Head and Neck Medicine by Alexandros G.Sfakianakis: 02/06/19

Objective: Temporomandibular joint (TMJ) dislocation means the condyle moves out of the normal position. There are several treatments for TMJ dislocation, including conservative treatment, injection treatment, minimally invasive treatment, and open surgical treatment. In this study, we tried to review the literature related to the augmentation of the articular eminence and proposed a modified eminoplasty technique of TMJ dislocation by computer-aided design and computer-aided manufacturing (CAD/CAM) cutting guides. Methods: The literature on eminoplasty for TMJ was reviewed with 3 charts. Besides, 2 (67 and 69 years old) patients with chronic recurrent dislocation were treated by the CAD/CAM-guided surgical technique in our study, and postoperative measures were recorded to verify the safety and effectiveness regarding this technique. Results: A total of 28 studies (including 268 patients) of the augmentation of the articular eminence have been reported since 1967, including the 2 present patients. According to the analysis of the recurrence and complications in the review, we found the modified technique had an obvious advantage. The technique with cutting guides was also found having higher accuracy. Conclusion: The modified technique was a reliable method when treating the TMJ dislocation, and the combination of CAD/CAM cutting guides was useful for more accuracy, even reduced the operation difficulty. Address correspondence and reprint requests to En Luo, DDS, PhD, State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases Department of oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China; E-mail: luoen521125@sina.com; Jian Hu, DDS, PhD, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedical Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; E-mail: 00008460@whu.edu.cn Received 18 May, 2018 Accepted 6 October, 2018 This study was supported by grants from the NSFC (81621062) and Key Research and Development Program of Science and Technology Department of Sichuan Province and Chengdu City (2018SZ0119 and 2018-YF05-00258-SN). The authors report no conflicts of interest © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2DVCWxu

Recombinant Human Bone Morphogenic Protein-2 Combined With Autogenous Bone Graft for Reconstruction of Alveolar Cleft

Recombinant human bone morphogenic proteins (rhBMPs) have been introduced for reconstruction of alveolar defects. The volume of the bone formed at the cleft region may be related to rhBMP-2 dose. Greater side effects have been reported with increased doses of rhBMP-2. The aim of the present study was to assess the bone at the cleft area using low dose of rhBMP-2 combined with autogenous bone graft for reconstruction of the alveolar cleft. Patients with unilateral cleft lip and palate between the 11 to 14 years old were enrolled. After palatal expansion, autogenous graft was placed at the side of cleft in the control group (n = 6). In the BMP group, the rhBMP-2 was injected into the autogenous bone graft at the defect site (n = 5). Cone beam computed tomography (CBCT) images were taken of all patients immediately and 3 months after graft surgery to compare the density, thickness, and height of the bone graft between the 2 groups. Intermolar and interpremolar widths were also measured. The authors found less diminish of density and height of the bone graft 3 months postsurgery in patients with autogenous bone graft combined with rhBMP-2. However, significant difference in the relapse tendency of transverse dimension of the arch or thickness of the bone graft was not observed between the 2 groups. Thus, low dose rhBMP-2 combined with autogenous bone graft can be promising to reach predictable results after alveolar reconstruction in cleft lip and palate patients. Address correspondence and reprint requests to Neda Eslami, DDS, MS, Department of Orthodontics, School of Dentistry, Park Square, Mashhad, Iran, 94388-13944; E-mail: islamin@mums.ac.ir Received 7 May, 2018 Accepted 6 October, 2018 Vice-Chancellor of Research of Mashhad University of Medical Sciences (Iran) financially supported the project. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2GtTvCq

Vertical to Sagittal Change of Vector Using a Single Pediatric Ramus Distractor of Mandible: An Innovation

No abstract available

http://bit.ly/2DZd7Nj

Transient Retinal Artery Occlusion After Uncomplicated Rhinoplasty

Purpose: Loss of vision is an extremely rare and unexpected complication following a routine uncomplicated nasal surgery. In majority of patients, visual loss has attributed to retinal emboli which occur with retrograde flow of the intra-arterially injected agents into the nasal cavity or direct trauma to the optic nerve. In this report, the authors present a patient with unilateral decreased vision due to branch retinal artery occlusion soon after a routine nasal surgery. Methods: Clinical report. Result: A 32-year-old female patient admitted to the author' clinic with the complaints of decreased visual acuity in the left eye. She stated that she had undergone rhinoplasty operation 1 week ago and vision loss started immediately after the surgery. In the ophthalmological examination, the best corrected visual acuity with Snellen chart was 1.0 in the right eye and 0.3 in the left eye. In the fundoscopic examination of left eye there was a pale area in the inferior part of the macula. Fundus fluorescein angiography showed no evidence of nonperfusion in the right and left eyes and vascular structure was normal. On the optic coherence tomography, hyperreflectivity and increased thickness were observed in the inner retinal layers of the left eye. In the visual field test, there was a loss of the visual field which corresponds to the pale area on the left eye. Hyperbaric oxygen therapy was recommended. The ophthalmologic examination carried out 2 months later revealed a best corrected visual acuity of the left eye 0.9. In the fundoscopy pale area was regressed in the left eye. Fundus fluorescein angiography showed a good perfusion. There was a little progression in the visual field test. Conclusion: Direct mechanical trauma and vasoplastic/embolic vascular events are thought to be possible mechanisms. The authors think in this case, there was a retrograde flow of agents used during the surgery through ophthalmic artery to retinal arteries and vasospasm by epinephrin worsened the situation. Although rare retinal artery occlusion may develop after rhinoplasty, vision loss as a result of a surgery, if done for aesthetic purposes is not acceptable. Address correspondence and reprint requests to Meryem Guler Alis, MD, Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; E-mail: meryem030@hotmail.com Received 13 January, 2018 Accepted 1 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2GtTsXg

Tissue Necrosis in Epstein–Barr Virus-Negative Orbital Diffuse Large B-Cell Lymphoma

An 82-year-old man presented with a history of diplopia for 5 months and painful swelling of the left eyelids for 3 months. Imaging studies revealed a lesion involving the left extraocular muscles, orbital fat, and optic nerve. Laboratory investigations were negative for Epstein–Barr virus antiviral capsid antigens-immunoglobulin M. Initial biopsy of the lesion was performed and histopathologic examination revealed only necrosis with positivity of cluster of differentiation 20. This prompted a second biopsy of the involved left extraocular muscles and the orbital fat. The results of histopathological and immunohistochemical tests corresponded to Epstein–Barr virus-negative diffuse large B-cell lymphoma, germinal center B-cell type. Address correspondence and reprint request to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 14 August, 2018 Accepted 11 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2DYESWi

Hyoid Periosteum Sutures: A Modified Tissue-Preserving Hyoid Suspension Technique for Obstructive Sleep Apnea

Objective: To present and assess a new, simple, conservative modification of hyoidthyroidpexy using 2 sutures between hyoid periosteum and thyroid lamina. Methods: Included patients had obstructive sleep apnea with apnea hypopnea index >20. Through a small midline neck incision, 2 Vicryl sutures were applied between the hyoid periosteum and thyroid cartilage. Infrahyoid and suprahyoid muscles were not traumatized. Results: In 19 patients, the mean apnea hypopnea index significantly dropped (P

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Effect of Electronic Cigarettes on the Inner Mucosa of the Craniofacial Region

Objectives: The aim of this paper is to investigate electronic cigarettes (e-cigarettes) from the otorhinolaryngologic point of view. Methods: The authors searched Central Database of Kirikkale University Library, Google, PubMed, and Proquest and Google Scholar. Results: An electronic cigarette or e-cigarette is a battery-powered device that vaporizes a liquid, generally including nicotine. Nowadays, e-cigarettes are used for smoking cessation or to reduce the consumption of conventional tobacco cigarettes. First generation e-cigarette devices were similar to conventional tobacco cigarettes in terms of shape and size and expressed as "cigalikes." Differently from traditional cigarettes in which tobacco is burned to generate smoke, electronic cigarettes contain a tank filled with liquid. It was found that e-cigarette liquids contained different types of chemical compounds which were either previously known carcinogens or probably prove to be carcinogenic to humans in the near future. It seems that the use of electronic cigarette does not harm the oral cells. However, the use of e-cigarette for 4 weeks led to metaplasia and hyperplasia of the laryngeal mucosa in rats. Furthermore, e-ciagarettes produce some adverse effects on the nasal mucosa, supressing the immune system. Conclusion: It should not be considered that e-cigarettes are safer unless their effects on the mucosa of the ear, nose, and throat are more precisely clarified. Address correspondence and reprint requests to Nuray Bayar Muluk, MD, Dr. Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Block, No: 6-3/43, 06610 Çankaya, Ankara, Turkey; E-mail: nuray.bayar@yahoo.com, nurayb@hotmail.com Received 4 September, 2018 Accepted 14 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2DYLOTb

Median Cleft of the Lower Lip and Mandible: Clinical Experience and Surgical Treatment

