Variables that predict response of nevus of ota to lasers

Summary

Nevus of ota is a dermal melanocytosis common among Asian patients, mottled, blue‐gray macule that is usually located unilaterally within the distribution of the first and second branches of the trigeminal nerve and almost always responds well to treatment with Q‐switched lasers (eg, ruby, alexandrite, and Nd: YAG). In spite of the plethora of science behind laser‐tissue interactions, the objective evaluation of nevus of ota response to laser is not on firm footing and most studies report subjective percentile scoring improvement. A knowledge of the variations in morphology of nevus of ota can help predict an optimal dose response and help to counsel patients appropriately.

http://bit.ly/2DfEIYM

PTX3 and D‐dimer in children with asthma: a real‐world study‐Reply

Abstract

Licari and colleagues detected plasma pentraxin 3 (PTX3) and serum D‐dimer levels, and reported significant elevated concentrations for both biomarkers in asthmatic patients compared with healthy controls, but neither was observed to be associated with clinical parameters.

Elevated PTX3 expressions in asthmatic airways were firstly observed by Zhang et al,¹ and the same group reported that PTX3 deletion enhanced airway inflammation, mucus production, and airway hyperresponsiveness in an ovalbumin‐induced asthma model through a TH17‐dominant phenotype.²

This article is protected by copyright. All rights reserved.

http://bit.ly/2t4Kgkg

Clinical relevance of human papillomavirus outside of oropharynx

Purpose of review The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites. Recent findings The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated. Summary Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted. Correspondence to Jan Klozar, MD, Department of Otolaryngology Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol Prague, V Úvalu 84, 150 06 Praha 5, Czech Republic. Tel: +420 727971911; e-mail: jan.klozar@fnmotol.cz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RHfbwP

Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects

Purpose of review To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer. Recent findings Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy. Summary The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications. Correspondence to Vincent Vander Poorten, MD, PhD, MSc, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32/16336340; e-mail: vincent.vanderpoorten@uzleuven.be Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WJ9baQ

Medial femoral condyle free flap for head and neck reconstruction

Purpose of review The aim of this article is to review the literature on medial femoral condyle (MFC) free flap in head and neck reconstruction. Recent findings The MFC flap is a superb material for head and neck reconstruction, especially in smaller bony defects. As an alternative to fibular free flap, it presents many advantages. Combining the periosteal bone with skin and/or muscle paddle, the MFC flap is suitable for complex reconstructions with favorable healing process. Even though this flap has a longer history of orthopedic and traumatologic reconstructions, a number of cases in head and neck surgery have been recently reported. Summary The MFC flap has been successfully used to reconstruct various head and neck sites, from the orbit, maxilla, and mandible, to the laryngeal and tracheal scaffolds. Correspondence to Jacek Banaszewski, Department of Otolaryngology Head and Neck Surgery, Poznan University of Medical Sciences. Przybyszewskiego 49, 60355 Poznan, Poland. Tel: +48 61 8691387; e-mail: bananana@poczta.onet.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RIpcKa

Quality of life after microvascular mandibular reconstruction for osteoradionecrosis—A prospective study

Abstract

Background

Reconstructive surgery for mandibular osteoradionecrosis is increasing; however, evidence regarding the impact on health‐related quality of life is lacking. The current exploratory study prospectively investigates whether resection with reconstruction is associated with changes in HRQoL parameters for these patients.

Methods

Seventeen patients underwent microvascular reconstruction for mandibular osteoradionecrosis between 2012 and 2015, and 16 completed the EORTC quality of life questionnaires QLQ‐C30 and QLQ‐H&N35 1 month before and 1 year after surgery.

Results

Increases in emotional (P = 0.01) and social functioning (P = 0.004) were observed, together with improvements in the fatigue (P = 0.04), appetite loss (P = 0.02) and pain (P = 0.02) scores, as evaluated by the QLQ‐C30. Pain reduction was further confirmed by the QLQ‐H&N35 (P = 0.04), which also showed improved scores for feeling ill (P = 0.001) and sexual difficulties (P = 0.04).

Conclusion

This exploratory study suggests that microvascular reconstruction after mandibular osteoradionecrosis may improve HRQoL, with an emphasis on pain reduction; however, further studies are needed.

http://bit.ly/2Gr5wJ4

Evaluating the Predicted Impact of Changes to the AJCC/TMN Staging System for Differentiated Thyroid Cancer (DTC): A prospective observational study of patients in South East Scotland

Abstract

Objectives To assess the impact of the eighth edition AJCC/TMN staging system on patients with new diagnoses of differentiated thyroid cancers presenting to our regional multi‐disciplinary team meetings. Design We analysed Endocrine Cancer MDT meeting records from 2009‐2015 to identify all patients in the region presenting with a new diagnosis of differentiated thyroid cancer. We re‐staged patients according to the eighth edition AJCC/TNM staging classification and analysed the survival outcomes of patients in each stage under the seventh and eighth systems. Setting Tertiary referral centre in South East Scotland (NHS Lothian). Participants Three hundred and sixty one patients were newly diagnosed with DTC within South East Scotland during the study period and met our inclusion criteria. Main outcome measures Mortality at any time during follow‐up Results In total 119/361 (33%) patients were re‐staged when the eighth edition AJCC/TMN system was applied. The number of patients classified as having advanced stage (III/IV) disease fell from 76 (21%) to 8 (2%). The most common reason for down‐staging was re‐classification of tumour size, a factor in 96 (80.7%) down‐staged patients. The five‐year disease specific survival of the cohort overall was 98%. Overall 7 (1.9%) thyroid cancer –related deaths occurred during follow‐up, three of whom were down‐staged. Conclusions On implementation of the eighth edition of the AJCC/TMN staging system, we expect many patients who would previously have been considered to have advanced thyroid cancer will now be classified as early stage. This will accurately reflect their excellent survival outcomes.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MPiW2w

Cost‐effectiveness of trans‐nasal endoscopic sphenopalatine artery ligation vs. arterial embolisation for intractable epistaxis: long‐term analyses

Summary

Objectives

Trans‐nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost‐saving strategy. Our main aim was to perform cost‐effectiveness analyses on TESPAL compared to embolisation to treat patients with epistaxis.

Design

We performed a retrospective, monocentric, comparative analyses on patients referred to our center and treated with embolisation or TESPAL.

Setting

This economic evaluation was carried out from a payer's perspective (i.e., French National Health Insurance) within a time horizon of 12 months.

Participants

Thirty‐seven TESPAL procedures and thirty‐nine embolisation procedures to treat intractable epistaxis were used in the analyses.

Main outcome measures

The primary outcome is presented as the cost per 1% of non‐recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1‐year follow‐up. Cost estimates were performed from the payer's perspective.

Results

Hospitalisation costs were higher for embolisation compared to TESPAL (5,972 vs. 3,769 euros). On average, hospitalization costs decreased by 41% when a patient was treated by TESPAL compared to an embolisation strategy (p= 0.06). The presence of comorbidities increased hospitalization costs by 79% (p=0.04). TESPAL enabled 1,867€ to be gained in intractable epistaxis.

Conclusions

The outcomes from our decision model confirm that TESPAL is more cost‐effective for patients with intractable epistaxis.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DUWLFu

Acute iliac arterial thrombosis during laparoscopic abdominoperineal resection

Abstract

Background

Acute iliac arterial thrombosis during surgery is very rare complication. There were few reports on this complication relative to gastroenterological surgery, and the risk has not been recognized.

Case presentation

A 70-year-old man, diagnosed with a rectal cancer (adenocarcinoma of rectum) with known history heavy cigarette smoking with no known history of peripheral vascular disease underwent a laparoscopic abdominoperineal resection. He presented severe pain in the left leg in the recovery room. A computed tomography (CT) scan revealed the complete obstruction of the left common iliac artery. A successful revasculization was achieved through a thrombotectomy and percutaneous transluminal angioplasty with a stent immediately after the diagnosis. The pain in the left leg disappeared immediately after the revasculization.

Conclusion

An acute arterial thrombosis is a potential complication of the laparoscopic colorectal surgery with the lithotomy position.

http://bit.ly/2Sft0rt

The Role of Glucagon-Like Peptide-1 in Energy Homeostasis

Metabolic Syndrome and Related Disorders, Ahead of Print.


http://bit.ly/2HRVgLW

Age, Sex, and Cardiovascular Risk Attributable to Lipoprotein Cholesterol Among Chinese Individuals with Coronary Artery Disease: A Case–Control Study

Metabolic Syndrome and Related Disorders, Ahead of Print.


http://bit.ly/2t5SxEx

The difference in nasal bacterial microbiome diversity between chronic rhinosinusitis patients with polyps and a control population

Background

Little is known regarding the role of the microbiome of the paranasal sinuses and its contribution to sinus mucosal health and disease. Consequently, we examined the microbiome of chronic rhinosinusitis patients with polyps (CRSwNP) and a control population to provide new insights into the microbiota associated with the pathogenesis of CRSwNP.

Methods

Fifty‐nine CRSwNP patients and 27 controls were enrolled in the study. The bacterial communities of the middle meatus were detected using 16S ribosomal RNA (rRNA)‒targeted Illumina MiSeq sequencing after microbial DNA was extracted from swabs.

Results

Although there was no difference in diversity between the 2 groups, richness was lower in the CRSwNP group than in the control group (p = 0.03). At the phylum level, Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes were predominant in both groups; however, the relative abundance was different, with the proportions of Actinobacteria (predominantly Corynebacterium) and Dolosigranulum being significantly higher in the control group than in the CRSwNP group.

Conclusion

These results support the theory of microbial dysbiosis as the pathogenesis of CRSwNP. The reduction in the proportions of potentially protective bacteria may decrease the overall stability of the sinonasal bacterial community.

http://bit.ly/2DVfYGU

An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients

Background

Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan.

Methods

Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1‐ and 2‐year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models.

