‘One tooth one child’: evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

https://ift.tt/2zXN0mB

Dental anxiety in relation to torture experiences and symptoms of post‐traumatic stress disorder

Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post‐traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire‐PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.

https://ift.tt/2Tn8Zfo

Effects of hypothermia during propofol anesthesia on learning and memory ability and hippocampal apoptosis in neonatal rats

Abstract

Objective

At present, the harm of hypothermia to the central nervous system has received a great attention from scholars. The present study aimed to investigate the effects of hypothermia on learning and memory abilities and hippocampal apoptosis in neonatal rats and the role of p-ERK and p-CREB in anesthesia.

Methods

In this study, 60 Sprague Dawley newborn rats (age 7-day-old) were randomly divided into 3 groups (n = 20), including Control Group (Group C), Anesthesia Group (Group A), and Anesthesia Hypothermia Group (Group AH). Group C was intraperitoneally injected with 0.1 ml saline, and rectal temperature was maintained in the range of 38–39 °C; Group A was intraperitoneally injected with 25 mg/kg of propofol (0.1 ml), the 1/2 initial dose was added per each period of 20 min, anesthesia was maintained for 2 h, and rectal temperature was kept in the range of 38–39 °C. The anesthesia mode and duration of Group AH were as same as Group A, room temperature was set to 23 °C, which caused body's temperature naturally dropped down. After the anesthesia recovered, each group randomly involved five rats for analyzing by Western blot to detect the expression level of p-ERK and p-CREB, and other five rates were also analyzed by flow cytometry assay to detect hippocampal apoptosis rate. The remaining 10 rats in each group were kept up to 30 days for conducting the Morris water maze test, five rats were tested for detecting the expression level of p-ERK and p-CREB, as well as hippocampal apoptosis rate in each group.

Results

Compared with Group C and Group A, the rectal temperature of Group AH was decreased significantly (P < 0.05); At the age of 7 days, compared with Group C and Group A, apoptosis rate of hippocampal tissue in Group AH was increased (P < 0.05), the expression level of p-ERK and p-CREB proteins in Group AH was significantly reduced (P < 0.05), and there were no significant differences between Group C and Group A. At the age of 36 days, there were no significant differences in the results of behavioral test, apoptotic rates, and expression level of the proteins.

Conclusion

Our findings suggest that hypothermia during anesthesia can increase the apoptosis rate in the hippocampus of neonatal rats, whose mechanism may be related to the downward adjustment of p-ERK and p-CREB. However, it has no obvious influence on the long-term learning and memory abilities.

https://ift.tt/2BdXtfs

Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain

Abstract

Inflammation is the body's response to injury and infection, involving a complex biological response of the somatosensory, immune, autonomic, and vascular systems. Inflammatory mediators such as prostaglandin, proinflammatory cytokines, and chemokines induce pain via direct activation of nociceptors, the primary sensory neurons that detect noxious stimuli. Neurogenic inflammation is triggered by nerve activation and results in neuropeptide release and rapid plasma extravasation and edema, contributing to pain conditions such as headache. Neuroinflammation is a localized inflammation in the peripheral nervous system (PNS) and central nervous system (CNS). A characteristic feature of neuroinflammation is the activation of glial cells in dorsal root ganglia, spinal cord, and brain which leads to the production of proinflammatory cytokines and chemokines in the PNS and CNS that drives peripheral sensitization and central sensitization. Here, we discuss the distinct roles of inflammation, neurogenic inflammation, and neuroinflammation in the regulation of different types of pain conditions, with a special focus on neuroinflammation in postoperative pain and opioid-induced hyperalgesia.

https://ift.tt/2FtPBLb

Bridging the gap between vaccination with Bacille Calmette-Guérin (BCG) and immunological tolerance: the cases of type 1 diabetes and multiple sclerosis

Giovanni Ristori | Denise Faustman | Giuseppe Matarese | Silvia Romano | Marco Salvetti

https://ift.tt/2qS6J2I

Progressive annular verrucous erosive plaques on the face

https://ift.tt/2K8G2zF

Voice therapy associated with a decrease in the reflux symptoms index in patients with voice complaints

Objectives/Hypothesis

Patients with muscle tension dysphonia often demonstrate an elevation in Reflux Symptom Index (RSI) and 10‐item Voice Handicap Index (VHI‐10) scores, and may be erroneously diagnosed with laryngopharyngeal reflux disease. In this study we assessed the effects of voice therapy on RSI and VHI‐10 scores in patients with voice complaints not responsive to antireflux medications.

Study Design

Retrospective cohort study.

Methods

A study of patients was conducted at a single tertiary‐care center over 1 year (January 2012–January 2013). Patients were included if they had dysphonia not responsive to proton pump inhibition, did not have neurologic or neoplastic disease, and participated in at least three voice‐therapy sessions in the absence of antireflux therapy. Primary analysis assessed change in RSI scores between the initial and follow‐up visits with a laryngologist.

Results

A total of 18 patients were included (mean age = 49.9 ± 14.5 years, 89% female, 83% with a primary complaint of dysphonia). From initial to follow‐up visit, the median RSI score (18.5 [interquartile range {IQR}, 9.5–22.8] vs. 10.5 [IQR, 4.5–14]; P = .02) and median VHI‐10 score (25.5 [IQR, 11.3–30.0] vs. 13.5 [IQR, 9.5–20.8]; P = .03) significantly decreased. A significant inverse correlation was found between the number of voice therapy sessions/month and change in RSI score (r = −0.4; P = .05).

Conclusions

In this study of patients with muscle tension dysphonia or vocal hyperfunction not responsive to antireflux therapy, RSI and VHI‐10 scores improved following voice therapy. Results suggest that self‐reported symptoms typically attributed to laryngopharyngeal reflux disease may actually be secondary to inefficient voice use patterns or anxiety about dysphonia that are responsive to voice therapy.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2qODmyt

Cutaneous squamous cell carcinoma metastasis to the parotid region lymph nodes

Objective

To determine the effect on survival of periauricular region cutaneous squamous cell carcinomas (cSCC) metastasizing to parotid region and cervical lymph nodes.

Methods

From May 1995 to October 2013, consecutive patients with cSCC undergoing parotidectomy/neck dissection ≥ 18 years without distant metastasis were included. Demographic, clinical, and pathologic data were analyzed. Uni‐ and multivariate analyses of disease‐specific survival and overall survival were performed. Statistical significance was set at P < 0.05.

Results

We evaluated 137 patients. Most patients were Caucasian males with an average age of 71.6 years. The median follow‐up time was 29.4 months.

Thirty‐six percent of patients had pathological evidence of cervical metastasis (N+). Seven percent had metastasis to level I, 21.9% to level II, 14.6% to level III, 8% to level IV, and 9.5% to level V. Thirty‐nine percent of patients had metastasis to parotid region (P+). The average number of positive:total nodes from parotidectomy was 1.9:4.6.

The median overall and disease‐specific survival times were 2.81 and 1.96 years, respectively. Patients with either neck or parotid metastasis (N + or P+) had significantly decreased survival, hazard ratio 2.298 (1.2739, 4.1445), compared to patients without metastasis (N0P0), P < 0.0057.

Conclusion

Patients with periauricular region cSCC metastasizing to parotid and cervical regions lymph nodes have significantly decreased survival compared with patients without cervical and/or parotid metastasis. Metastasis to parotid region should be considered as a distinct head and neck level when staging periauricular cancers. This study provides a basis for further studies to validate these findings.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2FsXyju

Sex bias: Is it pervasive in otolaryngology clinical research?

Objectives/Hypothesis

Recent initiatives highlight substantial sex bias in biomedical research. The objective was to determine whether sex bias is present in otolaryngology and whether sex is appropriately analyzed as an independent variable in otolaryngology clinical research.

Study Design

Literature review.

Methods

We systematically reviewed all 2016 articles in three major otolaryngology journals: The Laryngoscope, JAMA Otolaryngology–Head and Neck Surgery, and Otolaryngology–Head and Neck Surgery. Extracted data included study origin, location, subspecialty, number/sex of subjects, ≥50% sex matching (SM_≥50), and sex‐based statistical analysis.

Results

Six hundred of 1,209 articles comprising original clinical research were reviewed including 8,997,345,495 subjects (males: 3,898,559,264 [43.3%]; females: 5,095,592,583 [56.6%]; and unknown: 3,193,648 [0.04%]). There were 533/600 (88.8%) studies that included both sexes, eight (1.3%) included females only, five (0.8%) included males only, and 56 (9.3%) did not document participant sex. Only 280 studies (46.7%) analyzed data by sex, and 330 studies (60.7%) had SM_≥50. Sex‐based statistical analysis and SM_≥50 were similar in domestic and international studies (48.7% vs. 42.8% and 60.9% vs. 62%, respectively). Database studies performed sex‐based statistical analysis more frequently than single and multi‐institutional studies (79.1% vs. 40.4% and 43.4%, P < .00001). Analysis by sex was more frequently performed in head and neck surgery (53.6%) and pediatric otolaryngology (51.3%), whereas SM_≥50 was highest in pediatric otolaryngology (86.8%) and otology (82.4%).

Conclusions

Sex bias exists in the clinical otolaryngology literature, with less than half the studies analyzing sex. Acknowledging the intertwinement of sex with disease pathophysiology and outcomes is important. Eliminating sex bias in research and clinical care should become a major focus for otolaryngologists.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2qSrQlQ

Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger—United States 2012

Objectives/Hypothesis

To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.

