“How Important are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors”

Publication date: Available online 19 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Daniel M. Laskin, Arsalan Bhatti, Caroline K. Carrico

ABSTRACT

Purpose

Letters of recommendation are currently a part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in decision-making process.

Materials and Methods

In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared to other application attributes through a visual analog scale that ranged from 0 to 100, with 0 labeled as "Not Important" and 100 "Very Important." Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of both applicant attributes and components of recommendations were compared using random effects models to adjust for multiple responses from the same respondent. Post-hoc pairwise comparisons were performed using Tukey's adjustment.

Results

Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon, and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents.

Conclusions

Despite some of the deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.

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Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis

Abstract

Objectives

The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths.

Materials and methods

Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0.

Results

After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63).

Conclusions

Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.

Clinical relevance

Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.

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Longevity, effectiveness, safety, and impact on quality of life of low-concentration hydrogen peroxides in-office bleaching: a randomized clinical trial

Abstract

Objective

The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides.

Materials and methods

Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p < 0.05).

Results

The group HP15% presented significant color change (ΔE) from T1 to T4 (p = 0.002) and T1 to T5 (p < 0.001). Parameters L, a*, and b* differed significantly at T3, T4, and T5 compared T1 for both groups. At 6-month follow-up, 57.1% of HP6 and 43.7% of HP15% participants migrated from B1 to a darker color. No significant differences were observed between the groups in tooth sensitivity, gingival irritation, or impact on quality of life.

Conclusions

Both agents showed bleaching effectiveness, but HP15% presented greater color stability than HP6%, at 6-month follow-up. The agents showed low levels of tooth sensitivity, gingival irritation, and did not affect the oral health-related quality of life of the participants.

Clinical relevance

Despite the greater presence of sensitivity during treatment compared with 6% hydrogen peroxide, 15% hydrogen peroxide demonstrated better bleaching effectiveness, and greater color stability at the end of bleaching and at 6-month follow-up. The use of 15% hydrogen peroxide presents more suitable results.

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Does Preemptive administration of IV ibuprofen (Caldolor®) IV acetaminophen (Ofirmev®) reduce postoperative pain and subsequent narcotic consumption following third molar surgery?

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Archana Viswanath, Daniel Oreadi, Matthew Finkelman, Gustavo Klein, Maria Papageorge

Purpose

Preemptive analgesia is known to reduce postoperative pain following third molar removal. The purpose of this study was to compare postoperative pain in subjects receiving either preoperative IV ibuprofen or IV acetaminophen for third molar surgery.

Methods

This study was a randomized single blinded clinical study conducted in subjects undergoing surgical extraction of two or more impacted third molars under deep sedation. This study compared two interventions 800 mg Caldolor (IV ibuprofen) and 1000 mg Ofirmev (IV acetaminophen). The primary outcome variable was postoperative pain measured at different time points on the visual analog scale (VAS). The secondary outcome variable was amount of postoperative analgesic (narcotic and over the counter) medications taken in both the groups. Mann-Whitney U test were used to compare groups, outcomes Chi-square test was used to assess associations between nominal variables, and the Spearman correlation was used to assess associations between continuous variables. Significance was set at P < .05

Results

The study sample consisted of 58 (female 39 male 19) subjects. Forty-one subjects (IV ibuprofen n=19, IV acetaminophen n=22) completed the study. There was equal distribution of age, gender, number of impacted teeth between the groups. At 4 hours postoperative period pain levels in the ibuprofen group was significantly lower than acetaminophen group (p=0.004). This trend continued at 24 hours (p=0.019), 48 hours (p=0.017).The average amount of narcotic medications taken in the ibuprofen (2.68±2.26) group was lower than the acetaminophen (7.32±6.68) group and the results were statistically significant (p=0.005).

Conclusions

Preemptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.

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Evaluation of postoperative mandibular positional changes after mandibular setback surgery in a surgery-first approach: Isolated mandibular surgery versus bimaxillary surgery

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jeong Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook

ABSTRACT

Purpose

The aim of this study was to compare postoperative positional changes in the mandible after isolated mandibular surgery (IMS) or bimaxillary surgery (BMS) in a surgery-first approach (SFA).

Materials and Methods

The investigators designed and implemented a retrospective cohort study composed of patients who underwent mandibular setback surgery using the SFA. Surgical and postoperative changes were evaluated using lateral cephalograms taken 1 month before surgery (T0), 1 week after surgery (T1), and immediately after the debonding of orthodontic appliances (T2, 16.6 ± 8.7 months after surgery). To predict postoperative mandibular positional changes due to the increase in vertical dimension (VD) in surgical occlusion, the mandible was rotated counterclockwise to the preoperative VD on the lateral cephalogram at T1, and resultant mandibular positional changes were measured. To evaluate actual postoperative mandibular positional changes between each time point and compare them between the two groups, an independent t test, a paired t test, and repeated measures analysis of variance were performed.

Results

Thirty patients were evaluated (16 in the IMS group and 14 in the BMS group). Both groups showed significant time-course mandibular positional changes from T0 to T1 and from T1 to T2 within each group (point B, P < 0.001), although no statistically significant differences were observed between the groups. There was no statistically significant difference between groups in the predicted and actual postoperative rotational movements. In addition to the mandibular forward movement that resulted from the postoperative mandibular counterclockwise rotation, additional horizontal relapse occurred.

Conclusion

The present findings suggest that the mandible exhibits significant postoperative forward movement during the postoperative orthodontic treatment, regardless of the extent of the orthognathic surgery in the SFA, and it is necessary to consider mandibular forward movement due to the VD increase in surgical occlusion and additional relapse during the treatment planning stage.

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Dysphagia Requiring Nasogastric Feeding Following Orthognathic Surgery: An Unusual Complication, Case Report ,Literature Review and Recommendations

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bryant A. Salmon, Ali Dawlatly, Joseph E. Van Sickels

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Updated review of traumatic dislocation of the mandibular condyle into the middle cranial fossa

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): João Luiz Gomes Carneiro Monteiro, José Alcides Almeida de Arruda, Amanda Regina Silva de Melo, Ricardo Jorge Vasconcelos Barbosa, Suzana Célia de Aguiar Soares Carneiro, Belmiro Cavalcante do Egito Vasconcelos

Abstract

Purpose

Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event following maxillofacial trauma. Treatment may be a closed or open reduction (with or without craniotomy) and arthroplasty procedures might be necessary for long-standing cases. The aim of the present study was to perform an integrative review of traumatic DMCCF cases reported in an electronic database, and to report a case in which cerebrospinal fluid (CSF) leakage occurred after open treatment.

Patients and Methods

The study was carried out in two phases. In the first part, an electronic search was undertaken in Medline (via PubMed) in April/2018, with 52 articles being included. In the second, we report a case in which CSF leakage occurred trough the external auditory canal following open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months.

Results

A total of 59 cases were included. Most patients were females (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. A closed treatment was ideally performed within 2 weeks of intrusion. An open treatment was required for cases with ≥2 weeks of impaction. Types of open treatment were: open reduction, condylectomy, condylotomy or temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications include persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus.

Conclusion

Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurological surgeons. Close monitoring is extremely important to mitigate complications.

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Does Open Rhinoplasty Alter Voice Quality?

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Majid Nemati, Arash Tahmasebi, Hassan Mohajerani, Reza Tabrizi

Abstract

Purpose

Voice change may happen after upper airway manipulation. The current study aimed to evaluate voice change after open rhinoplasty.

