Thyroid Hormone Receptor Alpha Mutations Lead to Epithelial Defects in the Adult Intestine in a Mouse Model of Resistance to Thyroid Hormone

Thyroid, Ahead of Print.


http://bit.ly/2RSGFVe

Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014

Thyroid, Ahead of Print.


http://bit.ly/2CJ3zUO

Topical pimecrolimus versus betamethasone for oral lichen planus: a randomized clinical trial

Abstract

Objectives

Oral lichen plans (OLP) is a potentially malignant inflammatory mucocutaneous disease. CD133 is an investigated surface marker for cancer stem-like cells (CSCs) that may be involved in tumor initiation in head and neck carcinomas. We compared short-term clinical effectiveness of topical pimecrolimus as selective inflammatory cytokine release inhibitor with betamethasone cream for erosive/atrophic OLP and investigated the influence of this therapy on CD133 expression.

Material and methods

Thirty patients were randomly assigned into two equal groups to receive topical pimecrolimus (group I) or betamethasone (group II) four times daily for 4 weeks. A marker lesion in each patient were assessed at baseline using clinical score (CS) and visual analog scale (VAS) then at 1, 2, and 4 weeks and after 4 weeks of treatment-free period. CD133 expression was detected in pre- and post-treatment immunostained sections.

Results

Both drugs showed a reduction in CS, VAS, and CD133 expressions after treatment termination (p < 0.001). Pimecrolimus-treated lesions showed significant higher 1st week reduction in severity (33.1% (22.2)), pain score (57.53% (14.27)), less recurrence in follow-up period and less CD133 expression by the end of the 1st 4 weeks compared with betamethasone.

Conclusion

Pimecrolimus showed earlier clinical response and less recurrence rate compared with standard topical corticosteroid in symptomatic OLP lesions, and both treatment reduced CD133-positive CSC population.

Clinical relevance

The study proved the benefits of topical pimecrolimus in early management of painful lesions of OLP and its ability to inhibit CSCs, suggesting a possible role in reducing risk of malignant transformation.

http://bit.ly/2RbPjZT

Relationship between erosive tooth wear and beverage consumption among a group of schoolchildren in Mexico City

Abstract

Objective

To assess the association between erosive tooth wear (ETW) and consumption of different kinds of beverages in a group of schoolchildren 11–14 years old in Mexico City.

Methods

Cross-sectional study in a sample of students (n = 512) in Mexico City. The Basic Erosive Wear Examination (BEWE) was used to quantify ETW. Beverage consumption (BC) was determined using a frequency questionnaire; beverages included pure water, natural fruit juices, milk, hot beverages, and soft drinks. Ordinal logistic regression model was used to evaluate the association between the presence of ETW and BC.

Results

In total, 45.7% of the schoolchildren showed an initial loss of surface texture (BEWE = 1) and 18.2% a distinct defect involving loss of dental tissue (BEWE ≥ 2) in at least one tooth. For each glass (350 ml) of milk/week, the odds of not having erosive wear (BEWE = 0) versus having an initial loss of surface texture (BEWE = 1) or of having an initial loss of surface texture versus the presence of a defect involving the loss of dental tissue (BEWE ≥ 2) decreased 4% (OR = 0.96, 95% CI 0.93–0.99, p = 0.008); for each portion of sweet carbonated beverage consumed (350 ml), the odds increased 3% (OR = 1.03, 95% CI 1.001–1.07, p = 0.046).

Conclusion

The intake of milk and milk-based products could be a dietary means of helping prevent ETW, especially if their consumption could replace sweet carbonated drink consumption.

Clinical relevance

Knowing the impact of beverage consumption on ETW helps to provide suitable recommendations for the prevention and control of ETW in order to promote tooth longevity.

http://bit.ly/2RgVSKt

Both operator and heat treatment determine the centring ability of Reciproc® files in vitro

Abstract

Objectives

To determine the shaping ability of reciprocating files without/with post-manufacturing heat treatment (Reciproc®/Reciproc blue®, VDW) when used by six operators of similar level of experience.

Materials and methods

Plastic training blocs with curved root canals (5 mm radius, 55° angle) were mounted in a dental manikin. Each operator prepared six specimens with each instrument system using the file sizes R25, R40 and R50 consecutively. Specimens were photographed, and deviations from the centre of the canal were measured at intervals of 0.5 mm and averaged for the apical, middle and coronal part of the canal. Data were tested for significance using the Mann-Whitney U test and two-way ANOVA with instrument systems and operators serving as factors.

Results

Deviations were observed towards the outer curvature in the apical and coronal and to the inner curvature in the middle segment of the canal. They were larger after using larger size instruments and were smaller when using Reciproc blue® compared to Reciproc®. Significant differences among operators were observed in the middle (all sizes) and coronal part of the canals (only sizes R25 und R40). Coronally, interaction between the main factors was significant as well.

Conclusions

Post-manufacturing heat treatment significantly improved shaping ability of the reciprocating file system Reciproc®. The observed differences among operators suggest the possibility of further improvement by providing specific training for prospective users.

Clinical relevance

Maintenance of root canal curvature may be improved by using post-manufacturing heat-treated instruments, but specific training should be recommended as well.

http://bit.ly/2WjvfbS

2-Methacryloyloxyethyl phosphorylcholine (MPC)-polymer suppresses an increase of oral bacteria: a single-blind, crossover clinical trial

Abstract

Objectives

The biocompatible 2-methacryloyloxyethyl phosphorylcholine (MPC)-polymers, which mimic a biomembrane, reduce protein adsorption and bacterial adhesion and inhibit cell attachment. The aim of this study is to clarify whether MPC-polymer can suppress the bacterial adherence in oral cavity by a crossover design. We also investigated the number of Fusobacterium nucleatum, which is the key bacterium forming dental plaque, in clinical samples.

Materials and methods

This study was a randomized, placebo-controlled, single-blind, crossover study, with two treatment periods separated by a 2-week washout period. We conducted clinical trial with 20 healthy subjects to evaluate the effect of 5% MPC-polymer mouthwash after 5 h on oral microflora. PBS was used as a control. The bacterial number in the gargling sample before and after intervention was counted by an electronic bacterial counter and a culture method. DNA amounts of total bacteria and F. nucleatum were examined by q-PCR.

Results

The numbers of total bacteria and oral streptcocci after 5 h of 5% MPC-polymer treatment significantly decreased, compared to the control group. Moreover, the DNA amounts of total bacteria and F. nucleatum significantly decreased by 5% MPC-polymer mouthwash.

