Methemoglobinaemia with chronic phenazopyridine ingestion

http://bit.ly/2V2QXiQ

Neuroblastoma with an unusual ovarian metastasis in a 5-year-old girl

Neuroblastoma metastasizing to the ovary is rare. We report the 10th case and review the scarce literature. A 5-year-old girl with stage M neuroblastoma presented with an upper abdominal and a pelvic mass. Evaluation after induction showed very good tumour response with three remaining localisations: two abdominal and one pelvic. At gross total resection, the pelvic mass appeared to be the enlarged and abnormal right ovary and was removed completely. Pathology showed an ovarian metastasis. On completion of her postoperative treatment, she achieved complete remission. Literature review showed that underdiagnosing of ovarian metastasis in neuroblastoma is very likely.

http://bit.ly/2EbN6Kw

Spinal epidural lipomatosis following bilateral spinal decompression surgery

A 73-year-old man underwent bilateral spinal decompression of L4/5 for severe spinal canal stenosis, requiring minimal analgesia and providing immediate relief. Two days post-operatively, he presented with new onset bilateral leg pain and difficulty mobilising. MRI demonstrated spinal epidural lipomatosis (SEL), which was not present pre-operatively, at L5/S1. Further surgery was performed with decompression of L5/S1 through removal of epidural fat. At both 3 weeks and 5 months follow-up clinics, the patient was asymptomatic. To our knowledge, this is the first case of acute spinal epidural lipomatosis directly following spinal surgery. It is important to recognise SEL as a complication following spinal surgical intervention, due to the potential development of significant neurological consequences.

http://bit.ly/2V0fqFl

Liver transplant, toxoplasmosis and kidney stones: connecting the dots

http://bit.ly/2EfL6RB

MLL rearranged acute lymphoblastic leukaemia presenting as a maxillary sinus mass with a discordant immunophenotypic profile from the bone marrow

We describe an unusual case of pre-B lymphoblastic leukaemia presenting with a unilateral maxillary sinus mass in which biopsies of the primary mass and the bone marrow demonstrated conflicting immunophenotyping results. The extramedullary mass was consistent with a precursor B-cell malignancy, while the bone marrow was initially reported as a possible mature B-cell malignancy. The treatments for the two are fundamentally different, which necessitated a delay in the initiation of his chemotherapy until a clear diagnosis was made. Mixed lineage leukaemia gene rearrangement was confirmed by fluorescence in situ hybridisation in both the primary mass and bone marrow, which unified the diagnosis as pre-B acute lymphoblastic leukaemia given the common cytogenetic feature.

http://bit.ly/2V7LE1J

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea.

Related Articles

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Sarber KM, Ishman SL, Patil RD

PMID: 30763424 [PubMed - as supplied by publisher]

http://bit.ly/2GFIC0B

Reassessing the Safety of Bicycle Helmets-Finding Vulnerability in Strength.

Related Articles

Reassessing the Safety of Bicycle Helmets-Finding Vulnerability in Strength.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Joseph B, Hanna K

PMID: 30763413 [PubMed - as supplied by publisher]

http://bit.ly/2IfwvcM

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

Related Articles

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Bowe SN, Colaianni CA, Yamasaki A, Cummings BM, Hartnick CJ

Abstract
Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation.
Objective: Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR).
Design, Setting, and Participants: A standardized sedation weaning protocol was previously developed and instituted in February 2013. To address healthcare system-wide changes, a 7-step, Institute for Healthcare Improvement methodology was used to reevaluate a series of measures comparing a previous postweaning group (2013-2014; 13 patients) and current post-EHR group (2016; 11 patients). We conducted a focus group review of these 24 patients.
Main Outcomes and Measures: The primary outcome measure was length of sedation weaning. Secondary outcome, process, and balance measures included total length of sedation, absence of standardized wean document, absence of specific recommendations on weaning regimen, length of stay, continued weaning at discharge, discharge location, absence of discharge instructions on weaning regimen or iatrogenic withdrawal syndrome (IWS), discharge within 72 hours of stopping weaning, and readmission.
Results: The postweaning and post-EHR groups were similar in age, (20.5 months [95% CI, 11.92-29.15] vs 26.5 months [95% CI, 17.68-35.40]), as well as male sex, 11 of 13 [85%] vs 10 of 11 [91%]), respectively. In the post-EHR group, the standardized sedation wean document was missing from 9 of 11 (82%) medical records. However, the primary outcome measure, length of sedation weaning, remained stable at 9.45 (95% CI, 7.62-11.29) days in the post-EHR group compared with 9.08 (95% CI, 7.00-11.18) days in the postweaning group. In addition, only 5 of 11 (46%) of discharges in the post-EHR group had specific guidance on weaning since the standardized template was no longer in use. As a result, in the post-EHR group, patients were 15.2 (95% CI, 0.46-242.34) times as likely to lack discharge instructions on weaning or IWS.
Conclusions and Relevance: Quality improvement is meant to be a continuous process in which reevaluation of care practices are regularly performed. System-wide redesign can be achieved using a formal methodological approach. Moving forward, notable QI opportunities for our institution included the development of a flexible sedation weaning template, as well as enhancements to discharge instructions to include IWS diagnosis and treatment.

PMID: 30763412 [PubMed - as supplied by publisher]

http://bit.ly/2tmFVsH

TBX1 Functions as a Tumor Suppressor in Thyroid Cancer Through Inhibiting the Activities of the PI3K/AKT and MAPK/ERK Pathways

Thyroid, Ahead of Print.


http://bit.ly/2Gr8JJj

Calcifying Epithelial Odontogenic (Pindborg) Tumor in a Child: A Case Report and Literature Review

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is a rare neoplasm, which accounts for < 1% of all odontogenic tumors. CEOT occurs more frequently in adults with a peak incidence in the 5th decade of life and is extremely rare in the pediatric population. We present a case of a 13-year-old girl who was found to have a mandibular CEOT. We summarize the radiological features, pathological findings, clinical management and literature review focusing on this entity in children.

http://bit.ly/2SzYqJj

The stem cell markers expression CD44v6 and podoplanin in lip cancer: clinical significance

Abstract

This study aimed to analyze the immunoexpression of cancer stem cell markers, CD44v6, and podoplanin in 91 patients with lip squamous cell carcinomas (LSCC). The immunostaining of podoplanin and CD44v6 was evaluated in ten high-power fields (× 400 magnification) at the invasive front of LSCC, using a semi-quantitative score method. Chi-square test or Fisher's exact test was used to verify the association of podoplanin and CD44v6 expressions with clinicopathologic variables. Spearman's correlation test was used to analyze the correlation between the two antibodies in lip cancer. Disease-free survival probabilities in 5 and 10 years were estimated according to the Kaplan-Meier method and compared using the log-rank test. The independent effects of the significant variables were analyzed by Cox proportional hazards regression model. A strong podoplanin expression was observed in the membrane and cytoplasm of most lip tumor cells, and this was inversely associated with locoregional recurrence (p = 0.028) and with histopathological grade of malignancy (p = 0.026). Additionally, CD44v6 immunostaining was strongly expressed in the membrane of tumor cells in 95.4% of the LSCC. Patients with strong membranous (p = 0.016) or strong cytoplasmic (p = 0.030) podoplanin-positive tumors resulted in significantly better disease-free survival than those who had podoplanin weak/negative tumors, confirming podoplanin expression as a favorable independent prognostic factor. Podoplanin and CD44v6 were strongly expressed by tumor cells and podoplanin immunoexpression can help to determine lip cancer patients with lower risk for disease recurrence.

http://bit.ly/2Edcqjv

Human scalp hair: Modulation by various factors and hormones do estrogens inhibit or stimulate—A perplexing perspective

Summary

Several journal reports, reviews, and commentaries over the last 20‐25 years have pointed out the controversy attached to 17β‐estradiol's inhibitory or stimulatory influence on hair follicle growth/cycling citing rodent (murine) and human results. While 17β‐estradiol is the most potent sex steroid hormone in the body and has almost equal affinity for estrogen receptor (ER) alpha (α) and beta (β), there appears to be specific ER‐mediated effects on scalp hair follicles/growth, etc. Additionally, the newly discovered G protein‐coupled estrogen receptor (GPR30 or GPER) and the orphan receptor, estrogen‐related receptor (ERR) gamma (γ), in skin and other tissue sites have potential impacts of how estrogens via these receptors may alter scalp hair characteristics, but this remains to be elucidated. Conversely, the negative impact of the 5α‐reductase enzyme and its steroid product, 5α‐dihydrotestosterone, on scalp hair growth is clear. Less clear is how 17β‐estradiol is stimulatory in some scalp hair studies, but inhibitory in others. This brief summary examines the potential influences of steroidogenesis via aromatase (estrogen biosynthesis) and 5α‐reductase expression, their enzyme activities, and steroid products along with the concepts of how steroid acute regulatory protein (StAR) and estrone sulfate may be involved in the complex hormonal, cellular/molecular signaling cascade of the hair follicle in growth and cycling.

http://bit.ly/2tpUE6s

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 108-127
DOI: 10.1055/a-0664-5700

Die Lungensonografie ist in der Intensiv- und Notfallmedizin ein unterschätztes Werkzeug: Bei bestimmten klinischen Fragestellungen ist ihre Sensitivität drastisch höher als die der Röntgen-Thoraxuntersuchung 1. Ein standardisierter Untersuchungsgang verbessert dabei die Untersuchungsqualität 2. Dieser Artikel vermittelt Grundlagenwissen der Lungensonografie und stellt die Überlegenheit des Ultraschalls gegenüber Röntgenverfahren heraus.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2UVObfc

Ultraschall in AINS

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 88-89
DOI: 10.1055/a-0805-2279

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EcLiku

Extrakorporale kardiopulmonale Reanimation: Datenlage bis heute unklar

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-86
DOI: 10.1055/a-0823-5785

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2V1M5KJ

Kaffee, Kippe, Kaugummi – Mythen und Fakten zur präoperativen Nüchternheit

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 142-145
DOI: 10.1055/s-0043-124943