Materials and Methods

The current cross sectional study was conducted on subjects undergoing open rhinoplasty. Three acoustic parameters (frequency, bandwidth, and amplitude) were evaluated before open rhinoplasty, three, seven, and ten months after the operation. Subjects' sounds in pronouncing M/N/A were examined. The acoustic factors were measured in the first and second nasal murmurs. Time is a predictive factor and multiple acoustic parameters were the outcome of the study.

Results

Twenty-five subjects were studied. Amplitude and bandwidth decreased for the vowel A after rhinoplasty. However, frequency increased for pronouncing A. In constants, M and N, amplitude decreased after rhinoplasty. Unlike vowels, bandwidth increased in consonants. As vowels, frequency increased in consonants.

Conclusion

It seems that open rhinoplasty affects voice quality. Open rhinoplasty altered frequency, amplitude, and bandwidth of vowels and consonants during 10 months.

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Reconstruction of full thickness lower lid defects using Texier’s procedure: retrospective assessment of the indications

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarra Cristofari, Kessara Rem, Marc Revol, Michael Atlan, Alessio Stivala

Abstract

Purpose

Lower-lid defects involving more than 75% of lid's length or attaining the cheek are usually reconstructed by a Mustardé rotational cheek flap. This solution often induces a postoperative ectropion. Texier's procedure (upper lid myocutaneous flap and a chondro-mucosal alar graft) is usually indicated for one-step reconstruction of less than 50% long full thickness defects of the lower lid. This retrospective study aimed to evaluate larger indications of Texier's procedure for full thickness defects of the lower lid, and the results on defects longer than 50% or even 75% of the length of the lid, in combination with a chondromucosal nasal septal graft for over 75% length-defects.

Materials and Methods

All lower lid reconstructions using Texier's procedure over a period of 29 months were retrospectively included. Data regarding post-operative complications, and patients' satisfaction were collected.

Results

Fifteen patients were included, of which one third had a 50% or less defect of the lower lid, one third presented with a defect from 50 to 75%, and one third had a defect of 75% or more. In this last group, reconstruction included a septal graft. The mean follow-up was 35 months. Transitory palpebral edema was present in 100% of patients, and lasted 8 months on average. No postoperative ectropion, nor nasal alar retraction on the graft donor site were observed. Mean satisfaction score was 2,86/3.

Conclusions

Texier's procedure can be used at first-line to reconstruct most full thickness defects of the lower lid, including subtotal lid-length defects.

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Intratumoral heterogeneity in recurrent metastatic squamous cell carcinoma of the oral cavity: New perspectives afforded by multiregion DNA sequencing and mtDNA analysis

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Andrea Gabusi, Davide Bartolomeo Gissi, Achille Tarsitano, Sofia Asioli, Claudio Marchetti, Lucio Montebugnoli, Maria Pia Foschini, Luca Morandi

Abstract

Purpose

Improvements in sequencing technologies have revealed that genetic differences among neoplastic cells may reflect clonal expansion. Intratumor heterogeneity (ITH) has been suggested to explain differences in prognosis and treatment response, indicating that personalized medicine is the goal of the future. Here, we evaluated ITH in five patients with recurrent metastatic oral squamous cell carcinoma (OSCC) and tracked the evolution from non-neoplastic tissue to neoplastic events developing after primary tumor formation.

Patients and Methods

Representative regions were macrodissected from specimens obtained from patients with OSCC of the tongue (n=4) and mouth floor (n=1). ITH and tumor evolution were explored by analyzing DNA mutations revealed by next-generation sequencing of specific driver genes combined with changes in the mtDNA D-loop hypervariable region. Phylogenetic trees were generated employing MAFFT tool with UPGMA/Jukes-Cantor serving as the substitute model.

Results

High levels of heterogeneity were observed within and among tumors. ITH emerged as metastatic/recurrent events progressed, but the evolutionary patterns differed. In some patients, specific subclones persisted during tumor relapse. Neighboring tissue was also heterogeneous at the pre-malignant level.

Conclusions

A multiregion approach yielded more representative data than did single samples when tumors were subjected to molecular investigation. Persistent mutations that might be targeted by individualized medicine were thus unveiled. mtDNA is a useful adjunct tool when studying the phylogenetic evolution of subclones. The clinical implications of "field" heterogeneity should be studied in depth.

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Leptin levels in the synovial fluid of patients with temporomandibular disorders

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Haofei Xiong, Wei Li, Jin Ke, Wei Fang, Bo Li, Lili Wei

Purpose

This study was conducted to measure the concentrations of leptin and IL-6 in the synovial fluid (SF) of 38 patients with temporomandibular disorders (TMD) and 7 healthy controls, and analyze the correlation between leptin and IL-6.

Patients and Methods

Patients with TMD were divided into three subgroups according to imaging and clinical findings: displaced disc with reduction (DDR, n=12), displaced disc without reduction (DDNR, n=13), and osteoarthritis (OA, n=13). SF samples were collected, and leptin and IL-6 levels were measured by ELISA.

Results

No significant difference in leptin level was found between the control group and the DDR or DDNR group, whereas the OA group presented a higher leptin concentration than all other groups. IL-6 concentrations were significantly higher in all patient groups than in the control group. The levels were significantly higher in the OA group than in the DDR or DDNR group, but no significant differences were found between the DDR and DDNR groups. No significant correlation was found between the leptin and IL-6 concentrations.

Conclusion

Distinct changes in leptin and IL-6 concentrations in the SF occurred at the different stages of TMD, suggesting their potential implication in the pathogenesis of TMD.

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Takotsubo Syndrome Following Surgical And Non-Surgical Oral And Maxillofacial Events: Review Of Published Cases

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): John K. Brooks, Gary Warburton, Brian C. Clark

Abstract

Purpose

Takotsubo syndrome (TS) is an acute and potentially serious cardiac disorder and often attributed to an exuberant catecholaminergic response to a severely physical or emotional event. There is a paucity of information in the dental literature on TS, therefore, this article will provide an overview of this uncommon syndrome, including clinical presentation, demographics, etiopathogenesis, diagnosis, management, and recovery, particularly emphasizing its occurrence with oral and maxillofacial procedures.

Methods

A PubMed search with the keyword takotsubo, published from 1991 through May 2018, yielded 3,778 articles. Cases reports and case series of TS associated with surgical and nonsurgical procedures of the oral and maxillofacial region were reviewed. Other cases were identified using a defined search strategy.

Results

The literature search identified 28 documented episodes of TS that occurred with head and neck surgeries, mostly sinus, carotid, nasal, cancer reconstruction surgeries, and, notably, 3 cases were concurrent with dental extractions. All of the featured patients developed some degree of cardiovascular impairment and demonstrated phenotypic overlap with acute occlusive coronary disease. The majority of patients recovered within 2 weeks and the remainder extended up to 3 months.

Conclusion

On rare occasions, TS has been reported in association with oral and maxillofacial procedures. As stress appears to be a precipitating factor in the development of TS, perioperative efforts should be instituted to reduce an adrenergic cascade.

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“How Important are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors”

Publication date: Available online 19 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Daniel M. Laskin, Arsalan Bhatti, Caroline K. Carrico

ABSTRACT

Purpose

Letters of recommendation are currently a part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in decision-making process.

Materials and Methods

In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared to other application attributes through a visual analog scale that ranged from 0 to 100, with 0 labeled as "Not Important" and 100 "Very Important." Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of both applicant attributes and components of recommendations were compared using random effects models to adjust for multiple responses from the same respondent. Post-hoc pairwise comparisons were performed using Tukey's adjustment.

Results

Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon, and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents.

Conclusions

Despite some of the deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.

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Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis

Abstract

Objectives

The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths.

Materials and methods

Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0.

Results

After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63).

Conclusions

Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.

Clinical relevance

Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.

