Active Surveillance und die moderne Diagnostik des Prostatatkarzinoms

Zusammenfassung

Hintergrund

Ein Teil der Prostatakarzinome wird in der primären Prostatabiopsie nicht detektiert, sodass bei weiterbestehendem Verdacht eine erneute Biopsie erfolgen muss. Neben der Problematik der Falsch-negativ-Rate in der systematischen Biopsie, besteht eine hohe Missklassifikationsrate, insbesondere das Tumorgrading betreffend. Dadurch kann es zu einer verspäteten Diagnose aggressiverer Tumoreigenschaften und im ungünstigsten Falle zu einem Versäumnis kurativer Ansätze kommen. Aufgrund dieser Problematik bestehen zahlreiche Ansätze, die Therapieentscheidung und Überwachung durch den Einsatz moderner Bildgebung und genetischer Biomarker zu optimieren

Ziel

Der Beitrag vermittelt eine Übersicht über die Active-Surveillance(AS)-Definitionen, die Problematik der Prostatakarzinomdetektion und genaue Grading-Abschätzung in der systematischen transrektalen Biopsie und den Einsatz der multiparametrischen MRT (mpMRT), der gezielten MRT- Fusionsbiopsie und genetischer Biomarker als potenzielle Lösungsansätze sowie deren Integration im klinischen Alltag.

Material und Methoden

Aktuelle Literatur wurde recherchiert und im Kontext mit eigenen Erfahrungen ausgewertet.

Ergebnisse

Die mpMRT sowie die gezielte MRT-Fusionsbiopsie sind dem aktuellen Standard der systematischen Biopsie in der Detektion des klinisch signifikanten Prostatakarzinoms überlegen. Besonders deutlich zeigt sich dies im Falle der Wiederholungsbiopsie des anterioren Prostatakarzinoms, einer persistierend suspekten PSA-Dynamik und Einschluss und Monitoring von AS-Patienten. Auch die Kombination mit weiteren neuartigen Prädiktoren sind weitere vielversprechende Ansätze.

Schlussfolgerung

Der potenzielle diagnostische Mehrwert kann ausschließlich durch eine interdisziplinäre Verknüpfung der zunehmend komplexeren diagnostischen Schritte erreicht werden. Effektive Lösungen im Rahmen der interdisziplinären Zusammenarbeit von Radiologen und Urologen auf Niveau der Fachgesellschaften sind notwendig, um Fragen bezüglich des Zeitaufwands und der Ressourcenverteilung mit den Leistungserstattern zu adressieren.

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Issue Information ‐ TOC

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Corrigendum

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In this Issue: Graphical Abstracts

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Issue Information ‐ Cover and Editorial Board

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Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Abstract

Objectives

To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation.

Methods

Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared.

Results

The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected.

Conclusions

The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

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Management of cutaneous T‐cell lymphomas: Established and emergent therapies

Abstract

Cutaneous T‐cell lymphoma is an uncommon group of non‐Hodgkin's lymphoma primarily affecting the skin. It is comprised of a variety of entities with different clinical behaviours and prognosis. Mycosis fungoides is the commonest subtype, and Sézary syndrome is a much rarer form of cutaneous T‐cell lymphoma. At this stage, control rather than cure is the goal of therapy, with particular emphasis placed on preserving quality of life. Our review of the efficacy, safety profile and accessibility of treatment modalities for mycosis fungoides/Sézary syndrome is a tailored guide for the clinician treating these rare conditions.

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Assessment of the efficacy and safety of platelet poor plasma gel as autologous dermal filler for facial rejuvenation

Summary

Background

The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet poor plasma.

Objective

To evaluate the clinical efficacy and safety of plasma gel injection as a dermal filler for facial rejuvenation.

Patients and Methods

The current study was carried out on 52 females presented with facial aging divided into two groups: Group A included 34 females with facial wrinkles, and Group B included 18 females with tear trough deformity. After taking written informed consent, they received two sessions of plasma gel injections at 2‐week interval and followed up monthly for 3 months. They were assessed clinically before treatment sessions and at the end of follow‐up period.

Results

Both studied groups showed immediate significant clinical improvement after plasma gel injection that maintained till the end of follow‐up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) in Group A and Tear Trough Rating Scale (TTRS) in group B, and significant improvement of skin homogeneity and texture in both groups. In general, the reported side effects were minimal and transient.

Conclusion

Autologous platelet poor plasma gel injection seems to be a cost‐effective, safe, well‐tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear trough deformity.

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Comprehensive review of acute oesophageal necrosis

Acute oesophageal necrosis, also known as 'black oesophagus', is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover.

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Pharyngocutaneous fistula caused by dried 'Kombu (edible seaweed) after total laryngectomy

The most common early complication after total laryngectomy is pharyngocutaneous fistula (PCF). However, there are no reports of PCF after total laryngectomy caused by 'Kombu' (edible seaweed) as a foreign body in the digestive tract. A 68-year-old Japanese man had undergone total laryngectomy 5 years previously. He presented with PCF, neck swelling and pain. Video endoscopy showed that a dark green foreign body obstructed the digestive tract. PCF was successfully treated via emergency surgery comprising abscess drainage, foreign body removal and fistula closure. The foreign body was kombu. Clinicians who perform total laryngectomy should know the potential dangers of consuming hygroscopic food items that can cause bolus obstruction of the upper digestive tract and pharyngeal abscess and perforation.

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Thrombosis of abdominal aorta precipitating fatal subarachnoid haemorrhage

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Temporal bone involvement of IgG4-related disease: a rare condition misleading to petrous apicitis causing lateral rectus palsy

IgG4-related disease (IgG4-RD) of temporal bone is rare and clinical manifestation mimics infection. A 19-year-old female presented with progressive left earache and intermittent left nasal obstruction. Then, she rapidly developed left lateral rectus palsy. The physical examination revealed mild redness of left tympanic membrane and a small nasal polyp from the left middle meatus. CT scan showed left petrous apicitis and enhancing sinonasal mucosa. Therefore, Gradenigo's syndrome was first considered. The empirical intravenous antibiotic was immediately prescribed and surgery was performed. The intraoperative pale soft tissue mass in middle ear and polyp in the left nasal cavity were sent for pathological examination and found positive immunohistochemical stains for IgG4 in plasma cells. Systemic corticosteroid, the first-line treatment, was started and her symptoms were finally recovery.

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Endoscopic control of gastric emptying after administration of intravenous erythromycin in an awake patient scheduled for urgent rigid bronchoscopy

Certain interventional pulmonology procedures such as the placement of a tracheal stent or resection of stenosing tracheal tumours require rigid bronchoscopy under general anaesthesia. Unlike an endotracheal tube with a cuff, the rigid bronchoscope only partially protects the airway from bronchoaspiration. For this reason, this procedure is performed on an elective basis in fasted patients. We describe the case of a 60-year-old man with acute respiratory distress requiring emergent rigid bronchoscopy following distal migration of a tracheal stent. One hour before the procedure, the patient had eaten a full meal. Gastric emptying was accelerated by perfusion of intravenous erythromycin and verified by endoscopy with a small diameter gastric endoscope under local anaesthesia. This 1 min procedure was very well tolerated by the patient and allowed to verify with certainty that the stomach was empty. The urgent rigid bronchoscopy for stent retrieval could then be performed safely without any risk of bronchoaspiration.

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Case of autoimmune polyglandular syndrome type 2: how we uncovered the diagnosis

A 24-year-old man with no significant medical history presented to the medical clinic with vomiting and giddiness for 2 days, loss of appetite for 1 month and progressive fatigability for the preceding 4 months. On examination, he was found to be hypotensive and was admitted to the hospital for work-up. Considering his abnormal labs and physical findings, he was worked up and was diagnosed with primary adrenal insufficiency. On further work-up for the aetiology of his Addison's disease, he was found to have concurrent autoimmune thyroiditis and vitiligo. A final diagnosis of autoimmune polyglandular syndrome type 2 was made. The patient was started on hormone replacement therapy and reported improvement of symptoms on 3-month follow-up visit.

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Uncommon presentation of medication-related osteonecrosis of the mandible in a patient with metastatic prostate cancer

An 82-year-old man with a background of prostate carcinoma and bony metastases presented with bilateral discharging neck fistulae. Two years prior to presentation, the patient had been treated with intravenous zoledronic acid for 1 year as part of chemotherapy. Intraoral examination revealed extensive bilateral medication-related osteonecrosis, with orocutaneous fistulae within the neck. Treatment comprised removal of loose necrotic bone sequestrae, debridement of the fistulae and long-term administration of antibiotics, vitamin E and pentoxifylline. Four weeks later, the orocutaneous fistulae had healed.

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Unusual complication of an Alaskan cruise: thinking outside the box

A 69-year-old man with a medical history of hypertension and diabetes presented with altered mental status once he returned from a 14-day Alaskan cruise. An extensive workup for stroke was negative. His physical examination was normal without any focal motor deficits, but he had developed memory loss and paresthesia. He admitted to eating a lot of fish when he was in Alaska. The whole-blood mercury level was found to be elevated. He was managed conservatively and his symptoms resolved completely in a few days. This led to a diagnosis of organic mercury toxicity.

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Arterioportal fistula after partial gastrectomy treated with coil embolisation

Arterioportal fistulas are a rare complication of abdominal interventions. They can remain asymptomatic for a long time and manifest with symptoms of portal hypertension. We present the case of a 65-year-old man admitted to the emergency room with increasing fatigue and melena. He had a history of partial gastrectomy with Billroth II reconstruction 40 years earlier for peptic ulcer perforation. On physical examination, he was pale and presented a machinery-type murmur in the epigastric area. Blood tests revealed iron deficiency anaemia of 5.6 g/dL. During hospitalisation, he required several blood transfusions and maintained melenas. An abdominal CT angiography showed a fusiform aneurysm of the left gastric artery draining to the venous portal-splenic confluent. He was successfully treated with transarterial coil embolisation of the left gastric artery aneurysm. The correct diagnosis of arterioportal fistulas can be very challenging, whereas the standard treatment with coil embolisation offers a low morbidity resolution of symptoms.

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Rare mimic of recurrent anaphylaxis

The distinction between true anaphylaxis and conditions that mimic it can be challenging. We present the unique case of a 23-year-old woman treated for recurrent episodes of anaphylaxis over the course of 11 years and the subsequent discovery of an unlikely condition. We also discuss our approach in managing cases where an anaphylactic mimic is suspected.

