Differential expression of transcription factors NF-κB and STAT3 in periodontal ligament fibroblasts and gingiva of healthy and diseased individuals

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): R. Ambili, Prasanthila Janam, P.S. Saneesh Babu, Manu Prasad, D. Vinod, P.R. Anil Kumar, T.V. Kumary, S. Asha Nair
ObjectivePathogens and host mediators can activate transcription factors in periodontal cells to bring about gene level alterations, thereby accentuating the periodontal disease process. Nuclear factor-kappa B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) are two pivotal transcription factors implicated in chronic inflammatory diseases. But their importance in periodontal pathogenesis has not been investigated in detail. The aim of the present study was to evaluate the expression of activated transcription factors and their target genes in healthy and diseased periodontium.DesignPrimary culture of periodontal ligament fibroblasts (PDLF) were established from healthy and diseased periodontium using explant culture methods. NF-κB and STAT3 activation in these cells by Porphyromonas gingivalis LPS (lipopolysaccharide) was demonstrated using confocal microscopy and mRNA expression of target genes were evaluated by quantitative real time PCR. NF-κB and STAT3 expression in diseased and healthy gingival tissues were analyzed using immunohistochemistry.ResultsA basal upregulation of transcription factors and their target genes were noted in diseased PDLF compared to healthy ones. LPS challenge induced differential expression of NF-κB and STAT3 and their target genes in diseased PDLF compared to healthy ones. Immunohistochemical analysis revealed significant activation of transcription factors in diseased gingival tissues.ConclusionThe findings of the present study reveal the role of transcription factors NF-κB and STAT3 in periodontal pathogenesis and disease susceptibility of fibroblast subpopulations in periodontal disease could be mediated through activation of NF-κB and STAT3. Since genetic factors are nonmodifyable, transcription factors are promising targets for future host modulation therapy.



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Pharmacotherapy of mast cell disorders.

Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cutaneous T pseudolymphoma on the red pigmented areas of a tattoo

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Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction—Five Years of Experience

Facial plast Surg 2017; 33: 334-338
DOI: 10.1055/s-0037-1598041

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.
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Rhytidectomy: Analysis of Videos Available Online

Facial plast Surg 2017; 33: 311-315
DOI: 10.1055/s-0037-1602163

The objective of this study was to examine YouTube videos related to rhytidectomy created by both physicians and nonphysicians to determine the content of the videos, the selected topics of discussion, and other important parameters using a cross-sectional analysis study design. A YouTube search result for the keyword "facelift" was performed. Videos pertaining to the rhytidectomy procedure were included in this analysis. Authorship, length of video, primary objective, and total views were recorded. Total 80 videos (81%) were authored by physicians, 14 (14%) were authored by patients, and 5 (5%) were authored by a third party. Fifty-eight (59%) videos were shorter than 5 minutes, and 41 videos (41%) were longer than 5 minutes. Fifty-two (53%) videos were viewed fewer than 10,000 times, and 47 videos (47%) were viewed more than 10,000 times. Forty (40%) videos had a primary objective of providing information, 13 (13%) had a primary objective of providing the patient's perspective, and 46 (46%) had a primary objective of advertising a physician's practice. A chi-square test for independence with threshold of significance < 0.05 was used to compare whether or not the primary objective of the videos depended on the type of authorship. A significant difference was found between physician- and patient-authored videos. In addition, the 12 (12%) videos with the most views of videos included in this study were responsible for 75% of the total views of videos included in this study. Advertising was a goal of both physician- and patient-based videos, but physician-based videos were more likely to provide information about the procedure whereas patient-based videos more commonly presented a patient's personal perspective. The most popular 12% of videos were responsible for 75% of total views in this analysis, indicating that a small minority of perspectives dominates the YouTube viewership regarding rhytidectomy. The general public may be misled by information found by viewing these videos as the Internet generally lacks safeguards for quality or accuracy. It may be prudent for academic or professional organizations to provide videos intended to achieve a more neutral, well-informed perspective.
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The History of Rhytidectomy

Facial plast Surg 2017; 33: 247-249
DOI: 10.1055/s-0037-1603347

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Beyond the Facelift: Procedures to Enhance Rhytidectomy

Facial plast Surg 2017; 33: 245-246
DOI: 10.1055/s-0037-1603348

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Surgical Anatomy for Facelift

Facial plast Surg 2017; 33: 250-251
DOI: 10.1055/s-0037-1603528

Knowledge of surgical anatomy is of paramount importance during surgical dissection for facelift surgery, regardless of the type of facelift procedure performed. This article reviews the relevant surgical anatomy for facelift, including the superficial musculoaponeurotic system (SMAS), and course of the facial nerve relative to the SMAS, zygomatic arch, and mandible. Also, this article reviews the various retaining ligaments, and some types of facelift procedures recommend release of these ligaments to achieve a more effective aesthetic result.
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Preoperative Simulation in Planning Rhinoplasty: Evaluation from Patients' and Surgeons' Perspectives

Facial plast Surg 2017; 33: 324-328
DOI: 10.1055/s-0037-1601419

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.
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Psychology of the Facelift Patient

Facial plast Surg 2017; 33: 252-259
DOI: 10.1055/s-0037-1598071

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.
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Prophylactic Midface Lift in Midfacial Trauma

Facial plast Surg 2017; 33: 347-351
DOI: 10.1055/s-0037-1602165

The objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.
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The Superficial Musculoaponeurotic System Facelift: A Prudent Balance of Risks and Benefits

Facial plast Surg 2017; 33: 260-265
DOI: 10.1055/s-0037-1603316

Over the decades, facelifting has not escaped the natural history of trends and fads. And, as a profession, facial plastic surgery has not avoided falling into the trap of following corporate initiated technology, rather than leading common-sense methodologies to rejuvenating the aging face. The author is often reminded of a truism to which he was introduced in the 1980s. "When there are many ways of doing things, all of them work; or none of them work." Undeniably, any procedure that lifts and removes excessive skin of the face and neck "works." However, the questions that must be answered by leading teachers of facelifting surgery are: How well does a given technique work? How long-lasting are the results? Where does the risk–benefit curve cross over from optimal benefits to unacceptable risks? At what stage in a given patient's aging process are more aggressive techniques called for? At what stage in a surgeon's career should more invasive techniques be attempted, if ever? This article addresses the preceding questions as they relate to the contribution made by the superficial musculoaponeurotic fascia in repositioning sagging tissues of the face and neck.
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Skin Resurfacing in Combination with Facelift Surgery