Study Design

Cross‐sectional study.

Methods

The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.

Results

An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty‐one percent of the patients were ≤3 years old, and 62% were male. Forty‐eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.

Conclusions

Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2FptuoY

Long‐term swallowing performance following transoral robotic surgery for obstructive sleep apnea

Objectives/Hypothesis

This study aimed to evaluate the long‐term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA).

Study Design

Retrospective and prospective cohort study.

Methods

Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long‐term swallowing functions were assessed using subjective self‐evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES).

Results

Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty‐five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration.

Conclusions

BOT reduction via TORS has a negative effect on long‐term swallowing function. A self‐assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow‐up. Proper patient selection and detailed information about surgery and possible late‐swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2qQ7fOQ

Impact of a Formal Patient Safety and Quality Improvement Curriculum: A Prospective, Controlled Trial

Objective

To assess the impact of implementing a dedicated Patient Safety and Quality Improvement (PSQI) curriculum for otolaryngology residents.

Methods

Residents in two otolaryngology residency programs were recruited to participate in the study. Residents at institution A (intervention group) participated in a formal, newly developed, year‐long PSQI curriculum. Residents at institution B (control group) participated in traditional, morbidity, and mortality conference‐based PSQI education, with no formal curriculum in place. Curriculum participants completed anonymous surveys to assess learner satisfaction. Validated instruments were administered to assess for changes in resident confidence in the ability to develop PSQI projects, their attitudes toward patient safety, and PSQI‐related knowledge. The number and quality of PSQI‐related resident projects were also assessed.

Results

Survey responses demonstrated excellent learner satisfaction with the curriculum. Based on validated instrument‐based responses, both programs demonstrated similar confidence scores (P = 0.05), safety attitudes (P = 0.82), and PSQI knowledge (P = 0.29) at the beginning of the year. The residents of institution A demonstrated significant improvement in confidence (P = 0.00009) and knowledge (P = 0.0006) after completing the curriculum, with no improvement noted for residents at institution B in either confidence (P = 0.06) or knowledge (P = 0.79). Neither program demonstrated improvement in attitudes toward patient safety at the end of the year‐long curriculum.

Conclusion

Implementing a formal curriculum dedicated to PSQI led to an improvement in PSQI‐related project development confidence and PSQI knowledge. Attitudes toward safety did not improve over the course of a year. Longer‐term studies involving multiple institutions and other interventions are needed to evaluate the impact and duration of changes that occur.

Level of Evidence

1b. Laryngoscope, 2018

https://ift.tt/2FoEYJy

Evolving phenotype of the head and neck surgeon

Objective

Characterize the evolution of head and neck (H&N) surgical practices in the United States over two decades by using resident case log data as a surrogate.

Methods

National residency case log data from all Accreditation Council for Graduate Medical Education‐accredited otolaryngology residency programs was reviewed for the past 20 academic years (1996–2015). Key indicator procedures in each subcategory of H&N were analyzed to characterize standard ablative H&N surgical practices. Mean number of cases completed per resident each year was calculated.

Results

The proportion of H&N surgeries contributing to the total number of otolaryngology cases performed yearly remained relatively stable during the study period, ranging from 6.4% to 8.7%, indicating concurrent growth of H&N cases with all otolaryngology surgeries. Although each subcategory within H&N demonstrated modest increases in the number of cases performed per resident each year over the study period, the most significant growth occurred in the endocrine surgery subcategory: a 288% increase from 18.4 in 1996 to 71.5 in 2015. The proportion of H&N cases represented by each subcategory decreased, except for endocrine, which more than doubled in proportion from 21% in 1996 to 43% in 2015.

Conclusion

Our findings suggest that the modern H&N surgeon is increasingly becoming an endocrine and H&N surgeon. The proportion of endocrine surgeries performed in residency, which serves as a surrogate for H&N practices, has more than doubled over the past 20 years and now represents the largest subcategory of H&N surgery.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2qPyvND

Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

Objective

Describe the secondary capability of a robotic system to provide real‐time measurements of airway dimensions with high fidelity.

Methods

Seven unique phantoms of laryngotracheal stenosis (LTS) were modeled using a computer‐aided design tool and were three dimensionally printed. These stenoses were of different dimensions and orientations, and some were purposefully oblique. The dimensions of the stenoses were then measured with the novel Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS; Galen Robotics, Inc., Sunnyvale, CA) because it is capable of tool position memory in three dimensional (3D) space. Five participants (two laryngologists, two otolaryngology–head and neck surgery residents, one neurotology fellow) measured each axis of stenosis (anteroposterior, lateral, and craniocaudal) three times for each of the seven stenosis phantoms. These measurements were then compared to the known design dimensions. Mean magnitude of error (MOE) and interrater reliability (IRR) using an intraclass correlation coefficient (ICC) were then calculated.

Results

Mean MOE and standard deviation for all measurements was 0.306 ± 0.247 mm. Mean MOE was 0.374 ± 0.292 mm, 0.300 ± 0.237 mm, and 0.244 ± 0.185 mm for the anteroposterior, lateral, and craniocaudal dimensions of stenosis, respectively. Eighty‐two percent of all measurements had MOE < 0.5 mm. ICC was 0.945 (95% confidence interval [CI]: 0.847–0.989), 0.995 (95% CI: 0.984–0.999), and 0.993 (95% CI: 0.987–0.999) for anteroposterior, lateral, and craniocaudal dimensions, respectively, indicating excellent agreement among participants.

Conclusion

The REMS can be used to reliably and accurately measure airway dimensions in 3D regardless of the orientation of stenosis. This ability may be easily extrapolated to the measurement of any airway lesion during laryngotracheal surgery.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2FB8X0C

Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series

Objectives/Hypothesis

Upper airway stimulation has demonstrated marked improvements in apnea‐hypopnea index, oxygen desaturation index, and quality‐of‐life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair.

Study Design

Retrospective case series.

Methods

A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement.

Results

At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality.

Conclusion

Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2qQcL3W

Are chronic cough and laryngopharyngeal reflux more common in obstructive sleep apnea patients?

Objectives/Hypothesis

To assess if there is a significant difference in the prevalence and severity of chronic cough symptoms in obstructive sleep apnea (OSA) patients versus non‐OSA patients and examine this relationship in regard to laryngopharyngeal reflux (LPR) symptoms.

Study Design

Prospective cohort study.

Methods

Patients referred to Northwestern Medicine Sleep Lab for home sleep testing were enrolled. Patients filled out the Leicester Cough Questionnaire (LCQ) and Reflux Symptom Index (RSI) before completing sleep testing. Home sleep testing results were reviewed, and patients were separated into non‐OSA and OSA groups by standard Apnea‐Hypopnea Index (AHI) criteria. Demographic characteristics and questionnaire scores of the two groups were compared. The relationship between OSA severity, as determined by AHI, and LCQ and RSI scores was assessed.

Results

Of the 52 patients enrolled, 33 patients met criteria for OSA and 19 patients did not. Comparing patients without OSA versus those with OSA, there was a significant difference in mean LCQ score (129.9 vs. 120.0, respectively; P = .02), implying worse cough symptoms among OSA patients, and mean RSI score (3.2 vs. 11.2, respectively; P = .0013), implying worse upper‐airway reflux symptoms among OSA patients. There was a significant correlation between LCQ score and AHI (r = –0.39, P = .0061) and between RSI score and AHI (r = 0.37, P = .0078).

Conclusions

OSA patients demonstrate worse chronic cough and LPR‐related quality of life versus non‐OSA patients. Furthermore, the severity of these quality‐of‐life measures was correlated with the severity of the AHI. Chronic cough and particularly the pharyngeal LPR symptoms may be associated with the presence and severity of OSA.

Level of Evidence

2 . Laryngoscope, 2018

https://ift.tt/2FoEYt2

Give Thyroid Health on #GivingTuesday, November 27

This year, #GivingTuesday falls on November 27.

It inspires people to take collective action to improve their communities and to give back to the charities and causes they believe in to help create a healthier world.

Your Donation on Giving Tuesday Supports

• Vital Research for Thyroid Diseases and Thyroid Cancer
• Reliable Thyroid Information for Patients and Families
• Expert Clinical Practice Guidelines

Give Together, Give Thyroid Health on #GivingTuesday.