Conclusions

We suggest that MPC-polymer coating in the oral cavity may suppress the oral bacterial adherence.

Clinical relevance

MPC-polymer can be a potent compound for the control of oral microflora to prevent oral infection.

http://bit.ly/2WiYlb4

The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines

Abstract

Objectives

The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects.

Materials and methods

Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT).

Results

IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved.

Conclusions

IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur.

Clinical relevance

IO anesthesia is safe to use as a primary technique in teeth with normal pulp.

http://bit.ly/2WkmTRe

Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area

Abstract

Summary

Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa when compared to lateral palate grafts.

Objective

The study aims to understand the differences in the structural composition of soft tissue autografts harvested from the lateral palate or the tuberosity.

Material and methods

Patients were randomly allocated to receive autografts harvested either from palatal or tuberosity sites to augment horizontal volume deficiencies around single-tooth implants. Tissue biopsies were analyzed for histological and histo-morphometric analysis. Picro-sirius red stain was used to evaluate collagen 1 and 3. Also, immuno-histochemical analysis was performed against MMP1, MMP2, cytokeratin-10, cytokeratin-13, and lysine hydroxylase-2.

Results

Twenty specimens were harvested from 9 subjects in the lateral palate group (PG) and 11 subjects in the tuberosity group (TG). The percentage of lamina propria represented 51.08% in the PG group and 72.79% in the TG group, while the area of submucosa was minimal in the TG group representing 4.89% of the total sample vs 25.75% in the PG. The total area of COL-1 and 3 in the TG was 1.19 ± 0.57 and 0.72 ± 0.44 mm², respectively, while in the PG, the corresponding values were 1.4 ± 0.7 and 1.04 ± 0.5 mm². The immuno-histochemical analysis generally showed a higher expression of LLH-2, MMP2, CYT-10, and CYT-13 in the TG when compared with the PG.

Conclusion

Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa. The collagen content in the lamina propria was similar for both groups while the immuno-histochemical profile showed differences in the antibody expression of the epithelial cells.

Clinical relevance

Tuberosity grafts had more lamina propria and less submocusa, which may be beneficial for volume augmentation.

http://bit.ly/2Rd8dj2

In vitro evaluation by quantitative real-time PCR and culturing of the effectiveness of disinfection of multispecies biofilms in root canals by two irrigation systems

Abstract

Objectives

The purpose of this in vitro study was by using quantitative real-time PCR and culturing to determine the effectiveness of two irrigation and cleaning systems in removing multispecies oral biofilms from root canals.

Material and methods

Twenty extracted human molars were instrumented to size #15/.02 and then cleaned with the GentleWave (GW) System. The teeth were autoclaved to provide the same sterile baseline. The molars were filled with mixed plaque suspended in BHI and centrifuged to inoculate the biofilms. After 2 weeks of incubation, the teeth were randomly divided into two treatment groups. In GW group (26 canals), the teeth were further instrumented to size #15/04, and in PiezoFlow (PF) group (30 canals) to #35/.04. The teeth were then cleaned either with GW System or ProUltra PiezoFlow Active Ultrasonic System using 3% sodium hypochlorite NaOCl, 8% EDTA, and sterile water as irrigants. Samples (S1, S2, and S3) for bacterial cultures were taken from 13 canals before and after instrumentation and after final cleaning. Quantitative real-time PCR was performed from all 56 canals, and universal bacterial, one genus, and one species-specific primers were used to determine the presence of microorganisms in samples from root canals before and after instrumentation and after final cleaning. Statistical analyses were performed using the Mann-Whitney U test with the significance level set at P < 0.05.

Results

Bacterial culturing from the canal samples revealed strong reduction of bacteria from S1 to S2 in both groups after instrumentation and irrigation with water only. No growth was detected in any of the S3 samples after cleaning in either group. A highly significant reduction in bacterial DNA was recorded by qPCR for both groups (P < 0.001). GW System showed more constant and a significantly higher reduction of total microbial DNA (P = 0.007), Enterococcus faecalis DNA (P = 0.011) and Streptococcus spp. DNA (P = 0.029) than the Ultrasonic System. The amount of residual microbial DNA calculated as an average of residual DNA in each individual canal in PF group was 1.99% and in GW group 0.09%.

Conclusions

While both systems demonstrated a highly effective reduction of intracanal bacterial DNA, the final total amount and variation in the number of residual bacterial DNA was significantly smaller in the GW group.

Clinical relevance

Elimination of microbes from the infected root canal system is regarded as the key for long-term clinical success. While both GentleWave and Ultrasonic Systems used with NaOCl and EDTA demonstrated a highly effective reduction of intracanal bacterial DNA; GW produced higher reduction and better predictability.

http://bit.ly/2Riba1E

PEKK-made indirect temporary crowns and bridges: a clinical pilot study

Abstract

Objectives

The aim of the present study was to find out whether the high-performance polymer PEKK is an equivalent alternative compared to cobalt chrome (CoCr)-made restorations, regarding to biocompatibility, stability, and comfort.

Materials and methods

Twenty-two patients (m, 10; f, 12) who were indicated for a long-term temporary-fixed restoration were included. They were randomized through a lottery procedure into two groups: the first group was restored with veneered PEKK-made crowns and bridges (Pekkton ivory), while the second group was restored with veneered CoCr crowns. Clinical parameters (plaque index (PI), probing depth (PD), fracture, and chipping) were documented in a period of 3–5 months from the insertion of restoration. Furthermore, every patient completed the OHIP-14 questionnaire. An exchange of the restorations from the first to the alternative material was performed after a period of 3–5 months.

Results

All patients showed an improvement of the oral hygiene and probing depth after insertion of the temporary restorations. However, there were no significant differences between PEKK and CoCr-made restorations (P > 0.05). There was no chipping after 5 months for both kinds of materials. There was a noticeable reduction of pain and discomfort of patients after insertion of temporary restorations. However, there were no significant differences between the two materials (P > 0.05).

Conclusions

PEKK-made temporary restorations offer a good and stable alternative to CoCr-made restorations. They have a high aesthetical advantage over CoCr restoration.