Facial plast Surg 2017; 33: 299-310
DOI: 10.1055/s-0037-1602742

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and chronological and photoaging changes of the skin. A rhytidectomy will address the aging changes due to gravity on facial tissues but will do little to improve skin texture, thickness, and pigmentation. To address collagen loss, rhytids, and dyspigmentation, surgeons are incorporating resurfacing techniques including carbon dioxide/erbium ablative and fractionated lasers, 35% trichloroacetic acid chemical peel pretreated with Jessner's solution, phenol 88% chemical peel, Baker's solution chemical peel, and dermabrasion. More recently, surgeons are approaching facial aging with a more comprehensive approach to address both gravity and collagen changes by a combination of rhytidectomy with resurfacing. Technique and modality selection are keys to maximum single treatment results and therefore the greatest patient satisfaction.
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The Horizontal Neck Lift

Facial plast Surg 2017; 33: 266-270
DOI: 10.1055/s-0037-1598054

The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.
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Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series

Facial plast Surg 2017; 33: 316-323
DOI: 10.1055/s-0037-1602143

The objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.
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The Difficult Neck in Facelifting

Facial plast Surg 2017; 33: 271-278
DOI: 10.1055/s-0037-1598073

As the popularity and acceptance of facial and cervical rejuvenation procedures grows, surgeons are increasingly encountering patients with less favorable anatomical characteristics for rhytidectomy. These patients will typically display an obtuse cervicomental angle, underprojected chin, excess cervical adiposity, and platysmal banding, in addition to ptotic submandibular glands, tenacious jowls, and prejowl volume deficits. Recognition of these problems and the correct application of available techniques to address the difficult neck in facelifting are critical in maximizing success.
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V-Y Advancement Flap for Defects of the Lid–Cheek Junction

Facial plast Surg 2017; 33: 329-333
DOI: 10.1055/s-0037-1602144

We report a series of 10 patients who underwent inferolaterally based V-Y advancement flaps for reconstruction of defects involving the lower eyelid and infraorbital cheek junction. Defects ranged from 1.7 to 2.9 cm in largest diameter, and patients ranged from 59 to 84 years of age. All patients had excellent functional and cosmetic outcomes without subsequent surgical or laser revision. There were no instances of flap necrosis, hematoma, or ectropion. Vertically oriented V-Y flaps are often underused in this setting largely due to the perceived increase risk of ectropion. We describe a modification of the flap with lateral orientation that both diminishes the downward tension vector, which threatens ectropion, and conceals incision scars within resting tension lines, providing superior functional and aesthetic outcomes. Our series demonstrates that a properly designed and well-executed inferiorly based V-Y advancement flap can be used as a safe reconstructive modality for defects involving the lid–cheek junction.
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Cheek and Chin Implants to Enhance Facelift Results

Facial plast Surg 2017; 33: 279-284
DOI: 10.1055/s-0037-1598055

The traditional rhytidectomy addresses facial and neck aging as it relates to soft tissue laxity. The modern volumetric facelift provides optimal results by addressing not only skin laxity but also the loss of volume secondary to tissue atrophy and bony resorption. While multiple techniques including fat grafting, dermal fillers, and tissue resuspension are used to correct the tissue loss, alloplastic midface augmentation remains the most permanent method. In our practice we often address midface cheek hollowness or atrophy with the placement of submalar implants at the time of rhytidectomy. In addition to midface volumetric rejuvenation, alloplastic chin implantation can help strengthen and further define a retrusive chin and weak jawline. In this article we discuss technique, indications, and benefits of performing alloplastic augmentation as an adjunct to rhytidectomy.
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Effects of Tumescent Solution on Fat Survival

Facial plast Surg 2017; 33: 339-346
DOI: 10.1055/s-0037-1602164

Autologous fat transfer is a commonly used procedure in plastic surgery practice. The long-term survival rate of fat grafts is the most important issue for satisfactory results. The presented study includes the effects of different tumescent solutions on long-term fat graft survival. A total of 24 rats were divided into four groups: sham, lidocaine, adrenaline, and lidocaine + adrenaline groups. In all groups except the sham group, right inguinal fat pad was harvested 10 minutes after injecting 5 cc of the appropriate tumescent solution. The fat pad was trimmed and reimplanted to the interscapular area. After 3 months, fat pad was reharvested and sent for histopathologic evaluation. The harvested fat grafts were weighted in both surgical sessions. A significant difference was observed in comparison of fat grafts weights between the initial operation and the postoperative third month (p = 0.002). By intergroup comparisons, a significant difference was observed between sham and adrenaline groups (p = 0.002) and between sham and lidocaine + adrenaline groups (p = 0.007). No statistical difference was observed by the comparison of TUNNEL results (p = 0.663). The histopathologic evaluation of the specimens revealed similar results between groups. The injection of tumescent solutions containing only lidocaine before fat harvesting yields similar long-term fat graft survival rates in comparison to the conduction of surgical procedure without injecting any tumescent fluid. However, the injection of solutions containing adrenaline with or without lidocaine may decrease the long-term survival rates of fat autografts.
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Autologous Fat Grafting Combined with Facelifting

Facial plast Surg 2017; 33: 285-298
DOI: 10.1055/s-0037-1598072

There are multiple factors contributing to facial aging. Rejuvenation of the aging face, therefore, requires a multimodal approach to attain an overall natural and uniform result that is long lasting. Fat grafting has become a very important method for restoring facial soft-tissue atrophy, while facelifting procedures address the ptosis and descent of facial and neck tissue. These modalities performed together offer the patient a comprehensive approach to attain a more attractive and youthful facial appearance.
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Erratum: Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2017; 33: 352-352
DOI: 10.1055/s-0037-1602171

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Erratum: Absorbable Implant to Treat Nasal Valve Collapse

Facial plast Surg 2017; 33: 353-354
DOI: 10.1055/s-0037-1603201

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A Study of the Combination of Cetuximab and Methotrexate in Recurrent or Metastatic Cancer of the Head and Neck

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: Cetuximab;   Drug: Methotrexate
Sponsors:   Radboud University;   Merck Serono International SA;   Leiden University Medical Center;   Academisch Ziekenhuis Maastricht;   Erasmus Medical Center;   Medisch Spectrum Twente;   Medical Center Haaglanden;   Elisabeth-TweeSteden Ziekenhuis;   Medical Centre Leeuwarden;   Erasmus Medical Center, Rotterdam
Recruiting - verified May 2017

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Phosphaturic mesenchymal tumor of the nasal cavity and paranasal sinuses: A clinical curiosity presenting a diagnostic challenge

Phosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm associated with tumor-induced osteomalacia (TIO) and elevated serum FGF-23. Common in extremities, PMT rarely occurs in sinonasal region. We report a series of sinonasal PMT diagnosed at our institute over a 6-year period.Six cases of sinonasal PMT were identified during this period, of which five presented with features of TIO. Median age of patients was 45.5 years. All six tumors were composed of stellate to spindled cells, with prominent staghorn vasculature in four cases.

