We Need to Talk About Notch:Notch Dysregulation as an Epiphenomenon in Inflammatory Skin Disease

Abstract

The Notch signaling pathway is a highly evolutionarily conserved signaling pathway comprised of four type 1 transmembrane receptors. Canonical Notch signaling is stimulated by Jagged and Delta ligands resulting in translocation of the Notch Intracellular domain (ICD) to the nucleus resulting in activation of transcription factor CSL. Increased Notch activity is associated with epidermal keratinocyte maturation, proliferation and innate immune activation through maturation of dendritic cells, T cells and macrophages.

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IL‐36 receptor antagonistic antibodies inhibit inflammatory responses in preclinical models of psoriasiform dermatitis

Abstract

Psoriasis vulgaris (PV) results from activation of IL‐23/Th17 immune pathway and is further amplified by cytokines/chemokines from skin cells. Among skin derived pro‐inflammatory cytokines, IL‐36 family members are highly upregulated in PV patients and play a critical role in general pustular psoriasis. However, there is limited data showing crosstalk between the IL‐23 and IL‐36 pathways in PV. Herein, potential attenuation of skin inflammation in the IL‐23‐induced mouse model of psoriasiform dermatitis by functional inhibition of IL‐36 receptor (IL‐36R) was interrogated. Anti‐mouse IL‐36R monoclonal antibodies (mAbs) were generated and validated in vitro by inhibiting IL‐36α induced secretion of CXCL1 from NIH 3T3 cells. Antibody target engagement was demonstrated by inhibition of CXCL1 production in a novel acute model of IL‐36α systemic injection in mice. In addition, anti‐IL‐36R mAbs inhibited tissue inflammation and inflammatory gene expression in an IL‐36α ear injection model of psoriasiform dermatitis demonstrating engagement of the target in the ear skin. To elucidate the possible role of IL‐36 signaling in IL‐23/Th17 pathway, the ability of anti‐IL‐36R mAbs to inhibit skin inflammation in an IL‐23 ear injection model was assessed. Inhibiting the IL‐36 pathway resulted in significant attenuation of skin thickening and psoriasis‐relevant gene expression. Taken together, this data suggests a role for IL‐36 signaling in the IL‐23/Th17 signaling axis in PV.

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Diagnostik beim nichtkleinzelligen Lungenkarzinom

Zusammenfassung

Grundlage für die Behandlung des nichtkleinzelligen Lungenkarzinoms sind eingehende Kenntnisse der zugrunde liegenden Krankheitscharakteristikamerkmale und der verschiedenen Therapieoptionen. Die Ergebnisse der Diagnostik sollten in einer interdisziplinären Tumorkonferenz eingeordnet werden. Die präzise Histologie und die genaue TNM-Klassifikation sind prognoserelevant und führen zu einer individuellen und optimalen Therapie. Der vorliegende Artikel wurde basierend auf nationalen und internationalen Leitlinien sowie auf einer selektiven PubMed-Suche erstellt.

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Effect of lights with various wavelengths on bleaching by 30% hydrogen peroxide

Abstract

The objective of this study was to evaluate the bleaching effect of light sources with various wavelengths using 30% hydrogen peroxide (HP) in vitro. The hematoporphyrin-stained paper was bleached with HP and irradiated for 10 min using LED light sources with 265, 310, 365, 405, or 450 nm respectively. In control group, HP was applied for 10 min without light irradiation. The bleaching procedure was repeated two times. The L*a*b* values of the samples before bleaching and after each bleaching step were measured using a colorimeter. Color changes of specimens were then calculated and statistically analyzed. There was an interaction between light sources and time of irradiation in the color change (p < 0.05). Time and light sources significantly affected ΔE and ΔL (p < 0.05). The light source of 256 nm showed the highest bleaching effect over time followed by that of 310 nm, which were statistically different from other groups (p < 0.001). The 365 nm, 450 nm groups, and control group showed low bleaching effect visually with no significant differences in ΔE and ΔL (p > 0.05). It was concluded that the wavelengths of the light sources affected the bleaching by HP. The 310-nm light can be a potential source for bleaching.

