies, supports the quorum concept and is difficult to reconcile with the Danger Model.
https://ift.tt/2QlYqrn
MAbTope: A Method for Improved Epitope Mapping [MOLECULAR AND STRUCTURAL IMMUNOLOGY]
Abs are very efficient drugs, ~70 of them are already approved for medical use, over 500 are in clinical development, and many more are in preclinical development. One important step in the characterization and protection of a therapeutic Ab is the determination of its cognate epitope. The gold standard is the three-dimensional structure of the Ab/Ag complex by crystallography or nuclear magnetic resonance spectroscopy. However, it remains a tedious task, and its outcome is uncertain. We have developed MAbTope, a docking-based prediction method of the epitope associated with straightforward experimental validation procedures. We show that MAbTope predicts the correct epitope for each of 129 tested examples of Ab/Ag complexes of known structure. We further validated this method through the successful determination, and experimental validation (using human embryonic kidney cells 293), of the epitopes recognized by two therapeutic Abs targeting TNF-α: certolizumab and golimumab.
https://ift.tt/2Qtg4Ju
The Diverse Family of MR1-Restricted T Cells [BRIEF REVIEWS]
Mucosal-associated invariant T (MAIT) cells are characterized by a semi-invariant TCR that recognizes vitamin B metabolite Ags presented by the MHC-related molecule MR1. Their Ag restriction determines a unique developmental lineage, imbuing a tissue-homing, preprimed phenotype with antimicrobial function. A growing body of literature indicates that MR1-restricted T cells are more diverse than the MAIT term implies. Namely, it is increasingly clear that TCR α- and TCR β-chain diversity within the MR1-restricted repertoire provides a potential mechanism of Ag discrimination, and context-dependent functional variation suggests a role for MR1-restricted T cells in diverse physiological settings. In this paper, we summarize MR1-restricted T cell biology, with an emphasis on TCR diversity, Ag discrimination, and functional heterogeneity.
https://ift.tt/2qweyuS
Myoferlin-Mediated Lysosomal Exocytosis Regulates Cytotoxicity by Phagocytes [INNATE IMMUNITY AND INFLAMMATION]
During inflammation, phagocytes release digestive enzymes from lysosomes to degrade harmful cells such as pathogens and tumor cells. However, the molecular mechanisms regulating this process are poorly understood. In this study, we identified myoferlin as a critical regulator of lysosomal exocytosis by mouse phagocytes. Myoferlin is a type II transmembrane protein with seven C2 domains in the cytoplasmic region. It localizes to lysosomes and mediates their fusion with the plasma membrane upon calcium stimulation. Myoferlin promotes the release of lysosomal contents, including hydrolytic enzymes, which increase cytotoxicity. These data demonstrate myoferlin's critical role in lysosomal exocytosis by phagocytes, providing novel insights into the mechanisms of inflammation-related cellular injuries.
https://ift.tt/2Qtg6RC
Cutting Edge: IL-1{alpha} and Not IL-1{beta} Drives IL-1R1-Dependent Neonatal Murine Sepsis Lethality [CUTTING EDGE]
Sepsis disproportionately affects the very old and the very young. IL-1 signaling is important in innate host defense but may also play a deleterious role in acute inflammatory conditions (including sepsis) by promulgating life-threatening inflammation. IL-1 signaling is mediated by two distinct ligands: IL-1α and IL-1β, both acting on a common receptor (IL-1R1). IL-1R1 targeting has not reduced adult human sepsis mortality despite biologic plausibility. Because the specific role of IL-1α or IL-1β in sepsis survival is unknown in any age group and the role of IL-1 signaling remains unknown in neonates, we studied the role of IL-1 signaling, including the impact of IL-1α and IL-1β, on neonatal murine sepsis survival. IL-1 signaling augments the late plasma inflammatory response to sepsis. IL-1α and not IL-1β is the critical mediator of sepsis mortality, likely because of paracrine actions within the tissue. These data do not support targeting IL-1 signaling in neonates.
https://ift.tt/2QmefhB
Cutting Edge: Quantitative Determination of CD40L Threshold for IL-12 and IL-23 Production from Dendritic Cells [CUTTING EDGE]
Early secretion of IL-12 by mouse dendritic cells (DCs) instructs T cells to make IFN-. However, only activated, but not naive T cells are able to license DCs for IL-12 production. We hypothesized that it might be due to different levels of CD40L expression on the surface of these cells, as CD40 signals are required for IL-12 production. Using quantitative cell-free systems incorporating CD40L in lipid bilayers combined with total internal reflection fluorescence microscopy and flow cytometry, we show that as low as ~200 CD40L molecules/μm2 in combination with IL-4 is sufficient to induce IL-12 production by DCs. Remarkably, CD40L alone is adequate to induce IL-23 secretion by DCs. Thus, although activated T cells have somewhat higher levels of CD40L, it is the combination of CD40L and the cytokines they secrete that licenses DCs and influences the effector class of the immune response.
https://ift.tt/2qxGpuB
Differential Activation of Hepatic Invariant NKT Cell Subsets Plays a Key Role in Progression of Nonalcoholic Steatohepatitis [INNATE IMMUNITY AND INFLAMMATION]
Innate immune mechanisms play an important role in inflammatory chronic liver diseases. In this study, we investigated the role of type I or invariant NKT (iNKT) cell subsets in the progression of nonalcoholic steatohepatitis (NASH). We used α-galactosylceramide/CD1d tetramers and clonotypic mAb together with intracytoplasmic cytokine staining to analyze iNKT cells in choline-deficient l-amino acid–defined (CDAA)-induced murine NASH model and in human PBMCs, respectively. Cytokine secretion of hepatic iNKT cells in CDAA-fed C57BL/6 mice altered from predominantly IL-17+ to IFN-+ and IL-4+ during NASH progression along with the downmodulation of TCR and NK1.1 expression. Importantly, steatosis, steatohepatitis, and fibrosis were dependent upon the presence of iNKT cells. Hepatic stellate cell activation and infiltration of neutrophils, Kupffer cells, and CD8+ T cells as well as expression of key proinflammatory and fibrogenic genes were significantly blunted in Jα18–/– mice and in C57BL/6 mice treated with an iNKT-inhibitory RAR- agonist. Gut microbial diversity was significantly impacted in Jα18–/– and in CDAA diet–fed mice. An increased frequency of CXCR3+IFN-+T-bet+ and IL-17A+ iNKT cells was found in PBMC from NASH patients in comparison with nonalcoholic fatty liver patients or healthy controls. Consistent with their in vivo activation, iNKT cells from NASH patients remained hyporesponsive to ex-vivo stimulation with α-galactosylceramide. Accumulation of plasmacytoid dendritic cells in both mice and NASH patients suggest their role in activation of iNKT cells. In summary, our findings indicate that the differential activation of iNKT cells play a key role in mediating diet-induced hepatic steatosis and fibrosis in mice and its potential involvement in NASH progression in humans.
https://ift.tt/2Qme8mb
B Cell Development sans B Cell Receptor Responsiveness Due to Unfolded Protein Response-Triggered Mef2c Protein Degradation [IMMUNE REGULATION]
BCR engagement leads to activation and clonal expansion of B cells. The I-A12% mutant mouse possesses a branch site point mutation in the H2-Aa gene that causes highly reduced I-Aa protein expression. As I-A is a heterodimer made up of I-Aa and I-Ab, reduced I-Aa results not only in reduced surface I-A expression but also in an excess of unpaired I-Ab. B cells that develop in I-A12% mice proliferated in response to LPS stimulation but failed to do so upon BCR stimulation. Developing I-A12% B cells were engaged in unfolded protein response due to an excess of unpaired I-Ab. BCR responsiveness was restored by transduced I-Aa expression and by BiP, the unfolded protein response sensor. Reducing the load of unpaired I-Ab also restored BCR responsiveness of I-A12% B cells. Mef2c protein, a transcription factor required for BCR-stimulated proliferation, was missing in I-A12% B cells, and that transduced Mef2c expression restored BCR responsiveness. Mef2c protein appeared in I-A12% B cells after addition of proteasome inhibitors. Mef2c degradation was mediated by Skp2 E3 ligase, and that knockdown of Skp2 mRNA in I-A12% B cells restored BCR responsiveness. Our results point to a generalized incompatibility between BCR responsiveness and increased Skp2 stability. They also imply the existence of regulatory mechanisms other than Ig gene rearrangement that govern Mef2c turnover in a specific, exquisite, and dynamic fashion.