#GIVE2THYROID

The post Give Thyroid Health on #GivingTuesday, November 27 appeared first on American Thyroid Association.

https://ift.tt/2zhjCIi

Postoperative myxedema coma in patients undergoing major surgery: Case series

Myxedema coma is a serious complication of hypothyroidism that can be precipitated by major surgery. It is extremely rare, with only a few reports in the literature. This study aims to present a relatively large case series of post-surgical myxedema coma and to analyze medical and surgical risk factors.

https://ift.tt/2OKoKd2

MiR-196b affects the progression and prognosis of human LSCC through targeting PCDH-17

To explore the effect of miR-196bon the biological features of human laryngeal squamous cell carcinoma (LSCC) through targeting PCDH-17.

https://ift.tt/2zdooqi

A polycaprolactone-β-tricalcium phosphate-heparan sulfate device for cranioplasty

Large bone defects in the skull following trauma or brain surgery, such as trepanation, must be treated promptly to restore the protective and cosmetic function of the skull. Such cranioplasty procedures date back thousands of years yet they still remain a challenge for clinicians, despite extensive research and advances in our understanding of the human body and bone biology (Donati et al. 2007, Feroze et al. 2015). The current reported complication rate ranges from 16% to 40% and general reoperation rate is about 25% (Feroze et al.

https://ift.tt/2PuUeZT

Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry

To quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method.

https://ift.tt/2PCBFmM

Skull base reconstruction with pedicled nasoseptal flap: technique, indications, and limitations

Endoscopic skull base surgery allows extensive tumor resection but results in large defects requiring robust dural repair. The vascularized nasal septal flap pedicled on the posterior nasal septal artery is known to have an excellent success rate for dural defect coverage. Detailed step-by-step descriptions of the harvest and placement of this flap are scarce. Using a sketch, images, and a video, we describe a detailed method for endoscopically harvesting and placing a nasoseptal flap (NSF). We also describe the indications and the decision process leading to the use of NSF.

https://ift.tt/2QOW04L

Ex-vivo and In Vitro validation of an innovative mandibular condyle implant concept

The purpose of this study is to pre-validate a novel implant concept, and to compare the behavior of the mandibular condyle against a commercial Biomet implant in an ex vivo model and present results of the first cadaveric studies.

https://ift.tt/2Pxd3Ma

Experience with 5% Ethanolamine oleate for sclerotherapy of oral vascular anomalies: a cohort of 15 consecutive patients

To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.

https://ift.tt/2QOV2Fs

Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Late deformity/indentation is well-recognised following fronto-orbital remodelling (FOR) for metopic synostosis. We hypothesise that if damage to temporalis muscle were a contributor, the thickness of soft tissue and bone in the affected area would be reduced.

https://ift.tt/2QOVdR8

What is melasma?

Melasma causes dark patches to appear on the skin. It is a pigmentation disorder that is more common in women. Learn about the symptoms, risk factors, and treatments here.

https://ift.tt/2qPapCD

Shaved hair style scalp medical tattooing technique for treatment of advanced male pattern baldness patients

Abstract

Background

The most infallible approach to male pattern baldness (MPB) is hair transplantation in the thinning area in parallel to medical treatment to prevent further alopecia progression. For an individual with advanced stage hair loss, a megasession surgery is recommended to meet the high donor hair requirement. Yet a most effective therapeutic regimen for alopecia, hair transplantation inevitably has its advantages and disadvantages for it is done with the expense of donor hair sacrifice, intraoperative and postoperative pain, and unavoidable scars. Also, with poor donor condition, surgery may not even be an option. Nowadays, more patients with such limitations are undergoing shaved style scalp medical tattoo (SMT).

Objective

To assess the effectiveness of SMT technique for shaved hair style.

Methods and materials

A total of 80 patients who were included in the study underwent SMT for shaved hair style between June 2014 and June 2017 and were followed for at least 6 months afterward. Patients and the surgeon completed a survey about donor and recipient site surgical results using a 5‐point Likert scale.

Results

The average satisfaction scores of patients and surgeon were 4.8 and 4.9, respectively.

Conclusion

Shaved style SMT can be considered one of the most effective treatment methods for patients with advanced stage hair loss.

Level of evidence

IV.

https://ift.tt/2FqlR1B

Secretory carcinoma: the eastern Canadian experience and literature review

Secretory Carcinoma (SC) is a recently described malignancy affecting salivary glands of the head and neck, with a paucity of evidence regarding the natural history, morbidity, and mortality. This study aimed ...

https://ift.tt/2Q0wFrq

Citation for Michael J Fardy for Downs Surgical Prize 2017

Mike is the eldest son of an RAF navigator and ward sister.

https://ift.tt/2zYSrSa

Skin Diseases of the Breast and Nipple Part 2: Inflammatory and Infectious Diseases

Certain dermatologic conditions are unique to the breast and nipple, whereas others may incidentally involve these structures. All require a nuanced approach to diagnosis and treatment due to the functional, sexual and aesthetic importance of this area. The lactating patient requires special management since certain treatment options are contraindicated. All dermatologic conditions involving the breast and nipple require careful evaluation since breast malignancy can be mistaken for a benign condition or may trigger the development of certain dermatologic conditions.

https://ift.tt/2QJrCIS

Skin Diseases of the Breast and Nipple Part I: Benign and Malignant Tumors

Evaluation and management of dermatologic diseases of the breast and nipple requires an understanding of the unique anatomy of the breast and nipple as well as an awareness of the significant emotional, cultural, and sexual considerations that may come into play when treating this anatomic area. Part I of this 2 Part CME Series reviews breast anatomy, congenital breast anomalies, and benign and malignant breast tumors. Specifically, an emphasis is placed on inflammatory breast cancer and breast cancer with non-inflammatory skin involvement as well as on cutaneous metastases to the breast and from breast cancer.

https://ift.tt/2Py1qV5

A simple technique to increase field of view (FOV) of a USB dematoscope

https://ift.tt/2QOBnFM

SELF-ASSESSMENT

No abstract available

https://ift.tt/2OLE7lq

North American Contact Dermatitis Group Patch Test Results: 2015–2016

Background Patch testing is an important diagnostic tool for the assessment of allergic contact dermatitis (ACD). Objective This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2015, to February 28, 2017. Methods At 13 centers in North America, patients were tested in a standardized manner with a screening series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends were analyzed using χ2 test. Results A total of 5597 patients were tested. There were 3725 patients (66.6%) who had at least 1 positive reaction, and 2798 patients (50.2%) were ultimately determined to have a primary diagnosis of ACD. A total of 572 patients (10.2%) had occupationally related skin disease. There were 10,983 positive allergic reactions. Nickel remained the most commonly detected allergen (17.5%). Methylisothiazolinone, which was added to the screening series for the 2013–2014 cycle, had the second highest positive reaction rate of allergens tested (13.4%). Compared with the previous reporting periods (2013–2014) and (2005–2014), positive reaction rates for the top 35 screening allergens statistically increased for only 1 allergen: hydroxyethyl methacrylate (3.4%; risk ratios, 1.24 [confidence interval, 1.00–1.54] and 1.46 [confidence interval, 1.23–1.73]). Three newly added allergen preparations—ammonium persulfate (1.7%), chlorhexidine (0.8%), and hydroquinone (0.3%)—all had a reaction rate of less than 2%. Twenty-three percent of the tested patients had at least 1 relevant allergic reaction to an allergen not on the NACDG series; 12% of these were occupationally related. T.R.U.E. Test (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed one quarter to almost 40% of reactions detected by the NACDG screening series. Conclusions These results confirm that the epidemic of sensitivity to methylisothiazolinone has continued in North America. Patch testing with allergens beyond a screening tray is necessary for a complete evaluation of occupational and nonoccupational ACD.

https://ift.tt/2zbYMKE

Orthodontic Appliance Intolerance Due to Dental Adhesive Allergy

No abstract available

https://ift.tt/2ONZDpH

Trends in Patch Testing With the Mayo Clinic Standard Series, 2011–2015

Background Patch testing to a standard (baseline) series of allergens is the screening tool used to identify culprit allergens in patients with contact dermatitis. The allergens and concentrations used in a standard series are constantly evolving to be most relevant to the patients being patch tested. Objective The aim of this study was to analyze the 2011–2015 patch test results of the Mayo Clinic standard series. Methods We retrospectively reviewed patch test reactions of standard series allergens from 2011 through 2015 and compared these results with the 2011–2012 and 2013–2014 North American Contact Dermatitis Group (NACDG) reports. Conclusions Of 2582 patients included, 1566 (60.7%) had at least 1 positive reaction, and 516 (20.0%) had at least 1 irritant reaction. The 15 allergens with the highest reaction rates (from highest to lowest) were nickel sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, neomycin sulfate, cobalt (II) chloride hexahydrate, benzalkonium chloride, fragrance mix I, potassium dichromate, bacitracin, methylchloroisothiazolinone/methylisothiazolinone, carba mix, formaldehyde, p-phenylenediamine, quaternium-15, and methyldibromo glutaronitrile. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report; the 3 allergens not in the NACDG top 15 allergens were potassium dichromate, benzalkonium chloride, and methyldibromo glutaronitrile (the latter 2 allergens are not included in their series).

https://ift.tt/2zfBe7H

Dupilumab as a Treatment for Allergic Contact Dermatitis

No abstract available

https://ift.tt/2OOOViz

Associations of Nickel Co-Reactions and Metal Polysensitization in Adults

Background Allergic contact dermatitis to metals is a significant clinical and public health problem. Little is known about the determinants of polysensitization to metals. Objective The aim of the study was to determine the frequency and predictors of nickel co-reactions and metal polysensitization. Methods This is a retrospective chart review of 686 adults (age ≥ 18 years) who were patch tested from 2014 to 2017. Results Overall, 267 patients (38.9%) had 1 or more positive patch-test reactions to a metal allergen, most commonly nickel (17.4%), mercury (12.3%), and palladium (9.2%). Nickel reactions were inversely associated with age (logistic regression; adjusted odds ratio [95% confidence interval], 0.39 [0.29–0.78]). Among patients with positive reactions to nickel, 34.5%, 15.1%, and 5.0% had positive reactions to 1, 2, or 3 additional metals, respectively. The most common nickel co-reactors were palladium, mercury, and gold. Polysensitization to metals occurred in 11.8% of patients. Polysensitization to metal allergens was associated with female sex (6.67 [1.01–44.21]) and inversely associated with age (0.40 [0.18–0.88]). Conclusions Nickel-sensitized patients have high rates of metal co-reactions. Polysensitization to metals is common in adults. These results may help guide future strategies for allergen avoidance.

