Updates on autoinflammatory diseases

Narcisa Martinez-Quiles | Raphaela Goldbach-Mansky

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Symptomatic Primary Hyperparathyroidism as a Risk Factor for Differentiated Thyroid Cancer

Background. The primary hyperparathyroidism (PHPT) is a common disease for the endocrinologist. The concomitant thyroid disease and differentiated thyroid cancer (DTC) appear to be more frequent in patients with PHPT than in the general population. The aim of this study was to characterize patients with symptomatic PHPT with and without DTC and analyze frequency and risk factors. Methods. We consecutively studied patients with symptomatic PHPT diagnosed and treated at our center between 2013 and 2015. Patients with subclinical and syndromic forms of PHPT were excluded. Clinical and biochemical characteristics of patients with and without DTC were compared and risk factors were determined. All patients were studied with thyroid ultrasound and thyroid gammagraphy with TC-MIBI. Two expert surgeons performed all the surgical procedures. Results. In 59 patients included, we found 12 cases of PTC (20.3%). The final histopathological report of the PTC was 7 cases of follicular variant, 2 cases of oncocytic variant, 2 cases of classic variant, and 1 case of columnar cells variant of PTC. Patients with thyroid cancer were older than patients without thyroid cancer (62 ± 9.5 versus 52 ± 15.8, p = 0.03). Higher preoperative levels of iPTH were associated with PTC (p=0.03) [OR 5.16 (95% CI: 1.08-24.7)]. Conclusion. PTC is frequent in patients with symptomatic PHPT. Thyroid nodules in patients with symptomatic PHPT must be studied before parathyroidectomy. In symptomatic PHPT, higher level concentration of parathormone (PTH) was associated with higher risk of DTC.

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Forty cases of acquired oral syphilis and a review of the literature

The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties.

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Three-dimensional soft tissue effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: an automatic stereophotogrammetry landmarking analysis

Studies on mandibular midline distraction (MMD) are mostly performed using conventional research methods. Concerning surgically assisted rapid maxillary expansion (SARME), more research is conducted using three-dimensional (3D) techniques. Research on bimaxillary expansion, the combination of MMD and SARME, is reported sparsely. The main objective of this study was to provide a 3D evaluation of soft tissue effects following SARME and/or MMD. Patients who underwent SARME and/or MMD between 2008 and 2013 were included.

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Association of antinuclear antibody status with clinical features and malignancy risk in adult-onset dermatomyositis

Antinuclear antibody testing is positive in most adults with dermatomyositis. There is a strong association between negative antinuclear antibody status and increased risk of underlying malignancy in adults with dermatomyositis. More frequent follow-up and malignancy screening may be warranted in adults with dermatomyositis and negative antinuclear antibody testing.

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Vulvar Paget disease: a national retrospective cohort study

Vulvar Paget disease is a rare skin disorder with unknown malignant potential. Recurrence rates are about 40%. The risk of developing invasive disease after a non-invasive diagnosis is 8%. Five-year disease specific survival of invasive disease is significantly worse than in non-invasive or micro-invasive disease: 50% versus 98%.

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Acne Vulgaris in Patients with Hidradenitis Suppurativa

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Melanomas of the head and neck have high local recurrence risk features and require tissue rearranging reconstruction more commonly than BCC and SCC: A comparison of indications for microscopic margin control prior to reconstruction in 13,664 tumors

Consensus guidelines specify indications for microscopic margin control of keratinocyte carcinoma but not melanoma. Head and neck melanomas have high local recurrence risk features and require tissue rearranging reconstruction more frequently than keratinocyte carcinoma. Consensus guidelines with clear indications for microscopic margin control may improve outcomes for high-risk melanomas.

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Nipple and areola lesions: dermoscopy and reflectance confocal microscopy features

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Use of a cotton tip applicator for epidermal closures in dermatologic surgery, a video walkthrough

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Overall and Subgroup Prevalence of Acne Vulgaris Among Patients with Hidradenitis Suppurativa

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Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: a cohort study

5-fluorouracil and imiquimod are frequently prescribed actinic keratosis treatments, but no studies have compared their effectiveness at preventing keratinocyte carcinoma in a real-world setting. Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of site-specific keratinocyte carcinoma.

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Disentangling the heterogeneity of allergic respiratory diseases by latent class analysis reveals novel phenotypes

Abstract

Background

Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached.

Aim

To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis.

Methods

728 adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA‐classes.

Results

A six‐class model was obtained. Class 1 (25%): non‐allergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non‐allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (p<0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (p<0.001) or no nasal symptom (p<0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA‐classes.

Conclusions

Novel severe phenotypes of participants with co‐occurrence of ocular, nasal and bronchial symptoms, and exacerbation‐prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.

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Effect of oral hygiene programmes on oral opportunistic pathogens during stroke rehabilitation

Abstract

Objectives

This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation.

Methods

A total of 94 patients were randomized to two groups. Subjects were block randomized to: either (1) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (2) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram‐negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of three months, and six months.

Results

No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p<0.05), while the viable counts of yeasts and AGNB remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens.

Conclusions

Neither oral health care programme significantly affect AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts.

This article is protected by copyright. All rights reserved.

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Prevalence and normative values for Jaw Functional Limitations in the general population in Sweden

Abstract

Objectives

For Jaw Functional Limitations measured by the Jaw Functional Limitation Scale (JFLS), (i) determining prevalence in the Swedish general adult population, (ii) investigating the influence of demographic factors and self‐reported dental status, and (iii) deriving normative values.

Methods

A random sample of the general adult population in Sweden was approached (response rate: 46%, N=1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender, and dental status was investigated with regression analyses and normative values presented.

Results

The JFLS median score was 0 and all items had prevalences <30%. Age and gender did not influence Jaw Functional Limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7^th, 8^th, and 9^th decile, respectively. In dental status‐stratified norms, 9^th deciles were 20, 43, and 100, for subjects with natural teeth only, removable and complete dentures, respectively.

Conclusions

The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9^th decile as threshold for functional limitation.

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December iotaderma (#298)

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Iotaderma #299

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Circulating exosomes regulate T‐cell mediated inflammatory response in oral lichen planus

Abstract

Background

Exosomes are newly recognized natural nanocarrier and intercellular messenger that emerge as important mediators of signal transmission. Exosomes have been reported to modulate the inflammatory response of a number of diseases. This study investigated the effects of circulating exosomes from oral lichen planus (OLP) on T cells.

Methods

Plasma‐derived exosomes were purified from both OLP patients and control groups. T cells were observed under a confocal laser scanning microscope after co‐cultivation with PKH67 labeled exosomes for 12, 24, and 48 h. The effects of exosomes exposure on T cells were analyzed with several functional assays, investigating proliferation, apoptosis, and migration. Production of interleukin (IL)‐2, ‐4, ‐10, and interferon (IFN)‐γ was measured via enzyme‐linked immunosorbent assay.

Results

PKH67‐labeled exosomes were taken up by T cells in a time‐ and dose‐dependent manner. Several biological functions of T cells were promoted. In particular, the circulating erosive OLP exosomes significantly enhanced T cell proliferation and attenuated the apoptosis. The migration capacity of T cells increased remarkably in response to erosive OLP exosome treatment. In addition, the ratio of IFN‐γ/IL‐4 was significantly elevated in OLP patients.

Conclusions

Our findings indicate that the circulating OLP exosomes are involved in the biological functions of T cells, potentially promoting the OLP progression by regulating the T‐cell mediated inflammatory response.

This article is protected by copyright. All rights reserved.

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Prognostic Value of Serum Liver Enzymes in Oral and Oropharynx Squamous Cell Carcinomas

Abstract

Background

Serum liver enzymes, which catalyze relevant catabolic pathways, have been indicated to be diagnostic and prognostic tools for several malignant tumors. The correlation between serum liver enzymes levels and survival in patients with oral and oropharynx squamous cell carcinomas (OSCC) is still absent. Here, we conducted a study focusing on predictive value of serum liver enzymes in terms of prognosis in the patients.

Methods

A retrospective study including 134 OSCC patients from years 2009 to 2014 was performed to investigate the association between levels of pretreatment serum liver enzymes, various clinical parameters and prognostic outcomes, which are overall survival (OS) and disease‐free survival (DFS). Log‐rank tests with Kaplan‐Meier method were used to detect potential prognostic biomarkers. Multivariate analyses by Cox proportional hazards model were used to identify significant predictors of prognosis.

Results

Serum adenosine deaminase (ADA) level was associated with patients' OS and DFS by univariate analyses (P = 0.006 and P = 0.024, respectively). Multivariate analyses showed that higher serum ADA (>17.2 μmol/L) (P = 0.019) as well as positive lymph node status (P = 0.035) independently predicted worse OS of patients with OSCC. In addition, older age (≥ 60 years) (P = 0.043) and positive lymph node status (P = 0.027) were independently prognostic parameters for poorer DFS.

Conclusions

Preoperative serum ADA levels may serve as a reliable independent prognostic predictor for OS in OSCC patients.

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LncRNA LINC00974 activates TGF‐β/Smad signaling to promote oral fibrogenesis

Abstract

Background

Oral submucous fibrosis (OSF) is a progressive scarring disease and has been considered as a premalignant condition of the oral cavity. However, the detailed molecular mechanisms underlying the pathogenesis of OSF are still unclear.

