Neonatal Teratoma: Craniofacial Treatment

Teratomas are rare congenital neoplasms. Head and neck locations of the tumor are uncommon with combined intracranial and extracranial extensions being even more rare. The authors present a case of teratoma involving the temporal, buccal, maxillary, orbital and extending to the intracranial regions, which was successfully managed by surgical resection. Address correspondence and reprint requests to Dr Anand Sivadasan, MBBS, Department of Plastic Surgery, Baby Memorial Hospital, Calicut, India; E-mail: anand6527@gmail.com Received 22 May, 2018 Accepted 9 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Bone Flap Technique With Piezosurgery for Impacted Teeth Extraction and Bone Cysts Removal Without Additional Fixation

To explore a new surgical approach for impacted teeth extraction and cystectomy using piezosurgery that provides proper bone healing in normal anatomical structure without additional fixation and graft materials. In cases with intact and relatively thicker vestibular compact bone, a bone flap design was used with converging osteotomy lines made with piezosurgery tips which allow proper stabilization after enucleation or extraction. Procedure was performed in 10 patients with 9 to 36 months follow-up resulted in satisfactory healing without any complications. Comparing to traditional techniques, effective enucleation and accelerated bone regeneration are achieved, with reduced risk of complications, operation time, and costs. Address correspondence and reprint requests to Birkan Tatar, MD, Aydinlikevler mah Cemil Meric Cad IKCU Dis Hek Fak Agiz, Dis ve Cene Cerrahisi, 35640 Cigli/IZMIR, Turkey; E-mail: birkantatar@hotmail.com Received 6 June, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomical Variation in Morphometry and Morphology of the Foramen Magnum and Occipital Condyle in Dried Adult Skulls

Background: The foramen magnum (FM) is the largest opening and is outlet through which medulla oblongata and spinal cord along with meninges, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane, alar ligaments, and spinal branch of the accessory nerve. Occipital condyle (OC) is an important part of craniovertebral or craniocervical junction located anterolaterally on either side of the FM. The objective of the study was to assess variations of FM and OC in Ethiopian dried adult skulls. Methods: Observation-based descriptive study design was employed. The study was undertaken in 54 FM and 108 OC of 54 adult Ethiopian skulls. The morphometry of FM and OC were determined using a sliding vernier caliper. Results: The mean values of anteroposterior and transverse diameters of the FM were 35.19 and 30.17 mm, respectively, and the mean area of the FM was 853.36 mm2. The shapes of FM were determined as round in 22.2%, oval in 18.5%, egg like in 20.4%, triangular in 3.7%, pentagonal in 11.1%, hexagonal in 7.4%, irregular in 13%, and rectangular in 3.7% of the cases. The mean length of right and left OC was 25.69 and 26.96 mm, respectively, and the mean widths of the right and left OC were 12.76 and 13.04 mm, respectively. Conclusion: Our study identified various shapes of FM and diameter. The anteroposterior diameter is greater than the transverse diameter. The morphometric study of OC confirmed the length of left side is significantly greater than the right side. Address correspondence and reprint requests to Yared Asmare, MSc, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 196; E-mail: kyared091107@gmail.coms Received 19 June, 2018 Accepted 11 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Karapandzic Flap: A Useful Option for Reconstruction of Lower Lip

Lip carcinoma is a common cancer of the head and neck region and it more commonly affects the lower lip (>90%). Out of all the carcinomas affecting the lower lip, squamous cell carcinoma accounts for 95% of the patients. Reconstruction of lower lip is a challenging task, as it requires taking into consideration the restoration of function as well as aesthetics. In this study, a patient for whom successful reconstruction of lower lip defect was done using the Karapandzic flap was presented. Address correspondence and reprint requests to Vikrant Dilip Sane, MDS, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth University Dental College and Hospital, Katraj-Dhankwadi Educational Complex, Satara Road, Pune 411043, Maharashtra, India; E-mail: vikrantsane@gmail.com Received 25 June, 2018 Accepted 14 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications

The aim of this study was to compare the clinical outcomes of buccal advancement flap surgery to platelet-rich fibrin (PRF) application for the closure of acute oroantral communications (AOACs). In 36 patients, following the extractions of posterior maxillary teeth, AOACs which were larger than 3 mm diameter were detected. In group A, PRF clots were used in 21 patients and group B, classic buccal advancement flap was used in 15 patients. Baseline variables such as pain, the analgesic doses are taken, and swelling was assessed preoperatively. These were also examined on postoperative days 1, 2, 3, and 7, and patients were seen again in the 3rd week. In group A, statistically significant reduction was examined (P  0.05). In conclusion, both methods were successful for the immediate closure of AOACs. However, a lesser amount of pain and no swelling observed with the use of PRF clots for the immediate closure of AOACs compared to buccal advancement flap surgery. Address correspondence and reprint requests to Kani Bilginaylar, DDS PhD, Department of Oral and Maxillofacial Surgery, Near East University, Near East Boulevard, Nicosia, Mersin 10, Turkey; E-mail: kani_blgnylr@hotmail.com Received 7 March, 2018 Accepted 19 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Masseter-to-Facial Nerve Transfer for Reanimation of a Patient With Long-Term Facial Paralysis

Facial paralysis is a condition caused by a wide variety of etiologies, including neurologic, congenital, infectious, neoplastic, systemic, and iatrogenic causes. A patient suffering from long-term facial paralysis, with minimal innervation detected through electroneurography, who was successfully reanimated by performing a masseter-to-facial nerve transfer, was presented in this study. Facial paralysis had been caused after resection of an acquired middle ear cholesteatoma more than 5 years before. Address correspondence and reprint requests to Enrique Salmerón-González, MD, Francia Avenue, Number 45, 2nd stairs, 9th floor, 25th Door, 46023 Valencia, Comunidad Valenciana, Spain; E-mail: Enrikes900@gmail.com Received 26 October, 2017 Accepted 19 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Tympanogram Findings in Hemodialysis Patients

Background: The aim of this study is to investigate whether changes in cerebrospinal fluid (CSF) pressure during the hemodialysis (HD) treatment are reflected on tympanometric measurements. Methods: The study was performed on 24 HD patients. The static compliance and absorbance values of the patients before and after HD were measured using a wideband tympanometry. The tympanogram tests were performed immediately before and at the end of the HD session. Results: The static compliance values of the patients after HD were significantly lower than those before HD. This decrease significantly correlated with the adequacy of dialysis determined by urea reduction rate and Kt/V. The absorbance values showed a decrease in the band 343 and 727 Hz, but no significant difference was found in other frequencies. The static admittance and absorbance values were influenced by the HD process. Discussion: This influence might be due to the increase in CSF pressure as a result of the removal of urea from blood during HD session. Address correspondence and reprint requests to Mahmut Tayyar Kalcioglu, Department of Otorhinolaryngology, Istanbul Medeniyet, University, Department of Otorhinolaryngology, Goztepe Training and Research Hospital, Dr. Erkin Street, 34730, Goztepe, Kadikoy, Istanbul, Turkey; E-mail: mtkalcioglu@hotmail.com Received 6 June, 2018 Accepted 20 July, 2018 This work was supported by unit of Scientific Investigation Projects of Istanbul Medeniyet University (project no: T-BAG-2016-811). The study presented in the 6th National Otology & Neurotology Congress, April 28 to May 1, 2018, Antalya, Turkey and 11th Balkan Congress of Otorhinolaryngology, June 1 to 3, 2018, Varna, Bulgaria (International). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Distraction Osteogenesis of Fibula Graft for Mandibular Reconstruction Following Ameloblastoma Ablation

Background: Resection of maxillofacial may cause a series of complications such as loss of facial deformity, dysfunction, and psychological distress. Mandibular reconstruction following resection still remains difficult. Methods: A 18-year-old male patient with mandibular ameloblastoma was admitted in the hospital of stomatology. The tumor was dissected and the defect was reconstructed using vascularized fibula graft. One year later, distraction osteogenesis (DO) was performed on the fibula graft to augment the alveolar bone for dental implants. Panoramic radiographs, computed tomography, and clinical photographs were taken. Five months after completion of distraction, the distraction device was removed. Results: Panoramic radiographs, computed tomography, and clinical photographs showed the good healing after fibula graft for mandibular reconstruction following ameloblastoma ablation and satisfied alveolar bone with good width and height for dental implants after DO. Conclusions: This report suggests that DO of fibula graft following mandibular reconstruction was an efficient method to augment the alveolar bone for dental implants. Address correspondence and reprint requests to Yunfeng Li, PhD, Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu 610041, China; E-mail: doctorlyf@163.com Received 24 June, 2018 Accepted 14 July, 2018 This study was supported by grant from the National Natural Science Foundation of China (No. 8187041091). The West China Hospital of Stomalogy Institute Review Board has formally approved (disapproved) this project for period indicated. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Interventions to Reduce Intraoperative Costs: A Systematic Review” by Childers CP, Showen A, Nuckols T, Maggard-Gibbons M in Ann Surg 268:48–57, 2018

No abstract available

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The Precise Midline Positioning Instrument for Le Fort I Osteotomy

