Head and Neck Diseases by Alexandros G.Sfakianakis: 11/16/16

Τετάρτη 16 Νοεμβρίου 2016

Nanoparticle Improved Separations: from Capillary to Slab Gel Electrophoresis

Publication date: Available online 15 November 2016
Source:TrAC Trends in Analytical Chemistry
Author(s): Mohammad Zarei, Mohanna Zarei, Masoomeh Ghasemabadi
The potential application of nanoparticles (NPs) in various fields of separation science has been recognized and significant improvements have been achieved. The properties including electronic, magnetic, thermal, optical, mechanical, and catalytic can be tuned by the size, shape, and chemical structure of NPs. These unique properties and high surface-to-volume ratio have led to application in several analytical methods especially in capillary-based separation techniques. To understand the potentials of novel NPs in electrophoretic separations, we review here advances in materials development alongside a review of the directions in application of NPs in capillary-based systems and gel electrophoresis separations. This review describes recent advances in the use of NPs in electrophoretic separation techniques with emphasis on application in slab gel electrophoresis.

Graphical abstract

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Superelasticity and shape memory effect in Cu–Al–Mn–V shape memory alloys

Publication date: 5 February 2017
Source:Materials & Design, Volume 115
Author(s): Shuiyuan Yang, Fan Zhang, Jialin Wu, Yong Lu, Zhan Shi, Cuiping Wang, Xingjun Liu
In this study, Cu–Al–Mn–V alloys with bcc phase separation were designed through changing V and Mn contents, resulting in complex microstructure consisted of L21 parent, small amounts of δ(V, Mn) and 2H(γ^'1) martensite. The amounts of δ(V, Mn) phase and 2H(γ^'1) martensite increase with the increase of V content. The results further show that the stabilization of stress-induced 2H(γ^'1) martensite from L21 parent occurs among all Cu–Al–Mn–V alloys during deformation. Thus the same alloy not only exhibits superelasticity, but also shape memory effect after unloading when heated. The superelasticity and shape memory effect are summarized to three situations. Situation I includes Cu63.7Al25.3V1.9Mn9.1 and Cu63.7Al25.8V2.2Mn8.3 alloys (at.%), which have excellent superelasticity strains being up to 5.4% and 3.9% respectively. Cu63.8Al25.4V4.2Mn6.6 and Cu63.0Al26.2V4.7Mn6.1 alloys are situation II, and exhibit good shape memory effects being up to 3.5% and 3.9% respectively. The superelasticity and shape memory effect of Cu62.8Al26.2V2.6Mn8.4 alloy that is situation III are between the above two situations. The obtained results may open an avenue to design copper-based shape memory alloys simultaneously have superelasticity and shape memory effect under the same composition and deformation temperature through applying stress.

Graphical abstract

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Anaphylaxis induced by ingested molds

Publication date: Available online 15 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Ricardo Moreno-Borque, Teresa Collazo-Lorduy, Mariangélica Bermúdez-Martínez, Pilar Gajate-Fernández, Paula Sánchez-López, María Moreno-Geada, Nuria Plaza-Sánchez

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Prevalence of food allergies in South Asia

Publication date: Available online 15 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Schweta R. Arakali, Todd D. Green, Chitra Dinakar
ObjectiveTo evaluate the published medical literature on the prevalence and types of food allergies in South Asia.Data SourcesA PubMed search was performed using the keywords India and food allergy, Asia and food allergy, and South Asia and food allergy for any period. Articles cited in selected studies were reviewed for their appropriateness of inclusion into this review.Study SelectionPublications were included that were original research and fit the topic of food allergy and South Asia. South Asia is defined as region inclusive of India, Pakistan, Bangladesh, and Sri Lanka.ResultsA total of 169 articles were initially identified, and 47 were reviewed in detail for inclusion in this review. The primary focus was placed on 10 studies that consisted of case reports of newly reported or documented food allergy, survey studies that investigated food allergy prevalence in specific demographics, and prospective and cross-sectional studies with case controls, all of which investigated food allergy prevalence by allergy testing in a selected population.ConclusionThe medical literature on the prevalence and types of food allergy in South Asia indicates that there is a variety of unusual and unique allergens and an overall low incidence of food allergy. There is also an association of increased food allergy prevalence in individuals who live in metropolitan regions or who migrate to communities that have adopted westernization.

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Diurnal variations in subcutaneous allergen immunotherapy reactions

Publication date: Available online 15 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Aakash A. Bavishi, Leslie C. Grammer, Jacqueline Pongracic, Karen Rychlik, Rajesh Kumar, Phyllis Zee, Paul A. Greenberger, Anna B. Fishbein
BackgroundCircadian rhythms underlie many immune responses and allergic diseases. Subcutaneous immunotherapy (SCIT) can result in adverse reactions; however, it is unclear whether such reactions have a diurnal pattern.ObjectiveTo assess whether the timing of SCIT affects the rate of adverse reactions.MethodsThis study was a retrospective medical record review of adult patients (n = 289) who received SCIT at the Northwestern Medical Faculty Foundation, Chicago, Illinois, during a 10-year period (2004–2014). Injections were given in the outpatient setting. There were a total of 17,457 injections with 574 reactions. Covariates included age, sex, median income, asthma status, vial contents, number of injections, and previous immunotherapy reactions. Logistical regression was used to calculate the odds of having a reaction with time of SCIT administration as the primary determinate.ResultsImmunotherapy reactions occurred more frequently after afternoon or evening (pm) injections (328/8721 = 3.8%) vs morning (am) injections (246/8736 = 2.8%), (χ² = 12.26, P < .01). Systemic reactions, defined as World Allergy Organization grade 1 or higher, did not have diurnal variation (59/8721 = 0.67% for pm vs am 56/8736 = 0.64% for morning; χ² = 0.08; P = .77). pm injections resulted in higher odds of reaction compared with am injection in a fully adjusted logistic regression model (odds ratio = 1.43; 95% confidence interval, 1.20–1.70; P < .01). When considering time as 4 categories, the highest odds of reaction were noted for the period from 15:01 to 17:30 (odds ratio, 1.55; 95% confidence interval, 1.21–2.00; P < .01).Conclusionpm injections of SCIT are associated with increased cutaneous reaction rates when compared with am injections. In patients experiencing bothersome local reactions, it may be beneficial to administer SCIT in the morning.

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Successful desensitization to natalizumab using a 1-solution protocol

Publication date: Available online 15 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Eva Pérez-Rodríguez, Miguel Ángel Hernández-Pérez, Juan Antonio Martínez-Tadeo

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Skin testing and drug challenge outcomes in antibiotic-allergic patients with immediate-type hypersensitivity

Publication date: Available online 15 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stephanie L. Mawhirt, Luz S. Fonacier, Rose Calixte, Mark Davis-Lorton, Marcella R. Aquino
BackgroundThe evaluation of antibiotic immediate-type hypersensitivity is intricate because of nonstandardized skin testing and challenge method variability.ObjectiveTo determine the safety outcomes and risk factors for antibiotic challenge reactions in patients reporting a history of antibiotic immediate-type hypersensitivity.MethodsA 5-year retrospective review of patients evaluated for immediate-type antibiotic allergy was conducted. Data analyzed included patient demographics, index reaction details, and outcomes of skin testing and challenges, classified as single-step or multistep.ResultsAntibiotic hypersensitivity history was identified in 211 patients: 78% to penicillins, 10% to fluoroquinolones, 7.6% to cephalosporins, and 3.8% to carbapenems. In total, 179 patients completed the challenges (median age 67 years, range 50–76 years, 56% women), and compared with nonchallenged patients, they reported nonanaphylactic (P < .001) and remote index (P = .003) reactions. Sixteen patients (8.9%) experienced challenge reactions (5 of 28 for single-step challenge, 11 of 151 for multistep challenge), and 11 of these patients had negative skin testing results before the challenge. Challenge-reactive patients were significantly younger (P = .007), more often women (P = .036), and had additional reported antibiotic allergies (P = .005). No correlation was detected between the reported index and observed challenge reaction severities (κ = −0.05, 95% confidence interval −0.34 to 0.24). Anaphylactic rates were similar during single-step and multistep challenges (3.6% vs 3.3%).ConclusionIn the present population, younger women with multiple reported antibiotic allergies were at greatest risk for challenge reactions. Negative skin testing results did not exclude reactions, and index severity was not predictive of challenge outcome. The multistep and full-dose methods demonstrated a comparable reaction risk for anaphylaxis.

