Efficacy of two plant extracts against acne vulgaris: Initial results of microbiological tests and cell culture studies

Summary

Background

Acne vulgaris is a common skin disease characterized by increased sebum production, inflammation, and colonization of Propionibacterium acnes (P. acnes) on pilosebaceous follicles.

Aims

To determine the efficacy of two different plant extracts against P. acnes and to analyze the gene expression levels of IL‐1α, SRD5A1, and TNFα in HaCaT cells treated with these plant extracts.

Methods

Anti‐acne extract 1 (AE1) consisted of Juglans regia (walnut husk), Myrtus communis (myrtle leaves), Matricaria chamomilla (chamomilla flowers), Urtica dioica (stinging nettle leaves), and Rosa damascena (rose flowers). Anti‐acne extract 2 (AE2) contained Brassica oleracea var. botrytis (broccoli) and B. oleracea var. italica (cauliflower). The antimicrobial activities of the extracts were tested on two different P. acnes strains: the reference strain of P. acnes (ATCC 51277) and the clinical isolate from a patient. The minimum inhibitory concentration (MIC) of the extracts was determined using the broth dilution method. Human keratinocyte cells were used for in vitro tests. Gene expression analyses were performed with RT‐qPCR.

Results

The MIC values of the extracts were below 1/2048 µg/mL. In the gene expression analysis, AE1 increased the expression level of TNFα (1.1719, P < 0.0001), suppressed the expression level of IL‐1α, SRD5A1 (0.0588, P = 0.0231; 0.3081, P = 0.0351), respectively. AE2 suppressed gene expression level of IL‐1α, SRD5A1, TNFα (0.3815, P = 0.0254; 0.3418, P = 0.0271; 0.1997, P = 0.0623).

Conclusions

Both herbal extracts demonstrated strong antibacterial and anti‐inflammatory activity in this preliminary trial. In conclusion, the topical application of these botanical extracts can be good candidates for local acne treatment.

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Reconstruction of the Nose

Nasal reconstructive techniques have advanced significantly over the past 50 years. Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits. In order to achieve ideal outcomes, reconstructive surgeons must consider differences in tissue qualities across the nasal aesthetic subunits and formulate reconstructive plans based on these differences. Local flaps, skin grafts, and several types of interpolated flaps comprise the most commonly used techniques for nasal reconstruction. Defects that involve structural or internal lining defects require reconstruction of significantly higher complexity.

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Reconstruction of the Ear

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.

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Contents

Jeffrey S. Moyer

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Mohs Micrographic Surgery

Mohs micrographic surgery (MMS) is the gold standard for treating various cutaneous tumors. MMS has evolved into a single-day, outpatient procedure. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histologic evaluation. The process is repeated as necessary until the tumor is completely removed, with maximal conservation of normal tissue. Evaluation of 100% of the surgical margin allows for exceptional cure rates. The Mohs surgeon is trained in tumor excision, histopathology interpretation, and surgical reconstruction. The use of MMS is often part of a multidisciplinary approach to treating cutaneous tumors.

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Contributors

J. REGAN THOMAS, MD

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Reconstruction of Defects Involving the Lip and Chin

Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.

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Copyright

ELSEVIER

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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies

Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy. Although initially considered difficult and unreliable in the head and neck, experience with the technique has improved and evolved significantly over the last 3 decades. It is now recognized to be accurate and reliable for regional nodal staging and detection of occult nodal metastasis in the head and neck. Although initially described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy continues to expand and is now extended to other cutaneous malignancies.

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Skin Cancer Treatment

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Forthcoming Issues

Facial Gender Affirmation Surgery

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State-of-the-Art in Skin Cancer Surgery

Skin cancer remains the most common cancer in the United States, affecting approximately 20% of Americans during their lifetime. Despite major advances in care delivery, including targeted drug therapies and immunotherapy, the primary treatment for early nonmelanoma skin cancer (NMSC) and melanoma continues to be careful surgical extirpation with clear margins, along with meticulous reconstruction that optimally addresses functional and aesthetic deficits.

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Reconstruction of the Forehead and Scalp

Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique challenges during reconstruction. A thorough understanding of the surgical anatomy of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary wound closure is usually preferred over secondary intention healing and skin grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly used for most small to medium defects; however, microsurgical free tissue transfer can be considered for large full-thickness skin defects of the forehead and scalp.

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Adjuvant and Neoadjuvant Treatment of Skin Cancer

Skin cancer represents a broad classification of malignancies, which can be further refined by histology, including basal cell carcinoma, squamous cell carcinoma and melanoma. As these three cancers are distinct entities, we review each one separately, with a focus on their epidemiology, etiology including relevant genomic data, and the current evidence-based recommendations for adjuvant and neoadjuvant therapy. We also discuss future directions and opportunities for continued therapeutic advances.

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Reconstruction of the Cheek

The goal of cheek reconstruction is to restore an illusion of "normal." Attention must be directed toward the contralateral cheek skin color, texture, thickness, and contour, because this serves a template for reconstruction. The cheek is a peripheral facial subunit and largely frames the more central subunits (eyelids, nose, lips). As such, avoiding distortion or disfigurement of the central subunits is of paramount importance. The cheek possesses significant tissue laxity, elasticity, and mobility, thus allowing for the vast majority of cheek defects to be addressed with primary closure, local flaps, or locoregional flaps.

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Health Outcome Studies in Skin Cancer Surgery

As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.

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Radiotherapy for Skin Cancers of the Face, Head, and Neck

Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed.

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Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction

Three-dimensional (3D) printing has transformed craniofacial reconstruction over the last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies are available to assist with craniofacial bony reconstruction and preliminary soft tissue reconstructive efforts. With improved accessibility and simplified design software, 3D printing has opened the door for new techniques in anaplastology. Tissue engineering has more recently emerged as a promising concept for complex auricular and nasal reconstruction. Combined with 3D printing, several groups have demonstrated promising preclinical results with cartilage growth. This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction.

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Management of Early-Stage Melanoma

Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treatment guidelines for early-stage melanoma are reviewed and discussed.

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Periocular Reconstruction

Options for periorbital reconstruction include primary wound closure, local flaps, regional/distant flaps, or full-thickness skin grafts. Optimal aesthetic and functional outcomes are achieved by assessing regional contours, skin type, and facial aesthetic units. Like tissue should replace like tissue; for example, skin with skin, tarsus with tarsus (or equivalent material, eg, hard palate, ear cartilage, or autologous substitute), and conjunctiva with mucous membrane or like substitute (buccal mucous membrane, amniotic membrane). Patient characteristics including wound care needs, transportation needs, smoking status, and history of radiation can influence the reconstruction plan. Techniques most commonly used in our practice are reviewed.

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Nonmelanoma Skin Cancer

This article reviews the most common nonmelanoma skin cancers affecting the head and neck region. Although the most common of these malignancies rarely result in mortality, local morbidity caused by the tumors and their extirpation cannot be underestimated. Complete tumor extirpation with pathologically confirmed negative margins is the gold standard. Regional and distant metastases are rare, but must be treated appropriately should they occur. Although reconstructive surgery can be life changing for the patients and rewarding for the clinicians, it behooves the treating surgeons to remain true to oncologic principles above all else.

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Editorial Board

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Neuromodulatory treatment of recalcitrant plaque psoriasis with onabotulinumtoxinA

To the Editor: The role of neurocutaneous pathways in the pathogenesis of psoriasis has been suggested in cases of dermatomal improvement in psoriatic plaques following central or peripheral nerve damage1-3; however, few studies have assessed the effect of nerve-targeting treatments,4,5 especially in plaque psoriasis. This study investigated the effect of onabotulinumtoxinA injections on psoriasis severity, epidermal nerve fiber (ENF) density, and expression of the neuropeptides substance P (SP) and calcitonin gene–related peptide (CGRP).

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Author index∗∗July, pp. 1-182; August, pp. 183-406; September, pp. 407-598; October, pp. 599-788; November, pp. 789-986; December, pp. 987-1226.

