The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm

A randomized, open, controlled trial of tretinoin 0.05% cream vs. low‐dose oral isotretinoin for the treatment of field cancerization

Abstract

Background

Sun exposure may lead to actinic keratoses (AKs), field cancerization, and skin cancer. Effective treatment of AKs and field cancerization is important. Oral and topical retinoids can be used for this purpose. To compare clinical, histological, and immunohistochemical effects of oral and topical retinoid for AKs and field cancerization on face and upper limbs of immunocompetent patients, as well as the impact on quality of life, safety, and tolerability.

Methods

This study compared 10 mg/day oral isotretinoin (ISO) to 0.05% tretinoin cream (TRE) every other night, associated with sunscreen (SPF 60). Patients of both genders, aged 50–75 years, underwent cryotherapy with liquid nitrogen for AKs at baseline and after 120 days when they were randomized into two groups, TRE (n = 31) and ISO (n = 30), for 6 months. Outcome measures were: number of AKs, histological (thickness of stratum corneum and epithelium) and immunohistochemical parameters (p53, Bcl‐2 and Bax), dermatology life quality index (DLQI), and adverse events.

Results

Both treatments reduced the number of AKs (around 28%), the thickness of stratum corneum, and expression of p53 and Bax. By contrast, the epithelium thickness and Bcl‐2 expression increased. There was no difference in the outcomes between TRE and ISO. Both treatments improved quality of life and were well tolerated with minimal side effects.

Conclusions

Retinoids are effective and safe for field cancerization. Classical treatments for field cancerization (imiquimod and ingenol mebutate) are used for a short period; retinoids may be a good choice to intercalate with them and can be used continuously.

http://bit.ly/2WzgrG4

Transgenic versus conventional corn: fate of fumonisins during industrial dry milling

Abstract

The aim of this study was to compare the fate of fumonisins in transgenic and non-transgenic corn during industrial dry milling. For this purpose, whole corn samples and their fractions (germ, pericarp, endosperm, corn meal, and grits) were collected from one of the major Brazilian milling plants, totaling 480 samples. There was no significant difference (p > 0.05) between mean fumonisin (FB₁ + FB₂) levels in transgenic (1130 μg/kg) and non-transgenic (920 μg/kg) whole corn. However, in non-transgenic germ, endosperm and corn meal fraction fumonisin levels were higher (2940 μg/kg, 250 μg/kg and 190 μg/kg, respectively) than in transgenic fractions (2180 μg/kg, 130 μg/kg and 85.0 μg/kg, respectively). Furthermore, the highest percentages of fumonisins were distributed in the germ, corresponding to about 87 and 76% of the total fumonisins present in the whole corn from non-transgenic and transgenic hybrids, respectively. Concerning the endosperm from non-transgenic and transgenic corn, approximately, 23% and 13% of the total fumonisins were retained after the dry milling. Further processing in corn meal (300 to 420 μm particle size) and grits (590 to 1190 μm) decreased the percentages of remaining fumonisins to 4% and 2% (transgenic) and 10% and 3% (non-transgenic corn), respectively. These results suggested that fumonisin concentration was higher in outer and inner non-transgenic fractions when compared to transgenic ones and that the fate of fumonisins during the industrial dry milling could be affected by the transgenic status. However, it was not possible to conclude that the difference was exclusively due to this variable.

http://bit.ly/2SgBT3s

First report of Fusarium foetens as a mycotoxin producer

Abstract

Fusarium foetens, a pathogen of Begonia plants, has been recently described as a new fungal species. This Fusarium species causes a destructive vascular wilt disease which leads to the death of the plant. Moreover, Fusarium species are known to produce a huge variety of secondary metabolites such as mycotoxins and phytotoxins. Here, we studied the toxicogenic profile of one F. foetens strain, isolated from maize, employing two methods based on the use of ultra-performance liquid chromatography coupled to mass spectrometry-ion trap-time of flight detection. The mycotoxins beauvericin and fusaric acid were detected in a pure culture of F. foetens. In addition, four fusaric acid analogs (10,11-dihidroxyfusaric acid, hydroxyfusaric acid, dehydrofusaric acid, and a hydroxylated unsaturated fusaric acid analog) were tentatively identified on the basis of their accurate mass and fragmentation patterns. Therefore, these preliminary data indicate that F. foetens isolated from maize is able to produce Fusarium mycotoxins including beauvericin and fusaric acid.

http://bit.ly/2GeP2U6

Severe case of pneumonia with pleural effusion in an immunocompromised woman due to Fusobacterium necrophorum

Infections caused by fusobacteria have a wide clinical spectrum, and in certain patients, they can lead to severe systemic illness. We report the case of an immunocompromised young woman who presented with severe pneumonia complicated by parapneumonic pleural effusion, despite wide-spectrum antibiotic treatment. Fusobacterium necrophorum was isolated in the samples obtained after thoracentesis was performed. Apart from the pulmonary involvement, we could not identify the infectious focus, since the patient did not have poor dentition or Lemierre's syndrome. After an extended antibiotic regimen and placement of a chest tube, the patient fully recovered and was able to be discharged.

http://bit.ly/2t0VQga

Adipsic diabetes insipidus secondary to craniopharyngioma resection

Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.

http://bit.ly/2HLvo4t

Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy

Erythrodermic psoriasis (EP) is the most serious type of psoriasis with high morbidity and mortality. First-line recommended therapies for EP, cyclosporine and infliximab have significant adverse effects. Cyclosporine increases the risk of hypertension, leucopenia, infections and renal failure. Infliximab increases the risk of reactivation of tuberculosis, hepatitis B and histoplasmosis, and increases risk for hepatitis, autoantibody formation, congestive heart failure, demyelinating disorders, pancytopenia, lymphoma and skin cancer. An effective drug with a much safer side effect profile will be of significant benefit in EP. The phosphodiesterase 4 inhibitor apremilast is U.S Food and Drug Administration (FDA) approved for plaque psoriasis and psoriatic arthritis. Adverse effects of apremilast reported are headache, nausea, diarrhoea, upper respiratory tract infection, potential for depression and weight loss. We report complete and long-standing resolution of EP with first-line apremilast monotherapy. Apremilast may be an effective option with comparatively minor side effects for EP.

http://bit.ly/2HHaaVm

Ectopic varices masquerading as lower gastrointestinal bleeding

A middle-aged woman previously in good health arrived to hospital with severe haemorrhagic shock. An abdominal and pelvic CT scan showed hepatomegaly, fluid in the sigmoid colon, perigastric and right sided pelvic varices without a clear source of bleeding. Urgent esophagogastroduodenoscopy excluded gastric varices and active upper gastrointestinal bleeding and the colonoscopy was inconclusive due to haemodynamic instability and massive bleeding which made it impossible to proceed with a full colonoscopy. An explorative laparotomy identified liver cirrhosis and bleeding from varices of the right fallopian tube which had formed a fistula with the caecum. A right hemicolectomy with a side to side anastomosis and a right sided salpingo-oophorectomy were carried out. The patient was thereafter transferred to the intensive care unit intubated, requiring massive fluid resuscitation and high doses of vasoactive agents. Nine days after hospital admission she was transferred to the surgical ward and followed up by a hepatologist.

http://bit.ly/2t1RfKR

Rare cause of lung atelectasis in a young woman

Pulmonary mucoepidermoid carcinoma is an extremely rare intrathoracic malignancy, comprising less than 1% of all lung tumours. These are very slow growing and are classified into low grade and high grade based on histological features. Surgical resection is the primary treatment with excellent outcomes, while chemotherapy or radiotherapy effectiveness is not known. Preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) is useful for predicting tumour grade and postsurgical prognosis.

A clinical case of a 31-year-old woman who presented with dyspnoea on exertion, cough and wheezing is reported. Imaging studies revealed a mass involving the left lower lobe bronchus and atelectasis. 18F-FDG PET/CT showed uptake in the described mass with a maximum standardised uptake value of 9.7. Complete surgical resection was performed, and pathological examination revealed a high-grade mucoepidermoid carcinoma with tumour-free margins. Adjuvant chemotherapy was given and there is no evidence of tumour recurrence.

http://bit.ly/2HICtmd

Stickler syndrome: a possible presentation of Pierre Robin sequence

http://bit.ly/2t0VOF4

Long-lasting response to afatinib that persisted after treatment discontinuation in a case of EGFR-mutated lung adenocarcinoma

It is unknown whether tyrosine kinase inhibitors targeting epidermal growth factor receptor (EGFR) can be discontinued in patients in whom EGFR-mutated lung cancer has well stabilised. We present a case of a 73-year-old Japanese woman with no history of smoking. Right pulmonary lower lobectomy, lymph node dissection and segmental resection of the right middle lobe were performed. Additionally, she underwent adjuvant chemotherapy for stage IIIB adenocarcinoma harbouring an EGFR exon 19 deletion. Afatinib was administered for liver metastases after 15 months. A complete response of metastatic disease was achieved for 2 years. However, afatinib was unavoidably discontinued due to splenectomy for the treatment of idiopathic thrombocytopenic purpura. Although afatinib was not resumed, due to the abscess formation as surgery complication, a drug-free complete response was sustained for over 18 months. The present case suggests that exceptional and durable responses to afatinib can be achieved in individual cases.