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EGFR and EML4-ALK Updated Therapies in Non-Small Cell Lung Cancer

Background: Non-small cell lung cancer is the leading cancer-related cause of death. Objective: We review the latest therapies for NSCLC with EGFR and ELM4-ALK mutations as well as the most relevant studies and promising patents. Method: A literature search of PubMed database was carried out to identify recent Clinical Trials using EGFR therapies and novel patents involving diagnosis and therapies on NSCLC. We conducted a search to find new therapy strategies, new biomarkers, and selected five patents we find relevant. Results: Over the last few years, identification of cancer harboring epidermal growth factor receptor mutations (EGFR) or chromosomal rearrangements of anaplastic lymphoma kinase (ALK) led to new ways in classifying and treating NSCLC. On the other hand, acquired resistance are a constantly challenge in the management of patients with these mutations and new drugs options are in development to improve and amplify treatment strategies. Conclusions: Currently, EGFR TKIs (e.g.: erlotinib, gefitinib, osimertinib) and ALK inhibitors (crizotinib, ceritinib, alectinib) provided a new face for advanced NSCLC outcomes. To understand the disease molecular profile is mandatory to define the best approach for each patient. 

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Interesting case of base of skull mass infiltrating cavernous sinuses

A man aged 35 years presented with chronic headache and earache of 1-year duration. He had progressive vision loss and diplopia since last 9 months. He also had pain over the face and episodic profuse epistaxis. On examination, perception of light was absent in the right eye and hand movements were detected at 4 m distance in the left eye. Imaging revealed a lobulated mass in the nasopharynx extending into the bilateral cavernous sinuses and sphenoid sinus with bony erosions. Biopsy of the nasopharyngeal mass revealed pathological features which are characteristic of IgG4 disease. His serum IgG4 levels and acute inflammatory markers were also elevated. The patient was started on oral corticosteroid therapy. Fever, headache and earache resolved early and there was gradual improvement in the vision of the left eye. After 6 months, visual acuity in the left eye was 6/9, but right eye visual acuity had no change. Follow-up imaging revealed a significant reduction in the size of the mass.

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Acquired haemophilia A: an unusual postoperative complication

An African-American man aged 65 years with multiple malignancies in remission was admitted for small bowel obstruction. He was treated with laparotomy following failure of conservative management. Postoperatively, he developed intra-abdominal bleed, which persisted, despite surgical haematoma evacuation. Further haematological workup revealed isolated prolongation of activated partial thromboplastin time (aPTT) with reduced factor VIII (FVIII) activity and raised FVIII inhibitor titre. Assuming acquired haemophilia A (AHA), FVIII inhibitor bypassing activity and corticosteroids were started with subsequent resolution of the bleeding from the surgical site. The patient remained free of bleeding episodes at 3-month follow-up and the aPTT normalised. This case report highlights the association of surgery with AHA and summarises the treatments with underlying mechanisms.

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Brain morphometry predicts individual creative potential and the ability to combine remote ideas

Publication date: Available online 15 November 2016
Source:Cortex
Author(s): David Bendetowicz, Marika Urbanski, Clarisse Aichelburg, Richard Levy, Emmanuelle Volle
For complex mental functions such as creative thinking, inter-individual variability is useful to better understand the underlying cognitive components and brain anatomy. Associative theories propose that creative individuals have flexible semantic associations, which allows remote elements to be formed into new combinations. However, the structural brain variability associated with the ability to combine remote associates has not been explored. To address this question, we performed a voxel-based morphometry study and explored the anatomical connectivity of significant regions. We developed a Remote Combination Association Task adapted from Mednick's test, in which subjects had to find a solution word related to three cue words presented to them. In our adaptation of the task, we used free association norms to quantify the associative distance between the cue words and solution words, and we varied this distance. The tendency to solve the task with insight and the ability to evaluate the appropriateness of a proposed solution were also analysed. Fifty-four healthy volunteers performed this task and underwent a structural MRI. Structure-function relationships were analysed using regression models between grey matter volume and task performance. Significant clusters were mapped onto an atlas of white matter tracts. The ability to solve the task, which depended on the associative distance of the solution word, was associated with structural variation in the left rostrolateral prefrontal and posterior parietal regions; the left rostral prefrontal region was connected to distant regions through long-range pathways. By using a creative combination task in which the semantic distance between words varied, we revealed a brain network centred on the left frontal pole that appears to support the ability to combine information in new ways by bridging the semantic distance between pieces of information.

http://ift.tt/2ggOOAG

Successful recovery and allogeneic stem cell transplant following chemotherapy-induced severe cardiomyopathy: literature review of management and prognostic factors

Chemotherapy-induced cardiomyopathy is one of the major possible hazards that can result from potential cardiotoxic agents while treating cancer. Prognostic risk factors include the rate of drug administration, history of hypertension, female gender, extremes of age, previous history of mediastinal irradiation, cumulative dose and pre-existing heart disease. Close monitoring of the patients, timely diagnosis, use of well-known biomarkers including cardiac troponins, NT-ProBNP and imaging studies like 2D Echo or cardiac MRI are essential. Emerging biomarkers include carbonyl reductases (CBR1 and CBR3), aldo-keto reductases (AKR, type 1A1, 1C3, 7A2) and topoisomerase2β (Top2β). β blockers and ACE inhibitors have not only been shown to slow down the progression of cardiac dysfunction but also produce symptomatic improvement. Our case report describes a patient with acute myeloblastic leukaemia who developed severe cardiomyopathy acutely after starting the anthracycline-based regimen. Nevertheless, with timely intervention her symptoms improved and subsequently she successfully received allogeneic stem cell transplantation.

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Short-term memory binding deficits in Alzheimer's disease: A Reply to Parra's commentary, 2016

Publication date: Available online 15 November 2016
Source:Cortex
Author(s): Yuying Liang, Yoni Pertzov, Jennifer M. Nicholas, Susie M.D. Henley, Sebastian Crutch, Felix Woodward, Masud Husain

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Disseminated Mycobacterium tuberculosis following renal transplant with alemtuzumab induction

Mycobacterium tuberculosis presents unique challenges in the peritransplant period. Here, we describe a case of disseminated tuberculosis following renal transplantation with alemtuzumab induction immunosuppression in a patient with remotely treated pulmonary tuberculosis and ongoing risk factors for re-infection. We also review the available literature regarding the prevalence of tuberculosis infection following solid organ transplant and management of high-risk patients, including the role for isoniazid preventative therapy.

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Self-generation and positivity effects following transcranial random noise stimulation in medial prefrontal cortex: a reality monitoring task in older adults

Publication date: Available online 15 November 2016
Source:Cortex
Author(s): Nicola Mammarella, Alberto Di Domenico, Rocco Palumbo, Beth Fairfield
Activation of medial Prefrontal Cortex (mPFC) has been typically found during reality monitoring tasks (i.e. distinguishing between internal self-generated vs. external information). No study, however, has yet investigated whether transcranial Random Noise Stimulation (tRNS) over the mPFC leads to a reduction in reality-monitoring misattributions in aging. In particular, stimulating mPFC should increase the number of cognitive operations engaged while encoding and this distinctive information may help older adults to discriminate between internal and external sources better. In addition, given that older adults are more sensitive to positively-charged information compared to younger adults and that mPFC is typically recruited during encoding of positive stimuli with reference to themselves, activation of mPFC should further sustain source retrieval in older adults. In this double-blind, sham-controlled study, we examined whether tRNS over the mPFC of healthy younger and older adults during encoding enhances subsequent reality monitoring for seen vs. imagined emotionally-charged words. Our findings show that tRNS enhances reality monitoring for positively-charged imagined words in the older adult group alone, highlighting the role that mPFC plays in their memory for positive information. In line with the control-based account of positivity effects, our results add evidence about the neurocognitive processes involved in reality monitoring when older adults face emotionally-charged events.

