Viral Immunology, Ahead of Print.
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Τετάρτη 7 Νοεμβρίου 2018
Prostaglandin D2 Levels Regulate CD103+ Conventional Dendritic Cell Activation in Neonates During Respiratory Viral Infection
Three-dimensional force analysis of surgical manipulations at the long process of the incus
Abstract
Purpose
Surgical manipulation with application of inappropriate force may damage middle ear structures leading to hearing loss. This work analyzes the forces applied in simulated otosurgical exercises in a laboratory set-up by measuring the spatial components of applied forces with objective assessment criteria. With these criteria, the individual force characteristics applied by the surgeon can be quantified and an objective feedback can be given about their surgical maneuvers.
Methods
A natural size model of the human incus was mounted on a load cell to measure the spatial forces in all three directions during different manipulation tasks performed under the microscope by ten surgeons from our department having different levels of experience in otosurgery. The motions of the incus model and the instrument tip were recorded simultaneously with a video camera.
Results
Independent of surgical experience, a three-dimensional force pattern could be detected with components transverse to the desired force directions. The measured forces applied by trainees showed larger variations in magnitude, in spatial distribution and in temporal course than those applied by experienced surgeons. A better repeatability of identical tasks, constancy of force patterns and low peak force values could be seen in the group of experienced surgeons.
Conclusions
The laboratory system presented in this study using simultaneous video and 3-D force registration allows the objective assessment of surgical manipulations, e.g., at the long process of the incus. Training with video and force feedback provides information about surgical techniques and skill development of surgeons and has the potential to shorten the learning curve and to diminish intra-operative risks to patients.
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A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques
Abstract
Carotid Body Paraganglioma (CBPGL), is a type of neuroendocrine tumor that should be managed promptly due to their malignant potential and locally aggressive nature making resection at a later stage difficult. The objective of this case report is to explore the benefit of coil embolization and describe the surgical techniques employed in successful resection of a huge CBPGL.
https://ift.tt/2PO0B9X
A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques
Abstract
Carotid Body Paraganglioma (CBPGL), is a type of neuroendocrine tumor that should be managed promptly due to their malignant potential and locally aggressive nature making resection at a later stage difficult. The objective of this case report is to explore the benefit of coil embolization and describe the surgical techniques employed in successful resection of a huge CBPGL.
https://ift.tt/2PO0B9X
Paralytic Lagophthalmos: Comprehensive Approach to Management
Abstract
Purpose of Review
Facial paralysis can lead to lagophthalmos, loss of corneal protection, and devastating ocular consequences like corneal ulcers or even blindness. The purpose of this review is to discuss the importance of comprehensive and early eye care.
Recent Findings
Treatment of paralytic lagophthalmos should be individualized to each patient's situation; depending on the severity of the problem and the prognosis for recovery, treatment modalities are broad and include lubrication, selective chemodenervation, filler injection, fat augmentation, and surgical procedures like canthopexy and tarsorrhaphy.
Summary
This paper serves to highlight the importance of treating paralytic lagophthalmos and provides an overview of the optimal management algorithm of the compromised periocular complex to help improve function and quality of life. Prospective studies and long-term comparisons of surgical techniques for repair of paralytic lagophthalmos will help improve our understanding of this complex problem and perhaps introduce novel treatment strategies.
https://ift.tt/2Peir6F
Meilensteine der Schilddrüsenchirurgie
Laryngo-Rhino-Otol 2018; 97: 762-771
DOI: 10.1055/a-0664-8953
In der hier vorgelegten Darstellung der Entwicklung der Schilddrüsenchirurgie hin zu einer sicheren Chirurgie, die auf dem aktuellen chirurgischen und medizinhistorischen Forschungsstand und der verfügbaren einschlägigen Literatur basiert, wird die Entwicklungskontinuität hin zu den minimalinvasiven Operationsverfahren, die den dank der historischen Entwicklung erreichten hohen Sicherheitsstandards mindestens genügen müssen, erstmals im medizingeschichtlichen Kontext interpretiert. Das zunehmende Verständnis der Erkrankungen der Schilddrüse und der perioperativen Folgen und Komplikationen, die zu neuen medizinischen und therapeutischen Erkenntnissen führten, wird somit erstmals auch in diesem Kontext interpretiert.Zur Verbesserung des Patientenkomforts im Hinblick auf die Operationswunde und spätere Narbenbildung werden seit Beginn des 21. Jahrhunderts immer wieder neue minimalinvasive Operationsmethoden beschrieben, die sich durch die Zugangsmodalitäten und -wege unterscheiden. Zukünftige Weiterentwicklungen der operativen Zugangswege und Methoden müssen dem heutigen hohen Stand der chirurgischen und nuklearmedizinischen Therapie und ihren Qualitäts- und Sicherheitsstandards mindestens genügen.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Unterkieferprotrusionsschiene bei obstruktivem Schlafapnoesyndrom getestet
Laryngo-Rhino-Otol 2018; 97: 752-753
DOI: 10.1055/a-0677-5541
Marco Pitarch R et al. Effectiveness of a mandibular advancement device in obstructive sleep apnea patients: a prospective clinical trial. Eur Arch Otorhinolaryngol 2018; 275: 1903–1911 In einer prospektiven Studie wurde die Effektivität einer Unterkieferprotrusionsschiene (mandibular advancement device, MAD) bei Patienten mit obstruktivem Schlafapnoesyndrom getestet. Evaluiert wurden dabei verschiedene Merkmale der Patienten und der MAD als Prädiktoren des Behandlungsergebnisses.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Fragen für die Facharztprüfung
Laryngo-Rhino-Otol 2018; 97: 812-813
DOI: 10.1055/a-0652-6802
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Fixationsoptionen des Receivers/Stimulators bei Cochlea-Implantation begutachtet
Laryngo-Rhino-Otol 2018; 97: 753-754
DOI: 10.1055/a-0651-4028
Pamuk AE et al. The effect of cochlear implant bed preparation and fixation technique on the revision cochlear implantation rate. J Laryngol Otol 2018; 11:1–6 Zur Prävention einer Migration des Receivers/Stimulators bei der Cochlea-Implantation ist seine Einbettung entscheidend. Türkische Ärzte der Klinik für Hals-, Nasen- und Ohrenheilkunde der Universität von Istanbul verglichen zwei Techniken der Einbettung.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Schwieriger magnetresonanztomografischer Nachweis eines Hämangioms des N. facialis – Ein Fallbericht
Laryngo-Rhino-Otol 2018; 97: 793-795
DOI: 10.1055/a-0747-6990
© Georg Thieme Verlag KG Stuttgart · New York
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Oropharynx-Karzinom-CT: prognostische Bedeutung der extranodalen Ausbreitung
