Halitosis: Helicobacter pylori or oral factors

Abstract

Introduction

Halitosis is a common complaint among people which has various socioeconomic effects. The prevalence of halitosis includes a variety of 22% up to 50% in different societies. According to studies, there have been reports of remarkable improvements in halitosis after Helicobacter pylori eradication treatment. In studies on the relationship between H. Pylori and halitosis, the role of oral factors as the most important cause of halitosis has been neglected. This study was conducted with the aim of investigating the effect of oral factors on halitosis in patients with H. Pylori.

Materials and Methods

A total of 100 dyspeptic patients who had H. pylori‐positive serologic test were examined by an organoleptic method for the presence of halitosis. DMFT index was used in order to record the dental status. Oral hygiene was evaluated using the simplified oral hygiene index (OHI‐S).

Results

The mean DMFT index was 9.09 ± 3.97. The score of simplified oral hygiene index was 1.79 ± 0.949. There was a direct and significant relationship between halitosis with DMFT, OHI‐S (P < 0.01). There was no significant relationship between halitosis and coated tongue (P > 0.01).

Conclusions

According to the results of this study, there is a relation between oral factors and halitosis in patients with positive H. pylori test. Due to the lower level of all these indices in patients with halitosis, we cannot attribute halitosis in patients with H. pylori infection to the presence of this microorganism with certainty.

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Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

Abstract

Background

Helicobacter pylori treatment recommendations often recommend use of double‐dose PPI or greater. This is confusing because PPIs very markedly in relative potency such that a double dose of one may not even be equivalent to the single dose of another.

Objective

To relate the concept of double‐dose to specific amounts of the different PPIs

Methods

We used data standardizing PPI potency in terms of the duration of intragastric pH >4/24 hours (pH4‐time) to rank PPIs. Relative potency varies from 4.5 mg omeprazole equivalents (20 mg pantoprazole) to 72 mg omeprazole equivalents (40 mg rabeprazole).

Results

We defined PPI dosing for H. pylori therapy as low dose (eg, approximately 20 mg omeprazole equivalents, b.i.d.), high or double dose as approximately 40 mg omeprazole equivalents, b.i.d.) and high dose as approximately 60 mg omeprazole equivalents, b.i.d.). For example, standard double dose PPI would thus be 40 mg of omeprazole, 20 mg of esomeprazole or rabeprazole, 45 mg of lansoprazole, or 120 mg of pantoprazole each given b.i.d.

Conclusions

Simply doubling the dose of any PPI achieves markedly different effects on pH4‐time. However, PPIs can be used interchangeably and cost effectively based on their omeprazole equivalency.

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Evaluation of gastric microbiome and metagenomic function in patients with intestinal metaplasia using 16S rRNA gene sequencing

Abstract

Background

Despite recent advances in studies on the gastric microbiome, the role of the non‐Helicobacter pylori gastric microbiome in gastric carcinogenesis remains unclear. We evaluated the characteristics of the gastric microbiome and metagenomic functions in patients with IM.

Methods

Participants were classified into six groups according to disease status (chronic superficial gastritis [CSG], intestinal metaplasia [IM], and cancer) and H. pylori‐ infection status (H. pylori‐positive and H. pylori‐negative). The gastric microbiome was analyzed in mucosal tissues at the gastric antrum by 16S rRNA gene sequencing. Moreover, we assessed the metagenome including the type IV secretion system (T4SS) gene, as T4SS proteins are essential for transferring CagA from H. pylori- into the human gastric epithelium.

Results

Among the 138 included patients, 48, 9, 23, 14, 12, and 32 were classified into the H. pylori‐negative CSG, H. pylori‐negative IM, H. pylori‐negative cancer, H. pylori‐positive CSG, H. pylori‐positive IM, and H. pylori‐positive cancer groups, respectively. Cyanobacteria were predominant in the H. pylori‐negative CSG group compared to in the H. pylori‐negative IM and H. pylori‐negative cancer groups (H. pylori‐negative CSG vs H. pylori‐negative IM vs H. pylori‐negative cancer: 14.0% vs 4.2% vs 0.04%, P < 0.001). In contrast, Rhizobiales were commonly observed in the H. pylori‐negative IM group (H. pylori‐negative CSG vs H. pylori‐negative IM vs H. pylori‐negative cancer: 1.9% vs 15.4% vs 2.8%, P < 0.001). The relative abundance of Rhizobiales increased as H. pylori‐infected stomachs progressed from gastritis to IM. In the H. pylori‐negative IM group, genes encoding T4SS were prevalent among the metagenome. Additionally, after H. pylori- eradication therapy, the gastric microbiome was similar to the microbiome observed after spontaneous clearance of H. pylori-.

Conclusions

The relative abundance of Rhizobiales was higher in patients with H. pylori‐negative IM than in those with H. pylori‐negative CSG or cancer. Additionally, T4SS genes were highly observed in the metagenome of patients with IM. Highly abundant T4SS proteins in these patients may promote gastric carcinogenesis.

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Review of antimicrobial peptides with anti‐Helicobacter pylori activity

Abstract

Background

The emergence of antibiotic‐resistant Helicobacter pylori strains in recent years has increased the need for finding an alternative in the post‐antibiotic era. One of the fields being considered for this purpose is antimicrobial peptides. The aim of this review was to provide an obvious scheme from the studied anti‐H. pylori peptides and to investigate their common features.

Method

First, all of the antimicrobial peptides with their anti‐H. pylori effects have been proved up to September 2018 were selected and their information including structure, mechanism of action, and function was reviewed. To achieve this, three databases of PubMed, Scopus, and Web of science were used.

Results

A total of 9 groups containing 22 antimicrobial peptides were found with demonstrated anti‐H. pylori effects. The nine groups included pexiganan, tilapia piscidins, epinecidin‐1, cathelicidins, defensins, bicarinalin, odorranain‐HP, PGLa‐AM1, and bacteriocins. Most of the antimicrobial peptides, not all, had common features such as the ability to kill antibiotic‐resistant strains, having α‐helical structure, being cationic, with high positive charge and isoelectric point.

Conclusion

Antimicrobial peptides with anti‐H. pylori effects have the potential to replace the antibiotics, especially in the post‐antibiotic era, if a rapid and low‐cost production method would be found.

https://ift.tt/2PyAvIQ

Helicobacter pylori infection and prevalence of stroke

Abstract

Background

Helicobacter pylori causes peptic ulcer disease; however, conflicting evidence exists regarding its role in extragastric conditions. We aimed to examine associations of H pylori infection and peptic ulcer disease with stroke.

Methods

A cross‐sectional study was undertaken using data of 147 936 individuals aged 25‐95 years who underwent the urea breath test during 2002‐2012, based on the computerized database of the second largest health maintenance organization in Israel. Logistic regression models were fitted to control for potential confounders.

Results

Overall, 1397 (0.9%) patients had stroke and 76 965 (52.0%) had a H pylori positive test. The likelihood of prevalent stroke increased in relation to H pylori infection: adjusted odds ratio (aOR) 1.16 (95% confidence intervals [CI]: 1.04‐1.29), gastric ulcer: aOR 1.50 (95% CI: 1.18‐1.91), and duodenal ulcer: aOR 1.25 (95% CI: 1.07‐1.46).

Conclusions

The results support the premise that stroke may be associated with a history of H pylori infection.

https://ift.tt/2QKi68j

Prevalence of Helicobacter pylori infection among junior high school students in Grudziadz, Poland

Abstract

Background

The purpose of the study was to assess the prevalence of Helicobacter pylori infection among the junior high school students in city Grudziądz, Poland.

Materials and methods

A prospective cross‐sectional study among second junior high school students was conducted from September 2008 to June 2015 during seven consecutive school years. The studied group was 3241 students 13‐17 years old. The ¹³C‐urea breath test (UBT) was administered to all participants for current H. pylori infection. Clinical, sociodemographic, and hygienic risk factors for H. pylori positivity were analyzed in children with positive and negative UBT.

Results

Urea breath test was performed and results were obtained for 3067 of 3241 children, including 723 children (23.6%) with positive result (group 1) and 2344 children (76.4%) with negative result (group 2). The prevalence of H. pylori infection was not different in subsequent seven school years (P = 0.06) and depending on the gender (P = 0.57). In group 1 the cough and in group 2 the epigastric discomfort occurred more frequent (P = 0.04 and P = 0.002, respectively). In multivariate analysis, factors positively associated with prevalence of H. pylori were age >16 years (OR = 2.556; 95%CI 1.293‐5.025), living in old town district (OR = 1.374; 95%CI 1.097‐1.723), consumption of raw vegetables (OR 1.305; 95%CI 1.038‐1.642) or unboiled water (OR = 1.444; 95%CI 1.138‐1.832) and using collective catering facilities (OR 1.338; 95%CI 1.039‐1.724). Having a cat was protective against H. pylori (OR 0.78; 95%CI 0.614‐0.991).

Conclusions

Over the past 10 years, the prevalence of H. pylori infection in Polish adolescents has decreased. H. pylori infection remains problem closely associated with socioeconomic and sanitary conditions. Our results are important to develop prevention strategies for H. pylori‐related diseases.

https://ift.tt/2PxuJan

Evaluating the psychometric properties of two-item and four-item short forms of the Japanese Pain Self-Efficacy Questionnaire: a cross-sectional study

Abstract

Purpose

The Pain Self-Efficacy Questionnaire is a valid measure assessing self-efficacy in individuals with chronic pain. Short-form versions of the measure have been developed to decrease the assessment burden. However, few studies have evaluated the psychometric properties of the short forms in languages other than English. The aim of this study was to evaluate two 2-item short forms and one 4-item short form of the Japanese Pain Self-Efficacy Questionnaire in terms of internal consistency, criterion validity, structural validity, and construct validity.

Methods

This was a cross-sectional study. Data from 150 individuals with mixed chronic pain at a pain management center in a university hospital were extracted from clinical records and analyzed. The data included the information of the original version and short forms of the Japanese Pain Self-Efficacy Questionnaire, and other pain-related measures assessing pain intensity, pain interference, anxiety, depression and pain catastrophizing.