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Disseminated cryptococcosis in an immunocompetent child

Cryptococcus is a ubiquitous fungus and is known for causing meningitis and cutaneous infections in immunocompromised individuals. Disseminated cryptococcal infection is very rare and almost always found to occur in immunocompromised individuals especially in persons infected with HIV. This is particularly attributed to its capsulated spores. But there are few reported cases in which it has been found to cause disseminated infections even in immunocompetent individuals. We report a similar case of disseminated cryptococcal infection in an immunocompetent host. Early detection and treatment of disseminated cryptococcosis is essential to reduce morbidity and for better outcome.

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Evaluating how species niche modelling is affected by partial distributions with an empirical case

Publication date: Available online 16 November 2016
Source:Acta Oecologica
Author(s): Miguel A. Carretero, Neftalí Sillero
Ecological niche models (ENMs) will successfully identify a species' ecological niche, provided that important assumptions are fulfilled, namely environment equilibrium and niche equality across the distribution. Violations may seriously affect ENM reliability, leading to erroneous biogeographic conclusions and inappropriate conservation prioritisation. We evaluate the robustness of ENMs against incomplete knowledge of distribution with a real example, the threatened Iberian lizard Podarcis carbonelli, whose distribution was gradually discovered over a long time period. We used several ENM methods for presence-only data (Maxent, ENFA, Bioclim, and Domain) to infer the realised ecological niche at two spatial resolutions (1 km and 200 m). The distribution data were split into four partial datasets corresponding to separate subranges: Central System (CS); Viseu-Aveiro (VA); Atlantic coast (AC); and Doñana (DO). We then accumulated the datasets following the species discovery sequence: CS + VA, CS + VA + AC, and CS + VA + AC + DO. Niche equivalence and similarity between partial models were compared using Ecospat. ENMs were strongly affected by the violation of niche equilibrium; only the VA subrange forecasts the complete species range. ENMs were also sensitive to the violation of niche equality: only VA models were similar to the Iberian model, altitude being the most important variable followed by annual precipitation, maximum temperature in July, and annual radiation. When the ENMs were applied only to the first subrange discovered (CS), only the VA area was predicted, while the other subranges might have remained unknown, thus compromising conservation strategies. As assumptions of niche equilibrium and equality were violated, likely owing to the species' ecological multimodality, the models generated were biased and of limited predictive value. ENMs are useful tools in biogeography and conservation, but only if their basal assumptions are achieved. Partial models may be useful if they are considered as representing different suitable habitats.

Graphical abstract

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Cytochrome P450 enzymes but not NADPH oxidases are the source of the NADPH-dependent lucigenin chemiluminescence in membrane assays

Publication date: Available online 15 November 2016
Source:Free Radical Biology and Medicine
Author(s): Flávia Rezende, Kim-Kristin Prior, Oliver Löwe, Ilka Wittig, Valentina Strecker, Franziska Moll, Valeska Helfinger, Frank Schnütgen, Nina Kurrle, Frank Wempe, Maria Walter, Sven Zukunft, Bert Luck, Ingrid Fleming, Norbert Weissmann, Ralf P. Brandes, Katrin Schröder
Measuring NADPH oxidase (Nox)-derived reactive oxygen species (ROS) in living tissues and cells is a constant challenge. All probes available display limitations regarding sensitivity, specificity or demand highly specialized detection techniques. In search for a presumably easy, versatile, sensitive and specific technique, numerous studies have used NADPH-stimulated assays in membrane fractions which have been suggested to reflect Nox activity. However, we previously found an unaltered activity with these assays in triple Nox knockout mouse (Nox1-Nox2-Nox4^-/-) tissue and cells compared to wild type. Moreover, the high ROS production of intact cells overexpressing Nox enzymes could not be recapitulated in NADPH-stimulated membrane assays. Thus, the signal obtained in these assays has to derive from a source other than NADPH oxidases. Using a combination of native protein electrophoresis, NADPH-stimulated assays and mass spectrometry, mitochondrial proteins and cytochrome P450 were identified as possible source of the assay signal. Cells lacking functional mitochondrial complexes, however, displayed a normal activity in NADPH-stimulated membrane assays suggesting that mitochondrial oxidoreductases are unlikely sources of the signal. Microsomes overexpressing P450 reductase, cytochromes b5 and P450 generated a NADPH-dependent signal in assays utilizing lucigenin, L-012 and dihydroethidium (DHE). Knockout of the cytochrome P450 reductase by CRISPR/Cas9 technology (POR^-/-) in HEK293 cells overexpressing Nox4 or Nox5 did not interfere with ROS production in intact cells. However, POR^-/- abolished the signal in NADPH-stimulated assays using membrane fractions from the very same cells. Moreover, membranes of rat smooth muscle cells treated with angiotensin II showed an increased NADPH-dependent signal with lucigenin which was abolished by the knockout of POR but not by knockout of p22phox. In conclusion: the cytochrome P450 system accounts for the majority of the signal of Nox activity chemiluminescence based assays.

Graphical abstract

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Recoverable, Record-High Lactic Acidosis in a Patient with Glycogen Storage Disease Type 1: A Mixed Type A and Type B Lactate Disorder

A 17-year-old patient with GSD type 1a (von Gierke disease) was hospitalized with an extremely elevated serum lactate following an intercurrent infection and interruption of his frequent intake of carbohydrates. The patient developed shock, oliguric renal failure, and cardiorespiratory failure requiring mechanical ventilation and inotropes. At the peak of metabolic decompensation and clinical instability, serum lactate reached a level of 47.6 mmol/L which was accompanied by a severe anion gap metabolic acidosis with a pH of 6.8 and bicarbonate of 4 meq/L. The patient was stabilized with massive infusions of sodium bicarbonate (45 meq/h) and glucose and recovered without the need for dialysis. This patient illustrates pathophysiologic mechanisms involved in the development of extreme mixed type A and type B lactic acidemia, reflecting altered metabolic pathways in GSD type 1, combined with tissue hypoperfusion. The rationale for the specific interventions in this case is outlined.

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Systems biology for organotypic cell cultures.

Systems biology for organotypic cell cultures.

ALTEX. 2016 Nov 14;:

Authors: Grego S, Dougherty ER, Alexander FJ, Auerbach SS, Berridge BR, Bittner ML, Casey W, Cooley PC, Dash A, Ferguson SS, Fennell TR, Hawkins BT, Hickey AJ, Kleensang A, Liebman MN, Martin F, Maull EA, Paragas J, Qiao GG, Ramaiahgari S, Sumner SJ, Yoon M

Abstract
Translating in vitro biological data into actionable information related to human health holds the potential to improve disease treatment and risk assessment of chemical exposures. While genomics has identified regulatory pathways at the cellular level, translation to the organism level requires a multiscale approach accounting for intra-cellular regulation, inter-cellular interaction, and tissue/organ-level effects. Tissue-level effects can now be probed in vitro thanks to recently developed systems of three-dimensional (3D), multicellular, "organotypic" cell cultures, which mimic functional responses of living tissue. However, there remains a knowledge gap regarding interactions across different biological scales, complicating accurate prediction of health outcomes from molecular/genomic data and tissue responses. Systems biology aims at mathematical modeling of complex, non-linear biological systems. We propose to apply a systems biology approach to achieve a computational representation of tissue-level physiological responses by integrating empirical data derived from organotypic culture systems with computational models of intracellular pathways to better predict human responses. Successful implementation of this integrated approach will provide a powerful tool for faster, more accurate and cost-effective screening of potential toxicants and therapeutics. On September 11, 2015, an interdisciplinary group of scientists, engineers, and clinicians gathered for a workshop in Research Triangle Park, North Carolina, to discuss this ambitious goal. Participants represented laboratory-based and computational modeling approaches to pharmacology and toxicology, as well as the pharmaceutical industry, government, non-profits, and academia. Discussions focused on identifying critical system perturbations to model, the computational tools required, and the experimental approaches best suited to generating key data.