Laryngo-Rhino-Otol 2018; 97: 754-755
DOI: 10.1055/a-0677-5308
Patel MR et al. Radiographic Imaging Does Not Reliably Predict Macroscopic Extranodal Extension in Human Papilloma Virus-Associated Oropharyngeal Cancer. ORL 2018; 80: 85–95 Amerikanische Radiologen und Fachärzte für Otorhinolaryngologie evaluierten bei Patienten mit Oropharynx-Plattenepithelkarzinomen (OPSCC) die Genauigkeit der präoperativen kontrastmittelverstärkten Computertomographie (CECT), um die extranodale Ausdehnung (ENE) (> 2 mm) zu prognostizieren.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Reinke-Ödem
Laryngo-Rhino-Otol 2018; 97: 760-761
DOI: 10.1055/a-0652-6769
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Funktionell-ästhetische Rhinochirurgie unter besonderer Berücksichtigung physiologischer Aspekte
Laryngo-Rhino-Otol 2018; 97: 756-756
DOI: 10.1055/a-0719-7383
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Stimm- und Kehlkopfveränderungen im Alter (Presbyphonie und Presbylarynx)
Laryngo-Rhino-Otol 2018; 97: 772-776
DOI: 10.1055/a-0652-6758
Etwa 20 % der über 60-Jährigen weisen eine Altersstimmstörung (Presbyphonie) auf, die oftmals von Presbyakusis (Altersschwerhörigkeit), Presbyphagie (Schluckstörungen im Alter), Presbyvertigo (Altersschwindel) und/oder Presbyopie (Alterssichtigkeit) begleitet wird.Presbyphonie betrifft die Singstimme häufiger, früher und deutlicher als die Sprechstimme. Aber nicht nur Qualität und Belastbarkeit von Sing- und Sprechstimme werden beeinträchtigt, auch der Atemantrieb wird durch die eingeschränkte Lungenfunktion schwächer. Durch das Absenken des Kehlkopfes verändern sich bei Senioren zudem die Resonanzverhältnisse im Ansatzrohr, und das Aspirationsrisiko steigt.Die stimmlichen Einbußen beruhen auf morphologischen Altersveränderungen des Kehlkopfes (Prebylarynx), die sowohl das ektolaryngeale Kehlkopfskelett als auch die endolaryngealen Weichteile (insbesondere die Stimmlippen) betreffen.Der Vokalismuskel atrophiert und wird hypoton, was zu einer spindelförmig-ovalären Glottisschlussinsuffizienz mit Luftverlust bei Phonation führt. Die Schleimhäute trocknen aus im Sinne einer Laryngitis sicca.Bei der Stimmrehabilitation im Alter müssen allgemeine und speziell auf die Stimme bezogene Behandlungsoptionen unterschieden werden: Zu den allgemeinen Therapieansätzen gehört die Mitbehandlung internistischer und neurologischer Grunderkrankungen (z. B. Reflux, neurodegenerative oder zerebrovaskuläre Erkrankungen) – auch Nebenwirkungen von Medikamenten müssen beachtet werden. Ein gesunder Lebensstil ohne Noxen begünstigt den Funktionserhalt von Phonations- und Atemorganen. Stimmtherapeutisch kommen sowohl Tonisierungsübungen zur Verbesserung des phonatorischen Glottisschlusses als auch detonisierende Entspannungsübungen zum Abbau supraglottischer hyperfunktioneller Pressmechanismen in Betracht. In Einzelfällen mit großem Glottisspalt bei Phonation kann eine phonochirurgische Stimmlippenaugmentation den Glottisschluss verbessern und somit die Stimme kräftigen. Stimmhygienische Maßnahmen (z. B. regelmäßiges Befeuchten der Atemwege) ergänzen das Stimmtraining.Singen im Alter hat sowohl psychosozial (Steigerung des Wohlbefindens und der sozialen Teilhabe) als auch immunologisch (Anstieg des IgA im Speichel) positive Effekte.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Nachruf Prof. Dr. med. Joachim Heermann
Laryngo-Rhino-Otol 2018; 97: 758-759
DOI: 10.1055/a-0734-4304
Am 20.07.2018 ist Herr Prof. Dr. med. Joachim Heermann nach langer Krankheit im Kreise seiner großen Familie in Essen verstorben. Mit Joachim Heermann verliert die HNO-Gesellschaft eine außergewöhnliche Persönlichkeit, einen Pionier der Mikrochirurgie des Ohres und der Nase und einen menschlichen innovativen Geist.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Aus der Gutachtenpraxis: Die Bedeutung der Bulbusvolumometrie für die Begutachtung von Riechstörungen
Laryngo-Rhino-Otol 2018; 97: 796-798
DOI: 10.1055/a-0652-6791
© Georg Thieme Verlag KG Stuttgart · New York
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Fehlbildungschirurgie von Nase und Lippe
Laryngo-Rhino-Otol 2018; 97: 814-816
DOI: 10.1055/a-0652-6846
© Georg Thieme Verlag KG Stuttgart · New York
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Kommentar der Schriftleitung
Laryngo-Rhino-Otol 2018; 97: 748-749
DOI: 10.1055/a-0652-6736
© Georg Thieme Verlag KG Stuttgart · New York
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Recurrence of adenomatoid odontogenic tumor
Abstract
We were impressed with the meticulous attention to detail regarding the recurrence of adenomatoid odontogenic tumor (AOT) in the recent article by Chrcanovic and Gomez.1 It was a pleasure to learn that they had taken an interest in our report on AOT recurrence (see Supporting Information).1 This letter focuses on the unanswered questions relating to two cases of recurrent AOT published in Japanese to which Chrcanovic and Gomez1 referred.
This article is protected by copyright. All rights reserved.
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Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience
The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.
https://ift.tt/2JMREs2
Mechanical impairment on alveolar bone graft: a literature review
Cleft lip and palate represents the most common form of craniofacial malformation (1 in 700 newborns in Europe). Cleft lip and palate is usually closed within the first 2 years after birth. The alveolar cleft is left open so as not to impair on maxillary growth in the way that primary osteoplasty did (Robertson and Jolleys, 1968; Rehrmann et al., 1970). Secondary alveolar bone grafting has become well established since the original work of Boyne and Sands (1972). Cancellous iliac bone is most widely favored, but tibial shaft, mandible, rib, and calvaria have also been used.
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Immunology of the Ancestral Differences in Eosinophilic Esophagitis
Eosinophilic Esophagitis (EoE) is an allergen driven disease characterized by eosinophilic inflammation in the esophagus1. Like other atopic disorders such as atopic dermatitis (AD), food allergy (FA), allergic rhinitis (AR), and asthma, EoE has complex etiology with genetic predisposition and environmental factors playing a major role in disease development2. The genetic predisposition has been suggested as an important factor by familial and twin studies. Additionally, numerous genetic risk loci have been now described linked to EoE risk confirming that inheritability is associated with genetic predisposition3.
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Review of 400 Consecutive Oral Food Challenges to Almond
Diagnosis of almond allergy is complicated by a high rate of false positive test results. Accurate diagnosis of almond allergy is critical as almond is a source of nutrition and milk products for children with other food allergies.
https://ift.tt/2PfQw69
Unraveling the enigma: elucidating the relationship between the physicochemical properties of aluminium-based adjuvants and their immunological mechanisms of action
Aluminium salts are by far the most commonly used adjuvants in vaccines. There are only two aluminium salts which are used in clinically-approved vaccines, Alhydrogel® and AdjuPhos®, while the novel aluminium adj...