To reduce the deviations in the horizontal direction of posterior maxilla during the maxilla Le Fort I osteotomy, the authors develop and validate the precise midline positioning instrument for Le Fort I osteotomy, which can guide the precise relocation of the truncated maxillary bone segment. The patent application for the precise midline positioning instrument for Le Fort I osteotomy is already submitted (patent no: 201711245533.6, China). The accuracy of Le Fort I osteotomy can be improved significantly, because of the amplification effect of this patent on the rotation/micro-movement of the posterior maxilla in all directions to achieve the precise movement and pairing of the maxillary bone segment. And this method is simple, efficient, and laborsaving. Address correspondence and reprint requests to Dr Guomin Wu, PhD, School and Hospital of Stomatology, Jilin University, No 1500 Qinghua Road, Changchun, 130021 Jilin, China; E-mail: guominwu2006@sina.com Received 17 May, 2018 Accepted 24 July, 2018 This study was supported by grants from the Committee of National Nature Science Foundation (no: 81400532) in China, Horizontal joint project of Jilin Province (no: 3R215AX33431), the Graduate Innovation Fund of Jilin University (no: 2017064), Norman Bethune Program of Jilin University (no: 2015301), Fund Project of Jilin Health and Family Planning Commission (no: 2015Q017), Jilin University's Outstanding Young Teacher Training Program (no: 419080500367), the Program for Fundamental Research of Jilin University (no: 450060491134), and the 13th Five-Year Science and Technology Project of the Education Department of Jilin Province (no: 2016486). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Sensory Changes in Periocular Skin After Upper Eyelid Surgery

The aim of this interventional, prospective study is to estimate the change in periocular cutaneous sensation after upper eyelid surgery. The trial included 48 eyes of 24 patients undergoing upper eyelid blepharoplasty or upper eyelid blepharoplasty and blepharoptosis repair. Eyelid sensation was measured using a Cochet–Bonnet filament-type esthesiometer at 4 predetermined anatomical locations in the upper eyelid. The mean esthesiometry reading was calculated at the preoperative visit (4.06 cm), at 2-week postoperative visit (4.38 cm), and at final postoperative visit (4.52 cm). Paired t test showed no significant difference in sensation measurement at second visit compared with baseline (P = 0.205) or at final visit compared with baseline (P = 0.092). Paired t test showed no correlation between type of surgery and change in sensation. Sex and age did not influence change in sensation. In 40 of 42 eyelids, (95.24%), patients reported no reduction in subjective eyelid sensation. The authors conclude that eyelid sensation was not compromised objectively or subjectively by upper eyelid skin incision surgery. Surgeons can reassure patients contemplating surgery that it is very unlikely that cutaneous sensation will be damaged. Address correspondence and reprint requests to Tal Koval, MD, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba, Israel; E-mail: talkovalr@gmail.com Received 25 January, 2018 Accepted 25 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Step-by-Step Procedure for Bone Regeneration Using Calcium Phosphate Scaffolds: From Site Preparation to Graft Placement

Hydroxyapatite (HA) is the main mineral component of bone and teeth. HA is often used as a bone substitute and especially in its granular form it is osteoconductive and osseointegrating as shown by many investigations in animals and humans. HA granules are used for filling bone defects, but they have poor handling qualities and retention at the surgical site, leading to graft voids between the granules and bone tissue and resulting in mechanical instability. Furthermore HA implantation is not constantly followed by favorable results, especially when it is carried out for augmentation of the alveolar ridge. This article offers a protocol for bone reconstruction and predictable implant treatment outcomes. We provide a step-by-step description of both the recipient site and composite graft preparations using coralline HA granules (CHAG) and homologous fibrin glue (HFG). In the present study, 20 randomly selected patients (12 women and 8 men) underwent bone regeneration using CHAG-HFG before a dental implant procedure. Radiographic imaging, physical examination, and histological analysis were performed during a 2-year period. Biopsies were obtained at second-stage surgery before implant insertion using a 2.8-mm trephine bur. A morphological study of 20 bioptic human specimens was performed. Our results demonstrate that this surgical protocol for the preparation of the recipient site associated with a mixture of coralline HA granules with homologous fibrin glue provides reliable bone regeneration, thus reducing failures and minimizing risks of postoperative morbidity. Address correspondence and reprint requests to Antonello Maria Messina, DDS, Via Salaria 394/b, Rome 00199, Italy; E-mail: antonellomariamessina@gmail.com Received 14 February, 2018 Accepted 27 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Transoral Robotic Surgery With Transoral Retropharyngeal Lymph Node Dissection in Patients With Tonsillar Cancer: Anatomical Points, Surgical Techniques, and Clinical Usefulness

Objective: The purpose of this study was to evaluate the clinical usefulness of TORS and transoral robotic retropharyngeal lymph node (RPLN) dissection in tonsillar cancer patients with suspicious RPLN metastasis. Methods: From April 2008 to March 2014, 71 patients with tonsillar cancer underwent transoral robotic surgery and standard neck dissection at the Yonsei Head and Neck Cancer Center. Results: Three patients underwent transoral robotic ropharyngectomy with transoral robotic RPLN dissection because of suspicious RPLN metastasis. The mean age of the patients was 42 years (range, 31–50 years). There were no cases of wound infection or serious complications related to wound healing. Mild nasal regurgitation was observed during an oral diet immediately after surgery, but all patients spontaneously resolved without surgical treatment. There was no significant bleeding due to great vessel injury during surgery or swallowing difficulty due to cranial nerve IX injury. Conclusion: Although the oncologic stability and usefulness of this technique should be confirmed based on large-scale research, RPLN can be easily accessed and resected through our approach with less morbidity compared to the conventional surgical approach. In addition, because RPLN metastasis can be performed pathologically based on obtained specimens, it will be helpful to explore whether to perform adjuvant radiation. Address correspondence and reprint requests to Se-Heon Kim, MD, PhD, Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; E-mail: shkimmd@yuhs.ac Received 24 May, 2018 Accepted 25 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Suturing a Vomer Flap to the Hard Palate Through a Hole When the Nasal Lining is Not Available

The nasal lining by suturing a vomer flap onto the bony ridge of the cleft through a hole was repaired. A 16-month-old girl had an incomplete bilateral posterior cleft palate. While incising the periosteum and elevating the nasal mucosa from the cleft edge of the right side, the mucosa was sheared and a buttonhole was made, and as a result, the nasal lining could not be coapted. A vomer flap to close the nasal lining was applied. On the left side, the nasal mucosa from the cleft margin was sutured to the vomer flap. On the right side, where no nasal lining was available, 2 holes were drilled 5 mm lateral to each bony cleft margin, and the vomer flap was sutured to the palate with 4-0 vicryl through the holes. The elevated bilateral mucoperiosteal flaps were brought together to the midline and sutured to the anterior triangular flap in a V-Y pushback fashion. This method could be used to cover the nasal lining when nasal mucosa is not available. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Junggu, Incheon 22332, Korea; E-mail: jokerhg@inha.ac.kr Received 11 April, 2018 Accepted 25 July, 2018 This study was supported by a grant from National Research Foundation of Korea (NRF-2017R1A2B4005787). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Trans-Oral Robotic Surgery of Submandibular Gland Removal with Preservation of Sublingual Gland and Wharton's Duct

In surgical removal of a submandibular gland, trans-cervical approach has esthetic problem and existing trans-oral approaches are extensively invasive. The authors have used trans-oral robotic surgery to remove the submandibular gland with preservation of the sublingual gland and the Wharton's duct, and hereby report the case and discuss our preliminary experiences. Address correspondence and reprint requests to Dr Limin Liang, MD, DDS, Department of Stomatology, Hainan Branch, Chinese People's Liberation Army General Hospital, 80 Jianglin Road, Sanya, Hainan Province 572013, China; E-mail: lianglm_dr@126.com Received 2 July, 2018 Accepted 27 July, 2018 Dr Liang is currently receiving a grant (817356) from Hainan Provincial Department of Science and Technology. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Intraoral Endoscopic Ligation of Maxillary Artery in the Infratemporal Fossa

Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable. Address correspondence and reprint requests to Georgiy A. Polev, MD, PhD, Department of Oncology and Pediatric Surgery, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela str, 1, Moscow 117997, Russia; E-mail: drpolev@gmail.com Received 3 July, 2018 Accepted 24 July, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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Quantitative Analysis of Change in Intracranial Volume After Posterior Cranial Vault Distraction and Frontal Orbital Advancement/Remodeling

Introduction: Patients with craniosynostosis with shortened occipitofrontal diameter are mainly treated with posterior cranial vault distraction osteogenesis (PVDO) in our institution. If further intracranial volume (ICV) expansion is needed, additional treatment with frontal orbital advancement (FOA) is done. On the contrary, frontal orbital remodeling (FOR) is done for better aesthetic results. In this study, post-treatment ICV changes in patients with craniosynostosis treated with these methods have been investigated. Methods: Patients who underwent FOA or FOR in addition to PVDO at Juntendo University Hospital between 2011 and 2017 were reviewed for patient characteristics and pre/postoperative ICV measurements using 3-dimensional computed tomography scans. Results: Nine patients aged from 5 months to 6 years 8 months at the time of PVDO were included. For PVDO, the ICV change was 113 to 328 mL, and the enlargement ratio of ICV was 109% to 152%. Two patients were further operated with FOA while the remaining 7 with FOR. With FOA, ICV change was 73 to 138 mL, while enlargement ratio of ICV was 107% to 114%. With FOR, ICV change was 3 to 45 mL (mean 20 mL), while enlargement ratio of ICV was 100% to 103%. Conclusion: The PVDO is our first line of treatment for ICV expansion and posterior cranial fossa decompression in patients with severe craniosynostosis. The FOA is performed if extra ICV increase is necessary. This approach seems to enable larger ICV expansions compared with other conventional methods. The FOR should be reserved for patients in whom adequate ICV levels are achieved with PVDO yet additional frontal reshaping is necessary. Address correspondence and reprint requests to Yuzo Komuro, MD, Department of Plastic and Reconstructive Surgery, Teikyo University, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan; E-mail: ykomuro@med.teikyo-u.ac.jp Received 15 May, 2018 Accepted 17 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Does the Current American Society of Anesthesiologists Physical Status Classification Represent the Chronic Disease Burden in Children Undergoing General Anesthesia?