Zur Reduktion des Aspirationsrisikos gelten strikte Vorgaben für präoperative Nüchternzeiten. Für klare Flüssigkeiten (2 Stunden) und feste Nahrung (6 Stunden) sind diese eindeutig definiert; der Einfluss von Kaffee, Rauchen und Kaugummi wird dagegen kontrovers diskutiert. Dieser Beitrag zeigt, welche Mythen zur präoperativen Nüchternheit bestehen und durch welche Fakten sich das Risiko verlässlich einordnen lässt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2Ef1Fxb

Driving Pressure – ein neuer/alter Parameter zur Beatmungsoptimierung?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-85
DOI: 10.1055/a-0823-5844

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXSZV

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 90-106
DOI: 10.1055/a-0586-6146

Mithilfe der fokussierten transthorakalen Echokardiografie (TTE) erhalten wir rasch und nichtinvasiv aktuelle Informationen zum hämodynamischen Status eines Patienten. Diese können nachfolgend unsere aktuelle Therapie und dadurch unser Risikomanagement beeinflussen. Postoperativ hat sich die TTE als Untersuchungsmethode im Aufwachraum und auf der Intensivstation bewährt, um lebensbedrohliche Ursachen für eine Kreislaufdepression zeitnah zu diagnostizieren. Akutpathologika wie eine Perikardtamponade oder die fulminante Pulmonalarterienembolie können so schnell erfasst und evtl. auch zeitintensive Transporte in eine CT vermieden werden. Auch präoperativ kann der Einsatz der TTE sinnvoll sein zur Beurteilung des Volumenstatus, der Pumpfunktion oder hämodynamisch relevanter Vitien. Vor allem bei Operationen mit hohem perioperativem Komplikationsrisiko können diese Erkenntnisse mit in eine „goal-directed therapy" einfließen. Entsprechende Algorithmen für ein erweitertes hämodynamisches Monitoring und das Volumenmanagement existieren bereits in vielen Bereichen – sie werden aber häufig nicht konsequent umgesetzt und in die Abläufe der eigenen Klinik implementiert. Mit diesem Artikel legen wir Nutzen und Relevanz der hämodynamischen Evaluation mittels TTE in jeder Phase der Patientenversorgung dar. Darüber hinaus stellen wir einen möglichen Algorithmus für die Versorgung kritisch kranker Patienten vor, der auf den wichtigsten transthorakalen Untersuchungen und hämodynamischen Messverfahren basiert. Er soll im klinischen Alltag und insbesondere im Bereitschaftsdienst eine Hilfestellung für den sinnvollen Einsatz der TTE bieten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2EdNw38

Spinalanästhesie mit Chloroprocain 1% zeigt Vorteile bei ambulanten Arthroskopien

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 86-87
DOI: 10.1055/a-0823-5577

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXM4v

Abdominelle Notfallsonografie in der Intensiv- und Akutmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 128-141
DOI: 10.1055/a-0585-5237

Die sonografischen Untersuchungstechniken unterstützen die Point-of-Care-Diagnostik (POC-Diagnostik) bei akutmedizinischen Fragestellungen. Für den Intensiv- und Notfallmediziner gilt: Kenntnisse und Fertigkeiten einer fokussierten Sonografie sind unabdingbar. Dieser Artikel beleuchtet die Optionen der abdominellen Notfallsonografie und gibt praktische Hilfestellung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2Ed62sx

Gewalt in der Notfallmedizin – gegenwärtiger Stand in Deutschland

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 146-154
DOI: 10.1055/s-0043-112189

Hintergrund In den letzten Jahren werden Mitarbeiter von Rettungsdiensten und Notaufnahmen immer häufiger Opfer von gewalttätigen Übergriffen während ihres Dienstes. Jedoch wird die Erfassung von Häufigkeiten, Arten, Ursachen, Täterprofilen sowie möglichen Lösungsansätzen und Schutzmaßnahmen in Deutschland bisher – im Vergleich zum angloamerikanischen Sprachraum – eher stiefmütterlich behandelt. Ziel Das Ziel dieser Arbeit war eine weitgehende Erfassung der bisher vorliegenden aktuellen Daten der letzten Jahre, um einen zusammenfassenden Überblick über die Situation in Deutschland geben zu können. Ergebnisse Es liegen nur sehr wenige Arbeiten aus Deutschland zu diesem Thema vor. Die gefundenen Arbeiten zeigten, dass Gewalt im Rettungsdienst und in der Notaufnahme nicht nur ein Problem im angloamerikanischen Sprachraum ist. Bis zu 90% der Studienteilnehmer einer Befragung von Rettungsdienstmitarbeitern und 75% der teilnehmenden Mitarbeiter aus Notaufnahmen gaben an, in den letzten Monaten vor der Befragung Opfer von verbaler und/oder physischer Gewalt geworden zu sein. Die Mehrheit der Studienteilnehmer (je nach Studie zwischen 60 und 80%) fühlt sich gar nicht bis unzureichend auf aggressives und gewalttätiges Verhalten vorbereitet und wünscht sich professionelle regelmäßige Weiterbildung in Deeskalationstechniken und Selbstverteidigung. Auch die ständige Anwesenheit von Sicherheitsdiensten wurde zur Verminderung gewaltsamer Übergriffe auf Mitarbeiter durch Studienteilnehmer als sinnvoll erachtet. Um konkretere Aussagen treffen zu können, bedarf es weiterer prospektiver Multicenterstudien.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2UZXBWT

Massiver Informationsverlust bei Übergaben auf Intensivstation!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 84-85
DOI: 10.1055/a-0823-5728

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EdNtEu

Reconstruction of the temporomandibular joint: a comparison between prefabricated and customized alloplastic prosthetic total joint systems

The implantation of an alloplastic total temporomandibular joint (TMJ) prosthesis is an innovative approach for the treatment of end-stage TMJ disorders. Two types of system exist: prefabricated (stock) and customized computer-aided design/computer-aided manufacturing (CAD/CAM) devices. A clinical study was performed to evaluate the effectiveness of these two designs. Twenty-eight patients treated between 2015 and 2017 were included and assigned to two groups: stock prostheses (group 1) and customized CAD/CAM prostheses (group 2).

http://bit.ly/2WYIw9U

Locally advanced mammary analogue secretory carcinoma of the parotid gland

Mammary analogue secretory carcinoma (MASC) has recently been recognized as a salivary gland tumour that is characterized by the ETV6–NTRK3 fusion gene. A case of locally advanced MASC of the parotid gland in a 67-year-old man is presented here. The patient visited the hospital due to a large right infra-auricular mass, which had been enlarging gradually over a period of 2years. Contrast-enhanced computed tomography (CT) demonstrated a multilocular mass, 75×63mm in size, containing a fluid component with non-uniform contrast effects in the interior portion.

http://bit.ly/2S82Py6

Accuracy of custom-fitted temporomandibular joint alloplastic reconstruction and virtual surgical planning

The purpose of this study was to evaluate the accuracy of temporomandibular joint (TMJ) custom-made replacements by means of virtual surgical planning.The authors review 11 TMJ custom-made prostheses made of both mandibular and fossa components. Surgeries were virtually planned and patient-specific devices were designed together with surgical cutting and positional guides. Three-dimensional models for both preoperative planning and postoperative computed tomography scans were generated and overlapped in order to evaluate differences in measurements.

http://bit.ly/2XeP4l4

Influence of mandibular setback surgery on three-dimensional pharyngeal airway changes

The aim of this study was to investigate the factors influencing three-dimensional changes in pharyngeal airway space after mandibular setback surgery. Airway changes in 48 skeletal class III patients who had undergone mandibular setback surgery alone (n=25, group 1) or with maxillary surgery (n=23, group 2) were analyzed. Linear parameters, cross-sectional area, and volumes of the pharyngeal airway were evaluated before (T0), immediately after (T1), and 1year after surgery (T2) by cone beam computed tomography.

http://bit.ly/2S6D5SG

Adenoid cystic carcinoma with high-grade transformation forming spindle cell component of the submandibular gland

Adenoid cystic carcinoma (AdCC) with high-grade transformation (AdCC-HGT) is rare, and AdCC-HGT with spindle cell component is particularly rare. The patient was a 65-year-old man with a 5 cm sized swelling of the right submandibular gland. Submandibular sialoadenectomy was performed. Histopathological findings mainly showed conventional AdCC, and minorly showed two other components: (1) the pleomorphic component, a proliferation of atypical pleomorphic epithelial cells forming solid or small clusters and accompanied by necrosis; (2) the spindle cell component, containing atypical spindle cells invading the stroma.

http://bit.ly/2DIFZI5

Point of care ultrasonography in the allergy and immunology clinic

Point of care (POC) clinical ultrasonography is used across multiple medical specialties to guide diagnosis and treatment, and to enhance the safety of invasive procedures. POC clinical ultrasonography is defined as a focused ultrasonographic examination, performed and interpreted by the treating clinician, to answer a specific question or to guide a procedure.1 Emergency department physicians were early adopters of POC ultrasonography in the late 1990's; since then, technological advances have resulted in enhanced portability, improved image quality, and user-friendly interfaces, expanding the use of POC ultrasonography at the bedside.

http://bit.ly/2GKbyVg

Clinicopathologic, misdiagnosis and survival differences between clinically amelanotic melanomas and pigmented melanomas

http://bit.ly/2V0FiAR

Comment re Dear Dr. Dermatoethicist: Exam of the Future or Exam of Future Cheating?

http://bit.ly/2BAGTWY

Tracking changes nailfold capillary abnormalities in Dermatomyositis on treatment

http://bit.ly/2TSwc98

Optimizing the Total Body Skin Exam: An Observational Cohort Study

Total body skin examinations (TBSE) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE.

http://bit.ly/2BDlnkd

Adverse Events from Emollient Use in Eczema: A Restricted Review of Published Data