https://ift.tt/2QruuKw
RNA Splicing in the Transition from B Cells to Antibody-Secreting Cells: The Influences of ELL2, Small Nuclear RNA, and Endoplasmic Reticulum Stress [MOLECULAR AND STRUCTURAL IMMUNOLOGY]
In the transition from B cells to Ab-secreting cells (ASCs) many genes are induced, such as ELL2, Irf4, Prdm1, Xbp1, whereas other mRNAs do not change in abundance. Nonetheless, using splicing array technology and mouse splenic B cells plus or minus LPS, we found that induced and "uninduced" genes can show large differences in splicing patterns between the cell stages, which could influence ASC development. We found that ~55% of these splicing changes depend on ELL2, a transcription elongation factor that influences expression levels and splicing patterns of ASC signature genes, genes in the cell-cycle and N-glycan biosynthesis and processing pathways, and the secretory versus membrane forms of the IgH mRNA. Some of these changes occur when ELL2 binds directly to the genes encoding those mRNAs, whereas some of the changes are indirect. To attempt to account for the changes that occur in RNA splicing before or without ELL2 induction, we examined the amount of the small nuclear RNA molecules and found that they were significantly decreased within 18 h of LPS stimulation and stayed low until 72 h. Correlating with this, at 18 h after LPS, endoplasmic reticulum stress and Ire1 phosphorylation are induced. Inhibiting the regulated Ire1-dependent mRNA decay with 4u8C correlates with the reduction in small nuclear RNA and changes in the normal splicing patterns at 18 h. Thus, we conclude that the RNA splicing patterns in ASCs are shaped early by endoplasmic reticulum stress and Ire1 phosphorylation and later by ELL2 induction.
https://ift.tt/2Qme5qv
VASP Regulates NK Cell Lytic Granule Convergence [IMMUNE REGULATION]
NK cells eliminate viral-infected and malignant cells through a highly orchestrated series of cytoskeletal rearrangements, resulting in the release of cytolytic granule contents toward the target cell. Central to this process is the convergence of cytolytic granules to a common point, the microtubule-organizing center (MTOC), before delivery to the synapse. In this study, we show that vasodialator-stimulated phosphoprotein (VASP), an actin regulatory protein, localizes to the cytolytic synapse, but surprisingly, shows no impact on conjugate formation or synaptic actin accumulation despite being required for human NK cell–mediated killing. Interestingly, we also find that a pool of VASP copurifies with lytic granules and localizes with lytic granules at the MTOC. Significantly, depletion of VASP decreased lytic granule convergence without impacting MTOC polarization. Using the KHYG-1 cell line in which lytic granules are in a constitutively converged state, we find that either VASP depletion or F-actin destabilization promoted spreading of formerly converged granules. Our results demonstrate a novel requirement for VASP and actin polymerization in maintaining lytic granule convergence during NK cell–mediated killing.
https://ift.tt/2qvFF9G
Potential Use of Genetically Engineered Variable Lymphocyte Receptor B Specific to Avian Influenza Virus H9N2 [NOVEL IMMUNOLOGICAL METHODS]
The variable lymphocyte receptor (VLR) B of jawless vertebrates functions as a secreted Ab of jawed vertebrates and has emerged as an alternative Ab with a single polypeptide chain. After observing an upregulated VLRB response in hagfish immunized with avian influenza virus (AIV) subtype H9N2, we screened AIV H9N2–specific VLRB using a mammalian expression system. To improve the binding avidity of the Ag-specific VLRB to the Ag, we enabled multimerization of the VLRB by conjugating it with C-terminal domain of human C4b-binding protein. To dramatically enhance the expression and secretion of the Ag-specific VLRB, we introduced a glycine–serine linker and the murine Ig leader sequence. The practical use of the Ag-specific VLRB was also demonstrated through various immunoassays, detected by anti-VLRB Ab (11G5). Finally, we found that the Ag-specific VLRB decreased the infectivity of AIV H9N2. Together, our findings suggest that the generated Ag-specific VLRB could be used for various immunoapplications.
https://ift.tt/2Qtg2RS
Helminth-Induced Production of TGF-{beta} and Suppression of Graft-versus-Host Disease Is Dependent on IL-4 Production by Host Cells [IMMUNE REGULATION]
Helminths stimulate the secretion of Th2 cytokines, like IL-4, and suppress lethal graft-versus-host disease (GVHD) after bone marrow transplantation. This suppression depends on the production of immune-modulatory TGF-β and is associated with TGF-β–dependent in vivo expansion of Foxp3+ regulatory T cells (Treg). In vivo expansion of Tregs is under investigation for its potential as a therapy for GVHD. Nonetheless, the mechanism of induced and TGF-β–dependent in vivo expansion of Tregs, in a Th2 polarized environment after helminth infection, is unknown. In this study, we show that helminth-induced IL-4 production by host cells is critical to the induction and maintenance of TGF-β secretion, TGF-β–dependent expansion of Foxp3+ Tregs, and the suppression of GVHD. In mice with GVHD, the expanding donor Tregs express the Th2-driving transcription factor, GATA3, which is required for helminth-induced production of IL-4 and TGF-β. In contrast, TGF-β is not necessary for GATA3 expression by Foxp3+ Tregs or by Foxp3– CD4 T cells. Various cell types of innate or adaptive immune compartments produce high quantities of IL-4 after helminth infection. As a result, IL-4–mediated suppression of GVHD does not require invariant NKT cells of the host, a cell type known to produce IL-4 and suppress GVHD in other models. Thus, TGF-β generation, in a manner dependent on IL-4 secretion by host cells and GATA3 expression, constitutes a critical effector arm of helminthic immune modulation that promotes the in vivo expansion of Tregs and suppresses GVHD.
https://ift.tt/2Qtgek4
mTOR- and SGK-Mediated Connexin 43 Expression Participates in Lipopolysaccharide-Stimulated Macrophage Migration through the iNOS/Src/FAK Axis [INFECTIOUS DISEASE AND HOST RESPONSE]
Connexin 43 (Cx43) deficiency was found to increase mortality in a mouse model of bacterial peritonitis, and Cx43 is upregulated in macrophages by LPS treatment. In this study, we characterized a novel signaling pathway for LPS-induced Cx43 expression in RAW264.7 cells and thioglycolate-elicited peritoneal macrophages (TGEMs). LPS alone or LPS-containing conditioned medium (CM) upregulated Cx43. Overexpression or silencing of Cx43 led to the enhancement or inhibition, respectively, of CM-induced TGEM migration. This response involved the inducible NO synthase (iNOS)/focal adhesion kinase (FAK)/Src pathways. Moreover, CM-induced migration was compromised in TGEMs from Cx43+/– mice compared with TGEMs from Cx43+/+ littermates. Cx43 was upregulated by a serum/glucocorticoid-regulated kinase 1 (SGK) activator and downregulated, along with inhibition of CM-induced TGEM migration, by knockdown of the SGK gene or blockade of the SGK pathway. LPS-induced SGK activation was abrogated by Torin2, whereas LPS-induced Cx43 was downregulated by both Torin2 and rapamycin. Analysis of the effects of FK506 and methylprednisolone, common immunosuppressive agents following organ transplantation, suggested a link between these immunosuppressive drugs and impaired macrophage migration via the Cx43/iNOS/Src/FAK pathway. In a model of Escherichia coli infectious peritonitis, GSK650349-, an SGK inhibitor, or Torin2-treated mice showed less accumulation of F4/80+CD11b+ macrophages in the peritoneal cavity, with a delay in the elimination of bacteria. Furthermore, following pretreatment with Gap19, a selective Cx43 hemichannel blocker, the survival of model mice was significantly reduced. Taken together, our study suggested that Cx43 in macrophages was associated with macrophage migration, an important immune process in host defense to infection.
