Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A.G. Dellovo, L.M.A. Souza, J.S. de Oliveira, K.S. Amorim, F.C. Groppo

Abstract

Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15 mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO₂)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO₂. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P < 0.0001). More undesirable effects were observed with midazolam (P < 0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine.

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Response to the Letter to the Editor regarding “Impact of crack cocaine use on the occurrence of oral lesions and micronuclei”

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.P. Antoniazzi, L.C. Jardim, M.R. Sagrillo, K.L. Ferrazzo, C.A. Feldens

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Loss of an IgG plasma cell checkpoint in lupus

Publication date: Available online 13 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jolien Suurmond, Yemil Atisha-Fregoso, Emiliano Marasco, Ashley N. Barlev, Naveed Ahmed, Silvia A. Calderon, Mei Yin Wong, Meggan C. Mackay, Cynthia Aranow, Betty Diamond

Abstract

Background

IgG anti-nuclear antibodies (ANA) are a feature of several autoimmune diseases. These antibodies arise through defects in central or peripheral tolerance checkpoints. The specific checkpoints breached in autoimmune disease are not fully understood.

Objectives

To study whether autoreactive plasma cells in lupus models and SLE patients arise as a consequence of defective antigen-specific selection or a global enhancement of IgG PC differentiation.

Methods and Results

We optimized and validated a novel technique to detect naturally occurring ANA+ B cells and PC. We observed a major checkpoint for generation of ANA+ IgG+ PC in both non-autoimmune mice and healthy human subjects. Interestingly, we observed increased numbers of ANA+ IgG+ PC despite normal tolerance checkpoints in immature and naïve B cells in lupus-prone MRL/lpr and NZB/W mice as well as patients with systemic lupus erythematosus (SLE). This increase was due to increased numbers of total IgG+ PC rather than lack of selection against ANA+ PC.

Conclusion

Using a method that permits quick and accurate quantification of autoreactive B cells and PC in vivo within a native B cell repertoire in mice and humans, we demonstrate the importance of a checkpoint that restricts the generation of IgG plasma cells and protects against IgG ANA. Our observations suggest a fundamentally revised understanding of SLE: that it is a disease of aberrant B cell differentiation rather than a defect in antigen-specific B cell tolerance.

Clinical implication

Therapies for SLE might need to be targeted at IgG plasma cell differentiation rather than antigen-specific tolerance.

Graphical abstract

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Exosome swarms eliminate airway pathogens and provide passive epithelial immunoprotection through nitric oxide

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Angela L. Nocera, Sarina K. Mueller, Jules R. Stephan, Loretta Hing, Philip Seifert, Xue Han, Derrick T. Lin, Mansoor M. Amiji, Towia Libermann, Benjamin S. Bleier

Background

Nasal mucosa–derived exosomes (NMDEs) harbor immunodefensive proteins and are capable of rapid interepithelial protein transfer.

Objectives

We sought to determine whether mucosal exposure to inhaled pathogens stimulates a defensive swarm of microbiocidal exosomes, which also donate their antimicrobial cargo to adjacent epithelial cells.

Methods

We performed an institutional review board–approved study of healthy NMDE secretion after Toll-like receptor (TLR) 4 stimulation by LPS (12.5 μg/mL) in the presence of TLR4 inhibitors. Interepithelial transfer of exosomal nitric oxide (NO) synthase and nitric oxide was measured by using ELISAs and NO activity assays. Exosomal antimicrobial assays were performed with Pseudomonas aeruginosa. Proteomic analyses were performed by using SOMAscan.

Results

In vivo and in vitro LPS exposure induced a 2-fold increase in NMDE secretion along with a 2-fold increase in exosomal inducible nitric oxide synthase expression and function through TLR4 and inhibitor of nuclear factor κB kinase activation. LPS stimulation increased exosomal microbiocidal activity against P aeruginosa by almost 2 orders of magnitude. LPS-stimulated exosomes induced a 4-fold increase in NO production within autologous epithelial cells with protein transfer within 5 minutes of contact. Pathway analysis of the NMDE proteome revealed 44 additional proteins associated with NO signaling and innate immune function.

Conclusions

We provide direct in vivo evidence for a novel exosome-mediated innate immunosurveillance and defense mechanism of the human upper airway. These findings have implications for lower airway innate immunity, delivery of airway therapeutics, and host microbiome regulation.

Graphical abstract

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Mast Cell CRF2 Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Susan D'Costa, Saravanan Ayyadurai, Amelia J. Gibson, Emily Mackey, Mrigendra Rajput, Laura J. Sommerville, Neco Wilson, Yihang Li, Eric Kubat, Ananth Kumar, Hariharan Subramanian, Aditi Bhargava, Adam J. Moeser

Abstract

Background

Psychological stress and heightened MC activation are linked with important immunological disorders including allergy, anaphylaxis, asthma, and functional bowel diseases, but the mechanisms remain poorly defined. We have previously demonstrated that activation of the corticotropin releasing factor (CRF) system potentiates MC degranulation responses during IgE-mediated anaphylaxis and psychological stress, via CRF receptor subtype 1 (CRF₁) expressed on MCs.

Objective

In this study, we investigated the role of CRF receptor subtype 2 (CRF₂) as a modulator of stress-induced MC degranulation and associated disease pathophysiology.

Methods

In vitro MC degranulation assays were performed with bone marrow derived MCs (BMMCs) derived from WT and CRF₂-deficient (CRF₂^-/-) mice and RBL-2H3 MCs transfected with CRF₂-overexpressing plasmid or CRF₂-siRNA. In vivo MC responses and associated pathophysiology in IgE-mediated passive systemic anaphylaxis (PSA) and acute psychological restraint stress were measured in WT, CRF₂^-/-, and MC-deficient Kit^W-sh/W-sh knock-in mice.

Results

Compared with WT mice, CRF2-/- exhibited heightened serum histamine levels and exacerbated PSA-induced anaphylactic responses and colonic permeability. In addition, CRF₂^-/- mice exhibited increased serum histamine and colonic permeability following acute restraint stress. Experiments with BMMCs and RBL-2H3 MCs demonstrated that CRF₂ expressed on MCs suppresses store-operated Ca²⁺ entry (SOCE) signaling and MC degranulation induced by diverse MC stimuli. Experiments with MC-deficient Kit^W-sh/W-sh mice systemically engrafted with WT and CRF₂^-/- BMMCs demonstrated the functional importance of MC-CRF₂ in modulating stress-induced pathophysiology.

Conclusions

MC CRF₂ is a negative, global modulator of stimuli-induced MC degranulation and limits the severity of IgE-mediated anaphylaxis and stress-related disease pathogenesis.

Graphical abstract

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A randomized clinical trial evaluating maxillary sinus augmentation with different particle sizes of demineralized bovine bone mineral: histological and immunohistochemical analysis

Publication date: Available online 13 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.S. de Molon, F.S. Magalhaes-Tunes, C.V. Semedo, R.G. Furlan, L.G.L. de Souza, A.P. de Souza Faloni, E. Marcantonio, R.S. Faeda

Abstract

This study was performed to investigate sinus floor augmentation with two different particle sizes of demineralized bovine bone mineral (DBBM) by means of histological and immunohistochemical (IHC) analysis. A randomized clinical trial was conducted involving 10 individuals requiring two-stage bilateral maxillary sinus augmentation for implant installation. The patients were randomly divided into two groups following a split-mouth design: the maxillary sinus on one side was filled with small-sized particles (0.25–1 mm) and on the contralateral side with large-sized particles (1–2 mm). After a healing period of 8 months, 25 implants were placed. During implant site preparation, bone biopsies were obtained from each sinus, perpendicular to the long axis of the implant (buccal–palatal direction), for descriptive and histomorphometric analyses. IHC staining for protein expression of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and tartrate-resistant acid phosphatase (TRAP) was also performed. Histomorphometric analysis revealed no statistically significant difference in the percentage of biomaterial (32.4 ± 8.56% and 38.0 ± 6.92%), newly formed bone (36.1 ± 9.60% and 36.7 ± 5.79%), or connective tissue (30.4 ± 8.63% and 23.8 ± 6.16%) between the small- and large-sized particle groups, respectively. IHC analysis did not reveal differences in the expression of OCN, VEGF, or TRAP. These findings suggest that both particle sizes of DBBM are effective for bone augmentation in the maxillary sinus.

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Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Yang, P.-j. Li, T. Shuai, Y. Wang, C. Mao, G.-y. Yu, C.-b. Guo, X. Peng

Abstract

Free flap transplantation has become a mainstay for the restoration of oral and maxillofacial defects. However, the complexity of the surgical procedure and long hospitalization time result in high hospitalization costs. This study was performed to retrospectively analyse the composition of hospitalization expenses and factors influencing this for 507 patients who underwent oral and maxillofacial free flap transplantation at a representative medical institution in China. The aim was to provide evidence for the reasonable control of expenditure and effective utilization of medical resources, and to gain an indirect reflection of the healthcare model characteristics of public hospitals in China. The average hospitalization cost was found to be US$ 9265 ± 2284. Factors affecting hospitalization expenses were the type of free flap, tracheotomy, postoperative complications, and length of stay. The largest proportion of hospitalization expenses was the cost of materials (44.94%). Although the total hospitalization cost was lower than that in Western countries, the medical burden of patients was higher, and the corresponding medical charges do not fully reflect the value of medical services. We recommend reducing hospitalization expenses and the medical burden by shortening the hospital stay, selecting reasonably priced medical materials, strengthening airway management of patients undergoing tracheotomy, and enhancing the control and treatment of comorbidities in order to reduce the incidence of postoperative complications.