Results

Item statistics supported the item selection for each of the three short forms. All the short forms demonstrated adequate internal consistency and criterion validity. With respect to construct validity, one of the 2-item short forms failed to meet the criterion regarding the change in the magnitude of correlation with a depression scale. The 4-item short form met all the criteria including structural validity.

Conclusion

The study findings provide evidence for the reliability and validity of 2- and 4-item versions of the Japanese Pain Self-Efficacy Questionnaire for use in clinical and research settings.

https://ift.tt/2qOw65y

Analysis of 24‐hour surgical cancellations in an academic rhinology and skull base surgery practice

Background

Late cancellations within 24 hours of surgery lead to decreased utilization of operating room time with loss of productivity, decreased access to care, and inconvenience to patients and staff. To date, no studies have analyzed 24‐hour cancellations in a tertiary rhinology practice.

Methods

All procedures performed at a tertiary rhinology/skull base practice from January 2016 to December 2017 were reviewed. Twenty‐four‐hour cancellations were analyzed by procedure type and reason for cancellation. Avoidable cancellations were late cancellations that could have been prevented by review of medical records or communication by hospital staff with the patient before surgery. Univariate analysis was performed to determine predictive factors for cancellations.

Results

A total of 39 of 640 surgical cases were cancelled (6.1%) within 24 hours of surgery. Of these, 69.2% were inflammatory and 30.8% were skull base cases. The mean number of operating room minutes lost was 151 (60 of 210) for inflammatory and 263 (102 of 480) for skull base cases. Avoidable cancellations were seen in 25 of 35 (71.4%) cases. Patients undergoing inpatient or skull base surgery were more likely to have medical cancellations than patients undergoing outpatient or inflammatory surgery (91.7% vs 43.5%, p = 0.01; 83.3% vs 47.8%, p = 0.07).

Conclusion

This is the first study to analyze 24‐hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancellations in rhinology and identify strategies to try to prevent them.

https://ift.tt/2OM31Bf

In vitro characteristics of an airway barrier‐disrupting factor secreted by Staphylococcus aureus

Background

Staphylococcus aureus is a major contributor to the pathophysiology of chronic rhinosinusitis (CRS). Previous research has shown that S. aureus–secreted products disrupt the airway barrier.

Methods

S. aureus ATCC 13565 and 25923 strains were grown at exponential, postexponential, and stationary phases. Microbial conditioned media (CM) was collected from the cultures and ultrafiltered (UF). Liquid chromatography–electrospray ionization tandem mass spectrometry (LC‐ESI‐MS/MS) was performed on the UF‐CM. UF‐CM was subjected to heat and protease treatment, size fractionation, and ultracentrifugation (UC) separation. Human nasal epithelial cells grown at air‐liquid interface (HNEC‐ALI) cultures were exposed to purified alpha hemolysin (Hla), staphylococcal enterotoxin A (SEA), lipoteichoic acid (LTA), and UF‐CM. Barrier function outcomes were measured by transepithelial electrical resistance (TEER) and apparent permeability (Papp). UC fraction exposed cultures were subjected to immunofluorescence microscopy for tight junction (TJ) protein zonula occludens‐1 (ZO‐1).

Results

LC‐ESI‐MS/MS identified 107 proteins, with Hla being most abundant. Hla, SEA, and LTA did not alter the HNEC‐ALI barrier as measured by TEER or Papp. Barrier disruption caused by UF‐CM peaked in the postexponential phase, was sensitive to heat and protease treatment, >30‐kDa in size, and enriched in the UC fraction. HNEC‐ALI exposed to UF‐CM and UC demonstrated loss of ZO‐1 localization.

Conclusion

These results suggest that the S. aureus factor responsible for TJ disruption in HNEC‐ALI cultures is either a protein‐macromolecule or a combination of secreted factors. The product is enriched in the UC fraction, suggesting it is associated with large structures such as membrane components or vesicles.

https://ift.tt/2zlmRyL

A cadaveric model for measuring sinonasal continuous positive airway pressure—a proof‐of‐concept study

Background

Obstructive sleep apnea is a common respiratory disorder that can have negative effects on health and quality of life. Positive pressure therapy (CPAP) is the primary treatment. There is a lack of consensus on the risk of postoperative CPAP after endoscopic sinus or skull base surgery. We present a proof‐of‐concept cadaver model for measuring sinonasal pressure delivered by CPAP.

Methods

Three fresh cadaver heads were prepared by removing the calvaria and brain. Sphenoidotomies were made and sellar bone was removed. Pressure sensors were placed in the midnasal cavity, sphenoid sinus, and sella. CPAP was applied and the delivered pressure was recorded at increasing levels of positive pressure. Paired t tests and intraclass correlation coefficients were used to analyze results.

Results

Increases in positive pressure led to increased pressure recordings for all locations. Nasal cavity pressure was, on average, 81% of delivered CPAP. Pressure was highest in the sphenoid sinus. The effect of middle turbinate medialization on intrasphenoid pressure was not statistically significant in 2 heads. Intrasellar pressure was 80% of delivered CPAP with lateralized turbinates and 84% with medialized turbinates. Pressure recordings demonstrated excellent reliability for all locations. All heads developed non‒sellar‐based cranial base leaks at higher pressures. Cribriform region leaks were successfully sealed with DuraSeal®.

Conclusion

Our proof‐of‐concept cadaver model represents a novel approach to measure pressures delivered to the nasal cavity and anterior skull base by CPAP. With further study, it may have broader clinical application to guide the safe postoperative use of CPAP in this population.

https://ift.tt/2OM2Ndn

Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide

Background

Spontaneous cerebrospinal fluid (CSF) rhinorrhea has been associated with elevated intracranial pressure (ICP). As such, ICP reducing measures are commonly employed to optimize repair. Although postoperative acetazolamide use has been described, no data currently exists on the potential for preoperative use.

Methods

A retrospective review was performed including patients treated for anterior spontaneous CSF leaks by a single surgeon over a 6‐year period during which acetazolamide therapy (250 mg twice daily) was employed before considering surgical repair. The primary endpoint was whether the patient went on to require surgical repair.

Results

A total of 16 patients were identified who were pretreated with acetazolamide. Leak sites were noted as cribriform (5/16), sphenoid (8/16), ethmoid (1/16), multiple (1/16), and indeterminate (1/16). Five patients had resolution of their rhinorrhea without surgery (31.3%). Mean follow‐up for these nonsurgical patients was 470 days (range, 64 to 857 days). There were no differences in the patients' age or site of leak between surgical and nonsurgical patients (p = 0.65, p = 0.52, respectively). Nonsurgical patients had a lower body mass index (BMI) than surgical patients (p = 0.04).

Conclusion

This is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea.

https://ift.tt/2zlmHYb

Bioabsorbable steroid‐releasing implants in the frontal sinus ostia: a pooled analysis

Background

Bioabsorbable steroid‐releasing implants (mometasone furoate, 370 μg) are effective for improving postsurgical outcomes in the frontal sinus ostia (FSO). In this study we evaluated the effect of these implants on frontal outcomes in various patient subgroups with chronic rhinosinusitis (CRS) using pooled data from 2 randomized, controlled trials (RCTs).

Methods

A total of 160 subjects were enrolled in 2 RCTs. After surgery, subjects were randomized to receive an implant in 1 FSO with the contralateral side as control. Data through day 90 from the 2 studies were pooled and subgroup analyses were performed.

Results

At day 30, relative to controls, steroid‐releasing implants significantly reduced the need for postoperative interventions by 46.8% (95% confidence interval [CI], −60.7 to −27.9), for surgical interventions by 51.2% (95% CI, −68.2 to −25.2), and for oral steroid interventions by 37.2% (95% CI, −54.6 to −13.1) in the pooled data set. At day 90, statistically significant reductions (p < 0.05) in the need for postoperative interventions (relative reduction [RR], 30.2%), restenosis/occlusion rate (RR, 31.7%), and inflammation score (absolute difference, −6.0), and increase in estimated FSO diameter (absolute difference, 1 mm), favoring the treated side, were observed. Subgroup analyses of the pooled data showed statistically significant improvements (p < 0.05) at day 90 in restenosis/occlusion rate, and estimated FSO diameter, favoring the treated side across subgroups, with no statistically significant subgroup‐by‐treatment interactions.

Conclusion

Bioabsorbable steroid‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO.

https://ift.tt/2ONhKvN

Intralesional triamcinolone alone or in combination with botulinium toxin A is ineffective for the treatment of formed keloid scar: A double blind controlled pilot study

Cutaneous injury can ignite excessive fibroproliferative growth that results in keloid formation. Keloids are associated with significant morbidity related to disfigurement and/or symptoms (e.g. pain, pruritus). First‐line treatment of formed keloids involves topical or intralesional steroids. Recurrent or resistant keloids are managed by surgical excision or cryotherapy, followed by steroidal application or adjuvant irradiation. While adjuvant irradiation appears to be most efficacious, alternative therapeutic options are needed for patients without access to radiation centers. Botulinum Toxin A (BTA) appears to have similar inhibitory effects to irradiation on the cell cycle via downregulation of pathogenic cytokines. Herein, we conducted a study to compare the efficacy of intralesional triamcinolone used alone, or in combination with BTA, in the treatment of formed keloid scars. 20 patients with a cumulative of 40 keloids completed the study. There was no significant difference between treatment arms with respect to height vascularization, pliability and pigmentation scores. The addition of BTA resulted in significant symptomatic improvement of pain and pruritus as compared to intralesional triamcinolone alone (P<0.001). Irradiation is only effective when administered in the adjuvant setting where inhibitory effects on cell cycle and migration are optimized. Future studies with intralesional triamcinolone and BTA should be performed adjuvantly.

This article is protected by copyright. All rights reserved.

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Pleomorphic adenoma of the head and neck in children: presentation and management

Objective

Pleomorphic adenoma is the most common benign salivary gland neoplasm in children. Recurrence and malignant transformation are concerns necessitating proper treatment.

