Head and Neck Medicine by Alexandros G.Sfakianakis: 11/19/18

Δευτέρα 19 Νοεμβρίου 2018

Arsenic enhances cell death and DNA damage induced by ultraviolet B exposure in mouse epidermal cells through the production of reactive oxygen species

Summary

Background

Ultraviolet (UV)B radiation has long been considered a carcinogen in both epidemiological surveys and experimental studies. However, recent work has suggested that different dosages of UVB exert different influences on cells. There are also co‐carcinogenesis factors such as arsenic that affect the role of UVB.

Aim

To explore the co‐carcinogenesis effect of UVB and arsenic on the mouse epidermal cell line JB6 and the mechanism underlying it.

Methods

Growth of JB6 cells was measured by MTT assay. We carried out a comet assay to determine the DNA damage caused by UVB and arsenic, and tested the expression of DNA repair protein by western blotting. Reactive oxygen species (ROS) were measured using DCF and DHE staining, and changes in antioxidant enzymes were assessed using western blotting.

Results

Viability assays showed that arsenic increased the UVB‐induced death rate. Arsenic enhanced DNA damage caused by UVB both directly by injury to double‐stranded DNA and indirectly by reducing the capability of DNA repair in JB6 cells. All of these effects are the results of increased ROS generation and reduced expression of the antioxidant enzyme superoxide dismutase (SOD)1.

Conclusion

Arsenic was found to enhance UVB‐induced production of ROS and to downregulate SOD1 expression, leading to DNA damage and apoptosis in mouse skin cells. The combination of arsenic and UVB exposure was found to differentially regulate the expression of SOD1 and SOD2.

https://ift.tt/2PIxrdn

Training Groups

https://ift.tt/2TmJmLQ

Editorial Board

https://ift.tt/2A3RQyP

The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program

The SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, th...

https://ift.tt/2PBqwm1

Characterization of tenascin-C as a novel biomarker for asthma: utility of tenascin-C in combination with periostin or immunoglobulin E

Extracellular matrix proteins tenascin-C (TNC) and periostin, which were identified as T-helper cell type 2 cytokine-induced genes in human bronchial epithelial cells, accumulate in the airway basement membran...

https://ift.tt/2QSjmGB

Fetal cord blood and tissue immune responses to chronic placental inflammation and chorioamnionitis

Chorioamnionitis is a risk factor for future asthma development. Animal models of chorioamnionitis demonstrate increased TH17-to-Treg ratios associated with proinflammatory cytokine elevations. The association of...

https://ift.tt/2PG00I8

Racial differences in Atopic Dermatitis

Atopic dermatitis (AD), the most common chronic inflammatory skin disease,1 usually starts in early infancy, and can develop into a life-long therapeutic challenge, especially in its moderate-to-severe form.2 The etiology of this complex disease remains only partly understood, but it is most likely based on a complex interplay of genetic predisposition, skin barrier dysfunction, and environmental factors.3 AD is now understood to be an immune mediated disease with contributions of multiple inflammatory pathways, and particularly Type 2-associated inflammation.

https://ift.tt/2qTa1D0

"Drug Allergy in children and adults: is it the double X chromosome?"

It is well established that autoimmune diseases, atopic conditions and asthma affect adult females more frequently than adult males. This discrepancy typically develops after childhood and affects females differently depending on their life cycle. As children, males have higher total and allergen specific IgE levels than females and are more likely to suffer from atopic disease and asthma than girls. However, as adults, this prevalence reverses and females are more likely to develop atopic conditions such as food allergies, atopic dermatitis, urticaria, angioedema and asthma.

https://ift.tt/2Fwh3I8

Implementation of the NIAID Peanut Allergy Guidelines: Outcomes and Experience

The publication of the Learning Early About Peanut Allergy (LEAP) study in 2015 represented a paradigm shift in the field of food allergy with the finding of an 81% reduction in the incidence of peanut allergy when early introduction of peanut was compared to strict avoidance in high risk infants.1 In 2017, the National Institute of Allergy and Infectious Disease (NIAID) provided official recommendations for early peanut introduction with the publication of the Addendum Guidelines to the 2010 Guidelines for Diagnosis and Management of Food Allergy in the United States.

https://ift.tt/2qT9CjY

AllergyWatch - Feb-19

From Allergy Watch Vol 20, July-Aug 2018

https://ift.tt/2FwgZrS

The Glycerin Associated Pain (GAP) Study

Fifty percent glycerin is often used in allergen immunotherapy (AIT) extracts to preserve extract potency.1 However, glycerin is also an irritant and it is recommended to dilute glycerin to reduce pain and inflammation associated with immunotherapy.2, 3 The 2011 allergen immunotherapy practice parameter warns that "higher glycerin concentrations are associated with injection pain, which correlates with the total amount of glycerin injected."4 To date, two studies evaluating the role of glycerin during allergen immunotherapy differed regarding their methods and conclusions.

https://ift.tt/2qT9X6e

Immediate-hypersensitivity reactions to proton pump inhibitors – experience in a medical department

Proton pump inhibitors (PPIs) are prescribed worldwide for the treatment of acid-peptic diseases1,2,3. They antagonize the enzyme H+/K+ ATPase in gastric cells, inhibiting acid secretion and raising gastric pH3,4. Side effects related to PPIs are reported in only 1-3% of treated patients1,5. Omeprazole, esomeprazole and pantoprazole have a similar chemical structure, differing from rabeprazole and lansoprazole1,5.

https://ift.tt/2FvtiEB

Asthma in the Melting Pot

America is becoming more diverse, with minority groups increasing at higher rates than whites. The health implications are vast, impacting all medical conditions. However, as asthma remains a persistent public health problem where the disease burden is higher in minorities and low income populations – the need to find solutions is crucial 1. These disparities or differences have been documented and defined to a significant degree in the literature, but what is lacking are solutions to tackle these differences.

https://ift.tt/2qTTrmv

Inpatient Beta-lactam test-dose Protocol promotes Antimicrobial Stewardship in Patients with History of Penicillin Allergy

Penicillin allergy is the most commonly reported drug allergy in hospitalized patients, resulting in increased second-line antibiotic use, nosocomial infections, and healthcare utilization. Given that the vast majority of patients are not truly allergic, a safe strategy that empowers the admitting physician is needed.

https://ift.tt/2FwdmCe

A CASE OF NON-IMMUNOLOGIC ANAPHYLAXIS TO N-ACETYLCYSTEINE IN A PATIENT WHO OVERDOSED ON ACETAMINOPHEN

Management of acetaminophen toxicity typically involves administering N-acetylcysteine (NAC) in order to prevent hepatic injury. While NAC is considered the gold standard of therapy, it is also associated with risk of non-immunologic anaphylaxis. This case illustrates a less commonly recognized reaction to NAC and provides an opportunity to review management of acetaminophen toxicity in patients who demonstrate such a reaction.

https://ift.tt/2qT9Mb4

Oral & Maxillofacial surgery is ready for patient-centred eHealth interventions − the outcomes of a scoping review

Within the field of oral and maxillofacial (OMF) surgery, eHealth is expected to be a tool to improve quality of care. The aim of this study is to map the research of patient-centred eHealth interventions within OMF surgery by means of a scoping review.After a systematic literature search, relevant studies on patient-centred eHealth interventions for OMF-surgery patients were selected. The interventions were mapped based on their key components, target population and outcome measures. To gain insight in the research phase of evaluation, the framework of the Medical Research Council (MRC) was used.

https://ift.tt/2FwcTQu

Disposable otoscope specula cryotherapy for lesions in convoluted or sensitive locations

https://ift.tt/2KhArr9

Deep cheek fat flap: new technique to augment the soft tissues of the mandibular alveolus

Deep cheek fat is found in distinct compartments, which are separated by septae1 and, together with other compartments of facial fat, are currently "hot" topics in the rejuvenation of the face. They serve as a map for facial ageing, and are considered to be the best positioning system for injecting fillers.2 Apart from the buccal fat pad, however, this extraoral fat has not, to the best of my knowledge, been used in implant dentistry.

https://ift.tt/2Fx8zQY

TAOK3 Regulates Canonical TCR Signaling by Preventing Early SHP-1-Mediated Inactivation of LCK [MOLECULAR AND STRUCTURAL IMMUNOLOGY]

Activation of LCK is required for canonical TCR signaling leading to T cell responses. LCK activation also initiates a negative feedback loop mediated by the phosphatase SHP-1 that turns off TCR signaling. In this article, we report that the thousand-and-one amino acid kinase 3 (TAOK3) is a key regulator of this feedback. TAOK3 is a serine/threonine kinase expressed in many different cell types including T cells. TAOK3-deficient human T cells had impaired LCK-dependent TCR signaling resulting in a defect in IL-2 response to canonical TCR signaling but not to bacterial superantigens, which use an LCK-independent pathway. This impairment was associated with enhanced interaction of LCK with SHP-1 after TCR engagement and rapid termination of TCR signals, a defect corrected by TAOK3 reconstitution. Thus, TAOK3 is a positive regulator of TCR signaling by preventing premature SHP-1–mediated inactivation of LCK. This mechanism may also regulate signaling by other Src family kinase-dependent receptors.

https://ift.tt/2qWP7my

Aeroallergens Exacerbate Histoplasma capsulatum Infection [INFECTIOUS DISEASE AND HOST RESPONSE]

Allergens such as house dust mites (HDM) and papain induce strong Th2 responses, including elevated IL-4, IL-5, and IL-13 and marked eosinophilia in the airways. Histoplasma capsulatum is a dimorphic fungal pathogen that induces a strong Th1 response marked by IFN- and TNF-α production, leading to rapid clearance in nonimmunocompromised hosts. Th1 responses are generally dominant and overwhelm the Th2 response when stimuli for both are present, although there are instances when Th2 stimuli downregulate a Th1 response. We determined if the Th2 response to allergens prevents the host from mounting a Th1 response to H. capsulatum in vivo. C57BL/6 mice exposed to HDM or papain and infected with H. capsulatum exhibited a dominant Th2 response early, characterized by enhanced eosinophilia and elevated Th2 cytokines in lungs. These mice manifested exacerbated fungal burdens, suggesting that animals skewed toward a Th2 response by an allergen are less able to clear the H. capsulatum infection despite an intact Th1 response. In contrast, secondary infection is not exacerbated by allergen exposure, indicating that the memory response may suppress the Th2 response to HDM and quickly clear the infection. In conclusion, an in vivo skewing toward Th2 by allergens exacerbates fungal infection, even though there is a concurrent and unimpaired Th1 response to H. capsulatum.

https://ift.tt/2Fu0rRa

Circulating Plasma Extracellular Vesicles from Septic Mice Induce Inflammation via MicroRNA- and TLR7-Dependent Mechanisms [INNATE IMMUNITY AND INFLAMMATION]

We have previously reported that a group of host cellular microRNAs (miRNAs; miR-34a-5p, miR-122-5p, miR-145-5p, miR-146a-5p, miR-210-3p) are released into the blood during sepsis, some of which are capable of inducing complement activation, cytokine production, and leukocyte migration. Extracellular vesicles (EVs) have been proposed as vehicles for extracellular miRNA-mediated intercellular communication. However, the biological function of plasma EVs and the associated miRNAs in sepsis are largely unknown. In this study, we tested the hypothesis that plasma EVs in sepsis are proinflammatory and EV-associated miRNAs are responsible for EV-induced cytokine production. Compared with those of sham mice, the plasma EVs from septic mice were slightly smaller (157 ± 2 versus 191 ± 6 nm, p < 0.0001), but more abundant [(1.6 ± 0.14) x 10¹⁰ versus (0.93 ± 0.14) x 10¹⁰/ml plasma, p < 0.003]. miRNA array revealed that among 65 miRNAs, 8 miRNAs exhibited >1.5-fold increase in septic EVs compared with sham EVs, including miR-126-3p, miR-122-5p, miR-146a-5p, miR-145-5p, miR-26a-5p, miR-150-5p, miR-222-3p, and miR-181a-5p. Septic but not sham EVs were proinflammatory, promoting IL-6, TNF-α, IL-1β, and MIP-2 production. The effects of EVs were resistant to polymyxin B (an endotoxin inhibitor) but significantly inhibited by anti-miR inhibitors against miR-34a, miR-122, and miR-146a. Moreover, the septic EV-induced cytokine production was attenuated in TLR7^–/– or MyD88^–/– cells but remained the same in TLR3^–/– or Trif^–/– cells. In vivo, mice i.p. injected with septic EVs had marked peritoneal neutrophil migration, which was significantly attenuated in MyD88^–/– mice. Taken together, these data demonstrate that plasma EVs of septic animals play an important role in inflammation, and EV-associated miRNAs likely mediate the cytokine production via TLR7-MyD88 signaling.