Aaserud S (see Veierød et al). 2018;79:118-25 (Original article)

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JAAD Case Reports Article List

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Reply to: “Comment on ‘Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study’”

To the Editor: We thank Dr Kridin for his interest in our recent publications.1,2 The limitation that we may have not been able detect the association between newer diabetes drugs and bullous pemphigoid (BP) was already acknowledged in our previous article.1 The unpublished finding of Dr Kridin's group that the use of linagliptin is associated with BP is not surprising and further confirms the significance of the use of dipeptidyl peptidase 4 inhibitors (DPP4is) (or gliptins) as a risk factor for BP.

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Comment on “Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study”

To the Editor: We read with great interest the study performed by Varpuluoma et al.1 The authors conducted a nationwide case-control study aiming to estimate the prevalence of administration of oral antidiabetics among patients with bullous pemphigoid (BP) versus among matched control subjects. No association was found between exposure to any oral diabetes medications other than dipeptidyl peptidase-4 inhibitors (DPP4is) and the development of BP.1 DPP4is, particularly vildagliptin, have emerged as a risk factor for the development of BP.

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December Iotaderma #298

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Table of Contents

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Anti-aging effects of ingenol mebutate for patients with actinic keratosis

To the Editor: Ingenol mebutate (IM) gel has been approved by the Food and Drug Administration as a topical field-directed therapy for actinic keratosis (AK) and has been shown to cure subclinical and clinically apparent AKs.1 Recently, there have been reports of improvements in skin elasticity, wrinkles, and mottled pigmentation after the application of IM gel in patients with multiple AK lesions.2,3 In this study, we aimed to investigate histologic and molecular alterations after field cancerization by using topical IM gel in patients with multiple AK lesions and elucidate the mechanism underlying the skin-rejuvenating effect of IM gel.

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Information for Readers

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November iotaderma (#297)

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Journal Based CME Instructions and Information

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Answers to CME examination

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JAAD Virtual Journal Club

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CME examination

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Subject index

Abortion

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Answers to CME examination

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Cover Sheet for Index

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CME examination

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Dermatology Calendar

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Suture‐ligature technique for the closure of tracheocutaneous fistula in adults

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Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Objective

Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients.

Methods

Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality.

Results

Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet.

Conclusion

Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation.

Level of Evidence

4 Laryngoscope, 2018

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Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

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Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Objectives/Hypothesis

To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.

Study Design

Retrospective database review.

Methods

Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ#lary27405-bib-0002 test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.

Results

The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3‐1.6) and less common among white children (OR: 0.8, 95% CI: 0.8‐0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.

Conclusions

Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Level of Evidence

NA Laryngoscope, 2018

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Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

Objectives/Hypothesis

To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).

Study Design

Cadaver study.

Methods

Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.

Results

Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm² vs. 312.76 mm², P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm³ vs. 138.91 mm³, P < .005). MITA also offered greater angles of approach for all targets.

Conclusions

This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.

Level of Evidence

NA Laryngoscope, 2018

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Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Objectives

1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study Design

Multicenter randomized pilot trial.

Methods

Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of Evidence

1B. Laryngoscope, 2018

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Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

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Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Objectives/Hypothesis

To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years.

Study Design

Retrospective cohort study.

Methods

Nine‐year retrospective review of patients with SGS. Forty‐eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years.

Results

Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation‐related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI).

Conclusions

We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant.

Level of Evidence

4 Laryngoscope, 2018

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Interesting case of late Gore‐Tex extrusion following medialization laryngoplasty

A 65‐year‐old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore‐Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore‐Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 2018

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Aspiration in children with unilateral vocal fold paralysis

Objectives/Hypothesis

To describe the prevalence of aspiration in children with unilateral vocal fold paralysis who underwent objective assessment of swallow function.

Study Design

Retrospective chart review.

Methods

A study of patients presenting to our institution with unilateral vocal fold paralysis in 2015 was conducted. All patients were diagnosed using flexible laryngoscopy. Patients were included if they underwent at least one modified barium swallow (MBS) study for evaluation of their swallowing function due to recurrent respiratory issues and/or feeding difficulty.

Results

Twenty‐eight patients diagnosed with unilateral vocal fold paralysis underwent an MBS study at our institution in 2015. Median age at the time of MBS study was 1.7 years (interquartile range: 0.4–4.3). Twenty‐six patients (92.9%) had dysphagia. Sixteen patients were found to aspirate on MBS study. All patients who aspirated did so without overt signs (silent aspiration). Eighteen patients had congenital heart disease (64.3%) and nine had a history of prematurity (32.1%). Eight patients (28.6%) presented with developmental delays.

Conclusions

Patients who present with unilateral vocal fold paralysis and recurrent respiratory and/or feeding issues may be affected by prominent issues such as swallowing dysfunction and silent aspiration. Clinicians should be aware of this risk and evaluate patients for any signs of feeding or swallowing difficulties.

Level of Evidence

4 Laryngoscope, 2018

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The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

Objective

Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.

Methods

Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.

Results

The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.

Conclusion

The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.

Level of Evidence

3b. Laryngoscope, 2018

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Is a schirmer's test necessary before blepharoplasty?

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Does anatomic subsite influence oral cavity cancer mortality? A SEER database analysis

Objective

To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites.

Methods

Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5‐year cause‐specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5‐year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05.

Results

20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM.

Conclusion

Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite‐specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite‐directed research as a means to improve outcomes.

Level of Evidence

NA. Laryngoscope, 2018

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Topical Application of 5‐Aminolevulinic Acid Is Sufficient for Photodynamic Therapy on Vocal Folds

Objectives

To evaluate the feasibility of topical photodynamic therapy (PDT) using 5‐aminolevulinic acid (5‐ALA) for vocal fold leukoplakia.

Study Design

Ex vivo and in vivo.

Methods

5‐ALA was applied topically as a 20% solution to ex vivo canine vocal folds. The penetration depth and concentrations of 5‐ALA in tissue were quantified using frozen sectioning and fluorescamine derivatization after 5‐ALA contact incubation or topical spraying. Then, 5‐ALA solution was sprayed on leporine vocal folds once, twice, or given systemically in vivo. Protoporphyrin IX (PPIX) location was visualized using fluorescence microscopy, and PPIX concentrations were measured using a fluorescent quantitative method. Hematoxylin and eosin (H&E) staining was performed to visualize the histological changes of vocal folds after PDT for each group.

Results

Topical incubation of 15 minutes with 5‐ALA achieved a penetration depth of over 2 mm and similar concentrations within the superficial 500 μm of epithelium, compared with longer incubation times. Topical spraying of 5‐ALA produced sufficient concentrations in vocal folds, but the retention time is short. An in vivo leporine model showed that laryngeal spraying of 20% 5‐ALA induced similar penetration depth and concentrations of PPIX compared to systemic administration of 5‐ALA. Two sprays of 20% 5‐ALA solution with an interval of 30 minutes are needed to produce complete exfoliation of vocal fold epithelium.

Conclusion

Topical PDT with laryngeal spraying of 20% 5‐ALA solution achieves sufficient therapeutic effects and is potentially applicable for the treatment of vocal fold leukoplakia.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2DbhpkC

Evaluation of early oral cavity cancer treatment quality at a single institution

Objective

To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital.

Methods

This retrospective study identified patients treated for early‐stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992–2007) or after (current treatment group, 2008–2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups.

Results

Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time.

Conclusion

Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early‐stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified.

Level of Evidence

2c. Laryngoscope, 2018

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Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Objectives/Hypothesis

The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum.

Study Design

Retrospective cohort study in a tertiary referral center.

Methods

Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI).

Results

Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P = .066).

Conclusions

Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2Dev5eL

Measurement reliability of phonation threshold pressure in pediatric subjects

Objectives/Hypothesis

Phonation threshold pressure (PTP), the minimum subglottal pressure (P_s) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.

Study Design

Pilot study evaluating PTP and P_s measurement reliability in children using labial and mechanical interruption.

Methods

Twenty‐two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between P_s and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and P_s and intrasubject coefficients of variation were compared. Correlations with age were evaluated.