PMID: 27846345 [PubMed - as supplied by publisher]

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Chest Surgery in Female to Male Transgender Individuals.

Chest Surgery in Female to Male Transgender Individuals.

Ann Plast Surg. 2016 Nov 15;

Authors: Frederick MJ, Berhanu AE, Bartlett R

Abstract
BACKGROUND: Societal awareness of transgender individuals has led to increased acceptance and demand for sex-confirming surgery. In female to male transsexuals, the most common procedure is removal of breast tissue to masculinize the chest.
METHODS: Eighty-eight transgender patients underwent either a subcutaneous nipple-sparing mastectomy (NSM) with or without a periareolar mastopexy or nipple reduction, or bilateral mastectomies with free nipple grafts (MFNG) with or without nipple reduction. Surgical techniques are discussed. Demographic data, use of testosterone, specimen weights, rates of wound dehiscence, infection, hematoma, hypertrophic scars, nipple loss, and revision surgery were all assessed.
RESULTS: Of the 88 patients in the study, 40 underwent NSM and 48 underwent MFNG. Patients undergoing NSM were 4.1 times more likely to have a hematoma compared with patients undergoing MFNG (P <0.05). Mastectomy weight was not correlated with the occurrence of hematoma (P >0.80). Only 1 patient who underwent NSM required revision, whereas 5 patients in the MFNG patient population underwent revision. Patients were more likely to have hypertrophic scarring with the MFNG technique (0% vs 25%, P < 0.01) There were no infections, no wound dehiscence, and no nipple loss in any patient. Eighty-three percent of the patients who responded to a satisfaction survey (57/88) were very satisfied with their result, and 100% would recommend this procedure to other transgender individuals.
CONCLUSIONS: Female to male transgender mastectomy can be performed with low complication rates and high satisfaction. Nipple-sparing mastectomy were more likely to have a hematoma than patients undergoing MFNG.

PMID: 27845966 [PubMed - as supplied by publisher]

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The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction.

The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction.

Ann Plast Surg. 2016 Nov 15;

Authors: Weissler EH, Schnur JB, Lamelas AM, Cornejo M, Horesh E, Taub PJ

Abstract
INTRODUCTION: Satisfaction with breast reconstruction is thought to be greatest among patients who complete nipple and areolar complex (NAC) reconstruction. Anecdotally, many patients are known to decline NAC reconstruction. The authors aimed to characterize the epidemiology of and factors associated with incomplete breast reconstruction.
METHODS: Breast reconstruction patients with follow-up in a single institution's electronic medical record system were reviewed. Chi-squared and independent t-tests were used to identify variables associated with lack of NAC reconstruction; associated variables (P < 0.05) were used to build a binary logistic regression.
RESULTS: Four hundred thirty-three patients were reviewed. Reconstructions consisted of an average of 4.0 ± 2.0 procedures over 503 (range, 2-3,652) days. One hundred twelve patients had NAC reconstruction or tattooing (25.9%) and 73 (17.6%) had both-226 women (54.6%) had neither. On multivariate analysis, a history of any implant removal was associated with a 93.4% decreased chance of NAC reconstruction (P = 0.002), whereas prophylactic or early-stage mastectomy was associated with 52.9% increased chances of NAC reconstruction (P = 0.009).
CONCLUSIONS: Over half of the present cohort did not complete any NAC reconstruction. Patients with later-stage cancer and a history of implant removal were less likely to have NAC reconstruction. The high prevalence of incomplete reconstructions suggests that the classical definition of breast reconstruction completion as requiring NAC reconstruction may be outdated or not applicable to all populations. Instead, "completion" should be considered a subjective determination varying between patients.

PMID: 27845965 [PubMed - as supplied by publisher]

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Cadmium Telluride Quantum Dots as a Fluorescence Marker for Adipose Tissue Grafts.

Cadmium Telluride Quantum Dots as a Fluorescence Marker for Adipose Tissue Grafts.

Ann Plast Surg. 2016 Nov 15;

Authors: Deglmann CJ, Błażków-Schmalzbauer K, Moorkamp S, Susha AS, Herrler T, Giunta RE, Wagner E, Rogach AL, Baumeister RG, Ogris M

Abstract
Plastic and reconstructive surgeons increasingly apply adipose tissue grafting in a clinical setting, although the anticipation of graft survival is insecure. There are only few tools for tracking transplanted fat grafts in vivo.Murine adipose tissue clusters were incubated with negatively charged, mercaptoproprionic acid-coated cadmium telluride quantum dots (QDs) emitting in the dark red or near infrared. The intracellular localization of QDs was studied by confocal laser scanning microscopy.As a result, the adipose tissue clusters showed a proportional increase in fluorescence with increasing concentrations (1, 10, 16, 30, 50 nM) of cadmium telluride QDs. Laser scanning microscopy demonstrated a membrane bound localization of QDs. Vacuoles and cell nuclei of adipocytes were spared by QDs. We conclude that QDs were for the first time proven intracellular in adult adipocytes and demonstrate a strong fluorescence signal. Therefore, they may play an essential role for in vivo tracking of fat grafts.

PMID: 27845964 [PubMed - as supplied by publisher]

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Internal Distraction Osteogenesis With Piezosurgery Oblique Osteotomy of Supraorbital Margin of Frontal Bone for the Treatment of Unilateral Coronal Synostosis.

Internal Distraction Osteogenesis With Piezosurgery Oblique Osteotomy of Supraorbital Margin of Frontal Bone for the Treatment of Unilateral Coronal Synostosis.

Ann Plast Surg. 2016 Nov 15;

Authors: Shen W, Cui J, Chen J, Ji Y, Kong L

Abstract
PURPOSE: To assess the utility of internal distraction osteogenesis with Piezosurgery oblique osteotomy of supraorbital margin of frontal bone for the treatment of unilateral coronal synostosis and to study the outcome and complications of this procedure. Oblique osteotomy allows for entry into the cranial cavity, and along with parallel cut to the roof of the orbit, avoids the need to cut into the orbit which forms the frontal flap.
METHODS: Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (ages of patients were less than 1 year) or on the opposite side of the supraorbital rim (ages of patients were older than 1 year) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. Finally, the cranium pieces were divided in the middle and placed in the middle of the frontal bone using biological glue. Five days after the operation, a 0.6-mm distraction was done twice daily. The distraction was removed 6 months after reaching 2 to 3 cm.
RESULTS: Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in 9 patients suffering from unilateral coronal synostosis. Eight patients had no postoperative infections around the shaft puncture wounds. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment. During a mean follow-up period of 12 months (5-26 months), all patients were satisfied with the cosmetic and functional results. No complications, including fixed screw displacement, penetration of the cranium and dura mater or retraction of distraction devices, occurred. The devices were exposed in 1 patient, resulting in a postoperative scar. Despite these complications, the cranium was successfully expanded in all patients.
CONCLUSIONS: Use of this procedure avoids the need for frontal osteotomy to move the orbit forward. Adding 2 cranium strips can be used to reconstruct the frontal nodule to make up for inadequacy of the frontal nodules highlighting to distract operation. Retracting a separated cranium is not easy after it has been fixed for 6 months. Thus, the management of unilateral coronal synostosis using internal distraction osteogenesis with supraorbital oblique osteotomy is safe and effective.

