Association between hidradenitis suppurativa and hospitalization for psychiatric disorders: A cross‐sectional analysis of the National Inpatient Sample

Abstract

Background

Hidradenitis suppurativa (HS) is associated with pain, disfigurement, psychosocial distress and poor quality of life, all of which may lead to higher likelihood of mental health (MH) disorders. However, little is known about the MH comorbidities of HS.

Objectives

to determine the MH disorders and cost‐burden associated with HS.

Methods

Data were examined from the 2002‐2012 National Inpatient Sample, comprising a ~20% sample of all US pediatric and adult hospitalizations (n=87,053,155 admissions).

Results

MH disorders were much more common in inpatients with vs. without HS (34·27% vs. 20·05%). In multivariable logistic regression models controlling for gender, age, race/ethnicity, and insurance status, HS was associated with significantly higher odds of a MH disorder (adjusted odds ratio [95% confidence interval]: 2·53 [2·42‐2·63]), including 10 of 15 MH disorders examined. In contrast, HS was not associated with primary hospitalization for a MH disorder overall (0·95 [0·84‐1·07]), but was associated with primary hospitalization for 8 of 15 MH disorders examined. Among inpatients with HS, primary admission for a MH disorder was associated with female sex, public or no insurance, more chronic diseases, but inversely associated with older age, female sex, and non‐white race/ethnicity. HS was associated with >$38 million of excess mean annual costs of hospitalization for MH disorders.

Conclusions

Inpatients with HS had increased odds of comorbid mental health disorders, overall, and multiple primary mental health admissions, in particular, which were associated with considerable excess costs.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RTKHs5

Interaction of the mycotoxin metabolite dihydrocitrinone with serum albumin

Abstract

Citrinin (CIT) is a nephrotoxic mycotoxin produced by Penicillium, Monascus, and Aspergillus species. CIT appears as a contaminant in cereals, cereal-based products, fruits, nuts, and spices. During the biotransformation of CIT, its major urinary metabolite dihydrocitrinone (DHC) is formed. Albumin interacts with several compounds (including mycotoxins) affecting their tissue distribution and elimination. CIT-albumin interaction is known; however, the complex formation of DHC with albumin has not been reported previously. In this study, we aimed to investigate the interaction of DHC with albumin, employing fluorescence spectroscopy, circular dichroism, and molecular modeling studies. Furthermore, species differences and thermodynamics of the interaction as well as the effects of albumin on the acute in vitro toxicity of DHC and CIT were also tested. Our main observations/conclusions are as follows: (1) Fluorescence signal of DHC is strongly enhanced by albumin. (2) Formation of DHC-albumin complexes is supported by both fluorescence spectroscopic and circular dichroism studies. (3) DHC forms similarly stable complexes with human albumin (K~10⁵ L/mol) as CIT. (4) DHC-albumin interaction did not show significant species differences (tested with human, bovine, porcine, and rat albumins). (5) Based on modeling studies and investigations with site markers, DHC occupies the Heme binding site (subdomain IB) on human albumin. (6) The presence of albumin significantly decreased the acute in vitro cytotoxic effects of both DHC and CIT on MDCK cell line.

https://ift.tt/2OFUsbf

Thyroid® High-Impact Articles

FREE ACCESS through November 27, 2018.
Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

Read now:

Immune-Related Thyroiditis with Immune Checkpoint Inhibitors
Priyanka C. Iyer, Maria E. Cabanillas, Steven G. Waguespack, Mimi I. Hu, Sonali Thosani, Victor R. Lavis, Naifa L. Busaidy, Sumit K. Subudhi, Adi Diab, and Ramona Dadu

Patients with Benign Thyroid Diseases Experience an Impaired Sex Life
Nadia Sawicka-Gutaj, Marek Ruchala, Ulla Feldt-Rasmussen, Åse Krogh Rasmussen, Laszlo Hegedüs, Steen Joop Bonnema, Mogens Groenvold, Jakob Bue Bjorner, and Torquil Watt

Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options
Juan P. Brito, Jae Hoon Moon, Rebecca Zeuren, Sung Hye Kong, Yeo Goon Kim, Nicole M. Iñiguez-Ariza, June Young Choi, Kyu Eun Lee, Ji-hoon Kim, Ian Hargraves, Victor Bernet, Victor M. Montori, Young Joo Park, and R. Michael Tuttle

Association of Thyroid Function and Autoimmunity with Ovarian Reserve in Women Seeking Infertility Care
Tim I.M. Korevaar, Lidia Mínguez-Alarcón, Carmen Messerlian, Ralph A. de Poortere, Paige L. Williams, Maarten A. Broeren, Russ Hauser, and Irene C. Souter  

Hyperthyroidism and Papillary Thyroid Carcinoma in Thyrotropin Receptor D633H Mutant Mice
Holger Jaeschke, Henriette Undeutsch, Konrad Patyra, Christoffer Löf, Markus Eszlinger, Moosa Khalil, Meeri Jännäri, Kristiina Makkonen, Jorma Toppari, Fu-Ping Zhang, Matti Poutanen, Ralf Paschke, and Jukka Kero  

The post <i>Thyroid^®</i> High-Impact Articles appeared first on American Thyroid Association.

https://ift.tt/2T7j00i

A randomized clinical trial evaluating maxillary sinus augmentation with different particle sizes of demineralized bovine bone mineral: histological and immunohistochemical analysis

This study was performed to investigate sinus floor augmentation with two different particle sizes of demineralized bovine bone mineral (DBBM) by means of histological and immunohistochemical (IHC) analysis. A randomized clinical trial was conducted involving 10 individuals requiring two-stage bilateral maxillary sinus augmentation for implant installation. The patients were randomly divided into two groups following a split-mouth design: the maxillary sinus on one side was filled with small-sized particles (0.25–1mm) and on the contralateral side with large-sized particles (1–2mm).

https://ift.tt/2DhYfJT

Long‐term quality of life in older patients with HPV‐related oropharyngeal cancer

Abstract

Background

We explored if age affects quality of life (QOL) in survivors of locally advanced human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).

Methods

In a cross‐sectional survey of 185 patients, at least 12 months from radiation, we evaluated generic (EuroQOL‐5D questionnaire [EQ‐5D]) and head and neck specific (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire‐Head and Neck 35‐questions [EORTC‐QLQ‐H&N35]) QOL questionnaires and compared differences between younger (<65) and older (≥65) patients.

Results

The median age was 57.0 years (range 25‐77 years), and 31 patients (16.8%) were ≥65 years old. There was no significant difference in EQ‐5D global QOL scores by age (P = .53). Patients ≥65 years reported more immobility (P < .01), problems with social eating (P < .0001), and coughing (P < .01). Patients ≥65 years were not more likely to ever require a gastrostomy (P = .24) but were more likely to remain gastrostomy‐dependent at the time of the survey (P = .02).

Conclusion

Despite similar generic QOL, older survivors may have more mobility problems and issues with social eating compared with younger survivors deserving of further evaluation.

https://ift.tt/2zOGhv1

Patterns of failure after postoperative intensity‐modulated radiotherapy for locally advanced buccal cancer: Initial masticator space involvement is the key factor of recurrence

Abstract

Background

The purpose of this study was to determine failure patterns and clinicopathologic prognostic factors in patients with locally advanced buccal cancer after postoperative intensity‐modulated radiotherapy (IMRT).

Methods

Eighty‐two patients with locally advanced (American Joint Committee on Cancer [AJCC] stage III/IV) buccal cancer who underwent surgery followed by postoperative IMRT between January 2007 and October 2012 were retrospectively analyzed.

Results

Eighteen patients had local recurrences as the first recurrent site and 11 had supramandibular notch recurrences; the majority of recurrences were classified as marginal failures. The median time from the first local or regional recurrence to death was 5.9 months. In multivariate analyses of survivals, the initial masticator space involvement was the most important prognostic factor. Masticator space involvement, N classification, and maxillectomy were the significant prognostic predictors for supramandibular notch recurrences.

Conclusion

Postoperative IMRT for buccal cancer should not include the surgical beds alone, rather, it should be based on the potential patterns of spread.

https://ift.tt/2Tc2Ti4

Pattern of planned systemic therapy usage in newly diagnosed, nonmetastatic squamous cell carcinoma of the head and neck in a commercially insured population in the United States

Abstract

Background

We analyzed systemic therapy plans submitted for commercially insured patients with untreated, newly diagnosed squamous cell carcinoma of the head and neck (SCCHN) to investigate patterns of practice.

Methods

Consecutive chemotherapy treatment plans were submitted using Eviti Connect (https://www.marylandphysicianscare.com/content/dam/centene/maryland/pdfs/evitiConnectFactSheet.pdf) portal for preauthorization between June 1, 2011, and June 30, 2015, were analyzed.

Results

A total of 387 treatment plans were submitted for 340 patients; 68 and 272 patients were from academic centers and community practices, respectively. Single agent cisplatin (57%), cetuximab (18%), and carboplatin (9%) were the most commonly proposed regimens concurrent with definitive radiotherapy (RT). The frequency of cetuximab use was not significantly different between academic centers and community practices. A clinical trial was proposed in only 15% of patients.

Conclusion

Among commercially insured patients with newly diagnosed, nonmetastatic SCCHN, the choice of systemic therapy in initial treatment plans was not significantly different between academic centers and community practices. Clinical trials are underutilized and should be encouraged.

https://ift.tt/2zPWcct

The red leg dilemma: a scoping review of the challenges of diagnosing lower limb cellulitis

Abstract

Background

Suspected lower limb cellulitis presentations are commonly misdiagnoses, resulting in avoidable antibiotic prescribing or hospital admissions. Understanding the challenges posed in diagnosing cellulitis may help enhance future care.