https://ift.tt/2qwt2uY
Androgen and Androgen Receptor as Enhancers of M2 Macrophage Polarization in Allergic Lung Inflammation [IMMUNE REGULATION]
Allergic asthma is a disease initiated by a breach of the lung mucosal barrier and an inappropriate Th2 inflammatory immune response that results in M2 polarization of alveolar macrophages (AM). The number of M2 macrophages in the airway correlates with asthma severity in humans. Sex differences in asthma suggest that sex hormones modify lung inflammation and macrophage polarization. Asthmatic women have more M2 macrophages than asthmatic men and androgens have been used as an experimental asthma treatment. In this study, we demonstrate that although androgen (dihydrotestosterone) reconstitution of castrated mice reduced lung inflammation in a mouse model of allergic lung inflammation, it enhanced M2 polarization of AM. This indicates a cell-specific role for androgens. Dihydrotestosterone also enhanced IL-4–stimulated M2 macrophage polarization in vitro. Using mice lacking androgen receptor (AR) in monocytes/macrophages (ARfloxLysMCre), we found that male but not female mice exhibited less eosinophil recruitment and lung inflammation due to impaired M2 polarization. There was a reduction in eosinophil-recruiting chemokines and IL-5 in AR-deficient AM. These data reveal an unexpected and novel role for androgen/AR in promoting M2 macrophage polarization. Our findings are also important for understanding pathology in diseases promoted by M2 macrophages and androgens, such as asthma, eosinophilic esophagitis, and prostate cancer, and for designing new approaches to treatment.
https://ift.tt/2qwt1Hq
Differentiation of Langerhans Cells from Monocytes and Their Specific Function in Inducing IL-22-Specific Th Cells [INNATE IMMUNITY AND INFLAMMATION]
Human mucosal tissues and skin contain two distinct types of dendritic cell (DC) subsets, epidermal Langerhans cells (LCs) and dermal DCs, which can be distinguished by the expression of C-type lectin receptors, Langerin and DC-SIGN, respectively. Although peripheral blood monocytes differentiate into these distinct subsets, monocyte-derived LCs (moLCs) induced by coculture with GM-CSF, IL-4, and TGF-β1 coexpress both Langerin and DC-SIGN, suggesting that the environmental cues remain unclear. In this study, we show that LC differentiation is TGF-β1 dependent and that cofactors such as IL-4 and TNF-α promote TGF-β1–dependent LC differentiation into Langerin+DC-SIGN– moLCs but continuous exposure to IL-4 blocks differentiation. Steroids such as dexamethasone greatly enhanced TNF-α–induced moLC differentiation and blocked DC-SIGN expression. Consistent with primary LCs, dexamethasone-treated moLCs express CD1a, whereas monocyte-derived DCs (moDCs) express CD1b, CD1c, and CD1d. moDCs but not moLCs produced inflammatory cytokines after stimulation with CD1b and CD1d ligands mycolic acid and α-galactosylceramide, respectively. Strikingly, CD1a triggering with squalene on moLCs but not moDCs induced strong IL-22-producing CD4+ helper T cell responses. As IL-22 is an important cytokine in the maintenance of skin homeostasis, these data suggest that CD1a on LCs is involved in maintaining the immune barrier in the skin.
https://ift.tt/2qt03YR
IL-6 Promotes T Cell Proliferation and Expansion under Inflammatory Conditions in Association with Low-Level ROR{gamma}t Expression [IMMUNE REGULATION]
IL-6 is a critical driver of acute and chronic inflammation and has been reported to act as a T cell survival factor. The influence of IL-6 on T cell homeostasis is not well resolved. We demonstrate that IL-6 signaling drives T cell expansion under inflammatory conditions but not during normal homeostasis. During inflammation, IL-6Rα–deficient T cells are unable to effectively compete with wild type T cells. IL-6 promotes T cell proliferation, and this is associated with low-level expression of the RORt transcription factor. T cells upregulate Rorc mRNA at levels substantially diminished from that seen in Th17 cells. Blockade of RORt through genetic knockout or a small molecule inhibitor leads to T cell expansion defects comparable to those in IL-6Rα–deficient T cells. Our results indicate that IL-6 plays a key role in T cell expansion during inflammation and implicates a role for the transient induction of low-level RORt.
https://ift.tt/2QmecSX
Differential and Overlapping Immune Programs Regulated by IRF3 and IRF5 in Plasmacytoid Dendritic Cells [INNATE IMMUNITY AND INFLAMMATION]
We examined the signaling pathways and cell type–specific responses of IFN regulatory factor (IRF) 5, an immune-regulatory transcription factor. We show that the protein kinases IKKα, IKKβ, IKK, and TANK-binding kinase 1 each confer IRF5 phosphorylation/dimerization, thus extending the family of IRF5 activator kinases. Among primary human immune cell subsets, we found that IRF5 is most abundant in plasmacytoid dendritic cells (pDCs). Flow cytometric cell imaging revealed that IRF5 is specifically activated by endosomal TLR signaling. Comparative analyses revealed that IRF3 is activated in pDCs uniquely through RIG-I–like receptor (RLR) signaling. Transcriptomic analyses of pDCs show that the partitioning of TLR7/IRF5 and RLR/IRF3 pathways confers differential gene expression and immune cytokine production in pDCs, linking IRF5 with immune regulatory and proinflammatory gene expression. Thus, TLR7/IRF5 and RLR–IRF3 partitioning serves to polarize pDC response outcome. Strategies to differentially engage IRF signaling pathways should be considered in the design of immunotherapeutic approaches to modulate or polarize the immune response for specific outcome.
https://ift.tt/2quvKkF
IL-4 and IL-13 Guide Early Thymic Progenitors To Mature toward Dendritic Cells [IMMUNE SYSTEM DEVELOPMENT]
Recently we reported that IL-4 and IL-13 signaling in murine early thymic progenitors (ETPs) expressing the heteroreceptor (HR) comprising IL-4 receptor α (IL-4Rα) and IL-13 receptor α 1 (IL-13Rα1) activate STAT6 and inhibit ETP maturation potential toward T cells. In this study, we asked whether IL-4 and IL-13 signaling through the HR mobilizes other STAT molecules to shape ETP fate decision. The findings indicate that HR+ ETPs undergoing cytokine signaling display increased STAT1, but not STAT3, phosphorylation in addition to STAT6 activation. In parallel, the ETPs had a STAT1-dependent heightened expression of IRF-8, a transcription factor essential for development of CD8α+ dendritic cells (DCs). Interestingly, STAT1 phosphorylation and IRF-8 upregulation, which are independent of STAT6 activation, guided ETP maturation toward myeloid cells with a CD8α+ DC phenotype. Furthermore, these CD8α+ DCs display a thymic resident phenotype, as they did not express SIRPα, a molecule presumed to be involved in cell migration. These findings suggest that IL-4 and IL-13 cytokine-induced HR signaling provides a double-edged sword that simultaneously blocks T cell lineage potential but advances myeloid maturation that could impact T cell selection and central tolerance.
https://ift.tt/2qtFBXV
“Flip-over flap” in two-stage cleft palate repair
This study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge ("flip-over") flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991.
https://ift.tt/2qt4HGe
Post-obturation pain following the use of carrier-based system with AH Plus or iRoot SP sealers: a randomized controlled clinical trial
Abstract
Objectives
The aim of this study was to compare the postoperative pain after root canal treatment using a carrier-based obturation system and two different sealers.
