Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Σάββατο 9 Φεβρουαρίου 2019

Papular Spreaded Necrobiosis Lipoidica: a rare clinical presentation of this pathology

Abstract

A 69‐year‐old Caucasian woman suffering from long‐term diabetes mellitus type II was referred to our dermatology department with cutaneous lesions that appeared 3 years before. They were itchy and non‐tender, and spreaded progressively, with no history of previous trauma. Examination revealed multiple erythematous to yellowish papules on the lower legs, which merged in plaques, of varying shapes and sizes (Fig.1).

This article is protected by copyright. All rights reserved.



http://bit.ly/2TGpKSN

Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol.

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Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol.

Acta Otorhinolaryngol Ital. 2018 Dec 29;:

Authors: Meccariello G, Montevecchi F, D'Agostino G, Zeccardo E, Al-Raswashdeh MFH, De Vito A, Vicini C

Abstract
The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery is still controversial. The aim of this study was to assess the efficacy of an institutional antibiotic prophylactic protocol in preventing surgical site infection after parotidectomy. The medical charts of 448 patients who underwent parotidectomy were reviewed. Patients were divided in two groups according the use of perioperative administration of intravenous cefazolin or post-operative week course of antibiotics. Surgical site infection was registered in 29 (6.5%) cases, 16 (5.7%) within the group before the application of protocol and 13 (7.9%) within the antibiotic prophylaxis protocol group. The univariate and multivariate logistic regression analyses showed that predictors for surgical site infection were the amount of drain output ≥ 50 ml in the first post-operative 24 hours (OR: 4.86; 1.59-14.82 95% CI; p < 0.01) and history of a previous parotid acute infection (OR: 13.83; 5.31-36 95% CI; p < 0.01). The majority of post-surgical infections (82%) were treated with intravenous antibiotic therapy. The remnants were treated surgically. Perioperative antibiotic treatment is recommended for patients undergoing parotid gland surgery and intravenous antibiotics during the post-operative course are highly suggested in case of history of previous acute parotid infection and drain output ≥ 50 ml in first 24 hours.

PMID: 30632521 [PubMed - as supplied by publisher]



http://bit.ly/2RnDUuS

Oculorespiratory Reflex During Repair of an Orbital Fracture.

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Oculorespiratory Reflex During Repair of an Orbital Fracture.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Dang RP, Bhatt NK, Rizzi CJ, Chi JJ

PMID: 30730542 [PubMed - as supplied by publisher]



http://bit.ly/2GuWz14

The Centers for Medicare & Medicaid Services' Overhaul of Office-Visit Payments-What's the Bottom Line for Otolaryngology?

Related Articles

The Centers for Medicare & Medicaid Services' Overhaul of Office-Visit Payments-What's the Bottom Line for Otolaryngology?

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Rathi VK, Varvares MA, Naunheim MR

PMID: 30730534 [PubMed - as supplied by publisher]



http://bit.ly/2GxG0lc

Does Chronic Rhinosinusitis Lead to Psychiatric Disease?

Related Articles

Does Chronic Rhinosinusitis Lead to Psychiatric Disease?

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: McCoul ED

PMID: 30730532 [PubMed - as supplied by publisher]



http://bit.ly/2RTCiV8

„Für eine Welt ohne Allergien“

So weit, wie das ambitionierte Motto des 13. Deutschen Allergiekongresses erahnen lassen könnte, ist es leider noch lange nicht. Doch wie man diesem bislang noch weit entfernten Ziel ein Stück näher kommen könnte, wurde Ende September in Dresden diskutiert. Behandelte Themen waren unter anderem Defizite in der Anapylaxietherapie und gezielte Exposition versus Allergenvermeidung.



http://bit.ly/2MYdTwO

Gezielte Exposition versus Allergenmeidung



http://bit.ly/2SE9Gn9

Planung von langer Hand lohnt sich

Für die meisten niedergelassenen Ärzte ist der Verkauf ihrer Praxis am Berufsende ein wichtiger Baustein der eigenen Altersvorsorge. Ein Plan, der angesichts schwindender Zahlen junger Mediziner immer seltener aufgeht. Tatsächlich treibt viele Ärzte die Sorge um, wie sie ihren Ruhestand finanzieren sollen, so ein aktuelles Umfrageergebnis.



http://bit.ly/2MVqvEO

Schlechte Bewertungen im Internet: dulden oder löschen lassen?

Arztbewertungsportale im Internet erfreuen sich zunehmender Beliebtheit. Leider äußern sich dort aber vor allem unzufriedene Patienten. Vernichtende Kritik wirkt im Internet jedoch als Blickfang: Schon einige wenige solcher Bewertungen können die Leistung eines Arztes in ein völlig falsches Licht rücken. Ein Blick auf die rechtlichen Hintergründe zum Umgang mit solchen Bewertungen.



http://bit.ly/2SDTyC3

Allergologie unter Druck



http://bit.ly/2MZvftk

So sicher ist die intranasale Glukokortikoidtherapie

Auch wenn die intranasale Glukokorikoidtherapie als sicher gilt, befürchten manche systemische Nebenwirkungen, wie sie von einer oralen Anwendung bekannt sind. Bisher gab es keine Metaanalysen, mit deren Hilfe dies geklärt werden konnte. HNO-Ärzte aus den USA konnten diese Lücke nun schließen.



http://bit.ly/2N2f7r2

Weitergabe von Daten und Datenübertragung — nur mit Einwilligung?

Durch die Datenschutzgrundverordnung (DSGVO) ist in der Ärzteschaft Verunsicherung darüber entstanden, unter welchen Voraussetzungen Patientendaten an Dritte weitergegeben werden dürfen. Es besteht oftmals die Sorge, für jede Weitergabe von Patientendaten eine schriftliche Einwilligung des Patienten zu benötigen und so im Papierwust zu ersticken. Im Fokus steht dabei die Weitergabe von Daten an weiter- oder nachbehandelnde Ärzte, an Labore sowie an Abrechnungsgesellschaften. Doch auch außerhalb des Praxisalltags ist der Thematik Beachtung zu schenken.



http://bit.ly/2SE9xjB

Praxisöffnungszeiten — neuer Liebling der Populisten



http://bit.ly/2SE9tjR

Lesenswerte Therapiebegleitung für Tumorpatienten



http://bit.ly/2MYTZBJ

Spezifische Immuntherapie: Warnung vor unbedachter Anwendung



http://bit.ly/2SE9oN5

Akupunktur bei allergischen Erkrankungen — wann ist sie sinnvoll?



http://bit.ly/2MVqv7M

Leiomyosarcoma and Pleomorphic Dermal Sarcoma: Guidelines for Diagnosis and Treatment

B. Llombart, C. Serra-Guillén, C. Requena, M. Alsina, D. Morgado-Carrasco, I. Machado, O. Sanmartín
Actas Dermosifiliogr.2019;110:4-11

Abstract - Full Text - PDF

http://bit.ly/2DAhBZp

The Super Shaving Technique to Correct the Trapdoor Effect in Nasal Flaps

J. Correa, J. Magliano, I. Peres, C. Bazzano
Actas Dermosifiliogr.2019;110:33-7

Abstract - Full Text - PDF

http://bit.ly/2Dqu4hY

Skin, Body Dysmorphic Disorder, and Other Syndromes

C. Martínez-González
Actas Dermosifiliogr.2019;110:1

Full Text - PDF

http://bit.ly/2Smcypj

Is the Current Classification of Urethritis as Gonococcal or Nongonoccal Becoming Obsolete?

V.M. Leis-Dosil
Actas Dermosifiliogr.2019;110:2-3

Full Text - PDF

http://bit.ly/2SlWkwx

Psoriasis and Depression: The Role of Inflammation

S. González-Parra, E. Daudén
Actas Dermosifiliogr.2019;110:12-9

Abstract - Full Text - PDF

http://bit.ly/2Smcwhb

Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist

J. Arimany Manso, C. Martin Fumadó, J.M. Mascaró Ballester
Actas Dermosifiliogr.2019;110:20-7

Abstract - Full Text - PDF

http://bit.ly/2Drw89n

Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study

S.E. Marron, T. Gracia-Cazaña, A. Miranda-Sivelo, S. Lamas-Diaz, L. Tomas-Aragones
Actas Dermosifiliogr.2019;110:28-32

Abstract - Full Text - PDF

http://bit.ly/2Sp2XOy

Haemophilus Species Isolated in Urethral Exudates as a Possible Causative Agent in Acute Urethritis: A Study of 38 Cases

J. Magdaleno-Tapial, C. Valenzuela-Oñate, M.M. Giacaman-von der Weth, B. Ferrer-Guillén, Á. Martínez-Domenech, M. García-Legaz Martínez, J.M. Ortiz-Salvador, D. Subiabre-Ferrer, P. Hernández-Bel
Actas Dermosifiliogr.2019;110:38-42

