Sonographische Analyse des Schluckakts im zervikalen Ösophagusabschnitt

Zusammenfassung

Hintergrund und Fragestellung

Die Dysphagie ist ein häufig in verschiedenen Fachbereichen von Patienten benanntes Symptom, bei dem sich die Frage nach der anzustrebenden Diagnostik stellt. Neben der HNO-ärztlichen Spiegeluntersuchung stehen die derzeitigen Goldstandards Videofluoroskopie und fiberoptisch-endoskopische Evaluation des Schluckens (FEES) zur Verfügung. Häufig kommt im klinischen Alltag der Ultraschall zum Einsatz, dessen Anwendungsmöglichkeit im Hinblick auf die Schluckdiagnostik zu hinterfragen ist.

Material und Methoden

Zwischen April 2012 und Februar 2014 wurden 81 Probanden (zwischen 19 und 66 Jahren) ohne Hinweise auf eine Schluckstörung sonographisch untersucht. Es wurden die Darstellbarkeit anatomisch am Schluckakt beteiligter Strukturen überprüft und unter Verwendung verschiedener Substanzen (Speichel, Wasser und Götterspeise) Schluckvideos im zervikalen Ösophagusbereich aufgezeichnet und ausgewertet. Im Rahmen einer Pilotstudie wurde die Untersuchung an 3 dysphagischen Patienten erprobt.

Ergebnisse

Der Zungengrund, die intralaryngealen Strukturen, die Halswirbelsäule und die Schilddrüsen waren sehr gut darstellbar. In besonderer Weise gelang die sonographische Darstellung des zervikalen Ösophagusabschnitts. Dieser konnte mit einer Länge von 5,78 ± 1,66 cm eingesehen werden, der Durchmesser betrug 0,88 ± 0,10 cm. Am schlechtesten ließ sich der Sinus piriformis sonographisch beurteilen. Er war in 39,5 % der Fälle nicht einsehbar. In der Odds Ratio war die Darstellbarkeit des Sinus piriformis 5,6-fach höher bei Normalgewichtigen und 11,3-fach höher bei einem Alter unter 25 Jahren. Bei der Untersuchung jener Patienten, welche eine Schluckstörung aufwiesen, konnten 3 verschiedene Krankheitsbilder (ein M. Forestier, eine Ösophagusstenose und eine Motoneuronenerkrankung) als Ursache für die Beschwerden ermittelt werden.

Schlussfolgerung

Die Sonographie zeigte eine sehr gute Darstellbarkeit des Schluckakts mit Beurteilungsmöglichkeit des zervikalen Ösophagus. Der HNO-Arzt sollte bei der Verfügbarkeit des Ultraschalls an diese Diagnostikmöglichkeit denken, welche die wiederholte Beurteilung im zervikalen Abschnitt ermöglicht und die bisherigen Verfahren sinnvoll ergänzen kann.

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IgE blockade during food allergen ingestion enhances the induction of inhibitory IgG antibodies

Publication date: Available online 4 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Amanda J. Stranks, Samantha C. Minnicozzi, Samuel J. Miller, Oliver T. Burton, Stephanie L. Logsdon, Jonathan M. Spergel, Kari C. Nadeau, Jacqueline A. Pongracic, Dale T. Umetsu, Rima Rachid, Andrew J. MacGinnitie, Lynda Schneider, Hans C. Oettgen

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Safe and effective use of free tissue transfer for facial reanimation in complex facial palsy

Abstract

Background

In irreversible, dense facial paralysis, facial reanimation surgery to recreate the smile is established as the gold standard. Most patients presenting for treatment will have had little or no prior surgical interventions. A significant minority may have undergone prior surgery, making any attempt at facial reanimation complex. These include patients with previous free flap and neck dissection procedures and where multiple prior procedures have been undertaken, including attempts at facial reanimation. Occasionally, a composite tissue reconstruction is required. In these complex cases, it is challenging to determine the best surgical solution for facial reanimation. Microsurgical techniques utilising free tissue transfer may seem to be relatively contraindicated.

Methods

A series of 15 cases where free tissue transfer was used successfully for facial reanimation in complex cases is presented. These patients were otherwise deemed to be suitable for facial reanimation and were defined as complex utilising defined criteria. Results were assessed by using the Sunnybrook scoring system where possible and in all cases by measuring symmetry at rest and modiolar excursion when smiling. Standardised pre- and post-operative photos and videos were also used.

Results

The average improvement in Sunnybrook score was 39. The average improvement in resting symmetry was 8.5 mm. Thirteen patients developed facial movement corresponding to a good-quality smile with average improvement of modiolus movement of 6 mm. There were no free flap failures.

Conclusions

These results demonstrate that even very complex cases of facial paralysis can be effectively and safely treated with free tissue transfer for facial reanimation.

