Styloid-stylohyoid syndrome: a rare cause of cranio-facial pain—a retrospective case series of 12 patients

Abstract

Purpose

Elongated styloid process results in severe cranio-facial/cervico-facial pain. The purpose of this study is to determine the efficacy of treatment outcomes using transcervical approach in the management of styloid-stylohyoid syndrome/styloid syndrome.

Study design

This is a retrospective cohort study. Subjects were enrolled from out-patient clinics reporting between the periods Jan 2016–Jan 2018.

Methods & methods

Twelve patients diagnosed with styloid syndrome based on history, thorough clinical workup, and assessment were included in the study. The primary outcomes—improvement in pain and regression of chief complaints following surgery were assessed. Elongated styloid was resected using transcervical approach under general anesthesia.

Results

The intra-operative lengths of the styloid process varied from 40 to 43 mm. No post-operative complications were encountered and the symptoms regressed completely after surgery in all the patients at follow-up of 6 months.

Conclusions

Transcervical styloidectomy is an effective treatment for exposure and resection of the styloid process with minimal complications in patients with stylo-stylohyoid syndrome.

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Erratum zu: Primärversorgung von akutem Schwindel

Erratum zu:

HNO 2018 66:472–479

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Die Autoren möchten auf einen Tippfehler im Manuskript hinweisen. Dabei wurde die Arbeit von Maxwell et al. [40] zitiert, welche die Bedeutung der Kopf-Anteflexion für die Durchführung des vKIT untersucht hat. Diese Arbeit kam zu dem …

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Case 37-2018: A 23-Year-Old Woman with Vision Loss

Presentation of Case. Dr. Seth N. Levin (Neurology): A 23-year-old right-handed woman with a history of migraines was evaluated at this hospital for vertigo and vision loss affecting the right eye. Six days before admission, a right frontal headache and right retro-orbital pain developed; these…

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Case 35-2018: A 68-Year-Old Woman with Back Pain and a Remote History of Breast Cancer

Presentation of Case. Ms. Diane P. Doyle, M.S.N. (Medicine): A 68-year-old woman with a history of bilateral breast cancer was evaluated at the oncology clinic of this hospital for back and pelvic pain. Twenty-five years before the current evaluation, the patient was noted to have a small lump in…

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Role of phosphorylcholine in Streptococcus pneumoniae and nontypeable Haemophilus influenzae adherence to epithelial cells

Phosphorylcholine (PC) is a structural component of Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi), and is known to be associated with adherence through the platelet activating factor receptor (PAF-R). Furthermore, high PC expression is considered to be involved in Spn and NTHi virulence. In this study, we examined the influence of PC expression on the adherence of Spn and NTHi to epithelial cells in order to clarify the potential effectiveness of a vaccine targeting PC.

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Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases

To employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere's disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.

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Corrigendum to “Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study” [Auris Nasus Larynx 45 (2018) 1006–1013]

In the ethical considerations section of the article, the ethical committee should read as follows: "The University of Tokyo, Graduate School of Medicine".

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Anti-microbial Resistance In Atopic Dermatitis: Need for an Urgent Rethink

Atopic dermatitis (AD) results from a complex interplay of host genetic and environmental factors. There is a long established association between AD and Staphylococcus aureus. In healthy individuals this organism has a dichotomous relationship with the host, being a frequent component of the human microbiome, carried asymptomatically, and on occasion, an opportunistic pathogen capable of causing or influencing a broad ranging disease. In AD, high carriage rates of S. aureus on affected skin is commonly observed, with recent meta-analysis evidence demonstrating colonisation in approximately 70% of affected individuals 1.

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Corrigendum to “National Wisdom Tooth Treatment Audit” [Br. J. Oral Maxillofac. Surg. 54 (10) (December 2016) e71]

The authors regret that Kate Matin's name was missed of the author list in the original article. It appears correctly above.

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Incidence of Thyroid Cancer Among Residents Within 5 Years of the 2011 Fukushima Nuclear Accident

This cohort study of 324 301 children and young adults in Fukushima, Japan, evaluates the number of detected thyroid cancers by age group within 5 years of the 2011 Fukushima Daiichi nuclear power station accident and compares basic clinical characteristics and demographic patterns in first-round and second-round examinations.

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Effect of TIVA vs VIMA on Emergence Agitation After Nasal Surgery

This randomized clinical trial investigates the effect of total intravenous anesthesia (TIVA) vs volatile induction with maintenance anesthesia (VIMA) on the occurrence of emergence agitation among patients undergoing nasal surgery.

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Care of Patients With Endocrine Conditions

In this issue, we present the study by Ohtsuru and colleagues who analyzed clinical characteristics of thyroid cancers screened by ultrasonography in children and young adults during the first 5 years after the 2011 Fukushima Daiichi Nuclear Power Station accident. Along with the publication of this landmark study, I am excited to announce a new section editor in JAMA Otolaryngology–Head & Neck Surgery who will be dedicated to the care of patients with endocrine conditions. I invited Louise Davies, MD, MS, to serve as the first Endocrinology Section Editor. Dr Davies is an internationally recognized expert on thyroid cancer with a focus on appropriate treatment of adults diagnosed with small thyroid nodules and has methodologic expertise in epidemiology and mixed-methods research approaches. I am also excited to announce the appointment of Luc G. T. Morris, MD, MSc, to the editorial board. Dr Morris' research program straddles head and neck cancer genomics and the epidemiology of overdiagnosis, and he has methodologic expertise in biostatistics and bioinformatics. Together, they will provide breadth and depth to this renewed area of clinical focus.

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Why the Data From the Fukushima Daiichi Nuclear Power Station Accident Are Important

On March 11, 2011, the Great East Japan Earthquake and subsequent giant tsunami led to catastrophic damage at the TEPCO (Tokyo Electric Power Company Holdings) Fukushima Daiichi nuclear power station. Radioactive materials spread into the Fukushima Prefecture. Although the estimated release of radioactive material was quite small, the accident caused great alarm within the population. In response, 4 months later, in July 2011, the Fukushima Health Management Survey was launched to monitor for potential radiation-induced health effects, including a large-scale thyroid surveillance program. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Ohtsuru and colleagues provide data from the initial 2 rounds of ultrasound screening during the first 5 years after the accident, the first round between 2011 and 2013 and the second round between 2014 and 2015. Ultimately, 324 301 individuals who had been younger than 18 years at the time of the accident (the age group at higher risk of thyroid cancer after radiation exposure) were included in the analysis. During the 4 years after the accident that the screening rounds took place, 187 children and adolescents were diagnosed with thyroid cancer; the most common pathologic diagnosis was papillary thyroid cancer (98.0%).

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Thyroid Cancer Screening After Nuclear Accidents

This guideline recommendation by an expert group convened by the International Agency for Research on Cancer outlines recommendations for thyroid screening after nuclear events.

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An Indolent Middle Ear Mass

A woman in her 30s with a 1-year history of left ear fullness presented with left-sided hearing that improved temporarily with autoinsufflation. What is your diagnosis?

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Anemia and 30-Day Morbidity and Mortality After Thyroidectomy in Thyroid Cancer Treatment

This cross-sectional cohort study uses the American College of Surgeons National Surgical Quality Improvement Program database to evaluate whether an association exists between preoperative anemia and postoperative 30-day morbidity and mortality outcomes following thyroidectomy in adult patients with thyroid cancer.