Abstract - Full Text - PDF

http://bit.ly/2SkJTRI

Granulomatous Reaction in a Patient With Metastatic Melanoma Treated With Ipilimumab: First Case Reported With Isolated Cutaneous Findings

J. Cervantes, A. Rosen, L. Dehesa, G. Dickinson, J. Alonso-Llamazares
Actas Dermosifiliogr.2019;110:43-9

Abstract - Full Text - PDF

http://bit.ly/2DuG7Ls

Recessive Dystrophic Epidermolysis Bullosa and Pregnancy

F. Boria, R. Maseda, M. Martín-Cameán, M. De la Calle, R. de Lucas
Actas Dermosifiliogr.2019;110:50-2

Abstract - Full Text - PDF

http://bit.ly/2SkAIkn

Erythematous Papules on the Dorsum of the Hand

C. Maldonado Seral, C. Gómez de Castro, B. Vivanco Allende
Actas Dermosifiliogr.2019;110:e1-e2

Full Text - PDF

http://bit.ly/2DAhD3t

Recurrent Facial Edema

J. Sabater Abad, C. Lloret Ruiz, E. Quecedo Estébanez
Actas Dermosifiliogr.2019;110:e3-e4

Full Text - PDF

http://bit.ly/2SkAF8b

Scratch-Induced Lesions…Without the Scratching

J.L. Ramírez-Bellver, A. Alegre-Sánchez
Actas Dermosifiliogr.2019;110:e5

Full Text - PDF

http://bit.ly/2Smc2I4

Torus Palatinus

E. Rozas-Pérez, C. Bravo, E. Rozas-Muñoz
Actas Dermosifiliogr.2019;110:e6

Full Text - PDF

http://bit.ly/2DndWho

Granulocyte Colony-Stimulating Factor (G-Csf)–Producing Giant Squamous Cell Carcinoma of the Scrotum

M. Takako, K. Yasunobu, Y. Toshiyuki
Actas Dermosifiliogr.2019;110:57-9

Full Text - PDF

http://bit.ly/2SkAw4D

Advanced-Stage Thymoma Associating Multiple Paraneoplastic Syndromes with Good Response to Oral Corticosteroids and Topical Tacrolimus

S. Sánchez-Pérez, C. Monteagudo-Castro, J.M. Martín-Hernández, M.D. Ramón-Quiles
Actas Dermosifiliogr.2019;110:60-2

Full Text - PDF

http://bit.ly/2DsANYT

Mastocytosis With Associated Essential Thrombocythemia

J. Marcoval
Actas Dermosifiliogr.2019;110:63-4

Full Text - PDF

http://bit.ly/2SqDWmt

Dermatomyositis-like Eruption in a Woman Treated With Hydroxyurea

E. Moreno-Artero, J.J. Paricio, J. Antoñanzas, A. España
Actas Dermosifiliogr.2019;110:64-7

Full Text - PDF

http://bit.ly/2DuROS2

Black and Brown Oro-facial Mucocutaneous Neoplasms

Abstract

Black and brown-colored mucocutaneous lesions present a differential diagnostic challenge, with malignant melanoma being the primary clinical concern. The vast majority of pigmented lesions in the head and neck region are the result of benign, reactive factors such as post-inflammatory melanosis. However, it is not uncommon to discover a range of muco-cutaneous black and brown neoplasms in the oro-facial area. The majority of black/brown pigmented neoplasms are melanocytic in origin; these are neoplasms of neural crest derivation. Melanocytic nevi are a diverse group of benign neoplasms that are the result of specific oncogenic mutations. They are common on cutaneous surfaces but can manifest in mucosal sites. Currently, nevi are classified based on clinical and histological criteria. The most common cutaneous and oral mucosal nevus is the acquired melanocytic nevus; nevi do not pose an increased risk for the development of malignant melanoma. Emerging information on specific genetic differences supports the notion of biologically distinct nevi. This article will review the classic clinical and microscopic features of nevi commonly found in the head and neck region, and discuss emerging concepts in nevus pathogenesis and taxonomy. Melanoma is a malignant melanocytic neoplasm and is a result of cumulative genetic deregulation. The etiology of malignant melanoma (MM) is multifactorial and includes underlying genetic susceptibility, UV radiation, skin-type, and race. The majority of MM occurs on cutaneous surfaces and less commonly on mucosal and extra-cutaneous visceral organs. Regardless of location, MM exhibits clinical-pathological features that relate to horizontal or vertical tumor spread. Cutaneous and mucosal MM typically present as asymmetrical, irregularly bordered, large (> 0.5 cm), heterogeneous brown-black lesions with foci of erythema, atrophy or ulceration. As with melanocytic nevi, advances in melanomagenesis research have revealed primary oncogenic BRAF and NRAS mutations associated with cutaneous MM. Unlike their cutaneous counterparts, mucosal melanomas exhibit primary oncogenic alterations in c-KIT and other genes. This article will discuss the role of specific primary oncogenic and secondary/tertiary genetic defects in differential clinical presentation, anatomic distribution, future classification changes, and targeted therapy of melanoma. The clinical and microscopic features of mucosal melanomas and a summary of management guidelines will be discussed. Additionally, this article will cover the salient features of melanocytic neuroectodermal tumor of infancy, a neoplastic entity that can involve the oro-facial region, and the clinical-pathological features of selected, commonly occurring pigmented ectodermally-derived neoplasms that are often part of the clinical differential diagnosis of black–brown pigmented lesions.



http://bit.ly/2G6YR6q

Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

Abstract

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.



http://bit.ly/2E0qHzS

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

Abstract

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.



http://bit.ly/2TfsKp2

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.



http://bit.ly/2FZue3A

Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities

Abstract

Erythematous lesions of the oral mucosa are common and can reflect a variety of conditions, ranging from benign reactive or immunologically-mediated disorders to malignant disease. Together with vascular abnormalities, which can vary from reddish to bluish-purple in color, the differential diagnosis for erythematous oral mucosal change is quite diverse. This review focuses on salient clinical features and histopathologic findings of selected conditions which clinically present as red or vascular-like oral mucosal alterations, including oral vascular malformations and neoplasms, pyogenic granuloma, localized juvenile spongiotic gingival hyperplasia, denture stomatitis, benign migratory glossitis (geographic tongue), orofacial granulomatosis, granulomatosis with polyangiitis (Wegener granulomatosis), megaloblastic anemia, and erythroplakia. Recognition of the characteristic clinical features of these conditions, in conjunction with thorough patient history, will allow clinicians to narrow the differential diagnosis and guide appropriate clinical decision making, including the need for tissue biopsy, in order to complete the diagnostic process and initiate optimal patient care.



http://bit.ly/2G7qUmo

Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions

Abstract

Excluding human papillomavirus (HPV)-driven conditions, oral papillary lesions consist of a variety of reactive and neoplastic conditions and, on occasion, can herald internal malignancy or be part of a syndrome. The objectives of this paper are to review the clinical and histopathological features of the most commonly encountered non-HPV papillary conditions of the oral mucosa. These include normal anatomic structures (retrocuspid papillae, lingual tonsils), reactive lesions (hairy tongue, inflammatory papillary hyperplasia), neoplastic lesions (giant cell fibroma), lesions of unknown pathogenesis (verruciform xanthoma, spongiotic gingival hyperplasia) and others associated with syndromes (for instance Cowden syndrome) or representing paraneoplastic conditions (malignant acanthosis nigricans). Common questions regarding differential diagnosis, management, and diagnostic pitfalls are addressed, stressing the importance of clinico-pathologic correlation and collaboration.



http://bit.ly/2FUqLDk

A Rainbow of Colors and Spectrum of Textures: An Approach to Oral Mucosal Entities



http://bit.ly/2FZ9zNl

Candidiasis: Red and White Manifestations in the Oral Cavity

Abstract

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.



http://bit.ly/2G7qMmO

Lumps and Bumps of the Gingiva: A Pathological Miscellany

Abstract

Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.



http://bit.ly/2FWagql

HPV-Related Papillary Lesions of the Oral Mucosa: A Review

Abstract

Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.



http://bit.ly/2FYoPtE

Tongue Lumps and Bumps: Histopathological Dilemmas and Clues for Diagnosis

Abstract

Exophytic lesions of the tongue encompass a diverse spectrum of entities. These are most commonly reactive, arising in response to local trauma but can also be neoplastic of epithelial, mesenchymal or miscellaneous origin. In most cases, the microscopic examination is likely to provide a straightforward diagnosis. However, some cases can still raise microscopic diagnostic dilemmas, such as conditions that mimic malignancies, benign tumors with overlapping features and anecdotal lesions. A series of "lumps and bumps" of the tongue are presented together with suggested clues that can assist in reaching a correct diagnosis, emphasizing the importance of the clinico-pathological correlations.



http://bit.ly/2G7qH2u

Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa

Abstract

White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.