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Syringocystadenoma papilliferum of the cervix presenting as vulvar growth in an adolescent girl

Summary

Syringocystadenoma papilliferum (SCP) is a rare, benign, adnexal tumour of apocrine or eccrine differentiation. It is commonly located on head and neck region. We report the case of an 18‐year‐old woman who presented with a vulvar lobulated growth that was found to arise from the posterior lip of cervix. Histopathological examination revealed the diagnosis of SCP. To our knowledge, SCP arising from the cervix has never been reported previously in the literature, thus we believe this to be the first case of SCP arising from the posterior lip of the cervix.

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Evaluation of the efficacy of microneedle fractional radiofrequency in Turkish patients with atrophic facial acne scars

Summary

Background

Scarring is an undesirable and severe complication of acne resulting in loss of self‐esteem in young people. Although microneedle fractional radiofrequency (MFR) system has emerged as a good option to treat acne scars in recent years, it was examined in a few studies which were commonly from Asian countries.

Aims

We sought to evaluate the efficacy of MFR in Turkish patients with facial acne scars.

Methods

Nine patients with atrophic facial acne scars treated with MFR device were included in the study. The number of treatment sessions was varied from one to five (median three) with 4‐week intervals. Demographic and basal clinical features were recorded. Efficacy of the device was evaluated by the physicians' global assessment and patients' self‐assessment scales 4 weeks after the last treatment session.

Results

Of nine patients, two were male and seven were female (mean age, 31.33 years). Two patients had mild, four had moderate, and three had severe facial acne scars. Mean acne scar age was 13.22 ± 8.79 years. According to the predominant scar subtype, three patients had V‐shaped, three had U‐shaped, and three had M‐shaped atrophic acne scars. A clinical improvement of >25% has been reported in seven patients (77.7%) and eight patients (88.9%) by the physicians and patients, respectively. U‐shaped atrophic acne scars responded better to the treatment than the other types, as statistically nonsignificant. There were no severe side effects.

Conclusions

Microneedle fractional radiofrequency system showed a quite good efficacy and safety in the treatment of atrophic facial acne scars (Department of Dermato‐Cosmetology, Uludag University Medical School).

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Craniofacial and Dental Manifestations of Melnick–Needles Syndrome: Literature Review and Orthodontic Management

The aim of this article was to present a characteristic clinical image of Melnick–Needles syndrome using an example of an 11.5-year-old female patient treated at the Facial Congenital Disorders Outpatient Clinic as well as to present the actual literature review of the surgical treatment. The patient was diagnosed with several characteristics typical for Melnick–Needles syndrome: single-sided hearing loss, malocclusion, and facial dysmorphism, among others. Due to malocclusion and facial dysmorphism, the patient with Melnick–Needles syndrome requires orthodontic treatment with surgical intervention. Mandibular distraction with fixed appliance treatment is a recommended treatment protocol.

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Cochlear Ossification in a Patient with Cogan’s Syndrome Undergoing Bilateral Cochlear Implantation

We present the case of a young female patient diagnosed with Cogan's syndrome after the rapid onset of profond hearing and vestibular loss with concomitant eye symptoms. After appropriate medical treatment, her hearing did not respond and she underwent bilateral simultaneous cochlear implantation with findings of extensive cochlear ossification in both ears. The case and outcome are described in the body of the paper.

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Prevalence of human papillomavirus in oral rinse samples from healthy individuals in northern Thailand

Abstract

Background

The incidence of oral cancers associated with human papillomavirus (HPV) has been increasing in recent years. Therefore, it is necessary to elucidate HPV prevalence in oral cells and exposure to risk factors in various age groups.

Methods

Oral rinse samples from healthy individuals in northern Thailand were investigated for HPV prevalence and genotyped using the polymerase chain reaction (GP5+/6+ primers) and DNA sequencing of the PCR products.

Results

Samples were collected from 594 participants between 4 and 60 years of age. HPV was detected in 3.7% of samples: there was no gender difference. The prevalence of HPV positive cases was 8.6% in the 31 ‐50 age group. HPV prevalence increased with age and was the highest (9.2%) in the 41‐50 age group, but decreased (to 3%) in the 51‐60 age group. Risk factors significantly associated with HPV‐positive cases included alcohol consumption, coffee drinking, sexual activity and having children. HPV 16 and 18 were common genotypes, especially in the 31‐50 age group, and were associated with having sexual activity [odds ratio 19.0 (95% CI: 2.5‐142.5)]. At follow‐up of some individuals in the 4‐10 age group, a 9‐year‐old child was found to be positive for HPV18.