Clinical relevance

Esthetic and price-efficient temporary crowns can be offered for the patient during periodontal therapy to improve its success, in particular by improving the oral hygiene.

http://bit.ly/2WiY7Rg

A Comparison of the Efficacy of Ablative Fractional Laser Assisted Photodynamic Therapy according to Ablative Depth for Actinic Keratosis: A Single-blinded, Randomized, Comparative, Prospective Study

http://bit.ly/2CN24EO

Real-world drug survival of ixekizumab for psoriasis

http://bit.ly/2HzEzos

Pharmacy Costs of Medications for the Treatment of Onychomycosis in the United States

http://bit.ly/2RMqpVP

Augmented reality for temporomandibular joint arthrocentesis: a cadaver study

Temporomandibular joint (TMJ) arthroscopic procedures require the identification of a skin puncture point. The puncture point is conventionally estimated using the surface anatomy of the canthal-tragus line. However, the conventional puncture technique has been reported to fail at the first attempt in 18% of cases. We propose an augmented reality (AR) system-based method to identify the puncture point on the skin. A three-dimensional virtual model was reconstructed from computed tomography images of a cadaver head, and its rendered image was superimposed on the cadaver head before skin puncture.

http://bit.ly/2TgXk1i

Evaluation of the surface damage of dental implants caused by different surgical protocols: an in vitro study

The implant surface must withstand high insertion torque during implant insertion. The aim of this study was to investigate the damage to implant surfaces caused by two different insertion protocols in vitro. Fifteen titanium implants per group were inserted in standardized polyurethane foam models, group 1 according to a non-threaded surgical protocol and group 2 according to a threaded surgical protocol. Before and after insertion, the surfaces were visualized by scanning electron microscopy (SEM) and non-contact laser profilometry.

http://bit.ly/2B7DNtf

The second edition of the Oxford Handbook of Oral and Maxillofacial Surgery is the recently updated,...

The second edition of the Oxford Handbook of Oral and Maxillofacial Surgery is the recently updated, "must have" text for junior maxillofacial trainees (particularly dental core trainees), senior house officers, students, or anyone who is thinking about a career in the specialty.

http://bit.ly/2WlQGsv

Biological effects of acid-eroded MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells

Abstract

Objective

The aim of this study was to analyze the biological effects of MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells (hPDLSCs) after exposure to acidic and neutral environments.

Materials and methods

Discs of each material (n = 30) were exposed to phosphate buffered saline (pH = 7.4) or butyric acid (pH = 5.2) for 7 days, and biological testing was carried out in vitro on hPDLSCs. Cell viability and apoptosis assays were performed using eluates of each root-end filling material. To evaluate cell attachment to the different materials, hPDLSCs were directly seeded onto the material surfaces and analyzed by scanning electron microscopy. The chemical composition of the root-end filling materials was determined by energy-dispersive x-ray and eluates were analyzed by inductively coupled plasma-mass spectrometry. Statistical differences were assessed by ANOVA and Tukey test (p < 0.05).

Results

Under an acidic environment, both materials displayed similar ion release abilities, with the increased release of Si and Ca ions. Substantial changes in microstructure were observed for both materials after exposure to acidic pH. In addition, material exposure to an acidic environment showed a similar degree of cell adherence, and, surprisingly, MTA Repair HP exhibited higher cell viability rates at pH 5.2 than ProRoot MTA.

Conclusions

Exposure to an acidic environment promoted Si and Ca ion release from ProRoot MTA and MTA Repair HP. Moreover, we observed optimal biological properties of ProRoot MTA and MTA Repair HP in terms of cell viability, cell death, and cell attachment in both environments.

Clinical relevance

These results may suggest that MTA Repair HP and ProRoot exhibited optimal biological properties in terms of cell viability, cell death and cell attachment in acidic environment, being considered as materials for root-end filling and perforations.

http://bit.ly/2Rg8GRi

Treatment and prevention of spider veins

Spider veins are smaller and thinner than varicose veins and usually appear on the face or legs. They are generally painless and do not cause any health problems. However, some people may wish to treat them for cosmetic reasons. Learn more about the causes, treatment, and prevention of spider veins here.

http://bit.ly/2RcAvtL

The effectiveness of high-resolution ultrasound in the assessment of the carotid intima–media thickness for postirradiated neck

Abstract

Objective

The carotid intimal–medial thickness (CIMT) is a strong predictor of future cardiovascular events. We assessed the mean CIMT and evaluated associated factors in head and neck cancer (HNC) patients.

Materials and methods

Between January 2016 and March 2018, 70 volunteers underwent automatic ultrasound measurement of the common carotid artery CIMT. A mean CIMT ≥ 1.0 mm was regarded as an elevated risk for cardiovascular disease (CVD). We aimed to investigate the risk factors for an increased mean CIMT.

Results

We recruited 20 HNC survivors and 50 noncancer control individuals. Multiple linear regression analysis showed that old age (β = 0.006, 95% confidence interval, CI 0.004–0.008), increased weight (β = 0.003, 95% CI 0.001–0.005), hypertension (β = 0.10, 95% CI 0.03–0.17), and prior irradiation (β = 0.13, 95% CI 0.08–0.19) were positively correlated with the mean CIMT. From logistic regression analysis, it was shown that patients who underwent radiotherapy (OR 13.5, 95% CI 1.48–122.8) and who had higher bodyweight (OR 1.09, 95% CI 1.01–1.18) had a significantly higher risk of developing CVD.

Conclusion

Measurement of the mean CIMT using ultrasound could be useful for assessing CVD risk in HNC survivors after neck irradiation.

http://bit.ly/2FZfxgb

Headache deteriorates the quality of life in children with chronic spontaneous urticaria

Publication date: Available online 25 January 2019

Source: Allergologia et Immunopathologia

Author(s): S. Filiz, M.G. Kutluk, D.F.K. Uygun

Abstract

Background

Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU.

Objectives

To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU.

Methods

A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied.

Results

CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p = 0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p = 0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p < 0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT.

Conclusion

Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria.

http://bit.ly/2UkCdeV

Editorial board

Publication date: January 2019

Source: Annales de Dermatologie et de Vénéréologie, Volume 146, Issue 1

Author(s):

http://bit.ly/2UmQKXx

Remerciements aux experts

Publication date: January 2019

Source: Annales de Dermatologie et de Vénéréologie, Volume 146, Issue 1

Author(s):

http://bit.ly/2DwLgUb

Bacteremia after professional mechanical plaque removal in patients with chronic periodontitis

Abstract

Objective

The aim of this study was to investigate the characteristics of bacteremia caused by professional mechanical plaque removal (PMPR) in 2 groups of patients with generalized moderate chronic periodontitis.

Material and Methods

Venous blood samples were taken at multiple time points for one hour following PMPR in fifty patients with generalized moderate chronic periodontitis. Subjects consisted of two groups, one group was receiving supportive periodontal therapy (SPT, n = 25) and the other group was receiving initial periodontal therapy (IPT, n = 25). Blood samples were processed and analyzed for cultivable microflora. Pertinent clinical parameters were recorded for each patient in both groups.