https://ift.tt/2qTGitN

Correction: Nasopharyngeal Exposure to Streptococcus pneumoniae Induces Extended Age-Dependent Protection against Pulmonary Infection Mediated by Antibodies and CD138+ Cells [CORRECTIONS]

https://ift.tt/2qTGeKz

Unique Composition of Intronless and Intron-Containing Type I IFNs in the Tibetan Frog Nanorana parkeri Provides New Evidence To Support Independent Retroposition Hypothesis for Type I IFN Genes in Amphibians [IMMUNOGENETICS]

In vertebrates, intron-containing and intronless type I IFN genes have recently been reported in amphibian model species Xenopus tropicalis and X. laevis. However, whether intronless type I IFNs in amphibians are the ancestral genes of type I IFNs in amniotes or just represent the independent divergence in amphibians is unknown or even uninvestigated. In this study, both intron-containing and intronless type I IFN genes, as well as their receptor genes, were identified in the Tibetan frog Nanorana parkeri. The evidence obtained from homology, synteny, phylogeny, and divergence time showed that intronless type I IFN genes in N. parkeri and in Xenopus might have arisen from two independent retroposition events occurred in these two lineages, and the retrotransposition causing the generation of intronless type I IFN genes in amniotes is another independent event beyond the two in amphibians. It can then be proposed that intronless type I IFNs in N. parkeri and Xenopus may not be the ancestral genes of intronless type I IFNs in amniotes but may just represent two independent bifurcations in the amphibian lineage. Furthermore, both intronless and intron-containing type I IFNs in N. parkeri showed strong ability in inducing the expression of IFN-stimulated genes and the strong antiviral activity against frog virus 3. The present study thus provides the evolutionary evidence to support the independent retroposition hypothesis for the occurrence of intronless type I IFN genes in amphibians and contributes to a functional understanding of type I IFNs in this group of vertebrates.

https://ift.tt/2qTGkSr

ABIN2 Function Is Required To Suppress DSS-Induced Colitis by a Tpl2-Independent Mechanism [INNATE IMMUNITY AND INFLAMMATION]

The A20-binding inhibitor of NF-B 2 (ABIN2) interacts with Met1-linked ubiquitin chains and is an integral component of the tumor progression locus 2 (Tpl2) kinase complex. We generated a knock-in mouse expressing the ubiquitin-binding–defective mutant ABIN2[D310N]. The expression of Tpl2 and its activation by TLR agonists in macrophages or by IL-1β in fibroblasts from these mice was unimpaired, indicating that the interaction of ABIN2 with ubiquitin oligomers is not required for the stability or activation of Tpl2. The ABIN2[D310N] mice displayed intestinal inflammation and hypersensitivity to dextran sodium sulfate–induced colitis, an effect that was mediated by radiation-resistant cells rather than by hematopioetic cells. The IL-1β–dependent induction of cyclooxygenase 2 (COX2) and the secretion of PGE₂ was reduced in mouse embryonic fibroblasts and intestinal myofibroblasts (IMFs) from ABIN2[D310N] mice. These observations are similar to those reported for the Tpl2 knockout (KO) mice (Roulis et al. 2014. Proc. Natl. Acad. Sci. USA 111: E4658–E4667), but the IL-1β–dependent production of COX2 and PGE₂ in mouse embryonic fibroblasts or IMFs was unaffected by pharmacological inhibition of Tpl2 in wild-type mice. The expression of ABIN2 is decreased drastically in Tpl2 KO mice. These and other lines of evidence suggest that the hypersensitivity of Tpl2 KO mice to dextran sodium sulfate–induced colitis is not caused by the loss of Tpl2 catalytic activity but by the loss of ABIN2, which impairs COX2 and PGE₂ production in IMFs by a Tpl2 kinase–independent pathway.

https://ift.tt/2Fzc7lF

Consequences of Hypoxia for the Pulmonary Alveolar Epithelial Cell Innate Immune Response [INNATE IMMUNITY AND INFLAMMATION]

Pulmonary innate immune responses involve a highly regulated multicellular network to defend the enormous surface area of the lung. Disruption of these responses renders the host susceptible to pneumonia. Alveolar epithelial cells (AEC) are a critical source of innate immune molecules such as GM-CSF, which determine the functional maturation of alveolar macrophages. In many pulmonary diseases, heterogeneous ventilation leads to regional hypoxia in the lung. The effect of hypoxia on AEC innate immune function is unknown. We now report that exposure of primary murine AEC to hypoxia (1% oxygen) for 24 h results in significant suppression of key innate immune molecules, including GM-CSF, CCL2, and IL-6. This exposure did not cause toxicity but did induce stabilization of hypoxia-inducible factor 1α protein (HIF-1α) and shift to glycolytic metabolism. Focusing on GM-CSF, we found that hypoxia greatly decreased the rate of GM-CSF transcription. Hypoxia both decreased NF-B signaling in AEC and induced chromosomal changes, resulting in decreased accessibility in the GM-CSF proximal promoter of target sequences for NF-B binding. In mice exposed to hypoxia in vivo (12% oxygen for 2 d), lung GM-CSF protein expression was reduced. In vivo phagocytosis of fluorescent beads by alveolar macrophages was also suppressed, but this effect was reversed by treatment with GM-CSF. These studies suggest that in critically ill patients, local hypoxia may contribute to the susceptibility of poorly ventilated lung units to infection through complementary effects on several pathways, reducing AEC expression of GM-CSF and other key innate immune molecules.

https://ift.tt/2FvogrH

Type 2 Innate Lymphoid Cells Impede IL-33-Mediated Tumor Suppression [TUMOR IMMUNOLOGY]

Although a number of studies have recently explored the contribution of the adaptive immunity in IL-33–mediated antitumor effects, innate immune involvement has been poorly characterized. Utilizing Rag1^–/– mice (lacking T and B lymphocytes), we show in this study that either systemic administration of recombinant IL-33 or ectopic expression of IL-33 in melanoma cells is sufficient to inhibit tumor growth independent of adaptive antitumor immunity. We have demonstrated that IL-33–mediated antitumor effects depend on expansion and activation of NK cells. Interestingly, IL-33 also promoted the expansion of active type 2 innate lymphoid cells (ILC2s) via its receptor, ST2, which in turn inhibited NK activation and cytotoxicity. This IL-33–induced ILC2 activity coincided with greater expression of the immunosuppressive ectoenzyme CD73. Removal of CD73 from ILC2s in culture with NK cells resulted in markedly increased activation levels in NK cells, offering a potential mechanism by which ILC2s might suppress NK cell–mediated tumor killing. Thus, our data reveal an important contribution of IL-33–induced ILC2 to tumor growth by weakening NK cell activation and tumor killing, regardless of adaptive immunity.

https://ift.tt/2qTGg59

Kimishige Ishizaka, M.D., Ph.D. (AAI 58), December 3, 1925 to July 6, 2018 [IN MEMORIAM]

https://ift.tt/2qWmwOg

Speech Perception with Spectrally Non-overlapping Maskers as Measure of Spectral Resolution in Cochlear Implant Users

Abstract

Poor spectral resolution contributes to the difficulties experienced by cochlear implant (CI) users when listening to speech in noise. However, correlations between measures of spectral resolution and speech perception in noise have not always been found to be robust. It may be that the relationship between spectral resolution and speech perception in noise becomes clearer in conditions where the speech and noise are not spectrally matched, so that improved spectral resolution can assist in separating the speech from the masker. To test this prediction, speech intelligibility was measured with noise or tone maskers that were presented either in the same spectral channels as the speech or in interleaved spectral channels. Spectral resolution was estimated via a spectral ripple discrimination task. Results from vocoder simulations in normal-hearing listeners showed increasing differences in speech intelligibility between spectrally overlapped and interleaved maskers as well as improved spectral ripple discrimination with increasing spectral resolution. However, no clear differences were observed in CI users between performance with spectrally interleaved and overlapped maskers, or between tone and noise maskers. The results suggest that spectral resolution in current CIs is too poor to take advantage of the spectral separation produced by spectrally interleaved speech and maskers. Overall, the spectrally interleaved and tonal maskers produce a much larger difference in performance between normal-hearing listeners and CI users than do traditional speech-in-noise measures, and thus provide a more sensitive test of speech perception abilities for current and future implantable devices.

https://ift.tt/2Tpb2zH

Time-Compressed Speech Identification Is Predicted by Auditory Neural Processing, Perceptuomotor Speed, and Executive Functioning in Younger and Older Listeners

Abstract

Older adults typically have difficulty identifying speech that is temporally distorted, such as reverberant, accented, time-compressed, or interrupted speech. These difficulties occur even when hearing thresholds fall within a normal range. Auditory neural processing speed, which we have previously found to predict auditory temporal processing (auditory gap detection), may interfere with the ability to recognize phonetic features as they rapidly unfold over time in spoken speech. Further, declines in perceptuomotor processing speed and executive functioning may interfere with the ability to track, access, and process information. The current investigation examined the extent to which age-related differences in time-compressed speech identification were predicted by auditory neural processing speed, perceptuomotor processing speed, and executive functioning. Groups of normal-hearing (up to 3000 Hz) younger and older adults identified 40, 50, and 60 % time-compressed sentences. Auditory neural processing speed was defined as the P1 and N1 latencies of click-induced auditory-evoked potentials. Perceptuomotor processing speed and executive functioning were measured behaviorally using the Connections Test. Compared to younger adults, older adults exhibited poorer time-compressed speech identification and slower perceptuomotor processing. Executive functioning, P1 latency, and N1 latency did not differ between age groups. Time-compressed speech identification was independently predicted by P1 latency, perceptuomotor processing speed, and executive functioning in younger and older listeners. Results of model testing suggested that declines in perceptuomotor processing speed mediated age-group differences in time-compressed speech identification. The current investigation joins a growing body of literature suggesting that the processing of temporally distorted speech is impacted by lower-level auditory neural processing and higher-level perceptuomotor and executive processes.

https://ift.tt/2A6uLeH

Clinical features of poorly differentiated thyroid papillary carcinoma

To investigate the clinical feature of the poorly differentiated thyroid papillary carcinoma.

https://ift.tt/2qUxiEH

T Regulatory Cell Subpopulations Associated with Recent Ultraviolet Radiation Exposure in a Skin Cancer Screening Cohort [CLINICAL AND HUMAN IMMUNOLOGY]