Materials and methods
In this prospective randomized clinical trial, 160 patients were selected. Patients with vital and devital teeth were randomized into four groups using a randomized block design with block sizes of 10 patients each. The groups were devital/vital teeth treated with iRoot SP sealer and devital/vital teeth treated with AH Plus sealer. Patients were prescribed ibuprofen, a 200-mg analgesic, if needed, and postoperative pain was recorded by visual analogue scale at 6, 12, 24, and 72 h after obturation. Pain score and frequency of tablet intake were recorded and statistically analyzed.
Results
Results showed that there was no significant difference between groups in the incidence of postoperative pain; however, iRoot SP sealer was associated with less analgesic intake compared to AH Plus sealer.
Conclusion
The use of different sealers did not significantly affect pain levels.
Clinical relevance
iRoot SP sealer was associated with less analgesic intake compared to AH Plus sealer.
https://ift.tt/2ANQKbL
Pharmacologic inhibition of hypoxia inducible factor (HIF)‐hydroxylases ameliorates allergic contact dermatitis
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D51W5q
Preventive sublingual immunotherapy with House Dust Mite extract modulates epitope diversity in pre‐school children
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PceH5G
Pulsed‐dye laser as a novel therapeutic approach for post‐filler bruises
Dermatologic Therapy, EarlyView.
https://ift.tt/2D2KOxo
Vestibular assessment in the pediatric population
The Laryngoscope, EarlyView.
https://ift.tt/2PcKtPJ
A farewell from your Editor
Clinical and Experimental Dermatology, Volume 43, Issue 8, Page 867-867, December 2018.
https://ift.tt/2zvPQ25
Issue Information
Clinical and Experimental Dermatology, Volume 43, Issue 8, Page i‐ii, 865-866, December 2018.
https://ift.tt/2SNse1B
Subacute cutaneous lupus erythematosus triggered by an antiviral treatment combination for hepatitis C virus infection
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D5wfsY
The frequency of arthritis in Adamantiades‐Behçet's disease in Greek patients
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PddxXi
HrQoL in hair loss affected patients with Alopecia Areata, Androgenetic Alopecia and Telogen Effluvium: The role of personality traits and psychosocial anxiety
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D5wa8E
Morphological classification of melanoma metastasis with reflectance confocal microscopy
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2P9lAoe
Characteristics of IgG subclasses and complement deposition in BP230‐type bullous pemphigoid
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D5w5lm
Detailed ANA dynamics under adalimumab therapy show no significant correlation to PASI response and MTX co‐treatment: a retrospective study of 98 psoriasis patients
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Pd2qOj
Intravaginal CO2 laser as an emergent treatment of genitourinary syndrome
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D5vXCo
Rates of Antibiotic Resistance / Sensitivity in Bacterial Cultures of Hidradenitis Suppurativa Patients
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PbYeyp
Prediction of Insulin Resistance with Anthropometric and Clinical Laboratory Measures in Nondiabetic Teenagers
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2D5vPmo
Inverse Association Between Antiviral Immunity and Lupus Disease Activity
Viral Immunology, Ahead of Print.
https://ift.tt/2RD94du
Robot-Assisted Reconstruction in Head and Neck Surgical Oncology: The Evolving Role of the Reconstructive Microsurgeon
ORL 2018;80:178–185
https://ift.tt/2Dne7eN
Transoral Robotic Surgery Total Laryngectomy
ORL 2018;80:171–177
https://ift.tt/2JEUZJP
Hauterkrankungen und Fertilitäts‑/Hormonstörungen
Zusammenfassung
Die männliche Fertilität kann durch eine Vielzahl von Faktoren gestört werden. Neben Umwelt- und Lifestylefaktoren wie Stress, Lärm, Rauchen und Übergewicht können sich auch diverse Erkrankungen negativ auf die Zeugungsfähigkeit und den Hormonhaushalt, insbesondere den Testosteronspiegel, auswirken. Bei vielen Erkrankungen gehen die aktuellen Daten leider noch nicht über Beobachtungen eingeschränkter Fertilität hinaus. In diesem Beitrag sollen v. a. die Erkrankungen aus dem Behandlungsfeld der Dermatologie im Vordergrund stehen. Besonderes Augenmerk wird auf die chronisch entzündlichen und autoimmunen Hauterkrankungen gelegt. Hier zeigen Daten aus den letzten Jahren, dass die überschießende Entzündungsreaktion, die diesen Erkrankungen gemein ist, aller Wahrscheinlichkeit nach auch Einflüsse auf die Fertilität hat und in Interaktion mit der Testosteronkonzentration im Serum steht. Daneben wird auf die Auswirkung von hereditären Hauterkrankungen auf die männliche Fertilität eingegangen, die über Schädigung der Hypothalamus-Hypophysen-Gonaden-Achse direkten Einfluss auf die Zeugungsfähigkeit des Mannes haben können.
https://ift.tt/2JEagKJ
Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Marina Rinagel, Emmanuel Chatelus, Sandrine Jousse-Joulin, Jean Sibilia, Jacques-Eric Gottenberg, François Chasset, Laurent Arnaud
Abstract
Despite major recent advances in the therapeutic management of Giant cell arteritis (GCA), the diagnosis accuracy of temporal artery ultrasound remains controversial in this disease. We performed a systematic review to determine the sensitivity, specificity, and summary positive (LR+) and negative (LR-) likelihood ratios of temporal artery ultrasound for the diagnosis of GCA. For this, we searched EMBASE, MEDLINE and the Cochrane Database of Systematic Reviews without language restriction. Original articles reporting on diagnostic accuracy of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA, were selected. Sensitivity and specificity from each study were used to fit a bivariate diagnosis accuracy model. Of 1280 articles identified, 48 underwent full-text review, and 25 were included. Based on a total of 20 studies, the sensitivity and specificity of hypoechoic halo compared to positive temporal artery biopsy were respectively of 68% (95% CI: 57–78) and 81% (95%CI: 75–86). The summary mean positive and negative likelihood ratios were respectively of 3.64 (95%CI: 2.76–4.73) and 0.40 (0.28–0.52). Taking into account 11 studies reporting on the presence of any abnormal sign on temporal artery ultrasound yielded similar results with largely overlapping 95% confidence interval regions. This study provides the summary estimates of the diagnostic properties of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA. Those parameters allow the calculation of the post-test probability of GCA in a given patient, based on the results of temporal artery ultrasound and will help improving the diagnosis strategy for this common disease.
https://ift.tt/2qutN7B
Autoimmune diseases in myelodysplastic syndrome favors patients survival: A case control study and literature review
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Julie Seguier, Véronique Gelsi-Boyer, Mikael Ebbo, Zeinab Hamidou, Aude Charbonnier, Emmanuelle Bernit, Jean-Marc Durand, Jean-Robert Harlé, Norbert Vey, Nicolas Schleinitz
Abstract
Background
We conducted a monocentric retrospective study of patients with myelodysplastic syndromes (MDS) and autoimmune or inflammatory disorders (AIMs) and a literature review. We analyzed the association with subgroups of the WHO 2016 MDS classification and patient's survival in a case control study. Risk factors associated with survival were analyzed by uni- and multivariate analysis.
Results
From all MDS patients 11% presented with AIMs. These were heterogeneous and the most frequent where polyarthritis (25%) and autoimmune cytopenias (17%). No difference for frequency and type of AIMs was observed for the WHO 2016 MDS subgroups (p = .3). In the case control study WHO classification, karyotype abnormalities, IPSS-R and IPSS were similar in both groups. The overall survival from MDS diagnosis was better in the group with AIMs [10.3 ± 0.6 (IC95% 6.2–12.9) versus 4.8 ± 1.1 years (IC95% 4.2–8.7), p = .04]. The better survival was restricted to MDS with low or intermediate-1 IPSS [11.1 ± 1.5 (IC95% 9.9-NR) versus 8.7 ± 1.3 years (IC95% 4.8–10.3), p = .006]. The better survival was only observed when AIMs diagnosis was timely associated or appeared after MDS diagnosis (p = .04). Factors associated with a better overall survival and survival without AML were steroid dependence [respectively HR = 0.042, p = .003, (IC95% 0.005–0.33) and HR = 0.07, p = .002, (IC95% 0.013–0.39)], a diagnosis of AIMs and MDS timely associated [respectively HR = 0.05, p = .009, (IC95% 0.006–0.478) and HR = 0.1, p = .008, (IC95% 0.018–0.54)] or a diagnosis of AIMs after MDS [respectively HR = 0.024, p = .009, (IC95% 0.001–0.39) and HR = 0.04, p = .008, (IC95% 0.003–0.43)].