Results

Bacteremia was detected in 10/25 SPT and 8/25 IPT patients (p = 0.796).

In both groups, the prevalence of bacteremia was dependent on the time of blood sampling and varied in magnitude between < 10² CFU/ml and 10⁶ CFU/ml.

Sixteen different bacterial species were identified in both groups, mostly Actinomyces naeslundii

(SPT n = 3, IPT n = 4) and Streptococcus spp. (SPT n = 6, IPT n = 2).

In regression models, furcation involvement Grade II (p = 0.004) and Gingival Bleeding Index

(p = 0.036) had affected the occurrence of bacteremia but in the SPT group only.

Conclusions

PMPR was associated with bacteremia regardless of whether a patient was receiving SPT or IPT.

This article is protected by copyright. All rights reserved.

http://bit.ly/2HxQZxj

Deciphering myeloid-derived suppressor cells: isolation and markers in humans, mice and non-human primates

Abstract

In cancer, infection and inflammation, the immune system's function can be dysregulated. Instead of fighting disease, immune cells may increase pathology and suppress host-protective immune responses. Myeloid cells show high plasticity and adapt to changing conditions and pathological challenges. Despite their relevance in disease pathophysiology, the identity, heterogeneity and biology of myeloid cells is still poorly understood. We will focus on phenotypical and functional markers of one of the key myeloid regulatory subtypes, the myeloid derived suppressor cells (MDSC), in humans, mice and non-human primates. Technical issues regarding the isolation of the cells from tissues and blood, timing and sample handling of MDSC will be detailed. Localization of MDSC in a tissue context is of crucial importance and immunohistochemistry approaches for this purpose are discussed. A minimal antibody panel for MDSC research is provided as part of the Mye-EUNITER COST action. Strategies for the identification of additional markers applying state of the art technologies such as mass cytometry will be highlighted. Such marker sets can be used to study MDSC phenotypes across tissues, diseases as well as species and will be crucial to accelerate MDSC research in health and disease.

http://bit.ly/2UfOhOw

West Nile virus encephalitis in GATA2 deficiency

We report a male with longstanding warts who presented with severe West Nile virus encephalitis (WNVE) and recovered after interferon alfa-2b and intravenous immunoglobulin. He was later found to have GATA2 de...

http://bit.ly/2Re7VIP

From the pages of AllergyWatch

Publication date: Available online 25 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): John J. Oppenheimer, David Michael Lang, Stanley M. Fineman

http://bit.ly/2MwzqMO

Chronic Itch Management: Therapies Beyond Those Targeting the Immune System

Publication date: Available online 25 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Emilie Fowler, Gil Yosipovitch

http://bit.ly/2sLkCAR

Pattern of Medication Use in Children with Very Poorly Controlled Asthma

Publication date: Available online 25 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Arlene M. Butz, Tricia Morphew, Melissa Bellin, Mary Elizabeth Bollinger, Mona Tsoukleris

http://bit.ly/2MyTo9A

Editorial Board

Publication date: February 2019

Source: Auris Nasus Larynx, Volume 46, Issue 1

Author(s):

http://bit.ly/2S5nK97

SERPING1 exon 3 splicing variants using alternative acceptor splice sites

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Tereza Grymová, Lucie Grodecká, Přemysl Souček, Tomáš Freiberger

Abstract

Mutations in the C1 inhibitor (C1INH) encoding gene, SERPING1, are associated with hereditary angioedema (HAE) which manifests as recurrent submucosal and subcutaneous edema episodes. The major C1INH function is the complement system inhibition, preventing its spontaneous activation. The presented study is focused on SERPING1 exon 3, an alternative and extraordinarily long exon (499 bp). Endogenous expression analysis performed in the HepG2, human liver, and human peripheral blood cells revealed several exon 3 splicing variants alongside exon inclusion: a highly prevalent exon skipping variant and less frequent +38 and -15 variants with alternative 3′ splice sites (ss) located 38 and 15 nucleotides downstream and upstream from the authentic 3′ ss, respectively. An exon skipping variant introducing a premature stop codon, represented nearly one third of all splicing variants and surprisingly appeared not to be degraded by NMD. The alternative -15 3′ ss was used to a small extent, although predicted to be extremely weak. Its use was shown to be independent of its strength and highly sensitive to any changes in the surrounding sequence. -15 3′ ss seems to be co-regulated with the authentic 3′ ss, whose use is dependent mainly on its strength and less on the presence of intronic regulatory motifs. Subtle SERPING1 exon 3 splicing regulation can contribute to overall C1INH plasma levels and HAE pathogenesis.

http://bit.ly/2RMQ94z

Cartilage regeneration using decellularized cartilage matrix: long-term comparison of subcutaneous and intranasal placement in a rabbit model

Publication date: Available online 25 January 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Achim von Bomhard, Alexander Elsaesser, Ricarda Riepl, Katharina Pippich, Joseph Faust, Silke Schwarz, Ludwig Koerber, Roman Breiter, Nicole Rotter

Abstract

Autologous cartilage as donor tissue for various surgical reconstructions such as nasal septum regeneration is limited and associated with donor site morbidity. Our goal was to evaluate a new resorbable chondroconductive biomaterial made of decellularized porcine nasal septum cartilage compared with autologous native auricular cartilage as the gold standard. In order to examine the material and determine its long-term outcome further, we used subcutaneous implantation and septal implantation in an orthotopic rabbit model. In addition to non-seeded decellularized xenogenic cartilage, chondrocyte-seeded decellularized xenogenic cartilage was implanted as a septal replacement. After a three- or six-month period, the formation of newly synthesized cartilage extracellular matrix was evaluated immunohistochemically, whereas septal integrity and biocompatibility were evaluated histologically. The formation of the implanted neoseptum and form stability was analyzed by using 7-Tesla Magnetic Resonance Imaging.

Good biocompatibility with no excessive rejection was demonstrated in all groups. Long-term stable and reliable septal reconstruction could be achieved in the study groups with or without cell seeding with autologous auricular chondrocytes. Autologous cell seeding was advantageous only with regard to septal perforations. Thus, cell seeding provides a benefit regarding long-term stability. However, because of slightly better biocompatibility, less pronounced septum deviation and the markedly lower effort involved, the non-seeded scaffold is favoured for possible clinical application.

http://bit.ly/2S2fBlO

Maternal allergen-specific IgG may protect the child against allergic sensitization

Publication date: Available online 25 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Christian Lupinek, Heidrun Hochwallner, Catharina Johansson, Axel Mie, Eva Rigler, Annika Scheynius, Johan Alm, Rudolf Valenta

Abstract

Background

The analysis of allergen-specific IgE responses in birth cohorts with micro-arrayed allergens has provided detailed information regarding the evolution of specific IgE responses in children. High resolution data regarding early development of allergen-specific IgG are needed.