Median cleft of lower lip and mandible is a rare congenital craniofacial malformation and has been described as isolated clinical reports. Fewer than 100 cases have been reported in the world literature so far, and the first case was reported by French scholar Monroe in 1819. The authors report a patient with median complete cleft of the lower lip and mandible which we made a special repair surgery for him, surgical effect satisfied with the restoration of appearance and function ideal. Therefore, the appropriate period and method of surgical management are very important. Address correspondence and reprint requests to Guomin Wang, MD, PhD, Professor, Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China, 200011; E-mail: guomin1956211@163.com Received 5 September, 2018 Accepted 14 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2Gu6LXF

Allergic Epidural Effusion Following Polyetheretherketone Cranioplasty

Cranioplasty is a common procedure in neurosurgical practice. However, some complications may occur after the operation. We here presented a case of bilateral skull defect and underwent cranioplasty with polyetheretherketone (PEEK) prosthesis. The patient developed epidural effusion on both sides 7 days after surgery. The effusion was light yellow and transparent, and laboratory examinations revealed normal glucose level, negative bacteriological results, and increased IgG protein concentration. The effusion disappeared after treatment with dexamethasone and drainage. We speculated that the epidural effusion was because of delayed type allergic reactions after PEEK cranioplasty. However, further studies are needed to investigate its related mechanisms. Address correspondence and reprint requests to Xiaofeng Yang, MD, Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 Zhejiang Province, China; E-mail: zjcswk@zju.edu.cn Received 20 July, 2018 Accepted 18 November, 2018 SQ and WY authors contributed equally to this work. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2DW5tDp

Aflatoxin in maize: a review of the early literature from “moldy-corn toxicosis” to the genetics of aflatoxin accumulation resistance

Abstract

Aflatoxin is a potent toxin produced by Aspergillus flavus Link:Fr, an opportunistic ear-rot pathogen of maize (Zea mays L. subsp. Mays). Prior to the discovery of aflatoxin, A. flavus was considered a minor pathogen and was not a priority for maize breeders or pathologists. Aflatoxin was discovered in England in 1961 following an epidemic in poultry. By the early 1970s, surveys of agricultural commodities in the USA found that maize produced in the Southeast was especially vulnerable to aflatoxin contamination. Aflatoxin contamination was initially treated as a post-harvest issue, but pre-harvest contamination was proven by 1975. Pre-harvest contamination meant that genetically based host-plant resistance was a possible solution. The potential magnitude of the problem became apparent in 1977 when the southeastern US maize crop suffered epidemic aflatoxin contamination. The first experiment demonstrating the heritability of host-plant resistance to aflatoxin accumulation was published in 1978. These events combined to make breeding for reduced aflatoxin contamination both a high priority and a rational breeding objective. This review surveys the early scientific literature in order to place research on the genetics of aflatoxin accumulation in maize into historical context. It tells the story of how multi-disciplinary research began with veterinary diseases of unknown etiology and resulted in host-plant resistance to a previously minor plant pathogen becoming a central public sector breeding objective.

http://bit.ly/2SxA6Xz

High-Flow Nasal Oxygen Improves Safe Apnea Time in Morbidly Obese Patients Undergoing General Anesthesia: A Randomized Controlled Trial

BACKGROUND: Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. METHODS: Research ethics board approval was obtained. Elective surgical patients ≥18 years with body mass index ≥40 kg·m−2 were included. Patients with severe comorbidity, gastric reflux disease, known difficult airway, or nasal obstruction were excluded. After obtaining informed consent patients were randomized. In the intervention (high-flow nasal oxygenation) group, preoxygenation was provided by 100% nasal oxygen for 3 minutes at 40 L·minute−1; in the control group, preoxygenation was delivered using a facemask with 100% oxygen, targeting end-tidal O2 >85%. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was not performed. At 2 minutes after rocuronium, videolaryngoscopy was performed. If the laryngoscopy grade was I or II, laryngoscope was left in place and the study was continued; if grade III or IV was observed, the patient was excluded from the study. During the apnea period, high-flow nasal oxygenation patients received nasal oxygen at 60 L·minute−1; control group patients received no supplemental oxygen. The primary outcome, safe apnea time, was reached when oxygen saturation measured by pulse oximetry (SpO2) fell to 95% or maximum 6 minutes of apnea. The patient was then intubated. T tests and χ2 analyses were used to compare groups. P

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In Response

No abstract available

http://bit.ly/2GsZ2cA

A Multivariable Model Predictive of Unplanned Postoperative Intubation in Infant Surgical Patients

BACKGROUND: Unplanned postoperative intubation is an important quality indicator, and is associated with significantly increased mortality in children. Infant patients are more likely than older pediatric patients to experience unplanned postoperative intubation, yet the literature provides few characterizations of this outcome in our youngest patients. The objective of this study was to identify risk factors for unplanned postoperative intubation and to develop a scoring system to predict this complication in infants undergoing major surgical procedures. METHODS: In this retrospective cohort study, The National Surgical Quality Improvement Program-Pediatric database was surveyed for all infants who underwent noncardiac surgery between January 1, 2012 and December 31, 2015 (derivation cohort, n = 56,962) and between January 1 and December 31, 2016 (validation cohort, n = 20,559). Demographic and perioperative clinical characteristics were examined in association with our primary outcome of unplanned postoperative intubation within 30 days of surgery. Risk factors were analyzed in the derivation cohort (2012–2015 data) using multivariable logistic regression with stepwise selection. Parameters from the final model were used to create a scoring system for predicting unplanned postoperative intubation. Data from the validation cohort were utilized to assess the performance of the scoring system using the area under the receiver operating characteristic curve. RESULTS: In the derivation cohort, 2.2% of the infants experienced unplanned postoperative intubation within 30 days of surgery. Of the 14 risk factors identified in multivariable analysis, 10 (age, prematurity, American Society of Anesthesiologists physical status, inpatient status, operative time >120 minutes, cardiac disease, malignancy, hematologic disorder, oxygen supplementation, and nutritional support) were included in the final multivariable logistic regression model to create the risk score. The area under the receiver operating characteristic curve of the final model was 0.86 (95% CI, 0.85–0.87) for the derivation cohort and 0.83 (95% CI, 0.82–0.85) for the validation cohort. CONCLUSIONS: About 1 in 50 infants undergoing major surgical procedures experiences unplanned postoperative intubation. Our scoring system based on routinely collected perioperative assessment data can predict risk in infants with good accuracy. Further investigation should assess the clinical utility of the scoring system for risk stratification and improvement in perioperative care quality and patient outcomes. Accepted for publication December 20, 2018. Funding: L.D.E. is supported by an institutional training grant from the National Institutes of Health, T32GM008464-26. M.K. is supported by the National Center for Advancing Translational Sciences, National Institutes of Health through Grant Number KL2TR001874. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Lisa D. Eisler, MD, Department of Anesthesiology, Columbia University Medical Center, 622 W 168th St, PH 5, Suite 505C, New York, NY 10032. Address e-mail to LDL2113@cumc.columbia.edu. © 2019 International Anesthesia Research Society

http://bit.ly/2Sdi263

Cataract Surgery: When the Eyes Are Bigger Than the Stomach

No abstract available

http://bit.ly/2GuFpRw

Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis

BACKGROUND: Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo or no treatment in patients undergoing surgeries. The primary outcome of this meta-analysis was the incidence of shivering. The incidence of shivering was combined as a risk ratio with 95% CI using a random-effect model. The effect of the route of administration was evaluated in a subgroup analysis, and Trial Sequential Analysis with a risk of type 1 error of 5% and power of 90% was performed. The quality of each included trial was evaluated, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS: Sixty-four trials and 4303 patients (2300 and 2003 patients in magnesium and control groups, respectively) were included. The overall incidence of shivering was 9.9% in the magnesium group and 23.0% in the control group (risk ratio, 0.42; 95% CI, 0.33–0.52). Subgroup analysis revealed that the incidence of shivering was lower with IV (risk ratio, 0.29; 95% CI, 0.29–0.54; Grading of Recommendation Assessment, Development, and Evaluation, moderate), epidural (risk ratio, 0.24; 95% CI, 0.13–0.43; Grading of Recommendation Assessment, Development, and Evaluation, low), and intrathecal administration (risk ratio, 0.64; 95% CI, 0.43–0.96; Grading of Recommendation Assessment, Development, and Evaluation, moderate). Only trials with low risk of bias were included for Trial Sequential Analysis. The Z-cumulative curve for IV magnesium crossed the Trial Sequential Analysis monitoring boundary for benefit even though only 34.9% of the target sample size had been reached. The Z-cumulative curve for epidural or intrathecal administration did not cross the Trial Sequential Analysis monitoring boundary for benefit. No increase in adverse events was reported. CONCLUSIONS: Perioperative IV administration of magnesium effectively reduced shivering and Trial Sequential Analysis suggested that no more trials are required to confirm that IV magnesium effectively reduces shivering. Accepted for publication December 12, 2018. Funding: This study was supported by funding from the Department of Anesthesiology, Yokohama City University, Yokohama, Japan. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Trial registry number: CRD42018083337 (PROSPERO). URL: http://bit.ly/2Gu1mjl. Reprints will not be available from the authors. Address correspondence to Hiromasa Kawakami, MD, Department of Anesthesiology, Yokohama City University Medical Center, Urafunecho 4-57 Minamiku Yokohama, Kanagawa 232-0024, Japan. Address e-mail to hiro.k210@gmail.com. © 2019 International Anesthesia Research Society

http://bit.ly/2Sc7hka

Editorial by US Food and Drug Administration Attorney Fails to Address Core and Ongoing Issues Seen With Vasopressin Market

