Decreased levels of matrix metalloproteinase-2 in root-canal exudates during root canal treatment

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Kassara Pattamapun, Sira Handagoon, Thanapat Sastraruji, James L. Gutmann, Prasit Pavasant, Suttichai Krisanaprakornkit
ObjectiveTo determine the matrix metalloproteinase-2 (MMP-2) levels in root-canal exudates from teeth undergoing root-canal treatment.Material and methodsThe root-canal exudates from six teeth with normal pulp and periradicular tissues that required intentional root canal treatment for prosthodontic reasons and from twelve teeth with pulp necrosis and asymptomatic apical periodontitis (AAP) were sampled with paper points for bacterial culture and aspirated for the detection of proMMP-2 and active MMP-2 by gelatin zymography and the quantification of MMP-2 levels by ELISA.ResultsBy gelatin zymography, both proMMP-2 and active MMP-2 were detected in the first collection of root-canal exudates from teeth with pulp necrosis and AAP, but not from teeth with normal pulp, and their levels gradually decreased and disappeared at the last collection. Consistently, ELISA demonstrated a significant decrease in MMP-2 levels in the root-canal exudates of teeth with pulp necrosis and AAP following root canal procedures (p<0.05). Furthermore, the MMP-2 levels were significantly lower in the negative bacterial culture than those in the positive bacterial culture (p<0.001).ConclusionsThe levels of MMP-2 in root-canal exudates from teeth with pulp necrosis and AAP were gradually reduced during root canal procedures. Future studies are required to determine if MMP-2 levels may be used as a biomolecule for the healing of apical lesions, similar to the clinical application of MMP-8 as a biomarker.



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The effect of training level on complications after free flap surgery of the head and neck

Publication date: Available online 2 June 2017
Source:American Journal of Otolaryngology
Author(s): Jacob S. Brady, Meghan M. Crippen, Andrey Filimonov, Neil V. Nadpara, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
ObjectivesAnalyze postoperative complications after free flap surgery based on PGY training level.MethodsData on free flap surgeries of the head and neck performed from 2005 to 2013 was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cases identifying the status of resident participation in the surgery and the PGY level were included.ResultsThere were 582 cases with primary surgeon data available. 63 cases were performed with a junior resident, 211 were performed with the assistance of a senior resident, 279 cases were performed with a fellow, and 29 cases were performed by an attending alone without resident involvement. The overall complication rate was 55.2%. There was no statistically significant difference in the rate of complications between groups (47.6%, 59.7%, 53.0%, 58.6%, p=0.277). After controlling for all confounding variables using multivariate analysis there was no significant difference in morbidity, mortality, readmissions, and reoperation amongst the groups. Furthermore, when comparing resident versus fellow involvement using multivariate analysis there were no significant differences in morbidity (OR=0.768[0.522–1.129]), mortality (OR=1.489[0.341–6.499]), readmissions (OR=1.018[0.458–2.262]), and reoperation (OR=0.863[0.446–1.670]).ConclusionResident and fellow participation in microvascular reconstructive cases does not appear to increase 30-day rates of medical, surgical, or overall complications.



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Diagnostic accuracy of a general practitioner with video-otoscopy collected by a health care facilitator compared to traditional otoscopy

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Thorbjörn Lundberg, Leigh Biagio de Jager, De Wet Swanepoel, Claude Laurent
ObjectiveVideo-otoscopy is rapidly developing as a new method to diagnose common ear disease and can be performed by trained health care facilitators as well as by clinicians. This study aimed to compare remote asynchronous assessments of video-otoscopy with otoscopy performed by a general practitioner.MethodChildren, aged 2–16 years, attending a health center in Johannesburg, South Africa, were examined. An otologist performed otomicroscopy and a general practitioner performed otoscopy. Video-otoscopy was performed by a health care facilitator and video sequences were stored on a server for assessment by the same general practitioner 4 and 8 weeks later. At all examinations, a diagnosis was set and the tympanic membrane appearance was graded using the OMgrade-scale. The otologist's otomicroscopic diagnosis was set as reference standard to compare the accuracy of the two otoscopic methods.ResultsDiagnostic agreement between otologist's otomicroscopic examination and the general practitioner's otoscopic examination was substantial (kappa 0.66). Agreement between onsite otomicroscopy and the general practitioners asynchronous video assessments were also substantial (kappa 0.70 and 0.80).ConclusionVideo-otoscopy performed by a health care facilitator and assessed asynchronously by a general practitioner had similar or better accuracy compared to face-to-face otoscopy performed by a general practitioner.