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Comparison of rim-sparing versus rim-removal techniques in deep lateral wall orbital decompression for Graves’ orbitopathy

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Zhang, Y. Li, Y. Wang, S. Zhong, X. Liu, Y. Huang, S. Fang, A. Zhuang, J. Sun, H. Zhou, X. Fan

Abstract

The aim of this study was to compare the surgical outcomes of deep lateral orbital decompression using the rim-sparing technique versus the rim-removal technique in Graves' orbitopathy (GO). A retrospective cohort study of 75 orbits in 50 patients with GO was performed. Proptosis, best corrected visual acuity (BCVA), intraocular pressure (IOP), upper and lower lid margin to reflex distances (MRD-1 and MRD-2, respectively), diplopia, ocular restriction, and GO quality of life (GO-QOL) questionnaire results were analyzed pre- and postoperatively. The average proptosis reduction ranged from 3.5 mm to 6.7 mm with the rim-sparing technique and from 3.6 mm to 6.7 mm with the rim-removal technique (P > 0.05). All orbits with dysthyroid optic neuropathy in the rim-sparing group and 87.5% of such orbits in the rim-removal group showed improved BCVA (P = 0.321). Reductions in IOP, MRD-1, and MRD-2 were observed with both techniques. Patients in the rim-sparing group had greater improvements in GO-QOL appearance score (P = 0.043). In conclusion, rim-sparing orbital decompression provides efficacious outcomes with greater improvements in patient quality of life than the rim-removal technique. The rim-sparing technique should be considered as a preferable option because it preserves the integrity of the lateral vertical maxillary buttress and bony protection for the orbital contents.

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Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A.G. Dellovo, L.M.A. Souza, J.S. de Oliveira, K.S. Amorim, F.C. Groppo

Abstract

Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15 mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO₂)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO₂. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P < 0.0001). More undesirable effects were observed with midazolam (P < 0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine.

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Response to the Letter to the Editor regarding “Impact of crack cocaine use on the occurrence of oral lesions and micronuclei”

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.P. Antoniazzi, L.C. Jardim, M.R. Sagrillo, K.L. Ferrazzo, C.A. Feldens

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Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Matthias Balk, David Schwarz, Philipp Wolber, Andreas Anagiotos, Antoniu-Oreste Gostian

Abstract

Objective

To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures.

Methods

Out of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation.

Results

Patients undergoing partial mastoid obliteration (five ♀, 4 left ears) and overclosure of the external ear canal (one ♀, 3 left ears) averaged 56 years and 61 years, respectively. The radical cavities had been present for 21.8 years on average before partial obliteration and for 19.5 years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1 months and 3.8 months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal.

Conclusion

Partial mastoid obliteration with bone paté and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation.

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Efficacy of anti-PD-1 therapy in a patient with brain metastasis of parotid carcinoma: A case report

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kota Takemoto, Nobuyuki Miyahara, Nobuyuki Chikuie, Takao Hamamoto, Takashi Ishino, Tsutomu Ueda, Sachio Takeno

Abstract

CheckMate 141, an open-label, randomized phase III trial of nivolumab, indicated that treatment with nivolumab prolonged overall survival of patients with platinum-refractory, recurrent head and neck squamous cell carcinoma. Herein, we describe a case of brain metastasis of parotid carcinoma in which a good response was achieved after nivolumab treatment. The patient was a 67-year-old woman with parotid carcinoma (cT4bN0M0) who received induction chemotherapy followed by chemoradiation. Computed tomography and magnetic resonance imaging performed 10 weeks after the primary treatment revealed a residual tumor and brain and lung metastases. Thereafter, chemotherapy comprising cisplatin, 5-FU, and cetuximab was performed. Unfortunately, the tumor volume increased 5 months after chemotherapy, after which she received immunotherapy with biweekly nivolumab. After six cycles of nivolumab administration, the brain and lung metastases shrank markedly. Nivolumab had an intracranial effect in the patient with brain metastases of parotid carcinoma. This case report highlights the efficacy of nivolumab in the management of head and neck cancer with brain metastasis.

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Effects of l-carnitine administration on health-related quality of life during cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kazuhira Endo, Takayoshi Ueno, Kazuya Ishikawa, Yosuke Nakanishi, Satoru Kondo, Naohiro Wakisaka, Tomokazu Yoshizaki

Abstract

Objectives

Cancer-related fatigue impairs daily functioning and negatively impacts health-related quality of life (HRQoL). Our previous study revealed that cisplatin-based chemoradiotherapy (CRT) impairs the carnitine system and carnitine deficiency leads to poor physical functioning. This open label, randomized, controlled prospective study investigated the effects of l-carnitine administration on plasma carnitine concentration, CRT-induced fatigue, and decline in HRQoL in patients with head and neck squamous cell carcinoma (HNSCC).

Methods

Patients were divided into experimental group (received 1000 mg of oral liquid l-carnitine once daily for 8 weeks) and control group. The primary and secondary endpoints were the change in HRQoL scores and the change in carnitine levels, respectively, from baseline (pre-CRT) to after CRT.

Results

The mean total plasma carnitine concentration in the control group decreased significantly, 2 weeks after the end of chemotherapy, while no significant differences were seen in the l-carnitine group. l-carnitine administration, therefore, kept the physical functioning score unchanged.

Conclusion

Our study shows that patients who receive CRT experience chemotherapy-induced damage of carnitine homeostasis leading to deficiency of carnitine and impairment of HRQoL. l-carnitine administration is beneficial in improving the HRQoL in patients with HNSCC.

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Curcumin gum formulation for prevention of oral cavity head and neck squamous cell carcinoma

Objectives/Hypothesis

Head and neck squamous cell carcinoma represents the sixth most common cancer. As a result of field cancerization, second primaries and recurrences are high. Hence, research has focused on chemoprevention. Curcumin, a polyphenol compound with anticarcinogenic properties, is one such promising nutraceutical. As poor bioavailability limits curcumin's use, a novel gum formulation was tested allowing for direct mucosal absorption into the bloodstream. This preliminary study validates curcumin gum efficacy by assessing release and transmucosal absorption, along with measuring its effects on serum cytokine levels.

Study Design

Clinical trial.

Methods

Protocols consisting of initial chew (chewing gum for 30 minutes) and revised chew (alternating chewing and parking gum against buccal mucosa for 30 minutes) were tested in healthy volunteers. High‐performance liquid chromatography measured remnant curcumin in chewed gum, serum, and saliva. Serum levels were assayed for 15 proinflammatory cytokines via multiplex analysis.

Results

Revised chew samples demonstrated significantly higher curcumin release and absorption (P = .0078). Curcumin serum levels were significantly higher at 4 hours in samples > 2.0 g of curcumin release (P = .01). As saliva levels decreased, a concurrent increase in serum levels was observed, with no significance in the inverse relationship (P = .1423). When evaluating differences between gender, race, and age, the Asian population showed significantly lower curcumin release and serum levels (P = .009). CXCL1 (GRO‐α) and TNF‐α were significantly decreased in serum after chewing the gum (P = .036, P < .001, respectively).

Conclusions

Enhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF‐α both represent potential biomarkers for the future study of curcumin chemoprevention.

Level of Evidence

2b Laryngoscope, 2018

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Quantification of injection force mechanics during injection laryngoplasty

Objectives

In‐office or operative injection laryngoplasty requires needle stability for accurate material placement. To date, no reports compare injection forces based on needle gauge, bends, length, or material type or temperature. We hypothesize these factors alter injection forces and could impact clinical use.

Methods

Swine larynges were placed in a compression testing machine. Syringes were affixed to a stabilizing crossbeam. Straight needles (25G 1.5‐inch; 27G 1.25‐inch; or 9.8‐inch malleable shaft 16G per oral with 24G tapered needle tip) were inserted into the swine vocal folds to simulate realistic tissue resistance pressure. Compressive loading was conducted at 40 mm/minute until steady‐state force was achieved. Tests were completed with calcium hydroxylapatite (CaHa), carboxymethylcellulose, and hyaluronic acid at various temperatures and CaHa with various bends in the needles (n = 3 per group, comparisons performed by two‐way analysis of variance (ANOVA), Tukey's post‐hoc).

Results

Needle size, shape, and temperature altered injection force. Steady‐state force was highest with the per‐oral needle at a mean of 44.55N compared to 26.44N and 29.77N in the 25G and 27G percutaneous needles, respectively (P < 0.001). Stiffness rate (initial increasing force vs. distance to initiate injection) ranged from 19.75N/mm (per oral) to 22.06N/mm (25G) to 24.56N/mm (27G), (P = 0.875). Adding multiple bends to the per‐oral needle increased stiffness rate to 24.99N/mm (P = 0.035), whereas the 25G needle stiffness rate remained unchanged (P = 0.941), with the stiffness rate decreasing in the 27G needle with increasing bends (P = 0.033). Increased temperature decreased injection forces across all materials.

Conclusion

Needle caliber, length, and bends impact steady‐state forces and stiffness rates during vocal fold injection.