http://bit.ly/2HK9YEY

Seizure in infancy: not the usual suspect

http://bit.ly/2sWcAVW

'Never say never: the first successful management of a type A aortic dissection in Liberia

The West African country of Liberia ranks as one of the lowest in the world in most measures of health. The diagnosis and management of complex surgical cases such as aortic dissection is extremely challenging, for reasons ranging from lack of diagnostic imaging capabilities to the high resources required for definitive surgical intervention. We present the first known successfully managed case of aortic dissection in the country's history and with it highlight the challenges faced and a number of lessons learned that are beneficial to anyone working in resource-limited environments.

http://bit.ly/2HEE7W2

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention

Summary

This review is part of a series of annual updates summarizing the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2016 with a focus on treatment and prevention of AE. There is reasonable evidence of benefit for topical corticosteroids, calcineurin inhibitors, a glycyrrhetinic acid‐containing preparation (Atopiclair^®), oral ciclosporin, oral azathioprine, narrowband ultraviolet B radiation and education programmes. Overall, there is evidence that topical corticosteroids and calcineurin inhibitors have similar efficacy and that both can prevent AE flares when used twice weekly as maintenance therapy. However, topical calcineurin inhibitors are costlier and have more adverse reactions, thus topical corticosteroids should remain the standard of care for patients with AE. There is no evidence that multiple applications are better than once‐daily application of topical corticosteroid. There is inconsistent evidence to support omalizumab and specific allergen immunotherapy use in AE. There is some evidence that vitamin D supplementation and synbiotics reduce AE severity, although the margin of improvement may not be clinically meaningful. There is little evidence to support the use of wet wraps or of complementary/alternative medicine (including Chinese herbal medicine). There is some evidence to suggest that a diet high in fish in infancy may be preventative for AE, but other dietary interventions for the prevention of AE show little promise. This review provides a succinct guide for clinicians and patients wishing to remain up to date with the latest evidence for the treatment and prevention of AE.

http://bit.ly/2UBunO9

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: Epidemiology, aetiology and risk factors

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It presents the key findings from 14 systematic reviews published in 2016, focusing on AE epidemiology, aetiology and risk factors. For systematic reviews on the treatment and prevention of AE and for nomenclature and outcome assessments, see Parts 1 and 3 of this update, respectively. The annual self‐reported prevalence of AE is a range of 11.4–24.2%, compared with a general practioner‐diagnosed prevalence of 1.8–9.5%. The mean age of AE diagnosis is 1.6 years. Persistent AE is associated with more severe disease at the time of diagnosis, onset after the age of 2 years and female sex. There is a significant association between having AE and subsequent development of food allergy. Food allergy is also associated with more severe and persistent AE. No consistent association was found between the timing of allergenic food introduction and the risk of developing AE. Evidence from heterogeneous studies indicates that skin absorption is increased in patients with AE, and that there is increased colonization with Staphylococcus aureus in lesional and nonlesional skin and the nasal mucosa of patients with AE compared with controls. There is uncertain evidence indicating an association between AE and smoking exposure, antenatal infection and low maternal vitamin D levels during pregnancy. Weak evidence suggests an increased risk of basal cell carcinoma, but not of melanoma or squamous cell carcinoma, while the risk of glioma is reduced.

http://bit.ly/2RZXg9z

Quality and potency profile of eight recombinant isoallergens, largely mimicking total Bet v 1‐specific IgE binding of birch pollen

Abstract

Background

To date only limited information on structure, expression levels and IgE binding of Bet v 1 variants, which are simultaneously expressed in birch pollen, is available.

Objective

To analyze and compare structure and serum IgE/IgG binding of rBet v 1 variants to Bet v 1.0101.

Methods

Recombinant Bet v 1 variants were studied with sera of 20 subjects allergic to birch pollen. Folding, aggregation and solubility of the rBet v 1 variants was analyzed to attribute diverging IgE binding to either allergen structure or methodological features. IgE/IgG binding was studied with rBet v 1 in solution or adsorbed to solid phases. Allergen‐mediated crosslinking of FcεRI receptors was determined by mediator release of sensitized humanized rat basophil leukemia cells.

Results

All variants, except for rBet v 1.0113, were monomeric and had Bet v 1‐type conformation. Serum IgE binding to variants adsorbed to solid phase was reduced to 6.6% ‐ 36.5% compared with Bet v 1.0101. In contrast, inhibition of IgE binding to Bet v 1.0101 by rBet v 1 variants ranged from 62% ‐ 83%. Similarly, mediator release ranged from 30.7% ‐ 55.2% for all variants and was only clearly reduced for rBet v 1.0301 (10.4%). The IgE binding potency of rBet v 1 variants representing their native quantities in birch pollen was only slightly lower compared to extract. IgG binding to variants was between 50.9% ‐ 134.5% compared with rBet v 1.0101 (100%).

Conclusion and clinical relevance

Bet v 1 variants previously classified as hypoallergenic can exhibit similar functional IgE binding as Bet v 1.0101. Eight rBet v 1 variants largely reproduce total Bet v 1‐specific IgE binding of birch pollen extracts. Assay format dependent variation of IgE binding properties needs to be considered in the development of diagnostic or therapeutic products.

This article is protected by copyright. All rights reserved.

http://bit.ly/2G1Utqk

The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1677459

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss' kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal–Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.
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http://bit.ly/2HK0ZDP

Implant treatment of two failing or missing central incisors in the aesthetic region: a treatment protocol and 1-year prospective study

Implant treatment for two central incisors in the maxillary aesthetic region is complex due to concerns regarding inter-implant hard and soft tissue stability. A treatment protocol was therefore developed and implemented in a 1-year prospective case series study involving 16 patients with two failing or missing central incisors in the maxillary aesthetic region. The protocol consists of five options depending on whether teeth are still present (options 1–3) or not (options 4 and 5) and on the amount of bone available at the start of treatment: (1) extraction followed by immediate implant placement and provisionalization, (2) extraction followed by immediate implant placement and delayed provisionalization, (3) extraction followed by ridge preservation, delayed implant placement and immediate provisionalization, (4) delayed implant placement and guided bone regeneration with delayed provisionalization, (5) guided bone regeneration (extensive bone augmentation of the alveolar ridge), delayed implant placement, and delayed provisionalization.

http://bit.ly/2D0CH2H

Three-dimensional analysis of condylar changes in surgical correction for open bite patients with skeletal class II and class III malocclusions

The aim of this study was to quantify three-dimensional condylar displacements as a result of two-jaw surgery for open bite correction in patients with skeletal class II and class III malocclusion. Pre-surgical (T1) and post-surgical (T2) cone beam computed tomography scans were taken for 16 patients with skeletal class II (mean age 22.3±9.47years) and 14 patients with skeletal class III (mean age 25.6±6.27years). T2 scans were registered to T1 scans at the cranial base. Translational and rotational condylar changes were calculated by x,y,z coordinates of corresponding landmarks.

http://bit.ly/2RZAA9C

Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography

Resection of maxillary cancer often results in incomplete excision because of the tumour's proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images.

http://bit.ly/2B7uERx

Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants

Our aim was to evaluate neurosensory symptoms after lateralisation of the inferior alveolar nerve (IAN). We studied a retrospective case series with one-year follow up that included 139 procedures in 123 patients. After the IAN had been located it was deflected from the mandibular body and the implant placed. Sensitivity was mapped 24hours, one month, six months, and one year after the intervention by gently pressing the skin and lips with the tip of a probe. A total of 337 implants were placed in 123 patients aged between 44 and 68 years.

http://bit.ly/2TpMExo

Socio‐demographic factors do not have a large influence on psoriasis patients’ adherence to topical treatment

Abstract

Topical drugs containing corticosteroids are the most frequently used treatments for mild‐to‐moderate psoriasis, but adherence rates to topical drugs are low and up to 80% of psoriasis patients are classified as non‐adherent, which present a barrier to treatment success.³ Barriers to treatment adherence can be divided into socio‐demographic, healthcare, disease, treatment, and patient‐related factors. In a prospective study by Zaghloul et al., adherence to unspecified topical and systemic antipsoriatic drugs was investigated by counting pills or weighing medication bottles; lower adherence was associated with being single, male, or unemployed.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX8ehr

Hypoxia Improves Hair Inductivity of Dermal Papilla Cells via Nuclear NADPH Oxidase 4‐Mediated Reactive Oxygen Species Generation

Summary

Background

Dermal papilla cells (DPCs) play a key role in hair regeneration and morphogenesis. Therefore, tremendous efforts have been made to promote DPCsʼ hair inductivity

Objectives

The aim of this study was to investigate the mitogenic and hair inductive effects of hypoxia on DPCs and examine the underlying mechanism of hypoxia‐induced stimulation of DPCs.

