Clinico‐pathological predictors of mismatch repair deficiency in sebaceous neoplasia: A large case series from a single Australian private pathology service

Abstract

Background/Objectives

Loss of expression of mismatch repair (MMR) proteins is frequently observed in sebaceous skin lesions and can be a herald for Lynch syndrome. The aim of this study was to identify clinico‐pathological predictors of MMR deficiency in sebaceous neoplasia that could aid dermatologists and pathologists in determining which sebaceous lesions should undergo MMR immunohistochemistry (IHC).

Methods

An audit of sebaceous skin lesions (excluding hyperplasia) where pathologist‐initiated MMR IHC was performed between January 2009 to December 2016 was undertaken from a single pathology practice identifying 928 lesions from 882 individuals. Lesions were further analysed for differences in gender, age at diagnosis, lesion type and anatomic location, stratified by MMR status.

Results

The 882 individuals (67.7% male) had a mean (SD) age of diagnosis of 68.4 ± 13.3 years. Nearly two‐thirds of the lesions were sebaceous adenomas, with 82.6% of all lesions occurring on the head and neck. MMR deficiency, observed in 282 of the 919 lesions (30.7%), was most common in sebaceous adenomas (210/282; 74.5%). MMR‐deficient lesions occurred predominantly on the trunk or limbs (64.7%), compared with 23.2% in head or neck (P < 0.001). Loss of MSH2 and MSH6 protein expression was most frequent pattern of loss (187/281; 66.5%). The highest AUC for discriminating MMR‐deficient sebaceous lesions from MMR‐proficient lesions was observed for the ROC curve based on subgroups defined by type and anatomic location of the sebaceous lesion (AUC = 0.68).

Conclusion

The best combination of measured clinico‐pathological features achieved only modest positive predictive values, sensitivity and specificity for identifying MMR‐deficient sebaceous skin lesions.

https://ift.tt/2AILtBf

Pigmentary Skin Disorders. Edited by P Kumarasinghe. Springer International Publishing, Cham, Switzerland, 2018. 297 pages. €110. ISBN 978‐3‐319‐70418‐0.

https://ift.tt/2QqDcMj

Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India

Abstract

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility—Pseudomonas aeruginosa was sensitive to Cefoperazone–Sulbactam (96%), Imipenem (82%), Piperacillin–Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

https://ift.tt/2Sw65nJ

Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India

Abstract

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility—Pseudomonas aeruginosa was sensitive to Cefoperazone–Sulbactam (96%), Imipenem (82%), Piperacillin–Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

https://ift.tt/2Sw65nJ

Effect of continuous positive airway pressure on endothelin-1 in patients with obstructive sleep apnea: a meta-analysis

Abstract

Purpose

Obstructive sleep apnea (OSA) is related to endothelin-1 (ET-1). Continuous positive airway pressure (CPAP) is an effective therapy for OSA. However, the effectiveness of CPAP on ET-1 levels in patients with OSA yielded contradictory results. We conducted a meta-analysis to assess the effect of CPAP on ET-1 levels in OSA.

Methods

The Embase, and Cochrane Library and PubMed were searched before March, 2018. The overall effects were measured by the standardized mean difference (SMD) with a 95% confidence interval (CI). Ten studies were included and the meta-analysis was conducted using Stata 14.0.

Results

10 studies involving 375 patients were included in the meta-analysis. The result showed that there was a significant reduction in ET-1 levels in OSA patients before and after CPAP therapy (SMD = − 0.74, 95% CI = − 1.30 to − 0.17, z = 2.56, p = 0.01). Further, subgroup analysis demonstrated that Apnea–Hypopnea Index (AHI), CPAP therapy duration, and sample size also affected CPAP therapy.

Conclusions

Our meta-analysis indicated that CPAP treatment among OSA patients was significantly was related to a decrease in ET-1 levels. Further prospective long-term studies with a larger number of patients are needed to evaluate and clarify this issue.

https://ift.tt/2AJQUzU

Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration

Abstract

Purpose

The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids.

Methods

The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan.

Results

External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group.

Conclusions

Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.

https://ift.tt/2Ruo8dP

Clinical Thyroidology®High-Impact Articles

FREE ACCESS through December 11, 2018.
Read Now:

Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers
Jerome M. Hershman  

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI
Tim I.M. Korevaar 

Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism
Angela M. Leung 

Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?
Jacques Orgiazzi 

 

The post Clinical Thyroidology^®High-Impact Articles appeared first on American Thyroid Association.

https://ift.tt/2QztXJq

The rhinologist's role in the management of rathke's cleft cysts

Purpose of review To review the recent literature regarding the growing role of rhinologists and otolaryngologists with neurosurgeons in the joint multidisciplinary team approach for managing patients with Rathke's cleft cysts (RCC). Recent findings The transnasal endoscopic approach to the skull base has become relatively mainstream for surgical treatment of RCCs. Suprasellar lesions, especially those that are purely suprasellar, are associated with higher recurrence rates, though an extended approach may improve dissection and access and therefore aid in lesion removal. Endoscopic cyst drainage is a well tolerated and effective way to treat RCC, and often avoids the postoperative endocrinopathies associated with complete cyst wall removal. Novel techniques have been described for maintaining tract patency, including the use of stents and flaps, in order to prevent cyst stenosis and reaccumulation. A frontier in skull base surgery is in applications for pediatric patients, and managing RCCs in this population surgically appears to be associated with positive outcomes overall. Summary Team-based endoscopic skull base surgery has spurred advances in our understanding of skull base disease, including RCCs. Optimal outcomes are most apparent when the experience and technique of both the endoscopist and neurosurgeon have developed jointly over time. Correspondence to Edward C. Kuan, MD, MBA, Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine Medical Center, 101 The City Dr S, Bldg 56, Ste 500, Orange, CA 92868, USA.. Tel: +1 714 456 5753; fax: +1 714 456 5747; e-mail: eckuan@uci.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zGSMcV

Review and update on extracorporeal septoplasty

Purpose of review To examine the recent literature on extracorporeal septoplasty. Recent findings The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. Summary Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum. Correspondence to Daniel G. Becker, Penn Medicine – Becker ENT, LLC 570 Egg Harbor Road, Suite B2, Sewell, NJ 08080, USA. Tel: +1 856 589 6673; fax: +1 856 589 3343; e-mail: dbecker@beckerent.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Pe2NmP

Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis

Purpose of review New research in the pathogenesis of chronic rhinosinusitis has shed light on an emerging classification system based on endotypes, which help to explain the individualized mechanism of disease in patients suffering from chronic rhinosinusitis with and without nasal polyps. The purpose of this review is to advocate the use of structured histopathologic analysis in the diagnosis and management of patients affected by chronic rhinosinusitis with and without polyps. Recent findings Numerous studies have demonstrated the role of inflammation in chronic rhinosinusitis and the ensuing histopatholgic changes. Few studies have implemented structured histopathologic analysis to guide diagnosis and treatment. Individualized therapy including biotherapeutics and comprehensive surgery has shown to improve outcomes in patients with refractory disease. Summary Structured histopathologic analysis can provide helpful information on the endotype of chronic rhinosinusitis. Routine use in clinical practice should be standardized especially in cases of chronic rhinosinusitis refractory to medical therapy and/or surgery. Correspondence to Dr Bobby A. Tajudeen, MD, Co-Director, Rush Sinus Program, Rush University Medical Center, 1611W. Harrison St., Suite 550, Chicago, IL 60612, USA. Tel: +312 942 9174; fax: +312 942 6653; e-mail: bobby_tajudeen@rush.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zFCVeH

Management of sphenoid lateral recess encephalocoeles

Purpose of review Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. Recent findings Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. Summary SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear. Correspondence to Narayanan Prepageran, MBBS, MS, FRCS, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60 379 492062; e-mail: prepageran@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PhpwhU