Objectives

To examine and map out the challenges and facilitators identified by patients and health professionals in diagnosing lower limb cellulitis.

Methods

A scoping systematic review was performed in MEDLINE and Embase in October 2017. Thematic analysis was used to identify key themes. Quantitative data was summarised by narrative synthesis.

Results

Three themes were explored: (i) clinical case reports of misdiagnosis, (ii) service development and (iii) diagnostic aids. Forty‐seven different pathologies were misdiagnosed, including seven malignancies. Two different services have been piloted to reduce the misdiagnosis rates of lower limb cellulitis and save costs. Four studies have looked at biochemical markers, imaging and a scoring tool to aid diagnosis.

Conclusions

This review highlights the range of alternative pathologies that can be misdiagnosed as cellulitis, and emerging services and diagnostic aids developed to minimise misdiagnosis. Future work should focus on gaining a greater qualitative understanding of the diagnostic challenges from the perspective of patients and clinicians.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qIreij

Issue Information

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Issue Information

https://ift.tt/2PnNI7c

Low-Level Laser in Treatment of Head and Neck Lymphedema: A Pilot Study

Conditions:   Head and Neck Cancer;   Lymphedema;   Fibrosis
Intervention:   Device: Low-Level Laser
Sponsor:   University of Pennsylvania
Recruiting

https://ift.tt/2FwJSEr

Window of Opportunity Trial of Durvalumab (MEDI4736) or Durvalumab/Tremelimumab as Neoadjuvant Chemotherapy to Identify Immune Dynamics in Surgically Resectable Head and Neck Cancer Patients.

Conditions:   Stage II-IVB Operable HNSCC Oral Cavity;   Hypopharynx;   Oropharynx;   Larynx
Interventions:   Drug: Durvalumab;   Drug: durvalumab + tremelimumab
Sponsor:   Yonsei University
Not yet recruiting

https://ift.tt/2qL8jn4

Study on the Occurrence of Head and Neck Cancers During Pregnancy

Conditions:   Head and Neck Cancer;   Pregnancy Related
Intervention:  
Sponsors:   Centre Francois Baclesse;   French scientific group REFCOR
Not yet recruiting

https://ift.tt/2FjdIvR

Gustatory Function Following Radiotherapy to the Head and Neck

Condition:   Head and Neck Cancer
Interventions:   Other: Olfactory screening;   Other: Quantative Gustatory Testing using Taste Strips
Sponsor:   Royal Marsden NHS Foundation Trust
Recruiting

https://ift.tt/2OJdMEC

Strahlentherapie bei Gliomen

Zusammenfassung

Hintergrund

Die Strahlentherapie (RT) ist eine der wichtigen Säulen der Behandlung von Gliomen. Ständig werden neue Studien zum optimalen Bestrahlungszeitpunkt, der Dosierung und Fraktionierung und zur optimalen Kombination mit anderen Therapieformen publiziert.

Ziel

Die aktuellen Leitlinien und Studienergebnisse werden dargestellt und für die klinische Praxis zusammengefasst.

Material und Methode

Eine Literaturrecherche wurde durchgeführt, und die wichtigsten Publikationen und Leitlinien wurden als Grundlage der Empfehlungen für die klinische Praxis genommen.

Ergebnisse

Für die RT von Low-grade-Gliomen (WHO II) beim Erwachsenen ist das individuelle Risikoprofil entscheidend. Für die Patienten mit erhöhtem Rezidivrisiko ist eine frühe adjuvante RT mit 45–54 Gy empfohlen. Patienten mit High-grade-Gliomen sollten dagegen alle eine adjuvante RT mit einer Dosis von 59,4–60 Gy erhalten. Die Zielvolumendefinition und ob eine konkomittante oder adjuvante Chemotherapie notwendig ist, richtet sich nach dem WHO-Grad und der molekularen Diagnostik. Für Patienten in hohem Alter, mit reduziertem Allgemeinzustand und im Fall von Rezidiven gibt es immer mehr gute strahlentherapeutische Optionen.

Schlussfolgerungen

Die RT von Gliomen ist hinsichtlich der Zielvolumendefinition, Dosis und der Kombination mit Chemotherapie maßgeblich auf die WHO-Klassifikation, die molekulare Diagnostik und den klinischen Allgemeinzustand des Patienten ausgerichtet.

https://ift.tt/2z4SJY8

Salivary duct carcinoma: A prospective multicenter study of 61 cases of the Réseau d'Expertise Français des Cancers ORL Rares

Abstract

Background

The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors.

Methods

Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed.

Results

Sixty‐one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty‐seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety‐four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3‐year overall survival (OS) was 74% and the 3‐year disease‐free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio [HR] 4.3; P = .04). The N2/3 class reduced distant metastasis‐free survival (HR 7.3; P = .007).

Conclusion

Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.

https://ift.tt/2qLimJ4

Food OIT is Superior to Food Avoidance

Publication date: Available online 13 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): J. Andrew Bird

https://ift.tt/2FjMhSu

An Ounce of Caution: Superparamagnetic Iron Oxide Nanoparticle Based MRI Contrast Associated Anaphylaxis

Publication date: Available online 13 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Alexander J. Heckman, Anjali Agarwal, Keith A. Sacco, Brett T. Hiroto, Pramod K. Guru

https://ift.tt/2qKctMg

The Effect of Delayed and Early Diagnosis in Siblings, and Importance of Newborn Screening for SCID

Publication date: Available online 12 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew S. Krantz, Cosby A. Stone, James A. Connelly, Allison E. Norton, Yasmin W. Khan

https://ift.tt/2FjM7KS

Issue Information

https://ift.tt/2OFXj3O

Author Guidelines

https://ift.tt/2z6gxuu

Corrigendum

https://ift.tt/2OD75ny

Reviewers 2018

https://ift.tt/2z7pjbJ

Volume content for 2018

https://ift.tt/2OJeSjA

Celastrol antagonizes high glucose-evoked podocyte injury, inflammation and insulin resistance by restoring the HO-1-mediated autophagy pathway

Publication date: December 2018

Source: Molecular Immunology, Volume 104

Author(s): Xiaojiang Zhan, Caixia Yan, Yanbing Chen, Xin Wei, Jun Xiao, Lijuan Deng, Yuting Yang, Panlin Qiu, Qinkai Chen

Abstract

Diabetic nephropathy (DN) contributes to end-stage renal disease and kidney dysfunction with a proverbial feature of podocyte injury. Inflammation and insulin resistance is recently implicated in the pathogenesis of diabetic kidney injury. Celastrol exerts critical roles in inflammatory diseases and injury progression. However, its function and mechanism in DN remains elusive. Here, celastrol dose-dependently restored podocyte viability under high glucose (HG) conditions, but with little cytotoxicity in podocyte. Preconditioning with celastrol counteracted HG-evoked cell apoptosis, LDH release, ROS production and podocyte depletion. Additionally, HG-elevated high transcripts and secretions of pro-inflammatory cytokines were reversed following celastrol treatment, including IL-1β, TNF-α, IL-6. Simultaneously, the inhibitory effects of HG on insulin-triggered glucose uptake and nephrin expression were overturned after celastrol exposure. Intriguingly, celastrol restored HG-induced deficiency of autophagy pathway. Nevertheless, blocking the autophagy signaling by its antagonist 3-MA muted celastrol-protected against HG-evoked cell injury, inflammation and insulin resistance. Importantly, celastrol enhanced heme oxygenase-1 (HO-1) expression in HG-stimulated podocytes. Notably, HO-1 cessation depressed autophagy pathway activation and subsequently blunted beneficial effects of celastrol on HG-exposed podocytes. These finding suggest that celastrol may protect against HG-induced podocyte injury, inflammation and insulin resistance by restoring HO-1-mediated autophagy pathway, implying a promising therapeutic strategy against DN.

https://ift.tt/2QJFPWs

Detection and location of second mesiobuccal canal in permanent maxillary teeth: a cone-beam computed tomography analysis in a Taiwanese population

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Chi-Chun Su, Ren-Yeong Huang, Yu-Chiao Wu, Wan-Chien Cheng, Ho-Sheng Chiang, Ming-Pang Chung, Yi-Wen Cathy Tsai, Chi-Hsiang Chung, Yi-Shing Shieh

Abstract

Objectives

The aim of this study was to analyze the incidence, symmetry, concurrence of second mesiobuccal canal (MB2) and determine geometric relationships between each orifice of maxillary first and second molars by cone-beam computed tomography (CBCT) analysis.

Methods

A total of 216 qualified individuals' (503 teeth) CBCT image were enrolled in the present study. The consistency of bilateral symmetry and concurrent appearance of MB2 canals were analyzed among individuals with contralateral and adjacent molar teeth. The inter-orifice distances and angulations of first and second molars were also measured.

Results

The overall incidence of MB2 canal of maxillary molars was 39.2%, in which 45.9% and 32.3% in the first and second molars, respectively. The distribution of MB2 canal in contralateral molar teeth has significant gender difference in second molars (p = 0.024) while analyzing the frequency of MB2 canal appearing in contralateral molar pairs. The simultaneous occurrence of MB2 canal was 22.4% for contralateral molars, and the prevalence of concurrent appearance of MB2 canal in the adjacent molars was 43.4%. After adjusting for gender, age, and tooth type, the inter-orifice distances of mesiobuccal to palatal (odds ratios = 1.891) and to distobuccal (odds ratios = 1.448) canals, demonstrated significant differences between molars with and without MB2 canals.