Objective

To analyze IgG reactivity to micro-arrayed allergens in mothers during pregnancy, in cord blood samples, breast milk and in infants in the first years of life with the aim to investigate if maternal allergen-specific IgG may protect against IgE sensitization in the offspring.

Methods

Plasma samples from mothers during third trimester, cord blood, breast milk collected at 2 months after delivery, and plasma samples from children at 6, 12 and 60 months of age were analyzed for IgG reactivity to 164 micro-arrayed allergens (ImmunoCAP ISAC technology) in 99 families in the Swedish birth cohort ALADDIN. IgE sensitizations to micro-arrayed allergens were determined at 5 years of age in the children.

Results

Allergen-specific IgG reactivity profiles in mothers, cord blood and breast milk were highly correlated. Maternal allergen-specific IgG persisted in some children at 6 months. Children´s allergen-specific IgG production occurred at 6 months and reflected allergen exposure. Children who were IgE-sensitized against an allergen at 5 years of age had significantly higher allergen-specific IgG levels than non-sensitized children. For all 164 tested allergens, children from mothers with elevated (>30 ISU) specific plasma IgG against an allergen had no IgE sensitizations against that allergen at 5 years of age.

Conclusion

This is the first detailed analysis of the molecular IgG recognition profile in mothers and their children in early life. High allergen-specific IgG reactivity in mother´s plasma and breast milk and in cord blood seemed to protect against allergic sensitization at 5 years of age.

Clinical implication

High levels of allergen-specific IgG in mothers during third trimester and in cord blood seem to protect against allergic sensitization in the offsprings. This finding has implications for the prevention of allergy.

Graphical abstract

http://bit.ly/2Tf87Jo

Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis

Publication date: Available online 24 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Lisa Zhou, Alexandra Leonard, Ana B. Pavel, Kunal Malik, Aishwarya Raja, Jacob Glickman, Yeriel D. Estrada, Xiangyu Peng, Ester del Duca, Juan Sanz-Cabanillas, Juan Ruano, Hui Xu, Ning Zhang, Huei-Chi Wen, Juana Gonzalez, Sandra Garcet, James G. Krueger, Emma Guttman-Yassky

Abstract

Background

Atopic dermatitis/AD shows differential clinical presentation in older compared to younger patients. Nevertheless, changes in the AD molecular profile with age are unknown.

Objective

To characterize age-related changes in the AD profile.

Methods

We evaluated age-specific changes in lesional and non-lesional tissues and blood from moderate-to-severe AD patients (n=246) and age-matched controls (n=72) using immunohistochemistry, qRT-PCR, and Singulex in a cross-sectional study. Patients were analyzed using age-groups (18-40, 41-60, and 61+ years old).

Results

While disease severity/SCORAD was similar across AD age-groups (mean:∼60; P=0.873), dendritic cell infiltrates (CD1b⁺, FcεRI⁺; P<0.05) decreased with age. T_H2 measures (IL-5, IL-13, CCL13, CCL18, CCL26) significantly decreased with age in AD, despite increasing with age in controls. Consistent with T_H2 axis decreases, serum IgE and eosinophils negatively correlated with age in AD (r=-0.24, r=-0.23, P<0.05). T_H22-secreted IL-22 also decreased with age uniquely in AD (P<0.05). T_H1- (IFN-γ, IL-12/23p40, STAT1, CXCL9; P<0.05 for CXCL9) and T_H17-related markers (IL-17A, IL-20; P<0.05 for IL-20) increased with age in both AD and controls. Terminal differentiation measures significantly increased in older AD patients (LOR, FLG; P<0.05), while S100As (S100A8; P<0.01) and hyperplasia markers (epidermal thickness/ET, K16, Ki67; P<0.05 for K16) decreased. Serum trends in AD mimicked skin findings, with T_H2 downregulation (CCL26; r=-0.32, P<0.1) and T_H1 upregulation (IFN-γ; r=0.48, P<0.01) with age.

Conclusion

The adult AD profile varies with age. While T_H1/T_H17-skewing decreases in both AD and controls, AD shows unique decreases in T_H2/T_H22 polarization, and normalization of epithelial abnormalities. Thus, age-specific treatment approaches may be beneficial for AD.

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Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Publication date: Available online 24 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Z.-H. Ren, K. Wu, Y. Wang, Z.-W. Tian, J.-Z. Hu

Abstract

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n = 89) or control (n = 151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. Only two patients developed transoral salivary fistulas in the experimental group, while in the control group there were 14 (9%). The incidence of fistulas in the experimental group was significantly lower than that in the control group (p = 0.035). Regression analysis showed that there was a significant correlation between the groups and the incidence of salivary fistulas (p = 0.032). The two-step suture technique is safe, effective, and easy to learn, and could reduce the incidence of postoperative salivary fistulas.

http://bit.ly/2Uj74Zf

Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis

Abstract

Purpose

To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists.

Methods

We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations.

Results

166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines.

Conclusions

Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.

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Simultaneous transient global amnesia and Takotsubo syndrome after death of a relative: a case report

Simultaneous occurrence of transient global amnesia and Takotsubo syndrome has been only rarely reported. Here we report another patient with a transient global amnesia and concomitant Takotsubo syndrome.

http://bit.ly/2Mtw6Sw

Importancia de la cuantificación del desplazamiento hioideo en la valoración del estadio y evolución de la disfagia orofaríngea

Publication date: Available online 24 January 2019

Source: Acta Otorrinolaringológica Española

Author(s): Gemma Garmendia Merino, Helena Bascuñana Ambrós

Resumen

Introducción y objetivos

El objetivo de este trabajo es mostrar nuestra experiencia y consideraciones al cuantificar el desplazamiento hioideo, así como observar su correlación con las escalas cualitativas de valoración de la disfagia.

Métodos

Se mide el desplazamiento hioideo mediante el método descrito por el grupo de Molfenter y Steele 2014 en una serie de 14 pacientes con disfagia orofaríngea antes y después del tratamiento, y se valora su correlación con la Escala de penetración y aspiración de Rosenbek de 1996, y con la Functional Oral Intake Scale de Crary de 2005.