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Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Orysya Svystun, Wendy Johannsen, Rabin Persad, Justine M. Turner, Carina Majaesic, Hamdy El-Hakim
ObjectiveWhereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes.MethodsWe undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response.ResultsFrom 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5–124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3–88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score.Conclusiona significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.



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Staphylococcus aureus VraX specifically inhibits the classical pathway of complement by binding to C1q

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Jun Yan, Dianpeng Han, Chenghua Liu, Yaping Gao, Di Li, Yu Liu, Guang Yang
VraX is a protein secreted by Staphylococcus aureus, an important human pathogen. A dramatic over expression of VraX is observed when S. aureus is exposed to several antimicrobial agents; however, its function remains unclear. Here, we aimed to reveal the function of this protein and the mechanism by which it affects the immune system to enhance the pathogenesis of the bacterium. Our results showed that VraX specifically inhibited the classical pathway of the complement system. In particular, VraX could bind to the C1q protein and block the formation of the C1 complex. Deletion of VraX decreased the pathogenesis of S. aureus. Our findings indicate that over expression of VraX might be a protective response for S. aureus survival.



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Multiple supratentorial subependymomas causing obstructive hydrocephalus

Introduction

Subependymomas are benign intraventricular tumours that most often occur asymptomatically and are found incidentally on autopsy. Symptomatic examples requiring surgical intervention are exceedingly rare.

Case presentation

A 55-year-old man with no history of neurological symptoms presented with multiple episodes of loss of consciousness and increasing headaches. MRI revealed a lobulated intraventricular mass centred at the right Foramen of Monro. Obstructive hydrocephalus with localised midline shift and a second lesion were noted. Right frontal craniotomy with total removal via transcortical resection was performed.

Discussion

Symptomatic subependymomas generally present with signs of hydrocephalus due to obstruction of cerebrospinal fluid pathways. There is only one other reported case of multifocal subependymomas in a symptomatic patient. An example of multiple supratentorial subependymomas causing obstructive hydrocephalus has not been previously reported.

Conclusions

Multiple subependymomas are rare. Judicious surgical management with full excision led to symptomatic improvement in our patient.

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Multiple recurrent ischaemic strokes in a patient with cancer: is there a role for the initiation of anticoagulation therapy for secondary stroke prevention?

A 52-year-old woman with a medical history of cervical and thyroid cancer, hypertension, dyslipidaemia, uncontrolled diabetes and heavy smoking was diagnosed with a new metastatic cholangiocarcinoma. While undergoing palliative chemotherapy, she developed dysarthria and left-sided weakness. Imaging studies showed multiple bilateral ischaemic strokes. On hospital days 2 and 5, she developed worsening neurological symptoms and imaging studies revealed new areas of ischaemia on respective days. Subsequent workup did not revealed a clear aetiology for the multiple ischaemic events and hypercoagulability studies were only significant for a mildly elevated serum D-dimer level. Although guidelines are unclear, full-dose anticoagulation with low molecular weight heparin was initiated given her high risk of stroke recurrence. She was discharged to acute rehabilitation but, within a month, she experienced complications of her malignant disease progression and a new pulmonary thromboembolism. The patient died soon after being discharged home with hospice care.

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Corticosteroid treatment for traumatic acute subdural haematoma, maybe not such a good idea

Description

An 86-year-old woman with acute blunt head trauma (the patient's head was hit by a car) 10 days ago, associated with a right occipital fracture and an acute subdural haematoma (treated in the department of neurosurgery by oral prednisone 80 mg once a day) (figure 1), presented with focal left arm motor seizures. At that time, CT and MRI showed right cortical venous thrombosis (figure 1), absent on initial CT imaging. Corticosteroids were stopped and antiepileptic drugs and anticoagulation (warfarin) started. Three weeks later, CT showed complete resolution of the cortical venous thrombosis and spontaneous resorption of the subdural haematoma. Blood analyses in search of a prothrombotic state were negative in the absence of other blood test abnormalities (including normal metabolic profile).

Figure 1

Initial CT showing frontal (A) and temporal (B) acute subdural haematoma and right occipital fracture (C and D),...

