Medicine by Alexandros G. Sfakianakis

Τετάρτη 13 Φεβρουαρίου 2019

Medical Trichology : Trigeminal trophic syndrome simulating pityriasis amiantacea,Nerve sheath myxoma of scalp,Woolly hair nevus type 2,Trichodynia silenced effectively with propranolol,Serum interleukin-15 is a marker of alopecia areata severity,Tubular hair casts in trichoscopy of hair and scalp disorders,Research on the balance of thiol-disulfide in blood serum in women with telogen effluvium,Light microscopic morphology of hair from scalp, eyebrow, axilla, and pubic regions

COMMENTARY

	Autistic-undisciplined thinking in the practice of medical trichology	p. 1
	Ralph Michel Trueb, Hudson Dutra, Maria Fernanda Reis Gavazzoni Dias DOI:10.4103/ijt.ijt_79_18 Medical trichology is the branch of dermatology that deals with the scientific study of the hair and scalp in health and disease. As any discipline, the practice of medical trichology is not immune to malpractice, either deliberately or carelessly. In his publication "Autistic Undisciplined Thinking in Medicine and How to Overcome It," Swiss psychiatrist Eugen Bleuler describes yet another form of malpractice in medicine reflecting autistic-undisciplined thinking. Autism is not limited to psychopathology, but inherent to the thinking of man throughout history in his drive for knowledge, with thousands of theories lacking any basis in reality. Bleuler recognized the drive character of autistic thinking and how it leads to conclusions that are unshakable because they are determined by, and fulfill, emotional needs, rather than rational argumentation. Even with correct questions, the complexity and incalculability of some problems are often so great that it cannot do justice to realistic thinking and the boundaries between inadequately substantiated hypothesis and autistic sham explanation disappear. Statistics, careful research design, and the attempt to impose stringent methods on our thinking are to be commended. The habituation of the public to useless medicine, to misconceptions, is not hygiene, but negligent endangerment. It has created an industry that largely lives on the autistic thinking of patients and doctors and because it is prosperous, makes propaganda among lay people as well as among doctors that necessarily leads to abuses. This article aims at exposing the most prevalent among abuses in trichological practice due to autistic-undisciplined thinking, specifically: iron supplementation, antiandrogenic treatment, and individualized cell-based therapy in female androgenetic alopecia, treatment of folliculitis decalvans with retinoids, and the value of nutritional therapies.
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ORIGINAL ARTICLES


	Light microscopic morphology of indigenous Ghanaian African hair from scalp, eyebrow, axilla, and pubic regions	p. 8
	Yusra Kalmoni, Frederick Kwaku Addai, Saviour Kweku Adjenti, Kevin Kofi Adutwum-Ofosu, John Ahenkorah, Bismarck Afedo Hottor, Richard Michael Blay DOI:10.4103/ijt.ijt_70_18 Context: Relatively scanty literature on autochthonic African Negroid hair morphology provokes research interest for anthropological, forensic, and cosmetic purposes. Aims: This study aimed to contribute basic morphological information on Ghanaian African hairs. Settings and Design: The study was done in selected second-cycle schools in Accra, Ghana, using convenient sampling. Subjects and Methods: Hairs were obtained by pluck method, from 30 males and 30 females aged 15–20 years. Ghanaian African autochthony was established if individuals had two generations of indigenous Ghanaian parentage. Scalp, eyebrow, axilla, and pubic hairs were image captured using a digital light microscope eyepiece connected to a computer. Diameters of hair strands were measured; types of the medulla and the form and shape of the hair roots were studied. Statistical Analysis Used: ANOVA test (SPSS Version 17.0) was used to compare the means of quantitative hair features among the sexes and the four regions of the body studied. Results: Pubic hair shaft was thickest (respective male and female diameters were 100.21 μm, 88.40 μm) and eyebrow hair was thinnest (53.97 and 46.69-μm diameters in males and females, respectively). Axillary and scalp hairs were the closest in diameters with 76.21 and 72.02 μm, respectively, in males and 73.07 and 71.15 μm, respectively, in females. Continuous type medulla was predominant in all hairs, with a trend of percentage occurrence in descending order from the pubic, axilla, eyebrow, and scalp in both sexes. Conclusions: Bodily regional differences in diameter of hair shaft and medullary presence were affirmed.
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	Tubular hair casts in trichoscopy of hair and scalp disorders	p. 14
	Mahesh Mathur, Prakash Acharya, Alina Karki, Jyoti Shah, Nisha Kc DOI:10.4103/ijt.ijt_77_18 Introduction: Hair casts have been reported in a variety of hair and scalp disorders. Trichoscopy allows a quick and noninvasive method for the evaluation of hair and scalp disorders in high magnification. However, the study of hair casts seen in trichoscopy is lacking. Objective: The main objective is to study the occurrence and patterns of tubular hair cast (THC) in different hair and scalp disorders. Patients and Methods: The patients with hair and scalp disorders presenting at the dermatology department of our hospital were evaluated using trichoscopy. Cases of primary parakeratotic disorders and behavioral disorders were excluded. After a detailed history and evaluation of the hair and scalp, histopathology, light microscopic examination, potassium hydroxide examination, and fungal culture were done when necessary. Results: THC was seen in total 21 cases of seven different hair and scalp disorders. Of these, the majority of cases were of discoid lupus erythematosus (DLE) (5/21) and maximum frequency of THCs within a disorder was seen in cases of pemphigus foliaceus (PF) (50%). Proximal casts occurred in 90.47% of cases. Single cast involving two shafts was seen in a case of PF, and two casts within a single shaft were seen in two cases of DLE and one case of alopecia areata. Conclusions: THCs in trichoscopy can be seen in various hair and scalp disorders and their study may help during the diagnosis of those disorders when combined with other trichoscopic features.
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	Research on the balance of thiol-disulfide in blood serum in women with telogen effluvium	p. 20
	Ayşe Akbas, Fadime Kılınç, Sertaç Sener, Akta Akınş, Cemile Bıçer, Orhan Şen DOI:10.4103/ijt.ijt_78_17 Backgrounds: Telogen effluvium (TE) is the most common reason for hair loss in humans. Although the exact etiopathogenesis of TE has not been revealed clearly and completely, multifactorial etiologies are to be blamed. In recent years, since oxidative stress (OS) has been shown to play an important role in the etiopathogenesis of so many diseases, the effects of OS on several skin diseases are researched and analyzed. Thiols are antioxidant components that include sulfur group, and the balance of thiol-disulfide has an important role in the formation and prevention of OS. This balance is destroyed in many diseases and its effect on TE is not clearly understood yet. Objectives: In this study, we aimed to search the thiol–disulfide balance that could reveal OS in patients with TE. Materials and Methods: Fifty-two patients with TE and control group of 46 persons were included in the study. Native thiol, disulfide, and total thiol levels were evaluated by a new, automatic spectrophotometric method. Disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol rates were calculated. Results: There was no statistical difference between TE patients and control group in terms of native thiol, disulfide, and total thiol levels. Thiol–disulfide balance was fixed and not affected in TE patients.
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	Serum interleukin-15 is a marker of alopecia areata severity	p. 26
	Adel Ali Ebrahim, Rehab Mohammed Salem, Asmaa Adel El Fallah, Esraa Taha Younis DOI:10.4103/ijt.ijt_80_18 Background: Interleukin-15 (IL-15) is a cytokine that is involved in many inflammatory and autoimmune diseases. Although alopecia areata (AA) is an autoimmune disease, serum levels of IL-15 have not been studied well in AA patients. Aim of the Work: We aims at evaluating the serum levels of IL-15 in active AA. Subject and Methods:This case-control study included 40 AA patients and 40 apparently healthy matched controls. Written informed consents were obtained from all the participants. The scalp was examined to assess sites, number, and size of alopecia patches, and the severity of AA lesions was assessed using the Severity of Alopecia Tool score (SALT score) which determine the percentage of hair loss in the scalp. The body was carefully examined to detect any alopecia patches in any hairy area. Nail examination was carried out to detect any nail involvement. Serum IL-15 levels were measured using an ELISA kits. Results: Serum levels of IL-15 in patients were significantly higher than those in the control group (P < 0.001). Serum levels in alopecia totalis were significantly higher than those with one or two patches, and serum levels in patients with both scalp and body involvement were significantly elevated than the levels of patients with either scalp or body involvement. There was a statistically significant positive correlation between SALT score and serum levels of IL-15 (P < 0.001). Conclusion: Serum IL-15 may be a marker of AA severity.
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CASE REPORTS