UV radiation (UVR) causing DNA damage is a well-documented risk factor for nonmelanoma skin cancer. Although poorly understood, UVR may also indirectly contribute to carcinogenesis by promoting immune evasion. To our knowledge, we report the first epidemiological study designed to investigate the association between quantitative measures of UVR, obtained using a spectrophotometer, and circulating T regulatory (Treg) cells. In addition to total Treg cells, the proportion of functionally distinct Treg cell subsets defined by CD45RA and CD27 phenotypic markers, graded expression of FOXP3 and CD25, and those expressing cutaneous lymphocyte–associated Ag and the chemokine receptor CCR4 were enumerated in 350 individuals undergoing routine skin cancer screening exams and determined not to have prevalent skin cancer. No associations were identified for UVR exposure or the overall proportion of circulating Treg cells; however, Treg cell subpopulations with an activation-associated phenotype, CD45RA^–/CD27^–, and those expressing cutaneous homing receptors were significantly positively associated with UVR. These subpopulations of Treg cells also differed by age, sex, and race. After stratification by natural skin tone, and adjusting for age and sex, we found that spectrophotometer-based measures of UVR exposure, but not self-reported measures of past sun exposure, were positively correlated with the highest levels of these Treg cell subpopulations, particularly among lighter-skinned individuals. Findings from this large epidemiologic study highlight the diversity of human Treg cell subpopulations associated with UVR, thus raising questions about the specific coordinated expression of CD45RA, CD27, CCR4, and cutaneous lymphocyte–associated Ag on Treg cells and the possibility that UVR contributes to nonmelanoma skin cancer carcinogenesis through Treg cell–mediated immune evasion.

https://ift.tt/2FtMAKw

In This Issue [IN THIS ISSUE]

https://ift.tt/2Kh0WNo

Distinct Roles for CD4+ Foxp3+ Regulatory T Cells and IL-10-Mediated Immunoregulatory Mechanisms during Experimental Visceral Leishmaniasis Caused by Leishmania donovani [INFECTIOUS DISEASE AND HOST RESPONSE]

The outcome of intracellular parasitic infection can be determined by the immunoregulatory activities of natural regulatory CD4⁺ Foxp3⁺ T (Treg) cells and the anti-inflammatory cytokine IL-10. These mechanisms protect tissue but can also suppress antiparasitic CD4⁺ T cell responses. The specific contribution of these regulatory pathways during human parasitic diseases remains unclear. In this study, we investigated the roles of Treg cells and IL-10 during experimental visceral leishmaniasis caused by Leishmania donovani infection of C57BL/6 mice. We report only a limited contribution of Treg cells in suppressing antiparasitic immunity, but important roles in delaying the development of splenic pathology and restricting leukocyte expansion. We next employed a range of cell-specific, IL-10– and IL-10R–deficient mice and found these Treg cell functions were independent of IL-10. Instead, conventional CD4⁺ T cells and dendritic cells were the most important cellular sources of IL-10, and the absence of IL-10 in either cell population resulted in greater control of parasite growth but also caused accelerated breakdown in splenic microarchitecture. We also found that T cells, dendritic cells, and other myeloid cells were the main IL-10–responding cells because in the absence of IL-10R expression by these cell populations, there was greater expansion of parasite-specific CD4⁺ T cell responses associated with improved control of parasite growth. Again, however, there was also an accelerated breakdown in splenic microarchitecture in these animals. Together, these findings identify distinct, cell-specific, immunoregulatory networks established during experimental visceral leishmaniasis that could be manipulated for clinical advantage.

https://ift.tt/2qX2UcR

Opening the Black Box of Immunosuppression [PILLARS OF IMMUNOLOGY]

https://ift.tt/2BhLGNj

Thymic Epithelial Cell Support of Thymopoiesis Does Not Require Klotho [IMMUNE SYSTEM DEVELOPMENT]

Age-related thymic involution is characterized by a decrease in thymic epithelial cell (TEC) number and function parallel to a disruption in their spatial organization, resulting in defective thymocyte development and proliferation as well as peripheral T cell dysfunction. Deficiency of Klotho, an antiaging gene and modifier of fibroblast growth factor signaling, causes premature aging. To investigate the role of Klotho in accelerated age-dependent thymic involution, we conducted a comprehensive analysis of thymopoiesis and peripheral T cell homeostasis using Klotho-deficient (Kl/Kl) mice. At 8 wk of age, Kl/Kl mice displayed a severe reduction in the number of thymocytes (10–100-fold reduction), especially CD4 and CD8 double-positive cells, and a reduction of both cortical and medullary TECs. To address a cell-autonomous role for Klotho in TEC biology, we implanted neonatal thymi from Klotho-deficient and -sufficient mice into athymic hosts. Kl/Kl thymus grafts supported thymopoiesis equivalently to Klotho-sufficient thymus transplants, indicating that Klotho is not intrinsically essential for TEC support of thymopoiesis. Moreover, lethally irradiated hosts given Kl/Kl or wild-type bone marrow had normal thymocyte development and comparably reconstituted T cells, indicating that Klotho is not inherently essential for peripheral T cell reconstitution. Because Kl/Kl mice have higher levels of serum phosphorus, calcium, and vitamin D, we evaluated thymus function in Kl/Kl mice fed with a vitamin D–deprived diet. We observed that a vitamin D–deprived diet abrogated thymic involution and T cell lymphopenia in 8-wk-old Kl/Kl mice. Taken together, our data suggest that Klotho deficiency causes thymic involution via systemic effects that include high active vitamin D levels.

https://ift.tt/2KhywTg

Pillars Article: Cyclosporin A Specifically Inhibits Function of Nuclear Proteins Involved in T Cell Activation. Science. 1989. 246: 1617-1620 [PILLARS OF IMMUNOLOGY]

https://ift.tt/2Bi2h3j

Innate Lymphoid Cells Have Decreased HLA-DR Expression but Retain Their Responsiveness to TLR Ligands during Sepsis [INNATE IMMUNITY AND INFLAMMATION]

Sepsis, one of the leading causes of death in intensive care units, is caused by a dysregulated host response to infection that leads to life-threatening organ dysfunction. The proinflammatory and anti-inflammatory responses activated by the infecting microorganism become systemic, and the sustained anti-inflammatory response induces a state of immunosuppression that is characterized by decreased expression of HLA-DR on monocytes, T cell apoptosis, and reduced production of TNF-α by monocytes and macrophages in response to TLR ligands. Innate lymphoid cells (ILCs) are lymphocytes that lack Ag-specific receptors and lineage-specific markers; they express HLA-DR and are activated by cytokines and by direct recognition of microbial molecules. In this study, we evaluated if ILCs are affected by the anti-inflammatory response during sepsis. We found that the number of peripheral blood ILCs was decreased in septic patients compared with healthy volunteers; this decrease was caused by a reduction in ILC1 and ILC3 and is associated with apoptosis, because ILCs from septic patients expressed active caspase 3. ILCs from septic patients had decreased HLA-DR expression but increased expression of the activating receptors NKp46 and NKp44; they also showed a sustained expression of CD127 (IL-7R α-chain) and retained their capacity to produce TNF-α in response to TLR ligands. These results indicate that during sepsis, ILCs have decreased HLA-DR expression and die via apoptosis, similar to monocytes and T cells, respectively. However, other effector functions of ILCs (activation through NKp46 and NKp44, TNF-α production) may remain unaffected by the immunosuppressive environment prevailing in septic patients.

https://ift.tt/2Kilrcq

Calcium-Sensing Receptor Autoantibodies in Patients with Autoimmune Polyendocrine Syndrome Type 1: Epitopes, Specificity, Functional Affinity, IgG Subclass, and Effects on Receptor Activity [AUTOIMMUNITY]

A major manifestation of autoimmune polyendocrine syndrome type 1 (APS1) is hypoparathyroidism, which is suggested to result from aberrant immune responses against the parathyroid glands. The calcium-sensing receptor (CaSR), which plays a pivotal role in maintaining calcium homeostasis by sensing blood calcium levels and regulating release of parathyroid hormone (PTH), is an autoantibody target in APS1. In this study, the aim was to characterize the binding sites, specificity, functional affinity, IgG subclass, and functional effects of CaSR autoantibodies using phage-display technology, ELISA, and bioassays. The results indicated that CaSR autoantibody binding sites were at aa 41–69, 114–126, 171–195, and 260–340 in the extracellular domain of the receptor. Autoantibodies against CaSR epitopes 41–69, 171–195, and 260–340 were exclusively of the IgG1 subclass. Autoantibody responses against CaSR epitope 114–126 were predominantly of the IgG1 with a minority of the IgG3 subclass. Only autoantibodies recognizing CaSR epitopes 114–126 and 171–195 affected receptor activity; inositol-phosphate accumulation was increased significantly in HEK293-CaSR cells, and PTH secretion from PTH-C1 cells was reduced significantly when either were incubated with purified Ab and Ca²⁺ compared with Ca²⁺ alone. In conclusion, although the majority of APS1 patients do not have CaSR-stimulating autoantibodies, the hypoparathyroid state in a small minority of patients is the result of functional suppression of the parathyroid glands.

https://ift.tt/2BhLe1z

IL-17 in Renal Immunity and Autoimmunity [BRIEF REVIEWS]

The kidney is an organ particularly susceptible to damage caused by infections and autoimmune conditions. Renal inflammation confers protection against microbial infections. However, if unchecked, unresolved inflammation may lead to kidney damage. Although proinflammatory cytokine IL-17 is required for immunity against extracellular pathogens, dysregulated IL-17 response is also linked to autoimmunity. In this review, we will discuss the current knowledge of IL-17 activity in the kidney in context to renal immunity and autoimmunity and raise the intriguing question to what extent neutralization of IL-17 is beneficial or harmful to renal inflammation.

https://ift.tt/2BhLsWt

Increased Mitochondrial Biogenesis and Reactive Oxygen Species Production Accompany Prolonged CD4+ T Cell Activation [IMMUNE REGULATION]

Activation of CD4⁺ T cells to proliferate drives cells toward aerobic glycolysis for energy production while using mitochondria primarily for macromolecular synthesis. In addition, the mitochondria of activated T cells increase production of reactive oxygen species, providing an important second messenger for intracellular signaling pathways. To better understand the critical changes in mitochondria that accompany prolonged T cell activation, we carried out an extensive analysis of mitochondrial remodeling using a combination of conventional strategies and a novel high-resolution imaging method. We show that for 4 d following activation, mouse CD4⁺ T cells sustained their commitment to glycolysis facilitated by increased glucose uptake through increased expression of GLUT transporters. Despite their limited contribution to energy production, mitochondria were active and showed increased reactive oxygen species production. Moreover, prolonged activation of CD4⁺ T cells led to increases in mitochondrial content and volume, in the number of mitochondria per cell and in mitochondrial biogenesis. Thus, during prolonged activation, CD4⁺ T cells continue to obtain energy predominantly from glycolysis but also undergo extensive mitochondrial remodeling, resulting in increased mitochondrial activity.

https://ift.tt/2KikYqG

Cutting Edge: Human Vagus Produces Specialized Proresolving Mediators of Inflammation with Electrical Stimulation Reducing Proinflammatory Eicosanoids [CUTTING EDGE]

Inflammatory resolution is a process that, when uncontrolled, impacts many organs and diseases. As an active, self-limited inflammatory process, resolution involves biosynthesis of specialized proresolving mediators (SPM) (e.g., lipoxins, resolvins [Rv], protectins, and maresins). Because vagal stimulation impacts inflammation, we examined human and mouse vagus ex vivo to determine if they produce lipid mediators. Using targeted lipid mediator metabololipidomics, we identified lipoxins, Rv, and protectins produced by both human and mouse vagus as well as PGs and leukotrienes. Human vagus produced SPM (e.g., RvE1, NPD1/PD1, MaR1, RvD5, and LXA₄) on stimulation that differed from mouse (RvD3, RvD6, and RvE3), demonstrating species-selective SPM. Electrical vagus stimulation increased SPM in both human and mouse vagus as did incubations with Escherichia coli. Electrical vagus stimulation increased SPM and decreased PGs and leukotrienes. These results provide direct evidence for vagus SPM and eicosanoids. Moreover, they suggest that this vagus SPM circuit contributes to a new proresolving vagal reflex.

https://ift.tt/2BhLopH

Lipoxin B4 Enhances Human Memory B Cell Antibody Production via Upregulating Cyclooxygenase-2 Expression [IMMUNOTHERAPY AND VACCINES]

