Gut microbiome, metabolome, and allergic diseases

Publication date: Available online 8 July 2017
Source:Allergology International
Author(s): So-ichiro Hirata, Jun Kunisawa
The number of patients with allergic and inflammatory disorders has been increasing during the past several decades. Accumulating evidence has refined our understanding of the relationship between allergic diseases and the gut microbiome. In addition, the gut microbiome is now known to produce both useful and harmful metabolites from dietary materials. These metabolites and bacterial components help to regulate host immune responses and potentially affect the development of allergic diseases. Here, we describe recent findings regarding the immunologic crosstalk between commensal bacteria and dietary components in the regulation of host immunity and the influence of this relationship on the development of allergic diseases.



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Survey on the proper use of an adrenaline auto-injector in 551 Japanese outdoor workers after Hymenoptera stings

Publication date: Available online 8 July 2017
Source:Allergology International
Author(s): Hirokuni Hirata, Naruo Yoshida, Masamitsu Tatewaki, Sadaaki Shiromori, Kozo Sato, Tomoshige Wakayama, Shingo Tokita, Kumiya Sugiyama, Masafumi Arima, Kazuhiro Kurasawa, Takeshi Fukuda, Daisuke Shima, Yasutsugu Fukushima




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Total lower lip and chin reconstruction with radial forearm free flap: A novel approach

Publication date: Available online 8 July 2017
Source:American Journal of Otolaryngology
Author(s): Eliza H. Dewey, Ansley M. Roche, Cathy L. Lazarus, Mark L. Urken
BackgroundThe management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip.MethodsLiterature review performed.ResultsPresentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap.ConclusionsThis procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem.



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Mycoplasma pneumoniae as a cause of vulvar ulcers in a non-sexually active girl: a case report

Non-sexually active young females very rarely develop genital ulcers. Such ulcers pose a diagnostic challenge as well as physical and emotional distress for patients and family; therefore, the search for their...

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Editorial Board

Publication date: August 2017
Source:Clinical Immunology, Volume 181





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Immune complexes containing malondialdehyde (MDA) LDL induce apoptosis in human macrophages

Publication date: Available online 8 July 2017
Source:Clinical Immunology
Author(s): Gabriel Virella, Kelsey Wilson, Johnathon Elkes, Samar M. Hammad, Hussein A. Rajab, Yanchun Li, Charlyne Chassereau, Yan Huang, Maria Lopes-Virella
Immune complexes (IC) containing predominantly malondialdehyde-LDL and the corresponding autoantibodies (MDA-LDL IC) predict acute cardiovascular events, while IC rich in oxidized LDL (oxLDL IC) predict cardiovascular disease progression. Our objective was to determine mechanisms that could explain these prognostic differences. We compared the effects of the interaction of oxLDL, MDA-LDL and the corresponding IC with human macrophages focusing on apoptosis, metalloproteinases, and proinflammatory cytokines. MDA-LDL IC induced higher degrees of apoptosis, higher levels of caspase-3 expression, and increased expression and release of MMP-1 and TNF compared to MDA-LDL, oxLDL, and oxLDL-IC. The pro-apoptotic effects of MDA-LDL IC were inhibited by blocking TNFR 1 or FcγRI. Blocking FcγRI abrogated the induction and expression of MMPs and proinflammatory cytokines by MDA-LDL IC. In conclusion, the interaction of MDA-LDL IC with FcγRI triggers macrophage apoptosis and increased expression and release of TNF and MMP-1, which can lead to the rupture of unstable plaques.



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Idiopathic T cell lymphopenia identified in New York State Newborn Screening

Publication date: Available online 8 July 2017
Source:Clinical Immunology
Author(s): Stephanie Albin-Leeds, Juliana Ochoa, Harshna Mehta, Beth H. Vogel, Michele Caggana, Vincent Bonagura, Heather Lehman, Mark Ballow, Arye Rubinstein, Subhadra Siegel, Leonard Weiner, Geoffrey A. Weinberg, Charlotte Cunningham-Rundles
Quantification of T-cell receptor excision circles (TRECs) for newborn screening for SCID has advanced the diagnosis of severe combined immune deficiency (SCID). However, it has led to the identification of infants with T cell lymphopenia without known cause. The clinical characteristics, appropriate laboratory monitoring, and outcomes of patients remain unclear. We performed a retrospective review of clinical and laboratory studies for 26 infants collected from 7 New York State referral centers from 2010 to 2016 with low TRECs (mean, 70copies/μl) and subnormal CD3 counts (mean, 1150/cubicmm). Over time absolute CD3 counts increased in 17 and decreased in 9; 22 (85%) have done well clinically regardless of absolute T cell values. Additional infants with TCL will continue to be identified in newborn screening panels. While most patients seem to do well clinically, parameters for diagnosis and monitoring have yet to be formalized, and additional information needs to be collected, causes and outcomes reported.



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Assessment of human papillomavirus awareness in association with head and neck cancer at a screening event

Objectives/Hypothesis

To assess the baseline awareness of human papillomavirus (HPV) infection as a cause of head and neck cancer (HNC) to design improved targeted screening and education efforts.

Study Design

Retrospective review of collected survey at a cancer screening event.

Methods

This was a screening event at three hospitals and one community center in Miami, Florida. Participants were recruited throughout the Greater Miami area. Descriptive statistics were used to summarize the demographic characteristics of those who were aware of HPV and those who were not. Adjusted odds ratios, odds ratios, and χ² tests were used in statistical analysis.

Results

A total of 196 women and 112 men were screened across four sites, with 187 participants at hospital-based events and 124 participants at the community-based event. Forty percent of respondents had heard of HPV, and 28.0% identified HPV as a risk factor for HNC. Non-Hispanic and Hispanic respondents were 3.309 and 2.445 times, respectively, more likely than Haitian respondents to have heard of HPV. Women were 2.488 times more likely than men to be aware of HPV. College graduates were 2.268 times more likely than those with less than a college degree to be aware of HPV. Younger respondents were more likely to be aware of HPV. Of those who identified HPV as a risk factor for HNC, 95.4% also correctly identified smoking and 75.9% also correctly identified alcohol as risk factors.

