A modified supra-auricular approach with helix cartilage suture for surgical treatment of the preauricular sinus

Publication date: Available online 5 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kai-Chieh Chan, Han-Tse Kuo, Valerie Wai-Yee Ho, Wen-Yu Chuang, Zung-Chung Chen

Abstract

Objective

Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus (PAS). This study was designed to evaluate the surgical outcomes of PAS excision using a new modified supra-auricular approach (SAA) and to assess the predisposing factors for recurrence.

Methods

A total of 175 (158 patients) PAS excision procedures were performed from 2007 to 2016 in a single institute using this modified SAA with helix cartilage suture to obliterate the dead space. The specimens were assessed to measure the closest distance between the squamous tract and the excised auricular cartilage (sinocartilaginous distance). We also evaluated the surgical outcomes and investigated the predisposing factors for recurrence, including gender, lesion laterality, etiology (primary or revised), anesthesia methods (general or local), history of infection, and history of incision and drainage (I&D) for abscess.

Results

Patients were followed up for a median duration of 45 months (range from 6 months to 10 years). There was a 2.3% (4 ears) recurrence rate and a 1.7% (3 ears) complication rate in our series. The average sinocartilaginous distance was 0.44 mm (median distance, 0.3 mm) and this value was less than 0.5 mm in 66% of cases. Recurrence was not significantly affected by gender, lesion laterality, etiology of surgery, anesthesia method, or a history of infection or preoperative I&D for abscess.

Conclusions

Surgical PAS excision using the modified SAA with cartilage suture of dead space yielded low overall recurrence and complication rates in this series. Cosmesis was maintained due to a smaller incision. No significant predisposing factors for recurrence were identified. Thus, the modified technique described in the present study can be regarded as a simple, effective and reproducible surgical treatment for PAS.

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Predictors of Intratonsillar Abscess versus Peritonsillar Abscess in the Pediatric Patient

Publication date: Available online 5 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): S. Ahmed Ali, Kevin J. Kovatch, Josh Smith, Emily L. Bellile, John E. Hanks, Carl M. Truesdale, Paul T. Hoff

Abstract

Objective

To determine the incidence of intratonsillar abscess (ITA) patients within the population of patients diagnosed with peritonsillar abscess (PTA) and to further characterize the differences in symptomatology and successful treatment strategies between the two groups.

Methods

This study is a retrospective chart review of patients diagnosed with PTA or ITA at our institution from 2000-2017. Descriptive and inferential statistics are reported, including univariate and multivariate analyses.

Results

A total of 335 pediatric (<18 years) patients presenting with a PTA or ITA were identified, 31 (9%) of whom were diagnosed with ITA. Patients with ITAs had significantly lower proportions of trismus, otalgia, and dysphagia and were less likely to experience acute progression from their initial symptoms. The ITA group had fewer attempted aspiration and drainage attempts, with those attempts significantly less successful than for the PTA group. Recurrence was uncommon in ITA patients in comparison to PTA patients.

Conclusions

Intratonsillar abscess should be considered in the differential diagnosis for patients presenting with sore throat and concern for a pharyngeal infection or abscess. These patients have a significantly lower proportion of otalgia, trismus, vocal changes, and dysphagia. Given the low success rate of drainage attempts and lower recurrence rate, diagnosing physicians should consider medical management rather than procedural drainage in this patient population.

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Efficient segmentation and correction model for brain MR images with level set framework based on basis functions

Publication date: Available online 5 September 2018

Source: Magnetic Resonance Imaging

Author(s): Yunyun Yang, Sichun Ruan, Boying Wu

Abstract

With the wide application of MR images to detect disease in human's brain deeply, the shortcomings of the technology are necessarily waiting to be solved. For example, MR images always show serious intensity inhomogeneity called the bias field, which may prevent to deduce exact analysis of images. To eliminate the distraction, many methods are proposed. Though experimental results already have stood for the advantages of those methods, there are still lots of problems that cannot be neglected, such as bad segmentation, wrong correction and over-correction which has not attracted much attention yet. Among all those methods, the multiplicative intrinsic component optimization (MICO) model influenced us more. Based on the MICO model and split Bregman method, in this paper, we put forward a new model to segment and correct bias field moderately and simultaneously for MR images. Then, we applied our model to a large quantity of MR images, and gained lots of expected results. For a better observation, we compared our model with the MICO model in both segmentation and bias correction results, it can be seen from the experimental results that our model has performed well for the challenging intensity inhomogeneity problems. Many good characteristics like accuracy, efficiency and robustness also have been exhibited in numerical results and comparisons with the MICO model.

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ADC-histogram analysis in head and neck squamous cell carcinoma. Associations with different histopathological features including expression of EGFR, VEGF, HIF-1α, Her 2 and p53. A preliminary study

Publication date: Available online 4 September 2018

Source: Magnetic Resonance Imaging

Author(s): Hans Jonas Meyer, Leonard Leifels, Gordian Hamerla, Anne Kathrin Höhn, Alexey Surov

Abstract

Objective

Apparent diffusion coefficient (ADC) values derived from Diffusion-weighted images are able to reflect tumor microstructure, such as cellularity, extracellular matrix or proliferation potential. This present study sought to correlate prognostic relevant histopathologic parameters with ADC values derived from a whole lesion measurement in head and neck squamous cell carcinoma (HNSCC).

Materials and methods

Thirty-four patients with histological proven primary HNSCC were prospectively acquired. Histogram analysis was derived from ADC maps. In all cases, expression of Hif1-alpha, VEGF, EGFR, p53, p16, Her 2 were analyzed.

Results

In the overall patient sample, ADCmax correlated with p53 expression (p = −0.446, p = 0.009) and ADCmode correlated with Her2-expression (p = −0.354, p = 0.047). In the p16 positive group there were several correlations. P25, P90 and entropy correlated with Hif1-alpha (p = −0.423, p = 0.05, p = −0.494, p = 0.019, p = 0.479, p = 0.024, respectively). Kurtosis correlated with P53 expression (p = −0.466, p = 0.029).

For p16 negative carcinomas the following associations could be identified. Mode correlated with VEGF-expression (p = −0.657, p = 0.039). ADCmax, P75, P90, and Std correlated with p53-expression (p = −0.827, p = 0.002, p = −0.736, p = 0.01, p = −0.836, p = 0.001 and p = −0.70, p = 0.016, respectively). There were no statistically significant differences of ADC histogram parameters between p16 positive and p16 negative carcinomas.

Conclusion

ADC histogram values can reflect different histopathological features in HNSCC. Associations between ADC histogram analysis parameters and histopathology depend on p16 status.

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Development of white matter fibre density and morphology over childhood: A longitudinal fixel-based analysis

Publication date: December 2018

Source: NeuroImage, Volume 183

Author(s): Sila Genc, Robert E. Smith, Charles B. Malpas, Vicki Anderson, Jan M. Nicholson, Daryl Efron, Emma Sciberras, Marc L. Seal, Timothy J. Silk

Abstract

Purpose

White matter fibre development in childhood involves dynamic changes to microstructural organisation driven by increasing axon diameter, density, and myelination. However, there is a lack of longitudinal studies that have quantified advanced diffusion metrics to identify regions of accelerated fibre maturation, particularly across the early pubertal period. We applied a novel longitudinal fixel-based analysis (FBA) framework, in order to estimate microscopic and macroscopic white matter changes over time.

Methods

Diffusion-weighted imaging (DWI) data were acquired for 59 typically developing children (27 female) aged 9–13 years  at two time-points approximately 16 months apart (time-point 1: 10.4 ± 0.4 years, time-point 2: 11.7 ± 0.5 years). Whole brain FBA was performed using the connectivity-based fixel enhancement method, to assess longitudinal changes in fibre microscopic density and macroscopic morphological measures, and how these changes are related to sex, pubertal stage, and pubertal progression. Follow-up analyses were performed in sub-regions of the corpus callosum to confirm the main findings using a Bayesian repeated measures approach.

Results

There was a statistically significant increase in fibre density over time localised to medial and posterior commissural and association fibres, including the forceps major and bilateral superior longitudinal fasciculus. Increases in fibre cross-section were substantially more widespread. The rate of fibre development was not associated with age or sex. In addition, there was no significant relationship between pubertal stage or progression and longitudinal fibre development over time. Follow-up Bayesian analyses were performed to confirm the findings, which supported the null effect of the longitudinal pubertal comparison.

Conclusion

Using a novel longitudinal fixel-based analysis framework, we demonstrate that white matter fibre density and fibre cross-section increased within a 16-month scan rescan period in specific regions. The observed increases might reflect increasing axonal diameter or axon count. Pubertal stage or progression did not influence the rate of fibre development in the early stages of puberty. Future work should focus on quantifying these measures across a wider age range to capture the full spectrum of fibre development across the pubertal period.