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Paramedian chest wall dermoid cyst

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Endophthalmitis with bilateral deafness from disseminated Streptococcus suis infection

Streptococcus suis is a Gram-positive cocci bacterium that are found mainly in pigs and can be transmitted to human through pigs or pork exposure. The disease is mainly found among occupations involving swine contact in western countries whereas in Asia the disease is usually contracted through raw pork consumption. In this case report, we present a case of a middle-aged Thai man who acquired the infection from raw pork consumption. He presented with endogenous endophthalmitis with infective spondylodiscitis, sepsis and meningitis and later developed blindness of the right eye and permanent bilateral hearing loss disseminated from S. suis infection. Our report suggests that S. suis infection be considered as a causative factor in patient presenting with established clinical symptoms and predisposing factors. Cultural habit of eating raw pork should be taken into account especially in Asian countries.

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A pigmented and eroded lesion on the buttock

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Global rosacea treatment guidelines and expert consensus points: The differences

Summary

Background

Rosacea is a highly prevalent, chronic inflammatory disease. The treatment of rosacea remains a challenge to dermatologists. Therapies include skin care, medications, lasers, and various combinations of these modalities. The appropriate treatment depends on clinical types and patient's various clinical symptoms.

Purpose

The purpose of this study was to review and compare current therapies for rosacea of all severities from four different guidelines.

Methodology

We searched PubMed using the keywords "rosacea," "treatment" AND ["erythema rosacea" OR "papulopustular rosacea" OR "ocular rosacea" OR "phymatous rosacea"]. We selected randomized controlled trials, observational studies, controlled clinical trials, and clinical trials. We indentified further studies (including the guidelines) by hand‐searching relevant publications and included those that met the inclusion criteria.

Results

The total number of records identified was 421. We limited our search to the specific abovementioned study types. Twenty‐five of these studies met with our inclusion criteria. An additional five manuscripts were selected using the abovementioned method, and four guidelines were included in this review.

Conclusion

Diagnosing and choosing the appropriate treatment options of rosacea according to guidelines is the basis of scientific criteria. More large‐scale randomized controlled clinical trials on new treatment methods, new drugs, or new dosage forms provide a new guideline for future rosacea treatment. Although there are some differences in the treatment of rosacea, it is generally based on anti‐demodex, anti‐inflammatory, and anti‐angiogenesis.

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Inverse association between statin use and head and neck cancer: A population‐based case‐control study in Han population

Abstract

Background

This case‐control study aimed to find the relationship between prior statin use and head and neck cancer occurrence using a large population‐based database.

Methods

This study used claims data from the Taiwan Longitudinal Health Insurance Database. We included 5515 patients with head and neck cancer as cases and 5515 propensity score‐matched patients without head and neck cancer as controls. Conditional logistic regressions were performed to investigate the relationship between head and neck cancer and prior statin exposure.

Results

Of the 11 030 total sampled patients, 16.95% had previously received prescriptions for statins. In addition, statin exposure was found in 15.99% of cases and 17.91% of controls. The logistic regression also revealed that the adjusted odds ratio of prior statin exposure for cases was 0.86 (95% confidence interval: 0.77‐0.95) compared to propensity score‐matched controls.

Conclusion

This study found an inverse association between statin usage and head and neck cancer occurrence.

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Editorial Board

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Training Groups

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Positive pressure device treatment for Menière’s disease: an overview of the current evidence and a meta-analysis

Abstract

Objective

The objective was to critically assess the current evidence investigating the efficacy of using a positive pressure device in patients with definite or probable Menière's disease.

Methods

We performed a systematic literature search in MEDLINE, EMBASE and PsycINFO up to February 2018. We included both systematic reviews and primary literature [randomized controlled trials (RCTs)] investigating positive pressure treatment, in patients (≥ 18 years of age), with Menière's disease. We assessed the internal validity of systematic reviews using the AMSTAR tool and risk of bias of primary studies using the Cochrane Risk of bias tool. We performed a meta-analysis for each outcome based on the identified studies. The overall certainty of evidence for the outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results

The search for systematic reviews identified four relevant reviews. These all included the same four RCTs. An updated search identified one additional RCT. In total, five RCTs were included in the data synthesis. Our data synthesis showed no effect of positive pressure treatment on primary nor secondary outcomes. No serious adverse events were reported. The overall certainty of evidence ranged from very low to low, due to the serious risk of bias and imprecision.

Conclusion

The current available evidence does not support positive pressure device treatment in patients with Menière's disease. However, the limitations of the current literature hinder the possibility of any solid conclusion. There remains a need for randomized controlled trials of high quality to fully access the utility of this treatment.

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Coblator-Assisted Endoscopic Transnasal Resection of a Large Nasopharyngeal Pleomorphic Adenoma

Background. Pleomorphic adenomas occurring in the adult nasopharynx are rare, with our literature search identifying only 11 previous English-language reports. We document the unusual case of a large nasopharyngeal pleomorphic adenoma that was resected using radiofrequency coblation via an endoscopic transnasal approach. Methods. A 39-year-old male presented with worsening nasal congestion, intermittent otalgia, and a progressive change in voice. Flexible nasendoscopy showed a large homogeneous mass occupying the postnasal space, and computed tomography confirmed a 28 × 31 × 22 mm nasopharyngeal tumour. The biopsy-proven benign tumour was locally dissected using a coblator-assisted transnasal approach. Results. Histology confirmed complete excision of a myoepithelial-rich pleomorphic adenoma. The patient was symptom-free postoperatively, and no signs of recurrence were seen at one-year follow-up. Conclusions. This is a useful addition to the existing literature on surgical procedures used to treat benign pathology in the nasopharynx. The minimally invasive technique was well tolerated and had favourable patient outcomes.

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Three-Dimensional Displacement of Partial Craniofacial Bones Following Rapid Maxillary Expansion in Young Patients with Angle Class III Malocclusions

Objective: The aim of this study was to analyze the displacement in 3D direction of some craniofacial bones with the rapid maxillary expansion in Angle class III malocclusion. Method: Thirteen Angle class III patients (mean age: 12.4 ± 1.7 years; 7 males, 6 females) using rapid maxillary expansion as part of their orthodontic treatment were selected and computed tomography scans were taken before and after expansion. The 3D models were reconstructed using the Mimics software and the maxillary, zygomata, nasal bones were separated. With 3D models correction and registration, the displacements in the 3D directions of partial craniofacial bones were measured. Quantitative variables were analyzed by using SPSS19.0 and a t value less than 0.05 was considered statistically significant. Results: Measurement results showed that rapid maxillary expansion produced significant displacement in both sides of the maxillary, zygomata, and nasal bones. In the width of the midline palatine suture, the anterior nasal spine point was expanded a mean 4.18 mm (range 2.42 mm–5.68 mm, Pleft = 0.007, Pright = 0.014) and the posterior nasal spine point was expanded a mean 2.14 mm (range 1.96 mm–2.43 mm, Pleft 

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Difference in Degrees of Satisfaction with Orthognathic Surgery and Orthodontic Treatment between Skeletal Class III and Cleft Patients

Objective: The aim of this study was to compare the degrees of satisfaction with orthognathic surgery and orthodontic treatment between skeletal Class III and cleft patients. Materials and Methods: The samples consisted of Class III group (N = 25) and Cleft group (N = 16). The Modified Orthognathic Quality of Life Questionnaires, which had 5 domains (oral function [OF], awareness of dentofacial deformity [ADD], social relationship [SR], facial esthetics [FE], and nose/lip esthetics [NLE]), were evaluated with 5 rates (0 [very satisfactory] to 4 [very unsatisfactory]) at initial visit (T1), just before surgery (T2), 3 to 6 months after surgery (T3), and at debonding or 1 year after surgery (T4). The scores at each stage, amount of change between stages, and effect size (ES) in the 5 domains were investigated. Results: Compared to Class III group, Cleft group exhibited lower satisfaction scores of NLE domain during all stages (all P 

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Review of “Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program” by Nikolian VC et al in Ann Surg 268: 700–707, 2018

No abstract available

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Minimally-Invasive Endoscopic-Assisted Sinus Augmentation

Objectives: The purpose of this article is to evaluate endoscopic-assisted technique by lateral approach for sinus floor augmentation, to reduce the incidence of Schneiderian membrane perforation, and to guarantee a sufficient apposition of new bone even in the posterior maxillary sinus. Methods: From January 2017 to December 2017, 10 patients affected by severe maxillary atrophy underwent endoscopic-assisted sinus augmentation using a lateral approach. Results: In only 1 patient, a little perforation of sinus membrane was observed intraoperatively and it was repaired. No abnormal postoperative bleeding was observed. None of the patients experienced oro-antral fistula, infection, or V2 dysesthesia. The authors did not find radiologic evidences of biomaterial displaced on the maxillary sinus or postoperative sinusitis. Conclusions: The authors evaluated endoscopic-assisted maxillary sinus augmentation technique using a lateral approach that allows a direct and clear view of the surgical field. This technique, as the preliminary results demonstrate, is safe and helpful, especially in avoiding membrane perforation and in xenograft optimal distribution. It could be very useful in retreatment patients. Address correspondence and reprint requests to Giorgio Barbera, MD, Università degli Studi di Roma La Sapienza Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali. Viale del Policlinico 155, IT 00185, Roma; E-mail: giorgiobarbera87@gmail.com Received 4 October, 2018 Accepted 4 January, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Polymorphous Low-Grade Adenocarcinoma: A Proposed Reconstruction Protocol Based on Past Surgical Experience

Background: To propose a reconstructive protocol based on surgical management experience of polymorphous low-grade adenocarcinoma (PLGA) and the location of the primary lesion. Methods: Data on the surgical management and the reconstructive technique of 14 histologically conformed patients with PLGA, all treated by the same surgeon, were analyzed and evaluated. Results: Mean follow-up period in our series was 6.2 years. Mean age at diagnosis was 55.5 years and female to male ratio was 2.2:1. The most common presenting sign was a nonpainful lump or mass in an intraoral location. Most patients were managed by wide local excision and reconstruction method varied from primary closure to the use of radial forearm graft. Recurrence appeared in one of the patients in this series, while 2 required further radiation therapy. A protocol for reconstruction of intraoral patients with PLGA is suggested based on our analysis. Conclusion: Surgical management is the gold standard for PLGA treatment. Neck dissection is recommended only in patients with presurgery fine-needle aspiration confirmed lymph node involvement. The reconstruction depends mainly on location and size of the primary lesion. Address correspondence and reprint requests to Michael Joachim, DMD, MSc, Resident, Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya, MP Lower Galilee, Israel; E-mail: mike.joachim@gmail.com Received 8 October, 2018 Accepted 20 December, 2018 Ethics approval was waived by the institutions involved. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Unexpected Intracranial Hemorrhage and Death After Cranioplasty in a Patient With Massive Hemispheric Infarction