http://bit.ly/2U9yVL4

Lichenoid Characteristics in Premalignant Verrucous Lesions and Verrucous Carcinoma of the Oral Cavity

Abstract

Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features seen in these lesions. Following IRB approval, cases of VH and VC from 1994 to 2014 were retrieved from the archives of UF Oral Pathology Biopsy Service. A panel of 4 board-certified oral and maxillofacial pathologists reviewed and scored the presence or absence of 5 lichenoid features: band-like infiltrate (BLI), saw tooth rete ridges (STRR), interface stomatitis (IS), civatte bodies (CB), and basement membrane degeneration (BMD). Cases not fulfilling the stringent selection criteria were excluded. A total of 70 cases of VH and 56 cases of VC were included. Approximately 25% of both VH and VC cases exhibited 3 or more lichenoid features. By Chi square testing, BLI (p = 0.000), IS (p = 0.005), and CB (p = 0.026) were significantly more common in VC than VH. Gingival lesions had significantly less frequent BLI (p = 0.004) and IS (p = 0.024) versus other sites. However, STRR was significantly more common in VH than VC (p = 0.000) in the gingiva. (p = 0.002). Statistical analysis revealed that the only significant valid association was the increased presence of band-like infiltrate in VC over VH (p = 0.001). Lichenoid features are common in both VH and VC and may represent a nonspecific inflammatory response to the dysplasia or malignancy rather than concomitant lichenoid disease. This could lead to significant under diagnoses of these premalignant or potentially malignant lesions by pathologists.



http://bit.ly/2U87q4B

Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa

Abstract

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.



http://bit.ly/2DsEw9V

Development and Characterization of a Novel Monoclonal Antibody Against Chitinase-like Protein CHID1 Applicable for Immunohistochemistry on Formalin Fixed Paraffin-Embedded Sections

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


http://bit.ly/2tfTF8Q

PMab-210: A Monoclonal Antibody Against Pig Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


http://bit.ly/2UNxTVv

Epitope Mapping of Antidiacylglycerol Kinase α Monoclonal Antibody DaMab-2

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


http://bit.ly/2UQJ7sq

The Diagnostic Tests for Detection of Helicobacter pylori Infection

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


http://bit.ly/2teYmzN

Respiratory Syncytial Virus

Viral Immunology, Ahead of Print.


http://bit.ly/2UNxUJ3

Penalized Supervised Star Plots: Example Application in Influenza-Specific CD4+ T Cells

Viral Immunology, Ahead of Print.


http://bit.ly/2tewdIU

Serological and T Cell Responses After Varicella Zoster Virus Vaccination in HIV-Positive Patients Undergoing Renal Dialysis

Viral Immunology, Ahead of Print.


http://bit.ly/2US6VMn

Cerebrovascular pathology in cerebral amyloid angiopathy presenting as intracerebral haemorrhage

Abstract

Cerebral amyloid angiopathy (CAA) is the second most common cause of non-traumatic intracerebral haemorrhage (ICH) accounting for 12–15% of lobar haemorrhages in the elderly. Definitive diagnosis of CAA requires histological evaluation. We aimed to evaluate the spectrum of cerebrovascular changes in CAA-related ICH. Between 2011 and 2015, biopsy-confirmed cases of CAA were retrieved and clinical, radiological and pathological features were reviewed. The spectrum of vascular alterations was evaluated and amyloid deposition was graded in accordance with the Greenberg and Vonsattel scale. Seven cases of sporadic CAA [5 males and 2 females] were diagnosed, none of whom were suspected to have CAA pre-operatively. Six presented with large intracerebral haematoma (ICH) requiring neurosurgical intervention (age range: 56–70 years) and one had episodic headache and multiple microhaemorrhages requiring a diagnostic brain biopsy (45 years). In the presence of large ICH, vascular amyloid deposits were of moderate to severe grade (grade 4 in 4, grades 2 and 3 in 1 case each) with predominant involvement of medium (200–500 μm) to large (> 500 μm) leptomeningeal vessels. Fibrinoid necrosis was noted in four. Two were hypertensive and on antiplatelet agents. β-Amyloid plaques were detected in two, one of whom had symptomatic dementia. MRI performed in 3 of 6 cases with ICH did not reveal any microhaemorrhages. Amyloid deposits in small (50–200 μm) to medium (200–500 μm) calibre intracortical vessels produced parenchymal microhemorrhages. Histopathological examination of ICH is essential for diagnosing CAA. The vascular calibre rather than grade of amyloid deposits dictates size of the bleed. Presence of co-morbidities such as antiplatelet agents may predispose to haemorrhage.



http://bit.ly/2BpeNxB

Role of epithelial–mesenchymal transition factors in the histogenesis of uterine carcinomas

Abstract

Several subtypes of high-grade endometrial carcinomas (ECs) contain an undifferentiated component of non-epithelial morphology, including undifferentiated and dedifferentiated carcinomas and carcinosarcomas (CSs). The mechanism by which an EC undergoes dedifferentiation has been the subject of much debate. The epithelial–mesenchymal transition (EMT) is one of the mechanisms implicated in the transdifferentiation of high-grade carcinomas. To improve our understanding of the role of EMT in these tumors, we studied a series of 89 carcinomas including 14 undifferentiated/dedifferentiated endometrial carcinomas (UECs/DECs), 49 CSs (21 endometrial, 29 tubo-ovarian and peritoneal), 17 endometrioid carcinomas (grade 1–3), and 9 high-grade serous carcinomas of the uterus, using a panel of antibodies targeting known epithelial markers (Pan-Keratin AE1/AE3 and E-cadherin), mesenchymal markers (N-cadherin), EMT transcription factors (TFs) (ZEB1, ZEB2, TWIST1), PAX8, estrogen receptors (ER), progesterone receptors (PR), and the p53 protein. At least one of the three EMT markers (more frequently ZEB1) was positive in the sarcomatous component of 98% (n = 48/49) of CSs and 98% (n = 13/14) of the undifferentiated component of UEC/DEC. In addition, 86% of sarcomatous areas of CSs and 79% of the undifferentiated component of UEC/DEC expressed all three EMT-TFs. The expression of these markers was associated with the loss of or reduction in epithelial markers (Pan-keratin, E-cadherin), PAX8, and hormone receptors. In contrast, none of the endometrioid and serous endometrial carcinomas expressed ZEB1, while 6% and 36% of endometrioid and 11% and 25% of serous carcinomas focally expressed ZEB2 and TWIST1, respectively. Although morphologically different, EMT appears to be implicated in the dedifferentiation in both CSs and UEC/DEC. Indeed, we speculate that the occurrence of EMT in a well differentiated endometrioid carcinoma may consecutively lead to a dedifferentiated and undifferentiated carcinoma, while in a type II carcinoma, it may result in a CS.



http://bit.ly/2TFboSv

Acknowledgement to reviewers 2018



http://bit.ly/2BwYA9P

Comprehensive analysis of PD-L1 expression, HER2 amplification, ALK/EML4 fusion, and mismatch repair deficiency as putative predictive and prognostic factors in ovarian carcinoma

Abstract

Most ovarian carcinomas (OC) are characterized by poor prognosis, particularly the most frequent type high-grade serous carcinoma. Besides PARP inhibitors, target-based therapeutic strategies are not well established. We asked the question which other therapeutic targets could be of potential value and, therefore, analyzed a large cohort of OC for several predictive factors. Two hundred eighty-eight (288) cases of OC including the major histological types were analyzed by immunohistochemistry for PD-L1HER2, ALK, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6. HER2 amplification and ALK/EML4 fusion were assessed by fluorescence in situ hybridization. The most frequent finding was PD-L1 expression ≥ 1% in 19.5% of the cases, which correlated with a significantly better overall survival in multivariate analysis (p < 0.001). HER2 amplification was detected in 11 cases (4%), all high-grade serous carcinomas. Amplification of HER2 did not correlate with patients' survival. ALK/EML4 fusion was found in two cases (0.74%): one high-grade serous and one endometrioid carcinoma. MMR deficiency was only present in one case of stage IV high-grade serous carcinoma. Subsets of high-grade serous carcinomas show PD-L1 expression and HER2 amplification, respectively, and, therefore, could qualify for immune checkpoint inhibitor therapy or anti HER2 therapy. PD-L1 is also of prognostic impact. ALK/EML4 fusion is very rare in OC and not a putative therapeutic target.



http://bit.ly/2TFbklJ

Compact buds with biphasic differentiation and calcitonin-expressing neuroendocrine cells—previously unrecognized structures of thyroglossal duct unveiled by immunohistochemistry