	Trigeminal trophic syndrome simulating pityriasis amiantacea	p. 31
	Luisa Groba Bandeira, Maria Cláudia Alves Luce, Bruno De Castro E Souza, Priscila Kakizaki, Neusa Yuriko Sakai Valente DOI:10.4103/ijt.ijt_16_18 We report a case of trigeminal trophic syndrome (TTS) on the scalp of a 69-year-old woman. Initially, the diagnosis of pityriasis amiantacea was considered. The review of pathological antecedents and knowledge of TTS were fundamental for the diagnosis of this illness. We performed a brief review on TTS and differential diagnoses.
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	Nerve sheath myxoma of scalp: A rare site of presentation	p. 34
	Shakti Kumar Yadav, Sompal Singh, Namrata Sarin, Roshina Naeem, Sonam Kumar Pruthi DOI:10.4103/ijt.ijt_45_18 Nerve sheath myxoma, a superficial myxoid tumor, was first described in 1969 by Harkin and Reed. Tumor has cytological and histological resemblance with neurothekeoma, another cutaneous myxoid lesion. Nerve sheath myxoma affects individuals of all age groups and equal predilection for both genders with most favored sites being the fingers and knee. Here, we present a case report of nerve sheath myxoma of the scalp, diagnosed and confirmed with histopathology and immunohistochemistry.
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	Woolly hair nevus type 2: Rare entity	p. 38
	Farhana Tahseen Taj, Shraddha Kologi DOI:10.4103/ijt.ijt_28_18 Woolly hair nevus is a rare non hereditary disorder of scalp characterized by curling and kinking of hair. It can present in childhood or adolescent age. Dermoscopy is a useful noninvasive technique to help in the diagnosis of wolly hair nevus. We report a case of woolly hair nevus associated with linear epidermal nevus.
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LETTER TO EDITOR


	Trichodynia silenced effectively with propranolol	p. 41
	Piotr Brzezinski, Vijay Zawar, Anca Chiriac DOI:10.4103/ijt.ijt_8_19
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Regulation of Foxe1 by Thyrotropin and Transforming Growth Factor Beta Depends on the Interplay Between Thyroid-Specific, CREB and SMAD Transcription Factors

Thyroid, Ahead of Print.

http://bit.ly/2SxbE9D

Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk

Thyroid, Ahead of Print.

http://bit.ly/2DEdk7a

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.

http://bit.ly/2SwJUlK

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.

http://bit.ly/2DEdbAE

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.

http://bit.ly/2SzRuMa

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.

http://bit.ly/2DEd5cg

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.

http://bit.ly/2SzXEfw

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.

http://bit.ly/2DDGsv8

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.

http://bit.ly/2SAmyM3

Future Meetings

Thyroid, Volume 29, Issue 2, Page 307-308, February 2019.

http://bit.ly/2DEcUO8

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.

http://bit.ly/2SvqPQO

Long‐term functional and esthetic outcomes after fibula free flap reconstruction of the mandible

Abstract

Background

The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients.

Methods

Twenty‐five long‐term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient‐reported outcomes, using EORTC, QLQ‐C30, H&N35, and FACE‐Q questionnaires.

Results

Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ‐C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy.

Conclusion

To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.

http://bit.ly/2UXO7LI

Thermal water delivery in the nose: experimental results describing droplet deposition through computational fluid dynamics.

Thermal water delivery in the nose: experimental results describing droplet deposition through computational fluid dynamics.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Buijs EFM, Covello V, Pipolo C, Saibene AM, Felisati G, Quadrio M

Abstract
Thermal water therapies have a role in treating various inflammatory disorders dating back to ancient Greece. Several studies have demonstrated beneficial effects of thermal water inhalations for upper respiratory disorders, such as improvement of mucociliary function and reduction of inflammatory cell infiltration. This experimental study describes the numerical investigation and clinical implications of thermal water droplet deposition in the nasal cavity of a single patient. To our knowledge, the numerical flow simulations described are the first investigations specifically designed for thermal water applications. To simulate nasal airflow, a patient-specific 3D computer model was created from a CT scan. The numerical approach is based on the Large Eddy Simulation (LES) technique and builds entirely upon open-source software. Deposition on mucosa was studied for two droplet sizes (5 and 10 µm diameter), corresponding to common thermal therapy applications (aerosol and vapour inhalation). The simulations consider steady inspiration at two different (low and moderate) breathing intensities. The results of this preliminary study show specific deposition patterns that favour droplet deposition in the middle meatus region to the inferior meatus, with particle size- and breathing intensity-related effects. These global data on particle deposition differ from findings related to the single-phase nasal airflow, which is more evenly distributed between the middle and inferior meatus. The potential clinical consequences of deposition data are discussed. The study furthermore provides evidence for the effectiveness of thermal aerosol and vapour inhalation therapies in reaching important areas of nasal mucosa with considerable clinical significance.