The goal of this research was to discuss the presentation, evaluation, and management of pediatric pleomorphic adenoma of the head and neck.

Methods

Retrospective chart review of patients under 20 years of age treated for pleomorphic adenoma of the head and neck between 1998 and 2017. Data assessed included demographics, clinical presentation, imaging, treatment, complications, recurrence, and follow‐up.

Results

Forty‐one patients with pleomorphic adenoma were identified. Major salivary gland lesions were most common (n = 32, 78.0%); 78.1% (25 of 32) arising in the parotid and 21.9% (7 of 32) in the submandibular glands. Minor salivary gland lesions were removed from the palate (5 of 9, 55.6%), buccal mucosa (2 of 9, 22.2%), parapharyngeal space (1 of 9, 11.1%), and upper lip (1 of 9, 11.1%). Preoperative imaging was reviewed in 32 patients and consisted of nine ultrasound exams, 15 computerized tomography (CT) exams, and 23 magnetic resonance imaging (MRI) exams. Multimodality imaging was performed in 14 of 32 patients. Surgical excision was performed in all patients. Postoperative complications included transient facial paresis (n = 9), Frey syndrome (n = 1), and bacterial pharyngitis (n = 1). Average length of follow‐up was 25.5 months; confirmed recurrence occurred in two patients (4.9%).

Conclusion

Evaluation of pleomorphic adenoma in children should include preoperative imaging. The goal of surgery should be complete surgical excision with negative margins. Rate of recurrence is low; however, prolonged monitoring is recommended.

Level of Evidence

4. Laryngoscope, 2018

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Defining differences in patient characteristics between spasmodic dysphonia and laryngeal tremor

Objective

To compare presenting characteristics of patients with adductor spasmodic dysphonia (ADSD), ADSD with laryngeal tremor (ADSD + LT), and laryngeal tremor without ADSD (LT).

Design

Cross‐sectional analysis.

Methods

Patients treated for laryngeal movement disorders (1990–2016) were included. Analysis of variance and chi square tests measured differences in patient characteristics across the three disease groups. Using ADSD as the referent, multivariable logistic regression models were used to determine whether potential risk factors including patient demographics, family history, presence of potential inciting events prior to disease onset, and coprevalent movement disorders were associated with ADSD + LT or LT.

Results

In all, 652 patients with ADSD (n = 377), ADSD + LT (n = 98), and LT (n = 177) were included. ADSD patients were significantly younger than those with ADSD + LT and LT (52.5 ± 13.4, 63.9 ± 11.3, and 69.3 ± 10.5 years, respectively; P < 0.001). Coprevalent movement disorders were more common in ADSD + LT (38.7%) and LT (57.1%) groups than in the ADSD group (11.5%; P < 0.001). Compared to ADSD, patients with ADSD + LT and LT were more likely to develop an additional movement disorder during follow‐up. In multivariable analyses, increasing age, female gender, and having a movement disorder at presentation were associated with significantly greater odds of having ADSD + LT or LT when compared to ADSD.

Conclusion

ADSD + LT patients demonstrate intermediate gender composition and age distributions between those with ADSD and LT. These findings suggest that ADSD + LT may be a distinct phenotype in the spectrum of laryngeal movement disorders.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2QM95M6

Increased expression of PD1 and CD39 on CD3+CD4+ skin T‐cells in the elderly

Abstract

Normal aging is associated with an impaired systemic immune response contributing to an increased susceptibility to infectious diseases. The aim of this study was to compare the lymphocyte phenotype in human skin from old and young healthy subjects. Skin samples from donors were used for explant cultures before flow cytometry analysis. Our results depicted a higher proportion of CD4⁺ and a lower proportion of CD8⁺ among CD3⁺ T‐cells, a decreased proportion of CD45RA⁺ naive T‐cells (3.5 ± 1.9% vs 22.9 ± 11.1%, p≤0.007) and an upregulation of the expression of CD39 and PD1 on CD3⁺CD4⁺ T‐cells (25.1 ± 8.5% vs 12.5 ± 8.5%, p≤0.003, 68.8 ± 11.6% vs 50.0 ± 11.3%, p≤0.01, respectively) in the skin of old subjects. These findings could explain a reduced generation of long‐lived memory T‐cells and an impaired antitumoral response in the skin of the elderly.

This article is protected by copyright. All rights reserved.

https://ift.tt/2DpGXKJ

Melasma: Updates and Perspectives

Abstract

Management of melasma is highly challenging due to inconsistent treatment results and frequent relapses. However, recent studies revealed that melasma may not only be a disease of melanocytes, but also a photoaging skin disorder. Herein, we attempt to validate that melasma is indeed a photoaging disorder by presenting the histopathologic findings of melasma: solar elastosis, altered basement membrane, increased vascularization, and increased mast cell count. We also provide some therapeutic implications based on these findings and a discussion on the latest updates and perspectives regarding treatment.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Q3o8Us

Review of “The Surgeon Volume-Outcome Relationship: Not Yet Ready for Policy” by Modrall JG, Minter RM, Minhajuddin A, Eslava-Schmalbach J, Joshi GP, Patel S, Rosero EB in Ann Surg 267:863–867, 2018

No abstract available

https://ift.tt/2K6NFqz

Analysis of Cranial Morphology of Healthy Infants Using Homologous Modeling

Objective: Data on cranial morphology of healthy individuals can be used as the guide in the treatment of cranial deformity. There are many reports analyzing the cranial morphology of healthy children in the past. But most of them focus on 2-dimensional values, and there are only a few reports, which analyzed the cranial morphology of Japanese healthy infants. We report a novel method that enables the comprehensive analysis of cranial morphology of Japanese healthy infants in 3D. Methods: Craniofacial CT data of 20 healthy infants (9 males, 11 females) ranging in age from 1 to 11 months were collected. Based on the CT data, we created 20 homologous models of cranium using software specifically designed to support homologous modeling. We averaged vertex coordinates of the homologous models to create average model. We further performed principal component analysis, and created virtual models based on each principal component. The contribution rate was calculated, and the features described by each principal component were interpreted. Results: We created the average cranial model of Japanese healthy infants. Seven principal components (cumulative contribution rate: 89.218%) were interpreted as to which part of the cranial shape each component was related to. The elements were extracted that may characterize the cranial morphology of some of the clinical conditions such as dolico/brachycephaly and deformational plagiocephaly. Some of these elements have not been mentioned in the past literature. Conclusion: Homologous modeling was considered to be valid and strong tool for comprehensive analysis of cranial morphology. Address correspondence and reprint requests to Kosuke Kuwahara, MD, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; E-mail: 411kuwahara@gmail.com Received 16 March, 2018 Accepted 9 July, 2018 This work is supported by a grant for Regenerative Medicine in Pediatrics and Obstetrics (29-1) from National Center for Child Health and Development. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2BaJcjC

Review of “Artificial Intelligence in Surgery: Promises and Perils” by Hashimoto DA, Rosman G, Rus D, Meireles OR in Ann Surg 268:70–76, 2018

No abstract available

https://ift.tt/2K8pZBT

Personal Computer-Based Cephalometric Landmark Detection With Deep Learning, Using Cephalograms on the Internet

Background: Cephalometric analysis has long been, and still is one of the most important tools in evaluating craniomaxillofacial skeletal profile. To perform this, manual tracing of x-ray film and plotting landmarks have been required. This procedure is time-consuming and demands expertise. In these days, computerized cephalometric systems have been introduced; however, tracing and plotting still have to be done on the monitor display. Artificial intelligence is developing rapidly. Deep learning is one of the most evolving areas in artificial intelligence. The authors made an automated landmark predicting system, based on a deep learning neural network. Methods: On a personal desktop computer, a convolutional network was built for regression analysis of cephalometric landmarks' coordinate values. Lateral cephalogram images were gathered through the internet and 219 images were obtained. Ten skeletal cephalometric landmarks were manually plotted and coordinate values of them were listed. The images were randomly divided into 153 training images and 66 testing images. Training images were expanded 51 folds. The network was trained with the expanded training images. With the testing images, landmarks were predicted by the network. Prediction errors from manually plotted points were evaluated. Results: Average and median prediction errors were 17.02 and 16.22 pixels. Angles and lengths in cephalometric analysis, predicted by the neural network, were not statistically different from those calculated from manually plotted points. Conclusion: Despite the variety of image quality, using cephalogram images on the internet is a feasible approach for landmark prediction. Address correspondence and reprint requests to Soh Nishimoto, MD, PhD, Department of Plastic Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo 663-8131, Japan; E-mail: nishimot@hyo-med.ac.jp Received 7 March, 2018 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2B9iHv6

Approaches for Excision of Intramasseteric Nodules

Developmental lesions, including benign or malignant tumors, rarely arise in the masseteric region. This retrospective study was performed to evaluate the adequacy of different surgical approaches in a series of patients with lesions in the masseteric region. The surgical methods, postoperative complications, pathological diagnosis, and aesthetic outcome were compared in 4 patients who underwent excision of intramasseteric mass lesions. A flap was elevated in 3 patients and direct incisional resection was performed in 1 patient. Two patients underwent incisional biopsy to exclude malignancy before the total excision was performed. The final diagnosis was hemangioma in 3 patients and schwannoma in 1 patient. All patients were satisfied with the aesthetic results and there were no major complications. In conclusion, surgery with skin flap elevation was concluded to be the best approach based on overall assessment of technical considerations, complications, and the cosmetic outcome. However, the surgeon should not hesitate to perform direct incisional biopsy when malignancy needs to be excluded. Address correspondence and reprint requests to Tetsushi Aizawa, MD, Department of Plastic and Reconstructive Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan; E-mail: nagareyamatsudo@live.jp Received 20 June, 2018 Accepted 30 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2K8L7Ie

Telementoring Demonstration in Craniofacial Surgery with HoloLens, Skype, and Three-Layer Facial Models