Abstract

Immunophenotype of thyroglossal duct (TGD) cysts, including lining epithelium and thyroid remnants, is scarcely addressed in the literature. There is indirect evidence that C cells may be derived from progenitor cells of the midline thyroid primordium. This is supported by the recent concept of the endodermal origin of lateral thyroid anlagen and several case reports. We aimed to search for neuroendocrine cells in TGD cysts and to characterize immunophenotype of the thyroid follicles and epithelial lining of TGD. Out of 98 TGD cysts, 70% contained both cyst-lining epithelium and thyroid follicles, whereas 30% possessed only cyst-lining epithelium. Specimens eligible for immunohistochemistry (n = 61) were stained for thyroid-specific and neuroendocrine markers. Thyroid remnants were positive for thyroid transcription factor 1 (TTF-1) and other thyroid tissue-specific markers and negative for calcitonin. TGD epithelium showed strong p63 positivity. We found that respiratory epithelium in 9.8% of TGDs contained neuroendocrine cells positive for calcitonin, chromogranin A, and synaptophysin but negative for carcinoembryonic antigen. In 44.2% of the cases, we detected compact buds, microscopic structures appearing as nests of epithelial cells with a biphasic population of basal (p63+) and central (TTF-1+) cells. Thyroid remnants in TGD expressed full spectrum of thyroid-specific markers and contained no C cells. Instead, calcitonin-expressing neuroendocrine cells were found among the respiratory epithelium of TGD. These cells can be a potential source of neuroendocrine tumors mimicking medullary carcinoma in median anlage derivatives. We also discovered precursor compact buds with dual immunophenotype and proposed a concept of their morphogenesis.



http://bit.ly/2BtAEnQ

A mismatch repair-deficient and HPV-negative anorectal squamous cell carcinoma

Abstract

Invasive primary squamous cell carcinomas involving the anorectal region are challenging to manage. Microsatellite instability has been shown to impact clinical courses and outcomes of patients affected by many types of carcinomas. To the best of our knowledge, there are no reports on microsatellite instability in anorectal squamous cell carcinomas. Here, we report a HPV-negative anorectal squamous cell carcinoma which, despite cisplatin-based chemoradiation therapy, showed progression. Interestingly, after identification of its mismatch repair-deficiency (MLH1/PMS2-absent, MSH2/MSH6-intact), pembrolizumab-based immunotherapy was initiated, leading to a marked clinical response. This unique case illustrates that microsatellite instability testing and immunotherapy targeting immune checkpoint blockade should be considered for managing anorectal squamous cell carcinomas that fail conventional chemoradiation therapies or when patients are non-surgical candidates. This report provides the first evidence of microsatellite instability in anorectal squamous cell carcinomas and supports the role for microsatellite instability testing in this cancer type to optimize patient management.



http://bit.ly/2TBF8zI

National multicentric evaluation of quality of pathology reports for rectal cancer in France in 2016

Abstract

The quality of pathologic assessment of rectal cancer specimens is crucial for treatment efficiency and survival. The Royal College of Pathologists (RCP) recommends evaluating the quality of the pathology report in routine practice using three quality indicators (QIs): the number of lymph nodes (LNs) analyzed (≥ 12), the rate of venous invasion (VI ≥ 30%), and peritoneal involvement (pT4a ≥ 10%). In this study, we evaluated the three QIs of the French national pathology reports and compared them with British guidelines and assessed the influence of neoadjuvant radiochemotherapy on QIs. From January 1 to December 31, 2016, all pathology reports for rectal adenocarcinoma were collected from French departments. Neoadjuvant radiochemotherapy included long-course radiotherapy with concomitant 5-FU-based chemotherapy. A total of 983 rectal cancer pathology reports were evaluated. A median of 15 LNs were analyzed and 81% of centers had ≥ 12 LNs. The rate of VI was 30% and 41% of centers had ≥ 30% VI. The rate of pT4a was 4% and 18% of centers reported ≥ 10% pT4a. None of the centers reached the threshold for the three QIs. All three QIs were lower after radiochemotherapy compared to surgery alone. In conclusion, in French routine practice, the values of two of the three QIs (LNs analyzed and VI) were globally in line with RCP guidelines. However, the rate of pT4a was very low, particularly after radiochemotherapy, suggesting its low value in rectal cancer.



http://bit.ly/2BvCsfU

European follow-up of incorrect biomarker results for colorectal cancer demonstrates the importance of quality improvement projects

Abstract

Biomarker analysis for colorectal cancer has been shown to be reliable in Europe with 97% of samples tested by EQA participants to be correctly classified. This study focuses on errors during the annual EQA assessment. The aim was to explore the causes and actions related to the observed errors and to provide feedback and assess any improvement between 2016 and 2017. An electronic survey was sent to all laboratories with minimum one genotyping error or technical failure on ten tumor samples. A workshop was organized based on 2016 survey responses. Improvement of performance in 2017 was assessed for returning participants (n = 76), survey respondents (n = 13) and workshop participants (n = 4). Survey respondents and workshop participants improved in terms of (maximum) analysis score, successful participation, and genotyping errors compared to all returning participants. In 2016, mostly pre- and post-analytical errors (both 25%) were observed caused by unsuitability of the tumor tissue for molecular analysis. In 2017, most errors were due to analytical problems (50.0%) caused by methodological problems. The most common actions taken (n = 58) were protocol revisions (34.5%) and staff training (15.5%). In 24.1% of issues identified no action was performed. Corrective actions were linked to an improved performance, especially if performed by the pathologist. Although biomarker testing has improved over time, error occurrence at different phases stresses the need for quality improvement throughout the test process. Participation to quality improvement projects and a close collaboration with the pathologist can have a positive influence on performance.



http://bit.ly/2THIUrd

Analysis of the prognostic relevance of sex-steroid hormonal receptor mRNA expression in muscle-invasive urothelial carcinoma of the urinary bladder

Abstract

Muscle-invasive urothelial carcinoma of the urinary bladder (UCB) often recurs following radical cystectomy (RC). An altered expression of sex-steroid hormone receptors has been associated with oncological outcomes of UCB and may represent therapeutic targets. Here the expression of different hormone receptors was measured on mRNA levels in patients treated by RC and associated with outcomes. Androgen receptor (AR), estrogen receptor 1 (ESR1), and progesterone receptor (PGR) mRNA expression was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in RC samples of 87 patients with a median age of 66 (39–88) years. Univariate and multivariate analyses were performed to test associations with pathological and clinical characteristics as well as recurrence-free (RFS) and disease-specific survival (DSS). AR mRNA expression was lower in comparison with ESR1 and PGR expression (p < 0.0001). In univariate analysis, high expression levels of AR were associated with reduced RFS (HR 2.8, p = 0.015) and DSS (HR 2.8, p = 0.010). High AR mRNA expression and a positive lymph node status were independent predictors for reduced RFS (HR 2.5, p = 0.0049) and DSS (HR 3.4, p = 0.009). In patients with low AR mRNA expression, an increased ESR1 and PGR mRNA expression were associated with reduced RFS and DSS. High expression levels of AR are significantly associated with adverse outcome in patients with muscle-invasive UCB following RC. ESR1 and PGR expression status can further stratify patients with low AR expression into subgroups with significantly reduced RFS and DSS. Therapeutic targeting of AR may influence outcomes in patients with UCB.



http://bit.ly/2BrNO4P

Acute Epstein–Barr virus-positive cytotoxic T cell lymphoid hyperplasia in the upper aerodigestive tract, mimicking extranodal natural killer/T cell lymphoma, nasal type

Abstract

To describe the clinicopathological features of nine patients with acute Epstein–Barr virus (EBV)-positive cytotoxic T cell lymphoid hyperplasia (EBV+TLH) in the upper aerodigestive tract, in which initial findings led to a preliminary misdiagnosis of extranodal NK/T cell lymphoma, nasal type (ENKTL). A series of nine cases of EBV+TLH in one Chinese institution over a 9-year interval was retrospectively analyzed. Median age was 16 years (range 5–29 years) with a M:F ratio of 5:4. All patients were previously healthy with an acute onset period of < 1 month. Six patients (66%) presented with masses or polypoid protrusions in the upper aerodigestive tract. Nasopharyngeal symptoms, cervical lymphadenopathy, and fever were found in 89%, 78%, and 56% of patients, respectively. In seven cases, morphology mainly showed small-sized irregular cells and in two cases medium-to-large cells. In all cases, the cells diffusely expressed cytoplasmic CD3 and at least one marker for cytotoxic granules, but were negative for CD56. CD5 expression was detected in eight cases (8/9, 89%). In all cases, double staining for CD3 and EBER indicated that most T cells were infected with EBV. T cell receptor gene rearrangement was performed in five cases and all showed polyclonal results. All patients achieved complete remission within 1 month after diagnosis without any chemoradiotherapy and were followed up 19–124 months without recurrent disease. EBV+TLH in the upper aerodigestive tract is occasionally observed in China. The histopathologic features of EBV+TLH can mimic ENKTL. EBV+TLH should be taken into consideration as a potential diagnosis when the disease duration is short, spontaneous remission is achieved without intervention, and when histology shows infiltration with EBV-infected T lymphocytes.