Abstract

Atopic dermatitis/eczema is a chronic inflammatory skin condition, and emollients are the first-line treatment. Despite their widespread use, there is uncertainty about the frequency and type of adverse events associated with different emollients. We conducted a restricted review of published data on adverse events associated with emollient use in eczema. Medline (Ovid) was searched from inception (1946) to June 2018. All types of studies, with the exception of reviews, were included. Eligibility was assessed using a two-stage screening process against inclusion and exclusion criteria. References of all included papers were screened for any additional eligible papers. Data were subsequently extracted from all eligible publications. A limited body of data were found in the published data: 24 papers reported on adverse events with 29 different emollients (3 containing urea, 5 containing ceramide, 4 containing glycerol, 4 were herbal and 13 contained "other" ingredients). Interpretation of the results and comparison of the emollients were difficult due to poor reporting and missing data. Many publications contained no data at all on adverse events, and no study reported serious treatment-related adverse events for any emollient. The proportion of participants in the studies experiencing treatment-related adverse events varied between 2 and 59%. The most common adverse events were skin related and often mild. The range of participants experiencing non-treatment-related adverse events varied between 4 and 43%. From this restricted review, clinicians and patients can be reassured that the emollients studied appear to be generally safe to use. Better studies and reporting of adverse events associated with emollients in common use are needed.

http://bit.ly/2TNyoi9

The Use of 124-I-PET/CT Whole Body and Lesional Dosimetry in Differentiated Thyroid Cancer

Condition:   Thyroid Cancer
Interventions:   Drug: Thyrogen;   Radiation: I-131;   Radiation: I-124
Sponsor:   National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Recruiting

http://bit.ly/2GvCloS

A Single Center Study in Healthy Volunteers to Assess the Pharmacokinetics of AZD9977 When Administered Alone and With Itraconazole

Condition:   Heart Failure With Preserved Ejection Fraction (HFpEF)
Interventions:   Drug: AZD9977;   Drug: Itraconazole
Sponsor:   AstraZeneca
Not yet recruiting

http://bit.ly/2Ij5YLQ

Protein and Exercise to Counteract Frailty in Older Adults

Condition:   Physical Frailty
Interventions:   Other: Resistance training;   Other: High-protein diet;   Other: Recommendations
Sponsors:   University of Southern Denmark;   Metropolitan University College;   The Municipality of Odense, Denmark;   Arla Foods
Not yet recruiting

http://bit.ly/2GoF3fK

GP vs PF as Induction Chemotherapy Combined With CCRT for Locoregionally Advanced Nasopharyngeal Carcinoma

Conditions:   Nasopharyngeal Carcinoma;   Nasopharyngeal Neoplasms;   Nasopharyngeal Diseases;   Head and Neck Neoplasm
Interventions:   Drug: gemcitabine and cisplatin;   Drug: cisplatin and fluorouracil;   Radiation: IMRT;   Drug: cisplatin
Sponsors:   Sun Yat-sen University;   Affiliated Cancer Hospital & Institute of Guangzhou Medical University;   Guangdong General Hospital;   First Affiliated Hospital, Sun Yat-Sen University
Recruiting

http://bit.ly/2IgyAoT

FT500 as Monotherapy and in Combination With Immune Checkpoint Inhibitors in Subjects With Advanced Solid Tumors

Conditions:   Advanced Solid Tumors;   Lymphoma;   HER2 Positive;   Gastric Cancer;   Colorectal Cancer;   Head and Neck Cancer;   Squamous Cell Carcinoma;   EGFR Positive Solid Tumor;   HER2-positive Breast Cancer;   Hepatocellular Carcinoma;   Small Cell Lung Cancer;   Renal Cell Carcinoma;   Pancreas Cancer;   Melanoma;   NSCLC;   Urothelial Carcinoma;   Cervical Cancer;   Microsatellite Instability;   Merkel Cell Carcinoma
Interventions:   Drug: FT500;   Drug: Nivolumab;   Drug: Pembrolizumab;   Drug: Atezolizumab
Sponsor:   Fate Therapeutics
Not yet recruiting

http://bit.ly/2Grdcvr

A Study Evaluating Safety and Efficacy of Niraparib in Patients With Previously Treated Metastatic Esophageal/Gastroesophageal Junction/Proximal Gastric Adenocarcinoma

Conditions:   Esophageal Cancer;   Gastric Cancer;   Adenocarcinoma
Intervention:   Drug: Niraparib
Sponsors:   Shadia Jalal, MD;   Tesaro, Inc.;   Indiana University School of Medicine
Not yet recruiting

http://bit.ly/2IgyddZ

The open access tsunami hits France

Publication date: Available online 15 February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H. Maisonneuve, O. Laccourreye

http://bit.ly/2X5JEsh

Successful treatment with trastuzumab in HER2-positive squamous cell carcinoma of the head and neck

Publication date: Available online 14 February 2019

Source: Oral Oncology

Author(s): Khalil Saleh, Esma Saada, Nathalie Auger, Lamia Mayache-Badis, Odile Casiraghi, Francois Bidault, Rastislav Bahleda, Caroline Even

http://bit.ly/2Ii2Tvt

Letter to the Editor regarding, “Total thyroidectomy versus lobectomy for intermediate-risk papillary thyroid carcinoma: A single-institution matched-pair analysis”

Publication date: Available online 14 February 2019

Source: Oral Oncology

Author(s): Shi-Tong Yu, Zi-Zheng Xiao

http://bit.ly/2Gt5FMQ

Cranioplasty with patient-specific implants in repeatedly reconstructed cases

Publication date: Available online 14 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): David Koper, Mariel ter Laak-Poort, Bernd Lethaus, Kensuke Yamauchi, Lorenzo Moroni, Pamela Habibovic, Peter Kessler

http://bit.ly/2TPuRQE

The European registry on obstetric Antiphospholipid syndrome (EUROAPS): A survey of 1000 consecutive cases

Publication date: Available online 15 February 2019

Source: Autoimmunity Reviews

Author(s): Jaume Alijotas-Reig, Enrique Esteve-Valverde, R. Ferrer-Oliveras, L. Sáez-Comet, E. Lefkou, A. Mekinian, C. Belizna, A. Ruffatti, A. Tincani, L. Marozio, G. Espinosa, R. Cervera, S. de Carolis, O. Latino, E. LLurba, P.L. Meroni, C.B. Chighizola, M. Gerosa, V. Pengo, K. Lundelin

Abstract

Aim

To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS).

Methods

The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported.

Results

1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in IIa, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%).

Conclusion

In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.

http://bit.ly/2toQEmI

Juvenile polyautoimmunity in a rheumatology setting

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Clara Malagón, Maria del Pilar Gomez, Catalina Mosquera, Camilo Vargas, Tatiana Gonzalez, Cristine Arango, Lorena Martin, Pilar Perez, Laura Amaya-Uribe, Nicolas Molano-Gonzalez, Juan-Manuel Anaya

Abstract

Overt polyautoimmunity (PolyA) corresponds to the presence of more than one well-defined autoimmune disease (AD) manifested clinically in a single patient. The current study aimed to describe the main characteristics of juvenile PolyA in a pediatric rheumatology setting and analyze the chronological aspects, index cases, familial autoimmunity, and clustering pattern. This was a cross-sectional and multicenter study in which 313 children with overt PolyA were included. Patients were systematically interviewed and their medical records reviewed using a questionnaire that sought information about demographic, clinical, immunological, and familial characteristics. A hierarchical cluster analysis was done to determine similarities between autoimmune diseases based on PolyA. PolyA occurred simultaneously in 138 (44%) patients. Multiple autoimmune syndrome was observed in 62 (19.8%) patients. There were 25 index diseases of which, systemic lupus erythematosus (SLE, n = 134, 42.8%), juvenile idiopathic arthritis (JIA, n = 40, 12.7%), Hashimoto's thyroiditis (HT, n = 24, 7.66%), immune thrombocytopenic purpura (ITP n = 20, 6.39%), antiphospholipid syndrome (APS, n = 15, 4.79%), and vitiligo (VIT, n = 15, 4.79%) were the most frequent and represented 79.23% of the total number of patients. Familial autoimmunity influenced PolyA. A high aggregation of autoimmunity was observed (λ_r = 3.5). Three main clusters were identified, of which SLE and APS were the most similar pair of diseases (based on the Jaccard index) followed by HT and JIA, which were related to ITP and Sjögren's syndrome. The third cluster was composed of localized scleroderma and VIT. Our findings may assist physicians to make an early diagnosis of this frequent condition. Pediatric patients with ADs should be systematically assessed for PolyA.

http://bit.ly/2GMegcz

Enhanced type I interferon gene signature in primary antiphospholipid syndrome: Association with earlier disease onset and preeclampsia

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Michelle Remião Ugolini-Lopes, Giovana Tardin Torrezan, Ana Paula Rossi Gândara, Eloisa Helena Ribeiro Olivieri, Iana Souza Nascimento, Erika Okazaki, Eloisa Bonfá, Dirce Maria Carraro, Danieli Castro Oliveira de Andrade

Abstract

Objective

Recently, two studies demonstrated that a relevant percentage of primary antiphospholipid syndrome (PAPS) patients had an upregulation of interferon (IFN) genes. However, 20%–28% of these patients had anti-dsDNA, a highly specific systemic lupus erythematosus (SLE) autoantibody. This study aimed to determine the prevalence of the type I IFN signature in the peripheral blood mononuclear cells of PAPS patients without specific SLE autoantibodies and search for its clinical associations.

Methods

Fifty-three PAPS patients (Sydney's criteria) were consecutively selected and age-matched with 50 healthy controls. A third group of nonimmune-mediated thrombophilia patients was also included. The expression of 41 IFN-induced genes was analyzed using real time quantitative PCR. A principal component analysis determined which genes composed the IFN signature, and the z-score was calculated. An ROC curve defined the signature cut-off.

Results

Six genes remained in the IFN signature DNAJA1, IFIT5, IFI27, MX1, IFI6, and TYK2. The ROC cutoff was 3.9-fold (AUC = 0.706, S = 0.49, E = 0.86, PPV = 0.79, NPV = 0.61). The type I IFN signature was present in 49% of the patients with PAPS compared with 14.0% of the healthy controls and 17% of the nonimmune-mediated thrombophilia patients (p < .0001). The IFN signature was associated with a younger age at the first antiphospholipid syndrome event (p = .023) and with preeclampsia (p = .032).