Graphical abstract

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Where and how our brain represents the temporal structure of observed action

Publication date: December 2018

Source: NeuroImage, Volume 183

Author(s): R.M. Thomas, T. De Sanctis, V. Gazzola, C. Keysers

Abstract

Reacting faster to the behaviour of others provides evolutionary advantages. Reacting to unpredictable events takes hundreds of milliseconds. Understanding where and how the brain represents what actions are likely to follow one another is, therefore, important. Everyday actions occur in predictable sequences, yet neuroscientists focus on how brains respond to unexpected, individual motor acts. Using fMRI, we show the brain encodes sequence-related information in the motor system. Using EEG, we show visual responses are faster and smaller for predictable sequences. We hope this paradigm encourages the field to shift its focus from single acts to motor sequences. It sheds light on how we adapt to the actions of others and suggests that the motor system may implement perceptual predictive coding.

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Revealing the needs of children with tracheostomies

Publication date: Available online 5 September 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): R. Maunsell, M. Avelino, J. Caixeta Alves, G. Semenzati, J.F. Lubianca Neto, R. Krumenauer, L. Sekine, D. Manica, C. Schweiger

Abstract

Introduction

Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy.

Methods

A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded.

Results

A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities.

Conclusion

Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.

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The Role of Clinical History Collected by Diagnostic Imaging Staff in Interpreting of Imaging Examinations

Publication date: Available online 5 September 2018

Source: Journal of Medical Imaging and Radiation Sciences

Author(s): Nick N. Maizlin, Sat Somers

Abstract

Background

Requisitions for diagnostic imaging (DI) studies may occasionally contain incomplete, or lack any, clinical information. The value of technologist notes, provided in addition to the requisitions, for interpreting DI examinations has not yet been reported. The purpose of this study is to evaluate if the addition of clinical information in the form of technologist notes assists in interpreting DI examinations and if the impact of these notes depends on the completeness of medical history provided by the referring physician.

Materials and methods

The completeness of clinical information in 250 requisitions and the effect of a technologist's notes on radiological interpretation were recorded. The chi-square test was used to evaluate the distribution of outcomes.

Results

Technologist notes were important for interpreting a DI examinations in 69.2% of cases and not important in 30.8%. The notes were significantly more useful for reading radiographic examinations than ultrasound (US) examinations; 52.8% of the requisitions contained full, 25.6% incomplete, and 21.6% did not contain any medical history. Requisitions for ultrasound examinations contained a full medical history more frequently than those for radiographic examinations. The usefulness of technologist notes for both radiographic and US examinations was not different for groups with full, incomplete, or absent medical history.

Conclusion

Technologist notes were important for interpreting DI examinations in more than 2/3 of the cases and were more useful for reading of radiographic than US examinations. Their usefulness did not depend on the degree of completeness of patient history provided in the requisition. Therefore, the addition of technologist notes to clinical information in requisitions is recommended, regardless of medical history provided by the referring physician.

Résumé

Introduction

Les réquisitions pour les études d'imagerie diagnostique (ID) peuvent parfois contenir des renseignements cliniques incomplets. D'autres fois, ces renseignements sont tout à fait absents. La valeur des notes des technologues dans l'interprétation des examens d'ID n'a pas fait l'objet de rapports jusqu'à présent. Le but de cette étude est d'examiner si l'ajout de renseignements cliniques fournis par des technologues peut soutenir l'interprétation des examens d'ID et si l'effet de ces notes est influencé par le caractère complet ou non des antécédents médicaux fournis par le médecin traitant.

Matériel et méthodologie

Le caractère complet ou non des renseignements cliniques de 250 réquisitions et l'effet des notes des technologues sur l'interprétation radiologique ont été enregistrés. Le test du chi carré a été utilisé pour évaluer la répartition des résultats.

Résultats

L'importance des notes des technologues pour l'interprétation des examens d'ID a été confirmée dans 69,2% des cas (elles n'étaient pas importantes dans 30,8% des cas). Les notes étaient nettement plus utiles pour la lecture d'examens radiographiques que pour celle des échographies. Parmi les réquisitions, 52,8% comprenaient des renseignements complets, 25, 6% comprenaient des renseignements incomplets et 21,6% ne comprenaient pas d'antécédents médicaux. La fréquence des réquisitions d'échographie qui contenaient des antécédents médicaux complets était plus grande que celle des examens radiographiques. L'utilité des notes de technologues était semblable pour tous les groupes, que les antécédents médicaux fournis soient complets, incomplets ou manquants, et ce autant pour les examens radiographiques que pour les échographies.

Conclusion

Les notes de technologues se sont avérées importantes pour l'interprétation des examens d'ID dans plus des deux tiers des cas. Par ailleurs, elles étaient plus utiles pour la lecture d'examens radiographiques que pour la lecture d'échographies. Leur utilité n'était pas influencée par l'exhaustivité des antécédents médicaux du patient dans la réquisition. Ainsi, nous recommandons d'ajouter les notes des technologues aux renseignements cliniques, et ce peu importe les antécédents médicaux fournis par le médecin traitant.

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Effects of Reslizumab on Asthma Outcomes in a Subgroup of Eosinophilic Asthma Patients with Self-Reported Chronic Rhinosinusitis with Nasal Polyps

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Steven F. Weinstein, Rohit K. Katial, Philip Bardin, Stephanie Korn, Mirna McDonald, Margaret Garin, Eric D. Bateman, Flavia C.L. Hoyte, Matthew Germinaro

ABSTRACT

BACKGROUND

An estimated 7% of patients with asthma have chronic rhinosinusitis with nasal polyps (CRSwNP) and over 80% have at least some radiographic evidence of sinonasal inflammation. Aspirin sensitivity is strongly associated with elevated blood eosinophil levels and increased asthma severity. Intravenous (IV) reslizumab has been shown to improve asthma control in patients with nasal polyps.

OBJECTIVE

These post-hoc analyses of pooled data from two BREATH phase 3 clinical trials, studies 1 and 2 (NCT01287039 and NCT01285323), examined asthma-related outcomes in patients with comorbid, self-reported CRSwNP with and without aspirin sensitivity.

METHODS

Patients aged 12–75 years with elevated blood eosinophils (≥400 cells/μL) and inadequately controlled asthma were randomized to receive placebo or reslizumab (3 mg/kg IV) every 4 weeks for 52 weeks. Patients continued their background asthma maintenance therapy during the study. Information regarding the presence of CRSwNP was obtained through patient-reported medical history.

RESULTS

Add-on reslizumab treatment reduced the frequency of clinical asthma exacerbations (CAE) by 83% vs placebo among patients with CRSwNP. Among patients with and without aspirin sensitivity, reductions of 79% and 84%, respectively, were observed. Patients with CRSwNP (with and without aspirin sensitivity) treated with reslizumab add-on therapy also had significant improvements in lung function, as measured by FEV₁, compared with placebo. Among patients with CRSwNP, reslizumab was also associated with improvements in patient-reported asthma control and asthma quality of life.

CONCLUSION

Patients with eosinophilic asthma and self-reported CRSwNP, with and without aspirin sensitivity, are highly responsive to treatment with reslizumab for asthma-related outcomes. These findings suggest that prospective investigation of reslizumab in this patient population is warranted.

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Staphylococcus aureus nasal colonization and asthma in adults: systematic review and meta-analysis

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Young-Chan Kim, Ha-Kyeong Won, Ji Won Lee, Kyoung-Hee Sohn, Min-Hye Kim, Tae-Bum Kim, Yoon-Seok Chang, Byung-Jae Lee, Sang-Heon Cho, Claus Bachert, Woo-Jung Song

Abstract

Background

Staphylococcus aureus (SA) is a frequent colonizer in human and it is known to be associated with chronic allergic diseases including asthma. Recent individual studies suggested that nasal SA colonization may be positively associated with asthma.

Objective

To examine relationships between nasal SA colonization and asthma prevalence and activity in adults.

Methods

Electronic databases were searched for studies published until June 2018. Studies that reported nasal SA colonization prevalence and asthma outcome (prevalence and disease activity) in general adult populations or chronic rhinosinusitis (CRS) patients were included. Random effects meta-analyses were performed to calculate pooled odds ratio (OR) of the relationships. Subgroup analysis was conducted for the presence of nasal polyps within CRS populations.

Results

A total of 21 cross-sectional studies were identified, and the data from 16 studies using culture methods for SA detection were meta-analyzed (5 general population-based studies and 11 CRS patient studies). In studies of general populations, nasal SA colonization had significant relationships with asthma prevalence (OR 1.19; 95% confidence interval 1.06-1.34; I² = 1%). In CRS patient studies, positive associations were also found but had a considerable heterogeneity (OR 1.87; 95% CI 1.18-2.97; I² = 72%). However, the results were comparable between CRS with and without nasal polyps.

Conclusions

This study demonstrated modest but significant relationships between nasal SA colonization and asthma, supporting potential roles of SA in adult asthma patients. Further longitudinal cohort and intervention studies are warranted to identify host determinants and to clarify causality of the relationships.