Results

In 1‐ and 2‐year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40‐59 years of age had a lower dropout risk than patients 20‐29 years of age. Dropout hazard ratios (95% confidence interval) in 1‐ and 2‐year cohorts were 0.26 (0.12‐0.58) and 0.40 (0.17‐0.93) in patients 40‐49 years of age and 0.32 (0.14‐0.75) and 0.35 (0.13‐0.92) in patients 50‐59 years of age, respectively. Younger age contributed to lower compliance in 1‐ and 2‐year adult cohorts (p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents.

Conclusion

High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.

http://bit.ly/2MQWfLh

Sensitivity, specificity, and predictive value of oral mucosal brush biopsy for the diagnosis of peanut allergy

Background

Current diagnostic testing methods for peanut allergy, including serum specific immunoglobulin E (sIgE) and skin‐prick testing (SPT), have low specificity, whereas oral food challenge (OFC) carries significant risk of provoking adverse events. Mucosal brush biopsy (MBB) from the oral cavity is currently being studied as a new diagnostic test for peanut allergy, but normative data is not yet available with which to begin measuring specificity and predictive value.

Methods

Twenty individuals with no history of adverse reactions from eating peanuts underwent oral MBB and serum testing for peanut sIgE. These data were then compared with previously published data from 10 individuals with a history of clinical peanut allergy, in order to generate receiver operating characteristic (ROC) curves and calculate the sensitivity, specificity, and positive and negative predictive values for both testing modalities.

Results

The optimal cutoff levels for oral MBB and sIgE testing were 0.12 kU/L and 1.0 kU/L, respectively. At 0.12 kU/L, the sensitivity of oral MBB testing was 80% and the specificity was 85%, whereas at 1.0 kU/L, the sensitivity of sIgE testing was 50% and the specificity was 100%. From the ROC curves, the areas under the ROC curve (AUC) for oral MBB and sIgE were 0.91 (p < 0.001) and 0.74 (p = 0.007), respectively. Combination testing further increased both sensitivity and accuracy over oral MBB alone.

Conclusion

In this pilot study, oral MBB demonstrated high sensitivity and specificity for screening individuals with and without oral cavity clinical reactivity to peanuts and may represent a potentially useful testing method for the diagnosis of peanut allergy in the future.

http://bit.ly/2DUyGP2

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

Objectives/Hypothesis

To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea‐hypopnea syndrome (OSAHS) in awake patients.

Study Design

Prospective study.

Methods

Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal‐epiglottic aerospace (RPEA), modified Cormack‐Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.

Results

The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack‐Lehane scoring (κ = 0.38). The presence of a mega‐epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega‐epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23‐18.56, P = .024), modified Cormack‐Lehane score of 2 (aOR: 15.3, 95% CI: 1.8‐130.3, P = .012), or modified Cormack‐Lehane score of 3 (aOR: 10.03, 95% CI: 1.3‐78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01‐1.14, P = .025).

Conclusions

Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega‐epiglottis, and modified Cormack‐Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.

Level of Evidence

2 Laryngoscope, 2019

http://bit.ly/2RIvlGc

Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps

Objectives/Hypothesis

Establish treatment patterns and economic burden in US patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without chronic rhinosinusitis (CRS). Determine comparative costs of subgroups with high clinical burden.

Study Design

Observational, retrospective, case‐control study.

Methods

This study matched patients with CRSwNP to patients without CRS (1:1) using the Truven Health MarketScan US claims database. Categorical and continuous variables were compared using McNemar test and paired t test (normal distribution) or Wilcoxon signed rank tests (non‐normal distribution). Within subgroups, χ² and Wilcoxon or t tests were used (normal distribution).

Results

There were 10,841 patients with CRSwNP and 10,841 patients without CRS included. Mean age in the CRSwNP cohort was 45.8 years; 56.2% were male. During follow‐up, patients with CRSwNP had an increased diagnosis of asthma versus patients without CRS (20.8% vs. 8.1%, respectively; P < .001). Annual incremental costs were $11,507 higher for patients with CRSwNP versus those without CRS. Costs were higher in subgroups of patients with CRSwNP undergoing functional endoscopy sinus surgery (FESS), with a comorbid diagnosis of asthma, receiving oral corticosteroids, or macrolides versus the overall CRSwNP group. Patients with CRSwNP undergoing FESS had the highest costs of the four subgroups ($26,724, $22,456, $20,695, and $20,990, respectively).

Conclusions

Annual incremental costs were higher among patients with CRSwNP versus without CRS. Patients with CRSwNP with high clinical burden had higher overall costs than CRSwNP patients without.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2WK59Pb

Cost and efficiency of myringotomy procedures in minor procedure rooms compared to operating rooms

Objectives

Minor pediatric surgeries performed in the minor procedure room (MPR) may be more time efficient and less costly compared to those performed in the operating room (OR).

Study Design

Retrospective review.

Methods

This was a retrospective study on cost and efficiency differences of bilateral myringotomy with tube insertions performed in the MPR versus the OR. Charts were reviewed from June 2015 to May 2017. Cost data was based on supply cost and case costing of medical personnel including nurses, aides, and anesthesia assistants.

Results

Two hundred eighteen patients were included in the study. The median age was 2.7 years (range: 0.8–16.7), and there were no differences in gender between locations. One hundred twenty‐three patients had surgery in the MPR (56.4%), and 95 had surgery in the OR (43.6%). The median length of time in the procedure room was 11 minutes shorter for patients who underwent surgery in the MPR (12.0 minutes, range: 3.0–33.0) compared to patients in the OR (23.0 minutes, range: 11.0–52.0; P < .0001). Median hospital stay (2.0 hours vs. 4.3 hours; P < 0.0001) and median patient turnover time (6.0 minutes vs. 14.0 minutes; P < .0001) was shorter in the MPR compared to OR. The total overall cost of a myringotomy with tube insertion, including labor and supply cost, was $189.41 in the MPR compared to $468.56 in the OR, a difference of $279.15 per case.

Conclusion

Bilateral myringotomy with tube insertions are more time and cost‐efficient when performed in the MPR. This study supports the need for increased availability of MPR time for appropriate surgeries.

Level of Evidence

3. Laryngoscope, 2019

http://bit.ly/2RGn3yw

Weekly Plasma EBV DNA for Non-metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:  
Sponsor:   The University of Hong Kong
Recruiting

http://bit.ly/2Gr9fGj

Building a Renewed ImaGe After Head & Neck Cancer Treatment (BRIGHT) 2.0

Condition:   Head and Neck Cancer
Interventions:   Behavioral: BRIGHT;   Behavioral: Active Control
Sponsor:   Medical University of South Carolina
Not yet recruiting

http://bit.ly/2SxFpX2

Diagnostic Significance of FDG PET/CT Dynamic Imaging in Detecting Metastatic Lymph Nodes With Papillary Thyroid Cancer.

Conditions:   Positron-Emission Tomography;   Lymph Node Metastases;   Thyroid Cancer
Interventions:   Diagnostic Test: ^{18F-FDG PET/CT dynamic scan;   Diagnostic Test: B-ultrasonography
Sponsor:   Fifth Affiliated Hospital, Sun Yat-Sen University
Recruiting}

http://bit.ly/2Gr9wJl

Paclitaxel (Albumin Bound),Bleomycin And Cisplatin Or Carboplatin for Recurrent Or Metastatic Squamous Cell Carcinoma Of The Head And Neck

Condition:   Squamous Cell Carcinoma Of The Head And Neck
Intervention:   Drug: PaclitaxelPaclitaxel (Albumin Bound),Bleomycin combined with Cisplatin or Carboplatin
Sponsor:   Sun Yat-sen University
Not yet recruiting

http://bit.ly/2SuYMQH

A Study to Assess the Safety, Tolerability and Pharmacokinetics of AZD9977 in Japanese Healthy Participants With Single and Multiple Ascending Dose Administration

Condition:   Heart Failure
Interventions:   Drug: AZD9977;   Drug: Placebo
Sponsors:   AstraZeneca;   Parexel
Recruiting

http://bit.ly/2Sza1HE

Patient‐derived xenografts (PDX) of a case of ameloblastic fibrodentinoma

Abstract

Ameloblastic Fibrodentinoma (AFD) is a benign odontogenic tumour of unclear pathogenesis. It is usually diagnosed before the age of 20 years and treatment is conservative surgery, with occasional segmental resection (Philipsen et al., 1997, Chrcanovic & Gomez, 2017). AFD can perforate cortical bone and recur.

AFD is composed of odontogenic ectomesenchyme resembling the dental papilla and epithelial strands and nests resembling dental lamina and enamel organ, in addition to scattered dentinoid deposits (Slootweg, 1981, Cassidy et al, 1987, Bavle et al., 2017). During development odontoma can resemble AFD (Slootweg, 1981) and ameloblastic fibroodontoma (AFO) and the WHO 2017 head and neck tumours classification considered these lesions part of the spectrum of developing odontomas (EI‐Naggar et al., 2017). However, there is sufficient evidence that at least some AFD and AFO are true neoplastic lesions (Chrcanovic & Gomez, 2017, Slootweg, 1981, EI‐Naggar et al., 2017).

This article is protected by copyright. All rights reserved.

http://bit.ly/2MRnUMm

Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review

Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.

http://bit.ly/2Ssvhih

Correction to: CD73 expression in normal and pathological human hepatobiliopancreatic tissues

The following information must be added to the published article:

http://bit.ly/2t2rPwG

Early objective response to avelumab treatment is associated with improved overall survival in patients with metastatic Merkel cell carcinoma

Abstract

Background

Response rates are primary endpoints in many oncology trials; however, correlation with overall survival (OS) is not uniform across cancer types, treatments, or lines of therapy. This study explored the association between objective response (OR) and OS in patients with chemotherapy-refractory metastatic Merkel cell carcinoma who received avelumab (anti-PD-L1).