Background: Telementoring is the technology for providing surgical instruction from a remote place via a network. To demonstrate the use of telementoring in craniofacial surgery, Skype and a mixed reality device HoloLens were adopted, and 3-layer facial models had been developed. Methods: A resident in hospital A used the model surgery under remote guidance by a mentor surgeon in hospital B 4 times on different dates. The straight-line between hospitals A and B is 250 km. The mentor gave the resident guidance via Skype and HoloLens, communicating by voice, and video of the surgical field, and providing reference data. Results: There was no delay in voice communication and a delay of

https://ift.tt/2Ba5thK

The Effect Evaluation of Functional Appliance Used for Class II Patients With Temporomandibular Joint Anterior Disc Displacement

Orthopedic functional appliances are usually used to correct patients with retrognathic mandible. However, a part of cases have a trend of relapse after splint treatment. The aim of this study was to explore the role of temporomandibular joint disc position in functional appliance treatment. This study included 8 patients who had 1 joint anterior disc displacement with reduction (ADDWR) and the other joint anterior disc displacement without reduction (ADDWoR) confirmed by magnetic resonance imaging (MRI). Only the ADDWR joint could return to its normal position after wearing the anterior repositioning appliances (ARAs). Condylar morphology, condylar height, and disc length were evaluated 6 months after ARA treatment. The MRI showed that new bone appeared on 7 joints with ADDWR and on 1 joint with ADDWoR. The condylar height has increased 1.4 mm in the ADDWR group, while 0.1 mm shorter in the ADDWoR group. Disc length has increased from 8.5 to 8.7 mm in the ADDWR group and 0.4 mm shorter in the ADDWoR group after wearing the ARA. Our results suggested that it is noneffective of functional appliance used for class II malocclusion adolescents with ADDWoR and only a normal disc-condyle relationship benefits condyle growth by functional appliance. Thus it is important to reposition the disc as soon as possible. Address correspondence and reprint requests to Chi Yang, MD, Shanyong Zhang, MD, Department of Oral Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No 639, Zhi Zao Ju Rd, 200011 Shanghai, China; E-mail: yangchi63@hotmail.com, zhangshanyong@126.com Received 7 April, 2018 Accepted 9 July, 2018 PS and XL contributed equally to this work. This study was supported by the Youth Program of National Natural Science Foundation of China (81601915), Shanghai Municipal Hospital Emerging Frontier Technology United Key Project (SHDC12017101), and Science and Technology Commission of Shanghai Municipality Science Research Project (14DZ2294300). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2K8vUHg

Dural Reconstruction With Autologous Rectus Fascia: A New Technique for Addressing Large-Sized Defects During Cranioplasty

Introduction: Patients requiring cranioplasty reconstruction with customized cranial implants may unexpectedly present with cerebrospinal fluid (CSF) leaks and durotomies following previous neurosurgical procedures. As such, multiple factors influence the type of dural reconstruction chosen at this time, which are essential for achieving long-term success. Overall, the most common material used for duraplasty is currently an "off-the-shelf" xenograft construct. However, some believe that they are not suitable for large-sized defects and accompany a higher incident of complications. Therefore, based on our success and experience with scalp augmentation using rectus fascia grafts, the authors herein present our preliminary experience with duraplasty using autologous rectus fascia grafts (ARFGs). Methods: A retrospective review of our database, consisting of 437 cranial reconstructions from 2012 to 2017, was performed under institutional review board approval. Selection criteria included all adult patients (n = 6) requiring dural reconstruction (duraplasty) with ARF grafting for an active CFS leak with concomitant skull defect. Cadaver study and patient illustrations are also presented to demonstrate clinical applicability. All outcomes, including complications, were reviewed and are presented here. Results: A total of 6 patients underwent autologous duraplasty with either unilateral or bilateral ARFGs. All patients (6/6) of large-sized (>3 cm2) defect repair with ARFGs were indicated for repair of secondary CSF leaks following previous craniotomy by neurosurgery. To date, none have demonstrated recurrent leaking and/or dura-related complications. At this time, all 6 patients were reconstructed using customized cranial implants with a mean follow-up of 10 months. Conclusion: Based on our preliminary experience presented here, the use of rectus fascia grafts for autologous dural reconstruction appears to be both safe and reliable. This new technique adds another tool to the neurosurgical armamentarium by reducing the additional risk of "off-the-shelf" dural substitutes. Address correspondence and reprint requests to Chad R. Gordon, DO, FACS, Neuroplastic and Reconstructive Surgery, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, JHOC, 8th Floor, 601 N Caroline St, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 14 May, 2018 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2B9rH39

Anterior Maxillary Segmental Distraction Osteogenesis for Treatment of Maxillary Hypoplasia in Patients With Repaired Cleft Palate: Retraction

No abstract available

https://ift.tt/2K6C5vu

Textbooks in Plastic Surgery: Paper or Digital?

No abstract available

https://ift.tt/2BaVUyV

Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial

Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4‐wk (−3.82 vs. −0.89) and 3‐month (−4.22 vs. −0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time‐points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.

https://ift.tt/2RUA7kv

Early‐onset and persistent traumatic granuloma of the tongue (Riga‐Fede disease) associated with neonatal teeth and Down syndrome

Abstract

Riga‐Fede disease (RFD) is a rare disorder characterized by an ulcerated lesion on the ventral surface of the tongue. It can be seen at any age and has also been referred to as traumatic granuloma of the tongue, eosinophilic granuloma of the tongue, and traumatic ulcerative granuloma with stromal eosinophilia. The sucking reflex, uncontrolled movements of the tongue, and macro‐glossy are risk factors facilitating repetitive trauma produced by the teeth.

This article is protected by copyright. All rights reserved.

https://ift.tt/2DHn0Ak

A systematic review on risk factors in developing a first time Venous Leg Ulcer

Abstract

Venous Leg Ulcers (VLU) occur in about 1% of the Western population. A VLU takes three to twelve months to heal, it recurs often, and it has a negative impact on the quality of life. The risk factors for the development of a first VLU are not well‐understood and prevention of a first VLU therefore remains underappreciated. The aim of this study is to identify risk factors for developing a first VLU in adults (aged >18 years) by searching the literature. We searched the Cochrane Library, Pubmed, Cinalh, and Narcis to identify studies that investigated risk factors in developing a VLU. The last search was performed in January 2018. Two reviewers independently reviewed the abstracts and full‐text articles, and assessed the methodological quality of the included studies. Results of studies using duplex scanning, and comparing participants with and without VLUs were included in the qualitative analysis. Where possible a quantitative meta‐analysis was conducted. We found five studies that investigated the relation of several risk factors with VLU development. The methodological differences of the studies made it impossible to perform a quantitative analysis. The risk factors: higher age (four studies), higher Body Mass Index (four studies), low physical activity (four studies), arterial hypertension (four studies), deep vein reflux (three studies), deep venous thrombosis (three studies) and family history of VLU (three studies) were significantly associated with a VLU in the majority of the studies. To what extent they influence the development of a VLU remains unclear because of the limited number of studies that investigated the association of these risk factors with VLU development, and the heterogeneity of these studies. Further studies are needed to confirm the association of these risk factors with the development of a VLU and to explore overweight and low physical activity in more detail.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RTnar6

Dermoscopic features of psoriasis of the skin, scalp and nails ‐ A systematic review

Abstract

Dermoscopy is a non‐invasive in‐office method, which enables the diagnosis of many dermatoses and reduces the need for performing biopsies. To date, no systematic review about the diagnostic usability of dermoscopy in psoriasis has been available. The objective of this article is to summarize and critically analyze literature data on the dermoscopy of skin, scalp and nail changes in psoriasis. A systematic search of three medical databases was performed. A total of 45 articles were included into the analysis. Cutaneous psoriatic lesions assessed in all studies at a low magnification showed regularly distributed red dots. At a 50‐fold or higher magnification capillary bushes (glomerular vessels) with a diameter range of 50‐146 μm were observed. The background color was described as reddish or pinkish with white or yellowish scales. The most frequent dermoscopic (trichoscopic) feature of scalp psoriasis was the presence of red dots/globules and twisted red loops. Typical dermoscopic (onychoscopic) signs of nail psoriasis were onycholysis, salmon patches and splinter hemorrhages.

There is an accumulating body of evidence that dermoscopy (both handheld and videodermoscopy) is a useful tool in differential diagnosis in doubtful cases of psoriasis of the skin, scalp, nails, palms, soles, and genital regions.

This article is protected by copyright. All rights reserved.

https://ift.tt/2DHbZiu

Non‐invasive imaging in dermatology and the unique potential of Raster‐Scan Optoacoustic Mesoscopy (RSOM)

Abstract

In recent years, several non‐invasive imaging methods have been introduced to facilitate diagnostics and therapy monitoring in dermatology. The microscopic imaging methods are restricted in their penetration depth, while the mesoscopic methods probe deeper but provide only morphological, not functional, information. "Raster‐scan optoacoustic mesoscopy" (RSOM), an emerging new imaging technique, combines deep penetration with contrast based on light absorption, which provides morphological, molecular, and functional information. Here we compare the capabilities and limitations of currently available dermatological imaging methods and highlight the principles and unique abilities of RSOM. We illustrate the clinical potential of RSOM, in particular for non‐invasive, high‐resolution diagnosis and monitoring of inflammatory and oncological skin diseases.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RUamRm

Epidermolysis bullosa‐specific module of the Infants and Toddlers Dermatology Quality of Life (InToDermQoL) questionnaire

Abstract

Background

Epidermolysis bullosa (EB) may have severe impact on different aspects of patients' life. Until now there was no EB‐specific quality of life (QoL) instrument for young children.

Objective

To create EB‐specific proxy module of the Infants and Toddlers Dermatology Quality of Life (InToDermQoL) questionnaire.

Methods

Focus groups with parents of children with EB were organized. Parents of EB children were interviewed by the project staff with regard to their perception of QoL issues of the skin disease of their children.

Results

Focus groups with parents of EB children in Ukraine and Romania were organized. Parents represented 8 boys and 12 girls from 3 months to 4 years old with different EB types and disease severity. Based on the analysis of focus groups' results two EB specific items that were not mentioned by parents of children with other skin diseases and therefore were not included to the dermatology‐specific InToDermQoL questionnaire were developed: "problems with defecation" and "problems with shoes". These problems were mentioned by 55% of all parents and 11.76% of parents that represented EB children older than one year, respectively.