Conclusions

Disparities in HPV and HNC awareness were noted between gender, age, education level, and ethnicity.

Level of Evidence

NA Laryngoscope, 2017

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Revision rates and time to revision following endoscopic sinus surgery: A large database analysis

Objectives/Hypothesis

Endoscopic sinus surgery (ESS) is performed for patients with chronic rhinosinusitis (CRS) that have failed maximal medical therapy. This study seeks to determine the prevalence of revision surgery and factors predicting the need for revision after ESS using a large statewide surgery database.

Study Design

Large retrospective cohort study using the State Ambulatory Surgery Database for the state of California between 2005 and 2011.

Methods

We identified over 61,000 patients with CRS who underwent ESS, determined by Current Procedural Terminology code. We identified which patients underwent a repeat surgery, and performed multivariable modeling to determine which factors (nasal polyps, age, gender, insurance, hospital setting, ethnicity) predicted the need for revision. Adjusted odds ratios (AOR) and 95% confidence intervals are presented.

Results

Of 61,339 patients who underwent ESS, 4,078 (6.65%) returned for revision ESS during the time period investigated. In a multivariable logistic regression model, positive predictors of revision were a diagnosis of nasal polyps (AOR: 1.20, 95% CI: 1.11–1.29, P < .001) and female gender (AOR: 1.20, 95% CI: 1.11–1.29, P < .001); public insurance was marginally predictive of increased reoperation (AOR: 1.10, 95% CI: 1.00–1.21, P = .048). Patients of Hispanic ethnicity were less likely to have revision surgery (AOR: 0.86, 95% CI: 0.77–0.97, P = .011). Age, income, and hospital setting were not significant predictors.

Conclusions

A minority of patients with CRS who undergo ESS will have a revision surgery. This likelihood is increased in female patients and those with nasal polyps, and decreased in patients of Hispanic ethnicity, even when controlling for income, insurance, and hospital setting.

Level of Evidence

4. Laryngoscope, 2017

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Quality indicators of laryngeal cancer care in commercially insured patients

Objective

To examine associations between quality, complications, and costs in commercially insured patients treated for laryngeal cancer.

Study Design

Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data (Truven Health Analytics, Ann Arbor, Michigan, U.S.A.).

Methods

We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, performance, and an overall summary measure of quality.

Results

Higher-quality care in the initial treatment period was associated with lower odds of 30-day mortality (odds ratio [OR] = 0.21, 95% confidence interval [CI] [0.04–0.98]), surgical complications (OR = 0.39 [0.17–0.88]), and medical complications (OR = 0.68 [0.49–0.96]). Mean incremental 1-year costs were higher for higher-quality diagnosis ($20,126 [$14,785–$25,466]), initial treatment ($17,918 [$10,481–$25,355]), and surveillance ($25,424 [$20,014–$30,834]) quality indicators, whereas costs were lower for higher-quality performance measures (−$45,723 [−$56,246–−$35,199]) after controlling for all other variables. Higher-quality care was associated with significant differences in mean incremental costs for initial treatment in surgical patients ($−37,303 [−$68,832–−$5,775]), and for the overall summary measure of quality in patients treated nonoperatively ($10,473 [$1,121–$19,825]). After controlling for the overall summary measure of quality, costs were significantly lower for patients receiving high-volume surgical care (mean −$18,953 [−$28,381–−$9,426]).

Conclusion

Higher-quality larynx cancer care in commercially insured patients was associated with lower 30-day mortality and morbidity. High-volume surgical care was associated with lower 1-year costs, even after controlling for quality. These data have implications for discussions of value and quality in an era of healthcare reform.

Level of Evidence

2c. Laryngoscope, 2017

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Treatment disparities in the management of epistaxis in United States emergency departments

Objectives

There is limited data on epistaxis presentation and management patterns in U.S. emergency departments (EDs). We aim to characterize patients who present to the ED with epistaxis and identify factors associated with nasal-packing use.

Study Design

Retrospective review of Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Methods

NEDS was queried for patient visits with a primary diagnosis of epistaxis (International Classification of Diseases, Ninth Revision, Clinical Modification code 784.7). Patient demographics, comorbidities, and hospital characteristics were obtained. Predictors of nasal packing were determined by multivariable logistic regression.

Results

There were 1,234,267 ED visits for epistaxis. The highest proportion of patients were seen in the winter (37.2%) at nontrauma hospitals (76.9%), and were discharged home (95.5%). Fifteen percent of patients were on long-term anticoagulation, 33% had hypertension, and 0.9% had a coagulopathy. Nasal packing was utilized in 243,268 patients (19.7%). Predictors strongly associated with nasal packing included lower socioeconomic quartile (odds ratio [OR] 1.30, 95% confidence interval [CI] = 1.10–1.53), hospital located in the geographic South (OR 1.62, CI = 1.12–2.34) and Midwest (OR 1.85, P < 0.0001), and nontrauma hospital (OR 1.56, CI = 1.19–2.05). Other factors included long-term anticoagulation (OR 1.21, CI = 1.10–1.33), winter season (OR 1.20, CI = 1.12–1.23), male gender (OR 1.14, CI = 1.10–1.17), and older age (OR 1.01, CI = 1.01–1.02). Mean ED charge was greater for patients who were packed ($1,473 vs. $1,048, P < 0.0001).

Conclusion

Several factors, including lower socioeconomic status, geographic location, and nontrauma hospital designation, predict use of nasal packing. These results raise concerns about potential treatment disparities that may result in increased patient morbidity and costs.

Level of Evidence

2C. Laryngoscope, 2017

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Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair

Background

Vocal fold movement impairment (VFMI), a known complication following thoracic aortic surgery, has been associated with poorer surgical outcomes, including higher pulmonary complications and longer length of stay (LOS). Awake transcervical injection laryngoplasty in the inpatient setting serves to augment pulmonary toilet function for affected patients. This study investigates clinical outcomes of patients who underwent early versus late injection laryngoplasty following aortic surgery.