Conclusions

These results suggest that HPV can be acquired at a young age and the prevalence peaks in the middle age class among healthy individuals in northern Thailand, especially in the 31‐50 age group.

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Dividing neutrophils in subsets, reveals a significant role for activated neutrophils in the development of airway hyperreactivity

Abstract

Background

Previous research has emphasized the importance of eosinophils in allergic asthma, while paying less attention to neutrophils. The known functionality of neutrophils in the inflammatory process has recently changed and knowledge about subsets of neutrophils, as characterized by their expression of CD16 and CD62L, has surfaced. Their specific roles in asthma are still unknown.

Objective

To study the functional differences between subsets of neutrophils by characterising the impact of individual subsets on airway smooth muscle reactivity.

Methods

The direct effect of neutrophils on airway hyper‐responsiveness was assessed by co‐culturing different subsets of neutrophils (produced by LPS in vitro stimulation) with human isolated small airways or murine tracheae with subsequent evaluation of smooth muscle reactivity to bradykinin in myographs. Supernatants and tissue were saved for ELISA and immunohistochemistry.

Results

The CD16^highCD62L^dim neutrophils were found to enhance the response to bradykinin in both human isolated small airways and murine tracheae. No such effects were obtained for the other subsets. The response is due to an upregulation of bradykinin receptor 2 through release of TNFα from the neutrophil.

Conclusions & Clinical Relevance

The present study introduces a new concept regarding the role of neutrophils and defines a novel direct link between a specific activated neutrophil subset and airway smooth muscle, establishing neutrophils as important players in the development of asthmatic airway hyperactivity.

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Variability of blood eosinophils in patients in a clinic for severe asthma

Abstract

Background

Blood eosinophils are used to determine eligibility for agents targeting IL‐5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation.

Objective

To characterize variability and patterns of variability of blood eosinophil levels in a real‐world clinic for severe asthmatics.

Methods

Retrospective review of blood eosinophils measured over a 5‐year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analyzed.

Results

Patients treated in the Bellevue Hospital Asthma Clinic within a 3‐month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n= 13) of patients had levels that were consistently above 300 cells/μL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/μL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/μL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures.

Conclusion

In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability. These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention.

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Traffic‐related air pollution induces non‐allergic eosinophilic airway inflammation and cough hypersensitivity in guinea pigs

Abstract

Background

The pathogenesis and pathophysiology of eosinophilia‐related chronic cough such as non‐asthmatic eosinophilic bronchitis and cough variant asthma are still not clear.

Objective

This study is to examine the potential role of traffic‐related air pollution (TRAP) in eosinophilic inflammation and cough responses.

Methods

Non‐sensitized guinea pigs were exposed to TRAP in an urban traffic tunnel or kept in a filtered air environment for 7 or 14 days. Reflexive cough was measured using citric acid and allyl isothiocyanate (AITC) challenges, respectively. Spontaneous cough counting was determined using audio recording and a waveform analysis. Airway inflammation was evaluated using differential cells in bronchoalveolar lavage fluid (BALF) and lung histopathology. To further elucidate the relationship between airway inflammation and cough hypersensitivity, a subgroup of those exposed for 14 days received a dexamethasone treatment.

Results

Compared to reflexive cough count (mean (95% confidence interval) in 10 min) provoked by the AITC challenge for the unexposed animals (3.1 (1.7‐4.5)), those were increased significantly following both the 7‐day (12.0 (6.8‐17.2), p<0.01) and the 14‐day (12.0 (6.4‐17.6), p<0.01) TRAP exposure. The effect provoked by the citric acid challenge was more profound following the 14‐day exposure (26.0 (19.5‐32.5) vs. 3.8 (1.5‐6.0) for the control, p<0.001). TRAP exposures enhanced spontaneous cough events, caused a significant increase of eosinophils and neutrophils in BALF, and resulted in a dramatic eosinophilic infiltration in submucosal layer of trachea and bronchus, which can be inhibited significantly by dexamethasone treatment.

Conclusions & Clinical Relevance

TRAP exposures induced cough hypersensitivity and non‐allergic eosinophilic inflammation of airways in guinea pigs. This study highlights the potential mechanisms of eosinophilia‐related chronic cough that can be induced by traffic‐related air pollution.

