Complex regional pain syndrome type II arising from a gunshot wound (GSW) associated with infective endocarditis and aortic valve replacement

A 34-year-old man with a history of gunshot wound (GSW) to the right upper chest developed secondary aortic valve endocarditis (AVE) and was treated with an artificial valve placement (AVP). Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). The patient underwent a diagnostic sympathetic ganglion block, before undergoing endoscopic thoracic sympathectomy surgery. Successful outcomes revealed decreased pain, opioid utilisation and improved tolerance to therapy and activities of daily living. To our knowledge, this is the first case reporting CRPS II arising from a GSW complicated by AVE followed by AVP, which emphasises how unforeseen syndromes can arise from the management of seemingly unrelated pathology. This case demonstrates the importance of timely and proper diagnosis of uncharacterised residual pain status post-trauma and differential diagnosis and management of chronic pain syndromes.

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Metropolitan W135 meningococcal compressive pericarditis treated with intrapericardial fibrinolysis

Meningococcal pericarditis is a rare but severe form of acute purulent pericarditis. It is a classic complication of Neisseria meningitidis of serotype W135, usually occurring in pilgrims to Mecca and their household contacts. This severe form of meningococcaemia is difficult to diagnose and evolves frequently and gradually towards a tamponade, requiring emergency drainage. We report a case of meningococcal pericarditis caused by N. meningitidis W135 in an immunocompetent patient, without any other organ involvement especially meningeal, requiring pericardium drainage in emergency and then intrapericardial fibrinolysis.

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Rare origin of left main coronary artery from non-coronary sinus with aortic coarctation

Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.

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Fits, feet and HIV: lessons from a case of coexisting epilepsy and neuropathy in a patient with perinatally acquired HIV-1 infection

An 18-year-old black African man with well-controlled perinatally acquired HIV-1 was diagnosed in late adolescence with the unrelated diagnoses of Charcot-Marie-Tooth type 1A (CMT1A), epilepsy due to polymicrogyria and subsequently developed severe depression. The CMT1A diagnosis occurred after transfer of care from a local paediatric HIV service to a tertiary paediatric referral centre and was precipitated by recognition of a history and neurological signs not typically associated with perinatal HIV. The case resulted in the establishment of a quarterly combined paediatric HIV and paediatric neurology multidisciplinary team clinic to assess children and adolescents living with HIV with neurological symptoms.

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A Rare case of recurrent Guillain-Barre syndrome without albuminocytological dissociation

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy, often preceded by an illness. It is a self-limiting illness in most of the cases, but recurrence is rare and can be seen in about 1%–6% of patients. GBS is characterised by progressive, symmetrical, proximal and distal weakness. Areflexia and sensory disturbances are also common. Patients with GBS usually have albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. This is a case of a 69-year-old woman with recurrent GBS and normal CSF findings.

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Sinus arrest with prolonged asystole due to the trigeminocardiac reflex during application of local anaesthetic in the nasal mucosa

The trigeminocardiac reflex (TCR) is defined as a sudden onset of parasympathetic dysrhythmias during stimulation of the trigeminal nerve. We describe a peripheral variation of TCR during manipulation of the nasal mucosa. A 42-year-old patient suffering from severe obstructive sleep apnoea was scheduled for surgical treatment. After inducted anaesthesia, the surgeon infiltrated the nasal mucosa with a local anaesthetic. The patient immediately showed an asystole and was treated with ephedrine and five chest compressions, despite spontaneous sinus rhythm return after ceasing of manipulation. Treatment with atropine established this TCR episode and ensured an event-free surgery.

The authors present here, for the first time, a prolonged asystole caused by the TCR, triggered by minimal manipulation of the nasal mucosa. This severe manifestation of peripheral TCR demonstrates its importance in daily clinical business. This case was treated according to a modified treatment algorithm for all subtypes of TCR which is presented here.

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Friedreichs sign

Description  

An 82-year-old man with chronic atrial fibrillation treated with anticoagulation was admitted to the hospital for subacute progressive exertional dyspnoea. On examination, the jugular venous waveform was elevated to the mandibular angle with the patient sitting upright. Heart sounds were muffled. Transthoracic echocardiography (TTE) revealed a large circumferential pericardial effusion with early tamponade physiology. Pericardiocentesis yielded a large volume of sanguineous fluid. Following the procedure, there was improvement in jugular venous pressure to 14 cm H₂O. The height of the waveform increased with inspiration (Kussmaul's sign) and there was a prominent y descent, known as Friedreich's sign (see video 1). Repeat TTE revealed thickened pericardium, early diastolic septal bounce and respirophasic changes in early diastolic filling consistent with constrictive pericardial physiology. Friedreich's sign is a physical finding of constrictive pericarditis. The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds...

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Fungal thyroiditis in a lung transplant recipient

Description  

A 59-year-old man was admitted with 3 weeks of worsening shortness of breath 18 months after receiving a bilateral lung transplant for idiopathic pulmonary fibrosis. His immunosuppression included tacrolimus, everolimus and low-dose prednisone with no antifungal prophylaxis at the time of admission. CT chest revealed multiple, bilateral pulmonary nodules (figure 1—red arrows). CT-guided biopsy revealed fungal hyphae (figure 2). The initial CT and ultrasound of the neck at the onset of sore throat was negative; however, repeat CT neck for evolving neck pain and dysphasia during hospital course showed a mass-like lesion in the right thyroid lobe with extensive surrounding inflammatory changes (figure 3—green arrow). The lesion was also visualised on ultrasound, where it appeared as a hypoechoic solitary nodule (figure 4). Laboratory evaluation revealed hyperthyroidism, with a Thyroid Stimulating Hormone (TSH) of <0.01 µIU/mL (normal: 0.35–4.94 µIU/mL) and a...

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Herpesviral Infection in Periapical Periodontitis

Abstract

Purpose of Review

This review describes the most recent findings on herpesviral infections and offers current concepts of herpesviral role in the pathogenesis of periapical periodontitis.

Recent Findings

Thirty articles reported data on herpesviral infection in periapical periodontitis. Epstein-Barr virus and human cytomegalovirus are the most frequently detected herpesviruses in periapical samples. The main hypothesis postulates a bidirectional herpesviral-bacterial relationship in the etiopathogenesis of periapical periodontitis. A high heterogeneity of herpesviruses incidence was registered within the studies, in part, due to various methodological approaches used in laboratory testing, different inclusion criteria, study design, seroprevalence of herpesviruses, and sociodemographic characteristics of investigated populations.

Summary

Herpesviruses have been shown to potentially impair local host defense in periapical tissue. Although it has been demonstrated that endodontic pathogenic bacteria are able to reactivate herpesviruses, further, in vitro studies should provide more data on herpesviruses as a factor in the pathogenesis of the periapical pathoses. It is, therefore, necessary to investigate potential benefits of antiviral therapy in well-designed controlled longitudinal studies.

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Work-Related Musculoskeletal Discomfort and Injury in Microsurgeons

J reconstr Microsurg
DOI: 10.1055/s-0038-1675177

Background Long surgical procedures with loupe magnification and microscopes may put microsurgeons at an increased risk of musculoskeletal discomfort. Identifying the prevalence and impact of work-related musculoskeletal discomfort may guide preventive strategies to prolong well-being, job satisfaction, and career duration. Methods An online 29-question survey was designed to evaluate work-related musculoskeletal discomfort. The survey was created and distributed electronically through a private survey research center and was sent to the members of the American Society for Reconstructive Microsurgery. Results There were 117 respondents (16.7% response rate): 80% were men; 69% were aged 31 to 50 years; and 68% were in academic practice. On a scale of 0 to 10 (0, no pain and 10, worst pain), the median for work-related musculoskeletal discomfort for surgery without loupes or microscope was 2; with loupes, 4; and with a microscope, 5. Pain was most common in the neck. Half of the surgeons reported pain within 4 hours of surgery, and 57% feared that pain would influence future surgical performance. Surgeon discomfort affected posture (72%), stamina (36%), sleep (29%), relationships (25%), concentration (22%), and surgical speed (19%). Tremor caused by the discomfort occurred in 8%. Medical treatment for discomfort was sought by 29%. Time off work for treatment occurred for 8%. Conclusion Work-related musculoskeletal discomfort can affect many aspects of a microsurgeon's life and has the potential to limit a surgeon's ability to operate. Therefore, more emphasis is needed in the surgical community on the important issues of occupational health and surgical ergonomics for microsurgeons.
[...]

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Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

J reconstr Microsurg
DOI: 10.1055/s-0038-1675146

Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.
[...]

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Lower Extremity Free Tissue Transfer in the Setting of Thrombophilia: Analysis of Perioperative Anticoagulation Protocols and Predictors of Flap Failure

J reconstr Microsurg
DOI: 10.1055/s-0038-1675145

Aim No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. Methods Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon. Patients were divided into two cohorts based on the introduction of a novel, risk-stratified algorithm for perioperative anticoagulation in July 2015. Demographic data, chemoprophylaxis profiles, flap outcomes, and complications were retrospectively compared across time periods. Results Fifty-seven free flaps were performed in hypercoagulable patients treated with non-stratified (n = 27) or risk-stratified (n = 30) thromboprophylaxis. Patients in the risk-stratified cohort received intravenous heparin more often than non-stratified controls (73 vs. 15%, p < 0.001). Lower rates of total (3 vs. 19%, p = 0.06) and partial (10 vs. 37%, p = 0.025) flap loss were observed among risk-stratified patients, paralleling a significant reduction in the prevalence of postoperative thrombotic events (1.2 vs. 12.3%, p = 0.004). While therapeutic versus low-dose heparin infusion was associated with improved flap survival following intraoperative microvascular compromise (86 vs. 25%, p = 0.04), salvage rates in the setting of postoperative thrombosis remained 0%, regardless of protocol. On multivariate analysis, recipient-vessel calcification (odds ratio [OR]: 16.7, p = 0.02) and anastomotic revision (OR, 3.3; p = 0.04) were independently associated with total flap failure. Conclusions Selective therapeutic anticoagulation may improve microsurgical outcomes in high-risk patients with thrombophilia. Our findings highlight the importance of meticulous technique and recipient-vessel selection as critical determinants of flap success in this population.
[...]