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A 15-year-old Nepali boy with metastasised colorectal cancer

Nepal suffers from vast inequalities in modern healthcare. The low-income country wrestles with far-reaching insufficiencies in minimal preventative medicine, health awareness, limited infrastructure and difficult topography—all of which contribute to poor access and poor care-seeking behaviour. Our patient came from rural Nepal, where primary healthcare outposts are frequently understaffed and underequipped. He received supportive treatment in his village from the time symptoms presented until he was diagnosed 2 years later, at a tertiary medical centre, with colorectal cancer. An examination of the relevant literature indicates that younger patients often present in later stages of the disease due to initial misdiagnosis or overlooking colorectal cancer as a possibility. Beyond the rarity of the patient's condition, the logistical and financial obstacles he faced in Nepal, particularly outside of the capital of Kathmandu, deterred his access to a higher level of care and delayed his correct diagnosis and treatment.

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Two-staged en bloc excision of a retinal haemangioma

A 31-year-old man presented to us with diminution of vision in the right eye which he noticed since 10 days, with a visual acuity of hand motions only. On examination, festooned pupil and a complicated cataract were noted with no view of the retina. Ultrasonography of the right eye showed retinal detachment in all quadrants with suspected areas of traction and membranes in the vitreous. Left eye examination revealed a normal anterior and posterior segment. Intraoperatively, he underwent a pars plana lensectomy following which an inferior large retinal haemangioma was noted with dilated and tortuous feeder artery and draining vein. The haemangioma was managed by a two-staged procedure including ligature of the feeder artery in the first surgery and the en bloc excision of the angioma at the time of the second procedure after significant shrinkage in size of the tumour.

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An unusual position of retromandibular vein: a surgical challenge in parotid surgeries

A 44-year-old man presented with swelling in the left parotid region. The swelling was firm and Fine Needle Aspiration Cytology report proved pleomorphic adenoma. In the CT scan, the tumour was confined to the superficial lobe of parotid. So, left superficial parotidectomy was planned. Modified Wilson Blair's incision was used. On course of identifying the facial nerve, a large calibre vein was identified running vertically through the parotid substance. Assuming it as retromandibular vein, further dissection was carried out more meticulously. Marginal mandibularbranch of facial nerve was identified near the angle of mandible and retrograde dissection showed the cervicofacial division running medial to retromandibular vein with the main facial nerve trunk lying unusually medial and posterior to it. Adding to it, the temporofacial division was found 'forked' between the branches of retromandibular vein. These variations in head and neck venous channels are not that rare as we believe. All these variations have an embryological basis. Therefore, knowledge and understanding of this complex anatomy will help us preventing devastating complications like bleeding and facial nerve injury in such cases.

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Orbital myositis presenting with only unilateral orbital pain

Description

A 24-year-old woman developed sudden severe periorbital pain characterised by severe, unilateral, pounding, short-lived, repetitive pain. Consequently, she was diagnosed with paroxysmal haemicrania at the first visit. There was no history of diplopia or other ophthalmic symptoms. Her physical and other neurological findings were normal. Anti-thyroid and antinuclear antibodies were negative. IgG4, soluble interleukin-2 receptor, C-reactive protein and creatine kinase levels; cerebrospinal fluid analysis; and CT scan were normal. MRI revealed enlargement and increased signal in the left medial rectus muscle on gadolinium-enhanced T1-weighted imaging suggesting orbital myositis (OM) (figure 1A,B). The patient was treated with three cycles of intravenous methylprednisolone (IVMP) followed by oral prednisolone 30 mg/day, resulting in rapid resolution of the symptoms. There was no relapse after reducing the prednisolone dosage, and MRI findings were almost resolved after 2 months of steroid therapy (figure 1C,D). The most frequently used medication of OM...

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Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy

Publication date: Available online 2 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Marina Carvalho S. Côrtes, Pedro Weslley Rosario, Gabriela Franco Mourão, Maria Regina Calsolari
IntroductionIn patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma.ObjectiveThis prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy.MethodsThis was a prospective study. Patients with clinical examination showing no anomalies, basal Tg<1ng/mL, and elevated antithyroglobulin antibodies 8–12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis.ResultsThe time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p=1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p=0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p=0.58). There was no case of death related to the disease.ConclusionOur results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.