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Antihistamine‐resistant chronic spontaneous urticaria: 1‐year data from the AWARE study

Abstract

Background

Previous reports indicate that patients with chronic spontaneous urticaria (CSU) are undertreated and that physicians show poor adherence to guideline recommendations. Awareness of CSU has improved in recent years, but it remains unclear if this has improved the management of these patients in clinical practice.

Objective

To describe disease burden, quality of life (QoL), and treatment patterns of patients with H₁‐antihistamine‐refractory CSU in Germany.

Method

AWARE (A World‐wide Antihistamine‐Refractory chronic urticaria patient Evaluation) is a global prospective, non‐interventional study of chronic urticaria in the real‐world setting, supported by the manufacturer of omalizumab. Patients (18–75 years) were included who had H₁‐antihistamine‐refractory CSU for ≥2 months. Disease characteristics, pharmacological treatments, and QoL (dermatology life quality index [DLQI], chronic urticaria QoL questionnaire, and angioedema QoL questionnaire) are reported for patients enrolled in Germany.

Results

After 1 year in AWARE, CSU remained uncontrolled (urticaria control test [UCT] score <12) in 432 of 1032 (42.2%) patients. QoL impairment remained high after one year, with 28.2% of patients reporting that CSU had a moderate/very large/extremely large effect on the DLQI. Most patients did not receive guideline‐recommended treatments at the end of the one‐year observation period. Changes in treatments were most evident at the first patient visit, with an increase in patients receiving omalizumab vs. prior therapy from 8.5% to 21.4%, and a decrease in those receiving no treatment from 29.9% to 12.8%. These changes were associated with reduced hives, angioedema, UCT scores, and QoL scores at Month 3, but only modest improvements thereafter. Of 528 patients with uncontrolled CSU and who were eligible for treatment escalation, only 3% received up‐dosing of H₁‐antihistamines and only 5% were initiated on omalizumab during one year of treatment.

Conclusions & Clinical Relevance

This study highlights a significant discrepancy between recommendations for managing CSU in international guidelines, and in real‐world clinical practice in Germany.

This article is protected by copyright. All rights reserved.

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Bidirectional roles of IL-22 in the pathogenesis of allergic airway inflammation

Publication date: Available online 10 November 2018

Source: Allergology International

Author(s): Takashi Ito, Koichi Hirose, Hiroshi Nakajima

Abstract

Asthma is the most prevalent allergic disease of the airway, which is characterized by eosinophilic inflammation, mucus hyperproduction, and airway hyper-responsiveness. Although these pathognomonic features are mainly mediated by antigen-specific Th2 cells and their cytokines, such as IL-4, IL-5, and IL-13, recent studies have revealed that other inflammatory cells, including Th17 cells and innate lymphoid cells (ILCs), also play a critical role in the pathogenesis of asthma. IL-22, one of the cytokines produced by Th17 cells and type 3 ILCs, has distinct functional properties, as IL-22 exclusively acts on non-hematopoietic cells including epithelial cells of mucosal surface and exhibits a broad range of action in regeneration and host protection. In accordance with the fact that lung epithelial cells play a critical role in the pathogenesis of asthma, we and other groups have shown that IL-22 is involved in the regulation of allergic airway inflammation. In this review, we discuss recent advances in the biology of IL-22 and its involvement in the pathogenesis of allergic airway inflammation.

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Implementing universal newborn hearing screening in the French Rhône-Alpes region. State of affairs in 2016 and the 1st half of 2017

Publication date: Available online 10 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Lorène Bouillot, Maurice Vercherat, Catherine Durand

ABSTRACT

Introduction

Universal newborn hearing screening (UNHS) started as public health policy in 2015 in the French Rhône-Alpes region, aiming to screen for unilateral and bilateral hearing loss. After a first and second screening (retest) in the maternity hospital, the diagnostic process occurred at a limited number of specialist centers. A deferred preliminary screening (T3) was proposed before the age of 1 month. The aims of this study were to assess implementation of the program, impact of T3, and present the incidence of hearing loss in this population.

Materials and methods

The retrospective observational study was based on data transmitted routinely by the 51 maternities to the regional organization responsible for newborn screening, in 2016 and first half of 2017.