Conclusions

The clinical significance of the results presents critical information on the geometric features, including inter-orifice distances and angulations between each orifice in maxillary molar teeth. Further studies should be conducted to investigate the exact anatomic coordination between each orifice and its impact on access preparation and external crown morphology.

https://ift.tt/2OEDutP

PERIODONTAL MECHANORECEPTORS AND BRUXISM AT LOW BITE FORCES

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Gizem Yilmaz, Christopher Laine, Neslihan Tinastepe, M. Gorkem Ozyurt, Kemal S. Türker

Abstract

Objective

In this study, we examined if 6–9 Hz jaw tremor, an indirect indicator of Periodontal Mechanoreceptor (PMR) activity, is different in bruxists compared to healthy participants during production of a low-level constant bite force.

Methods

Bite force and surface EMG from the masseter muscle were recorded simultaneously as participants (13 patients, 15 controls) held a force transducer between the upper and lower incisors very gently.

Results

Tremor in 6–9 Hz band for bruxists was greater on average compared to controls, but the difference was not significant, both for force recordings and EMG activity.

Conclusions

The low effect sizes measured with the current protocol contrast highly with those of our previous study, where larger, dynamic bite forces were used, and where jaw tremor was markedly different in bruxists compared with controls.

Significance

We have now gained important insight into the conditions under which abnormal jaw tremor can be elicited in bruxism. From a scientific standpoint, this is critical for understanding the 'abnormality' of PMR feedback in bruxism. From a clinical perspective, our results represent progress towards the development of an optimal protocol in which jaw tremor can serve as a biological marker of bruxism.

https://ift.tt/2z4Lgs4

Development and use of a mouth gag for oral experiments in rats

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Ryutaro Kuraji, Shuichi Hashimoto, Hiroshi Ito, Katsuhisa Sunada, Yukihiro Numabe

ABSTRACT

Objective

Rodent models such as mice and rats are often used in investigations of the oral cavity in the fields of periodontology and dental anesthesiology. When various treatments are performed in the oral cavity, it is very important to secure the visual field while keeping the animal's mouth fully opened, in order to ensure the consistency of experimental procedures. Therefore, we developed a standardized gag conforming to various degrees of oral cavity size of different aged rats.

Design

The gag was composed of a rectangular incisor-opening frame constructed from a stainless steel wire with retractors and a dial to alter the opening amounts. Wistar rats (n = 5) aged 4, 8, and 12 weeks were used to evaluate the suitability of the gag in oral cavity. As tests for application of gag in intraoral experiments, the ligature placement around the molars, drug injection into the gingiva, measurement of gingival blood flow rate, and installation of stimulation an electrode for somatosensory-evoked potentials into the molar were performed.

Results

Adjusting the opening dial enabled both the maintenance of open state and more favorable intraoral observation compared with tweezers as a control device in all different types of rats. Furthermore, our gag made it possible to facilitate the insertion of diverse instruments into the oral cavity and to achieve various experimental purposes. The stainless-steel gag can also be autoclaved and dry-heat sterilized.

Conclusion

It was revealed that our mouth gag can be widely applied to various oral experiments in different old aged rats.

https://ift.tt/2OJ3tQW

Detection and location of second mesiobuccal canal in permanent maxillary teeth: a cone-beam computed tomography analysis in a Taiwanese population

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Chi-Chun Su, Ren-Yeong Huang, Yu-Chiao Wu, Wan-Chien Cheng, Ho-Sheng Chiang, Ming-Pang Chung, Yi-Wen Cathy Tsai, Chi-Hsiang Chung, Yi-Shing Shieh

Abstract

Objectives

The aim of this study was to analyze the incidence, symmetry, concurrence of second mesiobuccal canal (MB2) and determine geometric relationships between each orifice of maxillary first and second molars by cone-beam computed tomography (CBCT) analysis.

Methods

A total of 216 qualified individuals' (503 teeth) CBCT image were enrolled in the present study. The consistency of bilateral symmetry and concurrent appearance of MB2 canals were analyzed among individuals with contralateral and adjacent molar teeth. The inter-orifice distances and angulations of first and second molars were also measured.

Results

The overall incidence of MB2 canal of maxillary molars was 39.2%, in which 45.9% and 32.3% in the first and second molars, respectively. The distribution of MB2 canal in contralateral molar teeth has significant gender difference in second molars (p = 0.024) while analyzing the frequency of MB2 canal appearing in contralateral molar pairs. The simultaneous occurrence of MB2 canal was 22.4% for contralateral molars, and the prevalence of concurrent appearance of MB2 canal in the adjacent molars was 43.4%. After adjusting for gender, age, and tooth type, the inter-orifice distances of mesiobuccal to palatal (odds ratios = 1.891) and to distobuccal (odds ratios = 1.448) canals, demonstrated significant differences between molars with and without MB2 canals.

Conclusions

The clinical significance of the results presents critical information on the geometric features, including inter-orifice distances and angulations between each orifice in maxillary molar teeth. Further studies should be conducted to investigate the exact anatomic coordination between each orifice and its impact on access preparation and external crown morphology.

https://ift.tt/2OEDutP

PERIODONTAL MECHANORECEPTORS AND BRUXISM AT LOW BITE FORCES

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Gizem Yilmaz, Christopher Laine, Neslihan Tinastepe, M. Gorkem Ozyurt, Kemal S. Türker

Abstract

Objective

In this study, we examined if 6–9 Hz jaw tremor, an indirect indicator of Periodontal Mechanoreceptor (PMR) activity, is different in bruxists compared to healthy participants during production of a low-level constant bite force.

Methods

Bite force and surface EMG from the masseter muscle were recorded simultaneously as participants (13 patients, 15 controls) held a force transducer between the upper and lower incisors very gently.

Results

Tremor in 6–9 Hz band for bruxists was greater on average compared to controls, but the difference was not significant, both for force recordings and EMG activity.

Conclusions

The low effect sizes measured with the current protocol contrast highly with those of our previous study, where larger, dynamic bite forces were used, and where jaw tremor was markedly different in bruxists compared with controls.

Significance

We have now gained important insight into the conditions under which abnormal jaw tremor can be elicited in bruxism. From a scientific standpoint, this is critical for understanding the 'abnormality' of PMR feedback in bruxism. From a clinical perspective, our results represent progress towards the development of an optimal protocol in which jaw tremor can serve as a biological marker of bruxism.

https://ift.tt/2z4Lgs4

Development and use of a mouth gag for oral experiments in rats

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Ryutaro Kuraji, Shuichi Hashimoto, Hiroshi Ito, Katsuhisa Sunada, Yukihiro Numabe

ABSTRACT

Objective

Rodent models such as mice and rats are often used in investigations of the oral cavity in the fields of periodontology and dental anesthesiology. When various treatments are performed in the oral cavity, it is very important to secure the visual field while keeping the animal's mouth fully opened, in order to ensure the consistency of experimental procedures. Therefore, we developed a standardized gag conforming to various degrees of oral cavity size of different aged rats.

Design

The gag was composed of a rectangular incisor-opening frame constructed from a stainless steel wire with retractors and a dial to alter the opening amounts. Wistar rats (n = 5) aged 4, 8, and 12 weeks were used to evaluate the suitability of the gag in oral cavity. As tests for application of gag in intraoral experiments, the ligature placement around the molars, drug injection into the gingiva, measurement of gingival blood flow rate, and installation of stimulation an electrode for somatosensory-evoked potentials into the molar were performed.

Results

Adjusting the opening dial enabled both the maintenance of open state and more favorable intraoral observation compared with tweezers as a control device in all different types of rats. Furthermore, our gag made it possible to facilitate the insertion of diverse instruments into the oral cavity and to achieve various experimental purposes. The stainless-steel gag can also be autoclaved and dry-heat sterilized.

Conclusion

It was revealed that our mouth gag can be widely applied to various oral experiments in different old aged rats.

https://ift.tt/2OJ3tQW

A randomized clinical trial evaluating maxillary sinus augmentation with different particle sizes of demineralized bovine bone mineral: histological and immunohistochemical analysis

Publication date: Available online 13 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.S. de Molon, F.S. Magalhaes-Tunes, C.V. Semedo, R.G. Furlan, L.G.L. de Souza, A.P. de Souza Faloni, E. Marcantonio, R.S. Faeda

Abstract

This study was performed to investigate sinus floor augmentation with two different particle sizes of demineralized bovine bone mineral (DBBM) by means of histological and immunohistochemical (IHC) analysis. A randomized clinical trial was conducted involving 10 individuals requiring two-stage bilateral maxillary sinus augmentation for implant installation. The patients were randomly divided into two groups following a split-mouth design: the maxillary sinus on one side was filled with small-sized particles (0.25–1 mm) and on the contralateral side with large-sized particles (1–2 mm). After a healing period of 8 months, 25 implants were placed. During implant site preparation, bone biopsies were obtained from each sinus, perpendicular to the long axis of the implant (buccal–palatal direction), for descriptive and histomorphometric analyses. IHC staining for protein expression of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and tartrate-resistant acid phosphatase (TRAP) was also performed. Histomorphometric analysis revealed no statistically significant difference in the percentage of biomaterial (32.4 ± 8.56% and 38.0 ± 6.92%), newly formed bone (36.1 ± 9.60% and 36.7 ± 5.79%), or connective tissue (30.4 ± 8.63% and 23.8 ± 6.16%) between the small- and large-sized particle groups, respectively. IHC analysis did not reveal differences in the expression of OCN, VEGF, or TRAP. These findings suggest that both particle sizes of DBBM are effective for bone augmentation in the maxillary sinus.

https://ift.tt/2qIGfAZ

Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Yang, P.-j. Li, T. Shuai, Y. Wang, C. Mao, G.-y. Yu, C.-b. Guo, X. Peng