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Peripheral neuroectodermal tumor in the nasal cavity – a case report

Publication date: Available online 2 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Ramon Nobre Leal Oliva, Daniel Marcus San da Silva, Vitor Guo Chen, Maria Teresa de Seixas Alves, Reginaldo Raimundo Fujita




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A case of eel collagen allergy

Publication date: Available online 2 June 2017
Source:Allergology International
Author(s): Masao Tamura, Kiyoshi Matsui, Yukihiro Kobayashi, Chie Ogita, Kazuyuki Tsuboi, Minori Kusakabe, Kota Azuma, Takeo Abe, Takahiro Yoshikawa, Masahiro Sekiguchi, Naoto Azuma, Masayasu Kitano, Hajime Sano




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Innate mechanism of pollen and cat dander-induced oxidative stress and DNA damage in airways

Publication date: Available online 2 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Koa Hosoki, David Redding, Toshiko Itazawa, Anirban Chakraborty, Nisha Tapryal, Sun Qian, Huibin Qi, Leopoldo Aguilera-Aguirre, Allan R. Brasier, Sreenivas Phani Veeranki, Tapas K. Hazra, Istvan Boldogh, Sanjiv Sur

Teaser

Specific allergenic extracts induce TLR4-dependent oxidative stress and DNA damage.


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Cover 1

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Brief Overview of This Month's JACI

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Table of Contents

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Editorial Board

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Prostaglandin E2 stimulates adaptive IL-22 production and promotes allergic contact dermatitis

Publication date: Available online 3 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Calum T. Robb, Henry J. McSorley, Jinju Lee, Tomohiro Aoki, Cunjing Yu, Siobhan Crittenden, Anne Astier, Jennifer M. Felton, Nicholas Parkinson, Adane Ayele, Richard M. Breyer, Stephen M. Anderton, Shuh Narumiya, Adriano G. Rossi, Sarah E. Howie, Emma Guttman-Yassky, Richard B. Weller, Chengcan Yao
BackgroundAtopic dermatitis (AD) and allergic contact dermatitis (ACD) are both forms of eczema and are common inflammatory skin diseases with a central role of Th22-derived IL-22 in their pathogenesis. Although prostaglandin E2 (PGE2) is known to promote inflammation, little is known about its role in processes related to AD and ACD development, including IL-22 up-regulation.ObjectivesTo investigate whether PGE2 has a role in IL-22 induction and development of ACD, which has increased prevalence in patients with AD.MethodsT-cell cultures and in vivo sensitization of mice with haptens were used to assess the role of PGE2 in production of IL-22. The involvement of PGE2 receptors and their downstream signals were also examined. The effects of PGE2 were evaluated using the oxazolone (OXA)-induced ACD mouse model. The relationship of PGE2 and IL-22 signaling pathways in skin inflammation were also investigated using genomic profiling in human lesional AD skin.ResultsPGE2 induces IL-22 from T cells through its receptors EP2 and EP4 and involves cyclic adenosine monophosphate (cAMP) signaling. Selective deletion of EP4 in T-cells prevents hapten-induced IL-22 production in vivo, and inhibition of PGE2 synthesis limits atopic-like skin inflammation in the OXA-induced ACD model. Moreover, both PGE2 and IL-22 pathway genes were coordinately up-regulated in human AD lesional skin, but were below significant detection levels after corticosteroid or ultraviolet band B (UVB) treatments.ConclusionsOur results define a crucial role for PGE2 in promoting ACD by facilitating IL-22 production from T-cells.Clinical ImplicationsAllergic contact dermatitis is a common disabling disease characterized by elevated IL-22. The identification of a tightly regulated PGE2 driven pathway controlling IL-22 dysfunction offers a novel target for therapeutic intervention.

Teaser

Prostaglandin E2 promotes IL-22 production from T cells that mediates IL-22-driven development of allergic contact dermatitis.