The benefits and common complications of cranioplasty are often mentioned, but fatal complications are rarely documented. Here, the authors report a patient of intracranial hemorrhage and death after cranioplasty and discussed the possible mechanism. A 42-year-old man was admitted with the diagnosis of massive cerebral infarction in left fronto-temporo- parietal lobe, emergency surgery for decompressive large craniotomy and Encephalo-Myo-Synangiosis were performed. One year after surgery, cranioplasty was performed using a titanium mesh plate. Intraoperative cerebrospinal fluid leakage was occurred and dura mater was repaired using pieces of silk. During the postoperative anesthesia emergence, the patient had epileptic seizures and did not wake after surgery. The authors also observed about 150 mL bloody cerebrospinal fluid (CSF) in the subcutaneous vacuum drainage system within 2 hours. Emergency computed tomography of the brain showed epidural, subdural, subarachnoid hemorrhages in the postischemic area, the middle line left, and the brain stem swelling. The patient's family refused to immediately remove the titanium mesh plate. Finally, nonoperative treatment is invalid and the patient's neurological condition did not recover and he died 3 days after the surgery. In the authors' mind, patients with previous massive cerebral infarction and Encephalo-Myo-Synangiosis undergoing cranioplasty might be at heightened risk of a fatal event than other cranioplasty. Therefore, the patients should be paid more attention to prevent and treat the fatal complications. Address correspondence and reprint requests to Peng Zeng, MD, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, China; E-mail: 15261898010@163.com Received 6 November, 2018 Accepted 27 January, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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An Automatic Spatial Registration Method for Image-Guided Neurosurgery System

Objective: This study aimed to investigate the feasibility of an automatic marker-free patient-to-image spatial registration method based on the 4-points congruent sets (4PCS) and iterative closest point (ICP) algorithm for the image-guided neurosurgery system (IGNS). Methods: A portable scanner was used to obtain the point cloud of the patient's entire head. The 4PCS algorithm, which is resilient to noise and outliers, automatically registered the point cloud in the patient space to the surface reconstructed from the patient's preoperative images in the image space without any assumptions about initial alignment. A variant of the ICP algorithm was then used to finish the fine registration. Two phantoms and 3 patients' experiments were performed to demonstrate the effectiveness of the proposed method. Results: In the phantom experiments, the mean target registration error of 15 targets on the surface of the rigid and the elastic phantoms were 1.02 ± 0.18 mm and 1.27 ± 0.36 mm, respectively. In the clinical experiments, the mean target registration error of 7 targets on the first, second and third patient's head were 1.88 ± 0.19 mm, 1.84 ± 0.19 mm, and 1.89 ± 0.18 mm, respectively, which was sufficient to meet clinical requirements. The registration accuracy and registration time using the proposed method are better than that using the method based on manually coarse registration and automatic fine registration. Conclusions: It is feasible to use the automatic spatial registration method based on the 4PCS and ICP algorithm for the IGNS. Moreover, it can replace the spatial registration method based on manually selected anatomical landmarks combined with the automatic fine registration in the currently used IGNS. Address correspondence and reprint requests to Prof. Yifeng Fan, 481 Bingwen Road, Hangzhou, 310053, China, E-mail: fanyifeng@hmc.edu.cn; Prof. Xiufang Xu, 481 Bingwen Road, Hangzhou, 310053, China, E-mail: 2659189077@qq.com Received 11 November, 2018 Accepted 25 December, 2018 This study was partially supported by the Zhejiang Province Public Welfare Technology Application Research Project (No. LGF19H090018, LGF18H180009), the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (No. 2019309666), the Scientific Research Fund of Zhejiang Medical College (No. 2016B03), the Zhejiang Province College Students Xinmiao Talents Program (2017R436007), the Shanghai Municipality Natural Science Foundation (No. 16ZR1416000) and the Shanghai University of Medicine & Healthy Science (No. HMCI-16-11-002). The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Effect of a Superior Lateral Anterior Pedicle Flap for Draf Procedures

Several types of flap techniques have been developed to cover exposed bone after Draf procedures to reduce the possibility of re-stenosis. These techniques are relatively new and detailed measurements of the size of neo-Ostia during follow-up have not been reported. The authors aim to assess outcomes precisely by not only using endoscopic evaluation but also by measuring the diameter of the ostium and the thickness of the nasal beaks on pre- and postoperative computed tomography images. The authors reviewed 25 patients with 37 nasal cavities who have undergone a Draf surgery with a previously-reported superior lateral anterior pedicle flap technique. The anteroposterior (AP) distance of the frontal recess and the thickness of the nasal beaks were measured before, immediately after, and more than 6 months after surgery. Measured distances were statistically analyzed. The neo-ostium remained patent in long-term follow-up of all patients. The AP distance of the frontal recess and the thickness of the nasal beak were preserved during follow-up. Neither synechiae nor orbital injuries occurred. In conclusion, Draf type II and III procedures with superior lateral anterior pedicle flaps are safe and effective. Neo-Ostia remained patent throughout the follow-up period. Address correspondence and reprint requests to Kazuhiro Nomura, MD, PhD, Department of Otolaryngology, Tohoku Rosai Hospital. 4-3-21 Dainohara, Aoba-ku, Sendai-shi, Miyagi 981-8563, Japan; E-mail: nomura@orl.med.tohoku.ac.jp Received 12 November, 2018 Accepted 25 December, 2018 The authors declare that they have no conflict of interest. © 2019 by Mutaz B. Habal, MD.

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Saccular Aneurysm of the Internal Jugular Vein in an Adult Patient and Its Surgical Treatment

Objectives: Congenital jugular vein aneurysm in an adult patient is a rare condition. Clinical Report: A 17-year-old patient presented to the authors' clinic with left neck swelling. The clinical and radiological findings were appropriate with the internal jugular vein aneurysm. The authors detailed their experience in the surgical treatment of this true saccular aneurysm. Conclusion: Jugular venous aneurysm is a rare benign venous pathology and it can be easily confused with other neck pathologies. Its surgical excision can be sometimes difficult and troublesome than expected. Address correspondence and reprint requests to Murat Ozturk, MD, Associated Professor, Kocaeli Universitesi Tip Fakultesi, KBB Anabilim Dali, 41380 Umuttepe, Kocaeli, Turkey; E-mail: muratkbb@gmail.com Received 20 November, 2018 Accepted 25 December, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Does Orbital Volume Change Using the Mirror Technique Have a Correlation With Posttraumatic Enophthalmos?

An increase in orbital volume (OV) is an important factor in posttraumatic enophthalmos. The aim of this study was to evaluate the correlation of OV change using the mirror technique with posttraumatic enophthalmos. In this cross-sectional study, a 3-dimensional (3D) semi-automated volumetric method, using a 3D volume rendering tool, was applied to measure OV. The total orbital volume difference (TOVD), posterior orbital volume difference (POVD), and anterior orbital volume difference (AOVD) were measured as predictive factors in traumatic and intact orbits. Enophthalmos was also examined as the outcome, using a Hertel exophthalmometer. A total of 27 patients were examined in this study. The mean TOVD was 4.48 ± 1.82 mm3, the mean POVD was 1.91 ± 0.31 mm3, and the mean AOVD was 2.57 ± 1.71 mm3; also, the mean enophthalmos was 2.89 ± 1.12 mm. Pearson's correlation test demonstrated a positive correlation between enophthalmos and TOVD, POVD, and AOVD (P 

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Effectiveness of a Piezoelectric-Assisted Distraction Osteogenesis Procedure for the Treatment of Ankylosed Permanent Front Teeth

A common complication of tooth replantation after traumatic avulsion is tooth ankylosis causing dental malpositioning, partial loss of function, tipping of adjacent teeth and worsening of aesthetics. The aim of this study is to evaluate the effects of a repositioning procedure of such ankylosed permanent front teeth by a distraction osteogenesis procedure. Five patients (mean age 13.4 years), with an ankylosed permanent front tooth in the anterior area, were enrolled in the present study. After the pre-operatory orthodontic preparation, each selected site was treated with single-tooth dento-alveolar block osteotomy surgery performed with a piezoelectric surgery device with ultrasonic cuts on the buccal side. Subsequently, a custom distraction device, made by a resin splint and a sector expansion screw, was set in such a way it delivered a force with direction and sense towards the planned position of the tooth as well as the osteotomy's incision. After a latency period of 14 days, the distraction of the dento-alveolar block was started with a rate of distraction of 0.8 mm per day. The average shift obtained by the ankylosed teeth was 7.8 ± 0.75 mm (±SD), and the ankylosed tooth was regularly positioned into the occlusion in 20.4 ± 1.85 days (±SD), with a slight relapse (±0.5 mm) observed after 1 year. This study indicates that a therapeutic approach combining piezoelectric surgery and orthodontic therapy may be useful for the treatment of ankylosed permanent teeth in the frontal area with a long-term follow-up over 5 years. Address correspondence and reprint requests to Marco Cicciù, DDS, PhD, MSc, Oral Surgery Medical Practitioner, Assistant Professor Department of Odontostomatology, School of Dentistry University of Messina, Policlinico G. Martino, Via Consolare Valeria, 98100 Me, Italy; E-mail: acromarco@yahoo.it Received 26 November, 2018 Accepted 27 December, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Guided Bone Regeneration Using BioGlue As a Barrier Material With and Without Biphasic Calcium Phosphate: A Histological and Histomorphometric Study

The aim of this study was to investigate the effects of Bioglue as a mechanical barrier with or without biphasic calcium phosphate (BCP) in a rat tibia model. Sixty Sprague Dawley male rats weighing 250 ± 20 g and 10 to 12 weeks of age were studied. Unicortical defects were created on the right tibia of all rats. Subjects were randomly divided into 3 groups. BioGlue group (24 rats); BioGlue alone, Graft group (24 rats); BioGlue + BCP and Control group; unfilled and uncovered (12 rats). Animals were euthanized at 7th, 21st, and 45th days postoperatively for histological and histomorphometric analyses. BioGlue material exhibited no adverse effects until the end of observation period. Bone-healing scores did not differ statistically between Control and BioGlue group, but found to be lower in Graft group on 21st and 45th days, (P 