Indications and endonasal treatment of petrous apex cholesterol granulomas

Purpose of review Lesions of the petrous apex of the temporal bone can be challenging to access and approaches laterally through the mastoid as well as medially through an endonasal approach are utilized to access this region while preserving function of adjacent structures. Cholesterol granulomas of the petrous apex requiring surgery are marsupialized to prevent expansion of the inflamed cyst and relieve associated clinical symptoms. The endonasal approach to the petrous apex has in the past been limited to lesions medial to the internal carotid artery. Recent findings Endoscopic approaches have been developed to expand the range of petrous apex lesions that are accessible endonasally. These endonasal corridors include a nasopharyngeal/transclival corridor, lateralization of the internal carotid artery to create an expanded medial window, a pterygopalatine infrapetrosal approach, and a contralateral maxillary approach, which allow improved access to the inferior and lateral petrous apex. Nasoseptal flaps may reduce the risk of postoperative stenosis of the drainage tract. Summary Endoscopic endonasal approaches can be used safely to address both medial and lateral/inferior petrous apex lesions. Morbidity of these procedures is low and use of a nasoseptal flap may limit restenosis of the drainage pathway. Correspondence to Michael A. Kohanski, MD, PhD, Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 614 0491; e-mail: Michael.Kohanski@uphs.upenn.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zGSLpn

Current indications for balloon sinuplasty

Purpose of review The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. Recent findings The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Summary Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia. Correspondence to Cemal Cingi, MD, Professor, Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, 26020 Eskisehir, Turkey. Tel: +90 532 2676616; e-mail: ccingi@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PfJjhQ

Contemporary management of juvenile angiofibroma

Purpose of review To illustrate the latest developments and trends in the management of juvenile angiofibroma. Recent findings Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions. Summary Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity. Video abstract In the video, two of the authors describe the content of the review and present the main topics discussed in the article. https://ift.tt/2zCohVk. Correspondence to Giacomo Bertazzoni, MD, Unit of Otorhinolaryngology, University of Brescia, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 030 3995322; e-mail: ilbertaz@gmail.com 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/2JRSqmn). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zE4EfF

Oncologic management of sinonasal undifferentiated carcinoma

Purpose of review This article reviews the latest treatment paradigms in sinonasal undifferentiated carcinoma (SNUC). Recent findings The aggressive biology and associated advanced presentation of SNUC make successful treatment a challenge shared across medical specialties. Still, studies reporting outcomes in SNUC indicate that an aggressive treatment strategy consisting of surgery, radiation and chemotherapy offers the best chance of prolonged survival. Summary Successful treatment of SNUC requires highly specialized care at tertiary cancer treatment facilities. A better understanding of the biology of the disease coupled with increasing outcome reporting will lead to optimized treatment regimens. Correspondence to Zara M. Patel, MD, Assistant Professor, Director of Endoscopic Skull Base Surgery, Rhinology - Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch, Stanford, CA 94305, USA. Tel: +1 650 723 5651; e-mail: zmpatel@stanford.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PhOPR7

Endotypes of chronic rhinosinusitis

Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes. Correspondence to Yvonne Chan, MD, FRCSC, MSc, HBSc, Division Head, Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Trillium Health Partners, 102-101 Queensway West, Mississauga, ON L5B 2P7, USA. Tel: +1 905 277 4312; e-mail: y.chan@utoronto.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zGDLYz

Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes

Purpose of review To appraise the practice and role of open-neck organ preserving surgery for hypopharyngeal squamous cell carcinoma and to update the current indications, techniques, limits, and outcomes. Recent findings The role of primary surgery for hypopharyngeal carcinoma has shifted over the past two decades to primary nonsurgical management with the use of induction or concurrent chemoradiotherapy. The preferred and most suitable tumours for open-neck surgery are the small-volume T stage diseases, with small to medium-volume neck metastases, however such patients are exceedingly rare. Nonetheless, more advanced tumours with cartilage invasion, vocal cord paralysis, or located at piriform apex and postcricoid area, previously unsuitable for open-neck organ preserving surgery, can now be excised and repaired, minimizing morbidity and improving quality of patients' life. Much of this surgical progress has been developed by innovative surgeons using free tissue transfer, accurate placement surgery, reconstruction of a neoglottis, and perfecting the pharyngoesophageal anastomosis. Current practice of open-neck organ preserving surgery for hypopharyngeal carcinoma has been mainly reported in Asia: Korea, Taiwan, Japan, and China. Summary There are some patients who are deemed unsuitable and/or unwilling for current treatment by nonsurgical approaches, and open-neck organ preserving laryngopharyngeal surgery may be a more suitable alternative than selecting a 'lesser or modified' chemo or bioradiotherapy regimen, resulting in a prolonged quantity and quality of life. Correspondence to Professor Patrick J. Bradley, MBA, FRCS, MD, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PeQ0k0

Salivaomics in oral cancer

Purpose of review The goal of cancer screening is to detect tumor at an early stage, and early cancer detection is the hallmark of successful treatment. In addition to traditional tissue biopsy-based diagnostics, more reliable, inexpensive, and noninvasive methods are required for early diagnosis of cancer. In this review, we highlight some of the recent advancements in the field of salivary diagnostics in oral cancer. Recent findings 'Salivaomics' is a broad collection of technologies used to explore different types of molecules contained in saliva. Although many protein and mRNA salivary biomarkers have been identified that can detect oral squamous cell carcinoma (OSCC), none have so far been validated for current clinical use. As the heterogeneity in carcinogenesis and multifactorial cause for OSCC, the most reliable results are gathered with the use of multiple biomarker candidates to improve accuracy and sensitivity of the test used. This further requires sensitive technology to detect salivary biomarkers in low quantities. Summary Large scale studies that incorporate proteomic, transcriptomic, and additional 'omics,' need to be initiated to bring technology to clinical point-of-care applications. Correspondence to Katri Aro, MD, PhD, Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland. Tel: +358 50 4272000; e-mail: katri.aro@hus.fi Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zGDEw7

Chemically modified peanut extract shows increased safety while maintaining immunogenicity

Abstract

Background

Peanuts are most responsible for food‐induced anaphylaxis in adults in developed countries. An effective and safe immunotherapy is urgently needed. The aim of this study was to investigate the immunogenicity, allergenicity and immunotherapeutic efficacy of a well characterized chemically modified peanut extract (MPE) adsorbed to Al(OH)₃.

Methods

Peanut extract (PE) was modified by reduction and alkylation. Using sera of peanut allergic patients, competitive IgE‐binding assays and mediator release assays were performed. The immunogenicity of MPE was evaluated by measuring activation of human PE‐specific T‐cell lines and the induction of PE‐specific IgG in mice. The safety and efficacy of MPE adsorbed to Al(OH)₃ was tested in two mouse models by measuring allergic manifestations upon peanut challenge in peanut allergic mice.

Results

Compared to PE, the IgE‐binding and capacity to induce allergic symptoms of MPE was lower in all patients. PE and MPE displayed similar immunogenicity in vivo and in vitro. In mice sensitized to PE, the threshold for anaphylaxis (drop in BT) upon subcutaneous challenge with PE was 0.01 mg, while at 0.3 mg MPE no allergic reaction occurred. Anaphylaxis was not observed when PE and MPE were fully adsorbed to Al(OH)₃. Both PE and MPE + Al(OH)₃ showed to be efficacious in a model for immunotherapy.