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Information for Readers

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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News & Notes

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Continuing Medical Education Calendar

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6
Author(s): Tali Czarnowicki, James G. Krueger, Emma Guttman-Yassky
Skin barrier abnormalities have been suggested to play an essential role in initiation of early atopic dermatitis (AD). Antigen penetration through a compromised barrier likely leads to increased innate immune responses, antigen-presenting cell stimulation, and priming of overt cutaneous disease. In a TH2-promoting environment, T-cell/B-cell interactions occurring in regional lymph nodes lead to excessive IgE switch. Concurrent redistribution of memory T cells into the circulation not only leads to exacerbation of AD through T-cell skin infiltration but also spreads beyond the skin to initiate the atopic march, which includes food allergy, asthma, and allergic rhinitis. Possible primary interventions to prevent AD are focusing on improving skin barrier integrity, including supplementing barrier function with moisturizers. As for secondary prophylaxis in children with established AD, this can be stratified into prevention of disease exacerbations by using proactive approaches (with either topical corticosteroids or topical calcineurin inhibitors) in mild AD cases or the prevention of other atopic disorders that will probably mandate systemic immunosuppression in severe AD cases.



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Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6





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Phenotypic and genetic aspects of epithelial barrier function in asthmatic patients

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6
Author(s): Matthew Loxham, Donna E. Davies
The bronchial epithelium is continuously exposed to a multitude of noxious challenges in inhaled air. Cellular contact with most damaging agents is reduced by the action of the mucociliary apparatus and by formation of a physical barrier that controls passage of ions and macromolecules. In conjunction with these defensive barrier functions, immunomodulatory cross-talk between the bronchial epithelium and tissue-resident immune cells controls the tissue microenvironment and barrier homeostasis. This is achieved by expression of an array of sensors that detect a wide variety of viral, bacterial, and nonmicrobial (toxins and irritants) agents, resulting in production of many different soluble and cell-surface molecules that signal to cells of the immune system. The ability of the bronchial epithelium to control the balance of inhibitory and activating signals is essential for orchestrating appropriate inflammatory and immune responses and for temporally modulating these responses to limit tissue injury and control the resolution of inflammation during tissue repair. In asthmatic patients abnormalities in many aspects of epithelial barrier function have been identified. We postulate that such abnormalities play a causal role in immune dysregulation in the airways by translating gene-environment interactions that underpin disease pathogenesis and exacerbation.



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Etiology of epithelial barrier dysfunction in patients with type 2 inflammatory diseases

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6
Author(s): Robert P. Schleimer, Sergejs Berdnikovs
Epithelial barriers of the skin, gastrointestinal tract, and airway serve common critical functions, such as maintaining a physical barrier against environmental insults and allergens and providing a tissue interface balancing the communication between the internal and external environments. We now understand that in patients with allergic disease, regardless of tissue location, the homeostatic balance of the epithelial barrier is skewed toward loss of differentiation, reduced junctional integrity, and impaired innate defense. Importantly, epithelial dysfunction characterized by these traits appears to pre-date atopy and development of allergic disease. Despite our growing appreciation of the centrality of barrier dysfunction in initiation of allergic disease, many important questions remain to be answered regarding mechanisms disrupting normal barrier function. Although our external environment (proteases, allergens, and injury) is classically thought of as a principal contributor to barrier disruption associated with allergic sensitization, there is a need to better understand contributions of the internal environment (hormones, diet, and circadian clock). Systemic drivers of disease, such as alterations of the endocrine system, metabolism, and aberrant control of developmental signaling, are emerging as new players in driving epithelial dysfunction and allergic predisposition at various barrier sites. Identifying such central mediators of epithelial dysfunction using both systems biology tools and causality-driven laboratory experimentation will be essential in building new strategic interventions to prevent or reverse the process of barrier loss in allergic patients.



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The Editors' Choice

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




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News Beyond Our Pages

Publication date: June 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 6
Author(s): Marc E. Rothenberg, Jean Bousquet




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T-Cell Differentiation: Methods and Protocols

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Fred H. Hsieh




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Table of Contents

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6





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Instructions for Authors

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6





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Editorial Board

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6





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Hymenoptera venoms used to produce allergen extracts

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Greg Plunkett, Robert S. Jacobson, David B.K. Golden
ObjectiveTo review the methods and materials used for collection, purification, commercial production, and clinical application of Hymenoptera venoms.Data SourcesMost of the sources for this review are the experience and expertise of the authors. Published reports and review articles on Hymenoptera venom collection and production were identified through database searches (PubMed).Study SelectionsStudies describing the methods for Hymenoptera venom collection and production were selected for review.ResultsMeticulous methods for identification and collection of the insects are required. Collection and purification of the venoms from the insects are based on validated methods and result in a commercial extract that is standardized for the major allergenic proteins required for accurate diagnosis and safe and effective treatment of patients allergic to insect sting. The steps required for mixing, purifying, testing, and standardizing the products are described.ConclusionHymenoptera venom extracts were developed using many new methods for the collection, purification, and commercial production of the unique materials required for this product. Clinical applications for diagnosis and treatment are affected by the integrity and stability of the allergens after processing and purification.