Method

Here, we examined the expression of a novel long non‐coding RNA LINC00974 in OSF and investigated its function role in myofibroblast transdifferentiation. Phenotypic analyses, including collagen gel contraction, migration, invasion and wound healing assays, were used to assess the myofibroblast activities following overexpression or inhibition of LINC00974.

Results

We found that the expression of LINC00974 in OSF tissues or myofibroblasts was aberrantly upregulated, and there was a positive correlation between LINC00974 and myofibroblast markers. Our results showed that inhibition of LINC00974 suppressed the myofibroblast activities, while overexpression of LINC00974 increased the activation. We demonstrated that the expression levels of α‐SMA, α‐1 type I collagen, fibronectin were downregulated in the LINC00974‐inhibited myofibroblasts. Additionally, the TGF‐β secretion and phosphorylated Smad2 expression were also repressed in the LINC00974‐inhibited myofibroblasts. We further demonstrated that silence of LINC00974 prevented the arecoline‐induced myofibroblast activation, and LINC00974‐increased myofibroblast activities were via TGF‐β pathway.

Conclusion

Altogether, these findings suggested that arecoline‐increased myofibroblast transdifferentiation was via LINC00974‐mediated activation of TGF‐β signaling.

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Gamma‐delta T cell large granular lymphocyte leukemia with multiple cutaneous nodules that showed spontaneous regression

Abstract

T cell large granular lymphocyte leukemia (T‐LGLL) is a rare chronic lymphoproliferative disorder of mature post‐thymic large granular lymphocytes (LGL); either cytotoxic T‐lymphocytes or natural killer cells.¹ Major phenotype of LGL cells is TCRαβ+CD3+CD4‐CD5+CD8+CD27‐CD28‐CD45‐CD57+.² Less than 10% of cases express TCRγδ instead of TCRαβ.² Most cases of T‐LGLL have an indolent course¹ and its cutaneous manifestations have been poorly documented.

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Individual Risk Assessment Tool for School Age Asthma Prediction in UK Birth Cohort

Abstract

Background

Current published asthma predictive tools have moderate positive likelihood ratios (LR+) but high negative likelihood ratios (‐LR) based on their recommended cut‐offs, which limit their clinical usefulness.

Objective

To develop a simple clinically applicable asthma prediction tool within a population‐based birth cohort.

Method

Children from the Manchester Asthma and Allergy Study (MAAS) attended follow‐up at ages 3, 8 and 11 years. Data on pre‐school wheeze was extracted from primary‐care records. Parents completed validated respiratory questionnaires. Children were skin prick tested (SPT). Asthma at 8/11 years (school ‐age) was defined as parentally‐reported (1) physician‐diagnosed asthma and wheeze in the previous 12 months or (2) ≥3 wheeze attacks in the previous 12 months. An asthma prediction tool (MAAS APT) was developed using logistic regression of characteristics at age 3 years to predict school‐age asthma.

Results

Of 336 children with physician‐confirmed wheeze by age 3 years, 117(35%) had school‐age asthma. Logistic regression selected 5 significant risk factors which formed the basis of the MAAS APT: wheeze after exercise; wheeze causing breathlessness; cough on exertion; current eczema and SPT sensitisation(maximum score 5). A total of 281(84%) children had complete data at age 3 years and were used to test the MAAS APT. Children scoring ≥3 were at high risk of having asthma at school‐age(PPV>75%; +LR 6.3,‐LR 0.6), whereas children who had a score of 0 had very low risk(PPV 9.3%; LR 0.2).

Conclusion

MAAS APT is a simple asthma prediction tool which could easily be applied in clinical and research settings.

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Prognostic factors and survival in adenoid cystic carcinoma of the sinonasal cavity

Abstract

Background

Optimal treatment and prognostic factors affecting long‐term survival in patients with sinonasal adenoid cystic carcinoma (ACC) have yet to be clearly defined.

Methods

We conducted a retrospective review of patients treated with curative intent from 1980‐2015 at MD Anderson Cancer Center.

Results

One hundred sixty patients met inclusion criteria, including 8 who were treated with radiotherapy alone. Median follow‐up time was 55 months. The 5‐year overall survival (OS) and disease‐free survival (DFS) rates were 67.0% and 49.0%, respectively. The 10‐year OS and DFS rates were 44.8% and 25.4%, respectively. Factors that portended for poor survival on multivariate analysis were recurrent disease, any solid type histology, epicenter in the sinus cavity, the presence of facial symptoms, or the original disease not treated with surgery. There was no association between surgical margin status or nodal status and survival.

Conclusion

In this large cohort of patients with sinonasal ACC with extended follow‐up, long‐term survival is better than reported in prior literature. Future research should target patients with adverse risk factors.

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Cryosurgery combined with topical interventions for actinic keratosis: A systematic review and meta‐analysis

Summary

Background

Actinic keratoses (AK) are early in situ carcinomas of the skin due to cumulative sun exposure. Cryosurgery is an easy and practicable lesion‐directed approach for isolated lesions.

Objectives

To investigate if an upfront combination of cryosurgery with a topical intervention is superior to cryosurgery alone for AK.

Methods

We performed a systematic literature research in Medline, Embase, and CENTRAL and hand‐searched pertinent trial registers for eligible randomized controlled trials until 17 July 2018. Results from individual studies were pooled using a random‐effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach.

Results

Out of 1,758 records initially identified, 9 studies with a sample size of 1,644 patients were included. Cryosurgery in combination with a topical approach showed significantly higher participant complete clearance rates compared to monotherapy (RR 1·74, 95% CI 1·25‐2·43, I²=73%, 8 studies. The participant partial clearance rate was not statistically different (RR 1·64, 95% CI 0·88‐3·03, I²=77%, 3 studies). The number of patients who completed the study protocol and did not withdraw due to adverse events was equal in both groups (RR 0·98, 95% CI 0·95‐1·01, I²=75%, 7 studies). The studies were estimated at high risk for selective reporting bias.

Conclusions

Our results suggest superiority of a combination regimen regarding AK clearance with equal tolerability. This study highlights the importance of a field‐directed approach in patients with multiple AK or field‐cancerization.

This article is protected by copyright. All rights reserved.

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Efficacy of nivolumab monotherapy against acral lentiginous melanoma and mucosal melanoma in Asian patients

Abstract

Early clinical trials showed that treatment with anti‐programmed death‐1 (anti‐PD‐1) agents, such as nivolumab and pembrolizumab, led to marked improvements in the prognosis of advanced melanoma patients. However, most of the large‐scale studies of such treatment mainly analyzed the efficacy of anti‐PD‐1 agents in Caucasian populations. Since the clinical subtypes of melanoma differ widely among populations, and the response to anti‐PD‐1 agents is known to vary among the clinical subtypes of the disease, the efficacy of anti‐PD‐1 agents in Asian populations remains unclear.

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Citation for Michael J Fardy for Downs Surgical Prize 2017

Publication date: Available online 16 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Satyesh Parmar

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Accuracy of computer-assisted surgery in mandibular reconstruction: A postoperative evaluation guideline

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Gustaaf J.C. van Baar, Niels P.T.J. Liberton, Tymour Forouzanfar, Henri A.H. Winters, Frank K.J. Leusink

Abstract

Comparing accuracy results for mandibular reconstructions using computer-assisted surgery (CAS) is limited due to heterogeneity in image acquisition, extent of mandibular resection, and evaluation methodologies between studies. We propose a practical, feasible and reproducible guideline for standardizing evaluation methods to allow valid comparisons of postoperative results and facilitate meta-analyses in the future. It offers a guide to imaging, data comparison, volume assessment of 3-dimensional models, classification of defects, and it also contains a quantitative accuracy evaluation method.

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8 “S” in oral cancer

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Sameep S. Shetty, U.S. Vishal Rao

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Comparative effectiveness of primary radiotherapy versus surgery in elderly patients with locally advanced oropharyngeal squamous cell carcinoma

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): David J. Sher, Jingsheng Yan, Andrew Day, Baran D. Sumer, Nhat-Long Pham, Saad Khan, Hong Zhu

Abstract

Objectives

To determine the comparative effectiveness of primary radiotherapy (RT) and primary surgery (PS) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC).

Materials and methods

Eligible individuals were patients in the SEER-Medicare registry diagnosed with locally advanced OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT ± chemotherapy, or PS ± adjuvant RT or chemoradiotherapy (CRT). Overall survival (OS) was analyzed using Cox multivariable analysis (MVA). Risks of gastrostomy dependence (GD), esophageal stricture (ES), and osteoradionecrosis (ORN) were analyzed using logistic regression.

Results

A total of 2754 patients (69% RT, 31% PS) were included in this cohort, with a median age of 72 years. Patients treated with RT, CRT and PS experienced 3-year OS outcomes of 36.1%, 52.8%, and 54.9%, respectively (p < 0.001). Increasing age, unmarried status, increasing comorbidity, lower income, base of tongue (BOT) site, higher stage, no prior PET, and RT alone (but not CRT) were associated with inferior OS. Independent predictors of GD at 6 months included black race, BOT site, advanced stage, and CRT. The risks of ORN and stricture were not associated with treatment modality. Concurrent chemotherapy improved OS with definitive RT but had no impact in adjuvant RT. Only cisplatin- and taxane-containing regimens improved OS, but all concurrent agents, including cetuximab, significantly worsened GD.