Conclusion

In our studies an Al(OH)₃ adsorbed MPE showed reduced allergenicity compared to unmodified PE, while the efficacy of immunotherapy is maintained. The preclinical data presented in this study supports further development of modified peanut allergens for IT.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RpHSiI

Much ado about Biologicals:Highlights of the Master Class on Biologicals, Prague, 2018

https://ift.tt/2KNb3th

The rhinologist's role in the management of rathke's cleft cysts

Purpose of review To review the recent literature regarding the growing role of rhinologists and otolaryngologists with neurosurgeons in the joint multidisciplinary team approach for managing patients with Rathke's cleft cysts (RCC). Recent findings The transnasal endoscopic approach to the skull base has become relatively mainstream for surgical treatment of RCCs. Suprasellar lesions, especially those that are purely suprasellar, are associated with higher recurrence rates, though an extended approach may improve dissection and access and therefore aid in lesion removal. Endoscopic cyst drainage is a well tolerated and effective way to treat RCC, and often avoids the postoperative endocrinopathies associated with complete cyst wall removal. Novel techniques have been described for maintaining tract patency, including the use of stents and flaps, in order to prevent cyst stenosis and reaccumulation. A frontier in skull base surgery is in applications for pediatric patients, and managing RCCs in this population surgically appears to be associated with positive outcomes overall. Summary Team-based endoscopic skull base surgery has spurred advances in our understanding of skull base disease, including RCCs. Optimal outcomes are most apparent when the experience and technique of both the endoscopist and neurosurgeon have developed jointly over time. Correspondence to Edward C. Kuan, MD, MBA, Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine Medical Center, 101 The City Dr S, Bldg 56, Ste 500, Orange, CA 92868, USA.. Tel: +1 714 456 5753; fax: +1 714 456 5747; e-mail: eckuan@uci.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zGSMcV

Review and update on extracorporeal septoplasty

Purpose of review To examine the recent literature on extracorporeal septoplasty. Recent findings The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. Summary Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum. Correspondence to Daniel G. Becker, Penn Medicine – Becker ENT, LLC 570 Egg Harbor Road, Suite B2, Sewell, NJ 08080, USA. Tel: +1 856 589 6673; fax: +1 856 589 3343; e-mail: dbecker@beckerent.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Pe2NmP

Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis

Purpose of review New research in the pathogenesis of chronic rhinosinusitis has shed light on an emerging classification system based on endotypes, which help to explain the individualized mechanism of disease in patients suffering from chronic rhinosinusitis with and without nasal polyps. The purpose of this review is to advocate the use of structured histopathologic analysis in the diagnosis and management of patients affected by chronic rhinosinusitis with and without polyps. Recent findings Numerous studies have demonstrated the role of inflammation in chronic rhinosinusitis and the ensuing histopatholgic changes. Few studies have implemented structured histopathologic analysis to guide diagnosis and treatment. Individualized therapy including biotherapeutics and comprehensive surgery has shown to improve outcomes in patients with refractory disease. Summary Structured histopathologic analysis can provide helpful information on the endotype of chronic rhinosinusitis. Routine use in clinical practice should be standardized especially in cases of chronic rhinosinusitis refractory to medical therapy and/or surgery. Correspondence to Dr Bobby A. Tajudeen, MD, Co-Director, Rush Sinus Program, Rush University Medical Center, 1611W. Harrison St., Suite 550, Chicago, IL 60612, USA. Tel: +312 942 9174; fax: +312 942 6653; e-mail: bobby_tajudeen@rush.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zFCVeH

Management of sphenoid lateral recess encephalocoeles

Purpose of review Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. Recent findings Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. Summary SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear. Correspondence to Narayanan Prepageran, MBBS, MS, FRCS, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60 379 492062; e-mail: prepageran@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Indications and endonasal treatment of petrous apex cholesterol granulomas

Purpose of review Lesions of the petrous apex of the temporal bone can be challenging to access and approaches laterally through the mastoid as well as medially through an endonasal approach are utilized to access this region while preserving function of adjacent structures. Cholesterol granulomas of the petrous apex requiring surgery are marsupialized to prevent expansion of the inflamed cyst and relieve associated clinical symptoms. The endonasal approach to the petrous apex has in the past been limited to lesions medial to the internal carotid artery. Recent findings Endoscopic approaches have been developed to expand the range of petrous apex lesions that are accessible endonasally. These endonasal corridors include a nasopharyngeal/transclival corridor, lateralization of the internal carotid artery to create an expanded medial window, a pterygopalatine infrapetrosal approach, and a contralateral maxillary approach, which allow improved access to the inferior and lateral petrous apex. Nasoseptal flaps may reduce the risk of postoperative stenosis of the drainage tract. Summary Endoscopic endonasal approaches can be used safely to address both medial and lateral/inferior petrous apex lesions. Morbidity of these procedures is low and use of a nasoseptal flap may limit restenosis of the drainage pathway. Correspondence to Michael A. Kohanski, MD, PhD, Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 614 0491; e-mail: Michael.Kohanski@uphs.upenn.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Current indications for balloon sinuplasty

Purpose of review The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. Recent findings The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Summary Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia. Correspondence to Cemal Cingi, MD, Professor, Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, 26020 Eskisehir, Turkey. Tel: +90 532 2676616; e-mail: ccingi@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Contemporary management of juvenile angiofibroma

Purpose of review To illustrate the latest developments and trends in the management of juvenile angiofibroma. Recent findings Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions. Summary Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity. Video abstract In the video, two of the authors describe the content of the review and present the main topics discussed in the article. https://ift.tt/2zCohVk. Correspondence to Giacomo Bertazzoni, MD, Unit of Otorhinolaryngology, University of Brescia, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 030 3995322; e-mail: ilbertaz@gmail.com 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/2JRSqmn). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oncologic management of sinonasal undifferentiated carcinoma

Purpose of review This article reviews the latest treatment paradigms in sinonasal undifferentiated carcinoma (SNUC). Recent findings The aggressive biology and associated advanced presentation of SNUC make successful treatment a challenge shared across medical specialties. Still, studies reporting outcomes in SNUC indicate that an aggressive treatment strategy consisting of surgery, radiation and chemotherapy offers the best chance of prolonged survival. Summary Successful treatment of SNUC requires highly specialized care at tertiary cancer treatment facilities. A better understanding of the biology of the disease coupled with increasing outcome reporting will lead to optimized treatment regimens. Correspondence to Zara M. Patel, MD, Assistant Professor, Director of Endoscopic Skull Base Surgery, Rhinology - Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch, Stanford, CA 94305, USA. Tel: +1 650 723 5651; e-mail: zmpatel@stanford.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PhOPR7

Endotypes of chronic rhinosinusitis

Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes. Correspondence to Yvonne Chan, MD, FRCSC, MSc, HBSc, Division Head, Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Trillium Health Partners, 102-101 Queensway West, Mississauga, ON L5B 2P7, USA. Tel: +1 905 277 4312; e-mail: y.chan@utoronto.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes

Purpose of review To appraise the practice and role of open-neck organ preserving surgery for hypopharyngeal squamous cell carcinoma and to update the current indications, techniques, limits, and outcomes. Recent findings The role of primary surgery for hypopharyngeal carcinoma has shifted over the past two decades to primary nonsurgical management with the use of induction or concurrent chemoradiotherapy. The preferred and most suitable tumours for open-neck surgery are the small-volume T stage diseases, with small to medium-volume neck metastases, however such patients are exceedingly rare. Nonetheless, more advanced tumours with cartilage invasion, vocal cord paralysis, or located at piriform apex and postcricoid area, previously unsuitable for open-neck organ preserving surgery, can now be excised and repaired, minimizing morbidity and improving quality of patients' life. Much of this surgical progress has been developed by innovative surgeons using free tissue transfer, accurate placement surgery, reconstruction of a neoglottis, and perfecting the pharyngoesophageal anastomosis. Current practice of open-neck organ preserving surgery for hypopharyngeal carcinoma has been mainly reported in Asia: Korea, Taiwan, Japan, and China. Summary There are some patients who are deemed unsuitable and/or unwilling for current treatment by nonsurgical approaches, and open-neck organ preserving laryngopharyngeal surgery may be a more suitable alternative than selecting a 'lesser or modified' chemo or bioradiotherapy regimen, resulting in a prolonged quantity and quality of life. Correspondence to Professor Patrick J. Bradley, MBA, FRCS, MD, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2PeQ0k0