Results

Mean PTP (P < .001) and P_s (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and P_s (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical‐mask trials only (r = −0.628, P = .00175).

Conclusions

Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.

Level of Evidence

3b Laryngoscope, 2018

https://ift.tt/2POgpth

Real steak knives of cincinnati: Repeated foreign body ingestion with novel endoscopic removal

Repeated ingestion of foreign objects presents a multidisciplinary endoscopic dilemma. We report a 32‐year‐old female patient with history of multiple previous foreign body ingestions requiring several past exploratory laparotomies, who presents with a knife blade in the esophagus. We present a novel method of using a rigid cervical esophagoscope with a salivary bypass tube. The tip of the knife was isolated into the cervical esophagoscope, and the salivary bypass tube advanced off the cervical esophagoscope over the knife, shielding the serrated edge during removal preventing laceration to the esophagus.

https://ift.tt/2DdqQ32

I dream of Gini: Quantifying inequality in otolaryngology residency interviews

Objectives

Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended.

Study Design

Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data.

Methods

The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size.

Results

26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23.

Conclusion

There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PRIUq3

What defines asymmetric sensorineural hearing loss?

https://ift.tt/2D98tw9

Primavera: A new therapeutical approach to vulvo‐vaginal atrophy

Abstract

Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self‐confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non‐invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo‐vaginal biostimulation and considered simple, safe, and satisfactory.

https://ift.tt/2RLVWTc

Cost‐of‐illness of Melanoma in Europe – a systematic review of the published literature

Abstract

Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost‐effective or even cost saving. Cost‐of‐illness studies provide information on such potential savings.

The purpose of this study is to give an overview on cost‐of‐illness studies in European countries and to compare the cost‐of‐illness in total and by cost categories. The results can be used to model potential cost savings from prevention.

We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their cost‐of‐illness, all costs were adjusted for the purchasing power parity.

Studies focusing on stage III–IV melanoma all include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2,972 in Italy and € 17,408 in Sweden after adjusting for PPP.

Most studies on stage I–IV melanoma include costs of hospitalisation, outpatient treatment and GP consultation. Direct costs range from € 923 in Sweden to € 9,829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3,511 in Sweden and € 20,408 in England, morbidity costs between € 103 in Sweden and € 4,550 in England.

We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost‐effective or even cost saving.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PjQDh3

Decreasing sunbed use in the German population between 2001–2015: survey in 155,679 working persons

Abstract

Background

UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk.

Objective

To evaluate the proportion of regular sunbed use in Germany based on large‐scale population‐based surveys over 15 years.

Methods

Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behavior related to sunburns and sunbeds.

Results

Among 155,679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (p < 0.001). There were significantly higher rates of sunbed use in women (12.5% / 2.0%) versus men (7.3% / 1.3%; p < 0.001), in younger persons and in participants with darker skin (type II and III) versus fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; p = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001–2008 and 2.2% in 2009–2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening program.

Conclusion

Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening program may have contributed to this.

This article is protected by copyright. All rights reserved.

https://ift.tt/2QwQhAo

A novel role of angiotensin II in epidermal cell lineage determination: Angiotensin II promotes the differentiation of mesenchymal stem cells into keratinocytes through the p38 MAPK, JNK and JAK2 signalling pathways

Summary

Background

Recent evidence suggests that angiotensin II (Ang II) plays a role in cutaneous wound healing. Mesenchymal stem cells (MSCs) are known as a rich source of cells that re‐establish healed skin. However, the potential impact of Ang II on MSC differentiation into keratinocytes is still unknown.

Objective

The present study was conducted to explore the effect of Ang II on differentiation of bone marrow‐derived MSCs (BM‐MSCs) into keratinocytes.

Methods

BM‐MSCs were isolated from rat bone marrow and cultured. The expression of Ang II type 1 (AT₁) and type 2 (AT₂) receptors was examined by immunofluorescence staining. The differentiation of BM‐MSCs into keratinocytes was investigated by flow cytometry or/and histological observation.

Results

The BM‐MSCs constitutively expressed both AT₁ and AT₂ receptors. The differentiation of BM‐MSCs into keratinocytes was successfully induced. Interestingly, incubation of BM‐MSCs with Ang II further promoted the differentiation of BM‐MSCs into keratinocyte, which was abolished by pre‐treatment with losartan, an AT₁ receptor antagonist, but not by PD123319, an AT₂ receptor antagonist. Moreover, the p38 mitogen‐activated protein kinase (MAPK) inhibitor SB203580, the c‐Jun N‐terminal kinase (JNK) inhibitor SP600125 and the Janus‐activated kinase (JAK)2 inhibitor AG490 suppressed Ang II‐induced differentiation of BM‐MSCs into keratinocytes. The phosphoinositide‐3 kinase (PI3K) inhibitor wortmannin and MEK1/2 inhibitor U0126 had no effect on BM‐MSC differentiation into keratinocytes.

Conclusions

Our data demonstrated for the first time that Ang II plays a promotive role in the differentiation of BM‐MSC into keratinocytes through the AT₁ receptor, and that the p38 MAPK, JNK and JAK2 signalling pathways are involved in this process.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Qs1LVI

Mannosylerythritol lipids inhibit melanogenesis via suppressing ERK‐CREB‐MiTF‐tyrosinase signaling in normal human melanocytes and a three‐dimensional human skin equivalent

Abstract

Hyperpigmentation is caused by excessive production of melanin in melanocytes. Mannosylerythritol lipids (MELs) are glycolipid biosurfactants that are abundantly produced by yeasts and used commercially in cosmetics. However, the potential depigmenting efficacy of MELs has not been evaluated. In this study, the depigmentary effect of MELs was tested in primary normal human melanocytes (NHMs), α‐melanocyte‐stimulating hormone (MSH)‐stimulated B16 cells (murine melanoma cells) and a human skin equivalent (MelanoDerm) using photography, Fontana‐Masson (F&M) staining, and two‐photon microscopy. MELs significantly decreased the melanin contents in NHMs and α‐MSH‐stimulated B16 cells. Consistent with these findings, MELs treatment had a clear whitening effect in a human skin equivalent, brightening the tissue color and reducing the melanin content. The molecular mechanism underlying the anti‐melanogenic effect of MELs treatment was examined by real‐time PCR and Western blotting. Mechanistically, MELs clearly suppressed the gene expression levels of representative melanogenic enzymes, including tyrosinase, Tyrp‐1, and Tyrp‐2, by inhibiting the ERK/CREB/MiTF signaling pathway in NHMs. This work demonstrates for the first time that MELs exert whitening effects on human melanocytes and skin equivalent. Thus, we suggest that MELs could be developed as a potent anti‐melanogenic agent for effective whitening, beyond their use as a biosurfactant in cosmetics.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PkiLk5

Three strategies for displaying the postcricoid space and pyriform sinus: a matched case‐controlled study of 50 patients

Abstract

The postcricoid space and pyriform sinus are difficult to completely display under routine laryngoscopy examination.

We present the results obtained from 50 patients who were randomly recruited to receive a laryngoscopy examination via a routine, Valsalva manoeuvre combined with anterior cervical skin traction (V‐ACST), followed by a Valsalva manoeuvre combined with the modified Killian method (V‐MK).

The routine method is not suitable for displaying the postcricoid space.

In general, both the V‐ACST and V‐MK displayed the postcricoid space and pyriform sinus very well.

The V‐ACST displayed significantly more of the postcricoid space, whilst the V‐MK was clear better at exposing the pyriform sinus.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FfekTe

Design of Skin Islands for a Myocutaneous Serratus Anterior Free Flap ‐ An Anatomical Study and Clinical Implication for Pharyngeal Reconstruction after Laryngopharyngectomy

Abstract

Objectives

The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy.

Methods

Dissection and injection of methylene blue was performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these preclinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in 5 patients after laryngopharyngectomy.