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Advanced clinical testing of the adaptive immune system

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Stephanie Erdle, Anne K. Ellis, Julia E.M. Upton




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Information for Readers

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6





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The case for impulse oscillometry in the management of asthma in children and adults

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Stanley P. Galant, Hirsh D. Komarow, Hye-Won Shin, Salman Siddiqui, Brian J. Lipworth
ObjectiveTo provide a clinical rationale for including impulse oscillometry (IOS) as a part of standard office-based asthma assessment.Data SourcesPubMed and Google search, limited to English language and human disease, with the keywords IOS and asthma.Study SelectionsArticles included in this review were based on the expert opinion and previous publications by the authors.ResultsIn children, IOS was more useful than spirometry in identifying asthma and uncontrolled asthma and predicting loss of control and exacerbations. IOS predicts young children at risk for loss of lung function with age and the potential for early intervention to prevent further sequelae. In adults, peripheral airway impairment detected by IOS or spirometry (ie, forced expiratory flow between 25% and 75%) commonly occurs across severity, and each measure may be complementary in predicting loss of control even with normal forced expiratory volume in 1 second. Extrafine inhaled corticosteroids with or without long-acting β-agonists proved superior to standard particle aerosols in improving IOS-detected peripheral airway obstruction. Our data also suggest that currently available commercial reference values for lung resistance at 5 Hz and lung reactance at 5 Hz are applicable across diverse populations, but further studies are needed.ConclusionThe findings of this review suggest that IOS can add value to traditional clinical and spirometric assessment and thus improve management of asthma in children and adults, as well as have the potential to detect early dysfunction of the peripheral airways, which may result in better outcomes.



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A case of green tea (Camellia sinensis) imbibement causing possible anaphylaxis

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Shan Shan Wu, John A. Johnson, Brian Peppers, Haig Tcheurekdjian, Robert Hostoffer




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Cellular and noncellular bloodborne biomarkers in asthma

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Hannah Sinz, Harald Renz, Chrysanthi Skevaki
ObjectiveTo provide an overview of studied cellular and noncellular blood-derived asthma biomarkers.Data SourcesPubMed literature review.Study SelectionsArticles discussing cellular and noncellular bloodborne asthma biomarkers.ResultsDiscussed asthma biomarkers include peripheral blood cell counts of T cells, fibrocytes, or granulocytes, as well as levels of cytokines, periostin, IgE, and lipid mediators with or without stimulation. Moreover, this article summarizes the association of various blood biomarkers with the type of airway inflammation, presence of atopy, and dominance of specific T-cell subsets and associated pathways in asthma. Furthermore, biomarkers are here listed according to their proposed clinical use, such as diagnosis, disease phenotyping, classification of severity, assessment of disease control, and monitoring of and predicting treatment response.ConclusionFurther research on asthma biomarkers may improve asthma endotyping and ultimately lead to personalized treatment.



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Different prevalence and clinical characteristics of asthma–chronic obstructive pulmonary disease overlap syndrome according to accepted criteria

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Yong Suk Jo, Jinwoo Lee, Ho Il Yoon, Deog Kyeom Kim, Chul-Gyu Yoo, Chang-Hoon Lee
BackgroundA unified definition of asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) is not available, which makes it difficult to evaluate the prevalence and clinical features of patients with ACOS.ObjectiveTo investigate the prevalence and clinical characteristics of ACOS according to the updated widely accepted diagnostic criteria.MethodsParticipants were enrolled from a prospective cohort study conducted between April 2013 and November 2016 in South Korea. We adopted 4 criteria of ACOS: modified Spanish, American Thoracic Society (ATS) Roundtable criteria, the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO), and the Global Initiative for Asthma/Global Initiative for Chronic Obstructive Lung Disease (GINA/GOLD) criteria. The prevalence, clinical characteristics, and exacerbations of ACOS were investigated.ResultsAmong 301 patients with chronic obstructive pulmonary disease, 31.3%, 11.9%, 48.3%, and 46.15% were diagnosed with ACOS according to the modified Spanish, ATS Roundtable criteria, PLATINO, and GINA/GOLD criteria, respectively. Compared with other criteria, patients with ACOS diagnosed according to the modified Spanish criteria had better exercise capacity and lung function at baseline but higher risk of moderate to severe (adjusted hazard ratio, 1.97; 95% confidence interval, 1.14-3.41; P = .01) and total (adjusted odds ratio, 2.10; 95% confidence interval, 1.33-3.31; P < .01) exacerbations during at least a 1-year follow-up period than patients without ACOS.ConclusionThe prevalence of ACOS varied according to the diagnostic criteria. Among the different criteria, the modified Spanish criteria could identify patients with more asthmatic features and higher risk of exacerbation.Trial RegistrationClinicalTrials.gov Identifier: NCT02527486.