Resultados

Todos los pacientes variaron el desplazamiento total del hioides tras el tratamiento aplicado. Esta variación se correlacionó con las variaciones de la Escala de penetración y aspiración en todos los pacientes que presentaban aspiración o penetración. Sin embargo, las modificaciones del desplazamiento total hioideo no se correlacionaron con las variaciones de la Functional Oral Intake Scale.

Conclusiones

La mejora en el desplazamiento total del hioides es un indicador clínico de la mejora en la aspiración del paciente con disfagia orofaríngea, y puede ser utilizado en su diagnóstico y seguimiento. Sin embargo, no lo es como indicador de la tolerancia de la dieta oral.

Abstract

Introduction and objectives

The objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia.

Methods

Hyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment.

Results

All patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale.

Conclusions

The improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients.

http://bit.ly/2FPWwNO

Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

Abstract

Background

Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta‐analysis demonstrates the effect that radiation has on swallowing.

Methods

Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta‐analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies.

Results

The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta‐analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large‐scale studies using a randomized design and instrumental dysphagia assessments.

Conclusions

Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.

http://bit.ly/2CKh32l

Rationale and budget impact of bimonthly use of Cetuximab in patients with recurrent and/or metastatic head and neck cancer

Abstract

Background

In recurrent and/or metastatic head and neck squamous cell cancer, Cetuximab is administered once a week, followed by weekly doses. We present the clinical rationale of a different schedule of maintenance Cetuximab and we estimate the potential economic benefits on the health care budget from a societal perspective in Italy.

Methods

A budget impact (BI) excel‐based model was developed comparing a base case scenario of 100% weekly administration with a dose of 250 mg/m² to an every‐other‐week (EOW) administration at 50% or 100% with a dose of 500 mg/m².

Results

In the EOW, 50% scenario it was calculated a cost reduction of €347 000 of which 70% attributable to indirect costs, increasing to €694 000 after 4 months.

Conclusions

In our analysis, we showed that this simplified schedule could also reduce the costs of treatments both for the health system (direct costs) and for the society (indirect costs).

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Response to Letter to the Editor regarding follow‐up for NIFTP

http://bit.ly/2CFWmVo

Interventions for erythema multiforme: a systematic review

Abstract

Treatment of erythema multiforme (EM) is not codified. We performed a systematic review of the effect of any topical or systemic treatment on time to healing and frequency of episodes with acute and chronic forms of EM in adults. Four databases (MEDLINE, CENTRAL, EMBASE and LILACS) and other sources were searched for articles published up to March20, 2018. Randomized control trials (RCTs), observational studies and case‐series (n≥10) were considered. From 1558 references, we included 1 RCT and 6 case series. The RCT (n=20) showed a significant difference in complete remission of EM with continuous acyclovir versus placebo over 6 months. One case series found a mean reduction in flare duration with thalidomide for recurrent EM (5.1vs16.2 days) (n=20). Adverse events were poorly or not reported in included studies. Quality of life was never assessed. One limitation of our study is that we excluded the cases of isolated mucosal EM in order to prevent inclusion of Stevens‐Johnson syndrome cases. In conclusion, there is low‐level evidence for continuous acyclovir treatment for recurrent EM (one RCT). Evidence for other treatments is only based on retrospective case series. Results for thalidomide in particular encourage further research. Data concerning safety are insufficient.

PROSPERO registration no. CRD42016053175.

This article is protected by copyright. All rights reserved.

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Endoplasmic reticulum aminopeptidase 1 polymorphism Ile276Met is associated with atopic dermatitis and affects the generation of an HLA‐C associated antigenic epitope in vitro

Abstract

Background

Atopic dermatitis (AD) is a common inflammatory skin disease of complex etiology, with interactions between susceptibility genes and environmental factors. We have previously described a protective effect of the KIR2DS1 gene encoding the NK cell receptor, whose ligands are HLA‐C molecules. Here, we found an association of HLA‐C*05:01 allele with AD. KIR‐HLA‐C interactions are affected by peptides presented by HLA‐C. The generation of these peptides is strongly influenced by endoplasmic reticulum aminopeptidases 1 and 2 (ERAP1 and ERAP2). Expression and activity of ERAP molecules depend on the polymorphisms of their genes.

Objective

Possible associations of several single nucleotide polymorphisms (SNPs) in the ERAP1 and ERAP2 genes with susceptibility to AD.

Methods

Peripheral blood DNA isolation from 318 patients and 549 controls. PCR‐SSO or PCR‐SSP for HLA‐C typing; TaqMan Genotyping Assay for ERAP typing.

Results

Only one SNP in the ERAP1 gene, rs26618T>C, causing the amino acid change Ile276Met, had an association with AD. To gain insight on the functional role of this SNP we produced recombinant variants differing only at position 276 (Ile or Met) and tested their aminopeptidase activity against a N‐terminally extended precursor LIVDRPVTLV of the HLA‐C*05:01 epitope IVDRPVTLV. Both ERAP1 variants were able to efficiently generate the epitope, although the 276Ile allotype was able to do this about 50% faster. Furthermore, both variants were quite inefficient in further degradation of the mature epitope. Finally, we found that the effect of 276Met on susceptibility to AD was seen only in KIR2DS1‐negative individuals, not protected by this KIR.

Conclusion

Associations of HLA‐C*05:01 allele and rs26618T>C (Ile276Met) ERAP1 polymorphism with AD, and a significant difference between these two ERAP1 variants in their ability to generate an epitope for the HLA‐C*05:01 molecule were found.

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http://bit.ly/2MvbMQW

Itch: An Under‐recognized Problem in Psoriasis

Abstract

Psoriasis has historically been considered a nonpruritic dermatosis, in contrast with atopic dermatitis. Thus, itch has often been underappreciated and overlooked in psoriasis. However, increasing evidence over the past decade has shown that itch can be one of the most prevalent and burdensome symptoms associated with psoriasis, affecting almost every patient to some degree; it can involve the entire body, although it predominantly affects the legs, hands, back, body, and especially the scalp. Uncontrolled itch can significantly impact all aspects of the well‐being and quality of life of the patient. While there has been some progress in trying to better understand the pathophysiology of itch in psoriasis, more research effort and interest are needed. This under‐recognition of itch in psoriasis is clearly reflected in the dearth of treatment options targeting itch despite significant advancement in treating the lesions themselves. Recently, however, clinical studies have begun to include itch as a study outcome. The resulting data have demonstrated concomitant antipruritic benefits and improved Psoriasis Area and Severity Index (PASI) scores with mainstay treatments for psoriasis, such as topical corticosteroids and vitamin D analogs, phototherapies, and various systemics and biologics. This article takes a closer look at this debilitating symptom, reviewing the available epidemiology data for psoriatic itch, presenting the current understanding of psoriatic itch pathophysiology, and highlighting important clinical data for various treatment options for itch. Practical considerations for increasing the recognition of itch as well as improving its management in psoriasis are also provided.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sMHVdv

Fumaric acid ester‐induced T cell lymphopenia in the real‐life treatment of psoriasis

Abstract

Background

Fumaric acid esters (FAEs) are used to treat psoriasis and are known to cause lymphopenia in roughly 60% of the patients. Much remains to be elucidated about the biological effects of FAEs on lymphocytes.