Results

Hypoxia significantly increased the proliferation and delayed the senescence of DPCs via Akt phosphorylation and downstream pathways. Hypoxia upregulated the growth factor secretion of DPCs through mitogen‐activated protein kinase pathway. Hypoxia‐preconditioned DPCs induced the telogen‐to‐anagen transition in C₃H mice, and also enhanced hair neogenesis in a hair reconstitution assay. Injected GFP‐labeled DPCs migrated to outer‐root sheath of hair follicle, and hypoxia‐preconditioning increased the survival and migration of DPCs in vivo. Conditioned medium obtained from hypoxia increased the hair length of mouse vibrissa follicles via upregulation of alkaline phosphatase, vascular endothelial growth factor, and glial cell line‐derived neurotrophic factor. We examined the mechanism of this hypoxia‐induced stimulation, and found that reactive oxygen species (ROS) play a key role. For example, inhibiting of ROS generation by N‐acetyl‐L‐cysteine or diphenyleneiodonium treatment attenuated DPCsʼ hypoxia‐induced stimulation, but treatment with ROS donors induced mitogenic effects and anagen transition. NADPH oxidase 4 (NOX4) is highly expressed in DPCsʼ nuclear region, and NOX4 knockout by CRISPR‐Cas9 attenuated the hypoxia‐induced stimulation of DPCs.

Conclusions

Our results suggest that DPC culture under hypoxia has great advantages over normoxia, and is a novel solution for producing DPCs for cell therapy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHiOSB

Recommendation to include hydroxyethyl (meth)acrylate in the British Baseline Patch Test Series

Summary

Background

(Meth)acrylates are potent sensitisers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. (Meth)acrylates have to date not been routinely tested in the baseline patch test series in the U.K. and Europe.

Objectives

To determine whether inclusion of 2‐hydroxyethyl methacrylate (2‐HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD.

Methods

During 2016‐2017, 15 U.K. dermatology centres included 2‐HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2‐HEMA, were selectively tested with a short series of eight (meth)acrylate allergens.

Results

5,920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested to the (meth)acrylate series. 102 of 5,920 (1·7%) tested positive to 2‐HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2‐HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5,920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2‐HEMA (n=102; 1·7%), 2‐hydroxypropyl methacrylate (n=61; 1%) and 2‐hydroxyethyl acrylate (n=57; 1%).

Conclusions

We recommend that 2‐HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardised short (meth)acrylate series which is likely to detect most cases of (meth)acrylate allergy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MHj9ER

Decreased 5‐hydroxymethylcytosine immunoreactivity in primary Merkel cell carcinomas is a strong predictor for disease‐specific death

Abstract

Merkel cell carcinoma (MCC) is an infrequent malignant skin tumour with epithelial and neuroendocrine differentiation. Though it is a highly aggressive malignancy, the distinct molecular pathogenesis of MCC is not yet fully understood. Apart from DNA methylation, histone modification, and microRNA‐mediated and long non‐coding RNA‐mediated regulation, hydroxymethylation may also play an important role in cancer development. Loss of 5‐hydoxymethylcytosine (5‐hmc) has been reported in a variety of cancers, including skin malignancies such as melanoma.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sX889z

A Reliability Study Using Network Oriented Research Assistant (NORA®) Examining the Use of Digital Photographs in the Assessment of Psoriasis

Abstract

Psoriasis is a chronic immune‐modulated condition affecting approximately 2‐3% of the general population. In addition to cutaneous lesions, psoriasis is associated with systemic and mental health co‐morbidities. Psoriasis is among the most extensively researched dermatologic conditions, with many novel treatment options in the drug development pipeline.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MJbOov

Extremity nevus count is an independent risk factor for basal cell carcinoma and melanoma, but not squamous cell carcinoma

The presence of nevi portends an increased risk for melanoma.

http://bit.ly/2UuXeU0

Risk factors for acne development in the first 2 years after initiating masculinizing testosterone therapy among transgender men

To the Editor: Female-to-male transgender patients (herein referred to as transgender men) receive masculinizing doses of testosterone to induce virilization and suppress menstruation. Studies have shown that elevated androgen levels among transgender men have been associated with an increased incidence of acne.1-5 Studies suggest that testosterone therapy increases the development of acne, though severe acne occurs only rarely.3 Our study assessed the timing of acne onset relative to initiation of testosterone therapy in transgender men and the biologic, behavioral, and sociodemographic predictors of acne in this population.

http://bit.ly/2MHgYkF

The effect of baclofen combined with a proton pump inhibitor in patients with refractory laryngopharyngeal reflux: a prospective, open‐label study in thirty‐two patients

Abstract

Thirty‐two patients with refractory LPR confirmed by 24‐h MII‐pH were given a 3‐month course of baclofen 10 mg three times a day combined with PPI 15 mg twice a day.

Changes in RSI and reflux‐related quality of life from baseline to after treatment were evaluated.

MII‐pH monitoring of refractory LPR patients showed that the number of non‐acid reflux was much higher than acid reflux in laryngopharyngeal reflux and full‐column reflux.

After 3 months of PPI + baclofen medication, most RSI items and quality of life score showed a significant improvement compared to the baseline score, and the percentage of responders at 3 months was 53.1%.

In our experience, when a PPI therapy is unresponsive to LPR patients, baclofen can be considered as a second treatment option.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Sh6uOc

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The antimicrobial protein S100A12 identified as a potential autoantigen in a subgroup of atopic dermatitis patients

Atopic dermatitis (AD) is a complex heterogeneous chronic inflammatory skin disease. Specific IgE antibodies against autoantigens have been observed in a subgroup of AD patients, however, little is known about...

http://bit.ly/2RZw2Qz

Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997–2014: A Nationwide Study

Thyroid, Ahead of Print.


http://bit.ly/2DLIeeV

A Career in Global Surgery

This Viewpoint suggests that academic surgical departments are well positioned to lead global surgery efforts given their focus on teaching, innovation, and service.

http://bit.ly/2Bdfs5r

Toward a Broader, More Global Perspective for US Otolaryngology Residents

This essay discusses the benefits of the medical education system offering US otolaryngology residents the opportunity to gain a broader, more global perspective on the practice of otolaryngology.

http://bit.ly/2ToqTy5

Papillary Thyroid Microcarcinoma

A patient who was referred to our clinic for a second opinion on management of a small localized papillary thyroid cancer (PTC) asked, "Why should I have surgery to remove my thyroid if it's such a good cancer?" At the time of diagnosis, her health care practitioner told her she had a good cancer and recommended thyroidectomy. This question directly relates to the work by Davies et al in this issue of JAMA Otolaryngology–Head & Neck Surgery. However, it is important to first clarify some misconceptions about the experiences of patients with thyroid cancer.

http://bit.ly/2BaO5Ja

Patient Experience of Thyroid Cancer Active Surveillance in Japan

This study evaluates the concerns about cancer, treatment decisions, and overall experience of Japanese patients under active surveillance for thyroid cancer.

http://bit.ly/2TokPpr

Phosphaturic Mesenchymal Tumor of the Cerebellopontine Angle

This case report describes an otherwise healthy woman in her 30s who presented with left-ear hearing loss, tinnitus, distorted hearing, and occasional otalgia of a few months' duration.

http://bit.ly/2BdQCSV

Utilization of Nasal Endoscopy in the Medicare Population, 2000-2016

This study analyzes Medicare beneficiary and provider data from 2000 through 2016 to investigate trends in the number of nasal endoscopies performed among the Medicare population, reimbursement, and regional differences.

http://bit.ly/2TsOf5W

Variation in Care Delivery and Diagnostic Modality Among the Medicare Population

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hur et al suggest that during the past decade, the use of diagnostic nasal endoscopy in the Medicare population has increased substantially and this increase has not been paralleled by a similar increase in surgical ethmoidectomy. The overall increase in the number of endoscopies was also accompanied by marked variability in endoscopy utilization across different states, with some states showing a large increase and others showing smaller increases.

http://bit.ly/2BdJrdz

A Large Tonsillar Mass in a Healthy Teenager

A previously healthy 18-year-old woman presented with a growth in the right oropharynx of 4 months' duration as well as voice changes, recent weight loss, and decreased appetite. What is your diagnosis?

http://bit.ly/2Tnan1q

Combination of laparoscopy and endoscopy as an option for treatment patients with gastric neuroendocrine tumors

Abstract

Background

Neuroendocrine tumors (NETs) are relatively rare neoplasms with the increasing survival due to the development of early diagnostics. There is no universal position in treatment and follow up of small (~20 mm) gastric NETs.

Clinical cases

Two female patients 51 and 66 y.o. with multiple gastric NETs <2 cm were observed in our department. In both cases treatment was performed by combination of two minimally invasive technologies: laparoscopy and gastroscopy. According to the localization of tumors in one case intraluminal gastric resection controlled by laparoscopy was performed. In the second case laparoscopic gastric resection with gastroscopy assistance was done.