Methods

A 5-year review (2011–2016) of 35 patients who underwent inpatient injection laryngoplasty for VFMI following aortic repair was conducted. Data included demographics, surgery parameters, laryngologic evaluation, pulmonary complications, LOS, and mortality. Early injection was defined as within 5 days from extubation. Statistical analyses were performed using SPSS, version 17.0 (IBM Corp., Armonk, NY).

Results

All 35 patients (mean age 56, 77% male) underwent left vocal-fold injection laryngoplasty without complication. There were 15 (43%) early procedures and 20 (57%) late procedures. Mean LOS for early and late injection groups (13 vs. 20 days, respectively) significantly differed (P = 0.04, 95% confidence interval (CI) 0.3 to 14.4). Early laryngoplasty cohorts experienced less pulmonary complications (20%) than those who had late medialization (50%), but this did not reach significance (P = 0.06, 95% CI −0.3 to 8.1). The most common complication type in both groups was therapeutic bronchoscopy.

Conclusion

Early awake injection laryngoplasty within 5 days from extubation is feasible and may improve clinical outcomes for patients with VFMI following aortic repair. Further prospective studies on this approach for VFMI after thoracic surgery are needed.

Level of Evidence

4. Laryngoscope, 00:000–000, 2017

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Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique

Objective

To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia.

Study Design

Case-control study.

Methods

A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures.

Results

With the conventional all-SA anesthetic, the duration of SA was 209 ± 26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0 ± 18.9 minutes, a 62.3% reduction (P < 0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P = 0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution.

Conclusion

TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation.

Level of Evidence

3b. Laryngoscope, 2017

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Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

Abstract

Background. The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems.Methods. We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest).Results. A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a three-fold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failure-to-rescue, indicating differences between hospitals in the risk of death among patients after they develop complications.Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.

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Intraoperative dexamethasone alters immune cell populations in patients undergoing elective laparoscopic gynaecological surgery

Abstract

Background. Anaesthetists use dexamethasone principally for its anti-emetic effect. The purpose of this study was to characterize the effects of a single intraoperative dose of dexamethasone on cellular and metabolic components of the immune system in patients undergoing laparoscopic surgical procedures.Methods. In this prospective double-blind trial, female patients undergoing elective major laparoscopic surgery were randomized to receive saline (Control group, n=16) or dexamethasone 4 mg (Dexamethasone group, n=16) i.v. after the induction of anaesthesia. Inflammatory markers and immune cell counts were examined at 24 and 48 h and 6 weeks after surgery. The changes from baseline preoperative values were compared between groups using a Mann–Whitney U-test, and linear mixed models were used to validate the findings.Results. No differences in concentrations of serum glucose and interleukin-6 were observed between groups after surgery. The increase in C-reactive protein concentration at 24 h after surgery was greater in the control group [median (interquartile range), 33 (25–65) vs 17 (7–26) mg dl⁻¹; P=0.018]. Extensive changes in the counts of white cells, including most lymphocyte subsets, were observed 24 h after surgery, and dexamethasone appeared to attenuate most of these changes. Changes at 48 h and 6 weeks did not differ between groups.Conclusions. In female patients undergoing elective laparoscopic gynaecological surgery, dexamethasone administration appears to attenuate inflammation and to alter immune cell counts at 24 h, with no effects identified after this time. The importance of these changes for postoperative immune function is unknown.Trial registration. Australia and New Zealand Clinical Trials Registry (ACTRN12608000340336).

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Duty of candour: a statutory obligation or just the right thing to do?

In 1990 the case of Robbie Powell catalogued a story of medical errors and neglect that ultimately lead to his untimely death from Addison's disease at 10 years of age. In this high-profile case, the child's father felt that events were made even more unbearable by failures of health care providers to offer credible explanations for what had occurred and subsequently by the detrimental actions of investigatory bodies.¹ Despite tireless and tenacious legal challenges, Robbie Powell's father was denied the truth for nearly 2 decades. It is now established that forgery and falsification of patient medical records occurred and investigations were plagued by conflict of interest and dishonesty, including cabinet ministers providing false parliamentary answers.² Indeed, two Police Complaints Authority investigations into the handling of the case named the Dyfed-Powys police force as 'institutionally incompetent' and identified 35 separate potential criminal offences including falsification of documents and perverting the course of justice.³ No criminal prosecutions were brought and in May 2000 the European Court of Human Rights stated in a judgement on the case that:As the law stands now … doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even refrain from deliberately falsifying records.⁴Although this case must be considered rare and indeed extreme, it is important to take a moment to reflect on a purely human level how one would feel if a loved one suffered serious harm or death as the result of a medical incident. Add to that emotional turmoil the distress of not being told what had happened or the insult of being deceived by those with whom care and support had been entrusted. In the 27 years since this tragic case, the National Health Service (NHS) has slowly moved towards a culture of transparency and openness. This article discusses the UK statutory Duty of Candour (DoC) and the implications for enacting the legislation with respect to perioperative and intensive care medicine.

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A diffuse hematoma caused by spontaneous rupture of a parathyroid adenoma: a case report

Publication date: Available online 7 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Lifeng An, Tiefeng Ji, Lin Li




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Editorial introductions

No abstract available

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What is global surgery?

No abstract available

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Secondary reconstruction of maxillofacial trauma

Purpose of review: Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. Recent findings: The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Summary: Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

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Complications in facial Mohs defect reconstruction

Purpose of review: To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit. Recent findings: Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered. Summary: A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.

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Update on injectables in the nose

Purpose of review: The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures. Recent findings: Hyaluronic acid and calcium hydroxylapatite are the two most commonly used fillers for injection. Recent studies have found that most injectable fillers are met with success and patient satisfaction, but vascular complications are still a serious problem of which physicians should be wary. Summary: Injectable fillers should continue to be considered for patients on a case-by-case basis, but physicians should be knowledgeable of the various filler types, their indications, and injection technique to prevent serious complications.