Methods

Eighty-eight patients enrolled in JAVELIN Merkel 200 (part A; NCT02155647) received i.v. avelumab 10 mg/kg every 2 weeks until confirmed progression, unacceptable toxicity, or withdrawal. Using conditional landmark analyses, we compared OS in patients with and without confirmed OR (RECIST v1.1). We applied a Cox model that included OR as a time-varying covariate and adjusted for age, visceral disease, and number of previous therapies.

Results

Twenty-nine patients had confirmed OR; 20 by study week 7 and 7 more between study weeks 7 and 13. Survival probabilities 18 months after treatment initiation were 90% [95% confidence interval (CI) 65.6–97.4] in patients with OR at week 7 and 26.2% (95% CI 15.7–37.8) in patients without OR but who were alive at week 7. Median OS was not reached in patients with OR and was 8.8 months (95% CI 6.4–12.9) in patients without. Similar results were observed for the week 13 landmark. The adjusted Cox model showed OR was associated with a 95% risk reduction of death [hazard ratio 0.052 (95% CI 0.018–0.152)] compared with a nonresponse.

Conclusions

Patients with OR by 7 or 13 weeks had significantly longer OS than patients without, confirming that early OR is an endpoint of major importance.

http://bit.ly/2HRxUpP

Issue Information

http://bit.ly/2GaGdLY

Statin use associated with improved overall and cancer specific survival in patients with head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Abhinav Gupta, William Stokes, Megan Eguchi, Mohammad Hararah, Arya Amini, Adam Mueller, Rustain Morgan, Cathy Bradley, David Raben, Jessica McDermott, Sana D Karam

Abstract

Objectives

Studies have shown the utility of lipid-lowering agents in improving outcomes in various cancers. We aim to explore how statins affect overall survival and cancer specific survival in head and neck cancer patients using population-based datasets.

Patients and methods

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we separated HNC patients into three groups: those with no hyperlipidemia (nH), those with hyperlipidemia and not taking a statin (HnS), and those with hyperlipidemia and taking a statin (H + S). Overall survival (OS) and cancer specific survival (CSS) were compared between the three groups based on disease subsite (oral cavity, oropharynx, and other) using Kaplan-Meier and multivariate Cox regression analysis (MVA), controlling for demographic, socioeconomic, staging, treatment, and comorbidity covariates. Using Pearson chi-square analysis, we also compared the incidence of cancer-related toxicity events.

Results

There were 495 nH, 567 HnS, and 530 H + S patients. H + S patients had superior OS and CSS (73.0, 81.2%) relative to nH (58.6, 69.1%) and HnS groups (61.7, 69.2%) (p < 0.01). On MVA, H + S patients showed improved OS (p < 0.01) and CSS (p = 0.04) compared to nH (HR = 1.64, 1.56) and HnS (HR = 1.40, 1.37). MVA stratified by subsite yielded similar results for oral cavity and oropharyngeal disease. Toxicity-related events did not differ significantly between the groups.

Conclusion

HNC patients with hyperlipidemia and taking a statin demonstrated improved outcomes compared to nH and HnS patients, further supporting statins' role as a potential adjuvant anti-neoplastic agent in HNC. Further prospective studies to investigate the impact of statins on HNC outcomes are warranted.

http://bit.ly/2G9DHW9

Editorial Board/Aims & Scope

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s):

http://bit.ly/2DavPzI

Omalizumab Treatment Patterns in Chronic Idiopathic Urticaria (CIU): Evidence from a Large Allergy Practice in the United States (US)

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Brian D. Stone, Abhishek Kavati, Maryia Zhdanava, Benjamin Ortiz, Jason Lecocq, Bradd Schiffman, Hoi Ching Cheung, Patrick Lefebvre

http://bit.ly/2DVerAF

Pollen Food Allergy Syndrome (PFAS) Among Young Armenian Adults

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Mariam R. Movsisyan, Armine V. Hakobyan, Spartak S. Gambarov

http://bit.ly/2DVeQTH

NK cells in treated HIV-infected children display altered phenotype and function

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Sanjana Mahapatra, William T. Shearer, Charles G. Minard, Emily Mace, Mary Paul, Jordan S. Orange

Abstract

Background

Chronic human immunodeficiency virus (HIV) infection is known to trigger a population redistribution and alteration in the functional capacity of NK cells. Due to improved anti-retroviral treatments, there are rising numbers of adolescents and young adults worldwide that are living with HIV infection since birth.

Objective

We sought to determine how NK cell phenotypic and functional subsets are altered in treated pediatric patients.

Methods

NK cells were contrasted among 29 HIV-unexposed and uninfected controls (5-19 years), 23 HIV-exposed but uninfected patients (HEU) (3-19 years) and 25 HIV-infected patients (3-19 years) using multi-parametric flow cytometry.

Results

While majority of the NK cell markers did not differ, activating receptors like NKp46, DNAM-1, NKG2C and stimulatory receptors like CD2 and CD11c were expressed by a higher frequency of NK cells in HIV-infected patients than controls. Interestingly, there were less differences between HIV-infected and HEU children. There was an inverse relationship between CD4/CD8 T cell ratio (as a marker of disease progression) and CD11c and NKG2C frequency and CD69 upregulation on stimulation among HIV-infected patients.

Conclusions

A chronic NK cell activation phenotype persists in HIV-infected children receiving anti-retroviral therapy and is associated with declining CD4/CD8 T cell ratios. A lower CD4/CD8 T cell ratio was associated with higher baseline granzyme B (p=0.0068, R²=0.29) and degranulation potential (p=0.022, R²=0.22) in stimulated NK cells. Thus, NK cells in HIV-infected children receiving treatment have reduced functional potential and an activated phenotype that distinguishes them from uninfected children.

Graphical abstract

http://bit.ly/2DVeYTb

Mast cells within cellular networks

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Michael Stassen, Ann-Kathrin Hartmann, Sharon Jiménez Delgado, Susann Dehmel, Armin Braun

Abstract

Mast cells are highly versatile in terms of their mode of activation by a host of stimuli and their ability to flexibly release a plethora of biologically highly active mediators. Within the immune system, mast cells can best be designated as an active nexus interlinking innate and adaptive immunity. Herein, we try to draw an arc from the initiation of acute inflammatory reactions to microbial pathogens to the development of adaptive immunity and allergies. This multifaceted nature of mast cells is made possible by the interaction with multiple cell types of immunological and non-immunological origin. Examples for the former include neutrophils, eosinophils, T cells and professional antigen presenting cells. These interactions allow mast cells to orchestrate inflammatory innate reactions and complex adaptive immunity, including the pathogenesis of allergies.

Important partners of non-immunological origin include cells of the sensory neuronal system. The intimate association between mast cells and sensory nerve fibers allows bidirectional communication leading to neurogenic inflammation. Evidence is accumulating that this mast cell / nerve crosstalk is of pathophysiological relevance in allergic diseases like asthma.

http://bit.ly/2MOLGZe

Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy. An NIAID/AHRQ Workshop

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Lisa M. Wheatley, Robert Wood, Kari Nadeau, Andrew Liu, Edward Zoratti, Leonard Bacharier, Erica Brittain, Moises Calderon, Thomas Casale, Bradley Chipps, Linda Cox, Peter S. Creticos, Manisha Desai, Sten Dreborg, Stephen Durham, Peter J. Gergen, Rebecca Gruchalla, Harold Nelson, Robyn E. O'Hehir, Marshall Plaut

Abstract

The Agency for Healthcare Research and Quality and the National Institute of Allergy and Infectious Diseases organized a workshop to develop trial concepts that could improve the usage and effectiveness of aeroallergen immunotherapy (AAIT). Expert groups were formed to accomplish the following tasks: 1) Propose a study design to compare effectiveness and safety of subcutaneous versus sublingual AAIT; 2) Propose a study design to compare effectiveness and safety of AAIT using one or a few allergens vs all or most allergens to which a patient is sensitized; 3) Propose a study design to determine whether AAIT can alter the progression of childhood allergic airways disease; 4) Propose a study design to determine the optimal dose and duration of AAIT to achieve maximal effectiveness with acceptable safety. Study designs were presented by the workgroups, extensively discussed at the workshop and revised for this report. The proposed trials would be of long duration, and require large, highly characterized patient populations. Scientific caveats and feasibility matters are discussed. These concepts are intended to help the development of clinical trials that can address some of the major questions related to the practice of AAIT for the management and prevention of allergic airways disease.

http://bit.ly/2DVeSLj

New graft manipulation strategies improved outcome of mismatched stem cell transplantation in children with primary immunodeficiencies

Publication date: Available online 4 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Reem Elfeky, Ravi M. Shah, Mohamed NM. Unni, Giorgio Ottaviano, Kanchan Rao, Robert Chiesa, Persis Amrolia, Austen Worth, Terry Flood, Mario Abinun, Sophie Hambleton, Andrew J. Cant, Kimberly Gilmour, Stuart Adams, Gul Ahsan, Dawn Barge, Andrew R. Gennery, Waseem Qasim, Mary Slatter, Paul Veys

Abstract

Background

Mismatched stem cell transplantation is associated with high risk of graft loss, graft versus host disease (GvHD) and transplant related mortality (TRM). Alternative graft manipulation strategies have been employed over the last 11 years to reduce these risks.

Objective

We investigated the outcome of using different graft manipulation strategies among children with primary immunodeficiency (PID).

Methods

Between 2006-2017, 147 PID patients received 155 mismatched grafts; 30 TCRαβ/CD19 depleted, 43 cords (72% with no serotherapy), 17 CD34+ selection with T cell add-back and 65 unmanipulated grafts.