Conclusion

Local therapy decisions for locally advanced OPSCC must be individualized, with CRT increasing acute and chronic GD. The differential survival impact of concurrent chemotherapy in the definitive and adjuvant setting may be a consideration in decision-making.

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High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Sulsal Haque, Vidhya Karivedu, Muhammed K. Riaz, David Choi, Logan Roof, Sarah Z. Hassan, Zheng Zhu, Roman Jandarov, Vinita Takiar, Alice Tang, Trisha Wise-Draper

Abstract

Objectives

Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial.

Materials and Methods

We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS).

Results

Median age at diagnosis was 61 years (range 40–86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004).

Conclusions

Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.

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A myxoma in the temporomandibular joint: Case report and review of the literature

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): A. Cinza, F. Monje, J.J. Fernandez de Mera

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Postoperative myxedema coma in patients undergoing major surgery: Case series

Publication date: Available online 16 November 2018

Source: Auris Nasus Larynx

Author(s): Daniel Yafit, Narin Nard Carmel-Neiderman, Nadav Levy, Avrham Abergel, Alexander Niv, Ravit Yanko-Arzi, Arik Zaretski, Anat Wengier, Dan M. Fliss, Gilad Horowitz

Abstract

Objective

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.

Methods

Analysis of the patients' surgical records and medical charts.

Results

Four patients developed postoperative myxedema coma and were evaluated for risk factors. Three had known hypothyroidism. Two had undergone large head and neck composite resections necessitating a free flap repair for malignant disease. One had undergone coronary artery bypass graft for ischemic heart disease, and another had undergone endoscopic cholecystectomy for complicated cholecystitis. All four patients required prolonged hospitalization, including treatment in the intensive care unit. One patient had undergone full cardiopulmonary resuscitation directly related to the myxedema coma state.

Conclusion

We present a series of four patients who developed myxedema coma following major surgery. We recommend that patients with known hypothyroidism who are scheduled for major surgery should be tested for thyroid function status and assessed for postoperative risk of hypothyroidism. Those who develop complications following major surgery, should be immediately tested for thyroid function to rule out myxedema coma.

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

Publication date: Available online 16 November 2018

Source: Auris Nasus Larynx

Author(s): Min Luo, Gang Sun, Jing-wu Sun

Abstract

Objective

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

Methods

miR-196b and PCDH-17 expressions were determined in tissues, and the targeting relation of miR-196b and PCDH-17 was verified through dual-luciferase reporter system. In vitro, Hep-2 cells were divided into the Control, miR-196b inhibitors, miR-NC, PCDH-17, and miR-196b mimics + PCDH-17 groups. The miR-196b and PCDH-17 expressions were determined by qRT-PCR or/and Western blot, and the biological features by MTT, Annexin V-FITC/PI, wound-healing and Transwell assays.

Results

MiR-196b was found to be up-regulated, while PCDH-17 was down-regulated in a negative correlation in LSCC patients, which was related to histological grade and TNM stage. And low expression of miR-196b and high expression of PCDH-17 contributed to an increase in the 5-year-survival rate of LSCC patients. Besides, miR-196b directly targeted PCDH-17, while miR-196b inhibitors could up-regulate the PCDH-17 in Hep-2 cells. Moreover, miR-196b inhibitors and PCDH-17 curbed Hep-2 cell proliferation but facilitated the apoptosis, with decreases in cell invasion and migration. In addition, no statistical significance was found in cell proliferation, apoptosis, invasion and migration between Control group and miR-196b mimics + PCDH-17 group.

Conclusion

LSCC patients exhibited the up-regulated miR-196b and down-regulated PCDH-17, which are correlated with the major clinical features and prognosis. Inhibiting miR-196b may suppress proliferation, migration and invasion abilities, and promote apoptosis of Hep-2 cells via targeting PCDH-17.

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

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Diana Cassi, Giuditta Battistoni, Marisabel Magnifico, Chiara Di Blasio, Giuseppe Pedrazzi, Alberto Di Blasio

Summary

Purpose

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.

Materials and Methods

Twelve patients (mean age 13.1 ± 3.1 years) with different degrees of HFM and 15 healthy controls (mean age 12.2 ± 3.5 years) were imaged with a stereophotogrammetric facial scanner. The root mean square error (RMSE) of the distances between the corresponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of trigeminal branches. A statistical analysis was performed to compare the RMSE value of all facial areas within each group and between patients and controls.

Results

RMSE values progressively increased from the upper to the lower third of face, both in patients and controls. The level of asymmetry was significantly higher in HFM subjects for middle third (p<0.01), lower third (p<0.001) and whole face (p<0.001); no statistically significant differences were found between the groups for the upper third.

Conclusions

The reported technique provides an accurate topographic analysis of the facial asymmetry, and is recommended for conditions such as HFM affecting only part of the face.

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

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): António Ramos, Luis M. Gonzalez-Perez, Pedro Infante-Cossio, Michel Mesnard

Summary

Purpose

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.

Materials and Methods

Three experimental cadaveric condyles were tested under three conditions: one intact, another with the Biomet model, and one with the innovative concept. The condyle was tested with a reaction of 300N in all situations and the principal strains were measured. Before the geometry of the cadaveric condyle was reconstructed from a microCT scan, and a finite element model was created. Finally, a procedure was carried out with the new implant by two expert surgeons on a two cadaveric head model.

Results

In vitro the mandible condyle presents a linear behavior until maximum load. The strain measured with Biomet implant indicates a strain shielding effect in the proximal region, inducing bone loss in the long term. The lingual side of the Biomet implanted condyle presents an increase of +44% in strain.

Conclusion

The new concept was evaluated and showed a similar behavior to the intact model, and better behavior than the Biomet. The innovative concept proves that it is possible to avoid screws for a TMJ fixation and improve the TMJ alloplastic behavior.

https://ift.tt/2PyskfI

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

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Bach Quang Le, Bina Rai, Zophia Xue Hui Lim, Tuan Chun Tan, Tingxuan Lin, Jaslyn Jie Lin Lee, Sadasivam Murali, Teoh Swee Hin, Victor Nurcombe, Simon McKenzie Cool

https://ift.tt/2QQfxBE

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

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Gilles Reuter, Olivier Bouchain, Laurent Demanez, Félix Scholtes, Didier Martin

Summary

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/2PAtZBe

Cerebellar large B-cell lymphoma: a case report

Primary central nervous system lymphoma is a rare, malignant non-Hodgkin lymphoma that can arise in the brain, spinal cord, eye, leptomeninges, or cranial nerves. Primary central nervous system lymphoma is rar...

https://ift.tt/2KboQtj

Upregulation of tumor PD-L1 by neoadjuvant chemoradiotherapy (neoCRT) confers improved survival in patients with lymph node metastasis of locally advanced rectal cancers

Abstract

The expression of programmed cell death 1 ligand 1 (PD-L1) and interferon-γ (IFN-γ) is of great interest for the development of chemoradiotherapy and immune checkpoint inhibitor treatments. Patients with nodal metastasis (pN+) tend to have a poor prognosis, even after neoadjuvant chemoradiotherapy (neoCRT) and surgical treatment. In this study, we examined the roles of tumor PD-L1 and IFN-γ before and after neoCRT in locally advanced rectal cancer (LARC) patients. Our results demonstrate that patients with high PD-L1 expression in post-neoCRT tissues exhibit improved 5-year disease-free survival (DFS) and overall survival (OS) compared with those with low PD-L1 expression (p < 0.001). Furthermore, in the pN+ population, patients with high PD-L1 expression in post-neoCRT tissues exhibit improved 5-year DFS and OS. PD-L1 and IFN-γ upregulation increased in tumor tissues after neoCRT, and patients with high PD-L1 and high IFN-γ exhibit improved 5-year DFS and OS (p = 0.04 and p = 0.001, respectively). To the best of our knowledge, this study is the first to demonstrate that PD-L1 upregulation in a pN+ cohort correlates with improved prognosis, which is similar to that in patients without nodal metastasis. Moreover, this study verified that PD-L1 and IFN-γ were upregulated by neoCRT treatment in LARC patients and demonstrated that neoCRT may be useful not only for immune checkpoint inhibitor treatment but also for reinvigorating preexisting anti-cancer immunity.

https://ift.tt/2BcWWdD

Evidence for respiratory viruses interactions in asymptomatic preschool-aged children

Publication date: Available online 16 November 2018

Source: Allergologia et Immunopathologia

Author(s): K. Douros, D. Kotzia, C. Kottaridi, A. Giotas, B. Boutopoulou, E. Bozas, V. Matziou, K. Priftis, V. Papaevangelou

Abstract

Aim

To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children.

Methods

Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses.

Results

Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52–54.75, p = 0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14–14.16, p = 0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10–12.14, p = 0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02–16.05, p = 0.046). No other significant associations between viruses were observed.

Conclusion

Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear.

https://ift.tt/2QRLj15

Correlation of OX40 ligand on B cells with serum total IgE and IL-4 levels by CD4+ T cells in allergic rhinitis

Publication date: Available online 16 November 2018

Source: Allergologia et Immunopathologia

Author(s): S. Fouladi, M. Masjedi, M. G. Hakemi, R. Ghasemi, N. Eskandari

Abstract

Introduction and objectives

Allergic rhinitis (AR) is a classic Th2-mediated disease, with important contributions to the pathology of interleukins 4, 5, and 13. The co-stimulatory molecule of OX40 and its ligand interaction participate in the immune response by regulation of Th1/Th2 cells balance. Considering the paucity of information on the relation between OX40 ligand (OX40L) and AR, this study aimed to examine its expression on B lymphocytes.