Abstract

Free flap transplantation has become a mainstay for the restoration of oral and maxillofacial defects. However, the complexity of the surgical procedure and long hospitalization time result in high hospitalization costs. This study was performed to retrospectively analyse the composition of hospitalization expenses and factors influencing this for 507 patients who underwent oral and maxillofacial free flap transplantation at a representative medical institution in China. The aim was to provide evidence for the reasonable control of expenditure and effective utilization of medical resources, and to gain an indirect reflection of the healthcare model characteristics of public hospitals in China. The average hospitalization cost was found to be US$ 9265 ± 2284. Factors affecting hospitalization expenses were the type of free flap, tracheotomy, postoperative complications, and length of stay. The largest proportion of hospitalization expenses was the cost of materials (44.94%). Although the total hospitalization cost was lower than that in Western countries, the medical burden of patients was higher, and the corresponding medical charges do not fully reflect the value of medical services. We recommend reducing hospitalization expenses and the medical burden by shortening the hospital stay, selecting reasonably priced medical materials, strengthening airway management of patients undergoing tracheotomy, and enhancing the control and treatment of comorbidities in order to reduce the incidence of postoperative complications.

https://ift.tt/2QEDfkr

Comparison of rim-sparing versus rim-removal techniques in deep lateral wall orbital decompression for Graves’ orbitopathy

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Zhang, Y. Li, Y. Wang, S. Zhong, X. Liu, Y. Huang, S. Fang, A. Zhuang, J. Sun, H. Zhou, X. Fan

Abstract

The aim of this study was to compare the surgical outcomes of deep lateral orbital decompression using the rim-sparing technique versus the rim-removal technique in Graves' orbitopathy (GO). A retrospective cohort study of 75 orbits in 50 patients with GO was performed. Proptosis, best corrected visual acuity (BCVA), intraocular pressure (IOP), upper and lower lid margin to reflex distances (MRD-1 and MRD-2, respectively), diplopia, ocular restriction, and GO quality of life (GO-QOL) questionnaire results were analyzed pre- and postoperatively. The average proptosis reduction ranged from 3.5 mm to 6.7 mm with the rim-sparing technique and from 3.6 mm to 6.7 mm with the rim-removal technique (P > 0.05). All orbits with dysthyroid optic neuropathy in the rim-sparing group and 87.5% of such orbits in the rim-removal group showed improved BCVA (P = 0.321). Reductions in IOP, MRD-1, and MRD-2 were observed with both techniques. Patients in the rim-sparing group had greater improvements in GO-QOL appearance score (P = 0.043). In conclusion, rim-sparing orbital decompression provides efficacious outcomes with greater improvements in patient quality of life than the rim-removal technique. The rim-sparing technique should be considered as a preferable option because it preserves the integrity of the lateral vertical maxillary buttress and bony protection for the orbital contents.

https://ift.tt/2qIm9qn

Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A.G. Dellovo, L.M.A. Souza, J.S. de Oliveira, K.S. Amorim, F.C. Groppo

Abstract

Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15 mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO₂)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO₂. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P < 0.0001). More undesirable effects were observed with midazolam (P < 0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine.

https://ift.tt/2QFS9XI

Response to the Letter to the Editor regarding “Impact of crack cocaine use on the occurrence of oral lesions and micronuclei”

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.P. Antoniazzi, L.C. Jardim, M.R. Sagrillo, K.L. Ferrazzo, C.A. Feldens

https://ift.tt/2qK3Sc9

Loss of an IgG plasma cell checkpoint in lupus

Publication date: Available online 13 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jolien Suurmond, Yemil Atisha-Fregoso, Emiliano Marasco, Ashley N. Barlev, Naveed Ahmed, Silvia A. Calderon, Mei Yin Wong, Meggan C. Mackay, Cynthia Aranow, Betty Diamond

Abstract

Background

IgG anti-nuclear antibodies (ANA) are a feature of several autoimmune diseases. These antibodies arise through defects in central or peripheral tolerance checkpoints. The specific checkpoints breached in autoimmune disease are not fully understood.

Objectives

To study whether autoreactive plasma cells in lupus models and SLE patients arise as a consequence of defective antigen-specific selection or a global enhancement of IgG PC differentiation.

Methods and Results

We optimized and validated a novel technique to detect naturally occurring ANA+ B cells and PC. We observed a major checkpoint for generation of ANA+ IgG+ PC in both non-autoimmune mice and healthy human subjects. Interestingly, we observed increased numbers of ANA+ IgG+ PC despite normal tolerance checkpoints in immature and naïve B cells in lupus-prone MRL/lpr and NZB/W mice as well as patients with systemic lupus erythematosus (SLE). This increase was due to increased numbers of total IgG+ PC rather than lack of selection against ANA+ PC.

Conclusion

Using a method that permits quick and accurate quantification of autoreactive B cells and PC in vivo within a native B cell repertoire in mice and humans, we demonstrate the importance of a checkpoint that restricts the generation of IgG plasma cells and protects against IgG ANA. Our observations suggest a fundamentally revised understanding of SLE: that it is a disease of aberrant B cell differentiation rather than a defect in antigen-specific B cell tolerance.

Clinical implication

Therapies for SLE might need to be targeted at IgG plasma cell differentiation rather than antigen-specific tolerance.

Graphical abstract

https://ift.tt/2Qzm43r

Exosome swarms eliminate airway pathogens and provide passive epithelial immunoprotection through nitric oxide

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Angela L. Nocera, Sarina K. Mueller, Jules R. Stephan, Loretta Hing, Philip Seifert, Xue Han, Derrick T. Lin, Mansoor M. Amiji, Towia Libermann, Benjamin S. Bleier

Background

Nasal mucosa–derived exosomes (NMDEs) harbor immunodefensive proteins and are capable of rapid interepithelial protein transfer.

Objectives

We sought to determine whether mucosal exposure to inhaled pathogens stimulates a defensive swarm of microbiocidal exosomes, which also donate their antimicrobial cargo to adjacent epithelial cells.

Methods

We performed an institutional review board–approved study of healthy NMDE secretion after Toll-like receptor (TLR) 4 stimulation by LPS (12.5 μg/mL) in the presence of TLR4 inhibitors. Interepithelial transfer of exosomal nitric oxide (NO) synthase and nitric oxide was measured by using ELISAs and NO activity assays. Exosomal antimicrobial assays were performed with Pseudomonas aeruginosa. Proteomic analyses were performed by using SOMAscan.

Results

In vivo and in vitro LPS exposure induced a 2-fold increase in NMDE secretion along with a 2-fold increase in exosomal inducible nitric oxide synthase expression and function through TLR4 and inhibitor of nuclear factor κB kinase activation. LPS stimulation increased exosomal microbiocidal activity against P aeruginosa by almost 2 orders of magnitude. LPS-stimulated exosomes induced a 4-fold increase in NO production within autologous epithelial cells with protein transfer within 5 minutes of contact. Pathway analysis of the NMDE proteome revealed 44 additional proteins associated with NO signaling and innate immune function.

Conclusions

We provide direct in vivo evidence for a novel exosome-mediated innate immunosurveillance and defense mechanism of the human upper airway. These findings have implications for lower airway innate immunity, delivery of airway therapeutics, and host microbiome regulation.

Graphical abstract

https://ift.tt/2Pqa0oY

Mast Cell CRF2 Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Susan D'Costa, Saravanan Ayyadurai, Amelia J. Gibson, Emily Mackey, Mrigendra Rajput, Laura J. Sommerville, Neco Wilson, Yihang Li, Eric Kubat, Ananth Kumar, Hariharan Subramanian, Aditi Bhargava, Adam J. Moeser

Abstract

Background

Psychological stress and heightened MC activation are linked with important immunological disorders including allergy, anaphylaxis, asthma, and functional bowel diseases, but the mechanisms remain poorly defined. We have previously demonstrated that activation of the corticotropin releasing factor (CRF) system potentiates MC degranulation responses during IgE-mediated anaphylaxis and psychological stress, via CRF receptor subtype 1 (CRF₁) expressed on MCs.

Objective

In this study, we investigated the role of CRF receptor subtype 2 (CRF₂) as a modulator of stress-induced MC degranulation and associated disease pathophysiology.

Methods

In vitro MC degranulation assays were performed with bone marrow derived MCs (BMMCs) derived from WT and CRF₂-deficient (CRF₂^-/-) mice and RBL-2H3 MCs transfected with CRF₂-overexpressing plasmid or CRF₂-siRNA. In vivo MC responses and associated pathophysiology in IgE-mediated passive systemic anaphylaxis (PSA) and acute psychological restraint stress were measured in WT, CRF₂^-/-, and MC-deficient Kit^W-sh/W-sh knock-in mice.

Results

Compared with WT mice, CRF2-/- exhibited heightened serum histamine levels and exacerbated PSA-induced anaphylactic responses and colonic permeability. In addition, CRF₂^-/- mice exhibited increased serum histamine and colonic permeability following acute restraint stress. Experiments with BMMCs and RBL-2H3 MCs demonstrated that CRF₂ expressed on MCs suppresses store-operated Ca²⁺ entry (SOCE) signaling and MC degranulation induced by diverse MC stimuli. Experiments with MC-deficient Kit^W-sh/W-sh mice systemically engrafted with WT and CRF₂^-/- BMMCs demonstrated the functional importance of MC-CRF₂ in modulating stress-induced pathophysiology.

Conclusions

MC CRF₂ is a negative, global modulator of stimuli-induced MC degranulation and limits the severity of IgE-mediated anaphylaxis and stress-related disease pathogenesis.

Graphical abstract

https://ift.tt/2QFQMZ4

Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Matthias Balk, David Schwarz, Philipp Wolber, Andreas Anagiotos, Antoniu-Oreste Gostian

Abstract

Objective

To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures.

Methods

Out of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation.