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Are egg white face masks good for your skin?
Many people use egg white face masks as a way to boost the health of both oily and dry skin. However, there is little to no evidence to support the suggested benefits of these masks. We take a closer look at these alleged benefits and explain how to make an egg white face mask.
https://ift.tt/2DqQkuv
Blue light-emitting diode in healthy vaginal mucosa—a new therapeutic possibility
Abstract
A healthy female genital mucosa has an ecosystem that remains in balance through interactions between endogenous and exogenous factors. The light-emitting diode (LED) is a device that emits light at different wavelengths, with varying color and effects. Blue light in humans is most commonly used for antimicrobial purposes and has been already applied to treat facial acne and gastric bacteria. Although blue LED therapy in humans has been reported, its properties against vaginal infections have not yet been investigated. This study aims to test the safety and effects of 401 ± 5 nm blue LED on healthy vaginal mucosa. Phase I clinical trial involving 10 women between 18 and 45 years old with healthy vaginal mucosa. The participants were illuminated by 401 ± 5 nm blue LED for 30 min and anamnesis, oncotic cytology, and pH measurement were made again after 21/28 days of treatment. In the re-evaluation, adverse effects were investigated. The mean age was 27 ± 5.4 years and one of the women was excluded due to interruption of use of oral contraceptives. Oncotic cytology done before and after therapy showed that the composition of the microflora remained normal in all participants. Vaginal pH remained unchanged in eight of the women and had a reduction in one woman (5.0–4.0). No adverse effects were observed during or after illumination. 401 ± 5 nm blue LED did not generate any adverse effects or pathogenic changes in the microflora and vaginal pH. The effects of 401 ± 5 nm blue LED still need to be tested in vulvovaginal pathogens. Trial registration number: NCT03075046
https://ift.tt/2QvIC5v
Modified Ramped Position for Endotracheal Intubation of Obese Patients
Conditions: Obesity; Anesthesia
Interventions: Other: Modified ramped position; Other: Ramped position
Sponsor: Cairo University
Not yet recruiting
https://ift.tt/2JK2oHD
Interventions: Other: Modified ramped position; Other: Ramped position
Sponsor: Cairo University
Not yet recruiting
https://ift.tt/2JK2oHD
Panitumumab-IRDye800 and 89Zr-Panitumumab in Identifying Metastatic Lymph Nodes in Patients With Squamous Cell Head and Neck Cancer
Condition: Cutaneous Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Panitumumab-IRDye800; Drug: Zirconium Zr-89 Panitumumab; Device: Pinpoint IR IR9000 flourescence imaging system (FIS); Device: SPY-PHI IR9000 flourescence imaging system (FIS); Device: Explorer Air camera; Device: PDE-NEO II camera; Device: FIS-00 fluorescence imaging system (FIS); Device: Da Vinci Firefly Imaging System; Device: IGP-ELVIS-v4 Macroscopic Specimen Imager; Device: Vevo 3100 LAZR-X; Device: Pearl Triology Imaging System; Device: Odyssey CLx Imaging System; Device: Leica fluorescence microscope
Sponsors: Stanford University; National Institutes of Health (NIH); National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2ASTV2h
Interventions: Drug: Panitumumab-IRDye800; Drug: Zirconium Zr-89 Panitumumab; Device: Pinpoint IR IR9000 flourescence imaging system (FIS); Device: SPY-PHI IR9000 flourescence imaging system (FIS); Device: Explorer Air camera; Device: PDE-NEO II camera; Device: FIS-00 fluorescence imaging system (FIS); Device: Da Vinci Firefly Imaging System; Device: IGP-ELVIS-v4 Macroscopic Specimen Imager; Device: Vevo 3100 LAZR-X; Device: Pearl Triology Imaging System; Device: Odyssey CLx Imaging System; Device: Leica fluorescence microscope
Sponsors: Stanford University; National Institutes of Health (NIH); National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2ASTV2h
Disseminated Vegetating Plaques and Pustules
A teenaged male in Kenya presented with painful vegetating, bleeding plaques and pustules on his face, scalp, trunk, and extremities. He continued to develop new lesions despite prescribed daily medications. He was HIV negative. What is your diagnosis?
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https://ift.tt/2D8IZ1R
Staging Systems to Predict Metastatic Cutaneous Squamous Cell Carcinoma
Disease staging systems play 2 critical roles in oncology. In the first instance, these systems summarize the extent of a patient's cancer at the time of diagnosis and disease progression, by including information on the tumor characteristics at the primary site (eg, location, size, histologic features, etc) as well as locoregional (lymph node involvement) and distant metastatic state. Second, clinicians use these systems to evaluate treatment options, assess prognosis, and plan their patients' care. Ideally, staging systems should have strong prognostic value so that clinicians can inform patients, with a reasonable degree of certainty, about the course of their disease and eligibility for adjuvant and therapeutic interventions.
https://ift.tt/2PMVHdl
https://ift.tt/2PMVHdl
Effect of Platelet-Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin
This randomized clinical trial investigates whether platelet-rich plasma injection improves the visual appearance, including texture and color, of photodamaged facial skin in adults with bilateral cheek rhytids of Glogau class II or greater.
https://ift.tt/2D8IYLl
https://ift.tt/2D8IYLl
Effectiveness of Tacrolimus Swish-and-Spit Treatment in Patients With Geographic Tongue
This study evaluates the effectiveness of a twice daily tacrolimus swish-and-spit treatment regimen for geographic tongue.
https://ift.tt/2PIA5ih
https://ift.tt/2PIA5ih
Incomplete Data in Cutaneous Squamous Cell Carcinoma Staging System Analysis—Reply
In Reply On behalf of our coauthors, we thank Jambusaria-Pahlajani and colleagues for their interest in and comments to our study and appreciate the opportunity to respond to their concerns.
https://ift.tt/2D7wCTI
https://ift.tt/2D7wCTI
Incomplete Data in Cutaneous Squamous Cell Carcinoma Staging System Analysis
To the Editor We read with interest the article by Roscher et al on validation of 4 staging systems for cutaneous squamous cell carcinoma published in the April issue of JAMA Dermatology. We believe that such a population-based case-control comparison of staging systems is highly valuable in helping to refine subsequent staging. However, we have some concerns with the report's analysis and conclusions.
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https://ift.tt/2PIzZap
Notice of Retraction and Replacement
This is a notice of the retraction and replacement for an article by Roscher et al. to correct errors detected throughout the text.