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Evaluation of the Extent of Vessel Avulsion Injury: An Experimental Study Using a Rabbit Model

J reconstr Microsurg
DOI: 10.1055/s-0038-1675178

Background Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury. Methods Varying degrees of avulsion were applied to the aorta of 12 (n = 12) adult female New Zealand rabbits. Avulsion was first determined using adventitial findings and then with endothelial findings. The definitive extent of damage was determined histopathologically. Results The mean area of the histopathological sections was 16.7 ± 6.9 mm. The extent of damage measured from the adventitia was 15.8 ± 7.9 mm (the difference in histopathological examinations was not significant, p = 0.590, paired t-test), while the extent of damage from the lumen was 13.3 ± 8.2 mm (the difference in histopathological examinations was significant p = 0.004, paired t-test). Conclusion Excision based on adventitia findings is more effective in case of avulsion injury.
[...]

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Correction to: Cytokine release kinetics of concentrated growth factors in different scaffolds

Legend of fig. 1a and b was reversed in the original version of this article.

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In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide

Abstract

Objectives

To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use.

Materials and methods

We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed.

Results

In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05).

Conclusion

Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening.

Clinical relevance

For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

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Staphylococcus aureus from patients with chronic rhinosinusitis show minimal genetic association between polyp and non-polyp phenotypes

Abstract

Background

Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectrum with poorer surgical outcomes. We performed a microbial genome-wide association study (mGWAS) to investigate whether S. aureus isolates from CRS patients have particular genetic markers associated with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP).

Methods

Whole genome sequencing was performed on S. aureus isolates collected from 28 CRSsNP and 30 CRSwNP patients. A mGWAS approach was employed using large-scale comparative genomics to identify genetic variation within our dataset.

Results

Considerable genetic variation was observed, with > 90,000 single nucleotide polymorphisms (SNPs) sites identified. There was little correlation with CRS subtype based on SNPs and Insertion/Delection (Indels). One indel was found to significantly correlate with CRSwNP and occurred in the promoter region of a bacitracin transport system ATP-binding protein. Additionally, two variants of the highly variable superantigen-like (SSL) proteins were found to significantly correlate with each CRS phenotype. No significant association with other virulence or antibiotic resistance genes were observed, consistent with previous studies.

Conclusion

To our knowledge this study is the first to use mGWAS to investigate the contribution of microbial genetic variation to CRS presentations. Utilising the most comprehensive genome-wide analysis methods available, our results suggest that CRS phenotype may be influenced by genetic factors other than specific virulence mechanisms within the S. aureus genome.

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A Prospective Randomized Blinded Trial Comparing Digital Simulation to Textbook for Cleft Surgery Education

Background: Simulation is progressively being integrated into surgical training, yet its utility in plastic surgery has not been well described. We present a prospective, randomized, blinded trial comparing digital simulation to a surgical textbook for conceptualization of cleft-lip repair. Methods: Thirty-five medical students were randomized to learning cleft repair using a simulator or textbook. Participants outlined markings for a standard cleft-lip repair before (pre-intervention) and after (post-intervention) 20 minutes of studying their respective resource. Two expert reviewers blindly graded markings according to a 10-point scale, on two separate occasions. Intra-rater and inter-rater reliability were calculated using intra-class correlation coefficients. Paired and independent t-tests were performed to compare scoring between study groups. A validated student satisfaction survey was administered to assess the two resources separately. Results: Intra-rater grading reliability was excellent among both raters for pre-intervention and post-intervention grading (rater 1 ICC=0.94 and 0.95, respectively; rater 2 ICC=0.60 and 0.92, respectively; p

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“Flap Preconditioning with the Cyclic Mode (Triangular Waveform) of Pressure-Controlled Cupping in a Rat Model: An Alternative Mode to the Continuous System”

Background: Improving flap survival is essential for successful soft-tissue reconstruction. Although many methods have been attempted to increase the survival of the distal flap portion, there has been no widely adopted procedure. We evaluated the effect of flap preconditioning with two different modes (continuous and cyclic) of external volume expansion (pressure-controlled cupping) in a rat dorsal flap model. Methods: Thirty rats were randomly assigned to the control group and two experimental groups (n=10/group). The continuous group underwent 30 min of preconditioning with -25 mmHg pressure once daily for 5 days. The cyclic group received 0 to -25 mmHg pressure for 30 min with the cyclic mode once daily for 5 days. On the day after the final preconditioning, caudally based 2x8-cm dorsal random-pattern flaps were raised and replaced in the native position. On postoperative day 9, the surviving flap area was evaluated. Results: The cyclic group showed the highest flap survival rate (76.02%), followed by the continuous and control groups (64.96% and 51.53%, respectively). All inter-group differences were statistically significant. Tissue perfusion of the entire flap showed similar results (cyclic, 87.13%; continuous, 66.64%; control, 49.32%). Histologic analysis with hematoxylin and eosin, Masson trichrome, and CD31 staining showed the most increased and organized collagen production with hypertrophy of the attached muscle and vascular density in the cyclic group, followed by the continuous and control groups. Conclusions: Flap preconditioning with the cyclic mode of external volume expansion is more effective than the continuous mode in an experimental rat model. Further studies will be necessary for clinical application. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript Authors' Contributions: K.S.K. came up with the main idea and its concept of hypothesis in this experiment. He led the process of this study. Y.G.H. mainly conducted the animal experiment and further organized and analyzed histologic results. He wrote the article. S.C.K. supervised and advised the experimental process and participated in the laboratory meeting with the team and gave several opinions during discussion. Ethics Statement: All procedures were conducted in accordance with the Guide for the Care and Use of Laboratory Animals of the Asan Life Science Research Center animal review board (document no. 2017-13-113). Corresponding author: Kyung S. Koh, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul 05505, Korea. Tel.: +82-2-3010-3600, Fax: +2-476-7471, E-mail: kskoh@amc.seoul.kr, kyungskoh@gmail.com ©2018American Society of Plastic Surgeons

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Outcomes of Elbow Flexion Reconstruction in Patients Over 50 with Traumatic Brachial Plexus Injury

Background: There is controversy regarding the effectiveness of brachial plexus (BP) reconstruction for elbow function in older patients as reported outcomes are generally poor. The purpose of this study is to evaluate elbow function outcomes in patients over 50. Methods: Fifty-eight patients over the age of 50 underwent nerve grafting, transfers or free functioning muscle transfer (FFMT) to improve elbow function after traumatic BP injury. Patients were evaluated pre- and post-operatively for elbow flexion strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction. Results: The average age was 57.8 years (range 50-72) with an average follow-up of 24.0 months. The average modified BMRC (British Medical Research Council) elbow flexion grade improved significantly from 0.26 to 2.63. Thirty-three patients (60%) achieved functional flexion ≥M3 post-operatively, compared to zero patients pre-operatively. There was no correlation between age and modified BMRC grade. Active elbow ROM improved significantly post-operatively, with no effect of age on flexion motion. More patients achieved ≥M3 flexion with nerve transfers (69%) compared to FFMT (43%). Patients had worse outcomes with high energy injuries. The mean DASH score decreased from 51.5 to 49.6 post-operatively and the average pain score decreased from 5.0 to 4.3. Conclusion: BP reconstruction for elbow function in patients over the age of 50 can yield useful flexion. Conflicts of Interest: We have no conflicts of interest or financial interest to disclose. Corresponding author: Alexander Shin, MD, shin.alexander@mayo.edu, Division of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, 55905 Rochester, MN ©2018American Society of Plastic Surgeons

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Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon

Background: The purpose of this study was to investigate the clinical outcome of the wide-awake tendon reconstruction for chronic rupture of the flexor pollicis longus (FPL) tendon with evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit. Methods: Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery for chronic tendon rupture of the FPL. If the total of the passive distraction distance (PDD) and the ACD of the ruptured FPL musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the 4th flexor digitorum superficialis (FDS). Patients were evaluated with total active motion (TAM) before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disability of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and of tendon transfer were compared. Results: Tendon grafting was performed in 4 patients, and tendon transfer was performed in 7 patients while maintaining finger active motion during surgery. The final follow-up %TAM was 84.3%±12.7% in the tendon transfer group and 80.7%±10.2% in the tendon grafting group. There were no significant differences between tendon transfer and tendon grafting in the final follow-up %TAM and q-DASH scores. Conclusions: The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the ACD and PDD of the ruptured musculotendinous unit during wide-awake surgery. Evaluating the ACD and PDD may be a useful index to assess the ruptured musculotendinous unit. The greatest advantage of the wide-awake tendon reconstruction is that surgeons can evaluate the ruptured musculotendinous unit and measure TAM during surgery while adjusting suture tension. Financial Disclosure: none Acknowledgements: none This report was approved by the Ethics Comitee, University of Toyama (Toyama, Japan) and clinical reaserch number "21-22" was granted. Corresponding auther: Mineyuki Zukawa. MD ©2018American Society of Plastic Surgeons

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“Delayed Post-conditioning with External Volume Expansion (EVE) Improves Survival of Adipose Tissue Grafts in a Murine Model”