Results

Patients undergoing partial mastoid obliteration (five ♀, 4 left ears) and overclosure of the external ear canal (one ♀, 3 left ears) averaged 56 years and 61 years, respectively. The radical cavities had been present for 21.8 years on average before partial obliteration and for 19.5 years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1 months and 3.8 months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal.

Conclusion

Partial mastoid obliteration with bone paté and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation.

https://ift.tt/2QDa6pD

Efficacy of anti-PD-1 therapy in a patient with brain metastasis of parotid carcinoma: A case report

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kota Takemoto, Nobuyuki Miyahara, Nobuyuki Chikuie, Takao Hamamoto, Takashi Ishino, Tsutomu Ueda, Sachio Takeno

Abstract

CheckMate 141, an open-label, randomized phase III trial of nivolumab, indicated that treatment with nivolumab prolonged overall survival of patients with platinum-refractory, recurrent head and neck squamous cell carcinoma. Herein, we describe a case of brain metastasis of parotid carcinoma in which a good response was achieved after nivolumab treatment. The patient was a 67-year-old woman with parotid carcinoma (cT4bN0M0) who received induction chemotherapy followed by chemoradiation. Computed tomography and magnetic resonance imaging performed 10 weeks after the primary treatment revealed a residual tumor and brain and lung metastases. Thereafter, chemotherapy comprising cisplatin, 5-FU, and cetuximab was performed. Unfortunately, the tumor volume increased 5 months after chemotherapy, after which she received immunotherapy with biweekly nivolumab. After six cycles of nivolumab administration, the brain and lung metastases shrank markedly. Nivolumab had an intracranial effect in the patient with brain metastases of parotid carcinoma. This case report highlights the efficacy of nivolumab in the management of head and neck cancer with brain metastasis.

https://ift.tt/2qLeMyA

Effects of l-carnitine administration on health-related quality of life during cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kazuhira Endo, Takayoshi Ueno, Kazuya Ishikawa, Yosuke Nakanishi, Satoru Kondo, Naohiro Wakisaka, Tomokazu Yoshizaki

Abstract

Objectives

Cancer-related fatigue impairs daily functioning and negatively impacts health-related quality of life (HRQoL). Our previous study revealed that cisplatin-based chemoradiotherapy (CRT) impairs the carnitine system and carnitine deficiency leads to poor physical functioning. This open label, randomized, controlled prospective study investigated the effects of l-carnitine administration on plasma carnitine concentration, CRT-induced fatigue, and decline in HRQoL in patients with head and neck squamous cell carcinoma (HNSCC).

Methods

Patients were divided into experimental group (received 1000 mg of oral liquid l-carnitine once daily for 8 weeks) and control group. The primary and secondary endpoints were the change in HRQoL scores and the change in carnitine levels, respectively, from baseline (pre-CRT) to after CRT.

Results

The mean total plasma carnitine concentration in the control group decreased significantly, 2 weeks after the end of chemotherapy, while no significant differences were seen in the l-carnitine group. l-carnitine administration, therefore, kept the physical functioning score unchanged.

Conclusion

Our study shows that patients who receive CRT experience chemotherapy-induced damage of carnitine homeostasis leading to deficiency of carnitine and impairment of HRQoL. l-carnitine administration is beneficial in improving the HRQoL in patients with HNSCC.

https://ift.tt/2QCGhp7

Curcumin gum formulation for prevention of oral cavity head and neck squamous cell carcinoma

Objectives/Hypothesis

Head and neck squamous cell carcinoma represents the sixth most common cancer. As a result of field cancerization, second primaries and recurrences are high. Hence, research has focused on chemoprevention. Curcumin, a polyphenol compound with anticarcinogenic properties, is one such promising nutraceutical. As poor bioavailability limits curcumin's use, a novel gum formulation was tested allowing for direct mucosal absorption into the bloodstream. This preliminary study validates curcumin gum efficacy by assessing release and transmucosal absorption, along with measuring its effects on serum cytokine levels.

Study Design

Clinical trial.

Methods

Protocols consisting of initial chew (chewing gum for 30 minutes) and revised chew (alternating chewing and parking gum against buccal mucosa for 30 minutes) were tested in healthy volunteers. High‐performance liquid chromatography measured remnant curcumin in chewed gum, serum, and saliva. Serum levels were assayed for 15 proinflammatory cytokines via multiplex analysis.

Results

Revised chew samples demonstrated significantly higher curcumin release and absorption (P = .0078). Curcumin serum levels were significantly higher at 4 hours in samples > 2.0 g of curcumin release (P = .01). As saliva levels decreased, a concurrent increase in serum levels was observed, with no significance in the inverse relationship (P = .1423). When evaluating differences between gender, race, and age, the Asian population showed significantly lower curcumin release and serum levels (P = .009). CXCL1 (GRO‐α) and TNF‐α were significantly decreased in serum after chewing the gum (P = .036, P < .001, respectively).

Conclusions

Enhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF‐α both represent potential biomarkers for the future study of curcumin chemoprevention.

Level of Evidence

2b Laryngoscope, 2018

https://ift.tt/2QE7YOB

Quantification of injection force mechanics during injection laryngoplasty

Objectives

In‐office or operative injection laryngoplasty requires needle stability for accurate material placement. To date, no reports compare injection forces based on needle gauge, bends, length, or material type or temperature. We hypothesize these factors alter injection forces and could impact clinical use.

Methods

Swine larynges were placed in a compression testing machine. Syringes were affixed to a stabilizing crossbeam. Straight needles (25G 1.5‐inch; 27G 1.25‐inch; or 9.8‐inch malleable shaft 16G per oral with 24G tapered needle tip) were inserted into the swine vocal folds to simulate realistic tissue resistance pressure. Compressive loading was conducted at 40 mm/minute until steady‐state force was achieved. Tests were completed with calcium hydroxylapatite (CaHa), carboxymethylcellulose, and hyaluronic acid at various temperatures and CaHa with various bends in the needles (n = 3 per group, comparisons performed by two‐way analysis of variance (ANOVA), Tukey's post‐hoc).

Results

Needle size, shape, and temperature altered injection force. Steady‐state force was highest with the per‐oral needle at a mean of 44.55N compared to 26.44N and 29.77N in the 25G and 27G percutaneous needles, respectively (P < 0.001). Stiffness rate (initial increasing force vs. distance to initiate injection) ranged from 19.75N/mm (per oral) to 22.06N/mm (25G) to 24.56N/mm (27G), (P = 0.875). Adding multiple bends to the per‐oral needle increased stiffness rate to 24.99N/mm (P = 0.035), whereas the 25G needle stiffness rate remained unchanged (P = 0.941), with the stiffness rate decreasing in the 27G needle with increasing bends (P = 0.033). Increased temperature decreased injection forces across all materials.

Conclusion

Needle caliber, length, and bends impact steady‐state forces and stiffness rates during vocal fold injection.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PpLbJv

Gamification as a tool for resident education in otolaryngology: A pilot study

https://ift.tt/2QCope3

T‐Helper 2 Lymphocyte Immunophenotype Is Associated With Iatrogenic Laryngotracheal Stenosis

Objective/Hypothesis

This prospective controlled human and murine study assessed the presence of inflammatory cells and cytokines to test the hypothesis that immune cells are associated with fibroproliferation in iatrogenic laryngotracheal stenosis (iLTS).

Methods

Inflammation was assessed by histology and immunofluorescence (IF), quantitative real‐time polymerase chain reaction (qRT‐PCR), and flow cytometry of cricotracheal resections of iLTS patients compared to normal controls. An iLTS murine model assessed the temporal relationship between inflammation and fibrosis.

Results

iLTS specimens showed increased inflammation versus normal controls (159/high power field [hpf] vs. 119/hpf, P = 0.038), and increased CD3 + T‐cells, CD4 + cells, and CD3+/CD4 + T‐helper (T_H) cells (all P < 0.05). The inflammatory infiltrate was located immediately adjacent to the epithelial surface in the superficial aspect of the thickened lamina propria. Human flow cytometry and qRT‐PCR showed a significant increase in interleukin (IL)‐4 gene expression, indicating a T_H2 phenotype. Murine IF revealed a dense CD4 + T‐cell inflammatory infiltrate on day 4 to 7 postinjury, which preceded the development of fibrosis. Murine flow cytometry and qRT‐PCR studies mirrored the human ones, with increased T‐helper cells and IL‐4 in iLTS versus normal controls.

Conclusion

CD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a T_H2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2Pq9siU

Extranodal extension in resected oral cavity squamous cell carcinoma: more to it than meets the eye

Objective/Hypothesis

Extranodal extension (ENE) is an independent prognosticator in head–neck Squamous cell carcinoma (SCC). All patients with ENE, however, do not behave the same, and there is a need for further risk stratification. This study evaluates the prognostic significance of various grades of ENE and the number of nodes with ENE on overall survival (OS) in oral cavity SCC (OCSCC).

Study Design

Retrospective cohort study.

Methods

Ninety‐four patients with node‐positive OCSCC treated with primary surgery and appropriate adjuvant therapy during the year 2011 were evaluated. Surgical histopathology slides of all patients were reviewed, and ENE was graded according to the grading system proposed by Lewis Jr et al.

Results

On univariate analysis, lymph node density (LND) greater than or equal to 0.12 (P = 0.013), the presence of ENE in more than two nodes (P = 0.006), and ENE grade 3 through 4 (P = 0.035) were associated with worse (OS). Conventional prognostic factors such as tumor (T) stage, nodal (N) stage, stage grouping, depth of invasion, and pattern of invasion did not have a significant impact on OS. On multivariate analysis, the presence of ENE in more than two nodes (P = 0.018) independently predicted a worse OS. Extranodal extension grade 3 through 4 showed a trend toward significance (P = 0.08). A combination of LND greater than or equal to 0.12, ENE grade 3 through 4, and ENE in more than two lymph nodes conferred the poorest prognosis (3‐year OS: 18%; P = 0.000).