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Utility and tolerability of the long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of symptomatic or disfiguring vascular malformations in children and adolescents

Vascular malformations manifest with pain, bleeding, disability, and disfigurement in a subset of children. There are scant data available on the utility and tolerability of laser surgery for symptomatic or disfiguring non–port-wine stain vascular malformations in children.

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Systemic Embolization from an Unusual Intracardiac Mass in the Left Ventricular Outflow Tract

Endocarditis can affect any endocardial surface; in the vast majority of cases, the cardiac valves are involved. It is exceedingly rare to develop infective endocarditis on the endocardium of the left ventricular outflow tract due to the high velocity of blood that traverses this area. Herein, we present a rare case of left ventricular outflow tract endocarditis that likely occurred secondary to damage to the aortic valve leaflets (from healed prior aortic valve endocarditis) causing a high velocity aortic valve regurgitant jet that impinged upon the interventricular septum which damaged the endocardium and resulted in a fibrotic "jet lesion." This fibrous jet lesion served as a nidus for bacterial proliferation and vegetation formation. The high shear stress (due to high blood flow velocity through the left ventricular outflow tract) likely promoted the multiple embolic events observed in this case. Our patient was successfully treated with aortic valve replacement, vegetation resection, and antibiotics.

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Rising atmospheric CO 2 concentration may imply higher risk of Fusarium mycotoxin contamination of wheat grains

Abstract

Increasing atmospheric CO₂ concentration not only has a direct impact on plants but also affects plant–pathogen interactions. Due to economic and health-related problems, special concern was given thus in the present work to the effect of elevated CO₂ (750 μmol mol⁻¹) level on the Fusarium culmorum infection and mycotoxin contamination of wheat. Despite the fact that disease severity was found to be not or little affected by elevated CO₂ in most varieties, as the spread of Fusarium increased only in one variety, spike grain number and/or grain weight decreased significantly at elevated CO₂ in all the varieties, indicating that Fusarium infection generally had a more dramatic impact on the grain yield at elevated CO₂ than at the ambient level. Likewise, grain deoxynivalenol (DON) content was usually considerably higher at elevated CO₂ than at the ambient level in the single-floret inoculation treatment, suggesting that the toxin content is not in direct relation to the level of Fusarium infection. In the whole-spike inoculation, DON production did not change, decreased or increased depending on the variety × experiment interaction. Cooler (18 °C) conditions delayed rachis penetration while 20 °C maximum temperature caused striking increases in the mycotoxin contents, resulting in extremely high DON values and also in a dramatic triggering of the grain zearalenone contamination at elevated CO₂. The results indicate that future environmental conditions, such as rising CO₂ levels, may increase the threat of grain mycotoxin contamination.

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Prognostic impact of HER-2 Subclonal Amplification in breast cancer

Abstract

The presence of a limited number of cells with HER-2 amplification (Subclonal Amplification) in breast carcinomas is occasionally encountered, but its prognostic impact is poorly known. The purpose of this study is to evaluate the prognostic impact of HER-2 Subclonal Amplification in a retrospective series of breast cancers. Accordingly, 81 consecutive breast carcinomas showing HER-2 Subclonal Amplification were obtained from the histology files (case series). These cases were subdivided into two groups: (a) those cases in which the HER-2 Subclonal Amplification was consonant to the accepted criteria for amplification, showing clusters of amplified cells, and (b) those cases with rare HER-2 Subclonal Amplification that did not reflect the accepted criteria for amplification, showing scattered amplified cells only. The incidence of metastases and late recurrences of the case series was compared with a series composed of 109 consecutive cases, being HER-2 homogeneous (comprising 14 Amplified and 95 Non-Amplified cases), matched for grade and stage (control series). It appeared that cases showing Subclonal Amplification had an incidence of metastases intermediate between the cases Amplified and Non-Amplified. Specifically, Subclonal Amplification with clustered cells had a lower incidence of metastases than Amplified cases (12.9 versus 21.4%). On the contrary, Subclonal Amplification with scattered cells showed an incidence of metastases higher than Non-Amplified cases (14 versus 9.47%). In addition, patients Subclonal Amplification with clustered cells, who were treated with the specific monoclonal antibody, had a lower incidence of metastases than patients showing Subclonal Amplification with scattered cells, who did not receive target therapy. These data, together with those recently published, indicate that Subclonal Amplification has an impact on prognosis and should be taken into consideration to correctly plan the treatment of breast cancer patients.

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Early detection: the impact of genomics

Abstract

The field of genomics has shifted our view on disease development by providing insights in the molecular and functional processes encoded in the genome. In the case of cancer, many alterations in the DNA accumulate that enable tumor growth or even metastatic dissemination. Identification of molecular signatures that define different stages of progression towards cancer can enable early tumor detection. In this review, the impact of genomics will be addressed using early detection of colorectal cancer (CRC) as an example. Increased understanding of the adenoma-to-carcinoma progression has led to the discovery of several diagnostic biomarkers. This combined with technical advancements, has facilitated the development of molecular tests for non-invasive early CRC detection in stool and blood samples. Even though several tests have already made it to clinical practice, sensitivity and specificity for the detection of precancerous lesions still need improvement. Besides the diagnostic qualities, also the accuracy of the intermediate endpoint is an important issue on how the effectiveness of a novel test is perceived. Here, progression biomarkers may provide a more precise measure than the currently used morphologically based features. Similar developments in biomarker use for early detection have taken place in other cancer types.