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Latest advances in the management of facial synkinesis

Purpose of review: To provide an overview of the treatment options for nonflaccid facial paralysis including physical rehabilitation, botulinum toxin injection and surgical intervention. To also describe recent technique advances regarding facial synkinesis in each zone of facial movement. Recent findings: Physical therapy and neuromodulation with botulinum toxin continues to be the main treatment strategy for facial synkinesis. Treating the orbicularis oculi, mentalis and platysma muscles with neurotoxin has been well described. A symmetric smile can also be improved with ipsilateral depressor anguli oris and the contralateral depressor labi inferioris weakening. Novel surgical techniques to selectively ablate specific facial muscles have also been recently described. Summary: Nonflaccid facial paralysis is a spectrum of hypokinetic and hyperkinetic movement following facial nerve injury that is best treated in a patient-tailored graduated fashion. Novel techniques are evolving to maximize patient function while minimizing morbidity.

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Surgical orthodontics

Purpose of review: The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Recent findings: Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. Summary: A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

http://ift.tt/2u3iXti

Big data in facial plastic and reconstructive surgery: from large databases to registries

Purpose of review: There are many limitations to performing clinical research with high levels of evidence in facial plastic and reconstructive surgery (FPRS), such as randomization into surgical groups and sample size recruitment. Therefore, additional avenues for exploring research should be explored using big data, from databases to registries. Other organizations have developed these tools in the evolving landscape of outcomes measurement and value in healthcare, which may serve as models for our specialty. Recent findings: Over the last 5 years, FPRS literature of large-scale outcomes research, utilizing several administrative databases, has steadily grown. Our objectives are to describe key administrative databases, strengths and weaknesses of each, and identify recent FPRS publications utilizing big data. A registry with FPRS defined outcomes has the most potential. Summary: Although FPRS research has trended to a more evidence-based approach in the modern healthcare era, gaps persist. Several large administrative databases or registries can address voids in outcomes research within FPRS.

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Global surgery: current evidence for improving surgical care

Purpose of review: The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery. Recent findings: Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise. Summary: The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed.

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Masseteric to buccal branch nerve transfer

Purpose of review: To review recent literature pertaining to the use of masseteric–facial nerve neurorrhaphy (MFNN) for facial reanimation in patients with facial paralysis. Recent findings: First, MFNN effectively restores some midface tone and function, including the ability to smile. Second, use of the masseteric nerve minimizes synkinesis, dysarthria, and dysphagia that frequently occur after hypoglossal-facial nerve neurorrhaphy. Third, concurrent cable grafting to the zygomatic branch from an intact proximal facial nerve remnant – when available – can restore dynamic eye closure. Summary: Masseteric nerve transfer is an alternative to hypoglossal nerve transfer that improves midface appearance and function for properly selected patients with facial paralysis.

http://ift.tt/2u3fN8S

Zygomaticomaxillary complex fractures: diagnosis and treatment

Purpose of review: To provide an overview of zygomaticomaxillary complex (ZMC) fractures and their treatment. Aspects of anatomy, diagnosis, and treatment objectives of these common fractures will be reviewed including recent literature. Recent findings: Advances in technology such as guided surgery have allowed for better outcomes and a reduction in surgeon variability with regard to postoperative results. The use of titanium and bioresorbable mini screws and plates have expanded the ability to achieve stable and predictable results. There are many different challenges and techniques that are acceptable to treat zygoma fractures. Surgeon preference and training dictate these methods that vary among specialties. Summary: ZMC fractures are commonly encountered in the trauma setting. Although there is a multitude of treatment methods available, the ultimate goal for any surgeon should be to reproduce premorbid form and function. The availability of techniques such as 3D navigation, contralateral mirroring, and advances in fixation technology have shown promise for better outcomes, particularly in severely comminuted or displaced fractures.

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Pediatric nasal surgery: timing and technique

Purpose of review: Timing of pediatric nasal surgery has always been a controversial topic. Concern over disrupting growing parts of the face and causing permanent facial deformity has led to a primarily conservative approach. Many surgeons feel that it is prudent to wait until the patient has completed nasal growth after puberty to pursue nasal surgery. Recent findings: Recently, this attitude has been challenged with evidence that not only is nasal surgery in the pediatric age group not a detriment to facial growth, but failure to correct significant nasal deformity may actually cause dysmorphic facial growth secondary to obligate mouth breathing. Because of this, recent studies have focused on determining safe surgical techniques for pediatric nasal surgery, including inferior turbinate reduction, septoplasty and rhinoplasty. Research focus on this topic has also been expanded to include quality-of-life measures after nasal surgery. Summary: Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients.

http://ift.tt/2u2JxTb

Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures

Purpose of review: The purpose of this manuscript is to review the current literature regarding the management of frontal sinus fractures and offer the authors opinion on the current management of these traumatic injuries. We evaluate recently proposed management algorithms as well as novel surgical approaches reported within the last few years. Recent findings: Patient selection for sinus sparing treatment modalities is balanced between fracture severity, involved structures, and reliable patient surveillance. Minimally invasive, aesthetically favorable approaches grow in diversity for anterior table fractures. For fractures of the posterior sinus wall and nasofrontal outflow tract, the literature focuses on sinus sparing surgery, as well as better defining the patients in which obliteration and/or cranialization is appropriate. Summary: Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.

http://ift.tt/2u3bqdN

3D Printing: current use in facial plastic and reconstructive surgery

Purpose of review: To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Recent findings: Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs Summary: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.

http://ift.tt/2u2JwyB

Cosmetic bone contouring

Purpose of review: In recent years, cosmetic bone contouring surgery has become increasingly popular, especially in East Asian countries. These procedures are also being requested by patients in the United States at an increasing rate. The purpose of this study is to provide an overview of what is involved with these procedures and their potential complications. Recent findings: In some cultures, a wide jaw and a square face are aesthetically unpleasing, whereas an ovoid or 'melon seed face' is thought to be feminine, delicate and beautiful. Mandibular angloplasty, mandibular lateral cortex excision, reduction malarplasty, as well as genioplasty may be performed to alter the facial contour and bring about dramatic results. Summary: Whether a surgeon choses to incorporate these procedures into practice or not, the craniofacial surgeons should be familiar with the procedures as well as the potential complications.