PMID: 30745596 [PubMed - as supplied by publisher]

http://bit.ly/2GoiXdm

Free flap head and neck reconstruction in the elderly: what is the impact on quality of life?

Free flap head and neck reconstruction in the elderly: what is the impact on quality of life?

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Ferri A, Segna E, Varazzani A, Copelli C, Valsecchi S, Orabona GD, Baj A

Abstract
Morphofunctional reconstruction is a pivotal aspect in the surgery of head and neck neoplasms: nowadays, microvascular free flap surgery represents the gold standard. In choosing the surgical technique, the effects on residual quality of life, especially in elderly people, usually considered more fragile and so often excluded from microsurgical procedures, must be taken into account. This multicentre study evaluated the quality of life index in patients more than 75 years of age and who underwent to head and neck microsurgical reconstruction. Data from patients aged > 75 years at the time of major head and neck reconstruction conducted with free flaps between 1 January 2005 and 30 June 2015 were analysed retrospectively. We administered the Italian version of Quality of Life questionnaire SF-36, at least 24 months after surgery. Results were compared to those for the general Italian population of the same age. We enrolled 39 patients with an average age of 80.6 years. The results did not differ significantly from the reference population. The international literature has already shown that chronologic age is not a valid parameter to determine the surgical treatment modality. Even considering the quality of residual life, our study supports the indication for free-flap reconstruction of head and neck defects in the elderly, confirming its effectiveness in this population.

PMID: 30745595 [PubMed - as supplied by publisher]

http://bit.ly/2IaS66k

Barbed suture in oral cavity reconstruction: preliminary results.

Barbed suture in oral cavity reconstruction: preliminary results.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Crosetti E, Caracciolo A, Arrigoni G, Delmastro E, Succo G

Abstract
The purpose of this study is to evaluate the efficacy and safety of unidirectional barbed suture (V-Loc) compared to a standard monofilament stitch (Vicryl) in suturing of a free flap to local tissue after head and neck surgery for squamous cell carcinoma of the oral cavity. Complication rates, operative closure time, length of hospitalisation and costs were evaluated. The study cohort (group A) of 20 consecutive patients reconstructed using barbed stitches for suturing was prospectively compared to a control cohort (group B) of 20 consecutive patients reconstructed using conventional vicryl stitches. All patients were affected by squamous cell carcinoma of the tongue and underwent different types of glossectomy and reconstruction with free flaps. This analysis demonstrates the efficacy of the barbed suture compared with a standard monofilament stitch in terms of lower complication rate (15% group A, 30% group B), intra-operative closure times (486 minutes group A, 517 minutes group B), and length of hospitalisation (average length of hospitalisation 14.60 days group A, 16.85 days group B). These factors coupled with the use of a lower number of stitches compared with the standard stitches may compensate the increased cost of the barbed suture. In conclusion, this study demonstrates that the use of unidirectional barbed stitches for suturing of a free flap to the recipient site reduces the complication rate, principally in terms of dehiscence and fistula incidence, and reduces intra-operative time and length of hospitalisation. Based on these results and on the literature, the use of unidirectional barbed stitches can be considered as a safe and efficient alternative to conventional stitches for suturing of free flaps to local tissue.

PMID: 30745594 [PubMed - as supplied by publisher]

http://bit.ly/2E7DAs1

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds.

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Goncalves M, Aubreville M, Mueller SK, Sievert M, Maier A, Iro H, Bohr C

Abstract
Probe-based confocal laser endomicroscopy (CLE) is an innovative technique for real-time, non-invasive analysis of the surface epithelium. While being successfully used for diagnosis by experts, this method has not yet been established in clinical routine, partly due to the lack of standards and criteria for classifying various lesions. Our aim was to determine the diagnostic value and inter-rater reliability of CLE in detecting malignant lesions of the vocal cords. 58 video sequences were extracted from the probe-based CLE (GastroFlex probe with a Cellvizio® laser system) examinations of 3 patients with squamous cell carcinomas and 4 patients with benign alterations of the vocal folds. Two ENT surgeons, who were blinded to the histological result, were asked to identify the sequences representing a carcinoma. We showed an accuracy, sensitivity, specificity, PPV and NPV of 91.38-96.55%, 100%, 87.8-95.2%, 77.27-89.47% and 100%, respectively, with an inter-rater reliability of k = 0.89 ("almost perfect agreement"). Probe-based CLE is a promising method for diagnosis and assessment of vocal fold lesions in vivo. Our results suggest that, with adequate training, the diagnostic value of this technique can be improved and potentially provide important information during oncological surgery.

PMID: 30745593 [PubMed - as supplied by publisher]

http://bit.ly/2V0qT85

Comparison of electroglottographic variability index in euphonic and pathological voice.

Comparison of electroglottographic variability index in euphonic and pathological voice.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Nacci A, Romeo SO, Cavaliere MD, Macerata A, Bastiani L, Paludetti G, Galli J, Marchese MR, Barillari MR, Barillari U, Berrettini S, Laschi C, Cianchetti M, Manti M, Ursino F, Fattori B