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Longevity, effectiveness, safety, and impact on quality of life of low-concentration hydrogen peroxides in-office bleaching: a randomized clinical trial

Abstract

Objective

The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides.

Materials and methods

Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p < 0.05).

Results

The group HP15% presented significant color change (ΔE) from T1 to T4 (p = 0.002) and T1 to T5 (p < 0.001). Parameters L, a*, and b* differed significantly at T3, T4, and T5 compared T1 for both groups. At 6-month follow-up, 57.1% of HP6 and 43.7% of HP15% participants migrated from B1 to a darker color. No significant differences were observed between the groups in tooth sensitivity, gingival irritation, or impact on quality of life.

Conclusions

Both agents showed bleaching effectiveness, but HP15% presented greater color stability than HP6%, at 6-month follow-up. The agents showed low levels of tooth sensitivity, gingival irritation, and did not affect the oral health-related quality of life of the participants.

Clinical relevance

Despite the greater presence of sensitivity during treatment compared with 6% hydrogen peroxide, 15% hydrogen peroxide demonstrated better bleaching effectiveness, and greater color stability at the end of bleaching and at 6-month follow-up. The use of 15% hydrogen peroxide presents more suitable results.

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Ambient particulate matter enhances the pulmonary allergic immune response to house dust mite in a BALB/c mouse model by augmenting Th2 ‐ and Th17‐immune responses

Physiological Reports,Volume 6, Issue 18, September 2018. (Source: Physiological Reports)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction

To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC).

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Ambient particulate matter enhances the pulmonary allergic immune response to house dust mite in a BALB/c mouse model by augmenting Th2 ‐ and Th17‐immune responses

Physiological Reports,Volume 6, Issue 18, September 2018. (Source: Physiological Reports)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction

To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC).

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STAWAR: Pipe dreams go up in smoke

STAWAR: Pipe dreams go up in smoke  NewsandtribuneVaping: how safe is it?  SBSFull coverage

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STAWAR: Pipe dreams go up in smoke

STAWAR: Pipe dreams go up in smoke  NewsandtribuneVaping: how safe is it?  SBSFull coverage

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Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N. Subramaniam, D. Balasubramanian, S. Murthy, P. Rathod, S. Vidhyadharan, K. Thankappan, S. Iyer

Abstract

According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10 mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10 mm and a tumour diameter >4 cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10 mm and a tumour diameter <4 cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10 mm with tumour diameter below or above 4 cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10 mm may not be warranted in the absence of other risk features such as nodal disease or close margins.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2poPCVP

Management of nasopharyngeal teratomas associated with cleft palate

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): C. Diakité, H. Bénateau, S. Dakpé, P. Guerreschi, P. Galinier, A. Veyssière

Abstract

Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association.

We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft. The diagnosis of the teratoma was confirmed by histological analysis.

Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence.

Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2MPNiAa

Treatment of skeletal open bite using a navigation system: CAD/CAM osteotomy and drilling guides combined with pre-bent titanium plates

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): W. Du, G. Chen, D. Bai, C. Xue, W. Fei, E. Luo

Abstract

Severe skeletal open bite associated with posterior vertical maxillary excess and mandibular deformity is considered a difficult problem in orthodontic and surgical treatment. This study used a navigation system for the correction of severe skeletal open bite in order to accurately transfer the virtual plan to the actual operation and achieve precise rigid internal fixation in bimaxillary osteotomies of the jaws. Twelve patients with a severe skeletal open bite associated with vertical maxillary excess and mandibular deformity were recruited. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with the guidance of this navigation system. Computed tomography and cephalometric examinations were performed to evaluate the correction of the deformity. Deviations between the simulated plan and actual postoperative outcome were measured to determine the precision of the surgery. Satisfactory and stable results were achieved in all patients postoperatively, without complications or relapse during follow-up. Photographs and cephalometric evaluations showed that the facial profile and occlusion were improved. Assessment of the deviations between the simulated plan and actual postoperative outcome showed that the navigation system can precisely transfer the virtual plan to the actual operation. The results suggest that the navigation system can accurately transfer the virtual plan to the actual operation during bimaxillary jaw osteotomies, without relapse, in patients with a severe skeletal open bite.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pnh99Z

Doppler ultrasonography devices, including elastography, allow for accurate diagnosis of severe liver fibrosis

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Jean Delahaye, Paul Bazeries, Adrien Lannes, Jérome Lebigot, Victoire Cartier, Frederic Oberti, Isabelle Fouchard-Hubert, Anita Paisant, Sophie Michalak-Provost, Marie Christine Rousselet, Paul Cales, Jérome Boursier, Christophe Aubé

Abstract

Objectives

Advanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination.

Methods

514 patients with chronic liver disease who consecutively underwent percutaneous liver biopsy were included in the study. All patients had a Doppler-US examination and LSM with Virtual Touch Quantification (VTQ) on the same day as a liver biopsy. A subset of 326 patients also had LSM with 2D shear wave elastography (SSI). Severe fibrosis was defined as Metavir F ≥ 3 on liver biopsy.

Results

Multivariate analysis confirmed our three simple Doppler-US signs (liver surface irregularity, splenomegaly ≥110 mm, and demodulation of hepatic veins) as independently associated with severe fibrosis. The presence of at least one of these three signs showed 85.6% sensitivity and 36.1% specificity for the diagnosis of severe liver fibrosis. Using VTQ (≥1.59 m/s) where there was a positive Doppler-US sign increased the specificity to 80.8%, at the cost of a decrease in sensitivity (73.7%). Similar results were obtained with SSI (≥9.5 kPa), with 73.3% specificity and 81.5% sensitivity.

Conclusion

Elastography improves the accuracy of Doppler-US in the detection of severe fibrosis. This two-step procedure will help radiologists to accurately identify patients who need to be referred to specialist hepatologists during routine Doppler-US examinations.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NWenX5

Diagnostic performance of CT densities in selected gray- and white-matter regions for the clinical diagnosis of brain death: a retrospective study in a tertiary-level general hospital

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Lyda Marcela Archila-Rincon, Ma. Del Carmen Garcia-Blanco, Ernesto Roldan-Valadez

Abstract

Introduction

We aimed to determine the diagnostic performance of Hounsfield Units (HUs) in selected brain region using computed tomography for the clinical diagnosis of brain death (BD).

Methods

A retrospective, case-control study design. A total of 66 subjects (22 cases, 44 controls) underwent brain tomography between January 2011 and December 2016. Inclusion criteria for cases considered patients with a CT performed within the 24 first hours of a clinical diagnosis of brain death. Exclusion criteria applied to patients with no CT scan performed before BD diagnosis. Brain-healthy-control subjects were identified from the hospital's CT scan database. We selected 12 regions for each cerebral hemisphere (4 basal ganglia; 2 regions gray matter (GM) regions; 4 white matter (WM) regions; 2 brain stem regions); two GM and WM regions in each cerebellar hemisphere, and 4 GM/WM ratios. Measurements included analysis of variance, receiver operating characteristic (ROC) curve, and of pooled effect sizes.

Results

72 measures per subject were recorded. Without contrast material, the best performance was the GM/WM ratio at the basal ganglia level (AUROC = .893, 95% C.I. = .83, .96; p-value < .001). After contrast enhancement, the greatest AUROC value corresponded to the thalamus (AUROC = .959, 95% C.I. = .93, .99; p-value < .001).

Conclusions

There is not an absolute threshold of GM-WM differentiation below which all patients are diagnosed with BD, but a group of HUs in selected brain regions, some of them with very high sensitivity and specificity to be used as early predictors of BD.