No abstract available

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Pain Management: A Problem-Based Learning Approach

No abstract available

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Handbook of Sepsis

No abstract available

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A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery

BACKGROUND: Minimally invasive fetal surgery is commonly performed to treat twin-to-twin transfusion syndrome with selective fetoscopic laser photocoagulation and twin-reversed arterial perfusion sequence using radiofrequency ablation. Although an increasing number of centers worldwide are performing these procedures, anesthetic management varies. Both neuraxial anesthesia and monitored anesthesia care with local anesthesia are used at different institutions. We sought to determine the efficacy and outcomes of these 2 anesthetic techniques for fetal procedures at our institution. METHODS: All patients undergoing minimally invasive fetal surgery for twin-to-twin transfusion syndrome or twin-reversed arterial perfusion sequence over a 6-year time period (2011–2016) were reviewed. Patients receiving monitored anesthesia care with local anesthesia were compared with those receiving spinal anesthesia in both selective fetoscopic laser photocoagulation and radiofrequency ablation fetal procedures. The primary outcome examined between the monitored anesthesia care and spinal anesthesia groups was the difference in conversion to general anesthesia using a noninferiority design with a noninferiority margin of 5%. Secondary outcome measures included use of vasopressors, procedure times, intraoperative fluids administered, maternal complications, and unexpected fetal demise within 24 hours of surgery. RESULTS: The difference in failure rate between monitored anesthesia care and spinal was −0.5% (95% CI, −4.8% to 3.7%). Patients receiving monitored anesthesia care plus local anesthesia were significantly less likely to need vasopressors, had a shorter presurgical operating room time, and received less fluid (P

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Speaker Gender Representation at the American Society of Anesthesiology Annual Meeting: 2011–2016

The American Society of Anesthesiologists (ASA) Annual Meeting is the primary venue for anesthesiologists to present research, share innovations, and build networks. Herein, we describe gender representation for physician speakers at the Annual Meeting relative to the specialty overall. Details of ASA Annual Meeting presentations for individuals and panels were abstracted from the ASA archives for 2011–2016. Observed speaker gender composition was compared to expected composition based on the gender distribution of members of the ASA. There were 5167 speaker slots across 2025 presentations and panels. Of the speaker slots, 3874 were assigned to men and 1293 to women. Speaker slot gender composition was relatively consistent between 2011 and 2016 (annual percentage 22.3%–27.7% women, trend test P = .062). ASA membership composition of women increased slightly over the study period (24%–28%). The overall observed number of women in speaker slots over the study period did not differ significantly from what would be expected based on the ASA membership composition (25.0% observed vs 25.9% expected; P = .153). However, the percentage of single speakers who were women was significantly less than would be expected based on the ASA gender distribution (20.2% observed vs 25.9% expected; P

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The Impact of Postoperative Intensive Care Unit Admission on Postoperative Hospital Length of Stay and Costs: A Prespecified Propensity-Matched Cohort Study

BACKGROUND: In this prespecified cohort study, we investigated the influence of postoperative admission to the intensive care unit versus surgical ward on health care utilization among patients undergoing intermediate-risk surgery. METHODS: Of adult surgical patients who underwent general anesthesia without an absolute indication for postoperative intensive care unit admission, 3530 patients admitted postoperatively to an intensive care unit were matched to 3530 patients admitted postoperatively to a surgical ward using a propensity score based on 23 important preoperative and intraoperative predictor variables. Postoperative hospital length of stay and hospital costs were defined as primary and secondary end points, respectively. RESULTS: Among patients with low propensity for postoperative intensive care unit admission, initial triage to an intensive care unit was associated with increased postoperative length of stay (incidence rate ratio, 1.69 [95% CI, 1.59–1.79]; P

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General Anesthesia Alters the Diversity and Composition of the Intestinal Microbiota in Mice

Dysbiosis of the intestinal microbiota has been shown to result in altered immune responses and increased susceptibility to infection; as such, the state of the intestinal microbiome may have profound implications in the perioperative setting. In this first-in-class study, we used 16s ribosomal RNA sequencing and analysis in a mouse model of general anesthesia to investigate the effects of volatile anesthetics on the diversity and composition of the intestinal microbiome. After 4-hour exposure to isoflurane, we observed a decrease in bacterial diversity. Taxonomic alterations included depletion of several commensal bacteria including Clostridiales. These data identify volatile anesthetics as potential contributors to microbial dysbiosis in the postoperative patient. Accepted for publication October 17, 2018. Funding:This work was supported by grants from the National Institutes of Health (R01 GM120519-01). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Cyrus D. Mintz, MD, PhD, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Bldg 370, Baltimore, MD 21205. Address e-mail to Cmintz2@jhmi.edu. © 2018 International Anesthesia Research Society

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Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time

The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication October 18, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jeanine P. Wiener-Kronish, MD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, GRB 4–444, Boston, MA 02114. Address e-mail to jwiener-kronish@partners.org. © 2018 International Anesthesia Research Society

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Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy

Abstract

Background

Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence.

Methods

This was a prospective single‐blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin‐polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management‐related factors were recorded.

Results

Forty‐five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment‐related complications occurred.

Conclusion

Feasibility of application of an albumin‐polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula‐preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.

https://ift.tt/2rd6qjr

Posterior Reversible Encephalopathy Syndrome due to Hypomagnesemia: A Case Report and Literature Review

Background. Hypomagnesemia can cause various unspecific neurological complications, which can lead to diagnostic confusion. One of these complications is the posterior reversible encephalopathy syndrome (PRES), which is extremely uncommon and has been reported only twice in the English-language literature. Case presentation. We report the case of a 60-year-old man who presented with PRES involving only the cerebellar hemispheres and associated with hypomagnesemia. After excluding all the other possible etiologies of PRES, we started magnesium replacement therapy, which led to a remarkable but fluctuating clinical and chemical improvement. A full recovery with no need for further supplementation was achieved only after discontinuation of a proton pump inhibitor. Conclusions. This case highlights the role of magnesium in the pathophysiology of PRES; thereby, underlying hypomagnesemia should be considered in every PRES case with unclear etiology.

https://ift.tt/2KEnxUh

Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report

Pallister–Hall syndrome is a rare, autosomal dominant, genetic disorder characterized by different congenital abnormalities: hypothalamic hamartoblastoma, bifid or shortened epiglottis, polydactyly, renal anom...

https://ift.tt/2FOElJv

Der p 1‐specific regulatory T cell response during house dust mite allergen immunotherapy

Abstract

Background

Allergen‐specific immunotherapy (AIT) is the only available treatment for allergic diseases that can induce specific immune tolerance to allergens. The key mechanisms involved in this process include changes in allergen‐specific regulatory T (Treg) cells.

Methods

We studied 25 allergic rhinitis patients undergoing subcutaneous house dust mite‐specific immunotherapy. Peripheral blood mononuclear cells were studied before, after 10 weeks, 30 weeks and 3 years of AIT. Der p 1‐specific T regulatory cell responses was investigated by characterization of Der p 1‐MHC‐class II tetramer‐positive cells and correlated with nasal symptom score.

Results

Twelve of 25 AIT patients matched with their MHC‐class II expression to the Der p 1 peptide‐MHC‐class II tetramers. A significant increase in the numbers of Der p 1‐specific FOXP3⁺Helios⁺CD25⁺CD127^‐ Treg cells after 30 weeks was observed, which slightly decreased after 3 years of AIT. In contrast, Der p 1‐specific immunoglobulin‐like transcript 3 (ILT3)⁺CD25⁺ Treg cells decreased substantially from baseline after 3 years of AIT. ILT3⁺ Treg cells displayed compromised suppressive function and low FOXP3 expression. In addition, Der p 1‐specific IL‐10 and IL‐22 responses have increased after 30 weeks, but only IL‐10⁺ Der p 1‐specific Treg cells remained present at high frequency after 3 years of AIT. Increased number of FOXP3⁺Helios⁺, IL‐10⁺ and decreased ILT3⁺ Treg cell responses correlated with improved allergic symptoms.

Conclusion

The results indicate that AIT involves upregulation of the activated allergen‐specific Treg cells and downregulation of dysfunctional allergen‐specific Treg cells subset. Correction of dysregulated Treg cells responses during AIT is associated with improved clinical response.

This article is protected by copyright. All rights reserved.

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Eine seltene Ursache der asymptomatischen Arteria carotis interna Dissektion

Laryngo-Rhino-Otol
DOI: 10.1055/a-0798-3615

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2P8pU26

The efficiency of extended postoperative antibiotic prophylaxis in orthognathic surgery: a prospective, randomized, double-blind, placebo-controlled clinical trial

Postoperative antibiotics are commonly administered in orthognathic surgery, despite the fact that there is no consensus regarding their efficacy. The objective of this study was to investigate the effectiveness of postoperative antibiotics in orthognathic surgery by conducting a prospective, randomized, double-blind, placebo-controlled trial.Patients were randomly allocated into one of two study groups: the intervention group (treated with 1 gram of intravenous (IV) amoxicillin-clavulanate TID) or the placebo group (treated with 50 mL of IV 0.9% NaCl TID).

https://ift.tt/2Rimagk

Computer-assisted surgery for reconstruction of complex mandibular defects using osteomyocutaneous microvascular fibular free flaps: Use of a skin paddle-outlining guide for soft-tissue reconstruction. A technical report

We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery.

https://ift.tt/2PXurts

A pilot study of modified resection for anterior floor of the mouth squamous cell carcinoma without infiltration of the mandible

To explore the application of modified resection compared with traditional segmental resection of the mandible for patients with anterior floor of the mouth and tongue squamous cell carcinoma (SCC) without infiltration of the mandible.