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Decisional regret following ventilation tube insertion

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Michele M. Carr, Jillian Printz, Shreya Thakur
ObjectiveThe purpose of this study was to see if parental regret following ventilation tube (VT) insertion was related to non-resolution of ear infections and thus ongoing need for otolaryngological care and VT reinsertion.Materials and methodsAll consecutive parents presenting with children who had VT in place were given a validated regret survey and asked the reason for their visit. Chart review was used for medical history.ResultsTwo hundred and ten respondents were included. The children involved had a mean age of 5.2 years, 63.3% were male, and mean number of years since first VT insertion was 1.12 with a range of 0.04–9.28 years. 70.5% had a regret score of 0, with mean score 6.98 (95%CI 5.11–8.85). Scores were significantly higher for parents who presented their child with an ear complaint such as otorrhea (15.52, 95%CI 7.67–23.37, p = 0.004). Parents whose children had a history of reflux had significantly lower regret scores than parents whose children did not have a history of reflux (3.33 versus 7.89, p = 0.007). Parental regret was unrelated to patient age, other comorbidities, indication for initial tube insertion, hearing status on the day of inquiry, number of sets of tubes, visits for otorrhea, prescriptions given for eardrops, clinic visits, or length of follow-up.ConclusionTransient factors may influence decisional regret at any given time. For parents whose children receive VT, regret is not related to prolonged specialized ear care and need for VT reinsertion.



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Non-coeliac gluten sensitivity: A review of the literature

Publication date: Available online 1 June 2017
Source:Trends in Food Science & Technology
Author(s): Joana Clímaco Henggeler, Manuel Veríssimo, Fernando Ramos
BackgroundNon-coeliac gluten sensitivity (NCGS) is an emerging and still poorly defined clinical entity, which is part of the spectrum of gluten-related disorders (along with coeliac disease and wheat allergy) but also closely related to irritable bowel syndrome. It is characterised by a wide array of both gastrointestinal and extra-intestinal symptoms. NCGS was first defined in the 1970s, but has gained critical relevance in recent years.Scope and ApproachThis review covers the existing definitions, documented symptoms and methods of diagnosis, treatment via a gluten-free diet, history, prevalence in the general population and possible mechanisms for NCGS. It also looks into recent studies and their findings. All information is relative to studies published in the last 6 years (2011-present).Key Findings and ConclusionsDespite recent advances in characterising NCGS as a clinical entity and gaining novel insights into its pathogenesis, further studies are needed to better understand its etiology and mechanism and to establish specific biomarkers.



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Editorial Board/ Publication Information

Publication date: July 2017
Source:Molecular Immunology, Volume 87





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B cell lymphomas with discordance between pathological features and clinical behavior

Abstract

B-cell lymphomas encompass a large number of disease entities clinically ranging from indolent to aggressive. The defining pathological features usually predict clinical course, with small and large B-cell lymphomas correlating to low-grade vs high-grade features, but discordant situations may be encountered. Two sessions of the workshop of the XVIII meeting of the European Association for Haematopathology (EAHP) held in Basel in 2016 addressed this topic. One session illustrated various facets of "aggressiveness" in indolent lymphomas, either peculiar clinical manifestations, cytological variants, or unusual genetic features, as well as several examples of progression or transformation to a more aggressive disease. Another session exemplified large B-cell lymphomas with unexpected indolent behavior including cases arising in well-defined body compartments or in sanctuary sites. This paper describes the features of the cases presented in both groups, highlights the most salient points of discussion raised by the submitters and the panel, and summarizes current knowledge and recommendations relevant to diagnostic pathology practice.

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Functional and cosmetic outcomes of robot-assisted neck dissection by a postauricular facelift approach for head and neck cancer

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Yong Bae Ji, Chang Myeon Song, Hyang Sook Bang, Hae Jin Park, Ji Young Lee, Kyung Tae
ObjectivesThe purpose of this study was to compare the functional and cosmetic outcomes of robot-assisted neck dissection with those of conventional neck dissection.Materials and methodsWe prospectively analyzed 113 patients with head and neck cancer who underwent unilateral neck dissection by a robot-assisted postauricular facelift approach (38 patients) or conventional trans-cervical approach (75 patients). Postoperative functional outcomes such as edema, sensory loss, pain, and fibrosis in the neck, and limitations of neck and shoulder motion, and cosmetic satisfaction scored by questionnaire were evaluated serially up to 1year postoperatively, and compared between the two groups.ResultsThere were differences at baseline clinicopathologic characteristics including age, T classification and stage between the two groups. The mean score of neck edema was lower in the robotic group than that of the conventional group at 1day and 3days postoperatively, and sensory loss was also lower in the robotic group at 1day, 3days and 1week postoperatively (P<0.05). The postoperative cosmetic satisfaction were significantly higher in the robotic group than the conventional group at 1month, 3, 6, and 12months postoperatively. Transient marginal nerve palsy was higher in the robotic group than the conventional group (P=0.043).ConclusionPostoperative neck edema and sensory loss were lower in the robotic group in the early postoperative period although its clinical significance is not clear. Cosmetic satisfaction was superior in the robotic group.



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Gender Disparities in Financial Relationships Between Industry and Academic Otolaryngologists

This study evaluates the existence of gender disparities in industry relationships with academic otolaryngologists.

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An HIV-Positive Child With Gingival Mass

A young girl diagnosed as having varicella zoster encephalitis, cytomegalovirus retinitis, and HIV/AIDS had facial swelling and a violaceous, vascular-appearing lesion involving the left maxillary gingiva with numerous surrounding loose teeth.What is your diagnosis?

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Opsoclonus Recorded by a Smartphone

This is the report of a case wherein an acute attack of idiopathic opsoclonus was recorded in real time on a smart phone.

http://ift.tt/2rfRdyL

Free Flap Monitoring Techniques and Frequency

This multi-institutional review characterizes various techniques and frequencies of free flap monitoring by nurses and resident physicians and seeks to determine if adapted resident monitoring frequency is associated with recognition of flap compromise and outcome.

http://ift.tt/2qKdEJ4

Assumptions of Quality Medicine

This Viewpoint discusses the increasing pressure on physicians to provide safe, effective, patient-centered, timely, efficient, and equitable care to all patients and the potentially incorrect assumptions of the economic policies influencing decision making.