No abstract available

http://bit.ly/2SgG6Vl

Perioperative Care for Adolescents Undergoing Major Surgery: A Biopsychosocial Conceptual Framework

No abstract available

http://bit.ly/2GqT9MU

American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid Use: Definition, Incidence, Risk Factors, and Health Care System Initiatives

Persistent postoperative opioid use is thought to contribute to the ongoing opioid epidemic in the United States. However, efforts to study and address the issue have been stymied by the lack of a standard definition, which has also hampered efforts to measure the incidence of and risk factors for persistent postoperative opioid use. The objective of this systematic review is to (1) determine a clinically relevant definition of persistent postoperative opioid use, and (2) characterize its incidence and risk factors for several common surgeries. Our approach leveraged a group of international experts from the Perioperative Quality Initiative-4, a consensus-building conference that included representation from anesthesiology, surgery, and nursing. A search of the medical literature yielded 46 articles addressing persistent postoperative opioid use in adults after arthroplasty, abdominopelvic surgery, spine surgery, thoracic surgery, mastectomy, and thoracic surgery. In opioid-naive patients, the overall incidence ranged from 2% to 6% based on moderate-level evidence. However, patients who use opioids preoperatively had an incidence of >30%. Preoperative opioid use, depression, factors associated with the diagnosis of substance use disorder, preoperative pain, and tobacco use were reported risk factors. In addition, while anxiety, sex, and psychotropic prescription are associated with persistent postoperative opioid use, these reports are based on lower level evidence. While few articles addressed the health policy or prescriber characteristics that influence persistent postoperative opioid use, efforts to modify prescriber behaviors and health system characteristics are likely to have success in reducing persistent postoperative opioid use. Accepted for publication October 16, 2018. The authors declare no conflicts of interest. Funding: The PeriOperative Quality Initiative (POQI)-4 consensus conference was supported by unrestricted educational grants from the American Society for Enhanced Recovery (ASER) and the POQI, which have received grants from Baxter, Bev MD, Cadence, Cheetah Medical, Edwards, Heron Pharmaceutical, Mallinckrodt, Medtronic, Merck, Pacira, and Trevena. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Please see Supplemental Digital Content, Appendix 1, http://bit.ly/2GxzQ4N, for a list of the POQI-4 Workgroup members. Reprints will not be available from the authors. Address correspondence to Michael L. Kent, MD, Department of Anesthesiology, Duke University Medical Center, 3094 #4, Durham, NC 27710. Address e-mail to Michael.kent@duke.edu. © 2019 International Anesthesia Research Society

http://bit.ly/2Sdhq0f

I Tweet, Therefore I Learn: An Analysis of Twitter Use Across Anesthesiology Conferences

BACKGROUND: Twitter in anesthesiology conferences promotes rapid science dissemination, global audience participation, and real-time updates of simultaneous sessions. We designed this study to determine if an association exists between conference attendance/registration and 4 defined Twitter metrics. METHODS: Using publicly available data through the Symplur Healthcare Hashtags Project and the Symplur Signals, we collected data on total tweets, impressions, retweets, and replies as 4 primary outcome metrics for all registered anesthesiology conferences occurring from May 1, 2016 to April 30, 2017. The number of Twitter participants, defined as users who contributed a tweet, retweet, or reply 3 days before through 3 days after the conference, was collected. We also collected influencer data as determined by mentions (number of times a user is referenced). Two authors independently verified the categories for influencers assigned by Symplur. Conference demographic data were obtained by e-mail inquiries. Associations between meeting attendees/registrants and Twitter metrics, between Twitter participants and the metrics, and between physician influencers and Twitter participants were tested using Spearman rho. RESULTS: Fourteen conferences with 63,180 tweets were included. With the American Society of Anesthesiologists annual meeting included, the correlations between meeting attendance/registration and total tweets (rs = 0.588; P = .074), impressions (rs = 0.527; P = .117), and retweets (rs = 0.539; P = .108) were not statistically significant; for replies, it was moderately positive (rs = 0.648; P = .043). Without the American Society of Anesthesiologists annual meeting, total tweets (rs = 0.433; P = .244), impressions (rs = 0.350; P = .356), retweets (rs = 0.367; P = .332), and replies (rs = 0.517; P = .154) were not statistically significant. Secondary outcomes include a highly positive correlation between Twitter participation and total tweets (rs = 0.855; P

http://bit.ly/2Gpo10p

Prevalence and Multivariable Factors Associated With Preoperative Cognitive Impairment in Outpatient Surgery in the United States

Preoperative cognitive impairment increases the risk of adverse events after surgery but its prevalence in outpatient surgery has not been defined. We aimed to determine the prevalence and multivariable factors associated with cognitive impairment in individuals who present for outpatient surgery. We used data from the Health and Retirement Study, a longitudinal panel survey of older Americans. Of 1836 participants who reported having outpatient surgery, we found that 16.1% had evidence of cognitive impairment. Significant multivariable factors associated with preoperative cognitive impairment included non-Hispanic African American race, prior stroke, preoperative functional dependence, and lower socioeconomic status and education level. Accepted for publication December 18, 2018. Funding: This work was supported by a University of Pennsylvania Institute on Aging pilot grant. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Timothy G. Gaulton, MD, MSc, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, 310 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. Address e-mail to timothy.gaulton2@uphs.upenn.edu. © 2019 International Anesthesia Research Society

http://bit.ly/2SdhkFV

Contemplating Our Maternity Care Crisis in the United States: Reflections of an Obstetrician Anesthesiologist

No abstract available

http://bit.ly/2GuFnJo

Questions About the Study by Said Et Al

No abstract available

http://bit.ly/2GxzLy1

Arterial thrombosis as primary presentation of endogenous Cushings syndrome

Cushing's syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing's syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing's syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing's syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing's. A diagnosis of endogenous Cushing's syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

http://bit.ly/2Gpjmvr

High tibial osteotomy in combination with arthroscopic abrasion arthroplasty and autologous adipose-derived mesenchymal stem cell therapy in the treatment of advanced knee osteoarthritis

Osteoarthritis is a progressive and debilitating condition. An increasing number of total knee replacements are being performed under the age of 65. Improved understanding of the action of mesenchymal stem cells (MSC) has seen renewed interest in their role in cartilage repair. A 43-year-old man presented with grade IV medial compartment knee osteoarthritis. The patient underwent high tibial osteotomy (HTO) and arthroscopic abrasion arthroplasty in combination with adipose-derived MSC therapy. The patient reported improvement in pain and function as measured by validated outcome scores. Repeat MRI including T2 mapping techniques showed hyaline-like cartilage regeneration. This case highlights the potential benefit of surgical interventions including HTO in combination with MSC therapy in early-onset severe osteoarthritis. This technique may considerably delay or prevent the need for total knee replacement in young patients. Further controlled trials are needed to confirm the reproducibility of this outcome.

http://bit.ly/2SDmwSy

Intramural oesophageal abscess: an unusual complication of tonsillitis

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Anecdotally, there is concern that modern medical practice that counsels vigilance against overuse of antibiotics, could lead to increased complications of tonsillitis. We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. Despite antibiotic treatment he developed an intramural oesophageal abscess, to our knowledge, an unreported complication of tonsillitis.

http://bit.ly/2GqF3em

Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.

http://bit.ly/2SvOzU9

Pins and needles in the groin: an incidental finding of retained needle fragments in an intravenous drug user

A female intravenous drug user was reviewed in A&E following a deliberate overdose. After claiming to have swallowed a razor blade, an abdominal radiograph was performed; this showed a linear metallic density projected over the right side of the pelvis, eventually identified as a needle fragment. Subsequent CT imaging revealed three additional needles situated within the groin. Duplex assessment also identified bilateral arteriovenous fistulae. The patient remained asymptomatic and was managed conservatively. She could recall several occasions when a needle had broken while injecting. This scenario was more likely if the needle had been used many times previously, causing it to become blunt and bent. There are cases reported of adverse patient outcomes secondary to broken needle fragments but awareness among medical professionals remains poor.

http://bit.ly/2GraZiU

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8 years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

http://bit.ly/2UPs8a5

Laminin-511 Supplementation Enhances Stem Cell Localization with Suppression in the Decline of Cardiac Function in Acute Infarct Rats