https://ift.tt/2z97E3u

Patch Testing by Anton C. de Groot

No abstract available

https://ift.tt/2OOc84G

Comparison of Nickel Sulfate 2.5% and Nickel Sulfate 5% for Detecting Nickel Contact Allergy

Background Nickel is among the most common contact allergens found on patch testing worldwide and, because of its ubiquitous nature in our environment, often has important implications for allergen avoidance strategies. In both North America and Europe, nickel positivity is found in approximately 20% of patients who undergo patch testing. Whereas in North America, nickel sulfate is typically tested at a concentration of 2.5%, in Europe, it is tested at a 5% concentration. Objective The primary objective was to assess the differences in patch test positivity to nickel sulfate 2.5% and 5%. Methods We investigated 205 consecutive patients between September 2017 and February 2018 who were tested to nickel sulfate at concentrations of both 2.5% and 5%. Results Among the 205 patients tested, 33% were positive (+, ++, or +++) to at least 1 concentration of nickel sulfate, 20% were positive to nickel sulfate 2.5%, and 31% were positive to nickel sulfate 5% (χ21(N = 205) = 16.1, P = 0.0001). Patients were 6.5 times more likely to have a positive reaction to nickel sulfate 5% than 2.5% (odds ratio 95% confidence interval, 2.3–25.6). Conclusions Given our findings, we propose an additional evaluation of nickel sulfate 5% as a standard allergen for patch testing in North America.

https://ift.tt/2z97x84

Cannabidiol-Induced Acute Generalized Exanthematous Pustulosis

No abstract available

https://ift.tt/2ONjuVW

Skin Sensitization Induction Potential From Daily Exposure to Fragrances in Personal Care Products

Background Many chemicals used for fragrance purposes in a diversity of products have allergenic potential. Based on such concerns, industry groups developed concentration limits for use of fragrance chemicals in personal care and cosmetic products. Objective The aim of this study was to use a quantitative risk assessment to evaluate the potential for skin sensitization induction resulting from daily exposure to fragrance chemicals present in personal care and cosmetic products. Methods Product-specific dermal consumer exposure levels were calculated based on product use data in US adult females and benchmarked against acceptable exposure levels based on reported no expected sensitization induction levels to determine a margin of safety for each fragrance under evaluation. Conclusions The results demonstrate an increased risk of skin sensitization induction for several leave-on products (lipstick, solid antiperspirant, eye shadow, face cream) for most of the evaluated fragrance chemicals, particularly under high-use exposure scenarios. In contrast, rinse-off products (shampoo, conditioner, facial cleanser) were not associated with risk of skin sensitization induction. Because the approach was based on maximum use limits for fragrance chemicals with skin sensitization concerns, the results suggest these limits may not be protective, particularly in the United States.

https://ift.tt/2z97qcE

Erythema Multiforme Major After Immunotherapy With Diphenylcyclopropenone for Alopecia Areata

No abstract available

https://ift.tt/2OObXX4

Isothiazolinone in Residential Interior Wall Paint: A High-Performance Liquid Chromatographic–Mass Spectrometry Analysis

Background There is limited information regarding isothiazolinone content in residential wall paints in the United States. Objective The aim of this study was to evaluate the prevalence of 5 isothiazolinones—methylisothiazolinone (MI), methylchloroisothiazolinone, benzisothiazolinone (BIT), butyl BIT, and octylisothiazolinone—in US residential wall paints. Methods Forty-seven paints were obtained from retailers in Minneapolis/St Paul, Minnesota. Paint samples were assessed for the presence of the 5 isothiazolinones using high-performance liquid chromatographic–mass spectrometry. Results At least 1 isothiazolinone was detected in all 47 paints. However, no paint contained butyl BIT, and only 1 paint had octylisothiazolinone. The MI and BIT were found in 96% and 94% of the paints, respectively. Methylisothiazolinone ranged in concentration from 17 to 358 ppm, whereas BIT varied from 29 to 1111 ppm. Methylchloroisothiazolinone was found solely in oil-based paints. Isothiazolinones were declared in 15% of Safety Data Sheets but did not correlate with high-performance liquid chromatographic–mass spectrometry. One "preservative-free" paint had BIT at 71.5 ppm. Paint sheen was not statistically associated with BIT or MI concentrations. Unpigmented paints and paints with volatile organic compound claims had significantly lower concentrations of MI, but not BIT. Conclusions All paints contained at least 1 isothiazolinone. Methylisothiazolinone and BIT were the most common. Safety Data Sheets are insufficient for ascertaining isothiazolinone content in US paints.

https://ift.tt/2z97l8Q

Contact Allergy to Propylene Glycol and Cross-Reactions

No abstract available

https://ift.tt/2OKpSND

Moisturizers: A Comparison Based on Allergens and Economic Value

Background The economic burden of cosmetics, such as moisturizers, has been increasing. Despite the high price of some market moisturizers, there have been no studies evaluating the allergenicity of these products. Objective The aim of this study was to evaluate the potential allergens within moisturizers based on economic value, by analyzing the substances found in moisturizers available online at the largest drugstore chain—CVS Health (CVS Health, Woonsocket, RI). Methods In this cross-sectional study, ingredients found in 50 expensive and 50 inexpensive moisturizers were matched with sensitizers within the Core Allergen Series published by the American Contact Dermatitis Society and the North American Contact Dermatitis Group. Student t test was used to compare the mean number of allergens present in each group. A χ2 test or Fisher exact test, where necessary, was used to compare the rates of specific allergen groups between the expensive and inexpensive products. Results Twenty-six allergenic substances were present overall in the 100 total products surveyed. The expensive moisturizers averaged significantly more allergens per product (8.28 vs 5.60, P = 0.003) than the inexpensive products. Conclusions The sensitizing potential of expensive moisturizers may be higher than that of inexpensive moisturizers. Physicians may counsel cosmetic-induced allergic contact dermatitis (ACD) patients that monetary value is not a suitable proxy for evaluating the risk of ACD.

https://ift.tt/2zdVJRV

Long-term Likelihood of Patch Testing, Academic Practice, and American Contact Dermatitis Society Membership Among North American Alexander Fisher Award Winners From 1989 to 2012

Background The Alexander Fisher Award (AFA) recognizes excellence in research among dermatology residents or medical students who make formal presentations at the annual American Contact Dermatitis Society (ACDS) meeting. Objective The aim of the study was to investigate long-term likelihood of patch testing, academic practice, and society membership among Alexander Fisher Award winners (AFAWs). Methods The AFAWs from 1989 to 2012 were identified with Internet searches to obtain their current practice location. Each practice was contacted by phone, and staff was asked whether the AFAW performed patch testing. Current ACDS membership was confirmed by ACDS leadership. Academic status was assessed by university association on practice Web sites. Results Sixty-two awards were presented to 60 individuals from 1989 to 2012. Fifty AFAWs are actively practicing dermatology in the United States (n = 43) and Canada (n = 7). Of 50 practicing AFAWs, 18 (36%) are active patch testers, 29 (58%) do not perform patch testing, and 3 (6%) could not be reached or staff declined to answer. Of the 50, 14 (28%) practice in an academic setting, and 10 (20%) are current ACDS members.

https://ift.tt/2OLlG0l

Complements from the Lung

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. Stage. A 26-year-old man…

https://ift.tt/2DsVEwW

Follow‐up of patients with negative drug provocation tests to betalactams

Abstract

Drug allergy work‐up in betalactam (BL) allergy is probably the most‐developed drug‐allergy evaluation at present [1]. During the last few years, the debate on whether one‐day or several‐day (prolonged) drug provocation test (DPT) should be performed in non‐immediate reactions (i.e., occurring >1h after the last administered dose) in order to increase sensitivity has been ongoing and groups working in drug allergy diagnosis have been deploying pro and con arguments and studies in favour of either option [2‐5]. The most acceptable way to validate a negative DPT is by studying its negative predictive value (NPV) in patients who are re‐challenged to the negatively tested drug, in real‐life therapeutic conditions [6,7].

This article is protected by copyright. All rights reserved.

https://ift.tt/2Q1Tzi5

Th2 cell differentiation from naive CD4+ T cells is enhanced by autocrine CC chemokines in atopic diseases

Abstract

Background

Chemokines are involved not only in regulating leukocyte recruitment, but also in other activities. However, functions other than cell recruitment remain poorly understood. We have already shown that the production of CC chemokine ligand (CCL)17 and CCL22 by antigen‐stimulated naïve CD4⁺ T cells was higher in asthmatic patients than in healthy controls. However, the role of these chemokines in stimulated naïve CD4⁺ T cells remains unclear.

Objective

To clarify the biological function of CCL17 and CCL22 on naïve CD4⁺ T, we examined effects of these two chemokines on naïve CD4⁺ T cells expressing CC chemokine receptor (CCR)4 (a receptor for CCL17 and CCL22) during differentiation of Th2 cells in asthmatic patients as allergic subjects.

Methods

Naïve CD4⁺ T cells were prepared from healthy controls and patients with asthma. We analyzed effect of CCL17 and CCL22, and blocking their receptor on differentiation of Th2 cells.