Level of Evidence

NA. Laryngoscope, 2018

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Gamification as a tool for resident education in otolaryngology: A pilot study

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T‐Helper 2 Lymphocyte Immunophenotype Is Associated With Iatrogenic Laryngotracheal Stenosis

Objective/Hypothesis

This prospective controlled human and murine study assessed the presence of inflammatory cells and cytokines to test the hypothesis that immune cells are associated with fibroproliferation in iatrogenic laryngotracheal stenosis (iLTS).

Methods

Inflammation was assessed by histology and immunofluorescence (IF), quantitative real‐time polymerase chain reaction (qRT‐PCR), and flow cytometry of cricotracheal resections of iLTS patients compared to normal controls. An iLTS murine model assessed the temporal relationship between inflammation and fibrosis.

Results

iLTS specimens showed increased inflammation versus normal controls (159/high power field [hpf] vs. 119/hpf, P = 0.038), and increased CD3 + T‐cells, CD4 + cells, and CD3+/CD4 + T‐helper (T_H) cells (all P < 0.05). The inflammatory infiltrate was located immediately adjacent to the epithelial surface in the superficial aspect of the thickened lamina propria. Human flow cytometry and qRT‐PCR showed a significant increase in interleukin (IL)‐4 gene expression, indicating a T_H2 phenotype. Murine IF revealed a dense CD4 + T‐cell inflammatory infiltrate on day 4 to 7 postinjury, which preceded the development of fibrosis. Murine flow cytometry and qRT‐PCR studies mirrored the human ones, with increased T‐helper cells and IL‐4 in iLTS versus normal controls.

Conclusion

CD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a T_H2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS.

Level of Evidence

NA. Laryngoscope, 2018

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Extranodal extension in resected oral cavity squamous cell carcinoma: more to it than meets the eye

Objective/Hypothesis

Extranodal extension (ENE) is an independent prognosticator in head–neck Squamous cell carcinoma (SCC). All patients with ENE, however, do not behave the same, and there is a need for further risk stratification. This study evaluates the prognostic significance of various grades of ENE and the number of nodes with ENE on overall survival (OS) in oral cavity SCC (OCSCC).

Study Design

Retrospective cohort study.

Methods

Ninety‐four patients with node‐positive OCSCC treated with primary surgery and appropriate adjuvant therapy during the year 2011 were evaluated. Surgical histopathology slides of all patients were reviewed, and ENE was graded according to the grading system proposed by Lewis Jr et al.

Results

On univariate analysis, lymph node density (LND) greater than or equal to 0.12 (P = 0.013), the presence of ENE in more than two nodes (P = 0.006), and ENE grade 3 through 4 (P = 0.035) were associated with worse (OS). Conventional prognostic factors such as tumor (T) stage, nodal (N) stage, stage grouping, depth of invasion, and pattern of invasion did not have a significant impact on OS. On multivariate analysis, the presence of ENE in more than two nodes (P = 0.018) independently predicted a worse OS. Extranodal extension grade 3 through 4 showed a trend toward significance (P = 0.08). A combination of LND greater than or equal to 0.12, ENE grade 3 through 4, and ENE in more than two lymph nodes conferred the poorest prognosis (3‐year OS: 18%; P = 0.000).

Conclusion

In patients with ENE and advanced nodal disease, T stage, N stage, stage group, depth, and pattern of invasion lose their impact on OS. In patients with ENE, nodal characteristics such as LND, the number of nodes with ENE, and grade of ENE serve as important prognosticators and aid in further risk stratification.

Level of Evidence

4. Laryngoscope, 2018

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Nativity and Occupational Determinants of Physical Activity Participation Among Latinos

Publication date: Available online 13 November 2018

Source: American Journal of Preventive Medicine

Author(s): Sandra E. Echeverría, Anna Divney, Fatima Rodriguez, Madeline Sterling, Elizabeth Vasquez, Rosenda Murillo, Lenny Lopez

Introduction

Latinos in the U.S. bear a disproportionate burden of cardiovascular risk factors, including physical inactivity. Previous research among Latinos has focused on leisure-time physical activity, limiting understanding of the different ways in which populations, particularly working-class groups, achieve recommended levels of physical activity. This study examined associations of race/ethnicity; nativity; and leisure-time, transportation, and occupation-related physical activity among Latino and non-Latino white adults.

Methods

Participants sampled in the 2007–2012 waves of the National Health and Nutrition Examination Survey self-reported domain-specific physical activity. Data were analyzed in 2016–2017 using multivariable log binomial regression models to examine differences in meeting guidelines for each physical activity domain separately and as total physical activity among Latinos (n=4,692) and non-Latino whites (n=7,788). Models were adjusted for sociodemographic characteristics and health status and tested interactions between nativity and occupational categories.

Results

In adjusted models, foreign-born Latinos (prevalence ratio=0.70, 95% CI=0.63, 0.77) and U.S.-born Latinos (prevalence ratio=0.85, 95% CI=0.76, 0.95) were least likely to meet physical activity guidelines through occupation-related and leisure time physical activity, when compared with non-Latino whites. By contrast, foreign-born Latinos were more likely to meet physical activity guidelines through transportation physical activity than non-Latino whites (prevalence ratio=1.26, 95% CI=1.01, 1.56) and were proportionately more likely to participate in vigorous modes of physical activity. Interaction results indicated that foreign-born Latinos were the least likely to meet physical activity guidelines compared with U.S.-born Latinos and non-Latino whites if they worked in non-manual occupational categories. All racial/ethnic groups working in manual occupations saw the largest increase (40%–50%) in meeting physical activity guidelines when occupation-related physical activity was combined with leisure-time and transportation physical activity.

Conclusions

These findings suggest variability in the relationship between nativity and the physical activity domain Latinos engage in compared with non-Latino whites, with occupation contributing substantially to meeting physical activity recommendations for all population groups.

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Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Matthias Balk, David Schwarz, Philipp Wolber, Andreas Anagiotos, Antoniu-Oreste Gostian

Abstract

Objective

To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures.

Methods

Out of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation.

Results

Patients undergoing partial mastoid obliteration (five ♀, 4 left ears) and overclosure of the external ear canal (one ♀, 3 left ears) averaged 56 years and 61 years, respectively. The radical cavities had been present for 21.8 years on average before partial obliteration and for 19.5 years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1 months and 3.8 months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal.

Conclusion

Partial mastoid obliteration with bone paté and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation.

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Efficacy of anti-PD-1 therapy in a patient with brain metastasis of parotid carcinoma: A case report

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kota Takemoto, Nobuyuki Miyahara, Nobuyuki Chikuie, Takao Hamamoto, Takashi Ishino, Tsutomu Ueda, Sachio Takeno

Abstract

CheckMate 141, an open-label, randomized phase III trial of nivolumab, indicated that treatment with nivolumab prolonged overall survival of patients with platinum-refractory, recurrent head and neck squamous cell carcinoma. Herein, we describe a case of brain metastasis of parotid carcinoma in which a good response was achieved after nivolumab treatment. The patient was a 67-year-old woman with parotid carcinoma (cT4bN0M0) who received induction chemotherapy followed by chemoradiation. Computed tomography and magnetic resonance imaging performed 10 weeks after the primary treatment revealed a residual tumor and brain and lung metastases. Thereafter, chemotherapy comprising cisplatin, 5-FU, and cetuximab was performed. Unfortunately, the tumor volume increased 5 months after chemotherapy, after which she received immunotherapy with biweekly nivolumab. After six cycles of nivolumab administration, the brain and lung metastases shrank markedly. Nivolumab had an intracranial effect in the patient with brain metastases of parotid carcinoma. This case report highlights the efficacy of nivolumab in the management of head and neck cancer with brain metastasis.

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Effects of l-carnitine administration on health-related quality of life during cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma

Publication date: Available online 12 November 2018

Source: Auris Nasus Larynx

Author(s): Kazuhira Endo, Takayoshi Ueno, Kazuya Ishikawa, Yosuke Nakanishi, Satoru Kondo, Naohiro Wakisaka, Tomokazu Yoshizaki

Abstract

Objectives

Cancer-related fatigue impairs daily functioning and negatively impacts health-related quality of life (HRQoL). Our previous study revealed that cisplatin-based chemoradiotherapy (CRT) impairs the carnitine system and carnitine deficiency leads to poor physical functioning. This open label, randomized, controlled prospective study investigated the effects of l-carnitine administration on plasma carnitine concentration, CRT-induced fatigue, and decline in HRQoL in patients with head and neck squamous cell carcinoma (HNSCC).

Methods

Patients were divided into experimental group (received 1000 mg of oral liquid l-carnitine once daily for 8 weeks) and control group. The primary and secondary endpoints were the change in HRQoL scores and the change in carnitine levels, respectively, from baseline (pre-CRT) to after CRT.

Results

The mean total plasma carnitine concentration in the control group decreased significantly, 2 weeks after the end of chemotherapy, while no significant differences were seen in the l-carnitine group. l-carnitine administration, therefore, kept the physical functioning score unchanged.

Conclusion

Our study shows that patients who receive CRT experience chemotherapy-induced damage of carnitine homeostasis leading to deficiency of carnitine and impairment of HRQoL. l-carnitine administration is beneficial in improving the HRQoL in patients with HNSCC.