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Patient versus allergy specialist interpretation of a negative workup for suspected iodinated contrast media allergy

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Rik Schrijvers, Christine Breynaert, Jean-Luc Bourrain, Pascal Demoly, Anca Mirela Chiriac

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Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival and impaired clearance

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Jocelyn R. Grunwell, Susan T. Stephenson, Rabindra Tirouvanziam, Lou Ann S. Brown, Milton R. Brown, Anne M. Fitzpatrick

Background

Airway neutrophils are abundant in some children with severe asthma, but their functions are poorly understood.

Objective

We hypothesized that the inflammatory airway environment of children with neutrophil-predominant severe asthma promotes neutrophil survival and disrupts neutrophil-associated innate immune defenses.

Methods

Sixty seven children with severe asthma refractory to high-dose inhaled corticosteroid (ICS) treatment undergoing bronchoscopy with bronchoalveolar lavage (BAL) for clinical indications were stratified into neutrophil "high" versus "low" groups based on BAL differential counts. Neutrophil activation markers, functional assays and phenotyping studies were performed as well as airway macrophage functional assays. Results were compared to those from children with moderate asthma treated with ICS.

Results

Children with neutrophil-predominant severe asthma had increased markers of neutrophil activation/degranulation and a greater magnitude of airway pro-inflammatory cytokine and chemokine release. Primary neutrophils exposed to BAL of these children exhibited greater phagocytic capability and greater neutrophil extracellular trap formation, but a more impaired respiratory burst. Despite greater abundance of airway TGF-β1, the neutrophils were not more apoptotic. Instead, neutrophils had a highly pro-inflammatory phenotype associated with a number of surface markers that regulate neutrophil activation, recruitment/migration and granule release. Airway macrophages from children with neutrophil-predominant severe asthma were also more pro-inflammatory with impaired phagocytosis and increased apoptosis.

Conclusions

Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival. Airway macrophages are also pro-inflammatory and dysfunctional and may contribute to global innate immune impairment. Therapies that target neutrophils and related inflammation may be warranted in this subset of children.

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Bronchial Thermoplasty: A Decade of Experience: State of The Art

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Laren D. Tan, Ken Y. Yoneda, Samuel Louie, D.Kyle Hogarth, Mario Castro

Abstract:

Bronchial thermoplasty (BT) delivers targeted radiofrequency energy to bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation and intense follow up) that we believe promote successful patient outcomes and help build a successful BT program.

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Fatal asthma: an audit of 30 million patient-years of health plan membership from 2007 to 2015

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Eric Macy, Janis F. Yao, Wansu Chen

Abstract

Background

Without accurate data on deaths directly caused by asthma, prevention will be difficult.

Objective

Determine how often asthma could be confirmed as a proximal cause of death in a large well-defined population with active health plan membership and no acute barriers to medical care.

Methods

All deaths occurring in active Kaiser Permanente Southern California health plan members between 2007 and 2015 were identified. Asthma-coded deaths were manually audited for cause. Healthcare and asthma medication use in the 6 months prior to death were determined.

Results

There were 248 [0.80 per 100,000 patient-years] un-audited asthma-coded deaths. There were only 63 (26.5%) [0.20 per 100,000 patient-years] asthma-confirmed deaths. Individuals with asthma-confirmed deaths were younger, less likely to have ever smoked, and had fewer emergency visits in the 6 months prior to death compared to those with asthma excluded. Individuals with asthma-confirmed deaths used preventative inhalers at very low rates. We unexpectedly found that ever inclusion in the 2016 National Committee for Quality Assurance health effectiveness data and information set (HEDIS) for persistent asthma was associated with a higher risk of all cause early death. Individuals with asthma-confirmed deaths were also unlikely to be in the HEDIS asthma dataset in the year they died, thus not targeted for outreach.

Conclusions

Audit-confirmed fatal asthma is more likely to occur in younger, non-smoking, individuals, using very low rates of preventive inhalers. This will be a very difficult group to prospectively identify and manage effectively. Further research into the reasons for early death after HEDIS asthma dataset inclusion is warranted.

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Development of white matter fibre density and morphology over childhood: A longitudinal fixel-based analysis

Publication date: December 2018

Source: NeuroImage, Volume 183

Author(s): Sila Genc, Robert E. Smith, Charles B. Malpas, Vicki Anderson, Jan M. Nicholson, Daryl Efron, Emma Sciberras, Marc L. Seal, Timothy J. Silk

Abstract

Purpose

White matter fibre development in childhood involves dynamic changes to microstructural organisation driven by increasing axon diameter, density, and myelination. However, there is a lack of longitudinal studies that have quantified advanced diffusion metrics to identify regions of accelerated fibre maturation, particularly across the early pubertal period. We applied a novel longitudinal fixel-based analysis (FBA) framework, in order to estimate microscopic and macroscopic white matter changes over time.

Methods

Diffusion-weighted imaging (DWI) data were acquired for 59 typically developing children (27 female) aged 9–13 years  at two time-points approximately 16 months apart (time-point 1: 10.4 ± 0.4 years, time-point 2: 11.7 ± 0.5 years). Whole brain FBA was performed using the connectivity-based fixel enhancement method, to assess longitudinal changes in fibre microscopic density and macroscopic morphological measures, and how these changes are related to sex, pubertal stage, and pubertal progression. Follow-up analyses were performed in sub-regions of the corpus callosum to confirm the main findings using a Bayesian repeated measures approach.

Results

There was a statistically significant increase in fibre density over time localised to medial and posterior commissural and association fibres, including the forceps major and bilateral superior longitudinal fasciculus. Increases in fibre cross-section were substantially more widespread. The rate of fibre development was not associated with age or sex. In addition, there was no significant relationship between pubertal stage or progression and longitudinal fibre development over time. Follow-up Bayesian analyses were performed to confirm the findings, which supported the null effect of the longitudinal pubertal comparison.

Conclusion

Using a novel longitudinal fixel-based analysis framework, we demonstrate that white matter fibre density and fibre cross-section increased within a 16-month scan rescan period in specific regions. The observed increases might reflect increasing axonal diameter or axon count. Pubertal stage or progression did not influence the rate of fibre development in the early stages of puberty. Future work should focus on quantifying these measures across a wider age range to capture the full spectrum of fibre development across the pubertal period.

Graphical abstract

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Where and how our brain represents the temporal structure of observed action

Publication date: December 2018

Source: NeuroImage, Volume 183

Author(s): R.M. Thomas, T. De Sanctis, V. Gazzola, C. Keysers

Abstract

Reacting faster to the behaviour of others provides evolutionary advantages. Reacting to unpredictable events takes hundreds of milliseconds. Understanding where and how the brain represents what actions are likely to follow one another is, therefore, important. Everyday actions occur in predictable sequences, yet neuroscientists focus on how brains respond to unexpected, individual motor acts. Using fMRI, we show the brain encodes sequence-related information in the motor system. Using EEG, we show visual responses are faster and smaller for predictable sequences. We hope this paradigm encourages the field to shift its focus from single acts to motor sequences. It sheds light on how we adapt to the actions of others and suggests that the motor system may implement perceptual predictive coding.

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Revealing the needs of children with tracheostomies

Publication date: Available online 5 September 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): R. Maunsell, M. Avelino, J. Caixeta Alves, G. Semenzati, J.F. Lubianca Neto, R. Krumenauer, L. Sekine, D. Manica, C. Schweiger

Abstract

Introduction

Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy.

Methods

A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded.

Results

A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities.

Conclusion

Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.

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The Role of Clinical History Collected by Diagnostic Imaging Staff in Interpreting of Imaging Examinations

Publication date: Available online 5 September 2018

Source: Journal of Medical Imaging and Radiation Sciences

Author(s): Nick N. Maizlin, Sat Somers

Abstract

Background

Requisitions for diagnostic imaging (DI) studies may occasionally contain incomplete, or lack any, clinical information. The value of technologist notes, provided in addition to the requisitions, for interpreting DI examinations has not yet been reported. The purpose of this study is to evaluate if the addition of clinical information in the form of technologist notes assists in interpreting DI examinations and if the impact of these notes depends on the completeness of medical history provided by the referring physician.

Materials and methods

The completeness of clinical information in 250 requisitions and the effect of a technologist's notes on radiological interpretation were recorded. The chi-square test was used to evaluate the distribution of outcomes.

Results

Technologist notes were important for interpreting a DI examinations in 69.2% of cases and not important in 30.8%. The notes were significantly more useful for reading radiographic examinations than ultrasound (US) examinations; 52.8% of the requisitions contained full, 25.6% incomplete, and 21.6% did not contain any medical history. Requisitions for ultrasound examinations contained a full medical history more frequently than those for radiographic examinations. The usefulness of technologist notes for both radiographic and US examinations was not different for groups with full, incomplete, or absent medical history.