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Parents’ Knowledge, Attitude and Behaviour toward Cleft Lips and Cleft palate in Kencana Hospital, Serang, Banten

Introduction: Cleft lips (CL) and cleft palate (CP) are common congenital diseases caused by gene mutation in embriology development of the lips and mouth at 4 weeks of gestation. CL and CP can cause several problems such as difficulty in eating, speaking, abnormality in teeth and mouth development and ear iritation. Adequate treatment is needed to improve patients' quality of life. Material and Method: This cross sectional study take samples purposively from all parents who joined in cleft charity surgery in Kencana Hospital, Serang, Banten on October 24th 2018. This study identify parents' knowledge, attitude and behaviour towards CL and CP and analyzed the relationship of parents' knowledge and attitude towards CL and CP. Statistical analysis used in this study is Fisher method. Result: Ten patients undergo labioplasty surgery, 1 patient undergo labioplasty revision, 5 patients undergo palatoplasty surgery and 10 patients undergo labioandpalatoplasty surgery. The majority of parents' education background have income  0,05). Discussion: Parent's under knowledge is caused by their low educational background and inaccurate information and education provided by medical professional. But, they had a good attitude and behaviour toward CL and CP because they had initiative to look for medical help and treat their children same as other normal one. Although they received inaccurate information and education about cleft disease, all parents looked for medical help and did what they were told by medical professionals. Conclusion: The majority of parents in this study have under knowledge about cleft lips and cleft palate but they are still looking for medical help to treat their children. This charity significantly helps parents whose children have cleft lips, with or without cleft palate, to get treated in that area. Address correspondence and reprint requests to Alexandria Stephanie Suparman, MD, Atma Jaya School of Medicine and Health Science, Condominium Green Bay Pluit Tower K lantai 18B unit AN, North Jakarta, Indonesia; E-mail: alexaniesu@gmail.com Received 1 December, 2018 Accepted 26 December, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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Orthodontic-Orthopedic-Surgical Treatment of Syndromic Third Class: Proposal of a New Craniofacial Cephalometric Method

The management of patients suffering from class III due to syndromic craniosynostosis requires a multidisciplinary team to prevent and correct the complex clinical features related to the syndrome. Among the main clinical features, the midface hypoplasia requires surgical advancement with a rigid external distraction device. The comparison of pre- and postdistraction lateral cephalometries is often difficult in these patients, because the craniofacial advancement mobilizes the landmarks routinely used in cephalometry. Aim of this study is to evaluate occlusal, maxillary, and facial changes obtained after the midface osteodistraction using as reference the PM plane, that does not undergo postsurgical spatial modifications. The before and after surgery lateral X-rays of 12 patients were compared to test the cephalometric protocol: 10 angles and 11 linear distances were evaluated. The cephalometric comparison before and after osteodistractions of syndromic class III, using as reference the Enlow's PM plane, has confirmed the data present in current literature, consisting in forward and downward movements of facial middle 3rd, with clockwise rotation of the splanchnocranium and increase of the facial heights. The use of the PM plane as reference could be the solution to problems that have been an obstacle for the study of occlusal and facial changes in patients affected by craniofacial dysostosis. Address correspondence and reprint requests to Emanuela Coppotelli, DDS, Via Caserta, 6, 00161 Roma, Italy; E-mail: manu8803@live.it Received 28 January, 2018 Accepted 16 November, 2018 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

https://ift.tt/2H55CWM

The Influence of the First-Stage DO Treatment of Palate Defect on Growth of Maxilla

To study the influence of distraction osteogenesis (DO) on the maxillary growth as first-stage treatment of palatal defect. The uniform palate defect experimental animal models (21 miniature pigs) were established surgically. Then animals were randomly divided into negative control group (A, n = 6), conventional surgery group (B, n = 6), and distraction osteogenesis group (C, n = 9) respectively. The group A underwent none treatment as control group, the group B were undergoing a conventional defect repair surgery, and the group C were undergoing a distraction osteogenesis treatment. Cone beam computed tomography examination was performed monthly to analyze the growth of maxilla for 6 months. One pig of group C was randomly sacrificed at 2, 4, and 8 weeks after the completion of DO and the tissue of distraction gap was stained with hematoxylin–eosin and Masson staining. At the end of 6th months, all pigs were sacrificed and tissues of the surgical area were stained as previous described. The palate defect was repaired by the distraction osteogenesis with the successful bone formation on the distraction gap. Group A and group C kept a similar growth rate, but that of group B was relatively slow. Distraction osteogenesis is efficient and successful for closing the defect of palate and there is no significant disturbance on the subsequent growth of the maxilla. Address correspondence and reprint requests to Huaming Mai, DDS, PhD, Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical University, No. 10, Shuangyong Road, Nanning 530021, China; E-mail: huamingmai@163.com Received 8 May, 2018 Accepted 16 November, 2018 SL and HW are equal contributors and cofirst authors. This work is supported by the Research and Development subject of appropriate healthcare technology of Guangxi, China (S201305-04). The technical support is provided by Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction,Guangxi Key Laboratory of Maxillofacial Surgery Disease Treatment and Guangxi clinical Research Center for Craniofacial Deformity. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

https://ift.tt/2H55yX2

Evaluation of the Accuracy of Virtual Planning in Orthognathic Surgery: A Morphometric Study

Background: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome. Methods: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result. Results: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study. The average linear differences for selected points were

https://ift.tt/2tDEczv

Virtual Surgical Planning and Three-Dimensional Printed Guide for Soft Tissue Correction in Facial Asymmetry

Fat grafting has become a well-accepted surgical modality to correct soft tissue facial defects and asymmetries with overall good results. Several techniques have been reported over the last few years to assist in improving accurate evaluation of facial defects and in the preoperative planning of the reconstruction. Such techniques include among others, computer tomography, three-dimensional (3D) photogrammetry, high resolution ultrasound, and 3D laser scanning. There are advantages and disadvantages for each technique. With the rapid advance of 3D technologies that have become readily available to clinicians, new clinical applications continually emerge to guide and facilitate reconstructive procedures. The authors explored the possibility of fabricating a 3D printed surgical guide to define volume differences for soft tissue reconstruction in patients with facial asymmetry. The model was developed through the authors' virtual surgical simulation and planning system that consists of computer-assisted design (CAD) and 3D printing (3DP). Three-dimensional volumetric scans of patients' faces were analyzed with computer-aided design to quantify areas of facial asymmetry. Surgical guides with containers defining volumetric differences were fabricated using 3D printing to identify and quantify areas of soft tissue deficiency. The 3D printed patient-specific, guides were sterilized and used by the surgeon intraoperatively to accurately mark the areas of soft deficiency. Thus, facial symmetry was achieved by fat grafting the predetermined volume differences defined in the surgical guides. A postop mask was used by the surgeon at the end of the procedure and during follow-up clinic visit to verify and evaluate accurate fat grafting placement as well as to determine areas where to add volume if needed. This paper details the rational for the authors' approach, outlines the technical planning and fabrication process of these patient-specific custom surgical guides with quantified volumetric containers and their intraoperative use by the surgeon. Despite the authors' limited experience we conclude that the authors' technique offer surgeons a precise means for accurate volumetric reconstruction of facial asymmetry. Address correspondence and reprint requests to Eduardo Arias, BFA, The Craniofacial Center, Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, 811 South Paulina Street, Chicago, IL 60612-7314; E-mail: ariase@uic.edu Received 30 October, 2018 Accepted 19 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

https://ift.tt/2H55vdO

Evolution of Full Facial Feminization Surgery: Creating the Gendered Face With an All-in-one Procedure

Facial feminization surgery (FFS) has recently gained popularity to enhance the female facial profile and promote a real transformation of the male to female face in transgender patients. The term involves overlapping of the surgical procedures devoted to feminization and represents a dual and reversible procedure unique in plastic and reconstructive surgery. Indeed, FFS envisages modifications of the hard and soft tissues and is both reductive and augmentative. For these reasons, full FFS (F-FFS) is used by surgeons with special expertise in FFS. This study describes a novel approach to F-FFS performed in a single surgery and thus renamed, de facto, all-in-one and representing its most recent evolution. Forty-nine consecutive nonrandomized patients underwent FFS at a private clinical practice (Face Surgery Center, Parma, Italy) between January 2003 and December 2017. Following a retrospective review according to specific inclusion criteria, the authors identified 9 patients aged 19 to 33 years (mean age, 21 years) who underwent all-in-one F-FFS. Patients were discharged the day after surgery with written postoperative care instructions. No reports of wound infection/dehiscence or nerve/vessel damage were recorded. Patients typically returned to work within 30 days following surgery. The mean operative time was 281 minutes (range, 245–305 minutes). The evolved all-in-one F-FFS provides a further step technically (overlapping several procedures) in terms of surgical outcome (higher satisfaction rate) and reduced overall costs and low morbidity. Address correspondence and reprint requests to Tommaso Agostini, MD, Consultant Reconstructive Plastic Surgeon, Department of Maxillo-Facial Surgery, University of Florence, Largo Palagi 1, Florence, Italy; E-mail: tommasoagostini@ymail.com Received 2 August, 2018 Accepted 31 October, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

https://ift.tt/2tBqSM6

Salvage of Exposed Microtia Cartilage Framework in a Pediatric Patient With a Preauricular Perforator Cutaneous Flap

An 8-year-old boy with oculo-auriculo-vertebral syndrome presented to the authors' clinic for multidisciplinary management of his condition. His congenital ear deformity included bilateral protrusion as well as atypical Microtia affecting the left side. He underwent bilateral otoplasty combined with left canaloplasty at the first stage to address prominent ears and canal atresia and. The patient underwent subsequent reconstruction of his constricted left ear with costochondral cartilage graft to address elsewhere. He presented to the authors' clinic 2 weeks postoperatively with wound dehiscence and cartilage exposure along the scapha surface. The authors present their management strategy utilizing a preauricular pedicled perforator cutaneous flap in a staged manner with emphasis on technical details and review of available flap options for management of such complications. Address correspondence and reprint requests to Basel Sharaf, MD, DDS, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; E-mail: Oliver.jeremie@mayo.edu Received 14 October, 2018 Accepted 25 November, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

https://ift.tt/2H1FFHE

Stem Cells for Bone Regeneration: Current State and Future Directions

Mesenchymal stem cells (MSCs) are capable of differentiating into osteoblasts, chondrocytes, and adipocytes, each of which is important for musculoskeletal tissue regeneration and repair. Reconstruction and healing of bony defects remains a major clinical challenge. Even as surgical practices advance, some severe cases of bone loss do not yield optimal recovery results. New techniques involving implantation of stem cells and tissue-engineered scaffolds are being developed to help improve bone and cartilage repair. The invasiveness and low yield of harvesting MSCs from the bone marrow (BMSCs) has led to the investigation of alternatives, including adipose-derived mesenchymal stem cells (ASCs). A review of the literature yielded several studies concerning the use of BMSCs and ASCs for the treatment of bone defects in both in vitro and in vivo models. Although both ASCs and BMSCs have demonstrated bone regenerative capabilities, BMSCs have outperformed ASCs in vitro. Despite these in vitro study findings, in vivo study results remain variable. Analysis of the literature seems to conclude there is no significant difference between bone regeneration using ASCs or BMSCs in vivo. Improved study design and standardization may enhance the application of these studies to patient care in the clinical setting. Address correspondence and reprint requests to Steven R. Buchman, MD, Associate Professor of Plastic and Reconstructive Surgery, Department of Surgery, Michigan Medicine 1540 E. Hospital Drive, SPC 4219, Ann Arbor, MI 48109; E-mail: sbuchman@med.umich.edu Received 10 September, 2018 Accepted 1 November, 2018 The authors report no conflicts of interest. This work was supported by National Institutes of Health grant NIH-R01 CA 125187-06. © 2019 by Mutaz B. Habal, MD.