Results

All the facilities implemented the UNHS protocol, with 47 out of 51 using the recommended techniques. 99.7% of the 115,435 newborns were screened (excluding 0.2% of parental refusals). A retest was required for 10.2% of the babies. Among babies who didn't pass retest, 7.7% were lost to follow-up. 2.2% of the newborns were referred to diagnostic centers. The rate of T3 was 31.3% of newborns who did not pass retest. 88.6% of the infants passed T3. In the perinatal network making extensive use of T3 (75.8 % versus 14.9% elsewhere), 0.6 % of the infants were referred to a diagnostic center, versus 2.9% in the rest of the region (2016, p<0.001). For 2016, the outcomes at 6 months revealed an overall hearing loss rate of 1.7‰ (4.7‰ for neonatal care unit babies), and bilateral hearing loss in 1.2‰.

Conclusion

In Rhône-Alpes, the national and regional objectives for UNHS were exceeded, although limiting the number of infants lost to follow-up remains essential. Repeating an automated test around 2-4 weeks after birth improves the program by decreasing the false positives of the screening. It considerably limits the number of infants referred to specialist centers, without increasing the number of patients lost to follow-up.

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A 3-Dimensional Bioprinted Tracheal Segment Implant Pilot Study: Rabbit Tracheal Resection with Graft Implantation

Publication date: Available online 10 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Rachel Kaye, Todd Goldstein, Daniel A. Grande, David Zeltsman, Lee P. Smith

Abstract

Objectives

Surgical reconstruction of tracheal disease has expanded to include bioengineering and three dimensional (3D) printing. This pilot study investigates the viability of introducing a living functional tracheal replacement graft in a rabbit animal model.

Methods

Seven New Zealand White rabbits were enrolled and six completed participation (one intraoperative mortality). Tracheal replacement grafts were created by impregnating 3D printed biodegradable polycaprolactone (PCL) tracheal scaffolds with rabbit tracheal hyaline chondrocytes. 2cm of native trachea was resected and the tracheal replacement graft implanted. Subjects were divided into two equal groups (n=3) that differed in their time of harvest following implantation (three or six weeks). Tracheal specimens were analyzed with intraluminal telescopic visualization and histopathology.

Results

The two groups did not significantly differ in histopathology or intraluminal diameter. All sections wherein the implant telescoped over native trachea (anastomotic ends) contained adequate hyaline cartilage formation (i.e. chondrocytes within lacuna, surrounding extracellular matrix, and strong Safranin O staining). Furthermore, the PCL scaffold was surrounded by a thin layer of fibrous tissue. All areas without membranous coverage contained inadequate or immature cartilage formation with inflammation. The average intraluminal stenosis was 83.4% (range 34.2-95%).

Conclusions

We report normal cartilage growth in a tracheal replacement graft when chondrocytes are separated from the tracheal lumen by an intervening membrane. When no such membrane exists there is a propensity for inflammation and stenosis. These findings are important for future construction and implantation of tracheal replacement grafts.

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Beals Syndrome with Middle and Inner Ear Dysplasia and Encephalocele: A Case Report and Review of Imaging Findings

Publication date: Available online 10 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elizabeth K. Weidman, Peter F. Morgenstern, C. Douglas Phillips, Jeffrey P. Greenfield, Theodore H. Schwartz, Linda A. Heier

Abstract

A 10-year-old male with history of Beals syndrome presented with hearing loss and was found to have middle and inner ear dysplasia and left temporal encephalocele on imaging. Beals syndrome is a rare autosomal dominant connective tissue disorder caused by a mutation in the fibrillin-2 gene. Skeletal manifestations of Beals have been reported, including anomalies of the long bones, calvarium, and spine. External ear abnormalities with "crumpled ear" deformity are seen in the majority of patients. This is the first case to report imaging findings of the middle and inner ear in a patient with Beals.

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New insights into immune cells cross-talk during IgG4-related disease

Publication date: Available online 10 November 2018

Source: Clinical Immunology

Author(s): Fahd Touzani, Agnieszka Pozdzik

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a newly acknowledged entity, characterized by an immune-mediated fibro-inflammatory process affecting virtually all organs, with infiltration of IgG4⁺ bearing plasma cells. Until today the pathogenesis of IgG4-RD remains unknown. Treatment with anti-CD20 monoclonal antibodies efficiently induced remission and attenuated the secretory phenotype of myofibroblasts responsible of uncontrolled collagen deposition. This supports the pathogenic role of the adaptive immunity, particularly B cell compartment and B cell/T cell interaction. Latest studies have also highlighted the importance of innate immune system that has been underestimated before and the key role of a specific T cell subset, T follicular helper cells that are involved in IgG4-class-switching and plasmablast differentiation. In this review, we aim to review the most recent knowledge of innate immunity, T and B cells involvement in IgG4-RD, and introduce tertiary lymphoid organs (TLO) as a potential marker of relapse in this condition.