Conclusion

Technologist notes were important for interpreting DI examinations in more than 2/3 of the cases and were more useful for reading of radiographic than US examinations. Their usefulness did not depend on the degree of completeness of patient history provided in the requisition. Therefore, the addition of technologist notes to clinical information in requisitions is recommended, regardless of medical history provided by the referring physician.

Résumé

Introduction

Les réquisitions pour les études d'imagerie diagnostique (ID) peuvent parfois contenir des renseignements cliniques incomplets. D'autres fois, ces renseignements sont tout à fait absents. La valeur des notes des technologues dans l'interprétation des examens d'ID n'a pas fait l'objet de rapports jusqu'à présent. Le but de cette étude est d'examiner si l'ajout de renseignements cliniques fournis par des technologues peut soutenir l'interprétation des examens d'ID et si l'effet de ces notes est influencé par le caractère complet ou non des antécédents médicaux fournis par le médecin traitant.

Matériel et méthodologie

Le caractère complet ou non des renseignements cliniques de 250 réquisitions et l'effet des notes des technologues sur l'interprétation radiologique ont été enregistrés. Le test du chi carré a été utilisé pour évaluer la répartition des résultats.

Résultats

L'importance des notes des technologues pour l'interprétation des examens d'ID a été confirmée dans 69,2% des cas (elles n'étaient pas importantes dans 30,8% des cas). Les notes étaient nettement plus utiles pour la lecture d'examens radiographiques que pour celle des échographies. Parmi les réquisitions, 52,8% comprenaient des renseignements complets, 25, 6% comprenaient des renseignements incomplets et 21,6% ne comprenaient pas d'antécédents médicaux. La fréquence des réquisitions d'échographie qui contenaient des antécédents médicaux complets était plus grande que celle des examens radiographiques. L'utilité des notes de technologues était semblable pour tous les groupes, que les antécédents médicaux fournis soient complets, incomplets ou manquants, et ce autant pour les examens radiographiques que pour les échographies.

Conclusion

Les notes de technologues se sont avérées importantes pour l'interprétation des examens d'ID dans plus des deux tiers des cas. Par ailleurs, elles étaient plus utiles pour la lecture d'examens radiographiques que pour la lecture d'échographies. Leur utilité n'était pas influencée par l'exhaustivité des antécédents médicaux du patient dans la réquisition. Ainsi, nous recommandons d'ajouter les notes des technologues aux renseignements cliniques, et ce peu importe les antécédents médicaux fournis par le médecin traitant.

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Effects of Reslizumab on Asthma Outcomes in a Subgroup of Eosinophilic Asthma Patients with Self-Reported Chronic Rhinosinusitis with Nasal Polyps

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Steven F. Weinstein, Rohit K. Katial, Philip Bardin, Stephanie Korn, Mirna McDonald, Margaret Garin, Eric D. Bateman, Flavia C.L. Hoyte, Matthew Germinaro

ABSTRACT

BACKGROUND

An estimated 7% of patients with asthma have chronic rhinosinusitis with nasal polyps (CRSwNP) and over 80% have at least some radiographic evidence of sinonasal inflammation. Aspirin sensitivity is strongly associated with elevated blood eosinophil levels and increased asthma severity. Intravenous (IV) reslizumab has been shown to improve asthma control in patients with nasal polyps.

OBJECTIVE

These post-hoc analyses of pooled data from two BREATH phase 3 clinical trials, studies 1 and 2 (NCT01287039 and NCT01285323), examined asthma-related outcomes in patients with comorbid, self-reported CRSwNP with and without aspirin sensitivity.

METHODS

Patients aged 12–75 years with elevated blood eosinophils (≥400 cells/μL) and inadequately controlled asthma were randomized to receive placebo or reslizumab (3 mg/kg IV) every 4 weeks for 52 weeks. Patients continued their background asthma maintenance therapy during the study. Information regarding the presence of CRSwNP was obtained through patient-reported medical history.

RESULTS

Add-on reslizumab treatment reduced the frequency of clinical asthma exacerbations (CAE) by 83% vs placebo among patients with CRSwNP. Among patients with and without aspirin sensitivity, reductions of 79% and 84%, respectively, were observed. Patients with CRSwNP (with and without aspirin sensitivity) treated with reslizumab add-on therapy also had significant improvements in lung function, as measured by FEV₁, compared with placebo. Among patients with CRSwNP, reslizumab was also associated with improvements in patient-reported asthma control and asthma quality of life.

CONCLUSION

Patients with eosinophilic asthma and self-reported CRSwNP, with and without aspirin sensitivity, are highly responsive to treatment with reslizumab for asthma-related outcomes. These findings suggest that prospective investigation of reslizumab in this patient population is warranted.

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Staphylococcus aureus nasal colonization and asthma in adults: systematic review and meta-analysis

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Young-Chan Kim, Ha-Kyeong Won, Ji Won Lee, Kyoung-Hee Sohn, Min-Hye Kim, Tae-Bum Kim, Yoon-Seok Chang, Byung-Jae Lee, Sang-Heon Cho, Claus Bachert, Woo-Jung Song

Abstract

Background

Staphylococcus aureus (SA) is a frequent colonizer in human and it is known to be associated with chronic allergic diseases including asthma. Recent individual studies suggested that nasal SA colonization may be positively associated with asthma.

Objective

To examine relationships between nasal SA colonization and asthma prevalence and activity in adults.

Methods

Electronic databases were searched for studies published until June 2018. Studies that reported nasal SA colonization prevalence and asthma outcome (prevalence and disease activity) in general adult populations or chronic rhinosinusitis (CRS) patients were included. Random effects meta-analyses were performed to calculate pooled odds ratio (OR) of the relationships. Subgroup analysis was conducted for the presence of nasal polyps within CRS populations.

Results

A total of 21 cross-sectional studies were identified, and the data from 16 studies using culture methods for SA detection were meta-analyzed (5 general population-based studies and 11 CRS patient studies). In studies of general populations, nasal SA colonization had significant relationships with asthma prevalence (OR 1.19; 95% confidence interval 1.06-1.34; I² = 1%). In CRS patient studies, positive associations were also found but had a considerable heterogeneity (OR 1.87; 95% CI 1.18-2.97; I² = 72%). However, the results were comparable between CRS with and without nasal polyps.

Conclusions

This study demonstrated modest but significant relationships between nasal SA colonization and asthma, supporting potential roles of SA in adult asthma patients. Further longitudinal cohort and intervention studies are warranted to identify host determinants and to clarify causality of the relationships.

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Patient versus allergy specialist interpretation of a negative workup for suspected iodinated contrast media allergy

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Rik Schrijvers, Christine Breynaert, Jean-Luc Bourrain, Pascal Demoly, Anca Mirela Chiriac

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Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival and impaired clearance

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Jocelyn R. Grunwell, Susan T. Stephenson, Rabindra Tirouvanziam, Lou Ann S. Brown, Milton R. Brown, Anne M. Fitzpatrick

Background

Airway neutrophils are abundant in some children with severe asthma, but their functions are poorly understood.

Objective

We hypothesized that the inflammatory airway environment of children with neutrophil-predominant severe asthma promotes neutrophil survival and disrupts neutrophil-associated innate immune defenses.

Methods

Sixty seven children with severe asthma refractory to high-dose inhaled corticosteroid (ICS) treatment undergoing bronchoscopy with bronchoalveolar lavage (BAL) for clinical indications were stratified into neutrophil "high" versus "low" groups based on BAL differential counts. Neutrophil activation markers, functional assays and phenotyping studies were performed as well as airway macrophage functional assays. Results were compared to those from children with moderate asthma treated with ICS.

Results

Children with neutrophil-predominant severe asthma had increased markers of neutrophil activation/degranulation and a greater magnitude of airway pro-inflammatory cytokine and chemokine release. Primary neutrophils exposed to BAL of these children exhibited greater phagocytic capability and greater neutrophil extracellular trap formation, but a more impaired respiratory burst. Despite greater abundance of airway TGF-β1, the neutrophils were not more apoptotic. Instead, neutrophils had a highly pro-inflammatory phenotype associated with a number of surface markers that regulate neutrophil activation, recruitment/migration and granule release. Airway macrophages from children with neutrophil-predominant severe asthma were also more pro-inflammatory with impaired phagocytosis and increased apoptosis.

Conclusions

Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival. Airway macrophages are also pro-inflammatory and dysfunctional and may contribute to global innate immune impairment. Therapies that target neutrophils and related inflammation may be warranted in this subset of children.

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Bronchial Thermoplasty: A Decade of Experience: State of The Art

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Laren D. Tan, Ken Y. Yoneda, Samuel Louie, D.Kyle Hogarth, Mario Castro

Abstract:

Bronchial thermoplasty (BT) delivers targeted radiofrequency energy to bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation and intense follow up) that we believe promote successful patient outcomes and help build a successful BT program.