http://ift.tt/2u2RV52

Pathogenicity and genetic profile of oral Porphyromonas species from canine periodontitis

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Amanda do Nascimento Silva, Erica Dorigatti de Avila, Viviane Nakano, Mario J. Avila-Campos
ObjectiveIn this study, the presence of the prtC and fimA genes involved in the pathogenicity of oral Porphyromonas spp. isolated from dogs with periodontitis and healthy, as well as their genetic diversity was investigated.DesignThirty-two Beagle dogs, 24 with periodontitis and 8 healthy were evaluated. Subgingival samples from only one gingival site of both groups were collected. Bacteria grown in anaerobiosis were identified by RAPID ID 32A kits. From each strain the respective DNA was obtained and used to genotyping by conventional PCR and AP-PCR.ResultsDogs with periodontitis harbored 28 P. gulae, 2 P. creviocaricanis, 1 P. cangingivalis and 7 P. macacae; and from healthy dogs, 11 P. gulae and 5 P. circumdentaria. In P. gulae isolated from periodontal dogs the gene prtC was observed in 19 (67.85%) and in 7 (63.63%) from healthy dogs. P. gulae strains from periodontal dogs harbored either the gene fimA I or fimA II; while strains from healthy dogs harbored the gene fimA I, fimA II, fimA III or fimA IV, as well as 1 P. circumdentaria the gene fimA II. By AP-PCR strains were grouped in different clusters suggesting heterogeneity of these microorganisms.ConclusionsThe results presented herein inform that Porphyromonas spp. isolated from dogs with and without periodontitis harbored the prtC and fimA genes and it could be a role in the establishment of the infectious process.



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Sleep bruxism and related risk factors in adults: A systematic literature review

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Tommaso Castroflorio, Andrea Bargellini, Gabriele Rossini, Giovanni Cugliari, Andrea Deregibus
ObjectiveThe aim of this article was to systematically review the literature to assess the relationship between risk factors and sleep bruxism (SB) in adults (age ≥18 years).DesignA systematic search of the following databases was carried out: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs and SciELO. Nine out of the 4583 initially identified articles were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.ResultsAmong the nine analyzed articles, associations between SB and gastro-esophageal reflux disease (GERD) (OR=6.6, CI=1.4–30.9) was found in one randomized clinical trial (RCT). Four cross-sectional studies suggested history of SB during childhood (OR=8.1 CI=5.4–12–2), age (OR=3.1, CI=2.3–4.1) and chronic migraine (OR=3.8, C.I=1.8–7.8) as determinant factors for the development of SB. In one case-control study, patients with genetic polymorphisms were more likely to present SB (OR=4.3, CI=1.6–11.3). Smoking (OR=2.8, CI=2.2–3.5) and alcohol intake (OR=1.9, CI=1.2–2.8) showed moderate association in two case-control studies.ConclusionsHistory of SB during childhood, gastro-esophageal reflux disease and genetic polymorphisms seem to be important risk factors associated to SB in adults. Dry mouth on awakening seems to be a protective factor. Association does not infer with causality. Even if the evidence emerged from the considered studies was clinically relevant, further studies are requested to better understand the biological mechanisms behind the described associations.



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Effects of melatonin on the proliferation and differentiation of human dental pulp cells

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Qin Liu, Wenguo Fan, Yifan He, Fuping Zhang, Xiaoyan Guan, Qianyi Deng, Xianjun Lu, Hongwen He, Fang Huang
ObjectiveEffects of melatonin on the proliferation and differentiation of human dental pulp cells (hDPCs) remain unclear. The purpose of this study was to investigate the effect of melatonin on the proliferation and differentiation of the hDPCs.DesignPrimary hDPCs were obtained from the third molar of volunteer aged from 18 to 25. CCK8 assay evaluated the effect of melatonin upon cell proliferation at day 1, 2, 3, 4, 5. After 7days' osteogenic induction with melatonin or vehicle, alkaline phosphatase (ALP) activity was measured with a commercial kit. Then levels of dentin sialophosphoprotein (DSPP) were determined by immunocytochemical staining and western blot analysis, followed by quantitative real-time reverse transcription-Polymerase chain reaction (qRT-PCR) to analyse mRNA levels of ALP and DSPP. Finally hDPCs exposed to osteogenic medium containing melatonin or vehicle for 14days were stained with alizarin red to detect mineralization nodules formation.ResultsMelatonin significantly inhibited the proliferative ability of the hDPCs in a concentration- and time-dependent manner. The hDPCs cultured in osteogenic induction medium with melatonin presented an increase of ALP activity, expression of DSPP, mRNA levels of ALP and DSPP, and mineralization nodules formation.ConclusionsThese findings indicate that melatonin at physiological concentrations can inhibit proliferation and promote the differentiation of hDPCs, which might give some new insights into the mechanism of regulating DPCs to achieve dentine regeneration.



http://ift.tt/2sRgMsx

Regulatory myeloid cells: an underexplored continent in B-cell lymphomas

Abstract

In lymphomas arising from the germinal center, prognostic factors are linked to the myeloid compartment. In particular, high circulating monocyte or myeloid-derived suppressor cell counts are associated with poor prognosis for patients with high-grade B-cell lymphomas. Macrophages with an M2 phenotype are enriched within lymphoma tumors. However, the M1/M2 nomenclature is now deprecated and the clinical impact of this phenotype remains controversial. Across cancer types, myeloid cells are primarily thought to function as immune suppressors during tumor initiation and maintenance, but the biological mechanisms behind the myeloid signatures are still poorly understood in germinal center B-cell lymphomas. Herein, we describe the role and clinical relevance of myeloid cells in B-cell lymphoma and propose innovative approaches to decipher this complex cellular compartment. Indeed, characterization of this heterogeneous cell ecosystem has been largely accomplished with "low-resolution" approaches like morphological evaluation and immunohistochemistry, where cells are characterized using a few proteins and qualitative metrics. High-resolution, quantitative approaches, such as mass cytometry, are valuable to better understand myeloid cell diversity, functions, and to identify potential targets for novel therapies.