Results

Production of CCL17 and CCL22 by activated naive CD4⁺ T cells under Th2 condition was much more in asthmatic patients than in healthy controls. Proliferation and survival of the Th2 differentiating cells and restimulation‐induced IL‐4 production were much greater in asthmatic patients than in healthy controls. These cell biological phenomena were inhibited by blockade of CCR4. The biological effects of exogenous CCL17 and CCL22 were apparently observed in both healthy controls and asthmatic patients. The effectiveness of these chemokines on naïve CD4⁺ T cells from healthy controls was stronger than those from asthmatic patients. We found that thymic stromal lymphopoietin (TSLP), a Th2 promoting chemokine, is involved in the activation of CD4⁺ naïve T cells via production of CCL17 and CCL22.

Conclusions & Clinical Relevance

These data suggest that CCL17 and CCL22 produced by TSLP‐primed naïve CD4⁺ T cells in asthma might contribute to an increase in Th2 cells via autocrine loops.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Douyaa

The Quality of Reporting Randomised Controlled Trials in the Dermatology Literature in an Era where the CONSORT Statement is a Standard

Abstract

Background

The quality of reporting randomised controlled trials (RCTs) in the dermatology literature has not received much consideration since the late 2000s.

Objectives

We aimed to assess the quality of recently reported RCTs published in dermatology journals, focusing on randomisation processes, blinding, and trial registration.

Methods

We reviewed 2,042 original articles and identified 141 primary reports of RCTs in four dermatology journals (The Journal of the American Academy of Dermatology, JAMA Dermatology, The Journal of Investigative Dermatology, and The British Journal of Dermatology) from January 2015 to December 2017. Details were extracted from articles, supplements, and public trial registries. A multivariable logistic regression analysis was conducted to identify factors associated with optimal reporting quality.

Results

Among the 141 RCTs, 99 (70·2%), 82 (58·2%), and 69 (48·9%) RCTs described methods used for randomisation, allocation concealment, and implementation, respectively. Most trials (n = 126, 89·4%) reported blinding status; however, one‐third did not state similarity of intervention. Furthermore, 52 (36·9%) RCTs were not registered prospectively. Trials published in The British Journal of Dermatology and using central randomisation were significantly associated with optimal reporting quality after adjusting for covariates.

Conclusions

Several critical items in reporting RCTs, including allocation concealment, similarity of interventions in blinded trials, or prospective trial registration have remained unsatisfactory in the recent dermatology literature.

This article is protected by copyright. All rights reserved.

https://ift.tt/2OHWyYh

Antihelix/helix violaceous macules in Japanese patients with anti‐melanoma differentiation–associated protein 5 (MDA5) antibody–associated dermatomyositis

Abstract

The diagnosis of clinically amyopathic dermatomyositis (CADM) essentially depends on cutaneous manifestations. The early diagnosis of CADM associated with the anti‐melanoma differentiation‐associated protein‐5 (MDA5) antibody is especially important because it includes a subset of patients highly at risk for rapidly progressive interstitial lung disease (RP‐ILD) with potentially fatal outcomes. Moreover, the recognition of distinctive rashes for anti‐MDA5 antibody‐positive DM can greatly aid in distinguishing from other DM subsets since serological anti‐MDA5 antibody testing is not yet widely accessible.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zeU2ns

Heterogeneity of PD‐L1 Expression in a Case of Merkel Cell Carcinoma Exhibiting Complete Regression After Multiple Metastases

Abstract

Merkel cell carcinoma (MCC) is a highly malignant skin cancer with a propensity for local recurrence and regional lymph node metastases. Once recurrence occurs, tumour progression becomes hard to be controlled. Overexpression of programmed death‐ligand 1 (PD‐L1) in MCC correlates with better clinical outcomes, in contrast to other solid carcinomas, e.g., malignant melanoma. The successful results of treatment with the immune checkpoint inhibitor avelumab for metastatic MCC highlight this unusual relationship between MCC and PD‐L1 expression.

This article is protected by copyright. All rights reserved.

https://ift.tt/2OJBd0A

Cross‐sectional associations between cutaneous viral infections and regulatory T lymphocytes in circulation

Summary

Background

Cutaneous viral infections and immune suppression are risk factors for some forms of non‐melanoma skin cancer (NMSC), however, their interrelationship is poorly understood. Objective: To examine cross‐sectional associations between cutaneous viral infections and circulating forkhead‐box P3 (FOXP3) expressing T regulatory (Treg) cells, suppressive cells that dampen effective anti‐tumour immunity.

Methods

Blood, eyebrow hair (EBH) and skin swab samples (SSW) were collected from 352 skin screening patients 60 years and older without prevalent skin cancer participating in an ongoing prospective cohort study of cutaneous viral infections and skin cancer. DNA corresponding to 98 cutaneous human papillomavirus (HPV) types and five polyomaviruses (HPyV) was assessed in EBH and SSW. Distinct classes of circulating Treg cell subpopulations were defined by flow cytometry including cutaneous lymphocyte antigen (CLA) and CCR4^high Treg cells, both previously associated with cutaneous diseases. Age‐ and gender‐adjusted associations between circulating T‐cell populations and infection were estimated using logistic regression.

Results

Total Treg cell proportion in peripheral blood was not associated with beta HPV or HPyV infection. However, the proportion of circulating CLA⁺ Treg cells was inversely associated with gamma HPV EB infection (OR= 0·54, 95% CI=0·35‐0·84). Interestingly, circulating Treg cells expressing markers indicative of antigen activation (CD27^‐CD45RA^‐FOXP3⁺CD4⁺) were also inversely associated with gamma HPV infection in SS (OR=0·55, 95% CI=0·30‐0·99) and EB (OR=0·56, 95% CI=0·36‐0·86).

Conclusions

Inverse associations between circulating Treg cells and gamma HPV infection suggest that localised viral infection may promote immunosuppressive cell migration into skin.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zdFvZ3

The views of consultant dermatologists on creating centralised skin lesion units

Abstract

The proportion of United Kingdom (UK) specialist dermatology clinical activity related to skin lesions has been estimated at between 40–50%. With skin cancer incidence rising, this is likely to increase even further. In 2014, The King's Fund conducted research to investigate the sustainability of dermatology services, with participants identifying the need for service reconfiguration to improve efficiency. One suggestion was to create consultant‐led centralised skin lesion units, receiving all referrals within a region. To the best of our knowledge, there has been no published qualitative research on the organisation of dermatology services, and the views of key stakeholders on service reconfiguration remain unexplored. An independent review following the failed takeover of dermatology services in Nottingham by a private provider concluded that staff must be fully involved in service reconfiguration from the outset.

This article is protected by copyright. All rights reserved.

https://ift.tt/2ONFsbg

Unilesional mycosis fungoides is associated with increased expression of microRNA‐17~92, and Th1 skewing

Summary

Background

The molecular basis of unilesional mycosis fungoides (MF), characterized by a solitary lesion which is clinicopathologically indistinguishable from multifocal patch/plaque MF (early MF), is unknown.

Objectives

To investigate the microRNA (miR) profile in unilesional MF distinguishing it from early MF.

Methods

Biopsy samples of unilesional MF and early MF were evaluated with the Affymetrix microRNA array, with further comparison to inflammatory dermatosis, using quantitative polymerase chain reaction. NanoString technology was applied to analyze the gene expression of T‐helper (Th)1 immune markers and immunohistochemistry was used to evaluate C‐X‐C motif cytokine receptor 3 (CXCR3) and GATA binding protein 3 (GATA3), markers for Th1 and Th2 cells, respectively.

Results

Unilesional MF had a significantly higher level of expression of all members of the miR‐17~92 cluster than early MF. Specifically, compared to early MF, unilesional MF was characterized by a higher miR‐17 level and inflammatory dermatoses, downregulation of the expression of phosphatase and tensin homolog (Pten) and cAMP response element binding protein 1 (CREB1), known targets of miR 17~92 members, higher gene expressions of interluekin‐2 (IL‐2), and interferon gamma (IFN‐ɣ), and statistically lower average percentage of GATA3+ dermal cells (6·7% vs 42·3%, respectively). High immunoreactivity of CXCR3 was noted in both unilesional and early MF.

Conclusions

Unilesional MF exhibits a microRNA profile distinct from conventional early MF, with a higher level of miR‐17~92 members along with a Th1 skewing. These findings suggest a robust reactive T‐cell immune response in unilesional MF and might account for the localized nature of this disease.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zcENLR

Journées dermatologiques de Paris 2018

Publication date: Available online 16 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): E. Delaporte, au nom du Comité de Sélection

https://ift.tt/2PAYLKf

Secretory carcinoma: the eastern Canadian experience and literature review

Abstract

Background

Secretory Carcinoma (SC) is a recently described malignancy affecting salivary glands of the head and neck, with a paucity of evidence regarding the natural history, morbidity, and mortality. This study aimed to investigate the current treatment options utilized for SC, as well as its presentation and outcomes.

Methods

This study is a retrospective case series and includes patients diagnosed with SC at four Maritime Canadian institutions. Literature review of patient outcomes following treatment of SC is also included.

Results

Thirteen patients were identified. Parotid was the most common subsite (69%), followed by minor salivary gland (23%) and submandibular gland (8%). All patients were S100 positive and had at least one additional positive confirmatory stain, including mammaglobin, CK7, or vimentin. Two patients had N2b disease. All patients were treated with primary surgery, and four were offered adjuvant radiotherapy. There was one instance of locoregional recurrence, and one of metastasis. Three patients displayed perineural invasion on pathology, and one patient displayed lymphovascular invasion.