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Fatal asthma: an audit of 30 million patient-years of health plan membership from 2007 to 2015

Publication date: Available online 5 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Eric Macy, Janis F. Yao, Wansu Chen

Abstract

Background

Without accurate data on deaths directly caused by asthma, prevention will be difficult.

Objective

Determine how often asthma could be confirmed as a proximal cause of death in a large well-defined population with active health plan membership and no acute barriers to medical care.

Methods

All deaths occurring in active Kaiser Permanente Southern California health plan members between 2007 and 2015 were identified. Asthma-coded deaths were manually audited for cause. Healthcare and asthma medication use in the 6 months prior to death were determined.

Results

There were 248 [0.80 per 100,000 patient-years] un-audited asthma-coded deaths. There were only 63 (26.5%) [0.20 per 100,000 patient-years] asthma-confirmed deaths. Individuals with asthma-confirmed deaths were younger, less likely to have ever smoked, and had fewer emergency visits in the 6 months prior to death compared to those with asthma excluded. Individuals with asthma-confirmed deaths used preventative inhalers at very low rates. We unexpectedly found that ever inclusion in the 2016 National Committee for Quality Assurance health effectiveness data and information set (HEDIS) for persistent asthma was associated with a higher risk of all cause early death. Individuals with asthma-confirmed deaths were also unlikely to be in the HEDIS asthma dataset in the year they died, thus not targeted for outreach.

Conclusions

Audit-confirmed fatal asthma is more likely to occur in younger, non-smoking, individuals, using very low rates of preventive inhalers. This will be a very difficult group to prospectively identify and manage effectively. Further research into the reasons for early death after HEDIS asthma dataset inclusion is warranted.

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Staging/restaging performance of F18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in breast cancer: A review and meta-analysis

Publication date: Available online 5 September 2018

Source: European Journal of Radiology

Author(s): Chun-Yi Lin, Cheng-Li Lin, Chia-Hung Kao

Abstract

Purpose

This systematic review and meta-analysis was performed to assess the staging/restaging performance of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in breast cancer.

Methods

A comprehensive search was performed in PubMed databases for studies reporting the staging performance of F18-FDG PET/MRI in breast cancer from the inception of these databases to January 29, 2018. Eight studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of F18-FDG PET/MRI were calculated alongside 95% confidence intervals (CIs). A summary receiver operating characteristic curve (SROC) was plotted and the area under the SROC curve (AUC) was determined alongside the Q* index.

Results

The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.98 (95% CI, 0.95–0.99), 0.87 (95% CI, 0.76–0.95), 4.59 (95% CI, 1.91–11.05), 0.03 (95% CI, 0.01–0.09), 203.07 (95% CI, 50.33–819.38), and 0.99, respectively. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.91 (95% CI, 0.88–0.94), 0.95 (95% CI, 0.92–0.97), 11.28 (95% CI, 4.25–29.96), 0.07 (95% CI, 0.02–0.22), 286.46 (95 % CI, 64.15–1279.17), and 0.99, respectively. The overall diagnostic accuracies (Q* index) of the staging performance of F18-FDG PET/MRI in breast cancer were 0.96 (patient-based analysis) and 0.95 (lesion-based analysis).

Conclusion

F18-FDG PET/MRI has excellent diagnostic staging/restaging performance in patients with breast cancer, and thus should be considered for staging of patients with breast cancer.

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Historical Evolution of the Polymorphous Adenocarcinoma

Abstract

The 2017 World Health Organization Classification of Head and Neck Tumors introduced for the first time the diagnostic terminology "cribriform variant of polymorphous adenocarcinoma". This nomenclature attempts to reconciliate the ongoing taxonomical controversy related to cribriform adenocarcinoma of tongue. In order to better understand this classification conundrum, it is imperative for pathologist to comprehend the historical evolution of polymorphous adenocarcinoma formerly known as polymorphous "low grade" adenocarcinoma. This review highlights our understanding of these tumors since their origins.

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Evaluation of Radiomorphometric Indices and Bone Findings on Panoramic Images in Patients with Scleroderma

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Eda Didem Yalcin, Nihal Avcu, Serdar Uysal, Umut Arslan

Abstract

Objectives

: The aim of this study was to make radiomorphometric measurements on panoramic images and evaluate the radiological findings of bones and teeth of patients with scleroderma.

Study Design

: Panoramic images of 49 patients with scleroderma and 51 healthy controls were assessed. Mandibular Radiomorphometric Indices (MRI) including mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI), gonial index (GI) and antegonial index (AI) were performed. Furthermore mandibular osteolysis, changes of periodontal ligament (PDL) space and changes of lamina dura were recorded for the scleroderma group.

Results

: Statistically significant differences were found for MCI (p = 0.003), MI (p = 0.001) and PMI (p < 0.001) between the scleroderma and control group, but not for GI or AI (p > 0.05). Widening of PDL space (79.6%), thickening of lamina dura (44.9%), limited mouth opening (71.4%) and osseous resorption of the mandible (8%) were detected in the scleroderma group.

Conclusions

: The radiomorphometric indices performed in the present study can be used on panoramic images to determine the existence of porous structure in mandibular cortical bone in patients with scleroderma. The most common prevalent oral radiographic manifestations of scleroderma were widening of the PDL space and of the lamina dura.

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Benign and Malignant Odontogenic Neoplasms of the Jaws Show a Concordant Non-Discriminatory p63/p40 Positive Immunophenotype

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Prokopios P. Argyris, Chris Malz, Reda Taleb, Ioannis G. Koutlas

Abstract

Objectives

Antibody p40 which recognizes exclusively ΔNp63 but not TAp63, has shown diagnostic utility in salivary gland and sinonasal tract malignancies. Although p63 immunophenotypic characterization of odontogenic lesions has been reported, p40 expression has not been previously studied. We aimed to study p40 immunoreactivity in odontogenic tumors (OT) and cysts (OC), and to investigate possible discriminatory properties of the combined p63/p40 immunoprofile in OT and OC.

Study Design

Fourteen ameloblastomas (AME), 7 adenomatoid odontogenic tumors (AOT), 6 calcifying epithelial odontogenic tumors (CEOT), 1 squamous odontogenic tumor (SOT), 4 primary intraosseous odontogenic carcinomas (PIOC), 5 calcifying odontogenic cysts (COC), 4 glandular odontogenic cysts (GOC), 3 odontogenic keratocysts (OKC), 3 dentigerous cysts and 1 each radicular and orthokeratinized cysts were stained for p63 (4A4) and p40 (BC28) antibodies.

Results

AME, AOT, CEOT, SOT and PIOC demonstrated concordant p63+/p40+ immunophenotype. P40, similar to p63, highlighted almost all lesional cells of OT and, overall, the full thickness of the epithelial lining of OC and AME cystic areas. The keratin layer of OKC and adluminal ductal and mucous cells of GOC were p63-/p40-.

Conclusions

1) Both ΔNp63 and TAp63 isoforms are present in neoplastic and developmental odontogenic lesions; 2) p63/p40 immunophenotype is non-discriminatory pertaining to benign and malignant OT and OC.

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Multiple superficial mucoceles concomitant with oral lichen planus: A case series

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Kejia Lv, Jianhua Liu, Weijia Ye, Guohua Wang, Hua Yao

Abstract

Superficial mucoceles are a relatively rare variant of common mucoceles and have an unclear etiology. Clinically, they are small, translucent, subepithelial vesicles affecting the oral mucosa in the retromolar region, the lower labial and buccal regions and the bilateral soft palate. Superficial mucocele is easily misdiagnosed as pemphigoid, bullous lichen planus, herpes lesion or venous lake when it is concomitant with oral lichen planus (OLP) or lichen disorders, considering the initial impression. An inflammatory mechanism related to OLP has been hypothesized to induce the development of superficial mucoceles. It is essential to be familiar with this entity. This report presents 9 cases of multiple superficial mucoceles that occurred sequentially concomitant with OLP and with consistent clinical and histopathological features. Relevant works in the literature are also reviewed to provide additional clarification of the etiology, clinicopathological characteristics, and differential diagnosis.

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Dentofacial deformities and the quality of life of patients carrying these conditions; a comparative study.

Publication date: Available online 4 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Carlos Alberto Ribeiro Neto, Gabriely Ferreira, Gislaine Calselin Batista Monnazzi, Mario Francisco Real Gabrielli, Marcelo Silva Monnazzi

Abstract

Objectives: The aim of the present study was to evaluate the quality of life of patients with dentofacial deformities and of patients subjected to orthognathic surgery in order to compare their results to results of patients who have no dentofacial deformity, by applying the OQLQ instrument.

Study design: Three groups of patients were interviewed and the OQLQ instrument was applied to them by one only examiner.

Results: Results showed statistical difference between groups and suggested that patients with no deformity and the ones subjected to the orthognathic surgery have better quality of life when compared to facial deformity carriers.