Conclusion

We want to invite other centres and EB related organizations to join our project starting from the pilot test. There are many different reasons why QoL measurement is important in dermatology clinical practice and our goal is practical use of the instrument in children with EB.

This article is protected by copyright. All rights reserved.

https://ift.tt/2DHEr3B

Tattoos among elite football players during the 2018 FIFA World Cup Russia

Abstract

Currently 10 to 30% of the general population has tattoos. Professional athletes harbor visible tattoos during sports events and advertisement. Motivations for tattoos may include body embellishment, expression of personal values or group affiliation. Tattoos may bolster ego, be the expression of physical strength and of traits of aggression and rebelliousness. We wondered whether being tattooed reflects players' performance and discipline. We investigated this hypothesis among elite football players during the 2018 FIFA World Cup.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RXcszY

Injectable profiloplasty: Forehead, nose, lips, and chin filler treatment

Summary

Introduction

We propose a medical filler treatment algorithm of the profile which includes forehead, nose, and chin and to evaluate profilometric results and complications.

Materials and Methods

83 case reviews of associated liquid forehead, nose, and chin plasty performed consecutively from 2014 to 2016. We monitored the horizontal and vertical sagittal stability into two age group: <40 y.o. and >40 y.o. using profilometric Arnett analysis measurements on the F, Gb, Na, Nd, Nt, Sn, ULA, LLA, B, Pg, and Gn soft‐tissue points.

Results

The results at both 3 and 6 months were consistent with the normal ranges indicated by Arnett, with a 0.8 mm maximum of defect/excess. Forehead treatment was performed in 51 (61.4%) patient. Patients >40 y.o. always needed a global correction of the forehead profile. We performed nasal treatment in 83 (100%) patient, acute nasolabial angles was the more frequent nasal defect. The lips were injected in 59 patients (71.1) more frequently >40 y.o. In 83 (100%) patients we perform a chin augmentation. The average advancement of the chin was 3 mm.

Conclusions

The correction of the projection of the forehead, of the profile and shape of the nose, of the lips and chin as well as an overall improvement in face aesthetics and harmony gives a good solution in patients avoiding the need for a surgical intervention, scars and cost of general anesthesia, thus providing the optimum in patient satisfaction.

https://ift.tt/2K7ozYC

Intradermal injection of Fluorouracil versus triamcinolone in localized vitiligo treatment

Summary

Background

Vitiligo is an autoimmune disease with a prevalence of 1.22% in Egypt. Intralesional steroids use in localized vitiligo treatment still a matter of debate. Fluorouracil was tried in vitiligo treatment after lesion dermabrasion, ablative laser, or micro‐needling. The study aimed to compare the efficacy of intradermal fluorouracil and triamcinolone acetonide without any adjuvant therapy in localized vitiligo treatment.

Patients and methods

Sixty patients with localized non‐segmental stable vitiligo were assigned randomly and equally into groups. Patients subjected to intradermal injection of either fluorouracil (50 mg/mL), triamcinolone acetonide (3 mg/mL) or an equal mixture of both drugs. All patients had four treatment sessions every 2 weeks were followed up for 6 months.

Results

Intradermal fluorouracil showed the best overall improvement (median 52.27, IQR 36.25‐68.18) when compared with triamcinolone (median 13.86, IQR 3.83‐33.32) and the drug mixture (median 17.15, IQR 7.48‐41.67). During follow‐up, the vitiliginous patches continued to repigment for 6 months in fluorouracil and the drug mixture groups. The improvement stopped 1 month after the last session in the triamcinolone group.

Conclusion

The intradermal fluorouracil injection is an effective treatment of localized vitiligo. The intradermal steroid has a short‐acting therapeutic effect, but the mixture of drugs added no therapeutic effect.

https://ift.tt/2B8BFls

Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274. Correspondence to Claudia D. Spies, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany Tel: +49 30 450 551001; e-mail: claudia.spies@charite.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

https://ift.tt/2DqPXj5

Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

https://ift.tt/2DnkMF2

Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

https://ift.tt/2Q1PTN2

Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN A randomised, controlled and patient-blinded study. SETTING Single-centre trial, study period from June 2016 to February 2017. PATIENTS Seventy-four infants undergoing elective cardiac surgery. INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION ClinicalTrials.gov NCT02795468. Correspondence to Jong-Hwan Lee, MD, PhD, Associate Professor, Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea Tel: +82 2 3410 1928; fax: +82 2 3410 0361; e-mail: jonghwanlee75@gmail.com © 2018 European Society of Anaesthesiology

https://ift.tt/2DngSvR

Geringe Konkordanz zwischen Patient und Arzt

Für eine erfolgreiche Behandlung der Psoriasis ist essenziell, dass Patient und Arzt an einem Strang ziehen. Ob dies immer der Fall ist, wurde in einer multinationalen Befragung eruiert.

https://ift.tt/2PsVjBo

Zirkumskripte Sklerodermie: wie diagnostizieren, wie therapieren?

https://ift.tt/2QMjLKD

Hautkrebsscreening: Wohin geht die Reise?

https://ift.tt/2PvqY5e

Die besten Innovationen 2018

Im Rahmen einer Gala in Berlin ist der von Springer Medizin gestiftete Galenus-von-Pergamon-Preis für pharmazeutische Innovationen verliehen worden. Mit dem CharityAward wurde außerdem ehrenamtliches Engagement gewürdigt.

https://ift.tt/2QLLHyi

Exzellente Überlebensdaten: Kutane B-Zell-Lymphome reagieren gut auf Radiotherapie

Für die Therapie primär kutaner B-Zell-Lymphome hat sich noch kein allgemein akzeptierter Standard herausgebildet. Onkologen stellten nun vielversprechende Überlebensdaten strahlenbehandelter Patienten vor.

https://ift.tt/2Px8vp0

Immuntherapie wirkt auch gegen Melanommetastasen im Gehirn

Die übliche Initialtherapie bei intrakranieller Metastasierung eines malignen Melanoms ist die Resektion oder Bestrahlung. Eine mögliche Alternative dazu scheint die primäre Immuntherapie zu sein.

https://ift.tt/2QLLHhM

Hormonelle Therapie bei Akne: wann, warum, wie oft?

Die hormonelle antiandrogene Therapie wird bei Aknepatientinnen von vielen Experten als Erstlinientherapie empfohlen. Ob und wann Ärzte tatsächlich auf eine Hormontherapie zurückgreifen, wurde in einer aktuellen Studie evaluiert.

https://ift.tt/2PxQV3Y

Mikrobiom kann Immuntherapie beeinflussen

https://ift.tt/2QSP9He

Neue Wege in der Dermatoonkologie

Auf dem Deutschen Hautkrebskongress im Haus der Wirtschaft in Stuttgart wurde vom 13. bis 15. September 2018 über neue Forschungsdaten zum Nebenwirkungsmanagement bei Checkpointblockade, zum Hautkrebsscreening und dem Einfluss des Mikrobioms auf eine Immuntherapie diskutiert.

https://ift.tt/2Pt1l54

Haben Sie auch eine fachliche Frage?

https://ift.tt/2QGDmMe

Metastasiertes Melanom: Ältere sprechen besser auf Checkpointhemmer an

Auf eine Immuntherapie mit Pembrolizumab sprechen Patienten mit einem metastasierten Melanom, die älter als 60 Jahre sind, besser an als jüngere.

https://ift.tt/2PzAfZZ

„Für eine Welt ohne Allergien“

Das Motto des diesjährigen Deutschen Allergiekonkresses klingt ambitioniert, wenn auch noch in weiter Ferne. Wie man diesem bislang unsichtbaren Ziel ein Stück näher kommen könnte, wurde Ende September in Dresden diskutiert.

https://ift.tt/2QM1htE

Das ist bei einer Datenpanne zu tun

Bei einem Datenleck in der Praxis sind die Inhaber nach DSGVO dazu verpflichtet, dies zu melden. Wem und wie, erläutern Medizinrechtler.

https://ift.tt/2Py6UPK

Wählen und gewinnen!

https://ift.tt/2QNxBwb

Vitamin-D-Mangel bei Alopecia areata

Vitamin D spielt eine wichtige Rolle für den Kalziumstoffwechsel und das Immunsystem — eine Verbindung zu Autoimmunerkrankungen wie Alopecia areata scheint daher durchaus möglich.

https://ift.tt/2PuIeHY

Videosprechstunde — Patienten wollen, Ärzte warten noch

Eine Mehrheit der Patienten kann es sich vorstellen, per Video mit ihrem Arzt zu kommunizieren — doch die meisten Ärzte bieten das nicht an. Eine Chance für Unternehmen, die nur Onlinesprechstunden anbieten wollen, Ärzten Marktanteile abzunehmen?

https://ift.tt/2QLXg8L

Plaque am Zeigefinger einer 12-Jährigen

https://ift.tt/2PrQpEG

Milchtrinker erkranken häufiger an Akne

Die Verbindung zwischen Milchkonsum und der Entstehung von Akne wurde bereits in diversen Studien untersucht. Chinesische Dermatologen haben die Zusammenhänge nun mittels Metaanalyse genauer untersucht.

https://ift.tt/2QSP5as

Rauchen beeinflusst weißen Hautkrebs

Das Auftreten von weißem Hautkrebs wird durch Tabakkonsum beeinflusst — je nach Art und Lokalisation der Tumoren scheinbar nicht nur nachteilig.

https://ift.tt/2PAiTMQ

Wie riskant ist Nagelpilztherapie bei Kindern?