Abstract
In a recent study we introduced a new approach for analysis of the electroglottographic (ECG) signal. This method is based on the evaluation of variation of the EGG signal and its first derivative, through new software developed by the Pisan phoniatric school. This software is designed to extract quantitative indices related to the contacting and decontacting phases of the vocal folds during phonation. The software allows us to study the combined variability of vibration amplitude and velocity (i.e. the first derivative of the EGG signal). Pathological voices show a much more variable EGG signal compared to normal voices, since cordal vibration is made irregular due to the presence of glottis plane pathologies. With the aim of demonstrating the differences between normal and pathological voices relevant to combined vibration amplitude and velocity variability, we have introduced a new quantitative parameter named "variability index, VI". We studied 95 subjects (35 normal and 60 with pathological voice); among pathologic subjects, 15 showed functional dysphonia and 45 showed organic dysphonia. Subjects affected by organic dysphonia presented: 15 bilateral vocal nodules, 15 unilateral polyps and 15 unilateral cysts. All subjects were studied with videolaryngostroboscopy; electro-acoustic parameters of the voice were analysed with the KayPENTAX CSL (Model 4500) system. The EGG signal was recorded using KAY Model 6103 connected to the CSL system. The new software for the analysis of the EGG signal allows us to obtain not only a VI total value relevant to variability during all the recording, but also partial VI values relevant to the different glottis cycle phases. In fact, plotting the amplitude variation and its first derivative on a Lissajous graph, it is possible to divide the whole glottis cycle into four phases (each represented by four quadrants on the graph): the initial vocal folds contacting activity (VI-Q1), the last phase of vocal folds contacting (VI-Q2), the first phase of vocal folds decontacting (VI-Q3) and the last phase, up to the complete decontacting of vocal folds (VI-Q4). For each quadrant, it is also possible to work out the percent variability index. By comparing the variability indices in the normal and pathological groups, we obtained the following results: the total VI was significantly higher in the pathological subjects (0.25 vs 0.18; p = 0.01); the absolute value of VI was higher in pathological subjects, although the difference was not significant (VI-Q2, 0.041 vs 0.029; VI-Q3, 0.065 vs 0.058; VI-Q4, 0.054 vs 0.052). The percent variability in the Q2 quadrant (VI-Q2%) was significantly higher in pathological subjects compared to normal subjects (0.22 vs 0.16) (p = 0.01). The results of this study confirm that our new software for analysis of EGG signal can distinguish normal voice from pathological voice based on the new quantitative parameter VI, "variability index". Moreover, this study emphasises that the final contact phase of vocal folds is the most representative of the difference between the normal and pathological voice and shows a wider variability in terms of amplitude and vibration velocity. Further studies on larger groups of subjects will be required to confirm these results and assess differences in the EGG signal among the various vocal fold pathologies.

PMID: 30745592 [PubMed - as supplied by publisher]

http://bit.ly/2E6agSw

Comparative intraindividual ablative tissue effects of diode laser 980 nm versus radiofrequency in tonsillar hypertrophy management.

Comparative intraindividual ablative tissue effects of diode laser 980 nm versus radiofrequency in tonsillar hypertrophy management.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Kassab AN, Ahmed MR, Saber M, Mekawy S

Abstract
Tonsillotomy (tonsillar ablation) using diode laser and radiofrequency has been introduced for management of tonsillar hypertrophy as it is associated with fewer hazards to deep structures. We compared tissue volume and histological changes in the tonsils following radiofrequency tonsillotomy versus diode laser tonsillotomy in tonsillar hypertrophy. 40 tonsils excised from 20 patients were included in this study. Twenty tonsils were subjected to radiofrequency tonsillotomy (RFT) group 1, and the other 20 tonsils were subjected to diode laser 980 nm tonsillotomy (DLT) group 2. Both procedures were followed by cold dissection tonsillectomy for macroscopic and histological examination of tonsils. Tonsillar volume reduction was evident in both groups with a non-significant difference between groups. Histological changes were evident in both groups. In our study, both radiofrequency and diode laser were effective in tonsillar ablation in terms of volume reduction and keeping the histological pattern intact.

PMID: 30745591 [PubMed - as supplied by publisher]

http://bit.ly/2UXGUv9

Systemic inflammatory response after endoscopic surgery of Zenker's diverticulum.

Systemic inflammatory response after endoscopic surgery of Zenker's diverticulum.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Hering S, Wiegand S

Abstract
Zenker's diverticulum can be treated with a carbon dioxide laser or linear stapling device. A retrospective study on patients undergoing elective surgery for Zenker`s diverticulum with carbon dioxide laser or stapler was performed to analyse possible differences in inflammatory responses during the postoperative period. Leucocyte counts and C-reactive protein levels in peripheral blood were measured before and on days 1, 2, 3 and 5 after the operation. Statistical analysis was performed using the Mann-Whitney U-test. Of 34 patients, 16 were treated by laser and 18 by stapler. Age, sex ratio and ASA grade did not differ between the groups. Postoperative leukocytosis was significantly milder in the stapler group compared with patients who were treated by carbon dioxide laser. The mean C-reactive protein (CRP) level on day 1, 2 and 3 after surgery was significantly higher in the CO2 laser group than in the stapler group. Leukocyte counts recovered on day 3 after surgery in both groups while CRP levels did not decline to preoperative levels at day 5 after the operation in either group. No inflammatory complications such as mediastinitis or pneumonia occurred. In conclusion, the inflammatory response in the early period after carbon dioxide laser diverticulotomy of Zenker's diverticulum is higher than after stapler-assisted surgery of Zenker's diverticulum.

PMID: 30745590 [PubMed - as supplied by publisher]

http://bit.ly/2E6a4Ti

A case of external auditory canal osteoma complicated with cholesteatoma, mastoiditis, labyrinthitis and internal auditory canal pachymeningitis.

A case of external auditory canal osteoma complicated with cholesteatoma, mastoiditis, labyrinthitis and internal auditory canal pachymeningitis.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Iaccarino I, Bozzetti F, Piccioni LO, Falcioni M

Abstract
The association between external auditory canal osteoma and external auditory canal cholesteatoma is rare, with only a few reports in the current literature. Intracranial complications are very rare in the external auditory canal cholesteatoma, especially with direct propagation through the internal auditory canal. A case of 27-year-old male presenting with external auditory canal osteoma with secondary external auditory canal cholesteatoma is described. Progression of the disease created in turn a mastoiditis, labyrinthitis and pachymeningitis confined to the internal auditory canal. The patient was treated by a subtotal petrosectomy, without entering the internal auditory canal. A control MRI after 3 months showed reduction of the internal auditory canal enhancement.

PMID: 30745589 [PubMed - as supplied by publisher]

http://bit.ly/2UXiKBe

Retropharyngeal lymphatic malformations: report of two successfully treated cases and review of the literature.