Results

The estimated 8-year survival of the entire cohort was 79%, TRM was 21.7% and graft failure rate was 6.7%. Post-transplant viral reactivation, aGvHD grades II-IV and chronic GvHD complicated 49.6%, 35% and 15% transplants, respectively. The use of TCR αβ/CD19 depletion was associated with a significantly lower incidence of grade II-IV aGvHD (11.5%) and cGvHD (0%) however with a higher incidence of viral reactivation (70%) in comparison to other grafts. T cell immune reconstitution was robust among cord transplants however with a high incidence of aGvHD grade II-IV 56.7%. Stable full donor engraftment was significantly higher at 80% among TCRαβ⁺/CD19⁺depleted and cord transplants versus 40-60% among the other groups.

Conclusions

Rapidly accessible cord and haploidentical grafts are suitable alternatives for patients with no HLA matched donor. Cord transplantation without serotherapy and TCRαβ⁺/CD19⁺depleted grafts produced comparable survival rates of around 80% albeit with a high rate of aGvHD with the former and high risk of viral reactivation with the latter that need to be addressed.

http://bit.ly/2MOLZTS

A Randomized Phase 3 Study, Sinus-52, Evaluating the Efficacy and Safety of Dupilumab in Patients with Severe Chronic Rhinosinusitis with Nasal Polyps

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Claus Bachert, Martin Desrosiers, Joaquim Mullol, Peter W. Hellings, Anders Cervin, Lawrence Sher, John V. Bosso, Stella E. Lee, Jorge F. Maspero, Shigeharu Fujieda, Shoji Matsune, Xin Lu, Chunpeng Fan, Steven Draikiwicz, Nikhil Amin, Siddhesh Kamat, Asif Khan, Gianluca Pirozzi, Neil M.H. Graham, Marcella Ruddy

http://bit.ly/2MOLUzy

Field Study of a Novel Synthetic Peptide Immunotherapy in Cat Allergic Patients

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Geoff Down, Kirsten L. Evans, Mark Larché, Paul Laidler

http://bit.ly/2DVeNY1

Safety and Tolerability of Shortened Updosing with 7 Injections of Subcutaneous Allergen Immunotherapy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Eike G. Wuestenberg, Andreas Horn, Hendrik Wolf, Santiago Martin Hurtado, Katerina Koutromanou, Nadia Ghaussy, Montserrat Fernandez-Rivas

http://bit.ly/2MRcYhq

Innate Immune Memory in Paediatric Food Allergy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Melanie Neeland, Boris Novakovic, Jennifer Koplin, Thanh D. Dang, Richard Saffery, Katrina Allen

http://bit.ly/2DVeA7b

Time Trends in Adrenaline Auto-Injector Dispensing Patterns Using Australian Pharmaceutical Benefits Scheme Data

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Yichao Wang, Jennifer Koplin, Shaoke Lei, Rachel Peters, Simon Horne, Harriet Hiscock, Katrina Allen

http://bit.ly/2MOLhGc

Safety and Tolerability of a Novel Peptide-Based Immunotherapy for Peanut Allergy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Sara R. Prickett, Pascal LC. Hickey, Judy Bingham, Tracy Phan, Jodie Abramovitch, Jennifer M. Rolland, William B. Smith, Mark Hew, Robyn E.O. Hehir

http://bit.ly/2DVevQV

Double-Blind, Placebo-Controlled Randomized Trial of Epicutaneous Immunotherapy in Children of Milk-Induced Eosinophilic Esophagitis

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jonathan M. Spergel, Okan Elci, Amanda Muir, Chris A. Liacouras, Benjamin Wilkins, Deirdre D. Burke, Megan Ott Lewis, Terri F. Brown-Whitehorn, Antonella Cianferoni

http://bit.ly/2MOLdWY

Long-Term Outcomes of Omalizumab in Chronic Idiopathic Urticaria (CIU): Evidence from a Large Allergy Practice in the United States (US)

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jason Lecocq, Abhishek Kavati, Maryia Zhdanava, Benjamin Ortiz, Bradd Schiffman, Hoi Ching Cheung, Patrick Lefebvre, Brian D. Stone

http://bit.ly/2MOLaug

Demographic Characteristics, Comorbidities, and Exacerbation Frequency Among Patients Enrolled in the Chronicle Study: A Real-World, Prospective, Observational Study of US, Subspecialist-Treated Adults with Severe Asthma

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Weily Soong, Warner Carr, Bradley E. Chipps, Dennis K. Ledford, Njira Lugogo, Wendy C. Moore, Reynold A. Panettieri, Jennifer Trevor, Laura Belton, Frank Trudo, Christopher S. Ambrose

http://bit.ly/2DSCHDF

Withdrawn

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s):

http://bit.ly/2MP1lYu

Meta-Analysis of the Efficacy of Pharmacotherapies and Allergen Immunotherapy for Adult Perennial Allergic Rhinitis

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Eli O. Meltzer, Dana V. Wallace, Howard S. Friedman, Prakash Navaratnam, Christopher M. Burton, Erin P. Scott, Hendrik Nolte

http://bit.ly/2DSPSnL

DNA Methylation Predicts BMI Status Change from Pre-Adolescence to Post-Adolescence

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jiajing WANG, Hongmei Zhang, Syed H. Arshad, John W. Holloway

http://bit.ly/2MRcJTJ

The Influence of Patient Anxiety and Perception on the Effectiveness of Drug Allergy Testing

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Christine Rukasin, Cosby A. Stone, David G. Schlundt, Kemberlee Bonnet, Elizabeth J. Phillips

http://bit.ly/2DTxwmT

Diversity Among Allergic March Trajectories

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): David A. Hill, Robert Grundmeier, Jonathan M. Spergel

http://bit.ly/2MO4Aj3

Using Anxiolytics in a Pediatric Otolaryngology Clinic to Avoid the Operating Room

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Quinn Orb, Aida Rezaie, Sheldon Furst, Jeremy D. Meier, Albert H. Park

Abstract

Introduction

There is increasing concern regarding the risks associated with the use of general anesthesia in pediatric patients. Many otolaryngologic procedures performed under general anesthesia can also be performed in clinic. We hypothesize that anxiolytics can aid in performing common procedures in clinic thus avoiding the need to undergo general anesthesia in the OR.

Methods

We performed a retrospective review of patients undergoing inoffice procedures with anxiolytics in our pediatric otolaryngology outpatient clinic between February 2013 and January 2017. Charts were reviewed for age, past medical history, procedure type/duration, and outcome. These results were then compared to a cohort undergoing similar procedures in the OR.

Results

A total of 34 patients underwent an in-office procedure with an anxiolytic. The success rate was 97% (33/34). The average age was 6.2 years. Six children (17%) had a known history of chromosomal abnormalities and 2 children (6%) had autism. The four most common procedures performed were cerumen impaction removal (8), flexible laryngoscopy (6), ear canal foreign body removal (5), and septal cautery (4). Performing similar procedures in the OR resulted in an average additional cost of $822.

Conclusions

Performing procedures with anxiolytics in a pediatric otolaryngology clinic is safe, expeditious, and cost-effective. Anxiolytics can provide an effective alternative to general anesthesia.

http://bit.ly/2G9YGIs

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: a randomized clinical trial

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hadiseh Ghomi, Fariba Yadegari, Farin Soleimani, Brenda Lessen Knoll, Mahdi Noroozi, Ali Mazouri

Abstract

Objective

Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial.

Methods

This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge.

Results

The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P=0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P <0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%.

Conclusion

the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA).

The clinical trial registration number

IRCT20180410039260N1.

http://bit.ly/2DdkUFq

Acknowledgements to referees 2018

http://bit.ly/2SoTXbC

Neonatal Vocal Fold Motion Impairment After Complex Aortic Arch Reconstruction: What Should Parents Expect After Diagnosis?

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jennifer Rodney, Jess Thompson, Michael Anderson, Harold Burkhart

Abstract

Objectives

To study the incidence, sequelae, follow up, and recovery rate of vocal fold motion impairment (VFMI) after complex aortic arch reconstruction in neonates.

Study design

Retrospective case control study.

Methods

We retrospectively evaluated 105 neonates who underwent complex aortic arch reconstruction from 2014-2016. We compared patients that did have VFMI compared to a control group of patients with normal vocal fold movement. Descriptive statistics were computed for all demographic and clinical variables by treatment group.

Results

36% of patients were evaluated for VFMI (n=38) by an otolaryngologist. The incidence of VFMI was 22% (n= 23). Females were more likely to have VFMI (p= 0.02). Aspiration was more common in patients with VFMI (p=0.006). The difference in age, weight, incidence of pneumonia, nasogastric tube, gastrostomy, total length of stay, genetic anomaly, and reintubation was not significant between the VFMI group and control group (p> 0.05). Tracheostomy was not performed in any patients with unilateral paralysis. Only 61% of patients followed up in clinic (n=14). 64% of patients showed improvement or resolution (n=9). Average time to improvement was 4.8 months. Average time to complete resolution was 10.5 months.

Conclusions

VFMI after complex aortic arch reconstruction is relatively common. Despite increased aspiration in patients with VFMI, pneumonia did not occur at all in either group. Tracheostomy was not necessary in any patients with a unilateral paralysis. Most patients showed an improvement in the VFMI within 5 months of surgery. Our data support the need for otolaryngology follow-up.

http://bit.ly/2G9Am9v

Regulatory T Lymphocytes are Associated with Increased Nasopharyngeal Colonization in Children

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jessica Jane Browne, Evan Howard Matthews, Andrew William Taylor-Robinson, Jennelle Maree Kyd

Abstract

Objectives

Regulatory T lymphocytes (T_reg) have been linked to survival of commensal bacteria at mucosal sites, but their presence and role in chronic otitis media (COM) and their response to otopathogens has not been evaluated previously. We investigated the association between T_reg lymphocytes and otopathogens in COM prone and non-COM prone children.

Methods

Forty children, 2 to 7 years of age, scheduled for adenoidectomy were enrolled into COM (n = 20) or non-COM (n = 20) groups. Adenoid biopsy and nasopharyngeal aspirate bacteriology were assessed by conventional culture techniques. Peripheral blood and adenoid lymphocytes were stained with viability stain, monoclonal anti-CD19, anti-CD3, anti-CD4, anti-CD8, anti-CD25 and anti-CD127. Cells were stained intracellularly with monoclonal anti-FoxP3 and then quantified by flow cytometry.