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A novel germline gain-of-function variant in PIK3CD

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): William Rae, Yifang Gao, Daniel Ward, Christopher J. Mattocks, Efrem Eren, Anthony P. Williams




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Multimarker risk stratification approach at multiple sclerosis onset

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): Lidia Fernández-Paredes, Armanda Casrouge, Jérémie Decalf, Clara de Andrés, Luisa Maria Villar, Rebeca Pérez de Diego, Bárbara Alonso, José Carlos Álvarez Cermeño, Rafael Arroyo, Marta Tejera-Alhambra, Joaquín Navarro, Celia Oreja-Guevara, Margarita López Trascasa, Ansgar Seyfferth, Maria Angel García Martínez, Roberto Álvarez Lafuente, Matthew L. Albert, Silvia Sánchez-Ramón
Delay in the diagnosis of multiple sclerosis (MS) stems from the lack of specific clinical and analytical markers to assist in the early diagnosis and prediction of progressive course. We propose a decision-tree model that better defines early at onset MS patients and those with the progressive form by analysing a 12-biomarkers panel in serum and CSF samples of patients with MS, other neurological diseases (OND) and healthy contols. Thus, patients at onset of neurological disease were first classified by serum IL-7 levels <141pg/ml (OR=6.51, p<0.001). Combination of IL-7 and IP-10 indicated risk for a specific MS clinical form, where IL-7<141 and IP-10<570pg/ml were associated with the highest risk for PP-MS (OR=22, p=0.01). Unexpectedly, both PP-MS and RR-MS patients shared significantly decreased prototypical biomarkers of inflammation and tissue regeneration in CSF than OND suggesting a defective intrinsic immune response playing a role at the beginning of the disease.



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Hexamerization-enhanced CD20 antibody mediates complement-dependent cytotoxicity in serum genetically deficient in C9

Publication date: Available online 31 May 2017
Source:Clinical Immunology
Author(s): Ronald P. Taylor, Margaret A. Lindorfer, Erika M. Cook, Frank J. Beurskens, Janine Schuurman, Paul W.H.I. Parren, Clive S. Zent, Karl R. VanDerMeid, Richard Burack, Masashi Mizuno, B. Paul Morgan
We examined complement-dependent cytotoxicity (CDC) by hexamer formation-enhanced CD20 mAb Hx-7D8 of patient-derived chronic lymphocytic leukemia (CLL) cells that are relatively resistant to CDC. CDC was analyzed in normal human serum (NHS) and serum from an individual genetically deficient for C9. Hx-7D8 was able to kill up to 80% of CLL cells in complete absence of C9. We conclude that the narrow C5b-8 pores formed without C9 are sufficient for CDC due to efficient antibody-mediated hexamer formation. In the absence of C9, we observed transient intracellular increases of Ca²⁺ during CDC (as assessed with FLUO-4) that were extended in time. This suggests that small C5b-8 pores allow Ca²⁺ to enter the cell, while dissipation of the fluorescent signal accompanying cell disintegration is delayed. The Ca²⁺ signal is retained concomitantly with TOPRO-3 (viability dye) staining, thereby confirming that Ca²⁺ influx represents the most proximate mediator of cell death by CDC.



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Recurrent deep vein thrombosis with a protein S Tokushima mutation

Deep vein thrombosis (DVT) is multifactorial disease caused by acquired risk factors such as bed rest, surgery and malignancies as well as genetic factors. Regarding the genetic factors, factor V Leiden (c.1601G>A, p.R534Q) and the prothrombin G20210A mutations are well-known risk factors for DVT in Caucasians.¹ However, these two mutations do not exist in Japanese populations. A missense mutation (c.586A>G, p. K196E) in protein S gene, known as the protein S (PS) Tokushima mutation, was identified as a genetic risk factor for DVT in Japanese populations.² We herein report a young Japanese patient with recurrent DVT in whom a PS Tokushima mutation was detected.

This article is protected by copyright. All rights reserved.

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Lymphomatoid papulosis associated with chronic lymphocytic leukemia/small lymphocytic lymphoma: 3 cases

Lymphomatoid papulosis (LyP) is considered as an indolent CD30+ lymphoproliferative cutaneous disorder. ^1,2 Nevertheless, 10%–20% up to 50% of patients with LyP have coexistent lymphoma. ^{1, 3–7} The most frequently associated malignancies are mycosis fungoides, primary cutaneous anaplastic large cell lymphoma, or Hodgkin's disease. There are only seven reported cases of an association between LyP and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). ^{5, 7-9} Herein, we report and analyze three new cases.

This article is protected by copyright. All rights reserved.

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Morphological and molecular characterization of actinic lentigos reveals alterations of the dermal extracellular matrix

Abstract

Background

Actinic lentigos (AL) are benign hyperpigmented skin lesions associated with photoageing. Despite their high prevalence, biological mechanisms driving their formation remain unclear.

Objectives

To provide new insights about the physiopathology of AL through a comprehensive description of their histological and molecular features.

Methods

Quantitative analysis of dermoscopic images was used to select AL containing elongated patterns, predicted to display a highly deformed dermal-epidermal junction (DEJ), on the back of hands of 15 Caucasian women. Biopsies from lesional and adjacent non-lesional (NL) areas were processed for histological analysis or gene expression profiling.

Results

Histological staining confirmed a drastic deformation of the DEJ in AL, with deep epidermal invaginations into the dermis. Although the melanin content was significantly higher in AL compared to NL epidermis, the distribution of melanocytes along the DEJ was unchanged.

Transcriptomic analysis revealed a signature of 529 genes differently expressed in AL versus NL skin. Alteration of epidermal homeostasis was confirmed by the dysregulation of keratinocyte proliferation and differentiation markers. Surprisingly, canonical genes involved in melanogenesis were not significantly modulated in AL. A striking finding was the overexpression of a large group of genes involved in dermal extracellular matrix organization and remodelling. Dermal alterations were confirmed by immunolabellings on AL and NL sections.

Conclusions

Drastic disorganization of the cutaneous structure in AL is accompanied by a specific molecular signature revealing alterations in both epidermal and dermal compartments. Particularly, our results suggest that local modifications of the dermal extracellular matrix might contribute to hyperpigmentation in AL.

This article is protected by copyright. All rights reserved.

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A pretrained neural network shows similar diagnostic accuracy to medical students in categorising dermatoscopic images after comparable training conditions

Automated image classification by machine vision is evolving, largely because of the increasing efficiency of neural networks with special architectures such as convolutional neural networks (CNN)¹. A recent study comparing board certified dermatologists with CNN suggested that CNN may achieve diagnostic accuracies similar to human experts². We demonstrated that medical students without prior knowledge of dermatoscopy learn equally well from an analytic or heuristic teaching approach³.