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Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology.

https://ift.tt/2Sqaw2J

Neoadjuvant immunotherapy: is this the “new” induction chemotherapy?

Immunotherapy is rapidly becoming another option for the treatment of cancer of the head and neck. Harnessing the immune system with immune checkpoint inhibitors, co-stimulatory agonists, vaccines, toll-like receptor (TLR) inhibitors, and chimeric antigen receptor (CAR) T cells, has shown clinical benefit in various types of cancer.1,2

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Familial oligodontia and regional odontodysplasia associated with a PAX9 initiation codon mutation

Abstract

Objective

Tooth agenesis is one of the most common craniofacial developmental anomalies. In hypodontia, one to five teeth are missing, whereas oligodontia refers to the absence of at least six teeth, excluding the third molars. Mutations in several genes including MSX1, PAX9, AXIN2, and WNT10A have been shown to cause non-syndromic tooth agenesis. Regional odontodysplasia (RO), also known as "ghost teeth," is a rare developmental anomaly of tooth formation affecting both dentitions. Some possible causes of RO have been suggested, yet the etiology remains unknown. Because the phenotypes of both oligodontia and RO co-occur in one Finnish family, the aim here was to investigate the genetic etiology of the two conditions.

Materials and methods

A mutation screening of the genes MSX1, PAX9, AXIN2, and WNT10A was performed for the family members of a RO patient and family history of oligodontia.

Results

An initiation codon mutation of the PAX9 gene was found in the proband and segregating with oligodontia in the family.

Conclusions

The etiology of regional odontodysplasia (RO) may be genetic and the same genes can be involved both in RO and tooth agenesis.

Clinical relevance

Our results give new insights into the etiology of regional odontodysplasia, yet further results are needed.

https://ift.tt/2Ntp6pv

First-line therapy-stratified survival in BRAF-mutant melanoma: a retrospective multicenter analysis

Abstract

Background

Inhibition of the mitogen-activated protein kinase (MAPK) pathway as well as programmed death 1 receptor (PD-1) blockade was shown to prolong overall survival (OS) in patients with advanced B-Raf proto-oncogene (BRAF)-mutant melanoma. However, due to the lack of head-to-head trials, it remains unclear if one of these therapeutic approaches should be preferred in first-line therapy. Here, we present a retrospective analysis comparing anti-PD-1 monotherapy with BRAF/MAPK/ERK kinase (MEK) combined inhibition used as first-line agents in a real-world clinical setting.

Patients and methods

Clinical data, routine blood counts and lactate dehydrogenase (LDH) levels of 301 patients with unresectable or metastatic melanoma harboring an activating mutation in BRAF (V600E/K) were included. Of these, 106 received anti-PD-1 antibodies, while 195 patients were treated with a selective BRAF inhibitor combined with an MEK inhibitor as palliative first-line therapy. Patients were sub-grouped according to previously described predictive and prognostic markers.

Results

OS was significantly longer in patients receiving anti-PD-1 monotherapy compared to patients receiving combined MAPK inhibitors. Subsequent therapies were comparable among these groups. The difference in OS was less pronounced in patients with high LDH levels and visceral metastatic spread.

Conclusion

First-line treatment with a PD-1 blocking antibody might be associated with longer OS than first-line inhibition of the MAPK pathway in patients with advanced melanoma harboring mutant BRAF. These hypothesis-generating data need to be confirmed or rejected in prospective, randomized trials.

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Expression of a soluble IL-10 receptor enhances the therapeutic effects of a papillomavirus-associated antitumor vaccine in a murine model

Abstract

The presence of IL-10, produced either by tumor cells or immunosuppressive cells, is frequently associated with a poor prognosis for cancer progression. It may also negatively impact anticancer treatments, such as immunotherapies, that otherwise would promote the activation of cytotoxic T cells capable of detecting and destroying malignant cells. In the present study, we evaluated a new adjuvant approach for anticancer immunotherapy using a plasmid vector encoding a soluble form of the IL-10 receptor (pIL-10R). pIL-10R was coadministered to mice with a DNA vaccine encoding the type 16 human papillomavirus (HPV-16) E7 oncoprotein genetically fused with glycoprotein D of herpes simplex virus (HSV) (pgDE7h). Immunization regimens based on the coadministration of pIL-10R and pgDE7h enhanced the antitumor immunity elicited in mice injected with TC-1 cells, which express HPV-16 oncoproteins. The administration of the DNA vaccines by in vivo electroporation further enhanced the anticancer effects of the vaccines, leading to the activation of tumor-infiltrating polyfunctional E7-specific cytotoxic CD8⁺ T cells and control of the expansion of immunosuppressive cells. In addition, the combination of immunotherapy and pIL-10R allowed the control of tumors in more advanced growth stages that otherwise would not be treatable by the pgDE7h vaccine. In conclusion, the proposed treatment involving the expression of IL-10R enhanced the antitumor protective immunity induced by pgDE7h administration and may contribute to the development of more efficient clinical interventions against HPV-induced tumors.

https://ift.tt/2GNJJMl

Effects of septorhinoplasty on smell perception

Abstract

Purpose

To assess whether significant changes in smell perception occur after septorhinoplasty, and evaluate whether septum deviation, allergic rhinitis, and surgical technique affect postoperative smell perception.

Methods

Thirty-four patients (> 18 years old) awaiting septorhinoplasty were included, while those with previous severe hyposmia or anosmia were excluded. The participants self-assessed their smell perception using a 100-mm visual analogue scale (VAS), where 0 mm indicated the inability to smell and 100 mm indicated normal smell perception. The University of Pennsylvania Smell Identification Test (UPSIT) was applied before the procedure, and 4 and 12 weeks after surgery.

Results

The UPSIT score showed no significant changes at 4 (p = 0.59; 95% CI − 0.35 to + 2) or 12 weeks (p = 0.16; 95% CI − 1.13 to + 0.66). A comparison of the VAS scores before and 4 weeks after surgery (p = 0.62; 95% CI − 0.63 to + 0.39) yielded similar results. However, the average VAS scores improved 12 weeks after surgery (p = 0.007; 95% CI + 0.22 to + 1.30). Olfactory function, measured using the UPSIT, was not influenced by open or closed surgical techniques (p ≥ 0.10), the presence or absence of rhinitis (p ≥ 0.15), or obstructive septum deviation (p ≥ 0.38). Twelve weeks after surgery, self-evaluated smell perception was better in patients who underwent a closed procedure rather than an open procedure (p = 0.006; 95% CI: −1.39 to −0.37).

Conclusion

A validated test demonstrates that septorhinoplasty does not compromise smell perception 4 and 12 weeks after surgery. However, it might improve smell perception by the self-report observation.

https://ift.tt/2BS9OG2

Occlusal height difference between maxillary central and lateral incisors: should aesthetic perception influence bracket placement?

The aim of this study was to verify anecdotal evidence that the maxillary central-to-lateral occlusal height difference (OHD) of more than 0.5 mm is a feature displayed in the majority of media and to discuss ...

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IMRT Combined With Toripalimab in Unresectable Locally Recurrent Nasopharyngeal Carcinoma.

Conditions:   Nasopharyngeal Carcinoma;   Nasopharyngeal Neoplasms;   Nasopharyngeal Diseases;   Head and Neck Neoplasm
Interventions:   Drug: Tolipalimab;   Radiation: Reirradiation
Sponsor:   Sun Yat-sen University
Not yet recruiting

https://ift.tt/2BSw7M2

Experimental Pain Reporting Accuracy and Clinical Post-operative Pain

Conditions:   Surgical Procedure, Unspecified;   Pain, Postoperative;   ENT Disease
Intervention:   Device: pain reporting accuracy
Sponsors:   Carmel Medical Center;   University of Haifa
Not yet recruiting

https://ift.tt/2UbDmpi

A Dose Escalation Study of PF‑06939999 in Participants With Advanced or Metastatic Solid Tumors.

Conditions:   Advanced Solid Tumors;   Metastatic Solid Tumors
Intervention:   Drug: PF-06939999
Sponsor:   Pfizer
Not yet recruiting

https://ift.tt/2BTUs45

Nivolumab and BMS986205 in Treating Patients With Stage II-IV Squamous Cell Cancer of the Head and Neck

Conditions:   Lip;   Oral Cavity Squamous Cell Carcinoma;   Pharynx;   Larynx;   Squamous Cell Carcinoma
Interventions:   Biological: Nivolumab;   Biological: IDO1 Inhibitor BMS-986205;   Procedure: Therapeutic Conventional Surgery;   Other: Questionnaire Administration
Sponsor:   Thomas Jefferson University
Not yet recruiting

https://ift.tt/2U8lcoj

Serial Epstein-Barr Virus DNA Surveillance in Nasopharyngeal Carcinoma Patients

Condition:   Nasopharyngeal Carcinoma
Intervention:   Diagnostic Test: Plasma EBV DNA
Sponsor:   Sun Yat-sen University
Not yet recruiting

https://ift.tt/2BTUokR

Study of TQB2450 in Patients With Recurrent or Metastatic Squamous Cell Cancer of the Head and Neck（R/M SCCHN）

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: TQB2450+cisplatin or carboplatin + 5-Fluorouracil (5-FU);   Drug: placebo+cisplatin or carboplatin + 5-Fluorouracil (5-FU)
Sponsor:   Chia Tai Tianqing Pharmaceutical Group Co., Ltd.
Not yet recruiting

https://ift.tt/2U5q2ms

Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm

Abstract

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.