Background: External volume expansion (EVE) improves the survival of adipose tissue grafts by pre-operatively conditioning ('pre-conditioning') tissues that will receive the graft. EVE's mechanisms of action (induction of angiogenesis and of adipogenesis) could improve graft survival also when applied post-operatively (post-conditioning). We tested this hypothesis and optimized the parameters of post-operative application of EVE in a murine model. Methods: Fifty-six 8-week-old athymic (nu/nu) mice received dorsal subcutaneous grafts of human lipoaspirate (0.3 ml each) bilaterally before undergoing EVE (left dorsum) or no treatment (right dorsum, controls). EVE was started either on the same day of (Immediate group), two days after (Early group), or one week after surgery (Delayed group). At follow-up, grafts were analyzed for tissue survival, remodeling, adipogenesis, and angiogenesis using histology. Volume retention was assessed by MRI. We subsequently assessed the effects of the Delayed application of EVE adopting a foam-shaped interface (F-EVE) to deliver the treatment. Results: At 28 days follow-up delayed post-conditioning with EVE significantly improved the survival of grafts (+18%) compared to controls (viable graft thickness ratio: 58 ±15% vs 49 ±13%) and increased the density of blood vessels within the graft (+63%: blood vessels/ 10x magnification field: 44 ±12 vs 27 ±11). Other groups did not lead to significant changes. Adoption of F-EVE similarly improved outcomes while further reducing fibrosis within the grafts. Conclusions: Post-operative delayed application of EVE modestly improves the survival of adipose tissue grafts by inducing adipogenesis and angiogenesis. Use of a foam-shaped interface decreases the fibrosis induced in the grafts. # co-first authors Acknowledgments, conflict of interest and role of funding sources disclosure statement: Dr. Orgill receives research funding through grants from Acelity L.P. to Brigham and Women's Hospital and is a consultant for Acelity L.P. All other authors declare no actual or potential conflict of interests: in addition, they disclose no commercial or financial associations, personal or other relationships with other people or organizations that could inappropriately influence the reported manuscript or create a conflict of interest with the information presented. This study was funded by a research grant from Acelity L.P. Inc. to Brigham and Women's Hospital and a research grant by the Gillian Reny Stepping Strong Foundation to Brigham and Women's Hospital. Authorship: All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have seen and agreed to the submitted version of the manuscript and bear responsibility for it. Ethics: The study was carried out under high ethical standards. All the studies have been approved, when required, by the appropriate ethics committee and have been performed in accordance and in conformity to the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments. Meetings at which the paper has been presented: None. Corresponding authors: Dennis P. Orgill (* corresponding author), Tissue Engineering and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, 75 Francis St., Boston MA 02115 (USA). T: 617-732-5456F: 617-730-2855E:dorgill@partners.org ©2018American Society of Plastic Surgeons

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“Craniometric Analysis of Endoscopic Suturectomy for Bilateral Coronal Craniosynostosis.”

Background: Endoscopic suturectomy and helmeting represents a successful first-line surgical treatment for bilateral coronal craniosynostosis. Its effect on cranial morphology has not been previously described. Methods: Patients were identified who had bilateral coronal craniosynostosis treated with endoscopic suturectomy and postoperative helmeting at Boston Children's Hospital between 2005 and 2013 and who received pre- and post-operative CT scans. Two normative patient populations were identified from our trauma registry with CT scans completed at the same age as our pre- and post-treatment scans. Craniometric indices were utilized to quantify the effect of treatment. Results: Twenty-seven patients were identified who underwent bilateral coronal suturectomy. Twelve patients had preoperative and postoperative CT studies. Eight patients (66.7%) were syndromic. The average ages for preoperative and postoperative CT scan was 1.1 months (0.03–2.6) and 19.6 months (10.8–37.5). Thirteen patients with an average age of 1.1 months (0.5–1.6) were identified as a preoperative control group. Fourteen patients with an average age of 18.5 months (15.5–22.9) were identified as a postoperative control group. The anterior cranial height (ACH) stabilized with treatment and the anterior cranial base length increased (ACBL). The ACH:ACBL ratio significantly decreased with treatment (p=0.128). Frontal bossing normalized with endoscopic suturectomy (CS vs control; pre-op: p=0.001, post-op (p=0.8). Cephalic indices also normalized with treatment (CS vs control; pre-op: p=0.02, post-op, p=0.13). No cases of hydrocephalus were observed. Conclusion: Endoscopic suturectomy and helmeting improves anterior turricephaly and corrects frontal bossing and brachycephaly in patients with bilateral coronal craniosynostosis. FD - None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: S. Alex Rottgers MD, Assistant Professor of Plastic Reconstructive Surgery, John Hopkins All Children's Hospital, Division of Plastic and Reconstructive Surgery, 601 Fifth Street South, Suite 306, St. Petersburg, FL. srottge1@jhmi.edu ©2018American Society of Plastic Surgeons

https://ift.tt/2ykCWUC

Evaluation of Donor Morbidity Following Single-Stage Latissimus Dorsi Neuromuscular Transfer for Facial Reanimation

Background: Single-stage latissimus dorsi (LD) neuromuscular transfer has been a valuable option for dynamic smile reanimation. However, there is a paucity of studies evaluating the potential donor morbidity in such cases. The present study aimed to comprehensively analyze the donor morbidity following functional LD muscle transfer. Methods: Patients who underwent single-stage functional LD muscle transfer for smile reanimation between 2002 and 2016 were reviewed. Postoperative complications and functional impairments at the donor sites were evaluated. The Quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for assessing postoperative donor-site function. Results: Sixty patients including 12 pediatric (≤ 18 years) were analyzed. Mean length of a harvested thoracodorsal nerve was 14.9 cm. Fourteen patients were treated with dual innervation technique, in which both a descending and transverse branch of the thoracodorsal nerve were harvested. Donor complications were observed in seven cases; all of them were seroma and resolved by simple aspiration. No other complications including scoliosis and sensory and/or motor disturbances in the upper extremities were encountered. Fifty patients responded to the Quick-DASH questionnaire at a median follow-up period of 51 months. The average score was 2.64 and all but three patients scored less than 10. No variables, including patient age (pediatric versus adult) and the use of dual innervation technique, affected the donor morbidities including the functional deficits. Conclusions: Single-stage LD neuromuscular transfer for facial reanimation might be associated with a low rate of complications and minimal functional morbidity at the donor site. Financial Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at:13thInternational Facial Nerve Symposium, August 3-6, 2017, Los Angeles, CA (Podium) Corresponding Author Contact Information: Dr. Goo-Hyun Mun, MD, Ph D., Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, S. Korea. 135-710.,Tel.: 82-2-3410-2233, Fax: 82-2-3410-0036, E-mail: supramicro@gmail.com ©2018American Society of Plastic Surgeons

https://ift.tt/2yLxmdi

Ipilimumab/Nivolumab-related Opsoclonus-Myoclonus-Ataxia Syndrome Variant in a Patient with Malignant Pleural Mesothelioma

Introduction: Ipilimumab and nivolumab are immune-checkpoint inhibitors commonly used for melanoma. The combination is being investigated for its efficacy against several types of cancer, including malignant pleural mesothelioma. Although immune-related adverse events have been reported in patients receiving immune-checkpoint inhibitors, opsoclonus-myoclonus-ataxia syndrome has never been previously described. Case Presentation: We describe a 74-year-old male with malignant pleural mesothelioma who presented with opsoclonus and marked truncal ataxia ∼10 weeks following immunotherapy with ipilimumab and nivolumab. No myoclonus was present. Oligoclonal bands were detected in cerebrospinal fluid. Treatment with methylprednisolone and intravenous immunoglobulin along with clonazepam and valproic acid resulted in a rapid clinical improvement. A follow-up visit 2 months afterward showed a resolution of opsoclonus and he was able to walk with cane. Conclusions: A variant of opsoclonus-myoclonus-ataxia syndrome may occur following treatment with ipilimumab and nivolumab.

https://ift.tt/2Eo5eD1

Utilizing T-cell Activation Signals 1, 2, and 3 for Tumor-infiltrating Lymphocytes (TIL) Expansion: The Advantage Over the Sole Use of Interleukin-2 in Cutaneous and Uveal Melanoma

In this study, we address one of the major critiques for tumor-infiltrating lymphocyte (TIL) therapy—the time needed for proper expansion of a suitable product. We postulated that T-cell receptor activation in the first phase of expansion combined with an agonistic stimulation of CD137/4-1BB and interleukin-2 would favor preferential expansion of CD8+ TIL. Indeed, this novel 3-signal approach for optimal T-cell activation resulted in faster and more consistent expansion of CD8+CD3+ TIL. This new method allowed for successful expansion of TIL from cutaneous and uveal melanoma tumors in 100% of the cultures in

https://ift.tt/2RSHRV3

The Hexavalent CD40 Agonist HERA-CD40L Induces T-Cell–mediated Antitumor Immune Response Through Activation of Antigen-presenting Cells