Results

Children with nasopharyngeal otopathogen-positive culture had significantly more circulating CD3⁺CD4⁺FoxP3⁺CD25^hi+CD127^lo+ lymphocytes (M = 4.4%) compared to culture-negative children (M = 3.1%, p = 0.005). Circulating CD19⁺ lymphocytes were significantly increased in children with positive Moraxella catarrhalis nasopharyngeal culture (M = 12.4%) compared to culture-negative children (M = 8.6%, p = 0.006). Adenoid-derived lymphocytes were not significantly different in children with any positive nasopharyngeal culture compared to negative culture. Lymphocyte subsets were not significantly different between COM and non-COM prone children.

Conclusion

Clinically-detectable otopathogen nasopharyngeal culture is positively associated with T_reg lymphocytes, potentially inducing suppressive effector responses to promote colonization and infection chronicity. This finding supports further investigation of T_reg lymphocyte activity and influence on upper airway colonization of young children.

http://bit.ly/2GchK90

Sleep disordered breathing in children – diagnostic questionnaires, comparative analysis

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Marcin Burghard, Eliza Brożek-Mądry, Antoni Krzeski

Abstract

Study Objectives

The purpose of this work is to present available questionnaires enabling diagnostic screening when obstructive sleep disordered breathing (SDB) in a child is suspected or its effects are observed and polysomnography is unavailable. These questionnaires are designed to facilitate further diagnostic process or even therapeutic decisions, aid in selecting the optimal one for the specified conditions of clinical practice, with the caveat that none of these represents a diagnostic equivalent to PSG.

Methods

The questionnaires subjected to analysis: Pediatric Sleep Questionnaire (PSQ), Sleep Clinical Record (SCR), OSA-18 score (OSA-18), Brouilette score (BS), "I'm Sleepy" questionnaire (I'M SLEEPY), and "Sleeping Sleepless Sleepy Disturbed Rest" questionnaire (SSSDR).

The comparative analysis of questionnaires included the following parameters: simplicity and time of administer; necessity to engage a physician or other trained individual; taking into account examination of the patient; type and scope of considered symptoms and consequences of obstructive SDB, sensitivity, specificity, recommendations of the guidelines.

Results

Seven questionnaires were subjected to analysis with presentation of their similarities and differences. Six out of seven were evaluated as simple in administration. Time required to fulfill the questionnaires ranged between 1 and 60 minutes. Three of them involved a physician or a trained personnel. Physical examination was necessary in two out of seven questionnaires. Sensitivity was estimated in 5 of them and ranged between 59 and 96%. Specificity ranged between 46 and 72%.

Conclusions

Several questionnaires enabling quick, simple, and inexpensive screening for OSAS have been created. Four (of the seven analyzed) questionnaires may be useful in diagnosis of obstructive SDB in children – two follow current (2015) recommendations. However, there is a need for further work on optimizing such tools, particularly on improving their specificity.

http://bit.ly/2DdkNtu

Genetic susceptibility to aminoglycoside ototoxicity

Publication date: Available online 4 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tien Nguyen, Anita Jeyakumar

Abstract

Introduction

Aminoglycosides are a well-known clinically relevant antibiotic family used to treat bacterial infections in humans and animals and can produce toxic side effects. Aminoglycoside-induced hearing loss (HL) has been shown to have a genetic susceptibility. Mitochondrial DNA mutations have been implicated in inherited and acquired hearing impairment.

Objective

Literature review of genetic mutations associated with aminoglycoside-induced ototoxicity.

Methods

PubMed was accessed from 1993 to 2017 using the search terms "aminoglycoside, genetic, ototoxicity, hearing loss". Exclusion criteria consisted of a literature in a language other than English, uncompleted or ongoing studies, literature with non-hearing related diseases, literature on ototoxicity due to cisplatin/carboplatin based chemotherapy, literature on ototoxicity from loop diuretics, animal studies, literature studying oto-protective agents, and literature without documented aminoglycoside exposure.

Results

108 articles were originally identified, and 25 articles were included in our review. Mitochondrial 12S rRNA mutations were identified in all 25 studies in a total of 220 patients. Eight studies identified A1555G mutation as primary genetic factor underlying HL in cases of aminoglycoside-induced ototoxicity. The next most common mutation identified was C1494T.

Discussion

Mitochondrial 12s rRNA mutation A1555G was present in American, Chinese, Arab-Israeli, Spanish and Mongolian ethnicities. All mutations leading to aminoglycoside ototoxicity were mitochondrial mutations.

Conclusions

Consideration of preexisting genetic defects may be valuable in treatments involving aminoglycosides. In particular populations such as those of Chinese origin, clinicians should continue to consider the increased susceptibility to aminoglycosides.

http://bit.ly/2Ddl9jO

Caspse-11-GSDMD pathway is required for serum ferritin secretion in sepsis

Publication date: Available online 5 February 2019

Source: Clinical Immunology

Author(s): Dan Wang, Songlin Yu, Yening Zhang, Lingmin Huang, Yiting Tang, Kai Zhao, Ben Lu

Abstract

Ferritin is the major iron storage molecule of vertebrates, which can be detected in serum under numerous conditions, including inflammatory, neurodegenerative, and malignant diseases. Given this character, serum ferritin is frequently used as a biomarker in clinical settings. How the ferritin secreted to the serum has attracted much attention. Although some studies have found ferritin was mediated via the endoplasmic reticulum (ER)-Golgi secretion pathway or secretory lysosomes trafficking pathway under normal conditions, the secretion pathway of ferritin under pathological conditions, especially in sepsis is not very clear. In this report, we adopt a murine sepsis model to study the secretion pathway of ferritin in sepsis. We demonstrated caspase-11-GSDMD pathway and associated pyroptosis are required for secretion of ferritin in vitro and in vivo in sepsis. Moreover, our work connects pyroptosis to serum ferritin secretion and suggests a passive release process of ferritin, enhancing our understanding of the mechanism of ferritin secretion.

http://bit.ly/2BkRKnD

Mandibular Distraction Osteogenesis versus Sagittal Split Ramus Osteotomy in Managing Obstructive Sleep Apnea: A Randomized Clinical Trial

Publication date: Available online 5 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Wai Kin Tsui, Yanqi Yang, Colman Mcgrath, Yiu Yan Leung

Summary

Purpose

To compare mandibular distraction osteogenesis (MDO) to sagittal split ramus osteotomy (SSRO) to treat moderate-to-severe obstructive sleep apnea (OSA), and their surgical morbidities and skeletal stability.

Materials and methods

A randomized clinical trial was conducted on non-syndromic adult patients with apnea-hypopnea index (AHI) 15 or above to receive MDO or SSRO as part or whole skeletal advancement surgery. Post-operative 1 year OSA cure rate (AHI < 5/hour) and treatment success rate (50% reduction of AHI and AHI< 20/hour) were compared. Polysomnography were conducted pre-operatively and post-operatively up to 2 years. Surgical morbidities and skeletal stability were analyzed.

Results

Eighteen patients (9 in each group) were recruited. Patient recruitment was terminated after two major complications in the MDO group. The OSA cure rate and treatment success rate showed no statistical difference between MDO group or SSRO group at post-operative 1 year. Major complication rate was 44.4% in the MDO group and 0 in the SSRO group. No statistical difference was found in skeletal stability between the two groups.

Conclusion

Both MDO and SSRO were highly effective to treat moderate-to-severe OSA. MDO had a high major complication rate and was not superior than SSRO in airway function improvement and skeletal stability.

http://bit.ly/2G7RkFe

Catching Condyle – Endoscopic-assisted transoral open reduction and rigid fixation of condylar process fractures using an auto reposition and fixation osteosynthesis plate

Publication date: Available online 4 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Philipp Poxleitner, Pit Jacob Voss, David Steybe, Stefan Schlager, Steffen Schwarz, Marc Anton Fuessinger, Rainer Schmelzeisen, Marc Metzger

Abstract

Introduction

Fractures of the mandibular condyle are reported to account for 9 % to 45 % of all mandibular fractures. There has been a long lasting controversy on the superiority of different treatment options with endoscopic-assisted transoral approaches gaining increasing attention in recent years. In this article, we report the application of a newly developed osteosynthesis plate for an auto reposition, reconstruction and rigid fixation of condylar process fractures.

Material and Methods

We present 6 cases of uni- or bilateral fractures of the condylar process treated with a transoral open reduction and rigid fixation using an auto reposition plate. Via a transoral endoscopic assisted approach the proximal condyle fragment is captured using an anatomical defined clinch of the cranial part of the plate. The reposition of the condyle is facilitated with the distal bridge of the plate ranging around the posterior part of the ascending ramus.

Results

The results show a sufficient reposition, rigid fixation and no facial nerve palsy or postoperative long-term occlusal disturbances. The mean operating time was 86 minutes.

Conclusion

Transoral endoscopic-assisted surgery with application of an auto reposition, reconstruction and fixation plate offers a quick and convenient way for open reconstruction and rigid fixation of condylar process fractures.

http://bit.ly/2Dcxipd

What is the Prevalence of Undiagnosed Nevoid Basal Cell Carcinoma Syndrome in Children with an Odontogenic Keratocyst?

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Deepti S. Karhade, Salim Afshar, Bonnie L. Padwa

Abstract

Purpose

Odontogenic keratocysts (OKC) can occur in isolation or as part of nevoid basal cell carcinoma syndrome (NBCCS). Subjects with NBCCS are younger at OKC diagnosis than those with non-syndromic OKC (NS-OKC). The purpose of this study was to determine the prevalence of undiagnosed NBCCS in children who present with an OKC and to assess differences in demographic and presenting features between children with NBCCS and those with NS-OKC.