Vaccination has been the most effective way to prevent or reduce infectious diseases; examples include the eradication of smallpox and attenuation of tetanus and measles. However, there is a large segment of the population that responds poorly to vaccines, in part because they are immunocompromised because of disease, age, or pharmacologic therapy and are unable to generate long-term protection. Specialized proresolving mediators are endogenously produced lipids that have potent proresolving and anti-inflammatory activities. Lipoxin B₄ (LXB₄) is a member of the lipoxin family, with its proresolving effects shown in allergic airway inflammation. However, its effects on the adaptive immune system, especially on human B cells, are not known. In this study, we investigated the effects of LXB₄ on human B cells using cells from healthy donors and donors vaccinated against influenza virus in vitro. LXB₄ promoted IgG Ab production in memory B cells and also increased the number of IgG-secreting B cells. LXB₄ enhanced expression of two key transcription factors involved in plasma cell differentiation, BLIMP1 and XBP1. Interestingly, LXB₄ increased expression of cyclooxygenase-2 (COX2), an enzyme that is required for efficient B cell Ab production. The effects of LXB₄ are at least partially COX2-dependent as COX2 inhibitors attenuated LXB₄-stimulated BLIMP1 and Xpb-1 expression as well as IgG production. Thus, our study reveals for the first time, to our knowledge, that LXB₄ boosts memory B cell activation through COX2 and suggests that LXB₄ can serve as a new vaccine adjuvant.

https://ift.tt/2KikTTU

Divergent TCR-Initiated Calcium Signals Govern Recruitment versus Activation of Human Alloreactive Effector Memory T Cells by Endothelial Cells [ANTIGEN RECOGNITION AND RESPONSES]

Early human allograft rejection can be initiated when circulating human host versus graft Ag-specific CD8 and CD4 effector memory T cells directly recognize MHC class I and II, respectively, expressed on the luminal surface by endothelium lining graft blood vessels. TCR engagement triggers both graft entry (TCR-driven transendothelial migration or TEM) and production of proinflammatory cytokines. Both TCR-driven TEM and cytokine expression are known to depend on T cell enzymes, myosin L chain kinase, and calcineurin, respectively, that are activated by cytoplasmic calcium and calmodulin, but whether the sources of calcium that control these enzymes are the same or different is unknown. Using superantigen or anti-CD3 Ab presented by cultured human dermal microvascular cells to freshly isolated peripheral blood human effector memory T cells under conditions of flow (models of alloantigen recognition in a vascularized graft), we tested the effects of pharmacological inhibitors of TCR-activated calcium signaling pathways on TCR-driven TEM and cytokine expression. We report that extracellular calcium entry via CRAC channels is the dominant contributor to cytokine expression, but paradoxically these same inhibitors potentiate TEM. Instead, calcium entry via TRPV1, L-Type Ca_v, and pannexin-1/P2X receptors appear to control TCR-driven TEM. These data reveal new therapeutic targets for immunosuppression.

https://ift.tt/2Bi5XSQ

Computationally Designed Bispecific MD2/CD14 Binding Peptides Show TLR4 Agonist Activity [INNATE IMMUNITY AND INFLAMMATION]

Toll-like receptor 4 plays an important role in the regulation of the innate and adaptive immune response. The majority of TLR4 activators currently in clinical use are derivatives of its prototypic ligand LPS. The discovery of innovative TLR4 activators has the potential of providing new therapeutic immunomodulators and adjuvants. We used computational design methods to predict and optimize a total of 53 cyclic and linear peptides targeting myeloid differentiation 2 (MD2) and cluster of differentiation 14 (CD14), both coreceptors of human TLR4. Activity of the designed peptides was first assessed using NF-B reporter cell lines expressing either TLR4/MD2 or TLR4/CD14 receptors, then binding to CD14 and MD2 confirmed and quantified using MicroScale Thermophoresis. Finally, we incubated select peptides in human whole blood and observed their ability to induce cytokine production, either alone or in synergy with LPS. Our data demonstrate the advantage of computational design for the discovery of new TLR4 peptide activators with little structural resemblance to known ligands and indicate an efficient strategy with which to identify TLR4 targeting peptides that could be used as easy-to-produce alternatives to LPS-derived molecules in a variety of settings.

https://ift.tt/2Khywme

TRAF2 Deficiency in B Cells Impairs CD40-Induced Isotype Switching That Can Be Rescued by Restoring NF-{kappa}B1 Activation [MOLECULAR AND STRUCTURAL IMMUNOLOGY]

Effective humoral immunity requires class switch recombination (CSR) catalyzed by activation-induced cytidine deaminase (AID). In response to T cell–dependent (TD) Ags, CSR can be induced by CD40 signaling in B cells. TNFR-associated factors 2 and 3 (TRAF2/TRAF3) function as adaptors of the CD40 signaling pathway. B cell–intrinsic TRAF2 or TRAF3 (B-TRAF2 or B-TRAF3) knockout mice were previously reported to have indistinguishable phenotypes in gene expression, B cell survival and development, and enlarged peripheral lymphoid organs. However, it remains unknown whether deficiency of B-TRAF2 or B-TRAF3 differentially affects TD humoral immune responses and CD40-induced CSR. In this article, we show that B-TRAF2 is essential for optimal isotype switching induced by in vivo TD Ag immunization or by engaging CD40 in vitro. Our data clarify the controversial role of B-TRAF3 and confirm its dispensability in CD40-induced CSR. Mechanistically, CD40-induced AID expression was markedly impaired by B-TRAF2, but not B-TRAF3, deficiency. Moreover, B-TRAF2 deficiency causes defective activation of the NF-B1 complex in a CD40-autonomous manner, and restoring CD40-induced NF-B1 activation in TRAF2-deficient B cells rescues AID expression and CSR. We conclude that TRAF2 is essential but TRAF3 is dispensable for TD humoral immunity and CD40-induced CSR. Our studies provide significant biological bases for optimizing treatment of B cell–associated immune disorders by targeting CD40 signaling.

https://ift.tt/2KikJfg

Sublytic C5b-9 Induces IL-23 and IL-36a Production by Glomerular Mesangial Cells via PCAF-Mediated KLF4 Acetylation in Rat Thy-1 Nephritis [AUTOIMMUNITY]

Sublytic C5b-9 formation on glomerular mesangial cells in rat Thy-1 nephritis (Thy-1N), a model of human mesangioproliferative glomerulonephritis, is accompanied by the production of proinflammatory cytokines, but the relationship between sublytic C5b-9 and cytokine synthesis and the underlying mechanism remains unclear. To explore the problems mentioned above, in this study, we first examined the levels of proinflammatory ILs (e.g., IL-23 and IL-36a) as well as transcription factor (KLF4) and coactivator (PCAF) in the renal tissues of Thy-1N rats and in the glomerular mesangial cell line (HBZY-1) stimulated by sublytic C5b-9. Then, we further determined the role of KLF4 and PCAF in sublytic C5b-9–induced IL-23 and IL-36a production as well as the related mechanism. Our results showed that the levels of KLF4, PCAF, IL-23, and IL-36a were obviously elevated. Mechanistic investigation revealed that sublytic C5b-9 stimulation could increase IL-23 and IL-36a synthesis through KLF4 and PCAF upregulation, and KLF4 and PCAF could form a complex, binding to the IL-23 or IL-36a promoter in a KLF4-dependent manner, causing gene transcription. Importantly, KLF4 acetylation by PCAF contributed to sublytic C5b-9–induced IL-23 and IL-36a transcription. Besides, the KLF4 binding regions on IL-23 or IL-36a promoters and the KLF4 lysine site acetylated by PCAF were identified. Furthermore, silencing renal KLF4 or PCAF gene could significantly inhibit IL-23 or IL-36a secretion and tissue damage of Thy-1N rats. Collectively, these findings implicate that the KLF4/PCAF interaction and KLF4 acetylation by PCAF play a pivotal role in the sublytic C5b-9–mediated IL-23 and IL-36a production of Thy-1N rats.

https://ift.tt/2BiPAFD

Limited Phenotypic and Functional Plasticity of Influenza Virus-Specific Memory CD8+ T Cells during Activation in an Alternative Cytokine Environment [IMMUNE REGULATION]

Naive CD8⁺ T cells show phenotypic, functional, and epigenetic plasticity, enabling differentiation into distinct cellular states. However, whether memory CD8⁺ T cells demonstrate similar flexibility upon recall is poorly understood. We investigated the potential of influenza A virus (IAV)-specific memory CD8⁺ T cells from mice to alter their phenotype and function in response to reactivation in the presence of IL-4 and anti–IFN- Ab (type 2 conditions). Compared with naive CD8⁺ T cells, only a small proportion of IAV-specific memory T cells exhibited phenotypic and functional plasticity after clonal activation under type 2 conditions. The potential for modulation of cell-surface phenotype (CD8α expression) was associated with specific epigenetic changes at the Cd8a locus, was greater in central memory T cells than effector memory T cells, and was observed in endogenous memory cells of two TCR specificities. Using a novel technique for intracellular cytokine staining of small clonal populations, we showed that IAV-specific memory CD8⁺ T cells reactivated under type 2 conditions displayed robust IFN- expression and, unlike naive CD8⁺ T cells activated under type 2 conditions, produced little IL-4 protein. Secondary activation of memory cells under type 2 conditions increased GATA-3 levels with minimal change in T-bet levels. These data suggest that a small population of memory cells, especially central memory T cells, exhibits plasticity; however, most IAV-specific memory CD8⁺ T cells resist reprogramming upon reactivation and retain the functional state established during priming.

https://ift.tt/2Kfofqz

Fc{gamma}RIIb on B Cells and Myeloid Cells Modulates B Cell Activation and Autoantibody Responses via Different but Synergistic Pathways in Lupus-Prone Yaa Mice [AUTOIMMUNITY]

C57BL/6 (B6).FcRIIb^–/–.Yaa mice spontaneously develop lethal lupus nephritis. To define the cell type–specific role of FcRIIb in Yaa-associated lupus, we established B cell– (CD19^Cre.Yaa), myeloid cell– (C/EBPα^Cre.Yaa), and dendritic cell– (DC) (CD11c^Cre.Yaa) specific FcRIIb-deficient B6.Yaa mouse strains. CD19^Cre.Yaa mice developed milder lupus than B6.FcRIIb^–/–.Yaa mice, indicating that FcRIIb deficiency on B cells is not sufficient for the development of severe disease. Surprisingly, C/EBPα^Cre.Yaa mice also showed autoantibody production and mild lupus similar to that in CD19^Cre.Yaa mice, whereas CD11c^Cre.Yaa mice stayed disease free. These observations indicate that FcRIIb deficiency in B cells and myeloid cells, but not DCs, contributes to the severe disease in B6.FcRIIb^–/–.Yaa mice. Flow cytometric analysis showed that the frequency of peripheral Gr-1^– but not Gr-1⁺ monocyte was increased in B6.FcRIIb^–/–.Yaa and C/EBPα^Cre.Yaa but not CD19^Cre.Yaa mice, suggesting a link between FcRIIb deficiency on myeloid cells and the high frequency of Gr-1^– monocytes. RNA sequencing revealed that compared with Gr-1⁺ monocytes, Gr-1^– monocytes expressed higher levels of the B cell–stimulating cytokines BSF-3, IL-10, and IL-1β, the DC markers CD11c, CD83, and Adamdec1, and the antiapoptotic factors Bcl2 and Bcl6. In conclusion, in Yaa-associated lupus nephritis, FcRIIb on B cells and myeloid cells modulates B cell activation via different but synergistic pathways. Gr-1^– monocytes are the most likely candidate myeloid cells involved.

https://ift.tt/2Biokak

Loss of Canonical Notch Signaling Affects Multiple Steps in NK Cell Development in Mice [IMMUNE REGULATION]

