A nomogram for predicting the risk of neck node metastasis in pathologically node-negative oral cavity carcinoma

Abstract

Objective

To generate a nomogram for predicting the risk of neck node metastasis in pathologically node-negative patients using a combination of variables comprising of protein expression, ultrastructural alterations and clinicopathological parameters.

Materials And Methods

Surgically removed oral tumours (n=103) were analyzed for the expression of desmosomal and hemidesmosomal assembly proteins by immunohistochemistry and ultrastructural alterations by transmission electron microscopy (TEM). Protein expression, ultrastructural alterations and clinicopathological variables were used to construct nomogram from the training set in 75 patients. Clinical utility of the nomogram was validated in a discrete set of 28 patients.

Results

Univariate and multivariate analysis was performed on the training set and obtained significant variables comprising of integrin β4 expression (p=0.027), number of hemidesmosomes (p=0.027)/ desmosomes (p=0.046), tumour differentiation grade (p=0.033) and tumour thickness (p=0.024) were used for construction of the nomogram. The area under the curve was calculated for both training 0.821 (95% CI 0.725-0.918) and validation sets 0.880 (95% CI 0.743-1.000). The nomogram demonstrated a predictive accuracy of 73.3% and 78.6% with the sensitivity of 81.4% and 83.3% in the training and validation sets respectively.

Conclusions

The nomogram constructed on post surgical tumour samples will be a value addition to histopathology for the detection of neck node metastasis in pathologically node negative patients.

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Hypoesthesia associated with mandibular movement after sagittal split ramus osteotomy

Abstract

Purpose

This retrospective study investigated the relationship between the degree of neurosensory disturbance (NSD) and mandibular movement distance after sagittal split ramus osteotomy (SSRO) and assessed sensory recovery.

Methods

Lower lip hypoesthesia was evaluated at 1 week, 1 month, and 2 months after SSRO in 38 patients categorized according to the distance of mandibular movement: S group (0–7 mm; n = 17, 4 males and 13 females) and L group (7–14 mm; n = 21, 7 males, 14 females). Symptoms were evaluated by visual analog scale (VAS), tactile-threshold (SW) test, static 2-point discrimination (s-2PD) test, and current perception threshold (CPT) test.

Results

The two groups did not differ significantly in gender and age. The Aβ fiber results of the CPT test differed significantly between the groups at 1 week and 1 month postsurgery (P < 0.05). There were no significant differences between the groups throughout the period in terms of VAS, SW, s-2PD, Aδ fiber, and C fiber of CPT.

Conclusions

Post-SSRO, the incidence of NSD in terms of tactile sensation may be greater in the L group early postoperatively. This may assist surgeons in explaining postoperative hypoesthesia to patients preoperatively.

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Why Topical Retinoids Are Mainstay of Therapy for Acne

Abstract

Acne-focused dermatology expert groups have consistently recommended that most patients with acne be treated with a combination of topical retinoid and antimicrobial therapy. This is based on clinical data as well as evidence that these drug classes have different and complementary mechanisms of action that target multiple aspects of acne's complex pathophysiology. Recent evidence-based guidelines for acne, including those from the American Academy of Dermatology (AAD) and the European Dermatology Forum (EDF), have agreed that retinoids have an essential role in this widespread disease. The AAD states "retinoids are the core of topical therapy for acne because they are comedolytic, resolve the precursor microcomedone lesion, and are anti-inflammatory;" further, they "allow for maintenance of clearance." Despite uniform recommendation for use of topical retinoids, a recent study of prescribing practices from 2012 to 2014 indicated that dermatologists prescribed retinoids just 58.8% of the time while non-dermatologists prescribed them for only 32.4% of cases. In this article, we review the reasons supporting retinoids as the mainstay of acne therapy and discuss some of the perceived barriers that may be limiting use of this important drug class. Further, we discuss how and when titrating retinoid concentrations may be utilized in clinical practice.

Funding: Galderma International.