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https://ift.tt/2DbT4uK
Cutaneous Sensitization to Peanut in Children With Atopic Dermatitis
This Viewpoint discusses recent findings associating atopic dermatitis in infants with increased sensitization to peanut protein and how those findings are informing new guidelines and efforts to prevent peanut allergy.
https://ift.tt/2PIa4jg
https://ift.tt/2PIa4jg
The nature of the human T cell response to the cancer antigen 5T4 is determined by the balance of regulatory and inflammatory T cells of the same antigen-specificity: implications for vaccine design
Abstract
The oncofoetal antigen 5T4 is a promising T cell target in the context of colorectal cancer, as demonstrated by a recent clinical study where 5T4-specific T cell responses, induced by vaccination or cyclophosphamide, were associated with a significantly prolonged survival of patients with metastatic disease. Whilst Th1-type (IFN-γ+) responses specific to 5T4, and other oncofoetal antigens, are often readily detectable in early stage CRC patients and healthy donors, their activity is suppressed as the cancer progresses by CD4+CD25hiFoxp3+ regulatory T cells (Treg) which contribute to the immunosuppressive environment conducive to tumour growth. This study mapped the fine specificity of Th1 and Treg cell responses to the 5T4 protein. Surprisingly, both immunogenic peptides and those recognised by Tregs clustered in the same HLA-DR transcending epitope-rich hotspots within the 5T4 protein. Similarly, regions of low Th1-cell immunogenicity also did not contain peptides capable of stimulating Tregs, further supporting the notion that Treg and Th1 cells recognise the same peptides. Understanding the rules which govern the balance of Th1 and Treg cells responding to a given peptide specificity is, therefore, of fundamental importance to designing strategies for manipulating the balance in favour of Th1 cells, and thus the most effective anti-cancer T cell responses.
https://ift.tt/2PIuhFv
BRAF mutation testing in melanoma: results from a German observational multicenter study
Abstract
Quality control of BRAF mutation testing methods used in routine practice is crucial for optimal treatment selection. In this prospective study, we assessed the impact of patient/sample characteristics on BRAF mutation testing results in patients with melanoma, during clinical practice. Data were collected on routine testing practices and documented mutation status in patients with melanoma stages IIIB, IIIC, or IV across 28 diagnostic pathology centers in Germany. Patient/sample data collected included: patient age, location of primary melanoma and metastases, origin of sample, melanoma subtype, and quality of tissue. Statistical influence of patient/sample characteristics on BRAF mutation rate was assessed using multiple logistic regression analyses and statistical models developed to predict the probability of BRAF mutations for individual patient cohorts. Data/samples from 642 patients with melanoma were analyzed. BRAF mutations were documented in 241/642 patients (37.5%). The primary statistical model to predict BRAF mutation rates included: age (continuous), origin of sample, method of mutation analysis, and quality of tissue. Analyses of post hoc collected data identified major deviations between documented mutation rates included in this study vs. routinely recorded mutation rates for three centers. When samples from these centers were excluded, the influence of testing method was no longer statistically significant. The final model included patient age, origin of sample (including metastasis location), and quality of tissue. Once validated in an independent population, this type of model could allow pathology centers to compare the performance of their testing methods with what would be expected based on patient, tumor, and sample characteristics.
https://ift.tt/2F8ws0S
Synthetic polymeric barrier membrane associated with blood coagulum, human allograft, or bovine bone substitute for ridge preservation: a randomized, controlled, clinical and histological trial
Publication date: Available online 7 November 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s):
https://ift.tt/2D3VsUB
Les Annales de dermatologie ont 150 ans !
Publication date: Available online 7 November 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): B. Cribier
https://ift.tt/2OsgEpi
Programme des Posters
Publication date: Available online 6 November 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s):
https://ift.tt/2yVC1dK
Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience
Publication date: Available online 7 November 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Peter Balon, Aleš Vesnaver, Andrej Kansky, Miha Kočar, Luka Prodnik
Summary
Purpose
The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.
Materials and Methods
Twelve patients who met the inclusion criteria underwent operation between the years 2012 and 2016 at the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia. Seven patients had posttraumatic sequelae, 4 osteoarthritis and 1 psoriatic arthritis. We inserted 12 temporomandibular joint prostheses (Biomet- Lorenz). A retrograde analysis of the patients' subjective assessment of the pre- and postoperative temporomandibular pain, opening the mouth, the ability to chew food, and quality of life (VAS scale, 0–10) was performed. Additionally, we evaluated the inter-incisal distance pre- and postoperatively. Complications that occurred were also included in our evaluation.
Results
During final examinations, at least 15 months after the surgery (on average 39.5 months), we observed an improved ability to open the mouth in all patients. The average preoperative inter-incisal distance was 22 mm (15–30 mm); the average postoperative distance was 37.5 mm (32.3–1.8 mm), (p<0.001). The analysis of pain and other subjective variables (opening the mouth, the ability to chew, quality of life) showed a statistically significant improvement (p<0.001).
Conclusion
According to our initial experience, replacement of the temporomandibular joint with a total prosthesis is a safe and effective treatment method.
https://ift.tt/2JNAvhY
Next-Generation Robotic Head and Neck Surgery
ORL 2018;80:213–219
https://ift.tt/2SNiDrH
Editorial Board/Aims & Scope
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s):
https://ift.tt/2PMGedf
Apoptosis of tumor-infiltrating T lymphocytes: a new immune checkpoint mechanism
Abstract
Immunotherapy based on checkpoint inhibitors is providing substantial clinical benefit, but only to a minority of cancer patients. The current priority is to understand why the majority of patients fail to respond. Besides T-cell dysfunction, T-cell apoptosis was reported in several recent studies as a relevant mechanism of tumoral immune resistance. Several death receptors (Fas, DR3, DR4, DR5, TNFR1) can trigger apoptosis when activated by their respective ligands. In this review, we discuss the immunomodulatory role of the main death receptors and how these are shaping the tumor microenvironment, with a focus on Fas and its ligand. Fas-mediated apoptosis of T cells has long been known as a mechanism allowing the contraction of T-cell responses to prevent immunopathology, a phenomenon known as activation-induced cell death, which is triggered by induction of Fas ligand (FasL) expression on T cells themselves and qualifies as an immune checkpoint mechanism. Recent evidence indicates that other cells in the tumor microenvironment can express FasL and trigger apoptosis of tumor-infiltrating lymphocytes (TIL), including endothelial cells and myeloid-derived suppressor cells. The resulting disappearance of TIL prevents anti-tumor immunity and may in fact contribute to the absence of TIL that is typical of "cold" tumors that fail to respond to immunotherapy. Interfering with the Fas–FasL pathway in the tumor microenvironment has the potential to increase the efficacy of cancer immunotherapy.
https://ift.tt/2yX5d41
Application of indocyanine green in the parathyroid detection and protection: Report of 3 cases
Publication date: Available online 7 November 2018
Source: American Journal of Otolaryngology
Author(s): Jinrui Fan, Hao Jin, Jun Yang, Kun Liao, Zhuocheng He, Min Cui
Abstract
Background
It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid.
Case presentation
From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism.