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Anxiety and Genetic Polymorphisms in Catecol-O-Metiltransferase (COMT) and Serotonin Transportation Gene (5HTT) Are Associated with Benign Migratory Glossitis

Publication date: Available online 10 November 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Rafaela Scariot, Aline Monise Sebastiani, Michelle Meger, Vinicius Theodoro Broska, Juliana Feltrin Souza, Antonio Adilson Lima, João Armando Brancher, Cleber Machado de Souza, Paulo Henrique Couto Souza, Paula Cristina Trevillato

ABSTRACT

Objective

This case-control study aims to investigate if benign migratory glossitis (BMG) is associated with catechol-O-methyltransferase (COMT) and serotonin transportation gene (5HTT) polymorphisms and anxiety.

Study Design

The study comprised 43 patients with BMG and 114 patients without a history of BMG. We utilized the Hamilton Anxiety Rating Scale (HAM-A) to assess each individual's anxiety. We collected DNA from buccal cells and analysed polymorphisms of COMT and 5HTT. We conducted statistical evaluations using SPSS (IBM, USA) and STATA (StataCorp, USA). Alpha value was set at 0.05.

Results

Overall anxiety level was significantly higher in the case group than in the control group (p < 0.001). In an adjusted multiple logistic regression, the COMT markers were not associated with BMG. Individuals with CC genotype, in rs3813034 of 5HTT, presented an odds ratio of 2.85 (95%CI 1.03 -7.82; p = 0.042). Individuals with TT genotype, in rs1042173 of 5HTT, presented an odds ratio of 3.77 (95%CI 1.32-10.74; p = 0.013). For each incremental increase in anxiety score, there was an 8% increase in the probability of BMG (OR_a=1.08; 95%CI 1.03-1.14; p = 0.007).

Conclusion

Anxiety increases the risk of BMG. Moreover, the occurrence of BMG was associated with polymorphisms in 5HTT gene.

https://ift.tt/2qF40tv

Is injury to the inferior alveolar nerve still common during orthognathic surgery? Manual twist technique for sagittal split ramus osteotomy

Publication date: Available online 10 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): B.-K. Choi, W. Lee, L.-J. Lo, E.-J. Yang

Abstract

The osteotomy in a bilateral sagittal split ramus osteotomy (BSSRO) is made in close proximity to the inferior alveolar nerve (IAN), so direct damage to the nerve and irreversible neurosensory deficit may result. The aim of this study was to compare the incidence of injury to the nerve when a conventional osteotomy using an osteotome was made, with that after manual twist splitting. We retrospectively reviewed the casenotes of 769 consecutive patients who had bilateral SSRO either alone or with a simultaneous maxillary procedure by a single surgeon from May 2009 − October 2016. Patients were divided into two groups based on the technique used. Those in the first group had conventional split osteotomy using an osteotome and hammer for splitting (conventional group, 736 sides), and in those in the second group the manual twist technique was used (manual group, 802 sides). Patients who sustained Sunderland fifth degree injuries were identified from an existing record of nerve repairs. Fisher's exact test was used to evaluate the significance of the number of injuries to the nerve in each group. Conventional osteotomy and hammer-assisted SSRO resulted in 8/736 (1.1%) injuries to the IAN, whereas the manual twist splitting technique resulted in 1/802 injuries (0.1%). Our results confirm that the manual twist splitting technique significantly reduces the incidence of injury to the IAN, though the overall incidence was low.

https://ift.tt/2QvQwvv

Prognostic significance of bone morphogenetic protein 6 (BMP6) expression, clinical and pathological factors in clinically node-negative oral squamous cell carcinoma (OSCC)

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Petar Suton, Ante Bolanca, Lovorka Grgurevic, Igor Erjavec, Iva Nikles, Danko Muller, Spomenka Manojlovic, Slobodan Vukicevic, Mladen Petrovecki, Stjepan Dokuzovic, Ivica Luksic