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Gender-specific differences in the molecular signatures of adult Eosinophilic Eosophagitis

Abstract

The influence of gender on the prevalence, presentation and pathogenesis of allergic diseases is being increasingly recognized [1]. Eosinophilic Eosophagitis (EoE) is a chronic inflammatory disorder of the esophagus, seen in both children and adults, and is 3-4 times more common in males than females [2]. Diagnosis of EoE has relied on quantification of eosophageal eosinophils by biopsy and patient-reported symptoms but recent studies have supported the use of tissue-based molecular biomarker assessment, based on gene expression signatures [3], aiding patient diagnosis [4].

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The use of skin biomarker profiles to distinguish Schnitzler's syndrome from chronic spontaneous urticaria: results of a pilot study

Abstract

urticarial rash is a hallmark symptom of systemic autoinflammatory diseases such as Schnitzler's syndrome (SchS). Clinically, the urticarial rash cannot be distinguished from wheals in chronic spontaneous urticaria (CSU). Thus, it is commonly misdiagnosed as CSU.¹ SchS is characterized by monoclonal gammopathy, long-term complications including the development of lymphoma, and systemic inflammation.

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Secukinumab Sustains Good Efficacy and Favourable Safety in Moderate to Severe Psoriasis up to 3 Years of Treatment: Results from A Double-Blind Extension Study

Summary

Background

Secukinumab has demonstrated significant efficacy with a good safety profile through 1 year in plaque psoriasis. Given the chronic nature of this disease, long-term follow-up is needed to fully evaluate psoriasis therapies.

Objectives

Determine long-term (3-year) efficacy/safety of secukinumab in moderate-to-severe psoriasis.

Methods

Subjects completing 52 weeks of secukinumab treatment in the SCULPTURE core study entered an extension in which they continued the same double-blind regimens. Dosing regimens included a fixed-interval schedule (FI; every 4 weeks) and retreatment as needed (RAN), in which subjects were withdrawn from secukinumab and received placebo until start of relapse, at which time secukinumab every 4 weeks was re-initiated.

Results

168 subjects receiving secukinumab 300 mg FI and 172 receiving secukinumab 300 mg RAN entered the extension. Secukinumab 300 mg FI sustained high efficacy: at end of Year 3, the proportion of Psoriasis Area and Severity Index (PASI) 90 responders was 63.8% and PASI 100 responders was 42.6%. Mean absolute PASI remained low (2–4) from Week 52–Week 152 with 300 mg FI, with approximately two-thirds of subjects reporting no impact of skin disease on their lives (Dermatology Life Quality Index of 0/1). Improvements in overall and subscale scores on all quality of life instruments were well sustained. As in the core study, FI dosing was consistently more efficacious than RAN. No new safety signals were identified to Year 3.

Conclusions

Secukinumab 300 mg FI sustained high responses and improved quality of life with no new safety concerns through 3 years. (NCT01640951)

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Secukinumab is Superior to Fumaric Acid Esters in Treating Subjects with Moderate to Severe Plaque Psoriasis who are Naïve to Systemic Treatments: Results from the Randomized Controlled PRIME Trial

Abstract

Background

Secukinumab is a fully human antibody that neutralizes IL-17A and has significant efficacy and a favorable safety profile in moderate to severe plaque psoriasis and psoriatic arthritis.

Methods

In this 24-week, randomized, open-label, multicenter study with blinded assessment, subjects with moderate to severe plaque psoriasis, naïve to systemic treatments, were randomized to receive secukinumab 300 mg subcutaneously or oral fumaric acid esters (FAE). The primary objective was ≥75% improvement from Baseline Psoriasis Area and Severity Index (PASI) score (PASI 75 response) at Week 24 and missing subjects were considered responders if they were responders at the time of drop-out.

Results

202 subjects were randomized and 200 were treated with at least one dose. Outcomes at week 24 were available for 147 and imputed for 53 subjects. Discontinuations were mostly due to Adverse Events (AE) which occurred more frequently in the FAE group (1.9% vs. 33.0%). At week 24, significantly more subjects receiving secukinumab compared to FAE achieved PASI 75 response (89.5% vs. 33.7%, P<0.001), PASI 90 response (81.0% vs. 28.4%, P<0.001), and Dermatology Life Quality Index (DLQI) 0/1 response (71.4% vs. 25.3%, P<0.001).

Conclusions

Secukinumab demonstrates superior efficacy to FAE in psoriasis subjects over a 24-week period.

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