Conclusion

Secretory Carcinoma remains understudied regarding its natural history, presentation, and treatment options. This study is the largest single case series in Canada, and highlights the young age and possible aggressiveness of SC. As well, we provide the most comprehensive literature review to date, with a focus on treatment and outcomes for this disease entity.

https://ift.tt/2Fouiug

Three versus five lumbar paravertebral injections for inguinal hernia repair in the elderly: a randomized double-blind clinical trial

Abstract

Purpose

The objective of the study was to compare three nerve stimulator-guided paravertebral injections versus five injections for elderly patients undergoing inguinal hernia repair in terms of the amount of intraoperative fentanyl and propofol consumption and conversion to general anesthesia. The secondary objective was postoperative pain.

Methods

A prospective, randomized, double-blind clinical trial was performed. 200 elderly patients undergoing unilateral herniorrhaphy were randomized into two groups. Group III received three PVB injections from T₁₂ to L₂ and placebo at T₁₁ and L₃. Group V received five PVB injections from T₁₁ to L₃.

Results

The mean intraoperative fentanyl and propofol consumption were significantly lower in group V (4.9 ± 7.2 µg versus 20.0 ± 12.9 µg and 5.7 ± 11.6 mg versus 34.6 ± 22.9 mg, respectively, p value < 0.0001). Five patients (5.0%) in group III had failed block and were converted to general anesthesia (p value = 0.024). Group V had significantly lower pain scores compared to group III during the first three postoperative days (p value < 0.0001).

Conclusion

The five PVB injection technique is more suitable as a sole anesthetic technique for elderly patients undergoing herniorrhaphy, since it required less intraoperative supplemental analgesia and provided lower postoperative pain scores compared to the three PVB injection technique.

Trial registration

Clinicaltrials.gov identifier: NCT02537860.

https://ift.tt/2K9TSSl

Natural history of untreated squamous cell carcinoma of the head and neck

Abstract

The natural history of untreated head and neck squamous cell carcinoma (SCC) was not well defined.

A total of 206 patients with untreated head and neck SCC were retrospectively enrolled.

The 1‐year survival rate for cancers arising in oral cavity, oropharynx, throat, and hypopharynx was 31%, 20%, 0%, and 3%, respectively, the difference was significant (p<0.001).

57.2% of the patients died within 12 months, median survival time was 11 months.

The prognosis of untreated head and neck SCC patients is extremely unfavorable. T stage is the strongest predictors for the survival time.

This article is protected by copyright. All rights reserved.

https://ift.tt/2DpVtCs

SCT200 Injection in Patients With Head and Neck Squamous Cell Carcinoma

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: Anti-EGFR monoclonal antibody
Sponsor:   Shi Yuankai
Not yet recruiting

https://ift.tt/2qQWqfo

EffectiveNess of Low-dose Aspirin in Prevention of Cancer in the Stomach and Oesophagus (GastrointEstinal Cancer Prevention) - United Kingdom ("ENgAGE - UK"): Study to Evaluate the Risk of Cancer in the Stomach and Oesophagus Among New Users of Low-dose Aspirin Using the THIN Database in the UK

Condition:   Prevention of Oesophagus Cancer and Stomach Cancer
Intervention:   Drug: Acetylsalicylic Acid(BAYE4465, Aspirin )
Sponsor:   Bayer
Not yet recruiting

https://ift.tt/2FlAPG2

How Much Weight Loss Can Be Expected after Treating Mandibular Fractures?

Publication date: Available online 15 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Brian J. Christensen, Andrew G. Chapple, Brett J. King

Abstarct

PURPOSE

Surgeons treating facial trauma are faced with a dilemma: fracture healing requires tremendous energy expenditure yet the treatments for mandibular fractures commonly include dietary limitations. Despite this, there are almost no studies attempting to quantify the effect of fracture treatments on patient weight. The purpose of the study was to quantify the effect mandibular fractures and their treatment have on a patient's weight and to identify risk factors associated with increased change.

METHODS

A retrospective cohort study was designed. The patients were considered eligible for inclusion if they sustained a mandible fracture and had at least one follow-up visit within 4 weeks after the fracture from 8/1/2012 to 4/30/2015. The study variables were time since presentation, age, gender, open versus closed treatment, and TICU stay. The outcome variable of interest was the percent weight change from baseline. A linear mixed model was used to analyze the data.

RESULTS

There were 439 patients that met the inclusion criteria during the study period. In the final linear mixed model, TICU stay had a significant effect whereas open versus closed treatment did not have a significant effect. The final model predicts a peak weight loss of 4.9% of the initial body weight by day 49. For patients admitted to the TICU, the peak weight loss was 8.8%.

CONCLUSION

During the course of treatment for mandibular fractures, patients lost an average of almost five percent of their body weight. Closed reduction was not associated with an increased change in weight; however, a stay in the TICU was associated with an increase in the weight loss. Further studies will be directed at correlating declining weight with outcomes.

https://ift.tt/2Bbf1Jm

Dental Implants Can Facilitate Orthognathic Surgery In A Patient With Severe Maxillary Atrophy

Publication date: Available online 15 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Gabriel Cury Batista Mendes, Constantinos Laskarides, Eduardo Antonio Ayub, Paulo Domingos Ribeiro-Junior

Abstract

The surgical treatment of dentofacial deformities is performed routinely and predictably on dentate patients. However, when dealing with the edentulous maxilla, treatment becomes more challenging and less predictable. In these cases, the combination of orthognathic surgery (OS) and osseointegrated implants (OI) may be a viable alternative to enable fixed rehabilitation. A patient with an edentulous and atrophic maxilla with maxillo-mandibular discrepancy and high aesthetic requirement, was treated with a combination of osseointergrated implants and orthognathic surgery. The rehabilitative sequence was composed of maxillary grafting procedures, installation of dental implants, placement of a fixed implant-supported prosthesis and bimaxillary orthognathic surgery. During provisional restoration prior to OS, smaller teeth were used, allowing achievement of appropriate tooth length for the final restoration, even after natural and expected post-operative relapse. This restorative approach provided an implant-supported fixed prosthesis without prosthetic compensation with optimum aesthetics and biomechanics.

https://ift.tt/2K8vlx6

Anterior chamber fibrinoid syndrome after cataract extraction in a patient on ibrutinib for B-cell chronic lymphocytic leukemia: a case report and review of the literature

Ibrutinib is a tyrosine kinase inhibitor commonly used in patients with chronic lymphocytic leukemia. Based on the published literature, it has a very sound ophthalmologic safety profile. In the following, we ...

https://ift.tt/2qNQd3V

Ring chromosome 15 – cytogenetics and mapping arrays: a case report and review of the literature

Ring chromosome 15 has been associated in previous studies with different clinical characteristic such as cardiac problems, digit and musculoskeletal abnormalities, and mental and motor problems among others. ...

https://ift.tt/2Fp7pXv

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

Publication date: Available online 16 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Melissa H. Bloodworth, Mark Rusznak, Lisa Bastarache, Janey Wang, Dawn C. Newcomb

https://ift.tt/2QIFGCt

IMPROVING THE QUALITY OF DATA PRESENTATION IN HEALTH SCIENCES

Publication date: Available online 16 November 2018

Source: Archives of Oral Biology

Author(s): Paula Midori Castelo

https://ift.tt/2QLCCW9

IMPROVING THE QUALITY OF DATA PRESENTATION IN HEALTH SCIENCES

Publication date: Available online 16 November 2018

Source: Archives of Oral Biology

Author(s): Paula Midori Castelo

https://ift.tt/2QLCCW9

Genomic and phenotypic diversity of Streptococcus mutans

Publication date: Available online 15 November 2018

Source: Journal of Oral Biosciences

Author(s): Claudia María Bedoya-Correa, Ramiro Javier Rincón Rodríguez, Monica Tatiana Parada-Sanchez

Abstract

Background

Streptococcus mutans (S. mutans) is a commensal microorganism found in the human oral cavity. However, due to environmental changes, selective pressures, and the presence of a variable genome, it adapts and may acquire new physiological and metabolic properties that alter dental biofilm homeostasis, promoting the development of dental caries. Although the plasticity and heterogeneity of S. mutans is widely recognized, very little is known about the mechanisms for the expression of pathogenic properties in specific genotypes.

Highlight

The implementation of molecular biology techniques in the study of S. mutans has provided information on the genomic diversity of this species. This variability is generated by genome rearrangements, natural genetic transformation, and horizontal gene transfer, and continues to grow due to an open pan-genome. The main virulence factors associated with the cariogenic potential of S. mutans include adhesion, acid production (acidogenicity), and acid tolerance (aciduricity), and also show variability. These factors coordinate the modification of the physicochemical properties of the biofilm, which results in the accumulation of S. mutans and other acidogenic and aciduric species in the oral cavity.

Conclusion

We review the current literature on the main processes that generate S. mutans genomic diversity, as well as the phenotypic variability of its main virulence factors. S. mutans achieves its pathogenesis by sensing the intra- and extracellular environments and regulating gene transcription according to perceived environmental modifications. Consequently, this regulation gives rise to differential synthesis of proteins, allowing this species to potentially express virulence factors.