This article is protected by copyright. All rights reserved.

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Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery

ABSTRACT

Background

The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear.

Methods

A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC).

Results

Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02).

Conclusion

Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Study of Nivolumab Plus Ipilimumab in Patients With Salivary Gland Cancer

Condition:   Salivary Gland Cancer
Interventions:   Drug: Nivolumab;   Drug: Ipilimumab
Sponsors:   Memorial Sloan Kettering Cancer Center;   Bristol-Myers Squibb
Recruiting - verified May 2017

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Videolaryngoscopy during Conscious Sedation in Patients Not Suitable for Phonosurgery by Microlaryngoscopy: A Pilot Study

Background: Microlaryngoscopy is the preferred and most widely used technique in phonosurgery for the treatment of benign and early malignant glottic lesions. However, the procedure may be technically difficult or impossible due to alterations of the cervical spine that may not allow hyperextension of the head or may present general anesthesia contraindications. The aim of this study is to evaluate the efficacy and safety of our surgical approach for lesions of the vocal folds in patients who are not suitable for phonosurgery by microlaryngoscopy. This approach applies videolaryngoscopy during conscious sedation, which combines local anesthesia with moderate analgosedation by using midazolam and fentanyl with premedication. Methods: A total of 235 patients affected by benign diseases or suspicious cancerous lesions of the vocal folds were retrospectively evaluated. Results: The method has shown a success rate of 95.5, 89, 52.3, and 86.7% in cases of polyps of the vocal folds, Reinke's edema, cysts of the vocal folds, and suspicious lesions of the larynx, respectively. Only 3 patients (1.27%) have been reported to experience adverse events. Conclusion: The results suggest that the method is an effective and safe procedure without relevant local and/or general complications.
ORL 2017;79:185-190

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Lebensqualität von Patienten mit Vestibularisschwannom

Zusammenfassung

Hintergrund

Das Vestibularisschwannom (VS) ist eine Erkrankung, die die gesundheitsbezogene Lebensqualität („health-related quality of life", HR-QOL) negativ beeinflussen kann. Nachdem viele Jahre nur allgemeine Lebensqualitätsmessinstrumente wie der SF-36 zur Messung der gesundheitsbezogenen Lebensqualität zur Verfügung standen, existiert seit einigen Jahren mit dem Penn Acoustic Neuroma Quality Of Life (PANQOL) ein krankheitsspezifisches Messinstrument. Es ist zu erwarten, dass die Anwendung dieses Instruments in der Zukunft wichtige Aspekte der HR-QOL bei VS besser herausarbeiten kann. Eine validierte deutsche Version des Instruments existiert noch nicht.

Die von den Patienten am häufigsten beklagten Symptome im Rahmen der Erkrankung sind Kopfschmerzen und Schwindel.

Ergebnisse und Diskussion

Die bisher vorliegende Literatur zeigt, dass die therapeutischen Verfahren die HR-QOL unterschiedlich beeinflussen. Insbesondere die Strahlentherapie hat bei kleinen und mittelgroßen Tumoren keine ausgeprägten negativen Effekte auf die HR-QOL. Die Bewertung operationsbedingter Einschränkungen gleicht sich aber über den Verlauf einiger Jahre den Bewertungen nach Strahlentherapie an. Für große VS mit einem Durchmesser >3 cm liegen diesbezüglich noch keine richtungweisenden Daten vor. Wünschenswert für die Zukunft wären prospektive Studien mit einer Langzeitnachbeobachtung von 10 Jahren und mehr, um die offenen Fragen zu klären.

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Turkish validity and reliability of Eustachian Tube Dysfunction Questionnaire-7

Publication date: Available online 31 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Erdoğan Özgür, Cem Bilgen, Beyhan Cengiz Özyurt
IntroductionDuring clinical evaluations, in order to interpret patients' complaints caused by Eustachian Tube Dysfunction (ETD) and to monitor the success of the treatment, standardized and disease-related scales are necessary.ObjectiveThe aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian Tube Dysfunction Questionnaire-7.MethodsForty patients diagnosed with ETD and 40 healthy individuals were enrolled for the study. After language validation of the ETDQ-7 for Turkish, a scale was completed by the both ETD and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test–retest method, item-total score correlation and internal consistency analysis were used in reliability analyses.ResultsCronbach's alpha coefficient was 0.714 for the entire questionnaire. The test–retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the ETD group, total and each item scores were found significantly higher than the control group (p<0.001).ConclusionThe Turkish version of ETDQ-7 was found to be highly valid and reliable. This scale is recommended to use for screening of ETD and evaluating treatment outcome.



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Evaluating the ototoxicity of a antiMRSA peptide KR-12-a2

Publication date: Available online 31 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Chung Man Sung, Hyung Chae Yang, Yong Beom Cho, Song Yub Shin, Chul Ho Jang
IntroductionMethicillin-Resistant Staphylococcus Aureus (MRSA) is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat MRSA otorrhea.ObjectiveIn this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it applied topically in the middle ear of guinea pigs.MethodsThe antimicrobial activity of KR-12-a2 against MRSA strains was examined by using the inhibition zone test. Topical application of KR-12-a2 solution, Gentamicin (GM) and Phosphate Buffered Saline (PBS) were applied in the middle ear of the guinea pigs after inserting ventilation tubes. Ototoxicity was assessed by Auditory Brainstem Evoked Response (ABR) and Scanning Electron Microscope (SEM) examination.ResultsKR-12-a2 produced an inhibition zone against MRSA from 6.25 μg. Hearing threshold in the KR-12-a2 and PBS groups were similar to that before ventilation tube insertion. However, the GM group showed elevation of the hearing threshold and there were statistically significant differences compared to the PBS or the KR-12-a2 group. In the SEM findings, the KR-12-a2 group showed intact outer hair cells. However, the GM group showed total loss of outer hair cells. In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs.ConclusionIn our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. The KR-12-a2 solution can be used as ototopical drops for treating MRSA otorrhea; however, further evaluations, such as the definition of optimal concentration and combination, are necessary.



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Update HNO

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Large schwannoma of the femur – a common tumor at an unusual site: a case report and review of the literature

Schwannomas are benign nerve sheath tumors and are most frequently encountered as soft tissue tumors of peripheral nerves of the head and neck or the extensor extremities. Osseous involvement is very uncommon ...