https://ift.tt/2RlXTGr

Cutaneous extranodal natural killer/T-cell lymphoma: Clinical implications of whole blood Epstein-Barr virus DNA

https://ift.tt/2BFPOa9

A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery

Solid organ transplant and immunosuppressive medications confer higher risk of complications like infection and dehiscence due to larger defect size, complex repair, and impaired healing. Dermatologists should take into account the higher risk of complications when counseling and managing immunosuppressed solid organ transplant recipients undergoing Mohs surgery.

https://ift.tt/2KGU8sh

Alopecia Areata and Poliosis: A Retrospective Analysis of 258 Cases

https://ift.tt/2BFPGHH

A Cross-Sectional Survey and Analysis of Dermatology Foundation Career Development Award Recipients

The DF's CDA Program has had a major favorable impact on the academic workforce and supported innovations that have led to improved patient care. Each dollar of CDA funding through 2015 (i.e., $36.2 M) can be linked to over $10 and $12 in grant support through 2015 and 2017, respectively.

https://ift.tt/2KDvLf8

Clindamycin versus clindamycin plus rifampicin in Hidradenitis Suppurativa treatment: clinical and ultrasound observations

The aim of the study was to assess and compare the clinical efficacy of clindamycin versus clindamycin plus rifampicin in HS patients, after 8 weeks of treatment, according to Hidradenitis Suppurativa Clinical Response measure. Study results suggest that clindamycin in mono-therapy may be a useful and safety alternative to the combination of clindamycin and rifampicin regardless of the clinical stage of HS.

https://ift.tt/2BEaj6N

Response to tofacitinib therapy of eyebrows and eyelashes in alopecia areata

https://ift.tt/2KG5zAH

Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part II: Hepatitis Viruses, Human T-cell Leukemia Viruses, Herpesviruses, and Epstein-Barr Virus)

In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with many benign mucocutaneous diseases.

https://ift.tt/2BEa2Rj

Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part I: Papillomaviruses and Merkel cell polyomavirus)

In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with multiple benign mucocutaneous diseases.

https://ift.tt/2KI7qVq

Psoriasis and Hidradenitis Suppurativa: A Large-scale Population-based Study

How does this article integrate into what was already known This large-scale study reveals a significant association between psoriasis and hidradenitis suppurativa, and supports previous case reports and small studies. How does it change practice? That is, what does the article mean to the practice of dermatology and what should you do as a result of having read this article? What should change in the way you practice Awareness of this association is valuable to physicians treating patients with psoriasis, and systemic therapies confirmed as effective for both conditions may be preferred in patients with dual diagnosis.

https://ift.tt/2BE9ECl

Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy

Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study.

https://ift.tt/2P4KcJW

Horizontal alveolar transport distraction osteogenesis followed by implant placement

Alveolar transport distraction osteogenesis (ATDO) is an alternative treatment method to vertical alveolar distraction osteogenesis in cases of large bony defects, especially when the bone is limited in size. ATDO was performed in 10 patients with 12 defects. The mean age of the patients was 39.1years. The average bone length gain was 18.2mm. Implants were inserted following a 3-month consolidation period. Three patients needed additional bone grafting for horizontal widening. Final prosthetic rehabilitation was performed at least 3 months following implant insertion.

https://ift.tt/2zuH59k

Impaired eating‐related quality of life in chronic rhinosinusitis

Background

Despite the tremendous burden of smell and taste dysfunction in patients with chronic rhinosinusitis (CRS), objective measures of smell and taste fail to fully account for eating‐related disruptions in CRS patient quality of life (QOL). In this study we sought to investigate the driving force behind impaired eating‐related QOL in CRS patients.

Methods

Adult CRS patients were prospectively enrolled and answered a series of surveys relating to smell, taste, overall sinus‐specific QOL, and depression. Patients with both smell‐related and taste‐related eating complaints were considered to have impaired eating‐related QOL. Clinical demographics, objective chemosensory scores, and endoscopy scores were collected.

Results

Seventy patients were enrolled and 23% showed impaired eating‐related QOL. In multivariable analyses, patients with aspirin‐exacerbated respiratory disease (AERD) showed 10.7 times higher odds of impaired eating‐related QOL (odds ratio [OR] 10.72; 95% confidence interval [CI], 1.09 to 105.09; p = 0.042); meanwhile, for every 1‐point increase in depression scores, the odds of impaired eating‐related QOL increased by 1.3 (OR 1.31; 95% CI, 1.10 to 1.57; p = 0.003). For every 1‐point decrease in orthonasal olfactory threshold, the odds of impaired eating‐related QOL increased by 1.9 times (OR 1.85; 95% CI, 1.14 to 3.00; p = 0.013). Symptom scores, polyp status, endoscopic scores, and other olfactory measures did not remain significant after adjusting for other variables in forward‐selection multivariable modeling.

Conclusion

Disruptions in eating‐related QOL cannot be fully explained by objective smell or taste testing alone. We identified AERD and depression as independent risk factors for greater odds of impaired eating‐related QOL in CRS. Improved orthonasal threshold scores were independently associated with better eating‐related QOL.

https://ift.tt/2KHcbie

From stem cells protection to skin microbiota balance: Orobanche rapum extract, a new natural strategy

Summary

Background

Healthy skin is a delicate balance between skin renewal and microbiota homeostasis, and its imbalance promotes premature aging and dermatological disorders. Skin stem cells are key actors in this process but their sensitivity to aging and external stressors such as UV reduces the skin renewal power. The skin microbiota has been recently described as active in the healthy skin, and its imbalance could trigger some disorders.

Aims

We hypothesized that reactivation of stem cells and maintenance of microbiota could be a disruptive strategy for younger and healthier skin. We thus developed a new plant extract that restores the entire skin renewal process by sequential activation from stem cells stimulation to microbiota protection.

Methods

We studied stem cells comportment in the presence of Orobanche rapum extract by survivin immunocytochemistry and caspases 3 and 9 dosages. We also analyzed epidermal differentiation markers by immunohistochemistry and lipids organization by GC/MS At the clinical level, we investigated the impact of O. rapum extract on microbiota and on skin aspect.

Results

We demonstrated an active protection of skin stem cells through the maintenance of their clone‐forming capacity and resistance to UV through the overexpression of survivin coupled to caspases inhibition. Furthermore, we showed the restoration of epidermal differentiation markers and ceramide biosynthesis favorable to orthorhombic organization. Clinical studies, including microbiota analysis, showed an active skin surface renewal coupled with microbiota protection.

Conclusion

We evidenced that our active ingredient is able to stimulate skin rejuvenation while protecting the cutaneous microbiota, creating healthier skin and thereby beauty.

https://ift.tt/2zukycu

Pathogenesis investigation of miR‐199‐5p in oral submucous fibrosis based on bioinformatics analysis

Abstract

Objectives

Fibrosis diseases are one of the leading causes of suffering and death. However, no systematic investigation has been carried out on fibrosis‐related genes.

Materials and Methods

By querying PubMed using keywords "fibrosis" and "gene" or "protein", we identified fibrosis‐related genes in the last decade. Bioinformatics analysis was performed by MAS 3.0 software. Key miRNA was selected to assesse its relationship with oral submucous fibrosis (OSF) and fibroblast functions.

Results

1310 genes related to fibrosis were identified. TGF‐β1, CTGF, MMP9, HSP47 and S1P were found to be associated with mainly fibrotic organs. 244 cellular components terms, 595 molecular function terms, 1816 cellular component terms, 136 KEGG pathway annotations were predicted. MiR‐199‐5p was selected as the key miRNA, which has higher level in OSF. Upregulated miR‐199‐5p was significantly related to OSF duration and OSF histological grade (P = 0.028 and 0.012, respectively). Overexpressive miR‐199‐5p reduced proliferation and induced apoptosis in buccal fibroblasts. Additionally, expression levels of collagen I (COL I) and III (COL III) were promoted by overexpressive miR‐199‐5p in buccal fibroblasts.

Conclusion

These results indicate that fibrosis‐related genes are related to a series of complex mechanisms. The characteristics of miR‐199‐5p may supply important clues for developing therapeutic strategy for OSF.

This article is protected by copyright. All rights reserved.

https://ift.tt/2P6PKUk

SDHx gene detection and clinical Phenotypic analysis of multiple paraganglioma in the head and neck

Objectives

The goal of this study was to detect and explore the mechanisms of the succinate dehydrogenase (SDH) complex subunit‐related gene mutations in cases of multiple paraganglioma (PGL) in the head and neck.

Methods

In Beijing Tongren Hospital (Capital Medical University, Beijing, People's Republic of China) between January 2013 and February 2017, 23 cases of head and neck multiple PGL were evaluated by genetic sequencing. From these cases, four hereditary families and 10 cases with sporadic occurrences were found. Gene mutations, including SDHD, SDHB, SDHC, SDHAF2, VHL and RET in germ cells and somatic cells, were detected by gene capture and high throughput sequencing.

Results

In family 1, 12 instances of SDHD gene mutation were detected, eight of which manifested as bilateral carotid body tumor (CBT) with one bilateral malignant CBT. In family 2, three cases of SDHD mutation were found with one case of bilateral CBT and two cases of unilateral CBT. In family 3, two cases of SDHD gene mutation were found, both characterized by vagus PGL and pheochromocytoma. Of the 10 patients with sporadic manifestations, five cases of SDHD gene mutation and one case of RET gene mutation were detected. Two novel gene mutations, c.387_393del7 mutation of SDHD gene and c.3247A>G mutation of RET gene, were also detected.

Conclusion

In patients with multiple PGL in the head and neck, these are accompanied by a genetic mutation of the germ cell. In this case study, this mutation was most commonly a mutation of the SDHD gene.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2zu7yDM

When to replace legacy cochlear implants for technological upgrades: Indications and outcomes

Objective

To determine indications, surgical efficacy, and audiologic outcomes of replacing Advanced Bionics Clarion C1.2 internal devices (Advanced Bionics, LLC, Valencia, CA) as a means of technology upgrade.