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Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Naiara Rodriguez-Florez, Aran Florez-Tapia, Noor U.O. Jeelani, Sylvia Schievano, David J. Dunaway, Richard D. Hayward

Summary

Purpose

Late deformity/indentation is well-recognised following fronto-orbital remodelling (FOR) for metopic synostosis. We hypothesise that if damage to temporalis muscle were a contributor, the thickness of soft tissue and bone in the affected area would be reduced.

Materials and Methods

Soft tissues and bone were separately segmented and reconstructed three-dimensionally from computed tomograms of 8 patients 1.5 to 18 years post-FOR performed at 16 ± 2 months for metopic synostosis and from 8 age-matched controls. Soft tissue (taken as proxy for temporalis muscle) and bone thickness overall and in the indented areas were computed.

Results

Post-FOR, three-dimensional soft tissue thickness maps demonstrated temporalis extending upwards but falling short of the indented area. Overall skull thickness increased with age post-FOR (logarithmic fit R²= 0.71) and for controls (R²=0.90). Although immediately post-FOR the future indented area had a thickness of 98% of control, it decreased linearly to 64% 16 years later (Pearson's r=0.84).

Conclusion

These findings suggest that late post-FOR deformity/indentation is enhanced by limited upward extension (or retraction downwards) of temporalis muscle, while bone thickness in the affected area gradually decreases. This supports the hypothesis that aberrant re-attachment of the temporalis muscle makes a material contribution to late deformity following FOR for metopic synostosis.

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Experience with 5% Ethanolamine oleate for sclerotherapy of oral vascular anomalies: a cohort of 15 consecutive patients

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Camila de Nazaré Alves de Oliveira Kato, Michel Campos Ribeiro, Márcio Bruno Figueiredo do Amaral, Soraya de Mattos Camargo Grossmann, Maria Cássia Ferreira de Aguiar, Ricardo Alves Mesquita

Summary

Purpose

To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.

Materials and Methods

We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed.

Results

Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n=7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly.

Conclusion

The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

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Impact of incubation method on the release of growth factors in Non-Ca2+-activated PRP, Ca2+-activated PRP, PRF and A-PRF

Publication date: Available online 15 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Daniel Steller, Nele Herbst, Ralph Pries, David Juhl, Samer G. Hakim

Summary

The aim of this study was to investigate the influence of different incubation methods on the growth factor content of lysates of platelet-rich fibrin (PRF), advanced-platelet-rich fibrin (A-PRF) and platelet-rich plasma (PRP) products. A comparison of related studies suggests that the method of sample preparation has a significant influence on growth factor content. There are few reports on the comparison of non-Ca²⁺-activated PRP, Ca²⁺-activated PRP, A-PRF, and PRF, along with a lack of information on the release of PDGF-BB, TGF-β1, and VEGF among the different incubation methods.

The lysate preparation was made of non-Ca²⁺-activated PRP, Ca²⁺-activated PRP, PRF, and A-PRF, using a room-temperature, 37°C, or freeze–thaw–freeze incubation method. Afterwards the VEGF, PDGF-BB, and TGF-β1 content was investigated by running ELISA tests.

Growth factor levels were significantly increased in the non-Ca²⁺-activated PRP with freeze–thaw–freeze incubation, and in the PRF preparation there was a significant disadvantage to using room temperature incubation for releasing growth factors.

In conclusion, the freeze–thaw–freeze method is sufficient for releasing growth factors, and calcium activation is not necessary. Finally, the study demonstrates the possibility of preparing PRP products from platelet concentrates, so that preoperative blood sampling might not be required.

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

Publication date: Available online 15 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Thomas F. Putters, Gerry M. Raghoebar, Jenneke Klein-Nulend, Arjan Vissink, Jurjen Schortinghuis

Summary

Purpose

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.

Methods

In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-perative variables were scored. One bone biopsy sample was taken for histological analysis.

Results

The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23±0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling.

Conclusion

Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate.

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Salvage surgery for a locally persistent or recurrent tumour in maxillary cancer patients who have undergone radiotherapy and concomitant intra-arterial cisplatin: implications for surgical margin assessment

Publication date: Available online 15 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T. ono, K. Sakata, N. Tanaka, S. Hashiguchi, H. Migita, K. Kiyokawa, M. Morioka, T. Kurita, K. Sato, N. Takeshige, H. Umeno

Abstract

Limited information about salvage surgery is available for locally persistent and recurrent maxillary sinus cancers after the completion of chemoradiation therapy. Seventy-six maxillary sinus cancer patients who had undergone chemoradioselection using initial radiotherapy and concomitant intra-arterial cisplatin were screened retrospectively. Twenty-four of these patients who had a locally persistent or recurrent tumour were investigated. The 2-year overall survival rate of patients with maxillary sinus cancer of all types was 39.0% for those who underwent salvage surgery and 10.0% for those who did not. The 2-year overall survival rate of patients with maxillary sinus squamous cell carcinoma was 45.8% for those who underwent salvage surgery and 11.1% for those who did not. Furthermore, the 2-year local control and overall survival rates of patients with positive and negative surgical margins were 14.3% and 83.3% and 14.3% and 66.7%, respectively. There were significant differences in local control (P = 0.004) and overall survival (P = 0.005) regarding surgical margin status. Although salvage surgery for a locally persistent or recurrent maxillary sinus cancer is a feasible treatment, patients with positive surgical margins are more prone to local relapse. Therefore, surgical safety margins should be assessed thoroughly.

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SLAMF receptors on normal and malignant B cells

Publication date: Available online 15 November 2018

Source: Clinical Immunology

Author(s): Idit Shachar, Avital Barak, Hadas Lewinsky, Lital Sever, Lihi Radomir

Abstract

The Signaling Lymphocyte Activation Molecule family (SLAMF) is a collection of nine surface receptors expressed mainly on hematopoietic cells, and was found to modulate the behavior of immune cells. SLAMF receptors are expressed on B cells in health and disease. Each SLAM receptor has a unique differential expression pattern during the development and activation of B cells. Furthermore, recent findings have revealed a principal role for this family of receptors in B cell malignancies, emphasizing their importance in the control of malignant cell survival, cell to cell communication within the tumor microenvironment, retention in the supporting niches and regulation of T cell anti-tumor response. This review summarizes the latest studies regarding SLAMF expression and behavior in B cells and in B cell pathologies, and discusses the therapeutic potential of these receptors.

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Mechanisms and functions of IL-17 signaling in renal autoimmune diseases

Publication date: December 2018

Source: Molecular Immunology, Volume 104

Author(s): Tilman Schmidt, Jonas Luebbe, Hans-Joachim Paust, Ulf Panzer

Abstract

Immune-mediated glomerular diseases (glomerulonephritis) encompass a heterogeneous collection of diseases that cause inflammation within the glomerulus and other renal compartments with significant morbidity and mortality. In general, CD4⁺ T cells orchestrate the immune response and play a unique role in autoimmune and chronic inflammatory diseases. In particular, the characterization of a distinct, IL-17 cytokines producing CD4⁺ T cell subset named T_H17 cells has significantly advanced the current understanding of the pathogenic mechanisms of organ-specific immunity. Our group and others have shown that the recruitment of T_H17 cells to the inflamed kidney drives renal tissue injury in experimental and possibly human crescentic glomerulonephritis (GN), but much remains to be understood about the biological functions, regulation, and signaling pathways of the T_H17/IL-17 axis leading to organ damage. Here we review our current knowledge about the mechanisms and functions of IL-17 signaling in renal autoimmune diseases, with a special focus on experimental and human crescentic GN.

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Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study

Global chronic urticaria (CU) disease experience and management is not well documented. This study descriptively compares these aspects among CU patients residing in Europe (EU) and Central and South America (...

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Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam CT

Publication date: Available online 16 November 2018

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

Author(s): Bernardo Barbosa Freire, Eduarda Helena Leandro Nascimento, Karla de Faria Vasconcelos, Deborah Queiroz Freitas, Francisco Haiter-Neto

Objectives

: To compare the performance of panoramic radiography (PAN), extraoral bitewing radiography (EBW), and cone beam computed tomography (CBCT) in the assessment of mandibular third molars.

Study Design

: PAN and EBW were obtained to visualize 34 third molars. The teeth were evaluated according to their position, the presence of radiographic signs of proximity of the roots to the mandibular canal, the relationship of the roots to the canal, and the relationship of second and third molars in PAN and EBW. Third molar position and root relationship with the canal were also assessed with CBCT.

Results

: PAN and EBW showed significantly closer relationships than CBCT between the tooth and the mandibular canal (p≤0.002). For all other parameters, there were no differences between PAN and EBW (p≥0.072), although EBW produced a decreased overlap between proximal surfaces of second and third molars, and a greater trend than PAN towards approximating root apices and the canal.

Conclusions

: In comparison with PAN, EBW showed a tendency to project the roots closer to mandibular canal, but a decrease in the proximal surfaces overlapping the second molar. The relationship between the third molar and the mandibular canal appeared closer in PAN and EBW than in CBCT.

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Twist and E-Cadherin deregulation might predict poor prognosis in lower lip squamous cell carcinoma

Publication date: Available online 16 November 2018

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

Author(s): Everton Freitas de Morais, Hellen Bandeira de Pontes Santos, Israel Leal Cavalcante, Silvia Helena Barem Rabenhorst, Jean Nunes dos Santos, Hébel Cavalcanti Galvão, Roseana de Almeida Freitas

ABSTRACT

Objective

To evaluate the expression of Twist and E-cadherin in Lower Lip Squamous Cell Carcinoma (LLSCC) and their association to clinical-pathological parameters.