CD40 ligand (TNFSF5/CD154/CD40L), a member of the tumor necrosis factor (TNF) superfamily is a key regulator of the immune system. The cognate receptor CD40 (TNFRSF5) is expressed broadly on antigen-presenting cells and many tumor types, and has emerged as an attractive target for immunologic cancer treatment. Most of the CD40 targeting drugs in clinical development are antibodies which display some disadvantages: their activity typically depends on Fcγ receptor–mediated crosslinking, and depletion of CD40-expressing immune cells by antibody-dependent cellular cytotoxicity compromises an efficient antitumor response. To overcome the inadequacies of antibodies, we have developed the hexavalent receptor agonist (HERA) Technology. HERA compounds are fusion proteins composed of 3 receptor binding domains in a single chain arrangement, linked to an Fc-silenced human IgG1 thereby generating a hexavalent molecule. HERA-CD40L provides efficient receptor agonism on CD40-expressing cells and, importantly, does not require FcγR-mediated crosslinking. Strong activation of NFκB signaling was observed upon treatment of B cells with HERA-CD40L. Monocyte treatment with HERA-CD40L promoted differentiation towards the M1 spectrum and repolarization of M2 spectrum macrophages towards the M1 spectrum phenotype. Treatment of in vitro co-cultures of T and B cells with HERA-CD40L–triggered robust antitumor activation of T cells, which depended upon direct interaction with B cells. In contrast, bivalent anti-CD40 antibodies and trivalent soluble CD40L displayed weak activity which critically depended on crosslinking. In vivo, a murine surrogate of HERA-CD40L–stimulated clonal expansion of OT-I–specific murine CD8+ T cells and showed single agent antitumor activity in the CD40− syngeneic MC38-CEA mouse model of colorectal cancer, suggesting an involvement of the immune system in controlling tumor growth. We conclude that HERA-CD40L is able to establish robust antitumor immune responses both in vitro and in vivo.

https://ift.tt/2EoTtMT

Hemofiltration Successfully Eliminates Severe Cytokine Release Syndrome Following CD19 CAR-T-Cell Therapy

Cytokine release syndrome (CRS) remains to be a major adverse effect of chimeric antigen receptor T (CAR-T) cell therapy in B-cell acute lymphoblastic leukemia (B-ALL) and lymphoma. It was urgent to explore novel strategy for managing severe CRS. We conducted a clinical trial to assess the safety and efficacy of CD19-targeting CAR-T-cells in the treatment of relapsed and chemotherapy-refractory B-ALL and lymphoma. A 10-year-old boy with B-ALL who never achieved minimal residual disease (MRD) negative status after 5 courses of chemotherapy was enrolled into our study and received a total of 3.19×106/kg autologous CD19 CAR-T-cells. Before CAR-T-cell infusion, naive lymphocytes made up 41.8% of bone marrow cells, which were reduced to 1% at the 14th day after transfusion, with MRD

https://ift.tt/2RUoDyf

Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma: Evaluation of Early Clinical Implementation of an Advanced Therapy Medicinal Product

Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized. Subsequently, application of TIL-therapy was evaluated through semistructured interviews with 26 stakeholders according to 6 CTA domains: clinical, economic, patient-related, organizational, technical, and future. In addition, treatment costs were estimated. A number of barriers to clinical translation were identified in the literature, including: inadequate financial support, lack of regulatory knowledge, risks in using live tissues, and the complex path to market approval. Innovative reimbursement procedures could particularly facilitate translation. The CTA survey of TIL-therapy acknowledged these barriers, and revealed the following facilitators: the expected effectiveness resulting in institutional support for an internal pilot, the results of which led to the inclusion of TIL-therapy in a national coverage with evidence development program, the availability of an in-house pharmacist, quality assurance expertise and a TIL-skilled technician. Institutional and national implementation of TIL-therapy remains complex. The promising clinical effectiveness is expected to facilitate the adoption of TIL-therapy, especially when validated through a randomized controlled trial. Innovative and conditional reimbursement procedures, together with the organization of knowledge transfer, could support and improve clinical translation of TIL and ATMPs.

https://ift.tt/2Esw2SO

Determinants of Fasting Hyperglucagonemia in Patients with Type 2 Diabetes and Nondiabetic Control Subjects

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2EqYJ2y

Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2RUhSwv

c-Myc Is a Major Determinant for Antitumor Activity of Aurora A Kinase Inhibitor MLN8237 in Thyroid Cancer

Thyroid, Ahead of Print.


https://ift.tt/2P7XYPQ

Persistent/Recurrent Differentiated Thyroid Cancer: Clinical and Radiological Characteristics of Persistent Disease and Clinical Recurrence Based on Computed Tomography Analysis

Thyroid, Ahead of Print.


https://ift.tt/2PDo4qW

Pathological Interactions Between Mutant Thyroid Hormone Receptors and Corepressors and Their Modulation by a Thyroid Hormone Analogue with Therapeutic Potential

Thyroid, Ahead of Print.


https://ift.tt/2P22Xl3

Gasless Transaxillary Endoscopic Thyroidectomy with Robotic Assistance: A High-Volume Experience in North America

Thyroid, Ahead of Print.


https://ift.tt/2PDnXM2

Response to Lenvatinib in Children with Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2P1b15F

Comprehensive Transcriptomic and Genomic Profiling of Subtypes of Follicular Variant of Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2PDnTMi

Initial Ablation Ratio: Quantitative Value Predicting the Therapeutic Success of Thyroid Radiofrequency Ablation

Thyroid, Ahead of Print.


https://ift.tt/2P7XXeK

Staphylococcus aureus from patients with chronic rhinosinusitis show minimal genetic association between polyp and non-polyp phenotypes

Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectr...

https://ift.tt/2P14CYi

Effect of adjuvant use of metformin on periodontal treatment: a systematic review and meta-analysis

Abstract

Objective

The aim of the study was to perform a systematic review of the literature regarding the adjuvant effects of metformin on the results of mechanical periodontal treatment.

Methods

First, a search on the PubMed, EMBASE, and Scopus databases was performed up to March 2018. Randomized clinical trials with at least 3 months of follow-up and using metformin associated with mechanical periodontal treatment were included in the review. As comparison group, mechanical or periodontal therapy alone or in combination with placebo. The studies should involve adults with at least 30 years of age diagnosed with chronic periodontitis. For the evaluation of the risk of bias of the articles, the Cochrane Collaboration tool was used.

Results

Studies (1912) were retrieved and 4 were included in the review. The articles are all from the same research center and used metformin in gel at concentrations of 0.5%, 1%, or 1.5%. The majority of included studies presented low risk of bias. A linear meta-analysis was conducted for probing depth and clinical attachment loss outcomes. The results showed a weighted mean difference of 2.12 mm (95% CI 1.83–2.42) and 2.29 mm (95% CI 1.72–2.86) for probing depth and clinical attachment level, respectively, favoring the group exposed to 1% adjunct metformin.

Conclusion

The adjuvant use of metformin may promote an additional benefit to the results of mechanical periodontal therapy.

Clinical significance

The metformin as an adjuvant on periodontal treatment shows potential to reduce needs of additional interventions and also reduces the inflammatory burden in patients.

https://ift.tt/2RXcAR1

Current approaches to instrumental assessment of swallowing in children

Purpose of the review This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. Recent findings Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. Summary Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging. Correspondence to Isuru Dharmarathna, BSc, Speech Science, School of Psychology, Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 923 8177; fax: +64 9 373 7902; e-mail: pdha800@aucklanduni.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Afqnvh

Current approaches to instrumental assessment of swallowing in children

Purpose of the review This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. Recent findings Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. Summary Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging. Correspondence to Isuru Dharmarathna, BSc, Speech Science, School of Psychology, Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 923 8177; fax: +64 9 373 7902; e-mail: pdha800@aucklanduni.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Afqnvh

The speech perception after cochlear implantation: The hearing gain difference according to the implant systems is important?

The outcome of cochlear implantation (CI) is affected by various factors, including the manufacturer of the device. We validated the factors contributing to postoperative performance and evaluated the influence of different company devices on pure tone thresholds and postoperative performance.

https://ift.tt/2P7IYl0

Commentary: Risk Factors for Basal Cell Carcinoma in Men Younger Than 40 Years of Age A Case–Control Study

No abstract available

https://ift.tt/2RQ1n4q

Pleuroparenchymal fibroelastosis as a histological background of autoimmune diseases

Abstract

Patients with autoimmune disease–related interstitial lung disease (AID-ILD) occasionally develop radiologic pleuroparenchymal fibroelastosis (PPFE)–like lesions. However, the significance of AID as an etiology of PPFE has not been fully elucidated. The aim of this study is to verify the increase of elastic fibers in AID-ILD patients and evaluate the prevalence of histological PPFE in patients with AID-ILD. We selected cases of clinically diagnosed AID-ILD and idiopathic pulmonary fibrosis (IPF), in which an autopsy had been performed or in which the patient had undergone pneumonectomy for lung transplantation. We quantified the collagen fibers and elastic fibers in each lobe as the percentage of the non-aerated lung area (collagen fiber score and elastic fiber score, respectively) in histological specimens from a total of 73 patients (AID-ILD, n = 24; IPF, n = 49). There were no significant differences in the collagen fiber scores of the AID-ILD and IPF groups. Meanwhile, the elastic fiber scores of the AID-ILD group were significantly greater than those of the IPF group in the whole lung (17.3 ± 7.70 vs 11.6 ± 4.55), and the upper (16.6 ± 8.11 vs 11.2 ± 5.18), and lower (18.0 ± 9.68 vs 12.0 ± 5.55) lobes (all p < 0.01). Histological PPFE pattern was found in 12 of 24 AID-ILD patients (50%), and histological PPFE pattern as a dominant pattern of fibrosis was found in 2 of the 24 patients (8%). Thus, PPFE can be a manifestation of AID-ILD.

https://ift.tt/2yGMqcc

The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series

The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC).