Conclusion
Autoimmune and inflammatory diseases associated to MDS are heterogeneous. AIMs diagnosed after or concomitantly to MDS seems associated with a better survival. Prospective studies are necessary to demonstrate that autoimmunity is associated to a better control of the MDS clone.
https://ift.tt/2QiTGCB
Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Roberto Giacomelli, Antonella Afeltra, Alessia Alunno, Elena Bartoloni-Bocci, Onorina Berardicurti, Michele Bombardieri, Alessandra Bortoluzzi, Roberto Caporali, Francesco Caso, Ricard Cervera, Maria Sole Chimenti, Paola Cipriani, Emmanuel Coloma, Fabrizio Conti, Salvatore D'Angelo, Salvatore De Vita, Salvatore Di Bartolomeo, Oliver Distler, Andrea Doria, Eugen Feist
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care.
The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
https://ift.tt/2qsHSTd
Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Nicola Luigi Bragazzi, Dennis McGonagle, Samaa Watad, Mohammad Adawi, Naim Mahroum, Giovanni Damiani, Rosalynn Conic, Charlie Bridgewood, Hussein Mahagna, Luca Giacomelli, Roberto Eggenhöffner, Mahmud Mahamid, Paolo Daniele Maria Pigatto, Howard Amital, Abdulla Watad
Abstract
The immunological perturbations associated with systemic lupus erythematosus (SLE) puts many patients at higher risk of infections including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed on. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long term findings with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies in the present systematic reviews and meta-analysis. All studies were designed as longitudinal investigations, two, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Sample size ranged from 12 to 204 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36.0% to 97.6%. According to our metanalysis high erythrocyte sedimentation rate (ESR), older earlier SLE, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to third of cases reporting mild/low-grade and complaints.
In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness according our study in such patients, preventive strategies mainly by immunization are required in all age groups and in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment.
PROSPERO registration code 103605.
https://ift.tt/2Qp8ZtP
Systemic sclerosis and exposure to heavy metals
Publication date: Available online 4 November 2018
Source: Autoimmunity Reviews
Author(s): Isabelle Marie
Abstract
As a mirror image of the Roman god Janus Bifrons, the environment has a hidden face. To highlight this hidden face of the environment in the field of systemic sclerosis (SSc) will allow to identify responsible agents emerging in the future. To date, there is, in fact, a growing scientific evidence that environmental factors have a crucial impact on both alterations and modulation of epigenetic determinants, resulting in SSc onset and progression. It has been well established that there is a marked correlation between SSc onset and occupational exposure to crystalline silica and organic solvents. More recently, an association between SSc and exposure to heavy metals has further been found, including: antimony, cadmium, lead, mercury. These latter findings interestingly underscore that occupational exposure to heavy metals should be systematically checked in all SSc patients at diagnosis, as the identification of the occupational toxic agent will allow its interruption, which may result in potential improvement of SSc outcome.
https://ift.tt/2Qs0iP2
Chorea Hyperglycemia Basal Ganglia Syndrome in a 63-Year-Old Male
Chorea hyperglycemia basal ganglia syndrome (CHBG) is a rare condition that manifests within the setting of uncontrolled nonketotic diabetes mellitus. The objective of this case report is to present a patient found to have CHBG and provide a timeline in terms of his workup and subsequent treatment. We also present a commentary on the current understanding of the pathophysiology and treatment and how this was applied to our patient. The case involves a 63-year-old poorly controlled diabetic male who presented with a one-week history of uncontrolled choreiform movements of his left upper extremity. His initial glucose level was 339 mg/dl. HbA1C was 9.9%. CT scan of the head demonstrated an abnormal increased intensity within the right lenticular nucleus and right caudate head most likely due to microcalcifications/mineralization. MRI of the brain demonstrated nonspecific T1 and T2 hyperintense abnormalities in the same area about the right basal ganglia. These findings were consistent with the movement pattern he was displaying and with a diagnosis of CHBG. Gradual control of his blood sugar levels over 48 hours led to resolution of his choreiform symptoms. After better medication adherence as an outpatient, endocrinology follow-up 6 months after discharge found his HbA1C drop to a level of 7.1%. There was no recurrence of his symptoms. CHBG is a rare manifestation of poorly controlled diabetes but is the one that clinicians should be aware of. Early recognition and gradual treatment of elevated blood glucose levels appear to lead to total resolution of choreiform symptoms.
https://ift.tt/2PaVDog
Successful endoscopic management of efferent loop syndrome after Billroth II distal gastrectomy
Description
We present the case of a 60-year-old woman with gastric adenocarcinoma presenting for elective surgical resection. The patient underwent an uncomplicated distal gastrectomy with Billroth II reconstruction, and D2 lymphadenectomy.
On postoperative day 3, an upper gastrointestinal series showed interval progression of oral contrast into the colon. The patient was subsequently started on a liquid diet.
On postoperative days 4–6, the patient was unable to tolerate sufficient oral intake. A repeat upper gastrointestinal series was obtained (figure 1), with findings of obstruction of the efferent limb. The patient was taken for oesophagogastroduodenoscopy which demonstrated a stenosed Billroth II gastrojejunal anastomosis at the efferent limb site. The anastomosis was transversed, and a 2.3x10.5 cm WallFlex covered stent was placed under fluoroscopic guidance (figure 2).
Figure 1
Upper gastrointestinal series with findings suspicious for obstruction of the efferent limb. (A) Passage of contrast through...
https://ift.tt/2RAwvE2
Repetitive transcranial magnetic stimulation (rTMS) as a treatment for chronic dizziness following mild traumatic brain injury
A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus vehicle traffic accident. Post injury, he began to experience symptoms including light-headedness, spatial disorientation, nausea, fatigue and prominent dizziness brought on by postural change, physical activity or eye movements. Symptoms of dizziness persisted for over 5 years, despite numerous extensive and rigorous vestibular and vision therapy regimens. All investigations suggested normal peripheral and central vestibular functioning. The patient underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) treatment, with stimulation of the left dorsolateral prefrontal cortex at 70% of resting motor threshold and a frequency of 10 Hz. Dizziness symptom severity and frequency were reduced by greater than 50% at 3 months post treatment, with a clinically significant reduction of dizziness disability from 40 to 21 points on the Dizziness Handicap Inventory. We propose rTMS as a safe, effective and cost-effective treatment option for patients who experience persistent post-traumatic dizziness secondary to mTBI.
https://ift.tt/2PAQaXp
Use of mineral trioxide aggregate for retreatment of a tooth with large periapical lesion, wide-open apices and vertical root fracture
Chronic periapical lesions in necrotic teeth with open apex are difficult to manage. The situation becomes more complex if the tooth has a fracture line. This case report describes the management of a traumatised tooth that had already undergone unsuccessful endodontic treatment with a large periapical lesion and open apex along with a fracture line in the root. An attempt was made to save the tooth by using mineral trioxide aggregate (MTA) cement for orthograde filling, retrograde filling and also for sealing of the fracture line. Moreover, the bone defect was filled with autogenous bone harvested from the external oblique ridge. MTA, a bioactive tricalcium silicate cement, has been used in treating complex endodontic cases as it shows promising potential by inducing the biological mechanisms necessary for repair of involved teeth. A 1-year follow-up showed progressive healing as evident by radiographs and lack of any clinical signs and symptoms.
https://ift.tt/2Rzxmoq
Recurrent complications of PAAG implants during lactation
A 35-year-old lactating woman with pre-existing polyacrylamide gel (PAAG) implants for 10 years presented on numerous occasions following both her pregnancies with bilateral recurrent breast infection, pain and finally massive breast enlargement with a ruptured galactocoele necessitating surgical intervention. As the safety of PAAG for the breastfeeding baby is not known, breastfeeding with PAAG implants is not recommended.
https://ift.tt/2PAQ563
Effect of temperature on the cyclic fatigue resistance of thermally treated reciprocating instruments
Abstract
Objectives
The aim of this study was to evaluate the impact of body temperature on the cyclic fatigue resistance of different NiTi alloys used for the manufacturing of Reciproc Blue R25 (RB 25.08; VDW, Munich, Germany), X1 Blue File 25 (X1 25.06; MK Life Medical and Dental Products, Porto Alegre, Brazil) and WaveOne Gold Primary (WOG 25.07; Dentsply Maillefer, Ballaigues, Switzerland).