Study Design

Fifty-nine LLSCC cases were analyzed applying immunohistochemistry techniques in a semi-quantitative manner. The systems proposed by Bryne et al. (1992), Brandwein-Gensler et al. (2005) and Almangush et al. (2015) were applied for the histopathological malignancy grading system analysis.

Results

Higher E-cadherin expression (general and membrane) was observed in cases presenting disease-free survival after 5 years of follow-up (p < 0 .05). Higher Twist expression was observed in lesions classified as in advanced stages, displaying recurrence and a high degree of malignancy. A significant negative correlation was detected between cytoplasmic Twist expression and membrane E-cadherin expression (p = 0.028). A statistically significant relationship between high total Twist expression in tumors classified as high risk by Brandwein-Gensler et al. (2005) was detected, and no significant difference was observed between total, membrane and cytoplasmic E-cadherin expression in LLSCC cases and the three applied grading systems (p>0.05).

Conclusions

The results of the present study suggest the potential involvement of Twist and E-cadherin in the modulation of events related to worse LLSCC prognoses.

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Transplantation of human limbus–derived mesenchymal stromal cells via occipital approach improves hearing in animal auditory neuropathy

Publication date: Available online 15 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hsin-Chien Chen, Chang-Min Liang, Chih-Hung Wang, Ming-Yuan Huang, Yuan-Yung Lin, Cheng-Ping Shih, Chao-Yin Kuo, Yi-Chun Lin, Hang-Kang Chen

Abstract

Objective

To develop a surgical approach for cell transplantation into mouse cochlear nerves via an intracranial route and investigate whether transplantation of human limbus–derived mesenchymal stromal cells (HL-MSCs) can improve hearing in this model of auditory neuropathy.

Methods

We used 8-week-old CBA/CaJ male mice and created ouabain-induced auditory neuropathy. The surgical approach passed through the cerebellum to reveal the superior semicircular canal and brainstem, allowing access to the auditory nerve. Then HL-MSCs were injected around the cochlear nerve trunk using a micropipette driven by a micropump. Hearing thresholds in the mice were determined by auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs).

Results

We produced ouabain-induced neuropathy in mice with an elevated hearing threshold but normal DPOAE. Using immunohistological staining, we detected HL-MSCs were localized in the cochlear nerve trunk 2 days after cell transplantation via this occipital approach. More spiral ganglion neurons were detected in ouabain-treated cochleae 3 months after HL-MSCs transplantation compared to those without HL-MSCs transplantation. The ABR showed significant hearing improvement 3 months after HL-MSCs transplantation.

Conclusions

We successfully established a mouse model for cell transplantation into the intracranial cochlear nerve trunk and showed that HL-MSCs potentially can be applied as cell therapy to treat sensorineural hearing loss.

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Craniopharyngiomas and odontogenic tumors mimic normal odontogenesis and share genetic mutations, histopathological features and molecular pathways activation

Publication date: Available online 16 November 2018

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

Author(s): Carolina Cavalieri Gomes, Silvia Ferreira de Sousa, Ricardo Santiago Gomez

Odontogenic tumors bear some histopathological and molecular resemblance to craniopharyngiomas. Specifically, adamantinomatous craniopharyngioma (ACP) shares morphological features and CTNNB1 (the gene encoding β-catenin) mutations with calcifying odontogenic cyst (COC), whereas papillary craniopharyngioma (PCP) and ameloblastoma are driven by BRAF mutations. Recently, important similarities between ACP and the cell signaling pathways involved in tooth formation have been described. Here we expand the interpretation of this data in the context of odontogenic tumors. We discuss some morphological and molecular features that are shared by tumors from these two distinct sites (i.e., craniopharyngiomas and odontogenic tumors). Current conservative surgical treatment is effective for most cases of benign odontogenic tumors, but in the future, the understanding of the molecular pathogenesis could impact the treatment of aggressive and/or malignant cases.

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Hypersensitivity Pneumonitis: A Fibrosing Alveolitis Produced by Inhalation of Diverse Antigens

Publication date: Available online 15 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Paul A. Greenberger

Abstract

Hypersensitivity pneumonitis (HP) is a T_H1 lymphocyte biased fibrosing alveolitis that is caused by antigens ranging from avian excreta, fungi, thermophilic bacteria, and protozoa to reactive chemicals found in the workplace. Mimicking a viral syndrome, acute exposures to inciting antigens cause abrupt onset of non-productive cough, dyspnea, chills, with arthralgias or malaise usually from 4-8 hours later so that the temporal relationship between antigen exposure and symptoms may be unsuspected. The histology of HP reveals prominent lymphocyte infiltrates that thicken the alveolar septa with poorly formed granulomas or giant cells. Broncholalveolar lavage demonstrates > 20% lymphocytes in nearly all patients. Abnormalities on high resolution computerized tomography examinations range from nodular, centrilobular opacities in acute/subacute disease to increased reticular markings and honeycombing fibrosis, which typically are predominant in the upper lobes, in advanced disease. Descriptors include "mosaic attenuation" and "ground-glass" opacities. Repeated episodes can result in nodular pulmonary infiltrates and suspected nonspecific interstitial pneumonia or idiopathic pulmonary fibrosis. Clinicians require a high level of suspicion to make an early diagnosis of HP before extensive pulmonary fibrosis or restrictive lung disease has occurred.

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Editorial Board

Publication date: December 2018

Source: Autoimmunity Reviews, Volume 17, Issue 12

Author(s):

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

Publication date: Available online 16 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): R. Quirino de Almeida Barros, N. Bezerra de Melo, Í. de Macedo Bernardino, M.J. Arêa Leão Lopes Araújo Arruda, P. Meira Bento

Abstract

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. Most third molars tilted mesially (n = 33), while the mandibular canal was positioned below the roots of the third molar in most cases (n = 73). Contact between the two was most likely when the mandibular canal was between (RR = 1.49; 95% CI 1.27 to 1.75, p < 0.001), or to the lingual side (RR = 1.49; 95% CI 1.27 to 1.75, p < 0.001) of the roots of the tooth. These outcomes indicate a greater likelihood of contact between the canal and the roots when the canal is between, and to the lingual side, of the roots. We found no association between the angle of impaction and the position of the canal. These findings illustrate the importance of surgical planning using complementary imaging tests such as cone-beam CT.

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Citation for the 2017 Down Surgical Prize – Paul Johnson

Publication date: Available online 15 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Carrie Newlands

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Aggravation of vitiligo by an electric heating pad: A possible case of heat‐triggered Koebnerization in vitiligo

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Cancer risk in 892 089 patients with psoriasis in Korea: A nationwide population‐based cohort study

Abstract

The relationship between psoriasis and cancer has not yet been established. The aim of this study was to evaluate the association of psoriasis with certain cancers using national statistics. All patients with psoriasis (n = 892 089; 51.7% male) and age‐ and sex‐matched control subjects (n = 4 460 445) at a 5:1 ratio were enrolled using data from the National Health Insurance Service between 2007 and 2014 in Korea. In psoriatic subjects, overall cancer risk was higher than for subjects without psoriasis after adjusting for income level, diabetes, hypertension, dyslipidemia and place of residence (hazard ratio, 1.065; 95% CI, 1.049–1.081). The risk of cancer increased in the following order: prostate, thyroid, liver, ovarian, lung, leukemia, skin, multiple myeloma, lymphoma and testicular. The severity and sex of psoriatic patients also had different cancer risks. In psoriatic patients, a slightly increased risk for specific malignant neoplasms was shown. Therefore, periodic screening for cancer risk is recommended in patients with psoriasis.

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Upregulation of proteins of the NLRP3 inflammasome in patients with periodontitis and uncontrolled type 2 diabetes

Abstract

Objectives

To evaluate the expression of proteins related to activation of the NLRP3 inflammasome in patients with chronic periodontitis (CP) and type 2 diabetes mellitus (T2D), and to determine whether the exacerbated periodontal pathological process observed in diabetic patients is related to its upregulation.

Materials and Methods

We performed an observational, analytical, cross‐sectional study in three study groups: individuals systemically and orally healthy, and patients with CP with and without T2D. Gingival biopsies were taken from the three study groups. The expression of mRNAs for CASP1, NLRP3, and ASC was detected using real‐time PCR, the expression of NLRP3 and ASC proteins was determined by immunohistochemistry. The quantification of IL‐18 and IL‐1β was determined in the gingival crevicular fluid using ELISA. The results were analyzed by ANOVA followed by Tukey's test to compare differences between individual groups.

Results

Patients with CP and uncontrolled T2D presented severe periodontal disease and inflammation (PPD, p= 0.0072; CAL, p = 0.0480; bone loss, p = 0.0088), higher levels of CASP1 mRNA expression (p = 0.0026), a stronger pattern of staining for NLRP3 and ASC proteins in the epithelium and connective tissues, and significantly higher production of IL‐18 (p = 0.0063) and IL‐1β (p = 0.0018) in comparison with healthy or CP subjects.

Conclusion

The upregulation of genes and proteins involved in the activation of the NLRP3 inflammasome components in patients with periodontitis and uncontrolled T2D suggests a possible role in the more severe pathological processes leading to destruction of periodontal tissues observed in these patients.

This article is protected by copyright. All rights reserved.

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