Summary

Bone morphogenetic protein 6 (BMP6) has unique properties regarding structure and function in supporting bone formation during development and adult life. Despite its known role in various malignant tumors, the prognostic significance of BMP6 expression in oral squamous cell carcinoma (OSCC) remains unknown. The aim of the study was to investigate immunohistochemical expression of BMP6 in OSCC in correlation with clinical and pathological parameters, disease recurrence and survival. In addition, we investigated other parameters in order to identify prognosticators of neck metastases and final outcome. The study included 120 patients with clinically T1-3N0 OSCC who were primarily surgically treated between 2003 and 2008. There were 99 (82.5%) male and 21 (17.5%) female patients. The five-year disease-specific survival for the whole cohort was 79.7%. Tumors smaller than 2 cm in diameter showed higher incidence of strong BMP6 expression. No statistical correlation was observed between other clinico-pathological factors and BMP6 expression. Expression of BMP6 was not associated with disease recurrence and survival. BMP6 may not serve as prognosticator of final outcome or recurrence in clinically node-negative OSCC subjects. In multivariate analysis predictors of poorer survival were positive surgical margin, moderate tumor cell differentiation and pathological involvement of levels IV and/or V.

https://ift.tt/2T06tvL

The feasibility of rib grafts in long span mandibular defects reconstruction: a long term follow up

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Ahmed M.A. Habib, Shady A. Hassan

Abstract

Aims

To evaluate the efficiency of reconstruction of long span mandibular defects using split rib bundle bone graft.

Materials and methods

Six hundred patients with long span mandibular defects (more than 6 cm long), following resection of aggressive mandibular tumours, were reconstructed with split rib bundle bone graft technique. Immediate reconstruction was performed in all patients. A reconstruction plate was used to support the graft. Two ribs were harvested from the right side of the chest, split into four halves and used to restore the continuity of the mandible. The inclusion criterion was post-surgical mandibular bony defects without soft tissue deficiency. Defects with a history of previous or need of future irradiation were excluded.

Results

The appearance of the patients was accepted in 550 patients. Functional reconstruction was done in 320 patients by osseointegrated dental implants (after 15 months), and removable prosthesis in 150 patients. Infection was minor in 31 patients, moderate in 47 patients and severe in 42 patients. Partial loss of graft, up to 25%, due to moderate infection was reported. Total or near total loss of graft due to severe infection was corrected by reoperation six months later.

Conclusions

This technique is simple, safe, and can be effectively used to reconstruct long-span mandibular defects with minimal complications in selected patients.

https://ift.tt/2zMCyxZ

Recovery Pattern following Bimaxillary Orthognathic Surgery: Differences between Sexes

Publication date: Available online 10 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): In-Seok Song, Jimi Choi, Un-Bong Baik, Jae-Jun Ryu, Jong-Woo Lim, Young-Jun Choi, Ui-Lyong Lee

Abstract

The investigators hypothesized there would be differences between the sexes in recovery pattern following bimaxillary orthognathic surgery as measured by patient responses at 5 weeks postprocedure. A total of 378 participants underwent bimaxillary orthognathic surgery with or without adjunctive procedures. Participants received questionnaires 5 weeks postsurgery when they visited the outpatient clinic. The questionnaires include variances in surgical factors by sex, and postoperative symptoms which were most difficult to tolerate experiences by sex, respectively. Females were more likely to undergo malarplasty (zygoma reduction) than were male participants (P = <.001), and they required larger maxillary setback than did male participants (P = .003). Malarplasty was significantly correlated with ear fullness in total and female participants (p-value .018, .016, respectively). Snoring is significantly associated with malarplasty and segment osteotomy procedure without gender predominance (p-value= .026, .028, respectively). Over half of participants complained of nasal congestion (55.6%), followed by swelling (29.3%), pain (15.4%), breathing difficulty (10.6%). In conclusion, males and females showed different patterns of postoperative recovery following bimaxillary orthognathic surgery.

https://ift.tt/2T4JMXa

A simple method to estimate the linear length of the orbital floor in complex orbital surgery

Publication date: Available online 9 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Konstantinos Natsis, Maria Piagkou, Ioannis Chryssanthou, Georgios P. Skandalakis, Georgios Tsakotos, Giannoulis Piagkos, Constantinus Politis

Abstract

Background

The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit.