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Elevated expression of IL-17RB and ST2 on myeloid dendritic cells is associated with a Th2-skewed eosinophilic inflammation in nasal polyps

Interleukin(IL)-25, IL-33, and thymic stromal lymphopoietin (TSLP) underlie the crosstalk between epithelial cells and dendritic cells (DCs) during the development of Th2 responses. This study aimed to measure...

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Case of malignant melanoma responding to dacarbazine following nivolumab

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Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real‐life practice: The Resoswitch study

The main aim of this study was to describe switching practices in daily practice. Patients included were those seen in daily routine practice. Efficacy was defined as the achievement of at least 75% improvement in the PASI score (PASI75). A total of 1,157 patients were included. The frequency of switching was 29.9% and switching was efficient in 71.9% of the cases. The study's results allows a better understanding of the profile of patients who require switch and he appears a change of therapeutic class appears to be more effective in psoriasis patients who require a switch in their therapy.

This article is protected by copyright. All rights reserved.

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Sexual dimorphism in hepatitis B and C and hepatocellular carcinoma

Abstract

The incidence of viral hepatitis B or C (HBV/HCV) infection and hepatocellular carcinoma is higher in male compared to female populations, showing a faster disease progression and results in a worse overall survival. Indeed, women are in general better protected from viral infections and show a lower risk of death from malignant cancer in comparison to men. Females mount stronger innate and adaptive immune responses than males, and therefore, most of the autoimmune diseases occur predominantly in females. Next to occupational and/or behavioral factors, cellular and molecular differences between the two sexes contribute to this observation. In this review, we will discuss underlying mechanisms that are important for the observed sex-related differences in liver diseases. A better appreciation of these differences between the two sexes might be of value for better and gender-specific treatment options.

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Advancements in MAPK signaling pathways and MAPK‐targeted therapies for ameloblastoma: A review

Abstract

Numerous signal transduction pathways are closely associated with the occurrence, development, and prognosis of ameloblastoma(AM). Mitogen‐activated protein kinase (MAPK) is a serine/threonine‐specific protein kinase that transduces intracellular signals in critical cellular phenomena. A number of recent analyses have reported that the MAPK signaling pathway contributes significantly to AM. High‐throughput DNA sequencing methods, such as next‐generation sequencing using Illumina have yielded advancements in studies on MAPK signaling pathways and their association with AM; in particular, BRAF V600E is mediated by the activation of the Ras/Raf/MAPK pathway. This review discusses advancements in studies on MAPK signaling pathways and MAPK‐targeted inhibitors or antibodies, along with the merits and demerits of MAPK‐targeted therapies, finally followed by a discussion regarding more efficient potential MAPK‐targeted therapies to treat AM with few side effects, thereby providing novel insights into targeted therapy for AM.

This article is protected by copyright. All rights reserved.

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Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma

Abstract

Background

ADAR1 is an enzymatic protein, which catalyzes a RNA‐editing reaction by converting Adenosine to Inosine and its expression has been found to be dysregulated in many cancer types. The aim of this study was to analyze the expression of ADAR1 in oral squamous cells carcinoma.

Methods

In order to analyze the ADAR1 mRNA expression, data from The Cancer Genome Atlas (TCGA) database were downloaded and analyzed. In addition, immunohistochemistry analysis was performed on an institutional database including 46 samples of oral squamous cell carcinoma in a tissue microarray (TMA).

Results

No statistically significant correlation linked the mRNA ADAR1 expression to any clinic‐pathological variables in the TCGA database. Immunohistochemistry analysis of ADAR1 showed different expression between normal mucosa and tumor tissue. Focusing on the subcellular localization, the nuclear expression of ADAR1 correlated with higher grading of differentiation (ρ = 0,442 p‐value = 0,002); the general expression of ADAR1 either in cytoplasm or in nuclei, correlated with the Gender of patients (Cytoplasm expression: ρ = ‐0,295; p‐value = 0,049; while for nuclear expression: ρ = +0,374 p = 0,011); cytosol expression resulted to be an independent protective prognostic factor (HR = 0,047; C.I. 95% 0,007‐0,321; p‐value = 0,002).

Conclusion

Higher expression of ADAR1 into the cytoplasm resulted to be an independent prognostic factor. In order to understand ADAR1 role in cancer, further studies should be performed, in bigger cohort and under a bio‐molecular point of view.

This article is protected by copyright. All rights reserved.

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Masthead

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Table of contents

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A role for Th1-like Th17 cells in the pathogenesis of inflammatory and autoimmune disorders

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Ali N. Kamali, Seyedeh Masoomeh Noorbakhsh, Haleh Hamedifar, Farhad Jadidi-Niaragh, Reza Yazdani, José M. Bautista, Gholamreza Azizi

Abstract

The T helper 17 (Th17) cells contain a dynamic subset of CD4+ T-cells that are able to develop into other different lineage subsets, including the Th1-like Th17 cells. These cells co-express retinoic acid-related orphan receptor gamma t (RORγt) and transcription factor T-box-expressed-in-T-cells (T-bet) and produce both interleukin (IL)-17 and interferon (IFN)-γ. Recent reports have shown that Th1-like Th17 cells play crucial roles in the pathogenesis of autoimmune diseases such as inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis, as well as, some primary immunodeficiency with autoimmune features. Here, the actual mechanisms for Th17 cells plasticity to Th1-like Th17 cells are discussed and reviewed in association to the role that Th1-like Th17 cells have on inflammatory and autoimmune disorders.

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The ins and outs of type I iNKT cell development

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Susannah C. Shissler, Tonya J. Webb

Abstract

Natural killer T (NKT) cells are innate-like lymphocytes that bridge the gap between the innate and adaptive immune responses. Like innate immune cells, they have a mature, effector phenotype that allows them to rapidly respond to threats, compared to adaptive cells. NKT cells express T cell receptors (TCRs) like conventional T cells, but instead of responding to peptide antigen presented by MHC class I or II, NKT cell TCRs recognize glycolipid antigen in the context of CD1d. NKT cells are subdivided into classes based on their TCR and antigen reactivity. This review will focus on type I iNKT cells that express a semi invariant Vα14Jα18 TCR and respond to the canonical glycolipid antigen, α-galactosylceramide. The innate-like effector functions of these cells combined with their T cell identity make their developmental path quite unique. In addition to the extrinsic factors that affect iNKT cell development such as lipid:CD1d complexes, co-stimulation, and cytokines, this review will provide a comprehensive delineation of the cell intrinsic factors that impact iNKT cell development, differentiation, and effector functions – including TCR rearrangement, survival and metabolism signaling, transcription factor expression, and gene regulation.