Methods

Retrospective case series of children with an OKC presenting to Boston Children's Hospital from 2007 - 2018. To be included patients had to be < 18 years of age and have a newly diagnosed OKC. Patients were excluded if they had previous or recurrent OKC or NBCCS diagnosis. Records were reviewed for age at presentation, sex, number and location of OKC, treatment, recurrence, family history and clinical features consistent with NBCCS. Descriptive data were summarized.

Results

The sample included 50 subjects (27 males) diagnosed with an OKC at a mean age of 11.7 years (range 2-18); 36% (n=18) with NBCCS and 64% (n=32) with NS-OKC. NBCCS diagnosis was made in 8 of 18 (44%) subjects because of a family history at presentation, and in 10 subjects (56%) the diagnosis was made by genetic testing and/or documentation of diagnostic criteria. Eight of 18 patients (44%) with undiagnosed NBCCS presented with a single OKC. Patients with NBCCS were significantly younger at presentation (NBCCS 9.3 years: NS-OKC 13.0 years), had more cysts at the time of diagnosis (NBCCS 1.7; NS-OKC 1.0) (p<0.05), had more maxillary cysts (NBCCS 13; NS-OKC 11) and had a higher recurrence rate (p<0.05).

Conclusion

Given the prevalence of undiagnosed NBCCS in children with OKC clinicians should have a low threshold for referral for complete examination or genetic testing in children with even a single OKC.

http://bit.ly/2HSWWFh

First case of cutaneous orbital abscess caused by Gemella: A case report and review of the literature

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Michael McQuinn, Bruce B. Horswell

Abstract

This is the first report of an orbital abscess caused by Gemella bergeri, uncommonly identified in cardiac valvular infections. Through MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization-time-of- flight Mass Spectrometry) microbial identification and speciation resulted in timely identification and appropriate management. Successful management includes accurate microbial identification, incision and drainage and broad spectrum antibiotics.

http://bit.ly/2t6BOBe

The Effect of Oral and Maxillofacial Surgery Residency Curriculum Design on USMLE Step 1 Performance

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Adam P. Fagin, Mark E. Engelstad

Purpose

Over the years, a few types of combined OMS/MD residency curricula have evolved that differ in how the MD is integrated. The purpose of this study was to look for a difference in USMLE Step 1 pass rates among these different curricula.

Materials and Methods

An anonymous electronic survey was emailed to the directors of all forty-six US based OMS/MD integrated programs, querying OMS curriculum type and USMLE Step 1 results over the years 2007 - 2017. Programs were then characterized by curriculum sequence, whether USMLE Step 1 was taken before or after starting medical school, and amount of dedicated test preparation time.

Results

32 of 46 (70%) OMS/MD program directors responded. There was no statistically significant difference in USMLE Step 1 pass rate between the four main types of OMS/MD curricula, (range 89 – 95%, p = 0.06). Doing some part of medical school before taking USMLE step 1 also had no effect on OMS residents' pass rates, (94 and 92%, respectively, p = 0.23). However, increasing weeks of dedicated test preparation time was significantly correlated with increasing USMLE Step 1 pass rates, (87% with no dedicated test preparation time, increasing to 96% with 6 or more weeks of dedicated test preparation time. p = 0.05). Finally, only 7 of 806 total residents (0.9%) dropped out of a program due to inability to pass USMLE Step 1.

Conclusion

The data shows a high overall USMLE Step 1 pass rate with a direct correlation between duration of dedicated test preparation time and pass rate. There was no observed difference in USMLE Step 1 pass rates based on the sequence of OMS/MD integrated curricula or the completion of some pre-USMLE medical school prior to USMLE Step 1 among OMS residents.

http://bit.ly/2HU0Cql

Sialadenitis May Be Associated with an Increased Risk for Osteoradionecrosis: A Nationwide Population-Based Cohort Study

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yi-Fang Huang, Shih-Ping Liu, Chih-Hsin Muo, Chung-Ta Chang, Chun-Hao Tsai, Donald E. Morisky

Abstract

Purpose

The impact of sialadenitis on osteoradionecrosis is controversial. The aim of this study was to determine the association between sialadenitis and osteoradionecrosis.

Materials and Methods

The participants were derived from Taiwan's Longitudinal Health Insurance Database. From 2000/01/01 to 2008/12/31, sialadenitis (ICD-9-CM 527.2, 527.3, 527.5-527.7, 527.9, and 710.2) and osteoradionecrosis (ICD-9-CM 526.89, 526.5, 730.0, and 730.1) were identified. Variable treatment modalities including surgery or medicine were used to distinguish the severity of sialadenitis. The primary predictor variable was sialadenitis. The secondary predictor variable was severity of sialadenitis. The primary outcome variable was time to developing ORN. Other study variables were grouped into the following sets of age, gender, risk factor, and medical treatment. Cox proportional hazard regression was used to investigate the associations between sialadenitis and osteoradionecrosis after adjusting confounders in statistics.

Results

The sample was composed of 47,385 subjects with a mean age of 46.6 years (standard deviation = 19.9) and 37.2% were male. 20.0% had a diagnosis of sialadenitis. 1.13% had a diagnosis of osteoradionecrosis. Sialadenitis was associated with an increased risk of osteoradionecrosis [hazard ratio (HR) = 1.93, 95% confidence interval (CI) = 1.61–2.31, p <0.0001). After adjusted for confounders, sialadenitis was associated with osteoradionecrosis (multivariable HR = 1.83, 95% CI = 1.52–2.19, p <0.0001). Severity of sialadenitis was associated with an increased risk of osteoradionecrosis; the osteoradionecrosis risk was 1.79 and 3.52 in mild and serious sialadenitis patients (95% CI = 1.49–2.16 and 1.67–7.44, p <0.0001 and <0.001, respectively) compared with non-sialadenitis cohort. In the joint effect for ORN between sialadenitis and malignancy type, the sialadenitis patients had 11.6-fold osteoradionecrosis risk (95% CI = 5.58–23.9) compared to comparisons without malignancy.

Conclusions

Sialadenitis significantly raised the risk to develop osteoradionecrosis. The severity of sialadenitis was positively correlated with the incidence of osteoradionecrosis.

http://bit.ly/2t6BHFO

Buccal nerve dissection via an intraoral approach: correcting an error regarding buccal nerve blockade

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Joe Iwanaga, R. Shane Tubbs

Abstract

Purpose

The buccal nerve (BN) supplies sensation to the skin over the anterior part of the buccinator and the buccal mucosa, as well as the buccal gingivae corresponding to the second and third molar teeth. Some dental anatomy books show the main trunk of the BN coursing over the buccal shelf of the mandible, which leads to a significant misunderstanding of this anatomy. Therefore, this study aims to reveal the course of the BN on the retromolar area and establish new evidence based anatomy for appropriate buccal nerve blockade.

Methods

Twenty sides from ten fresh-frozen Caucasian cadaveric heads were used in this study. The closest distance from the BN to the injection site of the buccal nerve blockade (Dis A) was measured.

Results

The mean Dis A was 12.69±2.95 mm. On 16 of 20 sides (80%), Dis A was greater than 10 mm. In the majority of specimens, the injection site of the buccal nerve blockade was too far from the course of the main trunk of the BN and the injection site should be changed to 10 mm superolateral to the injection site based on our results and other previous studies.

Conclusion

Although the distribution of the BN is variable, in the majority of our specimens, the current injection site for BN blockade was too far from the course of the BN.

http://bit.ly/2HSWJ4X

Outpatient Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral & Maxillofacial Surgeons

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Evan Wardius, Ashkan Mobini, Ruben Figueroa, Pushkar Mehra

Abstract

Purpose

The purpose of this retrospective study is to document the prevalence of different complications and the rate of mortality for outpatient procedures performed under anesthesia by oral and maxillofacial surgeons in the Commonwealth of Massachusetts.

Materials and Methods

A mailed questionnaire was filled out by active members of the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS) who practiced using the single operator-anesthetist model. Morbidity and mortality information was acquired for the calendar years of 2015 and 2016.

Results

The findings of this study were consistent with previous publications on the same topic. There were no office deaths, and the rate of mortality was 0/431,680. The prevalence of other anesthesia-related complications was low.

Conclusion

Based on the results of our study, we can conclude that the office-based team model employed by oral and maxillofacial surgeons in Massachusetts for delivery of outpatient anesthesia is safe with a low complication rate.

http://bit.ly/2t6BAKo

Physical Simulation Models in Oral and Maxillofacial Surgery: A New Concept in 3-Dimensional Modeling for Removal of Impacted Third Molars

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Connor Witty, Peter Cervenka, Peter Liacouras, Christopher Crecelius

http://bit.ly/2HSWA1p

Surgery alone is effective in the management of pediatric salivary gland acinic cell carcinoma

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Chong Wang, Minghui Mao, Bo Li, Kyojin Kim, Zhengxue Han, Zhien Feng

Abstract

Purpose

The treatment strategy of salivary gland acinic cell carcinoma in pediatric patients remains controversial. This retrospective study was undertaken to analyze the role of surgery in the treatment of acinic cell carcinoma of the major salivary gland in pediatric patients.

Methods

In this retrospective cohort study, we reviewed the medical records of all pediatric patients with acinic cell carcinoma of the major salivary gland who were treated at Beijing Stomatological Hospital of Capital Medical University from 1998 to 2015. The predictor variable was treatment modality. The outcome variables were disease-free survival (DFS), overall survival (OS), local control (LC) and freedom from distant metastasis (FFM). Other variables of interest were as follows: age, gender, tumor sites, T stage, N stage, recurrence history, pathological grade, perineural invasion (PNI), extracapsular extension (ECE), positive margin and resection conditions. The data analysis methods used were descriptive, bivariate statistics and the Cox proportional hazards regression model.