Conclusion

Our results indicate that PAPS patients without lupus-specific antibodies have an enhanced type I IFN gene signature that is not observed in nonimmune-mediated thrombophilia. Also, this overexpression of type I IFN-regulated genes associated with an earlier onset of antiphospholipid syndrome event and preeclampsia.

http://bit.ly/2tosRmY

Lethal immunoglobulins: Autoantibodies and sudden cardiac death

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Varvara A. Ryabkova, Yuri V. Shubik, Mikhail V. Erman, Leonid P. Churilov, Darja Kanduc, Yehuda Shoenfeld

Abstract

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. Patients with cardiomyopathies, myocarditis, ischemic heart disease and cardiac channelopathies are at risk of SCD. However, a certain percentage of autopsy-negative cases of SCD in the young (<35 years) remain unexplained even after a post-mortem genetic testing. Autoantibodies against cardiac proteins may be potentially involved in the pathogenesis of different heart diseases and in the occurrence of unexplained SCD. In this review we analyze clinical and animal studies that elucidate the prevalence of these autoantibodies in patients with different cardiac diseases and their pathophysiological relevance. We propose a classification of the autoantibodies associated with heart diseases and focus on their molecular and cellular effects. Anti-beta adrenergic receptor antibodies and anti-muscarinic acetylcholine receptor antibodies affect myocardial electrophysiological properties and were reported to be the independent predictors of SCD in patients with different heart diseases. Autoimmune mechanism is proposed for cardiac-related adverse reactions following human papillomavirus (HPV) vaccination. The pentapeptid sharing between HPV's antigens, adrenergic receptors and muscarinic acetylcholine receptors supports this assumption. The dysregulating effects of the autoantibodies against calcium and potassium ion channels can be the basis for autoimmune phenocopies of genetic cardiac channelopathies, which are also associated with SCD.

http://bit.ly/2GKNt0m

The study of interactions between genome and exposome in the development of systemic lupus erythematosus

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Henrik Christian Bidstrup Leffers, Theis Lange, Christopher Collins, Constance Jensina Ulff-Møller, Søren Jacobsen

Abstract

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease characterized by a broad spectrum of clinical and serological manifestations. This may reflect a complex and multifactorial etiology involving several identified genetic and environmental factors, though not explaining the full risk of SLE. Established SLE risk genotypes are either very rare or with modest effect sizes and twin studies indicate that other factors besides genetics must be operative in SLE etiology. The exposome comprises the cumulative environmental influences on an individual and associated biological responses through the lifespan. It has been demonstrated that exposure to silica, smoking and exogenous hormones candidate as environmental risk factors in SLE, while alcohol consumption seems to be protective. Very few studies have investigated potential gene-environment interactions to determine if some of the unexplained SLE risk is attributable hereto. Even less have focused on interactions between specific risk genotypes and environmental exposures relevant to SLE pathogenesis. Cohort and case-control studies may provide data to suggest such biological interactions and various statistical measures of interaction can indicate the magnitude of such. However, such studies do often have very large sample-size requirements and we suggest that the rarity of SLE to some extent can be compensated by increasing the ratio of controls. This review summarizes the current body of knowledge on gene-environment interactions in SLE. We argue for the prioritization of studies that comprise the increasing details available of the genome and exposome relevant to SLE as they have the potential to disclose new aspects of SLE pathogenesis including phenotype heterogeneity.

http://bit.ly/2GKV5QH

Terbinafine‐resistant strain of Trichophyton interdigitale strain isolated from a tinea pedis patient

Abstract

Trichophyton interdigitale is an anthropophilic species that is frequently isolated from tinea unguium and tinea pedis throughout the world. In the present study, antifungal susceptibility testing was performed on T. interdigitale isolates from Japanese patients (isolated in 2017–2018; 24 strains) to assess itraconazole (ITZ) and terbinafine (TRF) susceptibility of these strains. E‐test determinations revealed that the mean ITZ minimum inhibitory concentration (MIC) of the 24 strains was 0.023 mg/L (range, 0.064–1). Clinical Laboratory Standards Institute M38‐A2 determinations revealed that the mean TRF MIC of 23 of the 24 strains was less than 0.03125 mg/L. Among these strains, one (NUBS18016) had a TRF MIC of 2 mg/L, confirming its resistance to TRF. The predicted amino acid sequences of the squalene epoxidase (SQLE) gene from the TRF‐resistant strain (NUBS18016) was 100% identical to the SQLE gene sequence of the reference strain T. interdigitale, indicating that no gene mutations were present in NUBS18016. Therefore, the TRF‐resistance mechanism of our TRF‐resistant strain NUBS18016 has not been defined. Dermatologists should be cautious about the prevalence of foot dermatophytosis due to antifungal drug‐resistant strains.

http://bit.ly/2TV8iu0

Effectiveness of dental implants placed in bone graft area of cleft Patients

Publication date: Available online 15 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): P.H.H. Sales, O.B. Oliveira-Neto, T.S. Torres, F.J.C. de Lima

Abstract

The purpose of this study was to determine the effectiveness of dental implants placed in the bone graft area of cleft patients. Electronic databases and relevant journals were searched to the end of August 2018. A total of 11 articles were eligible for systematic review considering the previously established inclusion and exclusion criteria, and then underwent risk of bias assessment. A total of 483 implants were placed and showed a survival rate of 93% after a mean follow-up of 60.5 months. The iliac bone was the most used for the reconstructive surgery in cleft patients, followed by the mandible. There is a high survival rate of dental implants placed in areas of bone grafts in patients with alveolar clefts. However, more studies with high methodological quality and with a longer follow-up are needed to offer more safety for practitioners and patients regarding the placement of dental implants in areas of alveolar clefts with bone grafting.

http://bit.ly/2GHSsii

Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function

Publication date: Available online 14 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): F.M. Weinberg, C.M. Speksnijder, T. Forouzanfar, A.J.W.P. Rosenberg

Abstract

The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. Serious injury to the disc and capsule of the temporomandibular joint is a contributing factor towards development of complications after closed treatment. The results of this review give an overview of the published studies focusing on articular soft tissue injuries caused by condylar mandibular fractures. Additionally, an overview of the magnetic resonance imaging (MRI) settings used to detect these injuries is provided. Until now, the relation between soft tissue injuries and type of condylar trauma and their influence on clinical outcome has been insufficiently investigated. Before considering reduction of soft tissues next to reduction of the fracture, more research is needed into the impact of soft tissue injuries on oral functioning, in which a uniform classification is used.

http://bit.ly/2tpx2yC

Relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke

Publication date: Available online 14 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Ertugrul, N.K. Keskin

Abstract

The aim of this study was to determine the relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke (FH). Temporal computed tomography images of 714 patients (1428 ears) who applied to the Otorhinolaryngology Department of Karabuk University Training and Research Hospital between January 2016 and June 2018 were retrospectively analysed. We compared the mastoid pnomatization levels of 95 patients (74 females, 21 males, mean age 53.18 ± 15.09 years) who had persistent FH and 135 patients (103 females, 32 males, mean age 54.29 ± 15.82 years) with no FH who had similar age and gender. FH was found to be unilateral (right: 23, left: 45) in 68 (71.5%) out of 95 patients with FH, and FH was bilateral in 27 (28.4%) patients. The degree of mastoid pnomatization of the patients with FH was significantly higher than the patients without FH (p = 0.015). The degree of pneumatization of the mastoid bone may lead to persistent FH by affecting the ossification process of the tympanic segment, which has a close anatomical relationship with it.

http://bit.ly/2GL7xjg

Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry

Publication date: Available online 14 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Ji, W. Du, C. Xu, Q. Zhao, B. Ye, E. Luo

Abstract

This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. The postoperative outcome was assessed for facial symmetry and surgical accuracy. All patients were followed up for at least 18 months and their level of satisfaction was investigated. Use of the computer-assisted osteotomy guides and pre-bent titanium plates was successful in all patients. Maxillary canting, mandibular ramus inclination, and mandibular length were corrected on both sides postoperatively. Superimposition of the surgical simulation and postoperative images demonstrated favourable accuracy. Quantitative analysis revealed a mean linear difference of <0.60 mm in the maxilla and 1.57 mm in the mandible. All patients were satisfied with the surgical outcome; there were no complications or cases of relapse during follow-up. The application of computer-assisted osteotomy guides and pre-bent titanium plates achieved favourable outcomes and accuracy, improving planning for the correction of facial asymmetry.

http://bit.ly/2twCArr

Hard and soft tissue changes and long-term stability after vertical height reduction genioplasty using biodegradable fixation

Publication date: Available online 14 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): J.H. Park, H.-D. Jung, J.-Y. Cha, Y.-S. Jung

Abstract

The aim of this work was to analyse the stability of vertical height reduction genioplasty using biodegradable material, as well as to determine vertical changes of hard and soft tissues during this procedure.

Forty patients underwent vertical height reduction genioplasty using two types of biodegradable fixation (Biosorb FX^® or OSTEOTRANS-MX^®), combined with mandibular setback surgery. We assessed lateral cephalographs over time (pre-operation; immediately post-operation; 3 months, 6 months and 12 months post-operation).

We found a mean vertical difference of 0.22 mm (standard deviation (SD) = 0.49 mm) at the menton point immediately post-operation, compared with 12 months post-operation. And there was no statistical significance(P > 0.05). The chin hard tissue remained stable from the immediate post-operation period to 1 year post-operation, and the chin soft tissue remained stable from 3 months to 1 year post-operation. The regression equation describing the replacement of hard tissue with soft tissue change, between pre-operation and 12 months post-operation is y = 0.590x + 0.885 (R² = 0.300, P < 0.001).