Material and methods

Ninety-seven (59 male and 38 female) European adult dry skulls were classified according to age: 20-39, 40-59 and 60 years and above. The length of each OrW was measured by using the direct distance between the optic foramen and a landmark in each orbital rim.

Results

A side asymmetry was detected for the lengths of the inferior, superior and medial OrW. Although a gender dimorphism was detected, no correlation with the age was found. Using the Stepwise multiple regression analysis two formulas were developed, one for the right and one for the left OrF with coefficient of determination R² 0.43 and 0.57, respectively.

Conclusions

The proposed formulas represent a simple, applicable and individualized method to calculate the OrF linear length in cases of complete destruction of the IOR and OrF, with accuracy and without the use of expertise material. Such data may improve the surgery planning of orbital floor fractures and complex orbital reconstructions.

https://ift.tt/2zIOdho

A comparison of the 7th and 8th editions of the AJCC staging system in terms of predicting recurrence and survival in patients with papillary thyroid carcinoma

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Sung Hoon Nam, Mi Rye Bae, Jong-Lyel Roh, Gyungyup Gong, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim

Abstract

Objectives

The recently published 8th edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system was significantly updated following the thyroid cancer-related guidelines to provide better predictability of survival but not focus on recurrence. Therefore, we compared the predictive values of the 7th and 8th editions of the AJCC staging systems for recurrence-free survival (RFS) and overall survival (OS) after thyroidectomy for papillary thyroid carcinoma (PTC).

Methods

This retrospective study included 2930 patients who underwent thyroidectomy and neck dissection for previously untreated PTC between 2006 and 2014. TNM stage was defined according to 7th and 8th editions. Univariate and multivariate Cox proportional hazard regression analyses were used to identify associations between variables and RFS or OS. Multivariate models for the AJCC TNM stages were adjusted for clinical and pathological variables.

Results

A significant number of patients classified as T3 with overall TNM stages II–IV in the AJCC 7th edition were down-staged in the 8th edition. Unadjusted T classification and overall TNM staging in both the 7th and 8th editions were significantly associated with RFS and OS rates (P < 0.001). After adjustment for clinicopathological factors, the overall TNM stage according to the AJCC 8th edition, but not the 7th edition, remained significantly associated with RFS and OS (P < 0.05), with better predictability of recurrence and survival, in patients with PTC.

Conclusions

The 8th edition AJCC staging system down-staged a large proportion of PTC patients, resulting in better predictability of recurrence and survival compared to the previous staging system.

Condensed abstract

This study compared the abilities of the 7th and 8th edition AJCC staging systems to predict recurrence and overall survival in 2930 patients with papillary thyroid carcinoma. The updated guidelines down-staged a large proportion of patients, resulting in better prediction of recurrence and survival than the previous staging system.

https://ift.tt/2Fh1iog

Potential application of tumor suppressor microRNAs for targeted therapy in head and neck cancer: A mini-review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Isaac Olatunji

Abstract

Head and neck cancer remains a leading cause of death worldwide. Most common available treatment methods which include surgery, radiotherapy, and chemotherapy are associated with numerous side effects. MicroRNA therapeutics is an emerging form of gene therapy with potential for use in treatment of head and neck cancer. MicroRNAs are short nucleotide RNAs that target mRNAs (messenger RNA) to regulate gene expression at the post-transcription level. They may act as either tumor suppressor or oncogene in cancer. In the past, their potential use in cancer management (diagnosis, treatment, prognosis prediction), based on their deregulation have been demonstrated and written about but summaries on their application for targeted therapy are limited. This article aims at discussing the potential of some known tumor suppressor microRNAs for treatment of head and neck cancer, either alone or in combination with other treatment forms. It also aims at highlighting some obstacles against their use. The search for literature was done on PubMed using the search term: "MicroRNA based head and neck cancer treatment". Only free full text original articles on specific microRNAs and their tumor suppressive abilities in head and neck cancer, written in English language were used. Most of the studies demonstrated the ability of microRNAs to inhibit tumor growth by targeting specific oncogenes in cancer cells. Tumor suppressor microRNAs show promise for the treatment of head and neck cancer but more researches are needed to further clear areas of concern.

https://ift.tt/2qBp58i