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Comparison of breast cancer detection and depiction between planar and rotating synthetic mammography generated from breast tomosynthesis

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Alejandro Rodriguez-Ruiz, Susanne Lardenoije, Alex J.T. Wanders, Ioannis Sechopoulos, Ritse M. Mann

Abstract

Purpose

To compare breast cancer detection and depiction between planar synthetic mammography (SM) and rotating synthetic mammography (RM) generated from digital breast tomosynthesis (DBT).

Materials and Methods

In a fully-crossed multi-reader multi-case (MRMC) study, three radiologists retrospectively reviewed 190 cases (27 malignant, 31 benign, 132 normal), once with SM alone and once with RM alone, the DBT stack of slices was not reviewed. Lesions were scored using BI-RADS® and level of suspiciousness ([1], [2], [3], [4], [5], [6], [7], [8], [9], [10]). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were computed using MRMC Analysis of Variance using the open-access software iMRMC. Additionally, readers were asked to make a visual grading analysis (VGA) on visibility of calcifications and soft tissue lesions (1-5 scale with 5 = Excellent visualization). The VGA scores were analyzed using the visual grading characteristics (VGC) method.

Results

On average, the AUC was similar between SM and RM (0.66 versus 0.67, P = 0.818). The sensitivity was equivalent (0.62 versus 0.60, P = 0.794), while specificity was significantly lower in SM than in RM (0.66 versus 0.72, P = 0.028). Radiologists significantly (P < 0.05) preferred the display of all types of lesions in RM over SM. The average reading time per case was higher for RM than for SM (30 s versus 23 s, P < 0.05).

Conclusion

Radiologists achieve similar cancer detection with RM as with SM. They prefer the 3D-like rotating representation of soft tissue lesions and calcifications in comparison to the 2D visualization, which might improve their specificity, but at the expense of longer reading time.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NQP8Wn

Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N. Subramaniam, D. Balasubramanian, S. Murthy, P. Rathod, S. Vidhyadharan, K. Thankappan, S. Iyer

Abstract

According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10 mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10 mm and a tumour diameter >4 cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10 mm and a tumour diameter <4 cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10 mm with tumour diameter below or above 4 cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10 mm may not be warranted in the absence of other risk features such as nodal disease or close margins.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2poPCVP

Management of nasopharyngeal teratomas associated with cleft palate

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): C. Diakité, H. Bénateau, S. Dakpé, P. Guerreschi, P. Galinier, A. Veyssière

Abstract

Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association.

We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft. The diagnosis of the teratoma was confirmed by histological analysis.

Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence.

Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2MPNiAa

Treatment of skeletal open bite using a navigation system: CAD/CAM osteotomy and drilling guides combined with pre-bent titanium plates

Publication date: Available online 20 September 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): W. Du, G. Chen, D. Bai, C. Xue, W. Fei, E. Luo

Abstract

Severe skeletal open bite associated with posterior vertical maxillary excess and mandibular deformity is considered a difficult problem in orthodontic and surgical treatment. This study used a navigation system for the correction of severe skeletal open bite in order to accurately transfer the virtual plan to the actual operation and achieve precise rigid internal fixation in bimaxillary osteotomies of the jaws. Twelve patients with a severe skeletal open bite associated with vertical maxillary excess and mandibular deformity were recruited. All patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with the guidance of this navigation system. Computed tomography and cephalometric examinations were performed to evaluate the correction of the deformity. Deviations between the simulated plan and actual postoperative outcome were measured to determine the precision of the surgery. Satisfactory and stable results were achieved in all patients postoperatively, without complications or relapse during follow-up. Photographs and cephalometric evaluations showed that the facial profile and occlusion were improved. Assessment of the deviations between the simulated plan and actual postoperative outcome showed that the navigation system can precisely transfer the virtual plan to the actual operation. The results suggest that the navigation system can accurately transfer the virtual plan to the actual operation during bimaxillary jaw osteotomies, without relapse, in patients with a severe skeletal open bite.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pnh99Z

Doppler ultrasonography devices, including elastography, allow for accurate diagnosis of severe liver fibrosis

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Jean Delahaye, Paul Bazeries, Adrien Lannes, Jérome Lebigot, Victoire Cartier, Frederic Oberti, Isabelle Fouchard-Hubert, Anita Paisant, Sophie Michalak-Provost, Marie Christine Rousselet, Paul Cales, Jérome Boursier, Christophe Aubé

Abstract

Objectives

Advanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination.

Methods

514 patients with chronic liver disease who consecutively underwent percutaneous liver biopsy were included in the study. All patients had a Doppler-US examination and LSM with Virtual Touch Quantification (VTQ) on the same day as a liver biopsy. A subset of 326 patients also had LSM with 2D shear wave elastography (SSI). Severe fibrosis was defined as Metavir F ≥ 3 on liver biopsy.

Results

Multivariate analysis confirmed our three simple Doppler-US signs (liver surface irregularity, splenomegaly ≥110 mm, and demodulation of hepatic veins) as independently associated with severe fibrosis. The presence of at least one of these three signs showed 85.6% sensitivity and 36.1% specificity for the diagnosis of severe liver fibrosis. Using VTQ (≥1.59 m/s) where there was a positive Doppler-US sign increased the specificity to 80.8%, at the cost of a decrease in sensitivity (73.7%). Similar results were obtained with SSI (≥9.5 kPa), with 73.3% specificity and 81.5% sensitivity.

Conclusion

Elastography improves the accuracy of Doppler-US in the detection of severe fibrosis. This two-step procedure will help radiologists to accurately identify patients who need to be referred to specialist hepatologists during routine Doppler-US examinations.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NWenX5

Diagnostic performance of CT densities in selected gray- and white-matter regions for the clinical diagnosis of brain death: a retrospective study in a tertiary-level general hospital

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Lyda Marcela Archila-Rincon, Ma. Del Carmen Garcia-Blanco, Ernesto Roldan-Valadez

Abstract

Introduction

We aimed to determine the diagnostic performance of Hounsfield Units (HUs) in selected brain region using computed tomography for the clinical diagnosis of brain death (BD).

Methods

A retrospective, case-control study design. A total of 66 subjects (22 cases, 44 controls) underwent brain tomography between January 2011 and December 2016. Inclusion criteria for cases considered patients with a CT performed within the 24 first hours of a clinical diagnosis of brain death. Exclusion criteria applied to patients with no CT scan performed before BD diagnosis. Brain-healthy-control subjects were identified from the hospital's CT scan database. We selected 12 regions for each cerebral hemisphere (4 basal ganglia; 2 regions gray matter (GM) regions; 4 white matter (WM) regions; 2 brain stem regions); two GM and WM regions in each cerebellar hemisphere, and 4 GM/WM ratios. Measurements included analysis of variance, receiver operating characteristic (ROC) curve, and of pooled effect sizes.

Results

72 measures per subject were recorded. Without contrast material, the best performance was the GM/WM ratio at the basal ganglia level (AUROC = .893, 95% C.I. = .83, .96; p-value < .001). After contrast enhancement, the greatest AUROC value corresponded to the thalamus (AUROC = .959, 95% C.I. = .93, .99; p-value < .001).

Conclusions

There is not an absolute threshold of GM-WM differentiation below which all patients are diagnosed with BD, but a group of HUs in selected brain regions, some of them with very high sensitivity and specificity to be used as early predictors of BD.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OzSc6a

Comparison of breast cancer detection and depiction between planar and rotating synthetic mammography generated from breast tomosynthesis

Publication date: Available online 19 September 2018

Source: European Journal of Radiology

Author(s): Alejandro Rodriguez-Ruiz, Susanne Lardenoije, Alex J.T. Wanders, Ioannis Sechopoulos, Ritse M. Mann

Abstract

Purpose

To compare breast cancer detection and depiction between planar synthetic mammography (SM) and rotating synthetic mammography (RM) generated from digital breast tomosynthesis (DBT).