https://ift.tt/2J3lgRq

Green Light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80 ml

Abstract

To analyze the efficacy of Green Light photoselective vaporization of the prostate (PVP) in elderly high-risk benign prostatic hyperplasia (BPH) patients with glands over 80 ml. From December 2013 to February 2016, we allocated 84 elderly (age 71–97) high-risk patients who underwent preoperative transrectal ultrasound (TRUS) examination with glands over 80 ml and divided them into two groups to receive 120 W (n = 40) and 180 W (n = 44) PVP. All the patients have been observed at least one intraoperative comorbidity: hypertension, diabetes mellitus, NYHA II, or combined. They were followed up for 12 months. All the conventional parameters were compared in this study. All the patients received successful operations without severe complications, and no patient needed blood transfusion. The operation time and catheterization time of the 180 W patients were significantly shorter than that of the 120 W patients (p < 0.05). The International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, maximum flow rate (Qmax), and residual urine volume (RUV) in both groups have been significantly improved. PVP is safe and effective for high-risk aging patients with gland over 80 ml. In addition, 180 W XPS system has a short operation time and catheterization time and less inflammatory response.

https://ift.tt/2RSi27u

Effects of low-level laser therapy on soft and hard tissue healing after endodontic surgery

Abstract

The aim of this prospective study was to examine possible benefits of low-level laser therapy (LLLT) on soft and hard tissue healing after endodontic surgery. Seventy-six endo-surgery cases on maxillary incisors were included. The patients were assigned randomly into control and laser groups. In the laser group, gallium-aluminum-arsenide (GaAlAs) diode laser irradiation (810 nm, 129 mW, 3.87 J/cm²) was performed immediately after surgery and daily for postoperative 7 days from buccal and palatal surfaces (5 min for each side). In the control group, patients were not subjected laser therapy. The patients were compared in terms of pain, clinical and radiological findings, and life quality indexes [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)]. Seventy-one patients completed the study (n = 37 for control group, n = 34 for laser group). The laser group showed better results in edema, wound healing, and the number of analgesic tablets used on the 1st, 3rd, and 7th postoperative days. Significant reduction in ecchymoses was observed in the laser group on the postop 3rd and 7th days. The patients had significantly lower pain on the 1st and 3rd postop days in laser group. The laser group showed significantly better results in OHIP-14 and GOHA indexes on postop days 1 and 3. The laser group showed significantly favorable results in terms of bone density, defect volume and area, and periapical index in the postop 3rd month. This study concluded that LLLT improved soft and hard tissue healing after endodontic surgery and also showed favorable effects on pain and life quality of patients especially in the early phase of healing period.

https://ift.tt/2ErxVz8

Correction to: Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans

The author found small mistakes in scientific content of article. Editor-in-Chief confirmed that mistakes do not change or invalidate conclusions of article.

https://ift.tt/2RPoufs

Appropriate laser wavelengths for photodynamic therapy with methylene blue

https://ift.tt/2ErxNzE

Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures

Abstract

The aim of the present work was to measure the fracture resistance of endodontically treated teeth that were apicoected with different procedures. Seventy-two extracted human maxillary anterior teeth were included in this study. The specimens were randomly assigned to three main groups according to the apical surgery procedures and then two subgroups according to the irrigation protocols during root canal treatment and total of six groups were obtained (n = 12). Group 1: served as a control and apical surgery process was not performed in this group. Group 2: apical surgery process was performed with tungsten carbide fissure bur Group 3: apical surgery process was performed with Er:YAG laser. Subgroup a: In this group, the specimens were irrigated with %5 NaOCl. Subgroup b: 15% EDTA solution was filled into the root canal and then agitated using a 1.5 W/100 Hz diode laser. The specimens were filled and mounted in acrylic resin blocks and compression strength test was performed. Statistical analysis was performed using two-way ANOVA. The statistical analysis revealed that there were no statistical significant differences between apical surgery procedures (groups 1, 2, and 3) (p < 0.05). Apical resection procedures did not affect the fracture resistance Significant differences were determined between the subgroups (p < 0.05). Agitation of the EDTA with the diode laser reduced the fracture resistance of the specimens. The different canal irrigation techniques altered resistance to fracture; however, apical surgery procedures did not altered the resistance to fracture when compared with the control group.

https://ift.tt/2RUXcEp

Cosmetics, Vol. 5, Pages 61: Endocrine Disruption by Mixtures in Topical Consumer Products

Cosmetics, Vol. 5, Pages 61: Endocrine Disruption by Mixtures in Topical Consumer Products

Cosmetics doi: 10.3390/cosmetics5040061

Authors: Emiliano Ripamonti Elena Allifranchini Stefano Todeschi Elena Bocchietto

Endocrine disruption has been gathering increasing attention in the past 25 years as a possible new threat for health and safety. Exposure to endocrine disruptor has been progressively linked with a growing number of increasing disease in the human population. The mechanics through which endocrine disruptors act are not yet completely clear, however a number of pathways have been identified. A key concern is the cumulative and synergic effects that endocrine disruptors could have when mixed in consumer products. We reviewed the available literature to identify known or potential endocrine disruptors, as well as endocrine active substances that could contribute to cumulative effects, in topical consumer products. The number of endocrine actives used daily in consumer products is staggering and even though most if not all are used in concentrations that are considered to be safe, we believe that the possibility of combined effects in mixtures and non-monotonic dose/response is enough to require further precautions. A combined in vitro approach based on existing, validated OECD test methods is suggested to screen consumer products and mixtures for potential interaction with estrogen and androgen hormone receptors, in order to identify products that could have cumulative effects or support their safety concerning direct endocrine disruption capabilities.

https://ift.tt/2CO4AgE

The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series

Abstract

Background

The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC).

Methods

Data of patients with stage IVb LHSCC who received induction chemotherapy for the purpose of tumor resection between January 2007 and January 2016 were retrospectively collected. Definitive surgery with postoperative adjuvant therapy was performed in patients whose tumors became resectable (resectable group). Chemoradiotherapy, radiotherapy, or supportive care was considered in patients whose tumors remained unresectable (unresectable group).

Results

Thirty-two patients were identified; the tumor resectability rate after induction chemotherapy was approximately 56%. The median overall survival (OS) rates of the resectable and unresectable groups were 20.0 months (range, 16.0–35.5 months) and 9.5 months (range, 6.0–15.0 months), respectively (p = 0.008). The estimated 2-year OS rates of the resectable and unresectable groups were 59.5% (95% confidence interval [CI], 33.2–78.3%) and 10.7% (95% CI, 1.1–35.4%), respectively (p = 0.008). The estimated 2-year disease-free survival (DFS) rates of the resectable and unresectable groups were 53.5% (95% CI, 27.9–73.6%), and 14.3% (95% CI, 2.3–36.6%), respectively (p = 0.009). On multivariate analysis, factors positively impacting OS and DFS in all patients were surgical resection, a laryngeal primary site, and induction chemotherapy with docetaxel, cisplatin, and fluorouracil.

Conclusions

In advanced unresectable stage IVb LHSCC patients, surgical resection following induction chemotherapy appears to improve survival outcomes.

https://ift.tt/2Ad4kFw

Radiation Oncology Mobile Application

Conditions:   Head and Neck Cancer;   Radiation Toxicity
Intervention:  
Sponsor:   King Hussein Cancer Center
Not yet recruiting

https://ift.tt/2RUVnro

Phase III Study of Camrelizumab in Combination With Chemotherapy in Recurrent/Metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Camrelizumab;   Drug: Placebos;   Drug: Gemcitabine;   Drug: Cisplatin
Sponsor:   Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting

https://ift.tt/2EmUpBn

The Effect of Functional Exercises on Balance With Postural Thoracic Kyphosis

Conditions:   Postural Kyphosis;   Balance
Interventions:   Behavioral: The Group I Postural Exercise;   Behavioral: The Group II Three-dimensional Exercise Therapy Program
Sponsor:   Istanbul Medipol University Hospital
Recruiting

https://ift.tt/2RMKS9r

Genetic Analysis of Blood and Tissue Samples From Participants With Advanced Cancer

Conditions:   Advanced Melanoma;   Advanced Renal Cell Carcinoma;   Anatomic Stage III Breast Cancer AJCC v8;   Anatomic Stage IIIA Breast Cancer AJCC v8;   Anatomic Stage IIIB Breast Cancer AJCC v8;   Anatomic Stage IIIC Breast Cancer AJCC v8;   Anatomic Stage IV Breast Cancer AJCC v8;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Prognostic Stage III Breast Cancer AJCC v8;   Prognostic Stage IIIA Breast Cancer AJCC v8;   Prognostic Stage IIIB Breast Cancer AJCC v8;   Prognostic Stage IIIC Breast Cancer AJCC v8;   Prognostic Stage IV Breast Cancer AJCC v8;   Stage III Colorectal Cancer AJCC v8;   Stage III Lung Cancer AJCC v8;   Stage III Ovarian Cancer AJCC v8;   Stage III Prostate Cancer AJCC v8;   Stage IIIA Colorectal Cancer AJCC v8;   Stage IIIA Lung Cancer AJCC v8;   Stage IIIA Ovarian Cancer AJCC v8;   Stage IIIA Prostate Cancer AJCC v8;   Stage IIIA1 Ovarian Cancer AJCC v8;   Stage IIIA2 Ovarian Cancer AJCC v8;   Stage IIIB Colorectal Cancer AJCC v8;   Stage IIIB Lung Cancer AJCC v8;   Stage IIIB Ovarian Cancer AJCC v8;   Stage IIIB Prostate Cancer AJCC v8;   Stage IIIC Colorectal Cancer AJCC v8;   Stage IIIC Lung Cancer AJCC v8;   Stage IIIC Ovarian Cancer AJCC v8;   Stage IIIC Prostate Cancer AJCC v8;   Stage IV Colorectal Cancer AJCC v8;   Stage IV Lung Cancer AJCC v8;   Stage IV Ovarian Cancer AJCC v8;   Stage IV Prostate Cancer AJCC v8;   Stage IVA Colorectal Cancer AJCC v8;   Stage IVA Lung Cancer AJCC v8;   Stage IVA Ovarian Cancer AJCC v8;   Stage IVA Prostate Cancer AJCC v8;   Stage IVB Colorectal Cancer AJCC v8;   Stage IVB Lung Cancer AJCC v8;   Stage IVB Ovarian Cancer AJCC v8;   Stage IVB Prostate Cancer AJCC v8;   Stage IVC Colorectal Cancer AJCC v8
Intervention:   Procedure: Biospecimen Collection
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2EnJmYH

Safety, Tolerability and Efficacy Profile of Rivoceranib With Paclitaxel in Advanced GC or GEJ Cancer.