Background. The extracellular matrix (ECM), in particular, basement membrane components such as laminins (LMs), is essential for stem cell differentiation and self-renewal. LM511 and LM221 are the main ECM components of the epicardium, where stem cells were abundant. Here, we examined whether LMs affected the regeneration process by modulating stem cell activities. Methods. In vitro, adhesive and proliferative activities of mesenchymal stem cells (MSCs) were evaluated on LM511 and LM221. To examine the effects of LMs in vivo, we established an acute myocardial infarction (MI) model by ligation of the proximal part of the left anterior descending artery at the height of the left atrial appendage and then placed atelocollagen sheets with or without LM511 and LM221 over the anterolateral surface of the left ventricular wall. Four or eight weeks later, cardiac function, histology, and cytokine expressions were analyzed. Results. MSCs showed greater proliferation and adhesive properties on LM511 than on LM221. In vivo, at four weeks, isolectin B4 (ILB4)-positive cells were significantly higher in the LM511-transplanted group than in the control group. Moreover, some ILB4-positive cells expressed both platelet-derived growth factor receptor α and CD90, suggesting that LM511 enhanced MSC recruitment and attachment at the implanted site. After eight weeks, these cells were more abundant than at 4 weeks. Transplantation with LM511-conjugated sheets increased the expression of cardioprotective and angiogenic factors. Conclusion. Transplantation with LM511-conjugated sheets enhanced MSC localization to the implantation site and modulated stem cells activities, leading to angiogenesis in acute MI rat models. Disclosures: The authors disclose no conflict of interest. Funding: This study was supported in part by the New Energy and Industrial Technology Development Organization. *Corresponding author: Professor Yoshiki Sawa, Chairman for Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. Phone: +81-6-6879-3154, Fax: +81-6-6879-3163, E-mail: sawa-p@surg1.med.osaka-u.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

http://bit.ly/2UPs8a5

Flow-controlled ventilation during ear, nose and throat surgery: A prospective observational study

BACKGROUND Flow-controlled ventilation (FCV) is a new mechanical ventilation mode that maintains constant flow during inspiration and expiration with standard tidal volumes via cuffed narrow-bore endotracheal tubes. Originating in manually operated 'expiratory ventilation assistance', FCV extends this technique by automatic control of airway flow, monitoring of intratracheal pressure and control of peak inspiratory pressure and end-expiratory pressure. FCV has not yet been described in a clinical study. OBJECTIVE The aim of this study was to provide an initial assessment of FCV in mechanically ventilated patients undergoing ear, nose and throat surgery and evaluate its potential for future use. DESIGN An observational study. SETTING Two German academic medical centres from 24 November 2017 to 09 January 2018. PATIENTS Consecutive patients (≥ 18 years) scheduled for elective ear, nose and throat surgery. Exclusion criteria were planned laser surgery, intended fibreoptic awake intubation, emergency procedures, increased risk of aspiration, American Society of Anesthesiologists (ASA) physical status more than III and chronic obstructive pulmonary disease classified as GOLD stage more than II. INTERVENTION Peri-operative use of FCV provided by a new type of ventilator (Evone) via a narrow-bore endotracheal tube (Tritube). MAIN OUTCOME MEASURES Minute volume, respiratory rate, intratidal tracheal pressure amplitude (Δp) and end-tidal CO2 (PetCO2) were recorded every 5 min. All adverse events were noted. Data are presented as median [IQR]. RESULTS Sixteen patients provided 15 evaluable data sets. A minute volume of 5.0 [4.4 to 6.4] l min−1 and a respiratory rate of 9 [8 to 11] min−1 generated a PetCO2 of 4.9 [4.8 to 5.0] kPa. Δp was 10 [9 to 12] cmH2O. Five adverse events were recorded: a tube obstruction due to airway secretions and four tube dislocations (two attributed to coughing, two not study-related). CONCLUSION FCV achieves adequate PetCO2 levels with minute volume and Δp in the normal range. Tritube's high flow resistance may increase the likelihood of tube dislocations if the patient coughs. Although further evaluation is necessary, FCV provides a new option for short-term mechanical ventilation. The successful operation of FCV with narrow-bore tubes contributes to the armamentarium for airway management. TRIAL REGISTRATION DRKS00013312 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://bit.ly/OBJ4xP Correspondence to Dr. Johannes Schmidt, Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2ylyqmW). © 2019 European Society of Anaesthesiology

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Pre-operative assessment of 30-day mortality risk after major surgery: the role of the quick sequential organ failure assessment: A retrospective observational study

BACKGROUND The quick Sequential Organ Failure Assessment (qSOFA) is intended for the assessment of the prognosis and risk of sepsis. It may also help predict the mortality risk of nonseptic patients. OBJECTIVE This study investigated the relationship between pre-operative qSOFA scores and 30-day mortality after major surgery. It also evaluated the predictive value of qSOFA scores combined with the American Society of Anesthesiologists (ASA) physical status and Charlson comorbidity index (CCI). DESIGN A retrospective observational study. SETTING Single tertiary academic hospital. PATIENTS Medical records of patients who underwent major surgery (estimated blood loss >500 ml; surgery time >2 h) between January 2010 and December 2017 were examined. MAIN OUTCOME MEASURES The qSOFA score was measured within 24 h before surgery, and its association with 30-day mortality was analysed using multivariable logistic regression. A receiver-operating characteristic curve analysis was used to investigate the predictive power of the pre-operative qSOFA scores combined with the ASA physical status and with CCI. RESULTS A total of 6336 patients were included in the final analysis, and 91 (1.4%) died within 30 days. The multivariable logistic regression analysis including all covariates indicated that 30-day mortality was 2.43-times higher for the score 1 group than for the score 0 group (P = 0.002), and it was 3.54-times higher for the score at least 2 group than for the score 0 group (P

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‘May you live in interesting times’: blessing or curse for an intensivist?

No abstract available

http://bit.ly/2GtB94y

Correlation of magnetic resonance imaging grades with cytokine levels of synovial fluid of patients with temporomandibular joint disorders: a cross-sectional study

Abstract

Objectives

Magnetic resonance imaging (MRI) is a standardized method for assisting joint diagnosis. To validate the reliability of different imaging-based grading systems, this study examined (1) the associations between grading systems for osseous change, joint effusion, and the Wilkes classification of temporomandibular joint (TMJ) disorders and (2) the correlation between cytokines in synovial fluid and imaging-based joint scores.

Materials and methods

Twenty-seven patients, who routinely received numeric rating scale (NRS) and MRI assessment before TMJ arthrocentesis, were enrolled. Each joint was evaluated through the grading criteria for severity of osseous change and joint effusion by blinded observers using MRI. ImageJ was employed for classifying joint effusion. Joint synovial fluid, collected through arthrocentesis, was examined for cytokine expression by using a Luminex multiplex assay. All data were analyzed using the Pearson correlation analysis.

Results

The Wilkes classification was strongly correlated with osseous change scores, but not with joint effusion scores. Joint effusion scores significantly correlated with NRS scores, but not with the Wilkes classification and osseous change scores. Compared with osseous change scores, joint effusion scores had a higher correlation with the levels of inflammatory cytokines (interleukin (IL)-8 and soluble IL-6 receptor (sIL-6R)) and with anti-inflammatory cytokines (soluble tumor necrosis factor receptors I and II (sTNF-RI/II)).

Conclusions

In patients with TMJ disorders, MRI grades are strongly correlated with NRS scores and levels of cytokines (IL-8, sIL-6R, and sTNF-RI/II) in the synovial fluid.

Clinical relevance

Joint effusion scoring can be a reliable and valid indicator for pathological assessment of TMJ disorders.

http://bit.ly/2SspiKz

Microbiological dynamics of red complex bacteria following full-mouth air polishing in periodontally healthy subjects—a randomized clinical pilot study

Abstract

Objectives

Suppression of periodontal pathogens in the oral cavity of periodontally healthy individuals may lower the risk for periodontal or periimplant diseases. Therefore, the present study aimed to analyze the effect of supragingival debridement (SD) with adjunctive full mouth glycine powder air polishing (FM-GPAP) on the prevalence of periodontal pathogens in periodontally healthy individuals.

Materials and Methods

Eighty-seven systemically and periodontally healthy intraoral carriers of red complex bacteria, i.e., Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola or other periodontal pathogens including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Eikenella corrodens were enrolled into the study and randomly assigned to receive SD with adjunctive FM-GPAP (test, n = 42) or SD alone (control, n = 45). In the first observation period, microbiological samples were obtained prior to, and 2, 5, and 9 days following intervention. If one of these periodontal pathogens could still not be identified, additional microbial sampling was performed after 6 and 12 weeks.

Results

The prevalence of red complex bacteria was significantly reduced in the test compared to the control group following treatment (p = 0.004) and at day 9 (p = 0.031). Intragroup comparison showed a significant (test, p < 0.001; control, p ≤ 0.01) reduction in the mean prevalence in both groups from BL through day 9 with an additional significant intergroup difference (p = 0.048) at day 9. However, the initial strong reduction returned to baseline values after 6 and 12 weeks.

Conclusion

In periodontally healthy carriers of periodontal pathogens, FM-GPAP as an adjunct to SD transiently enhances the suppression of red complex bacteria.

Clinical relevance

Whether the enhanced suppression of red complex bacteria by adjunctive FM-GPAP prevents the development of periodontitis in periodontally healthy carriers requires further investigations.

http://bit.ly/2Sg7Pp6

Editorial

I would like to extend my warmest New Year's greetings to all our readers as we commence the 31st volume and 30th year of publishing International Immunology. As we acknowledge and celebrate this particular milestone in the journal's history, I am very glad to be able to report on some good news from an eventful 2018. Last year saw International Immunology's Impact Factor rise to 5.189; the journal's highest Impact Factor to date and the first time it has risen above five. Several of the most highly cited papers which contributed to the Impact Factor were from our Special Issue on Antibody-Targeted Therapy, highlighting the global attention that this exciting field of research is currently receiving (1).

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In This Issue

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Vancomycin-associated Drug-Induced Hypersensitivity Syndrome (DIHS)

While hypersensitivity reactions are well-characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined.