Study Design

Retrospective review, case series.

Methods

Ten patients were initially implanted as a child (mean age = 3.87 years) and underwent cochlear implant reimplantation (CIR) with current Advanced Bionics internal device as a young adult (mean duration of implant use = 15.66 years). Demographic data and pre‐ and post‐CIR speech perception scores were collected.

Results

Technology upgrade was the primary (9) or secondary (1) motivation for CIR. No surgical complications were noted, and full insertion was obtained in nine cases. Intraoperative impedance levels and neural response imaging measures were within normal limits for eight patients. At most recent post‐CIR follow‐up evaluation, all patients (100%) performed within or better than the 95% confidence interval of their pre‐CIR word and sentence recognition scores; and 55.6%, 50.0%, and 50.0% of patients performed above the 95% confidence interval of their pre‐CIR scores for the CNC words, sentences in quiet, and sentences in noise, respectively.

Conclusion

Post‐CIR audiological benefit was stable or improved compared to pre‐CIR results in all categories by 3 months after reactivation. Given these results, patients who are unable to use the most current external processors due to incompatibility with a legacy internal device could consider reimplanation to optimize their overall performance with a cochlear implant.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2P6N9cX

Vocal motor control and central auditory impairments in unilateral vocal fold paralysis

Objectives

To evaluate differences in vocal motor control and central auditory processing between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts.

Study Design

Cross‐sectional.

Methods

Ten UVFP study patients treated by type I thyroplasty with stable voices were compared to 12 control subjects for vocal motor control using a pitch perturbation response task and central auditory processing performance using a battery of complex sound intelligibility assays that included adverse temporal and noise conditions. Standard clinical evaluations of voice production and peripheral audiometric sensitivity were performed.

Results

Vocal motor control was impaired in treated UVFP. The UVFP cohort exhibited a 32.5% reduction in the instantaneous, subconscious compensatory response to pitch feedback perturbation in the interval between 150 ms and 550 ms following onset (P < 0.0001, linear mixed effects model). This impairment cannot simply be ascribed to vocal motor capacity insufficiency in the UVFP cohort because both cohorts demonstrated comparable functional capacity to perform the vocal motor task. The UVFP cohort also showed greater propensity for central auditory processing impairment (P < 0.05), notably for temporal compression and added noise challenges.

Conclusion

Combined central vocal motor control and auditory processing impairments in treated UVFP highlight reciprocal interdependency of sensory and motor systems. This pilot study suggests that peripheral motor impairment of the larynx can degrade central auditory processing, which in turn may contribute to vocal motor control impairment. A more complete restoration communicative function in UVFP will require deeper understanding of sensory, motor, and sensorimotor aspects of the human communication loop.

Level of Evidence

3b Laryngoscope, 2018

https://ift.tt/2ztJdOe

Correlating laryngoscopic appearance of laryngeal lesions with histopathology

Objectives/Hypothesis

Meticulous scrutiny of laryngeal lesions with laryngoscopes and microscopes often identify angiogenic activity, one of the hallmarks of neoplastic and preneoplastic lesions. The aim of this study was to determine if there is an association between laryngoscopic appearance and histopathology of laryngeal lesions based on operative biopsies.

Study Design

Retrospective case‐control study.

Methods

One hundred forty‐four laryngeal biopsies from 92 patients between 2015 and 2017 met inclusion criteria. Cases were patients who had biopsy‐proven laryngeal dysplasia or malignancy. Controls were patients who had benign laryngeal pathology. All of the laryngeal lesions had either keratosis or vascular stippling, an indication of angiogenic activity. Medical records, videostroboscopies and operative findings of these patients were reviewed. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of laryngeal lesions and presence or absence of dysplasia and invasive carcinoma.

Results

Fifty percent of the 144 laryngeal lesions were classified either as dysplastic or malignant by histopathology. Vascular stippling was present in 31% of all laryngeal lesions. On logistic regression, vascular stippling was significantly associated with dysplastic and malignant lesions (P = .0018). Overall sensitivity and specificity of vascular stippling and the presence of dysplasia and malignancy were 51% and 89%, respectively.

Conclusions

Laryngoscopic and microscopic appearance of vascular stippling could inform clinicians on diagnostic sampling of suspicious laryngeal lesions that reduces delay in diagnosis. The low sensitivity of vascular stippling underlies the importance of maintaining high clinical suspicion and proceeding to the operating theater for adequate tissue sampling.

Level of Evidence

3 Laryngoscope, 2018

https://ift.tt/2P5ppG4

Infections of the Ears, Nose, Throat, and Sinuses. Edited by Marlene L. Durand and Daniel G. Deschler . Heidelberg, Germany: Springer; 2018; 404 pp. $199.00

https://ift.tt/2zvSO7f

Primär kutane Lymphome – eine Fallserie von 163 Patienten

Zusammenfassung

Hintergrund

Neben einem breiten, klinisch vielgestaltigen Spektrum bekannter primär kutaner Lymphome, für die eine Inzidenz von 1–3:100.000 angegeben wird, werden jedes Jahr weitere Entitäten präzisiert und definiert. Ziel ist die Darstellung einer Fallserie aus dem klinischen Alltag.

Methodik

Innerhalb eines Zeitraumes von 6 Jahren und 2 Monaten wurden Patienten mit kutanen Lymphomen in der Klinik für Dermatologie und Venerologie am Universitätsklinikum Freiburg registriert. Die Mycosis fungoides (MF) mit ihren Varianten, Sézary-Syndrome (SS), CD30⁺-lymphoproliferative Erkrankungen, Einzelfälle seltener kutaner Lymphome und Subkollektive der B‑Zell-Lymphome sind erfasst. Die große Anzahl der MF-Fälle erlaubte zusätzlich auch die quantitative Analyse der angewendeten Therapien.

Ergebnisse

Die Auswertung von 163 primär kutanen Lymphomen mit jährlich 16 bis 25 Neudiagnosen ergab 111 Fälle mit einer MF einschließlich 9 besonderer MF-Varianten (68,1 %), 15 primär kutane CD30⁺-lymphoproliferative Erkrankungen (9,2 %), dominierend mit 10 Fällen einer lymphomatoiden Papulose (LyP) neben 5 primär kutanen anaplastisch großzelligen Lymphomen (PCALCL), 6 SS (3,68 %) und 24 kutane B‑Zell-Lymphome (14,72 %). Drei Fälle seltener Varianten primär kutaner T/NK(natürliche Killerzellen)-Zell-Lymphome werden gesondert ausgeführt. Es waren 82 % der MF-Fälle im Stadium IA/IB. Für die Stadien I–III wurden therapeutisch in einem absteigenden Ranking Glukokortikoide und diverse UV-Therapien, Bexaroten, Interferon-α, Methotrexat und extrakorporale Photopherese eingesetzt.

Schlussfolgerungen

Lymphomdiagnosen gehören in ein weites differenzialdiagnostisches Spektrum. Die hier dargestellte Registrierung stellt häufige Befunde dar und zeigt seltene Varianten. Man diagnostiziert nur, was man kennt. Dementsprechend können Fallsammlungen, zu denen wir ermutigen möchten, zur Aufarbeitung und Spezifizierung von Entitäten beitragen.

https://ift.tt/2KLZSRX

Panorama Dermatologische Praxis

https://ift.tt/2BEAgn7

Warum Andrologie in der Dermatologie

Zusammenfassung

Die Andrologie entwickelte sich vor mehr als 100 Jahren, um der Gynäkologie eine spezifische Männermedizin v. a. in der Reproduktionsmedizin an die Seite zu stellen. Die ersten Impulse zur klinischen und wissenschaftlichen Entwicklung des Faches gingen in Deutschland von Dermatologen aus. Die Dermatologie darf daher als Mutterdisziplin der Andrologie angesehen werden. Im Jahr 2003 wurde der Sichtbarkeit der Andrologie im medizinischen Fächerkanon durch die Einführung einer Zusatzbezeichnung für Dermatologen, Endokrinologen und Urologen Rechnung getragen, da auch die beiden anderen medizinischen Disziplinen sich mehr und mehr mit andrologischen Fragestellungen beschäftigten. Heute sind die Urologen sowohl unter den Mitgliedern der Gesellschaft für Andrologie als auch unter den Ärzten mit der Zusatzbezeichnung in der Mehrheit. In der Dermatologie gibt es neben den reproduktionsmedizinischen Fragestellungen viele weitere Topics, die den Einschluss der Andrologie lohnen. Deshalb wird die Einbindung dieses Faches nicht nur aus historischen Gründen gepflegt. Die Andrologie ist eine lebendige Subdisziplin in der Dermatologie, und junge Dermatologen sollten zur Beschäftigung mit ihr motiviert sein.

https://ift.tt/2KJnt5G

Linear lipoatrophy following intra‐articular triamcinolone acetonide injection mimicking linear scleroderma

Abstract

A 12‐year‐old female with oligoarticular juvenile inflammatory arthritis developed an atrophic linear plaque involving the left medial forearm and proximal arm 7 months after intra‐articular triamcinolone injection for arthritis. The plaque spontaneously resolved without treatment over approximately one year. It is important to recognize this rare complication of intra‐articular steroid injection in order to avoid potential misdiagnosis as linear scleroderma and subsequent immunosuppressive treatment.

https://ift.tt/2BDI604

An unexpected cause of bilateral periorbital oedema

https://ift.tt/2zEvNiT

Assesment of Transient Palmoplantar Keratoderma With Bullous Pemphigoid

This case series study of 6 patients describes the clinical and immunologic characteristics of bullous pemphigoid associated with transient palmoplantar keratoderma.

https://ift.tt/2zykqbU

Erythematous Papule on the Glans Penis

A 60-year-old man with a history of IgA kappa multiple myeloma was referred for evaluation of an indolent, erythematous papule on his glans penis of 2 weeks' duration; he denied sexual risk behavior and reported no recent changes in medication. What is your diagnosis?