Conditions:   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Rivoceranib;   Drug: Paclitaxel
Sponsor:   LSK BioPartners Inc.
Not yet recruiting

https://ift.tt/2RW9Sez

Back Pain in Medical Students at The University of the West Indies, Mona, Jamaica

Condition:   Back Pain
Intervention:   Other: Spine Exercise Program
Sponsor:   The University of The West Indies
Not yet recruiting

https://ift.tt/2EkHuQi

CAR T and PD-1 Knockout Engineered T Cells for Esophageal Cancer

Condition:   Advanced Esophageal Cancer
Interventions:   Biological: Anti-MUC1 CAR-T cells;   Biological: PD-1 knockout Engineered T cells;   Combination Product: CAR-T combined with PD-1 Knockout T cells
Sponsors:   The First Affiliated Hospital of Guangdong Pharmaceutical University;   Guangzhou Anjie Biomedical Technology Co;LTD
Recruiting

https://ift.tt/2RUNxxD

A Study to Compare Efficacy and Safety of DRT VS CRT Plus Surgery in Patients Who Achieved CCR for Esophageal Cancer

Conditions:   Stage II Esophageal Cancer;   Stage III Esophageal Cancer
Interventions:   Combination Product: Definitive Radiochemotherapy;   Combination Product: Neoadjuvant Radiochemotherapy
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Cancer Institute and Hospital, Chinese Academy of Medical Sciences;   Sun Yat-sen University;   Beijing Cancer Hospital
Not yet recruiting

https://ift.tt/2EmU0yR

Radiation Oncology Mobile Application

Conditions:   Head and Neck Cancer;   Radiation Toxicity
Intervention:  
Sponsor:   King Hussein Cancer Center
Not yet recruiting

https://ift.tt/2RUVnro

Phase III Study of Camrelizumab in Combination With Chemotherapy in Recurrent/Metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Camrelizumab;   Drug: Placebos;   Drug: Gemcitabine;   Drug: Cisplatin
Sponsor:   Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting

https://ift.tt/2EmUpBn

The Effect of Functional Exercises on Balance With Postural Thoracic Kyphosis

Conditions:   Postural Kyphosis;   Balance
Interventions:   Behavioral: The Group I Postural Exercise;   Behavioral: The Group II Three-dimensional Exercise Therapy Program
Sponsor:   Istanbul Medipol University Hospital
Recruiting

https://ift.tt/2RMKS9r

Genetic Analysis of Blood and Tissue Samples From Participants With Advanced Cancer

Conditions:   Advanced Melanoma;   Advanced Renal Cell Carcinoma;   Anatomic Stage III Breast Cancer AJCC v8;   Anatomic Stage IIIA Breast Cancer AJCC v8;   Anatomic Stage IIIB Breast Cancer AJCC v8;   Anatomic Stage IIIC Breast Cancer AJCC v8;   Anatomic Stage IV Breast Cancer AJCC v8;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Prognostic Stage III Breast Cancer AJCC v8;   Prognostic Stage IIIA Breast Cancer AJCC v8;   Prognostic Stage IIIB Breast Cancer AJCC v8;   Prognostic Stage IIIC Breast Cancer AJCC v8;   Prognostic Stage IV Breast Cancer AJCC v8;   Stage III Colorectal Cancer AJCC v8;   Stage III Lung Cancer AJCC v8;   Stage III Ovarian Cancer AJCC v8;   Stage III Prostate Cancer AJCC v8;   Stage IIIA Colorectal Cancer AJCC v8;   Stage IIIA Lung Cancer AJCC v8;   Stage IIIA Ovarian Cancer AJCC v8;   Stage IIIA Prostate Cancer AJCC v8;   Stage IIIA1 Ovarian Cancer AJCC v8;   Stage IIIA2 Ovarian Cancer AJCC v8;   Stage IIIB Colorectal Cancer AJCC v8;   Stage IIIB Lung Cancer AJCC v8;   Stage IIIB Ovarian Cancer AJCC v8;   Stage IIIB Prostate Cancer AJCC v8;   Stage IIIC Colorectal Cancer AJCC v8;   Stage IIIC Lung Cancer AJCC v8;   Stage IIIC Ovarian Cancer AJCC v8;   Stage IIIC Prostate Cancer AJCC v8;   Stage IV Colorectal Cancer AJCC v8;   Stage IV Lung Cancer AJCC v8;   Stage IV Ovarian Cancer AJCC v8;   Stage IV Prostate Cancer AJCC v8;   Stage IVA Colorectal Cancer AJCC v8;   Stage IVA Lung Cancer AJCC v8;   Stage IVA Ovarian Cancer AJCC v8;   Stage IVA Prostate Cancer AJCC v8;   Stage IVB Colorectal Cancer AJCC v8;   Stage IVB Lung Cancer AJCC v8;   Stage IVB Ovarian Cancer AJCC v8;   Stage IVB Prostate Cancer AJCC v8;   Stage IVC Colorectal Cancer AJCC v8
Intervention:   Procedure: Biospecimen Collection
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2EnJmYH

Safety, Tolerability and Efficacy Profile of Rivoceranib With Paclitaxel in Advanced GC or GEJ Cancer.

Conditions:   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Rivoceranib;   Drug: Paclitaxel
Sponsor:   LSK BioPartners Inc.
Not yet recruiting

https://ift.tt/2RW9Sez

Back Pain in Medical Students at The University of the West Indies, Mona, Jamaica

Condition:   Back Pain
Intervention:   Other: Spine Exercise Program
Sponsor:   The University of The West Indies
Not yet recruiting

https://ift.tt/2EkHuQi

CAR T and PD-1 Knockout Engineered T Cells for Esophageal Cancer

Condition:   Advanced Esophageal Cancer
Interventions:   Biological: Anti-MUC1 CAR-T cells;   Biological: PD-1 knockout Engineered T cells;   Combination Product: CAR-T combined with PD-1 Knockout T cells
Sponsors:   The First Affiliated Hospital of Guangdong Pharmaceutical University;   Guangzhou Anjie Biomedical Technology Co;LTD
Recruiting

https://ift.tt/2RUNxxD

A Study to Compare Efficacy and Safety of DRT VS CRT Plus Surgery in Patients Who Achieved CCR for Esophageal Cancer

Conditions:   Stage II Esophageal Cancer;   Stage III Esophageal Cancer
Interventions:   Combination Product: Definitive Radiochemotherapy;   Combination Product: Neoadjuvant Radiochemotherapy
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Cancer Institute and Hospital, Chinese Academy of Medical Sciences;   Sun Yat-sen University;   Beijing Cancer Hospital
Not yet recruiting

https://ift.tt/2EmU0yR

Environmental and Life-Style Related Risk Factors for Sinonasal and Nasopharyngeal Malignancies among a Prospective Cohort in Jos, Nigeria

Background. Worldwide evidence indicates that environmental and life-style related factors are associated with increased risk for cancers in the head and neck region. We aim to study the association between these risk factors and cancers in the sinonasal and nasopharyngeal regions in our environment. Methods. Longitudinal prospective cohort study at the Jos University Teaching Hospital, Jos, Nigeria. Risk exposures were classified based on the International Agency for the Research on Cancer (IARC) classification of suspected carcinogens. Associations between variables were analyzed using logistic regression. Results. We studied 44 patients with malignancies in nasopharynx (n= 24; 54.5%) and sinonasal regions (n= 20; 45.5%). Male to female ratio is 1.9:1 and mean age is 45.2 years. Alcohol was the commonest risk factor in males (n= 19; 43.2%) while cooking wood fumes were the commonest in females (n= 14; 31.8%) which was associated with increased risk for malignancies for all sites, showing ten times risk in nasal cancers (OR= 9.67; 95% CI 1.87- 9.88; p= 0.01). Tobacco was associated with elevated risk of malignancies in the nasomaxillary and nasal regions. Other risks were herbicides, pesticides, and chemical fertilizers in farmers. Conclusion. The significant risk exposures in females were cooking wood fumes and alcohol, tobacco, and exposure to agricultural chemicals in males. Life-style modification and environmental changes to ensure clean air in Nigeria are essential to reduce risks.

https://ift.tt/2EqmZlr

Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM)

Abstract

Thyroid ultrasonography (US) is the gold standard for thyroid imaging and its widespread use is due to an optimal spatial resolution for superficial anatomic structures, a low cost and the lack of health risks. Thyroid US is a pivotal tool for the diagnosis and follow-up of autoimmune thyroid diseases, for assessing nodule size and echostructure and defining the risk of malignancy in thyroid nodules. The main limitation of US is the poor reproducibility, due to the variable experience of the operators and the different performance and settings of the equipments. Aim of this consensus statement is to standardize the report of thyroid US through the definition of common minimum requirements and a correct terminology. US patterns of autoimmune thyroid diseases are defined. US signs of malignancy in thyroid nodules are classified and scored in each nodule. We also propose a simplified nodule risk stratification, based on the predictive value of each US sign, classified and scored according to the strength of association with malignancy, but also to the estimated reproducibility among different operators.

https://ift.tt/2yp6mRz

Effect of air-blowing time and long-term storage on bond strength of universal adhesives to dentin

Abstract

Objectives

To evaluate the effects of air-blowing time and storage time on microtensile bond strength (μTBS) of universal adhesives to dentin.