Discussion

There are two positions for surgical treatment of small NETs: to operate as the typical premalignant neoplasm or to make submucosa resections. We demonstrated combination of laparoscopy and gastroscopy as feasible approach with minimal risk of complications.

http://bit.ly/2Tnkfbl

A tale of 1 year: a case of bilateral conductive hearing loss due to bilateral ossicular chain disruption post head trauma

Abstract

The traumatic hearing loss is a common finding after head trauma that involves the temporal bone fracture or skull base injury, but the late presentation of the hearing loss bilaterally is a rare presentation. This case report describes the rare and late presentation of bilateral conductive hearing loss 1-year after the head trauma, limited to ossicular chain disruption and hearing loss. This case of post head trauma that was limited to ossicular chain distribution progressed to bilateral conductive hearing loss without temporal bone fracture. A 14-year-old male was presented conductive hearing loss of one year after head injury, CT scan revealed bilateral ossicles disruption. Afterwards, osicuoloplasty was performed which improved the hearing of the patient. In conclusion, bilateral hearing loss with no obvious skull fracture should be suspected and investigated so an early intervention could be established. The CT was considered the imaging modality of choice for ossicular chain distribution.

http://bit.ly/2BffZnh

Proceed or palliate: Surgicel® mimicking tumor recurrence and causing a small bowel obstruction

Abstract

Surgicel® is a commonly used hemostatic agent. We report a case of small bowel obstruction secondary to the prior placement of Surgicel® within the peritoneal cavity, and the radiological diagnosis conundrum and potential prognostic implications this finding has in a patient with a known history of malignancy.

http://bit.ly/2TjYp8G

Unclassified autoimmune pancreatitis mimicking pancreatic cancer

Abstract

A 24-year-old black male presented with a 1-week obstructive jaundice and intermittent abdominal pain, with no significant weight loss and an unsuspicious abdominal exam. Blood chemistry showed a cholestatic pattern but a complete immunological and tumoral panel (anti-smooth muscle antibody, anti-mitochondrial antibody, anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, anti-Smith, anti-double-stranded-DNA antibody (anti-dsDNA), complement C3/C4, carcinoembryonic antigen, CA 19-9 and IgG4) were all within normal limits. Abdominal ultrasound revealed dilatation of the intra and extra-hepatic bile ducts. CT scan showed an abnormal dilatation of the distal bile duct but no focal enlargement of the head of the pancreas. Endoscopic ultrasound suggested an inflammatory process but the magnetic resonance cholangio-pancreatography favored a neoplastic obstruction of the distal common bile duct. Fine-needle aspiration cytology was insufficient for definitive diagnosis and the patient underwent major surgery. Follow-up with mild exocrine pancreatic insufficiency treated with enzyme replacement.

http://bit.ly/2BgqeYx

Small bowel intussusception and concurrent sigmoid polyp with malignant transformation in Peutz–Jeghers syndrome

Abstract

Peutz–Jeghers syndrome (PJS) is an autosomal dominant condition characterized by the association of gastrointestinal polyposis, mucocutaneous pigmentation and cancer predisposition McGarrity, Amos, Baker (Peutz–Jeghers Syndrome, GeneReviews(R), National Center of Biotechnology Information.). Intussusception and malignant polyps are not rare complications of PJS, where the lifetime risk of intussusception is 48% and the possibility of developing any cancer by age 65 years is 37% Kopacova, Tacheci, Rejchrt, Bures (Peutz-Jeghers syndrome: diagnostic and therapeutic approach. World J Gastroenterol 2009;15:5397–408.). Very few cases of malignant polyps causing intussusception associated with synchronous malignant polyp in PJS have been reported to date Cai, Tian, Zhou, He, Hu, Deng (Jejunal intussusception and polyps with different types of malignant transformation in Peutz-Jeghers syndrome: report of a case. Oncol Lett 2013;5:239–41.). We describe a case of a patient with PJS presenting with symptomatic jejunal intussusception and an incidentally found malignant hamartoma in the sigmoid colon.

http://bit.ly/2Bgqcjn

Coexistence of intracranial solitary fibrous tumor/hemangiopericytoma and right middle cerebral artery aneurysm

Abstract

Intracranial solitary fibrous tumors are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. From literatures, the incidence of coexistence of brain tumors and intracranial aneurysms is ~0.7–5.4%. Meningioma is the most frequent tumor coexisted with intracranial aneurysms, followed by pituitary adenoma, neuroepithelial tumor, and metastatic tumor. We would like to report a case of 74-year-old man harboring a rare intracranial solitary fibrous tumor/hemangiopericytoma and an unruptured aneurysm of the right middle cerebral artery which probably the first report of these combinations in the English literature. Both lesions were treated surgically in one session with favorable outcome. Magnetic resonance angiography should be performed in patients with brain tumor preoperatively not only to visualize neoplastic vascularization but also to pick up incidental aneurysm.

http://bit.ly/2Tn7b5L

Jejunal diverticulitis

Abstract

Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Small bowel diverticular disease has been reported in approximately 0.3–1.3% cases of post mortem studies (Fisher JK, Fortin D. Partial small bowel obstruction secondary to ileal diverticulitis. Radiology 1977;122:321–322.) and in only 0.5–1.9% of contrast media study cases (Cattell RB, Mudge TJ. The surgical significance of duodenal diverticula. N Engl J Med 1952;246:317–324). Diverticula located within the small bowel may have presentations and complications similar to that of colonic diverticular disease. However, there is no consensus for the management for small bowel diverticulitis. Given that small bowel diverticulitis, like a colonic diverticulitis, can cause an acute abdomen, surgical intervention may be required. In this particular case, a patient presented with symptoms of lower abdominal pain, nausea and fever. Following an x-ray and CT scan, the patient underwent an open laparotomy and small bowel resection of a portion of jejunum that contained a symptomatic diverticulum.

http://bit.ly/2Bgq9nH

Myogenic fibrosis of the flexor tendons after amphetamine drug abuse

Abstract

Myogenic fibrosis of the flexor tendons in a 23-year-old patient was caused by intense drug abuse. He was presented in the clinic with spastic flexor tendon contracture of his right hand. The patient was treated by tendon elongation with a satisfactory result. The treatment of flexor tendon contracture in those cases is very difficult and needs to be done in a complex way.

http://bit.ly/2TjEGGd

Anterior mediastinal mass 4 years after type A aortic dissection

Abstract

A 47-year-old male who previously underwent emergency surgery for type A aortic dissection presented to the emergency department 4 years later with acute chest pain radiating to his back and a significant drop in hemoglobin. Clinical presentation was concerning for aortic graft failure, but imaging revealed a large (6.0 × 3.2 × 12.8 cm³) soft tissue mediastinal mass that was not present 4 years before. Pathologic analysis revealed a rare thymic cyst with a hemorrhagic component. This was a challenging case from diagnostic and operative perspectives, involving the expertise of both cardiac and thoracic surgical teams.

http://bit.ly/2BffM3t

A novel case of late left ventricular outflow tract obstruction post mitral valve surgery

Abstract

Left ventricular outflow tract (LVOT) obstruction (LVOTO) is a rare but recognized complication of mitral valve surgery. Concomitant factors can cause significant clinical deterioration which requires urgent intervention. We present the case of a female patient who underwent closed valvotomy at age 20 for mitral stenosis secondary to rheumatic heart disease. Seventeen years later, a re-stenosed valve prompted mitral valve replacement (MVR) with a Carbomedics mechanical prosthesis. 8 years later, she re-presented with increasing dyspnoea. On echocardiogram a frond-like structure was visible in the LVOT, the valve housing was protruding into the LVOT and she had marked septal hypertrophy. The LVOT gradient was 72 mmHg. This is a novel case of mechanical MVR associated LVOTO due to at least three discrete factors. This case demonstrates how multiple factors can amalgamate to result in significant clinical deterioration. Over an 8-year period, all three distinct factors contributed to the development of severe LVOTO.

http://bit.ly/2TjEAOR

Doctoring and Hearing Loss

In treating hearing loss, I've found there's a particular tendency–especially in men losing their hearing in late middle age–for patients...

http://bit.ly/2RsViK3

Tonsillectomy: Tonsilliths, Pandas, and other great band names

I can't tell you how many times people at parties find out that I'm an ENT and have me look...

http://bit.ly/2Wut05q

Microwave ablation for the treatment of arterial epistaxis: “how I do it”

Background

Arterial epistaxis is commonly seen in the rhinology clinic and can have a significant impact on quality of life. Previous studies have explored various therapies to address epistaxis.

Methods

Patients were treated in the outpatient clinic or operating room by microwave ablation (MWA) with a 2450‐MHz cooled‐shaft antenna to treat an epistaxis bleeding point.