http://ift.tt/2sR4VdQ

Prolonged and high dosage of tigecycline – successful treatment of spondylodiscitis caused by multidrug-resistant Acinetobacter baumannii: a case report

The incidence of infectious spondylodiscitis has been increasing over the last few years. This reflects the expanding elderly and immunocompromised populations and the rising implementation of invasive spinal ...

http://ift.tt/2uVey7Z

Myo-inositol and selenium reduce the risk of developing overt hypothyroidism in patients with autoimmune thyroiditis

OBJECTIVE: The beneficial effects obtained by myo-inositol in association with seleno-methionine in patients affected by subclinical hypothyroidism have been recently demonstrated. Here, we evaluate the immune-modulating effect of myo-inositol in association with seleno-methionine in patients with euthyroid autoimmune thyroiditis (AT).

PATIENTS AND METHODS: Twenty-one consecutive Caucasian patients with newly diagnosed euthyroid chronic AT were evaluated. All subjects were treated with myo-inositol in association with selenium (600 mg/83 mg) tablets, twice per day, for six months. A complete thyroid assessment was done before the treatment, and after six months.

RESULTS: After the treatment thyroid-stimulating hormone (TSH) levels significantly declined with respect to basal values, overall in patients with an initial TSH value in the high normal range (2.1<TSH<4.0), suggesting that the combined treatment can reduce the risk of a progression to hypothyroidism in subjects with autoimmune thyroid diseases (AITD). We found that after the treatment antithyroid autoantibodies levels declined. Moreover, the immune-modulatory effect was first confirmed by the fact that after the treatment CXCL10 levels declined, too.

CONCLUSIONS:  We first show an immune-modulatory effect of myo-inositol in association with seleno-methionine in patients with euthyroid AT. Further studies are needed to extend the observations in a large population, to evaluate the effect on the quality of life, and to study the mechanism of the effect on chemokines.

L'articolo Myo-inositol and selenium reduce the risk of developing overt hypothyroidism in patients with autoimmune thyroiditis sembra essere il primo su European Review.

http://ift.tt/2tPEzZ5

STAT6 Reliably Distinguishes Solitary Fibrous Tumors from Myofibromas

Abstract

Solitary fibrous tumors (SFT) and myofibromas (MF) historically have belonged to the same morphologic spectrum and have been lumped together under the nonspecific umbrella term, "hemangiopericytoma" along with other pericytic/myoid tumors. While current evidence shows clear distinction between the two entities, they frequently remain in the same histopathologic differential diagnosis. This diagnostic dilemma especially is common for smaller incisional biopsies from the oral cavity. STAT6 immunohistochemistry (IHC) recently was established as a reliable method to detect solitary fibrous tumor; however, the literature is sparse regarding STAT6 reactivity in MFs. The authors report ten new cases of oral solitary fibrous tumor, discuss histopathologic similarities and differences between the two tumors, and list respective STAT6 IHC expressivity. After IRB approval, 10 cases diagnosed as SFT and 24 cases of MF were collected from the University of Florida Oral and Maxillofacial Pathology Biopsy Service between the years 1994 and 2016. The original hematoxylin and eosin slides and related IHC were reviewed. IHC with STAT6 antibody was performed on all 34 samples, and the findings were analyzed. All cases were from the oral cavity or perioral regions. 10/10 SFTs expressed STAT6 nuclear reactivity, while no cases of MF showed nuclear expression of STAT6. STAT6 is a dependable marker to differentiate SFTs from MFs.

http://ift.tt/2tTg9hP

Mixed papillary-sarcomatoid carcinoma of the penis: report of an aggressive subtype

Abstract

Several different histological subtypes of penile carcinoma had been described in the last decades, many with different biological behavior and prognosis. The association of two histological subtypes (mixed tumors) can be observed in one third of the cases. The most common association is of warty and basaloid tumors, two HPV-related carcinomas. Here, we described a mixed papillary-sarcomatoid carcinoma, never reported before. Although it is a clinical aspect of a low-grade verruciform tumor, its prognosis showed it to be very aggressive due to the sarcomatoid component hidden above the papillary component. The two components showed opposite cadherin/vimentin expression pointed to epithelial-mesenchymal transition between them.

http://ift.tt/2uVsM94

STAT6 Reliably Distinguishes Solitary Fibrous Tumors from Myofibromas

Abstract

Solitary fibrous tumors (SFT) and myofibromas (MF) historically have belonged to the same morphologic spectrum and have been lumped together under the nonspecific umbrella term, "hemangiopericytoma" along with other pericytic/myoid tumors. While current evidence shows clear distinction between the two entities, they frequently remain in the same histopathologic differential diagnosis. This diagnostic dilemma especially is common for smaller incisional biopsies from the oral cavity. STAT6 immunohistochemistry (IHC) recently was established as a reliable method to detect solitary fibrous tumor; however, the literature is sparse regarding STAT6 reactivity in MFs. The authors report ten new cases of oral solitary fibrous tumor, discuss histopathologic similarities and differences between the two tumors, and list respective STAT6 IHC expressivity. After IRB approval, 10 cases diagnosed as SFT and 24 cases of MF were collected from the University of Florida Oral and Maxillofacial Pathology Biopsy Service between the years 1994 and 2016. The original hematoxylin and eosin slides and related IHC were reviewed. IHC with STAT6 antibody was performed on all 34 samples, and the findings were analyzed. All cases were from the oral cavity or perioral regions. 10/10 SFTs expressed STAT6 nuclear reactivity, while no cases of MF showed nuclear expression of STAT6. STAT6 is a dependable marker to differentiate SFTs from MFs.