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Sequence and functional variability of Toll-like receptor 9 gene in equines

Publication date: Available online 28 November 2018

Source: Molecular Immunology

Author(s): Anju Manuja, Balvinder K. Manuja, Harisankar Singha

Abstract

Significant structural differences in the extracellular domain of toll-like receptor 9 (TLR9) account for species-specific recognition of its ligand CpG-ODN sequences. TLR9 is extensively studied in human, mice and some domestic animals. The recognition ability appears to be utilized differently by various species and breeds, but so far no comprehensive study exists about the equine TLR9 gene. We characterized TLR9 sequences of Marwari and Zanskari breeds of horses and Poitu donkey. We sequenced and identified the protein coding regions of equine TLR9 and compared with other animals and human beings. Furthermore, we also analyzed the amino acid substitutions and their likely implications on functions. The analysis revealed 14% evolutionary divergence between equine and human TLR9, while it was 1% between the Equus caballus and Equus asinus and less than 1% within Equus caballus. In phylogenetic analysis of predicted amino acids, the indigenous equines grouped with thoroughbred Equus caballus, while human, cattle, dog, sheep, mice, and buffalo formed separate clades. Furthermore, we also analyzed the amino acid substitutions and their likely implications on functions by sorting intolerant from tolerant (SIFT) analysis and predicted two substitutions of amino acids (D80N and S822P) in Marwari horses in leucine rich repeat 1 (LRR1) without any functional effects. The substitutions (V214A and Y579C) in LRR 3 and LRR11 in Zanskari horses were predicted to have functional consequences. Out of overall 8 substitutions, three substitutions (I420V, S970R and R1001C) were found in Equus asinus in LRR7, LRR 13, and toll interleukin receptor (TIR) domains, while the substitution G649S is observed in Poitu donkey only. We report for the first time that despite the conserved residues, the striking effect of substitutions, found within the TLR9 genes of different equine breeds/species may have possible implications.

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Perspectives of Sunless‐Only Tanning Business Owners

Abstract

To date, 16 states in the US restrict minors from using tanning beds.¹ The principal argument against policy restricting indoor tanning is the concern it would harm small businesses.^2‐4 One counterargument is that tanning businesses could stay financially viable by offering UV‐free sunless tanning services (e.g., spray or airbrush tanning) which would serve customers' desire for a tan while not exposing them to the risks associated with ultraviolet (UV) radiation exposure. Sunless only tanning businesses are already in existence and owners may provide insights on this alternative business model.

This article is protected by copyright. All rights reserved.

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A prospective, observational safety study of patients with BRAFV600‐mutated unresectable or metastatic melanoma treated with vemurafenib [Zelboraf Safety Study (ZeSS)]

Abstract

Vemurafenib is approved in more than 90 countries for the treatment of patients with BRAF ^V600‐mutated metastatic melanoma.^1,2 In the pivotal BRIM‐3 trial, treatment‐emergent cutaneous side effects were associated with vemurafenib, including the development of epithelial tumours and, in rare cases, new primary melanomas.^3,4 QTc interval prolongation and hepatic laboratory abnormalities were also noted.^3,4

This article is protected by copyright. All rights reserved.

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Comparison of microneedling and full surface erbium laser dermabrasion for autologous cell suspension grafting in non‐segmental vitiligo: a randomized controlled trial

Abstract

Autologous cell suspension is a well‐demonstrated effective approach for treating segmental or stable and localized forms of vitiligo¹. Full surface dermabrasion is considered as the gold standard technique for preparing the skin before grafting. Fractional ablative laser or microneedling have been shown to enhance the penetration into the skin of topical agents².

This article is protected by copyright. All rights reserved.

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Association of Pyrin mutations and Autoinflammation with Complex Phenotype Hidradenitis Suppurativa: A Case Control Study

Abstract

Background

Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterised by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS.

Aim

To investigate the association of variants of the MEFV gene with a complex HS phenotype.

Methods

First, we identified the clinical characteristics of 119 HS patients with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (OR) for pathogenic MEFV mutations were calculated using data from these HS patients and 191 healthy controls.

Results

The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with HS patients in general. Five of the HS patients (4.2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 (CI: 16.50‐99.84, p<0.001) when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The odds ratio for carrying a pathogenic MEFV allele was 2.80 (CI: 1.31‐5.97, p<0.001).

Conclusion

The frequency of MEFV mutations in a group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.

This article is protected by copyright. All rights reserved.

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Safety of guselkumab in patients with moderate‐to‐severe psoriasis treated through 100 weeks: a pooled analysis from the randomised VOYAGE 1 and VOYAGE 2 studies

Summary

Background

Long‐term evaluation is required to confirm the safety profile of newer biologic agents. Objectives

To report on pooled safety data from the on‐going VOYAGE 1 (NCT02207231) and VOYAGE 2 (NCT02207244) trials through 100 weeks of follow‐up.

Methods

Patients were randomized to guselkumab 100 mg at weeks 0 and 4 and every‐8‐weeks thereafter; placebo at weeks 0, 4, 12 followed by guselkumab 100 mg at weeks 16 and 20 and every‐8 weeks thereafter; or adalimumab 80 mg at week 0, 40 mg at week 1, and 40 mg every 2 weeks thereafter. Adalimumab patients crossed over to guselkumab at week 52 (VOYAGE1) and at/after week 28 based on clinical response (VOYAGE2). Open‐label extensions, when all patients received guselkumab, started at week 52 (VOYAGE1) and week 76 (VOYAGE2). Rates of adverse events (AEs) per 100 patient‐years [PY] are presented through 100 weeks of follow up.

Results

Through week 52, observed rates for guselkumab‐ and adalimumab‐treated patients, respectively, were 262.45/100PY and 328.28/100PY for AEs, 6.20/100PY and 7.77/100PY for serious AEs (SAEs), 1.22/100PY and 1.79/100PY for serious infections (SIs), 0.28/100PY and 0.40/100PY for malignancies other than nonmelanoma skin cancers (NMSCs), 0.56/100PY and 0.40/100PY for NMSCs, and 0.47/100PY and 0.40/100PY for MACE. Rates among guselkumab‐treated patients through week 52 and week 100, respectively, were (262.45/100PY and 210.41/100PY) for AEs, 6.20 and 6.29/100PY), for SAEs, 1.22/100PY and 1.06/100PY for SIs, 0.28/100PY and 0.38/100PY for malignancies, 0.56/100PY and 0.39/100PY for NMSCs, and 0.47/100PY and 0.38/100PY for MACE. Among adalimumab‐treated patients, rates of AEs (328.28/100PY vs 160.15/100PY), SAEs (7.77/100PY vs 4.44/100PY), SIs (1.79/100PY vs 0/100PY), malignancies (0.40/100PY vs 0.40/100PY), NMSCs (0.40/100PY vs 0.81/100PY), and MACE (0.40/100PY vs 0.20/100PY) showed some variability before and after crossover to guselkumab, though no new safety signals were noted after crossover.

Conclusions

The safety profile for guselkumab remains favorable through 100 weeks of treatment in patients with moderate‐to‐severe psoriasis.

This article is protected by copyright. All rights reserved.

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Pioneers in Dermatology and Venereology: an interview with Stephen I. Katz, MD, PhD

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Announcement

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Issue Information

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A Special Thank‐You to Our Reviewers!

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Should we prioritize psychological interventions in the management of vitiligo?

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A questionnaire for assessment of the burden posed by sensitive skin – a step forward to provide solid ground for an important concept

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2018 – What a year for dermatology!