Conclusions: The orthognathic surgery and the consequent dentofacial correction seems to make a positive effect in the quality of life.

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Staging/restaging performance of F18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in breast cancer: A review and meta-analysis

Publication date: Available online 5 September 2018

Source: European Journal of Radiology

Author(s): Chun-Yi Lin, Cheng-Li Lin, Chia-Hung Kao

Abstract

Purpose

This systematic review and meta-analysis was performed to assess the staging/restaging performance of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in breast cancer.

Methods

A comprehensive search was performed in PubMed databases for studies reporting the staging performance of F18-FDG PET/MRI in breast cancer from the inception of these databases to January 29, 2018. Eight studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of F18-FDG PET/MRI were calculated alongside 95% confidence intervals (CIs). A summary receiver operating characteristic curve (SROC) was plotted and the area under the SROC curve (AUC) was determined alongside the Q* index.

Results

The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.98 (95% CI, 0.95–0.99), 0.87 (95% CI, 0.76–0.95), 4.59 (95% CI, 1.91–11.05), 0.03 (95% CI, 0.01–0.09), 203.07 (95% CI, 50.33–819.38), and 0.99, respectively. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.91 (95% CI, 0.88–0.94), 0.95 (95% CI, 0.92–0.97), 11.28 (95% CI, 4.25–29.96), 0.07 (95% CI, 0.02–0.22), 286.46 (95 % CI, 64.15–1279.17), and 0.99, respectively. The overall diagnostic accuracies (Q* index) of the staging performance of F18-FDG PET/MRI in breast cancer were 0.96 (patient-based analysis) and 0.95 (lesion-based analysis).

Conclusion

F18-FDG PET/MRI has excellent diagnostic staging/restaging performance in patients with breast cancer, and thus should be considered for staging of patients with breast cancer.

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Historical Evolution of the Polymorphous Adenocarcinoma

Abstract

The 2017 World Health Organization Classification of Head and Neck Tumors introduced for the first time the diagnostic terminology "cribriform variant of polymorphous adenocarcinoma". This nomenclature attempts to reconciliate the ongoing taxonomical controversy related to cribriform adenocarcinoma of tongue. In order to better understand this classification conundrum, it is imperative for pathologist to comprehend the historical evolution of polymorphous adenocarcinoma formerly known as polymorphous "low grade" adenocarcinoma. This review highlights our understanding of these tumors since their origins.

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Evaluation of Radiomorphometric Indices and Bone Findings on Panoramic Images in Patients with Scleroderma

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Eda Didem Yalcin, Nihal Avcu, Serdar Uysal, Umut Arslan

Abstract

Objectives

: The aim of this study was to make radiomorphometric measurements on panoramic images and evaluate the radiological findings of bones and teeth of patients with scleroderma.

Study Design

: Panoramic images of 49 patients with scleroderma and 51 healthy controls were assessed. Mandibular Radiomorphometric Indices (MRI) including mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI), gonial index (GI) and antegonial index (AI) were performed. Furthermore mandibular osteolysis, changes of periodontal ligament (PDL) space and changes of lamina dura were recorded for the scleroderma group.

Results

: Statistically significant differences were found for MCI (p = 0.003), MI (p = 0.001) and PMI (p < 0.001) between the scleroderma and control group, but not for GI or AI (p > 0.05). Widening of PDL space (79.6%), thickening of lamina dura (44.9%), limited mouth opening (71.4%) and osseous resorption of the mandible (8%) were detected in the scleroderma group.

Conclusions

: The radiomorphometric indices performed in the present study can be used on panoramic images to determine the existence of porous structure in mandibular cortical bone in patients with scleroderma. The most common prevalent oral radiographic manifestations of scleroderma were widening of the PDL space and of the lamina dura.

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Benign and Malignant Odontogenic Neoplasms of the Jaws Show a Concordant Non-Discriminatory p63/p40 Positive Immunophenotype

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Prokopios P. Argyris, Chris Malz, Reda Taleb, Ioannis G. Koutlas

Abstract

Objectives

Antibody p40 which recognizes exclusively ΔNp63 but not TAp63, has shown diagnostic utility in salivary gland and sinonasal tract malignancies. Although p63 immunophenotypic characterization of odontogenic lesions has been reported, p40 expression has not been previously studied. We aimed to study p40 immunoreactivity in odontogenic tumors (OT) and cysts (OC), and to investigate possible discriminatory properties of the combined p63/p40 immunoprofile in OT and OC.

Study Design

Fourteen ameloblastomas (AME), 7 adenomatoid odontogenic tumors (AOT), 6 calcifying epithelial odontogenic tumors (CEOT), 1 squamous odontogenic tumor (SOT), 4 primary intraosseous odontogenic carcinomas (PIOC), 5 calcifying odontogenic cysts (COC), 4 glandular odontogenic cysts (GOC), 3 odontogenic keratocysts (OKC), 3 dentigerous cysts and 1 each radicular and orthokeratinized cysts were stained for p63 (4A4) and p40 (BC28) antibodies.

Results

AME, AOT, CEOT, SOT and PIOC demonstrated concordant p63+/p40+ immunophenotype. P40, similar to p63, highlighted almost all lesional cells of OT and, overall, the full thickness of the epithelial lining of OC and AME cystic areas. The keratin layer of OKC and adluminal ductal and mucous cells of GOC were p63-/p40-.

Conclusions

1) Both ΔNp63 and TAp63 isoforms are present in neoplastic and developmental odontogenic lesions; 2) p63/p40 immunophenotype is non-discriminatory pertaining to benign and malignant OT and OC.

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Multiple superficial mucoceles concomitant with oral lichen planus: A case series

Publication date: Available online 5 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Kejia Lv, Jianhua Liu, Weijia Ye, Guohua Wang, Hua Yao

Abstract

Superficial mucoceles are a relatively rare variant of common mucoceles and have an unclear etiology. Clinically, they are small, translucent, subepithelial vesicles affecting the oral mucosa in the retromolar region, the lower labial and buccal regions and the bilateral soft palate. Superficial mucocele is easily misdiagnosed as pemphigoid, bullous lichen planus, herpes lesion or venous lake when it is concomitant with oral lichen planus (OLP) or lichen disorders, considering the initial impression. An inflammatory mechanism related to OLP has been hypothesized to induce the development of superficial mucoceles. It is essential to be familiar with this entity. This report presents 9 cases of multiple superficial mucoceles that occurred sequentially concomitant with OLP and with consistent clinical and histopathological features. Relevant works in the literature are also reviewed to provide additional clarification of the etiology, clinicopathological characteristics, and differential diagnosis.

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Dentofacial deformities and the quality of life of patients carrying these conditions; a comparative study.

Publication date: Available online 4 September 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Carlos Alberto Ribeiro Neto, Gabriely Ferreira, Gislaine Calselin Batista Monnazzi, Mario Francisco Real Gabrielli, Marcelo Silva Monnazzi

Abstract

Objectives: The aim of the present study was to evaluate the quality of life of patients with dentofacial deformities and of patients subjected to orthognathic surgery in order to compare their results to results of patients who have no dentofacial deformity, by applying the OQLQ instrument.

Study design: Three groups of patients were interviewed and the OQLQ instrument was applied to them by one only examiner.

Results: Results showed statistical difference between groups and suggested that patients with no deformity and the ones subjected to the orthognathic surgery have better quality of life when compared to facial deformity carriers.

Conclusions: The orthognathic surgery and the consequent dentofacial correction seems to make a positive effect in the quality of life.

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Anesthetic efficiency of articaine versus lidocaine in the extraction of lower third molar: A meta-analysis and systematic review

Publication date: Available online 5 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Aobo Zhang, Huasong Tang, Shaopeng Liu, Chuan Ma, Shixing Ma, Huaqiang Zhao

Abstract:

Purpose

The purpose of this study was to evaluate whether the anesthetic efficiency of articaine is superior to lidocaine during the extraction of lower third molar (LTME).

Method

Pubmed, Cochrane, Web of science three electronic databases were searched to identify randomized controlled trials (RCTs) up to December, 31 2017. Five evaluation indexes were extracted, namely success rate of anesthesia (SRA), subjective and objective onset time of anesthesia (SOA, OOA), duration time of anesthesia (DTA) and intra-operative pain assessment (IPA) to assess the anesthesia efficiency of these two solutions. All data analyses were conducted by using Review Manager 5.3.

Results

Nine studies were included in this review, the sample was composed of 770 lower third molar extractions from 493 patients, of which 382 patients were in the lidocaine group and 388 in the articaine group. Compared with lidocaine, the 4% articaine with 1:100 000 epinephrine showed higher SRA (risk ratio(RR), 1.10; 95% confidence intervals (CI),1.01 to 1.21; P=0.03), shorter SOA (SMD, 1.20; 95%CI, 0.50 to 1.89; P=0.0007), longer DTA (MD, 0.83h; 95%CI, 0.59 to 1.07; P<0.00001); but for IPA (MD, 3.12mm; 95%CI, -0.13 to 6.37; P=0.06) and OOA (SMD, 0.44; 95%CI, -0.39 to 1.26; P=0.30), there was no significant difference between the two solutions.