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Curcumin gum formulation for prevention of oral cavity head and neck squamous cell carcinoma

Objectives/Hypothesis

Head and neck squamous cell carcinoma represents the sixth most common cancer. As a result of field cancerization, second primaries and recurrences are high. Hence, research has focused on chemoprevention. Curcumin, a polyphenol compound with anticarcinogenic properties, is one such promising nutraceutical. As poor bioavailability limits curcumin's use, a novel gum formulation was tested allowing for direct mucosal absorption into the bloodstream. This preliminary study validates curcumin gum efficacy by assessing release and transmucosal absorption, along with measuring its effects on serum cytokine levels.

Study Design

Clinical trial.

Methods

Protocols consisting of initial chew (chewing gum for 30 minutes) and revised chew (alternating chewing and parking gum against buccal mucosa for 30 minutes) were tested in healthy volunteers. High‐performance liquid chromatography measured remnant curcumin in chewed gum, serum, and saliva. Serum levels were assayed for 15 proinflammatory cytokines via multiplex analysis.

Results

Revised chew samples demonstrated significantly higher curcumin release and absorption (P = .0078). Curcumin serum levels were significantly higher at 4 hours in samples > 2.0 g of curcumin release (P = .01). As saliva levels decreased, a concurrent increase in serum levels was observed, with no significance in the inverse relationship (P = .1423). When evaluating differences between gender, race, and age, the Asian population showed significantly lower curcumin release and serum levels (P = .009). CXCL1 (GRO‐α) and TNF‐α were significantly decreased in serum after chewing the gum (P = .036, P < .001, respectively).

Conclusions

Enhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF‐α both represent potential biomarkers for the future study of curcumin chemoprevention.

Level of Evidence

2b Laryngoscope, 2018

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Quantification of injection force mechanics during injection laryngoplasty

Objectives

In‐office or operative injection laryngoplasty requires needle stability for accurate material placement. To date, no reports compare injection forces based on needle gauge, bends, length, or material type or temperature. We hypothesize these factors alter injection forces and could impact clinical use.

Methods

Swine larynges were placed in a compression testing machine. Syringes were affixed to a stabilizing crossbeam. Straight needles (25G 1.5‐inch; 27G 1.25‐inch; or 9.8‐inch malleable shaft 16G per oral with 24G tapered needle tip) were inserted into the swine vocal folds to simulate realistic tissue resistance pressure. Compressive loading was conducted at 40 mm/minute until steady‐state force was achieved. Tests were completed with calcium hydroxylapatite (CaHa), carboxymethylcellulose, and hyaluronic acid at various temperatures and CaHa with various bends in the needles (n = 3 per group, comparisons performed by two‐way analysis of variance (ANOVA), Tukey's post‐hoc).

Results

Needle size, shape, and temperature altered injection force. Steady‐state force was highest with the per‐oral needle at a mean of 44.55N compared to 26.44N and 29.77N in the 25G and 27G percutaneous needles, respectively (P < 0.001). Stiffness rate (initial increasing force vs. distance to initiate injection) ranged from 19.75N/mm (per oral) to 22.06N/mm (25G) to 24.56N/mm (27G), (P = 0.875). Adding multiple bends to the per‐oral needle increased stiffness rate to 24.99N/mm (P = 0.035), whereas the 25G needle stiffness rate remained unchanged (P = 0.941), with the stiffness rate decreasing in the 27G needle with increasing bends (P = 0.033). Increased temperature decreased injection forces across all materials.

Conclusion

Needle caliber, length, and bends impact steady‐state forces and stiffness rates during vocal fold injection.

Level of Evidence

NA. Laryngoscope, 2018

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Gamification as a tool for resident education in otolaryngology: A pilot study

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T‐Helper 2 Lymphocyte Immunophenotype Is Associated With Iatrogenic Laryngotracheal Stenosis

Objective/Hypothesis

This prospective controlled human and murine study assessed the presence of inflammatory cells and cytokines to test the hypothesis that immune cells are associated with fibroproliferation in iatrogenic laryngotracheal stenosis (iLTS).

Methods

Inflammation was assessed by histology and immunofluorescence (IF), quantitative real‐time polymerase chain reaction (qRT‐PCR), and flow cytometry of cricotracheal resections of iLTS patients compared to normal controls. An iLTS murine model assessed the temporal relationship between inflammation and fibrosis.

Results

iLTS specimens showed increased inflammation versus normal controls (159/high power field [hpf] vs. 119/hpf, P = 0.038), and increased CD3 + T‐cells, CD4 + cells, and CD3+/CD4 + T‐helper (T_H) cells (all P < 0.05). The inflammatory infiltrate was located immediately adjacent to the epithelial surface in the superficial aspect of the thickened lamina propria. Human flow cytometry and qRT‐PCR showed a significant increase in interleukin (IL)‐4 gene expression, indicating a T_H2 phenotype. Murine IF revealed a dense CD4 + T‐cell inflammatory infiltrate on day 4 to 7 postinjury, which preceded the development of fibrosis. Murine flow cytometry and qRT‐PCR studies mirrored the human ones, with increased T‐helper cells and IL‐4 in iLTS versus normal controls.

Conclusion

CD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a T_H2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS.

Level of Evidence

NA. Laryngoscope, 2018

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Extranodal extension in resected oral cavity squamous cell carcinoma: more to it than meets the eye

Objective/Hypothesis

Extranodal extension (ENE) is an independent prognosticator in head–neck Squamous cell carcinoma (SCC). All patients with ENE, however, do not behave the same, and there is a need for further risk stratification. This study evaluates the prognostic significance of various grades of ENE and the number of nodes with ENE on overall survival (OS) in oral cavity SCC (OCSCC).

Study Design

Retrospective cohort study.

Methods

Ninety‐four patients with node‐positive OCSCC treated with primary surgery and appropriate adjuvant therapy during the year 2011 were evaluated. Surgical histopathology slides of all patients were reviewed, and ENE was graded according to the grading system proposed by Lewis Jr et al.

Results

On univariate analysis, lymph node density (LND) greater than or equal to 0.12 (P = 0.013), the presence of ENE in more than two nodes (P = 0.006), and ENE grade 3 through 4 (P = 0.035) were associated with worse (OS). Conventional prognostic factors such as tumor (T) stage, nodal (N) stage, stage grouping, depth of invasion, and pattern of invasion did not have a significant impact on OS. On multivariate analysis, the presence of ENE in more than two nodes (P = 0.018) independently predicted a worse OS. Extranodal extension grade 3 through 4 showed a trend toward significance (P = 0.08). A combination of LND greater than or equal to 0.12, ENE grade 3 through 4, and ENE in more than two lymph nodes conferred the poorest prognosis (3‐year OS: 18%; P = 0.000).

Conclusion

In patients with ENE and advanced nodal disease, T stage, N stage, stage group, depth, and pattern of invasion lose their impact on OS. In patients with ENE, nodal characteristics such as LND, the number of nodes with ENE, and grade of ENE serve as important prognosticators and aid in further risk stratification.

Level of Evidence

4. Laryngoscope, 2018

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Nativity and Occupational Determinants of Physical Activity Participation Among Latinos

Publication date: Available online 13 November 2018

Source: American Journal of Preventive Medicine

Author(s): Sandra E. Echeverría, Anna Divney, Fatima Rodriguez, Madeline Sterling, Elizabeth Vasquez, Rosenda Murillo, Lenny Lopez

Introduction

Latinos in the U.S. bear a disproportionate burden of cardiovascular risk factors, including physical inactivity. Previous research among Latinos has focused on leisure-time physical activity, limiting understanding of the different ways in which populations, particularly working-class groups, achieve recommended levels of physical activity. This study examined associations of race/ethnicity; nativity; and leisure-time, transportation, and occupation-related physical activity among Latino and non-Latino white adults.

Methods

Participants sampled in the 2007–2012 waves of the National Health and Nutrition Examination Survey self-reported domain-specific physical activity. Data were analyzed in 2016–2017 using multivariable log binomial regression models to examine differences in meeting guidelines for each physical activity domain separately and as total physical activity among Latinos (n=4,692) and non-Latino whites (n=7,788). Models were adjusted for sociodemographic characteristics and health status and tested interactions between nativity and occupational categories.

Results

In adjusted models, foreign-born Latinos (prevalence ratio=0.70, 95% CI=0.63, 0.77) and U.S.-born Latinos (prevalence ratio=0.85, 95% CI=0.76, 0.95) were least likely to meet physical activity guidelines through occupation-related and leisure time physical activity, when compared with non-Latino whites. By contrast, foreign-born Latinos were more likely to meet physical activity guidelines through transportation physical activity than non-Latino whites (prevalence ratio=1.26, 95% CI=1.01, 1.56) and were proportionately more likely to participate in vigorous modes of physical activity. Interaction results indicated that foreign-born Latinos were the least likely to meet physical activity guidelines compared with U.S.-born Latinos and non-Latino whites if they worked in non-manual occupational categories. All racial/ethnic groups working in manual occupations saw the largest increase (40%–50%) in meeting physical activity guidelines when occupation-related physical activity was combined with leisure-time and transportation physical activity.

Conclusions

These findings suggest variability in the relationship between nativity and the physical activity domain Latinos engage in compared with non-Latino whites, with occupation contributing substantially to meeting physical activity recommendations for all population groups.