Materials and methods
Sixty instruments of the RB 25.08, X1 25.06 and WOG 25.07 systems were used (n = 20). Cyclic fatigue tests were performed at room temperature (20° ± 1 °C) and at body temperature (37° ± 1 °C). The instruments were reciprocated until fracture occurred in an artificial stainless steel canal with a 60° angle and a 5-mm radius of curvature. The time to fracture (TTF) was recorded. Also, the number of cycles to fracture (NCF) was calculated. Data were analysed using one-way ANOVA and Tukey's tests for inter-group comparison at both temperatures and for the reduction of cyclic fatigue at body temperature. For intra-group comparison at the different temperatures, the unpaired t test was used.
Results
The cyclic fatigue test at 20 °C showed that RB 25.08 and X1 25.06 presented significantly higher TTF and NCF than WOG 25.07 (P < 0.05). At 37 °C, all groups presented significant reduction of TTF and NCF (P < 0.05). RB 25.08 presented significant higher TTF than WOG 25.07 (P < 0.05). Regarding the NCF, there was no significant difference among the groups (P > 0.05). The WOG 25.07 presented the lowest percentage reduction of cyclic fatigue (P < 0.05).
Conclusion
The body temperature treatment caused a marked reduction of the cyclic fatigue resistance for all reciprocating instruments tested. The RB 25.08 and X1 25.06 systems presented similar results at both temperatures tested. However, WOG 25.07 presented the lowest percentage reduction in fatigue resistance at body temperature.
Clinical relevance
The cyclic fatigue resistance of NiTi reciprocating instruments has been evaluated at room temperature. However, the fatigue resistance significantly decreases upon exposure to body temperature, which could affect the mechanical behaviour of the NiTi instruments during root canal preparation.
https://ift.tt/2PDUVPW
Impact of a modified motion on the fatigue life of NiTi reciprocating instruments: a Weibull analysis
Abstract
Objectives
To evaluate the impact of a modified motion on the fatigue life of four brands of nickel–titanium (NiTi) reciprocating instruments.
Materials and methods
Cyclic fatigue (CF) resistance of 160 instruments was evaluated in an artificial stainless-steel canal (90° angle, 5-mm radius of curvature). WaveOne and WaveOne Gold (Denstply Maillefer, Baillagues, Switzerland) and Reciproc and Reciproc Blue (VDW, Munich, Germany) were tested with two different motions: (1) X-Smart Plus (Denstply Maillefer) endodontic motor and (2) a 4:1 contra-angle with an experimental motion (EVO) with different rotation angles and based on a sinusoidal acceleration. Motions with X-Smart Plus and EVO were recorded and analyzed at a reduced speed with VLC Media Player software for a more accurate analysis. Mean half-life, beta, and eta Weibull parameters were determined and compared.
Results
Reciproc Blue resulted the most resistant instruments either with EVO or X-Smart. WaveOne Gold lasted significantly longer than WaveOne with EVO (probability of 91%) while no significant differences were found with X-Smart. Considering NCF, Reciproc, WaveOne Gold, and Reciproc Blue lasted significantly longer with EVO (probabilities of 66%, 80%, and 89% respectively). WaveOne Gold showed the highest beta parameter.
Conclusions
The experimental motion was found to have a positive impact on fatigue lifetime of reciprocating instruments.
Clinical relevance
Current findings provide insight for future improvements in the clinical use of reciprocating files. Experimental motions may be considered when searching for additional strategies in order to increase the safer use of NiTi files during endodontic procedures.
https://ift.tt/2RznDyq
A rare skin condition masquerading as a serious wound infection
Abstract
Pyoderma gangrenosum is a rare, serious and commonly missed condition that can effect post-operative surgical patients. The condition is commonly misdiagnosed as a wound infection, with subsequent inappropriate antibiotic therapy and wound debridement. We present the case of a 46-year-old patient who suffered this delayed diagnosis and multiple unnecessary interventions. We present this in an effort to raise awareness of the rare but serious condition, pyoderma gangrenosum.https://ift.tt/2Rzr2NI
Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature
Pulmonary artery embolization due to projectile embolus is a rare complication in combat patients. Such embolization is rare for combat patients in the ongoing armed conflict, in East Ukraine since 2014.
https://ift.tt/2DmJoP6
Gridding Microsurgical Anatomy of Far Lateral Approach in the Three-Dimensional Model
Objective: The far lateral craniotomy involves osteotomy of various portions of occipital condyle. Intracranial operation exposing clivus encounters complicated neurovascular anatomy. The aim of the present study was to make refinement for the anatomy of far lateral approach by gridding route in the 3-dimensional model. Methods: Computed tomography and magnetic resonance imaging data were used to construct 3-dimensional model containing osseous and neurovascular structures of skull base. Then, far lateral approach was simulated by triangular prism and divided into gridding surgical route. The relationship of surgical route and osseous and neurovascular structures was observed. Measurement of volume was performed to evaluate surgical exposure. Results: Observation of 3-dimensional model showed bony drilling of far lateral approach started with the occipital condyle and passed through the lateral edge of foramen magnum. The cerebellum and medulla oblongata were exempted from the surgical route exposing clivus. The anatomy variances of operative space, osseous, and neurovascular structures in the gridding route were displayed clearly and compared objectively. Conclusion: The gridding operative spaces for the far lateral approach are useful to disclose the detailed discrepancy in the different surgical region. The volumetric measurement provides quantified information to facilitate a better understanding of the anatomy variance. Address correspondence and reprint requests to Ke Tang, MD, Department of Neurosurgery, The 309th Hospital of PLA, No. 17, Heishanhu Road, Haidian District, Beijing 100091, China; E-mail: tkshoushudao@sina.com Received 13 February, 2018 Accepted 18 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2yR8zW6
https://ift.tt/2yR8zW6
Preliminary Study to Evaluate Marginal Bone Loss in Cases of 2- and 3-Implant-Supported Fixed Partial Prostheses of the Posterior Mandible
Purpose: The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible. Methods: A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53–85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2–10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants. Results: The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055). Conclusions: Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss. Address correspondence and reprint requests to Eitan Mijiritsky, DMD, Ehud 12, Tel-Aviv, Israel; E-mail: mijiritsky@bezeqint.net Received 15 May, 2018 Accepted 18 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2OnhL9z
https://ift.tt/2OnhL9z
Multisuture Craniosynostosis and Papilledema in Pycnodysostosis: A Paradox?