Antimykotika zur Behandlung von Nagelpilz sind für die Anwendung bei Kindern in der Regel nicht zugelassen. Das heißt aber nicht, dass nicht auch Kindernägel befallen werden und behandelt werden müssen.

https://ift.tt/2QNx3GD

Thyroid function and autoantibody status in Bangladeshi patients with type 2 diabetes mellitus

A B. M. Kamrul-Hasan, Farhana Akter, Shahjada Selim, Md Asaduzzaman, Md Habibur Rahman, Palash Kumar Chanda, Marufa Mustari, Md Shah Alam, Md Nazrul Islam Siddiqui

Thyroid Research and Practice 2018 15(3):132-137

Background: Thyroid dysfunction is common in patients with type 2 diabetes mellitus (T2DM), and data on thyroid autoimmunity in T2DM are scarce. This study was designed to observe the frequency of thyroid dysfunction and autoimmune thyroid disease in Bangladeshi T2DM patients. Materials and Methods: In this cross-sectional study, we investigated 1056 T2DM patients with unknown thyroid function status throughout the country. Serum thyroid stimulating hormone (TSH) and free T4 (FT4) and antithyroid antibodies (antithyroid peroxidase or antimicrosomal) were measured. Statistical analysis was done using IBM SPSS Statistics for Windows, version 23.0 software. P ≤ 0.05 was considered statistically significant. Results: The observed frequency of thyroid dysfunction in our study was 21.9% (subclinical hypothyroid 14.1%, primary hypothyroid 4%, subclinical hyperthyroid 1.9%, overt hyperthyroid 1%, and secondary hypothyroid 0.9%). 32.9% of the participants were positive for thyroid autoantibodies. The patients with thyroid dysfunction had a higher body mass index (BMI), higher TSH, lower FT4, and higher thyroid autoantibody titer than euthyroid ones. Thyroid dysfunction was more common in females and autoantibody-positive individuals. TSH had an inverse negative correlation with FT4 in both euthyroid and thyroid dysfunction groups and had a positive correlation with age in the euthyroid group only. FT4 had an inverse correlation with age and duration of diabetes in both groups and with BMI in euthyroid diabetic patients. Conclusion: Thyroid dysfunction and autoimmunity are common in Bangladeshi T2DM patients. Thyroid dysfunction was more common in females and autoantibody-positive diabetic patients.

https://ift.tt/2zkXs8n

Trimester-specific reference interval for thyroid function test in pregnancy: A review of data from Asia and Africa

Om J Lakhani, Milind Patil

Thyroid Research and Practice 2018 15(3):103-104



https://ift.tt/2OLCwMh

Indian Thyroid Society – Journey so far and path ahead

KM Prasanna Kumar

Thyroid Research and Practice 2018 15(3):101-102



https://ift.tt/2z9IZMg

Trimester-specific thyroid hormone dynamics, iodine reserve, and pregnancy outcomes: A longitudinal study

Nikku Yadav, Atul Kathait, Dharmpal S Malik, Madanjeet Kaur Pasricha, Sunil Kumar Mishra, Asha Chandola-Saklani

Thyroid Research and Practice 2018 15(3):105-112

Background: Iodine is an integral constituent of thyroid hormones, and the physiological changes during pregnancy affect its turnover and excretion necessitating increased intake during pregnancy. Understandably, populations with deficient iodine would have a greater prevalence of thyroid dysfunction which would also affect reference-range estimations and hence unreliable diagnosis. Despite this, there is a conspicuous lack of data on the impact of iodine deficiency on thyroid hormone dynamics and reference-intervals during pregnancy. Objective: The aim of this study is to assess thyroid hormone ranges and pregnancy outcome in a mild-iodine-deficient population. Methods: Survey was conducted for goiter and adverse pregnancy outcomes on rural women from 13 Government Primary Health Centers in an iodine-deficient zone. Out of this population, 340 women completed the follow-up for thyroid status (Goiter, thyroid-stimulating hormone [TSH], free thyroxine) and pregnancy outcome. Data on pregnancy outcome for the last 10 years were also retrieved from health center records. Results: Urinary iodine concentration values re-affirmed the mild-iodine-deficient status of this population. TSH indicated relatively higher cutoffs (at 2.5th–97.5th percentile: 1.02–3.70, 1.54-4.83, 2.20–5.74 mIU/L, 1st, 2nd, and 3rd trimester) as compared to that of international guidelines imported in India, yet 98% of the population was found within normal range. Data indicated the possibility of misclassification error following imported guidelines. Survey revealed 1.1% Grade1 goiter, 0.4% miscarriages, 0.68% premature birth, and 1.59% stillbirth. Data retrieved from the past 10 years are comparable. Conclusion: Iodine deficiency appears to enhance the upper cutoffs of TSH. Thyroid function remains unimpaired in continued mild iodine deficiency during pregnancy as a result of efficient homeostasis. The study underscores the need for indigenous population-specific ranges to avoid misclassification errors.

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A rare incidental case of an occult breast carcinoma micrometastasis in papillary thyroid carcinoma: A view within a view

Jasmine Kaur, Sonam Sharma, Tejinder Singh Bhasin, Ranjan Agarwal, Rahul Mannan

Thyroid Research and Practice 2018 15(3):142-146

Metastasis to thyroid gland is rare, accounting for only 2%–3% of malignant lesions of thyroid and if present, is associated with a poor prognosis. Herein, we describe a case of a 42-year-old female who presented initially with papillary carcinoma of the thyroid and a synchronous malignancy was pointed toward on the basis of a secondary population of atypical cells in intrathyroidal as well as perithyroidal blood vessels emboli. Immunohistochemistry and systematic review of the patient later proved the micrometastasis to be that of carcinoma breast for which the patient was operated 6 years ago. The present case is worth reporting because it documents the presence of two different cancers in a single-organ system (a rare presentation of breast ductal cancer metastasizing to the papillary thyroid carcinoma) by the means of an important yet overlooked lymphovascular compartment, by the identification of the metastatic tumor emboli.

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Postprandial decline in thyroid-stimulating hormone is significant but not its correlation with postprandial change in plasma glucose

T V S Pradeep, Sree Harsha Varma, Sunanda Tirupati, Vijaya Sarathi, K Dileep Kumar

Thyroid Research and Practice 2018 15(3):113-116

Background: There are limited data on postprandial change in serum thyroid-stimulating hormone (TSH), especially on its correlation with postprandial change in plasma glucose. Hence, we evaluated the postprandial changes in thyroid function tests (TFTs) and their correlation with postprandial changes in plasma glucose. Materials and Methods: This prospective, cross-sectional study was conducted at a tertiary care hospital from South India. The study included 200 participants: 75 healthy volunteers without known thyroid dysfunction (Group A), 65 healthy pregnant women (Group B), and 60 patients who were known hypothyroid (clinical and subclinical hypothyroid) on levothyroxine therapy (Group C). All participants underwent biochemical investigations including plasma glucose and TFTs in fasting and 2-h postprandial states. Results: Serum TSH was significantly lower in the postprandial state than fasting sample in all the three groups, whereas the free triiodothyronine and free thyroxine levels were not significantly different in fasting and postprandial states. There was no significant correlation between change in plasma glucose and the change in TFT in any group. In pregnant women (Group B), the prevalence of hypothyroidism was significantly higher in fasting than postprandial while using a cutoff of 2.5 μIU/ml (41.5% vs. 18.4%, P = 0.004) as well as 4 μIU/ml (12.3% vs. 1.5%, P = 0.03) but not in other groups (Group A and Group C). Conclusion: Our study reports significant TSH decline in the postprandial state but no significant correlation between postprandial changes in plasma glucose and TSH.

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Serum concentrations of interleukin-17A but not interleukin-17F are elevated in children with recent-onset Hashimoto's thyroiditis

Sandhya Cautha, Devi Dayal, Naresh Sachdeva, Darshan Badal, Savita Verma Attri, Kushaljit Singh Sodhi

Thyroid Research and Practice 2018 15(3):128-131

Background: Recent advances in immunology suggest that T-helper 17 lymphocytes (Th17) have a major role in the disrupted autoimmunity in Hashimoto's thyroiditis (HT). However, there are no data on the Th17 characteristics, especially regarding the dominant interleukins (ILs) that they produce in children with HT. Material and Methods: With an aim to determine the role of two major Th17 cytokines in children with HT, we measured serum concentrations of IL-17A and IL-17F in 40 children with recent-onset HT and 40 age- and sex-matched controls by enzyme-linked immunosorbent assay. Results: Serum IL-17A concentrations were significantly higher in children with HT when compared to controls (3.39 ± 6.93 pg/mL vs. 0.12 ± 0.47 pg/mL, P = 0.00). However, the IL-17F concentrations were similar in patients and the controls (11.12 ± 15.34 pg/mL vs. 9.68 ± 12.87 pg/mL, P = 0.65). Conclusions: The elevated concentrations of IL-17A, one of the major effector cytokines of the Th17 system, suggest its possible role in the pathogenesis of HT in children.

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Trimester-specific reference ranges for thyroid function tests in South Indian women

K Sandhya Rani, Sunanda Tirupati, Vijaya Sarathi, K Dileep Kumar

Thyroid Research and Practice 2018 15(3):117-121

Background: There are no published data on trimester-specific reference intervals for thyroid function tests (TFTs) in south Indian pregnant women. Hence, this study was conducted to establish trimester-specific reference intervals for TFTs in south Indian pregnant women. Materials and Methods: This is a cross-sectional study conducted at a tertiary health-care center at Coastal region from South India. A total of 235 healthy women of age >18 years with uncomplicated singleton, intrauterine pregnancy who were consuming iodized salt were recruited for the study. Family history of thyroid illness, history of abortion, goiter, antithyroid peroxidase positivity, overt hypothyroidism, and overt hyperthyroidism were present in 11 (4.7%), 27 (11.5%), 50 (21.3%), 15 (6.38%), 1 (0.42%), and 3 (1.28%) had, respectively, and a total of 73 participants having one of these features were excluded from the study. A total of 162 (I trimester: 47, II trimester: 50, and III trimester: 65) women were included in the analysis to derive trimester-specific reference ranges. Results: The reference ranges for the first, second, and third trimester were 0.08–2.24, 0.42–2.84, and 0.40–3.14 μIU/ml for thyroid-stimulating hormone, 0.68–1.44, 0.59–1.21, and 0.53–1.15 ng/dl for free thyroxine 4 (FT4) and 2.08–3.48, 1.81–3.81, and 1.86–3.38 pg/ml for FT3. Conclusion: Our study reports trimester-specific reference ranges for TFTs in south Indian women from a coastal region.