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Forthcoming Events

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Long term effects upon rituximab treatment of acquired angio‐edema due to c1‐inhibitor deficiency

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Dupilumab reduces local type 2 pro‐inflammatory biomarkers in chronic rhinosinusitis with nasal polyposis

Abstract

Background

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a type 2‐mediated inflammatory disease associated with significant clinical, social, and economic burdens and high unmet therapeutic need. Dupilumab, a fully human monoclonal antibody targeting the interleukin‐4 receptor α (IL‐4Rα) subunit, demonstrated efficacy and acceptable safety in CRSwNP and other type 2 diseases (e.g. atopic dermatitis and asthma). We now report the local effects of dupilumab on type 2 inflammatory biomarkers in nasal secretions and nasal polyp tissues of patients with CRSwNP in a randomized, placebo‐controlled, phase 2 trial (NCT01920893).

Methods

Cytokines, chemokines, and total immunoglobulin E (IgE) levels were measured using immunoassay techniques in nasal secretions and nasal polyp tissue homogenates of CRSwNP patients receiving dupilumab 300 mg or placebo weekly for 16 weeks.

Results

With dupilumab, type 2 biomarker concentrations decreased in nasal secretions (LS mean area under the curve from 0–16 weeks for the change from baseline) vs placebo for eotaxin‐3 (−30.06 vs −0.86 pg/mL; P=0.0008) and total IgE (−7.90 vs −1.86 IU/mL; P=0.022)). Dupilumab treatment also decreased type 2 biomarker levels in nasal polyp tissues at Week 16 versus baseline for ECP (P=0.008), eotaxin‐2 (P=0.008), eotaxin‐3 (P=0.031), pulmonary and activation‐regulated chemokine (P=0.016), IgE (P=0.023), and IL‐13 (P=0.031).

Conclusions

Dupilumab treatment reduced multiple biomarkers of type 2 inflammation in nasal secretions and polyp tissues of patients with CRSwNP, demonstrating that antagonism of IL‐4Rα signaling suppresses IL‐4‐/IL‐13‐dependent processes, such as mucosal IgE formation, as well as the expression of chemokines attracting inflammatory cells to the nasal mucosa.

This article is protected by copyright. All rights reserved.

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Reticulate acropigmentation of Kitamura with a novel mutation in ADAM10

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Facial comedonal acne in orofaciodigital syndrome type 1 caused by a novel frameshift variant in OFD1

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Oral tranexamic acid for the treatment of melasma

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Mild clinical presentation of a patient with a mutation in the NSDHL gene

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R‐Ras regulates vascular permability, but not overall healing in skin wounds

Abstract

Wounds close by keratinocytes migrating from the edge of the wound and re‐epithelializing the epidermis. It has been proposed that the major stimuli for wound closure are blood‐derived growth factors, chemokines, and cytokines. The small GTPase R‐Ras, a known integrin activator, also regulates vascular permeability during angiogenesis, and blood vessels lacking R‐Ras leak plasma proteins constantly. We explored whether the access to blood‐derived proteins influences skin wound healing in R‐Ras knockout (KO) mice. In skin wounds, R‐Ras expression was mostly restricted to the vasculature in the granulation tissue. Angiogenic blood vessels in the R‐Ras KO mice were significantly more permeable than in wild‐type (WT) controls. Although the distances between epidermal tongues, and the panniculus carnosus muscles, were significantly longer in R‐Ras KO than WT controls before the granulation tissue formation took place, there were no differences in the wound closure or re‐epithelialization rates or granulation tissue formation. These findings were also corroborated in a special splint excision wound model. Our study shows that although R‐Ras does not influence the skin wound healing itself, but the blood vessels lacking R‐Ras are leaky and thus could facilitate the access of blood‐derived proteins to the wound.

This article is protected by copyright. All rights reserved.

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Computational fluid dynamics after endoscopic endonasal skull base surgery—possible empty nose syndrome in the context of middle turbinate resection

Background

Empty nose syndrome (ENS) is a rare and debilitating disease with a controversial definition, etiology, and treatment. One puzzling fact is that patients who undergo an endoscopic endonasal approach (EEA) often have resection of multiple anatomic structures, yet seldom develop ENS. In this pilot study, we analyzed and compared the computational fluid dynamics (CFD) and symptoms among post‐EEA patients, ENS patients, and healthy subjects.

Methods

Computed tomography scans of 4 post‐EEA patients were collected and analyzed using CFD techniques. Two patients had significant ENS symptoms based on results of the Empty Nose Syndrome 6‐item Questionnaire (score >11), whereas the other 2 were asymptomatic. As a reference, their results were compared with previously published CFD results of 27 non‐EEA ENS patients and 42 healthy controls.

Results

Post‐EEA patients with ENS symptoms had a similar nasal airflow pattern as non‐EEA ENS patients. This pattern differed significantly from that of EEA patients without ENS symptoms and healthy controls. Overall, groups with ENS symptoms exhibited airflow dominant in the middle meatus region and a significantly lower percentage of airflow in the inferior turbinate region (EEA with ENS, 17.74 ± 4.00% vs EEA without ENS, 51.25 ± 3.33% [t test, p < 0.02]; non‐EEA ENS, 25.8 ± 17.6%; healthy subjects, 36.5 ± 15.9%) as well as lower peak wall shear stress (EEA with ENS, 0.30 ± 0.13 Pa vs EEA without ENS, 0.61 ± 0.03 Pa [p = 0.003]; non‐EEA ENS, 0.58 ± 0.24 Pa; healthy subjects, 1.18 ± 0.81 Pa).

Conclusion

These results suggest that turbinectomy and/or posterior septectomy may have a varying functional impact and that ENS symptoms go beyond anatomy and correlate with aerodynamic changes. The findings open the door for CFD as a potential objective diagnosis tool for ENS.

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Noninvasive exosomal proteomic biosignatures, including cystatin SN, peroxiredoxin‐5, and glycoprotein VI, accurately predict chronic rhinosinusitis with nasal polyps

Background

Exosomes are secreted epithelial‐derived vesicles that contain a conserved protein array representative of their parent cell. Exosomes may be reproducibly and noninvasively purified from nasal mucus. The exosomal proteome can be quantified using SOMAscan^TM, a highly multiplexed, aptamer‐based proteomic platform. The purpose of this study was to determine whether chronic rhinosinusitis with nasal polyps (CRSwNP) has a unique predictive exosomal proteomic biosignature.

Methods

Exosomes were isolated from whole mucus sampled from control and CRSwNP patients (n = 20 per group) by differential ultracentrifugation. The SOMAscan^TM platform was used to simultaneously quantify 1310 biologically relevant human proteins. Matched tissue and whole mucus proteomes were also analyzed. Differential protein expression and discriminatory power were calculated using the unweighted pair group method with arithmetic‐mean and principal component analysis, respectively. Bioinformatic analysis was performed using Ingenuity Pathway, MetaCore, and GeneMANIA analyses.

Results

The exosomal proteome demonstrated 123 significantly (p < 0.05) differentially regulated proteins in CRSwNP relative to control. Eighty of these proteins overlapped with the matched CRSwNP tissue proteome as compared with only 4 among matched whole mucus samples. Forty‐three significantly dysregulated pathway networks overlapped between the exosomal and tissue proteome in CRSwNP as compared with only 3 among matched whole mucus samples. The best‐performing protein set (cystatin‐SN, peroxiredoxin‐5, and glycoprotein VI) achieved an area under the curve (AUC) value of up to 99%.