Patients and methods

This case–control study consisted of 20 AR patients and 20 healthy subjects. The serum level of total immunoglobulin E (IgE) was measured using the electro-chemiluminescence (ECL) technology. The percentage of B-lymphocytes expressing OX40L was assessed by flow cytometry. The amounts of IL-4 in CD4⁺ T cells culture supernatant was also measured by the enzyme-linked immunosorbent assay (ELISA).

Results

OX40L expression on B lymphocytes of patients was significantly higher than the control group (44.32 ± 19.21% vs. 2.79 ± 2.48% respectively, p < 0.001). In AR patients, OX40L expression correlated positively with the levels of serum total IgE and IL-4 produced by CD4⁺ T lymphocytes (p < 0.01 – p < 0.05) respectively.

Conclusions

Collectively, the findings of this work suggest that there is a relationship between the OX40L expression level on B lymphocytes and allergic markers such as IgE and IL-4 in patients with allergic rhinitis.

https://ift.tt/2PCqNFv

A Simulation-Based Workshop to Improve Dermatologists’ Communication Skills: A Pilot for Continuing Medical Education

Abstract

Introduction

Communication skills influence the quality of health care and patient experience; both may affect provider reimbursement. There are few opportunities available for practicing physicians to receive direct feedback on communication in patient encounters. The purpose of this simulation-based patient encounter workshop was for dermatologists to practice and obtain feedback on their communication skills.

Methods

In March 2016, dermatologists participated in a workshop with four simulated patient encounters. Cases were developed based on a prior needs assessment. Standardized patient educators evaluated participants' communication using the Master Interview Rating Scale and provided verbal feedback. Physicians rated the usefulness of the simulation and the feedback received through a survey upon workshop completion.

Results

Of the 170 physicians who registered, 103 participated in the simulation. The workshop was highly rated in meeting its three learning objectives (score of 4.5–4.6 out of a maximum score of 5). The lowest-rated communication skills were as follows: allowing the patient to share their narrative thread (3.1), summarizing the patient's history from the provider (3.8), and assessing patient understanding (3.8).

Conclusions

Participants reported that this communication workshop effectively satisfied its learning objectives. Opportunities to practice and improve communication skills as part of continuing medical education will benefit the clinical experience of patients and physicians alike, and the workshop may be formatted to serve physicians of other specialties. The lowest-scoring communication areas identified in this study present an opportunity to develop a tailored curriculum for physician–patient communication in the future.

https://ift.tt/2TkY71J

Treg/Th17 imbalance is associated with poor autoimmune hepatitis prognosis

Publication date: Available online 16 November 2018

Source: Clinical Immunology

Author(s): Yuli Liu, Weiming Yan, Wei Yuan, Peng Wang, Da Huang, Xiaoping Luo, Qin Ning

https://ift.tt/2Q2vHL1

Excision of preauricular sinus with abscess drainage in children

Publication date: Available online 16 November 2018

Source: American Journal of Otolaryngology

Author(s): Lizhi Wang, Lai Wei, Weili Lu, Ziye Liu, Meiyi Wang, Zhiqiang Wang

Abstract

Purpose

To introduce a feasible approach for excising a preauricular sinus with abscess in children.

Materials and methods

Patients under 14 years old with a preauricular sinus abscess and volunteering for surgery were involved in this study.

Results

Neither recurrence nor local deformity was found in these patients with a follow-up of 3 to 72 months.

Conclusions

Excising the preauricular sinus with abscess in children is a feasible approach to treatment.

https://ift.tt/2OOQihn

Role of P2X3 receptors in scratching behavior in mouse models

Publication date: Available online 17 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Miho Shiratori-Hayashi, Ayumi Hasegawa, Honami Toyonaga, Tsugunobu Andoh, Takeshi Nakahara, Makiko Kido-Nakahara, Masutaka Furue, Yasushi Kuraishi, Kazuhide Inoue, Xinzhong Dong, Makoto Tsuda

https://ift.tt/2TmQqbe

Tipping the balance: a biased nanobody antagonist of CCR3 with potential for the treatment of eosinophilic inflammation

Publication date: Available online 17 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): James E. Pease, Timothy J. Williams

https://ift.tt/2A23ZEn

Patterns of Congenitally Missing Teeth of Non-syndromic and Syndromic Patients Treated at a Single-Center over the Past Thirty Years

Publication date: Available online 16 November 2018

Source: Archives of Oral Biology

Author(s): Simone Heuberer, Christian Ulm, Werner Zechner, Brenda Laky, Georg Watzak

Abstract

Objectives

Literature regarding congenitally-missing-teeth (CMT) is lacking especially on CMT-patterns. Thus, the aim of this study was to present an in-depth analysis of 843 patients with CMT treated at a single-center over the past thirty years.

Design

Age, date-of-birth-year, gender, medical- and family-history, CMT-types, -numbers, -severity, -region, -symmetry, -patterns using the tooth agenesis code (TAC), and -growth types of all clinically and radiographically diagnosed CMT-patients were collected. Age and occurrence of syndromes were used to divide CMT-patients into non-syndromic patients older than nine years (group1) and syndromic CMT-patients (group2). Groups were compared especially regarding gender and CMT-severity.

Results

The average CMT-number per patient was 5.5 (group1, n = 816, 59.9% female) and 15.1 (group2, n = 27, 29.6% female). There were significant less male (40.1% vs. 70.4%, respectively; P = 0.002) as well as significantly less male-oligodontia (44.8% vs. 73.9%, respectively; P = 0.009) in group1 than in group2. Group1 resulted in decreased prevalence of similar CMT-patterns with severity; the most prevalent CMT was the 2^nd premolar; there were no significant differences between the right and left side, whereas more CMT affected the maxilla; the majority of patients presented with bilateral-CMT (82.8%); females were more affected by CMT but more males had severer forms; certain single CMT differed by gender, and CMT was related to first-grade-relatives.

Conclusion

The majority of CMT-patients presented with hypodontia. Furthermore, same CMT-patterns seem more like to be present in patients with milder forms of tooth agenesis. Gender-specific association regarding CMT-number, severity groups, and single CMT were detected.

https://ift.tt/2KcXNxK

Patterns of Congenitally Missing Teeth of Non-syndromic and Syndromic Patients Treated at a Single-Center over the Past Thirty Years

Publication date: Available online 16 November 2018

Source: Archives of Oral Biology

Author(s): Simone Heuberer, Christian Ulm, Werner Zechner, Brenda Laky, Georg Watzak

Abstract

Objectives

Literature regarding congenitally-missing-teeth (CMT) is lacking especially on CMT-patterns. Thus, the aim of this study was to present an in-depth analysis of 843 patients with CMT treated at a single-center over the past thirty years.

Design

Age, date-of-birth-year, gender, medical- and family-history, CMT-types, -numbers, -severity, -region, -symmetry, -patterns using the tooth agenesis code (TAC), and -growth types of all clinically and radiographically diagnosed CMT-patients were collected. Age and occurrence of syndromes were used to divide CMT-patients into non-syndromic patients older than nine years (group1) and syndromic CMT-patients (group2). Groups were compared especially regarding gender and CMT-severity.

Results

The average CMT-number per patient was 5.5 (group1, n = 816, 59.9% female) and 15.1 (group2, n = 27, 29.6% female). There were significant less male (40.1% vs. 70.4%, respectively; P = 0.002) as well as significantly less male-oligodontia (44.8% vs. 73.9%, respectively; P = 0.009) in group1 than in group2. Group1 resulted in decreased prevalence of similar CMT-patterns with severity; the most prevalent CMT was the 2^nd premolar; there were no significant differences between the right and left side, whereas more CMT affected the maxilla; the majority of patients presented with bilateral-CMT (82.8%); females were more affected by CMT but more males had severer forms; certain single CMT differed by gender, and CMT was related to first-grade-relatives.

Conclusion

The majority of CMT-patients presented with hypodontia. Furthermore, same CMT-patterns seem more like to be present in patients with milder forms of tooth agenesis. Gender-specific association regarding CMT-number, severity groups, and single CMT were detected.

https://ift.tt/2KcXNxK

Assessment of TILs, IDO-1, and PD-L1 in resected non-small cell lung cancer: an immunohistochemical study with clinicopathological and prognostic implications

Abstract

Several cancers, especially non-small cell lung cancer (NSCLC), are able to escape the immunosurveillance of tumor-infiltrating lymphocytes (TILs); among the molecules involved, the indoleamine 2,3-dioxygenase 1 (IDO-1) and the programmed cell death ligand-1 (PD-L1) play a crucial role. These aspects are of great interest in the current immunotherapeutic era, therefore the current study analyses the TILs, IDO-1, and PD-L1 interactions and their correlations with clinicopathological parameters and prognosis in NSCLC. One hundred ninety-three NSCLC surgical specimens, formalin-fixed, and paraffin-embedded were assessed for TILs density, TILs localization, IDO-1 (clone 4.16H1), and PD-L1 (clone E1L3N) immunohistochemical expressions. This data was correlated with clinicopathological parameters, disease free, and overall survivals. IDO-1 and PD-L1 high expressions were related to the solid pattern of adenocarcinomas (respectively p = 0.036 and p = 0.026); high PD-L1 expression was correlated with squamous histotype (p = 0.048). IDO-1 overexpression correlated with former smokers (p = 0.041), higher adenocarcinoma stages (p = 0.039), and with both higher TILs density and PD-L1 expression (respectively p = 0.025 and p = 0.0003). A better prognosis was associated with TILs intratumoral or mixed localizations (p = 0.029). TILs localization affects NSCLC prognosis; the higher expression of IDO-1 and PD-L1 in poorly differentiated and more aggressive lung adenocarcinomas, as well as the correlation between high PD-L1 expression and squamous cell histotype, confirm the more efficient immunoescaping of these NSCLC subgroups.

https://ift.tt/2KbN5HQ

Prostaglandin E2 decrease in induced sputum of hypersensitive asthmatics during oral challenge with aspirin

Abstract

Background

A special regulatory role for prostaglandin E₂ (PGE₂) has been postulated in Nonsteroidal anti‐inflammatory drugs (NSAIDs)‐exacerbated respiratory disease (NERD).