Results

Of the 481 patients with arterial epistaxis, bleeding was controlled within 1 to 2 minutes and only 2 patients with recurrent bleeding required re‐ablation. The shape of the thermal lesion was elliptical and it was approximately 2 mm in length, 1 mm in width, and 0.5 to 1 mm in penetration depth. Of the 481 patients, 167 (34.7%) complained of minor nasal pain on the same day of ablation. No patients complained of nasal pain or obstruction during the follow‐up period. In addition, 139 (28.9%) patients showed a minor increase in rhinorrhea during the first postoperative week. Of the 481 patients, 469 (97.5%) were followed‐up at 6 months with no severe MWA‐related complications, such as septal perforation, synechiae formation, or orbit and brain complications.

Conclusion

MWA is a technically feasible alternative method for patients with arterial epistaxis.

http://bit.ly/2Us2h7K

In‐vitro evaluation of a ciprofloxacin‐ and ivacaftor‐coated sinus stent against Pseudomonas aeruginosa biofilms

Background

We recently developed a novel ciprofloxacin‐coated sinus stent capable of releasing antibiotics over a sustained period of time. Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that has synergistic bactericidal activity with ciprofloxacin and also enhances sinus mucociliary clearance. The objective of this study was to optimize and evaluate the efficacy of a ciprofloxacin‐ and ivacaftor‐releasing biodegradable sinus stent (CISS) in vitro.

Methods

A CISS was created by coating ciprofloxacin/ivacaftor‐embedded nanoparticles with an acrylate and ammonium methacrylate copolymer onto a biodegradable poly‐L‐lactic acid stent. In‐vitro evaluation of the CISS included: (1) assessment of drug stability in nanoparticles by zeta potential, and drug‐coating stability within the CISS using scanning electron microscopy (SEM); (2) determination of ciprofloxacin‐ and ivacaftor‐release kinetics; and (3) assessment of anti‒Pseudomonas aeruginosa biofilm formation by calculating relative optical density units (RODUs) compared with control stents at 590‐nm optical density.

Results

The presence of drugs and a uniform coating on the stent were confirmed by zeta potential and SEM. Sustained drug release was observed through 21 days without an initial burst release. Anti‐biofilm formation was observed after placing the CISS for 3 days onto a preformed 1‐day P aeruginosa biofilm. The CISS significantly reduced biofilm mass compared with bare stents and controls (RODUs at 590‐nm optical density; CISS, 0.31 ± 0.01; bare stent, 0.78 ± 0.12; control, 1.0 ± 0.00; p = 0.001; n = 3).

Conclusion

The CISS maintains a uniform coating and sustained delivery of drugs providing a marked reduction in P aeruginosa biofilm formation. Further studies evaluating the efficacy of CISS in a preclinical model are planned.

http://bit.ly/2DLQsDK

Does bilateral inferior turbinate reduction affect long‐term quality‐of‐life outcomes in patients undergoing endoscopic sinus surgery?

Background

The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient‐reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Methods

This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ‐5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR.

Results

Significant demographic and comorbid differences between BITR and non‐BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease‐specific (SNOT‐22 and CSS) and general (EQ‐5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures.

Conclusion

Patients undergoing ESS achieve similar long‐term improvement in both disease‐specific and general QOL regardless of the performance of concurrent BITR.

http://bit.ly/2UvFLuB

Eustachian Tubes: Pop It Like It’s Hawt

This topic is a bit related to the ear tubes topic, and I think it's worth covering because I get...

http://bit.ly/2G0VQ8I

Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Abstract

Background

To evaluate plan quality using volumetric‐modulated arc therapy (VMAT) and step‐and‐shoot intensity‐modulated radiation therapy (SS‐IMRT) techniques and for patients treated for oropharyngeal squamous cell carcinoma (OPSCC).

Methods

Treatment plans for patients treated definitively for stages I‐IVb, OPSCC between December 2009 and August 2015 were retrospectively reviewed. Dosimetric endpoints of involved organs‐at‐risk (OARs) were retrieved from clinical plans. Common Terminology Criteria for Adverse Events scores of acute toxicities were compared.

Results

Two‐hundred twenty‐two patients were identified with 134 and 88 receiving SS‐IMRT and VMAT with median follow‐up time of 23.0 and 7.9 months, respectively. The dosimetric endpoints of the OARs were significantly improved in VMAT cohort, which translated into significantly lower rates of grade 2 or higher acute dysphagia and xerostomia.

Conclusion

Improvements in stages I‐IVb, oropharyngeal cancer plan quality are associated with reduced grade ≥ 2 acute dysphagia and xerostomia.

http://bit.ly/2Wy7ZXq

Issue Information

http://bit.ly/2RsQAfg

Cover Image

The cover image, by Yifan Meng MD et al., is based on the Original Article Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery, DOI: 10.1002/hed.25435.

http://bit.ly/2Wy7Rao

Juvenile case of multiple morphea profunda resulting in joint contracture that was successfully treated with cyclosporin A: A case report and review of the published works

Abstract

Morphea profunda refers to inflammatory and sclerotic lesions that start primarily from the deep dermis, subcutaneous fat and fascia. Its pediatric case published work is limited. Here, we report the case of an 8‐year‐old girl with a 5‐year history of multiple subcutaneous nodules on her extremities and a right wrist joint contracture who had been previously diagnosed with juvenile idiopathic arthritis and treated with salazosulfapyridine, low‐dose prednisolone (PSL) and methotrexate. We performed biopsies of two subcutaneous nodules, which revealed the typical morphology of morphea profunda. She was administrated a tapered course of oral PSL then cyclosporin A (CyA) for 20 weeks which completely resolved her joint contracture and subcutaneous nodules. We reviewed 11 previously reported cases of morphea profunda and found that some include circumscribed/linear morphea that develop into subcutaneous tissues, indicating that "classical" morphea profunda arising within the deep tissues has rarely been reported. Our report is the first to demonstrate the efficacy of CyA for treatment of morphea profunda, and the possibility of CyA as a treatment option to reduce oral steroid doses in juvenile cases.

http://bit.ly/2RtJRlh

Severe genital frostbite due to improper use of an aerosol spray: A case of raising awareness of the risk of skin necrosis with aerosol propellants

http://bit.ly/2WxaHN1

Management of Mandibular Osteomyelitis with Segmental Resection, Nerve Preservation, and Immediate Reconstruction

Publication date: Available online 31 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jeffrey S. Marschall, Robert L. Flint, George M. Kushner, Brian Alpert

Abstract

Purpose

To present our experience with management of mandibular osteomyelitis with segmental resection, nerve preservation and immediate reconstruction with non-vascularized bone grafts.

Patients and Methods

A retrospective analysis was completed of 18 cases overseen by a single practitioner at a university medical center from June 2011 to July 2018. All patients had osteomyelitis and were treated with segmental mandibular resection, inferior alveolar nerve (IAN) preservation, and immediate reconstruction with autogenous bone graft from the tibia. Data obtained from medical records included chief complaint at initial presentation, resection size, IAN neurosensory recovery at six months, as well as descriptive statistics of the patient cohort. The university institutional review board granted this study exempt status.

Results

The patient cohort had a mean age of 50.9 years, ranged from 29 to 70, and included 11 females and 7 males. Mean follow-up time was 15 months. The most common chief complaint at initial presentation was pathologic fracture (39%) followed closely by abscess (33%). Mandibular resection size of all patients was 8.1 cm (SD=3.3). Resection size with successful bone grafts (n=15) was 7.1cm (SD=2.6) and those that failed measured 13.1cm (n=3, SD=2.0; p=0.0016). IAN neurosensory testing demonstrated 54% of patients had no meaningful recovery at 6 months, 25% demonstrated partial recovery, and 21% demonstrated full recovery. Finally, osteomyelitis was eliminated in all patients.

Conclusion

Segmental mandibular resection is an effective method for eradicating mandibular osteomyelitis. Furthermore, immediate reconstructions via non-vascularized grafts were successful in cases with large defects, with a mean defect size of 7.1±2.6cm. However, IAN nerve sparing surgery is not effective for preserving patient IAN function. Taken together, we demonstrate that mandibular resection with immediate reconstruction is a viable method in the treatment of mandibular osteomyelitis. This method removes infection and shortens disease course.

http://bit.ly/2CUdK94

Piezosurgery: Ten-years experience of percutaneous osteotomies in rhinoplasty

Publication date: Available online 31 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Massimo Robiony, Andrea Lazzarotto, Riccardo Nocini, Fabio Costa, Salvatore Sembronio, Leonardo Franz

Abstract

Purpose

The possibility to obtain precise osteotomies without significant soft tissue damage represents a key point in modern approaches to rhinoplasty. In 2007, we first described the ultrasonic approach for percutaneous nasal bone osteotomies with minimal periosteal detachment.

In this article, we retrospectively analyse the results of our piezosurgical rhinoplasty technique through our ten-year experience and describe the new perspectives of this technique.

Patients and Methods

A series of 183 patients was retrospectively evaluated. Surgical technique was based on piezoelectric external nasal osteotomies, performed percutaneously, without periosteal detachment. For the last patients, the piezoelectric instrument was also tracked with navigator (piezo-navigated approach). Data about surgery, hospitalization, ecchymosis, edema, and postoperative complications were evaluated.