Materials and Methods

In a fully-crossed multi-reader multi-case (MRMC) study, three radiologists retrospectively reviewed 190 cases (27 malignant, 31 benign, 132 normal), once with SM alone and once with RM alone, the DBT stack of slices was not reviewed. Lesions were scored using BI-RADS® and level of suspiciousness ([1], [2], [3], [4], [5], [6], [7], [8], [9], [10]). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were computed using MRMC Analysis of Variance using the open-access software iMRMC. Additionally, readers were asked to make a visual grading analysis (VGA) on visibility of calcifications and soft tissue lesions (1-5 scale with 5 = Excellent visualization). The VGA scores were analyzed using the visual grading characteristics (VGC) method.

Results

On average, the AUC was similar between SM and RM (0.66 versus 0.67, P = 0.818). The sensitivity was equivalent (0.62 versus 0.60, P = 0.794), while specificity was significantly lower in SM than in RM (0.66 versus 0.72, P = 0.028). Radiologists significantly (P < 0.05) preferred the display of all types of lesions in RM over SM. The average reading time per case was higher for RM than for SM (30 s versus 23 s, P < 0.05).

Conclusion

Radiologists achieve similar cancer detection with RM as with SM. They prefer the 3D-like rotating representation of soft tissue lesions and calcifications in comparison to the 2D visualization, which might improve their specificity, but at the expense of longer reading time.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NQP8Wn

Intravoxel Incoherent Motion Diffusion‐Weighted MRI of Invasive Breast Cancer: Correlation With Prognostic Factors and Kinetic Features Acquired With Computer‐Aided Diagnosis

Journal of Magnetic Resonance Imaging, EarlyView.


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Intravoxel Incoherent Motion Diffusion‐Weighted MRI of Invasive Breast Cancer: Correlation With Prognostic Factors and Kinetic Features Acquired With Computer‐Aided Diagnosis

Journal of Magnetic Resonance Imaging, EarlyView.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2MOgTtV

Increase of viral hemorrhagic septicemia virus growth by knockout of IRF9 gene in Epithelioma papulosum cyprini cells

In this study, to increase the replication of VHSV, we generated IRF9 knockout Epithelioma papulosum cyprini (EPC) cells using a CRISPR/Cas9 vector that contains an EPC cell's U6 promoter-driven guide RNA cassette (targeting IRF9 gene) and a Cas9 expressing cassette. In the clones of IRF9 knockout EPC cells, there were no increase in ISG15 gene by poly I:C, and in Mx1 gene by both poly I:C and VHSV. Interestingly, although the increased folds were conspicuously lower than control EPC cells, the expression of ISG 15 gene in all the IRF9 knockout clones was significantly increased by VHSV infection. Control EPC cells pre-treated with poly I:C did not show any CPE when infected with VHSV, however, IRF9 knockout EPC cells showed CPE by VHSV infection in spite of being pretreated with poly I:C....

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QOHfiT

Cryotherapy for the Treatment of Chronic Rhinitis: A Qualitative Systematic Review.

Conclusions Although cryotherapy appears safe and efficacious, heterogeneous past investigations with low-quality evidence make strong, evidence-based recommendations difficult to make. Further study with validated metrics and controlled populations is certainly warranted and should be encouraged. PMID: 30229670 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xzCNvn

Teaching Residents Frontal Sinus Anatomy Using a Novel 3-Dimensional Conceptualization Planning Software-Based Module.

Conclusion There is minimal literature on proven methods for teaching frontal sinus anatomy. Objectively, participants of the modified FSMC simulation training using new software improved their ability to recognize cells of the frontal recess on CT scans. They especially exhibited better localization of the frontal sinus drainage pathway. Subjectively, participants reported benefit from the course and felt they would be better surgeons. PMID: 30229679 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QMfSWD

Increase of viral hemorrhagic septicemia virus growth by knockout of IRF9 gene in Epithelioma papulosum cyprini cells

In this study, to increase the replication of VHSV, we generated IRF9 knockout Epithelioma papulosum cyprini (EPC) cells using a CRISPR/Cas9 vector that contains an EPC cell's U6 promoter-driven guide RNA cassette (targeting IRF9 gene) and a Cas9 expressing cassette. In the clones of IRF9 knockout EPC cells, there were no increase in ISG15 gene by poly I:C, and in Mx1 gene by both poly I:C and VHSV. Interestingly, although the increased folds were conspicuously lower than control EPC cells, the expression of ISG 15 gene in all the IRF9 knockout clones was significantly increased by VHSV infection. Control EPC cells pre-treated with poly I:C did not show any CPE when infected with VHSV, however, IRF9 knockout EPC cells showed CPE by VHSV infection in spite of being pretreated with poly I:C....

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QOHfiT

Cryotherapy for the Treatment of Chronic Rhinitis: A Qualitative Systematic Review.

Conclusions Although cryotherapy appears safe and efficacious, heterogeneous past investigations with low-quality evidence make strong, evidence-based recommendations difficult to make. Further study with validated metrics and controlled populations is certainly warranted and should be encouraged. PMID: 30229670 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xzCNvn

Teaching Residents Frontal Sinus Anatomy Using a Novel 3-Dimensional Conceptualization Planning Software-Based Module.

Conclusion There is minimal literature on proven methods for teaching frontal sinus anatomy. Objectively, participants of the modified FSMC simulation training using new software improved their ability to recognize cells of the frontal recess on CT scans. They especially exhibited better localization of the frontal sinus drainage pathway. Subjectively, participants reported benefit from the course and felt they would be better surgeons. PMID: 30229679 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QMfSWD

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

Publication date: Available online 19 September 2018

Source: American Journal of Otolaryngology

Author(s): Di Deng, Jintao Du, Feng Liu, Bing Zhong, Yixin Qiao, Yafeng Liu

Abstract

Background

Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.

Objective

This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus.

Methods

Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017.

Results

The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients.

Conclusion

ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NSNyTR

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

Publication date: Available online 19 September 2018

Source: American Journal of Otolaryngology

Author(s): Di Deng, Jintao Du, Feng Liu, Bing Zhong, Yixin Qiao, Yafeng Liu

Abstract

Background

Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.

Objective

This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus.

Methods

Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017.

Results

The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients.

Conclusion

ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

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Thyroid Cancer Testing Market Healthcare, Clinical Reviews, Survey Reports 2018

Thyroid Cancer Testing Market Healthcare, Clinical Reviews, Survey Reports 2018  Tactical BusinessFull coverage

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Thyroid Cancer Testing Market Healthcare, Clinical Reviews, Survey Reports 2018

Thyroid Cancer Testing Market Healthcare, Clinical Reviews, Survey Reports 2018  Tactical BusinessFull coverage

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Non-smoking, non-drinking elderly females, a 5 year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Adrian DeAngelis, Omar Breik, Kendrick Koo, Tim Iseli, Alf Nastri, Tsien Fua, Danny Rischin, Michael McCullough, David Wiesenfeld

Abstract

Objectives

To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma.

Materials & methods

Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded.

Results

Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.

Conclusions

The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.

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Aurora kinases are a novel therapeutic target for HPV-positive head and neck cancers

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Mushfiq H. Shaikh, Adi Idris, Newell W. Johnson, Sora Fallaha, Daniel T.W. Clarke, David Martin, Iain M. Morgan, Brian Gabrielli, Nigel A.J. McMillan

Abstract

Objectives

Human papilloma virus (HPV) is the main culprit in cancers of the cervix, penis, anus, skin, eye and head and neck. Current treatments for HPV cancers have not altered survival outcomes for 30 years and there is a significant lack of targeted therapeutic agents in the management of advanced HPV-related HNSCC. Here we show that survival and maintenance of HPV-positive HNC cells relies on the continuous expression of the major HPV oncogene, E7, and that Aurora kinases are critical for survival of high-risk HPV-positive HNC cells.