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Corrigendum to 'Abstract 7058' [J Am Acad Dermatol (2018) AB112]

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Reply to: Comment on “Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study” and a case report of glucagon-like peptide-1 receptor agonist induced bullous pemphigoid

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Disposable paper cup as a cheap and ready to use stencil for spot cryo treatment

http://bit.ly/2GtSyKA

Overall and Subgroup Prevalence of Pyoderma Gangrenosum Among Patients with Hidradenitis Suppurativa: a population based analysis in the United States

Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although prevalence of PG among HS patients has not been systematically evaluated.

http://bit.ly/2DWwTca

Abnormal T-cell phenotype in episodic angioedema with hypereosinophilia (Gleich’s syndrome): frequency, clinical implication and prognosis

Episodic Angioedema with eosinophilia (EAE, Gleich's syndrome) is a rare disorder consisting of recurrent episodes of angioedema, hypereosinophilia and frequent elevated serum Immunoglobin M.

http://bit.ly/2GugHRg

An effective, low-cost technique for photograph and video capture, wireless transmission, and quality assurance assessments for dermatopathology, anatomic pathology, and Mohs micrographic surgery

Dermatopathology, like clinical dermatology, is dependent on effective teaching, mentoring, and quality assurance steps. The advent of digital cameras has allowed dermatologists to easily share clinical images around the world, but expanding this technology to histopathology has been fraught with logistical challenges. Using a standard binocular microscope precludes the ability of the dermatopathologist to easily share live or stored images of glass slides, while privacy considerations and the irreplaceability of slides limit the ability to share original material for quality assurance purposes, and multiheaded microscopes with specialized video camera arrays cost many thousands of dollars.

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“Oral diabetes medications other than dipeptidyl peptidase 4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case-control study”

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Polyglactin 910 suture compared with polyglactin 910 coated with triclosan in dental implant surgery: randomized clinical trial

Antibacterial coating of surgical sutures is a suggested approach to prevent surgical site infections. The aim of this study was to compare the incidence of surgical site infection following the use of polyglactin 910 (Vicryl) and polyglactin 910 coated with triclosan (Vicryl Plus) sutures in dental implant surgery. This single-blind, randomized clinical trial evaluated patients who received three implants in the posterior mandible. Patients were randomly divided into two groups to receive either Vicryl Plus sutures (group 1) or Vicryl sutures (group 2).

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The influence of lymph node ratio on survival and disease recurrence in squamous cell carcinoma of the tongue

This study was performed to report the outcomes of patients with oral squamous cell carcinoma (OSCC) of the tongue over a 10-year period with the aim of testing the hypothesis that the lymph node ratio (LNR) has a significant influence on loco-regional recurrence. The charts of 227 patients with OSCC of the mobile tongue treated at the University Hospital of Zurich from 2003 to 2012 were screened. Following the application of the exclusion criteria (prior chemotherapy, radiotherapy, or surgery, perioperative death, N3 disease, unresectable disease, synchronous second primary, no signed informed consent, and follow-up <3years), prospective data were collected and a retrospective analysis performed for 88 of these patients who were treated with selective neck dissection.

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Cytoplasmic HMGB1 and HMGB1-Beclin1 complex are increased in radioresistant oral squamous cell carcinoma

Cytoplasmic high mobility group box 1 (HMGB1) is an autophagy regulator, and autophagy is important in the radioresistance of various solid cancers. We evaluated the degree of autophagy and cytoplasmic HMGB1 in radioresistant oral squamous cell carcinoma (SCC) by culturing the SCC15 and quasiliquid layer 1 (QLL1) SCC cell lines that originate from cancer of the oral tongue and a metastatic lymph node, respectively, and then delivered radiation to induce radioresistance to cells. We then compared the degree of autophagy between non-irradiated control and radioresistant cancer cells using a western blot assay.

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4 tips for airway management mastery

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Successful airway management is the culmination of preparation, practice and technique mastery

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Trends in Gender of Speakers at the American Academy of Dermatology Annual Meeting, 2010-2018

This retrospective review of American Academy of Dermatology Annual Meeting data for even years between 2010 and 2018 was performed to identify the number of female speakers and associated presentation times.

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Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma—Reply

In Reply We thank Drs Montuno and Coldiron, Kantor, and MacFarlane and Perlis for their comments on our Viewpoint. As our colleagues understand, the Mohs appropriate use criteria (MAUC) were created to limit use of Mohs surgery (MS) when simpler treatments would be more appropriate. Our Viewpoint was written with this in mind, reinforcing the importance of MS for more complex tumors, while emphasizing that primary superficial basal cell carcinoma (sBCC) can generally be treated more efficiently and less expensively with simple excision and curettage alone or combined with other modalities.

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Representation of Women Among Physician Authors of Perspectives in High-Impact Dermatology Journals

This cross-sectional, descriptive study analyzes the number of women among physician first authors of articles published in the Journal of the American Academy of Dermatology and JAMA Dermatology across a 5-year period.

http://bit.ly/2BnMXlD

Mohs Appropriate Use Criteria for Primary Superficial Basal Cell Carcinoma

To the Editor Appropriate patient care relies on many factors, including data and judgment. Steinman and colleagues contend that the biological behavior of superficial basal cell carcinomas (sBCCs) should lead to their reclassification by the Mohs surgery appropriate use criteria (MAUC) as "uncertain" or "inappropriate" for Mohs surgery (MS). This type of discussion of hypotheses is essential to optimizing patient care. At its inception, the MAUC were intended to evolve as increasing empirical evidence became available.

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Nonmelanoma Skin Cancer Incidence by Treatment Modality in Recipients of Multiple Kidney Transplants

This study uses Irish national registry data to characterize variation in nonmelanoma skin cancer incidence by treatment modality among patients receiving multiple kidney transplants.

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Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma

To the Editor I read with great interest the Viewpoint by Steinman and colleagues on treating superficial basal cell carcinoma (sBCC) with Mohs surgery. The authors rightly point to the paucity of evidence regarding sBCC management, though this limitation applies not just to sBCC but to most other nonmelanoma skin cancers as well.

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Percentage of Women in the Dermatology Workforce Presenting at American Academy of Dermatology Annual Meetings

This study assesses the percentage of female speakers at American Academy of Dermatology conferences from 1992 through 2017 and compares it with the overall percentages of board-certified female dermatologists.

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Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma

To the Editor We read with interest the Viewpoint by Steinman and colleagues suggesting a reevaluation of appropriate use criteria for Mohs micrographic surgery (MMS) with respect to primary superficial basal cell carcinoma (sBCC). We must note that MMS is only 1 means of margin control of skin cancers, and perhaps the Viewpoint title would more accurately read "Reevaluation of Excisional Surgery for Primary Basal Cell Carcinoma."

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Pityriasis Rubra Pilaris

This Patient Page describes pityriasis rubra pilaris

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Gender Equity in Clinical Dermatology

It is not news that medicine struggles to achieve gender equity, particularly in leadership, academics, and research. In an analysis of more than 90 000 academics in 2014, only 12% of women were full professors compared with 29% of men. Even when accounting for experience, productivity, specialty, and age, women were still statistically significantly less likely to be full professors. Women are so scarce in senior leadership positions that chairs of academic departments are more likely to be men with mustaches than to be women. Women in medicine also report high levels of discrimination. Junior faculty women receive less start-up support, and women are more likely than men to leave academics. Salaries are lower for women, even when adjusting for specialty, rank, leadership, publications, and research time. Women speakers at grand rounds are introduced informally statistically significantly more often than their male peers.

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Invited Review: Association of nitric oxide with oral lichen planus

Abstract

Background

The small signalling molecule nitric oxide (NO) has been postulated to have a mediator role in the pathogenesis of several diseases including oral lichen planus (OLP). This systematic review aimed to quantify the existing literature and assess the association of NO and OLP.

Methods

The focused question being addressed was "Is there an association between nitric oxide and OLP?" PubMed, EMBASE, Scopus, and Web of Science, and grey literature from January 1990 to August 2018 were searched. Two independent reviewers performed the study selection using specified eligibility criteria.

Results

Seven studies that met the eligibility criteria were included. All of these were case‐control studies and 151 patients with OLP were evaluated (mostly females), with an age ranged from 20 to 75 years. The included studies showed a significant higher NO levels in OLP patients compared to the healthy controls, with two studies demonstrated a higher NO levels in erosive OLP compared to non‐erosive OLP .

Conclusion

These findings support that an association exists between higher NO concentration and OLP. However, larger high‐quality studies with refined methodological design are needed to confirm the role of NO in the aetiology and pathogenesis of OLP.

http://bit.ly/2I5ACbg

Re: “Association Between Primary Hypothyroidism and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis” by Mantovani et al. (Thyroid 2018;28:1270–1284)

Thyroid, Ahead of Print.

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Metabolic Obesity Phenotypes and Thyroid Cancer Risk: A Cohort Study

Thyroid, Ahead of Print.