We confirm that the use of biodegradable fixation is a stable method, in terms of skeletal tissues, and a relatively stable method, in terms of soft tissues. In vertical height reduction genioplasty, soft tissue does not reflect 100% of the vertical tissue reduction in hard tissues. This data may influence establishment of surgical treatment objectives.

http://bit.ly/2GL7ofI

A submucosal nodule on the buccal mucosa

Publication date: Available online 14 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Eduardo Morato de Oliveira, Lauren Frenzel Schuch, Patrícia Carlos Caldeira, Karine Duarte da Silva, Evandro Neves Abdo, Maria Cássia Ferreira de Aguiar

http://bit.ly/2SDPH98

CD40LG duplications in patients with X-LAG syndrome commonly undergo random X-chromosome inactivation

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Giampaolo Trivellin, Constantine A. Stratakis

http://bit.ly/2BD35zT

Reply

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Carole Le Coz, Neil Romberg

http://bit.ly/2TO9S0s

Regulation of the pleiotropic effects of tissue resident mast cells

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Michael Huber, Andrew C.B. Cato, George K. Ainooson, Marc Freichel, Volodymyr Tsvilovskyy, Rolf Jessberger, Eva Riedlinger, Christian P. Sommerhoff, Stephan C. Bischoff

Abstract

Mast cells, best known for their detrimental role in allergic diseases, act in a diverse array of physiological and pathological functions, made possible by the plurality of mast cell types. Their various developmental avenues and their distinct sensitivity to (micro-) environmental conditions convey extensive heterogeneity, resulting in diverse functions. We briefly summarize this heterogeneity, elaborate on molecular determinants that allow mast cells to communicate with their environment to fulfill their tasks, discuss their protease repertoire stored in secretory lysosomes, and consider different aspects of mast cell signaling. Further, we describe key mast cell governance mechanisms, i.e. the high-affinity receptor for IgE (FcεRI), the stem cell factor receptor KIT, the IL-4 system, and Ca²⁺-dependent as well as phosphatase-dependent mechanisms. Finally, we focus on distinct physiological functions such as chemotaxis, phagocytosis, host defense, and the regulation of mast cell functions at the mucosal barriers of the lung, the gastrointestinal tract, and the skin. A deeper knowledge of the pleiotropic functions of mast cell mediators as well as the molecular processes of mast cell regulation and communication should enable us to promote beneficial mast cell traits in physiology and suppress detrimental mast cell functions in disease.

http://bit.ly/2BD2Zbv

An updated protocol for the treatment of condylar hyperplasia: computer-guided proportional condylectomy

Publication date: Available online 15 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Salvatore Sembronio, Alessandro Tel, Fabio Costa, Massimo Robiony

Purpose

To present an updated protocol for proportional condylectomy in which virtual surgical planning and 3D printing allow one to precisely define the osteotomy level.

Methods

3D mirroring was performed to generate a virtual replica of the healthy hemi-mandible, which was subsequently aligned and overlapped with the actual mandible to estimate the level for condylectomy. A custom-fitted 3D printed surgical guide was modeled for the condylar head allowing one to reproduce virtual planning in the surgical scenario. The updated protocol for computer-guided condylectomy was applied to 7 patients.

Results

For all patients, a follow-up period of twelve months was considered. Surface deviation color maps showed a high correspondence between the virtually calculated condylectomy and the surgical outcome achieved with the aid of the surgical guide. No cases of condylar hyperplasia recurrence were observed.

Conclusion

An updated protocol based on accurate three-dimensional analysis was performed by means of virtual surgical planning and 3D printing. Virtual surgical planning allows one to precisely define the level of condylectomy, and custom-made 3D printed cutting guides are useful to reproduce virtual measurements during surgical maneuvers.

http://bit.ly/2DG7T7x

Opioids: Combating Misuse While Properly Caring for Our Patients

Publication date: Available online 14 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): James R. Hupp

http://bit.ly/2SB1fK5

A Summary of 2018 and What Lies Ahead for Dermatology and Therapy in 2019

http://bit.ly/2TT9LRm

Pediatric ear foreign body retrieval: A comparison across specialties

Publication date: Available online 15 February 2019

Source: American Journal of Otolaryngology

Author(s): Katie Mingo, David Eleff, Samantha Anne, Kyra Osborne

Abstract

Objectives

To analyze what characteristics of patients and/or ear foreign bodies should prompt referral to otolaryngology with the goal to maximize successful removal and minimize complications.

Methods

This was a retrospective chart review of pediatric patients who presented for ear foreign body removal from January to December 2016 at a tertiary hospital center. Data collection included successful removal, major or minor complications, use of general or conscious sedation, use of otic or oral antibiotics, age of patient, comorbid behavioral disorders, and foreign body characteristics. Major complications included tympanic membrane perforation or ossicular damage. Minor complications included injury of the canal wall. Patients with retained or extruded tympanostomy tubes were excluded.

Results

Of 275 patients aged 1–18 years, 16% presented initially to otolaryngology (ENT), 48.4% presented to the emergency department (ED), 21.8% presented to a pediatrician, and 13.8% presented to ENT after prior attempts at removal. Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). Retrieval by ENT after prior failed attempts had the highest rate of minor complications (26.3% vs 2.3–6.0%). There were two tympanic membrane perforations that were noted by ENT after prior failed attempts. Rate of operative intervention was significantly higher in patients who presented to ENT after prior attempts compared to patients who presented initially to ENT (34.2 vs 4.6%, p = 0.001). Of the patients who presented to ENT after previous failed attempts, there was a higher rate of complications and operative intervention if the patient was age 5 or under or the foreign body was difficult to grasp.

Conclusions

Pediatric ear foreign body presentation is common. Repeated attempts at removal are associated with higher rates of minor complications and operative intervention. Early consultation to otolaryngology should be considered if the foreign body is deemed difficult to grasp such as a bead or stone, especially if the patient is age five or younger.

http://bit.ly/2GOVQs1

Stratum corneum interleukin-33 expressions correlate with the degree of lichenification and pruritus in atopic dermatitis lesions

Publication date: Available online 14 February 2019

Source: Clinical Immunology

Author(s): Naomi Nakamura, Risa Tamagawa-Mineoka, Risa Yasuike, Koji Masuda, Hiroshi Matsunaka, Yumi Murakami, Emiko Yokosawa, Norito Katoh

http://bit.ly/2GHJnpI

Cytokines, growth factors and proteases in medium and large vessel vasculitis

Publication date: Available online 14 February 2019

Source: Clinical Immunology

Author(s): Cornelia M. Weyand, Ryu Watanabe, Hui Zhang, Mitsuhiro Akiyama, Gerald J. Berry, Jörg J. Goronzy

Abstract

Giant cell arteritis and Takayasu arteritis are autoimmune vasculitides that cause aneurysm formation and tissue infarction. Extravascular inflammation consists of an intense acute phase response. Deeper understanding of pathogenic events in the vessel wall has highlighted the loss of tissue protective mechanisms, the intrusion of immune cells into "forbidden territory", and the autonomy of self-renewing vasculitic infiltrates. Adventitial vasa vasora critically control vessel wall access and drive differentiation of tissue-invasive T cells. Selected T cells establish tissue residency and build autonomous, self-sufficient inflammatory lesions. Pathogenic effector T cells intrude and survive due to failed immune checkpoint inhibition. Vasculitis-sustaining T cells and macrophages provide a broad portfolio of effector functions, involving heterogeneous populations of pro-inflammatory T cells and diverse macrophage subsets that ultimately induce wall capillarization and intimal hyperplasia. Redirecting diagnostic and therapeutic strategies from control of extravascular inflammatory markers to suppression of vascular inflammation will improve disease management.

http://bit.ly/2tmgnMt

Resultados de cirugía endoscópica nasal en el tratamiento de sinusitis fúngica invasiva en niños con cáncer e inmunosupresión

Publication date: Available online 14 February 2019

Source: Acta Otorrinolaringológica Española

Author(s): Jorge Javier Ramírez Argueta, Juan Pablo Díaz Molina, Ricardo Jose Ortiz Oliva, Roman Carlos Bregni, Yomara Bustamante

Resumen

Antecedentes y objetivo

El objetivo del estudio ha sido describir los resultados del tratamiento de sinusitis fúngica invasiva con cirugía endoscópica nasal en una población oncológica pediátrica con inmunosupresión e informar sobre la seguridad, la eficacia y las complicaciones del procedimiento

Métodos

Se realizó un estudio retrospectivo de la totalidad de los pacientes con diagnóstico de sinusitis fúngica invasiva operados en la Unidad Nacional de Oncología Pediátrica entre los años 2012 y 2016. Los datos tomados de su historial médico incluyeron: características epidemiológicas, diagnóstico oncológico, datos hematológicos, síntomas, estudios tomográficos, intervenciones quirúrgicas, resultados de enfermedad y cultivos, medicamentos recibidos, complicaciones, evolución y supervivencia. Los datos fueron analizados utilizando estadística descriptiva, las variables continuas con medidas de tendencia central y las variables categóricas de forma porcentual.

Resultados

Se identificó a 18 pacientes, 7 de sexo masculino y 11 de sexo femenino. El promedio de edad fue de 12 años, 13 tuvieron diagnóstico de leucemia linfoide aguda y 5 de leucemia mieloide aguda; 17 pacientes presentaron neutropenia severa en el momento del diagnóstico. El agente etiológico más frecuentemente identificado fue Aspergillus en 13 pacientes. En 16 pacientes (89%) se controló la enfermedad con cirugía endoscópica nasal. Diez pacientes fallecieron por causas no relacionadas a lo largo del estudio.

Discusión y conclusiones

La sinusitis fúngica invasiva es una enfermedad cuya incidencia va en aumento entre pacientes con inmunosupresión y debe de considerarse una urgencia médica debido a su alta mortalidad. El diagnóstico se basa en un alto índice de sospecha en pacientes con factores predisponentes (leucemia, neutropenia, fiebre persistente, sonda nasogástrica) y la evaluación endoscópica nasal. El tratamiento médico antifúngico y cirugía endoscópica nasal agresiva está indicado independientemente del estado del paciente para disminuir la carga fúngica y la alta mortalidad asociada. El tratamiento debe de ser suministrado por un equipo multidisciplinario que incluye pediatría, hemato-oncología, infectología y otorrinolaringología.