Materials and methods

To assess the role of HPV E7 on HNC cell survival, RNA interference (RNAi) of the E7 gene was initially performed. Using an Aurora kinase inhibitor, Alisertib, the role of Aurora kinases in the carcinogenesis of HPV E7 positive HNC tumour lines was then investigated. An in vivo HNC xenograft model was also utilised to assess loss of tumour volume in response to RNAi E7 gene silencing and Alisertib treatment.

Results

RNAi silencing of the HPV E7 gene inhibited the growth of HPV-positive HNC cells and in vivo tumour load. We show that HPV E7 oncogene expression confers sensitivity to Alisertib on HNC cells where Alisertib-mediated loss in in vitro cell viability and in vivo tumour load is dependent on E7 expression. Moreover, Aurora kinase inhibition induced degradation of MCL-1 in HPV E7-expressing HNC cells.

Conclusion

Overall, we show that Aurora kinases are a novel therapeutic target for HPV-positive HNCs. It might be feasible to combine Aurora kinase and MCL-1 inhibitors for future HNC therapies.

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Aurora kinases are a novel therapeutic target for HPV-positive head and neck cancers

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Mushfiq H. Shaikh, Adi Idris, Newell W. Johnson, Sora Fallaha, Daniel T.W. Clarke, David Martin, Iain M. Morgan, Brian Gabrielli, Nigel A.J. McMillan

Abstract

Objectives

Human papilloma virus (HPV) is the main culprit in cancers of the cervix, penis, anus, skin, eye and head and neck. Current treatments for HPV cancers have not altered survival outcomes for 30 years and there is a significant lack of targeted therapeutic agents in the management of advanced HPV-related HNSCC. Here we show that survival and maintenance of HPV-positive HNC cells relies on the continuous expression of the major HPV oncogene, E7, and that Aurora kinases are critical for survival of high-risk HPV-positive HNC cells.

Materials and methods

To assess the role of HPV E7 on HNC cell survival, RNA interference (RNAi) of the E7 gene was initially performed. Using an Aurora kinase inhibitor, Alisertib, the role of Aurora kinases in the carcinogenesis of HPV E7 positive HNC tumour lines was then investigated. An in vivo HNC xenograft model was also utilised to assess loss of tumour volume in response to RNAi E7 gene silencing and Alisertib treatment.

Results

RNAi silencing of the HPV E7 gene inhibited the growth of HPV-positive HNC cells and in vivo tumour load. We show that HPV E7 oncogene expression confers sensitivity to Alisertib on HNC cells where Alisertib-mediated loss in in vitro cell viability and in vivo tumour load is dependent on E7 expression. Moreover, Aurora kinase inhibition induced degradation of MCL-1 in HPV E7-expressing HNC cells.

Conclusion

Overall, we show that Aurora kinases are a novel therapeutic target for HPV-positive HNCs. It might be feasible to combine Aurora kinase and MCL-1 inhibitors for future HNC therapies.

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Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Parul Sinha, Omar A. Karadaghy, Michelle M. Doering, Methodius G. Tuuli, Ryan S. Jackson, Bruce H. Haughey

Abstract

The optimal management of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with primary surgical versus non-surgical treatment is unclear. The objective of this systematic review was to evaluate the literature and compare survival for primary surgical versus non-surgical treatment of HPV-positive OPSCC. We performed a comprehensive literature search of multiple electronic databases for relevant articles up to February, 2017. Studies reporting mortality or hazard ratio (HR) for overall survival (OS) in primary HPV-positive OPSCC patients were eligible. Seventy-three articles were eligible, of which 66 included single-modality (19 surgical, 47 non-surgical), and 7 included both surgical and non-surgical modalities. There were no randomized studies comparing outcomes between both modalities. In a meta-analysis of both-modality studies, OS with surgical treatment was not significantly different from non-surgical treatment (pooled HR 1.12; 95% CI: 0.35, 3.57). There was significant heterogeneity between studies (I² = 82.4%). Among single-modality studies, the mortality rate was lower with surgical [pooled proportion 0.15 (95% CI: 0.09, 0.21)] versus non-surgical treatment [0.20 (95% CI:0.15, 0.24)]. In a subgroup analysis, OS was higher for HPV-positive versus HPV-negative OPSCC, irrespective of the treatment modality. We conclude that there is an absence of high-quality studies that compare survival for HPV-positive OPSCC treated with primary surgical versus non-surgical approach. The available data suggest no statistical or clinically meaningful difference in survival between the two approaches. HPV-positivity was a key prognostic factor irrespective of treatment modality. Further high-quality studies with consistent data reporting are needed to inform the choice for optimal treatment modality for HPV-positive OPSCC.

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Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Parul Sinha, Omar A. Karadaghy, Michelle M. Doering, Methodius G. Tuuli, Ryan S. Jackson, Bruce H. Haughey

Abstract

The optimal management of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with primary surgical versus non-surgical treatment is unclear. The objective of this systematic review was to evaluate the literature and compare survival for primary surgical versus non-surgical treatment of HPV-positive OPSCC. We performed a comprehensive literature search of multiple electronic databases for relevant articles up to February, 2017. Studies reporting mortality or hazard ratio (HR) for overall survival (OS) in primary HPV-positive OPSCC patients were eligible. Seventy-three articles were eligible, of which 66 included single-modality (19 surgical, 47 non-surgical), and 7 included both surgical and non-surgical modalities. There were no randomized studies comparing outcomes between both modalities. In a meta-analysis of both-modality studies, OS with surgical treatment was not significantly different from non-surgical treatment (pooled HR 1.12; 95% CI: 0.35, 3.57). There was significant heterogeneity between studies (I² = 82.4%). Among single-modality studies, the mortality rate was lower with surgical [pooled proportion 0.15 (95% CI: 0.09, 0.21)] versus non-surgical treatment [0.20 (95% CI:0.15, 0.24)]. In a subgroup analysis, OS was higher for HPV-positive versus HPV-negative OPSCC, irrespective of the treatment modality. We conclude that there is an absence of high-quality studies that compare survival for HPV-positive OPSCC treated with primary surgical versus non-surgical approach. The available data suggest no statistical or clinically meaningful difference in survival between the two approaches. HPV-positivity was a key prognostic factor irrespective of treatment modality. Further high-quality studies with consistent data reporting are needed to inform the choice for optimal treatment modality for HPV-positive OPSCC.

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Design and Validation of a Peer-Teacher-Based Musculoskeletal Ultrasound Curriculum

Publication date: Available online 19 September 2018

Source: Academic Radiology

Author(s): Netanel S. Berko, Jenna N. Le, Beverly A. Thornhill, Dan Wang, Abdissa Negassa, E. Stephen Amis, Mordecai Koenigsberg

Rationale and Objectives

To design and validate a peer-teacher based musculoskeletal ultrasound curriculum for radiology residents.

Materials and Methods

A musculoskeletal ultrasound curriculum with hands-on scanning workshops was designed for radiology residents. Prior to the workshops, several residents received 3 hours of hands-on training in ultrasound scanning technique which was overseen by an attending musculoskeletal radiologist; these "peer teachers" then led small-group hands-on scanning during the workshops. Participants performed diagnostic ultrasound examinations at the conclusion of the workshops to assess skill acquisition and 2 months following the workshops to quantify skill retention. Participants also completed surveys to determine confidence in performing musculoskeletal ultrasound examinations. Median scores and interquartile range (25–75%) were calculated, and t test was used to compare results.