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Comparative study of photodynamic activity of methylene blue in the presence of salicylic acid and curcumin phenolic compounds on human breast cancer

Abstract

Curcumin and salicylic acid are both phenolic compounds and they can both affect cancer treatment efficacy. In this study, the effects of methylene blue-curcumin (CU-MB) and methylene blue-salicylic acid (SA-MB) ion pair complexes on MDA-MB-231 human breast cancer cells are studied. According to the thermodynamic parameters, the stability of curcumin and salicylic acid complexes ion pair complexes was compared. The free energy of ion pair interactions was calculated based on binding constants. A comparison of the free energies of the complexes (CU-MB: ∆G^°_b1 = − 21.11 kJ/mol and ∆G^°_b2 = − 8.37 kJ/mol, SA-MB: ∆G^°_b1 = − 12.92 kJ/mol and ∆G^°_b2 = − 9.02 kJ/mol) indicates that the interaction of methylene blue in first binding interaction with curcumin is greater than that of methylene blue with salicylic acid. Electrostatic interactions are the main forces in the binding of both compounds to methylene blue. All forces are inter-molecular physical interactions. The results of cellular experiments show that ion pairing has enhanced the reduction of cell viability. By increasing molecular stability and prevention of dimerization of methylene blue, the cell killing potential of methylene blue increases and it subsequently causes enhancement of photodynamic efficacy.

https://ift.tt/2EyejHx

Correction to: Outpatient erbium:YAG (2940 nm) laser treatment for snoring: a prospective study on 40 patients

In the originally published article, the name of the first author was incorrectly labeled. Given name is Isabelle and family name is Fini Storchi.

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Dental acid etchant as a sensitizing agent in photodynamic therapy to reduce S. mutans in dentinal carious lesions

Abstract

The study aims to assess the utility of dental acid etchant containing 37% phosphoric acid and methylene blue dye (DAE) as a sensitizing agent for photodynamic therapy (PDT) to reduce Streptococci mutans in dentinal caries. Forty-five permanent third molars were sectioned and the coronal dentin exposed. A cariogenic challenge was performed using brain-heart infusion (BHI) supplemented with 0.5% yeast extract, 1% glucose, 1% sucrose, and S. mutans ATCC 25175 standardized to 0.5 McFarland turbidity. Specimens were incubated in anaerobic jars at 37 °C for 15 days. During this period, BHI broth was renewed every 24 h. After 15 days, specimens were randomly divided into three groups (n = 15): DAE, application of dental acid etchant containing 37% phosphoric acid and methylene blue dye for 15 s; LLL, application of low-level laser (wavelength 660 nm, energy 4 J/cm², power 5 W) for 15 s; and PDT, application of DAE for 15 s followed by LLL irradiation (660 nm, 4 J/cm², 5 W). Carious tissue from each specimen was collected before and after the applications. Five decimal dilutions were performed and the resulting solution was seeded in mitis-salivarius-bacitracin agar. Plates were incubated in anaerobic jars at 37 °C for 48 h. Analysis of variance (ANOVA) with post hoc Tukey's test was used to compare total S. mutans counts. Significant reductions in S. mutans were observed after DAE application (40.70%, p < 0.0001), LLL (12.35%, p = 0.0036), and PDT (55.22%, p < 0.0001). Dental acid etchant containing 37% phosphoric acid and methylene blue dye can be used as a photosensitizing agent for PDT to reduce S. mutans burden in dentinal caries.

https://ift.tt/2EyxqBi

Influence of laser wavelength and beam profile on the coagulation depth in a soft tissue phantom model

Abstract

In laser tissue soldering (LTS), a protein solution is thermally denatured and cross-linked to obtain a strong bond between tissues or tissue and a wound dressing. However, if the extension of the heat-affected zone is too large, wound healing is impaired by thermal tissue injuries. Therefore, heat input and coagulation depth have to be limited. We investigate the influence of wavelength and beam profile on coagulation depth using a soft tissue phantom in case of weakly (980 nm) and strong (1540 nm) absorbed laser radiation. The soft tissue phantom is doped with polystyrene (PS) beads to obtain similar scattering properties as natural tissue. The propagation of the laser radiation in the phantom is simulated by Monte–Carlo method and the optical penetration (OPD) depth calculated from isophotes. The simulation results are compared with the experimental determination of the coagulation volume. The results reveal that scattering effect of tissues on laser radiation increases the losses of a Gaussian beam profile laterally leading to a half-sphere coagulation volume. The depth profile of the coagulation follows approximately the intensity distribution of the laser beams as long as scattering effects are weak. As scattering effects become significant, as for 980-nm radiation, the intensity distribution of the laser beam in the tissue deviates from the original one, leading to different profile of the coagulation depth.

https://ift.tt/2Vmg3t6

Examination of the cellular mechanisms of leukocyte elevation by 10.6 μm and 650 nm laser acupuncture-moxibustion

Abstract

To investigate the cell cycle and cellular mechanisms of leukocyte elevation by laser acupuncture in rats with cyclophosphamide (CTX)-induced leukopenia. Sixty-six rats were randomized into six groups: normal, model control group, sham treatment group, 10.6 μm laser treatment group, 650 nm laser treatment group, and 10.6 μm–650 nm compound laser treatment group. Eleven rats were used in the normal group and 55 were models that were injected with cyclophosphamide to induce leukopenia. For the three laser treatment groups, 10.6-μm and 650-nm lasers, and 10.6-μm–650-nm compound lasers were used to irradiate the DU14 (Dazhui) and bilateral ST36 (Zusanli) for 5 min each. The sham laser group received the same operation as the laser group but without irradiation. The normal group and model group were not treated. Differences in the number of nucleated cells in the femoral bone marrow, and cell cycle and cellular apoptosis of peripheral leukocytes in rats in various groups were compared. Compared with the model group and the sham laser group, the number of nucleated cells in the femoral bone marrow in the 10.6-μm laser, 650-nm laser, and 10.6-μm–650-nm compound laser group was significantly increased after treatment (P = 0.001, 0.002, 0.034, respectively) and did not show any significant difference with the normal group (P = 0.964, P = 0.838, P = 0.287, respectively). The number of cells in G2 phase in the 10.6 μm laser group was similar to that of the normal group (P = 0.973). The number of cells in G2 phase in the model, sham, 650-nm laser group, and 10.6-μm–650-nm compound laser group were significantly lower than in the normal group and 10.6-μm laser group (P = 0.016, P = 0.023, P = 0.044, P = 0.039, respectively). In the model group and the sham treatment group, the apoptosis rates of peripheral leukocytes were increased compared with the normal group (P = 0.001), while the proportion of cells in the G2 phase was significantly lower than in the normal group (P = 0.016), and the proportion of cells in S phase was higher than in the normal group (P = 0.014). The incidence of apoptosis in peripheral blood cells in the three laser treatment groups did not show any statistically significant difference when compared with the normal group (P > 0.05). Treatment with the 10.6-μm, 650-nm, and 10.6-μm–650-nm compound lasers increased the number of nucleated cells in the bone marrow, decreased the unfavorable effects of cyclophosphamide on the cell cycle, induced the cell cycle towards proliferation, decreased apoptosis, improved the intramedullary hematopoietic system, and increased peripheral leukocyte count.

https://ift.tt/2ExyZPX

The impact of intravenous isotonic and hypotonic maintenance fluid on the risk of delirium in adult postoperative patients: retrospective before-after observational study

Abstract

Purpose

To assess the impact of intravenous isotonic and hypotonic maintenance fluid on the risk of delirium in adult postoperative patients, we conducted retrospective before-after study in a tertiary teaching hospital.

Methods

We examined all adult patients admitted ICU after an elective operation for head and neck cancer, or esophageal cancer from February 2014 to January 2017. From February 2014 to July 2015, patients were administered hypotonic fluid (sodium; 35 mmol/L) as the National Institute for Health and Care Excellence (NICE) have recommended. From August 2015 to January 2017, patients were administered isotonic fluid (sodium; 140 mmol/L). We defined the incidence of delirium as the primary outcome. The delirium was defined as the Intensive Care Delirium Screening Checklist during the ICU stay ≥ 4. A propensity score-matched model was used to adjust confounders.

Results

As postoperative intravenous maintenance fluid, hypotonic fluid was administered to 119 patients and isotonic fluid was administered to 92 patients. Among those total cohorts, the incidence of postoperative delirium in the hypotonic group was 21.8%, which was significantly higher than that (9.8%) in the isotonic group (p = 0.019). After propensity score matching, we selected 77 patients in each group. The incidence of delirium during the ICU stay in the hypotonic group was 26.0%, which was significantly higher than the incidence of 11.7% in the isotonic group (p = 0.023).

Conclusions

In this study, the use of postoperative hypotonic maintenance fluid was associated with a higher risk of postoperative delirium than that when isotonic maintenance fluid was used.

https://ift.tt/2GKZpjv

Experimental research on the therapeutic effect of MMR vaccine to juvenile-onset recurrent respiratory papillomatosis

Abstract

Objective

To evaluate the efficacy of MMR vaccine in the treatment of juvenile-onset recurrent respiratory papillomatosis as adjuvant therapy by experimental research.

Methods

Thirty-one children with RRP were enrolled and assigned randomly to intervention group or control group. Fifteen subjects in intervention group were treated with local application MMR vaccine on the lesion after surgery; sixteen subjects in the control group were treated with surgical excision alone. The quantity of virus of positive specimens was measured by fluorescence quantitative polymerase chain reaction.

Results

After treatment with MMR vaccine, viral load of intervention group was (9.56 ± 11.03) × 10⁸  copies/ml, that of control group was (22.01 ± 17.78) × 10⁸ copies/ml, and there was significant difference between the two groups (P = 0.040).