Salivaomics in oral cancer

Purpose of review The goal of cancer screening is to detect tumor at an early stage, and early cancer detection is the hallmark of successful treatment. In addition to traditional tissue biopsy-based diagnostics, more reliable, inexpensive, and noninvasive methods are required for early diagnosis of cancer. In this review, we highlight some of the recent advancements in the field of salivary diagnostics in oral cancer. Recent findings 'Salivaomics' is a broad collection of technologies used to explore different types of molecules contained in saliva. Although many protein and mRNA salivary biomarkers have been identified that can detect oral squamous cell carcinoma (OSCC), none have so far been validated for current clinical use. As the heterogeneity in carcinogenesis and multifactorial cause for OSCC, the most reliable results are gathered with the use of multiple biomarker candidates to improve accuracy and sensitivity of the test used. This further requires sensitive technology to detect salivary biomarkers in low quantities. Summary Large scale studies that incorporate proteomic, transcriptomic, and additional 'omics,' need to be initiated to bring technology to clinical point-of-care applications. Correspondence to Katri Aro, MD, PhD, Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland. Tel: +358 50 4272000; e-mail: katri.aro@hus.fi Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through December 14, 2018.
Watch now:

Transoral Endoscopic Thyroidectomy Vestibular Approach: Technical Tips and Tricks
Gustavo G. Fernandez Ranvier, Patrick Neshiwat, William B. Inabnet III

Central Neck Dissection: The Five Key Steps
Nathaniel J. Walsh, Asif M. Talukder, David J. Terris 

Transoral and Submental Thyroidectomy
Yufei Chen, Kathryn H. Chomsky-Higgins, Iheoma Nwaogu, Carolyn D. Seib, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Insoo Suh 

3D Anatomic Adrenal Modeling Aids Preoperative Planning in Cortical-Sparing Adrenalectomy
Janeil M. Mitchell, Michael J. Magnetta, Kelly L. McCoy, Sally E. Carty, Linwah Yip

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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Review of “Improving Benchmarks for Global Surgery: Nationwide Enumeration of Operations Performed in Ghana” by Gyedu A, Stewart B, Gaskill C, Boakye G, Appiah-Denkyira E, Donkor P, Maier R, Quansah R, Mock C in Ann Surg 268:282–288, 2018

No abstract available

https://ift.tt/2DWSq4T

Microsurgical Replantation of Completely Avulsed Nasal Segment

Complete avulsion of the nose is a devastating injury that may result in permanent disfigurement. Microvascular reattachment is technically difficult due to small size of the injured vessels, associated avulsion or crush injury, and relative inability to achieve venous anastomosis. This report describes a successful case of microsurgical replantation of the distal third of the nose in a 47-year-old patient after a dog bite injury with the use of a superficial temporal vein graft for arterial repair and leeching for venous outflow. The recovery was uneventful with total survival of the replant noted except for marginal skin necrosis, which healed by secondary intention. There was no need for any transfusion. The authors found that use of the superficial temporal vein for arterial revascularization was efficient and convenient as it was in the same surgical field, offering a favorable donor site scar in the preauricular sulcus. Microsurgical replantation should be attempted whenever feasible in cases of complete nose amputation. Address correspondence and reprint requests to Mustafa Akyurek, MD, PhD, Division of Plastic Surgery, University of Massachusetts Medical School, 281 Lincoln St, Worcester, MA 01605; E-mail: akyurekm@ummhc.org Received 27 June, 2018 Accepted 23 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2QucqlZ

Intraparotid Facial Nerve Schwannoma in a Nine-Year-Old Patient: Diagnosis, Classification, and Surgical Approach Stages

Intraparotid facial nerve schwannoma (IFNS) is rarely observed in children compared with adults. Only a few cases have been reported in the literature. After radiological imaging and fine needle aspiration biopsy, an IFNS diagnosis may be skipped and confused with pleomorphic adenoma, which has a high prevalence among patients who have a mass in the parotid gland. The probability of IFNS can be recognized by a close relation between the mass and the facial nerve during the application of parotidectomy and by the frozen biopsy of the mass. The surgeon evaluates the mass and faces with surgical mass excison and facial nerve reconstruction according to the relation between the mass and the facial nerve because there is no diagnostic method for the presurgery diagnosis of IFNS. Therefore, the surgeon should be prepared for the possibility of functional lossin the facial nerve during parotidectomy. This article presents the case of a 9-year-old patient with an IFNS diagnosis who had a surgical operation in our clinic, and the algorithm designed according to the literature for the diagnosis and surgical classification of IFNS, as well as the approaches to facial nerve reconstruction. Address correspondence and reprint requests to Murat Gumussoy, MD, Department of Otolaryngology and Head and Neck Surgery, The Ministry of Health Izmir Tepecik Training and Research Hospital, Güney mahallesi 1140, 1 sokak no: 1 yenişehir, konak, Izmir, Turkey; E-mail: mgumussoy@hotmail.com Received 29 June, 2018 Accepted 24 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DWSotN

Primary Non-Hodgkin Lymphoma of the Parotid Gland Masquerading Chronic Sialadenitis

No abstract available

https://ift.tt/2Qz80Kw

Multiple Variations at the Base of an Adult Skull: Implications in Radiology and Skull Base Surgery

Knowledge of variations at the base of the skull may be important for academic, anthropological, forensic, and clinical purposes, especially in computed tomography and magnetic resonance imaging and while performing safe radical surgery. This report presents multiple variations at the base of an adult Indian skull. The variations noted include the presence of foramen of Civinini bilaterally, absence of carotid canal on the left side, reduced size of foramen lacerum on the left side, presence of petro-occipital foramen bilaterally, asymmetry between the jugular fossae, and asymmetrical occipital condyles. The rare, multiple variations reported here might be useful for neurosurgeons, orthopedic surgeons, and radiologists. Address correspondence and reprint requests to Satheesha B. Nayak, MSc, PhD, Professor of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka State 576104, India; E-mail: nayaksathish@gmail.com Received 23 August, 2018 Accepted 6 October, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DWSkKz

Significance of Medial Osteotomy on the Olfactory Function in Patients Who Underwent Septorhinoplasty

Objective: This study was designed to explore the impact of medial osteotomy on olfactory function. Methods: This nonrandomized, prospective study included 60 adult patients who underwent open technique septoplasty (group 1), rhinoplasty with only lateral osteotomy (group 2), and septorhinoplasty with medial and lateral osteotomies (group 3). Olfactory functions were evaluated by using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. The CCCRC test includes the butanol threshold test and smell identification test using common smells. The butanol threshold test and smell identification test scores of each group were recorded preoperatively and at 1st and 4th months and compared. Results: Each group is consisted of 20 patients. The preoperative smell identification test and butanol threshold test scores were similar in each group. The smell identification test, butanol threshold test, and CCCRC olfactory test scores of the 1st month were statistically significantly low in group 3. There was no statistically significant difference between the groups at 4th month postoperatively. Conclusion: The present study is the first analysis of the effect of medial osteotomy on olfactory function. Medial osteotomy may decrease the olfactory function in early time, but afterwards olfaction could recover at preoperative levels. Address correspondence and reprint requests to Dr Hasan Emre Koçak, MD, Bakirköy Dr Sadi Konuk Eğitim ve Araştirma Hastanesi, Zuhuratbaba Mah Tevfik Sağlam Cad No 11, Bakirköy, Istanbul, Turkey; E-mail: drhekbb@gmail.com Received 7 March, 2018 Accepted 17 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2QsNrzC