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Differentiation Between Glioblastoma and Solitary Brain Metastasis using Neurite Orientation Dispersion and Density Imaging

Publication date: Available online 12 November 2018

Source: Journal of Neuroradiology

Author(s): Yoshihito Toshinori Hirai, Minako Yohei Hattori, Zaw Aung Khant, Masaaki Hori, Kiyotaka Saito, Kiyotaka Yokogami, Hideo Takeshima

Abstract

Background and purpose – Neurite orientation dispersion and density imaging (NODDI) is a new technique that applies a three-diffusion-compartment biophysical model. We assessed the usefulness of NODDI for the differentiation of glioblastoma from solitary brain metastasis.

Methods – NODDI data were prospectively obtained on a 3 T magnetic resonance imaging (MRI) scanner from patients with previously untreated, histopathologically confirmed glioblastoma (n = 9) or solitary brain metastasis (n = 6). Using the NODDI Matlab Toolbox, we generated maps of the intracellular-, extracellular-, and isotropic volume (VIC, VEC, VISO) fraction. Apparent diffusion coefficient- and fraction anisotropy maps were created from the diffusion data. On each map we manually drew a region of interest around the peritumoral signal-change (PSC)- and the enhancing solid area of the lesion. Differences between glioblastoma and metastatic lesions were assessed and the area under the receiver operating characteristic curve (AUC) was determined.

Results – On VEC maps the mean value of the PSC area was significantly higher for glioblastoma than metastasis (p < 0.05); on VISO maps it tended to be higher for metastasis than glioblastoma. There was no significant difference on the other maps. Among the 5 parameters, the VEC fraction in the PSC area showed the highest diagnostic performance. The VEC threshold value of ≥ 0.48 yielded 100% sensitivity, 83.3% specificity, and an AUC of 0.87 for differentiating between the two tumor types.

Conclusions – NODDI compartment maps of the PSC area may help to differentiate between glioblastoma and solitary brain metastasis.

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Association between carotid artery plaque inflammation and brain MRI

Publication date: Available online 12 November 2018

Source: Journal of Neuroradiology

Author(s): Luca Saba, Letizia Lai, Pierleone Lucatelli, Roberto Sanfilippo, Roberto Montisci, Jasjit S Suri, Gavino Faa

Abstract

Purpose: To explore the association between presence of inflammatory cells in the carotid plaques surgically treated and brain MRI findings.

Material and Methods: Forty consecutive patients were prospectively analyzed. Brain MRI was performed with a 1.5 Tesla scanner and infacts (lacuna and non-lacunar) pertinence of the anterior circulation were recorded. All patients underwent carotid endarterectomy "en bloc"; carotid plaques histological sections were prepared and immuno-cytochemical analysis was performed to characterize and quantify the presence of inflammatory cells. ROC curve analysis, Pearson Rho correlation and Mann-Whitney test were applied.

Results: The immuno-cytochemical analysis demonstrated that plaques of symptomatic patients (stroke\TIA; n = 25) had more inflammatory cells, mainly macrophages (CD68) compared with plaques of patients without symptoms (Mann-Whitney = p < 0.001, ROC curve area = 0.901). Correlation analysis showed a statistically significant association between the number of brain non-lacunar infarcts and the entity of macrophages (p < 0.001); whereas no association with lacunar infarcts (p = 0.1934) was found.

Conclusion: Results of this preliminary study suggest that the presence and amount of inflammatory cells within carotid artery plaque is associated with cerebrovascular events and with the number of MRI brain detectable infarct.

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Effect of technetium‐99 conjugated with methylene diphosphonate (99Tc‐MDP) on OPG/RANKL/RANK system in vitro

Abstract

Background

RANKL and RANK play an important role in jaw resorption during the development of the ameloblastomas. Therefore, the aim of this study was to explore the effect of ⁹⁹Tc‑MDP on OPG/RANKL/RANK system on RAW264.7 and MC3T3‐E1 cell lines in vitro, and provide the theoretical basis for the clinical treatment of the jaw ameloblastoma.

Methods

Different concentrations of ⁹⁹Tc‐MDP were used to treat RAW264.7 and MC3T3‐E1 cell lines. The cell proliferative inhibition rate was analyzed by CCK‐8. Cell apoptosis and cell cycle were detected by flow cytometry. Western blot were used to detect the expression of OPG, RANKL and RANK.

Results

Treatment of RAW264.7 cell lines with different concentrations of ⁹⁹Tc‐MDP had inhibitory effects and decreased the expression of RANK protein. The cell proliferation of ⁹⁹Tc‐MDP on MC3T3‐E1cell lines was stronger at 48h than at 24h except for 100μg/ml concentration group. Compared with the concentration of 0.01μg/ml, the treatment of MC3T3‐E1 cells with 100μg/ml ⁹⁹Tc‐MDP showed that the cell proliferative effect decreased at 24h and 48h (P<0.05). After treatment with 0.01μg/ml ⁹⁹Tc‐MDP, the expression of OPG in MC3T3‐E1 cells was significantly increased (P<0.05). Compared with 0.01μg/ml, the expression of RANKL was decreased after treatment with 100μg/ml ⁹⁹Tc‐MDP (P<0.05).

Conclusion

⁹⁹Tc‐MDP can induce apoptosis of RAW264.7 cells and inhibit the expression of RANK protein. The effect of 0.01μg/ml of low concentration of ⁹⁹Tc‐MDP can promote the proliferation of MC3T3‐E1 cells and increase the expression of OPG and RANKL protein. ⁹⁹Tc‐MDP may have adjuvant therapeutic effects on the treatment of jaw ameloblastoma.

This article is protected by copyright. All rights reserved.

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A Machine Learning Approach for Distinguishing Uterine Sarcoma from Leiomyomas Based on Perfusion Weighted MRI Parameters

Publication date: Available online 13 November 2018

Source: European Journal of Radiology

Author(s): Mahrooz Malek, Masoumeh Gity, Azadeh Alidoosti, Zeinab Oghabian, Pariya Rahimifar, Mahdieh Ebrahimi, Elnaz Tabibian, Mohammad Ali Oghabian

Abstract

Purpose

: To propose a computer-assisted method for distinguishing uterine sarcoma from leiomyomas based on perfusion weighted magnetic resonance imaging (PWI).

Materials and methods

: Forty-two women confirmed to have a total of 60 masses (10 uterine sarcomas and 50 benign leiomyomas) were included. The reference diagnosis was based on postoperative histopathological examination. All women underwent the standard MRI protocol with 3-Tesla MR imager (Magnetom Trio, Siemens, Erlangen, Germany) for assessment of myometrial masses, followed by PWI. For each mass, two regions of interest (ROI) were outlined manually by an experienced radiologist; one (ROI_L) represented the entire tumor while the other (ROIs) was placed on the area of the lesion with the most marked contrast enhancement. Two additional ROI_s with diameters similar to ROI_s (3.0 to 3.1 mm) were placed on psoas muscle (ROI_P) and myometrium (ROI_M) in order to provide baselines for comparisons. The obtained ROIs of PWI images were then analyzed using the DCE Tool plug-in (version 2.0SP1) within ClearCanvas (Toronto, Ontario, Canada) framework. The DCE Tool provides seven parameters (K^trans, k_ep, V_b, IAUC, initial slope, peak, the mean squared error) for modelling contrast uptake within an ROI using the modified Tofts model. Parameters extracted from the ROIs were fed into a decision tree ensemble, which classified the corresponding lesions either as malignant or benign. The leave-one-out cross validation (LOOCV) was utilized to evaluate the performance of the classifier.

Results

: None of the parameters extracted from ROI_L or ROI_s differed significantly between uterine sarcoma and benign leiomyomas (all p > 0.05). The overall accuracy of 66.7% was obtained by feeding seven parameters extracted from ROI_L to the classifier. When 21 features extracted from ROI_L, ROI_M, and ROI_P were fed into the classifier an accuracy of 91.7%, sensitivity of 100%, and specificity of 90% were achieved in the optimal operating point of classifier.

Conclusion

: Although none of the PWI parameters differed significantly between benign and malignant lesions, when the information provided by the extracted features was aggregated using a machine learning method, a promising discriminative power was obtained. This suggests that the proposed model for combining the PWI parameters is potentially useful for differentiating uterine sarcoma from leiomyomas.

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Differentiation Between Glioblastoma and Solitary Brain Metastasis using Neurite Orientation Dispersion and Density Imaging

Publication date: Available online 12 November 2018

Source: Journal of Neuroradiology

Author(s): Yoshihito Toshinori Hirai, Minako Yohei Hattori, Zaw Aung Khant, Masaaki Hori, Kiyotaka Saito, Kiyotaka Yokogami, Hideo Takeshima

Abstract

Background and purpose – Neurite orientation dispersion and density imaging (NODDI) is a new technique that applies a three-diffusion-compartment biophysical model. We assessed the usefulness of NODDI for the differentiation of glioblastoma from solitary brain metastasis.

Methods – NODDI data were prospectively obtained on a 3 T magnetic resonance imaging (MRI) scanner from patients with previously untreated, histopathologically confirmed glioblastoma (n = 9) or solitary brain metastasis (n = 6). Using the NODDI Matlab Toolbox, we generated maps of the intracellular-, extracellular-, and isotropic volume (VIC, VEC, VISO) fraction. Apparent diffusion coefficient- and fraction anisotropy maps were created from the diffusion data. On each map we manually drew a region of interest around the peritumoral signal-change (PSC)- and the enhancing solid area of the lesion. Differences between glioblastoma and metastatic lesions were assessed and the area under the receiver operating characteristic curve (AUC) was determined.