Pycnodysostosis (PYCD) is a rare autosomal-recessive skeletal disorder that typically presents with osteosclerosis of the majority of the postcranial skeleton and osteolysis of the calvarium, manifesting as persistent open cranial fontanelles and widely spaced cranial sutures. Craniosynsostosis in PYCD is a somewhat paradoxical feature, and has only been rarely reported. The authors present a unique case of a 6-year-old girl with PYCD, multisuture craniosynostosis involving the coronal and sagittal sutures, severe obstructive sleep apnoea, and raised intracranial pressure presenting as papilledema. She underwent a frontofacial monobloc distraction advancement which successfully corrected her papilledema and obstructive sleep apnoea. Pycnodysostosis is caused by a loss of function mutation in the CTSK gene that codes for the lysosomal cysteine protease, cathepsin K (CTSK). Loss of CTSK impairs the ability of osteoclasts to degrade bone extracellular matrix. Differences in osteoclast phenotype and extracellular matrix composition between membranous and cartilaginous bone may explain the clinical features of PYCD. Animal model studies suggest that craniosynostosis may arise due to variations in patient genetic background. Address correspondence and reprint requests to David Johnson, Oxford Craniofacial Unit, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK; E-mail: david.johnson@ouh.nhs.uk Received 9 February, 2018 Accepted 2 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2ySod3I
https://ift.tt/2ySod3I
The External Jugular Vein Used as Recipient Vessel in Head and Neck Free Flap Reconstruction: Outcomes Compared to the Internal Jugular Vein
Background: Contradictory data exists on the success rates of employing the external jugular (EJ) vein as a recipient vessel for venous outflow in free flap head and neck reconstruction compared with the internal jugular (IJ) vein. The authors hereby present a retrospective study of prospectively collected data over a 14-year period. Methods: Five hundred seventy-eight patients underwent 639 free flap head and neck over 14 years. Two hundred seventy-eight free flaps employed the EJ vein as the recipient vessel while 326 free flaps employed the IJ vein. Rates of acute and late complications were compared. Results: There were no differences in rates of complications: flap loss, venous thrombosis, arterial thrombosis, bleeding, hematoma, or infection between the EJ and IJ vein groups. Conclusion: The external jugular vein as a recipient vessel for venous outflow in head and neck free flap reconstruction of postoncologic resection defects is a valid option for both primary reconstructions and secondary surgeries. Address correspondence and reprint requests to Amir E. Ibrahim, MD, PO box 11-0236, Riad El Solh 11072020, Beirut, Lebanon; E-mail: amir.ibrahim78@gmail.com Received 12 October, 2017 Accepted 3 July, 2018 Presented as an abstract at the American Society for Reconstructive Surgery 2015 Meeting; Paradise Island, Bahamas: Jan 21-27, 2015. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2OvHgG4
https://ift.tt/2OvHgG4
Full-Thickness Skin Grafting for Local Defect Coverage Following Scalp Adjacent Tissue Transfer in the Setting of Cranioplasty
Introduction: Numerous techniques have been described to overcome scalp deficiency and high-tension closure at time of cranioplasty. However, there is an existing controversy, over when and if a free flap is needed during complex skull reconstruction (ie, cranioplasty). As such the authors present here our experience using full-thickness skin grafts (FTSGs) to cover local defects following scalp adjacent tissue transfer in the setting of cranioplasty. Methods: By way of an institutional review board-approved database, the authors identified patients treated over a 3-year period spanning January 2015 to December 2017, who underwent scalp reconstruction using the technique presented here. Patient demographics, clinical characteristics, technical details, outcomes, and long-term follow up were statistically analyzed for the purpose of this study. Results: Thirty-three patients, who underwent combined cranioplasty and scalp reconstruction using an FTSG for local donor site coverage, were identified. Twenty-five (75%) patients were considered to have "high complexity" scalp defects prior to reconstruction. Of them, 12 patients (36%) were large-sized and 20 (60%) medium-sized; 21 (64%) grafts were inset over vascularized muscle or pericranium while the remaining grafts were placed over bare calvarial bone. In total, the authors found 94% (31/33) success for all FTSGs in this cohort. Two of the skin grafts failed due to unsuccessful take. Owing to the high rate of success in this series, none of the patient's risk factors were found to correlate with graft failure. In addition, the success rate did not differ whether the graft was placed over bone verses over vascularized muscle/pericranium. Conclusion: In contrary to previous studies that have reported inconsistent success with full-thickness skin grafting in this setting, the authors present a simple technique with consistent results—as compared to other more complex reconstructive methods—even in the setting of highly complex scalp reconstruction and simultaneous cranioplasty. Address correspondence and reprint requests to Chad R. Gordon, DO, FACS, Director, Neuroplastic and Reconstruction Surgery, Associate Professor, Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, JHOC, 8th Floor, 601 N. Caroline Street, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 22 June, 2018 Accepted 2 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2yR8q50
https://ift.tt/2yR8q50
Reconstructions with Different and New Techniques of Large and Extensive Myelomeningocele Defects
Background: Myelomeningocele and/or meningocele is a defect of spine and spinal cord, and it is congenital. Although meningocele is a mild form of spina bifida, myelomeningocele is a more complex and serious form. There is a sac in both forms at the back. Difference is that myelomeningocele contains neural structures or spinal cord elements, and meningocele does not contain these neural or spinal cord elements. Methods: Between 2012 and 2018, 77 (45 females, 32 males) newborns with myelomeningocele were operated by mean age 35 days. The O-S flap (26 patients) method was used in patients who have circular defect. The Emsen 1 flap (31 patients) was used in patients who have elliptic defect. The Emsen 2 flap (20 patients) was also used in patients who have triangular defect. Mean follow-up was 22 months (9–50 months). Results: A successful tension-free closure was made with these methods. Defects of the newborn were divided the subgroups as circular, elliptic, and triangular. Hydrocephalus was detected in 19 patients. Ventriculoperitoneal shunt was done at the same time with the myelomeningocele surgical procedure. All complications were noted in patients with hydrocephalus such as cerebrospinal fluid leakage (in 8 patients), wound infection (in 3 patients), and partially wound dehiscence (in 4 patients). Conclusion: There are many techniques about myelomeningocele closure in literature. The problem is not number of techniques. Literature presents different geometric flap design, muscle flaps, and musculocutaneous flaps on these defects. Large or extensive skin defects need more complex flap methods, and unfortunately, number of these is too limited. Three methods on large or extensive myelomeningocele skin defects are presented in this study. With these flaps, large or extensive skin defects could be easily closed. In all techniques, major advantages are no skin grafting, no abnormal blood loss, no muscle sacrificing, short operation time, and most important one is that 1-step surgery could be sufficient. Address correspondence and reprint requests to Ilteris M. Emsen, MD, PhD, Department of Plastic Reconstructive and Aesthetic Surgery, Training and Research Hospital, Erzurum 25090, Turkey; E-mails: ilterisemsen@hotmail.com, iemsen@yahoo.com Received 15 March, 2018 Accepted 2 July, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2OpmdVt
https://ift.tt/2OpmdVt
A Patient With Schimmelpenning Syndrome and Mosaic KRAS Mutation
Schimmelpenning syndrome is a neurocutaneous disorder characterized by craniofacial nevus sebaceus that fall along embryonic cutaneous lines and tend to be associated with neurological, ocular, skeletal, and vascular abnormalities. We report a child with extensive nevus sebaceus of the scalp, face, and thorax and other unusual physical findings who was found to have a mosaic mutation of KRAS c.35G>A p.12D pathognomonic of Schimmelpenning syndrome. Address correspondence and reprint requests to Gary F. Rogers, MD, Division of Plastic & Reconstructive Surgery, Children's National Medical Center, 111 Michigan Ave., N.W. Washington, D.C. 20010; E-mail: grogers@childrensnational.org Received 6 March, 2017 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2yST1RX
https://ift.tt/2yST1RX
Biological Aging Parameters Can Be Improved After Autologous Adipose-Derived Stem Cell Injection