http://bit.ly/2TNSE3a

Targeted sequencing with a customized panel to assess histological typing in endometrial carcinoma

Abstract

The two most frequent types of endometrial cancer (EC) are endometrioid (EEC) and serous carcinomas (SC). Differential diagnosis between them is not always easy. A subset of endometrial cancers shows misleading microscopical features, which cause problems in differential diagnosis, and may be a good scenario for next-generation sequencing. Previous studies have assessed the usefulness of targeted sequencing with panels of generic cancer-associated genes in EC histological typing. Based on the analysis of TCGA (The Cancer Genome Atlas), EEC and SC have different mutational profiles. In this proof of principle study, we have performed targeted sequencing analysis with a customized panel, based on the TCGA mutational profile of EEC and SC, in a series of 24 tumors (16 EEC and 8 SC). Our panel comprised coding and non-coding sequences of the following genes: ABCC9, ARID1A, ARID5B, ATR, BCOR, CCND1, CDH19, CHD4, COL11A1, CSDE1, CSMD3, CTCF, CTNNB1, EP300, ERBB2, FBXW7, FGFR2, FOXA2, KLLN, KMT2B, KRAS, MAP3K4, MKI67, NRAS, PGAP3, PIK3CA, PIK3R1, PPP2R1A, PRPF18, PTEN, RPL22, SCARNA11, SIN3A, SMARCA4, SPOP, TAF1, TP53, TSPYL2, USP36, and WRAP53. Targeted sequencing validation by Sanger sequencing and immunohistochemistry was performed in a group of genes. POLE mutation status was assessed by Sanger sequencing. The most mutated genes were PTEN (93.7%), ARID1A (68.7%), PIK3CA (50%), and KMT2B (43.7%) for EEC, and TP53 (87.5%), PIK3CA (50%), and PPP2R1A (25%) for SC. Our panel allowed correct classification of all tumors in the two categories (EEC, SC). Coexistence of mutations in PTEN, ARID1A, and KMT2B was diagnostic of EEC. On the other hand, absence of PTEN, ARID1A, and KMT2B mutations in the presence of TP53 mutation was diagnostic of SC. This proof of concept study demonstrates the suitability of targeted sequencing with a customized endometrial cancer gene panel as an additional tool for confirming histological typing.



http://bit.ly/2TFZWpV

In this issue



http://bit.ly/2BpeKlp

Validation of the pathological prognostic staging system proposed in the revised eighth edition of the AJCC staging manual in different molecular subtypes of breast cancer

Abstract

The authors investigated the clinical utility of the revised prognostic staging system proposed in the eighth edition of the American Joint Committee on Cancer (AJCC) staging manual in breast cancer (BC) patients. We retrospectively reviewed the data of 714 BC patients that received surgical treatment and standard adjuvant therapy from January 2005 to December 2007. All patients were restaged for anatomic TNM stage and pathological prognostic (PP) stage as defined in the revised eighth edition of the AJCC manual. Compared with anatomic stage, PP stage was different from anatomic stage in 325 (45.5%) patients, 254 were down-staged and 71 were upstaged. There were significant differences in overall survival (OS) and disease-free survival (DFS) according to different anatomic stages or PP stages (all, p < 0.001). In anatomic stage I patients, OS was significantly different between PP stages IA and IB (p < 0.001), but no significant difference was observed between anatomic stages IA and IB (p = 0.413). PP stages exhibited significant OS differences in anatomic stage IIB (p = 0.011), but survival differences according to PP stages were not observed in anatomic stage IIA, IIIA, or IIIC. PP stages were found to have prognostic value with respect to OS and DFS for luminal (p < 0.001 and p < 0.001), HER2-positive (p = 0.001 and p = 0.013), and triple-negative (p = 0.008 and p = 0.03) subtypes. The prognostic staging system proposed in the eighth edition of the AJCC more accurately predicts the clinical outcomes of BC patients than the traditional anatomic staging system.



http://bit.ly/2TGeyFP

Evaluation of tumor-infiltrating lymphocytes in osteosarcomas of the jaws: a multicenter study

Abstract

The aim of the present study was to investigate the profile of tumor-infiltrating lymphocytes (TIL) in osteosarcomas of the jaws (OSJ). A total of 21 OSJ samples were analyzed in a retrospective and cross-sectional multicenter study. Immunohistochemistry was performed to determine the recognition of TIL such as CD4+, CD8+, granzyme B+ (GrB), programmed cell death protein+ (PD-1), and cytotoxic T lymphocyte-associated antigen 4+ (CTLA-4) in intratumoral and peripheral (stromal) regions. Positivity was determined based on the percentage and density of TIL+ per square millimeter [1 = absent (< 25 cells/mm2), 2 = low (25 to 130 cells/mm2), and 3 = high (> 130 cells/mm2)]. The association of TIL density with clinicopathologic data was determined by the Mann-Whitney test (p < 0.05). OSJ were positive for CD8+ cells in 45% (n = 9) of cases, for CD4+ cells in 30% (n = 6) of cases, and for CTLA-4+ in 4.8% (n = 1) of cases, with a score of 2 (low TIL) in all cases. All cases were negative for GrB and PD-1 (score 1). No association was observed between immune infiltrate and clinicopathologic findings. OSJ showed a microenvironment with low TIL, including failure of effectiveness of the antitumor immune response (absence of GrB+ cells), and few cells exhibited immunotherapeutic targets, such as CTLA-4 and PD-1.



http://bit.ly/2BqxIs4

Dental injuries in patients associated with fracture of facial bones

Abstract

Purpose

To assess different types of dental injuries associated with facial bone fractures.

Method

One hundred dentate patients were selected randomly of all age and gender who had maxillofacial trauma only and having dental injury in association with facial bones fractures were included. They were thoroughly examined for injury/fracture to facial region as well as for dental injuries (teeth). Tooth injuries were noted according to Ellis classification. The data was collected, compiled, and put to statistical analysis.

Results

Dental injuries were more in females than males found to be statistically significant with (p < 0.05).Crown fracture of maxillary teeth was more as compared to mandibular except molars found to be statistically significant (p < 0.05). Root fracture was more in maxillary incisors followed by canine as compared to mandibular incisors and canines found to be insignificant. Avulsion, extrusion and luxation were more in maxilla as compared to mandible found to be significant.

Conclusion

Different types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth.



http://bit.ly/2ShDMgS

Guaiacol/β-cyclodextrin for rapid healing of dry socket: antibacterial activity, cytotoxicity, and bone repair—an animal study

Abstract

Purpose

Dry socket (DS) is one the most common and symptomatic post-extraction complications; however, no consensus on its treatment has been reached. This study aimed to develop a novel dressing material for DS containing the phenolic agent guaiacol and evaluate its biological properties.

Methods

An inclusion complex of guaiacol and β-cyclodextrin (Gu/βcd) was prepared by freeze-drying. Its antibacterial activity over six oral bacteria was analyzed using the microdilution method, and its cytotoxicity in osteoblasts was assessed with the MTT assay. The alveolar healing process induced by Gu/βcd was evaluated histologically after the treatment of DS in rats.

Results

βcd complexation potentiated Gu's antibacterial effect and reduced its cytotoxicity in osteoblasts. Bone trabeculae were formed in the alveolar apices of rats treated with Gu/βcd by day 7. On day 14, woven bone occupied the apical and middle thirds of the sockets; on day 21, the entire alveolus was filled by newly formed bone, which was in a more advanced stage of repair than the positive control (Alvogyl™).

Conclusion

The improvement in Gu's biological properties in vitro and the rapid alveolar repair in comparison with Alvogyl™ in vivo demonstrated the benefits of the Gu/βcd complex as a future alternative for the treatment of DS.



http://bit.ly/2E1GkXO

Surgical management of recurrent TMJ dislocation—a systematic review

Abstract

Purpose

Recurrent temporomandibular joint (TMJ) dislocation can be challenging to treat and the current understanding regarding aetiology and management of this condition is limited. The aim of this paper was to conduct a systematic review regarding the management of recurrent TMJ dislocation.

Methods

A literature review was conducted using PRISMA guidelines to identify papers published between 2006 and 2016. The resultant papers were analysed.

Results

A total of 33 papers were found relevant to the study. Minimally invasive techniques described included autologous blood injection, which was associated with an overall success of 80% at 12 months. Other modalities investigated included OK-432 sclerotherapy, laser capsulorrhaphy, botulinum toxin of the lateral pterygoid muscle or modified dextrose. These publications show promising success rates.

Surgical techniques described included disc plication, eminoplasty and eminectomy. These modalities had a similar success rate, although numbers were limited. The true incidence of recurrent TMJ dislocation is unknown and aetiology is limited to expert opinion.