PMID: 27845963 [PubMed - as supplied by publisher]

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Anatomical Study of Cutaneous Venous Flow of the Palm.

Anatomical Study of Cutaneous Venous Flow of the Palm.

Ann Plast Surg. 2016 Nov 15;

Authors: Kim BK, Kwon H, Imanishi N, Chang H

Abstract
BACKGROUNDS: Various flaps elevated from the palm have been widely used for finger and hand reconstruction. Recently, perforator-based free flaps or venous free flaps have received popularity due to several advantages. The cutaneous venous system has been chosen as the circulatory outlet when designing and harvesting the flap from the palmer area due to the small size and thin nature of the flap. However, there have been few descriptions about the anatomy of the palmar cutaneous veins. A more detailed knowledge will be valuable for elevating various flaps from the palmar area.
METHODS: Whole-body and hand venography with a contrast medium was performed on 9 fresh cadavers. Dissection and investigation of the skin and subcutaneous tissue were performed using a soft x-ray system with a stereogram. During all the processes that involved elevating the tissue, observations were made on the macroscopic structure of the palmar vein.
RESULTS: In the palm, a complex network of veins are connected with the distal branches of the cephalic vein, basilic vein, and dorsal venous arch. The pattern and geometric formation of the venous network in all cases showed distinctive features according to each region of the palm. The venous branches create a network extending to palmar margins and webs between fingers.
CONCLUSIONS: Venous arrangement should be considered when designing flaps from the palm to prevent venous congestion and safely extend the length of the flap.

PMID: 27845962 [PubMed - as supplied by publisher]

http://ift.tt/2eFpd2P

Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft.

Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft.

Ann Plast Surg. 2016 Nov 15;

Authors: Han J, Baek RM, Kim BK

Abstract
BACKGROUND: Secondary cleft lip nasal deformity is a complex deformity, and the variety of recommended techniques used to correct this deformity attests to it. Much of the nasal deformity can be attributed to an abnormal lower lateral cartilage. This study presents our experience with applying a lateral crural turnover flap with a sandwiched strut graft in adjunct with other procedures to correct unilateral secondary cleft lip nasal deformity.
METHODS: A retrospective review was conducted of 20 cases of unilateral cleft lip patients undergoing secondary rhinoplasty with lateral crural turnover flap with strut graft. Nostril base augmentation, columellar strut, suture techniques, and alar base reduction were performed as needed. Anthropometric analysis and subjective grading of the postoperative results were performed to evaluate the effect of the procedure on nostril symmetry.
RESULTS: At long-term follow-up of 1 year, the symmetry for cleft side and noncleft side nostril height, width, and angulation of long axis of nostril improved after surgery. Subjective evaluation revealed improved results for all patients.
CONCLUSIONS: The lateral crural turnover flap with sandwiched strut graft is a useful technique for reinforcing, repositioning, and reshaping the lower lateral cartilage in cleft lip patients with hyperconcave lateral crus and hypoplastic pyriform margin. Combined with other techniques, the nostril is increased in height, decreased in width, and thus satisfactory symmetry is obtained.

PMID: 27845961 [PubMed - as supplied by publisher]

http://ift.tt/2fgkNf5

Vascularised bone transfer: History, blood supply and contemporary problems.

Vascularised bone transfer: History, blood supply and contemporary problems.

J Plast Reconstr Aesthet Surg. 2016 Jul 27;:

Authors: Sparks DS, Saleh DB, Rozen WM, Hutmacher DW, Schuetz MA, Wagels M

Abstract
BACKGROUND: Since the description of the free fibula flap by Taylor in 1975, many flaps composed of bone have been described. This review documents the history of vascularised bone transfer and reflects on the current understanding of blood supply in an effort to define all clinically described osseous flaps.
METHODS: A structured review of MEDLINE and Google Scholar was performed to identify all clinically described bone flaps in humans. Data regarding patterns of vascularity were collected where available from the anatomical literature.
RESULTS: Vascularised bone transfer has evolved stepwise in concert with advances in reconstructive surgery techniques. This began with local flaps of the craniofacial skeleton in the late 19th century, followed by regional flaps such as the fibula flap for tibial reconstruction in the early 20th century. Prelaminated and pedicled myo-osseous flaps predominated until the advent of microsurgery and free tissue transfer in the 1960s and 1970s. Fifty-two different bone flaps were identified from 27 different bones. These flaps can be broadly classified into three types to reflect the pedicle: nutrient vessel (NV), penetrating periosteal vessel (PPV) and non-penetrating periosteal vessel (NPPV). NPPVs can be further classified according to the anatomical structure that serves as a conduit for the pedicle which may be direct-periosteal, musculoperiosteal or fascioperiosteal.
DISCUSSION: The blood supply to bone is well described and is important to the reconstructive surgeon in the design of reliable vascularised bone suitable for transfer into defects requiring osseous replacement. Further study in this field could be directed at the implications of the pattern of bone flap vascularity on reconstructive outcomes, the changes in bone vascularity after osteotomy and the existence of "true" and "choke" anastomoses in cortical bone.

PMID: 27843061 [PubMed - as supplied by publisher]

http://ift.tt/2f3ZgbL

The expression of Smad signaling pathway in myocardium and potential therapeutic effects.

The expression of Smad signaling pathway in myocardium and potential therapeutic effects.

Histol Histopathol. 2016 Nov 15;:11845

Authors: Duan Y, Zhu W, Liu M, Ashraf M, Xu M

Abstract
Myocardial infarction (MI) is a life-threatening disease. The expression of Smad proteins in the ischemic myocardium changes significantly following myocardial infarction, suggesting a close relationship between Smad proteins and heart remodeling. Moreover, it is known that the expression of Smads is regulated by transforming growth factor-β (TGF-β) and bone morphogenetic proteins (BMP). Based on these findings, regulating the expression of Smad proteins by targeting TGF-β and BMP in the ischemic myocardium may be considered to be a possible therapeutic strategy for the treatment of myocardial infarction.

PMID: 27844469 [PubMed - as supplied by publisher]

http://ift.tt/2eZD13K

Recurrent Post Tonsillectomy Secondary Hemorrhage in Patients with Factor XIII Deficiency: A Case Series and Review of Literature.

Recurrent Post Tonsillectomy Secondary Hemorrhage in Patients with Factor XIII Deficiency: A Case Series and Review of Literature.

Am J Case Rep. 2016 Nov 15;17:850-854

Authors: ALtamimi ZA, Sheikh R, Omar H, Al Taweel H, Ganesan S

Abstract
BACKGROUND Post-tonsillectomy hemorrhage (PTH) has been reported in the literature as a serious complication after tonsillectomy that has high morbidity and can be life threatening. In cases of recurrent secondary PTH, one should consider coagulopathies as the hidden pathology. Factor XIII deficiency is very rare, suggested to be present 1 in 2 million people. Patients with undiagnosed factor XIII deficiency with secondary PTH are extremely rare. CASE REPORT We report on the cases of six patients (four adults and two children) who presented with recurrent attacks of secondary PTH. CONCLUSIONS Recurrent, severe PTH could be related to undiagnosed hematological disorders.

PMID: 27843132 [PubMed - in process]

http://ift.tt/2eFnc6R

BOOK REVIEW.

BOOK REVIEW.