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Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is t...

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Spiraling Out of Control

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 22-year-old man presented to the…

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Mucositis Secondary to Chlamydia pneumoniae Infection: Expanding the Mycoplasma pneumoniae–Induced Rash and Mucositis Concept

Abstract

The term Mycoplasma pneumoniae–induced rash and mucositis (MIRM) was recently proposed to identify the mucocutaneous condition secondary to M. pneumoniae infection that had historically been regarded among the more confusing pathologies of erythema multiforme and Stevens–Johnson syndrome. Based on a number of previous reports, these syndromes require differentiation since they have different prognoses and specific treatment requirements. We report a case of oral and genital erosions that strongly resembled MIRM without rash but were found to be secondary to a Chlamydia pneumoniae infection. After a thorough review of the literature on this subject, we propose that C. pneumoniae should also be considered a potential causative agent of MIRM and that this term should be amended to include C. pneumoniae infection.

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Sarkoidose

Zusammenfassung

Die Sarkoidose ist eine seltene entzündliche Systemerkrankung, deren Ätiologie weitgehend unverstanden ist. Nach der Lungenbeteiligung stellt der Befall der Haut, der in bis zu 30 % der Fälle zu beobachten ist, die zweithäufigste Organmanifestation dar. Entsprechend kommt der Dermatologie eine besondere Rolle sowohl bei der Erstdiagnose und der differenzialdiagnostischen Einordnung der Erkrankung als auch bei der interdisziplinären Betreuung der Patienten zu. Klinisch präsentiert sich die Sarkoidose der Haut vielgestaltig, was die Diagnosestellung mitunter erschwert. Es werden spezifische Hautmanifestationen (mit histologischem Nachweis von Granulomen) und unspezifische Hautläsionen (ohne Granulome) unterschieden. Da es sich um eine Multisystemerkrankung handelt, die unterschiedlichste Organsysteme betreffen kann, ist eine gute Abstimmung der betreuenden Fachdisziplinen unabdingbar. Die Therapie der Sarkoidose ist schwierig, evidenzbasierte Therapieempfehlungen und Studien fehlen weitgehend. Im Folgenden wird ein Überblick über dieses seltene Krankheitsbild gegeben, wobei charakteristische Manifestationsformen der kutanen Sarkoidose vorgestellt werden, das diagnostische Vorgehen auch im Hinblick auf die weitere Organbeteiligung beschrieben und die Therapie der Hautsarkoidose anhand eines Therapiealgorithmus aufzeigt wird.

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Prevalence of food allergies and intolerances documented in electronic health records

Publication date: Available online 31 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Warren W. Acker, Joseph M. Plasek, Kimberly G. Blumenthal, Kenneth H. Lai, Maxim Topaz, Diane L. Seger, Foster R. Goss, Sarah P. Slight, David W. Bates, Li Zhou
BackgroundFood allergy prevalence is reported to be increasing, but epidemiological data using patients' electronic health records (EHRs) remain sparse.ObjectiveWe sought to determine the prevalence of food allergy and intolerance documented in the EHR allergy module.MethodsUsing allergy data from a large health care organization's EHR between 2000 and 2013, we determined the prevalence of food allergy and intolerance by sex, racial/ethnic group, and allergen group. We examined the prevalence of reactions that were potentially IgE-mediated and anaphylactic. Data were validated using radioallergosorbent test and ImmunoCAP results, when available, for patients with reported peanut allergy.ResultsAmong 2.7 million patients, we identified 97,482 patients (3.6%) with 1 or more food allergies or intolerances (mean, 1.4 ± 0.1). The prevalence of food allergy and intolerance was higher in females (4.2% vs 2.9%; P < .001) and Asians (4.3% vs 3.6%; P < .001). The most common food allergen groups were shellfish (0.9%), fruit or vegetable (0.7%), dairy (0.5%), and peanut (0.5%). Of the 103,659 identified reactions to foods, 48.1% were potentially IgE-mediated (affecting 50.8% of food allergy or intolerance patients) and 15.9% were anaphylactic. About 20% of patients with reported peanut allergy had a radioallergosorbent test/ImmunoCAP performed, of which 57.3% had an IgE level of grade 3 or higher.ConclusionsOur findings are consistent with previously validated methods for studying food allergy, suggesting that the EHR's allergy module has the potential to be used for clinical and epidemiological research. The spectrum of severity observed with food allergy highlights the critical need for more allergy evaluations.



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An osteometric study on the variation in orientation of the lesser trochanter in an early medieval human skeletal assemblage and comparison with an individual from the Late Upper Paleolithic

Abstract

Anatomical textbooks describe the lesser trochanter in contemporary humans as being oriented posteromedially. In contrast, orientation of the lesser trochanter towards posterior was observed in some human femora from the Upper Paleolithic, including the femur of a young adult individual from Germany (Irlich 1), radiocarbon dated to 12,500 - 11,200 BP (calibrated AMS age). The present study analysed the orientation of the lesser trochanter in femora originating from an early medieval skeletal assemblage (Greding, Germany) and compared the results with those for the Irlich 1 femur. Eleven landmarks, four on the proximal femur, four on the mid-shaft and three on the distal femur, were recorded with a MicroScribe® digitizer, and analyzed using Auto-CAD® 2010 software. Seven angles and five distances were measured. In the Greding femora, significant differences (P < 0.05) between sexes were found for several linear measurements, while no significant sex-related differences existed for angular measurements. For some angular variables related to the orientation of the lesser trochanter, the values for the Irlich 1 femur lay outside the range of variation of the Greding specimens, reflecting the more posterior orientation of the lesser trochanter in the Irlich 1 femur. This posterior orientation of the lesser trochanter was not associated with a particularly low degree of femoral anteversion. It is hypothesized that the differences in orientation of the lesser trochanter between the Irlich 1 femur (and other femora of Upper Paleolithic individuals) and the femora from Greding could basically reflect differences in traction exercised by the iliopsoas muscle during infancy and childhood between the sedentary agricultural population from Greding and Upper Paleolithic hunter-gatherers with a mobile lifestyle.