Results

Among the 19 patients, 7 received surgery alone, and 12 received initial surgery combined with postoperative radiotherapy (RT). During the median follow-up of 86 months, the overall estimates of DFS, OS, LC and FFM were 82.6, 93.3, 89.5, and 94.4%, respectively. Good outcomes were achieved in patients who received surgery alone (100% OS and 85.7% DFS). Initial surgery combined with postoperative RT was appropriate for patients with risk factors (91.7% OS and 83.3% DFS).

Conclusion

Surgery alone is appropriate for salivary gland acinic cell carcinoma in pediatric patients without risk factors, even if extracapsular excision is adopted. Preserving the invaded facial nerve during surgery is a good choice because a curative effect can be obtained when adjuvant RT is administered. Older age, high-grade pathology, incomplete resection, recurrence history and ECE were identified as risk factors of poor prognosis.

http://bit.ly/2t6Bv9y

Autogenous Mandibular Bone Graft for Maxillary LeFort I Osteotomy Inter-positional Gap in Orthognathic Surgery: A Technique Case Series

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ashish P. Sharma, Dale E. Stringer

Abstract

Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. LeFort I maxillary osteotomies are performed to correct maxillary horizontal, vertical and transverse discrepancies. Repositioning of the maxilla creates an inter-positional gap in bone which may lead to psuedoarthrosis, instability, mobility, infection and eventual relapse. Grafting the inter-positional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union and inhibits soft tissue herniation. This can be accomplished utilizing autogenous bone harvested from the patient. Donor sites include calvarium, rib and iliac crest bone. Although, these donor sites have their advantages and specific indications, they require a second surgical site, which can lead to potential complications such as infection, donor site morbidity, pneumothorax and gait disturbances.

In conjunction with LeFort I maxillary osteotomy, for correction of maxillary deformities, bilateral sagittal split mandibular osteotomy is a common procedure used for mandibular advancement, setback and correction of mandibular asymmetry with or without concurrent genioplasty. Five patients (one male and four female) underwent orthognathic surgery for correction of their maxillofacial skeletal dental deformities at Loma Linda University Hospitals between 2015 and 2017.

This case series describes a technique to harvest autogenous bone from the posterior aspect of the distal sagittal split osteotomy segment of the mandible, which is milled and used to graft the inter-positional gap in the maxilla. Principles of guided bone regeneration are incorporated to improve surgical outcomes.

http://bit.ly/2HSWeb5

Is repeated arthrocentesis beneficial in the treatment of temporomandibular disorders: A retrospective study

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Nükhet Kütük, Burcu Baş, Dilara Kazan, Ezgi Yüceer

Abstract

Purpose

Arthrocentesis is an effective, simple and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of one- or two-session arthrocentesis procedures in the management of TMJ-CL.

Materials and Methods

A retrospective cohort study was conducted using the files of patients with TMJ-CL according to diagnostic criteria for TMD. Patients who underwent one- or two-session arthrocentesis were included to the study. The decision of one or two session arthrocenthesis were given according to patients's choice. Patients who accepted a second arthrocentheis procedure were assigned to group 1 (repeated arthrocentesis group), and patients who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (VAS) and maximal mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of one or two-session arthrocentesis, MMO and VAS values before the treatment and at 1, 3, and 6 month follow-up were analysed. Descriptive, comparative, correlation, and multivariate analyses were conducted.

Results

Thirty patients (25 female and 5 male) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decrease in pain scores and an increase in maximum mouth opening values were observed in both treatment groups at 3 and 6 months (p<.05). At 6 months, mouth opening values were significantly higher, and the pain levels were significantly lower in patients who received two arthrocentesis.

Conclusion

Repeated arthrocentesis is more successful to reduce pain and improve maxium mouth opening, than a single intervention in the treatment of TMJ-CL.

http://bit.ly/2t4eR1v

Corrigendum to “Using single cell analysis for translational studies in immune mediated diseases: Opportunities and challenges” [Mol. Immunol. 103 (2018) 191–199]

Publication date: Available online 4 February 2019

Source: Molecular Immunology

Author(s): Siddhartha Sharma, Louis Gioia, Brian Abe, Marie Holt, Anne Costanzo, Lisa Kain, Andrew Su, Luc Teyton

http://bit.ly/2SbGVin

Bite force measurements for objective evaluations of orthodontic tooth movement-induced pain in rats

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Hu Long, Di Shan, Renhuan Huang, He Liu, Yang Zhou, Muyun Gao, Fan Jian, Yan Wang, Wenli Lai

Abstract

Objective

To examine the reliability of bite force for evaluating orthodontic tooth movement-induced pain in rats.

Design

Orthodontic tooth movement-induced pain was induced by mounting springs (40 g) between incisors and ipsilateral molars in male Sprague-Dawley rats. Five group sets of animals were used: for the first group set, 20 rats were randomly divided into a force group (n = 10) and a sham group (n = 10); for the second group set, 20 rats were divided into a 20-g group and a 80-g group; for the third group set, 20 rats were randomly divided into either a CFA group (complete freund's adjuvant) (n = 10) receiving periodontal injections of CFA at baseline or a control group (n = 10) receiving periodontal injections of saline at baseline; for the forth group set, 24 rats were randomly divided into the following four groups: force + saline, control + saline, force + antiNGF and control + NGF (NGF: nerve growth factor). Rats in the fifth group set were used for immunostaining against CGRP. Bite force and bite frequency were measured at baseline (day 0) and following interventions (day 1, day 3, day 5, day 7 and day 14). Two-way ANOVA with repeated measures was used for statistical analysis and a p value less than 0.05 was considered statistical significance.

Results

Our results revealed that bite force was significantly smaller in the force group than in the sham group at all time points (p < .001). As compared to the control group, periodontal injections of CFA significantly decreased bite force on the 3^rd day (p < .01). Moreover, bite force was significantly higher in the force + antiNGF group than in the force + saline group (p = .01 < .05) while significantly smaller in the control + NGF group than in the control + saline group (p < .05). Bite force was similar between the force + antiNGF group and the control + saline group (p = .71 > .05) and between the control + NGF group and the force + saline group (p = .58 > .05). Similar results were found for bite frequency.

Conclusion

Bite force, an indicator of mechanical hyperalgesia, is a viable and reliable index for evaluating orthodontic tooth movement-induced pain.

http://bit.ly/2Bl7pmS

Heterogeneous localization of muscarinic cholinoceptor M1 in the salivary ducts of adult mice

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Atsara Rawangwong, Suthankamon Khrongyut, Surang Chomphoo, Kohtaro Konno, Miwako Yamasaki, Masahiko Watanabe, Hisatake Kondo, Wiphawi Hipkaeo

Abstract

We hypothesize variation in expression and localization, along the course of the glandular tubule, of muscarinic cholinergic receptor M₁ which plays as a distinct contribution, though minor in comparison with M₃ receptor, in saliva secretion. Localization of the M₁ receptor was examined using immunohistochemistry in three major salivary glands. Although all glandular cells were more or less M₁-immunoreactive, acinar cells were weakly immunoreactive, while ductal cells exhibited substantial M₁-immunoreactivity. Many ductal cells exhibited clear polarity with higher immunoreactivity in their apical/supra-nuclear domain. However, some exhibited indistinct polarity because of additional higher immunoreactivity in their basal/infra-nuclear domain. A small group of cells with intense immunoreactivity was found, mostly located in the intercalated ducts or in portions of the striated ducts close to the intercalated ducts. In immuno-electron microscopy, the immunoreactive materials were mainly in the cytoplasm including various vesicles and vacuoles. Unexpectedly, distinct immunoreactivity on apical and basal plasma membranes was infrequent in most ductal cells. The heterogeneous localization of M₁-immunoreactivity along the gland tubular system is discussed in view of possible modulatory roles of the M₁ receptor in saliva secretion.

http://bit.ly/2TyKDPQ

Bite force measurements for objective evaluations of orthodontic tooth movement-induced pain in rats

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Hu Long, Di Shan, Renhuan Huang, He Liu, Yang Zhou, Muyun Gao, Fan Jian, Yan Wang, Wenli Lai

Abstract

Objective

To examine the reliability of bite force for evaluating orthodontic tooth movement-induced pain in rats.

Design

Orthodontic tooth movement-induced pain was induced by mounting springs (40 g) between incisors and ipsilateral molars in male Sprague-Dawley rats. Five group sets of animals were used: for the first group set, 20 rats were randomly divided into a force group (n = 10) and a sham group (n = 10); for the second group set, 20 rats were divided into a 20-g group and a 80-g group; for the third group set, 20 rats were randomly divided into either a CFA group (complete freund's adjuvant) (n = 10) receiving periodontal injections of CFA at baseline or a control group (n = 10) receiving periodontal injections of saline at baseline; for the forth group set, 24 rats were randomly divided into the following four groups: force + saline, control + saline, force + antiNGF and control + NGF (NGF: nerve growth factor). Rats in the fifth group set were used for immunostaining against CGRP. Bite force and bite frequency were measured at baseline (day 0) and following interventions (day 1, day 3, day 5, day 7 and day 14). Two-way ANOVA with repeated measures was used for statistical analysis and a p value less than 0.05 was considered statistical significance.

Results

Our results revealed that bite force was significantly smaller in the force group than in the sham group at all time points (p < .001). As compared to the control group, periodontal injections of CFA significantly decreased bite force on the 3^rd day (p < .01). Moreover, bite force was significantly higher in the force + antiNGF group than in the force + saline group (p = .01 < .05) while significantly smaller in the control + NGF group than in the control + saline group (p < .05). Bite force was similar between the force + antiNGF group and the control + saline group (p = .71 > .05) and between the control + NGF group and the force + saline group (p = .58 > .05). Similar results were found for bite frequency.