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Increased serum soluble vascular endothelial cadherin levels in patients with chronic spontaneous urticaria

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Tao Chen, Zai-pei Guo, Wen-ju Wang, Li-xin Fu, Qiao-mei Sun, Pei-mei Zhou
BackgroundChronic spontaneous urticaria (CSU) is a common skin disease characterized by recurrent itchy wheals with or without angioedema that lasts longer than 6 weeks. Vascular endothelial (VE)-cadherin is an endothelial cell-specific adhesion molecule that plays critical roles in angiogenesis and endothelial permeability.ObjectiveTo investigate serum levels of soluble VE (sVE)-cadherin in patients with CSU.MethodsSerum levels of sVE-cadherin in patients with CSU, patients with atopic dermatitis, and healthy controls were determined by enzyme-linked immunosorbent assay. In addition, changes in sVE-cadherin serum levels were compared in patients with CSU before and after H1 antihistamine treatment. Furthermore, the effects of histamine on sVE-cadherin release by HMEC-1 cells were determined by enzyme-linked immunosorbent assay. The inhibition effects of H1 antihistamine and H2 antihistamine on sVE-cadherin release, VE-cadherin phosphorylation, and VE-cadherin disruption were evaluated in histamine-treated HMEC-1 cells by western blot and immunofluorescence.ResultsSerum levels of sVE-cadherin in patients with CSU were significantly higher than those in patients with atopic dermatitis and healthy controls. Serum sVE-cadherin levels in patients with CSU were correlated with the severity of CSU according to Urticaria Activity Scores. Furthermore, serum sVE-cadherin levels in patients with CSU at pretreatment decreased after H1 antihistamine treatment. In addition, histamine markedly induced sVE-cadherin release in HMEC-1 cells. Moreover, H1 antihistamine, but not H2 antihistamine, significantly inhibited sVE-cadherin release in histamine-treated HMEC-1 cells. Western blot data showed that histamine induced phosphorylation of VE-cadherin in HMEC-1 cells, which was blocked by H1 antihistamine.ConclusionThe present data showed serum levels of sVE-cadherin are increased in patients with CSU. Histamine-induced sVE-cadherin release from endothelial cells could play a role in the pathogenesis of CSU.



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Atopic dermatitis and food sensitization in South African toddlers

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Mahboobeh Mahdavinia, Heather E. Rasmussen, Phillip Engen, Jolice P. Van den Berg, Erika Davis, Krista Engen, Stefan J. Green, Ankur Naqib, Maresa Botha, Claudia Gray, Nonhlanhla Lunjani, Carol Hlela, Wisdom Basera, Lelani Hobane, Alexandra Watkins, Mary C. Tobin, Alan Landay, Ali Keshavarzian, Michael E. Levin




http://ift.tt/2qKKMkE

Use of the basophil activation test in monitoring clinical tolerance after desensitization to brentuximab vedotin

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Raquel de la Varga Martínez, Diego Gutiérrez Fernández, Gustavo A. Áñez, Antonio Foncubierta Fernández, José A. Andrés García, Fermín Medina Varo




http://ift.tt/2s3Obz0

Insights into the global effect of nickel dermatitis on polysensitization

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6
Author(s): Brittanya A. Limone, Sharon E. Jacob




http://ift.tt/2qKk0J8

Author Index to Volume 118, 2017

Publication date: June 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 6





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Evaluation of the safety and efficacy of a novel product for the removal of impacted human cerumen

This open-label study evaluated the safety and efficacy of a novel product for the removal of impacted cerumen in adult patients.

http://ift.tt/2sA2tnC

Evaluation of the safety and efficacy of a novel product for the removal of impacted human cerumen

Abstract

Background

This open-label study evaluated the safety and efficacy of a novel product for the removal of impacted cerumen in adult patients.