Int J Audiol. 2016 Nov 15;:1-2

Authors: Scollie S

PMID: 27845615 [PubMed - as supplied by publisher]

http://ift.tt/2fVpsTU

Efficacy and Safety of the SQ House Dust Mite SLIT-tablet in Japanese Adults and Adolescents with House Dust Mite-induced Allergic Rhinitis

Publication date: Available online 15 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Kimihiro Okubo, Keisuke Masuyama, Toru Imai, Kazuhiro Okamiya, Brian Sonne Stage, Dorthe Seitzberg, Akiyoshi Konno
BackgroundThe SQ HDM SLIT-tablet has been approved in 11 European countries and Japan for patients suffering from house dust mite (HDM) respiratory allergic disease.ObjectiveThis trial was conducted to confirm efficacy and safety in Japanese patients with moderate to severe HDM allergic rhinitis (AR).MethodsThe trial was a randomized, double-blind, placebo-controlled trial including 946 Japanese adults and adolescents (12-64 years). Subjects were randomly assigned to daily treatment with SQ HDM SLIT-tablet at a dose of 10,000 JAU or 20,000 JAU or with placebo (1:1:1). Primary endpoint was the total combined rhinitis score (TCRS) composed of AR symptom and medication scores, during the efficacy evaluation period. Symptom and medication scores of AR and conjunctivitis, rhinitis quality of life, and symptom-free and -severe days were evaluated as secondary endpoints.ResultsAnalysis of the primary endpoint demonstrated statistically significant reductions of the TCRS of 1.15, 22% (p<.001) in the 10,000 JAU and 0.99, 19% (p<.001) in the 20,000 JAU compared to placebo. The statistically significant treatment effect was evident from 12 weeks of treatment and onwards. All secondary endpoints, except AR medication score, were statistically significant in favor of active treatment compared to placebo. Post hoc analysis of TCRS in adolescents showed the same efficacy as adults (p<.05). The treatment was well-tolerated both adults and adolescents.ConclusionThe trial confirmed efficacy and safety profile of the SQ HDM SLIT-tablet in Japanese adult and adolescent patients with moderate to severe HDM AR. These data support the robust efficacy and safety profile of previously reported European data.

Teaser

This trial confirmed efficacy and safety of the SQ HDM SLIT-tablet in Japanese adults and adolescents with moderate to severe HDM AR. TCRS was reduced from week 12 and throughout the 1 year trial.

http://ift.tt/2fX1pr0

Association of ORAI1 Gene Polymorphisms with Chronic Spontaneous Urticaria and the Efficacy of Nonsedating H1-antihistamines

Publication date: Available online 15 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Jie Li, Aiyuan Guo, Lianghua Bin, Yijing He, Wu Zhu, Siyu Yan, Cong Peng, Mingliang Chen, Jianglin Zhang, Juan Su, Mei Yi, Zhaoqian Liu, Wei Zhang, Weiqi Zeng, Donald Y.M. Leung, Wangqing Chen, Xiang Chen

Teaser

Human ORAI1 polymorphisms were associated with susceptibility to CSU, and the CSU patients who carry rs3741595C allele have reduced responsiveness to nonsedating H1-antihistamines.

http://ift.tt/2fX3HXt

The vestibular system and cognition.

The vestibular system and cognition.

Curr Opin Neurol. 2016 Nov 10;

Authors: Smith PF

Abstract
PURPOSE OF REVIEW: The last year has seen a great deal of new information published relating vestibular dysfunction to cognitive impairment in humans, especially in the elderly. The objective of this review is to summarize and critically evaluate this new evidence in the context of the previous literature.
RECENT FINDINGS: This review will address the recent epidemiological/survey studies that link vestibular dysfunction with cognitive impairment in the elderly; recent clinical investigations into cognitive impairment in the context of vestibular dysfunction, both in the elderly and in the cases of otic capsule dehiscence and partial bilateral vestibulopathy; recent evidence that vestibular impairment is associated with hippocampal atrophy; and finally recent evidence relating to the hypothesis that vestibular dysfunction could be a risk factor for dementia.
SUMMARY: The main implication of these recent studies is that vestibular dysfunction, possibly of any type, may result in cognitive impairment, and this could be especially so for the elderly. Such symptoms will need to be considered in the treatment of patients with vestibular disorders.

PMID: 27845944 [PubMed - as supplied by publisher]

http://ift.tt/2fVBBrV

BOOK REVIEW.

BOOK REVIEW.

Int J Audiol. 2016 Nov 15;:1-2

Authors: Scollie S

PMID: 27845615 [PubMed - as supplied by publisher]

http://ift.tt/2fVpsTU

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users.

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users.

Acta Otolaryngol. 2016 Nov 15;:1-6

Authors: Suarez H, Alonso R, Arocena S, Ferreira E, Roman CS, Suarez A, Lapilover V

Abstract
CONCLUSIONS: The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development. Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI).
METHODS: Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10-16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n = 14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.
RESULTS: (1) GV in CG was lower in DT than with EN (p = .019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p = .006; DT, p = .0001; CI-OFF, p = .03). (3) CIU had slower GV walking with EN (p = .037) and with DT (p = .022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.

PMID: 27844494 [PubMed - as supplied by publisher]

http://ift.tt/2fVy3pw

Measurement of middle ear pressure changes during balloon eustachian tuboplasty: a pilot study.

Measurement of middle ear pressure changes during balloon eustachian tuboplasty: a pilot study.

Acta Otolaryngol. 2016 Nov 15;:1-5

Authors: Todt I, Abdel-Aziz T, Mittmann P, Lehmann M, Ebmeyer J, Scholtz LU, Sudhoff H

Abstract
CONCLUSION: The middle ear pressure changes detected during BET can be directly attributed to the balloon inflation and may represent a second, immediate, mechanism of action of BET. BET seems to be safe with respect to the risk of a barotrauma. Further human studies are now necessary to confirm the results and gain more insight into the mechanism of action of BET.
OBJECTIVE: Since the introduction of Balloon Eustachian Tuboplasty (BET) as a treatment of chronic Eustachian tube dysfunction, the precise mechanism of action is unknown. Long-term effects of BET may be related to observed microfractures of the Eustachian tube cartilage. However, clinical observations indicate a second, immediate mode of action. Therefore, this study investigated and characterized middle ear pressure changes occurring directly during BET procedure.
METHODS: Using a micro-optical pressure sensor, pressure changes during BET were monitored transtympanically in a cadaveric animal study using heathland sheep.
RESULTS: Middle ear pressure amplitudes during BET are dependent on the speed of balloon inflation as well as the maximum inflation pressure. A 10-bar inflation pressure yielded a mean middle ear pressure of 5.34 mmHg (71.0 daPA). Negative pressure amplitudes occurring on withdrawal of the balloon catheter are influenced by the speed of withdrawal. No pressure amplitudes capable of causing barotrauma to membranous ear structures could be detected.

PMID: 27844486 [PubMed - as supplied by publisher]

http://ift.tt/2fUGIcN

Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies.

Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies.

Eur Arch Otorhinolaryngol. 2016 Nov 14;