Materials and methods

Ninety flat dentin surfaces from extracted human third molars were bonded with three universal adhesives (Clearfil Universal Bond-CU; G-Premio Bond-GP; Scotchbond Universal Adhesives-SB). Bonded dentin surfaces were air-dried for 5 s, 15 s, or 30 s followed by resin composite built-up. Resin-dentin beams were tested with μTBS test after different storage time in distilled water (24 h and 1 year). Data were analyzed by three-way ANOVA and Duncan test at (α = 0.05). Failure mode and resin-dentin interfaces were observed using a scanning electron microscope (SEM). Specific features of fractured beams after μTBS were further observed using SEM at high magnification.

Results

Extension of air-blowing time from 5 s to 30 s increased the 24 h μTBS of CU only. Bond strength of all adhesives significantly decreased after 1-year storage except for CU at 5 s and 30 s of air-blowing time. One-year μTBS were significantly higher when air-blowing times were extended to 15 s for SB and 30 s for CU. Air-blowing time had no influence on GP.

Conclusion

The effect of air-blowing time and storage time on resin-dentin bond was material-dependent.

Clinical relevance

Extended air-blowing time increased the bond strength and bond durability of CU. Extension of air-blowing time to 15 s and 30 s improve the long-term bond strength of SB and CU, respectively.

https://ift.tt/2NHIw8s

Bilateral subdural empyemas with meningitis secondary to acute barosinusitis

Publication date: Available online 15 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): J. Sung, O. Kwon, D. Kim, K. Kim

Abstract

Introduction

Intracranial complications of acute rhinosinusitis are rare, but may turn life-threatening.

Case summary

We report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae.

Conclusion

To the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.

https://ift.tt/2yGll9c

Congenital bilateral dacryocystocele

Publication date: Available online 15 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Pedro Carneiro de Sousa, Marta Neves, Delfim Duarte, Paula Azevedo

Abstract

Introduction

Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral dacryocystocele is a possible etiology for neonatal respiratory distress.

Case summary

Case report of a male newborn with respiratory distress caused by a bilateral polypoid and bluish lesion occupying almost the entire inferior nasal meatus. Imaging confirmed bilateral dacryocystocele. Treatment was conservative. There was spontaneous drainage, with relief of respiratory distress. Discussion The diagnosis of congenital dacryocystocele is clinical, although imaging exams may be requested to confirm it. Treatment is controversial, because the natural history is variable. An initial conservative management may be recommended, but, if there is a permanent respiratory obstruction without improvement, surgical management is mandatory.

https://ift.tt/2yl6stA

Rekonstruktive Orbitachirurgie

Zusammenfassung

Hintergrund

Komplexe Orbitarekonstruktionen erfordern die korrekte und sorgfältige Wiederherstellung der Hart- und Weichgewebe als Voraussetzung für ein ästhetisches und funktionelles Resultat. Der Einsatz der computerassistierten Chirurgie („computer-assisted surgery", CAS) kann den Operateur vor und während der Rekonstruktion sowie im Rahmen der Qualitätskontrolle maßgeblich unterstützen. Dies soll allgemein sowie mithilfe von 3 klinischen Beispielen erläutert werden.

Material und Methoden

Anhand eines 3D-Datensatzes werden die zu rekonstruierenden Strukturen und deren Umgebung erfasst. Einen Anhalt für die erwünschte Rekonstruktion bietet meist die nichtbetroffene Gegenseite durch Spiegelung. Das erzeugte virtuelle Modell kann nun zur Herstellung patientenspezifischer Modelle und Implantate, intraoperativ per Navigation oder zur direkten Qualitätskontrolle mithilfe des intraoperativen Röntgens genutzt werden.

Ergebnisse

Zur Rekonstruktion primärer und sekundärer traumatologischer Defekte sowie im Rahmen angeborener Fehlbildungen oder neoplastischer Erkrankungen kann der beschriebene Arbeitsablauf zum Einsatz kommen. Virtuelle Visualisierung, patientenspezifische Rekonstruktionen und direkte Qualitätskontrolle mithilfe des intraoperativen Röntgens erzielen ein planungskonformes Ergebnis. Unter Einhaltung des Wechselspiels von Hart- und Weichgewebe werden bestmögliche Rekonstruktionen erreicht.

Schlussfolgerung

Die CAS hat sich in den letzten Jahren stetig weiterentwickelt und ist im klinischen Alltag im Einsatz. Patientenspezifische Implantate in Kombination mit der direkten intraoperativen Qualitätskontrolle erleichtern die Rekonstruktion komplexer Orbitaverletzungen und -defekte und ermöglichen die ideale Rekonstruktion sowohl aus ästhetischen als auch funktionellen Aspekten.

https://ift.tt/2ynXdsm

Treatment of early-stage laryngeal cancer: A comparison of treatment options

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Brandon Jackson Baird, C. Kwang Sung, Beth M. Beadle, Vasu Divi

Abstract

Over the course of the last several decades, the treatment options for early laryngeal cancers (T1 and T2) have evolved; however, simultaneously the mortality rate has increased. As larynx preservation approaches have become the standard of care, the selection of the proper treatment modality has become paramount. Radiation therapy or transoral laser microsurgery are the most common options for treatment of these early lesions. Oncologic and functional outcomes are considered equivalent between the two modalities for early glottic cancers; however, no direct comparisons exist for robust analysis. In terms of larynx preservation, there also is not compelling data favoring one treatment option or another. For early stage lesions, the goal for any larynx-sparing technique, either radiation or surgery, should be the intent to cure with single modality treatment and minimal short- and long-term toxicity. This article is designed to create a frame of reference for managing early stage disease with respect to lesions of the glottis and supraglottis while weighing treatment implications from an oncologic, functional, and cost perspective.

https://ift.tt/2IYduZ5

Endoscopic Management of Subperiosteal Orbital Abscesses

Publication date: Available online 16 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Christopher Pool, Johnathan McGinn

Abstract

While the progression of acute rhinosinusitis to orbital infections has decreased in the modern antibiotic era, they still occur, particularly in the pediatric population. Infection may spread from the nasal cavity and sinuses via direct extension into the orbit through the thin lamina papyracea or through the valveless veins in the bony orbital wall.¹ Congenital dehiscence and trauma also allow for direct extension of the infection to the orbit.¹ Most of these orbital infections originate in the ethmoid sinuses and subperiosteal abscesses most commonly occur along the medial orbital wall. However, the frontal sinus is implicated in superior abscesses in older children and adults. Postseptal orbital infections require prompt diagnosis and treatment as they may impact vision and progress centrally, manifesting as cavernous sinus and intracranial infections associated with significant morbidity and mortality.2, 3

https://ift.tt/2AcQzXg

Investigating mobility of crude oil adsorbates on mineral surfaces by NMR

Publication date: Available online 15 October 2018

Source: Magnetic Resonance Imaging

Author(s): Henrik N. Sørgård, Christian Totland, Willy Nerdal, John Georg Seland

Abstract

We have applied diffusion and relaxation Nuclear Magnetic Resonance experiments to investigate the translational and rotational mobility of adsorbents on quartz and calcite mineral surfaces. On both surfaces it was found that water is the dominant molecule. On the quartz surface the majority of water molecules have a relatively high degree of both rotational and translational mobility, while a minor fraction of water molecules, and all hydrocarbon molecules, have a significantly lower mobility. On the calcite surface the translational mobility is very low for all the adsorbed molecules, while there is a large diversity in rotational mobility, indicating that the hydrocarbon molecules are strongly attached to the surface, but that some part of each molecule still have a large degree of rotational mobility. Diffusion and relaxation experiments give a detailed description of both the molecular mobility of adsorbed species on these mineral surfaces, which leads to new insight with respect to aging processes on a molecular level.

https://ift.tt/2yGwuXo

Under-sampling and compressed sensing of 3D spatially-resolved displacement propagators in porous media using APGSTE-RARE MRI

Publication date: Available online 15 October 2018

Source: Magnetic Resonance Imaging

Author(s): Daan W. de Kort, Stefan A. Hertel, Matthias Appel, Hilko de Jong, Michael D. Mantle, Andrew J. Sederman, Lynn F. Gladden

Abstract

A method for under-sampling and compressed sensing of 3D spatially-resolved propagators is presented and demonstrated for flow in a packed bed and a heterogeneous carbonate rock. By sampling only 12.5% of q,k-space, the experimental acquisition time was reduced by almost an order of magnitude. In particular, for both systems studied, a 3D image was acquired at 1 mm isotropic spatial resolution such that 134,400 local propagators were obtained. Data were acquired in ~1 h and ~11 h for the packed bed and rock, respectively. It is shown that spatial resolution and under-sampling using this implementation retains the quantitative nature of the propagator measurement, and differences between implementation of this measurement in two and three dimensions are identified. The potential for 3D spatially-resolved propagators to provide new insights into transport processes in porous media by characterisation of the statistical moments of the propagators is discussed.