Objective

To investigate the effect of systemic aspirin (acetylsalicylic acid) administration on airways PGE₂ biosynthesis in induced sputum supernatant (ISS) among subjects with NERD or aspirin‐tolerant asthma with chronic rhinosinusitis with nasal polyposis (ATA‐CRSwNP), as well as healthy controls (HC).

Methods

Induced sputum (IS) was collected from patients with NERD (n=26), ATA‐CRSwNP (n=17), and HC (n=21) at baseline and after aspirin challenge. Sputum differential cell count and IS supernatant (ISS) levels of prostanoids: PGE₂, 8‐iso‐PGE₂, tetranor‐PGE‐M, 8‐iso PGF₂α and leukotriene C₄, D₄ and E₄ were determined using mass spectrometry. Urinary excretion of LTE₄ was measured by ELISA.

Results

NERD subjects had elevated sputum eosinophilic count as compared to ATA‐CRSwNP and HC (median NERD 9.1%, ATA‐CRSwNP 2.1% and HC 0.4%; P<0.01). Baseline ISS levels of PGE₂ were higher in asthmatics as compared to HC at baseline (NERD vs. HC P=0.04, ATA‐CRSwNP vs. HC P<0.05). Post‐challenge ISS levels of PGE₂ compared to baseline significantly decreased in NERD and HC (P<0.01 and P=0.01), but not in ATA‐CRSwNP. In NERD a similar decrease of PGE₂ as in HC resulted from 2.8 times lower dose of aspirin.

Conclusions

Aspirin‐precipitated bronchoconstriction is associated with a decrease in airway PGE₂ biosynthesis. These results support the mechanism of PGE₂ biosynthesis inhibition as a trigger for bronchoconstriction in NERD.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FExTon

Modified technique of total hepatectomy in polycystic liver disease with caval flow preservation: the exposure left lateral sectionectomy

Background Liver transplantation (LT) for polycystic liver disease (PLD) is rare, extremely challenging and hemorrhagic, without standard approach. Moreover, LT for PLD presents the highest mortality rate (12 to 18%) among all causes of LT. In this setting, the combination of difficult mobilization of a heavy polycystic native liver with narrow access to inferior vena cava (IVC) and fragile venous wall may lead to venous tearing and cataclysmic bleeding during dissection. The aim of this study was to evaluate a modified technique of total hepatectomy in order to limit hazardous liver manipulation and improve exposure of IVC in patients with massive hepatomegaly related to PLD: the exposure left lateral sectionectomy (ELLS). Methods From 2011 to 2018, ELLS was performed during LT for PLD. Key technical points for safe and fast ELLS include avoidance of left triangular ligament section and placement of a tape behind the left lateral section allowing its ascension and prior dissection of the hepatic pedicle to limit bleeding. The transection plane is mainly composed of cysts, with limited parenchyma, this allows for rapid and bloodless transection using electric scalpel. Results Fifteen patients had ELLS with no postoperative death or intraoperative complication. Median ELLS duration was 16 min and no massive bleeding occurred during this step. During total hepatectomy, median blood loss was 500 ml and no patient required total caval clamping. All patients were alive at the end of the follow-up. Conclusions ELLS during LT for PLD facilitates total hepatectomy with vena cava and caval flow preservation. Corresponding author: Prof. Olivier Soubrane, MD, PhD, Département de Chirurgie Hépato-pancréato-biliaire, AP-HP Hôpital Beaujon, Clichy, 100 Boulevard du Général Leclerc, 92210 Clichy, France. Tel: 01 40 87 52 52. Fax: 01 40 87 50 67. Mail: olivier.soubrane@aphp.fr ORCID : 0000 0002 4668 9275 Autorship page: Participated in research design: FC, OS, FD Participated in the writing of the paper : BL, OS, FD, Participated in the performance of the research: OS, FC; TY Contributed new reagents or analytic tools: SD, EW, MC, CF Participated in data analysis: AS, FD, SD, EW, MC, CF Disclosure of conflict of interest: The authors of this manuscript have no conflicts of interest to disclose. Disclosure of funding: None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2DLxFdl

ENDOTHELIAL GLYCOCALYX SHEDDING PREDICTS DONOR ORGAN ACCEPTABILITY AND IS ASSOCIATED WITH PRIMARY GRAFT DYSFUNCTION IN LUNG TRANSPLANT RECIPIENTS

Background The endothelial glycocalyx, a sieve-like structure located on the luminal surface of all blood vessels, has been found to be integral to regulation of capillary permeability and mechanotransduction. Given this, we investigated the role of endothelial glycocalyx breakdown products in organ donors and recipients in terms of acceptability for transplant and risk of primary graft dysfunction (PGD). Methods Endothelial glycocalyx breakdown products were measured in the peripheral blood of 135 intended and actual organ donors. Breakdown product levels were tested for association with donor demographic and clinical data, organ acceptability for transplant along with lung recipient outcomes (n=35). Liquid chromatography mass-spectrometry analysis was performed to confirm glycosaminoglycan levels and sulphation patterns on donor samples (n=15). In transplant recipients (n=50), levels were measured pre-transplant and daily for 4 days post-transplant. Levels were correlated with PGD severity and intubation time. Results Decreased hyaluronan levels in peripheral blood independently predicted organ acceptability in intended and actual donors (OR 0.96; (95%CI: 0.93-0.99) p=0.026). Furthermore, high donor syndecan-1 levels were associated with PGD in recipients (3142(1575-4829) vs 6229(4009-8093)pg/ml; p=0.045). In recipient blood, levels of syndecan-1 were correlated with severe (Grade 2-3) PGD at 72 hrs post-transplant (5982((3016-17191) vs 3060(2005-4824))pg/ml; p=0.01). Conclusions Endothelial glycocalyx breakdown occurs in lung transplant donors and recipients and predicts organ acceptability and development of PGD. Glycocalyx breakdown products may be useful biomarkers in transplantation, and interventions to protect the glycocalyx could improve transplant outcomes. Corresponding Author/ Reprint requests: Daniel Chambers, MBBS, MD, Queensland Lung Transplant Service, Level 1, Administration Building, The Prince Charles Hospital, Rode Rd, Chermside, Queensland, 4032, Australia. Telephone: +61-7-31394000. Fax +61-7-31395696. E-mail address: daniel.chambers@health.qld.gov.au Authors contributions: Timothy M Sladden contributed to research design, performance of the research, data analysis and writing of the paper. Stephanie Yerkovich and Daniel C Chambers contributed equally to research design, data analysis and writing of the paper. Michelle Grant, Michael Trotter and Peter Hopkins contributed to data collection and/ or analysis and critical revision of the manuscript. Xinyue Liu and Fuming Zhang contributed to performance of research, data analysis and writing of the paper. Robert J Linhardt contributed to analytic tools, data analysis and writing of the paper. Disclosures: The authors declare no conflicts of interest. Funding: This research was funded by a Program Grant from the Prince Charles Hospital Foundation and National Health and Medical Research Council Project Grant # 1103862. Neither funding source were involved in the research or manuscript preparation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2RWxUFb

A Propensity Matched Survival Analysis: Do Simultaneous Liver-Lung Transplant Recipients Need a Liver?