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Incipient iron deficiency in primary hypothyroidism

Tanveer Hassan Banday, Sadaf Bashir Bhat, Sabreen Bashir Bhat, Shahnawaz Bashir, Shah Naveed

Thyroid Research and Practice 2018 15(3):138-141

Background: Hypothyroidism affects around 1% of general population. Anemia in association with hypothyroidism has been studied since 1881. Iron deficiency has multiple adverse affects on thyroid metabolism. It decreases circulating thyroid hormone concentration, blunts thyrotropic response to thyrotropin-releasing hormone (TRH) and decreases serum triiodothyronine (T3). Objectives: To find the prevalence of iron deficiency in primary hypothyroids. Material and Methods: In our study, 70 patients were selected, out of which 50 were females and 20 were males, who were suffering from hypothyroidism. Iron deficiency in the study group was confirmed at baseline using multiple iron status indicators (serum ferritin, serum iron, total iron-binding capacity and percentage saturation). These patients were between age group 18–65 years. Results: In our study, only 14 patients (20%) manifested with anemia (which was defined as HB < 12 gm/dl), whereas the prevalence of iron deficiency (with or without anemia) was 34.2%), in which 28.5% were females and 5.70% were males, thus showing that prevalence of iron deficiency (with or without anemia) can be higher than iron deficiency anemia itself, which is supported by literature. Conclusion: Iron deficiency was present in a significant portion of patients with primary hypothyroidism. It also concluded that frequency of iron deficiency (with or without anemia) was higher than iron-deficiency anemia.

https://ift.tt/2z9ITUU

Clinical spectrum and outcome of patients with hyperthyroidism in Nepal

Robin Maskey, Jeet Prasad Ghimire, Bickram Pradhan, Vivek Kattel, Prahlad Karki, Madhab Lamsal

Thyroid Research and Practice 2018 15(3):122-127

Context: Thyroid dysfunction is a major public health problem among the Nepalese population. The average prevalence of thyroid disorder was 30% seen in different parts of Nepal. It is important to detect these disorders at the preclinical stage and manage them accordingly. Aims: This study aimed to assess the clinical spectrum and outcome of patients with hyperthyrdoism in BP Koirala Institute of Health Sciences, a tertiary care teaching hospital of Nepal. Settings and Design: This is a prospective observational study. Subjects and Methods: All adult hyperthyroid patients presenting to the Department of Internal Medicine were enrolled for 1 year and evaluated for clinical spectrum and outcome after treatment with antithyroid drugs. Statistical Analysis Used: Descriptive statistics such as frequencies, mean, standard deviation, and proportion for quantitative variable were calculated and association was established using Chi-square test with P values. P < 0.05 was considered statistically significant. Results: Among sixty patients of hyperthyroidism enrolled in the study, common clinical manifestation was palpitations (92.7%), tremulousness, and heat intolerance (70.1%). Similarly, most common clinical sign was warm, moist skin (89.1%), followed by tremors (72.7%). After treatment with antithyroid drugs, 60% became euthyroid within 6 weeks. Conclusions: The most common symptoms of hyperthyroidism were palpitation. Majority of patients improved with antithyroid drugs within 6 weeks of treatment.

https://ift.tt/2OOoDgJ

Somatization, anxiety, and depression triad in hypothyroidism

Samir Kumar Praharaj

Thyroid Research and Practice 2018 15(3):147-148



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Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: A prospective pilot study

The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafs for augmentation of the severely resorbed maxilla and to assess the treatment results.

https://ift.tt/2PwSAHd

Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography

Our aim was to assess the association between the angle of impaction of the third molar and the position of the mandibular canal on cone-beam computed tomography (CT). We designed a retrospective study of 100 cone-beam CT images of 173 mandibular third molars that were obtained between January 2012 and December 2015, and recorded the angle of impaction of the third molar, the position of the mandibular canal in relation to the impacted tooth, and the potential contact between the roots of the tooth and the mandibular canal.

https://ift.tt/2BamuIo

Citation for the 2017 Down Surgical Prize – Paul Johnson

Ladies and Gentlemen, Mr President, Paul and Karen.

https://ift.tt/2K83Zr1

Familial frontal fibrosing alopecia: A cross‐sectional study of 20 cases from nine families

Abstract

Background/Objectives

Frontal fibrosing alopecia (FFA) is a scarring alopecia whose prevalence is increasing. The pathogenesis of this disease is not well known. Genetic, environmental, hormonal and autoimmunity related factors have been considered; however, only a few cases of familial frontal fibrosing alopecia have been reported.

Material and methods

A cross‐sectional study was performed at University Hospital in Granada (Spain). Twenty patients with frontal fibrosing alopecia belonging to nine different families were included, and clinical and dermoscopic features were analysed.

Results

Overall, 90% of the patients studied were women (mean age 61.4 years). About 50% of the patients had grade II frontal fibrosing alopecia at the time of diagnosis, whilst 35% had grades III or V. Mean recession was 2.83 cm in the frontal area and 1.99 cm in the temporo‐parietal area. Daughters presented a shorter recession area and earlier debut of the disease than mothers. Androgenetic alopecia was found in only two patients (10%). The dermoscopic signs most commonly found were perifollicular erythema (85%), hyperkeratosis (85%), and absence of vellus hair in the hairline (78.9%).

Conclusion

This study adds to the growing evidence that there is a genetic component to frontal fibrosing alopecia. The clinical pattern of frontal fibrosing alopecia was not different from that found in non‐familial cases, but the debut of the disease in daughters of mothers with frontal fibrosing alopecia may be earlier.

https://ift.tt/2qN9e6z

Subcutaneous immunotherapy induces alterations in monocytes and dendritic cells homeostasis in allergic rhinitis patients

Specific subcutaneous immunotherapy (SCIT) can achieve long-term remission in patients with allergic rhinitis (AR) through complex and still unknown mechanisms. The aim of this study is to evaluate the effect ...

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Estrogen receptor-alpha (ESR1) polymorphism rs1999805 associates with asthma

As adults, women have higher rates of asthma and allergic disease as well as increased asthma severity compared to men.1 Pre or peri-menstrual worsening of asthma symptoms (PMA) were reported in 17% of women enrolled in the severe asthma research program, with 52% of these women with PMA having severe asthma.2, 3 Further, use of birth control medications or hormone replacement therapy during peri or post-menopause was also linked to worsening of asthma in some women.2, 4 Mouse models of asthma showed estrogen signaling through estrogen receptor-alpha (ER-α), and not ER-β, increased allergic airway inflammation, mucus production, and/or airway hyperresponsiveness.

https://ift.tt/2zfulmF

Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery

This matched cohort study examines the association of the addition of celecoxib to the standard analgesia regimen with opioid use in patients after head and neck cancer surgery.

https://ift.tt/2H95Jly

Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors

This cross-sectional survey study of oropharyngeal cancer survivors investigates the association of late lower cranial neuropathy with severity of cancer treatment–related symptoms and general functional impairment.

https://ift.tt/2oJj8VM

Identification of Baseline Factors Associated With Development of Depression in Head and Neck Cancer

This ad hoc secondary analysis of a randomized clinical trial of patients with new or recurrent stages II through IV head and neck epidermoid carcinoma assesses the factors that may be associated with the development of moderate or severe depression during treatment.

https://ift.tt/2Q0Vljt

The 2018 American Head and Neck Society Presidential Address—Reflections

This Presidential Address presented at the 2018 meeting of American Head and Neck Society (AHNS) highlights the challenges and opportunities of the AHNS ongoing reorganization in the rapidly changing practice of head and neck surgery and details how AHNS members can harness this change to direct the future of their field.

https://ift.tt/2Doevcn

Close Margins and Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Parotid Gland

This case series evaluates the oncologic outcomes of patients with acinic cell carcinoma of the parotid gland and the results of adjuvant therapy for those with close (≤1-mm) margins.

https://ift.tt/2IUJax6

RNA Oncoimmune Phenotyping of HPV-Positive Oropharyngeal Cancer by Nodal Status

This cohort study explores whether a tumor-specific genetic signature exists for node-negative vs node-positive HPV 16–positive/p16-positive oropharyngeal squamous cell carcinomas.

https://ift.tt/2qILv7M

Marijuana Use and Psychosocial and QOL Outcomes Among Patients With Head and Neck Cancer

This case-matched cohort study investigates differences in psychosocial and quality of life outcomes between marijuana users and nonusers among patients with newly diagnosed head and neck cancer.

https://ift.tt/2vtR0J9

FDG PET–CT in the Detection of Oropharyngeal Cancer Recurrence

This cohort study compares the accuracies of the initial posttreatment positron emission tomography and computed tomography between primary treatment groups and attempts to define indicators of false-positive findings in patients treated for oropharyngeal cancer.

https://ift.tt/2CRPV4R

Is Improved Insurance Coverage a Fleeting Opportunity?