Conclusions

Local application MMR vaccine as adjuvant therapy can reduce HPV viral load significantly. It is suggested that the MMR vaccine may inhibit replication of HPV DNA, but the curative effect needs further confirmation.

https://ift.tt/2NsUT9S

Bilateral Syphilitic Optic Neuropathy with Secondary Autoimmune Optic Neuropathy and Poor Visual Outcome

We describe the case of a 65-year-old man who suffered progressive visual loss despite appropriate treatment of ocular syphilis. Our patient initially presented with a unilateral 6th nerve palsy and associated double vision, which self-resolved over 6 months. His ophthalmic examination was otherwise normal. 12 months after the initial complaint, he represented with dyschromatopsia, reduced visual acuity, tonic pupils, and optic nerve atrophy. He tested positive for syphilis and was admitted for treatment of neurosyphilis with high-dose benzylpenicillin. Despite treatment, at a 4-month review his visual acuity remained poor and progression of optic nerve atrophy was noted alongside the development of bilateral central scotomas. Further testing was congruent with a diagnosis of autoimmune optic retinopathy. We propose this to be secondary to his syphilitic infection. Syphilis is known as the "great mimicker," and despite being quite treatable, this case highlights ongoing complexity in the diagnosis and management of syphilis, unfortunately with a poor visual outcome.
Case Rep Ophthalmol 2019;10:81–88

https://ift.tt/2T0sVbz

Photodynamic enhancement of the activity of antibiotics used in urinary tract infections

Abstract

Photodynamic therapy (PDT) has been proven to kill different microbial cells. However, to our knowledge, none of the available reports describes the modulatory effect of this therapy on the antibacterial activity of antibiotics against Escherichia coli rods being the main causative agent of urinary tract infections (UTIs). Therefore, the aim of our study was to verify if the PDT can enhance the antibacterial activity of antibiotics recommended in the treatment of UTIs. An attempt to determine the optimal conditions of PDT to enhance the bactericidal activity of ciprofloxacin, amikacin, and colistin has been made. In order to find the optimal antimicrobial conditions, the efficacy of four protocols associated with the use of different energy doses (70 and 120 J/cm²) and chlorin e6 (Ce6) concentrations (50 and 100 μg/mL) has been verified. The antibacterial effect of combined PDT and antibiotics was assessed by the time-kill assay. The best results were achieved for Ce6 at a concentration of 100 μg/mL and the energy dose 120 J/cm² for bacterial suspensions treated with ciprofloxacin. Taken together, our results showed that PDT using Ce6 improves the antibacterial activity of antibiotics effectively inhibiting bacterial growth and being promising in the elimination of bacterial UTIs in humans.

https://ift.tt/2ICrtaD

The ubiquitin-like modifier FAT10 is required for normal IFN-γ production by activated CD8+ T cells

Publication date: April 2019

Source: Molecular Immunology, Volume 108

Author(s): Mei Min Mah, Michael Basler, Marcus Groettrup

Abstract

FAT10 is the only ubiquitin-like modifier which directly targets its substrate proteins for rapid degradation by the proteasome. While the conjugation and proteasomal targeting of FAT10 are fairly well understood, the biological functions of FAT10 have remained largely elusive. Here we have investigated the role of FAT10 in cytokine responses in mice upon viral infection. We used lymphocytic choriomeningitis virus (LCMV) infection of mice to induce the IFN-γ and TNF-α-dependent expression of FAT10. We found that TCR-stimulated splenocytes derived from LCMV-infected FAT10^−/− mice secreted less IFN-γ and expressed less mRNA for IL-12 p40 but secreted more IFN-α and IFN-β compared to FAT10^+/− mice. The reduction in IFN-γ secretion could be assigned to CD8⁺ T cells. Nevertheless, LCMV viral clearance was similar in FAT10^−/− as compared to FAT10^+/− mice. Since FAT10 has previously been reported to promote influenza A virus (IAV) replication in vitro we have studied the effect of FAT10 deficiency during IAV infection in mice. Unexpectedly, IAV titers and disease symptoms were not changed in FAT10^−/− mice even though the Fat10 mRNA was rapidly induced in the lung upon IAV infection. In conclusion, we find that FAT10 fine-tunes the balance of interferons during viral infection by lowering the production of type I and enhancing type II interferons.

https://ift.tt/2ICkaQf

Otorhinolaryngological manifestations and delayed diagnosis in Kawasaki Disease

Publication date: Available online 26 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): M. Rouault, A. Coudert, R. Hermann, Y. Gillet, E. Truy, S. Ayari-Khalfallah

Abstract

Objectives

Kawasaki disease (KD) is a febrile multisystemic vasculitis of unknown etiology whose coronary prognosis is improved by early diagnosis and management. The objective of this study was to describe ENT manifestations encountered and to look for a delayed diagnosis associated with these manifestations.

Methods

A retrospective descriptive single-center study was conducted in Lyon between January 2009 and December 2017. All children treated for Kawasaki disease were included in the study. Clinical, biological and cardiac ultrasound data were collected. According to the diagnosis made at the first medical visit, children were classified into two groups: diagnosis of ENT spectrum or non-ENT diagnosis. The diagnostic times were compared by a Student test.

Results

142 patients were included: 64 in the ENT diagnostic group, 78 in the non-ENT diagnostic group. When the initial diagnosis was of ENT spectrum, the diagnostic time of KD was significantly longer: 8.51 days vs 5.77 days - (p <0.01). The total duration of fever was also longer - 10.92 vs 8.32 days – (p = 0.013) - and the frequency of antibiotics intake more important - 92.2% vs 46.2% - (p <0.01). Four children underwent surgery in the ENT diagnostic group: two retro-pharyngeal abscesses, one paracentesis and one cervicectomy.

Conclusions

ENT manifestations are frequently at the forefront of KD and constitute a misleading clinical picture responsible for delayed diagnosis and potentially inappropriate medico-surgical management. It is necessary to provide more education to practitioners for earlier recognition of Kawasaki disease.

https://ift.tt/2To2wEd

Radiation Exposure during Videofluoroscopic Swallowing Studies in Young Children

Publication date: Available online 25 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Eun Jae Ko, In Young Sung, Kyoung Hyo Choi, Yong Gyu Kwon, Jisun Yoon, Taehoon Kim

Abstract

Objectives

Swallowing difficulties are best assessed by videofluoroscopic swallowing studies (VFSS). However, limiting radiation exposure is important, especially in young children. The purpose was to evaluate radiation dose in young children during VFSS, and to investigate factors associated with it.

Methods

Children with swallowing difficulty who underwent VFSS from February 2012 to July 2014 were recruited. Dose area product (DAP) and screening time were offered by the fluoroscopy machine, and effective dose was calculated from the DAP using a conversion coefficient published by the National Radiological Protection Board (NRPB-R262). The age, gender, height, weight, body mass index (BMI), body surface area (BSA), underlying disease of the subject children, and results of VFSS were investigated.

Results

In 89 children (mean age 1.57±2.17, 55 boys and 34 girls), mean effective dose was 0.29±0.20 mSv, mean DAP was 2.41±1.65 Gy cm², and mean screening time was 2.24±0.99 minutes. The effective dose correlated with the screening time (r=0.598, p<0.001), age (r=0.210, p=0.049), height (r=0.521, p<0.001), weight (r=0.461, p<0.001), and BSA (r=0.493, p<0.001). There was no such correlation with gender, BMI, underlying disease, or the results of VFSS.

Conclusion

s: The effective dose during VFSS (0.29 mSv) in young children, which is affected by screening time, age, and body size, is considerably lower than the pediatric radiation exposure limit of 1mSv per year. However more than 4 VFSS annually would exceed this limit. Our findings will help physicians to reduce the radiation exposure and provide a useful references for future pediatric VFSS guidelines.

https://ift.tt/2IDPLBb

F-BAR domain only protein 1 (FCHO1) deficiency is a novel cause of combined immune deficiency in humans

Publication date: Available online 26 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Enrica Calzoni, Craig D. Platt, Sevgi Keles, Hye Sun Kuehn, Sarah Beaussant-Cohen, Yu Zhang, Julia Pazmandi, Gaetana Lanzi, Francesca Pala, Azzeddine Tahiat, Hasibe Artac, Raul Jimenez Heredia, Jasmin Dmytrus, Ismail Reisli, Vedat Uygun, Dilara Uygun, Aysen Bingol, Erdem Basaran, Kamel Djenouhat, Nafissa Benhalla

https://ift.tt/2EvPLik

Aberrant natural killer (NK) cell activation and dysfunction among ART-treated HIV-infected adults in an African cohort

Publication date: Available online 26 February 2019

Source: Clinical Immunology

Author(s): Rose Nabatanzi, Lois Bayigga, Stephen Cose, Sarah Rowland-Jones, Glenda Canderan, Moses Joloba, Damalie Nakanjako

Abstract

Background

We examined NK cell phenotypes and functions after seven years of ART and undetectable viral loads (<50 copies/ml) with restored CD4 T-cell counts (≥500 cells/μl) and age-matched healthy-HIV-uninfected individuals from the same community.

Methods

Using flow-cytometry NK cell phenotypes were described using lineage markers (CD56^+/-CD16^+/−). NK cell activation was determined by expression of activation receptors (NKG2D, NKp44 and NKp46) and activation marker CD69. NK cell function was determined by CD107a, granzyme-b, and IFN-gamma production.

Results

CD56 dim and CD56 bright NK cells were lower among ART-treated-HIV-infected than among age-matched-HIV-negative individuals; p = 0.0016 and p = 0.05 respectively. Production of CD107a (P = 0.004) and Granzyme-B (P = 0.005) was lower among ART-treated-HIV-infected relative to the healthy-HIV-uninfected individuals. NKG2D and NKp46 were lower, while CD69 expression was higher among ART-treated-HIV-infected than healthy-HIV-uninfected individuals.

Conclusion

NK cell activation and dysfunction persisted despite seven years of suppressive ART with "normalization" of peripheral CD4 counts.

https://ift.tt/2EenjAp

Initial safety analysis of a randomized phase II trial of nelipepimut-S + GM-CSF and trastuzumab compared to trastuzumab alone to prevent recurrence in breast cancer patients with HER2 low-expressing tumors

Publication date: Available online 25 February 2019

Source: Clinical Immunology

Author(s): Clifton G. Travis, M. Peace Kaitlin, P. Holmes Jarrod, J. Vreeland Timothy, F. Hale Diane, S. Herbert Garth, K. Litton Jennifer, K. Murthy Rashmi, Lukas Jason, E. People George, A. Mittendorf Elizabeth

Abstract

The development of HER2-targeted therapy has decreased recurrence rates and improved survival, transforming the natural history of HER2-positive breast cancer. However only a minority of breast cancer patients benefit as these agents are not used in patients with tumors expressing low levels of HER2. Preclinical data suggests a synergistic action of HER2-targeted vaccination with trastuzumab. We report the initial safety interim analysis of a phase II trial that enrolled patients with HER2 low-expressing (IHC 1+/2+) breast cancer who were clinically disease-free after standard therapy. Patients were randomized to receive the HER2-peptide vaccine nelipepimut-S + GM-CSF with trastuzumab (vaccine arm) or trastuzumab + GM-CSF (control arm) and were followed for recurrence. A planned analysis that occurred after enrollment of 150 patients showed no significant differences in toxicity between the two arms, including cardiac toxicity. The clinical efficacy of this combination will be reported 6 months after the final patient was enrolled.