Background There is debate whether simultaneous lung-liver transplant (LLT) long-term outcomes warrant allocation of 2 organs to a single recipient. We hypothesized that LLT recipients would have improved posttransplant survival compared to matched single-organ lung recipients with an equivalent degree of liver dysfunction. Methods The OPTN/UNOS STAR file was queried for adult candidates for LLT and isolated lung transplantation from 2006-2016. Waitlist mortality and transplant odds were calculated for all candidates. Donor and recipient demographic characteristics were compiled and compared. LLT recipients were matched 1:2 with a nearest neighbor method to single-organ lung recipients. Kaplan-Meier methods with log-rank test compared long-term survival between groups. Univariate regression was used to calculate the association of LLT and mortality within 6-months of transplant. A proportional hazards model was used to calculate risk-adjusted mortality after 6-months posttransplantation. Results Thirty-eight LLT patients were matched to 75 single-organ lung recipients. After matching, no differences in baseline demographics or liver function were observed between cohorts. Length of stay was significantly longer in LLT recipients compared to isolated lung recipients (45.89 days vs. 22.44 days, p

https://ift.tt/2DHV1jT

Cell-free microRNA miR-505-3p in graft preservation fluid is an independent predictor of delayed graft function after kidney transplantation

Background Delayed graft function (DGF), a common complication after transplantation of deceased donor kidneys, affects both short- and long-term outcomes. Currently available biomarkers during graft preservation lack sensitivity in predicting risk for DGF. The aim of this study is to identify cell-free microRNA biomarkers in graft preservation fluid predictive of DGF after kidney transplantation. Methods Vascular bed preservation fluid was collected from 48 kidney grafts from DCD or DBD (donation after circulatory death or brain death) donors. MiRNA profiles were determined by PCR array (n=8) and validated by RT-qPCR (n=40). Graft function post-transplantation was defined as immediate good function (IF) or DGF. Results A total of 223 miRNAs fulfilled the pre-set parameters (Ct

https://ift.tt/2RX5yL6

Deceased brain dead donor liver transplantation and utilization in the United States: nighttime and weekend effects

Background Understanding factors that contribute to liver discards and non-usage is urgently needed to improve organ utilization. Methods With SRTR data, we studied a national cohort of all U.S. adult, deceased brain dead donor, isolated livers available for transplantation from 2003-2016, including organ-specific and system-wide factors that may affect organ procurement and discard rates. Results Of 73,686 available livers, 65,316 (88.64%) were recovered for transplant, of which 6,454 (9.88%) were ultimately discarded. Livers that were not procured or, upon recovery, discarded were more frequently from older, heavier, HCV+, and more comorbid donors (p

https://ift.tt/2DJnRAj

Case of generalized anhidrosis associated with diffuse reticular hyperpigmentation and syndactyly

https://ift.tt/2OMzUxP

Reply to “Early ambulation versus bedrest after skin grafting in extramammary Paget's disease”

https://ift.tt/2zfpz8B

Demographic and clinical characteristics of spinal calcinosis in systemic sclerosis: Possible association with peripheral angiopathy

Abstract

The objective was to evaluate the demographic and clinical characteristics of systemic sclerosis (SSc) patients with spinal calcinosis. Paraspinal and intraspinal calcinosis was assessed blindly by orthopedic surgeons specializing in spinal diseases using chest high‐resolution computed tomography (CT) that was performed for the screening and prospecting of interstitial lung disease in 159 Japanese SSc patients. Among these patients, we identified 27 (17%) with spinal calcinosis, and the most common site was cervical level at 77.8% (21/27). The frequency of spinal calcinosis in the late stage was higher than in the early stage (44.4% vs 29.6%). Multiple calcinosis was identified in 18.5% (5/27). The frequency of paraspinal calcinosis only was 59.3%, intraspinal calcinosis only 18.5%, and both intraspinal and paraspinal calcinosis 22.2%. Among SSc patients, 4.4% (7/159) had CT‐based evidence of spinal cord compression. Among cases with spinal cord compression, only one had neurological symptoms, and surgical removal improved the symptoms. The other six SSc patients with spinal calcinosis (3.8% of 159) had no symptoms. Male sex (29.6%) and severe peripheral vasculopathy such as digital ulcers (55.6%) and acro‐osteolysis (33.3%) were significantly more frequent in the SSc patients with spinal calcinosis than in the SSc patients without spinal calcinosis (10.6%, 32.6% and 14.4%, respectively). Our results suggest that severe peripheral vasculopathy may be associated with the development of spinal calcinosis. Because SSc patients are prone to spinal calcinosis, when SSc patients claim symptoms such as pain, numbness and movement disorder of the extremities, spinal calcinosis is a complication that should be taken into consideration.

https://ift.tt/2OMzPu1

Brain Protection Beyond the OR: Consensus Statement on Perioperative Neurocognitive Disorders (PND)

No abstract available

https://ift.tt/2DIY2Ah

Mild Perioperative Hypothermia and Myocardial Injury: A Retrospective Cohort Analysis

BACKGROUND: We tested the primary hypothesis that final intraoperative esophageal temperature is associated with increased odds of a composite of in-hospital all-cause mortality and myocardial injury within 7 days after noncardiac surgery. Secondary exposures were time-weighted average intraoperative temperature and area

https://ift.tt/2qOYkNE

Going With the Flow: Cerebrovascular Disease and Autoregulation

No abstract available

https://ift.tt/2S16f6c

Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study

BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25–0.86; P = .014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02–1.475; P = .029), but not moderate-severe large cerebral arterial stenosis (P = .406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21–8.71; P = .019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.

https://ift.tt/2DGnNBz

Preliminary Analysis on Characteristics of Rib Cartilage Calcification in Patients With Congenital Microtia

Autogenous rib cartilage graft procedure for microtia reconstruction has been adopted as the most standardized current method. But calcification would make it difficult for cartilage harvesting and ear framework sculpting. The objective of this study was to explore the rate, degree, and pattern of rib cartilage calcification in microtia and to guide rib cartilage harvesting and the optimal timing of auricular reconstruction. A retrospective study was performed with the imaging data from 320 consecutive patients who received a preoperative 3-dimensional chest computed tomography (CT). Overall, calcification rate of cartilages in female patients was higher than male's (P  0.05). So merely the age increasing is not the contradiction for cartilage harvesting, as long as the authors effectively evaluate the condition of rib cartilage before operation. Rib cartilages serve as the key material in auricular framework sculpting and determine the feasibility and outcomes of the surgery. So CT examinations for preoperative evaluation of rib cartilage could be a useful method for planning microtia reconstruction. Address correspondence and reprint requests to Haiyue Jiang, PhD, Department of Auricular Reconstruction, Plastic Surgery Hospital, Badachu Road 33, 100144 Beijing, China; E-mail: jianghaiyue_psh@163.com Received 29 November, 2017 Accepted 14 July, 2018 This study was supported by the Capital Characteristic Clinic Project (No Z141107002514048) and the Capital Characteristic Clinic Project (No Z151100004015185). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluation of Temporomandibular Joint Movement After Mandibular Reconstruction

Mandibular head dislocation and problems with mouth opening may develop after mandibular reconstruction. The authors investigated dislocation of the mandibular head and amount of protrusive sliding (excursion) and their effect on mouth opening. The authors divided 55 mandibular reconstruction patients into 3 groups on the basis of the extent of masticatory muscle and mandibular resection and investigated mandibular head dislocation. On the other hand, the authors focused on mandibular head protrusive excursion as a function of a reconstructed mandible. Protrusive excursion was measured by plain radiography in 29 patients. The extent of mouth opening was measured between the central incisors. Fluoroscopy was performed in 9 patients and the motions of the mandible were analyzed with video-analysis software. Mandibular head dislocation was observed in 15 patients (27.2%) who underwent resection of the mandibular ramus and coronoid process. The extent of mouth opening did not vary significantly among the 3 groups but was lower than that in healthy persons. Mandibular excursion was restricted in patients with conserved temporalis and lateral pterygoid muscles. Protrusive excursion was correlated with the extent of mouth opening. Structural problems involving dislocation of the mandibular head are caused by severing the coronoid process and protrusive excursion disorders are important factors causing mouth opening problems. Physiological sliding and other motions were observed in reconstructed models. The authors believe that when the ramus is resected, there is a greater chance of articular head dislocation. These findings suggest that dislocation of the mandibular head and protrusive excursion disorders arise from imbalances of the remaining masticatory muscles. Address correspondence and reprint requests to Masataka Shiozaki, MD, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-0021, Japan; E-mail: mstk28@gmail.com Received 31 January, 2017 Accepted 17 August, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Dacryocystitis and Rhinosinusitis Secondary to Sarcoidosis

Sarcoidosis rarely develops in the lacrimal sac. Lacrimal sac sarcoidosis may be associated with sarcoidosis-related rhinosinusitis. The anatomical and histological relationship between the lacrimal drainage system and nasal mucosa has been indicated as a predisposing factor for this concomitance. However, the characteristics of this condition are not fully understood. Herein, the authors report a case where dacryocystitis and rhinosinusitis developed secondary to sarcoidosis. Pathological examination of the lacrimal sac wall revealed noncaseating epithelioid granulomas in the subepithelial layer, which contains the lacrimal-drainage-associated lymphoid tissue. The lacrimal-drainage-associated lymphoid tissue comprises the main immune mechanism of the lacrimal system and forms a functional unit with the lacrimal gland, conjunctiva, and nasal mucosa to maintain ocular surface integrity through lymphocyte recirculation. Because sarcoidosis is an autoimmune disorder, this lymphocyte recirculation may be associated with the concurrent nasal lesions in the authors' case. Address correspondence and reprint requests to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 17 July, 2018 Accepted 21 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Gingival Neurofibroma With Teardrop-Shaped Defects of the Interdental Alveolar Bone: An Unusual Oral Manifestation of Neurofibromatosis Type 1

Gingival enlargement, although frequently encountered in clinical settings, is rarely associated with systemic diseases or syndromes. Among the diverse pathological conditions of neurofibromatosis type 1 (NF-1), minor manifestations in the orofacial region are occasionally overlooked. Herein, the authors present an unusual case of gingival neurofibroma in a patient with NF-1 associated with characteristic osseous defects in the alveolus in the long-term course of 17 years from the first examination. A 5-year-old boy with NF-1 was referred for the evaluation of gingival enlargement in the posterior left maxilla. An incisal biopsy led to the diagnosis of neurofibroma. At 22 years of age, the patient was referred again with a complaint of bleeding and pain in the same region refractory to periodontal therapy. The gingiva and tuberosity were swollen, and the second molar was affected by the tumor. Radiography revealed a low level of the interdental septum beneath the tumor with a relatively intact periodontal cortical bone, exhibiting a teardrop-shaped bone defect. The lesion was completely resected with the periosteum. Gingival neurofibroma in NF-1 may be associated with osseous and dental abnormalities and can be mistaken for periodontitis. Raising awareness of this clinical entity can lead to proper management of the esthetic and functional problems in the oral and maxillofacial region. Address correspondence and reprint requests to Tomoaki Imai, DDS, PhD, Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0862, Japan; E-mail: hsc12@hotmail.com Received 7 August, 2018 Accepted 5 September, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Modified Posterolateral Approach for Pterygium Colli