Results

Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm². Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm, respectively. Flap size did not significantly differ between males and females (p=0.998), left compared to right hemithoraces (p=0.468) and between paired specimens (p=0.915). All skin islands were found within the upper 29.3% to 51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in 5 patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7.

Conclusion

Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qBGIoe

The influences of age, gender and geometric pattern of visual image on the verticality perception: a subjective visual vertical (SVV) study among Malaysian adults

Abstract

Objectives

Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults.

Study Design

This study employed a repeated measures design.

Settings

Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia.

Participants

Eligible Malaysian adults (N=187, aged 21‐75 years) were recruited and categorized into young (N=60), middle‐aged (N=66) and older (N=61) groups. Most of them were Malay and 51.3% were men.

Main outcome measures

SVV angles (in degrees) were determined from each participant in a static upright condition using a computerized SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern).

Results

Three‐way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P>.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P=.004).

Conclusion

While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (i.e. arrow pattern). Further SVV research on vestibular‐disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FeLjXT

The use of video‐laryngoscopy in head and neck surgery

Abstract

Direct visualisation of the upper aerodigestive tract is a fundamental skill for ENT surgeons. Rigid endoscopes themselves have seen little transformation since they were first developed for gastroscopy by Kussmaul in 1868¹. In an era of ultra high definition and 3D technology, a straight, rigid metal tube with adjoining light source carrier to inspect mucosal surfaces up to 40cm from the surgeon's eye could benefit from updating. In our department, we favour the use of the video‐laryngoscope, specifically the C‐MAC system from Karl Storz.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qCOvCx

Surgical management of onychopapilloma, onychomatricoma, and subungual osteochondroma: Case series

Swagata A Tambe, Saba M M Ansari, Chitra S Nayak, Ramya Chokkar, Priyanka D Patil

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):143-147

The clinical diagnosis of benign and malignant nail tumors can be difficult. Dermoscopy can provide a clue to the diagnosis but nail biopsy is the gold standard in establishing the diagnosis. Here, we report three cases of rare nail tumors, that is, onychopapilloma, onychomatricoma, and subungual osteochondroma, which were diagnosed on histopathology and managed surgically.

https://ift.tt/2PRERtG

Fourth dimension in reconstruction of defects following excision of basal cell carcinoma of head and neck!

Kandasamy Mahadevan, Sridhar Sruthi, Shanmugam Sridevi, Rajamanoharan Vivek

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):110-119

Background: Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction. Aim: To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction. Materials and Methods: This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III. Results: A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction. Conclusion: Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery.

https://ift.tt/2DdMtA1

Harmonic devices: The workhorse for surgical resection of vascular malformations

Chirayu Parwal, Lalit Choudhary, Anurag Pandey, Vivek Kumar, Puran Singh, Jessy Ragi

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):157-160

Management of vascular malformations is multimodal with documented role of surgical resection in specific facets of this condition. Surgical resection of these lesions is technically challenging owing to diffuse and relatively ill-defined extent with involvement of multiple tissue planes limitation of access and excessive intra-operative bleeding. An observational study was conducted in 24 cases taken up for surgical resection of vascular malformations. The cases were divided into two groups based on the hemostasis technique used: Group A: Harmonic shears (n = 12) (Ethicon Inc. Somerville, New Jersey, United States). Group B: Electrosurgery (monopolar/bipolar) with standard knot tying (n = 12). We conclude that use of harmonic scalpel in surgical resection causes less parallel tissue damage, secures haemostasis promptly, does not impede vision and aids surgical dissection thereby significantly reducing the operative time and improving the surgical outcome, typically in large vascular malformations of head and neck region.

https://ift.tt/2PMLQ7o

Gentle is better: The original “gentle technique” for fat placement in breast lipofilling

Pietro Gentile, Barbara De Angelis, Verdiana Di Pietro, Vittoria Amorosi, Maria G Scioli, Augusto Orlandi, Valerio Cervelli

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):120-126

Context: Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival. Aims: Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes. Settings and Design: This was a retrospective cohort study. Materials and Methods: Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by "Gentle technique." To establish the effects of the injection's procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure. Statistical Analysis Used: Values are expressed as mean plus standard error and analyzed using Student's t test. Results: In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year (P < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman. Conclusions: Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.

https://ift.tt/2DdRdG8

Maintenance of the anatomic contours in auricular reconstruction: The button technique

Brandon Worley, Joel L Cohen

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):150-152

Background and Objective: Reconstructing the contours of the auricle is a unique challenge. Various bolster techniques have been tried to help prevent complications such as hematoma, seroma, and morbidity. Here, we describe a simple technique using a button to maintain the natural ear contour when it is at risk of a poor aesthetic outcome. Materials and Methods: A 77-year-old man underwent resection of a squamous cell carcinoma of the postauricular skin on the right ear, which involved the helical margin. A skin graft was chosen to close the defect. However, on initial inspection of the repair, buckling of the scaphoid fossa, collapse of the antihelical fold, and notching of the helix were observed. When these buckling changes persisted even after the anesthesia-related swelling resolved the following day, a button bolster was placed for 2.5 weeks to provide support for the cartilage. Results: Standardized digital imaging revealed maintenance of the original contours and sulci of the ear with an excellent cosmetic result. Conclusion: Recreation of the auricular contours is critical for an excellent cosmetic outcome. Using a button bolster is worth considering as it is of low cost, can easily fit into the natural ear contours, and can provide a rigid structure to ensure maintenance of the ear shape.

https://ift.tt/2PRvcn3

Comparative (quantitative and qualitative) analysis of three different reagents for preparation of platelet-rich plasma for hair rejuvenation

Sukhbir Singh

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):127-131

Objective: The aim of this study was to compare the quantity and quality of platelets in platelet-rich plasma (PRP) samples prepared using three different reagents, namely, ethylenediaminetetraacetic acid (EDTA), sodium citrate, and acid citrate dextrose-A (ACD-A) solution. Materials and Methods: A prospective study was carried out in which all the 50 patients who attended the outpatient department for hair rejuvenation were enrolled for the study. All the patients had a history of hair fall with diffuse thinning of hair, Norwood Grades 2 and 3. Patients with complete hair loss were not included in the study. No specific randomization was carried out. All the patients were explained about the procedure and the use of vials containing the aforementioned three reagents. Then, 40mL blood was taken from each patient. Both quantitative and qualitative analyses of platelets were carried out on PRP samples. Quantitative analysis was done by using an automatic cell counter and cross-checking manually. Qualitative analysis was carried out by preparing smears from each of the three samples from each vial. All the patients were followed up at 4 weekly intervals for a duration of 6 months and then at the end of 1 year. All the patients received six sessions of PRP. Results: All the data were subjected to statistical analysis using Student's t-test, and P value of <0.001 was obtained in samples from ACD-A vials, which was statistically significant. In all the 50 patients, the samples collected in vials containing ACD-A yielded the maximum quantitative count and the best morphology of platelets under smear examination. Conclusion: Within the limits of this study, we would like to conclude that ACD-A vials should be used for collecting and processing blood for PRP preparation to obtain best results in hair rejuvenation.

https://ift.tt/2DemiZZ

Objective quantification of liposuction results

Alain J Azzi, Ann-Sophie Lafrenière, Alex Viezel-Mathieu, Thomas M Hemmerling, Mirko Gilardino

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):105-109

Currently, no reliable gold standard exists for the objective outcome measurement following liposuction. The purpose of this systematic review was to summarize reported methods of monitoring liposuction results by objectively measuring subcutaneous adipose tissue. A systematic literature search was performed to identify relevant articles that described techniques for objectively quantifying adipose tissue following traditional liposuction. The search included published articles in three electronic databases—Ovid MEDLINE, Embase, and PubMed. Subcutaneous adipose tissue was estimated using the following techniques: ultrasound, dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and three-dimensional imaging volumetric analysis. Reported benefits of liposuction objective measurements included providing patients with a quantitative assessment of the liposuction results pre- and postoperatively, detecting significant changes in body fat deposits, and following patterns of fat redistribution. This review provides a summary of various techniques for quantification of liposuction results. More studies are needed to study the clinical relevancy and impact of the various imaging modalities reviewed as well as to develop automated volumetric measurement technology with improved accuracy, efficacy, and reproducibility.