Results

Thirty seven residents from all years of training and six senior resident or fellow peer teachers participated in four workshops. Diagnostic ultrasound images were obtained in 100% at the conclusion of the workshop and in 79% 2 months later. Prior to the workshops, residents reported low level of musculoskeletal ultrasound knowledge (median 2, interquartile ranges 1–2), and low confidence in performing (1, 1–2) and interpreting (1, 1–2) musculoskeletal ultrasound examinations. There was a significant increase in knowledge (3, 3–4) and confidence performing (3, 3–4) and interpreting (3, 3–4) studies following the workshops (p < 0.001 for all comparisons).

Conclusion

Hands-on musculoskeletal ultrasound workshops, utilizing a peer teacher led small group format is an effective method of teaching scanning skills to residents. There was excellent skill acquisition, good skill retention, and significant increase in confidence performing and interpreting these studies following completion of the curriculum.

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Why Radiology Residents Experience Burnout and How to Fix It

Publication date: Available online 19 September 2018

Source: Academic Radiology

Author(s): Dexter Mendoza, Frederic J. Bertino

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Design and Validation of a Peer-Teacher-Based Musculoskeletal Ultrasound Curriculum

Publication date: Available online 19 September 2018

Source: Academic Radiology

Author(s): Netanel S. Berko, Jenna N. Le, Beverly A. Thornhill, Dan Wang, Abdissa Negassa, E. Stephen Amis, Mordecai Koenigsberg

Rationale and Objectives

To design and validate a peer-teacher based musculoskeletal ultrasound curriculum for radiology residents.

Materials and Methods

A musculoskeletal ultrasound curriculum with hands-on scanning workshops was designed for radiology residents. Prior to the workshops, several residents received 3 hours of hands-on training in ultrasound scanning technique which was overseen by an attending musculoskeletal radiologist; these "peer teachers" then led small-group hands-on scanning during the workshops. Participants performed diagnostic ultrasound examinations at the conclusion of the workshops to assess skill acquisition and 2 months following the workshops to quantify skill retention. Participants also completed surveys to determine confidence in performing musculoskeletal ultrasound examinations. Median scores and interquartile range (25–75%) were calculated, and t test was used to compare results.

Results

Thirty seven residents from all years of training and six senior resident or fellow peer teachers participated in four workshops. Diagnostic ultrasound images were obtained in 100% at the conclusion of the workshop and in 79% 2 months later. Prior to the workshops, residents reported low level of musculoskeletal ultrasound knowledge (median 2, interquartile ranges 1–2), and low confidence in performing (1, 1–2) and interpreting (1, 1–2) musculoskeletal ultrasound examinations. There was a significant increase in knowledge (3, 3–4) and confidence performing (3, 3–4) and interpreting (3, 3–4) studies following the workshops (p < 0.001 for all comparisons).

Conclusion

Hands-on musculoskeletal ultrasound workshops, utilizing a peer teacher led small group format is an effective method of teaching scanning skills to residents. There was excellent skill acquisition, good skill retention, and significant increase in confidence performing and interpreting these studies following completion of the curriculum.

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Injury, dysbiosis and filaggrin deficiency drive skin inflammation via keratinocyte IL-1α release

Publication date: Available online 19 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Nathan K. Archer, Jay-Hyun Jo, Steven K. Lee, Dongwon Kim, Barbara Smith, Roger V. Ortines, Yu Wang, Mark C. Marchitto, Advaitaa Ravipati, Shuting S. Cai, Carly A. Dillen, Haiyun Liu, Robert J. Miller, Alyssa G. Ashbaugh, Angad S. Uppal, Michiko Oyoshi, Nidhi Malhotra, Sabine Hoff, Luis A. Garza, Heidi H. Kong

Abstract

Background

Atopic dermatitis (AD) is associated with epidermal barrier defects, dysbiosis and skin injury from scratching. In particular, the barrier defective epidermis of AD patients with loss-of-function filaggrin mutations has increased IL-1α and IL-1β levels but the mechanisms by which IL-1α and/or IL-1β are induced and whether they contribute to the aberrant skin inflammation in AD is unknown.

Objective

We sought to determine the mechanisms by which skin injury, dysbiosis and increased epidermal IL-1α and IL-1β contribute to the development of skin inflammation in a mouse model of injury-induced skin inflammation in filaggrin-deficient mice.

Methods

Skin injury of wild-type, filaggrin-deficient (ft/ft), and MyD88-deficient ft/ft mice was performed and ensuing skin inflammation was evaluated by digital photography, histologic analysis and flow cytometry. IL-1α and IL-1β protein expression was measured by ELISA and visualized by immunofluorescence and immuno-electron microscopy. The composition of skin microbiome was determined by 16S rDNA sequencing.

Results

Skin injury of ft/ft mice induced chronic skin inflammation involving dysbiosis-driven intracellular IL-1α release from keratinocytes. IL-1α was necessary and sufficient for skin inflammation in vivo and secreted from keratinocytes by various stimuli in vitro. Topical antibiotics or co-housing of ft/ft mice with unaffected wild-type mice to alter or intermix skin microbiota, respectively, resolved the skin inflammation and restored keratinocyte intracellular IL-1α localization.

Conclusions

Taken together, skin injury, dysbiosis and filaggrin deficiency triggered keratinocyte intracellular IL-1α release that was sufficient to drive chronic skin inflammation, which has implications for AD pathogenesis and for potential therapeutic targets.

Graphical abstract

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Trans-maternal Helicobacter pylori exposure reduces allergic airway inflammation in offspring through regulatory T-cells

Publication date: Available online 19 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Andreas Kyburz, Angela Fallegger, Xiaozhou Zhang, Aleksandra Altobelli, Mariela Artola-Boran, Timothy Borbet, Sabine Urban, Petra Paul, Christian Münz, Stefan Floess, Jochen Huehn, Timothy L. Cover, Martin J. Blaser, Christian Taube, Anne Müller

Abstract

Background

The trans-maternal exposure to tobacco, microbes, nutrients and other environmental factors shapes the fetal immune system through epigenetic processes. The gastric microbe Helicobacter pylori represents an ancestral constituent of the human microbiota that causes gastric disorders on the one hand, and is inversely associated with allergies and chronic inflammatory conditions on the other.

Objective

Here, we investigate the consequences of trans-maternal exposure to H. pylori, in utero and/or during lactation, for susceptibility to viral and bacterial infection, predisposition to allergic airway inflammation, and the development of immune cell populations in the lung and lymphoid organs.

Methods

We use experimental models of house dust mite- or ovalbumin-induced airway inflammation and influenza A virus or Citrobacter infection along with metagenomics analyses, multi-color flow cytometry and bilsufite pyrosequencing to study the effects of H. pylori on allergy severity and immunological and microbiome correlates thereof.

Results

Perinatal exposure to H. pylori extract, or its immunomodulator VacA, confers robust protective effects against allergic airway inflammation not only in the first, but also the second offspring generation, but does not increase susceptibility to viral or bacterial infection. Immune correlates of allergy protection include skewing of regulatory over effector T-cells, expansion of Treg subsets expressing CXCR3 or RORγt, and demethylation of the FOXP3 locus. The composition and diversity of the gastrointestinal microbiota is measurably affected by perinatal H. pylori exposure.

Conclusion

We conclude that exposure to H. pylori has consequences not only for the carrier, but also for subsequent generations that may be exploited for interventional purposes.