Conclusion

The results of this study suggest that 4% articaine with 1:100 000 epinephrine possesses superior anesthetic efficiency relative to lidocaine for IANB during LTME.

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What Are The Risk Factors For External Root Resorption of Second Molars Associated With Impacted Third Molars?

Publication date: Available online 4 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Melek Tassoker

Purpose

In relation to an impacted third molar, which is the most frequently impacted tooth, external root resorption (ERR) or dental caries can be seen on the distal surface of the adjacent second molar. The purpose of this study was to investigate the risk factors of ERR in second molars associated with impacted third molars using cone-beam computed tomography (CBCT).

Materials and Methods

In this cross-sectional study, the presence of ERR on the adjacent second molar was investigated retrospectively on sagittal and axial CBCT slices of the patients, who underwent CBCT examination for diagnostic reasons (surgical removal of third molars, orthodontic assessments, etc.) between 2013 and 2017, at Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. The primary outcome variable was ERR (y/n). Predictor variables included demographic (age and gender) and radiographic (impacted tooth angulation and tooth type) parameters. Given there are multiple observations per subject (1 to 4 impacted teeth), one third molar was selected per subject at random for study inclusion. Statistical analysis was performed using the descriptive statistics, Mann-Whitney U test, and Pearson's chi-squared test. Logistic regression analysis was used to determine the risk factors for ERR in second molars. Cohen's Kappa test was used for testing the intra-observer agreement. The significance level was set at p < 0.05.

Results

Two hundred patients were analyzed and of the 200 impacted third molars evaluated 42 (21%) showed ERR. It was found that the severity of resorption increased with aging (p<0.05). Logistic regression analysis indicated that tooth number and inclination of third molars could predict the occurrence of ERR associated with an impacted third molar (p<0.05).

Conclusion

Mesioangular and horizontal inclinations and impacted mandibular third molars posed a greater risk for ERR lesions in adjacent second molars than other inclinations (distoangular and vertical) and maxillary third molars.

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Reconstruction of complex full thickness scalp defects after dog bite injuries using Dermal Regeneration Template (Integra): Case report and literature review

Publication date: Available online 4 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Vanessa Watts, Mikhail Daya Attie, Shawn McClure

Abstract

Purpose

The purpose of this article is to review the current applications of Dermal Regeneration Templates in reconstruction of full thickness scalp defects, most commonly resulting from oncologic surgery, and demonstrate its success in reconstruction of a complex full-thickness scalp defect resulting from a dog bite injury.

Materials and Methods

A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on characteristics of size of defects, procedural protocol, and reconstruction modalities. Outcomes reported were based on reports of follow-up, complications, and percent graft take. The case report presents reconstruction of a complex full-thickness scalp defect secondary to a dog-bite injury with a Dermal Regeneration Template (DRT).

Results

Fifteen articles were included. Reported ages ranged from 2 to 93 years of age. Mean defect size ranged from 6 to 610cm² with 66% of defects averaging more than 50cm2.All articles reported the two stage approach to Integra-based reconstruction with follow-up ranging from 5-23 months with only two articles reporting less than 90% graft take.

Conclusions

Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction, and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Moh's surgical defects as well as burns of the trunk and extremities; however, reports of reconstruction of post traumatic soft tissue defects of the head and neck is limited. Based on the reported successes from the reviewed literature, and the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic full-thickness complex scalp defects when used appropriately.

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Sjögren’s Syndrome and Autoimmune Thyroid Disease: Two Sides of the Same Coin

Abstract

The coexistence of Sjögren's syndrome (SS) and autoimmune thyroid disease (AITD) has been documented. However, there is no consensus whether this coexistence should be considered as the same nosological condition or as polyautoimmunity. Thus, in this monocentric retrospective study, patients with SS alone (i.e., primary) were compared with patients with SS and AITD. In addition, a discussion of previous studies including those about genetic and environmental factors influencing the development of both conditions is presented. In our series, all patients with AITD had Hashimoto's thyroiditis (HT). No significant differences in age, gender, age of disease onset, and disease duration were found between the two groups. Lymphadenopathy and urticaria were more frequently registered in patients with SS-HT than in patients with SS alone (p < 0.05). Anti-Ro/SSA antibodies were more frequent in the primary SS group (p = 0.01). SS-HT patients were more likely to report a positive history of smoking (p = 0.03). The clinical expression of SS varies slightly when HT coexists. Although both entities share common physiopathological mechanisms as part of the autoimmune tautology, they are nosologically different and their coexistence should be interpreted as polyautoimmunity. Further studies based on polyautoimmunity would allow establishing a new taxonomy of autoimmune diseases.

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Protein expression in submandibular glands of young rats is modified by a high-fat/high-sugar maternal diet

Publication date: Available online 5 September 2018

Source: Archives of Oral Biology

Author(s): Martine Morzel, Hélène Brignot, Franck Ménétrier, Géraldine Lucchi, Vincent Paillé, Patricia Parnet, Sophie Nicklaus, Marie-Chantal Canivenc-Lavier

Abstract

Objective

Maternal diet has consequences on many organs of the offspring, but salivary glands have received little attention despite the importance of the saliva secretory function in oral health and control of food intake. The objective of this work was therefore to document in rats the impact of maternal high-fat / high-sugar diet (Western Diet) on submandibular glands of the progeny.

Design

Sprague-Dawley rat dams were fed either a Western diet or control diet during gestation and lactation and their pups were sacrificed 25 days after birth. The pups' submandibular gland protein content was characterized by means of 2D-electrophoresis followed by LC-MS/MS. Data were further analyzed by Gene Ontology enrichment analysis and protein-protein interactions mapping. The expression of two specific proteins was also evaluated using immunohistochemistry.

Results

Combining both male and female pups (n = 18), proteome analysis revealed that proteins involved in protein quality control (e.g. heat shock proteins, proteasome sub-units) and microtubule proteins were over-expressed in Western diet conditions, which may translate intense metabolic activity. A cluster of proteins controlling oxidative stress (e.g. Glutathione peroxidases, peroxiredoxin) and enhancement of the antioxidant activity molecular function were also characteristic of maternal Western diet as well as under-expression of annexin A5. The down-regulating effect of maternal Western diet on Annexin A5 expression was significant only for males (p < 0.05).

Conclusions

A maternal Western diet modifies the protein composition of the offspring's salivary glands, which may have consequences on the salivary function.

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Anesthetic efficiency of articaine versus lidocaine in the extraction of lower third molar: A meta-analysis and systematic review

Publication date: Available online 5 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Aobo Zhang, Huasong Tang, Shaopeng Liu, Chuan Ma, Shixing Ma, Huaqiang Zhao

Abstract:

Purpose

The purpose of this study was to evaluate whether the anesthetic efficiency of articaine is superior to lidocaine during the extraction of lower third molar (LTME).

Method

Pubmed, Cochrane, Web of science three electronic databases were searched to identify randomized controlled trials (RCTs) up to December, 31 2017. Five evaluation indexes were extracted, namely success rate of anesthesia (SRA), subjective and objective onset time of anesthesia (SOA, OOA), duration time of anesthesia (DTA) and intra-operative pain assessment (IPA) to assess the anesthesia efficiency of these two solutions. All data analyses were conducted by using Review Manager 5.3.

Results

Nine studies were included in this review, the sample was composed of 770 lower third molar extractions from 493 patients, of which 382 patients were in the lidocaine group and 388 in the articaine group. Compared with lidocaine, the 4% articaine with 1:100 000 epinephrine showed higher SRA (risk ratio(RR), 1.10; 95% confidence intervals (CI),1.01 to 1.21; P=0.03), shorter SOA (SMD, 1.20; 95%CI, 0.50 to 1.89; P=0.0007), longer DTA (MD, 0.83h; 95%CI, 0.59 to 1.07; P<0.00001); but for IPA (MD, 3.12mm; 95%CI, -0.13 to 6.37; P=0.06) and OOA (SMD, 0.44; 95%CI, -0.39 to 1.26; P=0.30), there was no significant difference between the two solutions.

Conclusion

The results of this study suggest that 4% articaine with 1:100 000 epinephrine possesses superior anesthetic efficiency relative to lidocaine for IANB during LTME.

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What Are The Risk Factors For External Root Resorption of Second Molars Associated With Impacted Third Molars?

Publication date: Available online 4 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Melek Tassoker

Purpose

In relation to an impacted third molar, which is the most frequently impacted tooth, external root resorption (ERR) or dental caries can be seen on the distal surface of the adjacent second molar. The purpose of this study was to investigate the risk factors of ERR in second molars associated with impacted third molars using cone-beam computed tomography (CBCT).