http://ift.tt/2tTg9hP

STAT6 Reliably Distinguishes Solitary Fibrous Tumors from Myofibromas

Abstract

Solitary fibrous tumors (SFT) and myofibromas (MF) historically have belonged to the same morphologic spectrum and have been lumped together under the nonspecific umbrella term, "hemangiopericytoma" along with other pericytic/myoid tumors. While current evidence shows clear distinction between the two entities, they frequently remain in the same histopathologic differential diagnosis. This diagnostic dilemma especially is common for smaller incisional biopsies from the oral cavity. STAT6 immunohistochemistry (IHC) recently was established as a reliable method to detect solitary fibrous tumor; however, the literature is sparse regarding STAT6 reactivity in MFs. The authors report ten new cases of oral solitary fibrous tumor, discuss histopathologic similarities and differences between the two tumors, and list respective STAT6 IHC expressivity. After IRB approval, 10 cases diagnosed as SFT and 24 cases of MF were collected from the University of Florida Oral and Maxillofacial Pathology Biopsy Service between the years 1994 and 2016. The original hematoxylin and eosin slides and related IHC were reviewed. IHC with STAT6 antibody was performed on all 34 samples, and the findings were analyzed. All cases were from the oral cavity or perioral regions. 10/10 SFTs expressed STAT6 nuclear reactivity, while no cases of MF showed nuclear expression of STAT6. STAT6 is a dependable marker to differentiate SFTs from MFs.

http://ift.tt/2tTg9hP

The Impact of Liver Graft Injury on Cancer Recurrence Posttransplantation.

Liver transplantation is the most effective treatment for selected patients with hepatocellular carcinoma (HCC). However, cancer recurrence, posttransplantation, remains to be the critical issue which affects the long-term outcome of HCC recipients. In addition to tumor biology itself, increasing evidence demonstrates that acute phase liver graft injury is a result of hepatic ischemia reperfusion (I/R) injury (which is an inevitable consequence during liver transplantation) and may promote cancer recurrence at late phase posttransplantation. The liver grafts from living donors, donors after cardiac death (DCD), and steatotic donors have been considered as promising sources of organs for liver transplantation and are associated with high incidence of liver graft injury. The acute phase liver graft injury will trigger a series of inflammatory cascades, which may not only activate the cell signaling pathways regulating tumor cell invasion and migration, but also mobilize the circulating progenitor and immune cells to facilitate tumor recurrence and metastasis. The injured liver graft may also provide the favorable microenvironment for tumor cell growth, migration, and invasion through the disturbance of microcirculatory barrier function, induction of hypoxia and angiogenesis. This review aims to summarize the latest findings about the role and mechanisms of liver graft injury resulted from hepatic I/R injury on tumor recurrence posttransplantation, both in clinical and animal cohorts. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sQNeLG

Effects of residual hearing on cochlear implant outcomes in children: A systematic-review

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Julia Santos Costa Chiossi, Miguel Angelo Hyppolito
Objectivesto investigate if preoperative residual hearing in prelingually deafened children can interfere on cochlear implant indication and outcomes. Methods: a systematic-review was conducted in five international databases up to November-2016, to locate articles that evaluated cochlear implantation in children with some degree of preoperative residual hearing. Outcomes were auditory, language and cognition performances after cochlear implant. The quality of the studies was assessed and classified according to the Oxford Levels of Evidence table - 2011. Risk of biases were also described. Results: From the 30 articles reviewed, two types of questions were identified: (a) what are the benefits of cochlear implantation in children with residual hearing? (b) is the preoperative residual hearing a predictor of cochlear implant outcome? Studies ranged from 04 to 188 subjects, evaluating populations between 1.8 and 10.3 years old. The definition of residual hearing varied between studies. The majority of articles (n = 22) evaluated speech perception as the outcome and 14 also assessed language and speech production. Conclusion: There is evidence that cochlear implant is beneficial to children with residual hearing. Preoperative residual hearing seems to be valuable to predict speech perception outcomes after cochlear implantation, even though the mechanism of how it happens is not clear. More extensive researches must be conducted in order to make recommendations and to set prognosis for cochlear implants based on children preoperative residual hearing.



http://ift.tt/2trWZi0

Hearing loss in children with growth hormone deficiency

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): John S. Muus, Forest W. Weir, Kathryn L. Kreicher, Deborah A. Bowlby, Christopher M. Discolo, Ted A. Meyer
ObjectiveAlthough insulin-like growth factor 1 (IGF-1) has been shown to be important for inner-ear development in animal models, little is known about the otologic and audiologic findings of children with growth hormone deficiency (GHD). The goal of this study is to evaluate the prevalence, type, and severity of hearing impairment in children with GHD.MethodsAudiologic, otologic, and demographic data were recorded for children with a diagnosis of GHD in the AudGen database. Data for each patient were selected based on the first encounter with available complete audiometric data or the first encounter with a type of hearing loss documented. The patients were then stratified by type and severity of hearing loss, and otologic issues were documented. A separate cohort comprised of children with GHD without hearing loss was compared as a control.Results209 children with GHD met inclusion criteria. 173 (83%) of these patients had hearing loss. 79% of losses were bilateral and 21% were unilateral (309 total ears with hearing loss). 293 of the 309 ears with hearing loss had audiograms with ear-specific thresholds; 47 had conductive, 24 had sensorineural, 65 had mixed and 157 had undefined hearing loss with incomplete audiograms. Pure-tone averages (PTA) were higher among patients with mixed hearing loss compared to patients with all other loss types.ConclusionHearing loss is prevalent in children with GHD with a predisposition to be bilateral. These findings suggest the need for increased awareness and routine hearing screening for patients with GHD. Further studies may elucidate the etiology of the hearing impairment in children with GHD to better aid pediatricians, endocrinologists, otolaryngologists and audiologists when assessing and managing these children.



http://ift.tt/2tArel2

A novel management of streptococcal pharyngotonsillar infections by laser-activated silver nanoparticles and methylene blue conjugate, in vitro study