https://ift.tt/2PMbadK

Mondor’s disease after aesthetic breast surgery: A case series and literature review

Alberto Goldman, Uwe Wollina

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):132-135

Background: Mondor's disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor's disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer. Materials and Methods: This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years. Results: We found three cases of Mondor's disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2–3 weeks. Conclusion: Mondor's disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

https://ift.tt/2DeDkYh

Innovative skin hook

Saurabh Gupta, Devi P Mohapatra, Ravi K Chittoria, Elankumar Subbarayan, Sireesha K Reddy, Vinayak Chavan, Abhinav Aggarwal, Likhitha C Reddy

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):148-149

Skin hook is an important instrument for skin surgeries. There are situations, such as operating in a health camp or operating at a peripheral health center with a limited number of instruments, where skin hook is not available in the operation theater. We present an innovative design of skin hook, which can be prepared by surgeons in the operation theater with the help of readily available materials. The innovative skin hook is a simple, safe, and effective solution for performing skin surgeries in a limited-resource setup.

https://ift.tt/2PMsMX0

Extensive Nicolau syndrome following intramuscular injection of paracetamol in a patient who is HIV positive

Tasleem Arif, Konchok Dorjay

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):136-139

Nicolau syndrome (NS) is a type of adverse skin reaction occurring after parenteral drug injection. In certain conditions, it can cause ischemic necrosis of the skin and the underlying adipose tissue. The actual cause of NS is not clear though inflammation, vasospasm, and thromboembolic occlusion of blood vessels have been proposed. In this case presentation, we report an interesting case of a 30-year-old man who turned out be human immunodeficiency virus (HIV) positive on investigations, developed extensive purpuric lesions of his skin on left buttock and then spread to the trunk and shoulders after receiving intramuscular injection of paracetamol. With a suggestive history and further supported by clinical examination, a diagnosis of NS following injection of paracetamol was made. Though NS is considered to be rare, at times it can be devastating. Being a common procedure in the life of a health-care professional, the awareness regarding this entity is very essential. Despite intense medical literature search in, we could not find a single report of NS after intramuscular injection of paracetamol in a patient who is HIV positive, thus obliging this communication.

https://ift.tt/2Dalm90

A pocket-friendly and sustainable iontophoresis apparatus for palmoplantar hyperhidrosis: Advancement over a previously described homemade design

Sourabh Jain, Vivek K Dey, Nihit Agrawal

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):153-156

Introduction and Objectives: Tap water iontophoresis is a promising therapy for palmoplantar hyperhidrosis. Non-affordability and nonavailability of the marketed device restrict its usage for many patients hailing from villages or small cities. Materials and Methods: In an article named "A simple user-made iontophoresis device for palmoplantar hyperhidrosis" published previously in this journal, a simple inexpensive homemade device that runs on 12 V direct current battery was described. We made a small modification by using a 220–12 V alternate current to direct current semiconductor diode–based transformer for the current supply. Results: The added innovation made the device lightweight, cheaper, and usable with domestic electric supply at home/clinic. Sustained supply of current at same voltage without dip and non-requirement to change/replace battery are added advantages. Cost of the whole assembly is ₹310. Working and clinical efficacy of our device were comparable to the commercially available apparatus as reported by 13 patients who received thrice a week of 15min sessions with our device. Mild electric pricking sensation was felt by all patients. Four of thirteen reported that pricking sensation was a bit more with our device as compared to the marketed device. No calibration for intensity is available in our device. Conclusion: This simple to assemble and inexpensive device makes iontophoresis applicable in many needy patients with similar efficacy and few limitations compared to expensive marketed devices.

https://ift.tt/2PMaULO

Surgical management of onychoheterotopia

Chander Grover, Geetali Kharghoria

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):140-142

Onychoheterotopia (ectopic nail) is a rare condition characterized by the development of nail tissue, distinct from the normal nail unit. It is usually acquired following traumatic inoculation of nail matrix; the congenital variety being less common. The exact pathogenesis of the disease is not clear. It affects the dorsal aspect of fingers and toes mostly. Herein, we report a case of a 35-year-old man with post-traumatic onychoheterotopia of left middle finger, who was treated with surgical avulsion of the ectopic nail along with chemical matricectomy of the well-formed ectopic matrix. The patient had a satisfactory cosmetic outcome with normal growth of the nail unit and no recurrence. The report serves to highlight clinical presentation of acquired onychoheterotopia along with its surgical management.

https://ift.tt/2DeaS8T

Chemical peeling for nail disorders: Need for a systematic approach

Sidharth Sonthalia, Ramanjit Singh

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):161-163



https://ift.tt/2PMaQf2

Identification of Pen m 4 as a potential cause of occupational asthma to Gammarus shrimp

We present the case of a 34-year-old male patient employed for 8 years in a company manufacturing and packaging animal feed. The patient developed occupational asthma to dry Gammarus powder. The diagnosis was ...

https://ift.tt/2PmgmWm

Flu Facts: Keeping Your Family Healthy

Flu season is here again. In this episode, our team talks all things flu, from the importance of getting a vaccine to what medications are most effective for children. Plus, we'll answer questions like, what are the most common symptoms of the flu, and when are they bad enough to see a doctor? Be prepared this flu season!

The post Flu Facts: Keeping Your Family Healthy appeared first on ChildrensMD.

https://ift.tt/2DwGtUc

Study of Anti-PD-1 Antibody SHR-1210 Plus Apatinib as Second-Line Treatment of Advanced Esophageal Squamous Cell

Condition:   Esophageal Cancer
Intervention:   Drug: Apatinib+SHR-1210
Sponsor:   The First Affiliated Hospital of Zhengzhou University
Not yet recruiting

https://ift.tt/2SXY77L

Alpha Radiation Emitters Device for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia (DaRT)

Conditions:   Skin Cancer;   Mucosal Neoplasm of Oral Cavity;   Soft Tissue Neoplasm
Intervention:   Device: Radiation: Diffusing Alpha Radiation Emitters Therapy (DaRT)
Sponsor:   Alpha Tau Medical LTD.
Not yet recruiting

https://ift.tt/2zEwLL8

Treatment of alopecia areata: An Australian expert consensus statement

Abstract

Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.

https://ift.tt/2qCKs92

Acrodermatitis continua of Hallopeau with dense infiltration of IgG4‐positive cells in the lesional dermis

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular subtype of psoriasis. The characteristic feature of ACH is chronic, painful and destructive disease affecting the hands and feet, especially the fingertips and toes. The pathogenic mechanisms of ACH have not been fully elucidated. We report a case of ACH whose skin lesions showed dense infiltration of IgG₄‐positive cells in the dermis.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qDxoQN

Multiple cutaneous reticulohistiocytomas after haematopoietic cell transplantation: contribution of donor and host‐derived cells

Abstract

Reticulohistiocytoma or reticulohistiocytosis of the skin is a histiocytic disorder which is histologically characterized by the presence of numerous reticulohistiocytes: large histiocytes with an abundant eosinophilic cytoplasm. The aetiology of reticulohistiocytosis and the origin of reticulohistiocytes are unknown. Multiple cutaneous reticulohistiocytomas (MCR) is a reticulohistiocytosis of the skin that is characterized by generalized eruptions and an absence of articular symptoms or internal malignancies. Around 20 MCR cases have been reported in the literature, but the association between reticulohistiocytosis and haematopoietic cell transplantation (HCT) has not been described.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FarH6X

Recruitment of CCR6+ Foxp3+ regulatory gastric infiltrating lymphocytes in Helicobacter pylori gastritis