Authors: Zuo JJ, Tao ZZ, Chen C, Hu ZW, Xu YX, Zheng AY, Guo Y

Abstract
Tobacco smoking was one of the risk factors for upper aerodigestive tract cancer, but exclusive quantification of the impact of cigarette smoking on laryngeal cancer had not been investigated. A meta-analysis of researches that had reported quantitative estimates of cigarette smoking and risk of laryngeal cancer by March 2016 was performed. Pooled estimates of relative risks and their 95% confidence intervals were obtained and summarized. Sensitivity analysis and subgroup analysis were implemented to find out sources of research heterogeneity and the effect of potential confounders. Publication bias was investigated and corrected if found to be present through Egger's and Begg's test, and trim and fill algorithm. Thirty researches based on a total of 14,292 cases from three cohort and fifteen case-control studies were included and pooled estimate for the correlation between cigarette smoking and the risk of laryngeal cancer was 7.01 (95% confidence interval 5.56-8.85), with moderate heterogeneity across the researches (I (2) = 56.7%, p = 0.002). The RRs were 5.04 (95% CI 3.09-8.22) for cohort studies (p = 0.121), 7.59 (95% CI 5.86-9.82) for case-control studies (p = 0.005). The risk kept elevated within the first fifteen years of quitting smoking(RR 3.62, 95% CI 1.88-7.00) but dropped in the 16 years and more after smoking cessation(RR 1.88, 95% CI 1.16-3.05). Individuals who smoked with 40 or more pack-years had nine times the risk of laryngeal cancer(RR 9.14; 95% CI 6.24-13.39). Subjects who smoked 30 or more cigarettes a day had sevenfolds the risk of laryngeal cancer (RR 7.02; 95% CI 4.47-11.02) and who smoked 40 or more years had five times the risk versus never smokers (RR 5.76; 95% CI 3.69-8.99). Evidence of publication bias was not detected for the correlation between current cigarette smoking and risk of laryngeal cancer (p = 0.225 with Begg's test, p = 0.317 with Egger's test). The results demonstrated strong correlation referring to dose-response and time-response between cigarette smoking and risk of laryngeal cancer for both men and women. The probability of developing laryngeal cancer was decreased by quitting smoking, particularly among former cigarette smokers who had stopped smoking for 15 or more years. The subgroup analysis demonstrated that study type influenced the RRs estimates of the studies.

PMID: 27844225 [PubMed - as supplied by publisher]

http://ift.tt/2fg0Oxd

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

Eur Arch Otorhinolaryngol. 2016 Nov 14;

Authors: Sieskiewicz A, Buczko K, Janica J, Lukasiewicz A, Lebkowska U, Piszczatowski B, Olszewska E

Abstract
Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

PMID: 27844224 [PubMed - as supplied by publisher]

http://ift.tt/2eZZMVa

Untreated head and neck cancer in Korea: a national cohort study.

Untreated head and neck cancer in Korea: a national cohort study.

Eur Arch Otorhinolaryngol. 2016 Nov 14;

Authors: Choi HG, Park B, Ahn SH

Abstract
Few studies have analyzed the survival of patients with untreated head and neck cancer. The objective of this study is to assess the survival rates of untreated head and neck cancer patients and to determine why the patients were not treated. Using data from a national patient sample cohort (1,025,340 cases) from the Korean Health Insurance Review and Assessment Service, 605 patients with diagnoses of head and neck cancer (lip and oral cavity, oropharynx, hypopharynx, and laryngeal cancer) between 2003 and 2013 were evaluated. Cox proportional hazards modeling and multiple logistic regression analysis were performed. Of the considered cases of head and neck cancer, 32.2% were untreated. The median survival rate of untreated groups was 9 months. The untreated group showed poorer survival than the treatment groups. Old age [adjusted odds ratio (AOR) = 1.37, 95% confidence internal (CI) 1.25-1.49, P < 0.001] and low income (AOR = 0.94, 95% CI 0.89-1.00, P = 0.028) were related to not receiving treatment. Many head and neck cancers go untreated. Clinicians should focus on untreated patients and seek to understand the reasons for their lack of treatment.

PMID: 27844223 [PubMed - as supplied by publisher]

http://ift.tt/2fUM4ov

The role of compact polysomnography/polygraphy in sleep breathing disorder patients' management.

The role of compact polysomnography/polygraphy in sleep breathing disorder patients' management.

Eur Arch Otorhinolaryngol. 2016 Nov 14;

Authors: Bosi M, De Vito A, Vicini C, Poletti V

Abstract
While managing obstructive sleep apnea (OSA) or suspicious OSA patients, the otorhinolaryngologist frequently has to deal with patients undergoing repeated polysomnography (PSG) or portable monitoring (PM) and, on the other hand, should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), which should be reported in all PSG/PM report, could represent an efficient tool to confirm the quality of PSG/PM diagnosis and to recognize the sleep breathing disorders (SBD): OSA, no-OSA SBD and overlap of OSA with no-OSA SBD. In this study, a synthetic and clear guided iconography and an easy decision-making algorithm based on desaturation patterns (phasic, prolonged and overlap desaturation patterns) identifiable on the CP are suggested for a quick check of the quality of PSG/PM diagnosis and to achieve an improvement in the patient's clinical management.

PMID: 27844222 [PubMed - as supplied by publisher]

http://ift.tt/2fUGmmP

Moroccan adaptation and validation of the rhinosinusitis quality-of-life survey.

Moroccan adaptation and validation of the rhinosinusitis quality-of-life survey.

Eur Arch Otorhinolaryngol. 2016 Nov 14;

Authors: Adouly T, Adnane C, Khallouk A, Chenguir M, Rouadi S, Abada RL, Roubal M, Mahtar M

Abstract
The aim of this study was to validate the Moroccan translation and sociocultural adaptation of the RhinoQOL questionnaire. The questionnaires were translated into Moroccan and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS) (n = 99). Both of the groups answered the questionnaire before and one year after surgery. The psychometric properties, reliability, validity with correlation to other clinical instruments and responsiveness to treatment, were analyzed. Univariate and multivariate analyses were performed. The test-retest reliability was excellent [intraclass correlation coefficient (ICC) >0.9], indicating a good reliability when administering the instrument on repeated occasions. The internal consistency was 0.80, 0.75 and 0.94 for the scores of the RhinoQOL sub-scales (frequency, bothersomeness, and impact, respectively). Firstly, our questionnaire was able to detect differences between patients with CRS and group of healthy volunteers (p < 0.0001) and secondly, it improved significantly after surgery (p < 0.0001), indicating a good responsiveness. A good correlation was found between the Moroccan version, the preoperative objective scores, and SNOT-22 and RSDI scores. The Moroccan RhinoQOL questionnaire appears to be culturally appropriate and psychometrically valid.

PMID: 27844221 [PubMed - as supplied by publisher]

http://ift.tt/2eZQDvS

B cells differentiate in Human thymus and express AIRE

Publication date: Available online 15 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Vincent Gies, Aurélien Guffroy, François Danion, Philippe Billaud, Céline Keime, Jean-Daniel Fauny, Sandrine Susini, Anne Soley, Thierry Martin, Jean-Louis Pasquali, Frédéric Gros, Isabelle André-Schmutz, Pauline Soulas-Sprauel, Anne-Sophie Korganow

http://ift.tt/2fF5Hkb

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users.

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users.

Acta Otolaryngol. 2016 Nov 15;:1-6

Authors: Suarez H, Alonso R, Arocena S, Ferreira E, Roman CS, Suarez A, Lapilover V

PMID: 27844494 [PubMed - as supplied by publisher]

http://ift.tt/2fVy3pw

Measurement of middle ear pressure changes during balloon eustachian tuboplasty: a pilot study.

Measurement of middle ear pressure changes during balloon eustachian tuboplasty: a pilot study.

Acta Otolaryngol. 2016 Nov 15;:1-5

Authors: Todt I, Abdel-Aziz T, Mittmann P, Lehmann M, Ebmeyer J, Scholtz LU, Sudhoff H

PMID: 27844486 [PubMed - as supplied by publisher]

http://ift.tt/2fUGIcN

Supraclavicular node disease is not an independent prognostic factor for survival of esophageal cancer patients treated with definitive chemoradiation.

Supraclavicular node disease is not an independent prognostic factor for survival of esophageal cancer patients treated with definitive chemoradiation.

