What causes webbed toes in humans?

Some people are born with extra skin between their toes. This is called webbing, and it can be a genetic condition, although sometimes the cause is unknown. The treatment to correct webbed toes usually involves surgery to remove the extra skin. In this article, learn more about webbed toes and how to treat them.

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Adverse effects of chemotherapy on the teeth and surrounding tissues of children with cancer: A systematic review with meta-analysis

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Dan Mike Busenhart, Juliane Erb, Georgios Rigakos, Theodore Eliades, Spyridon N. Papageorgiou
ObjectiveThe aim of this systematic review was to assess evidence on dental adverse effects associated with chemotherapy (CH) administered to children with cancer.Material and methodsEight databases were searched without restrictions up to March 2017 for studies reporting on dental effects of CH administered for childhood cancer. After elimination of duplicates, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of Relative Risks (RR) and Mean Differences (MD) and their 95% Confidence Intervals (CI) were performed, followed by meta-regression and sensitivity analyses.ResultsThe literature search identified a total of 15 non-randomized case-control studies including at least 2315 patients (mean age at diagnosis or CH of 6.6 years; 36% male) followed for up to 22.9 years after CH. Meta-analysis indicated that CH was associated with increased risk for tooth agenesis compared to healthy controls (RR = 2.47; 95% CI = 1.30–4.71; P = 0.006). This translated to every seventh child with CH having agenesis of at least one tooth that would not otherwise have. Additionally, CH was significantly associated with increased risk of tooth discoloration, arrested tooth development, enamel hypoplasia, microdontia, premature apexification, and decreased salivary flow rate, as well as worse oral hygiene and greater caries experience compared to controls. However, the strength of evidence was very low due to the inclusion of non-randomized study designs with high risk of bias.ConclusionsCurrent evidence from childhood cancer survivors indicates that chemotherapy is associated with considerable dental adverse effects that might be associated with greater burden of disease and treatment costs.



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Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): J.M. Patterson, E. McColl, P.N. Carding, J.A. Wilson
ObjectiveThe objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome.Materials and methods42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test.ResultsAt six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures.ConclusionPatients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.



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Risk and survival of patients with medullary thyroid cancer: National perspective

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Zaid Al-Qurayshi, Helmi Khadra, Kristi Chang, Nitin Pagedar, Gregory W. Randolph, Emad Kandil
BackgroundMedullary thyroid carcinoma (MTC) is a neuroendocrine tumor account for 1–2% of thyroid cancer. In this study, we aim to examine the characteristics and survival of patients with MTC.MethodsA retrospective cohort study utilizing the National Cancer Data Base, 2004–2014. The study population included adults with either MTC (cases) or with differentiated thyroid cancer (DTC) (controls).ResultsA total of 2,776 MTC and 171,631 DTC patients were included. The median follow-up time for MTC was 55.5 months (interquartile range: 31.2–84.6 months). As compared to DTC, patients with MTC were more likely to be ≥ 45-year old, male, and Black (p < 0.001). Neck dissection improved survival in patients with stage III [HR: 0.26, 95%CI: (0.10, 0.64), p = 0.004]. In patients with stages I and II, neck dissections did not add significant survival benefit to thyroidectomy [stage I, HR: 1.00, 95%CI: (0.54, 1.86), p = 0.99],[stage 2, HR: 0.72, 95%CI: (0.40, 1.29), p = 0.27]. However, neck dissections upgraded staging to N1A and N1B in 17.7% and 14.3% of patients with clinically N0 neck, respectively. In stage IV, thyroidectomy with neck dissection had the highest 5-year survival (84.9%), but this was not significantly different from thyroidectomy alone (84.1%); Patients who had thyroidectomy and EBRT with or without neck dissection had a lower survival than thyroidectomy alone (p < 0.01).ConclusionsNeck dissection performed on patients with clinically N0 neck, is important for accurate staging and associate with improved survival in advanced stages. Thyroidectomy and neck dissection in stage IV not only have palliative role but also add survival advantage.



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Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin

There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels.

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Mechanisms of fibronectin-binding protein A (FnBPA110–263) vaccine efficacy in Staphylococcus aureus sepsis versus skin infection

Publication date: Available online 12 June 2018
Source:Clinical Immunology
Author(s): Rui Zhang, Sun Li, Xiao-Kai Zhang, Yu Wang, Liu-Yang Yang, Hao Zeng, Da-Peng Yan, Quan-Ming Zou, Qian-Fei Zuo
Increasing rates of life-threatening infections and decreasing susceptibility to antibiotics urge an effective vaccine targeting Staphylococcus aureus. Here we investigate the role of cellular immunity in FnBPA110–263 mediated protection in Staphylococcus aureus infection. This study revealed FnBPA110–263 broadly protected mice from seven FnBPA isotypes strains in the sepsis model. FnBPA110–263 immunized B-cell deficient mice were protected against lethal challenge, while T-cell deficient mice were not. Reconstituting mice with FnBPA110–263 specific CD4+ T-cells conferred antigen specific protection. In vitro assays indicated that isolated FnBPA110–263 specific splenocytes from immunized mice produced abundant IL-17A. IL-17A deficient mice were not protected from a lethal challenge by FnBPA110–263 vaccination. Moreover, neutralizing IL-17A, but not IFN-γ,reverses FnBPA110–263-induced protective efficacy in sepsis and skin infection model. These findings suggest that IL-17A producing Th17 cells play an essential role in FnBPA110–263 vaccine-mediated defense against S. aureus sepsis and skin infection in mice.



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Induced surface proteins of Streptococcus epidermidis adhering to titanium implant substrata

Abstract

Objective

Staphylococcus epidermidis, as a primary colonizer, is strongly associated with infections of (dental) implants (i.e., peri-implantitis), but little is known about the surface proteome of this bacterium. For the identification of bacterial adhesins, this study investigated the surface proteome of S. epidermidis adhering directly to titanium implant substrata.

Materials and methods

S. epidermidis strain ATTC 35984 was cultured either planktonically or on titanium implant specimens. The surface proteomes were isolated by mutanolysin digestion, and proteins were separated by 2D gel electrophoreses to reveal highly expressed proteins only. Protein spots were visualized by silver staining and proteins were identified by mass spectrometry.

Results

Surface proteome analyses of S. epidermidis on titanium identified six expressed proteins. Three proteins were highly expressed on the titanium implants including accumulation-associated protein Q8CQD9. These specific proteins could be potential pathogenicity factors of bacteria in peri-implant biofilms.

Conclusion

For the first time, our study identified S. epidermidis surface proteins, which are expressed after adhesion to titanium implant materials.

Clinical relevance

Our study reveals possible candidates for a newly protein-based vaccine against peri-implantitis.

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