Graphical abstract

https://ift.tt/2yjUEI0

Long-chain omega-3 polyunsaturated fatty acids decrease mammary tumor growth, multiorgan metastasis and enhance survival

Abstract

Epidemiological studies show a reduced risk of breast cancer (BC) in women consuming high levels of long-chain (LC) omega-3 (ω-3) fatty acids (FAs) compared with women who consumed low levels. However, the regulatory and mechanistic roles of dietary ω-6 and LC-ω-3 FAs on tumor progression, metastasis and survival are poorly understood. Female BALB/c mice (10-week old) were pair-fed with a diet containing ω-3 or an isocaloric, isolipidic ω-6 diet for 16 weeks prior to the orthotopic implantation of 4T1 mammary tumor cells. Major outcomes studied included: mammary tumor growth, survival analysis, and metastases analyses in multiple organs including pulmonary, hepatic, bone, cardiac, renal, ovarian, and contralateral MG (CMG). The dietary regulation of the tumor microenvironment was evaluated in mice autopsied on day-35 post tumor injection. In mice fed the ω-3 containing diet, there was a significant delay in tumor initiation and prolonged survival relative to the ω-6 diet-fed group. The tumor size on day 35 post tumor injection in the ω-3 group was 50% smaller and the frequencies of pulmonary and bone metastases were significantly lower relative to the ω-6 group. Similarly, the incidence/frequencies and/or size of cardiac, renal, ovarian metastases were significantly lower in mice fed the ω-3 diet. The analyses of the tumor microenvironment showed that tumors in the ω-3 group had significantly lower numbers of proliferating tumor cells (Ki67⁺)/high power field (HPF), and higher numbers of apoptotic tumor cells (TUNEL⁺)/HPF, lower neo-vascularization (CD31⁺ vessels/HPF), infiltration by neutrophil elastase⁺ cells, and macrophages (F4/80⁺) relative to the tumors from the ω-6 group. Further, in tumors from the ω-3 diet-fed mice, T-cell infiltration was 102% higher resulting in a neutrophil to T-lymphocyte ratio (NLR) that was 76% lower (p < 0.05). Direct correlations were observed between NLR with tumor size and T-cell infiltration with the number of apoptotic tumor cells. qRT-PCR analysis revealed that tumor IL10 mRNA levels were significantly higher (six-fold) in the tumors from mice fed the ω-3 diet and inversely correlated with the tumor size. Our data suggest that dietary LC-ω-3FAs modulates the mammary tumor microenvironment slowing tumor growth, and reducing metastases to both common and less preferential organs resulting in prolonged survival. The surrogate analyses undertaken support a mechanism of action by dietary LC-ω-3FAs that includes, but is not limited to decreased infiltration by myeloid cells (neutrophils and macrophages), an increase in CD3⁺ lymphocyte infiltration and IL10 associated anti-inflammatory activity.

https://ift.tt/2P6Jtw0

Effect of a structured plaque control on MMP-1 and MMP-9 crevicular levels in patients with desquamative gingivitis associated with oral lichen planus

Abstract

Objectives

No data are available in the literature on the extent to which the immune host-response and bacterial-elicited inflammation separately contributes to the increase in gingival crevicular fluid (GCF) levels of inflammatory biomarkers in patients affected by desquamative gingivitis (DG) secondary to oral lichen planus (OLP). The aim of this study was to investigate the effect of a structured plaque control intervention on GCF levels of MMP-1 and MMP-9 in OLP patients with DG and to compare them with those of non-OLP patients.

Materials and methods

The study population consisted of 18 unrelated Caucasian patients with DG, while 18 periodontally healthy subjects were recruited for the control group. Periodontal parameters and GCF biomarker amounts were evaluated at baseline and 2 months after a structured plaque control intervention, comprising professional oral hygiene sessions, manual toothbrushing, and interdental cleaning advice, only for DG patients. Determination of MMP-1 and MMP-9 levels was carried out by means of an enzyme-linked immunosorbent assay.

Results

Plaque control program led to improvement in all examined clinical parameters and resulted in significant decrease in GCF total amount and concentration of MMP-1 and MMP-9 in comparison to baseline (p < 0.001). However, MMP-1 and MMP-9 levels in DG patients were still significantly higher than those in the healthy control group (p < 0.01).

Conclusions

These findings would seem to support an intrinsic upregulated expression of MMPs in DG patients that is exacerbated by bacterial plaque.

Clinical relevance

The present outcomes provide further scientific grounds for the importance of strict professional oral hygiene sessions in DG patients.

https://ift.tt/2QQitOr

Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches

Abstract

Objectives

The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants.

Materials and methods

This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests.

Results

There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011).

Conclusions

QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion.

Clinical relevance

Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

https://ift.tt/2PCh7q6

Does endoscopic stapedotomy increase hearing restoration rates comparing to microscopic? A systematic review and meta-analysis

Abstract

Objective

To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery.

Methods

MEDLINE, the Cochrane Library and Web of Science databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic stapedotomy in patients with otosclerosis or congenital stapedial fixation were included. Achievement of a postoperative air-bone gap ≤ 10 decibel was the primary outcome. Secondary outcomes were postoperative dysgeusia, scutum drilling and operation time. In case of homogenous, processable data (I² < 60%) a meta-analysis was performed. Odds ratio (OR) and Chi-square test were used to compare the two methods.

Results

Seven studies met the inclusion criteria. The OR analysis showed no significant differences between the two methods (OR 1.41, 95%CI [0.84, 2.38]), but goodness-of-fit analysis showed a correlation of endoscopic stapedotomy with normal hearing restoration (p = 0.00). Dysgeusia and scutum drilling took place significantly less often in the endoscopy group (OR 0.31, 95%CI [0.14, 0.69], p = 0.00 and OR 0.01, 95%CI [0.00, 0.07], p = 0.00 respectively).

Conclusion

As of yet, endoscopic surgery does not seem to confer benefit on audiological improvement comparing to conventional microscopic, however, it leads to less scutum drilling and fewer postoperative dysgeusia cases. High-quality, large-sample studies need to be performed in the future.

https://ift.tt/2J0AMxF

The 8th edition AJCC/UICC TNM staging for p16-positive oropharyngeal carcinoma: is there space for improvement?

Abstract

The 8th edition of the AJCC/UICC TNM-staging system for p16[HPV]-positive OPSCC manages to improve prediction of prognosis and will essentially influence choice of therapy in future. Nonetheless, adjustments of the current version are needed. The surrogate marker p16 alone is inadequate for HPV detection, the role of ECS in HPV-positive OPSCC is not fully understood, and the patient's characteristics as well as molecular signatures and genetics have not been taken into consideration yet.

https://ift.tt/2OqlWGw

Structural mapping of hot spots within human CASPR2 discoidin domain for autoantibody recognition

Publication date: Available online 15 October 2018

Source: Journal of Autoimmunity

Author(s): Wenjun Liang, Junying Zhang, Margaux Saint-Martin, Fei Xu, Nelly Noraz, Jianmei Liu, Jérôme Honnorat, Heli Liu

Abstract

Accumulating evidence has showed that anti-CASPR2 autoantibodies occur in a long list of neurological immune disorders including limbic encephalitis (LE). Belonging to the well-known neurexin superfamily, CASPR2 has been suggested to be a central node in the molecular networks controlling neurodevelopment. Distinct from other subfamilies in the neurexin superfamily, the CASPR subfamily features a unique discoidin (Disc) domain. As revealed by our and others' recent studies, CASPR2 Disc domain bears a major epitope for autoantibodies. However, structural information on CASPR2 recognition by autoantibodies has been lacking. Here, we report the crystal structure of human CASPR2 Disc domain at a high resolution of 1.31 Å, which is the first atomic-resolution structure of the CASPR subfamily members. The Disc domain adopts a total β structure and folds into a distorted jellyroll-like barrel with a conserved disulfide-bond interlocking its N- and C-termini. Defined by four loops and located in one end of the barrel, the "loop-tip surface" is totally polar and easily available for protein docking. Based on structure-guided epitope prediction, we generated nine mutants and evaluated their binding to autoantibodies of cerebrospinal fluid from twelve patients with limbic encephalitis. The quadruple mutant G69N/A71S/S77N/D78R impaired CASPR2 binding to autoantibodies from eleven LE patients, which indicates that the loop L1 in the Disc domain bears hot spots for autoantibody interaction. Structural mapping of autoepitopes within human CASPR2 Disc domain sheds light on how autoantibodies could sequester CASPR2 ectodomain and antagonize its functionalities in the pathogenic processes.

https://ift.tt/2IXILvj

Retrospective Comparison of Velcro® and Twill Tie Outcomes Following Pediatric Tracheotomy

Publication date: Available online 16 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Anna C. Bitners, William B. Burton, Christina J. Yang

Abstract

Objectives

To compare the rates of skin-related complications and accidental decannulation in pediatric patients who received Velcro^® ties versus twill ties during the early postoperative period following tracheotomy. The rates of skin-related complications and accidental decannulation in patients with Velcro^® ties was hypothesized to differ from those in patients with twill ties.

Methods

Medical records of 109 patients ≤18 years old who underwent elective tracheotomy were reviewed: 70 received twill ties and 39 received Velcro^® ties. Patients were followed for the first seven postoperative days. The primary outcome was skin-related complications, which were further categorized into mild (irritation) and severe (breakdown). The secondary outcome was accidental decannulation. Rates of skin-related complication and accidental decannulation were compared across the two groups using chi-square analysis.

Results

Skin irritation occurred in 32 patients (45.7%) with twill ties and 10 patients (25.6%) with Velcro^®. Skin breakdown occurred in 20 patients (28.6%) with twill ties and 6 patients (15.4%) with Velcro^®. There were no accidental decannulation events. The use of Velcro^® ties was associated with a decreased rate of skin irritation (OR: 0.41; 95% CI: 0.17 – 0.97; P = 0.039).

Conclusions

The use of Velcro^® ties was associated with a decrease in the rate of skin irritation. There were no accidental decannulation events. These findings support the use of Velcro^® ties at the time of pediatric tracheotomy placement.

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