Graphical abstract

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Trans-maternal Helicobacter pylori exposure reduces allergic airway inflammation in offspring through regulatory T-cells

Publication date: Available online 19 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Andreas Kyburz, Angela Fallegger, Xiaozhou Zhang, Aleksandra Altobelli, Mariela Artola-Boran, Timothy Borbet, Sabine Urban, Petra Paul, Christian Münz, Stefan Floess, Jochen Huehn, Timothy L. Cover, Martin J. Blaser, Christian Taube, Anne Müller

Abstract

Background

The trans-maternal exposure to tobacco, microbes, nutrients and other environmental factors shapes the fetal immune system through epigenetic processes. The gastric microbe Helicobacter pylori represents an ancestral constituent of the human microbiota that causes gastric disorders on the one hand, and is inversely associated with allergies and chronic inflammatory conditions on the other.

Objective

Here, we investigate the consequences of trans-maternal exposure to H. pylori, in utero and/or during lactation, for susceptibility to viral and bacterial infection, predisposition to allergic airway inflammation, and the development of immune cell populations in the lung and lymphoid organs.

Methods

We use experimental models of house dust mite- or ovalbumin-induced airway inflammation and influenza A virus or Citrobacter infection along with metagenomics analyses, multi-color flow cytometry and bilsufite pyrosequencing to study the effects of H. pylori on allergy severity and immunological and microbiome correlates thereof.

Results

Perinatal exposure to H. pylori extract, or its immunomodulator VacA, confers robust protective effects against allergic airway inflammation not only in the first, but also the second offspring generation, but does not increase susceptibility to viral or bacterial infection. Immune correlates of allergy protection include skewing of regulatory over effector T-cells, expansion of Treg subsets expressing CXCR3 or RORγt, and demethylation of the FOXP3 locus. The composition and diversity of the gastrointestinal microbiota is measurably affected by perinatal H. pylori exposure.

Conclusion

We conclude that exposure to H. pylori has consequences not only for the carrier, but also for subsequent generations that may be exploited for interventional purposes.

Graphical abstract

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MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials

Abstract

Objective

This study aims to perform a systematic review and meta-analysis of clinical trials in order to evaluate the clinical and radiographic success rates of primary teeth pulpotomy performed with biodentine, when compared to MTA.

Methods

Search strategies were conducted in nine databases on August 5th, 2017, update on February 14th, 2018. Clinical articles were selected, which were in accordance with the inclusion and exclusion criteria and the research objective. They were analyzed by meta-analysis at three time points (6, 12, and 18 months).

Results

Out of the 233 publications initially identified, only 9 studies that fulfilled the inclusion criteria were included in the review. The 6-month overall clinical (RR = 0.99; 95% CI = 0.96–1.02, p = 0.92) and radiographic success rates (RR = 0.96; 95% CI = 0.92–1.00, p = 0.28) showed that biodentine vs. MTA did not differ statistically. The 12 and 18-month overall clinical success rates, respectively (RR = 1.01; 95% CI = 0.97–1.04, p = 0.77; RR = 0.98; 95% CI = 0.92–1.05, p = 0.74) and radiographic success rates, respectively (RR = 0.97; 95% CI = 0.92–1.02, p = 0.11; RR = 1.00; 95% CI = 0.91–1.10, p = 0.56) also showed that biodentine vs. MTA did not differ statistically.

Conclusion

There is no superiority of one material over the other, MTA versus biodentine.

Clinical relevance

This systematic review comparing the performance of biodentine in relation to the MTA when used in the pulpotomy technique in primary teeth. Although MTA is considered the gold standard material for pulpotomy procedures, it has some drawbacks (poor handling, staining potential, long setting time); thus, it is important to evaluate the clinical performance of other calcium silicate-based cements like biodentine that overcome this drawbacks.

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MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials

Abstract

Objective

This study aims to perform a systematic review and meta-analysis of clinical trials in order to evaluate the clinical and radiographic success rates of primary teeth pulpotomy performed with biodentine, when compared to MTA.

Methods

Search strategies were conducted in nine databases on August 5th, 2017, update on February 14th, 2018. Clinical articles were selected, which were in accordance with the inclusion and exclusion criteria and the research objective. They were analyzed by meta-analysis at three time points (6, 12, and 18 months).

Results

Out of the 233 publications initially identified, only 9 studies that fulfilled the inclusion criteria were included in the review. The 6-month overall clinical (RR = 0.99; 95% CI = 0.96–1.02, p = 0.92) and radiographic success rates (RR = 0.96; 95% CI = 0.92–1.00, p = 0.28) showed that biodentine vs. MTA did not differ statistically. The 12 and 18-month overall clinical success rates, respectively (RR = 1.01; 95% CI = 0.97–1.04, p = 0.77; RR = 0.98; 95% CI = 0.92–1.05, p = 0.74) and radiographic success rates, respectively (RR = 0.97; 95% CI = 0.92–1.02, p = 0.11; RR = 1.00; 95% CI = 0.91–1.10, p = 0.56) also showed that biodentine vs. MTA did not differ statistically.

Conclusion

There is no superiority of one material over the other, MTA versus biodentine.

Clinical relevance

This systematic review comparing the performance of biodentine in relation to the MTA when used in the pulpotomy technique in primary teeth. Although MTA is considered the gold standard material for pulpotomy procedures, it has some drawbacks (poor handling, staining potential, long setting time); thus, it is important to evaluate the clinical performance of other calcium silicate-based cements like biodentine that overcome this drawbacks.

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Treatment of buccal soft tissue dehiscence around single implant: 5-year results from a prospective study

Abstract

Objectives

The aim of this study is to report the 5-year outcomes of a coverage procedure of shallow maxillary soft tissue dehiscences, around single tissue-level implants.

Material and methods

The original population consisted of 16 patients presenting a single maxillary buccal implant soft tissue recession. A connective tissue graft, taken from the maxillary tuberosity, was inserted underneath a split-thickness envelope flap. After treatment, patients received individually tailored supportive periodontal therapy (SPT).

Results

Two patients were lost to follow-up, while one implant was removed due to peri-implantitis, before the final examination. At 5 years, complete implant soft tissue coverage was depicted in 8 out of 13 cases (62%). Mean soft tissue dehiscence coverage was 86%. Patients' esthetic evaluation showed the persistency of high VAS scores.

Conclusions

Treatment of buccal soft tissue dehiscence around single implant, followed by regular supportive therapy, resulted in good esthetic and functional results in the majority of patients.

Clinical relevance

Within the limits of this study, the positive results suggest that the proposed technique may be a reliable option in selected cases.

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Treatment of buccal soft tissue dehiscence around single implant: 5-year results from a prospective study

Abstract

Objectives

The aim of this study is to report the 5-year outcomes of a coverage procedure of shallow maxillary soft tissue dehiscences, around single tissue-level implants.

Material and methods

The original population consisted of 16 patients presenting a single maxillary buccal implant soft tissue recession. A connective tissue graft, taken from the maxillary tuberosity, was inserted underneath a split-thickness envelope flap. After treatment, patients received individually tailored supportive periodontal therapy (SPT).

Results

Two patients were lost to follow-up, while one implant was removed due to peri-implantitis, before the final examination. At 5 years, complete implant soft tissue coverage was depicted in 8 out of 13 cases (62%). Mean soft tissue dehiscence coverage was 86%. Patients' esthetic evaluation showed the persistency of high VAS scores.

Conclusions

Treatment of buccal soft tissue dehiscence around single implant, followed by regular supportive therapy, resulted in good esthetic and functional results in the majority of patients.

Clinical relevance

Within the limits of this study, the positive results suggest that the proposed technique may be a reliable option in selected cases.

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