Results

168 of the 183 patients (91.8%) showed grade 0 or 1 edema. Grade 2 edema was noticed in only 15 of 183 patients (8.2%). In 6 of the 183 procedures (3.3%), postoperative complications potentially related to the piezoelectric osteotomy system occurred.

Conclusion

Piezoelectric external approach could be considered as a safe and reliable technique. Preliminary data suggest the possibility of using surgical planning and navigation in positioning the osteotomies in selected subsets of patients.

http://bit.ly/2RW2fs5

Management of non-syndromic craniosynostoses in France in 2015: a national survey

Publication date: Available online 30 January 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Raphaëlle Prevost, Pierre Keribin, Claire Batut, Benjamin Guichard, Béatrice Ambroise, Alin Bohra, Hervé Benateau, Alexis Veyssiere

Summary

Purpose

Craniosynostoses are managed by surgical and anaesthetic teams in specialist centres. Despite the availability of international guidelines, the perioperative management of craniosynostoses remains highly variable between centres. The aim of our study was to describe the different protocols for the management of non-syndromic craniosynostoses in France in 2015.

Materials and Methods

This descriptive study consisted of a survey about the protocols of pre-operative, per-operative and post-operative management of craniosynostoses. The survey was sent to the departments in French university hospitals that perform this surgery.

Results

Nineteen departments out of twenty replied to the survey. Sixteen departments organised multi-disciplinary meetings. The most frequent preoperative imaging requested was a Computed Tomography. More than half of the centres organised a follow-up until early adulthood.

Conclusion

This study showed a great variability in the management of craniosynostoses. A recommendation from the study is to establish a scientific committee of practitioners in order to establish a standardised protocol. In addition, this study showed the need to create a specific section in the French rare diseases database (CeMaRa) for craniosynostoses.

http://bit.ly/2Wx5Efx

Prenatal intrauterine maxillary development — an evaluation with three-dimensional ultrasound

Publication date: Available online 30 January 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Florian D. Grill, Alexandra V. Behr, Andrea Rau, Lucas M. Ritschl, Maximilian Roth, Franz X. Bauer, Klaus-Dietrich Wolff, Tilman Esser, Denys J. Loeffelbein

Abstract

Objectives

The aim of this prospective study was to investigate normal fetal maxillary development with volume ultrasound during the prenatal phase, for a better estimation of maxillary growth processes.

Methods

Some 210 3D volumes were obtained in two measurement series from 38 healthy women (gestational age: 19⁺² to 31⁺⁴ weeks) using a GE Voluson^TM E10 ultrasound system. Maxillary length and width were determined in the axial and sagittal planes. Clearly defined, reproducible landmarks were used for measurements. The results were correlated with gestational age and compared with previously reported studies.

Results

Total maxillary length ranged from 10.30–24.75 mm, total maxillary width from 13.65–7.30 mm in an observation period during the second trimester, with high reproducibility for all landmarks. All evaluation results showed exponential character. Length growth was determined to be more dominant than width growth. Intra-rater correlation was evaluated to be almost perfect (ICC (3) > 0.8).

Conclusion

This study presents measurements of physiological fetal maxillary development. The defined landmarks proved to be representative for further investigations. This study serves as a baseline for a better understanding of fetal maxillary growth processes, and may be useful for standardising detection of malformations or intrauterine growth restrictions.

http://bit.ly/2RscS0L

The “European Zygomatic Fracture” research project: the epidemiological results from a multicenter European collaboration

Publication date: Available online 30 January 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Matteo Brucoli, Paolo Boffano, Emanuele Broccardo, Arnaldo Benech, Pierre Corre, Helios Bertin, Petia Pechalova, Nikolai Pavlov, Petko Petrov, Tiia Tamme, Andrey Kopchak, Andrii Hresko, Eugen Shuminsky, Emil Dediol, Marko Tarle, Vitomir S. Konstantinovic, Milan Petrovic, Simon Holmes, K.Hakki Karagozoglu, Tymour Forouzanfar

Summary

Purpose

Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials and Methods

This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results

A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between ION anesthesia and B class (p < .00000005).

Conclusion

The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.

http://bit.ly/2Ww0znS

Development of a liquid chromatography-tandem mass spectrometry method for quantification of the egg allergen ovalbumin in rat plasma

Publication date: Available online 31 January 2019

Source: Allergology International

Author(s): Ryohei Ogino, Tomoharu Yokooji, Asahi Omoto, Takanori Taogoshi, Eishin Morita, Hiroaki Matsuo

http://bit.ly/2RscBef

Age-related changes in serum periostin level in allergic and non-allergic children

Publication date: Available online 31 January 2019

Source: Allergology International

Author(s): Hiroko Fujitani, Saki Kasuga, Takuma Ishihara, Yusuke Higa, Shiori Fujikawa, Nobuo Ohta, Junya Ono, Kenji Izuhara, Haruo Shintaku

http://bit.ly/2Wx5btN

A very rare case of allergy to beluga caviar

Publication date: Available online 30 January 2019

Source: Allergology International

Author(s): Ciara Jade Bansal, Amolak Singh Bansal

http://bit.ly/2Rrwm5t

Prof. Heinz Stammberger, MD (Hon. FRCS (Ed.), Hon. FRCS (Engl.), Hon. FACS) December 1st 1946–December 9th 2018

http://bit.ly/2DJ2pdq

Unique considerations in pediatric skull base surgery

Publication date: Available online 30 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Irit Duek, Dan M. Fliss

Pediatric skull base and craniofacial surgery presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.

http://bit.ly/2sVIqlP

Issue Information

http://bit.ly/2SiRwXZ

3‐O‐Laurylglyceryl ascorbate improves the development of sensitive skin through the reduction of oxidative stress

Abstract

Skin sensitivity is a serious problem for many people, and it can be induced by various factors such as UV irradiation, physical and mental stresses, air pollution, dry air and so on. Skin dryness triggered by UV and dry air is one of the most important causes inducing the development of sensitive skin, and it has been reported that oxidative stress contributes to skin dryness. In this study, we investigated whether treatment with 3‐O‐laurylglyceryl ascorbate (VC‐3LG), which is an amphipathic ascorbic acid derivative, can suppress the development of sensitive skin. The results demonstrate that VC‐3LG restores the expression levels of interleukin‐1α, nerve growth factor and matrix metalloprotease‐9 in the dry skin models of reconstructed human epidermal equivalents (RHEEs) and in H₂O₂‐treated keratinocytes. In addition, VC‐3LG suppresses the dendrite elongation of nerve cells induced in RHEEs by dry skin conditions and by H₂O₂ treatment of keratinocytes. Therefore, we consider that treatment of the skin with VC‐3LG is an effective approach to improve the development of sensitive skin.

http://bit.ly/2HH7yqz

Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety

Abstract

Nicotinamide is a water‐soluble vitamin B3 derivative that has many roles in medicine. This review examines the role of nicotinamide in dermatology and its actions in preventing photoageing and skin cancers in humans. Nicotinamide prevents ultraviolet radiation (UV) from reducing ATP levels and inhibiting glycolysis, thus preventing the UV radiation‐induced energy crisis. This enhances DNA repair and reduces UV‐induced suppression of immunity. Randomised controlled clinical trials have also shown that nicotinamide reduces transepidermal water loss and the development of new non‐melanoma skin cancers in high‐risk humans. This review also examines nicotinamide's safety profile.

http://bit.ly/2Sjny6i

Basic analysis of facial ageing: The relationship between the superficial musculoaponeurotic system and age

Abstract

Background

The superficial musculoaponeurotic system (SMAS) is an anatomical structure involved in the facial ageing process. We aimed to evaluate the SMAS laxity using multi‐detector row computed tomography (MDCT) as a diagnostic tool, and to analyse the relationship between SMAS laxity and age.

Methods

Fifty‐seven female subjects (aged 21‐57 years) were enrolled in the study. The subjects were divided into two age groups: one below the mean age (Group Y, 30 subjects) and one over it (Group O, 27 subjects). The Posture Change (PC)‐induced SMAS Laxity Index was measured using reconstructed CT images, and the relationship between the PC‐induced SMAS Laxity Index and age was analysed.

Results

The PC‐induced SMAS Laxity Index was significantly larger in Group O than in Group Y. As well, a strong and significant positive correlation was detected between the PC‐induced SMAS Laxity Index and age (r = 0.72; P < 0.001).