Pterygium colli is a congenital deformity associated with malformation syndromes. Various surgical procedures have been reported, but these procedures have advantages and disadvantages. The modified posterolateral approach has been reported as a new surgical procedure for pterygium colli. However, there has been no confirmatory report. In this study, a case of pterygium colli that was treated with the modified posterolateral approach was reported. An 11-year-old girl with Turner syndrome was referred with chief complaints of web neck deformity and an abnormal hairline. The modified posterolateral approach was selected. Hairy excessive skin was excised at the posterolateral and posterior neck. An inferior skin incision was made parallel to the hairline, and a superior skin incision was made along the desired hairline. Hairless excessive skin was excised along the posterior midline of the neck. Undermining was extended over the sternocleidomastoid muscle, and flaps were rotated upward and inward. Z-plasty was performed at the posterior midline of the neck to prevent hypertrophic scar formation. The web neck deformity disappeared, but the patient expressed concern for excessive skin at the posterior midline. Thus, secondary surgery was performed 12 months later. The operative scar was opened 2 months after secondary surgery owing to suture abscess, and the wound was closed directly. The web neck deformity had not recurred, and the natural hairline was maintained at 65 months after the primary surgery. The modified posterolateral approach is beneficial for pterygium colli, because it allows the correction of the web neck deformity and abnormal hairline without a noticeable scar. Address correspondence and reprint requests to Seiji Komatsu, MD, PhD, Department of Plastic and Reconstructive Surgery, Okayama Rosai Hospital, 1-10-25 Chikko Midorimachi Minami-ku, Okayama 702-8055, Japan; E-mail: komats-s@cc.okayama-u.ac.jp Received 13 August, 2018 Accepted 3 October, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reliability of Ultrasound-Guided One-Point Fixation for Zygomaticomaxillary Complex Fractures

This study aimed to analyze the precision and postoperative stability of ultrasound guided 1-point fixation on the zygomaticomaxillary buttress for the treatment of zygomaticomaxillary complex (ZMC) fractures. The authors analyzed 24 consecutive patients who underwent ultrasound-guided 1-point fixation for ZMC fractures without separation of the fracture at the frontal process of the zygomatic bone. The authors used titanium plates in the first 6 cases, and biodegradable plates in the remaining 18 cases. The authors obtained computed tomography images preoperatively, and again the first day after surgery (T1) and 6 months after the surgery (T2). The authors calculated vertical change (VC) and horizontal change (HC) of the zygoma on computed tomography. Precision was evaluated with T1 images. Stability was evaluated from T1 to T2, and titanium and biodegradable plates were compared. From T1 images, the mean VC and HC was 0.22° (range, 1.60°–1.08°) and 0.33° (range, 1.86°–1.03°), respectively. From T1 to T2, the mean VC and HC was 0.08° and 0.28°, respectively. Comparing the types of plates, the mean HC in the biodegradable plate group was 0.39°, which was significantly greater than that in the titanium plate group (mean −0.10°). However, as the degree of change was relatively small, this did not pose any clinical problems. Our findings suggest that ultrasound-guided 1-point fixation on the zygomaticomaxillary buttress provides accurate reduction on ZMC fractures without the separation of the frontal process of the zygomatic bone fracture. Sufficient stability was obtained, even with the use of biodegradable plates. Address correspondence and reprint requests to Akimitsu Sato, MD, PhD, Tohoku University, Sendai City, Miyagi, Japan; E-mail: akimitsu@med.tohoku.ac.jp Received 25 August, 2018 Accepted 3 October, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Assessment of Simultaneous Surgery for Odontogenic Sinusitis: Endoscopic Sinus Surgery With Endoscopic Apicoectomy

Odontogenic sinusitis (OS) is a disease commonly encountered by otolaryngologists and oral surgeons. There is currently no standard consensus for the management of the causative teeth of OS, and the therapeutic outcomes of endodontic surgery remain unclear. The authors herein report the outcomes of simultaneous surgery for OS, endoscopic sinus surgery (ESS) with endoscopic apicoectomy. Twenty-one OS patients who underwent ESS were included in the intent-to-treat population. Eleven patients who simultaneously underwent endoscopic apicoectomy were included as the study group, and another 10 patients who were subjected to the extraction of the causative teeth preceding or during surgery were included as the control group. The postoperative tooth course after surgery in the study group was assessed as the primary outcome by periodic radiographs. The postoperative sinus course was compared between the 2 groups as the secondary outcome. Seventeen teeth were subjected to endoscopic apicoectomy concurrently with ESS, and the treatment success rate for periapical lesions was 94.1% (16 out of 17 teeth), which was consistent with previously reported outcomes for endodontic microsurgery. Ten of 11 patients (90.9%) had good postoperative sinus courses, and the mean wound-healing period of the sinus mucosa was 6.9 ± 3.5 weeks. These results were not significantly different from those obtained for the control group (90% and 6.1 ± 3.2 weeks). This surgical procedure may contribute to the preservation of causative teeth without having an impact on the successful treatment of sinusitis. A comprehensive surgical approach by otolaryngologists and oral surgeons is desirable for the treatment of OS. Address correspondence and reprint requests to Kosuke Akiyama, MD, Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan; E-mail: kakaka@med.kagawa-u.ac.jp Received 29 August, 2018 Accepted 3 October, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Zygomatic Nonunion: A Misunderstood Complication of Reduction Malarplasty

Reduction malarplasty is a popular facial skeletal contour surgery in East Asia. Zygomatic nonunion is a reported complication. However, it is often misunderstood and misdiagnosed. Here we present typical misdiagnosed zygomatic nonunion cases, propose and preliminarily clarify 4 major misunderstandings of zygomatic nonunion: diagnostic standard, the cause, the incidence, and the prognosis of zygomatic nonunion. Address correspondence and reprint requests to Ying Chen, MD, Address: Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College. No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, China; E-mail: chenying831119@163.com Received 21 January, 2018 Accepted 12 April, 2018 X.F. and X.M. contributed equally to this work and should be considered co-first authors. The authors report no conflicts of interest . © 2018 by Mutaz B. Habal, MD.

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Surgical Treatment of Growing Skull Fracture: Technical Aspects of Cranial Bone Reconstruction

Background: Growing skull fracture (GSF) is a rare, posttraumatic complication observed mainly in young infants. In GSF, the skull fracture associated with an underlying dural tear gradually expands due to herniation of the intracranial tissue into the fracture site. Many reports have discussed GSF from various points of view. However, only a few studies have focused on the details of cranial reconstruction. The present study aims to redress this omission by shedding some light on bone work in GSF surgery. Methods: Patients registered in the institutional database who underwent surgical repair of GSF were retrospectively reviewed. Results: Four patients underwent surgical repair for GSF. The site of injury was parietal in 3 patients and occipital in 1 patient . Age at the time of injury ranged from 3 months to 1 year 5 months (mean: 7 months). The duration from injury to surgery ranged from 5 to 7 months (mean: 5 months). In all patients, dural reconstruction was performed with autologous periosteum and cranial reconstruction was performed with an autologous calvarial bone graft. Regardless of the age distribution, split bone grafting was possible for all patients. Conclusion: To diagnose GSF promptly and thereby reduce the risk of neurologic sequelae, careful observation of the course, and education of the patients' parents are desirable. Although most children with GSF are under 3 years old, the age before the formation of the diploic layer, split bone grafts should be considered for the treatment of GSF to reduce the risk of residual cranial bone defects. Address correspondence and reprint requests to Ikkei Tamada, MD, PhD, Director, Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo 183-8561, Japan; E-mail: prstamada@gmail.com Received 13 March, 2018 Accepted 17 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Bony Orbital Decompression Following Lateral Canthotomy and Cantholysis for Traumatic Orbital Compartment Syndrome

Purpose: To describe the clinical course of patients with traumatic orbital compartment syndrome who underwent bony orbital decompression due to persistently abnormal pupillary light reflex after lateral canthotomy and cantholysis. Methods: Four consecutive patients were retrospectively reviewed. The authors performed bony orbital decompression as there was no improvement in the pupillary light reflex and a tight orbit persisted even after lateral canthotomy and cantholysis. Results: The median interval between injury and bony decompression was 8.8 hours (range, 7–12 hours). All patients showed a preoperative intraocular pressure of 40 mm Hg or greater, which decreased to 20 mm Hg or less the next day. Two patients showed globe tenting with a posterior globe angle of 110° or less, which was resolved on the following day. Two patients with initial visual acuity of counting fingers or better showed complete visual recovery. By contrast, only 1 of the 2 patients with no light perception slightly improved to light perception while the other showed no improvement after surgery. Conclusions: Bony orbital decompression is effective for the treatment of traumatic orbital compartment syndrome in patients whose preoperative visual acuity is counting fingers or better. Address correspondence and reprint requests to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 19 March, 2018 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Comparison of Nasal Symmetry Between Presurgical Nasal Stenting and Postsurgical Nasal Retainer Placement in Unilateral Clefts