Assessment of Therapeutic Effect of Intra-Articular Nanofat Injection for Temporomandibular Disorders

Introduction: Temporomandibular disorders (TMD) refer to a group of heterogeneous, pain and dysfunction conditions involving the masticatory system, which influences life quality of the sufferers. Nanofat graft injection in temporomandibular joint (TMJ) is a simple and less invasive surgical procedure for treatment of TMJ problems. The aim of this study was to evaluate influence and effectiveness of nanofat injection in TMJ for treatment of TMD. Patients and Methods: This study was performed in Al-Shaheed Ghazi Al-Hariri Hospital, Department of Oral and Maxillofacial Surgery, Baghdad Medical City from October 2016 and December 2017. A total of 11 patients (3 males) and (8 females) with range of age 18 to 34 years old. Every patient was assessed for the following parameters preoperatively: Pain level, maximum mouth opening (MMO), joint clicking, and deviation. Results: This study was revealed marked female predilection with female ratio about 72.7% (8 patients) and male ratio 27.3% (3 patients), range between 18 and 34 years old. Three patients were presented with single joint (15.8%) and 16 patients were presented with both joints (84.2%). In general, all patients tolerated treatment procedures without any serious complications during the procedure or after the procedure. The results of parameters were pain, clicking, and deviation (P 

https://ift.tt/2DYw1Er

A Novel Approach for the Reconstruction of Premaxilla by Archwise Distraction in Bilateral Cleft Lip and Palate

Interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing large clefts. In this article, a new method for reconstruction of the premaxilla in 2 bilateral cleft lip and palate patients is introduced. The aim was to distract the lateral segments through the curve of the dental arch, achieve complete closure of the gaps, and use the premaxilla as a bone graft. Patient 1 (20-year-old female) had double jaw surgery before but presented residual alveolar cleft and small premaxilla. Patient 2 (21-year-old male) had anterior and posterior crossbite and caries of teeth on premaxilla. Following the preliminary fixed orthodontic treatment in both patients, archwise distraction protocol was performed. The distraction duration and the achieved amount of new bone per side were 4 weeks/22 mm and 5 weeks/25 mm in Patients 1 and 2, respectively. At the end of a 2-month retention period, docking side surgery was performed and premaxilla was used as the bone graft. The protocol was very effective for not only closure of the large cleft defects but also the reconstruction of the premaxilla. Anteroposterior relationship and the patients' profiles were considerably and positively affected. Address correspondence and reprint requests to Hanife Nuray Yilmaz, DDS, PhD, Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Marmara University, Basibuyuk Mahallesi, Basibuyuk Yolu Marmara Universitesi Basibuyuk Saglik Yerleskesi 9/3, 34854 Basibuyuk, Maltepe, Istanbul, Turkey; E-mail: hanarikan@yahoo.com Received 20 April, 2018 Accepted 17 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DXKkZD

Study on the Therapeutic Effects of Trigeminal Neuralgia With Microvascular Decompression and Stereotactic Gamma Knife Surgery in the Elderly

Objective: The aim of the study was to evaluate the efficacy of microvascular decompression (MVD) and stereotactic gamma knife surgery (GKS) in the treatment of trigeminal neuralgia (TN) in the elderly. Patients and Methods: Retrospective analysis of 137 elderly cases with TN underwent MVD, partial sensory rhizotomy (PR) treatment from August 2007 to March 2017 and 56 cases underwent GKS treatment from May 2014 to February 2017 was made, compared the efficacy of MVD and GKS in different age groups. Results: In 125 patients of MVD alone, the responsible vessels included 60 cases of superior cerebellar artery, 55 cases of anterior inferior cerebellar artery, 4 cases of venous vascular compression, 13 cases of mixed arteriovenous compression and 3 cases of vertebral artery, and 2 cases of no responsible vessel. Operation methods: MVD 125 cases, MVD + PR 10 cases, PR 1 cases, simple exploration in 1 case. Results of MVD surgery: Among 125 patients of MVD alone, 95 cases were cured, 15 cases improved, and 15 cases were ineffective. Among 10 cases of MVD + PR, cured in 9 cases and improved in 1 case. PR and simple exploration in 2 cases got pain disappeared. Postoperative complications of MVD: No deaths, CSF leakage in 2 cases, intracranial infection in 3 cases, ipsilateral hearing loss in 1 case, and ipsilateral facial paralysis in 1 case, delayed intracranial hematoma in 2 cases. After GKS treatment, the shortest onset time was from 9 days up to 6 months, an average of 2.2 months. Among 56 patients, 30 cases were cured, accounting for 53.6%, 20 cases improved, accounting for 35.7%, 6 cases were ineffective, accounting for 10.7%. Postoperative complications were facial numbness and dysesthesia, 7 cases, the incidence was 12.5%. In the group of 60 to 70 years old and the group of 70 to 80 years old, the treatment effect of MVD was better than that of GKS (χ2 test, P 80 years old group (χ2 test, P > 0.05). There was no significant difference in the therapeutic effect of TN underwent GKS among all age groups (χ2 test, P > 0.05). Conclusion: Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years. Address correspondence and reprint requests to Shengcheng Wei, MD, Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, China; E-mail: shengcheng77@163.com Received 16 March, 2018 Accepted 28 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Comparison of the Effects of Two Different Analgesics on Bone Regeneration During Mandibular Distraction Osteogenesis

Introduction: Mandibular distraction osteogenesis (DO) is frequently used in the management of bone defects and craniofacial deformities, with analgesics commonly administered to relieve acute postoperative pain. This experimental animal study investigated the effects of 2 analgesics, acetaminophen and acemetacin, on bone regeneration after DO. Materials and methods: This study was conducted with 14 mature male New Zealand rabbits (2.8–3.2 kg) randomized into 2 groups of 7. Mandibular osteotomies were performed under optimal operating conditions, and a custom-made distractor was applied to the mandible of each subject, with distraction initiated after a 5-day latency period at a rate of 1.0 mm/d (2 × 0.5 mm/d) for 10 days. Analgesics were administered via oral gavage during the latency period and for the first 5 days of the distraction period for 10 days in total, with group I receiving acetaminophen (200 mg/kg/d) and group II receiving acemetacin (5 mg/kg/d). Subjects were sacrificed and their mandibles dissected at the end of 4 weeks postoperatively. Bone mineral density (BMD) and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry (DEXA), and histomorphometric analysis was performed to evaluate the quality of newly formed bone. Paired group comparisons of non-normally distributed numerical variables were made using the Mann–Whitney U test, with a P value of

https://ift.tt/2DX5zuG

Review of “Caring for Older Surgical Patients: Contemporary Attitudes, Knowledge, Practices, and Needs of General Surgeons and Residents” by Chesney TR, Pang G, Ahmed N in Ann Surg 268:77–85, 2018

No abstract available

https://ift.tt/2QucaDx

New Technique for Closure of Alveolar Cleft With Umbilical Cord Stem Cells

This article presents the case of a newly born female patient with a cleft of the primary palate (alveolar cleft), with an in utero diagnosis of the described cleft, from whom umbilical cord stem cells are obtained and cryopreserved. The patient is managed with nasoalveolar molding, and at 5 months of age, she is taken to surgery for cheiloplasty and gingivoperiostioplasty with umbilical cord stem cells. A radiographic and CT follow-up is carried out on the described cleft. Address correspondence and reprint requests to Botero Alejandra Garcia, MD, Department of Plastic and Reconstructive Surgery, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Carrera 19 No 8 – 32 Servicio Cirugía Plástica Estética y Reconstructiva – Pabellón Arcadio Forero, Bogotá, Colombia; E-mail: alebotero@hotmail.com Received 30 May, 2018 Accepted 19 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2Quc6nh