Within the hematopoietic system, the Notch pathway is critical for promoting thymic T cell development and suppressing the B and myeloid lineage fates; however, its impact on NK lymphopoiesis is less understood. To study the role of Notch during NK cell development in vivo, we investigated different NK cell compartments and function in Rbp-Jk^fl/flVav-Cre^tg/+ mice, in which Rbp-Jk, the major transcriptional effector of canonical Notch signaling, was specifically deleted in all hematopoietic cells. Peripheral conventional cytotoxic NK cells in Rbp-Jk–deleted mice were significantly reduced and had an activated phenotype. Furthermore, the pool of early NK cell progenitors in the bone marrow was decreased, whereas immature NK cells were increased, leading to a block in NK cell maturation. These changes were cell intrinsic as the hematopoietic chimeras generated after transplantation of Rbp-Jk–deficient bone marrow cells had the same NK cell phenotype as the Rbp-Jk–deleted donor mice, whereas the wild-type competitors did not. The expression of several crucial NK cell regulatory pathways was significantly altered after Rbp-Jk deletion. Together, these results demonstrate the involvement of canonical Notch signaling in regulation of multiple stages of NK cell development.

https://ift.tt/2KgA0NI

Seropositivity and Antibody Profiling of Patients Are Dramatically Impacted by the Features of Peptides Used as Immunosorbents: A Lesson from Anti-Citrullinated Protein/Peptide Antibody [AUTOIMMUNITY]

Quantification of Abs toward a single epitope is critical to understanding immunobiological processes. In autoimmunity, the prognostic value of the serological profiles of patients draws much attention, but the detection of Abs toward a single epitope is not well controlled. Particularly, the rheumatoid arthritis (RA)–specific anti–citrullinated protein/peptide Abs (ACPA) are specific to a two-atom change on arginyl residues and are considered a heterogeneous family of Abs. As a model, we studied ACPA to decipher how peptide features used as immunosorbent impact Ab detection. We synthesized 30 peptides encompassing immunodominant epitopes of citrullinated fibrin differing by their length and biotin location and tested them using ELISA with 120 sera from RA and non-RA rheumatic disease controls, generating over 3000 experimental measurements. We showed that minor molecular changes in peptide chemical structure had dramatic consequences. Even when peptides exhibited the same epitope, measured Ab titers were extremely variable, and patients' seropositivity was discordant in up to 50% of cases. The distance between epitope and biotin was the most critical parameter for efficient Ab detection irrespective of biotin position or peptide length. Finally, we identified a 15-mer peptide bearing a single citrullinated epitope detecting almost all ACPA-positive sera, thus revealing a high degree of homogeneity in RA autoimmune response. This integrative analysis deciphers the dramatic impact of the molecular design of peptide-based technologies for epitope-specific Ab quantification. It provides a model for assay development and highlights that the studies using such technologies can give a wrong perception of biological processes and therefore that medical use of data must be cautious.

https://ift.tt/2Bi2d3z

Speech Perception with Spectrally Non-overlapping Maskers as Measure of Spectral Resolution in Cochlear Implant Users

Abstract

https://ift.tt/2Tpb2zH

Time-Compressed Speech Identification Is Predicted by Auditory Neural Processing, Perceptuomotor Speed, and Executive Functioning in Younger and Older Listeners

Abstract

https://ift.tt/2A6uLeH

Ist sicher: Active Surveillance beim Prostatakarzinom mit niedrigem Risiko

https://ift.tt/2DL15rL

The long-term outcomes of breast implants studied

A recent analysis on existing data unearths information about the rare but serious long-term risks associated with silicone breast implants.

https://ift.tt/2DvWzfN

Personalisierte Medizin im Bereich entzündlicher Hauterkrankungen

Zusammenfassung

Hintergrund

Für eine ausreichende Versorgung von Patienten mit chronisch entzündlichen Hauterkrankungen müssen neue Konzepte entwickelt und Biomarker identifiziert werden.

Fragestellung

Dargestellt werden neue Marker sowie deren Qualität und Implikation für den klinischen Alltag.

Material und Methode

Es erfolgen die Diskussion von Grundlagenarbeiten und die Zusammenfassung neuer Entwicklungen der personalisierten Medizin im Bereich chronisch entzündlicher Hauterkrankungen.

Ergebnisse

Vielversprechende Biomarker für unterschiedliche Entitäten des chronisch entzündlichen Formenkreises wurden bereits vorgeschlagen, bedürfen jedoch einer prospektiven Validierung und Umsetzung in kostengünstige, praktikable Tests.

Schlussfolgerungen

Der Weg zur personalisierten Medizin im Gebiet der chronisch entzündlicher Hauterkrankungen ist noch weit und bedarf nicht zuletzt einer multizentrischen Kollaboration zur Validierung und Implementierung von Biomarkern.

https://ift.tt/2zhRWTF

Versatility of cervicofacial flaps: Cervical‐medial cheek flap for reconstruction in cutaneous substance loss of the inner cheek

Abstract

Background

Preservation of facial harmony is a major challenge in reconstruction after resection of head and neck skin tumors. For large medial cheek‐skin defects, we used a derived posterior‐based cervicofacial flap, or cervical‐medial cheek flap (CMCF).

Methods

We present a retrospective review of cases treated at a university‐based cancer center. Patient characteristics, surgical technique, and complication rates are described.

Results

Eighteen patients were treated between 2014 and 2017 with reconstruction for integumentary cheek defect after skin tumor surgery using CMCF. Mean defect size was 5.7 cm in length and 3.9 cm in width. The main histological subtype was lentigo maligna (33.3%). We report no flap necrosis but 4 minor complications occurred over a mean follow‐up of 14.4 months. At last follow‐up, satisfaction rate was very high (88.9%) with no evidence of recurrence.

Conclusion

The CMCF is a promising yet infrequently used option in medial cheek reconstruction, with excellent cosmetic and functional outcomes.

https://ift.tt/2QVUVIv

Impact of treatment expertise on the outcome of patients with head and neck cancer treated within 6 randomized trials

Abstract

Background

We evaluated the impact of center expertise, in terms of number of patients treated, on the overall survival (OS) and progression‐free survival (PFS) of patients with head and neck squamous cell carcinoma (SCC).

Methods

We performed a pooled analysis including data from 6 randomized trials in head and neck SCC conducted in Italy. We evaluated the association between OS or PFS and the number of patients recruited by the center.

Results

The outcome of 903 patients who had received radiotherapy (RT) was analyzed (median follow‐up 76 months). The hazard ratio (HR) comparing the third and the first quartiles of the distribution of number of patients per center showed an advantage in PFS (HR 0.59, range 0.53‐0.65, P < .0001) and in OS (HR 0.70, 0.60‐0.81, P < .0001) for centers with a higher number of patients recruited. A similar benefit was observed in PFS (HR 0.63, 0.60‐0.66) and OS (HR 0.74, 0.69‐0.79) considering the mean number of patients per year.

Conclusions

The PFS and OS were longer for patients treated in high‐case‐volume centers.

https://ift.tt/2PDEWC7

A COMMON THERAPY FOR ALLERGIC REACTION YET A RARELY SUSPECTED CAUSE OF HYPERSENSITIVITY

While corticosteroid allergy is uncommon, reactions have been described. Increasing reports suggest the frequency of steroid reactions may be increasing, though the exact incidence is unknown.

https://ift.tt/2KffH3b

TOXIC EPIDERMAL NECROLYSIS COMPLICATED BY CHRONIC INFLAMMATORY KERATITIS/CONJUNCTIVITIS AND INFLAMMATORY PERIPHERAL NEURITIS

We present a patient who developed chronic keratitis and conjunctivitis, inflammatory neuropathy of the hands, and onychomadesis as complications of her toxic epidermal necrolysis (TEN). Neuropathy was treated with glucocorticoids, methotrexate, and high dose IVIG; however the keratitis and conjunctivitis were resistant and required adalimumab. To the best of our knowledge, there are no other reports of inflammatory neuropathy as a sequelae of Stevens Johnson Syndrome (SJS)/TEN, nor management of chronic ocular inflammation with adalimumab.

https://ift.tt/2Bg9SzE

SEMINAL FLUID SENSITIVITY: ABSTINENCE IS NOT THE ANSWER

Seminal fluid sensitivity with localized late phase symptoms and successful intravaginal desensitization is described.

https://ift.tt/2Kicks0

NOT ALL LIP SWELLING IS ANGIOEDEMA

Cheilitis granulomatosa (CG) is a rare form of recurrent or persistent swelling of one or both lips and one form of orofacial granulomatosis. It is important for allergists to consider the need for mucosal biopsy in patients initially referred for angioedema, especially if the lip swelling has been persistent.

https://ift.tt/2Biy6sX

THREE CASES OF DELAYED-ONSET REPETITIVE EMESIS AFTER AVOCADO INGESTION

Food Protein-Induced Enterocolitis (FPIES) is a non-IgE mediated gastrointestinal food hypersensitivity typically presenting in infancy with vomiting and diarrhea, but can progress to shock. Rarely reported as an FPIES trigger, avocado is listed as among low-risk complementary foods to introduce for infants in the first international consensus guidelines for FPIES. Here we report 3 cases of FPIES to avocado.

https://ift.tt/2KfuF9e

EDUCATIONAL OUTCOMES OF AN ANAPHYLAXIS SIMULATION ACTIVITY AMONG MEDICAL STUDENTS AND RESIDENTS¶

Failure to recognize anaphylaxis or delayed epinephrine auto-injector (EAI) administration may result in poor patient outcomes. Clinical simulation is an educational method used for environment-controlled, team-based learning.

https://ift.tt/2Bg9Asy

GENETIC TESTING IDENTIFIES CAUSE OF ENTEROPATHY AND GROWTH FAILURE IN A 10 YEAR OLD MALE

Enteropathies with features of celiac disease or inflammatory bowel disease (IBD) should spark consideration of an immunodeficiency when presenting at an early age.

https://ift.tt/2KeVkTG

HIGHER STARTING DOSE PROTOCOLS IN CORONARY ARTERY DISEASE PATIENTS WITH ASPIRIN HYPERSENSITIVITY

Aspirin is a cornerstone of atherosclerosis therapy, but 1.5% of coronary artery disease (CAD) patients report aspirin allergy. Past protocols of challenge and/or desensitization for aspirin allergy excluded acute coronary syndrome (ACS) patients and/or started at low doses. Recent studies propose higher starting doses with fewer steps. The safety and efficacy of these newer protocols are not established, especially in the acute setting where the ability to tolerate aspirin is time-sensitive.

https://ift.tt/2BgaghA

NEWBORN T-CELL RECOMBINATION EXCISION CIRCLE SCREENING REVEALS NON-ARCHETYPAL DIGEORGE PATIENT

DiGeorge Syndrome (DGS) is a spectrum of disorders with variable manifestations including congenital heart malformations, immunodeficiency, facial dysmorphism, hypocalcemia, and developmental delay, leading to diagnosis at a wide age range.1 Patients without classic cardiac malformations frequently remain undiagnosed longer, diagnosed only after developing recurrent infections, learning difficulties, or mental health problems. 2

https://ift.tt/2KeTGl5

SOCIO-DEMOGRAPHIC DIFFERENCES IN PATIENTS HOSPITALIZED FOR ANAPHYLAXIS IN THE UNITED STATES

Anaphylactic shock is a life-threatening emergency that can lead to significant morbidity and mortality. Data from European studies have shown significant disparities in healthcare utilization for anaphylaxis, however there are limited studies describing the association between socioeconomic status and patient characteristics for hospitalizations related to anaphylaxis in the United States.

https://ift.tt/2BgPkH0

URTICARIA, NAUSEA, AND VOMITING, IS THIS THE GALT ENZYME DEFICIENCY?