Objective

To evaluate the influence of long‐term FAE (Fumaderm^®) treatment on peripheral blood CD4⁺ and CD8⁺ T cells, CD19⁺ B cells and CD56⁺ natural killer (NK) cells in psoriasis.

Methods

In this single‐centre retrospective observational subcohort study, we obtained leucocyte and lymphocyte subset counts before initiating FAE therapy in 371 psoriasis patients (mean age, 47.8 years; 63.3% males) and monitored them during treatment (mean treatment duration, 2.9 years). Multiparametric flow cytometry was used for immunophenotyping.

Results

FAEs significantly reduced the numbers of CD4⁺ T, CD8⁺ T, CD19⁺ B, and CD56⁺ NK cells. Among lymphocyte subsets, the mean percentage reduction from baseline was always highest for CD8⁺ T cells, with a peak of 55.7% after 2 years of therapy. The risk of T cell lymphopenia increased significantly with the age of the psoriasis patients at the time that FAE therapy was initiated. It was significantly decreased for the combination therapy with methotrexate and folic acid (vitamin B9) supplementation. Supporting evidence was found suggesting that T cell lymphopenia enhances the effectiveness of FAE therapy.

Conclusions

Monitoring distinct T cell subsets rather than just absolute lymphocyte counts may provide more meaningful insights into both the FAE treatment safety and efficacy. We therefore suggest optimising pharmacovigilance by additionally monitoring CD4⁺ and CD8⁺ T cell counts at regular intervals, especially in patients of middle to older age. Thus, further prospective studies are needed to establish evidence‐based recommendations to guide dermatologists in the management of psoriasis patients who are taking FAEs and who develop low absolute T cell counts.

This article is protected by copyright. All rights reserved.

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Phenotypic and Genotypic Analysis of Amelanotic and Hypomelanotic Melanoma Patients

Abstract

Background

Amelanotic/hypomelanotic melanoma is associated with poorer outcomes due to a more advanced disease stage at diagnosis.

Objective

To determine phenotypic risks and genotypic associations with amelanotic/hypomelanotic melanoma to develop a clinical and genetic profile that could assist in identifying high‐risk individuals.

Methods

The Brisbane Naevus Morphology Study conducted from 2009‐2016 has recruited a core of 1254 participants. Participants were drawn from a combination of volunteers from dermatology outpatient clinics, private dermatology clinics, the Brisbane Longitudinal Twin Study and QSkin study. Case participants had a personal history of melanoma and control participants no personal history of melanoma. We specifically examined seven known candidate pigmentation and melanoma genes and pigmentary phenotypic characteristics in participants with amelanotic/hypomelanotic melanoma compared to pigmented melanomas. This assayed single nucleotide polymorphisms (SNPs) in MC1R, TYR, HERC/OCA2, IRF4, MTAP, PLA2G6 and MITF.

Results

47 participants had at least one amelanotic/hypomelanotic melanoma and 389 had pigmented melanomas, with amelanotic/hypomelanotic melanoma patients significantly older than pigmented melanoma participants (63.3 ± 13.0 vs 54.6 ± 15.3 years; P<0.001). Amelanotic/hypomelanotic melanoma patients were more likely than pigmented melanoma patients to have red hair (34% vs 15%; P=0.01), severe hand freckling (13% vs 5%; P=0.01) and propensity to sunburn (63% vs 44%; P=0.01). MC1R R/R genotype was much more frequent in our amelanotic/hypomelanotic melanoma population (31.1% vs 11%; P<0.001; OR 26.4 vs 5.9; control 1.0). Amelanotic/hypomelanotic melanoma was associated with TYR rs1126809*A/A (OR[CI95%] 2.7 [1.1‐6.8] vs 1.2 [0.8‐1.9]) and PLA2G6 rs11570734*A/A (OR[CI95%] 3.7 [1.0‐13.6] vs 1.3[0.9‐2.0]). The MTAP melanoma risk SNP genotype, associated with darker pigmentation, (rs4636294*A/A) was less common in amelanotic/hypomelanotic melanoma patients (OR[CI95%] 0.8 [0.3‐2.1] vs 2.0 [1.3‐3.1]).

Conclusions

Knowledge of phenotypic and genotypic associations of amelanotic/hypomelanotic melanoma can help predict risks and associations of this difficult to diagnose melanoma, which may ultimately assist clinical management and patient skin self‐examination.

This article is protected by copyright. All rights reserved.

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Clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis: a review

Publication date: Available online 25 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T. Maehara, S. Pillai, J.H. Stone, S. Nakamura

Abstract

Immunoglobulin G4-related disease (IgG4-RD), recognized only recently as a single diagnostic entity, is a chronic inflammatory condition of unknown etiology. The diagnosis of IgG4-RD relies heavily on histopathological analysis and the correlation of histology findings with clinical, serological, and radiological data. CD4⁺ T and B cells, including IgG4-expressing plasmablasts, constitute the major inflammatory cell populations in IgG4-RD and are believed to cause organ damage and tissue fibrosis. Patients with IgG4-RD, who have active, untreated disease, exhibit marked expansion of IgG4-secreting plasmablasts in the blood. Important mechanistic insights correlated with the pathogenesis of IgG4-RD have been disclosed in recent years through the application of novel molecular biology approaches, including next-generation and single-cell RNA sequencing. Exploration of the interactions between these CD4⁺ T cells and cells of the B lymphocyte lineage is critical to understanding the pathophysiology of IgG4-RD. The establishment of pathogenic T cell clones and the identification of antigens specific to these clones constitute the first steps in determining the pathogenesis of this disease. This review focuses on clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis, from a perspective suitable for oral and maxillofacial surgeons.

http://bit.ly/2G0377W

Are tattoos associated with negative health‐related outcomes and risky behaviors?