Conclusion

In patients with ENE and advanced nodal disease, T stage, N stage, stage group, depth, and pattern of invasion lose their impact on OS. In patients with ENE, nodal characteristics such as LND, the number of nodes with ENE, and grade of ENE serve as important prognosticators and aid in further risk stratification.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2QLAei0

Effects of oral isotretinoin therapy on the nasal cavities

Publication date: Available online 12 November 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Hamdi Tasli, Aslan Yurekli, Mert Cemal Gokgoz, Omer Karakoc

Abstract

Introduction

Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure.

Objective

The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy.

Methods

Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints.

Results

The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0–5); 0.35 ± 1.30 (0–5) at admission, 3.57 ± 4.45 (0–10); 2.26 ± 4.71 (0–20) at the first month, and 4.28 ± 6 (0–20); 2.26 ± 4.71 (0–20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12–0.56) Pa/cm³/s at admission, 0.21 ± 0.084 (0.12–0.54) Pa/cm³/s at the first month, and 0.216 ± 0.081 (0.14–0.54) Pa/cm³/s at the third month.

Conclusion

Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.

Resumo

Introdução

A isotretinoína (ácido-13 cis-retinóico) é o tratamento por via oral mais eficaz para acne vulgar e é a única opção de tratamento que pode produzir remissão ou cura permanente.

Objetivo

O objetivo deste estudo foi utilizar métodos subjetivos e objetivos para avaliar as queixas nasais de pacientes com acne grave que receberam terapia com isotretinoína oral.

Método

Cinquenta e quatro indivíduos foram incluídos no estudo. Todos os indivíduos foram avaliados por meio de testes subjetivos (questionários NOSE e escala EVA) e objetivos (rinomanometria e teste de sacarina) para determinar a gravidade de suas queixas nasais.

Resultados

Os escores médios de gravidade (min: 0; max: 100) para ressecamento/crostas e epistaxe nasal foram de 0,47 ± 1,48 (0-5); 0,35 ± 1,30 (0-5) no início, 3,57 ± 4,45 (0-10); 2,26 ± 4,71 (0-20) no primeiro mês e 4,28 ± 6 (0-20); 2,26 ± 4,71 (0-20) no terceiro mês do tratamento, respectivamente. A resistência nasal total foi de 0,195 ± 0,079 (0,12 a 0,56) Pa/cm³/s no início, 0,21 ± 0,084 (0,12 a 0,54) Pa/cm³/s no primeiro mês e 0,216 ± 0,081 (0,14 a 0,54) Pa/cm³/s no terceiro mês.

Conclusão

A terapia com isotretinoína por via oral pode resultar em queixa de obstrução nasal. Além disso, queixas nasais tais como ressecamento/formação de crostas e epistaxe, aumentam significativamente nos pacientes durante o esquema terapêutico.

https://ift.tt/2B2F9pF

Effect of technetium‐99 conjugated with methylene diphosphonate (99Tc‐MDP) on OPG/RANKL/RANK system in vitro

Abstract

Background

RANKL and RANK play an important role in jaw resorption during the development of the ameloblastomas. Therefore, the aim of this study was to explore the effect of ⁹⁹Tc‑MDP on OPG/RANKL/RANK system on RAW264.7 and MC3T3‐E1 cell lines in vitro, and provide the theoretical basis for the clinical treatment of the jaw ameloblastoma.

Methods

Different concentrations of ⁹⁹Tc‐MDP were used to treat RAW264.7 and MC3T3‐E1 cell lines. The cell proliferative inhibition rate was analyzed by CCK‐8. Cell apoptosis and cell cycle were detected by flow cytometry. Western blot were used to detect the expression of OPG, RANKL and RANK.

Results

Treatment of RAW264.7 cell lines with different concentrations of ⁹⁹Tc‐MDP had inhibitory effects and decreased the expression of RANK protein. The cell proliferation of ⁹⁹Tc‐MDP on MC3T3‐E1cell lines was stronger at 48h than at 24h except for 100μg/ml concentration group. Compared with the concentration of 0.01μg/ml, the treatment of MC3T3‐E1 cells with 100μg/ml ⁹⁹Tc‐MDP showed that the cell proliferative effect decreased at 24h and 48h (P<0.05). After treatment with 0.01μg/ml ⁹⁹Tc‐MDP, the expression of OPG in MC3T3‐E1 cells was significantly increased (P<0.05). Compared with 0.01μg/ml, the expression of RANKL was decreased after treatment with 100μg/ml ⁹⁹Tc‐MDP (P<0.05).

Conclusion

⁹⁹Tc‐MDP can induce apoptosis of RAW264.7 cells and inhibit the expression of RANK protein. The effect of 0.01μg/ml of low concentration of ⁹⁹Tc‐MDP can promote the proliferation of MC3T3‐E1 cells and increase the expression of OPG and RANKL protein. ⁹⁹Tc‐MDP may have adjuvant therapeutic effects on the treatment of jaw ameloblastoma.

This article is protected by copyright. All rights reserved.

https://ift.tt/2ODvHwh

Secondary alveolar bone grafting in cleft lip and palate: A comparative analysis of donor site morbidity in different age groups

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Andrzej Brudnicki, Martin Rachwalski, Łukasz Wiepszowski, Ewa Sawicka

Abstract

Introduction

There is no consensus regarding the optimal timing for secondary alveolar bone grafting for clefts defects. We aimed to investigate the potential correlation between the age of patients during surgery, donor site symptoms, surgical time and hospitalization following this procedure.

Material and methods

The outcome of 195 consecutive alveolar bone grafting procedures among different age groups (mean: 7.1 years; range 1.8-40.5) was retrospectively assessed based on a chart review and purpose-prepared report forms. The association between age, gender and hospitalization following bone harvesting was tested by Spearman rank correlation, while relationships (i.e. between age and pain) were evaluated by logistic regression.

Results

The most frequent donor site complaints included: pain equal to or exceeding that of the recipient site (93%) and gait disturbances (92.5%) immediately after the procedure. Chronic complaints included: iliac contour alteration (40.1%), unsightly scar (23%) and recurring discomfort (2.1%). Statistical analysis showed no correlation between donor site symptoms, their duration or hospitalization time following surgery at different ages, except a higher incidence of significant pain immediately after bone harvesting in older females (r = 0.268; p = 0.030).

Conclusion

Alveolar bone grafting at an earlier age does not increase donor site symptoms, surgical duration or hospitalization following surgery.

https://ift.tt/2qLb73Q

Reliable manifestations of increased intracranial pressure in patients with syndromic craniosynostosis

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): So Young Kim, Jung Won Choi, Hyung-Jin Shin, So Young Lim

Summary

Purpose

Systematic examination of increased intracranial pressure (ICP) is important during the follow-up period after surgical repair of syndromic craniosynostosis. In these patients, postoperative progress can be unclear due to the involvement of multiple sutures and the high incidence of relapse due to the progressive nature of the disease and to genetic variability. In this study, we investigated the clinical manifestations of increased ICP in syndromic craniosynostosis patients before and after surgery.

Materials And Methods

We collected pre- and post-operative data from patients with syndromic craniosynostosis from January 2004 and December 2014 on the clinical manifestations of increased ICP, namely, the presence of 1) subjective symptoms 2) visual disturbances and papilledema, 3) thumbprinting phenomenon (beaten copper appearance) on skull x-ray, and 4) hydrocephalus on computed tomography.

Results

A total of 17 syndromic craniosynostosis patients were included in this study, and three distinct patterns of disease progress were noted. Among all patients who underwent cranioplasty, the significant finding with regards to clinical manifestations was amelioration of the beaten copper appearance on skull x-ray after surgery. Likewise, among patients with recurrent increased ICP during the postoperative follow-up period, numerous clinical manifestations were noted, including subjective symptoms (33.3%), papilledema (50%), ventricular dilation (66.6%), and a beaten copper appearance on skull x-ray (100%).

Conclusion

Close monitoring to detect increased ICP is important during follow-up of patients with syndromic craniosynostosis. Among non-invasive methods for indirectly assessing ICP post-operatively, a beaten copper appearance on skull x-ray may be a reliable indicator of increased ICP.

https://ift.tt/2QCky0z

Cyanoacrylate tissue adhesive or silk suture for closure of surgical wound following removal of an impacted mandibular third molar: A randomized controlled study

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Afisu A. Oladega, Olutayo James, Wasiu L. Adeyemo

Summary

Aim

The aim of the study was to compare postoperative sequelae and wound healing outcome following closure of surgical wound with either cyanoacrylate tissue adhesive or silk suture.

Methods

Subjects with mesio-angularly impacted mandibular third molar were allocated randomly into 2 equal groups. The control group had wound closure with silk suture and study group with cyanoacrylate tissue adhesive. Subjects were followed up for 7 postoperative days. Post-operative pain, swelling, trismus, bleeding, wound dehiscence and wound infection were evaluated.

Results

Sixty subjects in each group completed the study. No significant difference was observed in the mean post-operative pain, swelling, trismus, wound dehiscence and infection between the 2 groups. There was a statistically significant difference in post-operative bleeding between the 2 groups on post-operative day 1, with more bleeding in the control group.