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The Role of Sub-mental Ultrasonography in Diagnosing Obstructive Sleep Apnea and Its Correlation With Subjective Scales

Conditions: Obstructive Sleep Apnea; Diagnostic Imaging; Ultrasound
Intervention: Diagnostic Test: Sub-mental ultrasonography
Sponsor: Bartin State Hospital
Recruiting

http://bit.ly/2TAvJZ4

Team-based Ergonomics Educational Model for Workplace WELLNESS Improvement: A Pilot Study

Conditions: MSDs; Muscle Pain
Intervention: Behavioral: stretching exercises
Sponsor: Milton S. Hershey Medical Center
Not yet recruiting

http://bit.ly/2BkSYzy

Validation of Smartphone App for Head and Neck Cancer Control and Patient Support

Condition: Head Neck Cancer
Intervention: Other: Virtual Coach
Sponsors: Vibrent Health; Stanford University; Johns Hopkins University; Massachusetts General Hospital
Not yet recruiting

http://bit.ly/2Tzwm5r

A Study of pING-hHER3FL Vaccine in Cancer Patients WITH ADVANCED MALIGNANCIES

Condition: Advanced Cancer
Intervention: Biological: pING-hHER3FL
Sponsor: Herbert Lyerly
Not yet recruiting

http://bit.ly/2BkSRnC

Einführung der neuen Rubrik „OP-Techniken“

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Hot Topic: Schilddrüse

http://bit.ly/2MTqKR0

Quality of life in Swedish children receiving grommets – An analysis of pre- and postoperative results based on a national quality register

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Job van Brink, Marie Gisselsson-Solen

Abstract

Background

Otitis media with effusion (OME) and recurrent otitis media (rAOM) are two common diagnoses in childhood, both of which are treated with grommets, or ventilation tubes. It is known that affected children have a worse quality of life (QoL), and various questionnaires have been used to evaluate this. The national Swedish quality register for grommet insertions contains some QoL questions that have hitherto never been analysed.

Methods

Data from 2010 to 2016 was extracted from the register and analysed with regards to QoL questions, reasons for surgery, hearing levels and number of AOM episodes.

Results

Preoperative QoL data was available for 3835 children. Before surgery, most parents felt that the QoL of their children was negatively affected by the ear disease. Parents of children with OME were more likely to suspect that their child had a hearing loss (ORs 10.1 and 28.2 for suspecting a mild and severe hearing loss, respectively), but less likely to find that the ear disease affected the child's general wellbeing than did parents of children with rAOM (ORs 0.54 and 0.33 for somewhat and much affected, respectively). Many children underwent surgery despite not fulfilling the criteria for surgery as stipulated in the national guidelines. Those who did fulfil criteria, however, had a more severely affected QoL. A significant improvement was seen in individual QoL scores after surgery (p < 0.001). The degree of postoperative improvement in pure tone average correlated with the improvement in QoL (p < 0.001).

Conclusion

This is the first time that the QoL aspect has been analysed in the Swedish grommet register. Though the validity of the questions has not been proven, they provide valuable information. The relevance of the surgical criteria in national guidelines is illustrated by their correlation with the QoL questions, particularly for OME, and the postoperative improvement in QoL suggests parents find that their children benefit from surgery.

http://bit.ly/2Ddo5wX

Outcome Of Drug-Induced Sleep Endoscopy-Directed Surgery For Persistent Obstructive Sleep Apnea After Adenotonsillar Surgery

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): E. Esteller, J.C. Villatoro, A. Agüero, E. Matiñó, R. Lopez, Aristimuño A, Nuñez V, M.A. Díaz-Herrera

Abstract

PURPOSE

Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment.

METHODS

Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12±3 months.

RESULTS

All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1±4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895±1.11 vs 6.143±4.88; p<0.05) and, in 85% (n=17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12±3 months (15%; n= 3) compared to before surgery (75%; n=15) (p<0.005).

CONCLUSION

DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

http://bit.ly/2SvgaVh

Receptive and productive speech and language abilities in hearing-impaired children with German as a second language

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Annerose Keilmann, Barbara Friese, Vanessa Hoffmann

Abstract

Objectives

Many studies examining early bilingualism in migrant populations focus on the development of the first language. As language acquisition is closely related to the hearing development, there is a critical need to investigate language development in hearing-impaired children being raised bilingually who were fitted with cochlear implants and/or hearing aids. Therefore, this research project aimed to study the linguistic development of hearing-impaired children being raised with German as a second language who were provided with hearing aids or cochlear implants. Further, the language development of these children is compared with that of hearing-impaired children being raised in a monolingual environment and with normal-hearing children being raised bilingually.

Methods

In this prospective study, we analyzed data from 95 typically developing children with hearing loss (43 bilingual and 52 monolingual) aged 3;0 to 10;11 (years; months) on four language measures in German: receptive vocabulary, productive vocabulary, receptive grammar, productive grammar (sentence repetition). Additionally, 30 bilingual children with normal hearing were included in this study.

Results

44 children were provided with hearing aids in both ears; 34 used cochlear implants bilaterally and 17 were fitted bimodally. Statistical analysis showed that bilingual hearing-impaired children scored significantly poorer than monolingual hearing-impaired children.

Conclusion

Hearing-impaired children being raised bilingually should have speech and language examinations on a regular basis. An examination of both languages would be desirable in order to be able to fully assess speech and language acquisition.

http://bit.ly/2DcXfFm

Does influenza vaccination or RSV prophylaxis impact resource utilization for children after the diagnosis of airway disorders?

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jeffrey Cheng, Congwen Zhao, Hui-Jie Li

Abstract

Objective

Quantify the rates influenza vaccination and RSV prophylaxis for children with airway stenosis and/or other disorders and assess impact on resource utilization.

Methods

This was a retrospective study with data extracted from Duke Enterprise Data Unified Content Explorer (DEDUCE) between January 1, 2006 and December 1, 2017. Children aged 18 years and younger with at least one diagnosis code for airway stenosis and/or disorders were included. The index date was defined as the first date of airway stenosis/disorders diagnosis. Each patient was followed for up to one year after the index date. Influenza vaccination or RSV prophylaxis documented within one year of index date were included. We defined emergency department (ED) visits and/or hospital admissions related to respiratory diagnoses as the primary outcome of increased resource utilization.

Results

A total of 2718 patients were included. In our institution, our results have indicated that there are fairly low vaccination documentation rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders, 14.1% (389/2718), 1.1% (30/2718), and 0.6% (17/2718), respectively, within the first year after diagnosis. Around 5% (139/2718) and 10% (269/2718) experienced ED visits or hospitalizations related to respiratory issues within the first year after diagnosis, respectively. Among 139 and 269 patients with ED visits or hospitalizations, 34 (25%) and 54 (20%) had multiple visits, respectively. Very few patients had documented influenza vaccination (11/139, 0.4%) or RSV prophylaxis (5/269, 0.18%) before ED visits or hospitalization.

Conclusions

There is little available evidence at this time for strategies to prevent adverse events or complications in children with airway stenosis/disorders. In our institution, our results have indicated that there are fairly low documented rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders in the first year after diagnosis. This is an area of significant clinical interest for potentially limiting adverse events and optimizing resource utilization for children with airway stenosis/disorders.

http://bit.ly/2SuMKqA

Genetic risk of FCRL3 and FCRL5 Polymorphisms in children with asthma and allergic rhinitis in a Chinese Han Population

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Zheng Gu, Yang Shen, Xin-Ye Tang, Xia Ke, Hong-Bing Yao, Su-Ling Hong, Hou-Yong Kang

Abstract

Objectives

Asthma and allergic rhinitis (AR) frequently occur as comorbid diseases of the upper airways. Single-nucleotide polymorphisms (SNPs) in the FCRL3 and FCRL5 genes have recently been shown to be associated with various immune-related disorders. This study evaluated the association of FCRL3 and FCRL5 polymorphisms with asthma and allergic rhinitis (AR) in a Han Chinese population.

Methods

Seven single nucleotide polymorphisms (SNPs) of the FCRL3 and FCRL5 were genotyped in 300 asthmatic children, and 206 healthy unrelated individuals using PCR-restriction fragment length polymorphism (PCR-RFLP) assay. Genotyping was validated by direct sequencing.

Results

Our results showed that the frequencies of the rs6692977 CT genotype and T allele within FCRL5 were significantly higher in asthma with comorbid AR compared to healthy controls (Bonferroni-corrected p (Pc) = 3.75 × 10^-6; Pc = 0.006, respectively), whereas these of the CC genotype and C allele were significantly lower (Pc = 4.15 × 10^-5; Pc = 0.006, respectively). The frequencies of the rs7528684 A allele (Pc = 1.80 × 10^-3) and the rs10489678 G allele (Pc = 0.04) within FCRL3 were higher in asthma with comorbid AR than in controls. However, no differences in the tested genetic polymorphisms were detected between asthma and healthy individuals.

Conclusion

This study identified novel SNPs in FCRL3 and FCRL5 significantly associated with the risk for asthma with comorbid AR in the Chinese population. The genetic variants may play role in the development of the asthma phenotype in children with asthma.

http://bit.ly/2DgAWOQ

Evaluation of bone regeneration in a critical size cortical bone defect in rat mandible using microCT and histological analysis

Publication date: Available online 5 February 2019

Source: Archives of Oral Biology

Author(s): Cynthia G. Trejo-Iriarte, Janeth Serrano-Bello, Rocío Gutiérrez-Escalona, Crisóforo Mercado-Marques, Natalio García-Honduvilla, Julia Buján-Varela, Luis Alberto Medina

Abstract

Goal

Evaluate bone regeneration in a critical size bone defect model in the jaw of healthy rats as a function of gender and defect location.