Materials and Methods

In this cross-sectional study, the presence of ERR on the adjacent second molar was investigated retrospectively on sagittal and axial CBCT slices of the patients, who underwent CBCT examination for diagnostic reasons (surgical removal of third molars, orthodontic assessments, etc.) between 2013 and 2017, at Necmettin Erbakan University, Faculty of Dentistry, Konya, Turkey. The primary outcome variable was ERR (y/n). Predictor variables included demographic (age and gender) and radiographic (impacted tooth angulation and tooth type) parameters. Given there are multiple observations per subject (1 to 4 impacted teeth), one third molar was selected per subject at random for study inclusion. Statistical analysis was performed using the descriptive statistics, Mann-Whitney U test, and Pearson's chi-squared test. Logistic regression analysis was used to determine the risk factors for ERR in second molars. Cohen's Kappa test was used for testing the intra-observer agreement. The significance level was set at p < 0.05.

Results

Two hundred patients were analyzed and of the 200 impacted third molars evaluated 42 (21%) showed ERR. It was found that the severity of resorption increased with aging (p<0.05). Logistic regression analysis indicated that tooth number and inclination of third molars could predict the occurrence of ERR associated with an impacted third molar (p<0.05).

Conclusion

Mesioangular and horizontal inclinations and impacted mandibular third molars posed a greater risk for ERR lesions in adjacent second molars than other inclinations (distoangular and vertical) and maxillary third molars.

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Reconstruction of complex full thickness scalp defects after dog bite injuries using Dermal Regeneration Template (Integra): Case report and literature review

Publication date: Available online 4 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Vanessa Watts, Mikhail Daya Attie, Shawn McClure

Abstract

Purpose

The purpose of this article is to review the current applications of Dermal Regeneration Templates in reconstruction of full thickness scalp defects, most commonly resulting from oncologic surgery, and demonstrate its success in reconstruction of a complex full-thickness scalp defect resulting from a dog bite injury.

Materials and Methods

A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on characteristics of size of defects, procedural protocol, and reconstruction modalities. Outcomes reported were based on reports of follow-up, complications, and percent graft take. The case report presents reconstruction of a complex full-thickness scalp defect secondary to a dog-bite injury with a Dermal Regeneration Template (DRT).

Results

Fifteen articles were included. Reported ages ranged from 2 to 93 years of age. Mean defect size ranged from 6 to 610cm² with 66% of defects averaging more than 50cm2.All articles reported the two stage approach to Integra-based reconstruction with follow-up ranging from 5-23 months with only two articles reporting less than 90% graft take.

Conclusions

Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction, and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Moh's surgical defects as well as burns of the trunk and extremities; however, reports of reconstruction of post traumatic soft tissue defects of the head and neck is limited. Based on the reported successes from the reviewed literature, and the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic full-thickness complex scalp defects when used appropriately.

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Sjögren’s Syndrome and Autoimmune Thyroid Disease: Two Sides of the Same Coin

Abstract

The coexistence of Sjögren's syndrome (SS) and autoimmune thyroid disease (AITD) has been documented. However, there is no consensus whether this coexistence should be considered as the same nosological condition or as polyautoimmunity. Thus, in this monocentric retrospective study, patients with SS alone (i.e., primary) were compared with patients with SS and AITD. In addition, a discussion of previous studies including those about genetic and environmental factors influencing the development of both conditions is presented. In our series, all patients with AITD had Hashimoto's thyroiditis (HT). No significant differences in age, gender, age of disease onset, and disease duration were found between the two groups. Lymphadenopathy and urticaria were more frequently registered in patients with SS-HT than in patients with SS alone (p < 0.05). Anti-Ro/SSA antibodies were more frequent in the primary SS group (p = 0.01). SS-HT patients were more likely to report a positive history of smoking (p = 0.03). The clinical expression of SS varies slightly when HT coexists. Although both entities share common physiopathological mechanisms as part of the autoimmune tautology, they are nosologically different and their coexistence should be interpreted as polyautoimmunity. Further studies based on polyautoimmunity would allow establishing a new taxonomy of autoimmune diseases.

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Protein expression in submandibular glands of young rats is modified by a high-fat/high-sugar maternal diet

Publication date: Available online 5 September 2018

Source: Archives of Oral Biology

Author(s): Martine Morzel, Hélène Brignot, Franck Ménétrier, Géraldine Lucchi, Vincent Paillé, Patricia Parnet, Sophie Nicklaus, Marie-Chantal Canivenc-Lavier

Abstract

Objective

Maternal diet has consequences on many organs of the offspring, but salivary glands have received little attention despite the importance of the saliva secretory function in oral health and control of food intake. The objective of this work was therefore to document in rats the impact of maternal high-fat / high-sugar diet (Western Diet) on submandibular glands of the progeny.

Design

Sprague-Dawley rat dams were fed either a Western diet or control diet during gestation and lactation and their pups were sacrificed 25 days after birth. The pups' submandibular gland protein content was characterized by means of 2D-electrophoresis followed by LC-MS/MS. Data were further analyzed by Gene Ontology enrichment analysis and protein-protein interactions mapping. The expression of two specific proteins was also evaluated using immunohistochemistry.

Results

Combining both male and female pups (n = 18), proteome analysis revealed that proteins involved in protein quality control (e.g. heat shock proteins, proteasome sub-units) and microtubule proteins were over-expressed in Western diet conditions, which may translate intense metabolic activity. A cluster of proteins controlling oxidative stress (e.g. Glutathione peroxidases, peroxiredoxin) and enhancement of the antioxidant activity molecular function were also characteristic of maternal Western diet as well as under-expression of annexin A5. The down-regulating effect of maternal Western diet on Annexin A5 expression was significant only for males (p < 0.05).

Conclusions

A maternal Western diet modifies the protein composition of the offspring's salivary glands, which may have consequences on the salivary function.

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A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?

Publication date: Available online 4 September 2018

Source: Addictive Behaviors

Author(s): James Davies, John Read

Abstract

Introduction

The U.K.'s current National Institute for Health and Care Excellence and the American Psychiatric Association's depression guidelines state that withdrawal reactions from antidepressants are 'self-limiting' (i.e. typically resolving between 1 and 2 weeks). This systematic review assesses that claim.

Methods

A systematic literature review was undertaken to ascertain the incidence, severity and duration of antidepressant withdrawal reactions. We identified 23 relevant studies, with diverse methodologies and sample sizes.

Results

Withdrawal incidence rates from 14 studies ranged from 27% to 86% with a weighted average of 56%. Four large studies of severity produced a weighted average of 46% of those experiencing antidepressant withdrawal effects endorsing the most extreme severity rating on offer. Seven of the ten very diverse studies providing data on duration contradict the UK and USA withdraw Guidelines in that they found a significant proportion of people who experience withdrawal do so for more than two weeks, and that it is not uncommon for people to experience withdrawal for several months. The findings of the only four studies calculating mean duration were, for quite heterogeneous populations, 5 days, 10 days, 43 days and 79 weeks.

Conclusions

We recommend that U.K. and U.S.A. guidelines on antidepressant withdrawal be urgently updated as they are clearly at variance with the evidence on the incidence, severity and duration of antidepressant withdrawal, and are probably leading to the widespread misdiagnosing of withdrawal, the consequent lengthening of antidepressant use, much unnecessary antidepressant prescribing and higher rates of antidepressant prescriptions overall. We also recommend that prescribers fully inform patients about the possibility of withdrawal effects.

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Substance usage intention does not affect attentional bias: implications from Ecstasy/MDMA users and alcohol drinkers

Publication date: Available online 4 September 2018

Source: Addictive Behaviors

Author(s): Thomas D.W. Wilcockson, Emmanuel M. Pothos, Andrew C. Parrott

Abstract

Background

An attentional bias towards substance-related stimuli has been demonstrated with alcohol drinkers and many other types of substance user. There is evidence to suggest that the strength of an attentional bias may vary as a result of context (or use intention), especially within Ecstasy/MDMA users.

Objective

Our aim was to empirically investigate attentional biases by observing the affect that use intention plays in recreational MDMA users and compare the findings with that of alcohol users.

Method

Regular alcohol drinkers were compared with MDMA users. Performance was assessed for each group separately using two versions of an eye-tracking attentional bias task with pairs of matched neutral, and alcohol or MDMA-related visual stimuli. Dwell time was recorded for alcohol or MDMA. Participants were tested twice, when intending and not intending to use MDMA or alcohol. Note, participants in the alcohol group did not complete any tasks which involved MDMA-related stimuli and vice versa.

Results

Significant attentional biases were found with both MDMA and alcohol users for respective substance-related stimuli, but not control stimuli. Critically, use intention did not affect attentional biases. Attentional biases were demonstrated with both MDMA users and alcohol drinkers when usage was and was not intended.

Conclusions

These findings demonstrate the robust nature of attentional biases i.e. once an attentional bias has developed, it is not readily affected by intention.

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