Results – On VEC maps the mean value of the PSC area was significantly higher for glioblastoma than metastasis (p < 0.05); on VISO maps it tended to be higher for metastasis than glioblastoma. There was no significant difference on the other maps. Among the 5 parameters, the VEC fraction in the PSC area showed the highest diagnostic performance. The VEC threshold value of ≥ 0.48 yielded 100% sensitivity, 83.3% specificity, and an AUC of 0.87 for differentiating between the two tumor types.

Conclusions – NODDI compartment maps of the PSC area may help to differentiate between glioblastoma and solitary brain metastasis.

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Association between carotid artery plaque inflammation and brain MRI

Publication date: Available online 12 November 2018

Source: Journal of Neuroradiology

Author(s): Luca Saba, Letizia Lai, Pierleone Lucatelli, Roberto Sanfilippo, Roberto Montisci, Jasjit S Suri, Gavino Faa

Abstract

Purpose: To explore the association between presence of inflammatory cells in the carotid plaques surgically treated and brain MRI findings.

Material and Methods: Forty consecutive patients were prospectively analyzed. Brain MRI was performed with a 1.5 Tesla scanner and infacts (lacuna and non-lacunar) pertinence of the anterior circulation were recorded. All patients underwent carotid endarterectomy "en bloc"; carotid plaques histological sections were prepared and immuno-cytochemical analysis was performed to characterize and quantify the presence of inflammatory cells. ROC curve analysis, Pearson Rho correlation and Mann-Whitney test were applied.

Results: The immuno-cytochemical analysis demonstrated that plaques of symptomatic patients (stroke\TIA; n = 25) had more inflammatory cells, mainly macrophages (CD68) compared with plaques of patients without symptoms (Mann-Whitney = p < 0.001, ROC curve area = 0.901). Correlation analysis showed a statistically significant association between the number of brain non-lacunar infarcts and the entity of macrophages (p < 0.001); whereas no association with lacunar infarcts (p = 0.1934) was found.

Conclusion: Results of this preliminary study suggest that the presence and amount of inflammatory cells within carotid artery plaque is associated with cerebrovascular events and with the number of MRI brain detectable infarct.

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Effect of technetium‐99 conjugated with methylene diphosphonate (99Tc‐MDP) on OPG/RANKL/RANK system in vitro

Abstract

Background

RANKL and RANK play an important role in jaw resorption during the development of the ameloblastomas. Therefore, the aim of this study was to explore the effect of ⁹⁹Tc‑MDP on OPG/RANKL/RANK system on RAW264.7 and MC3T3‐E1 cell lines in vitro, and provide the theoretical basis for the clinical treatment of the jaw ameloblastoma.

Methods

Different concentrations of ⁹⁹Tc‐MDP were used to treat RAW264.7 and MC3T3‐E1 cell lines. The cell proliferative inhibition rate was analyzed by CCK‐8. Cell apoptosis and cell cycle were detected by flow cytometry. Western blot were used to detect the expression of OPG, RANKL and RANK.

Results

Treatment of RAW264.7 cell lines with different concentrations of ⁹⁹Tc‐MDP had inhibitory effects and decreased the expression of RANK protein. The cell proliferation of ⁹⁹Tc‐MDP on MC3T3‐E1cell lines was stronger at 48h than at 24h except for 100μg/ml concentration group. Compared with the concentration of 0.01μg/ml, the treatment of MC3T3‐E1 cells with 100μg/ml ⁹⁹Tc‐MDP showed that the cell proliferative effect decreased at 24h and 48h (P<0.05). After treatment with 0.01μg/ml ⁹⁹Tc‐MDP, the expression of OPG in MC3T3‐E1 cells was significantly increased (P<0.05). Compared with 0.01μg/ml, the expression of RANKL was decreased after treatment with 100μg/ml ⁹⁹Tc‐MDP (P<0.05).

Conclusion

⁹⁹Tc‐MDP can induce apoptosis of RAW264.7 cells and inhibit the expression of RANK protein. The effect of 0.01μg/ml of low concentration of ⁹⁹Tc‐MDP can promote the proliferation of MC3T3‐E1 cells and increase the expression of OPG and RANKL protein. ⁹⁹Tc‐MDP may have adjuvant therapeutic effects on the treatment of jaw ameloblastoma.

This article is protected by copyright. All rights reserved.

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A Machine Learning Approach for Distinguishing Uterine Sarcoma from Leiomyomas Based on Perfusion Weighted MRI Parameters

Publication date: Available online 13 November 2018

Source: European Journal of Radiology

Author(s): Mahrooz Malek, Masoumeh Gity, Azadeh Alidoosti, Zeinab Oghabian, Pariya Rahimifar, Mahdieh Ebrahimi, Elnaz Tabibian, Mohammad Ali Oghabian

Abstract

Purpose

: To propose a computer-assisted method for distinguishing uterine sarcoma from leiomyomas based on perfusion weighted magnetic resonance imaging (PWI).

Materials and methods

: Forty-two women confirmed to have a total of 60 masses (10 uterine sarcomas and 50 benign leiomyomas) were included. The reference diagnosis was based on postoperative histopathological examination. All women underwent the standard MRI protocol with 3-Tesla MR imager (Magnetom Trio, Siemens, Erlangen, Germany) for assessment of myometrial masses, followed by PWI. For each mass, two regions of interest (ROI) were outlined manually by an experienced radiologist; one (ROI_L) represented the entire tumor while the other (ROIs) was placed on the area of the lesion with the most marked contrast enhancement. Two additional ROI_s with diameters similar to ROI_s (3.0 to 3.1 mm) were placed on psoas muscle (ROI_P) and myometrium (ROI_M) in order to provide baselines for comparisons. The obtained ROIs of PWI images were then analyzed using the DCE Tool plug-in (version 2.0SP1) within ClearCanvas (Toronto, Ontario, Canada) framework. The DCE Tool provides seven parameters (K^trans, k_ep, V_b, IAUC, initial slope, peak, the mean squared error) for modelling contrast uptake within an ROI using the modified Tofts model. Parameters extracted from the ROIs were fed into a decision tree ensemble, which classified the corresponding lesions either as malignant or benign. The leave-one-out cross validation (LOOCV) was utilized to evaluate the performance of the classifier.

Results

: None of the parameters extracted from ROI_L or ROI_s differed significantly between uterine sarcoma and benign leiomyomas (all p > 0.05). The overall accuracy of 66.7% was obtained by feeding seven parameters extracted from ROI_L to the classifier. When 21 features extracted from ROI_L, ROI_M, and ROI_P were fed into the classifier an accuracy of 91.7%, sensitivity of 100%, and specificity of 90% were achieved in the optimal operating point of classifier.

Conclusion

: Although none of the PWI parameters differed significantly between benign and malignant lesions, when the information provided by the extracted features was aggregated using a machine learning method, a promising discriminative power was obtained. This suggests that the proposed model for combining the PWI parameters is potentially useful for differentiating uterine sarcoma from leiomyomas.

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Reply: “Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI”

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Reply: “Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI”

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Novel mutations identified in patients with tooth agenesis by whole‐exome sequencing

Abstract

Objectives

To identify potentially pathogenic mutations for tooth agenesis by whole‐exome sequencing.

Subjects and Methods

Ten Chinese families including 5 families with ectodermal dysplasia (syndromic tooth agenesis) and 5 families with selective tooth agenesis were included. Whole‐exome sequencing was performing using genomic DNA. Potentially pathogenic mutations were identified after data filtering and screening. The pathogenicity of novel variants were investigated by segregation analysis, in silico analysis and functional studies.

Results

One novel mutation (c.441_442insACTCT) and three reported mutations (c.252delT, c.463C>T, and c.1013C>T) in EDA were identified in families with ectodermal dysplasia. The novel EDA mutation was co‐segregated with phenotype. A functional study revealed that NF‐κB activation was compromised by the identified mutations. The secretion of active EDA was also compromised detecting by western blotting. Novel Wnt10A mutations (c.521T>C and c.653T>G) and EVC2 mutation (c.1472C>T) were identified in families with selective tooth agenesis. The Wnt10A c.521T>C mutation and the EVC2 c.1472C>T mutation were considered as pathogenic for affecting highly conserved amino acids, co‐segregated with phenotype and predicted to be disease‐causing by SIFT and PolyPhen2. Moreover, several reported mutations in PAX9, Wnt10A and FGFR3 were also detected.

Conclusions

Our study expanded our knowledge on tooth agenesis spectrum by identifying novel variants.

This article is protected by copyright. All rights reserved.

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Novel mutations identified in patients with tooth agenesis by whole‐exome sequencing

Abstract

Objectives

To identify potentially pathogenic mutations for tooth agenesis by whole‐exome sequencing.

Subjects and Methods

Ten Chinese families including 5 families with ectodermal dysplasia (syndromic tooth agenesis) and 5 families with selective tooth agenesis were included. Whole‐exome sequencing was performing using genomic DNA. Potentially pathogenic mutations were identified after data filtering and screening. The pathogenicity of novel variants were investigated by segregation analysis, in silico analysis and functional studies.