Cone Beam Computed Tomographic Evaluation of Intracranial Physiologic Calcifications

Objective: The aim of the present study was to evaluate the incidence of physiologic intracranial calcifications detected in cone beam computed tomography (CBCT) images of a Turkish subpopulation. Methods: The CBCT image of the full head of 573 patients taken between 2015 and 2018 was evaluated retrospectively. The prevalence of habenular calcification, petroclinoid ligament, coroid plexus, interclinoid ligament (ICL), and carotico-clinoid ligament (CCL) calcifications was investigated. The age and gender of the patients were recorded. Results: Intracranial calcification was found in 190 (33.1%) of 573 cases. The frequency of physiological calcifications is respectively; 19.2% were found as habenular, 4.88% as ICL, 3.83% as CCL, 2.7% as petroclinoid ligament, and 2.4% as choroid plexus. 38.2% of the women and 29.3% of the men had intracranial calcification. In 4 patients, both ICL and CCL ossification were detected. No statistically significant relationship was found between age, gender, and calcifications. Conclusion: Cone beam computed tomography is a widely used imaging technique for dental diagnosis and treatment. Intracranial physiological calcifications may be a common incidental finding of CBCT scans. Address correspondence and reprint requests to Seval Bayrak, DDS, PhD, Dentomaxillofacial Radiology, Faculty of Dentistry, Abant Izzet Baysal University, Bolu, Turkey, 14000; E-mail: dtseval@hotmail.com Received 2 June, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DW3Wxm

Postoperative Visual Loss: A Report of One Patient With Unilateral Blindness After Orthognathic Surgery

Introduction: Blindness after orthognathic surgery may be the result of the surgical procedure itself or the consequence of factors induced by general anesthesia. However, the exact mechanism between is not known. The purpose of this article is to present a case of a postoperative visual loss after orthognathic surgery under general anesthesia concluding with a brief literature review about this topic. Report of case: We report the case of a patient who suffered unilateral blindness with homolateral frontal paresthesia after orthognathic procedure in 2 steps. He presented intraoperative bradycardia with a potential undiagnosed hypertension, associated with significant blood loss and volume resuscitation by colloids and cristalloids. Postoperative examination concluded to posterior ischemic optic neuropathy. Discussion and Conclusion: By a systematic literature review, we discuss about surgical and anesthesic causes of postoperative visual loss, and particularly pathophysiology mechanism of posterior ischemic optic neuropathy. Some predisposition and risk factors have been identified and need to be taken into account. Address correspondence and reprint requests to Constance Delmotte, Service de Chirurgie Maxillo-Faciale Et Stomatologie, Hôpital Roger Salengro, CHRU Lille, 59000 Lille, France; E-mail: constancedelmotte@hotmail.com Received 3 June, 2018 Accepted 14 October, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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The Fate of the Mandibular Reconstruction Plate

To preserve the continuity of the mandible after resection or traumatic bone loss, the defect is usually reconstructed with a bone graft fixed by a reconstruction plate. The fate of these plates is the objective of this study. Twenty-three patients (4 females and 19 males) required a reconstructive procedure to restore the discontinuity defect in the mandible by a mandibular reconstruction plate. Postoperative follow-up was performed to assess the outcomes of these plates. The mean age of the patients was 28.22 years. The most common cause of the discontinuity defect was bullet injury. The mean follow-up period was 3.65 years. The most common postoperative complication was the surgical site infection. The reconstruction plate of the mandible is associated with long-term success and body acceptance in the hands of an experienced surgeon. Address correspondence and reprint requests to Saif Saadedeen Abdulrazaq, BDS, FIBMS, Specialist Oral and Maxillofacial Surgeon, Lecturer, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Bab-Almoadham, PO Box 1417, Baghdad, Iraq; E-mail: drsaif.sa@codental.uobaghdad.edu.iq Received 4 June, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Clinical Research on Prevention and Treatment of Respiratory Tract Complications With Acupoint Application After Operation Under General Anesthesia

There are various respiratory tract complications in patients undergoing general anesthesia, with postoperative sore throat (POST) being the most commonly seen. Although measures have been taken to prevent and treat POST in clinical practice, the control of POST is still not satisfactory. In this study, 880 ASA patients with grade I to II general anesthesia were randomly assigned into control group and experimental group. After patients entered into the operating room, the plasters were applied to the designated points (Tianzhu, Lianquan, Dazhui, etc), and the clinical efficacy of acupoint application in prevention and treatment of respiratory tract complications after general anesthesia was observed. The results showed that patients starting using acupoint application before operation could significantly reduce the incidence of postoperative respiratory tract complications, and the effects lasted for up to 24 hours. In this study, acupoint application was used, providing a simple, safe, efficient, and durable approach to prevent and treat respiratory tract complications after operation under general anesthesia. Address correspondence and reprint requests to Si-Lan Liu, PhD, Anesthesia Surgery Department, The First Affiliated Hospital of Suzhou University, 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province 215006, China; E-mail: szliusl@126.com; Fang-Qin Jiang, Anesthesia Surgery Department, The First Affiliated Hospital of Suzhou University, 899 Pinghai Road, Gusu District, Suzhou City, Jiangsu Province 215006, China; E-mail: jiangfangqing@126.com Received 9 June, 2018 Accepted 30 July, 2018 X-HL and X-MZ equally contributed to this work and should be considered as co-first authors. S-LL and F-QJ authors contributed equally to this work and should be considered co-corresponding authors. The authors acknowledge funding from the National Natural Science Fund (81471136) and Jiangsu Provincial Medial Youth Talent (QNRC2016740). This study was financially supported by the program of Further Accelerating the Development of Chinese Medicine Three-Year Action Plan of Shanghai (2014–2016) (no. ZY3-RCPY-3-1013). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomic Landmarks in Transoral Oropharyngeal Surgery

Introduction: Minimally invasive transoral surgery for oropharyngeal cancer is a challenge for head and neck surgeons because of the inside-out anatomic presentation and the confined workspace. This study was performed to describe the main neurovascular and muscular landmarks in a transoral approach. The authors propose an anatomic stratification for this surgery. Materials and Methods: Lateral wall of the oropharynx and base of the tongue of 15 formalin-fixed heads (30 sides) and 5 fresh cadaveric heads (10 sides) sagittal sectioned were dissected from the inside outwards. Dissection of 7 fresh cadaveric heads via an endoscopic transoral approach was also performed. Results: The lateral oropharyngeal wall was divided into 3 layers from medial to lateral, based in the styloid muscle diaphragm. The first layer, medial to styloid muscles, includes the tonsillar vascularization and the lingual branch of the glossopharyngeal nerve. The second layer, lateral to constrictor muscles, includes the pharyngeal venous plexus, the glossopharyngeal nerve, and the lingual artery. The third layer, lateral to styloid diaphragm, includes the parapharyngeal and submandibular spaces, the carotid vessels and lingual, vagus, glossopharyngeal and hypoglossal nerves. The base of the tongue was divided into central and lateral parts, which contain the lingual artery and lingual branches of the glossopharyngeal nerve. The main landmarks to find the neurovascular structures in each layer are described. Conclusion: The authors propose an anatomic division, which helps to plan oropharynx and base of the tongue surgery. This anatomic stratification is useful to surgeons when performing a reconstruction of the oropharynx with a transoral approach. Address correspondence and reprint requests to David Virós Porcuna, PhD, Otolaryngology Section, Head and Neck Surgery, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n 08916 Badalona (Barcelona), Spain; E-mail: davidviros@gmail.com Received 15 June, 2018 Accepted 11 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Immunoglobulin G4-Related Periorbital Soft-Tissue Destruction