Conclusions

The use of MDCT provides insight into the detailed changes associated with ageing that take place within the cheeks. This study objectively demonstrated that SMAS laxity and age are factors associated with facial ageing, as the SMAS laxity increased with age. Finally, the imaging features confirmed the dermatological and aesthetic knowledge gained from plastic surgery regarding the loss of the SMAS supporting force due to facial ageing.

http://bit.ly/2SjnGmi

Facial site distribution of basal cell carcinoma in Japanese

Abstract

Basal cell carcinoma (BCC) occurs preferentially on the face. We retrospectively analyzed 200 cases of BCC treated at Nagoya City University Hospital from April 2004 to October 2015 and examined regional features based on modified facial aesthetic units. BCC occurred more frequently on the cheek, nasal and orbital areas. There was no significant difference between sides, and age was the only factor affecting tumor size.

http://bit.ly/2HH7MxV

The beneficial role of functional food components in mitigating ultraviolet‐induced skin damage

Abstract

Excessive exposure to ultraviolet (UV) radiation can chemically alter biological molecules and is one of the major environmental health risks with potential to damage the structure and function of the skin. Numerous dietary supplements are known to optimize the skin's defenses against radiation exposure. Several studies in which the beneficial roles of functional food components, that can protect against UV‐induced skin damage, have been demonstrated. Supplemental dietary sphingomyelin maintains covalently bound ω‐hydroxy ceramides to avert skin barrier defects after UVB irradiation. The oral administration of collagen hydrolysates has been shown to limit decreases in skin elasticity via increases in the dermal hyaluronic acid content. Milk fermented with lactic acid bacteria has been shown to augment DNA repair mechanisms and improve skin immunity in the aftermath of UVB damage. Furthermore, long‐term ingestion of fermented milk containing lactic acid bacteria, collagen hydrolysates and sphingomyelin increases the minimal erythema dose (MED) in human subjects with moderate sunburn or redness and tanned skin after exposure to UV solar radiation. Thus, products containing these functional food components are one means by which the adverse effects of UV radiation on the skin can be mitigated.

http://bit.ly/2SjnJyu

Facial distribution of squamous cell carcinoma in Japanese

Abstract

Squamous cell carcinoma (SCC) is a malignant tumor of the skin. SCC is frequently distributed on highly exposed areas such as the face and dorsal surface of the hands because it is closely related to ultraviolet damage. We retrospectively analyzed 106 cases of SCC treated at Nagoya City University Hospital from April 2004 to October 2015 and examined regional features based on modified facial aesthetic units. SCC occurred more frequently on the cheek and forehead on the right side. The site of the tumor (nose and eyelid) was the only factor affecting tumor diameter.

http://bit.ly/2HH7DKT

The impact of carbonylated proteins on the skin and potential agents to block their effects

Abstract

Carbonylated proteins (CPs) are synthesized by reactions between amino groups in proteins and reactive aldehyde compounds (RAC) yielded from lipid peroxidation initiated by reactive oxygen species (ROS). In the skin, CPs are detected in a higher frequency at sun‐exposed sites of the skin in elderly subjects. Since CPs in the stratum corneum (SC) have been reported to correlate with skin water content and transepidermal water loss, it is considered that the accumulation of CPs in the SC involves the loss of skin moisture functions. However, the roles of CPs in the dermis on skin physiology are still unclear. The purpose of this study was to investigate the roles of CPs in the dermis during the progression of photoaged skin and to propose a method to prevent or reduce the synthesis of CPs. The exposure of human normal dermal fibroblasts to CPs increased intracellular ROS levels and the synthesis of intracellular CPs. In addition, CPs caused morphological changes of fibroblasts. Furthermore, CPs caused alterations of mRNA expression levels of dermal matrix‐related proteins, such as upregulating MMP‐1 and IL‐8. These results indicated that CPs disrupt construction of the dermal matrix. On the other hand, α‐tocopherol and β‐carotene suppressed the synthesis of RAC during lipid peroxidation which resulted in the reduction of UVA‐induced CPs in the SC. From these results, we propose that extracellular CPs increase intracellular ROS levels and contribute to alterations of the dermal matrix. To prevent the synthesis of CPs, the application of α‐tocopherol or β‐carotene could be effective.

http://bit.ly/2HIXRbf

Perioperative changes in knowledge and attitude towards oral health by oral health education

Abstract

Objectives

Perioperative oral health care can prevent postoperative complications, but it is also important to maintain oral health afterwards to avoid later adverse events. This study examined 1) the relationship between knowledge and attitude towards oral health (KAOH) and oral/periodontal status (OPS) in patients receiving surgery, and 2) the changes in KAOH by perioperative oral health care and education.

Methods

Patients receiving surgery who visited our hospital's dental clinic beforehand were prospectively recruited. All participants received oral health care and education. In questionnaires assessing KAOH before and after surgery, respondent answers were generally classified as positive or negative. OPS was assessed before surgery. Associations between KAOH and OPS and perioperative changes in KAOH were statistically tested.

Results

A total of 507 patients answered the questionnaire before surgery, among whom 324 patients also completed it afterwards. Preoperative OPS was significantly worse in the negative than in the positive KAOH group. Positive answers for KAOH increased significantly from 68.6% to 92.2% during the perioperative period.

Conclusions

We found that patients with poor KAOH also had poor OPS, but KAOH could be improved by perioperative oral health care and education, suggesting that perioperative oral health management could improve oral health knowledge and attitudes.

This article is protected by copyright. All rights reserved.

http://bit.ly/2CVicEs

How stiff is skin?

Abstract

The measurement of the mechanical properties of skin (such as stiffness, extensibility and strength) is a key step in characterisation of both dermal ageing and disease mechanisms and in the assessment of tissue‐engineered skin replacements. However, the biomechanical terminology and plethora of mathematical analysis approaches can be daunting to those outside the field. As a consequence, mechanical studies are often inaccessible to a significant proportion of the intended audience. Furthermore, devices for the measurement of skin function in vivo generate relative values rather than formal mechanical measures, therefore limiting the ability to compare studies. In this viewpoint essay, we discuss key biomechanical concepts and the influence of technical and biological factors (including the nature of the testing apparatus, length scale, donor age and anatomical site) on measured mechanical properties such as stiffness. Having discussed the current state‐of‐the‐art in macro‐mechanical and micromechanical measuring techniques and in mathematical and computational modelling methods, we then make suggestions as to how these approaches, in combination with 3D X‐ray imaging and mechanics methods, may be adopted into a single strategy to characterise the mechanical behaviour of skin.

http://bit.ly/2Sh5DNs

Pyridoxine (VB6) restores the down‐regulation of serine palmitoyltransferase mRNA expression in keratinocytes cultured in highly oxidative conditions through enhancement of the intracellular antioxidant system

Abstract

Background

Pyridoxine (VB₆), which acts as a coenzyme in the biosynthesis of niacin, is formulated in pharmaceuticals to treat skin roughness. However, the mechanism of action of VB₆ is not known precisely.

Objective

This study was conducted to clarify the influence of highly oxidative conditions on the expression of skin moisture‐related mRNAs and to evaluate the preventive effects of VB₆ focusing on antioxidant behaviour.

Methods

Intracellular levels of reactive oxygen species (ROS) in normal human epidermal keratinocytes (NHEKs) were determined using the 2′,7′‐dichlorofluorescein diacetate assay. Real‐time PCR was employed to investigate the influence of higher oxidative conditions on the expression of mRNAs encoding serine palmitoyl transferase (SPT) and filaggrin, and to characterize the mechanism of the antioxidant effect of VB₆. Intracellular glutathione was quantified using an assay based on the glutathione recycling system with 5,5′‐dithiobis (2‐nitrobenzoic acid) reagent and glutathione reductase. Carbonylated proteins (CPs) were semi‐quantified by detecting aldehyde residues.

Results

Treatment of NHEKs with BSO increased the level of intracellular CPs by interfering with intracellular glutathione synthesis. Further, treatment with BSO down‐regulated the expression level of SPT mRNA, but VB₆ restored SPT mRNA expression in BSO‐treated NHEKs. VB₆ decreased the level of intracellular CPs with or without BSO treatment in a dose‐dependent manner. In addition, VB₆ increased levels of intracellular NADH/NADPH and glutathione through the activation of nuclear factor E2‐related factor 2 (Nrf2) signalling.

Conclusion

These results suggest that highly oxidative conditions cause an impaired skin barrier function due to the down‐regulation of SPT that results in skin roughness. VB₆ improved the down‐regulation of SPT mRNA expression initiated by highly oxidative conditions by enhancing the intracellular antioxidant system.

http://bit.ly/2HH847Z

The reciprocal association between diabetes mellitus and erosive oral lichen planus

Abstract

We read with interest the article by Otero Rey E. M. and colleagues that was recently published in Oral Diseases (Otero Rey E. M. et al., 2018). They provided evidence showed that the prevalence of diabetes mellitus (DM) among patients with oral lichen planus (OLP) ranges from 1.6% to 37.7% while the prevalence of OLP among patients with DM ranges from 0.5% to 6.1%.