Conclusions
This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.
https://ift.tt/2OwHvk7
Expression of T‐cell immunoglobulin and immunoreceptor tyrosine‐based inhibitory motif domain on CD4+ T cells in patients with atopic dermatitis
Abstract
The T‐cell immunoglobulin and immunoreceptor tyrosine‐based inhibitory motif domain (TIGIT) is a co‐inhibitory receptor mainly expressed on T cells. Although TIGIT plays an important role in various autoimmune diseases, its role in atopic dermatitis (AD) remains unclear. In this study, we examined the expression levels of TIGIT and their association with clinical features in patients with AD. TIGIT expression on CD4+ T cells, central memory T cells, effector memory T cells and regulatory T cells was determined by flow cytometry. CD4+ T cells exhibited enhanced TIGIT expression in patients with AD compared with healthy individuals. In particular, effector memory T cells and regulatory T cells, but not central memory T cells, exhibited higher TIGIT expression in patients with AD than in healthy individuals. The frequency of TIGIT+ cells among CD4+ T cells was significantly increased in patients with mild AD compared with healthy individuals, while decreased in patients with severe AD. Consistently, the frequency of TIGIT+ cells among CD4+ T cells was negatively correlated with both serum thymus and activation‐regulated chemokine levels and immunoglobulin E levels in patients with AD. Furthermore, TIGIT expression on CD4+ T cells inhibited cell proliferation in patients with AD. These results suggest that TIGIT expression on CD4+ T cells in patients with AD may be increased to suppress chronic cutaneous inflammation. Moreover, TIGIT expression may be impaired in a subset of patients with AD, leading to a deterioration of skin inflammation. Our study may provide new insight into a TIGIT pathway‐based therapeutic approach for AD.
https://ift.tt/2PMyvMh
Interleukin-4/interleukin-13 versus interleukin-5: a comparison of molecular targets in biologic therapy for the treatment of severe asthma
Purpose of review Asthma is a chronic, inflammatory disorder of the airways caused by a complex interplay of various biologic mechanisms. Several monoclonal antibody therapies targeting interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed for the treatment of severe eosinophilic asthma. As individuals can display biomarkers and clinical features characteristic of several asthma phenotypes, selection of anoptimal biologic can be difficult. Recent findings Dupilumab, a monoclonal antibody that binds to the α subunit of the IL-4 receptor (IL-4Rα) and has been approved for the treatment of adults with severe atopic dermatitis, has been shown in recent phase 3 trials to also have significant clinical benefits in the asthmatic population irrespective of baseline eosinophil counts. Summary As monoclonal antibodies targeting either IL-4 or IL-13 cytokines individually have failed to demonstrate significant clinical benefits, biologics that target cytokine receptors may be more efficacious compared to those that target cytokines. Furthermore, inhibition of the IL-4/IL-13 signaling cascades may disrupt a broader Th2 inflammatory response compared to a more selective impairment of eosinophil proliferation and activity via blockage of the IL-5 pathway. Future research with independently funded, head-to-head trials of approved biologics is needed to elucidate a favorable therapeutic option. Correspondence to Julia W. Tripple, MD, Allergy and Immunology Division, University of Texas Medical Branch, Galveston, TX 77555, USA. E-mail: jgwoodar@utmb.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2PJkejl
https://ift.tt/2PJkejl
Strategies to reduce corticosteroid-related adverse events in asthma
Purpose of review Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. Recent findings Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). Summary The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents. Correspondence to Professor Enrico Heffler, Personalized Medicine, Asthma and Allergy Unit, Istituto Clinico Humanitas, Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano MI, Italy. Tel: +39 282247013; fax: +39 282246484; e-mail: enrico.heffler@hunimed.eu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Dbg4KL
https://ift.tt/2Dbg4KL
“Normal‐appearing” scalp areas are also affected in lichen planopilaris and frontal fibrosing alopecia: an observational histopathologic study of 40 patients
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocyte‐mediated scarring alopecias which clinically affect primarily the anterior and mid scalp. However, unaffected scalp areas have not yet been investigated in a systemic manner. In this study we assessed histopathologic changes in affected and unaffected scalp in both diseases and healthy control subjects and compared these findings with clinical signs and scalp symptoms. We have demonstrated that "normal‐appearing" scalp that is devoid of clinical lesions of LPP and FFA showed lymphocytic perifollicular inflammation around the isthmus/infundibulum areas in 65% of biopsy specimens, perifollicular fibrosis in 15% and mucin deposits in 7.5% of the cases. None of these findings were found in control samples. No direct correlation was found between the degree of histopathological inflammation, scalp symptoms and clinical lesions in the corresponding affected scalp areas. This preliminary study suggests that both diseases may be more generalized processes which affect the scalp and therefore, need systemic or total scalp therapy.
This article is protected by copyright. All rights reserved.
https://ift.tt/2RGIBf0
Interleukin-4/interleukin-13 versus interleukin-5: a comparison of molecular targets in biologic therapy for the treatment of severe asthma
Purpose of review Asthma is a chronic, inflammatory disorder of the airways caused by a complex interplay of various biologic mechanisms. Several monoclonal antibody therapies targeting interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed for the treatment of severe eosinophilic asthma. As individuals can display biomarkers and clinical features characteristic of several asthma phenotypes, selection of anoptimal biologic can be difficult. Recent findings Dupilumab, a monoclonal antibody that binds to the α subunit of the IL-4 receptor (IL-4Rα) and has been approved for the treatment of adults with severe atopic dermatitis, has been shown in recent phase 3 trials to also have significant clinical benefits in the asthmatic population irrespective of baseline eosinophil counts. Summary As monoclonal antibodies targeting either IL-4 or IL-13 cytokines individually have failed to demonstrate significant clinical benefits, biologics that target cytokine receptors may be more efficacious compared to those that target cytokines. Furthermore, inhibition of the IL-4/IL-13 signaling cascades may disrupt a broader Th2 inflammatory response compared to a more selective impairment of eosinophil proliferation and activity via blockage of the IL-5 pathway. Future research with independently funded, head-to-head trials of approved biologics is needed to elucidate a favorable therapeutic option. Correspondence to Julia W. Tripple, MD, Allergy and Immunology Division, University of Texas Medical Branch, Galveston, TX 77555, USA. E-mail: jgwoodar@utmb.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2PJkejl
https://ift.tt/2PJkejl
Strategies to reduce corticosteroid-related adverse events in asthma
Purpose of review Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. Recent findings Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). Summary The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents. Correspondence to Professor Enrico Heffler, Personalized Medicine, Asthma and Allergy Unit, Istituto Clinico Humanitas, Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano MI, Italy. Tel: +39 282247013; fax: +39 282246484; e-mail: enrico.heffler@hunimed.eu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Dbg4KL
https://ift.tt/2Dbg4KL
Active vaccination against Interleukin‐5 as long‐term treatment for insect bite hypersensitivity in horses
Abstract
Background
Insect‐bite hypersensitivity (IBH) in horses is a chronic allergic dermatitis caused by insect bites. Horses suffer from pruritic skin lesions, caused by type‐I/type‐IV allergic reactions accompanied by prominent eosinophil infiltration into the skin. Interleukin‐5 (IL‐5) is the key cytokine for eosinophils and we have previously shown that targeting IL‐5 by vaccination reduces disease symptoms in horses.