A study on immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with destructive changes in periorbital soft tissues was presented. The patient was an 89-year-old-man who developed a left-sided orbital lesion involving the globe, lacrimal gland, and extraocular muscles. A diagnosis of definite IgG4-ROD was made based on clinical and histopathologic findings. The patient was started on oral prednisolone, which afforded good response initially. However, when tapering was initiated, full-thickness destruction developed on the lateral half of the lower eyelid margin. Steroid dose was increased, and the patient underwent a series of surgeries (suspension of the lower eyelid and lateral tarsorrhaphy, subtotal exenteration, and debridement and endonasal sinus surgery) in an attempt to manage the progression and recurrence of the condition. Medical management consisting of antibiotics and anti-fungal was administered to control the disease process. With close follow-up, repeated ancillary testing, and continuous management, the periocular and systemic findings were stable for 3 months after the last surgery. Address correspondence and reprint requests to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 18 June, 2018 Accepted 11 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Wider Suturectomy Before Posterior Distraction for Craniosynostosis

The aim of the surgery for craniosynostosis is to release increased intracranial pressure and to normalize cranial shape. The procedure has developed so far in Japan, from a simple strip craniectomy before 1960s through a total calvarial remodeling after 1970s and later methods of 1990s, such as distraction and its modifications applying to the posterior cranium. Since a distracter needs certain hardness and thickness of the bone, the surgery has to be stood by until 5 to 6 months of age. Modified Jimenez procedure, as a latest option, were applied for very early years of 10 patients with several types of craniosynostosis, in our team in the past 3 years. The experience was small with short follow-up; the results are all good in those volume change and shape. The procedure proved to be another alternative especially prior to posterior distraction of syndromic patients in terms of positive and expedited control in an earlier surgical management. Address correspondence and reprint requests to Shigeo Kyutoku, MD, PhD, Division of Reconstructive Plastic Surgery, Nara City Hospital, 1-50-1 Higashi-Kidera-cho, Nara-shi, 630-8305, Japan; E-mail: s-kyuutoku@nara-jadecom.jp Received 20 May, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Supplemental Internal Wire Suspension in Orthognathic Surgery Fixation

Internal wire suspensions were previously used in the management of maxillary trauma and orthognathic surgery, but currently the gold standard is rigid internal fixation with bone plates and screws. The authors report a case of bimaxillary osteotomy in a skeletal class III patient where a supplemental circum-zygomatic-mandibular suspension was done to stabilize the maxilla because of the instability after rigid internal fixation due to poor bone thickness. Address correspondence and reprint requests to Dr Pandurangan Harikrishnan, MDS, FDSRCS (Eng), FCrfOrth (Taiwan), Consultant Orthodontist and Oral Surgeon, Teeth "N" Jaws Center, 23 and 25, 1st Cross Street, Lake Area, Nungambakkam, Chennai 600034, Tamilnadu, India; E-mail : teethnjaws@rediffmail.com Received 3 June, 2018 Accepted 10 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Rush desensitization with a single antigen induces subclinical activation of mast cells and protects against bystander challenge in dually sensitized mice

Abstract

Background

Rush desensitization can provide short‐term tolerance to individuals who are allergic to certain medications in instances where other therapeutic interventions are limited. While rush DS is typically successful in preventing adverse type I hypersensitivity reactions, the mechanism of allergic protection remains unknown. Given the rise in prevalence of individuals displaying multiple allergies, understanding the impact of rush DS on "bystander" allergens, or additional allergens to which an individual is sensitized, could help inform clinical recommendations.

Objective

To evaluate the effect of rush DS on bystander sensitization.

Materials and Methods

We used a murine model of rush DS, whereby BALB/c mice were sensitized to ovalbumin (OVA) and desensitized through repeated intraperitoneal injections of OVA. Using a local anaphylaxis assay, we measured ear swelling by Evans blue extravasation following intradermal challenge. In studies to measure the impact on bystander antigens, a modified protocol was used in which mice were dually sensitized to OVA and Keyhole limpet hemocyanin (KLH), and densensitized to either OVA or KLH prior to allergic challenge.

Results

The immunological effects of rush DS were independent of changes in Th1 and Th2 cytokine production and circulating OVA‐IgE levels. Instead, rush DS resulted in subclinical degranulation of mast cells prior to challenge. In our dual sensitization model, rush DS with a single antigen conferred protection against allergic challenge to a secondary antigen. Bystander protection required prior sensitization, as DS with an irrelevant antigen did not impact allergic responsiveness.

Conclusions and Clinical Relevance

We reveal that a key mechanism of rush DS protection against allergic responsiveness may be the subclinical degranulation of mast cells. Therefore, performing rush DS to a single antigen to which one is IgE‐sensitized may be sufficient to desensitize to multiple allergens. Future studies could lead to streamlined protocols of rush DS for patients with multiple allergies.

This article is protected by copyright. All rights reserved.

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An integrated framework using high‐dimensional mass cytometry and fluorescent flow cytometry identifies discrete B cell subsets in patients with red meat allergy

Abstract

Background

B cells play a critical role in the development and maintenance of food allergy by producing allergen‐specific IgE. Despite the importance of B cells in IgE‐mediated food allergy, the identity of sIgE‐producing human B cells and how IgE is regulated are poorly understood.

Objective

To identify the immunophenotypes of circulating B cells associated with the production of galactose‐alpha‐1,3‐galactose specific IgE production in patients with red meat allergy.

Methods

B cells in PBMC samples obtained from 19 adults with physician‐diagnosed red meat allergy and 20 non‐meat allergic healthy controls were assessed by mass cytometry along with a bioinformatics analysis pipeline to identify discrete B cell phenotypes that associated with serum sIgE. Fluorescent flow cytometry was then applied to sort purify discrete B cell subsets, and B cells were functionally evaluated on an individual cell level for the production of sIgE by ELISPOT.

Results

Discrete B cell phenotypes abundant in meat allergic subjects compared to non‐meat allergic controls were found in peripheral blood that do not share typical characteristics of classical isotype‐switched memory B cells that express high levels of CD27. These B cell subsets shared higher IgD and lower IgM expression levels coupled with CXCR4, CCR6 and CD25 expression. In vitro polyclonal stimulation of purified B cell subsets from meat allergic subjects demonstrated that these subsets were enriched for cells induced to secrete sIgE.

Conclusions and Clinical Relevance

Circulating B cells display increased abundance of discrete B cell subsets in meat allergic subjects. This observation, coupled with the capacity of individual B cell subsets to produce sIgE following activation, implicates these novel B cell phenotypes in promoting IgE in meat allergy.

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Enhancement of lipid content and inflammatory cytokine secretion in SZ95 sebocytes by palmitic acid suggests a potential link between free fatty acids and acne aggravation

Abstract

A relationship between acne and free fatty acids (FFAs) has been suggested recently. However, the effects of FFAs on sebaceous glands are still largely unknown. At the same time, the role of FFAs during chronic inflammation is well established. Considering that FFAs are also a major component of sebum, it is likely that changes in FFA affect both the synthesis of sebum and the inflammatory response in sebaceous glands.

In this study, we examined a hypothesis that FFAs increase the production of sebum and induce inflammation in the sebaceous glands. We found that treatment of SZ95 sebocytes with exogenously applied palmitic acid (PA), a major saturated FFA, induced a significant increase in intracellular lipid levels. Moreover, PA treatment also increased the expression and secretion of the proinflammatory cytokines in SZ95 sebocytes. We also found that Toll‐like receptors were required for the inflammatory response triggered by PA.

The results of our study strengthen the notion about the link between acne and FFAs and suggest the mechanism underlying this relationship. Our results serve as a foundation for future work that will explore the association between FFA and acne and pave way to the development of novel treatment options for acne.