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Ahmed Kassab, Ola Dabous, Mona Morsy
IntroductionSpecies of Streptococcus are classified based on their hemolytic properties into alpha and beta types. And, since antimicrobial drug resistance is an increasingly problematic issue, the efforts to develop modalities that would overcome this obstacle and avoid antibiotic side effects is an ongoing challenge.Methods and materials20 patients from both sexes were selected. The isolated organisms were identified according to standard laboratory methods. Bacterial Cultures were subjected to the low-level diode laser (660 nm), methylene blue (MB) as a photosensitizing agent and for silver nanoparticles.ResultsAll the experimental groups showed statistically lower values of CFU/ml than the positive control group. Conclusion: The photoactivated MB, silver nanoparticles conjugate showed the maximum inhibitory effect on Streptococci, which opens a gate to further investigation of such a promising protocol to establish a safe and efficient method of management for resistant cases of streptococcal tonsillar infections.



http://ift.tt/2sQOApD

Intracranial complications of CSOM in pediatric patients: A persisting problem in developing countries

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Avani Jain, Nikhil Arora, Ravi Meher, J.C. Passey, Ramanuj Bansal
BackgroundIntracranial complications (ICC) of chronic suppurative otitis media (CSOM) occur even in the antibiotic area. These complications are commonly seen in pediatric patients due to poor hygiene and low immunity. They are more prevalent in developing countries due to illiteracy, low socioeconomic status and lack of access to health care facilities.ObjectiveTo study the incidence, clinical profile, treatment and outcome of pediatric patients presenting with intracranial complications of chronic suppurative otitis media.MethodsA retrospective analysis of intracranial complications of CSOM in pediatric patients was conducted over a period of 15 years at a tertiary level institute. Data regarding age, sex, clinical presentation, laboratory and radiological investigations, management, duration of hospitalization, and outcomes were recorded.ResultsThere were 142 patients, in the pediatric age group, diagnosed as having intracranial complications due to chronic otitis media during the study period. There was a decline in the incidence of ICC of CSOM. The most frequent intracranial complication seen was brain abscess (58.5%). All patients were administered intravenous antibiotics for 4–6 weeks and underwent canal wall down mastoidectomy. Neurosurgical intervention was considered in the required patients. The case fatality rate in our study was 2.8% (4 patients).ConclusionOtogenic intracranial complications can be fatal if not managed appropriately and timely. Broad spectrum intravenous antibiotics are usually required for 4–6 weeks with or without neurosurgical intervention and mastoid exploration. A high index of suspicion is required in all patients presenting with danger symptoms.



http://ift.tt/2tAdtDa

The construing of trainee clinical psychologists in relation to personality, theoretical orientation and factors that influence clinical practice

Simmonds, DW; (2008) The construing of trainee clinical psychologists in relation to personality, theoretical orientation and factors that influence clinical practice. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2trJI9g

The effects of prostate cancer-related plexin-B1 mutations on protein function

Wong, GW; (2008) The effects of prostate cancer-related plexin-B1 mutations on protein function. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2trBHRs

The contribution of the frontal lobes to propositional language

Robinson, G; (2006) The contribution of the frontal lobes to propositional language. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sXijsi

Taking a line for a walk': Axpanding architectural concepts of the line - preliminary course experiments at the Bauhaus

Wingham, I; (2007) Taking a line for a walk': Axpanding architectural concepts of the line - preliminary course experiments at the Bauhaus. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sXLRG4

MOCDroid: multi-objective evolutionary classifier for Android malware detection

Martín, A; Menéndez, HD; Camacho, D; (2016) MOCDroid: multi-objective evolutionary classifier for Android malware detection. Soft Computing 10.1007/s00500-016-2283-y . (In press).

http://ift.tt/2trYI6N

Analysing temporal performance profiles of UAV operators using time series clustering

Rodríguez-Fernández, V; Menéndez, HD; Camacho, D; (2016) Analysing temporal performance profiles of UAV operators using time series clustering. Expert Systems with Applications , 70 (C) pp. 103-118. 10.1016/j.eswa.2016.10.044 .

http://ift.tt/2sXvTvO

Support vector machines for drug discovery

Trotter, MWB; (2007) Support vector machines for drug discovery. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2trSK5X

Studies on the interplay between the microtubule cytoskeleton and Cdc2-cyclin B kinase at the onset of mitosis in fission yeast

Renwick, SJ; (2005) Studies on the interplay between the microtubule cytoskeleton and Cdc2-cyclin B kinase at the onset of mitosis in fission yeast. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sXCmH3

A study on performance metrics and clustering methods for analyzing behavior in UAV operations

Rodríguez-Fernández, V; Menéndez, HD; Camacho, D; (2017) A study on performance metrics and clustering methods for analyzing behavior in UAV operations. Journal of Intelligent & Fuzzy Systems , 32 (2) pp. 1307-1319. 10.3233/JIFS-169129 . Green open access

http://ift.tt/2trJG18

Studies on aspects that affect chromatin structure and function of the human CD2 locus control region

Williams, AJ; (2006) Studies on aspects that affect chromatin structure and function of the human CD2 locus control region. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sXvSHS

Time-Resolved Spectroscopic Investigation of Charge Trapping in Carbon Nitrides Photocatalysts for Hydrogen Generation

Godin, R; Wang, Y; Zwijnenburg, MA; Tang, J; Durrant, JR; (2017) Time-Resolved Spectroscopic Investigation of Charge Trapping in Carbon Nitrides Photocatalysts for Hydrogen Generation. Journal of The American Chemical Society , 139 (14) pp. 5216-5224. 10.1021/jacs.7b01547 . Green open access

http://ift.tt/2trMXgD

Sustained myrmecophagy in Nigerian chimpanzees: Preferred or fallback food?

Sommer, V; Buba, U; Jesus, G; Pascual-Garrido, A; (2017) Sustained myrmecophagy in Nigerian chimpanzees: Preferred or fallback food? American Journal of Physical Anthropology , 162 (2) pp. 328-336. 10.1002/ajpa.23122 .

http://ift.tt/2sXs0Xu