Retropharyngeal lymphatic malformations: report of two successfully treated cases and review of the literature.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Chen J, Li W, Li X

Abstract
Retropharyngeal lymphatic malformations (LMs) are exceedingly rare and have rarely been reported in the literature. This condition can be life threatening, and its management is particularly challenging. Over a two-year period, two patients who presented with symptomatic (dyspnoea, snoring) retropharyngeal LMs were treated in our hospital. Both patients were treated using radiofrequency ablation of LMs through a trans-oral approach and bleomycin sclerotherapy as adjunctive treatment. No major complications occurred following surgery. During follow-up, no recurrence was noted, and both patients were asymptomatic. Our result suggests that radiofrequency ablation combined with bleomycin sclerotherapy can be a safe and effective treatment.

PMID: 30745588 [PubMed - as supplied by publisher]

http://bit.ly/2E9CsnP

Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature.

Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature.

Acta Otorhinolaryngol Ital. 2019 Jan 31;:

Authors: Lum SG, Gendeh BS, Husain S, Gendeh HS, Ismail MR, Toh CJ, Izaham A, Tan HJ

Abstract
Iatrogenic internal carotid artery injury is a catastrophic but uncommon complication of endonasal sinus surgery. We present our experience in managing this emergency situation. A 52-year-old man underwent revision endoscopic repair of recurrent cerebrospinal fluid leak that was complicated with profuse haemorrhage during removal of the anterior wall of sphenoid sinus using a Hajek sphenoid punch forceps. Immediate packing of the sphenoid sinus controlled the haemorrhage. Urgent angiography revealed injury at the paraclival segment of the left internal carotid artery. An endovascular stent was initially placed but thrombosed; it was subsequently converted to coil embolisation. The patient had watershed cerebral infarct with hemiparesis post procedure but made full recovery within 6 weeks. Immediate nasal packing followed by urgent angiography and endovascular stent placement is the least invasive definitive treatment. If stenting is unsuccessful, endovascular balloon occlusion or coil embolisation is the next preferred treatment, if there is adequate cross-cerebral circulation. The success of treatment relies on its immediate management by a multidisciplinary team.

PMID: 30745587 [PubMed - as supplied by publisher]

http://bit.ly/2UWluyF

Replacement of the Nasal Dorsum with a Diced Cartilage Glue Graft

Facial plast Surg 2019; 35: 053-057
DOI: 10.1055/s-0039-1677802

The reconstruction of the nasal dorsum after a hump resection is challenging if narrowing of the nose is to be avoided, the nasal skin is very thin, and the nasal bones are short. This report describes the replacement of the bony and cartilaginous nasal dorsum after resection with an anatomically shaped dorsal replacement graft of diced cartilage in fibrin glue. The technique is illustrated with a clinical case and sonographic morphometry of the nasal dorsum and tip. A modification of the diced cartilage glue graft for thin-skinned patients is presented.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2SQrvQ7

Digital Analysis of Nasal Airflow Facilitating Decision Support in Rhinosurgery

Facial plast Surg 2019; 35: 003-008
DOI: 10.1055/s-0039-1677720

Successful functional surgery on the nasal framework requires reliable and comprehensive diagnosis. In this regard, the authors introduce a new methodology: Digital Analysis of Nasal Airflow (diANA). It is based on computational fluid dynamics, a statistical shape model of the healthy nasal cavity and rhinologic expertise. diANA necessitates an anonymized tomographic dataset of the paranasal sinuses including the complete nasal cavity and, when available, clinical information. The principle of diANA is to compare the morphology and the respective airflow of an individual nose with those of a reference. This enables morphometric aberrations and consecutive flow field anomalies to localize and quantify within a patient's nasal cavity. Finally, an elaborated expert opinion with instructive visualizations is provided. Using diANA might support surgeons in decision-making, avoiding unnecessary surgery, gaining more precision, and target-orientation for indicated operations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2N9hR5W

Current Practical Concepts for Using Rib in Secondary Rhinoplasty

Facial plast Surg 2019; 35: 031-046
DOI: 10.1055/s-0039-1677801

Rhinoplasty is universally considered as the most demanding procedure in facial plastic surgery. Secondary rhinoplasty is its crown jewel, even more complex, and likewise highly fascinating. The evolution of thought and practice in rhinoplasty in the last decades has been quick and steady, progressively acknowledging the importance of maintaining structure in primary rhinoplasty and rebuilding structure in secondary procedures. No longer is the paradigm to achieve a small, thin, and pointy nose, but rather a well-proportioned nose which looks natural, albeit elegant and breathing well. Rib is an essential tool in many secondary procedures, and thus some important concepts have to be well understood and some finesse points mastered. This will provide an elegant reconstruction, identical if possible, or at least not far apart, to what could be achieved by a well-executed primary rhinoplasty, while avoiding the feared luck of a bulky nose stuffed with grafts. These guiding concepts and specific nuances regarding harvesting rib and working with it are the scope and contents of this article.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2SQr1cL

The Healthy Nasal Cavity—Characteristics of Morphology and Related Airflow Based on a Statistical Shape Model Viewed from a Surgeon's Perspective

Facial plast Surg 2019; 35: 009-013
DOI: 10.1055/s-0039-1677721

Functional surgery on the nasal framework requires referential criteria to objectively assess nasal breathing for indication and follow-up. This motivated us to generate a mean geometry of the nasal cavity based on a statistical shape model. In this study, the authors could demonstrate that the introduced nasal cavity's mean geometry features characteristics of the inner shape and airflow, which are commonly observed in symptom-free subjects. Therefore, the mean geometry might serve as a reference-like model when one considers qualitative aspects. However, to facilitate quantitative considerations and statistical inference, further research is necessary. Additionally, the authors were able to obtain details about the importance of the isthmus nasi and the inferior turbinate for the intranasal airstream.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2N3mEpg

Profile Templates to Use during Surgery in Precision Rhinoplasty

Facial plast Surg 2019; 35: 111-112
DOI: 10.1055/s-0039-1677830

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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http://bit.ly/2SM7eLE