Conclusion

The current understanding of management for recurrent TMJ dislocation is limited to case series and case reports. This paper compiles the current understanding of management of recurrent TMJ dislocation. Compared to previous reviews, this paper describes some novel minimally invasive techniques with promising success in the management of recurrent TMJ dislocation.



http://bit.ly/2Dj1jDZ

A case of minor salivary gland sialolithiasis of the upper lip

Abstract

Background

Sialolithiasis is the most common disease of the salivary glands. Sialolithiasis usually develops in the major salivary glands, and rarely in the minor salivary glands, with only 2% of all cases of sialolithiasis occurring in the minor salivary glands and sublingual glands. Sialoliths in the minor salivary glands result in few or no clinical symptoms and are seldom identified on imaging.

Case presentation

We report herein our experience with a case of minor salivary gland sialolithiasis in a 67-year-old woman. On examination, an elastic soft, mobile, and well-circumscribed mass was palpable within the left upper lip. Ultrasound examination revealed a hypoechoic mass with heterogeneous internal echoes. The mass was excised under local anesthesia. Based on histopathological findings, a diagnosis of minor salivary gland sialolithiasis was established.

Conclusions

Diagnosis of minor salivary gland sialolithiasis is challenging due to the difficulty of detecting sialoliths on imaging. A well-circumscribed mass was detected in the upper lip, and ultrasound examination revealed a round lesion, raising the suspicion of a benign tumor. Other diseases that can develop at the upper lip are calcified lymph node, phlebolith, fibroma, pleomorphic adenoma, myxoma, vascular malformation, salivary gland tumor, non-specific sialadenitis, and malignant tumor. Surgical excision is the favored approach for confirming a diagnosis of intramucosal nodular lesions.



http://bit.ly/2SnDODn

Bone response after immediate placement of implants in the anterior maxilla: a systematic review

Abstract

Purpose

The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla.

Methods

After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochrane, and Scopus. In addition, the gray literature was also researched using Google Scholar and ProQuest. Two reviewers independently screened for eligible studies, assessed the methodological quality, and extracted the data. The inclusion criteria were observational studies and experimental studies that assessed bone response after the immediate installation of a single implant in a fresh extraction socket, immediately loaded or not, in the region between the maxillary canines. Studies were included in any language, with no publication date restrictions and with a minimum of 6 months of follow-up after the surgical procedure.

Results

From a total of 3272 articles, only 12 studies met the inclusion criteria and were selected for the review. Bone remodeling after immediate installation of a dental implant was assessed using standardized periapical radiographs and cone beam computed tomography (CBCT).

Conclusion

It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation.



http://bit.ly/2WLc6jg

Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study

Abstract

Introduction

To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis.

Methods

The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05).

Results

The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm2), G2(1.05 ± 0,27 mm2), and G3(1.08 ± 0.27 mm2).There was a statistically significant difference between CO (0.87 ± 0.12 mm2), G2 (1.00 ± 0.12 mm2), and G3 (1.11 ± 0.14 mm2) at 14 days. There was a statistically significant linear difference between the groups in all periods.

Conclusion

Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.



http://bit.ly/2S0rYj3

Use of population data for assessing trends in work-related asthma mortality

Purpose of review Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. Recent findings A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. Summary Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available. Correspondence to Jacek M. Mazurek, MD, MS, PhD, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Mailstop HG908, 1095 Willowdale Road, Morgantown, WV 26505, USA. Tel: +1 304 285 5983; e-mail: jmazurek1@cdc.gov Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GI3SEx

Phenotypes of wheezing and asthma in preschool children

Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezing phenotypes are heterogeneous and complex, with trajectories that are related to factors including environmental exposures. More research is needed to characterize these relationships, hopefully leading to targeted prevention strategies. Correspondence to Leonard B. Bacharier, MD, Campus Box 8116, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Tel: +1 314 454 2694; e-mail: Bacharier_l@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2QGvlpU

The impact of exercise on asthma

Purpose of review Asthma is one of the most common chronic diseases in children and adults in developed countries around the world. Despite international treatment guidelines, poor asthma control remains a frequent problem leading to missed school and work, and emergency room visits and hospitalizations. Many patients with asthma report exercise as a trigger for their asthma, which likely leads to exercise avoidance as a means to control symptoms. Evolving research has suggested that routine exercise may actually help improve some aspects of asthma control. This review discusses the recent research addressing how routine exercise affects important asthma-related outcomes including symptoms, lung function and quality of life. Recent findings Several systematic reviews and meta-analyses have been conducted in recent years, which strongly support the safety of routine exercise in children and adults with asthma. Exercise appears to favor improvements in aerobic fitness, asthma symptoms and quality of life, but results so far are less consistent in demonstrating improvements to lung function and airway hyperresponsiveness. Summary In addition to routine management guidelines, clinicians should recommend for their patients with asthma routine exercise for its general health benefits and likely improvement in asthma symptoms and quality of life. Correspondence to Jason E. Lang, MD, MPH, Division of Allergy/Immunology and Pulmonary Medicine, Duke Children's Hospital and Health Center, MSRB-1 203 Research Drive Rm 127, Durham, North Carolina, USA. Tel: +1 919 684 8657; fax: +1 919 684 2292; e-mail: jason.lang@duke.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RjRtuy

How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience

Purpose of review Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice. Recent findings DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable. Summary DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context. Correspondence to Alessandro Fiocchi, MD, Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City. Tel: +39 06 6859 4777; e-mail: Agiovanni.fiocchi@opbg.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Fpio1v

Severe asthma in children: therapeutic considerations

Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. Recent findings Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain. Summary Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed. Correspondence to Sejal Saglani, MD, Imperial College London, London, UK. E-mail: s.saglani@imperial.ac.uk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Bg2LH5

Advances in the pathogenesis representing definite outcomes in chronic urticaria

Purpose of review We reviewed in this article, the recent advances in CSU physiopathology and potential clinical and laboratory biomarkers in CSU. Recent findings In addition to the central role of mast cells in urticaria physiopathology, increased interest in basophils has arisen. Recent data corroborate the autoimmunity pathway as one of the main pathways in mast cell activation. The association of inflammatory cytokines, heat shock proteins and staphylococcal infection with CSU are also reviewed. C-reactive protein, D-dimers, autologous serum skin test, IgE levels and FcεRI expression in basophils have shown their potential as biomarkers for disease duration, activity, severity and/or response to treatment. Summary A comprehensive understanding of chronic spontaneous urticaria mechanisms is essential to find novel biomarkers and treatments. The use of these biomarkers in clinical practice will guide us in choosing the best treatment option for our patients. Correspondence to Luis Felipe Ensina, MD, PhD, Rua Barata Ribeiro, 490, São Paulo, SP 01308-000, Brazil. Tel: +55 11 3123 5777; e-mail: drluisensina@imunologiaealergia.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2U7uznR

Neutrophil activation in occupational asthma

Purpose of review The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. Recent findings Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. Summary New insights into neutrophils in the pathogenesis of occupational asthma may provide a novel approach to the individual patient with occupational asthma. Correspondence to Hae-Sim Park, MD, PhD, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Korea. Tel: +82 31 219 5196; fax: +82 31 219 5154; e-mail: hspark@ajou.ac.kr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RjRHlo

Contributions of innate lymphocytes to allergic responses

Purpose of review Allergic diseases represent a growing global health concern, especially among pediatric populations. Current strategies for the treatment of allergies and asthma focus on limiting the severity of the symptoms; however, additional research investigating the mechanisms promoting inflammation in the context of allergic reactions may lead to the development of more effective therapeutic strategies. Recent findings Novel studies have highlighted the contributions of innate lymphocytes to the induction of inflammatory responses to allergens. Remarkably, neuron-derived signals, hormones, and even vitamins have been suggested to modulate the activity of innate lymphocytes, opening new windows of opportunity for the treatment of allergic inflammation. Summary These studies highlight the complex interactions of the nervous, endocrine, and immune system that promote pathology in the context of allergic inflammation. Further studies are required to understand these interactions in order to aid in the development of novel and much-needed therapies to treat allergic conditions. Correspondence to Mark C. Siracusa, Department of Medicine Cancer Center, G1226 Rutgers New Jersey Medical School 205 South Orange Avenue, Newark, NJ 07103, USA. Tel: +1-973-972-1265; fax: +1-973-972-2525; e-mail: mark.siracusa@rutgers.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DrgaNU

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design

Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies. Recent findings For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed. Summary Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies. Correspondence to Ekaterina Safroneeva, PhD, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland. E-mail: ekaterina.safroneeva@ispm.unibe.ch Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2QZ7SQY

Diagnosis of occupational hypersensitivity pneumonitis

Purpose of review To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. Recent findings In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers tend to rely on their own experience and establish diagnosis by consensus among their multidisciplinary teams. Though recommendable in many ways, this method presents significant limitations. Summary Diagnosis of OHP should be made with a thorough clinical history of the symptoms and clinical signs as well as a meticulous review, if possible by an expert, of possible exposures in the working environment; a meticulous physical examination; high-resolution computed tomography of the thorax; serum determination of specific immunoglobuline Gs; bronchoalveolar lavage and possibly cryobiopsy; fungal culture; and, when appropriate, a specific inhalation challenge test with the suspected antigen. Correspondence to Ferran Morell, MD, PhD, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Catalonia, Spain. Tel: +34 932746157; fax: +34 932746083; e-mail: fmorell@vhebron.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pFtO