The timing of cleft lip nose surgery remains controversial. The less invasive the procedure at the time of primary cleft lip repair, the less the growth and development of the nose is affected. Therefore, the nasal-stenting component of presurgical nasoalveolar molding has increasingly been used. However, not all cleft centers use such treatment. Conventional postsurgical placement of silicone nasal retainers remains popular. No report has yet compared presurgical nasal stenting (preNS) and postsurgical nasal retainer placement (postNR). In this study, postoperative nasal form outcomes after primary lip repair using preNS or postNR in patients with complete unilateral cleft lips, alveoli, and palates were compared. Patients in whom preNS alone was used for 6 months (group I) were compared with those receiving postNR (no preNS) for 6 months after primary nasal cartilage dissection (group II) and controls with no appliance (group III). Nasal anthropometric distances and angular relationships were measured photographically to assess nasal symmetry at 4 years of age in all groups. Compared to group III, groups I and II exhibited significantly greater nostril heights (P = 0.0075, P = 0.0015 respectively) and columellar deviation angles (P = 0.0020, P = 0.0221). Groups I and II did not differ significantly. No significant between-treatment difference in terms of nasal symmetry between preNS and postNR was observed. However, both treatments afforded significantly better results than no treatment. Since older infants tend to resist the placement of nasal devices, preNS is more feasible in this age group. Address correspondence and reprint requests to Masayuki Osawa, MD, PhD, Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan; E-mail: osw@fb3.so-net.ne.jp Received 21 March, 2018 Accepted 19 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Overcorrected Midface Advancement to Improve Airway Problems in Severe Pfeiffer Syndrome Types II and III

Introduction: Treatment of patients with severe Pfeiffer syndrome types II and III is difficult. The purpose of this article is to present our method of overcorrecting midface advancement to improve airway problems in such patients. Materials and Methods: One boy and two girls with types II and III Pfeiffer syndrome and who underwent Le Fort III midface advancement using our previously described corrected cephalometric analysis and distraction system were included in the study. Results: The authors overcorrected by advancing the midface to make it look as similar as possible to an adult face. While the overcorrected midface advancement widened the upper airway spaces in the 3 patients, the tracheostomy that had already been placed during infancy could not be closed, probably because of an underlying tracheal abnormality or tracheomalacia. Discussion: Overcorrected midface advancement cannot enable tracheostomy closure, probably because of severe tracheal anomalies, such as tracheomalacia, below the tracheostomy. However, with the possibility of gradual improvement of the tracheomalacia with age, closure of the tracheostomy can eventually be expected. Therefore, efforts to close a tracheostomy should be pursued even if the probability of its removal is low. Conclusion: Overcorrected midface advancement did not enable tracheostomy closure, probably because of severe tracheal anomalies such as tracheomalacia. However, the severe exophthalmos and angle III malocclusion were improved, and with the possibility of gradual improvement of the tracheomalacia with age, closure of the tracheostomy can eventually be expected. Therefore, efforts to close a tracheostomy should be pursued even if the probability of its removal is low. Address correspondence and reprint requests to Shinji Kobayashi, MD, Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama, Kanagawa, Japan Zip: 232-8555; E-mail: skobayashi@kcmc.jp Received 26 March, 2018 Accepted 9 July, 2018 This work was supported by grant from the Health and Labor Sciences Research Grants Research on intractable disease (No 2011-164) in Japan. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Mandibular Regeneration With Autologous Human Bone Marrow Derived Mesenchymal Stem Cells to Treat Unicystic Ameloblastoma: a Clinical Report

Ameloblastoma is a rare, benign tumor found in the jaw. These tumors have a tendency for locally aggressive expansion, and thus require surgical removal. For the previous 3 decades, autologous bone grafting and free flap surgeries have been most commonly used to correct bone defects after surgical removal of the lesion. In this report, the authors describe a case of unicystic ameloblastoma in a 14-year-old girl who was successfully treated with mandibular regeneration, attained by autologous human bone marrow mesenchymal stem cells without any autologous bone graft and free flap transfer. This case shows that autologous human bone marrow mesenchymal stem cells can be used as an alternative method to autologous bone graft and free flap transfer in a large bone defect of the jaw. Address correspondence and reprint requests to Hun Jun Lim, DDS, PhD, Assistant Professor, Department of Oral and Maxillofacial Surgery, Daejeon, Dental Hospital, College of Dentistry, Wonkwang University, 77 Dunsan-ro, Seo-gu, Daejeon 35233, Republic of Korea; E-mail: hun216@gmail.com Received 3 April, 2018 Accepted 10 July, 2018 This work was supported by Wonkwang University in 2017. This study was approved by the local ethics committee of the Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon, Korea, after obtaining written consent from the patient (IRB No. W1720/001-001). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Modification of the Lazy-T Procedure for Correction of Punctal Ectropion

The Lazy-T procedure is used to correct moderate-to-severe punctal ectropion in the lower eyelid. It includes full-thickness wedge resection of the medial lower eyelid and horizontal tarso-conjunctival diamond excision inferior to the lower punctum. However, the skin wound vertical to the relaxed skin tension lines is often conspicuous and horizontal excision of a part of the tarsus may impair function of the meibomian gland. In this study, the authors developed a modified Lazy-T procedure, which includes subciliary incision, pentagonal tarso-conjunctival resection, and medial spindle excision for submerging the vertical wound after suturing the pentagonal tarso-conjunctival resection under the skin flap and minimizing damage to the tarsus. The modified Lazy-T procedure was applied in 4 eyelids of 3 patients and achieved good anatomical results with cosmetically acceptable postoperative appearances and no remarkable complication. Address correspondence and reprint requests to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 17 April, 2018 Accepted 12 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Assessing the Compliance of Randomized Controlled Trials Published in Craniofacial Surgery Journals With the CONSORT Statement

Background: Randomized controlled trials (RCTs) are gold standard assessments for healthcare interventions. The Consolidated Standards of Reporting Trials (CONSORT) statement was published to maximize RCT reporting transparency. The authors conducted a systematic review to assess current compliance of RCTs published within craniofacial surgery with the CONSORT statement. Methods: The Thomson Reuters Impact Factor Report 2016 was consulted to identify craniofacial surgery journals. PubMed was used to search for recent RCTs published within the 5 journals identified. Two independent researchers assessed each study for inclusion and performed data extraction. The primary outcome was compliance of each RCT with the CONSORT statement. Secondary outcomes were the pathology and interventions examined, impact factor, multi-versus-single center, number of authors, and publication date. Results: Eighty-six studies met the inclusion criteria, across which a median of 56% (range 33%–94%) applicable CONSORT items were reported. The 5 least reported items were: trial design (3a); registration number and name of trial registry (23); who generated random allocation sequences, enrolled participants, and assigned participants to interventions (10); sample size determination (7a); mentioning "randomized trial" in the title (1a). Conclusion: The compliance of craniofacial surgery RCTs with the CONSORT statement requires improvement. Areas in need are identified, and methods to improve reporting transparency, are discussed. Address correspondence and reprint requests to Mimi R. Borrelli, MBBS, MSc, Division of Plastic Surgery, Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305; E-mail: mimi.r.borrelli@gmail.com Received 29 April, 2018 Accepted 2 July, 2018 Accepted for presentation at ASGBI 2018, Liverpool. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Effects of Ultraviolet Irradiation on Cellular Senescence in Keratinocytes Versus Fibroblasts

Aging is a biologic process characterized by time-dependent functional declines that are influenced by oxidative stress-induced inflammatory reactions. In particular, ultraviolet (UV) irradiation plays a key role in cellular senescence in photo-aged skin. However, the cellular senescence of epidermal keratinocytes and dermal fibroblasts by UV irradiation may differ depending on the exposure time and dosage of UV irradiation. Therefore, the purpose of the study was to evaluate and compare the effects of UV irradiation on cellular senescence in human epidermal keratinocytes (HaCaT) and human dermal fibroblasts (HDFs). After cell viability test, 200 mJ/cm2 UV irradiation was used in this study. To evaluate the reactive oxygen species and reactive nitrogen species production, the levels of glutathione (GSH) and nitrite (NO2) were measured. We also performed reverse transcription-polymerase chain reaction, Western blot analysis, and senescence-associated beta-galactosidase assay. An overall decrease in GSH and an increase in NO2 were observed in the HaCaT and HDF cells. However, the time-line and dose-dependent effects varied. Higher expressions of tumor necrosis factor-α, inducible nitric oxide synthase, and interleukin-1β than that of the control group were observed in both cells. The HDF cells showed high levels of matrix metallopeptidase 9 and neutral endopeptidase protein but low levels of SIRT1 and procollagen I. The expression of nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) was increased in the HaCaT cells, but not in the HDF cells. The NF-κB peaked at 1 hour after UV irradiation in the HaCaT cells. The "turning-on" signal was faster in the irradiated HaCaT cells. Address correspondence and reprint requests to Eun-Sang Dhong, MD, PhD, Department of Plastic Surgery, Korea University Guro Hospital, 148 Guro-Dong, Guro-Ku, Seoul 152-703, South Korea; E-mail: prsdhong@kumc.or.kr Received 3 May, 2018 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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