https://ift.tt/2P8eb3x

Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

This population-based study assesses the national incidence of cutaneous and metastatic cutaneous squamous cell carcinoma in England from 2013 through 2015.

https://ift.tt/2zvwYRl

Creating a Partnership Between Dermatologists and Geriatricians

To the Editor We read with great interest and enthusiasm the recent Viewpoint by Linos et al about the need to create a coherent framework to address geriatric dermatologic issues. We agree that older adults are a rapidly expanding and vulnerable segment of the population who require special attention by dermatologists.

https://ift.tt/2P6W3Hi

Creating a Partnership Between Dermatologists and Geriatricians—Reply

In Reply We thank Drs Mundluru and Lee for their thoughtful response to our Viewpoint titled "Geriatric Dermatology—A Framework for Caring for Older Patients With Skin Disease." We agree that we need to create practical collaborations that simultaneously support increased knowledge of dermatology in the field of geriatrics while also broadening the knowledge and application of geriatrics in the field of dermatology. We share a common goal—to improve the care of older adults with skin disease. Collaboration is essential. We support the proposed approach to improving the content of dermatology in geriatrics fellowships.

https://ift.tt/2zwTbi3

Patch Testing and Allergen-Specific Inhibition in a Patient Taking Dupilumab

This case report describes changes in repeated patch test results in a patient receiving dupilumab therapy.

https://ift.tt/2P7eag8

Expert-Level Diagnosis of Nonpigmented Skin Cancer by Combined Convolutional Neural Networks

This study compares the accuracy of a convolutional neural network–based classifier with that of physicians with different levels of experience at classifying dermoscopic and close-up images of nonpigmented lesions.

https://ift.tt/2zvwP0f

Utility of Naltrexone Treatment for Chronic Inflammatory Dermatologic Conditions

This systematic review examines the literature on low- and high-dose naltrexone to summarize evidence about the drug's potential use in treatment of chronic inflammatory conditions of the skin.

https://ift.tt/2P6M44Y

The Difficult Secondary Tracheoesophageal Puncture: A Technique for Safe Insertion

Background/Aims: The tracheoesophageal prothesis (TEP) has become the primary modality for laryngeal communication after total laryngectomy due to high success rates, minimal morbidity, and more natural pulmonary driven speech. Fibrosis, kyphosis, and post-radiation contracture may preclude TEP placement through rigid esophagoscopy, and certain patients may not tolerate an in-office awake procedure. For such patients, a technique for flexible esophageal stenting and TEP placement is necessary. Methods: We performed a retrospective review of 3 patients who underwent TEP placement through endotracheal-tube esophageal stenting at the Massachusetts Eye and Ear Infirmary. Results: All 3 patients underwent laryngectomy after prior chemoradiotherapy for laryngeal cancer with resulting neck contracture and fibrosis preventing rigid esophagoscopy. All patients underwent successful TEP placement through endotracheal stenting without complication and developed excellent tracheoesophageal speech. Specific technical details are highlighted. Conclusions: In patients with anatomical constraints preventing traditional TEP placement through rigid esophagoscopy, fiberoptic guidance through an endotracheal tube stent provides a safe and efficient approach for TEP placement.
ORL 2019;81:10–15

https://ift.tt/2KDaHFP

Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017

Abstract

The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03‐05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.

This article is protected by copyright. All rights reserved.

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Aktuelle Therapiekonzepte bei Kopf-Hals-Karzinomen

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Implantierbare Hörsysteme

https://ift.tt/2E2JImE

Subglottic acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is one of the the most common malignancies of childhood and can occasionally present as acute airway obstruction. We present the unusual case of a 1-year-old boy who was referred to our Paediatric Otolaryngology (ENT) clinic with a recurrent history of croup. This is the first reported case of localised ALL presenting as a subglottic mass in a paediatric patient. It highlights the need to have a broader differential diagnosis in children presenting with 'recurrent croup' including extramedullary presentation of leukaemia and to have a low threshold for performing endoscopy in such cases.

https://ift.tt/2zsdehC

Metformin-associated lactic acidosis precipitated by liraglutide use: adverse effects of aggressive antihyperglycaemic therapy

Older patients with type 2 diabetes are prone to developing adverse events with aggressive antihyperglycaemic therapy. Metformin-associated lactic acidosis (MALA) is one such rare, life-threatening adverse drug effect. We report the case of a 70-year-old man with a glycated haemoglobin of 7.9% who was on a stable, maximally tolerated dose of metformin for managing his type 2 diabetes. He was initiated on liraglutide injections with hopes to achieve better glycaemic control, but developed unrelenting nausea and vomiting during the third week of treatment. He presented to the hospital with these symptoms and was noted to have severe MALA. He sustained an in-hospital cardiac arrest requiring emergent resuscitation along with vasopressor and mechanical ventilator support. He underwent continuous venovenous haemodiafiltration to remove metformin and correct the acidosis, following which he stabilised and supportive therapy was weaned off. He was discharged from the hospital on insulin therapy with incomplete renal recovery.

https://ift.tt/2P7O10V

Corynebacterium striatum prosthetic valve endocarditis with severe aortic regurgitation successfully treated with transcatheter aortic valve replacement

We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.

https://ift.tt/2zucOXY

Tardy ulnar nerve palsy following a neglected childhood lateral epicondyle fracture non-union and resultant cubitus valgus deformity

https://ift.tt/2P8IUxl

Insertion of a Dumon Y-stent via a permanent tracheostoma without using a rigid bronchoscope

A 63-year-old man who had received a permanent tracheostoma after oesophageal cancer surgery developed fistulas in the left and right main bronchi and suffered repeated aspiration pneumonia. Placing an indwelling Dumon Y-stent using a rigid bronchoscope is an option to treat fistula and stenosis at the tracheal bifurcation, but in some cases, it may be difficult to use a rigid bronchoscope in patients with a permanent tracheostoma. In this study, we report placing a Dumon Y-stent in a patient with a permanent tracheostoma using a specially modified stent and forceps instead of a rigid bronchoscope.

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Spontaneous intestinal perforation in a preterm neonate

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Superior sinus venosus atrial septal defect with anomalous pulmonary venous drainage

https://ift.tt/2zycPdv

Foot drop post varicella zoster virus

Leg pain and weakness can often be seen in a musculoskeletal physiotherapy outpatient setting. While the differential diagnoses for neuropathic pain and weakness is often spine related, this unusual cause for polyradiculopathy is less commonly seen. Shingles is not something routinely seen in a physiotherapy department but is usually associated with skin eruptions and pain but less so with motor loss. The purpose of this case report is to therefore raise awareness that this presentation can occur and should not be mistaken for spinal radiculopathy.

https://ift.tt/2P6YZnb

Dandy-Walker variant with precocious puberty: a rare association

Precocious puberty is characterised by premature appearance of secondary sexual characteristics before the age of 7 years in girls and 9 years in boys. Dandy-Walker malformation comprises a spectrum of intracranial malformations of the posterior fossa. We present a case of a 7-year-old male child who has presented with features of central precocious puberty and on further evaluation has been found to have Dandy-Walker variant and secondary hypothyroidism. The following case report describes this association which is extremely rare and has never been described in literature.

https://ift.tt/2zyfBzk

Hiding in plain sight: a brain lesion in a patient with a history of colon and breast cancer

We present a case of a 76-year-old woman who was admitted to our hospital with a low Glasgow Coma Scale score. She had a medical history of breast and colon cancer. The CT scan showed possible diagnosis of brain metastasis. However, the MRI scan showed this to be a completely different diagnosis.

https://ift.tt/2P1X2sp

Does ocular inflammation play a role in xeroderma pigmentosum with endothelial dysfunction: an immunological study

We report a case of xeroderma pigmentosum (XP) with endothelial dysfunction where the analysis of tears revealed elevated levels of proinflammatory cytokines, even in the absence of active inflammation and neovascularisation of the ocular surface. Although the role of ultraviolet (UV) radiation-induced inflammation in the occurrence of ocular manifestations of XP is known, little is published on the molecular mechanisms and there are no reports quantifying the presence of inflammatory cytokines in the tears of patients with ocular involvement of XP. Tear analysis demonstrated an increase in inflammatory cytokines and chemokines, especially interleukin-8 (2.38 ng/µg), tumour necrosis factor alpha (0.87 ng/µg) and granulocyte monocyte colony stimulating factor (0.44 ng/µg) as compared with the control eye. Effective management of the underlying UV-induced inflammation and promoting DNA repair may play a vital role in managing ocular manifestations and its sequelae in patients of XP.

https://ift.tt/2zuIWus

Laundry detergents and detergent residue after rinse directly disrupt tight junction barrier integrity in human bronchial epithelial cells

Publication date: Available online 27 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Ming Wang, Ge Tan, Andrzej Eljaszewicz, Yifan Meng, Paulina Wawrzyniak, Swati Acharya, Can Altunbulakli, Patrick Westermann, Anita Dreher, Liying Yan, Chengshuo Wang, Mubeccel Akdis, Luo Zhang, Kari C. Nadeau, Cezmi A. Akdis

Abstract

Background

Defects in epithelial barrier have recently been associated with asthma and other allergies. The influence of laundry detergents on human bronchial epithelial cells (HBECs) and their barrier function remain unknown.

Objective

We investigated the effects of laundry detergents on cytotoxicity, barrier function, transcriptome and epigenome in HBECs.

Methods

Air-liquid interface cultures of primary HBECs from healthy control subjects, asthma and chronic obstructive pulmonary disease patients were exposed to laundry detergents and detergent residue after rinse. The cytotoxicity and epithelial barrier function were evaluated. RNA sequencing, assay for transposase accessible chromatin with high-throughput sequencing and DNA methylation arrays were used for checking transcriptome and epigenome.