Objective
Here we analyzed the potential for long‐term therapy by assessing a second follow‐up year of the previously published study.
Methods
The vaccine consisted of equine IL‐5 (eIL‐5) covalently linked to a cucumber mosaic virus‐like particle (VLP) containing a universal T cell epitope (CuMVTT) using a semi‐cross over design to follow vaccinated horses during a second treatment season. Thirty Icelandic horses were immunized with 300 μg of eIL‐5‐CuMVTT without adjuvant.
Results
The vaccine was well tolerated and did not reveal any safety concerns throughout the study. Upon vaccination all horses developed reversible anti‐eIL‐5 auto‐antibody titers. The mean course of eosinophil levels was reduced compared to placebo treatment leading to significant reduction of clinical lesion scores. Horses in their second vaccination year showed a more pronounced improvement of disease symptoms when compared to first treatment year, most likely due to more stable antibody titers induced by a single booster injection. Hence, responses could be maintained over two seasons and the horses remained protected against disease symptoms.
Conclusion
Yearly vaccination against IL‐5 may be a long‐term solution for the treatment of IBH and other eosinophil‐mediated diseases in horses and other species including humans.
This article is protected by copyright. All rights reserved.
https://ift.tt/2RH23bz
Funktionelle Rehabilitation schwerer laryngopharyngealer Verletzungen nach Suizidversuch durch Erhängen
Zusammenfassung
Hintergrund
Die Mortalitätsrate nach einem Suizidversuch durch Erhängen beträgt etwa 70 %. Die häufigste Todesursache ist hierbei eine zerebrale Hypoxie, aber auch schwere Verletzungen des oberen Aerodigestivtrakts werden selten überlebt. Die klinisch erhobenen Befunde von Patienten, die lebend das Krankenhaus erreichen, können trotz schwerer Verletzungen gering sein. Es ist daher entscheidend, zügig eine multidisziplinäre Diagnostik und Therapie einzuleiten, welche gefolgt ist von einer psychiatrischen Behandlung und der funktionellen Rehabilitation.
Fallbeschreibung und Ergebnisse
Anhand zweier Fälle von Patienten mit einer schweren Verletzung des oberen Aerodigestivtrakts nach suizidalem Erhängen wird die primäre Versorgung sowie die funktionelle Rehabilitation dargestellt. Die anschließende Kanülenversorgung und Schlucktherapie bis zur vollständigen Erholung werden beschrieben. Darüber hinaus wird ein Algorithmus für die Behandlung solcher Fälle vorgeschlagen, der nicht nur die primäre interdisziplinäre Diagnostik und Therapie, sondern auch die funktionelle Rehabilitation und die psychiatrische Behandlung berücksichtigt.
Schlussfolgerung
Minimale Symptome oder äußere Befunde nach Suizidversuchen durch Erhängen schließen schwere Verletzungen des oberen Aerodigestivtrakts nicht aus. Nach der chirurgischen Rekonstruktion sind ein angepasstes Kanülenmanagement sowie eine frühe und intensive Schlucktherapie, begleitet von der psychiatrischen Behandlung, für eine rasche Rehabilitation der Stimme, Luftwege und Schluckfunktion unerlässlich.
https://ift.tt/2DrKklq
Anteriomediale Maxillektomie zur Verbesserung der Nasenatmung
Zusammenfassung
Das Ziel der klassischen chirurgischen Korrektur bei Nasenatmungsbehinderung besteht darin, durch eine Operation an Nasenscheidewand und unteren Nasenmuscheln den physiologischen Spaltraum in der Nase harmonisch zu erweitern. Hierbei sollen der Durchflusscharakter erhalten bleiben und die Schleimhaut geschont werden, um die respiratorische Funktion der Nase nicht zu gefährden. Die vorliegende Arbeit stellt ein seit wenigen Jahren schrittweise entwickeltes operatives Vorgehen vor, bei dem verschiedene operative Teilschritte entsprechend der individuellen anatomischen Situation und der zugrunde liegenden Schleimhauterkrankung durchgeführt werden. Die anteriomediale partielle Maxillektomie steht im Mittelpunkt.
https://ift.tt/2RDfwkH
Hyperresponsiveness to interferon gamma exposure as a response mechanism to anti-PD-1 therapy in microsatellite instability colorectal cancer
Abstract
Colorectal cancer (CRC) with high-level microsatellite instability (MSI-H) tends to be associated with a better response to programmed death receptor-1 (PD-1) blockade than does microsatellite stable CRC. However, emerging evidence makes the use of programmed death ligand-1 (PD-L1) as a biomarker problematic. Here, we sought to characterize the interactions between PD-L1 expression and the response to PD-1 blockade therapy in BALB/c mice with a subcutaneous tumor challenge. We further focused on interferon gamma (IFNγ)-induced PD-L1 expression in an in vitro setting to evaluate the responsiveness to IFNγ exposure and the specific signaling of PD-1 in HCT116 and SW480 cell lines. In this study, enhanced PD-L1 expression increased survival in CT26 cells, and PD-1 blockade increased the CTL profile and apoptotic cells in mice with CRC. Our in vitro findings showed that PD-L1 expression was significantly upregulated by a low-dose IFNγ treatment, and the MSI-H cell line might exhibit hyperresponsiveness to IFNγ exposure partly through the JAK–STAT pathway. These results suggest that intrinsic PD-L1 in cooperation with extrinsic IFNγ exposure in CRC may be more responsive to anti-PD-1 therapy, mainly through the CTL profile in the tumor microenvironment.
https://ift.tt/2PMCCIa
Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption
Abstract
Epidermal growth factor receptor inhibitors (EGFRI), EGFR tyrosine kinase inhibitors (TKI) and anti‐EGFR antibodies commonly develop skin toxicities including acneiform eruption (AfE). However, precise skin changes and risk factors for severe AfE are still unclear. The objective of the current study was elucidation of the useful parameters for early and sensitive detection of the skin changes by EGFRI. Transepidermal water loss (TEWL), skin surface hydration, skin surface lipid levels and erythema/melanin index were serially measured for 2 weeks in 19 EGFR‐TKI afatinib/erlotinib‐treated patients and for 8 weeks in 20 anti‐EGFR antibody cetuximab‐treated patients. The TEWL levels of the cheek in the patients who developed AfE of grade 2 and more (AfE ≥ Gr2) were already elevated at 7 days after the initiation of afatinib/erlotinib therapy compared with those before therapy as well as in patients with grade 1 or less (AfE ≤ Gr1). In patients treated with cetuximab, the skin surface hydration on the cheek in AfE ≥ Gr2 patients significantly decreased compared with that of AfE ≤ Gr1 patients at the 2nd and 6th week. Baseline skin surface lipid levels and erythema index on the cheek of patients with AfE ≥ Gr2 were significantly higher than those with AfE ≤ Gr1. The small sample size of the present study, especially for logistic regression analysis, is a limitation. In conclusion, instrumental evaluation declared rapid inflammatory changes of the skin by EGFRI and elucidated oily skin as a risk for severe AfE.
https://ift.tt/2F5f4dl
Determination of nicotine content in teeth submitted to prophylaxis and in-office bleaching by gas chromatography–mass spectrometry (GC-MS)
Abstract
Objectives
The objective of this study was to evaluate the dental color exposed to acute cigarette smoke treatment and quantify the amount of nicotine in samples exposed to cigarette smoke, after dental prophylaxis and after in-office bleaching.