Vitamin D and childhood asthma: causation and contribution to disease activity

Purpose of review To review the literature of the past 18 months (April 2017 through September, 2018) relating to vitamin D and childhood asthma. Recent findings A combined analysis of two clinical trials of maternal vitamin D supplementation trials showed a significant protective effect of vitamin D supplementation trials in the primary prevention of asthma and recurrent wheeze up to age 3 years. Secondary analyses from these trials have also suggested that initial maternal vitamin D status could affect the response to supplementation during pregnancy, with the biggest protective effect in children born to mothers with initial 25hydroxyvitamin D (25OHD) levels of at least 30 ng/ml. A postnatal, 6-month vitamin D supplementation trial in black, premature babies showed a 34% decreased risk of recurrent wheezing at 1 year among the infants who received supplementation. An individual patient data meta-analysis of published clinical trials concluded that vitamin D supplementation decreased the risk of asthma exacerbations in those with 25OHD levels less than 10 ng/ml. Results of observational analyses on primary prevention of asthma and in prevention of exacerbations remain mixed, with the bulk of the evidence suggesting that there is a protective effect of higher vitamin D levels. Summary Evidence continues to accumulate that vitamin D supplementation helps to prevent the development of asthma and recurrent wheeze in early life, and may also help in the management of asthma. The level(s) of circulating vitamin D that maximizes these effects remains to be identified. Correspondence to Augusto A. Litonjua, MD, MPH, Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY 14642, USA. Tel: +1 585 275 6544; e-mail: augusto_litonjua@urmc.rochester.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2SvXGRo

Management of acute loss of asthma control: yellow zone strategies

Purpose of review Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative. Correspondence to Brooke I. Polk, MD, Division of Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, Campus Box 8116, St. Louis, MO 63110, USA. Tel: +1 314 454 2694; fax: +1 314 454 2694; e-mail: bpolk@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2R0AGIz

Precision medicine in childhood asthma

Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Summary Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab. Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma. Correspondence to Mariëlle W. Pijnenburg, MD, PhD, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC – Sophia, University Medical Center Rotterdam, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 107036263; e-mail: m.pijnenburg@erasmusmc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pAX2

Single inhaler maintenance and reliever therapy in pediatric asthma

Purpose of review Asthma affects more than 25 million people worldwide and continues to grow in prevalence. According to a center for disease control and prevention (CDC) report, the total annual cost of asthma in the United States between 2008 and 2013, including medical care, absenteeism, and mortality, was $81.9 billion. Although the National Institute of Health guidelines recommend fixed inhaled corticosteroid (ICS) dosing, the 2008–2010 Medical Expenditure Panel Survey showed that asthma is still poorly controlled. Single inhaler maintenance and reliever therapy (SMART) offers a possible alternative management plan. This is a review of SMART vs. current treatment guidelines. Recent findings SMART addresses variable inflammation with symptom-driven dosing of ICS. It relies on a combination inhaler that has a long-acting β-agonist, which has an immediate onset of action to provide quick relief, in combination with an ICS. Recent studies show that SMART decreases the frequency and severity of asthma exacerbations when compared to fixed ICS dosing. In addition, intermittent use of ICS gave a reduced effect on growth and permitted a lower total amount of ICS to be delivered. Summary SMART appears to outperform treatment that is based on current guidelines in the United States. As inhalers capable of being used for SMART are already approved, what is needed is Food and Drug Administration approval of the SMART strategy. Correspondence to Jay M. Portnoy, MD, Section of Allergy, Asthma and Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. Tel: +1 816 960-8885; fax: +1 816 960-8888; e-mail: jportnoy@cmh.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D6QXbv

An Execution in Medieval Sicily: CT scan analysis and 3D reconstruction of an ancient forensic context.

Abstract

The bioarchaeological and forensic approach is increasingly applied in the study of funerary contexts in archeology. Here, we present a case of an atypical medieval burial recently discovered in Piazza Armerina (Sicily) in which the integrated use of traditional bioarchaeological and forensic anthropology methods was crucial. The skeleton was lying in a prone position and was characterized by a peculiar injury pattern. We recorded six clear stab wound marks on the posterior surface of the sternum. The use of CT scan and 3D modelling techniques has made it possible to obtain a reliable reconstruction of the cause and modality of death, pointing to the execution of the individual. The importance of this case study is twofold. First, the injury pattern recorded currently constitutes a unicum in the bioarchaeological record. Second, it represents the first well‐documented case of an atypical burial in Sicily.



http://bit.ly/2US3buj

CANINE SEX ESTIMATION AND SEXUAL DIMORPHISM IN THE COLLECTION OF IDENTIFIED SKELETONS OF THE UNIVERSITY OF COIMBRA, WITH AN APPLICATION IN A ROMAN CEMETERY FROM FARO, PORTUGAL

Abstract

Sexual estimation of human remains is an aspect of great importance for the characterization of demographic profiles in bioarcheology and to identify individuals in forensic cases. The aims of this paper are threefold: to generate population‐specific formulae for sex estimation based on permanent canine metrics, to evaluate the dental sexual dimorphism and to develop a Bayesian approach in a sample of 115 individuals from the documented human sample housed in the University of Coimbra (Portugal). Discriminant functions and logistic regression equations were developed and posterior probabilities were calculated. Formulae offered high percentages of correct sex assignation (77.42‐86.54% for the discriminant functions and 81.63‐85.18% for the logistic regression), while posterior probabilities ranged between 0.71 and 0.85. The procedures were then applied in an archaeological sample of 32 individuals from the Roman (I‐III century AC) cemetery of Ossonoba Romana (Faro, Portugal) in order to test the relevance of their use in this geographical‐related sample. The results of correct estimation are higher than 75% for three formulae and four combinations of variables in the Bayesian approach. Although phenotypic variation may be a factor influencing the sex estimations, canine odontometrics are powerful tools when previously tested, and can increase the amount of data obtained for paleodemographic and forensic purposes. In this case, some of the methods developed for the modern sample can be used in archaeological samples and in spatial and temporal‐related skeletal collections.



http://bit.ly/2E1hMy2

Exploring the Introduction of European Dogs to North America Through Shoulder Height

Abstract

The introduction of domesticated species to new environments has been used to identify colonization events in the archaeological record, but rarely provides the opportunity to investigate colonists' selection of particular breeds or stock. This analysis employs morphometrics, the measurement of skeletal landmarks, supported by historic documentation to explore the intersection between colonists' breed preferences and species translocation. In doing so, this analysis provides insight into the differential effects of human selective breeding on domestic dog's (Canis familiaris) physical characteristics in Native American and European societies. Historic sources suggest that European colonists selectively imported large dog breeds capable of defending settlements and livestock, acting as war dogs, and aiding hunters. Colonists' dogs are reputed to have been significantly larger than Native American dogs. This study compares standardized measurements taken on bones to estimate shoulder height. We find that dog populations in England and North America spanning the period 0‐1800 AD exhibit an almost identical average stature; however, the range of shoulder height variation in European dogs is far greater than seen in eastern Native American dog populations. Dogs in colonial American contexts are statistically larger than both Native American and European dog populations, supporting documentary accounts that colonists selectively imported breeds from the largest available in Europe.



http://bit.ly/2tdl4rR

Changes in indigenous population structure in colonial Mexico City and Morelos

Abstract

The Spanish conquest and colonization of Mexico had disastrous effects on indigenous people. Disease, coupled with drastic changes in the economic, political, and religious structures, led to an enormous depopulation event throughout the colony of New Spain. What remains unclear in historic and archaeological accounts of Spanish colonization in Mexico is the effects of these changes on indigenous population structure and variation. In this study, we use biological distance and population structure analyses of two Mexico City church ossuary samples from the 16th to 17th centuries, as well as a sample of burials from a convent in nearby Morelos, to investigate these relationships at the center of the Spanish colony in Central Mexico. Colonial samples are compared with a large dataset of pre‐contact samples from Central Mexico and the surrounding regions, to evaluate changes in population structures. We compare colonial and pre‐contact samples using biological distance analysis and a population structure program commonly applied in genetic analyses and modified for phenotypic data. Our results show that the colonial Mexico City samples are more biologically similar to the pre‐contact samples from Veracruz, Toluca Valley, and West Mexico than to other pre‐contact samples from the Valley of Mexico. The sample from Yecapixtla in Morelos is also most similar to the Veracruz, Toluca Valley, and West Mexico samples, but is also somewhat similar to the pre‐contact sample from Morelos and the nearby Oaxaca Valley. Generally, biological similarities among colonial samples and pre‐contact samples do not correlate with geographic proximity or population size, but coincide with cultural changes. Our study provides bioarchaeological evidence of some degree of population replacement, resulting from either forced migration from surrounding areas for labor, or through indigenous alliances with the Spanish conquerors. Our results also show concordance between traditional biodistance analysis, and non‐traditional analyses employed in population genetics studies.



http://bit.ly/2UKEEaK

Victims of a 17th century massacre in Central Europe: perimortem trauma of castle defenders

Abstract

Interments of massacre victims typically differ from normal funerary practices. Bodies are commonly not orderly buried, but are thrown into a single grave‐pit and exhibit multiple perimortem traumatic injuries. Although perimortem skeletal trauma constitutes the most direct and unambiguous evidence for violence and warfare in the past, analysis should take contextual information into account. The aim of our research is to examine the skeletal evidence of interpersonal violence in the remains of defenders of a castle in Gołańcz, Poland, who were killed in AD 1656 during the Polish‐Swedish War. This event is well documented in the historical sources, thereby providing the detailed socio‐cultural context.