Galactosemia is a rare genetic disorder not frequently encountered in clinical practice. GALT enzyme deficiency is in the spectrum of non IgE mediated food intolerance. However, when encountered with symptoms consistent anaphylaxis, the possibility of an IgE mediated reaction should not be excluded.

https://ift.tt/2KgNQj0

DIRECT ORAL AMOXICILLIN CHALLENGE WITHOUT PRELIMINARY SKIN TESTING IN PATIENTS WITH REPORTED PENICILLIN ALLERGY

10% of hospitalized patients report penicillin allergy; studies indicate that ∼98% are not truly allergic. Unconfirmed penicillin allergy labels pose public health risks, and evaluation is recommended to improve antibiotic stewardship. While the most widely accepted protocol is penicillin skin testing (PST) followed by oral amoxicillin challenge, time constraints and resources may preclude this. Recent literature supports the safety and efficacy of direct oral amoxicillin challenge in low-risk individuals.

https://ift.tt/2BgPk9Y

A CASE OF VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE, CHRONIC LUNG DISEASE, AND RECURRENT INFECTIONS

Very early onset inflammatory bowel disease (VEOIBD) may correlate with multiple immunodeficiencies, including severe combined immunodeficiency (SCID), common variable immunodeficiency (CVID), chronic granulomatous disease (CGD), Wiskott-Aldrich syndrome (WAS), and IL-10 signaling defects. It may be difficult to differentiate between intestinal inflammation and immune dysfunction leading to systemic symptoms and elevated inflammatory markers. This patient, a 5-year-old male with very early onset Crohn's disease, chronic lung disease, 1p36 duplication, failure to thrive, eczema, and systemic infections including Candidemia, Klebsiella bacteremia, histoplasmosis, recurring pneumonia, multiple upper respiratory and sinus infections, and recurring IBD flares, presented due to concern for underlying primary immunodeficiency.

https://ift.tt/2KeV9I0

IMPROVING EMERGENCY CARE FOR ANAPHYLAXIS: IMPACT OF A CLINICAL PATHWAY IN A PEDIATRIC EMERGENCY DEPARTMENT

Emergency Department (ED) management of anaphylaxis has not kept pace with advances in knowledge. Epinephrine use and utilization of guideline-based practice recommendations remains sub-optimal, particularly in children. We implemented a clinical pathway in our pediatric ED in August 2017 to improve care.

https://ift.tt/2Bh2vIj

SECONDARY IMMUNODEFICIENCY DUE TO GAMING DISORDER

Gaming disorder is a new ICD-11 diagnosis wherein obsessive video-gaming results in an interference of daily activities, which can lead to downstream health effects such as cachexia and malnutrition. We report a patient whose gaming disorder led to severe malnutrition and secondary immunodeficiency.

https://ift.tt/2Kmdh2V

PREDICTIVE DECLINE IN PEANUT SKIN TEST AND RAST AMONG PEANUT-ALLERGIC CHILDREN UNDERGOING HIGH-DOSE ORAL IMMUNOTHERAPY

Peanut immunotherapy remains a limited form of treatment for peanut allergic children. Limitations primarily stem from small study sizes, significant adverse events, unclear long-term immunological outcomes and the inability to reach tolerance. In our cohort of peanut anaphylaxis patients undergoing tolerance induction oral immunotherapy, we sought to determine the rate of decline in peanut skin prick testing (SPT) and RAST results following one year of high-dose, weekly peanut immunotherapy.

https://ift.tt/2BgK8D4

DIFFERENTIAL DIAGNOSIS IN PEDIATRIC SEVERE ASTHMA

Despite drug treatment, a small percentage of patients with asthma cannot reach control. Therefore, it is important to have differential diagnosis in mind.

https://ift.tt/2KeTEtt

PERCEPTION AND PRACTICE OF SUBLINGUAL IMMUNOTHERAPY AMONG PRACTICING ALLERGISTS IN THE US: 2018 FOLLOW-UP SURVEY.

Limited information regarding current trends of sublingual immunotherapy (SLIT) use in the United States and perception of SLIT relative to 2007 and 2013 is available, especially in light of recent FDA-approved SLIT options.

https://ift.tt/2BfR9nB

RESOLUTION OF MILK-PROTEIN ALLERGY AFTER HEMATOPOIETIC STEM CELL TRANSPLANT IN A PATIENT WITH IPEX SYNDROME

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is due to a FOXP3 gene mutation leading to regulatory T cell dysfunction and multi-organ autoimmunity. Patients present in infancy with protracted diarrhea, dermatitis, insulin-dependent diabetes mellitus, and thyroiditis. Some patients may have severe food allergies. We present a patient with IPEX syndrome whose milk protein allergy resolved after receiving a stem cell transplant for his primary immunodeficiency.

https://ift.tt/2KfUS7K

COMPARATIVE STUDY OF βS-LACTAM DE-LABELING ON THE FREQUENCY OF PERI-OPERATIVE VANCOMYCIN USE

Vancomycin is the antibiotic of choice in β-lactam allergic adults undergoing surgical antibiotic prophylaxis. Because it is a suboptimal option, in 2015 a pre-operative drug allergy screening program began at the Montreal General Hospital (MGH). It de-labeled 94 % of patients evaluated, reducing vancomycin use to 3 %. To validate the program effectiveness a prospective study comparing the Royal Victoria Hospital (RVH), which lacked de-labeling was undertaken.The aim of the study was to determine the effect of a de-labeling program on vancomycin use.

https://ift.tt/2Bit4gh

Syzygium cumini extract induced reactive oxygen species mediated apoptosis in human oral squamous carcinoma cells

Abstract

Background

Syzygium cumini (L.) Skeels (jambolan) is commonly used in Indian traditional medicine to treat a variety of diseases such as obesity, diabetes etc. The cytotoxic potential of Syzygium cumini (SC) against oral cancer cell line is remains elusive. Therefore, in this study, we evaluated the cytotoxic effect of S. cumini in human oral squamous cell carcinoma (OSCC) cell line (SCC‐25 cells).

Material and Methods

OSCC cells are treated with different concentrations (10, 20 and 40 μg/mL) of S. cumuni for 24 h and cytotoxicity was analyzed by MTT assay. The intracellular reactive oxygen species (ROS) was measured using the indicator dye, 2',7'‐dichlorofluorescin diacetate staining. Apoptosis‐related morphological changes were evaluated by dual acridine orange/ethidium bromide (AO/EB) fluorescent staining and phosphatidylserine externalization was measured by annexin V assays. The protein and gene expression of cadherin‐1 was evaluated by western blotting and PCR analysis.

Results

SC treatments caused cytotoxicity of OSCC cell line and induced intracellular ROS accumulation. This treatment also caused apoptosis related morphological changes and externalization of phosphatidylserine in OSCC cells. Further, SC treatments increased protein and gene expression of cadherin‐1.

Conclusion

S. cumini extract inhibits the proliferation of OSCC cells and induces apoptosis through ROS accumulation and therefore, it could be used for the prevention of OSCC.

https://ift.tt/2BismPV

Effect of glycerol on reconstructed human oral mucosa

The majority of severely ill patients experience dry mouth. For institutionalized patients, this condition is commonly treated using glycerol as a lubricant. However, because of its possibly desiccating effect, some countries do not advocate the use of glycerol. This study aimed to investigate dose‐dependent effects of glycerol on homeostasis and tissue integrity of in vitro‐reconstructed normal human buccal mucosa (RNHBM). Primary keratinocytes and fibroblasts were isolated and expanded from biopsies of mucosa from eight healthy volunteers. Ninety‐six samples of RNHBM were prepared and exposed for 24 h to 17%, 42.5%, or 85% glycerol, or to distilled H₂O (control). Sections were stained with haematoxylin and eosin (H&E) to evaluate epithelial thickness or used for immunohistochemistry to measure expression of Ki67 (proliferation), cleaved caspase‐3 (apoptosis), and E‐cadherin (tissue‐integrity). Positive cells and cell layers, as detected by immunohistochemistry, were counted. Epithelial thickness, proliferation, and apoptosis were significantly increased by exposure to 42.5% and 85% glycerol. No significant differences in apoptosis or proliferation were found between controls and RNHBM exposed to 17% glycerol. E‐cadherin expression was not significantly affected by exposure to any of the concentrations of glycerol tested. This study shows that glycerol affects tissue homeostasis, but not tissue integrity, of RNHBM at glycerol concentrations above 42.5%.

https://ift.tt/2BgWoDB

Definitive radiotherapy for Merkel cell carcinoma in the setting of epidermolysis bullosa simplex

https://ift.tt/2Ts5R1S

Pelvic lymph node metastasis in extramammary Paget disease of the scrotum without inguinal lymph node metastasis

https://ift.tt/2A2NAzB

Unusual dermoscopic feature of a melanocytic naevus on load bearing plantar skin never pressured because of cerebral palsy

https://ift.tt/2ToV3le

The functions of FoxO transcription factors in epithelial wound healing

Abstract

Re‐epithelialisation is a complex process that involves the migration and proliferation of keratinocytes, as well as the production of cytokines and growth factors that affect wound healing. The precise mechanisms that control the tissue repair process remain poorly understood. Recent evidence indicates that FoxO transcription factors play a crucial role in wound healing. In mammals, different isoforms of FoxO, namely, FoxO1, FoxO3, FoxO4 and FoxO6, are present; however, FoxO1 and FoxO3 primarily function in epithelial wound healing. The functions of FoxO proteins in normal wound healing are opposite of those in diabetic wound healing. On the one hand, FoxO transcription factors promote the migration of keratinocytes through up‐regulating the expression of transforming growth factor‐beta and protecting keratinocytes from oxidative stress. On the other hand, FoxO transcription factors negatively regulate some genes that are needed for re‐epithelialisation and keratinocyte migration. This review provides a summary of the functions of FoxO proteins in re‐epithelialisation.

https://ift.tt/2A4XYXo

Clinical and dermoscopic features associated with lichen planus‐like keratoses that undergo skin biopsy: A single‐center, observational study

Abstract

Background/Objectives

Lichen planus‐like keratoses (LPLK) are benign skin lesions that can mimic malignancy; the clinical and dermoscopic features distinguishing lichen planus‐like keratoses from skin tumors have not been extensively studied. The objective of this study was to identify dermoscopic features that may prevent unnecessary biopsies of lichen planus‐like keratoses.

Methods

Retrospective, observational study of biopsied skin lesions. We compared 355 lichen planus‐like keratoses to 118 non‐lichen planus‐like keratoses lesions with lichen planus‐like keratose in the differential diagnosis biopsied from August 1, 2015, to December 31, 2016. The investigators were blinded to the diagnosis of the lesions. A single‐center, observational study in a tertiary center.

Results

Lichen planus‐like keratoses were most frequently non‐pigmented (61.7%), truncal (52.1%), and on sun‐damaged skin (69.6%); the majority occurred in Whites (95.5%) and females (62.8%). Dermoscopically, lichen planus‐like keratoses were more likely than non‐lichen planus‐like keratoses to have scale (42.5% vs 31.4%, P = 0.03) and orange colour (8.2% vs 0.9%, P = 0.01). Among lesions with peppering (n = 76; 63 lichen planus‐like keratose and 13 non‐lichen planus‐like keratose), coarse ± fine peppering (73% vs 38.5%, P = 0.02) and peppering as the only feature (34.9% vs 0%, P = 0.01) were associated with lichen planus‐like keratoses.

Conclusions

Lichen planus‐like keratoses can be challenging to distinguish from benign and malignant skin tumors. The presence of dermoscopic scale and orange colour may aid in the recognition of lichen planus‐like keratose. Coarse peppering and the presence of peppering as the only dermoscopic feature may further aid the identification of pigmented lichen planus‐like keratoses.

https://ift.tt/2Tlt6e2

Anti‐PD1 in Merkel cell carcinoma and cutaneous squamous cell carcinoma, description of 5 cases and recent data from the literature

Abstract

Merkel cell carcinoma (MCC) and cutaneous squamous cell carcinoma (CSCC) are tumors of the elderly due to UV exposure with increasing incidence. These highly mutated tumors are more likely to express immunogenic tumor neo‐antigens. In this context, the use of an anti‐PD1 (Programmed cell Death protein 1) is an interesting option. We report 5 patients treated with nivolumab (3mg/kg every 2 weeks).

https://ift.tt/2FuyrNb

Heterogeneity and Variation of Innovator Biologics

Abstract

Biologics are large and complex glycoprotein molecules formed using complementary DNA vectors. The structure of biologics involves higher level protein folding and addition of glycoprotein moieties, which can be difficult to characterize and replicate. Both glycoprotein additions and 3D folding can result in heterogeneity and variation. Amino acid modifications, glycosylation, and folding patterns can differ between batches of biologics. Alterations in these glycoprotein structures canimpact the half‐life, tissue targeting, immunogenicity, degradation and activity of innovator biologics .

https://ift.tt/2qTIH7C

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real‐life data from the Scandinavian registry (HISREG)

Abstract

Background

Hidradenitis suppurativa (HS) substantially affects health‐related quality‐of‐life outcomes. Most treatment options are supported by low quality of evidence without validated outcomes.