Conclusion

Our data contribute a significant advance in the development of a reproducible, noninvasive, serial, and quantitative "liquid biopsy" for rhinosinusitis. The exosomal proteomic approach has revealed a unique biosignature associated with CRSwNP, which outperforms whole mucus sampling, and thus provides a method of noninvasive disease detection and proposes new potential therapeutic targets.

https://ift.tt/2AxMhc6

Endoscopic Evaluation of the Eustachian Tube: assessment of a novel tool for grading Eustachian tube inflammation

Background

Signs of inflammation are commonly encountered during endoscopic examination of the Eustachian tube (ET) region. The clinical applicability of these findings may be enhanced by use of a standardized assessment score.

Methods

Digital video recordings were obtained of 50 nasal endoscopy examinations of the nasopharyngeal portion of the ET. Four fellowship‐trained rhinologists independently reviewed the videos with regard to specific physical findings: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. Scoring of this Endoscopic Evaluation of the Eustachian Tube (3ET) was reported using both 2‐point and 3‐point scales. Each reviewer repeated the scoring at a 10‐day interval. Interrater and intrarater agreement were calculated for each item and the total scores.

Results

Interrater and intrarater agreement were greater for the 3‐point scale than the 2‐point scale. Interrater agreement for overall instrument using the 3‐point scale was in the "acceptable" range for Krippendorff's alpha on both the first trial (0.6922) and second trial (0.7238). Intrarater agreement was generally "excellent" for individual items as well as the overall instrument.

Conclusion

The 3ET comprising these 4 physical findings has acceptable interrater and intrarater reliability, and may be applied to future clinical studies of ET function and disease.

https://ift.tt/2TVHABM

Patterns of olfactory dysfunction in chronic rhinosinusitis identified by hierarchical cluster analysis and machine learning algorithms

Background

Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). We previously identified several cytokines potentially linked to smell loss, potentially supporting an inflammatory etiology for CRS‐associated olfactory dysfunction. In the current study we sought to validate patterns of olfactory dysfunction in CRS using hierarchical cluster analysis, machine learning algorithms, and multivariate regression.

Methods

CRS patients undergoing functional endoscopic sinus surgery were administered the Smell Identification Test (SIT) preoperatively. Mucus was collected from the middle meatus using an absorbent polyurethane sponge and 17 inflammatory mediators were assessed using a multiplexed flow‐cytometric bead assay. Hierarchical cluster analysis was performed to characterize inflammatory patterns and their association with SIT scores. The random forest approach was used to identify cytokines predictive of olfactory function.

Results

One hundred ten patients were enrolled in the study. Hierarchical cluster analysis identified 5 distinct CRS clusters with statistically significant differences in SIT scores observed between individual clusters (p < 0.001). A majority of anosmic patients were found in a single cluster, which was additionally characterized by nasal polyposis (100%) and a high incidence of allergic fungal rhinosinusitis (50%) and aspirin‐exacerbated respiratory disease (AERD) (33%). A random forest approach identified a strong association between olfaction and the cytokines interleukin (IL)‐5 and IL‐13. Multivariate modeling identified AERD, computed tomography (CT) score, and IL‐2 as the variables most predictive of olfactory function.

Conclusion

Olfactory dysfunction is associated with specific CRS endotypes characterized by severe nasal polyposis, tissue eosinophilia, and AERD. Mucus IL‐2 levels, CT score, and AERD were independently associated with smell loss.

https://ift.tt/2AAtYDf

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect

Publication date: Available online 28 November 2018

Source: American Journal of Otolaryngology

Author(s): Feng-Ming Gu, Fang-Lu Chi

Abstract

Purpose

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD).

Methods

A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated.

Results

The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05).

Conclusion

It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.

https://ift.tt/2zwY0b1

Aluminum granuloma in a child secondary to DTaP‐IPV vaccination: A case report

Abstract

Reports detailing the acute formation of aluminum granulomas, which can cause persistent, intensely pruritic nodules secondary to the administration of aluminum‐containing vaccines, are infrequently described in medical literature. To our knowledge, this is the first report describing the development of an aluminum granuloma causing a persistent, pruritic nodule at the injection site following the administration of the DTaP‐IPV vaccine. We present the case of a 6‐year‐old girl who developed a severely pruritic subcutaneous nodule on her anterior right thigh at the injection site three weeks after the administration of the aluminum‐containing DTaP‐IPV (Kinrix) vaccine. The nodule was eventually excised 14 months after its initial appearance, after which her symptoms resolved. Histologic inspection demonstrated a dense, deep dermal and subcutaneous nodular mixed infiltrate of lymphocytes, histiocytes, and eosinophils, with germinal center formation. The bluish, amphophilic granular cytoplasm found in most of the histiocytes is a characteristic feature of "aluminum granulomas." This adverse reaction should be considered in any patient presenting with similar findings in the weeks following a DTaP‐IPV vaccination or other aluminum‐containing vaccines. Furthermore, the self‐limiting tendency of these nodules should not preclude affected patients from any future vaccinations, though vaccines without aluminum should be preferentially selected when possible.

https://ift.tt/2AzPCHx

Characteristics of persistent diaper dermatitis in children with food allergy

Abstract

Background/Objectives

Diaper dermatitis is often caused by irritant contact occurring beneath the diaper of an infant, and it is aggravated by factors such as dampness, friction, urea, and feces. Food‐allergic patients are known to exhibit various skin lesions ranging from urticaria to eczema. This study aims to determine the relationship between persistent diaper dermatitis and food allergy.

Methods

A retrospective chart review was conducted of pediatric patients with a diagnosis of persistent diaper dermatitis between August 2015 and November 2017.

Results

The study included 157 patients diagnosed with persistent diaper dermatitis (67 male, 72 female; median age: 13 months). Diaper dermatitis was more common and included the whole perineum in children who had multiple food allergies (P = 0.001). In children with multiple food allergies, the course of diaper dermatitis was more severe, and the condition did not respond to topical treatment (P = 0.025). A longer elimination diet was required for patients with Type I reactions and persistent diaper dermatitis (P = 0.018). In patients with Type II and mixed reactions, diaper dermatitis was more diffuse and covered the whole perineum (P = 0.025). In patients with Type II and mixed reactions, diaper dermatitis was more severe and did not respond to topical treatment (P = 0.025).

Conclusions

Persistent diaper dermatitis lasting longer than a month may be associated with food allergy. The diaper rash may also be the only indicator of the food allergy. Elimination of the responsible food may allow these patients to recover from persistent diaper dermatitis.

https://ift.tt/2TWEY6M

Corneal Toxicity Induced by ABT-414 Therapy for Glioblastoma Multiforme: A Case Report

Background: To describe a case of corneal toxicity associated with the use of the epidermal growth factor receptor (EGFR) inhibitor ABT-414 in the treatment of glioblastoma multiforme. Case Presentation: Case report of a 56-year-old male with glioblastoma multiforme who developed mild painless blurred vision after systemic treatment with the investigational EGFR inhibitor ABT-414. The patient had best corrected visual acuity of 20/60 right eye and 20/50 left eye. Ophthalmic examination revealed corneal toxicity with whorl-like opacities in the inferior interpalpebral cornea. The patient was treated with topical fluoromethalone and lifitegrast, and his ocular symptoms as well as the corneal findings improved. Conclusions: The systemic use of EGFR inhibitor ABT-414 may be associated with corneal toxicity and the effects are reversible with treatment.
Case Rep Ophthalmol 2018;9:479–483

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Presence in head and neck cancer multidisciplinary team meeting: The patient's experience and satisfaction

Publication date: Available online 28 November 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): D. Chaillou, G. Mortuaire, V. Deken-Delannoy, B. Rysman, D. Chevalier, F. Mouawad

Abstract

Background

In oncology, multi-disciplinary team meetings improve overall survival and reduce time to treatment in head and neck cancer. Interestingly, no study has examined the experience of patients attending an MTM. The present study addressed two questions: Does the MTM cause anxiety/depression for patients who are present? Are patients satisfied at the end of the meeting?