Methods

This was a prospective, single-center, single-arm, self-controlled clinical trial conducted in a community general practice setting. The novel product contains glycolic acid in an otologically-acceptable buffer containing sodium bicarbonate and glycerin and other buffering agents. The product was instilled into the ear canal prior to irrigation with warm water. Severity of cerumen impaction was graded using a 5-point scale. Improvement in tympanic membrane visualization was assessed after instillation and irrigation.

Results

A majority (83%, 25/30) of ears showed improvement with one application: with 53% (16/30) totally dissolved and gained 100% TM visualization. Total dissolution was observed in 80% (24/30) of the study ears per the intent-to-treat analysis and 86% (24/28) if irrigation instructions were followed. Most of the ears/participants that had cerumen blockage symptoms experienced significant improvement with the application. Feelings of fullness disappeared in 92% (11/12) of the affected ears; ears itching, 91% (10/11); water trapping or cracking, 78%, and decreased hearing disappeared in 71% (10/14). All (100%, 18) of the participants who completed the application satisfaction assessment were satisfied with the application process in terms of time needed and the overall rinse procedure. Only one mild adverse event (ear pruritis) occurred that was related to application.

Conclusions

The tested cerumen removal product was effective and safe for removing moderate to severe blockage in patients with impacted cerumen. Procedure satisfaction for the product was high.

Trial Registration

This trial is registered on http://ift.tt/PmpYKN. The registration number is NCT02829294. The trial was retrospectively registered on July 8, 2016.

http://ift.tt/2qNH3Ch

HSCT Based Approaches for Tolerance Induction in Renal Transplant.

Renal transplantation has become the preferred treatment for end stage kidney failure. Although short-term graft survival has significantly improved as advances in immunosuppression have occurred, long term patient and graft survival have not. Approximately only 50% of renal transplant recipients are alive at 10 years due to the toxicities of immunosuppression and alloimmunity. Emerging research on cell-based therapies is opening a new door for patients to receive the organs they need without sacrificing quality of life and longevity because of drug based immunosuppression. Research has focused upon inducing tolerance, a state in which the body accepts the transplant and graft function is stable. Cell-based therapies to facilitate chimerism and achieve tolerance in MHC-disparate recipients have been developed in mouse, swine, canine, and nonhuman primate models. These finding are now being translated into the clinic in several trials currently underway. Protocols that utilize a combination of traditional therapeutic agents paired with cell populations including hematopoietic stem cells (HSC), regulatory T cells (Treg), and facilitating cells (FCRx) are being conducted with the objective to harness the donor immune system to protect the transplanted tissue. The benefits and feasibility of the clinical application of cell-based therapy has been demonstrated and promising results have been achieved. Here we discuss the preclinical work that has led to the clinical application of the various approaches and a summary of the most current clinical data from groups throughout the world. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Advanced Donation Programs and Deceased Donor Initiated Chains - 2 Innovations in Kidney Paired Donation.

Kidney paired donation strategies have facilitated compatible living-donor kidney transplants for end stage renal disease patients with willing but incompatible living donors. Success has inspired further innovations that expand opportunities for kidney-paired donation. Two such innovations are the advanced donation strategy in which a donor provides a kidney before their recipient is matched, or even in need of, a kidney transplant, and deceased donor initiated chains in which chains are started with deceased donors rather than altruistic living donors. While these innovations may expand kidney paired donation, they raise several ethical issues. Specific concerns raised by advanced donation include the management of uncertainty, the extent of donor and recipient consent, the scope of the obligation that the organization has to the kidney exchange paired recipient, the naming of alternative recipients, and the potential to unfairly advantage the recipient. Use of deceased donors for chain initiating kidneys raises ethical issues concerning the consent process for each involved party, the prioritization of deceased donor kidneys, the allocation of chain ending kidneys, and the value of a living donor kidney versus a deceased donor kidney. We outline each ethical issue and discuss how it can be conceptualized and managed so that these kidney paired donation innovations programs are ultimately successful. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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