Results

Laundry detergents and rinse residue showed dose dependent toxic effect to HBECs with irregular cell shape and leakage of lactate dehydrogenase after 24h exposure. A disrupted epithelial barrier function was found with decreased transepithelial electric resistance, increased paracellular flux and stratified tight junction immunostaining in HBECs exposed to laundry detergent at 1:25,000 dilutions or rinse residue at further 1:10 dilutions. RNA sequencing analysis showed that lipid metabolism, apoptosis progress and epithelial-derived alarmins related genes were up-regulated, while cell adhesion related genes were down-regulated by laundry detergent at 1:50,000 dilutions after 24h exposure without substantially affecting chromatin accessibility and DNA methylation.

Conclusion

Our data demonstrate that laundry detergents even at a very high dilution and rinse residue show significant cell toxic and directly disruptive effects on the tight junction barrier integrity of HBECs without affecting the epigenome and tight junction genes expression.

https://ift.tt/2Sl6c5r

Early B cell developmental impairment with progressive B cell deficiency in NFKB2 mutated CVID disease without autoimmunity

Publication date: Available online 28 November 2018

Source: Clinical Immunology

Author(s): Vassilios Lougaris, Daniele Moratto, Manuela Baronio, Tiziana Lorenzini, Stefano Rossi, Luisa Gazzurelli, Maria Pia Bondioni, Alessandro Plebani

Abstract

This study provides evidence for a novel role for NFKB2 in human B cell development in the bone marrow and in the periphery, leading to progressive peripheral B cell deficiency not always combined with autoimmune phenomena, broadening thus the clinical spectrum of NFKB2 mutated CVID disease and implying an essential role for NFKB2 in early human B cell development.

https://ift.tt/2E3ATca

The role and clinical significance of programmed cell death- ligand 1 expressed on CD19+B-cells and subsets in systemic lupus erythematosus

Publication date: Available online 28 November 2018

Source: Clinical Immunology

Author(s): Xiao-Yun Jia, Qing-qing Zhu, Yuan-Yuan Wang, Yang Lu, Zhi-Jun Li, Bai-Qing Li, Jie Tang, Hong-Tao Wang, Chuan-Wang Song, Chang-Hao Xie, Lin-Jie Chen

Abstract

Background

Programmed cell death-1 (PD-1) and programmed death-ligand 1 (PD-L1)-targeted therapies have enhanced T-cell response and demonstrated efficacy in the treatment of multiple cancers. However, the role and clinical significance of PD-L1 expression on CD19⁺ B-cells and their subsets, with particular reference to systemic lupus erythematosus (SLE), have not yet been studied in detail.

Objective

The present study aimed to investigate PD-L1 expression on CD19+ B-cells and their subsets, in addition to exploring its possible role in Tfh-cell activation and B-cell differentiation in SLE.

Methods

Frequencies of CD19⁺ B-cells, their subsets, PD-L1 and Tfh cells in the peripheral blood of SLE patients and healthy controls (HCs) were determined using cytometry. The clinical data of SLE patients were recorded in detail, and the correlation between their laboratory parameters, clinical parameters and disease activity indices was statistically analyzed. CD19⁺PD-L1⁺B-cells and CD19⁺PD-L1⁻ B-cells were sorted and cultured with a stimulant, following which the supernatants were collected for immunoglobulin G and anti-double stranded DNA detection via enzyme-linked immunosorbent assay.

Results

In SLE patients, CD19⁺B-cells and partial subgroups were enriched in peripheral blood. Also, the observed increase in the frequency of CD19⁺PD-L1⁺B-cells was significantly associated with a higher disease activity index. An in vitro culture test demonstrated that the amounts of anti-dsDNA and immunoglobulin G secreted by the CD19⁺PD-L1⁺B-cells of SLE patients and HCs were vastly different. In addition, a strong correlation existed between the frequencies of CD19⁺PD-L1⁺B-cells and defined Tfh cells of SLE patients.

Conclusion

This study demonstrated that the expression of CD19⁺PD-L1⁺B-cells in the peripheral blood of SLE patients was abnormal, and that disease-related laboratory parameters and clinical indicators were correlated. CD19⁺PD-L1⁺B-cells were enriched and played a critical role in activating the pathogenic T-cell and B-cell responses in patients with SLE.

https://ift.tt/2Sk6R79

Magnolol attenuates the inflammation and enhances phagocytosis through the activation of MAPK, NF-κB signal pathways in vitro and in vivo

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Hongce Chen, Wuyu Fu, Hongyuan Chen, Siyuan You, Xiawan Liu, Yujiao Yang, Yao Wei, Jun Huang, Wen Rui

Abstract

Magnolol is a natural extract and the main bioactive component from Chinese medicine-Magnolia. We speculate that it's functional action might be associated with the anti-inflammatory effects of magnolol. Herein, the main purpose was to elucidate the phagocytic immune function and anti-inflammatory activities associated. The toxicity of magnolol on U937 and LO-2 cells was assayed by MTT, flow cytometry and laser scanning confocal microscope was utilized to detect the phagocytosis effect on U937 cells, C57BL/6 mice and the follow-up hematoxylin-eosin staining methods were used to evaluate its bioactivity in vivo. The results showed that magnolol had dose dependent effects on enhancement of phagocytosis ability and significantly inhibited the NO production at the concentration range from10 to 40 μM. Furthermore, Magnolol significantly reduced the gene expression and protein release of IL-1β and TNF-α. However, the p-ERK1/2 in MAPK signaling pathway was not significantly affected by magnolol, whereas p-JNK and p-P38 were down-regulated. Magnolol also inhibited the expression of p-IκBα and p-P65 of NF-κB signaling pathways. The loss of body weight and the shorter length of colon were significantly improved in DSS-treated colitis C57BL/6 mice after the administration of magnolol. The cytokines of pro-inflammatory factors TNF-α, IL-6 and IL-1β attenuated significantly in a concentration dependent manner. The histopathological manifestations of 5–20 mg/kg after the treatment magnolol were markedly improved in the DSS-treated mice. These findings showed that magnolol exerted an anti-inflammatory effect through immunoregulatory phagocytosis, MAPK and NF-κB signaling pathways. Our results provide experimental evidence and theory basis for research on anti-inflammatory effects for magnolol as a potentially anti-inflammatory drug candidate.

Graphical abstract

https://ift.tt/2r7aG3S

E. coli induced larger neutrophils in the peritoneal cavity of mice with severe septic peritonitis

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Yilan Song, Guang Yang, Zhiqin Li, Peiyan Zhao, Lei Yang, Cuiyun Cui, Shiyu Xing, Liying Wang, Yongli Yu

Abstract

Neutrophils, classified as professional phagocytes, are crucial in killing bacteria and preventing inflammation. When studying the roles of neutrophils in the development of the septic peritonitis induced by E. coli, we noticed some of the larger cells existed among peritoneal lavage fluid cells (PLCs). Besides the large size, their nuclei are segmented and flat, and squeezed to the marginal zone of the inner membrane. The cells, therefore, were designated as E. coli induced larger neutrophils (e-Neus). Further studies showed that, the e-Neus were ly6G positive, indicating the e-Neus were a type of neutrophils. The enlarged cell size and marginal nucleus of the e-Neus were caused by engulfing abundant of E. coli, marking the active participation of the e-Neus in clearance of E. coli. Functionally, the e-Neus generated reactive oxygen species (ROS) and IL-10. Furthermore, the occurrence and accumulation of the e-Neus were closely correlated with the severity of septic peritonitis and mortality of the mice. Overall, the e-Neus presented here may enrich the understandings on neutrophil transitions in response to various insults, and could be used to evaluate the severity of septic peritonitis induced by E. coli.

https://ift.tt/2FLPfQ6

Toll like receptor induces Ig synthesis in Catla catla by activating MAPK and NF-κB signalling

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Bhakti Patel, Rajanya Banerjee, Madhubanti Basu, Saswati S. Lenka, Mahismita Paichha, Mrinal Samanta, Surajit Das

Abstract

The molecular crosstalk of proximal innate immune receptor signaling mediated by Toll-like receptors (TLRs) is crucial in generating an adaptive immune response. The extracellular-signal regulated kinases (ERK) participate in propagating intracellular signals initiated by stimulated TLRs to transcription factors eliciting cytokine release. Although ERK signaling has been extensively studied in mammalian counterparts, very little is known about its existence in carps and its role in augmentation of immunoglobulin (Ig) synthesis. Therefore, to gain insights into the efficacy of MAP kinase cascade in orchestrating fish antigen receptor generation, Catla catla fingerlings were induced with various TLR agonists or pathogen associated molecular patterns (PAMPs). Analysis of upstream signaling events revealed that PAMPs stimulated the tissues leading to a significant upregulation (P < 0.001, One-way ANOVA) of different TLRs (TLR2, TLR3, TLR4 and TLR5) followed by activation of MyD88 dependent and independent pathway. Activation of ERK and NF-κB mediated cytokine production consequently triggered the enhanced expression of IgZ and IgM as was evident by qRT-PCR analysis, flow cytometry, immunoblotting and ELISA. Pretreatment with ERK inhibitor (UO126) antagonized PAMPs mediated TLR stimulation, leading to sequential downregulation of MyD88/NF-κB/cytokines via interrupting ERK/NF-κB signaling axis. Together these results demonstrate that TLR stimulation triggers IgZ and IgM production via activation of ERK and NF-κB in C. catla indicating that NF-κB mediated cytokine production and ERK1/2 signaling is not only functional in fish, but may be crucial for generation of Ig repertoire in lower vertebrates.