Patients and methods

The study included all patients attending an MTM, who agreed to participate in the study and who fully completed two questionnaires. The Hospital Anxiety and Depression Scale (HADS) and a satisfaction questionnaire were filled out at three time-points: T0 before MTM, T1 at end of MTM, and T2 1 month after MTM for the HADS; and T1 and T2 for the satisfaction questionnaire.

Results

There were no significant differences in the number of patients experiencing anxiety between T0 and T1 (P = 0.6085), T0 and T2 (P = 1) or T1 and T2 (P = 1). Likewise, there were no significant differences in the number of patients in depression between T0 and T1 (P = 0.9397), T0 and T2 (P = 1) or T1 and T2 (P = 1). Mean satisfaction was good (question 14 on the satisfaction questionnaire: 8.7/10 at T1 and 7.7/10 at T2), but with a significant decrease between T1 and T2 (P = 0.0009: i.e., < 0.05). Percentage information remembered (question 12) significantly decreased between T1 (mean 86%, standard deviation 0.2, median 94%) and T2 (78% ± 0.2, median 81%) (P = 0.03). Presence in the MTM did not appear to induce or increase anxiety or pre-existing depressive syndrome.

https://ift.tt/2KGBXmD

Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis

Abstract

Purpose

This study was conducted in order to determine whether marsupialization before definitive enucleation of nonsyndromic odontogenic keratocysts (OKCs) is capable of decreasing the recurrence rate more effectively than just enucleation.

Methods

We searched MEDLINE, Web of Science, Scopus, and Cochrane Library, until August 5th of 2017 for original studies reporting on the treatment of OKCs with and without previous marsupialization and the related recurrence rate. All records and data were independently assessed, meta-analysis was performed, and the odds ratio of recurrence was the effect measure; P value for the summary effect of < 0.05 was considered statistically significant.

Results

The 748 records retrieved were reduced to 6 studies to be qualitatively assessed and 5 studies were included in the meta-analysis. The overall odds ratio of 0.57 [0.25–1.28] of the pooled values pointed that marsupialization reduced the recurrence rate in comparison to just enucleation; however, the P value showed that there is no strong evidence to support this statement.

Conclusions

Marsupialization followed by enucleation after 12 to 18 months reduces the recurrence rate, but more studies are necessary to support this statement.

https://ift.tt/2KG5MDW

Identification of DNA methylation module in seasonal allergic rhinitis

Publication date: Available online 29 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Zhenfeng Gao, Mengmeng Huang, Zhe Qu, Junchao Wang, Xiaolan Cai

Abstract

Objective

In this study, we aimed to characterize the significant DNA methylation module of seasonal allergic rhinitis.

Methods

Methylation profiling E-GEOD-50222 was obtained from ArrayExpress database. Differential co-methylation network (DCN) was constructed based on the methylation data. From the DCN, we characterized multiple differential modules (M-DMs). Significant module was mapped to pathways to identify significant enriched pathways.

Results

At the criteria of absolute Pearson coefficient value > 0.8, the edges were chose to construct DCN. In the DCN, 16 seed genes were identified. Seed genes were used to construct M-DMs. After statistical analysis, one significant module with p<0.05 were obtained. After pathways enrichment analysis, 17 significant pathways with p<0.05 were obtained, and most of these pathways were associated with DNA replication.

Conclusion

One multiple differential module was identified in SAR, and seventeen significant pathways mapped by the module were identified as important factors in SAR. These results may provide new insights into the molecular mechanism of DNA methylation in SAR.

https://ift.tt/2DUPrtV

Predictors for Hemorrhage Following Pediatric Adenotonsillectomy

Publication date: Available online 29 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elizabeth Burckardt, Whitney Rebholz, Samantha Allen, Elizabeth Cash, Julie Goldman

Abstract

Objective

To determine risk factors and trends for posttonsillectomy hemorrhage (PTH) following adenotonsillectomy (T&A) at a single children's tertiary referral hospital.

Methods

Charts from all patients 2-12 years old undergoing T&A alone at a single children's hospital from January 1, 2010 through December 31, 2015 were reviewed. Data was collected on patient demographics, indication for procedure, time of year, academic affiliation of surgeon, surgical technique and method, post-operative pain medication prescribed, and readmission for PTH. Univariate chi-square analyses and logistic regression along with multivariable stepwise logistic regression were used to identify predictors of PTH. SPSS version 24 was used for statistical analyses with p<0.05 indicating statistical significance.

Results

There were 2,565 children undergoing T&A during the study period. One hundred seventy-three (6.7%) patients were readmitted, of which 53 (30.6%) were due to PTH. Univariate analyses identified children at the highest age quartile of the study, 7.72-12.97 years old (odds ratio [OR]=5.775, 95% confidence interval [CI] = 2.248-14.837, p<.001) and children with a BMI z-score of 2 or greater (OR=3.391, 95% CI=1.497-7.680, p=.003) were at increased risk for PTH. Multivariable analyses also identified both the highest age quartile and BMI z-score of 2 or greater to be a risk factor for PTH.

Conclusion

In children undergoing T&A, age greater than 7.72 years old and BMI z-score of 2 or greater are significant risk factors for PTH. Replication of these findings in a more highly powered trial is needed.

https://ift.tt/2Qpl9Wx

Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults

Publication date: Available online 28 November 2018

Source: Archives of Oral Biology

Author(s): Jitsuro Yano, Sayako Yamamoto-Shimizu, Tomonori Yokoyama, Isami Kumakura, Kozo Hanayama, Akio Tsubahara

Abstract

Objective

The aim of the present study was to investigate whether anterior tongue muscle strengthening exercises can affect the strength of posterior tongue muscles.

Design

Eleven healthy subjects (20.6 ± 1.2 years) were included. The subjects exercised by pushing the anterior tongue to the palate 30 times, three times a day, 3 days a weekfor 8 weeks. The exercise intensity was set at 60% of maximum tongue pressure (MTP) in the first week and 80% of MTP for the remainder of training. After the completion of training, MTP measurements were continued every month for another 3 months to evaluate whether training effects were sustained.

Results

MTP was significantly increased after 8 weeks of training compared with before training. No significant differences were seen between MTP immediately after completion of training and MTP 1-3 months after completion of training. However, MTP was significantly higher 1-3 months after completion of training than before training.