The data from the Surveillance, Epidemiology, and End Results (SEER) database analyzed by Cannon et al in this issue of JAMA Otolaryngology–Head & Neck Surgery are highly relevant as the future of the Patient Protection and Affordable Care Act (ACA) becomes progressively more fragile. The authors provide objective data on improved rates of health care coverage after implementation of the ACA among patients with head and neck cancer. Reviewing the evolving payer mix is an important metric when assessing access to care. The decline in uninsured patients with head and neck cancer from 6.2% in 2013 to 3.0% in 2014 is a significant improvement. This finding does not mean that increased coverage is inexpensive, uniformly successful, or synonymous with improved patient adherence to treatment and healthier living. Although SEER survival outcomes data are not yet available for comparison of the periods before and after implementation of the ACA, this article is an important catalyst in our specialty for future study of the influence that major health policy change has on patients with head and neck cancer.

https://ift.tt/2p2D9Xw

Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Opioid Prescriptions

This cohort study assesses the association of institutional availability of multimodal analgesia pathways with adoption and adherence to such pathways, and the frequency of opioid prescriptions at discharge among adults following thyroid and parathyroid surgery.

https://ift.tt/2LtuVVq

November Issue HighlightsTheme Issue: From the American Head and Neck Society

Presentations From the American Head and Neck Society Annual Meeting; 2018; April 18-19, 2018; National Harbor, Maryland.

https://ift.tt/2DnfPMt

Positive Initial Margins and Survival Among Patients With SCC Treated With Total Laryngectomy

This cohort study investigates the association between positive initial margins and survival among patients with squamous cell carcinoma who underwent total laryngectomy and had negative final margins.

https://ift.tt/2LrhqWX

Effect of Perioperative Gabapentin Use in Patients Undergoing Head and Neck Mucosal Surgery

This randomized clinical trial investigates the effect of perioperative gabapentin treatment vs placebo on postsurgical pain in patients undergoing head and neck mucosal surgery.

https://ift.tt/2Jvopst

Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer

This cohort study assesses the baseline cognition of patients with oropharyngeal cancer using the Patient-Reported Outcomes Measurement Information System and National Institutes of Health (NIH) Toolbox Cognitive Battery instrument.

https://ift.tt/2J6rJtV

Risk Factors Associated With Unplanned Reoperation in Major Head and Neck Surgery

This cohort study uses the American College of Surgeons National Surgical Quality Improvement Program 2005-2014 database to identify risk factors associated with unplanned reoperation following major head and neck surgical procedures.

https://ift.tt/2xE1p72

Patient-Perceived Voice Changes and Quantitative Voice Measures in the Year After Thyroidectomy

This mixed methods study assesses the quality-of-life consequences of postthyroidectomy voice change from the perspective of patients with thyroid cancer and compares patient-perceived voice changes with changes in quantitative vocal variables at 5 time points in the first postoperative year.

https://ift.tt/2JcgboL

Association of the ACA With Insurance Coverage for Head and Neck Cancer

This population-based study uses data from the Surveillance, Epidemiology, and End Results database to examine the association of the Patient Protection and Affordable Care Act with rates of insurance coverage and access to care among patients with head and neck squamous cell cancer.

https://ift.tt/2p66lwK

Gene Expression Profiling in p16-Positive Oropharyngeal Squamous Cell Carcinomas

Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is associated with p16 overexpression and a better prognosis than HPV-negative OPSCC. Concurrent treatment with standard-dose radiation therapy (RT) (66-70 Gy) and platinum-based chemotherapy is highly effective for most patients with p16-positive OPSCC, but more than 40% of patients experience severe late toxic effects when treated with concurrent chemoradiation therapy (CRT). The advent of transoral minimally invasive surgical approaches to the oropharynx, such as transoral robotic surgery (TORS) and transoral laser microsurgery (TLM), has provided an opportunity to treat patients with OPSCC while potentially minimizing long term sequelae of CRT. Treatment choice (ie, surgery with or without adjuvant therapy vs primary RT-CRT) and deintensification are areas of current investigation. However, given heterogeneity among patients with p16-positive OPSCC, optimal treatment paradigms remain unclear.

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Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures

This observational study compares postoperative use of opioids between the United States and Hong Kong in patients undergoing head and neck surgery.

https://ift.tt/2wOZHiO

JAMA Otolaryngology–Head & Neck Surgery

Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician's understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology—head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

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Successful therapy with secukinumab in a patient with generalized pustular psoriasis carrying homozygous IL36RN p.His32Arg mutation

https://ift.tt/2K7ysWj

Use of Corticosteroid-Eluting Sinus Stents Between 2012 and 2017

This study characterizes the extent and cost of the use of corticosteroid-eluting sinus stents between 2012 and 2017.

https://ift.tt/2PympY5

Parental Perspectives and Concerns About Pediatric Tonsillectomy in Social Media

This study analyzes comments on Twitter from parents before, during, and after their children's tonsillectomy.

https://ift.tt/2QGnQjC

The Tonsillectomy Tweet

The phrase social media is quickly becoming a misnomer. Although initially intended to be used for networking, marketing, and entertainment purposes, social media has extended its utility into the academic and research realms. Previous research has demonstrated the ability of social media to disseminate health information quickly as well as connect individuals around the globe with similar diseases, conditions, and procedures.

https://ift.tt/2Pymo6t

Retained Nasal Trumpet for 20 Months

This case study examines a man in his 30s who presented 20 months after an emergency intubation with an iatrogenic retained nasal trumpet.

https://ift.tt/2QMm8Ny

Association Between Lymph Node Ratio and Recurrence and Outcomes in Patients With Oral Cavity Cancer

This cohort study examines the association between lymph node ratio and tumor recurrence and survival outcomes in patients with oral cavity squamous cell carcinoma.

https://ift.tt/2PuJryQ

A Posterior Triangle Neck Mass in a Pediatric Patient

A pediatric female presented with a left posterior triangle neck mass that had progressed for 3 years following a motor vehicle accident. What is your diagnosis?

https://ift.tt/2QMnJ6a

Histology of Nivolumab-Induced Thyroiditis

Thyroid, Ahead of Print.


https://ift.tt/2DGoM4v

Norovirus GII.17 Virus-Like Particles Bind to Different Histo-Blood Group Antigens and Cross-React with Genogroup II-Specific Mouse Sera

Viral Immunology, Ahead of Print.


https://ift.tt/2qOvehl

A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology: Erratum

No abstract available

https://ift.tt/2FnBQ0d

Auditory Brainstem Response in Infants with Iron Deficiency Anemia

Publication date: Available online 14 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hemawathiy Sundagumaran, Jayashree Seethapathy

Abstract

Background

Auditory brainstem response (ABR) in infants with Iron Deficiency Anemia (IDA) helps in understanding the auditory aspects of central nervous system.

Objectives

To analyze and compare absolute and interpeak latencies of ABR in infants with and without IDA.

Methods

ABR traces were obtained from 40 anemic ears and 40 non anemic ears, aged 6-24 months. ABR was recorded with 11.1/s clicks at different intensity levels.

Results

Absolute latencies of all the peaks were prolonged in infants with IDA at 70, 50 and 30 dBnHL except for peak I. Amplitude of peaks I, III and V was not statistically different between the two groups at 70 and 50 dBnHL. Reduced peak amplitude was noted only at 30 dBnHL in infants with IDA which was statistically significant (P<0.05). Interpeak interval showed no significant difference between anemic and non-anemic infants at 70 dBnHL. Prolonged interpeak latency of peak III-V and I-V was noted at 50 and 30dBnHL.

Conclusion

Functional development of auditory system seems to be affected due to iron deficiency. IDA has a long lasting effects on central auditory system when IDA is left untreated This will in turn lead to an alteration in the neuro-functional maturation.

https://ift.tt/2OPVsKc

DOOR syndrome: a case report and its embryological basis

Publication date: Available online 14 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mariline Santos, Ângela Reis - Rego, Miguel Coutinho, Cecília Almeida e Sousa

Abstract

DOOR syndrome is an extremely rare genetic disorder. "DOOR" is an acronym to describe the combination of: deafness, onychodystrophy, osteodystrophy and mental retardation. We present a patient, with all of the above-mentioned main symptoms, that was rehabilitated with convencional hearing aids. The presented case suggested that every case of deafness and abnormal nails and phalanges in the hands and feet should have a clinical diagnosis of possible DOOR syndrome. Based on embryological process, congenital abnormal nails or phalanges highlights the importance for detailed hearing screening.

https://ift.tt/2zaTHCm

Gingival mesenchymal stem cells attenuate pro-inflammatory macrophages stimulated with oxidized low-density lipoprotein and modulate lipid metabolism

Publication date: Available online 14 November 2018

Source: Archives of Oral Biology

Author(s): Rundan Hong, Zhiguo Wang, Aihua Sui, Xiaoxuan Liu, Chun Fan, Sofya Lipkind, Quanchen Xu

Abstract

Objective

To examine the effects of gingival mesenchymal stem cells (GMSCs) on inflammatory macrophages upon oxidized low-density lipoprotein (ox-LDL) stimulation and evaluate therapeutic potential of GMSCs on mouse model of periodontitis associated with hyperlipidemia.

Methods

In vitro, GMSCs were co-cultured with macrophages for 48 hours in the absence or presence of M1 polarizing conditions and oxidized low-density lipoprotein in the transwell system. The supernatants were collected for ELISA. M1 and M2 markers of macrophages were analyzed by flow cytometry and PCR, and lipid accumulation was assessed by oil red O staining. In vivo, eighteen mice were divided into three groups (n = 6): Group A (periodontally healthy mice as control), Group B (periodontitis mice with hyperlipidemia), Group C (periodontitis mice with hyperlipidemia with the transplantation of GMSCs). The serum levels of cholesterol and inflammatory factors were measured by automatic analyzer. Bone regeneration was evaluated by Masson staining.

Results

When co-cultured with GMSCs, the M1 markers of Tumor Necrosis Factor (TNF) -α, Interleukin (IL) -6, Interleukin (IL) -1β, CD86, and Human Leukocyte Antigen (HLA) -DR were significantly reduced. In contrast, M2 markers such as Interleukin(IL) -10 and CD206 were moderately increased. Similar results were obtained in the cell culture supernatants. In animal experiment, GMSCs suppressed the expression of sterol regulatory element binding transcription factor 1c (SREBP-1c) and elevated the levels of peroxisome proliferator-activated receptor alpha (PPARα) and peroxisome proliferator activator receptor- coactivator 1(PGC-1α) in the liver, attenuated cholesterol dysfunction via the downregulation of low-density lipoprotein (LDL) and total cholesterol (TC), and the upregulation of high-density lipoprotein (HDL), and decreased the levels of TNF-α and IL-6. Moreover, GMSC treatment improved bone regeneration.

Conclusion

GMSCs inhibit the activation of M1 macrophages, regulate lipid metabolism and reduce inflammatory response, and promote bone regeneration in mouse model of periodontitis associated with hyperlipidemia.

https://ift.tt/2PtzXEa