Nasal Valve Lift in Nasal Valve Stenosis—A 2 Years Clinical Trial

Facial plast Surg 2019; 35: 014-022
DOI: 10.1055/s-0039-1677854

A clinical study was conducted to determine the effect of nasal valve lift treatment using absorbable, polylactic acid, self-retaining cone threads (Silhouette Soft) in patients with nasal valve stenosis. Sixty patients (n = 60) were included in this prospective study which was performed from January 2015 until December 2018, 19 patients dropped out due to noncompliance. Initially, participants were divided into two equal groups. One was treated by nasal valve lift only, the other additionally received turbinoplasty. A visual analog scale (VAS) was used to rate the sense of nasal ventilation. Patients' satisfaction was examined by a categorical scale, preoperatively, after 1 week, and after 1, 6, 12, 18, and 24 months. For statistical analysis, an univariant variance analysis was conducted to test the significance of differences in nasal breathing within one group at different points of postoperative controls, with the statistical significance set at p < 0.05. Moreover, the two groups were compared with each other regarding results of the categorical scale. After surgical treatment, an improvement is reported by all participants. Average VAS scores were significantly lower between preoperative and every postoperative rating. Although a decline in the effect of breathing improvement is recognizable as threads are dissolved, patients' satisfaction in improvement of nasal breathing is persistent in most cases, even at long-term observation. Overall, these results demonstrate that valve lift is an effective method to treat patients with nasal valve stenosis.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2N76pYe

Outcomes in Rhinoplasty

Facial plast Surg 2019; 35: 047-052
DOI: 10.1055/s-0039-1677829

In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2SQqxDt

Bony Fixation of the Nasal Framework

Facial plast Surg 2019; 35: 023-030
DOI: 10.1055/s-0039-1677767

The importance of a straight and stable central framework is beyond dispute. Many authors allude to technical aspects how to achieve the above-mentioned requirements. Far less is said about the contact zones of the framework and how to achieve a long-lasting and solid fixation. In the authors' patient group, they found the need to work on the septum/the central framework in approximately 84% of the cases. In 61% of the patients, the authors had to operate on the fixation point. Of course, there is a great variety of anatomical findings. So the required techniques differ immensely. The surgeon must be prepared for all kinds of different situations. Especially the dorsal fixation and the anchoring on the maxilla without having a standard anterior nasal spine can be a great challenge. In their daily routine, suture techniques (e.g., the transcutaneous transosseous cerclage suture) have become the authors' working horse for these complex fixation situations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2N76hIe

Minimally Invasive Rhinoplasty Technique Using a Hyaluronic Acid Filler and Polydioxanone Threads: An Effective Combination

Facial plast Surg 2019; 35: 109-110
DOI: 10.1055/s-0039-1677719

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2SQXj7w

Open Piezo Preservation Rhinoplasty: A Case Report of the New Rhinoplasty Approach

Facial plast Surg 2019; 35: 113-118
DOI: 10.1055/s-0039-1678578

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2N62xXN

New Tools and Proven Techniques in Rhinoplasty

10-1055-s-0039-1677885_01276preface-1.jp

Facial plast Surg 2019; 35: 001-002
DOI: 10.1055/s-0039-1677885

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2SNL9Mr

A first case of primary gastric verrucous carcinoma with isolated squamous epithelium in the stomach

Abstract

Primary gastric squamous cell carcinoma (SCC) is a rare histological subtype of gastric cancer. Here, we report the first case of primary gastric verrucous carcinoma (VC), a well-differentiated variant of SCC. Gastroscopy revealed a papillary polypoid lesion at the posterior wall of the upper gastric body and isolated squamous epithelium at the greater curvature of the fornix in a 78-year-old woman. Endoscopic submucosal dissection was performed. Microscopically, the lesion comprised very well-differentiated squamous epithelium with minimal atypia and exhibited coarse papillary structure and bulbous epithelial downgrowth with submucosal invasion. Conventional SCC or adenocarcinoma components were not included, and the lesion was surrounded by the metaplastic intestinal mucosa. Human papillomavirus infection was not detected. Although the pathogenesis of primary gastric SCC remains controversial, here, the disease is suggested as having originated from squamous epithelium. Knowledge of primary gastric VC and difficulty in diagnosing it using surface biopsy is necessary.

http://bit.ly/2E9w3sz

The value of MYB as a prognostic marker for adenoid cystic carcinoma: A meta‐analysis

Abstract

The aim of this meta‐analysis is to evaluate myeloblastosis (MYB) as a prognostic marker for patients with adenoid cystic carcinoma (ACC) with respect to MYB gene fusion, MYB protein expression, and tumor sites.

Local RD was seen in 19/352 patients (5%), all of them were HPV negative. The FDG-PET/CT had a sensitivity of 100% (8/8), specificity 85% (73/86), PPV 38% (8/21), NPV 100% (73/73), and accuracy 86%. Patients with local RD had significantly worse OS at 2 years, compared to those without (10 versus 88%, P < 0.001). In multivariable analysis, local RD remained a significant predictive factor for death with a hazard ratio of 11.9 (95% CI 5.8–24.3). The number of patients that underwent PET/CT increased over time (P < 0.001), whereas the number of patients that underwent EUA declined (P = 0.072).

Conclusion

FDG-PET/CT has excellent performance for the detection of RD, with the sensitivity and negative predictive value approaching 100%. Due to these excellent results is examination under anaesthesia today in the vast majority of the PET-negative cases not necessary anymore.

http://bit.ly/2tj0tm1

Demographic and Clinical Characteristics of 5294 Jaw Cysts: A Retrospective Study of 38 Years

Abstract

The aim of the present study is to report the demographic and clinical characteristics of all jaw cysts diagnosed in a single Oral Pathology Department. 5294 cases of jaw cysts diagnosed during a 38-year period were retrospectively collected and classified according to the latest classification of Head and Neck Tumors of the World Health Organization. The patients' gender and age, as well as the main clinical features of the cysts were retrieved from biopsy report forms. Jaw cysts were more common in male patients, with a male to female ratio of 1.6:1. Most patients were in the 4th–6th decade of life, with a mean age of 42.3 ± 16.1 years. There was no jaw predilection and the majority of lesions were more commonly encountered in the anterior region of the maxilla, followed by the molar region of the mandible. The most common jaw cyst was radicular cyst followed by dentigerous cyst, residual cyst and odontogenic keratocyst. The majority of jaw cysts are of inflammatory origin and represent a sequale of pulp necrosis. However, other type of jaw cysts may also be found.

http://bit.ly/2DyITiG

Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements

Abstract

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.

http://bit.ly/2SAeNWf

Special Populations in Implantable Auditory Devices

Children with hearing loss and additional disabilities can benefit from cochlear implants and other implantable auditory devices. Although each individual child must be evaluated, and families uniquely counseled on goals and realistic expectations, overall many gains and benefits are possible in this population. In this article, an overview of the considerations for this group is discussed and outcomes are reviewed, including auditory and speech measures as well as benefits in other skills and quality of life.