Materials and methods
Sixty-nine healthy human molars were subjected to cigarette smoke in a cigarette machine. The teeth were divided into three groups: positive control, prophylaxis, and bleaching. Forty cycles of smoke exposition with duration of 15 min each were performed using 10 cigarettes (positive control). Dental prophylaxis was performed with a rotating brush and prophylaxis paste; in-office bleaching was performed with 35% hydrogen peroxide, in two sessions of three 15-min applications, with a 1-week interval between sessions. The color was evaluated at the baseline, after exposure to cigarette smoke, after dental prophylaxis, and after in-office bleaching. Teeth from each group were powdered and analyzed by gas chromatography–mass spectrometry in order to measure the amount of nicotine present in each group. Data from quantification of nicotine and color change were analyzed by one-way ANOVA and Tukey's test (α = 0.05).
Data for subjective and objective color evaluation, a perceptible dental darkening occurred in teeth after exposure to cigarette smoke. Dental prophylaxis was able to recover the original color of teeth however, only after bleaching teeth became whiter than at the baseline (p < 0.001). The amount of nicotine was significantly different and higher in positive control group (3.3 ± 1.3 μg/g of tooth), followed by the prophylaxis group (2.1 ± 1.4 μg/g) and the bleaching group (0.8 ± 0.3 μg/g) (p < 0.001).
Conclusions
Cigarette smoke penetrates into the dental structure. Dental prophylaxis and bleaching with 35% hydrogen peroxide can partially remove the nicotine from tobacco smoke. However, when in-office bleaching was applied, a more significant nicotine removal was achieved.
Clinical significance
Dental prophylaxis could remove most of the external nicotine-staining on the tooth surfaces while bleaching could further reduce the external and internal nicotine-staining of teeth.
https://ift.tt/2D73jka
Oral health in Alzheimer’s disease: a multicenter case-control study
Abstract
Objectives
The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.
Materials and methods
A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.
Results
Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).
Conclusions
After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.
Clinical relevance
Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.
https://ift.tt/2PPKicY
The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study
Abstract
Objectives
Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.
Materials and methods
A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).
Results
This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).
Conclusion
Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.
Clinical relevance
The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.
https://ift.tt/2D9McOS
The potential association between periodontitis and non-alcoholic fatty liver disease: a systematic review
Abstract
Objectives
Many animal and human studies have shown associations between periodontitis and non-alcoholic fatty liver disease (NAFLD). Hence, the present systematic review sought to investigate such a potential association.
Methods
PubMed/Medline, Scopus, Embase, and Web of Science databases were thoroughly searched to identify all relevant studies. The eligibility criteria were all observational (cross-sectional studies, case-control, cohort studies, and case reports) and interventional studies that assessed the relationship between periodontitis and NAFLD in humans. Due to remarkable heterogeneity and inconsistency among the included studies, no statistical analyses were conducted.
Results
A total of 12 studies comprising 53,384 patients were included in the present systematic review. The sample size in the individual studies ranged from 52 to 24,470 patients. All studies except one found significant associations between clinical and/or microbial periodontal parameters and NAFLD. Eight studies found significant associations between clinical periodontal parameters and NAFLD. Four microbial studies found a significant association between periodontal pathogens, especially Porphyromonas gingivalis and NAFLD development and progression.
Conclusions
The available evidence suggests that periodontitis may be a risk factor for development and progression of NAFLD. However, due to limited number of prospective cohort studies included in this review along with the substantial heterogeneity among the included studies, further well-designed prospective cohort studies are highly warranted.
Clinical relevance
Given the potential association between periodontitis and NAFLD, it can be assumed that healthy periodontium may be essential for liver health.
https://ift.tt/2PHspwS
A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride
Abstract
Objective
To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).
Materials and methods
In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.
Results
No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.
Conclusion
The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.
Clinical relevance
Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.
Trial registration
NCT02809014
https://ift.tt/2D60hg6
Prospective evaluation of psychological burden in patients with oral cancer
Publication date: Available online 7 November 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): K. Kumar, S. Kumar, D. Mehrotra, S.C. Tiwari, V. Kumar, S. Khandpur, R.C. Dwivedi
Abstract
The high morbidity and mortality that is associated with oral cancer places a huge psychological burden on patients. The purpose of this prospective study was to evaluate levels of depression, anxiety, and stress, at three time points using DASS-21 (Depression, Anxiety and Stress Scale-21). We also compared DASS-21 with HADS (Hospital Anxiety and Depression Scale). A total of 111 patients were enrolled and 75 of them completed the questionnaires at diagnosis, one month after treatment, and three months after discharge. Scores were high for stress at diagnosis, and for depression at the other time points, but were low for anxiety at all three. The results of Friedman's ANOVA showed that mean ranks for depression and stress were significant (p < 0.05). Scores for depression and stress rose significantly between diagnosis and three months after operation, but those for anxiety (which had increased between diagnosis and operation p > 0.05), were stable three months postoperatively. The DASS-21 was a useful method of evaluating stress. Correlation of the results from the two questionnaires showed a strongly positive association. We therefore recommend psychological intervention to improve overall outcome.
https://ift.tt/2Qq5XFw
Tuberculous coxitis with trochanteric bursitis manifesting a year after immigration to Germany: a case report
Osteoarticular tuberculosis is rare in Germany. In particular, trochanteric bursitis is an extremely rare manifestation of osteoarticular tuberculosis. We describe a case of tuberculous coxitis with trochanter...