Standard anthropological methods were used to estimate age‐at‐death and biological sex. Macroscopic morphological features developed by forensic anthropologists were applied to distinguish between antemortem, perimortem and postmortem trauma. Descriptive and metric attributes were analyzed for each injury.

Of the 25 skeletons recovered from a mass grave, 22 displayed evidence of perimortem trauma. In total, 90 injuries were found, mainly consisting of sharp‐force trauma. These included 79 injuries to the skull, two injuries to the teeth and nine injuries to the postcranial skeleton. Multiple traumatic lesions were found in 15 individuals (68.1%). The most prevalent were sharp‐force trauma (21 individuals, 95.5%), followed by blunt‐force trauma (two individuals, 9.1%.), with high‐velocity projectile wounds being least common (one individual, 4.5%). Two individuals had their teeth broken off in the perimortem period.

Our study revealed that the inhabitants of Gołańcz were subjected to an extreme level of interpersonal violence, as evidenced by the location, pattern, and distribution of the observed traumatic injuries. From archaeological and historical data, it is known that the event took place during the Swedish invasion into Poland. Our data demonstrate that violence was inflicted not only upon men, but also upon women and children. These findings are in contrast to written accounts, which maintain that the Swedish army spared women and children during the attack, and as such show bias inherent to culture‐related sources of information.



http://bit.ly/2tcvrfw

Acts of life: Assessing entheseal change as an indicator of social differentiation in post‐medieval Aalst (Belgium)

Abstract

Lower levels of physical activity are often linked to higher socio‐economic status (SES) in past societies. As an activity marker, changes at muscle attachment sites known as entheseal changes (EC) have been used with varying efficacy. This study investigates this proposed link between EC as a physical activity marker and socio‐economic status within one well‐defined temporo‐geographic context. EC data from 16 entheses in three skeletal collections from the post‐medieval town of Aalst, Belgium, were evaluated using the Coimbra method. The skeletal assemblages represent distinct socio‐economic groups, evidenced by historical and dietary isotope data. The Louis D'haeseleerstraat sample represents lower class individuals (n=46), the Hopmarkt sample middle class individuals (n=110), and the Saint Martin's church (n=13) higher class individuals. EC data are tested for correlation to status, age, and sex. EC patterns did not differ significantly between the SES groups at any entheses except the M. iliopsoas and common extensor, where the higher class showed more EC. Within the populations, at the Hopmarkt sexual differences were only observed in the Achilles tendon attachment, whereas at the Louis D'haeseleerstraat sexual differences were present in the M. triceps brachii, M. brachioradialis, and quadriceps entheses. Only some entheses showed a significant correlation with age, and these were inconsistent between populations. EC are not a reliable indicator of socio‐economic status in post‐medieval Aalst. This could suggest that the hypothesis that the wealthy were less physically active oversimplifies the lives of people in the past. It could also suggest that EC is not a suitable proxy for physical activity, or that it cannot be used without in‐depth knowledge of the types of activities performed by various socio‐economic groups in addition to consideration of all other etiological factors. This study illustrates the caution necessary when using EC as a proxy for social status in past societies.



http://bit.ly/2USDBWl

BONE TOOLS OF LATE HOLOCENE HUNTER‐GATHERER‐FISHERS OF NORTH‐CENTRAL CHILE: CASE STUDY OF THE PUNTA TEATINOS ASSEMBLAGE

Abstract

During the Late Holocene, important changes can be identified in the social dynamics of hunter‐gatherer populations in different regions of the southern Andes. These transformations are associated with processes of demographic growth, territoriality, increased social complexity, technological innovations, and intensified exploitation of the environment. One of the technological transformations associated with these processes is the popularization of bone instruments. In this study, we discuss the functions of bone tools made by Late Holocene coastal hunters‐gatherers of North‐Central Chile, by carrying out a morphological characterization and identifying use‐wear patterns on their surfaces. Our results show that bone technology was used for hunting, fishing, and gathering activities, from flint working to processing vegetal fibres and hide. A reduce number of artefacts had an ornamental use as well. These results suggest a varied and intensive exploitation of the surrounding space by coastal groups, where bones of land animals constituted an important part of the raw materials used in bone industry. Also, we argue that some bone artefacts were elements structuring social relations, as they participated in flows of information and social networks. We conclude by arguing that the popularization of bone industry reflects the dynamics of social complexity, as well as how bone was integrated as a productive, economic, and social resource in the process of coastal hunters and gatherers who inhabited the area.



http://bit.ly/2tiEcVf

Black woodpecker (Dryocopus martius L.) in the archaeozoological context of the Savvatiev Pustyn', a medieval rural Russian monastery

Abstract

Here we report a discovery of a bone of the black woodpecker (Dryocopus martius L.) in medieval layers of the rural Savvatiev Monastery (Tver Region, Russia). Deposited in the wooden house, presumably refectory, sub‐floor woodpecker's remains could be associated with an activity of the cat. A complex of bones, associated with the find, characterizes the place as a monastery.



http://bit.ly/2E20roR

Analysis of pathology and activity‐related changes to the patellae of individuals from Tell Abraq

Abstract

The examination of comingled ossuary collections creates unique analytical issues as bones are rarely articulated, requiring that the skeletal elements be examined on an individual basis. A result is that the estimation of crucial demographic information like age at death and sex becomes problematic and attempts to ascertain this information involve a high degree of error. Bearing these issues in mind, however, the focus of this project is to identify and interpret signs of osteoarthritis, osteochondritis dissecans, and osteochondral fracturing, as well as to score for the presence and degree of musculoskeletal markers, on patellae from the ossuary at Tell Abraq. A secondary goal of this project was to utilize the patellae to elicit both estimations of minimum number of individuals and the ratio of sex within the population.

Preliminary results indicate a high prevalence of osteoarthritis, osteochondritis dissecans, and enchondral fracture that was not correlated to estimated sex. This lack of correlation may be due to several factors, including difficulty in sex estimation based on metric analysis of a single element, a skewed sex distribution, or an actual lack of correlation. Regardless of the difficulties of estimating sex in a comingled collection, it seems clear that both men and women were exposed to conditions that fostered the development of osteoarthritis and that trauma to the knee was a common occurrence for those ultimately interred in the ossuary.



http://bit.ly/2GBc6wr

Leukemia in Ancient Egypt: earliest case and state‐of‐the‐art, techniques for diagnosing generalized osteolytic lesions

Abstract

Malignant bone tumors are uncommon among archaeological skeletal remains, and the general skeletal involvement is even less frequent. Multiple myelomas along with metastases are the most common conditions in paleopathology, whereas malignant myeloproliferative diseases have only been described in a handful of cases.

We present a probable case of acute lymphocytic leukemia in a skeleton of an individual from Ancient Egypt, dated to the end of the First Intermediate Period and the beginning of the Middle Kingdom (c 2160‐2000 BC). The excavation of the Temple of Millions of Years of Thutmosis III located in el‐Assasif (Luxor, Upper Egypt), recovered a total of 41 complete individual from an associated grave‐Necropolis placed close to the north enclosure wall. The individual, a 16 to 21 year‐old male, showed a severe disease affecting all the skeleton with, predominantly, osteolytic lesions and areas of new bone formation. Gross examination under magnification and X‐ray in field were performed.

We review the paleopathological literature to compare the cases previously reported of malignant disease. The morphology and distribution of the lesions of the individual are discussed to make an adequate differential diagnosis in the individual. Several criteria suggest that the disease was most likely acute lymphocytic leukemia: the individual died before the age of 21, the patterns of the bone lesions as well as its distribution below the elbow and knee joints, the presence of a gap in the coronal suture and the mandible involvement.

If this is the case, it would be the oldest case of leukemia described in Ancient Egypt, and could help to understand the evolution patterns of cancer in the history.



http://bit.ly/2E1tglk