Conclusions

The present study showed significant increases in both anterior and posterior MTPs by anterior tongue muscle strengthening exercises. In the future, a database on tongue muscle strengthening exercises in elderly persons,patients with dysphagia, etc. will need to be generated, with the aim of preventing frailty.

https://ift.tt/2FOo5Ip

Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults

Publication date: Available online 28 November 2018

Source: Archives of Oral Biology

Author(s): Jitsuro Yano, Sayako Yamamoto-Shimizu, Tomonori Yokoyama, Isami Kumakura, Kozo Hanayama, Akio Tsubahara

Abstract

Objective

The aim of the present study was to investigate whether anterior tongue muscle strengthening exercises can affect the strength of posterior tongue muscles.

Design

Eleven healthy subjects (20.6 ± 1.2 years) were included. The subjects exercised by pushing the anterior tongue to the palate 30 times, three times a day, 3 days a weekfor 8 weeks. The exercise intensity was set at 60% of maximum tongue pressure (MTP) in the first week and 80% of MTP for the remainder of training. After the completion of training, MTP measurements were continued every month for another 3 months to evaluate whether training effects were sustained.

Results

MTP was significantly increased after 8 weeks of training compared with before training. No significant differences were seen between MTP immediately after completion of training and MTP 1-3 months after completion of training. However, MTP was significantly higher 1-3 months after completion of training than before training.

Conclusions

The present study showed significant increases in both anterior and posterior MTPs by anterior tongue muscle strengthening exercises. In the future, a database on tongue muscle strengthening exercises in elderly persons,patients with dysphagia, etc. will need to be generated, with the aim of preventing frailty.

https://ift.tt/2FOo5Ip

Horizontal alveolar transport distraction osteogenesis followed by implant placement

Publication date: Available online 28 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Uckan, G. Senol, E. Ogut, G. Muftuoglu

Abstract

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 39.1 years. The average bone length gain was 18.2 mm. 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. The mean follow-up period was 63 months and the survival rate of the 25 implants placed was 92%. All failures (n = 2) occurred during the early healing period. Although the results are not totally predictable, it can be concluded that ATDO can be effective in the reconstruction of the alveolar crest prior to implant placement.

https://ift.tt/2rbteQz

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

Publication date: Available online 28 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N. Tomomatsu, K. Kurohara, K. Nakakuki, H. Yoshitake, T. Kanemaru, S. Yamaguchi, T. Yoda

Abstract

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. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r = −0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.

https://ift.tt/2FPqIJT

Favorable kidney function in pediatric liver transplant recipients: results of a single-center cohort study

Background Although chronic kidney disease (CKD) is still a common complication, the prognosis of kidney function after LT is not well known. Moreover, kidney function after LT in children with renal involvement is unknown. Methods We retrospectively analyzed patients aged

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Outcome of liver transplant patients with high urgent priority. Are we doing the right thing?

Background About 15% of liver transplantations in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients that have acute liver failure or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization. Methods Patients that were listed for liver transplantation with HU status from 01.01.2007 up to 31.12.2015 were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with labMELD scores ≥40 (MELD 40+). Results In the study period, 2,299 HU patients were listed for liver transplantation. At 10 days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary acute liver failure showed better patient survival at 3 years (69%) as compared to patients in the MELD 40+ group (57%). HU patients with labMELD≥45 and patients with HU status for acute retransplantation and LabMELD≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively. Conclusions Current prioritization for patients with acute liver failure is highly effective in preventing mortality on the waiting list. Although patients with HU status for acute liver failure have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU-status, over other recipients with an expected, substantially better prognosis after transplantation. Corresponding author: J.D. de Boer, MD, Medical Staff Eurotransplant. E-mail: jacob.deboer@eurotransplant.org Reprints will not be available from the authors. Authorship Study concept and design: Jacob de Boer (JdB), Aad van den Berg (AvdB), Andries Braat (AB), Markus Guba (MG) Acquisition of data: Jan de Boer (JB), Marieke van Rosmalen (MvR), Erwin de Vries (EV), Christian Strassburg (CS), Zoltan Mathe (ZM), Bart van Hoek (BH), Felix Braun (FB), Danko Mikulic (DM), Peter Michielsen (PM), Blaz Trotovsek (BT), Andreas Pascher (AP), Gabriela Berlakovich (GB), MG. Statistical analysis: JdB, EV, Hein Putter (HP) Analysis and interpretation of data: JdB, EV, AB, AvdB, Gabriela Berlakovich (GB), MG Drafting of the manuscript: JdB, US, AB, AvdB, MG. Critical revision of the manuscript: JdB, MG, AB, HP, AvdB, EV, CS, ZM, BH, FB, DM, PM, BT, AP, GB, HZ, JB, MvR, US. Study supervision: US, AB, MG. Conflicts of interest: The authors of this manuscript have no conflict of interest to disclose. Funding: The manuscript was not prepared by or funded in any part by a commercial organization. No financial support or grants were used for the preparation of this manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Current state of renal regenerative therapies

The worldwide increase in the number of end stage renal disease (ESRD) patients leads to a growing waiting list for kidney transplantation due to the scarcity of kidney donors. Therefore, alternative treatment options for patients with ESRD are being sought. In vitro differentiation of stem cells into renal tissue is a promising approach to repair non-functional kidney tissue. Impressive headway has been made in the use of stem cells with the use of adult renal progenitor cells (ARPCs), Embryonic Stem Cells (ESCs) and induced Pluripotent Stem Cells (iPSCs) for the development towards primitive kidney structures. Currently, efforts are directed at improving long-term maintenance and stability of the cells. This review aims to provide a comprehensive overview of the cell sources used for the generation of kidney cells and strategies used for transplantation in in vivo models. Furthermore, it provides a perspective on stability and safety during future clinical application of in vitro generated kidney cells. Correspondence information: Anusha S. Shankar, Mailing address: Department of Internal Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, The Netherlands. E-mail address: a.shankar@erasmusmc.nl Authorship A.S.S.: concept and design, manuscript writing, final approval of manuscript, E.J.H and M.H.: concept and design, manuscript writing, final approval of manuscript, J.G. and C.C.B: final approval of manuscript. Disclosure: The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Challenges in allergy immunology practice

As our knowledge base continues to increase, many of the diseases we see and treat seem to have become more complex. This may come from a variety of factors, including better technology, better research, and better diagnostic techniques, among other factors. Not that long ago, asthma was classified more simply as either "intrinsic" or "extrinsic," and rhinitis was either "allergic" or "nonallergic." Now, with the vast improvements we enjoy in the practice of medicine, we have phenotypes and endotypes; we have biomarkers, treatment guidelines, practice parame-->ters, and more.

https://ift.tt/2AvloWj

A new acronym for PPI-REE?

Eosinophilic esophagitis (EoE) is a complex allergic disease commonly associated with food-induced symptomatic esophageal dysfunction.1 This includes reflux, dysphagia, and dysmotility.2 Consensus guidelines have provided clinical information to guide EoE evaluation, including the use of proton pump inhibitors (PPIs), to distinguish gastroesophageal reflux disease from EoE, and observations that a unique subset of eosinophilic esophageal infiltration might be largely resolved using a PPI, also termed PPI-REE (PPI-responsive esophageal eosinophilia).