Abstract

Helicobacter pylori (H. pylori) infection is associated with an inflammatory response in the gastric mucosa, leading to chronic gastritis, peptic ulcers, and gastric cancer. Increased T‐cell infiltration is found at sites of H. pylori infection. The CCR6⁺ subset of CD4⁺ regulatory T cells (Tregs), a newly characterized subset of Tregs, has been reported to contribute to local immune inhibition. However, whether CCR6⁺ Tregs are present in H. pylori gastritis, and what their relationship is to disease prognosis, remains to be elucidated. In this study, gastric infiltrating lymphocytes were isolated from endoscopic biopsy specimens of H. pylori gastritis patients and analyzed. We found that in gastric infiltrating lymphocytes, CCR6⁺ CD4⁺ CD25^high Tregs, which express high levels of CD45RO, are positively associated with more severe inflammation in gastric mucosa during H. pylori infection. Furthermore, the frequency of CCR6⁺ Tregs in gastric infiltrating lymphocytes, but not CCR6⁻ Tregs, is significantly increased in inflamed gastric tissues, which is inversely correlated with significantly lower expression of IFN‐γ⁺ CD8⁺ T cells. We also found that the frequency of CCR6⁺ Tregs is positively correlated with the frequency of CD4⁺ IFN‐γ⁺ T cells. In addition, the frequency of CCR6⁺ Tregs, but not that of CCR6⁻ Tregs, is significantly correlated with increased inflammation in H. pylori gastritis. This study demonstrates that immunosuppression in H. pylori gastritis might be related to the activity of CCR6⁺ Tregs, which could influence disease prognosis.

https://ift.tt/2PNftVX

Hydroxyurea‐induced dermatomyositis koebnerizing at the site of previous shingles

https://ift.tt/2QrgYWV

Dipolarization Fronts With Associated Energized Electrons in Saturn's Magnetotail

Smith, AW; Jackman, CM; Thomsen, MF; Sergis, N; Mitchell, DG; Roussos, E; (2018) Dipolarization Fronts With Associated Energized Electrons in Saturn's Magnetotail. Journal of Geophysical Research: Space Physics , 123 (4) pp. 2714-2735. 10.1002/2017JA024904 . Green open access

https://ift.tt/2z0Hpft

Stem cell therapy in severe pediatric motility disorders

McCann, CJ; Borrelli, O; Thapar, N; (2018) Stem cell therapy in severe pediatric motility disorders. Current Opinion in Pharmacology , 43 pp. 145-149. 10.1016/j.coph.2018.09.004 . (In press).

https://ift.tt/2OwpqCI

On the interaction of P-stranding and Sluicing in Bulgarian

Abels, K; (2017) On the interaction of P-stranding and Sluicing in Bulgarian. In: Mueller-Reichau, O and Guhl, M, (eds.) Aspects of Slavic Linguistics: Formal Grammar, Lexicon and Communication. De Gruyter: Berlin/Munich/Boston. Green open access

https://ift.tt/2z2zVZx

Differential expression of secreted factors SOSTDC1 and ADAMTS8 cause pro-fibrotic changes in linear morphoea fibroblasts.

Badshah, II; Brown, S; Weibel, L; Rose, A; Way, B; Sebire, N; Inman, G; ... O'Shaughnessy, R; + view all Badshah, II; Brown, S; Weibel, L; Rose, A; Way, B; Sebire, N; Inman, G; Harper, J; Kinsler, V; O'Shaughnessy, R; - view fewer (2018) Differential expression of secreted factors SOSTDC1 and ADAMTS8 cause pro-fibrotic changes in linear morphoea fibroblasts. British Journal of Dermatology 10.1111/bjd.17352 .

https://ift.tt/2OF0yJa

Health psychology interventions to improve adherence to maintenance therapies in asthma

Normansell, R; Chan, AHY; Katzer, CB; Kew, KM; Mes, MA; Newby, CJ; Chauhan, AJ; ... Wileman, V; + view all Normansell, R; Chan, AHY; Katzer, CB; Kew, KM; Mes, MA; Newby, CJ; Chauhan, AJ; Taylor, SJC; Pinnock, H; Sheikh, A; Wileman, V; - view fewer (2018) Health psychology interventions to improve adherence to maintenance therapies in asthma. Cochrane Database of Systematic Reviews , 2018 (10) , Article CD013147. 10.1002/14651858.CD013147 .

https://ift.tt/2z0iIzK

The Semiotic Landscape in Nuuk, Greenland

Valijarvi, R; Kahn, L; (2018) The Semiotic Landscape in Nuuk, Greenland. In: (Proceedings) FEL XXI Communities in Control: Learning tools and strategies for multilingual endangered language communities. (pp. pp. 1-9). Foundation for Endangered Languages

https://ift.tt/2OAy3fs

Pulmonary metastatic colonisation and granulomas in NOX2-deficient mice

van der Weyden, L; Speak, AO; Swiatkowska, A; Clare, S; Schejtman, A; Santilli, G; Arends, MJ; van der Weyden, L; Speak, AO; Swiatkowska, A; Clare, S; Schejtman, A; Santilli, G; Arends, MJ; Adams, DJ; - view fewer (2018) Pulmonary metastatic colonisation and granulomas in NOX2-deficient mice. Journal of Pathology , 246 (3) pp. 300-310. 10.1002/path.5140 . (In press). Green open access

https://ift.tt/2z1Dqzf

GM1 locates to mature amyloid structures implicating a prominent role for glycolipid-protein interactions in Alzheimer pathology

Michno, W; Wehrli, PM; Zetterberg, H; Blennow, K; Hanrieder, J; (2018) GM1 locates to mature amyloid structures implicating a prominent role for glycolipid-protein interactions in Alzheimer pathology. Biochimica et Biophysica Acta (BBA) - Proteins and Proteomics 10.1016/j.bbapap.2018.09.010 . (In press).

https://ift.tt/2OCmhkG

GENETIC VARIANTS IN PNPLA3 AND TM6SF2 PREDISPOSE TO HEPATOCELLULAR CARCINOMA IN PATIENTS WITH ALCOHOL-RELATED CIRRHOSIS

Stickel, F; Buch, S; Rosendahl, J; Nischalke, H-D; Lammert, F; Casper, M; Vogel, A; ... Morgan, MY; + view all Stickel, F; Buch, S; Rosendahl, J; Nischalke, H-D; Lammert, F; Casper, M; Vogel, A; Deltenre, P; Eyer, F; Gotthardt, D; Berg, T; Hampe, J; Morgan, MY; - view fewer (2018) GENETIC VARIANTS IN PNPLA3 AND TM6SF2 PREDISPOSE TO HEPATOCELLULAR CARCINOMA IN PATIENTS WITH ALCOHOL-RELATED CIRRHOSIS. Presented at: Meeting of the International-Digestive-Disease-Forum (IDDF), Hong Kong, HONG KONG.

https://ift.tt/2yZECTI

Blood-based biomarkers for Alzheimer disease: mapping the road to the clinic

Hampel, H; O'Bryant, SE; Molinuevo, JL; Zetterberg, H; Masters, CL; Lista, S; Kiddle, SJ; ... Blennow, K; + view all Hampel, H; O'Bryant, SE; Molinuevo, JL; Zetterberg, H; Masters, CL; Lista, S; Kiddle, SJ; Batrla, R; Blennow, K; - view fewer (2018) Blood-based biomarkers for Alzheimer disease: mapping the road to the clinic. [Review]. Nature Reviews Neurology , 14 pp. 639-652. 10.1038/s41582-018-0079-7 .

https://ift.tt/2OAxO42

Paying Attention to Attention

Cook, J; (2018) Paying Attention to Attention. Anthropology of This Century , 22

https://ift.tt/2yYak3W

Optimisation approaches for supply chain planning and scheduling under demand uncertainty

Aguirre, AM; Liu, S; Papageorgiou, LG; (2018) Optimisation approaches for supply chain planning and scheduling under demand uncertainty. Chemical Engineering Research and Design , 138 pp. 341-357. 10.1016/j.cherd.2018.08.021 . Green open access

https://ift.tt/2OAKVSG

Helping language learning in inclusive classrooms

Radford, JA; (2017) Helping language learning in inclusive classrooms. In: Bar-on, A and Ravit, D, (eds.) Handbook of Communication Disorders: Theoretical, Empirical and Applied Linguistics Perspectives. (pp. 387-402). De Gruyter: Berlin/Munich/Boston.

https://ift.tt/2z10FJP

Remote ischemic conditioning in ST-segment elevation myocardial infarction - an update

Chong, J; Bulluck, H; Yap, EP; Ho, AF; Boisvert, WA; Hausenloy, DJ; (2018) Remote ischemic conditioning in ST-segment elevation myocardial infarction - an update. Conditioning Medicine , 1 (5) pp. 13-22. Green open access

https://ift.tt/2OzlEZm

MiD49 and MiD51: New mediators of mitochondrial fission and novel targets for cardioprotection.