Abstract

Background and objective

to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population.

Methods

retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival.

Results

18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study.

Discussion and conclusions

Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.

http://bit.ly/2TT7u8M

Con: OIT is safe/better than food avoidance

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Braun Camille, Caubet Jean-Christoph

http://bit.ly/2SRnV8d

Pro-Con Debate: Component resolved diagnostic testing is not useful for making food allergy diagnoses

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew Greenhawt.

http://bit.ly/2NcbS0g

Drug Hypersensitivity Reactions in the Americas: Similarities and Differences

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Pedro Giavina-Bianchi, Edgardo Jares, Marcelo Vivolo Aun, Bernard Thong

http://bit.ly/2SUbCbp

African American Ancestry Contribution to Asthma and Atopic Dermatitis

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Michelle Daya, Kathleen C. Barnes

http://bit.ly/2NcbMWs

From the pages of AllergyWatch May 2019

Publication date: Available online 14 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Stanley M. Fineman, David A. Khan, Chitra Dinakar

http://bit.ly/2SQKOc2

Drug Induced Enterocolitis Syndrome (DIES): a clinical entity which deserves more awareness

Publication date: Available online 14 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): A.O.J. Van Thuijl, L.J. Landzaat, O. Liem, J.A.M. Emons, N.J.T. Arends

http://bit.ly/2NcbI9a

Spontaneous bilateral osteonecrosis of the mandible in a bisphosphonate-naive patient

Publication date: Available online 14 February 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A.W. Sklavos, S.N. Delpachitra, A.M. Thomas, A. Nastri

Abstract

Medication-related osteonecrosis of the jaw is a well-described, yet poorly understood disease of bone that is commonly associated with antiresorptive and antiangiogenic drugs. We report a case of spontaneous bilateral osteonecrosis of the mandible in a patient with no previous exposure to either.

http://bit.ly/2S4yMam

A phase I/IIa study of the mRNA-based cancer immunotherapy CV9201 in patients with stage IIIB/IV non-small cell lung cancer

Abstract

CV9201 is an RNActive^®-based cancer immunotherapy encoding five non-small cell lung cancer-antigens: New York esophageal squamous cell carcinoma-1, melanoma antigen family C1/C2, survivin, and trophoblast glycoprotein. In a phase I/IIa dose-escalation trial, 46 patients with locally advanced (n = 7) or metastatic (n = 39) NSCLC and at least stable disease after first-line treatment received five intradermal CV9201 injections (400–1600 µg of mRNA). The primary objective of the trial was to assess safety. Secondary objectives included assessment of antibody and ex vivo T cell responses against the five antigens, and changes in immune cell populations. All CV9201 dose levels were well-tolerated and the recommended dose for phase IIa was 1600 µg. Most AEs were mild-to-moderate injection site reactions and flu-like symptoms. Three (7%) patients had grade 3 related AEs. No related grade 4/5 or related serious AEs occurred. In phase IIa, antigen-specific immune responses against ≥ 1 antigen were detected in 63% of evaluable patients after treatment. The frequency of activated IgD⁺CD38^hi B cells increased > twofold in 18/30 (60%) evaluable patients. 9/29 (31%) evaluable patients in phase IIa had stable disease and 20/29 (69%) had progressive disease. Median progression-free and overall survival were 5.0 months (95% CI 1.8–6.3) and 10.8 months (8.1–16.7) from first administration, respectively. Two- and 3-year survival rates were 26.7% and 20.7%, respectively. CV9201 was well-tolerated and immune responses could be detected after treatment supporting further clinical investigation.

http://bit.ly/2Gr0zk8

Effects of electromyographic biofeedback as an adjunctive therapy in the treatment of swallowing disorders: a systematic review of the literature

Abstract

Purpose

To describe the primary effects of electromyographic biofeedback therapy on swallowing via a systematic review.

Methods

A blind search was carried out by two researchers in the PubMed and Bireme platforms and in the Medline, Lilacs, SciELO, PsycINFO, CINAHL, and Web of Science databases, and the journal articles identified therein were evaluated for inclusion in the study. Original articles associated with the theme were selected with no population-, region-, or language-associated limits. A protocol was created for this study with the following points: author, year, place, number and characteristics of participants, activities evaluated, instruments used, and main results. The PEDro scale was used to analyze the quality of the studies.

Results

Among the 686 articles identified in the combined searches, 566 were duplicates. A total of 65 articles were discarded after the title and abstract were read, and a further 29 articles were discarded after the full text was read, yielding a total of six articles for inclusion. In summary, the results lead us to believe that positive effects on the laryngeal lifting capacity, improved swallowing functions, and increased excursion and maximal elevation of the hyoid bone, may be directly related to this method of therapy.

Conclusions

Adjunctive therapeutic protocols with biofeedback electromyography exert positive effects on swallowing function.

http://bit.ly/2tpq3G2

Twenty-and-a-half syndrome: a case report

In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half sy...

http://bit.ly/2EdumdT

Variability of allergens in commercial fish extracts for skin prick testing

Abstract

Background

Commercial allergen extracts for allergy skin prick testing (SPT) are widely used for diagnosing fish allergy. However, there is currently no regulatory requirement for standardisation of protein and allergen content, potentially impacting the diagnostic reliability of SPTs. We therefore sought to analyse commercial fish extracts for the presence and concentration of fish proteins and in vitro IgE reactivity using serum from fish‐allergic patients.

Methods

Twenty‐six commercial fish extracts from 5 different manufacturers were examined. The protein concentrations were determined, protein compositions analysed by mass spectrometry, followed by SDS‐PAGE and subsequent immunoblotting with antibodies detecting 4 fish allergens (parvalbumin, tropomyosin, aldolase, collagen). IgE‐reactive proteins were identified using serum from 16 children with confirmed IgE‐mediated fish‐allergy, with focus on cod, tuna, and salmon extracts.

Results

The total protein, allergen concentration and IgE reactivity of the commercial extracts varied over 10‐fold between different manufacturers and fish species. The major fish allergen parvalbumin was not detected by immunoblotting in 6/26 extracts. In 7/12 extracts 5 known fish allergens were detected by mass spectrometry. For cod and tuna almost 70% of patients demonstrated the strongest IgE reactivity to collagen, tropomyosin, aldolase A, or β‐enolase but not parvalbumin.

Conclusions

Commercial fish extracts often contain insufficient amounts of important allergens including parvalbumin and collagen, resulting in low IgE reactivity. A comprehensive proteomic approach for the evaluation of SPT extracts for their utility in allergy diagnostics is presented. There is an urgent need for standardised allergen extracts, which will improve the diagnosis and management of fish allergy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2SxNrjw

Lipid Transfer Protein allergy in the United Kingdom; characterisation and comparison with a matched Italian cohort

Abstract

Background

Although pollen‐related food allergy occurs in all European populations, Lipid Transfer Protein (LTP) allergy is considered to manifests mainly in Mediterranean countries. We aimed to characterise adults presenting with LTP allergy in a Northern European country.

Method

The clinical history and sensitisation patterns of subjects born and residing in the United Kingdom (UK), with a prior diagnosis of LTP allergy and sensitisation to the peach LTP allergen Pru p 3, were compared to UK subjects with pollen food syndrome (PFS). The sensitisation patterns were also evaluated against a matched cohort of Italian subjects diagnosed with LTP allergy.

Results

None of the 15 UK PFS subjects had a positive SPT to LTP‐enriched peach reagent, compared to 91% of the 35 UK LTP subjects. The UK LTP cohort were also more likely to have positive skin prick tests to barley, tomato and cashew nut and sensitisation to the LTP allergens in peach, walnut, mugwort and plane tree These sensitisation patterns to individual allergens were not significantly different from those obtained from the Italian LTP subjects, with significant correlations between Pru p 3 and the LTP allergens in peanuts, walnuts, plane tree and mugwort in both groups.

Conclusion

Native UK subjects with LTP allergy are not dissimilar to those with LTP allergy in Southern Europe. Testing to LTP‐enriched peach SPT reagent and/or LTP allergens in peach, walnut, mugwort and plane tree may enhance diagnostic accuracy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DRjWPN

Relationship between periodontal inflammation and calcium channel blockers induced gingival overgrowth—a cross-sectional study in a Japanese population

Abstract

Objectives

Periodontal inflammation is regarded as a risk factor for drug-induced gingival overgrowth (DIGO). In order to elucidate the involvement of periodontal inflammation in DIGO, the periodontal status of subjects who do not develop DIGO despite receiving causative drugs (non-responders) needs to be examined. Therefore, the aim of the present study which was a pilot study was to assess periodontal inflammatory variables in responders (calcium channel blocker induced-GO patients), non-responders, and patients who did not receive causative drugs (non-consumers).

Materials and methods

The following parameters were measured: (1) existence of gingival overgrowth, (2) number of teeth, (3) mean periodontal pocket depth (PPD), and (4) percentage of positive sites for bleeding on probing (BOP). The periodontal inflamed surface area (PISA) and periodontal epithelial surface area (PESA) and the PISA/PESA ratio which indicated the degree of periodontal inflammation in each patient were also used to evaluate periodontal inflammation.

Results

Thirteen responders, 32 non-responders, and 83 non-consumers were included in the analyses. The mean PPD, percentage of BOP, PESA, and PISA, and the PISA/PESA ratio were significantly higher in responders than in non-responders and non-consumers (p < 0.01). The BOP, PISA, and PISA/PESA ratio were significantly lower in non-responders than in non-consumers (p < 0.05). A positive correlation was found between PPD and age in non-consumers. On the other hand, a negative correlation was noted between PPD and age in non-responders.

Conclusions

Periodontal inflammation may be associated with the initiation of DIGO.

Clinical relevance

It could be speculated that periodontal therapy before the administration of calcium channel blockers may prevent the development of gingival overgrowth.

http://bit.ly/2TRjmIe

Do electrical current and laser therapies improve bone remodeling during an orthodontic treatment with corticotomy?