Level of Evidence: Level IV

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Dual functionality of lamprey VLRB C-terminus (LC) for multimerization and cell surface display

Publication date: December 2018

Source: Molecular Immunology, Volume 104

Author(s): Jung Seok Lee, Jaesung Kim, Se Pyeong Im, Si Won Kim, Jae Wook Jung, Jassy Mary S. Lazarte, Jeong Ho Lee, Kim D. Thompson, Tae Sung Jung

Abstract

Lamprey, one of the living representatives of jawless vertebrates, uses variable lymphocyte receptors B (VLRB) for antigen recognition, rather than immunoglobulin (Ig) based receptors as used by higher vertebrates. The C-terminus of lamprey VLRB (LC) possess a glycosylphosphatidylinositol (GPI) signal sequence and seven cysteine residues providing dual functionality of the VLRB antibody in the form of a humoral agglutinin and cell membrane receptors. Here, we show that the LC can be either secreted or be membrane anchored as a heterologous fused protein in a multimeric form comprising of eight or ten monomeric units. Using serially truncated LC variants, we showed that the LC, in which the last three amino acid "RKR" were deleted, referred to as LC7, was the most suitable domain for multimeric construction, whereas, the intact LC is more tailored for applications involving membrane anchorage. We show that an antibody specific for viral hemorrhagic septicemia virus (VHSV) (VLR43), displayed on HEK-293F cells using a PiggyBac (PB) transposase system, exhibited a dose-dependent reaction with its antigen, verifying that the LC can be applied in antibody display technology. Therefore, the present report provides valuable insight into the structure of the lamprey VLRB and highlights its potential use as a novel fusion partner for multimerization and membrane anchorage of chimeric proteins.

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Acidic pH promotes oxidation-induced dissociation of C-reactive protein

Publication date: December 2018

Source: Molecular Immunology, Volume 104

Author(s): Shuo-Lei Li, Jun-Rui Feng, Hai-Hong Zhou, Chun-Miao Zhang, Guang-Bo Lv, Yu-Bo Tan, Zhong-Bo Ge, Ming-Yu Wang

Abstract

Background

Circulating levels of the systemic inflammation marker C-reactive protein (CRP) have been associated with increased risk and poor outcomes of many diseases, such as cardiovascular events and cancer. Accumulating evidence has indicated that the conformational rearrangement of human pentameric CRP (pCRP) to monomeric CRP (mCRP) is a prerequisite for participation in the pathogenesis. Therefore, determining the mechanism of the dissociation of pCRP into pro-inflammatory mCRP under physiological/pathological circumstances has been intriguing.

Methods

The effects of oxidative and acidic stress occurring in inflammation on pCRP were examined by electrophoresis, electron microscopy, protein fluorescence, neoepitope expression and endothelial cell responses.

Results

Reactive oxygen species (ROS) generated by the copper-hydrogen peroxide system could rapidly induce the dissociation of CRP at mild acidic pH within four hours, but not at physiological pH of 7.4. Meanwhile, mannitol, a ROS scavenger, could not protect against dissociation, which implied that local ROS from accessible histidine residues may be crucially beneficial to the formation of mCRP in a redox-balanced microenvironment. Furthermore, mCRP generated by ROS could be reduced by DTT, which indicated the exposure of functional motif aa35-47, and showed potent proinflammatory actions on endothelial cells, comparable to mCRP generated by urea.

Conclusion

dissociation of pCRP to mCRP could be rapidly induced by ROS from copper- hydrogen peroxide system in dependence on mildly acidic stress regardless of a redox-balanced microenvironment.

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Corrigendum to “Immune modulatory properties of 6-gingerol and resveratrol in Atlantic salmon macrophages” [Mol. Immunol. 95 (2018) 10–19]

Publication date: Available online 5 November 2018

Source: Molecular Immunology

Author(s): Nicole C. Smith, Sherri L. Christian, Richard G. Taylor, Javier Santander, Matthew L. Rise

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Thirdhand smoke component can exacerbate a mouse asthma model through mast cells

Publication date: November 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 5

Author(s): Mang Yu, Kaori Mukai, Mindy Tsai, Stephen J. Galli

Background

Thirdhand smoke (THS) represents the accumulation of secondhand smoke on indoor surfaces and in dust, which, over time, can become more toxic than secondhand smoke. Although it is well known that children of smokers are at increased risk for asthma or asthma exacerbation if the disease is already present, how exposure to THS can influence the development or exacerbation of asthma remains unknown.

Objective

We investigated whether epicutaneous exposure to an important component of THS, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), can influence asthma pathology in a mouse model elicited by means of repeated intranasal challenge with cockroach antigen (CRA).

Methods

Wild-type mice, α7 nicotinic acetylcholine receptor (nAChR)– or mast cell (MC)–deficient mice, and mice with MCs that lacked α7 nAChRs or were the host's sole source of α7 nAChRs were subjected to epicutaneous NNK exposure, intranasal CRA challenge, or both, and the severity of features of asthma pathology, including airway hyperreactivity, airway inflammation, and airway remodeling, was assessed.

Results

We found that α7 nAChRs were required to observe adverse effects of epicutaneous NNK exposure on multiple features of CRA-induced asthma pathology. Moreover, MC expression of α7 nAChRs contributed significantly to the ability of epicutaneous NNK exposure to exacerbate airway hyperreactivity to methacholine, airway inflammation, and airway remodeling in this model.

Conclusion

Our results show that skin exposure to NNK, a component of THS, can exacerbate multiple features of a CRA-induced model of asthma in mice and define MCs as key contributors to these adverse effects of NNK.

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