http://bit.ly/2WTb30y

Auditory Neuropathy

Auditory neuropathy spectrum disorder (ANSD) is a complex and heterogeneous disorder associated with altered neural synchrony with respect to auditory stimuli. Patients have characteristic auditory findings including normal otoacoustic emissions in the setting of abnormal auditory brainstem response. Patients with ANSD have a high incidence of comorbid developmental delay that may impact speech outcomes. Treatment options for ANSD include hearing amplification and cochlear implantation. The article highlights issues and controversies with the diagnosis and treatment of this complex disorder.

http://bit.ly/2RVJuA8

Future of Implantable Auditory Devices

The advances in technology leading to rapid developments in implantable auditory devices are constantly evolving. Devices are becoming smaller, less visible, and more efficient. The ability to preserve hearing outcomes with cochlear implantation will continue to evolve as surgical techniques improve with the use of continuous feedback during the procedure as well as with intraoperative delivery of drugs and robot assistance. As engineering methods improve, there may one day be a totally implantable aid that is self-sustaining in hearing-impaired patients making them indistinguishable from patients without hearing loss.

http://bit.ly/2X0vbhr

Totally Implantable Active Middle Ear Implants

The Envoy Esteem and the Carina system are the 2 totally implantable hearing devices. The Esteem is designed for patients with bilateral moderate to severe sensorineural hearing loss who have an unaided speech discrimination score of greater than and equal to 40%. The Carina system is designed for patients with moderate to severe sensorineural hearing loss or those with mixed hearing loss. The Esteem offers a technologically advanced method to provide improvements in hearing and is available in the United States, whereas the Carina system is currently not available in the United States.

http://bit.ly/2RZFu1x

Special Populations in Implantable Auditory Devices

Hearing loss is common in the geriatric population. Most hearing loss is associated with presbycusis or age-related hearing loss, impacting one-third of individuals over 65 years and increasing in prevalence with age. Hearing loss impacts quality of life, psychological health, and cognition. Implantable auditory devices are an exceptional option to improve hearing and quality of life. Various implantable auditory devices have been implemented safely with significant improvement in communication and performance on auditory tasks. Counseling is essential to establishing realistic expectations. Rehabilitation may be required to optimize outcomes and auditory performance with use.

http://bit.ly/2WZdWgu

Demographic and Clinical Characteristics of 5294 Jaw Cysts: A Retrospective Study of 38 Years

Abstract

http://bit.ly/2DyITiG

Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements

Abstract

http://bit.ly/2SAeNWf

Atorvastatin increases oxidative stress and inhibits cell migration of oral squamous cell carcinoma in vitro

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Patrícia Matos Biselli-Chicote, Amanda Trabachini Lotierzo, Joice Matos Biselli, Érika Cristina Paravino, Eny Maria Goloni-Bertollo

Abstract

Objective

This study aimed to evaluate the effect of atorvastatin treatment on reactive oxygen species (ROS) production and tumor angiogenesis in oral squamous cell carcinomas.

Material and Methods

An HN13 cell line was treated with 1 µM, 5 µM, and 10 µM of atorvastatin. VEGF-A gene expression was evaluated by quantitative real time PCR. VEGF-A protein expression was quantified from total protein and conditioned media by ELISA. Cellular oxidative stress was measured using 2′,7′-dichlorfluorescein-diacetate (DCFH-DA). Angiogenesis assay was performed using human umbilical vein endothelial cells (HUVEC). The effect of atorvastatin on cell migration was evaluated by wound healing assay.

Results

5 µM and 10 µM of atorvastatin significantly increased VEGF-A gene expression in the HN13 cell line. Intracellular expression of the VEGF-A protein was higher in the cells treated with 5 µM and 10 µM than in the control cells. VEGF-A protein expression was also higher in the conditioned media from the atorvastatin-treated cells than in the media from the DMSO-treated cells. 5 µM and 10 µM of atorvastatin increased oxidative stress. Regarding angiogenesis assay, 5 µM of atorvastatin resulted in higher numbers of branch points, compared to the solvent. 10 µM of atorvastatin treatment resulted in significantly reduced cell migration.

http://bit.ly/2TOztGO

USP6 Gene Rearrangement by FISH Analysis in Cranial Fasciitis: A Report of Three Cases

Abstract

http://bit.ly/2Bwfh5i

Robotic transoral thyroidectomy: Total thyroidectomy and ipsilateral central neck dissection with da Vinci Xi Surgical System

Abstract

Background

Transoral approach for thyroidectomy draws attention recently among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. The aim of this study is to demonstrate the details and the steps of transoral robotic thyroidectomy.

Methods

We made three incisions in the gingival‐buccal sulcus for three 8‐mm intraoral ports: one inverted U‐shaped 1‐cm midline incision approximately 2 cm above the frenulum, and two 0.5‐cm lateral incisions near the commissure of lips. An additional 8‐mm axilla port was inserted for countertraction and later drain insertion.

Results

Right thyroid lobectomy, ipsilateral central neck dissection, and left thyroid lobectomy were performed with preserving recurrent laryngeal nerves and parathyroid glands. There was no development of transient or permanent hypoparathyroidism, vocal cord palsy, postoperative bleeding, or surgical site infection.

Conclusion

Transoral robotic total thyroidectomy and ipsilateral central neck dissection using the da Vinci Xi Surgical System are feasible and safe.

http://bit.ly/2StswhE

Randomized control trial comparing the titanium osteosynthesis and the biodegradable osteosynthesis in mandibulotomy access

Abstract

Background

The clinical degradation rate and strength of biodegradable implant exposed to postoperative radiotherapy (PORT) are unknown.

Methods

A prospective randomized control trial of 40 consecutive mandibulotomy patients randomly divided into titanium and biodegradable cohorts. All patients received PORT. The following parameters were compared: maximal mouth opening, occlusal force, center of force trajectory, occlusal status, radiographic evidence of bony union, mandibular function impairment questionnaire (MFIQ), overall satisfaction score, and complication rates.

Results

Both the mandibular function and occlusal status parameter of the biodegradable and the titanium groups were not significantly difference. Biodegradable cohort showed better MFIQ scores (P = .08) and overall satisfaction scores (P = .64) but was not statistically significant. Of note, 40% of patients in the titanium cohort complained of plate palpability/cold intolerance and required plate removal (P = .02); 10% of patients in the titanium cohort developed osteoradionecrosis.