Graphical abstract

https://ift.tt/2rbuPWk

Unveiling the regulation of NKT17 cell differentiation and function

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Ageliki Tsagaratou

Abstract

Invariant natural killer T cells (iNKTs) are distinct from conventional T cells. iNKT cells express a semi-invariant T cell receptor (TCR) that can specifically recognize lipid antigens presented by CD1d, an MHC class I-like antigen-presenting molecule. Currently, iNKT cells are distinguished in three functionally distinct subsets. Each subset is defined by lineage-specifying factors: T-bet shapes the fate of NKT1 subset that mainly secretes IFNγ, Gata3 specifies the NKT2 subset that produces robustly IL-4 whereas RORγt seals the differentiation of NKT17 subset that secretes IL-17. In the present review, the focus is placed on the regulation of NKT17 specification and their function.

https://ift.tt/2FNqX8t

Palmatine attenuated dextran sulfate sodium (DSS)-induced colitis via promoting mitophagy-mediated NLRP3 inflammasome inactivation

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Chu-Tian Mai, Mei-Mei Wu, Chun-Li Wang, Zi-Ren Su, Yuan-Yuan Cheng, Xiao-Jun Zhang

Abstract

Activation of NLRP3 inflammasomes is crucial in the pathological process of Ulcerative colitis (UC), which could be negatively regulated by PINK1/Parkin-driven mitophagy. Palmatine is a herb derived isoquinoline alkaloid with potent anti-inflammatory and anti-bacteria activities. In present study, we evaluated the effect of palmatine on dextran sulfate sodium (DSS)-induced mice colitis and examined whether its effect is exerted by promoting mitophagy-mediated NLRP3 inflammasome inactivation. The result showed that palmatine (40, 100 mg/kg) significantly prevented bodyweight loss and colonic shortening in DSS mice, and reduced the disease activity index and histopathologic score. The levels of MPO, IL-1β, TNF-α and the number of F4/80+ cells in colon of DSS mice were remarkably decreased by palmatine. Moreover, palmatine suppressed NLRP3 inflammasomes activation, but enhanced the expression of the mitophagy-related proteins involving LC3, PINK1 and Parkin in colonic tissue of DSS mice. These effects was consistent with the in vitro data revealing that palmatine inhibited the activation of NLRP3 inflammasomes, while promoted the expression and mitochondrial recruitment of PINK1 and Parkin in THP-1 cell differentiated macrophages. Furthermore, the effect of palmatine on THP-1 cells was neutralized by a mitophagy inhibitor Cyclosporin A (CsA) and PINK1-siRNA. In parallel, CsA significantly attenuated the therapeutic effect of palmatine in DSS mice, illustrating that the anti-colitis effect of palmatine is closely related to mitophagy. Taken together, the current results demonstrated that palmatine protected mice against DSS-induced colitis by facilitating PINK1/Parkin-driven mitophagy and thus inactivating NLRP3 inflammasomes in macrophage.

Graphical abstract

https://ift.tt/2r8C3ux

Editorial board

Publication date: December 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 12

Author(s):

https://ift.tt/2E2hRmw

Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI

Publication date: Available online 27 November 2018

Source: Auris Nasus Larynx

Author(s): Kayoko Higashi-Shingai, Takao Imai, Tomoko Okumura, Atsuhiko Uno, Tadashi Kitahara, Arata Horii, Yumi Ohta, Yasuhiro Osaki, Takashi Sato, Suzuyo Okazaki, Takefumi Kamakura, Yasumitsu Takimoto, Yoshiyuki Ozono, Yoshiyuki Watanabe, Ryusuke Imai, Yukiko Hanada, Kazuya Ohata, Ryohei Oya, Hidenori Inohara

Abstract

Objective

This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (−SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD).

Methods

Twenty-one patients with unilateral MD who underwent sac surgery were included in this study. All patients underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI) before and 2 years after sac surgery. We evaluated the difference in vestibular and cochlear endolymphatic hydrops between before and after surgery in both ears and compared these findings with the frequency of vertigo attacks, hearing level, and ECochG findings.

Results

In affected ears, the presence of vestibular endolymphatic hydrops and the frequency of vertigo attacks significantly decreased after surgery. However, affected ears showed no significant improvement in the presence of cochlear endolymphatic hydrops or the −SP/AP ratio by ECochG; there was also no significant improvement or deterioration in the hearing level.

Conclusion

The present findings suggest that sac surgery reduces vestibular endolymphatic hydrops and prevents aggravation of cochlear endolymphatic hydrops, and these changes lead to a reduction of vertigo attacks and suppress the progression of hearing impairment associated with vertigo attacks.

https://ift.tt/2RiDMIV

Fluorescence imaging of invasive head and neck carcinoma cells with integrin αvβ6-targeting RGD-peptides: an approach to a fluorescence-assisted intraoperative cytological assessment of bony resection margins

Publication date: Available online 28 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): M. Nieberler, U. Reuning, H. Kessler, F. Reichart, G. Weirich, K.-D. Wolff

Abstract

We assessed the use of peptides containing arginylglycylaspartic acid (RGD) that target integrin αvβ6 as a potential approach for a fluorescence-assisted intraoperative cytological assessment of bony resection margins (F-AICAB) in patients who had bone-infiltrating squamous cell carcinoma (SCC) of the head and neck. This was assessed to demarcate invasive carcinoma cells that stained for αvβ6. Specimens from bony resection margins (n=362) were defined as either malignant or benign according to the results of cytological and histological examinations. Integrin αvβ6-targeting fluorescence-labelled RGD peptides were added to the cytological samples and the accuracy of the resulting signal assessed by comparing it with the cytological findings. The value of F-AICAB was evaluated to find out if it could help to improve future diagnoses, tests, and treatments. Integrin αvβ6 was strongly expressed in invasive SCC cells and qualified as a marker for bone-infiltrating carcinoma cells. It showed a high affinity to bind to invasive SCC cells and enabled swift and specific demarcation of αvβ6-stained carcinoma cells. It was also diagnostic, with a sensitivity of 100% (95% CI 81.3% to 99.3%), specificity of 98.3% (95% CI 94.4% to 99.0%), positive predictive value of 92% (95% CI 70.2% to 94.3%), and negative predictive value of 100% (95% CI 96.9% to 99.9%), compared with the cytological findings. The targeting of specific integrin subtypes with selective, synthetic ligands, adapted for multimodal imaging, is a promising new approach to diagnosis. Further studies are necessary to provide more evidence for successful clinical translation and to establish the impact on clinical procedures.

https://ift.tt/2DOBpcX

Patterns of distant metastasis in head and neck cancer at presentation: Implications for initial evaluation

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Jeffrey C Liu, Mihir Bhayani, Kristine Kuchta, Thomas Galloway, Christopher Fundakowski

Abstract

Importance

Evaluation of distant metastasis (DM) is part of every new cancer evaluation. Understanding DM presentation patterns may impact the imaging workup of Head and Neck Squamous Cell Carcinoma (HNSCC).

Objective

Examine the frequency and location of DM at presentation in HNSCC. We hypothesize that DM are rare, and the lung is the most common site for DM. Secondary evaluation includes identifying patient and tumor factors predictive of DM, and the implications for selection of workup imaging.

Design

Data from the National Cancer Data Base (NCDB) from 2010 to 2015 were analyzed. Subsites evaluated included oral cavity, oropharynx, larynx, hypopharynx, and nasopharynx. Sites of distant metastasis were evaluated in available cases and analyzed.

Setting

Population based database study.

Results

151,730 cases were available for analysis. Nasopharynx had the highest percentage of M1 disease (9.1%) followed by hypopharynx (7.3%). Excluding the nasopharynx (NP), 3.1% of cases were reported as M1. Advanced T-stage, positive N-stage, and N3 status were all predictors of M1 status on univariate and multivariate analysis for all subsites (P < 0.05). Where site of metastasis was available, most (53.1%) DM cases presented with at least lung involvement. In nasopharynx cancers, only 32.8% of DM included the lung.

Conclusions and relevance

Distant metastasis in HNSCC are rare events. PET/CT offers many advantages, but for routine distant metastasis evaluation in HNSCC, CT scan of the chest may be more cost-effective.

https://ift.tt/2PW9nDL

Comparative study of epidermal growth factor and observation only on human subacute tympanic membrane perforation

Publication date: Available online 27 November 2018

Source: American Journal of Otolaryngology

Author(s): Zheng-Cai Lou, Yihan Dong, Zi-Han Lou

Abstract

Objective

To compare the effects of epidermal growth factor (EGF) and observation only on human subacute tympanic membrane perforation (TMP).

Methods

A total of 44 patients with traumatic TMPs >2 months after trauma were divided into an observation group (n = 18) and EGF group (n = 26). Patients in the EGF group underwent direct application of EGF without stripping of the perforation edge. All patients were followed up for at least 6 months. The TMP closure rate, closure time, and hearing gain were evaluated.

Results

At 6 months, 25 of 26 (96.2%) perforations achieved complete closure with a mean closure time of 9.1 ± 3.9 days (range, 3–14 days) in the EGF group. However, only 11 of 18 (61.1%) perforations achieved complete closure in the observation group, with a mean closure time of 20.6 ± 10.7 days (range = 9–71 days). The patients in the EGF-treated group had significantly improved closure rates (P = 0.026) and a reduced closure time (P < 0.01) compared to those in the observation group. The difference in mean hearing improvement between the two groups was not statistically significant (P = 0.86).

Conclusions

Topical application of EGF improved the closure rate and shortened the closure time of human subacute TMPs compared with spontaneous healing, the stripping of the perforation edge was unnecessary. This treatment is simple and convenient and should be recommended pre-myringoplasty.

https://ift.tt/2P7vQbB

Recurrent Desmoid Tumor of the Neck: A Case Report of a Benign Disease with Aggressive Behavior

We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases.

https://ift.tt/2Q4CR2w