Biological aging (BA) is a comprehensive assessment tool for elderly persons. The authors aimed to develop a rat model that can be used to assess BA by evaluating various blood, biochemical, and hormonal parameters and demonstrate that the intravenous administration of autologous adipose-derived stem cells (ADSCs) improves BA. Twelve elderly (aged 20 months) male Sprague–Dawley rats were used in this study and divided into 2 groups: autologous ADSC administration (n = 6) and saline administration (n = 6). The complete blood count, biochemical and hormonal parameters, and antioxidant potential were evaluated before harvesting the rat inguinal fat tissue and intravenous ADSC administration as well as at 1, 3, and 5 weeks after ADSC administration. Adipose-derived stem cells administration regulated blood content, biochemical parameters, renal function, and antioxidant enzymes in elderly rats. Furthermore, changes in several hormonal levels were identified in the ADSC administration group compared with the saline administration group. An assessment model of BA in elderly rats was successfully developed after the intravenous administration of autologous ADSCs. The authors suggest that intravenously injected ADSC treatment may be a valuable method to improve BA. Address correspondence and reprint requests to Ji-Ung Park, MD, Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, 20 Boramae-ro-5-gil, Dongjak-gu, Seoul 07061, Republic of Korea; E-mail: alfbskan@gmail.com Received 4 March, 2018 Accepted 9 July, 2018 H-YS and H-SB equally contributed to this work. This work was supported by Grant No. 04-2016-0670 from the SNUH Research Fund and a Mi-Rae international consortium grant (Grant No. BR17-0040). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2OrDHAD
https://ift.tt/2OrDHAD
The Morphology of the Infraorbital Nerve and Foramen in the Presence of an Accessory Infraorbital Foramen
Background: The accessory infraorbital foramen (AIOF) is an anatomical variation associated with the infraorbital foramen (IOF) and nerve (ION). Its occurrence and neural contents have clinical implications regarding failure of loco-regional anesthesia and risk of neural damage during surgical interventions involving the maxillary region. Thus, morphologic characterization of the AIOF and neural contents as well as the spatial relationships to the IOF are potentially useful for optimizing surgical procedures. Additionally, predictive features of the AIOF based on its relationship to IOF morphology could enable the surgeon to anticipate its presence and proceed accordingly. The purpose of this study was to determine whether the presence of an AIOF and its neural contents affected the size, shape, and composition of the IOF and ION. The specific hypothesis tested was that the topography and fascicular composition of the ION and IOF differs between individuals possessing an AIOF and those lacking this anatomical variant. Methods: Gross topographic features of the IOF (42 crania) were compared between specimens possessing (test) or lacking (control) an AIOF. Nerve fascicles of ION (60 cadaveric sides) were examined histologically and compared morphometrically between specimens presenting or lacking an AIOF. An additional sample of 30 crania was subjected to cone-beam computed tomography (CBCT) analysis to determine the course of the canal leading to the AIOF. Results: The AIOF incidence was 47.6% (20 crania) and 32.1% of the sides (27 sides). A single AIOF was observed in 24 sides and double AIOF in three sides. The AIOF occurred bilaterally in 7 specimens (16.7%). The majority of AIOF (86.7%) were located superomedial to IOF. A slightly higher frequency of the AIOF was found in left side compared to the right. Using CBCT, a patient sample showed an AIOF incidence in 21 sides of 16 patients (65.6%). A single AIOF was observed in 19 sides. Only 1 double AIOF was found in the scans, whereas 3 were found in the dry skull group. The AIOF occurred bilaterally in 3 scans (10%). The majority of AIOF (90.4%) were located superomedial to the IOF based on the CBCT scans. The AIOF was consistently seen connected to the infraorbital canal and progressed superiorly and medially from the infraorbital canal to the maxillary surface. The size of the ION without an AIOF was not significantly different than the ION in the presence of an AIOF (1.45 × 106/1.32 × 106 μm2, P
https://ift.tt/2yR8fXo
https://ift.tt/2yR8fXo
Tranexamic Acid Decreases Blood Transfusion Burden in Open Craniosynostosis Surgery Without Operative Compromise
In the surgical management of craniosynostosis, there is a high red blood cell (RBC) transfusion burden due to the small blood volume of the patients combined with significant blood loss that can occur with open surgery (OS). Tranexamic acid (TXA) is an antifibrinolytic which has been shown to decrease such a burden in particular surgeries. The aim of this study was to compare the operative outcomes of craniosynostosis OS which did and did not utilize TXA. Searches of 7 electronic databases from inception to February 2018 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 206 articles screened against selection criteria for inclusion. Relevant data were extracted and analyzed using meta-analysis of proportions. A total of 9 comparative studies were included for meta-analysis. Compared with the control cohort, craniosynostosis OS utilizing TXA demonstrated significantly lower intraoperative RBC transfusion volumes (mean difference, −8.25 mL/kg; P
https://ift.tt/2OpmbwP
https://ift.tt/2OpmbwP
Trichoepithelioma Misdiagnosed as Basal Cell Carcinoma
Trichoepithelioma is a benign tumor which can be easily confused with basal cell carcinoma. Since both tumors are histologically similar, it is important to distinguish them correctly as the courses for treatment are very different. Basal cell carcinoma is malignant; therefore, it requires total surgical excision, including a wide healthy margin. In contrast, trichoepithelioma requires only simple excision. A study involving a 69-year-old woman with a simple mass on the nasal tip was described in this study. On examination, a single skin-colored, round protruding mass (approximately 0.5 × 0.5 cm) was observed. Simple excision was performed and basal cell carcinoma was diagnosed at the initial biopsy. However, clinically, we considered it to be a benign tumor; therefore, we sought a histologic reconfirmation. Consequently, trichoepithelioma was diagnosed on histopathologic examination. When a small, round protruding simple mass is histologically diagnosed to be a basal cell carcinoma, it is important to suspect trichoepithelioma and seek histologic reconfirmation. Address correspondence and reprint requests to Sung-No Jung, MD, PhD, Department of Plastic and Reconstructive Surgery, Uijeongbu St Mary's Hospital, College of Medicine, the Catholic University of Korea, 271 Chenbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Korea; E-mail: jsn7190@hanmail.net Received 26 May, 2018 Accepted 2 September, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2yTKNZF
https://ift.tt/2yTKNZF
Dental Implants With a Platform-Switched Morse Taper Connection and an Osteo Growth Induction Surface
Aim: The aim of this study was to analyze the clinical outcomes after using an innovative implant system characterized by a modern platform-switched Morse taper connection and an osteo growth induction titanium surface (a particular type of SLA surface). Peri-implant bone loss (PBL) and implant success rate were examined after a 1- to 3-year follow-up. Methods: The study was conducted as a cross-sectional analysis on all patients treated from January 2011 to December 2014 using CLC CONIC implants. Implants were divided into 3 main groups, based on the duration of the follow-up (1 year, 2 years, and 3 years), then subgrouped by diameter, length, and type of prosthetic rehabilitation to compare differences in PBL. X-rays were taken at the time of surgery, at prosthetic loading, at 1 year, and then annually thereafter. Previously-established success criteria were used to assess the implants. Frequency analyses and comparisons between the means (with 95% CI) were conducted for the statistical analysis of the data collected. Results: One hundred twenty patients met inclusion and exclusion criteria, and completed the follow-up, and were thus eligible for the study, with a total of 261 CLC CONIC implants. The mean follow-up was 22.45 months. No implants failed, giving an overall success rate of 100%. The average PBL at 1-year follow-up was 0.047 mm, at 2 years it was 0.128 mm, and at 3 years it was 0.236 mm. Conclusions: The CLC CONIC implant system had a high success rate after 1 to 3 years of follow-up, in line with previous reports in the scientific literature. Combining platform switching with the Morse taper connection enabled stable bone levels to be achieved in the short to medium term. 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 23 May, 2018 Claudio Soldini declares a conflict of interest with the implant brand used in this clinical study as co-owner of the company CLC Scientific. The remaining authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2OotWTP
https://ift.tt/2OotWTP
Smartphone app review: British National Formulary (BNF)
British Journal of Dermatology, EarlyView.
https://ift.tt/2D3nJKT
Inhibition of HYBID (KIAA1199)‐mediated hyaluronan degradation and anti‐wrinkle effect of Geranium thunbergii extract
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2zqnFkY
A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2SLVMgc
Fractional microneedling radiofrequency treatment for axillary osmidrosis: A minimally invasive procedure
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2zvbzqy
Efficacy of platelet‐rich plasma in androgenetic alopecia patients
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2SMxX7K
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