Acta Oncol. 2016 Nov 15;:1-6

Authors: Jeene PM, Versteijne E, van Berge Henegouwen MI, Bergmann JJ, Geijsen ED, van Laarhoven HW, Hulshof MC

Abstract
BACKGROUND: The prognostic value of supraclavicular lymph node (SCN) metastases in esophageal cancer is not well established. We analyzed the prognostic value of SCN disease in patients after definitive chemoradiation (dCRT) for esophageal cancer.
METHODS: We retrospectively analyzed 207 patients treated between 2003 and 2013 to identify the prognostic value of metastasis in the SCN on treatment failure and survival. All patients were treated with external beam radiotherapy (50.4 Gy in 28 fractions) combined with weekly concurrent paclitaxel 50 mg/m(2) and carboplatin AUC2.
RESULTS: Median follow-up for patients alive was 43.3 months. The median overall survival (OS) for all patients was 17.5 months. OS at one, three and five years was 67%, 36% and 21%, respectively. For patients with metastasis in a SCN, OS was 23.6 months compared to 17.1 months for patients without metastasis in the SCN (p = .51). In multivariate analyses, higher cT status, cN status and adenocarcinoma were found to be prognostically unfavorable, but a positive SCN was not (p = .67). Median OS and median disease-free survival for tumors with SCN involvement and N0/1 disease was 49.0 months and 51.6 months, respectively, compared to 14.2 months and 8.2 months, respectively, in patients with N2/3 disease.
CONCLUSION: In esophageal cancer treated with dCRT, the number of affected lymph nodes is an important independent prognostic factor, whereas involvement of a SCN is not. Supraclavicular lymph nodes should be considered as regional lymph nodes and treated with curative intent if the total number of involved lymph nodes is limited.

PMID: 27842455 [PubMed - as supplied by publisher]

http://ift.tt/2fERfbM

Heterotaxy Syndrome with and without spleen: different infection risk and management

Publication date: Available online 15 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Eva Piano Mortari, Anwar Baban, Nicoletta Cantarutti, Chiara Bocci, Rachele Adorisio, Rita Carsetti
We compared the clinical disease and immunological conditions of Heterotaxy syndrome patients with or without spleen and found that asplenia is associated to significant increased frequency of infection and reduction of IgM memory B cells.

http://ift.tt/2fX31RK

Modified release and conventional glucocorticoids and diurnal androgen excretion in congenital adrenal hyperplasia.

Modified release and conventional glucocorticoids and diurnal androgen excretion in congenital adrenal hyperplasia.

J Clin Endocrinol Metab. 2016 Nov 15;:jc20162855

Authors: Jones CM, Mallappa A, Reisch N, Nikolaou N, Krone N, Hughes BA, O'Neil DM, Whitaker MJ, Tomlinson JW, Storbeck KH, Merke DP, Ross RJ, Arlt W

Abstract
CONTEXT: The classic androgen synthesis pathway proceeds via DHEA, androstenedione and testosterone to 5α-dihydrotestosterone (DHT). However, DHT synthesis can also be achieved by an alternative pathway originating from 17α-hydroxyprogesterone (17OHP), which accumulates in congenital adrenal hyperplasia (CAH). Similarly, recent work has highlighted androstenedione-derived 11-oxygenated 19-carbon steroids as active androgens and, in CAH, androstenedione is generated directly from 17OHP. The exact contribution of alternative pathway activity to androgen excess in CAH and its response to glucocorticoid therapy is unknown.
OBJECTIVE: We sought to quantify classic and alternative pathway-mediated androgen synthesis in CAH, their diurnal variation and their response to conventional glucocorticoid (GC) therapy and modified release hydrocortisone.
METHODS: We employed urinary steroid metabolome profiling by gas chromatography-mass spectrometry for 24-h steroid excretion analysis, studying the impact of conventional GCs (hydrocortisone, prednisolone, dexamethasone) in 55 adults with CAH and 60 controls. We studied diurnal variation in steroid excreton by comparing 8-hourly collections (23:00-7:00h, 7:00-15:00h, 15:00-23:00h) in 16 CAH patients on conventional glucocorticoids and during six months of treatment with modified release hydrocortisone, Chronocort.
RESULTS: CAH patients on conventional GCs showed low excretion of classic pathway androgen metabolites but excess excretion of the alternative pathway signature metabolites 3α,5α-17-hydroxypregnanolone and 11β-hydroxyandrosterone. Chronocort reduced 17OHP and alternative pathway metabolite excretion to near normal levels more consistently than other GC preparations.
CONCLUSIONS: Alternative pathway mediated androgen synthesis significantly contributes to androgen excess in CAH. Chronocort therapy appears superior to conventional GC therapy in controlling androgen synthesis via alternative pathways through attenuation of their major substrate, 17OHP.

PMID: 27845856 [PubMed - as supplied by publisher]

http://ift.tt/2fwywRT

[Stomal Cancer Recurrency, A Clinic-Pathological Consideration].

[Stomal Cancer Recurrency, A Clinic-Pathological Consideration].

Laryngorhinootologie. 2016 Nov 15;

Authors: Teutsch S, Bas M, Bier H, Knopf A

Abstract
Objectives: Analysis of pre-operative tracheostomy and circumjacent tumour free margins as risk factors in the development of stomal recurrent disease after (pharyngo)laryngectomy. Material and Methods: 124 patients after (pharyngo)laryngectomy were analyzed for disease related data and tumour samples were analyzed for tumour free margins. The overall cohort was divided into patients with/withour pre-operative tracheostomy. Results: 18 patients suffered from recurrent disease (10 stomal, 8 distant metastases). Advanced T-status, female gender, and sub-/glottic tumour manifestation resulted in a higher rate of prior tracheostomy. Pre-operative tracheostomy did not influence the development of stomal recurrency. R0 resection was achieved in 94% of our patients, with significant reduced tumour free margins in patients with stomal recurrency (p=0.002) Conclusion: Pre-operative tracheostomy did not influence the development of stomal recurrent disease. The clinical identification of ventral soft tissue infiltration should result in extensive surgical concepts.

PMID: 27846642 [PubMed - as supplied by publisher]

http://ift.tt/2ggDqok

Editorial.

Editorial.

J Cosmet Laser Ther. 2016 Nov;18(7):363

Authors: Goldberg DJ

PMID: 27845619 [PubMed - in process]

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Painful Radiation Thyroiditis after (131)I Therapy for Graves' Hyperthyroidism: Clinical Features and Ultrasonographic Findings in Five Cases.

Painful Radiation Thyroiditis after (131)I Therapy for Graves' Hyperthyroidism: Clinical Features and Ultrasonographic Findings in Five Cases.

Eur Thyroid J. 2016 Sep;5(3):201-206

Authors: Mizokami T, Hamada K, Maruta T, Higashi K, Tajiri J

Abstract
BACKGROUND: Radiation thyroiditis caused by (131)I therapy for Graves' hyperthyroidism is asymptomatic in most patients and is rarely associated with pain or fever. Currently, there are few reports on the ultrasonographic findings of radiation thyroiditis after (131)I therapy for Graves' hyperthyroidism.
CASE REPORT: We herein report 5 cases with painful radiation thyroiditis (including 2 febrile cases) after (131)I therapy for Graves' hyperthyroidism. The cases included 4 women, aged 49, 50, 76, and 81 years, and 1 man, aged 60 years. Anterior neck pain developed 0-10 days after (131)I administration (fixed dose of 481 MBq). Each patient visited our clinic 0-4 days after the development of anterior neck pain. The thyroid glands were noticeably enlarged (increasing from 18 g at (131)I administration to 35 g after the development of anterior neck pain in 1 patient, and from 20 to 33 g, 21 to 39 g, 21 to 51 g, and 40 to 51 g in the other patients) and tender. The echogenicity of the thyroid parenchyma was increased, and the parenchyma was more heterogeneous. Granular hyperechoic lesions were scattered throughout the thyroid gland in the most severe case. The border between the thyroid gland and the surrounding tissue was blurred, and the surrounding tissue was hyperechoic.
CONCLUSION: Painful radiation thyroiditis should be reacknowledged as one of the complications of (131)I therapy for Graves' hyperthyroidism. Ultrasonography demonstrated the characteristic changes caused by (131)I-induced radiation thyroiditis.

PMID: 27843811 [PubMed - in process]

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Τετάρτη 16 Νοεμβρίου 2016

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