Results

One novel mutation (c.441_442insACTCT) and three reported mutations (c.252delT, c.463C>T, and c.1013C>T) in EDA were identified in families with ectodermal dysplasia. The novel EDA mutation was co‐segregated with phenotype. A functional study revealed that NF‐κB activation was compromised by the identified mutations. The secretion of active EDA was also compromised detecting by western blotting. Novel Wnt10A mutations (c.521T>C and c.653T>G) and EVC2 mutation (c.1472C>T) were identified in families with selective tooth agenesis. The Wnt10A c.521T>C mutation and the EVC2 c.1472C>T mutation were considered as pathogenic for affecting highly conserved amino acids, co‐segregated with phenotype and predicted to be disease‐causing by SIFT and PolyPhen2. Moreover, several reported mutations in PAX9, Wnt10A and FGFR3 were also detected.

Conclusions

Our study expanded our knowledge on tooth agenesis spectrum by identifying novel variants.

This article is protected by copyright. All rights reserved.

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Does apico-coronal implant position influence peri-implant marginal bone loss? A 36-months follow-up randomized clinical trial.

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Hilario Pellicer-Chover, Maria Peñarrocha-Diago, Amparo Aloy-Prosper, Luigi Canullo, Miguel Peñarrocha-Diago, David Peñarrocha-Oltra

Abstract

Objective

Preserving peri-implant bone and reducing the exposure of rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiological parameters after crestal and subcrestal dental implant placement at 36 months of follow-up.

Material and methods

A randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown was carried out. The patient was randomized according to the implant insertion depth: test group (implants placed approximately 2 mm below the bone crest) or control group (implants placed at bone crest level). The patients were evaluated 6, 12, 24 and 36 months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36 months of follow-up were calculated.

Results

The study comprised 128 patients (83 men and 45 women – mean age 54.4±12.2 years) and a total of 265 implants (133 in the control group and 132 in the test group). There were no statistically significant differences in the peri-implant clinical parameters. After three years of follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of -0.2±0.3 mm and -0.09±0.1 mm, respectively (p=0.001). The overall success rate was 99.6%.

Conclusions

Crestal and subcrestal implants showed similar clinical outcomes three years after prosthetic loading. Significant differences were observed in the radiological parameters, showing subcrestal implants less peri-implant marginal bone loss.

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Shining Sunlight on Industry Payments in Oral and Maxillofacial Surgery: The Sunshine Act

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yisi D. Ji, Zachary S. Peacock

Abstract

Purpose

To characterize industry payments to oral and maxillofacial surgeons (OMSs) and to determine the accuracy of the Centers for Medicare & Medicaid Services (CMS) Open Payments Databases.

Methods

This was a cross-sectional study of the CMS General and Research Payments Database in 2016 for clinicians categorized as an OMS. General payments include consulting fees, honoraria, gifts, entertainment, food and beverage, travel, and education, and others. Research payments include payments associated with research. Variables collected included number of OMSs who receive payments, type of and number of payments, total amount paid, geographic distribution, and proportion of funding allotted to research. The accuracy of payee categorization was determined by verifying a random selection of 5% of those categorized as 'OMS' in the database to publicly available data. To assess impact on research productivity, the h-index of research payment recipients was calculated.

Results

A total of 6720 OMSs received industry compensation in 2016. The accuracy was 88% (297/336) in the General Payments database and 50% (4/8) in the Research payments database.

OMSs received 28456 General payments totalling $5,971,800.79. The average number of payments and amount per payment was 4.27 and $1597.60, respectively. CMS reported total Research payments of $23,592.17. The 4 verified OMSs received a total of $18,500 in research payments and had an average h-index of 3.25 (range 0 to 8).

The most common payments made were for food and beverage (80.2%), travel and lodging (5.83%), education (3.91%), compensation for services other than consulting (3.1%) and gifts (3.03%). Research accounted for 0.07% of all payments.

Conclusion

Although industry payments to OMSs were common, research funding was negligible. The majority of industry value-transfers were related to food and beverage or travel and lodging. Clinicians were accurately classified in CMS' Open Payments General database but not for Research Payments.

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Shining Sunlight on Industry Payments in Oral and Maxillofacial Surgery: The Sunshine Act

Publication date: Available online 12 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yisi D. Ji, Zachary S. Peacock

Abstract

Purpose

To characterize industry payments to oral and maxillofacial surgeons (OMSs) and to determine the accuracy of the Centers for Medicare & Medicaid Services (CMS) Open Payments Databases.

Methods

This was a cross-sectional study of the CMS General and Research Payments Database in 2016 for clinicians categorized as an OMS. General payments include consulting fees, honoraria, gifts, entertainment, food and beverage, travel, and education, and others. Research payments include payments associated with research. Variables collected included number of OMSs who receive payments, type of and number of payments, total amount paid, geographic distribution, and proportion of funding allotted to research. The accuracy of payee categorization was determined by verifying a random selection of 5% of those categorized as 'OMS' in the database to publicly available data. To assess impact on research productivity, the h-index of research payment recipients was calculated.

Results

A total of 6720 OMSs received industry compensation in 2016. The accuracy was 88% (297/336) in the General Payments database and 50% (4/8) in the Research payments database.

OMSs received 28456 General payments totalling $5,971,800.79. The average number of payments and amount per payment was 4.27 and $1597.60, respectively. CMS reported total Research payments of $23,592.17. The 4 verified OMSs received a total of $18,500 in research payments and had an average h-index of 3.25 (range 0 to 8).

The most common payments made were for food and beverage (80.2%), travel and lodging (5.83%), education (3.91%), compensation for services other than consulting (3.1%) and gifts (3.03%). Research accounted for 0.07% of all payments.

Conclusion

Although industry payments to OMSs were common, research funding was negligible. The majority of industry value-transfers were related to food and beverage or travel and lodging. Clinicians were accurately classified in CMS' Open Payments General database but not for Research Payments.

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Early invasive Squamous Cell Carcinoma recurrence rates: a study examining surgical margins, tumor surface diameter, invasion depth and grade of differentiation in 1,296 cases over 9 years

Background

Invasive squamous cell carcinoma (SCC) is typically treated by surgical excision.

Method

Consecutive SCC excisions were reviewed prospectively in a single Australian center from 2009‐2017. Cases were examined for recurrence by histopathologic margins, microscopic tumor surface diameter, invasion depth, grade of differentiation and anatomic site.

Results

Over 9 years 1,296 cases were collected. By grade of differentiation maximum average microscopic surface diameters ranged from 8.0 to 9.6mm and maximum average depths from 1.3 to 2.5mm. Minimum average histopathologic margins for well, moderate and poorly differentiated SCC respectively were 1.4, 1.1 and 1.3mm. Recurrence occurred in 1.7 % of well (n=18/1084), 1.8 % moderate (n=3/165) and 6.4% in poorly differentiated (n=3/47) SCC. No recurrence occurred beyond a histopathologic margin of 3.5 mm for well and 2.5 mm for moderately differentiated SCC. Highest recurrence for well differentiated SCC by anatomic site were the lip (7.0%) then ear (4.6%).

Conclusion

We found a recurrence rate of 1.0% for histopathologic margins of 1.5 mm with early well differentiated SCC. The grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins. Poorly differentiated SCC and ear or lip sites require wider surgical margins.

This article is protected by copyright. All rights reserved.

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No wonder it itches: quick bedside visualization of a scabies infestation using reflectance confocal microscopy

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Issue Information

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Intramural schwannoma involving a vein

Schwannoma involving the blood vessels is a rare phenomenon. So far, only three cases of intravascular schwannoma have been described (all of which were intraluminal), and the origin of the schwannoma in such cases is not yet completely understood. Here we describe a very rare intramural venous schwannoma in the subcutaneous right prepatellar area of a 31‐year‐old man. The schwannoma grew by enlarging and thickening the blood vessel wall, between two preserved layers of the vein. In some areas, there was erosion of the luminal layer, with fibrin apposed to the tumor. The tumor expressed S100 and was negative for CD31, CD34, desmin and smooth muscle actin. The expression of p16 was preserved. Endothelial markers such as CD31 and Factor VIII demonstrated the endothelial lining (which was D2‐40‐negative) above the tumor. Although degenerative atypia was present, there were no mitoses or necrosis identified.

This article is protected by copyright. All rights reserved.

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Early invasive Squamous Cell Carcinoma recurrence rates: a study examining surgical margins, tumor surface diameter, invasion depth and grade of differentiation in 1,296 cases over 9 years

Background

Invasive squamous cell carcinoma (SCC) is typically treated by surgical excision.

Method

Consecutive SCC excisions were reviewed prospectively in a single Australian center from 2009‐2017. Cases were examined for recurrence by histopathologic margins, microscopic tumor surface diameter, invasion depth, grade of differentiation and anatomic site.

Results

Over 9 years 1,296 cases were collected. By grade of differentiation maximum average microscopic surface diameters ranged from 8.0 to 9.6mm and maximum average depths from 1.3 to 2.5mm. Minimum average histopathologic margins for well, moderate and poorly differentiated SCC respectively were 1.4, 1.1 and 1.3mm. Recurrence occurred in 1.7 % of well (n=18/1084), 1.8 % moderate (n=3/165) and 6.4% in poorly differentiated (n=3/47) SCC. No recurrence occurred beyond a histopathologic margin of 3.5 mm for well and 2.5 mm for moderately differentiated SCC. Highest recurrence for well differentiated SCC by anatomic site were the lip (7.0%) then ear (4.6%).

Conclusion

We found a recurrence rate of 1.0% for histopathologic margins of 1.5 mm with early well differentiated SCC. The grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins. Poorly differentiated SCC and ear or lip sites require wider surgical margins.