Samangouei, P; Crespo-Avilan, GE; Cabrera-Fuentes, H; Hernández-Reséndiz, S; Ismail, NI; Katwadi, KB; Boisvert, WA; Samangouei, P; Crespo-Avilan, GE; Cabrera-Fuentes, H; Hernández-Reséndiz, S; Ismail, NI; Katwadi, KB; Boisvert, WA; Hausenloy, DJ; - view fewer (2018) MiD49 and MiD51: New mediators of mitochondrial fission and novel targets for cardioprotection. Conditioning Medicine , 1 (5) pp. 239-246. Green open access

https://ift.tt/2yYktgP

The nascent empirical literature on psychopathology and terrorism

Corner, E; Gill, P; (2018) The nascent empirical literature on psychopathology and terrorism. World Psychiatry , 17 (2) pp. 147-148. 10.1002/wps.20547 .

https://ift.tt/2OAxzpE

Redox Active Dynamic Self-supporting Thixotropic 3D-printable G-quadruplex Hydrogel

Das, A; BIswas, A; Maiti, S; Kalaskar, DM; (2018) Redox Active Dynamic Self-supporting Thixotropic 3D-printable G-quadruplex Hydrogel. Chemistry - An Asian Journal 10.1002/asia.201801409 . (In press).

https://ift.tt/2yYkotx

HIV-1 Nef Impairs the Formation of Calcium Membrane Territories Controlling the Signaling Nanoarchitecture at the Immunological Synapse

Silva, JG; Martins, NP; Henriques, R; Soares, H; (2016) HIV-1 Nef Impairs the Formation of Calcium Membrane Territories Controlling the Signaling Nanoarchitecture at the Immunological Synapse. Journal of Immunology , 197 (10) pp. 4042-4052. 10.4049/jimmunol.1601132 .

https://ift.tt/2OAxrGG

Visual Pool: A tool to visualize and interact with the pooling method

Lipani, A; Lupu, M; Hanbury, A; (2017) Visual Pool: A tool to visualize and interact with the pooling method. In: SIGIR '17 Proceedings of the 40th International ACM SIGIR Conference on Research and Development in Information Retrieval. (pp. pp. 1321-1324). ACM: USA: New York. Green open access

https://ift.tt/2z2xaHI

Neurofilament light chain as disease biomarker in a rodent model of chemotherapy induced peripheral neuropathy

Meregalli, C; Fumagalli, G; Alberti, P; Canta, A; Carozzi, VA; Chiorazzi, A; Monza, L; ... Cavaletti, G; + view all Meregalli, C; Fumagalli, G; Alberti, P; Canta, A; Carozzi, VA; Chiorazzi, A; Monza, L; Pozzi, E; Sandelius, A; Blennow, K; Zetterberg, H; Marmiroli, P; Cavaletti, G; - view fewer (2018) Neurofilament light chain as disease biomarker in a rodent model of chemotherapy induced peripheral neuropathy. Experimental Neurology , 307 pp. 129-132. 10.1016/j.expneurol.2018.06.005 .

https://ift.tt/2OxQwJz

Association of adjuvant radioactive iodine therapy with survival in node-positive papillary thyroid cancer

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Yungang Sun, Jian Gong, Bin Guo, Jingjie Shang, Yong Cheng, Hao Xu

Abstract

Purpose

To assess the effect of adding radioactive iodine (RAI) therapy to total thyroidectomy (TT) on overall survival (OS) in patients presenting with papillary thyroid cancer (PTC) and cervical pathologically proven LN metastases (pN1).

Methods and materials

We identified a cohort of patients with PTC and nodal metastases treated with TT alone or TT plus RAI in the Surveillance, Epidemiology and End Results database between 2004 and 2013. Propensity score 1-to-1 matching was used to balance baseline characteristics. Cox proportional hazards regression models and Kaplan-Meier survival analysis were used to test the relationship between RAI and OS.

Results

In all, 15,953 patients were identified. After propensity score matching, 12,128 patients remained in each group. Based on multivariate Cox analysis, patients treated with TT + RAI had a statistically significant improvement in OS compared with those treated with TT alone [hazard ratio (HR) = 0.54, P < 0.001)], and significance persisted in the matched cohort (HR = 0.41, P < 0.001). In a subgroup analysis, the survival benefit was observed among patients ≥55 years but not among those <55 years (age < 55: HR = 1.06, P = 0.72; age ≥ 55: HR = 0.33, P < 0.001). Patients with stage T4 benefited most from RAI treatment (HR = 0.29, P < 0.001).

Conclusion

This propensity-matched analysis suggests that RAI therapy after TT was associated with improved OS in PTC patients with pN1 disease. Adjuvant RAI therapy needs to be considered in this patient group.

https://ift.tt/2T4ey2u

The genomic landscape of UM-SCC oral cavity squamous cell carcinoma cell lines

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Megan L. Ludwig, Aditi Kulkarni, Andrew C. Birkeland, Nicole L. Michmerhuizen, Susan K. Foltin, Jacqueline E. Mann, Rebecca C. Hoesli, Samantha N. Devenport, Brittany M. Jewell, Andrew G. Shuman, Matthew E. Spector, Thomas E. Carey, Hui Jiang, J. Chad Brenner

Abstract

Objectives

We sought to describe the genetic complexity of 14 UM-SCC oral cavity cancer cell lines that have remained uncharacterized despite being used as model systems for decades.

Materials and Methods

We performed exome sequencing on 14 oral cavity UM-SCC cell lines and denote the mutational profile of each line. We used a SNP array to profile the multiple copy number variations of each cell line and use immunoblotting to compare alterations to protein expression of commonly amplified genes (EGFR, PIK3CA, etc.). RNA sequencing was performed to characterize the expression of genes with copy number alterations.

Results

The cell lines displayed a highly complex network of genetic aberrations that was consistent with alterations identified in the HNSCC TCGA project including PIK3CA amplification, CDKN2A deletion, as well as TP53 and CASP8 mutations, enabling genetic stratification of each cell line in the panel. Copy number FISH and spectral karyotyping analysis demonstrate that cell lines retain chromosomal heterogeneity.

Conclusions

Collectively, we developed an important resource for future oral cavity HNSCC cell line studies and highlight the complexity of genomic aberrations in cell lines.

https://ift.tt/2zB7rW4

Prevalence of hepatitis C virus infection and its impact on the prognosis of head and neck cancer patients

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Juliana de Brito Rangel, Luiz Claudio Santos Thuler, Jorge Francisco da Cunha Pinto

Abstract

Objective

Several studies have shown a higher prevalence of hepatitis C virus (HCV) infection among patients with head and neck cancer (HNC) compared to the general population. In Brazil, the prevalence of HCV infection is considered low (1.38%). The aim of this study was to determine HCV prevalence and how this can modify outcomes of patients with HNC.

Study design

Retrospective cohort.

Methods

Patients with a diagnosis of malignant neoplasm in the head and neck (HN) region and who had serology performed for HCV were included. Patients were classified into two groups: head and neck squamous cell carcinoma (HNSCC) and other head and neck malignant neoplasms (OHNMN). Descriptive statistics were performed for all variables of interest. Means were compared using ANOVA and proportions using chi-square tests. Survival data were compared by Kaplan-Meier curves and log-rank test.