Abstract

Objectives

Evaluate the bone remodeling during orthodontic movement with corticotomy when submitted to low-intensity electrical stimulation application (microcurrent—MC) and low-level laser therapy (LLLT).

Material and methods

One hundred and fifty Wistar rats were divided into the following 5 groups: (C) submitted to tooth movement; (Cort) tooth movement/corticotomy; (Cort-L) tooth movement/corticotomy/laser AsGaAl 808 nm (4.96J/50s); (Cort-Mc) tooth movement/corticotomy/microcurrent (10 μA/5 min); (Cort-L-Mc) tooth movement/corticotomy and laser/microcurrent alternated. Inflammation, angiogenesis, and osteogenesis were evaluated in the periodontal ligament (PDL) and alveolar bone on the 7th, 14th, and 21st days of orthodontic movement.

Results

The quantification of inflammatory infiltrate, angiogenesis and expression of TGF-β1, VEGF, and collagen type I were favorably modulated by the application of therapies such as low-level laser therapy (LLLT), MC, or both combined. However, electrical stimulation increased fibroblasts, osteoclasts and RANK numbers, birefringent collagen fiber organization, and BMP-7 and IL-6 expression.

Conclusions

Low-level laser therapy (LLLT) and MC application both improved the process of bone remodeling during orthodontic treatment with corticotomy. Still, electrical current therapy promoted a more effective tooth displacement but presented expected root resorption similar to all experimental treatments.

Clinical relevance

It is important to know the effects of minimally invasive therapies on cellular and molecular elements involved in the bone remodeling of orthodontic treatment associated with corticotomy surgery, in order to reduce the adverse effects in the use of this technique and to establish a safer clinical routine.

http://bit.ly/2BCMRGS

In response to the letter to the editor regarding management and follow‐up results of salivary fistulas treated with botulinum toxin

http://bit.ly/2SA5tlq

Calcifying Epithelial Odontogenic (Pindborg) Tumor in a Child: A Case Report and Literature Review

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is a rare neoplasm, which accounts for < 1% of all odontogenic tumors. CEOT occurs more frequently in adults with a peak incidence in the 5th decade of life and is extremely rare in the pediatric population. We present a case of a 13-year-old girl who was found to have a mandibular CEOT. We summarize the radiological features, pathological findings, clinical management and literature review focusing on this entity in children.

http://bit.ly/2SzYqJj

Food Protein‐Induced Enterocolitis Syndrome in South Tyrol 2012‐2016: a population based study

Abstract

Food protein‐induced enterocolitis syndrome (FPIES) is a rare non‐IgE‐mediated food allergy to protein mainly in cow milk (CM) that typically presents in early infancy. Projectile and repetitive vomiting are the main clinical symptoms after 1‐4 hours of trigger food ingestion. Rapid recognition and installment of a specific diet are important to avoid serious complications in affected children (see figure 1).¹ According to a multicenter Italian study² atopy as co‐morbidity is rarer than in other countries being 9% compared to a much higher frequency of 28% in Spain,³ 57% in Australia⁴ and over 70% in the USA.⁵ To analyze this topic further we retrospectively retrieved all clinical documents reporting FPIES, as described by Sopo et al.,² from 2012‐2016 from all pediatric services in South Tyrol, a northern Italian province near the Austrian border with 524.256 inhabitants at 2016 census.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GHmsuG

Korean gender differences in hidradenitis suppuratva: nature or nurture?

Abstract

In a recent population‐based study on hidradenitis suppurativa (HS) in Korea, Lee et al. found that the female to male ratio was 1:1.6. They describe "a remarkable predisposition for HS among males" and note that this finding was contrary to what is usually reported in European studies.^2,3 Drs. Lee and coworkers argue that the inverse female‐to‐male ratio suggests "a major racial difference". On the other hand, the female to male ratio of 1:1.6 was consistent with the results obtained in a Japanese study.

This article is protected by copyright. All rights reserved.

http://bit.ly/2tnbN0v

Validation of the dermatology‐specific proxy instrument the Infants and Toddlers Dermatology Quality of Life

Abstract

Background

The first dermatology‐specific proxy health related quality of life (HRQoL) instrument for children 0‐4 years old with skin diseases, the Infants and Toddlers Dermatology Quality of Life (InToDermQoL), was recently developed. In order to avoid the problem of cross‐cultural inequivalence focus groups work and pilot tests were organized simultaneously in all national centres of the project. The InToDermQoL showed good comprehensibility, clarity and acceptance.

Objective

To validate the InToDermQoL questionnaire during international field tests.

Methods

Internal consistency, test‐retest reliability, convergent and discriminant validity of the InToDermQoL questionnaire were checked during international field tests.

Results

Parents of 473 children with skin diseases filled in national language versions of the InToDermQoL questionnaire. All three age‐specific versions of the InToDermQoL questionnaire with 10, 12 and 15 items, respectively, showed high internal consistency (Cronbach's alpha 0.90‐0.93), good test‐retest reliability (correlation coefficients>0.9), significant correlations with the most widely used atopic dermatitis‐specific proxy instrument, the Infants Dermatitis Quality of Life Index (correlation coefficients 0.68‐0.79). The InToDermQoL versions for children less than 3 years old well correlated with the atopic dermatis severity measure SCORAD (correlation coefficients 0.66 and 0.86 for 10 and 12 items versions, respectively). The InToDermQoL questionnaire discriminated well among different diagnoses and disease severity levels.

Conclusion

Our field tests confirmed internal consistency, test‐retest reliability, convergent and discriminant validity of the InToDermQoL questionnaire. Development and validation of the InToDermQoL questionnaire makes it possible to assess dermatology‐specific aspects of HRQoL in youngest children with skin diseases. There are many reasons to assess HRQoL in dermatologic clinical practice and we hope that our new instrument will be used internationally in pediatric dermatology for research and practical needs.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GHTcUN

General health status in psoriasis patients, as assessed by the SF‐12 questionnaire, is poorly associated with PASI

Abstract

An important issue in medicine is how to measure the clinical severity of a disease. In psoriasis this is traditionally assessed using the Psoriasis Area and Severity Assessment (PASI). However, it is a concern that this measure does not really capture the burden that the disease has on patients. The aim of this observational study was to assess, in patients with psoriasis, the relationship between health status and clinical severity measures.

This article is protected by copyright. All rights reserved.

http://bit.ly/2tnPyHV

Alopecia neoplastica as a sign of visceral malignancies: a systematic review

Abstract

Alopecia neoplastica (AN) from visceral tumors is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumor.

We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered.

We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed.

In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% versus 46.3%). The most frequent site of the primary tumor was the gastro‐intestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of cases (66.1%) AN lesions were single and were mainly diagnosed after the primary visceral tumor (71.5%). Finally, survival analysis highlighted a lower progression free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GHmnHo

Response to “Korean gender differences in hidradenitis suppurativa: nature or nurture?”

Abstract

We thank R. Happle for his invaluable comments¹ on our recent article² regarding the prevalence of hidradenitis suppurativa (HS) in Korea. We agree with the opinion that the low prevalence of HS in Korean women may be due to the low number of female smokers in Korea. Although the Korean National Health Insurance Claims Database used in our study did not record the smoking habit of each individual, another recent Korean study revealed interesting findings regarding this issue.

This article is protected by copyright. All rights reserved.

http://bit.ly/2trDIfz

Extended surgical safety margins and ulceration are associated with an improved prognosis in pleomorphic dermal sarcomas (PDS)

Abstract

Background

Pleomorphic dermal sarcomas (PDS) are frequent UV‐induced sarcomas of the skin of intermediate grade malignant potential. Despite the fact that PDS have a noteworthy potential to recur (up to 28%) as well as to metastasize (up to 20%), there are no specific clinical guidelines with respect to follow‐up these patients. Moreover, little is known about clinical, histological or molecular prognostic factors in PDS.

Objective

The aim of the present study was to identify risk factors to predict relapse in a large multicenter sample cohort of PDS which could aid to optimize personalized treatment recommendations regarding surgical safety margins and adjuvant radiotherapy.

Methods

Patients with a diagnosis of PDS were selected from 9 European institutions based on the histopathologic criteria described by Fletcher. Clinicopathologic and follow‐up data were collected and statistically analyzed calculating univariate hazard ratios with 95% confidence intervals by use of the Cox proportional‐hazards model and a significance level of p <0.05. Patients with an incomplete excision of the tumor were excluded.

Results

Univariate Cox regression analysis of possible prognostic factors for progression‐free survival (PFS) performed in 92 patients revealed that an excision margin of less than 2 cm is significantly associated with relapse of PDS (hazard ratio 4.478 [95% CI 1.536‐13.055],p=0.006). Ulceration of the tumor was associated with a significantly better prognosis (0.396 [0.174‐0.904], p=0.028) whereas adjuvant radiotherapy did not reach statistical significance to improve prognosis in patients with PDS (0.775 [0.231‐2.593], p=0.679). Gender, age, immunosuppression, intratumoral necrosis, tumor location, vertical thickness or horizontal diameter did not significantly influence PFS in PDS.

Conclusion

We identified surgical safety margins of less than 2 cm and absence of ulceration as risk factors for relapse in patients with PDS. These findings may be implemented into both the primary treatment as well as the further monitoring of patients with PDS.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GHmkvc

The spectrum of benign dermal dendritic melanocytic proliferations

Abstract

Dermal melanocytoses (DMs) comprise a heterogeneous group of benign lesions, located on skin and mucous membranes, characterized by dendritic melanocytes in the dermis. Although they share common histopathological features, some variants may present only as bluish or gray patches, some only as papules/nodules/plaques and others may show combination of all of these lesions. Despite the fact that blue nevus is typically characterized with papulonodular lesions, its variants may show all of the aforementioned presentations. Mongolian spot, nevus of Ota and nevus of Ito are patchy DMs distinguished by their specific localizations. Apart from these classical forms, many atypical variants without unique clinicopathological characteristics have been described in the literature making the nomenclature of DMs more complicated. However, congenital dermal melanocytosis and acquired dermal melanocytosis seem to be crucial umbrella terms that encompass all patchy DMs in atypical locations. Papules or subcutaneous nodules on patchy lesions and association of epidermal pigmentation presenting as brownish patches may be encountered as rare features of DMs. On the other hand, delayed‐onset subcutaneous nodules may be typical presentations of melanoma in patchy DMs, therefore they deserve special attention. Large plaque‐type blue nevus with subcutaneous cellular nodules is a newly described entity, harboring clinical features of various DMs together and has a high risk of melanoma. The whole spectrum of dermal dendritic melanocytic proliferations is discussed including novelties and controversial issues.