This article is protected by copyright. All rights reserved.

http://bit.ly/2S13Ah4

Mechanisms of repigmentation induced by photobiomodulation therapy in vitiligo

Abstract

Photobiomodulation (PBM) therapy is based on the exposure of biological tissues to low‐level laser light (coherent light) or light‐emitting diodes (LEDs; noncoherent light), leading to the modulation of cellular functions, such as proliferation and migration, which result in tissue regeneration. PBM therapy has important clinical applications in regenerative medicine. Vitiligo is an acquired depigmentary disorder resulting from disappearance of functional melanocytes in the involved skin. Vitiligo repigmentation depends on available melanocytes derived from (a) melanocyte stem cells located in the bulge area of hair follicles and (b) the epidermis at the lesional borders, which contains a pool of functional melanocytes. Since follicular melanoblasts (MBs) are derived from the melanocyte stem cells residing at the bulge area of hair follicle, the process of vitiligo repigmentation presents a research model for studying the regenerative effect of PBM therapy. Previous reports have shown favourable response for treatment of vitiligo with a low‐energy helium‐neon (He‐Ne) laser. This review focuses on the molecular events that took place during the repigmentation process of vitiligo triggered by He‐Ne laser (632.8 nm, red light). Monochromatic radiation in the visible and infrared A (IRA) range sustains matrix metalloproteinase (MMP), improves mitochondrial function, and increases adenosine triphosphate (ATP) synthesis and O₂ consumption, which lead to cellular regenerative pathways. Cytochrome c oxidase in the mitochondria was reported to be the photoacceptor upon which He‐Ne laser exerts its effects. Mitochondrial retrograde signalling is responsible for the cellular events by red light. This review shows that He‐Ne laser initiated mitochondrial retrograde signalling via a Ca²⁺‐dependent cascade. The impact on cytochrome c oxidase within the mitochondria, an event that results in activation of CREB (cyclic‐AMP response element binding protein)‐related cascade, is responsible for the He‐Ne laser promoting functional development at different stages of MBs and boosting functional melanocytes. He‐Ne laser irradiation induced (a) melanocyte stem cell differentiation; (b) immature outer root sheath MB migration; (c) differentiated outer root sheath MB melanogenesis and migration; and (d) perilesional melanocyte migration and proliferation. These photobiomodulation effects result in perifollocular and marginal repigmentation in vitiligo.

http://bit.ly/2Sfk196

Placental extracts regulate melanin synthesis in normal human melanocytes with alterations of mitochondrial respiration

Abstract

Placental extracts have been widely used as skin lightening agents in the Japanese cosmetic market. Here, we show that placental extracts contain factors that can decrease or increase melanin synthesis by normal human melanocytes in vitro in possible association with mitochondrial respiration. When normal human melanocytes were treated with a whole porcine placental extract, melanin synthesis was decreased. In contrast, a porcine placental extract in which exudates and insoluble materials including lipids had been removed increased melanin synthesis. In addition, the amount of tyrosinase, the enzyme critical for melanin synthesis, changed in accordance with the alteration of melanin synthesis. Interestingly, the amount of manganese‐dependent superoxide dismutase (MnSOD), a mitochondrial‐resident antioxidant enzyme, was increased when melanin synthesis was decreased by the whole placental extract. Mitochondrial respiration and glycolysis also changed following treatment with the placental extracts. These results suggest that placental extracts contain factors that can increase or decrease melanin synthesis by normal human melanocytes and that mitochondrial function may be associated with the placental extract‐induced regulation of melanogenesis.

http://bit.ly/2HEdtMT

Effects and interactions of increased environmental temperature and UV radiation on photoageing and photocarcinogenesis of the skin

Abstract

Solar radiation is one of fundamental elements sustaining and maintaining life on earth. Previous studies on health effects from the sun exposure mostly focused on ultraviolet (UV) radiation. Although exposure to the solar radiation likely occurs in an environment with elevated temperature, the effects and interactions of elevated environmental temperature with UV radiation on the skin, especially in the context of ageing and carcinogenesis, have not been carefully examined. It is known that UVA radiation results in reduced production and increased degradation of dermal collagen, contributing to photoageing of the skin. Previous studies showed conflicting results regarding the effects of increased environmental temperature on dermal collagen. Additionally, we demonstrated that solar‐simulated radiation and increased environmental temperature have similar impacts on dermal fibroblasts through activation of distinct pathways. UVB radiation is well known for its carcinogenic capacity. Previously, it was reported that exposure to heat treatment before UVB radiation reduces epidermal keratinocyte cell death. We demonstrated that exposure to elevated environmental temperature prior to UVB radiation reduces UVB‐induced skin tumor formation. We proposed that alterations in molecular dynamics and quantum mechanics were involved for the observed increased environmental temperature‐induced protective effect against UVB damage. This review emphasizes that both environmental temperature and solar radiation are important elements in nature that have significant impacts on the human health, and future studies should focus on the biological effects and interactions of environmental temperature and solar radiation since this scenario is most relevant to the real‐world setting.

http://bit.ly/2Sh5tpk

Novel nanocapsule of α‐lipoic acid reveals pigmentation improvement: α‐Lipoic acid stimulates the proliferation and differentiation of keratinocyte in murine skin by topical application

Abstract

α‐Lipoic acid is amphipathic with low molecular sulphur‐containing fatty acid and has strong antioxidant effects. It has been used at the purposes of anti‐ageing, treatment of diabetic neuropathy, and supplement as antioxidant. Though α‐lipoic acid is normally administered in oral or injection, it has not been used in a topical use via skin because of its bad penetration. We developed the novel nanocapsule of α‐lipoic acid, named α‐lipoactive (nLA), to improve skin permeability. The nLA is constructed as micelles of α‐lipoic acid mixed with the non‐ionic surfactant, and its surface of the micelles was coated with inorganic metal salts. It is water soluble and has a diameter of approximately 8‐15 nm. After nLA was applied to the murine skin, epidermal thickening was observed. It was confirmed that this effect is caused by α‐lipoic acid molecule, but not by the raw material used for encapsulation. In in vivo experiments, it was found that nLA is very effective for improving UV‐induced pigmentation and epidermal thickening. Our findings suggest that nanoencapsulation of α‐lipoic acid is considerably effective for topical application.

http://bit.ly/2HGxCSx

Preface

http://bit.ly/2Sh5lWS

Engineering of scaffold‐free tri‐layered auricular tissues for external ear reconstruction

Objectives

Current strategies for external ear reconstruction can lead to donor site morbidity and/or surgical complications. Tissue‐engineered auricular tissues may provide readily available reconstructive materials that resemble native auricular tissue, which is composed of a cartilaginous region sandwiched between two perichondrial layers. We previously developed scaffold‐free bi‐layered auricular tissues, consisting of a perichondrial layer and a cartilaginous layer, by cultivating chondrocytes and perichondrial cells in a continuous flow bioreactor. Here, we aimed to improve construct properties and develop strategies to engineer tri‐layered auricular constructs that better mimic native auricular tissue.

Study Design

Experimental study.

Methods

Different concentrations of insulin‐like growth factor (IGF)‐1 and insulin were supplemented during bioreactor culture to determine conditions for engineering bi‐layered constructs. We also investigated two methods of engineering tri‐layered constructs. Method 1 used Ficoll separation to isolate perichondrial cells, followed by the seeding of isolated perichondrial cells onto the opposing side of the bi‐layered constructs. Method 2 involved the growth of the bi‐layered constructs in osteogenic culture medium.

Results

The combination of 10 nM IGF‐1 and 100 nM insulin led to increased collagen content in the engineered bi‐layered constructs. For developing tri‐layered constructs, method 2 yielded thicker constructs with better mechanical and biochemical properties compared to method 1. In addition, the presence of the perichondrial layers protected the engineered constructs from tissue calcification.

Conclusion

Auricular tissues with a biomimetic microstructure can be created by growing chondrocytes and perichondrial cells in a continuous flow bioreactor, followed by cultivation in osteogenic medium.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2MIgKK1

Feasibility and tolerability of measuring translaryngeal pressure during exercise

Objectives/Hypothesis

To determine if simultaneous tracheal and supraglottic pressure measurement performed during a continuous laryngoscopy exercise (CLE) test is possible, tolerable, and feasible, and if so, whether measurements can be used to determined airflow resistance over the larynx, thus providing an objective outcome measure for the CLE test, the gold standard for diagnosing exercise‐induced laryngeal obstruction.

Study Design

Explorative descriptive clinical study.

Methods

A CLE test was performed with the addition of two pressure sensors (Mikro‐Cath 825‐0101; Millar, Houston, TX) placed at the epiglottic tip and at the fifth tracheal ring. To place sensors, laryngeal anesthesia and a channel scope were required. Tolerability and feasibility was determined by a Likert score and subjective indication from subjects and operators. Adjustments to the technique were made to increase tolerability. The pressure data were continuously collected and analyzed for artifacts, drifts, frequency response, and used with flow data to calculate translaryngeal resistance.

Results

All subjects (n = 7) completed all procedures. Two main areas of concern were identified regarding tolerability: application of topical anesthesia to the larynx and nasal discomfort due to the added diameter of the laryngoscope. Protocol adjustments improved both. Pressure data were obtained from all procedures in all subjects, were consistent, and followed physiological trends.

Conclusions

Continuous measurement of the translaryngeal pressure gradient during a CLE test is possible, feasible, and tolerable. A CLE test with direct measurement of the translaryngeal pressure gradient might become a valuable tool in the objective assessment of respiratory function, and normal values should be established in health and disease.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2sWEy3P