Design

A series of microCT and histological studies were performed to evaluate the process of bone regeneration in rats with a mandibular critical size defect. Rats were placed in two groups according to gender and sorted in terms of bone defect location. Bone regeneration rate and hydroxyapatite concentration were assessed with microCT imaging at specific times after surgery. Histological analysis was also performed to evaluate bone regeneration.

Results

No more that 85% of bone regeneration was observed after 60 days, with a low rate constant (K) indicating a slow restoration of the defect. Assessment of microCT images showed partial closure of the defect in all cases, which was confirmed by histological analysis. Hydroxyapatite concentration values revealed that regenerated bone was not fully calcified. No statistically significant differences in terms of gender or defect location were found.

Conclusion

The defect model studied here, located in the jaw of healthy rats, shows potential as a preclinical critical size bone defect model to evaluate bone regeneration therapies in the fields of dentistry and maxillofacial surgery.

http://bit.ly/2DgwwaI

Evaluation of bone regeneration in a critical size cortical bone defect in rat mandible using microCT and histological analysis

Publication date: Available online 5 February 2019

Source: Archives of Oral Biology

Author(s): Cynthia G. Trejo-Iriarte, Janeth Serrano-Bello, Rocío Gutiérrez-Escalona, Crisóforo Mercado-Marques, Natalio García-Honduvilla, Julia Buján-Varela, Luis Alberto Medina

Abstract

Goal

Evaluate bone regeneration in a critical size bone defect model in the jaw of healthy rats as a function of gender and defect location.

Design

Results

Conclusion

http://bit.ly/2DgwwaI

Can lithium disilicate ceramic crowns be fabricated on the basis of CBCT data?

Abstract

Objectives

Evaluating the fit of CAD/CAM lithium disilicate ceramic crowns fabricated on basis of direct and indirect digitalization of impressions by CBCT or of dental casts.

Material and methods

A metal model with a molar chamfer preparation was digitized (n = 12 per group) in four ways: IOS—direct digitalization using an Intra-Oral scanner (CS3600), cone-beam computed tomography scan (CBCT 1)—indirect digitalization of impression (CBCT-CS9300), CBCT 2—indirect digitalization of impression (CBCT-CS8100), and Extra-Oral scanner (EOS)—indirect digitalization of gypsum-cast (CeramillMap400). Accuracy of 3D datasets was evaluated in relation to a reference dataset by best-fit superimposition. Marginal fit of lithium disilicate crowns after grinding was evaluated by replica technique. Significant differences were detected for 3D accuracy by Mann–Whitney U and for fit of crowns by One-way ANOVA followed by Scheffe's post hoc (p = 0.05).

Results

3D analysis revealed mean positive and negative deviations for the groups IOS (− 0.011 ± 0.007 mm/0.010 ± 0.003 mm), CBCT 1 (− 0.046 ± 0.008 mm/0.093 ± 0.004 mm), CBCT 2 (− 0.049 ± 0.030 mm/0.072 ± 0.015 mm), and EOS (− 0.023 ± 0.007 mm/0.028 ± 0.007 mm). Marginal fit presented the results IOS (0.056 ± 0.022 mm), CBCT 1 (0.096 ± 0.034 mm), CBCT 2 (0.068 ± 0,026 mm), and EOS (0.051 ± 0.017 mm).

Conclusions

The marginal fit of EOS and IOS, IOS and CBCT 2, and CBCT 2 and CBCT 1 showed statistical differences. The marginal fit of CBCT 1 and CBCT 2 is within the range of clinical acceptance; however, it is significant inferior to EOS and IOS.

Clinical relevance

The use of a CBCT enables clinicians to digitize conventional impressions. Despite presenting results within clinical acceptable levels, the CBCT base method seems to be inferior to Intra-Oral scans or to scanning gypsum models regarding the resulting accuracy and fit.

http://bit.ly/2t67Hts

Immunotherapy with checkpoint inhibitors in non-small cell lung cancer: insights from long-term survivors

Abstract

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death-1 (PD-1)–programmed cell death ligand-1 (PD-L1) axis have shown promising results in non-small cell lung cancer (NSCLC) patients, some of them with persistent responses to these agents that form a population of long-term survivors. Despite the variable definition of PD-L1 positivity in tumors, an association between expression and response has been reasonably consistent in advanced NSCLC. In addition, the clinical efficacy of ICIs seems to be related to the genomic landscape of the tumor in terms of mutational burden and clonal neoantigens. Furthermore, increasing evidence shows that excessive activation of the immune response elicited by ICIs, leading to immune-related toxicities, might be associated with an improved response to immunotherapy. There are still many unanswered questions about the proper use of these agents to maximize their efficacy, which may be improved through combination with radiation, chemotherapy, targeted therapies, or other immune mediators, including dual checkpoint blockade. To search for clues for addressing these challenges, this review focused on the characteristics and clinical features of long-term NSCLC survivors and the potential biomarkers of response to ICIs.

http://bit.ly/2UPYYrp

A Case of Castleman Disease with Recurrence in the Neck: Case Report and Literature Review

Publication date: Available online 6 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Feng Feng, Jianjin Zheng, Tao Li, Wen Liu

Abstract

Castleman disease (CD) is a rare lymphoproliferative disorder with an uncertain etiology. It is necessary to review the known cases since it is easy to overlook the possibility of CD in clinical diagnosis.

http://bit.ly/2WK8y0x

Annual Meeting to Focus on Research

Publication date: Available online 6 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s):

http://bit.ly/2RHzcDx

Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit

The aim of this study was to investigate whether there is an association between temperament characteristics of preschool children, dental anxiety, and their dental behaviour. A total of 100 children, aged 3–5 yr, who were attending their initial dental visit accompanied by a parent, were included in this cross‐sectional study. Dental anxiety of children was measured using the Facial Image Scale. The behaviour of children during the initial oral examination and oral prophylaxis was assessed using Frankl's behaviour rating scale. Temperament was assessed using Emotionality, Activity, Shyness Temperament Survey for Children (parental ratings). Statistically significant weak linear positive correlations were seen between the following: the percentage duration of definitely negative behaviour and shyness scores (r _s = 0.28); anxiety level and emotionality scores (r _s = 0.28); and anxiety level and shyness scores (r _s = 0.26). Multinomial logistic regression analysis revealed that children with higher anxiety had higher odds of showing definitely negative behaviour, which decreased with increasing age of the child. Emotionality and shyness temperaments may be weakly associated with dental anxiety, and shyness may be weakly associated with the dental behaviour of the preschool child. Definitely negative dental behaviour is associated with dental anxiety and age of the child.

http://bit.ly/2WNdS35

Tumor volume as a predictive parameter in the sequential therapy (induction chemotherapy) of head and neck squamous cell carcinomas

Abstract

Purpose

Tumor volume in locally advanced head and neck squamous cell carcinomas (LAHNSCC) treated by induction chemotherapy (ICT) and followed by radiochemotherapy (RCT) was measured. The presence of potential correlation of initial tumor volume and volume reduction after ICT and RCT with remission status, overall survival (OS) and disease-free survival (DFS) were investigated. Furthermore, reliability of approximation of the tumor volume relying on its diameter to manual three-dimensional measurement was assessed.

Methods

Data of patients with LAHNSCC treated by ICT consisting of docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by definite RCT were retrospectively analyzed. The tumor volume was calculated slice-by-slice in contrast-enhanced CT or MRI before and after ICT as well as after complete treatment. The volume was compared to radiologic remission status, correlated with OS and DFS, and to volume estimation using tumor diameter.

Result

65 patients were included. Primary tumor volume did not correlate with complete remission rate (CR) after ICT and RCT, OS or DFS. The change in tumor volume between baseline imaging and post-RCT had a significant impact on OS (p = 0.026) and DFS (p = 0.028). The agreement between tumor volume and radiologic remission was 72.14%.

Conclusion

The initial tumor volume had no influence on CR, OS or DFS. A severe response to ICT did not predict a powerful RCT outcome. The change in tumor volume post-RCT had an impact on OS and DFS. Tumor volume estimation using its diameter seems to be a reliable method.

http://bit.ly/2GbQaZu

Pediatric otogenic lateral sinus thrombosis: focus on the prognostic role of contralateral venous drainage

http://bit.ly/2MThH2u

Diagnostik und Therapie von Riechstörungen

Zusammenfassung

Hintergrund

Dysosmien zählen zu den häufigsten Störungen/Erkrankungen im HNO-Fachgebiet, epidemiologische Daten fehlen weitgehend, und die Therapiestrategien sind unzureichend standardisiert.

Fragestellung

Erhebung der Ursachen von Riechstörungen und den angewendeten Behandlungsstrategien an HNO-Kliniken im deutschsprachigen Raum. Auswertung und Vergleich mit den Ergebnissen aus der Umfrage im Jahr 2000 und Durchführung einer Literaturanalyse zur Therapie von Riechstörungen.