Results

Global HCV prevalence in patients with HNC was 7.8%, reaching 12.8% in HNSCC and 3.4% in OHNMN (p = 0.003). There was a higher risk of developing a second primary neoplasm in HNSCC compared to OHNMN patients (20.6% versus 4.6%; p = 0.001). The mean survival was not different between HCV-positive and HCV-negative patients (6.0 years versus 6.6 years, respectively, p = 0.516).

Conclusion

The prevalence of HCV infection was higher in HNC patients compared to the general Brazilian population. It seems reasonable to consider that HCV infection is associated with an increased risk of HNC, but HCV infection does not worsens the prognosis of HNC patients.

https://ift.tt/2SZ0EOX

Programme des Communications Orales

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s):

https://ift.tt/2PTXbTm

Présentations rares d’hémangiomes infantiles : 4 cas

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): V. Babic, A. Schoeffler, S. Moawad, L. Mainard, J.-L. Schmutz, A.-C. Bursztejn

Résumé

Introduction

L'hémangiome infantile (HI) est une tumeur vasculaire fréquente et bénigne de l'enfant. Dans la majorité des cas, son diagnostic est clinique. L'examen complémentaire de première intention est l'échographie-doppler quand il existe un doute diagnostique. Nous rapportons quatre cas d'hémangiomes infantiles dont la présentation atypique était responsable d'un retard diagnostique et pour lesquels l'imagerie n'a pas été contributive.

Observations

Un enfant avait des papules et des nodules violacés congénitaux sur le dos du pied, le second une ulcération inaugurale du siège et les deux derniers des télangiectasies isolées ou surmontant une tache érythémateuse. Dans deux cas, l'échographie ne mettait en évidence aucune lésion vasculaire et dans les deux autres cas, l'absence d'hyperhémie ne permettait pas de conclure au diagnostic d'HI. Chez un patient, le diagnostic a été établi par biopsie cutanée, et chez les trois autres, par l'évolution clinique.

Discussion

Nous rapportons quatre formes rares d'hémangiomes infantiles responsables d'une errance diagnostique initiale. Le caractère atypique de certains HI oriente le clinicien et le radiologue vers d'autres lésions, qui n'ont parfois aucun contingent vasculaire. Il est important pour le dermatologue de connaître ces formes rares d'HI afin de raccourcir le délai diagnostique et de permettre une prise en charge précoce et adaptée.

Summary

Background

Infantile hemangioma (IH) is a common benign vascular tumor in children. In most cases, diagnosis is based entirely on clinical examination. When the diagnosis is uncertain, the first-line complementary examination is Doppler ultrasound. We report 4 cases of atypical infantile hemangiomas with delayed diagnosis and non-contributory imaging.

Patients and methods

One child had congenital purple papules and nodules on the back of the foot, the second had inaugural ulceration of the buttocks, and the last two presented telangiectasia, either isolated or on an erythematous macula. In two cases, ultrasound showed no vascular lesions, and in the other two cases, the absence of hyperemia did not allow a diagnosis of IH to be made. For one patient, diagnosis was made on the basis of cutaneous biopsy, and for the other three, on the basis of clinical course.

Discussion

We report 4 rare forms of infantile hemangioma resulting in initial diagnostic error. The atypical nature of some IHs may direct the clinician and the radiologist toward other diagnoses that in some cases have no vascular contingent. It is important for the dermatologist to be aware of these rare forms of IH in order to reduce the time to diagnosis and allow early initiation of appropriate management.

https://ift.tt/2Dfqnxp

Maladie de Grover sous anti PD-1 pour mélanome métastatique

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Amini-Adle, B. Balme, S. Dalle

https://ift.tt/2PQPLjs

Granulomes pyogéniques récidivants

Publication date: Available online 8 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Roberge, M. Levavasseur, S. Darras, C. Capelle, C. Becquart, M. Vonarx, E. Martin de Lassalle, E. Delaporte, D. Staumont-Salle

https://ift.tt/2DfqbhF

Le syndrome de Huriez enfin déchiffré : haplo-insuffisance d’un gène impliqué dans la réparation de l’ADN par recombinaison homologue

Publication date: Available online 8 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure

https://ift.tt/2PQHhsw

Allergen‐specific IgE over time in women before, during and after pregnancy

https://ift.tt/2yZlfdK

Hypnotherapeutische Interventionen zur Behandlung von Schmerzen

Zusammenfassung

Hintergrund

Schmerzen sind ein häufiges Problem bei Tumorerkrankungen. Die ressourcenorientierte Nutzung subjektiver Trancephänome bietet sich zu deren Behandlung in besonderer Weise an.

Ziel der Arbeit

Ziel dieser Übersichtsarbeit ist die Darstellung der Vorgehensweise, der Evidenz für die klinische Wirksamkeit und des Interventionsspektrums der Hypnotherapie bei Schmerzen

Material und Methoden

Es wurde eine Literaturrecherche zu den einzelnen Anwendungsbereichen durchgeführt und klinisches Erfahrungswissen gesammelt.

Ergebnisse

Hypnose und Hypnotherapie erlauben die Behandlung und erfolgreiche Kontrolle eines breiten Spektrums von akuten und chronischen Schmerzen. Es gibt ein wirksames empirisch belegtes Interventionsspektrum, von dem die Mehrzahl aller Patienten zu profitieren vermag. Die Unterweisung in Selbsthypnose bildet eine wertvolle Basisfertigkeit zur Rückerlangung von Kontrolle und zur Steigerung der Selbstwirksamkeit und sollte frühzeitig im Behandlungsverlauf erfolgen. Die verschiedenen zur Verfügung stehenden Techniken sollten möglichst kombiniert zum Einsatz kommen und auf die individuellen subjektiven Ressourcenerfahrungen der Patienten zurückgreifen. Erkenntnisse der Neurowissenschaften über die zentralnervöse Schmerzverarbeitung legen die Verwendung verarbeitungsspezifischer Suggestionen nahe, die die jeweiligen Schmerzkomponenten systematisch ansprechen.

Schlussfolgerung

Hypnotherapeutische Interventionen zur Behandlung von Schmerzen bieten sich aufgrund ihrer raschen Wirksamkeit sowie des permissiven Vorgehens bei Tumorpatienten an. Besondere Stärken dieser Interventionen sind die ressourcenorientierte Nutzung der subjektiven Trancephänomene sowie die gleichzeitige Berücksichtigung verschiedener Komponenten des Schmerzkomplexes.

https://ift.tt/2RFycjE

Role of induction chemotherapy in sinonasal malignancies: a systematic review

Background

Cancers of the paranasal sinuses are rare tumors that tend to be aggressive and usually are diagnosed at an advanced stage. Despite being rare, these tumors include a wide spectrum of histological subtypes with different biological behaviors. Choosing the optimal treatment modalities and analyzing the different oncological outcomes is therefore challenging. This study aims to evaluate the role of induction chemotherapy prior to definitive local therapy for sinonasal malignancies.

Methods

A systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was conducted. With the assistance of a medical librarian, data sources including MEDLINE, PubMed, Cochrane library, EMBASE, NCBI Bookshelf, National Guideline Clearinghouse, and Clinicaltrials.gov were searched using a customized search strategy that yielded 1758 articles. Inclusion criteria used were as follows: (1) the study has a patient population with 3 or more patients with previously untreated sinonasal malignancies; (2) patients underwent induction chemotherapy prior to definitive local therapy; (3) pretreatment staging information was documented; (4) overall survival was reported by histology type either in table or Kaplan‐Meier format. Nine studies with 220 patients ultimately met inclusion criteria and were analyzed in groups based on tumor histology.

Results

For squamous cell carcinoma (SCC), the 5‐year overall survival was 51%. For neuroendocrine tumors, the 5‐year overall survival was 78%. Eighteen percent (18%) of patients with pretreatment orbital involvement ultimately underwent orbital exenteration.

Conclusion

Induction chemotherapy in the management of sinonasal malignancies has similar overall survival outcomes as other standard treatment modalities and can be offered as an option to patients as part of multimodality therapy.

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