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Information for Readers

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Erratum

In the Original Article, "Omalizumab chronic spontaneous urticaria: Efficacy, safety, predictors of treatment outcome, and time to response" (Ann Allergy Asthma Immunol. 2018;121:474-478), the title should have been set as "Omalizumab in chronic spontaneous urticaria: Efficacy, safety, predictors of treatment outcome, and time to response."

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Table of Contents

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Author Index

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Information for Authors

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Editorial Board

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Medikamentöse Therapie des metastasierten oder rezidivierten mutationsnegativen NSCLC

Zusammenfassung

Hintergrund

Die Behandlung des metastasierten nichtkleinzelligen Lungenkarzinoms (NSCLC) ohne behandelbare Treibermutation hat sich in den vergangenen Jahren insbesondere durch die Einführung der Immuncheckpointinhibitoren (ICI) rasch verändert.

Ziel

Ein kurzer historischer Abriss sowie der aktuelle Stand der Behandlung des NSCLC Stadium IV sollen knapp zusammengefasst werden.

Material und Methoden

Eine selektive Literaturrecherche der Datenbank Pubmed wurde durchgeführt. Suchbegriffe: NSCLC stage IV, checkpointinhibitors, chemotherapy.

Schlussfolgerung

Immuncheckpointinhibitoren wurden zunächst in der Zweitlinientherapie eingeführt, weil sie sich in mehreren großen Phase-III-Studien einer Standard-Docetaxel-Therapie als deutlich überlegen erwiesen hatten. Mittlerweile wird Pembrolizumab als Standard-Erstlinientherapie bei hoher Programmed-death-ligand-1(PD-L1)-Expression (Tumor Proportion Score [TPS] > 50 %) eingesetzt. In mehreren Phase-III-Studien hat sich eine Kombination mit ICI und Chemotherapie in der Erstlinientherapie einer Standardchemotherapie als überlegen erwiesen. Zulassungen für die Kombinationserstlinientherapie liegen für das nichtsquamöse NSCLC (nsNSCLC) bereits vor und weitere Zulassungen sind zu erwarten. Erst seit Einführung der ICI lässt sich bei einem Teil der Patienten mit metastasiertem NSCLC ein Langzeitüberleben von 3 Jahren und mehr erzielen.

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Cetuximab und FOLFOX-4 beim metastasierten kolorektalen Karzinom

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In Response to To Image or Not to Image? A Cost‐effectiveness Analysis of MRI for Patients With Asymmetric Sensorineural Hearing Loss

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Discrimination of “hot potato voice” caused by upper airway obstruction utilizing a support vector machine

Objectives/Hypothesis

"Hot potato voice" (HPV) is a thick, muffled voice caused by pharyngeal or laryngeal diseases characterized by severe upper airway obstruction, including acute epiglottitis and peritonsillitis. To develop a method for determining upper‐airway emergency based on this important vocal feature, we investigated the acoustic characteristics of HPV using a physical, articulatory speech synthesis model. The results of the simulation were then applied to design a computerized recognition framework using a mel‐frequency cepstral coefficient domain support vector machine (SVM).

Study Design

Quasi‐experimental research design.

Methods

Changes in the voice spectral envelope caused by upper airway obstructions were analyzed using a hybrid time‐frequency model of articulatory speech synthesis. We evaluated variations in the formant structure and thresholds of critical vocal tract area functions that triggered HPV. The SVMs were trained using a dataset of 2,200 synthetic voice samples generated by an articulatory synthesizer. Voice classification experiments on test datasets of real patient voices were then performed.

Results

On phonation of the Japanese vowel /e/, the frequency of the second formant fell and coalesced with that of the first formant as the area function of the oropharynx decreased. Changes in higher‐order formants varied according to constriction location. The highest accuracy afforded by the SVM classifier trained with synthetic data was 88.3%.

Conclusions

HPV caused by upper airway obstruction has a highly characteristic spectral envelope. Based on this distinctive voice feature, our SVM classifier, who was trained using synthetic data, was able to diagnose upper‐airway obstructions with a high degree of accuracy.

Level of Evidence

2c Laryngoscope, 2018

https://ift.tt/2rdfrJm

Cost comparison of treatment for oropharyngeal carcinoma

Objectives/Hypothesis

Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to compare financial parameters between chemoradiation and transoral robotic surgery (TORS) in this patient population.

Study Design

Case‐control study.

Methods

In this study we identified patients with selected American Joint Committee on Cancer 7th Edition stage II to IVa OPC treated with TORS between January 2013 and December 2014. Fifteen patients who underwent TORS were stage matched with 15 patients treated with chemoradiation. Total charges and cost data for each patient were analyzed at 4‐month and 1‐year time points; functional and oncologic outcomes were assessed.

Results

There were no significant differences in functional and oncologic outcomes. Patients undergoing TORS had a longer inpatient hospital stay, and most required a nasogastric tube for an average of 3.5 days. There were no local or regional recurrences. Across all time points, the TORS group had lower charges and costs compared to the chemoradiation group, with 14% lower costs at 1 year. In the chemoradiation group, nearly two‐thirds of costs came from radiation therapy and pharmacy expenses. Chemotherapy accounted for most pharmacy costs. The costs of operating the surgical robot accounted for a about half of surgical costs.

Conclusions

Selected patients with stage II to IVa oropharyngeal carcinoma treated with TORS may incur lower costs than those treated nonsurgically. With rising healthcare spending, the financial impact of treatment might be considered for those patients eligible for treatment regimens with comparable functional and oncologic outcomes.

Level of Evidence

3b Laryngoscope, 2018

https://ift.tt/2FPcAQM

Cartilage tympanoplasty combined with eustachian tube balloon dilatation in the treatment of adhesive otitis media

Objectives/Hypothesis

To investigate the simultaneous application of cartilage tympanoplasty combined with eustachian tube (ET) balloon dilatation in the treatment of adhesive otitis media (AdOM).

Study Design

Multicenter, prospective, double‐blind, randomized, controlled clinical trial.

Methods

Patients with AdOM were randomly divided into four groups: control group (conservative treatment), ET balloon dilatation (ETBD) group, cartilage tympanoplasty (CT) group, and cartilage tympanoplasty combined with ET balloon dilatation (ETBD+CT) group. Patients were followed up at 3 months, 6 months, 1 year, and 2 years after treatment, receiving otoendoscopy and pure‐tone audiometry, and were evaluated using the Tinnitus Handicap Inventory (THI), visual analogue scale (VAS) for the symptom of ear stuffiness, Chronic Otitis Media Outcome Test (COMOT‐15), and eustachian tube scores (ETS).

Results

There was no improvement in tympanic membrane (TM) morphology and mean pure‐tone air‐bone gap (ABG) after treatment in the control and ETBD groups. The postoperative TM morphology was improved in the CT group and ETBD+CT group, although retraction pockets reoccurred in two cases of CT group. Reduced ABG and improvements in ETS, THI, VAS, and COMOT‐15 were all achieved in these two groups, but the difference was not statistically significant.

Conclusions

Cartilage tympanoplasty combined with ET balloon dilatation could be used as an appropriate surgical technique for AdOM, which could relieve the symptoms of tinnitus and ear stuffiness, and improve postoperative TM morphology, hearing level, ET functions, and quality of life, with low incidence of complications.

Level of Evidence

2 Laryngoscope, 2018

https://ift.tt/2rappuL