https://ift.tt/2Pd8Cpw
Serum Concentrations of Lidocaine During Bariatric Surgery
Lidocaine has been shown to be clinically beneficial during bariatric surgery. However, information about lidocaine serum concentrations in this setting is scarce. This prospective clinical trial included 42 obese patients undergoing laparoscopic bariatric surgery. They received lidocaine based on adjusted body weight. Administration began with a 1.5 mg·kg−1 bolus of intravenous lidocaine followed by a continuous infusion of 2 mg·kg−1·hour−1. After skin closure, administration was decreased to 1 mg·kg−1·hour−1 until discharge from the recovery room. No serum concentrations of lidocaine were outside the usual accepted range (1.5–5 µg·mL−1). Accepted for publication October 3, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical trial number: NCT02525016. https://ift.tt/2ST81HK. Reprints will not be available from the authors. Address correspondence to Jean-François Carabalona, MD, Département d'Anesthésie Réanimation, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France. Address e-mail to jeffcarabalona@gmail.com. © 2018 International Anesthesia Research Society
https://ift.tt/2JOzwOE
https://ift.tt/2JOzwOE
Comparison of Invasive and Noninvasive Blood Pressure Measurements for Assessing Signal Complexity and Surgical Risk in Cardiac Surgical Patients
BACKGROUND: Continuous arterial blood pressure (ABP) is typically recorded by placement of an intraarterial catheter. Recently, noninvasive ABP monitors have been shown to be comparable in accuracy to invasive measurements. In a previous study, we showed that the fluctuations in beat-to-beat ABP measurements were not random variations but had a complex dynamical structure, and that ABP dynamical complexity was inversely associated with surgical risk estimated using the Society of Thoracic Surgeons (STS) index. Dynamical complexity is a mathematical construct that reflects the capacity of a physiological system to adapt to stimuli. The objectives of present study were to: (1) determine whether noninvasive beat-to-beat ABP measurements also exhibit a complex temporal structure; (2) compare the complexity of noninvasive versus invasive ABP time series; and (3) quantify the relationship between the complexity of noninvasive ABP time series and the STS risk scores. METHODS: Fifteen adult patients undergoing coronary artery bypass graft, valve, or combined coronary artery bypass graft/valve surgery ;were enrolled in this observational study. Preoperative ABP waveforms were simultaneously recorded for ≥15 minutes using a radial artery catheter (invasive) and a continuous noninvasive arterial pressure monitor. Beat-to-beat systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) time series were extracted from the continuous waveforms. Complexity was assessed using the multiscale entropy method. The Wilcoxon signed-rank test was used to compare the mean ranks of indices derived from invasive versus noninvasive ABP time series. Spearman correlation coefficients were used to quantify the relationship between invasive and noninvasive indices. Linear regression analysis was used to quantify the association between each of the complexity indices and the STS risk scores. RESULTS: Beat-to-beat fluctuations in noninvasive ABP measurements were not random but complex; however, their degree of complexity was lower than that of fluctuations in invasively obtained ABP signals (SBP: 7.05 vs 8.66, P
https://ift.tt/2SSaXUX
https://ift.tt/2SSaXUX
A Randomized Controlled Trial of Naloxone for Optimization of Hypoxemia in Lung Donors after Brain Death
Background Persistent hypoxemia is the principal reason lungs from otherwise eligible BD organ donors are not transplanted. Experimental models and retrospective studies have suggested that naloxone attenuates neurogenic pulmonary edema and reverses hypoxemia after brain death. We undertook a multi-site randomized placebo-controlled trial to evaluate whether naloxone is able to improve oxygenation in BD donors with hypoxemia. Methods BD organ donors at four OPOs were randomized in a blinded manner to naloxone 8-mg or saline placebo if lung were being considered for allocation but exhibited hypoxemia (PFR below 300 mm Hg). The primary outcome was change in PFR from baseline to final ABG. Secondary outcomes included early improvement in PFR and proportion of lungs transplanted. Results A total of 199 lung-eligible BD donors were randomized to naloxone (n=98) or placebo (n=101). Groups were comparable at baseline. Both groups exhibited similar improvements in oxygenation (median improvement in PFR of 81 with naloxone vs. 80 with saline, p=0.68) with 37 (39%) vs. 38 (40%) exhibiting reversal of hypoxemia. There was no difference in the rate of lungs transplanted (19% in both groups, p=0.97) although it was significantly higher in those with reversal of hypoxemia (32/69 vs. 2/111, p
https://ift.tt/2PeXGHW
https://ift.tt/2PeXGHW
Effect of case volume on mortality after pediatric liver transplantation in Korea
Background The purpose of this study was to evaluate whether institutional case volume affects clinical outcomes after pediatric liver transplantation. Methods: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1-10, and 10 pediatric liver transplantations/year) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/year). Hannah Lee and Eun Jin Jang equally contributed to this work and are co-first authors. Corresponding author: Ho Geol Ryu, M.D. Ph.D. Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea, Tel: +82-2-2072-2065, Fax: +82-2-747-5639, E-mail: hogeol@gmail.com Authorship H.G.R., E.J.J. and H.L. designed the study. H.L., E.J.J. and H.G.R wrote the article. E.J.J., G.H.K. and D.H.K. analyzed the data. S.Y., H.S.R., C.W.J. and S.Y.O. participated in the performance of the research. C.W.J. and H.S.R. collected the data. N.J.Y. and S.Y.O. provided feedback and suggestions. Funding None. Conflicts of Interest None declared. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2PeWx2V
“Chylous Ascites: Complication of laparoscopic donor nephrectomy. Case Report and review of literature.”
Background Chylous ascites (CA) is an extremely rare complication after laparoscopic donor nephrectomy (LDN). It can increase the hospital stay, morbidity in postoperative period and thus negating the benefits of laparoscopic surgery. Most of the cases were managed conservatively, but surgical intervention may be occasionally required. This report describes importance of accurate localization of the leaking chyle duct and its repair by endosuturing in a renal donor not responding to conservative treatment. Methods A comprehensive review of literature regarding this rare complication after LDN was performed with Pubmed/Medline and Google Scholar using "chyle, complications, laparoscopic donor nephrectomy" as keywords. The demographic profile and management of patients is discussed in detail. The various surgical modalities used to manage these patients are described. Results Fifty-four cases of Chyle leak/ascites have been reported after LDN in literature till date. Around 77% donors with CA could be successfully managed conservatively with dietary measures and total parentral nutrition. Surgical intervention was required in nearly 23% donors ranging from clip application, use of argon coagulation, endosuturing with application of glue after 36.1±19.07 days of failed conservative treatment. Donors with massive ascites or requiring frequent large volume paracentesis on conservative treatment are likely to require surgical therapy. The present case was successfully managed with laparoscopic endosuturing and has no recurrence at 6 month follow-up. Conclusions Chylous ascites is a rare complication after donor nephrectomy in experienced centers. While conservative management remains the first line of treatment, early surgical treatment shall be undertaken in cases of massive ascites. Corresponding Author: Sarbpreet Singh, Assistant Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector -12, Pin code: 160012, Chandigarh, India. Email: drsarbpreetsingh@yahoo.com Authorship Page Authors: Abhinav Seth, Ashish Sharma, Deepesh Benjamin Kenwar, Sarbpreet Singh, Abhinav Seth, M.S. General Surgery, Senior Resident, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: drabhinavseth@gmail.com Contribution: Participated in research design, writing of paper and data analysis. Ashish Sharma, M.S. General Surgery, Professor and Head, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: ashish_chd@hotmail.com Contribution: Participated in research design. Deepesh Benjamine Kenwar, Additional Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: deepesh.doc@gmail.com Contribution: Participated in the performance of the research Sarbpreet Singh (Corresponding author), Assistant Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: drsarbpreet@yahoo.com Contribution: Participated in research design, writing of paper and data analysis Disclosure: The authors declare no conflict of interests. Funding: The authors did not receive any funding for this manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2QpGkol
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