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Cranial variation and biodistance in three Imperial Roman cemeteries

Abstract

Ancient Roman populations are expected to exhibit considerable biological variation due to extensive trade networks and migration patterns throughout Europe and the circum-Mediterranean. The purpose of this research is to examine regional biological variation in Italy during Imperial Roman times (I-III Centuries AD) using three samples exhibiting distinctive class and economic systems. The individuals buried at Isola Sacra and Velia represent middle class tradesmen and merchants from coastal port populations from central and southern Italy, respectively; while the individuals from Castel Malnome represent an inland population near Rome of freed slaves and other lower class individuals, involved in heavy labor associated with salt production. Data were recorded from 25 three-dimensional cranial coordinate landmarks and analyzed using Procrustes Superimposition and associated multivariate statistics in MORPHOJ.

Procrustes ANOVA statistics were unable to detect any significant group differences for centroid size (p=0.595); but did detect differences in shape (p=0.0154), suggesting some variation between the three samples. Canonical variates analyses based on Procrustes distance values suitable for small sample sizes indicated that while Castel Malnome was not significantly different from either of the coastal sites (Isola Sacra, p=0.2071 and Velia, p=0.8015); Isola Sacra and Velia were significantly different (p=0.0119). The similarity of Castel Malnome to the other sites may reflect inherent heterogeneity in the sample, as it represents a group of freed slaves likely originating from various geographic locations. The separation of the two coastal sites is not unexpected, as Velia's location was influenced by an influx of Greek populations in the southern Italian peninsula. This work supports previous studies using traditional craniometrics and dental metrics showing group similarity across the Italian peninsula and a separation between more northern and southern groups.

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Eosinophilic esophagitis induced by aeroallergen sublingual immunotherapy in an enteral feeding tube–dependent pediatric patient

Publication date: Available online 31 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michaela Rokosz, Cindy Bauer, Shauna Schroeder




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Prospective evaluation of electronic medical record penicillin allergy documentation at a tertiary community teaching hospital

Publication date: Available online 31 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Mary L. Staicu, Matthew Plakosh, Allison Ramsey




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Patient-reported outcomes (PROs) in chronic urticaria

Abstract

Chronic urticaria is an itching skin disease which persists for more than 6 weeks. Chronic urticaria has great impact on the daily life of the patient, and the fluctuating nature of the symptoms complicates the monitoring and treatment of the disease. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, use of patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of seven different PROs used in chronic urticaria and highlight their strengths, limitations, and use in clinical practice and research.

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Lipid resuscitation in acute poisoning: after a decade of publications, what have we really learned?.

Purpose of review: The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both human and animals attested to its clinical use, but current supporting evidence supporting inconsistent. Recent findings: A recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials and large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning. Summary: ILE can be used to resuscitate local anesthetics especially bupivacaine. The impact of ILE on oral overdoses is controversial and clear evidence on benefit is lacking. A thorough risk benefit assessment with consideration of alternative options is warranted to minimize the risk of adverse effects. Evidence supports using bolus doses of ILE, while infusion rates are still debatable Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Neurotoxicity of anesthetic drugs: an update.

Purpose of review: This article reviews the most recently published evidence that investigated anesthesia-induced neurotoxicity in both animals and humans, especially as it pertains to the perinatal period. Recent findings: Several recent studies have focused on better understanding the complex mechanisms that underlie intravenous and volatile anesthesia-induced neurotoxicity in animals. Adjuvant agents that target these pathways have been investigated for their effectiveness in attenuating the neuroapoptosis and neurocognitive deficits that result from anesthesia exposure, including dexmedetomidine, rutin, vitamin C, tumor necrosis factor [alpha], lithium, apocynin, carreic acid phenethyl ester. Five clinical studies, including one randomized control trial, provided inconsistent evidence on anesthesia-induced neurotoxicity in humans. Summary: Despite a growing body of preclinical studies that have demonstrated anesthesia-induced neurotoxic effects in the developing and aging brain, their effects on the human brain remains to be determined. The performance of large-scale human studies is limited by several important factors, and noninvasive biomarkers and neuroimaging modalities should be employed to define the injury phenotypes that reflect anesthesia-induced neurotoxicity. Ultimately, the use of these modalities may provide new insights into whether the concerns of anesthetics are justified in humans. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Procedural sedation in the ICU and emergency department.

Purpose of review: Procedures are increasingly being performed in the acute care setting, outside of the operating rooms (OR). This article aims to review the current literature on out-of-OR procedural sedation with a focus on the ICU and emergency department, highlighting the following topics: multidisciplinary team approach, choice of pharmacologic agent, sedation scales, current safety guidelines, anticipating complications, appropriate monitoring and necessary resources. Recent findings: Subjective assessment of sedation using sedation scales is controversial. Addition of ketamine and dexmedetomidine to propofol for sedation improves patient and proceduralist satisfaction. The short-acting benzodiazepine remimazolam shows promise in initial phase 2 trials. Use of capnography for monitoring during sedation is being challenged by new literature from the emergency department setting. Hypoxia is the most common adverse event with procedural sedation, and the risk of pulmonary aspiration is low. Summary: Multimodal/synergistic sedation under a multidisciplinary team provides the best patient satisfaction. Collection and analysis of physiological data and outcomes of patients undergoing procedural sedation is necessary to maintain compliance with regulatory bodies. There is a paucity of comprehensive guidelines for conducting research in procedural sedation; therefore, it is being currently addressed by the Sedation Consortium. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Patch testing in patients with suspected cosmetic dermatitis: A retrospective study

Summary

Background

Growing use of cosmetics has led to an increase in the incidence of allergic contact dermatitis (ACD) to cosmetics. Patch testing helps to confirm allergy to cosmetics and pinpoint the exact offending allergens.

Aims and Objectives

The study aimed to find the frequency of positive patch test reactions in cases with suspected ACD to cosmetics, and the common allergens responsible for it.

Methods

This is a retrospective record-based study of 58 patients, with suspected ACD to cosmetics, who had undergone patch testing with Indian standard series and Indian cosmetic and fragrance series from January 2013 to December 2015.

Results

The majority of patients (60.34%) belonged to the age group of 20-40 years. The most common site of involvement was face (94.8%) followed by neck (22.4%). The most commonly implicated cosmetics in history were soaps (53.4%), and face creams (24.1%). The most common allergens detected on patch testing were cetrimide (20.7%) and thimerosal (15.5%) followed by paraphenylenediamine (6.9%), and fragrance mix (5.2). Positive allergic reactions were obtained in 2.12% of the patches.

Conclusion

Most common cosmetic products implicated for causing ACD were face creams, soaps, and hair dyes. The principal culprit allergens were cetrimide and thimerosal.

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