Objective

The aim of this study was to evaluate the efficacy of surgical and medical interventions using physician‐ and patient‐reported outcomes registered in HISREG.

Methods

Data were extracted for all adult patients registered in HISREG between January 2013 and April 2016. Primary endpoints included Dermatology Life Quality Index (DLQI) scores, pain as measured using a numeric rating scale (NRS), Sartorius score, and Hurley classification. Minimum clinically important differences (MCIDs) for DLQI and NRS pain were analyzed. Secondary endpoints included comparisons among different treatment groups, safety, and complications of various treatments.

Results

Two hundred fifty‐five patients were included in the study: 31, 188, and 36 patients had Hurley stages I, II, and III disease, respectively. Treatment with CO₂ lasers was the most common treatment modality. One hundred forty‐nine patients (58.4%) were treated with surgical intervention, 87 (34.1%) received antibiotics and/or anti‐inflammatory treatments, and 19 (7.5%) were treated with both surgery and medical intervention. No patients received biologic treatment. In patients with surgical treatments, Sartorius scores were significantly improved compared with baseline (p=0.001), 83 patients (55%) achieved a DLQI MCID, and 75 patients (49.7%) achieved an NRS pain MCID. In patients with medical treatments, Sartorius scores were not significantly improved compared with baseline (p=0.582); 25 patients (28%) achieved a DLQI MCID and 28 patients (31%) achieved an NRS pain MCID. In patients treated with surgical and medical combination, 9 (48%) achieved DLQI and NRS pain MCIDs and Sartorius scores were significantly improved.

Conclusions

CO₂ laser treatment is more effective than the non‐biologic medical treatments in this analysis based on physician‐ and patient‐derived outcomes. The study provides limited evidence for the combination of medical and surgical therapies in patients with HS.

https://ift.tt/2FqiYOe

Apremilast for moderate hidradenitis suppurativa: no significant change in lesional skin inflammatory biomarkers

Abstract

Background

Treatment with apremilast has recently demonstrated clinically meaningful improvement in moderate hidradenitis suppurativa (HS).

Objective

To evaluate the change in expression of inflammatory markers in lesional skin of HS patients receiving apremilast 30 mg twice daily (n=15) for 16 weeks compared with placebo (n=5).

Methods

At baseline 5‐mm punch biopsies were obtained from an index lesion (HSL) and non‐lesional (HSN) skin in the same anatomical area. Subsequent HSL samples were taken as close as possible to the previously biopsied site at week 4 and week 16. After sampling, biopsies were split; one half was processed for in vivo mRNA analysis using real‐time quantitative PCR; the other half was cultured for ex vivo protein analysis using a proximity extension assay (Olink). Linear mixed effects models were calculated to compare the levels of inflammatory markers in HSL skin between apremilast and placebo over time.

Results

At baseline, 17 proteins with a fold change >2 in HSL versus HSN skin were identified in 20 patients. The top 5 were IL‐17A (5), S100A12, CST5, IL‐12/23p40, CD6 (1)

with fold changes ranging from 6.6 to 1638, respectively (FDR<0.044). Linear mixed effects models for 75 assays were calculated. Protein levels of S100A12 decreased during treatment in the apremilast group compared with the placebo group (p=0.014, FDR=0.186). None of the 14 genes exhibited significant changes in expression over time. However, an evident downward trend in relative mRNA expression of IL‐17A and IL‐17F was demonstrated in patients receiving apremilast.

Conclusion

We did not detect statistically significant changes in inflammatory markers in HSL skin of HS patients receiving apremilast compared with placebo, despite clinical improvement in the apremilast group. Nonetheless, S100A12 and IL‐17A were significantly elevated in HSL skin and showed a decrease in response to apremilast. The translational model in clinical trials involving HS clearly needs further improvement.

https://ift.tt/2qVFHYm

Gender differences, UV exposure, and risk of lentigo maligna in a nationwide healthcare population cohort study

Abstract

Background

Our understanding of the relationship between ultraviolet radiation exposure and lentigo maligna (LM) has been largely derived from epidemiologic/clinical studies based on invasive melanoma. Recent studies have shown gender differences in melanocytic tumors incidence.

Objective

To examine the association of UV light with LM by gender remains unclear.

Methods

Two prospective cohort study (Nurses' Health Study [1980‐2012]) and (Health‐Professionals Follow‐up Study [1986‐2010]) were analyzed. All participants with LM or MIS, non‐LM type were included in analysis. UV index at birth, age 15, and age 30 were calculated by gender. Lifetime UV flux was calculated. Hazard ratios (HRs) were calculated.

Results

110,485 women from NHS and 41,015 men from HPFS were examined. 281 LM and 776 melanoma in situ (MIS), non‐LM cases were reported. Risk of LM increased with increasing UV flux exposure in multivariate‐adjusted models for men (p for trend=0.04), but not for women (p for trend=0.91).

Conclusions

UV flux may be associated with LM in men but not in women.

https://ift.tt/2FxcQnD

Predictors of response to omalizumab and relapse in chronic spontaneous urticaria: a study of 470 patients

Abstract

Background

Chronic spontaneous urticaria (CSU) is defined as spontaneous occurrence of wheals and/or angioedema for ≥ 6 weeks. Omalizumab is a monoclonal anti‐IgE antibody effective in refractory CSU but its mechanism of action and markers predictive of response remain not completely defined.

Objectives

To correlate baseline levels of two proposed biomarkers, total IgE (bIgE) and D‐dimer (bD‐dimer), and clinical parameters to omalizumab response and to relapses after drug withdrawal.

Methods

In this retrospective Italian multicenter study, clinical data were collected in 470 CSU patients, and bIgE and bD‐dimer were measured in 340 and 342 patients, respectively. Disease activity was determined by Urticaria Activity Score 7 (UAS7) at week 1 and 12 after omalizumab starting. Relapses were evaluated during a 2‐month and 3‐month interval after a first and a second course of treatment, respectively.

Results

bIgE correlated to a good response to omalizumab since levels were significantly higher in responders than non‐responders (P = 0.0002). Conversely, bD‐dimer did not correlate to response. There was no correlation between both bIgE and D‐dimer and either first or second relapse. Disease duration was significantly longer in patients who experienced either first or second relapse (P < 0.0001 and P = 0.0105, respectively), whilst baseline UAS7 correlated only to first relapse (P = 0.0023).

Conclusions

Our study confirms bIgE as a reliable biomarker predicting response to omalizumab in CSU, while it does not support the usefulness of bD‐dimer unlike previous findings. CSU duration before omalizumab and baseline UAS7 may be clinical markers of relapse risk.

https://ift.tt/2qVFHrk

Loss‐of‐function mutation in DSG1 underlies focal palmoplantar keratoderma

Abstract

Inherited palmoplantar keratodermas (PPKs) are clinically and genetically heterogeneous genodermatoses characterized by hyperkeratosis of the palms and soles. Based on the distribution pattern of hyperkeratotic lesions, PPKs are clinically classified into four types: diffuse, striate, focal and punctate. To date, more than 20 genes have been reported to be responsible for PPKs. Although the majority of reported heterozygous loss‐of‐function mutations in the gene encoding desmoglein 1 (DSG1), a key molecule for epidermal adhesion and differentiation, are associated with striate PPK, a very limited number of studies have suggested that dominant DSG1 mutations also cause non‐striate PPK.

https://ift.tt/2FEUrVE

Patients’ understandings about cellulitis and views about how best to prevent recurrent episodes: mixed methods study in primary and secondary care

Summary

Background

Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. The only proven strategy to reduce the risk of recurrence is long‐term, low‐dose antibiotics. Given current concerns about antibiotic resistance and the pressure to reduce antibiotic prescribing, other prevention strategies are needed.

Objectives

To explore patients' views about cellulitis and different ways of preventing recurrent episodes.

Methods

Adults aged 18 or over with a history of first episode or recurrent cellulitis were invited through primary care, hospitals and advertising to complete a survey, take part in an interview, or both.

Results

Thirty interviews were conducted between August 2016 and July 2017. Two hundred and forty surveys were completed (response rate 17%). Triangulation of quantitative and qualitative data showed that people who have had cellulitis have wide‐ranging beliefs about what can cause cellulitis and are often unaware of risk of recurrence or potential strategies to prevent recurrence. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were more popular potential strategies than use of compression stockings or long‐term antibiotics. Participants expressed caution about long‐term oral antibiotics, particularly those who had experienced only one episode of cellulitis.

Conclusions

People who have had cellulitis are keen to know about possible ways to prevent further episodes. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were generally viewed to be more acceptable, feasible strategies than compression or antibiotics, but further research is needed to explore uptake and effectiveness in practice.

https://ift.tt/2S4hUkI

POT1 germline mutations but not TERT promoter mutations are implicated in melanoma susceptibility in a large cohort of Spanish melanoma families

Summary

Background

Germline mutations in telomere‐related genes such as POT1 and the TERT promoter predispose to familial melanoma.

Objective

To evaluate the prevalence of germline mutations in the POT1 gene and in the TERT promoter in a large cohort of Spanish melanoma‐prone families (at least two affected individuals in first‐ or second‐degree relatives).

Methods

Overall, 228 CDKN2A wild‐type melanoma‐prone families were included in the study. Screening of POT1 was performed in one affected case of each family and TERT promoter was sequenced in one affected case from 202 families (26 families were excluded due to DNA exhaustion/degradation). Additionally, TERT promoter sequencing was extended to addition 30 CDKN2A mutated families and 70 sporadic multiple primary melanoma patients (MPM) with a family history of other cancers.

Results

We identified four families with potentially pathogenic POT1 germline mutations: a missense variant c.233T>C (p.Ile78Thr), a nonsense variant c.1030G>T (p.Glu344*), and two variants c.255G>A (r.125_255del) and c.1792G>A (r.1791_1792insAGTA, p.Asp598Serfs*22), which we confirmed disrupted POT1 mRNA splicing. A TERT promoter variant of unknown significance (c.‐125C>A) was detected in a MPM patient, but no germline mutations were detected in the TERT promoter in familial melanoma cases.

Conclusions

Overall, 1·75% of our CDKN2A/CDK4‐wild type Spanish melanoma‐prone families carry probably damaging mutations in POT1. The frequency of TERT promoter germline mutations in melanoma families in our population is extremely rare.

https://ift.tt/2DONArl

Painful punctate palmoplantar keratoderma due to heterozygous mutations in AAGAB

Abstract

Punctate palmoplantar keratoderma (PPPK) is a rare, autosomal dominant disorder of keratinization with three main variants. PPPK type 1 (MIM 148600), also known as Buschke‐Fischer‐Brauer disease, is characterized by the progressive development of multiple small hyperkeratotic papules with central indentations that are irregularly distributed on the palms and soles, often deteriorating to more extensive diffuse hyperkeratosis on the weight‐bearing areas of plantar skin. The PPPK1 gene was recently identified as the α and γ‐adaptin binding protein p34 gene AAGAB, and in a single case, the COL14A1 gene.

https://ift.tt/2S4hQ4s

Inhibition of arachidonate 15‐lipoxygenase reduces the epithelial–mesenchymal transition in eosinophilic chronic rhinosinusitis with nasal polyps

Background

The epithelial–mesenchymal transition (EMT) is a distinguishing characteristic of chronic rhinosinusitis with nasal polyps (CRSwNP). The underlying mechanism remains largely unknown. Arachidonate 15‐lipoxygenase (ALOX15), an enzyme involved in arachidonic acid metabolism, has been reported to cause airway epithelial injury and thus may further promote the EMT. The aim of this study was to evaluate the role of ALOX15 during the EMT process in CRSwNP.