This article is protected by copyright. All rights reserved.

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Ultraviolet radiation, both UVA and UVB, influences the composition of the skin microbiome

Abstract

Background

Studies have begun to investigate the complex relationship between host and microorganisms in non‐infectious pathologies such as acne, atopic dermatitis, and psoriasis. Though the skin is exposed to environmental stressors such as ultraviolet radiation (UVR), no studies exist examining the effects of both UVA and UVB on the skin microbiome.

Objective

To test the effect of UVA and UVB on human skin microbiome.

Methods

To test whether UV will alter the cutaneous microbiome, participants were exposed to doses of UVA (22‐47 J/cm²) or UVB (100‐350 mJ/cm²) and samples were collected. DNA was isolated and sequenced to identify the microbial composition of each sample.

Results

There was vast intra‐ and inter‐subject variation at all time points and phylum and species‐level differences were identified. These included an increase in the phylum Cyanobacteria and a decrease in the family Lactobacillaceae and Pseudomonadaceae. The sensitivity of microbes to UVR and their re‐colonization potential following exposure differed in UVA vs UVB samples.

Limitations

The sample size was small, and the study was limited to males.

Conclusion

The results demonstrate that UVR has profound qualitative and quantitative influences on the composition of the skin microbiome, possibly effecting skin pathology in which UVR is a factor.

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Pigmented skin lesions displaying regression features: dermoscopy and reflectance confocal microscopy criteria for diagnosis

Abstract

Melanomas and nevi displaying regression features can be difficult to differentiate.

To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy.

Methods: Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis.

The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9±15.4 vs. 46.1±14.8; p<0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n=83/108; 76.9%; p<0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs. 59.6%; p<0.001) and were more frequently widespread distributed (65.6% vs. 20.0%; p<0.001) and both dendritic and roundish (36.6% vs. 15.4%; p<0.001) in shape. Aspecific architecture at the dermo‐epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs. 11.9%; p=0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs. 18.3% and 19.4% vs. 3.7%; p<0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion.

In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.

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Periodic patterns in Rodentia: development and evolution

Abstract

Mammalian periodic pigment patterns, such as spots and stripes, have long interested mathematicians and biologists because they arise from nonrandom developmental processes that are programmed to be spatially constrained, and can therefore be used as a model to understand how organized morphological structures develop. Despite such interest, the developmental and molecular processes underlying their formation remain poorly understood. Here, we argue that Arvicanthines, a clade of African rodents that naturally evolved a remarkable array of coat patterns, represent a tractable model system in which to dissect the mechanistic basis of pigment pattern formation. Indeed, we review recent insights into the process of stripe formation that were obtained using an Arvicanthine species, the African striped mouse (Rhabdomys pumilio), and discuss how these rodents can be used to probe deeply into our understanding of the factors that specify and implement positional information in the skin. By combining naturally evolved pigment pattern variation in rodents with classic and novel experimental approaches, we can substantially advance our understanding of the processes by which spatial patterns of cell differentiation are established during embryogenesis, a fundamental question in developmental biology.

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Inhibition of autophagy by chloroquine makes chemotherapy in nasopharyngeal carcinoma more efficient

Publication date: Available online 2 December 2018

Source: Auris Nasus Larynx

Author(s): Tomomi Aga, Kazuhira Endo, Akira Tsuji, Mitsuharu Aga, Makiko Moriyama-Kita, Takayoshi Ueno, Yosuke Nakanishi, Miyako Hatano, Satoru Kondo, Hisashi Sugimoto, Naohiro Wakisaka, Tomokazu Yoshizaki

Abstract

Objectives

A combination of platinum-based chemotherapy and radiotherapy is the standard treatment for nasopharyngeal carcinoma (NPC). However, the efficacy of chemotherapy has reached a plateau. Many autophagy studies suggest that autophagy can either promote or suppress to cancer progression. Thus, a role of autophagy in the acquisition of chemoradioresistance has recently been a notable event. Therefore, we examined the relationship between autophagy and chemotherapy in NPC.

Methods

The expression of Beclin 1 and microtubule-associated protein light chain 3 (LC3), a marker of autophagy, was determined by immunohistochemistry in the biopsy samples of patients with NPC before and after the first course of chemotherapy. Additionally, to investigate in the effect of autophagy suppression in chemotherapy, NPC cell line C666-1 cells were treated with cisplatin and/or chloroquine, an inhibitor of autophagy.

Results

The expression of Beclin 1 increased after chemotherapy in all patients. In NPC cell line C666-1, compared to cisplatin alone, combination therapy (cisplatin and chloroquine) reduced cell viability, and promoted cell apoptosis.

Conclusions

These results suggest that autophagy, represented by Beclin 1, is upregulated after chemotherapy in both in vitro and in vivo NPC studies. Inhibition of autophagy could therefore be new strategy for NPC treatment.

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Subjective analysis of the application of enhancement filters on magnetic resonance imaging of the temporomandibular joint

Publication date: Available online 2 December 2018

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

Author(s): Gonzalo André Montesinos, Sérgio Lucio Pereira de Castro Lopes, Tarcila Trivino, José Andrés Sánchez, Fernando Akio Maeda, Claudio Fróes de Freitas, Andre Luiz Ferreira Costa

ABSTRACT

Objective

The aim of this research was to study the effect of enhancement filters on the magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ).

Study Design

In total, 66 temporomandibular joint MRI scans were analysed without filtration and with the application of two filters: Sharpen 1 and Sharpen 2 (OnDemand software). Two dentomaxillofacial radiologists examined the original and filtered images individually. Intra- and inter-observer concordance was measured with generalized estimating equations. The observers evaluated the subjective image quality and the visibility of three components of the TMJ: disc, condyle, and articular eminence. The images were ranked on a four-point scale from poor to excellent. The image quality of all filtered images was compared by using the chi-square test and Bonferroni correction for multiple comparisons.

Results

Intra- and inter-observer concordance was good. The images filtered with Sharpen 1 and Sharpen 2 provided better definition of the structures compared to non-filtered images, providing the highest scores for subjective image quality for all structures (p < 0.0001).

Conclusion

The use of enhancement filters led to improved subjective quality and may improve the diagnostic efficacy of MRI in TMJ evaluation.

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The value of the apparent diffusion coefficient calculated from diffusion-weighted magnetic resonance images in the differentiation of maxillary sinus inflammatory diseases

Publication date: Available online 1 December 2018

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

Author(s): Luciana Munhoz, Reinaldo Abdala Júnior, Emiko Saito Arita

Abstract

Objectives

This study examined the value of the apparent diffusion coefficient (ADC) calculated in diffusion-weighted magnetic resonance images (DWI) in the differentiation of inflammatory lesions of the maxillary sinus.

Study Design

65 maxillary sinus magnetic resonance images (MRI) with findings suggestive of inflammatory lesions were qualitatively categorized into four distinct groups using T2-weighted images: Group 1: Presence of mucosal thickening; Group 2: Presence of sinonasal polyps or mucous retention cysts; Group 3: Presence of fluid identified by air-fluid levels with a homogeneous signal intensity; Group 4: Presence of fluid identified by air-fluid levels with a heterogeneous signal intensity. The ADC of each imaging finding was measured using a 5-mm area of interest. The statistical differences between the groups were tested using nonparametric tests with a 5% significance level.

Results

Statistically significant differences were observed between Group 1 and the other groups. Mucosal thickening was associated with lower ADC values than the other inflammatory lesions.

Conclusions

The ADC can be useful in differentiating mucosal thickening from other inflammatory alterations in the maxillary sinuses. Mucosal thickening had more restricted water diffusion than the other inflammatory lesions.

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