Material und Methoden

Die Umfrage erfolgte 2010 mit einem zweiseitigen Fragebogen zu Riechstörungen, der an alle HNO-Kliniken im deutschsprachigen Raum verschickt wurde. Die Analyse schloss die Literatur aus PubMed, der Cochrane Library sowie themenrelevanten Leitlinien ein.

Ergebnisse

An HNO-Kliniken wurde die Diagnose Dysosmie seltener gestellt (Rückgang um 52 %) Die 3 am häufigsten genannten Therapieansätze waren Kortikosteroide (topisch und systemisch) und systemische Antibiotika. Bei sinunasalen Dysosmien zeigte sich in der Literaturanalyse ein kleiner bis mittlerer Effekt von topischen Steroiden.

Schlussfolgerung

Da eine Halbierung der Prävalenz von Riechstörungen unwahrscheinlich ist, beruht die geringere Patientenzahl möglicherweise auf einer kritischeren Diagnostik. Die Anwendung des Riechtrainings hat in den Kliniken stark zugenommen (von <6 % auf 29 %). Der Einsatz von topischen Steroiden bei der Behandlung von sinunasalen Dysosmien ist evidenzbasiert. Das Riechtraining stellt besonders bei postinfektiösen und posttraumatischen Riechstörungen eine sichere und effektive Therapieoption dar.

http://bit.ly/2GqfbQ2

Sweet syndrome in metastatic melanoma during treatment with dabrafenib and trametinib

http://bit.ly/2MTgFn8

Dermoscopy of blue naevus on acral volar skin: A review of the literature

http://bit.ly/2DW5tmM

Acute inflammatory and immunologic responses against antigen in chronic bird-related hypersensitivity pneumonitis

Publication date: Available online 6 February 2019

Source: Allergology International

Author(s): Yukihisa Inoue, Masahiro Ishizuka, Haruhiko Furusawa, Takayuki Honda, Tatsuo Kawahara, Tomoya Tateishi, Yasunari Miyazaki

Abstract

Background

Hypersensitivity pneumonitis (HP) is an immune-mediated lung disease induced by the inhalation of a wide variety of antigens and a persistent antigen exposure induces inevitably pulmonary fibrosis in chronic HP. Although neutrophils, Th1 and Th17 cells contribute to lung inflammation in acute phase of HP, there is no clear explanation as to how the immunological reaction occurs just after the inhalation of causative antigens in the chronic phase of HP.

Methods

We examined the inflammatory and immunologic profiles before and after the inhalation provocation test (IPT) in serum and bronchoalveolar lavage fluid (BALF) from patients with chronic bird-related HP (BRHP) and other interstitial lung diseases (ILDs). We analyzed BALF samples from 39 patients (19 BRHP and 20 other ILDs) and serum samples from 25 consecutive patients (20 BRHP and 5 other ILDs) who underwent the IPT.

Results

A significant increase of neutrophils was observed in the BALF from the BRHP patients following the IPT. Neutrophil chemoattractants, namely, granulocyte colony-stimulating factor, IL-6, IL-8, IL-17, and CXCL2 significantly increased in both the serum and BALF of the BRHP patients after the IPT. Serum IFN-γ and CXCL10, cytokines/chemokines that contributed to Th1 inflammation, were also significantly increased in BRHP following the IPT.

Conclusions

This study demonstrated the exposure to the causative antigen provoked acute neutrophilic and Th1 immunologic responses similar to acute HP even in the chronic phase of HP.

http://bit.ly/2SBz6BM

Urban/rural residence effect on emergency department visits arising from food-induced anaphylaxis

Publication date: Available online 5 February 2019

Source: Allergology International

Author(s): Rie Sakai-Bizmark, Scott M.I. Friedlander, Karin Oshima, Eliza J. Webber, Laurie A. Mena, Emily H. Marr, Yoshikazu Ohtsuka

Abstract

Background

Anaphylaxis is a severe and potentially fatal allergic response. Early-life exposure to rural environments may help protect against allergic reaction. This study assesses urban/rural differences by age and race/ethnicity in emergency department (ED) pediatric visit rates for food-induced anaphylaxis.

Methods

This observational study examined 2009–2014 inpatient and ED data from New York and Florida, using ICD-9-CM diagnostic code (995.6) to identify food-induced anaphylaxis cases <18 y/o. Primary predictor of interest was urban/rural setting, with race/ethnicity and age also evaluated. Associations between ED visit rates and urban/rural setting were evaluated by multivariable hierarchical negative binomial regression with state and year fixed effects.

Results

ED visit rates (per 100,000) for food-induced anaphylaxis were 12.31 and 4.60 in urban and rural settings, respectively. Rates were highest among Blacks (15.26) younger urban children (17.29) and older rural children (6.99). Compared to rural, urban children had significantly higher anaphalaxis ED visit rates (IRR 2.77).

Conclusions

Food-induced anaphylaxis ED visit rates were highest among younger urban children and Black children, with a notable contrast in age distribution between urban and rural rates. Higher urban rates may be attributed to Hygiene Hypothesis, though racial, economic and emergency care access disparities may also influence these outcomes.

http://bit.ly/2Gqwhgt

A pilot study of interferon-alpha-2b dose reduction in the adjuvant therapy of high-risk melanoma

http://bit.ly/2t94ucz

Mutations resulting in the formation of hyperactive complement convertases support cytocidal effect of anti-CD20 immunotherapeutics

Abstract

Anti-CD20 monoclonal antibodies (mAbs) rituximab and ofatumumab are potent activators of the classical complement pathway, and have been approved for the treatment of B-cell malignancies. However, complement exhaustion and overexpression of complement inhibitors by cancer cells diminish their therapeutic potential. The strategies of targeting membrane complement inhibitors by function-blocking antibodies and the supplementation with fresh frozen plasma have been proposed to overcome tumour cell resistance. We present a novel approach, which utilizes gain-of-function variants of complement factor B (FB), a component of alternative C3/C5 convertases, which augment mAb-activated reactions through a positive feedback mechanism called an amplification loop. If complement concentration is limited, an addition of quadruple gain-of-function FB mutant p.D279G p.F286L p.K323E p.Y363A (or selected single mutants) results in significantly increased complement-mediated lysis of ofatumumab-resistant tumour cells, as well as the complete lysis of moderately sensitive cells. Importantly, this effect cannot be achieved by further increasing ofatumumab concentration. Potentiation of cytotoxic effect towards moderately sensitive cells was less apparent at physiological serum concentration. However, an addition of hyperactive FB could compensate the loss of cytotoxic potential of serum collected from the NHL and CLL patients after infusion of rituximab. Residual levels of rituximab in such sera, in combination with added FB, were able to efficiently lyse tumour cells. We suggest that the administration of gain-of-function variants of FB can restore CDC potential of complement-exhausted serum and maximize the therapeutic effect of circulating anti-CD20 mAbs.

http://bit.ly/2HU7pjz

Malformations of the lateral semicircular canal correlated with data from the audiogram

Abstract

Objectives

Lateral semicircular canal (LSCC) malformations are one of the most common inner ear malformations. The purpose of this study is to analyze the prevalence and type of hearing losses associated with LSCC malformations, compared to a control group.

Materials and methods

We retrospectively included 109 patients (166 ears) presenting with a CT-confirmed LSCC malformation, compared to a control group (24 patients). The bony island surface and the width of the inner portion of the LSCC were measured to confirm the malformation. There results were correlated to audiogram data: sensorineural (SHNL), mixed (MHL) or conductive hearing loss (CHL) by an otologist.

Results

In the LSCC group, 60.9% of patients presented with an audiogram-confirmed hearing loss, especially SNHL (39.2%, n = 65) and MHL (12.7%, n = 21). Hearing was normal in 39.2% (n = 65) of the cases. Bilateral LSCC malformations (n = 57) were frequently associated with hearing loss (80.7%), SNHL in most of the cases (33.3%). Unilateral LSCC malformations were associated with hearing alterations (51.9%, n = 27), but we also observed a high rate (81%, n = 42) of contralateral abnormalities of the audiogram.

Conclusion

LSCC malformations are commonly associated with hearing loss (61%), especially SHNL (39%). The high rate (81%) of contralateral hearing disturbances in unilateral LSCC malformations should be taken into account in the patient's daily life to avoid triggering or exacerbating any hearing loss. Otologists and radiologists must cooperate to ensure that all malformations are correctly described on CT, especially to improve the patient's education regarding hearing preservation.

http://bit.ly/2HWEETz

Endovascular Treatment of Ruptured Renal Artery Aneurysm: A Case-Based Literature Review

Renal artery aneurysms are extremely uncommon with a reported incidence of less than one percent in general population. They are being more frequently detected due to increasing availability and use of abdominal imaging. Renal artery aneurysm rupture is an extremely unusual cause of acute flank pain with hemodynamic instability. Given the rarity of diagnoses, clinicians may not consider and address this ruptured renal artery aneurysm early which can potentially lead to adverse clinical outcomes. We report the case of a 55-year-old male who presented with retroperitoneal bleeding from a ruptured aneurysm of the interlobular branch of renal artery. He was endovascularly treated with coil embolization. We have also reviewed the inherent literature.

http://bit.ly/2MOQTjE

Αρχειοθήκη ιστολογίου

Τετάρτη 6 Φεβρουαρίου 2019

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