Conclusion

Bite force, an indicator of mechanical hyperalgesia, is a viable and reliable index for evaluating orthodontic tooth movement-induced pain.

http://bit.ly/2Bl7pmS

Heterogeneous localization of muscarinic cholinoceptor M1 in the salivary ducts of adult mice

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Atsara Rawangwong, Suthankamon Khrongyut, Surang Chomphoo, Kohtaro Konno, Miwako Yamasaki, Masahiko Watanabe, Hisatake Kondo, Wiphawi Hipkaeo

Abstract

We hypothesize variation in expression and localization, along the course of the glandular tubule, of muscarinic cholinergic receptor M₁ which plays as a distinct contribution, though minor in comparison with M₃ receptor, in saliva secretion. Localization of the M₁ receptor was examined using immunohistochemistry in three major salivary glands. Although all glandular cells were more or less M₁-immunoreactive, acinar cells were weakly immunoreactive, while ductal cells exhibited substantial M₁-immunoreactivity. Many ductal cells exhibited clear polarity with higher immunoreactivity in their apical/supra-nuclear domain. However, some exhibited indistinct polarity because of additional higher immunoreactivity in their basal/infra-nuclear domain. A small group of cells with intense immunoreactivity was found, mostly located in the intercalated ducts or in portions of the striated ducts close to the intercalated ducts. In immuno-electron microscopy, the immunoreactive materials were mainly in the cytoplasm including various vesicles and vacuoles. Unexpectedly, distinct immunoreactivity on apical and basal plasma membranes was infrequent in most ductal cells. The heterogeneous localization of M₁-immunoreactivity along the gland tubular system is discussed in view of possible modulatory roles of the M₁ receptor in saliva secretion.

http://bit.ly/2TyKDPQ

Could Isotretinoin flare Hidradentis suppurativa? A Case Series

Summary

We report eight cases of patients with severe acne who were treated with Isotretinoin and developed painful nodules in their axillae and groin consistent with Hidradenitis Suppurativa (HS). The pathogenesis of HS is still not completely understood; recent research from a study in 2011 of biopsies from HS lesions showed a reduction or absence of sebaceous glands compared to normal skin in HS patients and the author suggested this contributes to the pathogenesis of the disease^. Interestingly the main effect of Isotretinoin is to decrease the size and action of sebaceous glands; so hypothetically, as Isotretinoin acts by reducing the sebaceous glands further it could potentially aggravate the condition. Our experience has instilled caution in our prescribing of Isotretinoin; patients are questioned about symptoms of HS prior to and during treatment, particularly patients with acne conglobata.

This article is protected by copyright. All rights reserved.

http://bit.ly/2UFJy8L

The addition of chemotherapy to radiotherapy did not reduce the rate of distant metastases in low‐risk HPV‐related oropharyngeal cancer in a real‐world setting

Abstract

Background

Distant metastases (DM) are a leading cause of death for patients with oropharyngeal cancer (OPSCC). The objective of this study was to compare the rates of DM after chemoradiotherapy (CRT) and radiotherapy alone (RT) in patients with human papillomavirus (HPV)‐positive and HPV‐negative OPSCC.

Method

In a retrospective population‐based study of 525 patients across Ontario, Canada, in 1998/99/03/04, we compared treatment effectiveness using cumulative incidence function curves and cause‐specific Cox regression models.

Results

Sixty of 525 patients developed DM. There was no difference in rates (overall 10%‐15%) between HPV‐positive and HPV‐negative patients or between CRT‐ and RT‐treated patients. CRT reduced the risk of DM for the 15% of all HPV‐positive patients with higher risk (T4 and/or N3) and not for HPV‐negative patients (hazard ratio, 1.82 [0.65‐5.07]).

Conclusion

The addition of platin‐based chemotherapy to conventional RT did not decrease the rates of DM in the majority of patients with HPV‐positive or in HPV‐negative OPSSC.

http://bit.ly/2MPJalF

Sudden elevation of plasma D‐dimer levels induced by the combination therapy of dabrafenib and trametinib: Report of two cases

Abstract

The combination therapy of dabrafenib and trametinib revolutionized the treatment for BRAF V600‐mutated melanoma. Various adverse events have been reported for this treatment, most notably fever. Herein, we report two cases of novel an adverse event, namely sudden and significant elevation of plasma D‐dimer level induced by this therapy. In the first case, the remarkable elevation of plasma D‐dimer level up to 87.4 mg/dL was noted on day 11, and in the second case, the plasma D‐dimer level reached 125.5 mg/dL on day 25. In both cases, D‐dimer levels gradually decreased after the cessation of this therapy. Although the exact cause is not clear, we assume two possible hypotheses: the first is that the combination therapy may induce disseminated intravascular coagulation, and the second is that the therapy induced pathological condition of secondary thrombotic microangiopathies. Our cases suggest that this thrombotic adverse event should not be overlooked, and coagulation parameters need to be monitored during the course of this treatment.

http://bit.ly/2DbZoki

B‐cell lymphoblastic leukemia/lymphoma in infants: Report of two cases on the face

http://bit.ly/2GbX2pN

Varied responses to and efficacies of hydroxychloroquine treatment according to cutaneous lupus erythematosus subtypes in Japanese patients

Abstract

Hydroxychloroquine is recommended as the first‐line systemic treatment for cutaneous lupus erythematosus (CLE) in Western countries, and it was approved in Japan in 2016. However, the efficacy of hydroxychloroquine in various cutaneous lupus erythematosus subtypes in Japanese patients has not been elucidated to date. Therefore, we investigated the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to CLE subtypes in Japanese patients. We enrolled 35 patients (29 diagnosed with systemic lupus erythematosus and six with CLE) in this retrospective study. We analyzed the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to cutaneous lupus erythematosus subtypes, time to the first skin improvement, as well as effects on laboratory data and reduction of concomitant immunosuppressive drug administration at 16 and 32 weeks of therapy. Complete improvement was observed at high rates for acute CLE (ACLE); however, partial or non‐improvement rates were higher for chronic CLE (CCLE) at 16 weeks. Several patients with alopecia without scarring achieved complete improvement at 32 weeks. CCLE tended to take more time to improve than ACLE. Overall, hydroxychloroquine was highly effective for skin: 87% of patients had at least some beneficial response at 16 weeks. Nevertheless, there were wide variations in complete improvement rates and duration for improvement among CLE subtypes. Our findings suggest that a therapeutic approach considering the subtypes of CLE will improve its management.

http://bit.ly/2D8Aja9

T‐cell responses against 4‐tertiarybutylphenol‐exposed pigmented cells in a patient with occupational vitiligo

Abstract

Several case studies on contact/occupational vitiligo after skin contact with 4‐tertiairybutylphenol (4‐TBP) have been reported. Biochemical and cellular effects of 4‐TBP on melanocytes have been shown in vitro, but immunological analyses explaining the immunising ability of 4‐TBP leading to wide‐spread vitiligo lesions beyond areas of primary contact are still lacking. We report here the presence of a systemic T‐cell response to 4‐TBP‐exposed pigmented cells in a patient with chemically‐induced vitiligo.

This article is protected by copyright. All rights reserved.

http://bit.ly/2HRKqpf

Photobiomodulation can alter mRNA levels cell death-related

Abstract

Photobiomodulation (PBM) by low-level laser has demonstrated excellent results for inflammatory treatments, promoting repair of injured tissues. Knowledge regarding the molecular mechanisms involved in this process has been increasing, but its effect on cell death/survival-related gene expression after laser irradiation with different doses is not well understood. So, it is important to know these effects in order to guarantee the safety of therapeutic protocols based on PBM. This study aimed to investigate the mRNA levels of genes related to proteins involved in cell death/survival pathways of healthy tissues from talocrural joint of mice after PBM. Mice were divided into three groups: control, PBM at 3 J cm⁻², and PBM at 30 J cm⁻². Laser irradiation was performed on talocrural joint during four consecutive days. Morphological analyses, immunocytochemistry, FasL, Fas, Bax, Apaf1, Caspase9, Caspase3, Caspase6, Bcl2 mRNA levels, and DNA fragmentation were performed to verify cell death induction after laser irradiation. PBM can increase mRNA levels of almost genes pro-apoptotic. On the other hand, mRNA level of anti-apoptotic protein Bcl-2 gene was not significantly altered. Bcl-2/Bax ratio (indicator of protective molecular response) was decreased after PBM at 30 J cm⁻², trending to DNA fragmentation. Results obtained in this study indicate that PBM by low-level infrared laser alters mRNA relative levels of genes involved in cell death pathways. However, these molecular alterations were not able to cause DNA fragmentation in cells in talocrural joint tissues, indicating that infrared laser was not enough to cause cell death.

http://bit.ly/2WGGJGu

Measurement properties of patient‐reported outcome measures in radiotherapy‐induced trismus

Abstract

Trismus or lockjaw is the reduction in mouth opening. Radiotherapy‐Induced Trismus occurs when the masticatory muscles are within range of radiation treating head and neck cancer, resulting in muscular fibrosis and trismus. We aim to assess the measurement properties of available validated patient‐reported outcome measures relevant to radiotherapy‐induced trismus in head and neck cancer patients. Systematic electronic searches were performed in MEDLINE and EMBASE databases to identify studies validating radiotherapy induced trismus with patient‐reported outcome measures up to January 2018. Two reviewers independently rated the methodological quality of identified validation studies, using the consensus‐based standards for the selection of health status measurement instrument (COSMIN) checklist. The level of evidence for measurement properties was then summarised based upon pre‐defined criteria. Only one of the 280 retrieved studies were deemed fit for inclusion. The Gothenburg Trismus Questionnaire was assessed and found to have a good methodological quality of measurement properties except for reliability, which was poor. There was a moderate level of evidence supporting internal consistency, content validity, structural validity and hypothesis testing. The evidence for test‐retest reliability remains unknown in the population of interest. The Gothenburg Trismus Questionnaire is the only patient‐reported outcome measure in the field of showing some good measurement properties and it may therefore represent a useful instrument for the assessment of radiotherapy‐induced trismus in head and neck cancer patients. However further validation studies are needed especially with respect to the reliability, measurement error and the responsiveness of this instrument.

This article is protected by copyright. All rights reserved.

http://bit.ly/2G9MWWo