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Comparative evaluation of SPECT/CT and CBCT in patients with mandibular osteomyelitis and osteonecrosis

Abstract

Objectives

Therapy of osteomyelitis and osteonecrosis very often requires surgery. Proper preoperative radiological evaluation of a lesion's localization and extent is a key in planning surgical bone resection. This study aims to assess the differences between single-photon emission computed tomography and cone beam computed tomography when detecting an osteomyelitis/osteonecrosis lesion as well as the lesion's qualitative parameters, extent, and localization.

Material and methods

Identification of candidates was performed retrospectively following a search for patients with histologically or clinically confirmed osteomyelitis or osteonecrosis. They were matched with a list of patients whose disease extent and localization had been evaluated using single-photon emission computed tomography and cone beam computed tomography in the context of clinical investigations. Subsequently, two experienced examiners for each imaging technique separately performed de novo readings. Detection rate, localization, extent, and qualitative parameters of a lesion were then compared.

Results

Twenty-one patients with mandibular osteomyelitis and osteonecrotic lesions were included. Cone beam computed tomography detected more lesions than single-photon emission computed tomography (25 vs. 23; 100% vs. 92%). Cone beam computed tomography showed significantly greater depth, area, and volume, whereas length and width did not differ statistically between the two groups.

Conclusion

Both single-photon emission computed tomography and cone beam computed tomography could sensitively detect osteomyelitis/osteonecrosis lesions. Only single-photon emission computed tomography showed metabolic changes, whereas cone beam computed tomography seemed to display anatomic morphological reactions more accurately. The selection of the most adequate three-dimensional imaging and the correct interpretation of preoperative imaging remains challenging for clinicians.

Clinical relevance

In daily clinical practice, three-dimensional imaging is an important tool for evaluation of osteomyelitis/osteonecrosis lesions. In this context, clinicians should be aware of differences between single-photon emission computed tomography and cone beam computed tomography when detecting and assessing an osteomyelitis/osteonecrosis lesion, especially if a surgical bone resection is planned.

https://ift.tt/2SZw8by

Expression of Toll-like receptors 2 and 4 and its association with matrix metalloproteinases in symptomatic and asymptomatic apical periodontitis

Abstract

To determine Toll-like receptors (TLR)2 and TLR4 expression levels and associate them with matrix metalloproteinases (MMPs) in asymptomatic apical periodontitis (AAP), symptomatic apical periodontitis (SAP), and healthy controls. Apical tissue/lesion samples were obtained from chronic AAP (n = 35) and SAP (n = 29), and healthy periodontal ligament (HPL, n = 10) with indication of tooth extraction, respectively. mRNA expression levels of TLR2, TLR4, MMP-1, MMP-2, MMP-8, and MMP-13 were determined by real-time reverse-transcription polymerase chain reaction. The data were analyzed with Kruskal-Wallis and Dunn's pot hoc test (p < 0.05). The correlation coefficient was obtained using the Spearman correlation (p < 0.05). TLR2, MMP-1, MMP-2, and MMP-13 mRNA levels were the highest in SAP followed by AAP and controls (p < 0.05). TLR4 and MMP-8 were over expressed in AAP and SAP compared to HPL (p < 0.05). TLR2 positively correlated with TLR4, MMP-1, MMP-8, and MMP-13 in SAP (p < 0.05). TLR2 and TLR4 are overexpressed in apical lesions versus healthy periodontal ligament and correlate with collagenolytic MMPs. Particularly, TLR2 is overexpressed in SAP in association with MMP-1, MMP-8, and MMP-13. Our results suggest that the activation of TLR2 along with MMP overexpression might contribute to SAP clinical presentation and progression. TLRs, MMPs, and their interaction can explain the clinical presentations and evolution of apical periodontitis and might represent key targets for new diagnostic and treatment approaches.

https://ift.tt/2BUCYEr

Influence of timing on the horizontal stability of connective tissue grafts for buccal soft tissue augmentation at single implants: a prospective controlled pilot study

Publication date: Available online 26 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Pier Paolo Poli, Paolo Carlo Maridati, Enrico Stoffella, Mario Beretta, Carlo Maiorana

Abstract

Purpose

The influence of different timing for soft tissue augmentation during implant therapy is still debated. Therefore, the present study aimed to evaluate clinically whether immediate versus delayed soft tissue augmentation procedures had an impact on the stability of peri-implant mucosal thickness.

Methods

Subjects requiring a single implant posterior to the canines in association with soft tissue augmentation procedures at the buccal aspect of single implants by means of connective tissue graft (CTG) were enrolled. Patients were randomly allocated to two different timing protocols: implant placement and simultaneous CTG (test group) or implant placement and CTG after 3 months (control group). PMT was measured clinically at the mid-buccal aspect of the implant site by bone sounding with an endodontic K-file using customized acrylic stents. PMT measurements were recorded before and after implant placement, and at 1, 2, 3, 4, 6, 9, and 12 months following implant insertion. Parametric statistical tests were used to compare the PMT between test and control groups at each study period and to evaluate the changes in PMT over time. The level of significance was set at P < .05.

Results

A total of 14 implants placed in 14 patients were available for the statistical comparison.

At 12 months, the difference in PMT between test and control groups was 0.12 ± 0.51 mm. This difference was not statistically significant (P = .54). A significant increase in PMT was observed from baseline to 12 months post-implantation in both test (P = .004) and control (P < .001) groups.

Conclusions

The present study indicated that changes in PMT following CTG were not influenced by the timing of soft tissue augmentation, and remained stable up to one year after implant insertion.

https://ift.tt/2Ezwm0d

Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures

Publication date: Available online 26 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ramakrishnan Karthik, Scott Cynthia, Narayanan Vivek, Chandran Saravanan, Gurram Prashanthi

Abstract

Purpose

Orbital trapdoor fractures may constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures.

Patients And Methods

The study included 11 patients with linear trapdoor fracture of the orbital floor in five years with a minimum of one year follow up. Patients with associated facial bone fractures were excluded. The demographic, etiologic, radiologic, interval between trauma and surgery and surgical techniques were recorded.

Results

The age range was 9 to 29 years with the mean being 16.3 years. The mean time to surgical intervention from the time of injury was 3.9 days (range 0-11). Intraoperatively we observed macroscopic segmental necrosis of the entrapped inferior rectus muscle in 3 patients. Post operative review was conducted for a minimum of 12 months at the interval of 1st week, one month, 3 months, 6 months and 12 months. At the end of the follow-up period, incomplete recovery was observed in five patients which included all the three patients with intraoperative necrosed muscle and the other two patients were operated at 7th day and 8th day from the time of injury.

Conclusion

From our study, we observed that segmental necrosis of the entrapped inferior rectus muscle is possible in linear trapdoor fracture of the orbital floor. We also noted that incomplete recovery correlates with clinical evidence of inferior rectus muscle necrosis and late surgical intervention.

https://ift.tt/2VkpZTZ

Quality of Life after oral cancer resection and free flap reconstruction

Publication date: Available online 25 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Shuai Wang, Shoucheng Yin, Ze-liang Zhang, Xingzhou Su, Zhong-fei Xu

Abstract

Purpose

This study focused on quality of life for patients in northeast China who underwent oral cancer resection directly before flap reconstruction. Additionally, this study compared differences between the radial forearm free flap (RFFF), ulnar forearm free flap (UFFF), and anterolateral thigh flap (ALTF) for defect reconstruction.

Methods

To assess the patients' quality of life, the UW-QOL (University of Washington Quality of Life) and OHIP-14 (14-Item Oral Health Impact Profile) questionnaires were given six months after reconstruction.

Results

The flap size of the ALTF group was much larger than that of the UFFF and RFFF groups. Meanwhile, the appearance score in the ALTF group was significantly higher than that in the UFFF and RFFF groups, while these groups had a much higher swallowing score than the ALTF group did. Furthermore, the ALTF group had much lower social disability OHIP-14 scores than the RFFF group did.

Conclusion

The results indicate that all three reconstruction methods are similar, but ALTF has a slight advantage over UFFF and RFFF.

https://ift.tt/2ExmlQW

Tapered Vs Cylindrical Implant: Which Shape Inflicts Less Pain after Dental Implant Surgery? A Clinical Trial

Publication date: Available online 25 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sahand Samieirad, Vajiheh Mianbandi, Farid Shiezadeh, Majid Hosseini-Abrishami, Elahe Tohidi

Abstract

Objective

Since no study has evaluated the post-operative pain caused by dental implants shape up to now, the aim of this study was to compare the amount of postoperative pain between tapered and cylindrical implants inserted in the posterior region of the maxilla.

Method and materials

The study was designed as a double-blind randomized clinical trial. It was implemented on 50 healthy patients with the age range of 20-60 years who were edentulous in the posterior maxilla and were candidates for single implantation. All of the patients had the same surgical difficulty with appropriate bone width and height. The BioHorizons implants (tapered or cylindrical) with 4.5 mm platform diameter were randomly selected for each group. In order to evaluate the amount of pain, "Visual Analog Scale" (VAS) was used. Pain severity in each group was measured at 30-minutes, 3-h, 6-h, 12-h and 24-h as well as 2-day, 3-day and 1-week intervals. The predictor variable was the implant shape and the outcome was postoperative pain severity. Finally, the data were statistically analyzed with SPPS 16 at the significance level of p < 0.05.

Results

50 patients (2 groups of 25 cases) with the mean age of 43.7 ± 10.9 were included in this study. It was considerable that the pain level in both groups reached its maximum at 6-h postoperative interval. The pain severity decreased significantly over time in both implant groups (P<0.001).

It was observed that the postoperative pain severity amounts in the tapered implant group at 3-, 6-, 12-h and 24-h intervals were statistically lower than those in the cylindrical group (P<0.05).

Conclusion

The implant shape had an impact on the postoperative pain. It can be concluded that the tapered implants lead to less post-operative pain compared to cylindrical ones.

https://ift.tt/2VkLgwE