Methods

A total of 54 samples were obtained, including 10 from healthy control, 16 from non‐eosinophilic CRSwNP, and 28 from eosinophilic CRSwNP. Hematoxylin and eosin staining was performed to determine the basement membrane (BM) thickness. The concentration of molecules mediating remodeling was assayed by Luminex. The messenger RNA (mRNA) and protein levels of target genes were measured by quantitative real‐time polymerase chain reaction (PCR) and Western blotting.

Results

EMT was enhanced in eosinophilic CRSwNP compared with the healthy controls and non‐eosinophilic CRSwNP infiltrated with lymphocytes and/or plasma cells. The expression pattern of molecules related to remodeling, including matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and transforming growth factor β (TGF‐β) family members, differed between the subtypes of CRSwNP. The mRNA level of ALOX15 was correlated with the BM thickness and MMP‐1 and TGF‐β3 expression. The inhibition of ALOX15 by PD146176 could induce claudin‐1, claudin‐4, claudin‐7, zonula occludens (ZO)‐1, ZO‐2, E‐Cadherin, TIMP‐1, and TIMP‐3 expressions and reduce the levels of MMP‐1 and N‐Cadherin in epithelial cells acquired from eosinophilic CRSwNP patients.

Conclusion

The specific inhibition of ALOX15 could attenuate the EMT, which may provide an alternative method for the treatment of CRSwNP.

https://ift.tt/2qTNeXC

In‐office balloon sinus dilation versus medical therapy for recurrent acute rhinosinusitis: a randomized, placebo‐controlled study

Background

A limited number of studies have demonstrated symptomatic improvement for recurrent acute rhinosinusitis (RARS) patients after endoscopic sinus surgery. In this randomized, controlled study we evaluated 24‐week outcomes for balloon sinus dilation (BSD) performed in‐office (IO) with medical management (MM) as compared with MM only for RARS patients.

Methods

Adults diagnosed with RARS were randomized to groups with BSD plus MM (n = 29) or MM alone (n = 30). Patients who received MM alone also received a sham BSD‐IO procedure to blind them to group assignment. Patients were followed to 48 weeks posttreatment. The primary outcome was the difference between arms in change in Chronic Sinusitis Survey (CSS) score from baseline to 24 weeks. Secondary endpoints included comparisons of Rhinosinusitis Disability Index (RSDI) score, medication usage, medical care visits, and sinus infections.

Results

Change in patient‐reported quality of life (QOL), as measured by the CSS total score from baseline to 24 weeks, was significantly greater in the BSD plus MM group compared with the MM‐only group (37.3 ± 24.4 [n = 26] vs 21.8 ± 29.0 [n = 27]; p = 0.0424).

Conclusion

BSD plus MM proved superior to MM alone in enhancing QOL for RARS patients. BSD plus MM should be considered as a viable treatment option for properly diagnosed RARS patients.

https://ift.tt/2FuY806

Quality of recovery in patients undergoing endoscopic sinus surgery after general anesthesia: total intravenous anesthesia vs desflurane anesthesia

Background

For sinus surgery, some centers favor total intravenous anesthesia (TIVA) over inhalation anesthesia. However, whether TIVA affects the patient's perceived quality of recovery remains unclear. This study used the Quality of Recovery–40 questionnaire (QoR‐40) to compare patient recovery between surgical patients who received TIVA and those who received desflurane (DES) anesthesia.

Methods

Eighty patients (20 to 65 years old) undergoing endoscopic sinus surgery were prospectively enrolled and randomized to either the TIVA (propofol and remifentanil infusion) or DES (desflurane inhalation and remifentanil infusion) group. The QoR‐40 was administered before surgery, at 6 hours after surgery, and on postoperative day 1 (POD1). Incidence of nausea and vomiting, remifentanil consumption, blood loss, and pain treatment were recorded. The influence of lesion extent (indexed as Lund‐Mackay [LM] score) on recovery quality was also assessed.

Results

Forty patients were randomized into the TIVA group, and 40 patients were randomized into the DES group. The QoR‐40 score at 6 hours after surgery was significantly higher in the TIVA group compared with the DES group (188.2 vs 182.6, respectively; p = 0.049), indicating a better quality of recovery in the TIVA group. TIVA resulted in less blood loss (p < 0.0001). A high LM score (≥12) was associated with lower QoR‐40 scores at 6 hours after surgery (180.2 vs 187.2, p = 0.028) and on POD1 (181.5 vs 190.3, p = 0.003).

Conclusion

This study shows that the quality of recovery for endoscopic sinus surgery patients was better with TIVA than with desflurane anesthesia. A high LM score was related to poorer recovery quality.

https://ift.tt/2qW3EPo

Pediatricians’ proficiency in the care of the dysphonic child

Objectives/Hypothesis

Pediatricians are the first physicians to see a dysphonic child (DC), yet there are limited data on their proficiency in caring for them. The objective of this study was to understand how pediatricians' experience and their comfort in recognizing/diagnosing voice disorders affects their referral patterns and use of basic treatment options.

Study Design

Survey study.

Methods

A 13‐question survey was sent to pediatricians in the Children's Hospital of Philadelphia's primary care network; 45/216 were returned. Statistical analyses were performed using the Student t test, linear/logistic regression model, Fisher exact test, Kruskal‐Wallis test, and Spearman's correlation test.

Results

Pediatricians practicing longer are more comfortable recognizing dysphonia (P = .0022). They are significantly more likely to refer a DC, even without subjective complaints of hoarseness by the family/patient or compounding medical issues. For each year in practice, the probability of referring increases by 1.55% (P = .0017). Pediatricians with a higher percentage of dysphonic children in their practice are more likely to trust their own perceptual recognition when deciding to refer (P = .0496). Nearly all pediatricians (40/45) would refer to a pediatric otolaryngologist. None would refer to a laryngologist or a voice therapist. No factors significantly affected treatment options.

Conclusions

Veteran pediatricians feel more comfortable diagnosing a voice disorder and are more likely to refer a DC, regardless of patient/parent complaints or compounding factors. Pediatricians are most likely to refer to a pediatric otolaryngologist versus a voice specialist. These findings suggest that education of younger, less‐experienced pediatricians about recognizing voice disorders and options for referral is needed. This may improve the overall care of the DC.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2A5DLAU

Characterization of aged rat vocal fold fibroblasts

Objectives/Hypothesis

To elucidate the aging physiology of the vocal folds, we examined the characters of aged vocal fold fibroblasts (VFFs) in various conditions.

Study Design

In vitro study.

Methods

VFFs from young (12‐week‐old) and aged (19‐month‐old) Sprague‐Dawley rats were compared. Proliferative capacity, ratio of myofibroblast to fibroblast, myofibroblast function, and extracellular matrix production were examined in the following conditions: naïve, basic fibroblast growth factor (bFGF) supplemented, and hepatocyte growth factor (HGF) supplemented.

Results

Aged VFFs demonstrated reduced proliferation by cell counting, though the ratio of Ki‐67–positive cells showed no difference. Aged VFFs exhibited an increased expression of α‐smooth muscle actin (α‐SMA); however, they demonstrated no enhanced contractile ability in a gel contraction assay. Type I collagen protein was increased age dependently, accompanied with decreased Mmp1 and unchanged Col1a1 transcription. Type I collagen protein and α‐SMA represented quite similar reduction patterns to bFGF or HGF administration.

Conclusions

The following possible characteristics of aged VFFs were implied: long duration of mitosis, increased myofibroblast population size with certain dysfunctions, reduced type I collagen turnover, and correlation between α‐SMA expression and type I collagen metabolism. Further investigations of these features will help to clarify presbyphonia's pathology and establish treatment strategies.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2Tr8Qrl

Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base

Objectives

Adenoid cystic carcinoma (ACC) is a locally aggressive salivary gland malignancy prone to perineural invasion and local recurrences. In the literature, few data exist to guide treatment when this tumor involves the paranasal sinuses and skull base. We report our experience in the management of sinonasal adenoid cystic carcinoma through an endoscopic endonasal approach.

Methods

Retrospective analysis of patients affected by sinonasal ACC treated through an endoscopic endonasal approach from 1997 to 2015, managed at the Universities of Varese and Brescia, Italy.

Results

Thirty‐four patients were included in the analysis. The ethmoid sinus (55.9%), nasal septum (17.7%), maxillary sinus (11.7%), and sphenoid sinus (5.9%) were the primary tumor sites encountered. Twenty patients (58.8%) presented with T3 or T4, without any systemic spreading. Twenty‐nine patients underwent endoscopic transnasal resection, whereas the involvement of the anterior skull base in five cases required a transnasal endoscopic craniectomy. Overall, 20 of 34 (58.8%) patients received some form of adjuvant radiotherapy. The follow‐up ranged from 12 to 202 months (mean of 73.2 months). The 5‐year overall, disease‐specific, and recurrence‐free survival rates were 86.5% ± 7.39%, 86.5% ± 7.39%, and 71.8% ± 8.67%, respectively.

Conclusions

The endoscopic approach is safe and effective for selected sinonasal ACC, reducing the comorbidities of the external approaches while producing similar oncological results. High T‐stage, grade III histology, positive surgical margins, and perineural infiltration all have an important negative prognostic value.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2A44tK4

Changing trends in management of vestibular schwannoma: A National Cancer Database study

Objective

To describe changes in management trends of vestibular schwannoma (VS) and the effects of median income, education level, insurance status, and tumor size on receipt of treatment.

Methods

Cross‐sectional analysis using the National Cancer Database from 2004 to 2014. All patients with a diagnosis of VS were identified between 2004 and 2014. Trends in treatment modality over time were analyzed. Correlation between demographics, institution type, median income, education level, and insurance status were assessed using univariate and multivariate logistic regressions.

Results

Of the 22,290 VS patients identified, 16,011 (71.8%) received treatment, whereas 6,279 (28.2%) received observation. Management trend analysis over the 11‐year period revealed patients with tumor size < 1 cm are more frequently observed (34.6% of cases in 2004 vs. 60.8% of cases in 2014) and less frequently received surgery (34.6% vs. 16.8%). Multivariate analysis showed observation was more frequently used in patients ≥ 65 years; black patients; and those on Medicaid, Medicare, and noninsured (P < 0.0001). All tumors > 2 cm were more likely to be treated with surgery, specifically subtotal resections (P < 0.0001). Patients treated at nonacademic centers were more likely to receive linear accelerator, or LINAC (Accuray Incorporated, Sunnyvale, CA) therapy than Gamma Knife (Elekta, Stockholm, Sweden) (P < 0.0001).

Conclusion

Management of VS is shifting toward increased observation, most significantly in tumors size < 1 cm. Insurance provider plays a significant role on receipt of treatment and modality, whereas income and education do not.

Level of Evidence

N/A Laryngoscope, 2018

https://ift.tt/2ToQuY8

Αρχειοθήκη ιστολογίου

Δευτέρα 19 Νοεμβρίου 2018

Summary

Background

Aim

Methods

Results

Conclusion

Abstract

Abstract

Abstract

Abstract

Zusammenfassung

Hintergrund

Fragestellung

Material und Methode

Ergebnisse

Schlussfolgerungen

Abstract

Background

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusions

Abstract

Background

Material and Methods

Results

Conclusion

Abstract

Abstract

Background/Objectives

Methods

Results

Conclusions

Abstract

Abstract

Abstract

Background

Objective

Methods

Results

Conclusions

Abstract

Background

Objective

Methods

Results

Conclusion

Abstract

Background

Objective

Methods

Results

Conclusions