This article is protected by copyright. All rights reserved.

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No wonder it itches: quick bedside visualization of a scabies infestation using reflectance confocal microscopy

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Issue Information

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Intramural schwannoma involving a vein

Schwannoma involving the blood vessels is a rare phenomenon. So far, only three cases of intravascular schwannoma have been described (all of which were intraluminal), and the origin of the schwannoma in such cases is not yet completely understood. Here we describe a very rare intramural venous schwannoma in the subcutaneous right prepatellar area of a 31‐year‐old man. The schwannoma grew by enlarging and thickening the blood vessel wall, between two preserved layers of the vein. In some areas, there was erosion of the luminal layer, with fibrin apposed to the tumor. The tumor expressed S100 and was negative for CD31, CD34, desmin and smooth muscle actin. The expression of p16 was preserved. Endothelial markers such as CD31 and Factor VIII demonstrated the endothelial lining (which was D2‐40‐negative) above the tumor. Although degenerative atypia was present, there were no mitoses or necrosis identified.

This article is protected by copyright. All rights reserved.

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Debt, disfigurement place survivors of these types of cancer at higher risk of suicide

Debt, disfigurement place survivors of these types of cancer at higher risk of suicide  St. Louis Public RadioHead and Neck Cancer Market to Perceive Substantial Growth During 2018–2026  Coherent Chronicle (press release) (blog)Head And Neck Cancer Treatment Market 2017 – 2021: Analysis, Key Venders, Research, Trends and Segments  TokensTree (press release)Full coverage

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Debt, disfigurement place survivors of these types of cancer at higher risk of suicide

Debt, disfigurement place survivors of these types of cancer at higher risk of suicide  St. Louis Public RadioHead and Neck Cancer Market to Perceive Substantial Growth During 2018–2026  Coherent Chronicle (press release) (blog)Head And Neck Cancer Treatment Market 2017 – 2021: Analysis, Key Venders, Research, Trends and Segments  TokensTree (press release)Full coverage

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Impact of water exposure on skin barrier permeability and ultrastructure

Background

Skin occlusion due to use of diapers or sanitary napkins often results in irritant contact dermatitis. Furthermore, prolonged occlusion and exposure to body fluids are known to increase skin hydration and permeability, thus leading to irritant contact dermatitis.

Objective

The effects of water exposure on the skin and its barrier functions were investigated to get more insight into the mechanisms of irritant contact dermatitis.

Methods

Water patches were applied to the volar forearm skin of 10 human subjects for 3 hours. Permeability of the stratum corneum (SC) was examined using methyl nicotinate (MN). Alterations in the hydration and ultrastructure of the SC were measured by Raman spectroscopy and multiphoton microscopy, respectively.

Results

Water profiles found using Raman spectroscopy demonstrated notable increases in water content throughout the SC and skin surface. Multiphoton microscopy revealed morphological changes that were formed in the intercellular space of the SC. Emerged pools seemed to contribute to increased MN absorption.

Conclusion

Excessive skin hydration leading to changes in the SC ultrastructure might result in increased skin permeability of skin irritants and allergens.

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Issue Information

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Simultaneous four‐channel recording of bilateral cervical and ocular vestibular‐evoked myogenic potentials in response to stimulation by forehead bone‐conducted vibration: Our experience in 20 healthy adults

Abstract

Various vestibular stimuli, including air‐conducted sound (ACS), bone‐conducted vibration (BCV), and galvanic vestibular stimulation (GVS), can be used to elicit vestibular‐evoked myogenic potential (VEMP). VEMP obtained from the sternocleidomastoid (SCM) muscle is called cervical VEMP (cVEMP), while that recorded at extraocular muscles is termed ocular VEMP (oVEMP). cVEMP was first recognized as fundamental in determining the sacculo‐collic reflex (SCR) pathway in the mid‐1990s. In the mid‐2000s, oVEMP was successfully recorded and emerged as the basis for a promising examination for evaluating the integrity of the vestibulo‐ocular reflex (VOR) pathway.

This article is protected by copyright. All rights reserved.

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Impact of water exposure on skin barrier permeability and ultrastructure

Background

Skin occlusion due to use of diapers or sanitary napkins often results in irritant contact dermatitis. Furthermore, prolonged occlusion and exposure to body fluids are known to increase skin hydration and permeability, thus leading to irritant contact dermatitis.

Objective

The effects of water exposure on the skin and its barrier functions were investigated to get more insight into the mechanisms of irritant contact dermatitis.

Methods

Water patches were applied to the volar forearm skin of 10 human subjects for 3 hours. Permeability of the stratum corneum (SC) was examined using methyl nicotinate (MN). Alterations in the hydration and ultrastructure of the SC were measured by Raman spectroscopy and multiphoton microscopy, respectively.

Results

Water profiles found using Raman spectroscopy demonstrated notable increases in water content throughout the SC and skin surface. Multiphoton microscopy revealed morphological changes that were formed in the intercellular space of the SC. Emerged pools seemed to contribute to increased MN absorption.

Conclusion

Excessive skin hydration leading to changes in the SC ultrastructure might result in increased skin permeability of skin irritants and allergens.

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The European baseline series and recommended additions: 2019

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Issue Information

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Thank you to reviewers

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Dedifferentiated liposarcoma of the gallbladder: first reported case

Liposarcoma of the gallbladder is an extremely rare sarcoma, with only five cases reported in the literature according to our knowledge.

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Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer

To observe the effect of red light phototherapy (RLPT) on radioactive dermatitis (RD) caused by radiotherapy in patients with head and neck cancer (HNC).

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Dedifferentiated liposarcoma of the gallbladder: first reported case

Liposarcoma of the gallbladder is an extremely rare sarcoma, with only five cases reported in the literature according to our knowledge.

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Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer

To observe the effect of red light phototherapy (RLPT) on radioactive dermatitis (RD) caused by radiotherapy in patients with head and neck cancer (HNC).

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Your Gut Bacteria Get Jet Lag Too

Many processes in our bodies are orchestrated on a ~24 hour schedule called the circadian rhythm. Body temperature, heart rate, blood pressure, the immune system, melatonin and other hormones, alertness and sleepiness, and much more, rise and fall over the course of a day timed by our internal clock. When we travel between time zones faster than our internal clock can adjust, we experience jet lag. Our internal clock is out of sync with local time. We notice this with difficulty being alert during the day and difficulty sleeping at night. We might not notice it, but our physical and mental performance may be impaired as well. Fellow Travelers We carry within our gut about 100 trillion bacteria each with their own internal clocks. The composition and function of this microbiome community ch...

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Why it ’s important to determine who’s truly penicillin-allergic

A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection. But one of the most commonly reported allergies — to penicillin — often isn't a true allergy at […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)

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Your Gut Bacteria Get Jet Lag Too

Many processes in our bodies are orchestrated on a ~24 hour schedule called the circadian rhythm. Body temperature, heart rate, blood pressure, the immune system, melatonin and other hormones, alertness and sleepiness, and much more, rise and fall over the course of a day timed by our internal clock. When we travel between time zones faster than our internal clock can adjust, we experience jet lag. Our internal clock is out of sync with local time. We notice this with difficulty being alert during the day and difficulty sleeping at night. We might not notice it, but our physical and mental performance may be impaired as well. Fellow Travelers We carry within our gut about 100 trillion bacteria each with their own internal clocks. The composition and function of this microbiome community ch...

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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Why it ’s important to determine who’s truly penicillin-allergic

A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection. But one of the most commonly reported allergies — to penicillin — often isn't a true allergy at […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)

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Aerobiology of Cupressaceae in Porto city, Portugal

AbstractIn the last years, pollen-related respiratory allergies have increased worldwide. In the case of Cupressaceae pollen, allergy symptoms appearing during the winter are often confused with generic respiratory diseases such as the common cold, influenza syndrome, among others. The aim of our study was to monitor the atmospheric of Cupressaceae pollen in the city of Porto, investigate its diurnal variation, as well as find the meteorological factors influencing its atmospheric concentration. Airborne pollen sampling was performed using a 7-day Hirst-type volumetric spore trap for 5  years (2013–2017). Cupressaceae main pollen season, interannual and diurnal variations, as well as correlations with the meteorological parameters were determined. During the study period, 2015 was the y...

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Sequence analysis of isolates of Aspergillus from patients with chronic and allergic aspergillosis reveals a spectrum of cryptic species

Future Microbiology, Ahead of Print. (Source: Future Microbiology)

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Aerobiology of Cupressaceae in Porto city, Portugal

AbstractIn the last years, pollen-related respiratory allergies have increased worldwide. In the case of Cupressaceae pollen, allergy symptoms appearing during the winter are often confused with generic respiratory diseases such as the common cold, influenza syndrome, among others. The aim of our study was to monitor the atmospheric of Cupressaceae pollen in the city of Porto, investigate its diurnal variation, as well as find the meteorological factors influencing its atmospheric concentration. Airborne pollen sampling was performed using a 7-day Hirst-type volumetric spore trap for 5  years (2013–2017). Cupressaceae main pollen season, interannual and diurnal variations, as well as correlations with the meteorological parameters were determined. During the study period, 2015 was the y...

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Sequence analysis of isolates of Aspergillus from patients with chronic and allergic aspergillosis reveals a spectrum of cryptic species

Future Microbiology, Ahead of Print. (Source: Future Microbiology)

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