Abstract

Background

Tattoos have reached broadening mainstream acceptance. Medical professional societies have noted that tattoos may co‐occur with high risk behaviors.

Methods

Using a variety of statistical models applied to a sample of 2,008 adults residing in the United States via Amazon's Mechanical Turk, we estimate the associations between tattoo characteristics, three health‐related outcomes (overall health status, ever diagnosed with a mental health issue, sleep problems), and three risky behaviors (current smoking, ever spent time in jail or prison, and number of sex partners).

Results

We find that the presence, number, and specific features of tattoos are positively correlated with two of the health‐related outcomes (ever diagnosed with a mental health issue and trouble sleeping) and all three of the risky behaviors (P < .05). Magnitudes are larger for those with multiple, visible, and offensive tattoos.

Conclusions

Our results suggest that individuals with tattoos are more likely to engage in risky behaviors relative to their non‐tattooed counterparts, which may lead to health consequences. Dermatologists, healthcare providers, and public health advocates should recognize that having a tattoo(s) is a potential marker for mental health issues and risky behaviors.

http://bit.ly/2Ufls4M

Alopecia areata in Tunisia: epidemio‐clinical aspects and comorbid conditions. A prospective study of 204 cases

Abstract

Background

Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients.

Methods

Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016.

Results

Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001).

Conclusions

Our study aimed to review epidemio‐clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early‐onset AA, long disease duration, and nail involvement were seen in our study.

http://bit.ly/2DwZQuR

Pre-auricular Sinus with Post-auricular Extension: An Uncommon Variant

Abstract

Pre-auricular sinus usually presents in front of the auricle without any diagnostic dilemma. But confusion arises when it presents with post-auricular swelling, abscess or discharging sinus. Here we describe series of pre-auricular sinus with post-auricular extension, a "variant type" of pre-auricular sinus and their management. A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from April 2015 to March 2018. After control of infection and proper pre-operative investigations patients, sinus was excised using bi-directional approach. The sinus tract along with a thin rim of conchal cartilage and pre and post-auricular cuff of skin was excised in toto. Among 76 cases of pre-auricular sinus, seven had "variant type". There were five males and two females in the variant group. Five patients were in the first decade of life and two patients were in the second decade of life. Four patients presented with post-auricular scar, two patients presented with post-auricular discharging sinus and one patient presented with post-auricular abscess. Wound healing was perfectly normal in all patients. None had recurrence till 1 year follow up. Pre-auricular sinus may present as "variant type" with post-auricular abscess or discharging sinus. So when a patient presents with post-auricular abscess or discharging sinus, pre-auricular region and pinna should be examined carefully. This helps to avoid unnecessary investigations and interventions which only complicate future management of these patients.

http://bit.ly/2FNGsw8

Comparison of Functional Organ Preservation by Concomitant Boost Radiotherapy Versus Concurrent Chemoradiation in Locally Advanced Carcinoma of Larynx or Hypopharynx: A Prospective Randomized Study

Abstract

Functional organ preservation is a major challenge in management of advanced laryngeal and hypopharyngeal carcinoma. Although ideal approach is a subject of much debate, radiotherapy with or without chemotherapy is most commonly used modality. This randomized study was conducted to compare functional organ preservation by chemoradiation (CRT) versus concomitant boost radiotherapy (CBRT). A total of 40 patients with advanced (stage III/stage IVa) laryngeal and hypopharyngeal cancer were randomized to receive either CRT (n = 20) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m² on days 1, 22 and 43) or CBRT (n = 20) to a dose of 67.5 Gy in 40 fractions over 5 weeks. Patients were assessed for organ preservation rate, toxicities, voice and swallowing functions utilizing Voice Related Quality of Life (VRQOL) and MD Anderson Dysphagia Inventory (MDADI) scores, respectively, for minimum follow up of 6 months. Organ preservation rate (intact disease free larynx) at 6 months post treatment was observed in 100% in CRT arm and 95% in CBRT arm. There was no significant difference in mucositis and dermatitis in two arms (p = 0.82 and 0.78, respectively). Dysphagia was observed more in CRT arm (n = 12 vs n = 6). Late toxicities grade 3 xerostomia, grade 2 dysguesia, were seen significantly more in CRT arm. There was no statistical difference between the two arms in terms of VRQOL (p = 0.55) and MDADI scores (p = 0.13). In CRT arm 13 patients complete response and in CBRT arm 12 patients had complete response. Accelerated fractionation with concomitant boost schedule is as effective as CRT in anatomical and functional preservation of larynx. The toxicities, voice and dysphagia related quality of life is comparable.

http://bit.ly/2G0xBXs

Dermoscopic features of nonpigmented eccrine poroma

http://bit.ly/2HsZVUB

Localisation of treatment‐resistant areas in patients on biologics

Summary

Background

Traditionally, psoriasis in certain body sites such as the scalp, nails, palms, soles, and the intertriginous areas has been acknowledged as difficult‐to‐treat.

Objective

To investigate the body location of treatment‐resistant psoriasis in patients treated with biologic agents in real‐world clinical practice, and to study the association between localisation and the quality of life.

Methods

In this observational study we investigated the skin and/or nail location of treatment‐resistant psoriasis in patients with moderate‐to‐severe psoriasis treated for > 6 months with biologic agents with a partial or good response to treatment defined as having a PASI ≥ 1 and ≤ 5. Experienced PASI assessors used a uniform data collection form in which the body area was divided into 26 regions and 20 nails.

Results

We included 146 patients with chronic plaque‐type psoriasis (74·7% men, mean [SD] age 49·8 [13·7] years, with a median PASI score of 2·4 (IQR 1·2‐3·2). The median PASI reduction from treatment initiation was 86·1% (IQR 78·1‐91·3).

The most common site of recalcitrant psoriasis was the anterior lower leg (49·3%; 95% confidence interval (CI): 41·2–57·4). Further common sites of recalcitrant psoriasis were the posterior lower leg (24·7%; 95% CI: 17·7‐31·6), the elbow (35·6%; 95% CI: 27·8‐43·4), and the scalp (19·2%; 95% CI: 12·8‐25·6%). No association between DLQI and specific areas of recalcitrant psoriasis were observed.

Conclusion

In real‐world clinical practice, the most common sites of recalcitrant psoriasis in patients treated with biologic agents are the anterior lower leg, the posterior lower leg, and the elbows. Recalcitrant psoriasis in no specific area caused a greater impact on quality of life than any other area.

This article is protected by copyright. All rights reserved.

http://bit.ly/2RZvQQH