Conclusions

This study shows that cyanoacrylate tissue adhesive compares favourably with silk suture as a wound closure material. In addition, cyanoacrylate tissue adhesive seems to have beneficial haemostatic effect on post-operative bleeding.

https://ift.tt/2qKUSDE

An in-vitro evaluation of a novel design of miniplate for fixation of fracture segments in the transition zone of parasymphysis-body region of mandible using finite element analysis

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Abhay Datarkar, Shikha Tayal, Abhishek Thote, Manlio Galie

Summary

The mandibular parasymphysis and body regions are highly dynamic areas. They are constantly subjected to both occlusal and muscular forces. Fractures at this transition zone of the parasymphysis and body region thus represent a special pattern that creates a dilemma for the surgeons — whether to use one miniplate fixation or two miniplates as per Champy's guidelines. Mental nerve paresthesia is a very common complication due to dissection and stretching of the mental nerve in this region. Hence, an in-vitro research study of a novel twin fork design of miniplate is performed, which evaluates the biomechanical behavior using computerized finite element analysis. A comparison is carried out with the conventional design. The results show that the twin fork miniplate produces the lowest stresses — 23.821 MPa — and the least total structural deformation after applying the maximum occlusal bite force. This study concludes that the newly designed miniplate is superior in terms of stability because it shows the least structural deformation, and produces the lowest equivalent stresses on application of maximal occlusal forces. An additional advantage is the preservation of the mental nerve during the plating procedure because the broad end of the Y shape allows atraumatic positioning of the miniplate and hence the fixation of fractured segments.

https://ift.tt/2QEwe2S

Novel mutations identified in patients with tooth agenesis by whole‐exome sequencing

Abstract

Objectives

To identify potentially pathogenic mutations for tooth agenesis by whole‐exome sequencing.

Subjects and Methods

Ten Chinese families including 5 families with ectodermal dysplasia (syndromic tooth agenesis) and 5 families with selective tooth agenesis were included. Whole‐exome sequencing was performing using genomic DNA. Potentially pathogenic mutations were identified after data filtering and screening. The pathogenicity of novel variants were investigated by segregation analysis, in silico analysis and functional studies.

Results

One novel mutation (c.441_442insACTCT) and three reported mutations (c.252delT, c.463C>T, and c.1013C>T) in EDA were identified in families with ectodermal dysplasia. The novel EDA mutation was co‐segregated with phenotype. A functional study revealed that NF‐κB activation was compromised by the identified mutations. The secretion of active EDA was also compromised detecting by western blotting. Novel Wnt10A mutations (c.521T>C and c.653T>G) and EVC2 mutation (c.1472C>T) were identified in families with selective tooth agenesis. The Wnt10A c.521T>C mutation and the EVC2 c.1472C>T mutation were considered as pathogenic for affecting highly conserved amino acids, co‐segregated with phenotype and predicted to be disease‐causing by SIFT and PolyPhen2. Moreover, several reported mutations in PAX9, Wnt10A and FGFR3 were also detected.

Conclusions

Our study expanded our knowledge on tooth agenesis spectrum by identifying novel variants.

This article is protected by copyright. All rights reserved.

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Extranasopharyngeal Angiofibroma Arising from the Anterior Nasal Septum in a 35-Year-Old Woman

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1675809

Angiofibroma is a relatively rare vascular lesion originating predominantly in the nasopharynx and occurs typically in male adolescents. Extranasopharyngeal sites of origin, such as nasal cavity, paranasal sinuses, pharynx, and larynx, are extremely rarely seen in clinical practice. In the nasal cavity, extranasopharyngeal angiofibromas (ENAs) have been reported to originate from the nasal septum, as well as from the middle and inferior turbinate. In this study, we report a case of a 35-year-old female patient with angiofibroma originating from the anterior part of the nasal septum with left-sided nasal obstruction and mild-to-moderate epistaxis as main complaints. After the radiological diagnostics and embolization of sphenopalatine artery, we performed the excision of the lesion with removal of small part of septal mucosa and perichondrium around the attachment of tumor pedicle. Histopathological examination suggested the presence of angiofibroma and diagnosis was confirmed by immunohistochemical analysis. This is the fifth reported case of septal ENA in female population in the English-language literature.
[...]

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

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The absence of Rab27a accelerates the degradation of Melanophilin

Abstract

Melanophilin (Mlph) forms an interaction with Rab27a and the actin‐based motor protein MyosinVa (MyoVa) on mature melanosome membranes and the tripartite complex regulates melanosome transport in melanocytes. In this study, we found that Rab27a siRNA decreased Mlph and Rab27a protein levels, but Mlph mRNA levels were not changed. Other Rab27a siRNA sequences also showed the same results. When Rab27a siRNA was treated with melan‐a melanocytes, Rab27a protein was decreased within 6 h and Mlph protein was decreased within 24 h. To determine whether the absence of Rab27a promotes Mlph degradation, we inhibited protein degradation by treatment with proteasome (MG132) and lysosomal enzyme (E64D and Pepstatin A) inhibitors in melan‐a melanocytes. MG132 inhibited the degradation of Mlph, but E64D and Pepstatin A had no effect on Mlph. The absence of Rab27a enhanced ubiquitination of Mlph and induced proteasomal degradation. From these results, we concluded that Mlph interaction with Rab27a is important for Mlph stability and melanosome transport.

This article is protected by copyright. All rights reserved.

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Depilatory chemical thioglycolate affects hair cuticle and cortex, degrades epidermal cornified envelopes and induces proliferation and differentiation responses in keratinocytes

Abstract

Thioglycolate is a potent depilatory agent. In addition, it has been proposed to be useful as a penetration enhancer for transepidermal drug delivery. However, the effects on hair structure and stress responses it elicits in epidermal keratinocytes have not been fully characterized. We have used label‐free confocal and fluorescence lifetime imaging supported by electron microscopy to demonstrate how thioglycolate damages hair cuticle cells by generating breakages along the endocuticle and leading to swelling of cortex cells. Maleimide staining of free SH‐groups and a decrease in the average fluorescence lifetime of endogenous fluorophores demonstrate a specific change in protein structure in both hair cuticle and cortex. We found that the thioglycolate damages cornified envelopes isolated from the stratum corneum of the epidermis. However, thioglycolate‐treated epidermal equivalent cultures recover within 48 hours, which highlights the reversibility of the damage. HaCaT keratinocytes respond to thioglycolate by increased proliferation, onset of differentiation and expression of the chaperone protein Hsp 70, but not Hsp 27. Up‐regulation of involucrin can be blocked by an application of c‐Jun N–terminal kinase (JNK) inhibitor, but the up‐regulation of Hsp 70 takes place regardless of the presence of the JNK inhibitor.

This article is protected by copyright. All rights reserved.

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A paediatric puzzle: pulsating, pruritic papules and plaques

https://ift.tt/2QJz0UQ

The Invisible Costs of Hearing Loss.

The Invisible Costs of Hearing Loss.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: McKee MM

PMID: 30419139 [PubMed - as supplied by publisher]

https://ift.tt/2zKEaby

Incident Hearing Loss and Comorbidity: A Longitudinal Administrative Claims Study.

Incident Hearing Loss and Comorbidity: A Longitudinal Administrative Claims Study.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Deal JA, Reed NS, Kravetz AD, Weinreich H, Yeh C, Lin FR, Altan A

Abstract
Importance: Because hearing loss is highly prevalent and treatable, determining its association with morbidity has major public health implications for disease prevention and the maintenance of health in adults with hearing loss.
Objective: To investigate the association between the diagnosis of incident hearing loss and medical comorbidities in adults 50 years or older.
Design, Setting, and Participants: Retrospective, propensity-matched cohort study using administrative claims data from commercially insured and Medicare Advantage members in a geographically diverse US health plan. Adults 50 years or older with claims for services rendered from January 1, 2000, to December 31, 2016, were observed for 2 (n = 154 414), 5 (n = 44 852), and 10 (n = 4728) years. This research was conceptualized and data were analyzed between September 2016 and November 2017.
Exposures: A claim for incident hearing loss is defined as 2 claims for hearing loss within 2 consecutive years without evidence of hearing device use, excluding claims for sudden hearing loss or hearing loss secondary to medical conditions.
Main Outcomes and Measures: Incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke.
Results: After cohort matching, 48% of participants were women (n = 74 464), 61% were white (n = 93 442), and 31% (n = 48 056) were Medicare Advantage insured, with a mean (SD) age of 64 (10) years. In a multivariate-adjusted modified Poisson regression with robust standard errors, relative associations were strongest for dementia (relative risk at 5 years, 1.50; 95% CI, 1.38-1.64) and depression (relative risk at 5 years, 1.41; 95% CI, 1.26-1.58). The absolute risk of all outcomes was greater in persons with hearing loss than in those without hearing loss at all times, with the greatest risk difference observed at 10 years for all outcomes. The 10-year risk attributable to hearing loss was 3.20 per 100 persons (95% CI, 1.76-4.63) for dementia, 3.57 per 100 persons (95% CI, 1.67-5.47) for falls, and 6.88 per 100 persons (95% CI, 4.62-9.14) for depression.
Conclusions and Relevance: In this large observational study using administrative claims data, incident untreated hearing loss was associated with greater incident morbidity than no hearing loss across a range of health conditions. Future studies are needed to elucidate the mechanisms underlying these associations and to determine if treatment for hearing loss could reduce the risk of comorbidity.

PMID: 30419134 [PubMed - as supplied by publisher]

https://ift.tt/2T6Ticd

Analysis of Clinical Features of Mammary Analog Secretory Carcinoma Using the Surveillance, Epidemiology, and End Results Database.

Analysis of Clinical Features of Mammary Analog Secretory Carcinoma Using the Surveillance, Epidemiology, and End Results Database.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Anderson JL, Haidar YM, Armstrong WB, Tjoa T

PMID: 30419133 [PubMed - as supplied by publisher]

https://ift.tt/2zNjXSv

Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years.

Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Reed NS, Altan A, Deal JA, Yeh C, Kravetz AD, Wallhagen M, Lin FR

Abstract
Importance: Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.
Objective: To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.
Design, Setting, Participants: Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.
Exposures: Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.
Main Outcomes and Measures: Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.
Results: Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.
Conclusions and Relevance: Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.

PMID: 30419131 [PubMed - as supplied by publisher]

https://ift.tt/2T6T057

Epidemiologic, Imaging, Audiologic, Clinical, Surgical, and Prognostic Issues in Common Cavity Deformity: A Narrative Review.

Epidemiologic, Imaging, Audiologic, Clinical, Surgical, and Prognostic Issues in Common Cavity Deformity: A Narrative Review.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Brotto D, Avato I, Lovo E, Muraro E, Bovo R, Trevisi P, Martini A, Manara R

Abstract
Importance: Common cavity deformity is a rare congenital inner ear malformation associated with profound hearing loss and attributed to an early developmental arrest of the cochlear-vestibular structures. This narrative review highlights the need to identify reliable indicators of hearing rehabilitation outcome.
Observations: Despite its relatively simple definition, common cavity deformity varies widely in morphologic features, presence of cochlear nerve fibers and remnants of Corti organ, and outcome after cochlear or brainstem implant.
Conclusions and Relevance: Cochlear implant has been shown to be a valid option for common cavity deformity, but its outcome remains variable and poor. Identification of specific neuroradiologic, audiologic, and neurophysiologic prognostic features; tailoring of the surgical approach; and standardization of outcome measures are needed to optimize the management of common cavity deformity and hearing rehabilitation after implant.

PMID: 30419122 [PubMed - as supplied by publisher]

https://ift.tt/2zLikF0

Association of Age-Related Hearing Loss With Multiple Adverse Health Outcomes.

Association of Age-Related Hearing Loss With Multiple Adverse Health Outcomes.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Loughrey D

PMID: 30419115 [PubMed - as supplied by publisher]

https://ift.tt/2T6SMeh

Severe Nasal Swelling.

Severe Nasal Swelling.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 08;:

Authors: Goldman-Yassen A, Bello J, Shifteh K

PMID: 30419094 [PubMed - as supplied by publisher]

https://ift.tt/2zLi4Wy

Does apico-coronal implant position influence peri-implant marginal bone loss? A 36-months follow-up randomized clinical trial.

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Hilario Pellicer-Chover, Maria Peñarrocha-Diago, Amparo Aloy-Prosper, Luigi Canullo, Miguel Peñarrocha-Diago, David Peñarrocha-Oltra

Abstract

Objective

Preserving peri-implant bone and reducing the exposure of rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiological parameters after crestal and subcrestal dental implant placement at 36 months of follow-up.

Material and methods

A randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown was carried out. The patient was randomized according to the implant insertion depth: test group (implants placed approximately 2 mm below the bone crest) or control group (implants placed at bone crest level). The patients were evaluated 6, 12, 24 and 36 months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36 months of follow-up were calculated.

Results

The study comprised 128 patients (83 men and 45 women – mean age 54.4±12.2 years) and a total of 265 implants (133 in the control group and 132 in the test group). There were no statistically significant differences in the peri-implant clinical parameters. After three years of follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of -0.2±0.3 mm and -0.09±0.1 mm, respectively (p=0.001). The overall success rate was 99.6%.

Conclusions

Crestal and subcrestal implants showed similar clinical outcomes three years after prosthetic loading. Significant differences were observed in the radiological parameters, showing subcrestal implants less peri-implant marginal bone loss.

https://ift.tt/2T5EDy2

Dental and maxillofacial signs in Leri-Weill dyschondrosteosis

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Arnaud Depeyre, Matthias Schlund, Romain Nicot, Joel Ferri

https://ift.tt/2zMEKpq

Shining Sunlight on Industry Payments in Oral and Maxillofacial Surgery: The Sunshine Act

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yisi D. Ji, Zachary S. Peacock

Abstract

Purpose

To characterize industry payments to oral and maxillofacial surgeons (OMSs) and to determine the accuracy of the Centers for Medicare & Medicaid Services (CMS) Open Payments Databases.

Methods

This was a cross-sectional study of the CMS General and Research Payments Database in 2016 for clinicians categorized as an OMS. General payments include consulting fees, honoraria, gifts, entertainment, food and beverage, travel, and education, and others. Research payments include payments associated with research. Variables collected included number of OMSs who receive payments, type of and number of payments, total amount paid, geographic distribution, and proportion of funding allotted to research. The accuracy of payee categorization was determined by verifying a random selection of 5% of those categorized as 'OMS' in the database to publicly available data. To assess impact on research productivity, the h-index of research payment recipients was calculated.

Results

A total of 6720 OMSs received industry compensation in 2016. The accuracy was 88% (297/336) in the General Payments database and 50% (4/8) in the Research payments database.

OMSs received 28456 General payments totalling $5,971,800.79. The average number of payments and amount per payment was 4.27 and $1597.60, respectively. CMS reported total Research payments of $23,592.17. The 4 verified OMSs received a total of $18,500 in research payments and had an average h-index of 3.25 (range 0 to 8).

The most common payments made were for food and beverage (80.2%), travel and lodging (5.83%), education (3.91%), compensation for services other than consulting (3.1%) and gifts (3.03%). Research accounted for 0.07% of all payments.

Conclusion

Although industry payments to OMSs were common, research funding was negligible. The majority of industry value-transfers were related to food and beverage or travel and lodging. Clinicians were accurately classified in CMS' Open Payments General database but not for Research Payments.

https://ift.tt/2TaEzgl

Simultaneous four‐channel recording of bilateral cervical and ocular vestibular‐evoked myogenic potentials in response to stimulation by forehead bone‐conducted vibration: Our experience in 20 healthy adults

Abstract

Various vestibular stimuli, including air‐conducted sound (ACS), bone‐conducted vibration (BCV), and galvanic vestibular stimulation (GVS), can be used to elicit vestibular‐evoked myogenic potential (VEMP). VEMP obtained from the sternocleidomastoid (SCM) muscle is called cervical VEMP (cVEMP), while that recorded at extraocular muscles is termed ocular VEMP (oVEMP). cVEMP was first recognized as fundamental in determining the sacculo‐collic reflex (SCR) pathway in the mid‐1990s. In the mid‐2000s, oVEMP was successfully recorded and emerged as the basis for a promising examination for evaluating the integrity of the vestibulo‐ocular reflex (VOR) pathway.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PSoe1c

Implementation of modern tools in autopsy practice—the way towards contemporary postmortal diagnostics

Abstract

Medical, legal, and socioeconomic issues have contributed to the decline of autopsy rates. Pathology-related factors, however, with changing clinical duties on the one hand and decreasing interest and lack of substantial technical developments in this field on the other, may have contributed to this condition as well. We present our experience of a restructuring project that culminated in the introduction of a modernized postmortal diagnostic (PMD) unit: Workflows of PMD procedures and space organization were restructured according to LEAN management principles method. Classical autopsy suites were transformed into postmortal operating rooms. A PMD pathologist staff was designated to perform postmortal operative diagnostics (i.e., using laparotomy and thoracotomy approaches) with the intention of gradually replacing classical autopsy procedures. Postmortal minimal invasive diagnostics (PMID) using laparoscopy and thoracoscopy were successfully implemented with the expertise of clinical colleagues. Reorganization of workflow reduced turn-around times for PMD reports from a median of 33 days to 15 days. Short-term analysis revealed that this combined effort leads to a slight increase in the number of adult postmortal examinations 1 year after the introduction of this project. A change of culture in postmortal diagnostics may contribute to a better reputation of postmortal examinations from the perspective of clinicians, the general public, and affected relatives of the deceased. It may also serve to demonstrate that the pathology community is keen not only to preserve but also to further develop this valuable tool for medical quality control and education.

https://ift.tt/2B4i1Hr

An unusual presentation of metastatic malignant melanoma causing jejuno-jejunal intussusception: a case report

Small bowel intussusception in adults is rarely encountered. In most cases small bowel intussusception is caused by benign neoplastic lesions, but metastasis of cutaneous malignant melanoma causing small bowel...

https://ift.tt/2FiN32f

15q23 Gain in a Neonate with a Giant Omphalocele and Multiple Co-Occurring Anomalies

Background. Omphalocele is a rare congenital abdominal wall defect. It is frequently associated with genetic abnormality and other congenital anomalies, although isolated omphalocele cases do exist. Data have shown that omphalocele with co-occurring genetic abnormality has worse prognosis than isolated omphalocele. Chromosomal analysis by a conventional technique such as karyotyping can only detect aneuploidy and large segmental duplication or deletion. Newer techniques such as high-resolution microarray analysis allow for the study of alterations in chromosomal segments that are less than 5 Mb in length; this has led to identification of critical region and genes in the pathogenesis of omphalocele. Case Presentation. The current study is the initial report of a newborn male with a 15q23 gain and a giant omphalocele. High-resolution chromosomal microarray analysis identified this gain of copy number spanned 676 kb, involving almost the entire NOX5 gene (except for exon 1 of the longer transcript), the entirety of the EWSAT1, GLCE, PAQR5, KIF23, RPLP1, and DRAIC genes and exons 1–3 of the PCAT29 gene. Conclusion. To date, this is the first report of an associated 15q23 gain in a case with omphalocele. Interestingly, Giancarlo Ghiselli and Steven A Farber have reported that GLCE knockdown impairs abdominal wall closure in zebrafish. We also identified GLCE gene alteration in our case. This highlights the importance of GLCE in abdominal wall development. Further study of the function of GLCE and other genes might lead to a better understanding of the molecular mechanism of omphalocele.

https://ift.tt/2z9Enpl