This article is protected by copyright. All rights reserved.

http://bit.ly/2tlh6h3

JAK inhibitors for alopecia areata: a systematic review and meta‐analysis

Abstract

Background

There have been a number of case reports and small clinical trials reporting promising outcomes of JAK inhibitors tofacitinib, ruxolitinib, and baracitinib for alopecia areata (AA). The majority of the literature to date is based on small volume data, with a lack of definitive evidence or guidelines.

Objective

To determine the expected response of AA to JAK inhibitor therapy, and factors which influence response and recurrence rates.

Methods

A systematic review and meta‐analysis was performed according to PRISMA guidelines.

Results

From 30 studies and 289 cases, there was 72.4% responders, good responders 45.7%, and partial responders 21.4%. Mean time to initial hair growth was 2.2 ± 6.7 months, and time to complete hair regrowth was 6.7 ± 2.2 months. All 37 recurrences occurred when treatment was ceased after 2.7 months. Oral route was significantly associated with response to treatment compared to topical therapy. No difference was found between pediatric and adult cases in proportion of responses.

Conclusion

There is promising low‐quality evidence regarding the effectiveness of JAK inhibitors in AA. Future large‐sized randomized studies are required to confirm findings.

This article is protected by copyright. All rights reserved.'

http://bit.ly/2GKjkye

Algorithms for ascertaining keratinocyte carcinomas using health insurance claims and prescription records

Abstract

Skin cancer is the most common human malignancy with an ongoing continual increase in global incidence.^1‐3 Despite their high prevalence, keratinocyte carcinomas (KCs), namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are often excluded from population‐based cancer registries. As there are over 3000 defined skin disease varieties that can be diagnosed,⁴ robust ascertainment methods are needed to capture KC cases for epidemiologic purposes. In the United States (US), Eide et al.

This article is protected by copyright. All rights reserved.

http://bit.ly/2tlh1df

Calcifying Epithelial Odontogenic (Pindborg) Tumor in a Child: A Case Report and Literature Review

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is a rare neoplasm, which accounts for < 1% of all odontogenic tumors. CEOT occurs more frequently in adults with a peak incidence in the 5th decade of life and is extremely rare in the pediatric population. We present a case of a 13-year-old girl who was found to have a mandibular CEOT. We summarize the radiological features, pathological findings, clinical management and literature review focusing on this entity in children.

http://bit.ly/2SzYqJj

Microarray Immunodiagnostics for Aeroallergens

Abstract

Purpose of Review

The impact of new technologies, especially multiplexed molecular allergy diagnostics based on allergen arrays, on the management of complex patients with respiratory allergies has been important.

Recent Findings

Currently, the detailed characteristics of the IgE profile of the patient, such as sensitization to genuine or cross-reacting components or the sensitization to potentially harmful allergens, allow an allergist to tailor treatment in the context of precision medicine rules.

Summary

A number of relevant articles have been published in recent years on this topic, and, in this review, the new added values of allergen array-based diagnostics are reported.

http://bit.ly/2SVBjYY

Phacomatosis pigmentokeratotica: Postzygotic HRAS mutation with malignant degeneration of the sebaceous naevus

http://bit.ly/2BCmUqG

A Morel‐Lavallée lesion simulating acute bacterial skin infection

http://bit.ly/2TRewL5

Nasal response to stress test in healthy subjects: an experimental pilot study

Abstract

Purpose

Stress has been suspected to play a role in rhinitis. The role of stress on nasal patency has been not yet elucidated. The aim was to evaluate the potential effects of stress on nasal patency in healthy subjects.

Methods

We conducted a prospective pilot study including 12 healthy subjects. Experimental protocol was divided in three periods (pre-task, task and recovery). In the task period, subjects were exposed to the "Trier Social Stress Test" (TSST), a standardized laboratory stressor. Different parameters including Spielberger State Anxiety Inventory (SSAI) score, visual analogic scale (VAS) of nasal patency feeling, heart rate, acoustic rhinometry measurements have been compared between the three different periods. The study population was divided into two groups according to the Spielberger Trait Anxiety Inventory (STAI) score: A "non anxious" group and a "weakly anxious" group.

Results

Seven subjects were in the "non anxious" group and five in the "weakly anxious" group. TSST significantly increased heart rate in all volunteers. SSAI score was significantly increased (p = 0.04) after the task period (36.6 ± 11.3) when compared to the SSAI score in pre-task period (31.9 ± 12.6). VAS score of nasal patency feeling significantly decreased from pre-task to task and recovery periods. Mean minimal cross-sectional areas and mean volumes of the nasal cavities were not significantly different between the three periods, except in "weakly anxious" group, but the small number of subjects does not allow to draw a definite conclusion.

Conclusion

We observed that stress influenced the feeling of nasal patency in healthy subjects. However, the objective effects of stress on nasal geometry were globally non-significant except in "weakly anxious" group. This latter result of our pilot study needs to be confirmed in a larger cohort.

http://bit.ly/2BEf28q

Chronic leg ulcerations associated with livedoid vasculopathy successfully treated with rivaroxaban

http://bit.ly/2N60y5y

Asymptomatic erythematous hardened plaque on the scalp

http://bit.ly/2SSHjSm

Conceptual, Statistical and Clinical interpretation of results from A Systematic Review and Meta‐Analysis of Cryosurgery combined with Topical interventions for Actinic Keratosis

Abstract

Furthermore, when conducting meta‐analysis by pooling studies, the studies should be analysing the outcome of the same input effect (for ex. in a meta‐analysis regarding efficacy of two treatments A & B, you cannot pool the results of a cohort that received treatment A with one that received treatment B, even though the outcome of both cohorts is measured in terms of Risk Ratio). Heppt et al.'s meta‐analysis fails to comply with said point. In Fig.3 of Heppt et al.'s manuscript, we observe that studies assessing different treatments (5‐FU, Imiquinod, Ingenol Mebutate, Diclofenac and ALA‐PDT) have been pooled, to determine the overall Risk Ratio, which is incorrect.

This article is protected by copyright. All rights reserved.

http://bit.ly/2N7wW82

Microarray Immunodiagnostics for Aeroallergens

Abstract

Purpose of Review

The impact of new technologies, especially multiplexed molecular allergy diagnostics based on allergen arrays, on the management of complex patients with respiratory allergies has been important.

Recent Findings

Currently, the detailed characteristics of the IgE profile of the patient, such as sensitization to genuine or cross-reacting components or the sensitization to potentially harmful allergens, allow an allergist to tailor treatment in the context of precision medicine rules.

Summary

A number of relevant articles have been published in recent years on this topic, and, in this review, the new added values of allergen array-based diagnostics are reported.

http://bit.ly/2SVBjYY

Predicting glottal closure insufficiency using fundamental frequency contour analysis

Abstract

Background

Voice analysis has a limited role in a day‐to‐day voice clinic. We developed objective measurements of vocal folds (VF) glottal closure insufficiency (GCI) during phonation.

Methods

We examined 18 subjects with no history of voice impairment and 20 patients with unilateral VF paralysis before and after injection medialization laryngoplasty. Voice analysis was extracted. We measured settling time, slope, and area under the fundamental frequency curve from the phonation onset to its settling‐time.

Results

The measured parameters, settling time, slope, and area under the curve were in correlation with the traditional acoustic voice assessments and clinical findings before treatment and after injection medialization laryngoplasty.

Conclusion

We found that the fundamental frequency curve has several typical contours which correspond to different glottal closure conditions. We proposed a new set of parameters that captures the contour type, and showed that they could be used to quantitatively assess individuals with GCI.

http://bit.ly/2SRRJl3

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

Abstract

Background

Bismuth‐containing quadruple therapy has been suggested as first‐line and rescue alternative for Helicobacter pylori eradication. Our objective was to perform a meta‐analysis evaluating the efficacy and safety of single capsule Pylera^® (bismuth, metronidazole, and tetracycline) plus a proton‐pump inhibitor (PPI) in any line of treatment.

Methods

Studies were selected up to October 2018. Outcomes were eradication and adverse events (AEs) rates pooled using the generic inverse variance method.

Results

In total, 30 studies (6482 patients) were included in the systematic review. The intention‐to‐treat (ITT) efficacy was 90% (95% CI: 87%‐92%, 21 studies, I ² = 88%) in first‐line therapy, 89% (95% CI: 86%‐93%, 12 studies, I ² = 78%) in second‐line and 82% (95% CI: 78%‐87%, nine studies, I ² = 60%) in third‐line; with no differences by the type or dosage of PPI used. For metronidazole‐resistant infection, the ITT efficacy as first‐line therapy was 93% (95% CI: 90%‐96%, six studies, I ² = 0%). In second‐line therapies where patients had been previously treated with clarithromycin, the ITT efficacy was 90% (95% CI: 87%‐93%, 11 studies, I ² = 78%). The overall incidence of AEs was 43% (95% CI: 35%‐50%, 24 studies, I ² = 92%) and they were mostly mild. In nearly 3% of the cases, treatment was interrupted due to AEs.

Conclusions

A 10‐day treatment with Pylera^® achieved an effective eradication rate of approximately 90% both in first‐ and second‐line therapy. This applies regardless of the type and dose of the PPI, in patients with clarithromycin‐ or metronidazole‐resistant strains, and in those previously treated with clarithromycin.

http://bit.ly/2SPManr