Conclusion

Biodegradable osteosynthesis is as reliable as titanium osteosynthesis for mandibulotomy fixation. PORT did not increase the complication rate in the biodegradable group.

http://bit.ly/2DB7iEa

Neural Regeneration Research

The hypothalamic-spinal dopaminergic system: a target for pain modulation
Michelino Puopolo

Neural Regeneration Research 2019 14(6):925-930

Nociceptive signals conveyed to the dorsal horn of the spinal cord by primary nociceptors are subject to extensive modulation by local neurons and by supraspinal descending pathways to the spinal cord before being relayed to higher brain centers. Descending modulatory pathways to the spinal cord comprise, among others, noradrenergic, serotonergic, γ-aminobutyric acid (GABA)ergic, and dopaminergic fibers. The contributions of noradrenaline, serotonin, and GABA to pain modulation have been extensively investigated. In contrast, the contributions of dopamine to pain modulation remain poorly understood. The focus of this review is to summarize the current knowledge of the contributions of dopamine to pain modulation. Hypothalamic A11 dopaminergic neurons project to all levels of the spinal cord and provide the main source of spinal dopamine. Dopamine receptors are expressed in primary nociceptors as well as in spinal neurons located in different laminae in the dorsal horn of the spinal cord, suggesting that dopamine can modulate pain signals by acting at both presynaptic and postsynaptic targets. Here, I will review the literature on the effects of dopamine and dopamine receptor agonists/antagonists on the excitability of primary nociceptors, the effects of dopamine on the synaptic transmission between primary nociceptors and dorsal horn neurons, and the effects of dopamine on pain in rodents. Published data support both anti-nociceptive effects of dopamine mediated by D2-like receptors and pro-nociceptive effects mediated by D1-like receptors.

Characteristics and advantages of adeno-associated virus vector-mediated gene therapy for neurodegenerative diseases
Yuan Qu, Yi Liu, Ahmed Fayyaz Noor, Johnathan Tran, Rui Li

Neural Regeneration Research 2019 14(6):931-938

Common neurodegenerative diseases of the central nervous system are characterized by progressive damage to the function of neurons, even leading to the permanent loss of function. Gene therapy via gene replacement or gene correction provides the potential for transformative therapies to delay or possibly stop further progression of the neurodegenerative disease in affected patients. Adeno-associated virus has been the vector of choice in recent clinical trials of therapies for neurodegenerative diseases due to its safety and efficiency in mediating gene transfer to the central nervous system. This review aims to discuss and summarize the progress and clinical applications of adeno-associated virus in neurodegenerative disease in central nervous system. Results from some clinical trials and successful cases of central neurodegenerative diseases deserve further study and exploration.

Gene expression changes in dorsal root ganglia following peripheral nerve injury: roles in inflammation, cell death and nociception
Sarah L Martin, Adam J Reid, Alexei Verkhratsky, Valerio Magnaghi, Alessandro Faroni

Neural Regeneration Research 2019 14(6):939-947

Subsequent to a peripheral nerve injury, there are changes in gene expression within the dorsal root ganglia in response to the damage. This review selects factors which are well-known to be vital for inflammation, cell death and nociception, and highlights how alterations in their gene expression within the dorsal root ganglia can affect functional recovery. The majority of studies used polymerase chain reaction within animal models to analyse the dynamic changes following peripheral nerve injuries. This review aims to highlight the factors at the gene expression level that impede functional recovery and are hence are potential targets for therapeutic approaches. Where possible the experimental model, specific time-points and cellular location of expression levels are reported.

Nicotinamide adenine dinucleotide phosphate oxidase activation and neuronal death after ischemic stroke
Jiamei Shen, Radhika Rastogi, Xiaokun Geng, Yuchuan Ding

Neural Regeneration Research 2019 14(6):948-953

Nicotinamide adenine dinucleotide phosphate oxidase (NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however, excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis. Moreover, recent studies have established that glucose, as a NOX substrate, plays a vital role in the pathogenesis of reperfusion injury. Thus, NOX inhibition has the potential to mitigate the deleterious impact of hyperglycemia on stroke. In this paper, we provide an overview of this research, coupled with a discussion of its implications for the development of NOX inhibition as a strategy for the treatment of ischemic stroke. Both inhibition using apocynin, as well as the prospect of developing more specific inhibitors based on what is now understood of the biology of NOX assembly and activation, will be highlighted in the course of our discussion.

Autophagy: novel insights into therapeutic target of electroacupuncture against cerebral ischemia/ reperfusion injury
Ya-Guang Huang, Wei Tao, Song-Bai Yang, Jin-Feng Wang, Zhi-Gang Mei, Zhi-Tao Feng

Neural Regeneration Research 2019 14(6):954-961

Electroacupuncture is known as an effective adjuvant therapy in ischemic cerebrovascular disease. However, its underlying mechanisms remain unclear. Studies suggest that autophagy, which is essential for cell survival and cell death, is involved in cerebral ischemia reperfusion injury and might be modulate by electroacupuncture therapy in key ways. This paper aims to provide novel insights into a therapeutic target of electroacupuncture against cerebral ischemia/reperfusion injury from the perspective of autophagy. Here we review recent studies on electroacupuncture regulation of autophagy-related markers such as UNC-51-like kinase-1 complex, Beclin1, microtubule-associated protein-1 light chain 3, p62, and autophagosomes for treating cerebral ischemia/reperfusion injury. The results of these studies show that electroacupuncture may affect the initiation of autophagy, vesicle nucleation, expansion and maturation of autophagosomes, as well as fusion and degradation of autophagolysosomes. Moreover, studies indicate that electroacupuncture probably modulates autophagy by activating the mammalian target of the rapamycin signaling pathway. This review thus indicates that autophagy is a therapeutic target of electroacupuncture treatment against ischemic cerebrovascular diseases.

Lessons from glaucoma: rethinking the fluid-brain barriers in common neurodegenerative disorders
Francisco Javier Carreras

Neural Regeneration Research 2019 14(6):962-966

Glaucoma has been recently characterized as a member of the group of anoikis-related diseases. Anoikis, a form of apoptosis, can be triggered by the unfastening of adherent junctions present in astrocytes. In those areas of the central nervous system in which the soma of the neurons or their axons and dendrites are metabolically dependent on the activity of astrocytes, a derangement of the lactate shuttle caused by a separation between the plasma membranes of neurons and astrocytes would result in metabolic impairment of the neurons themselves. In glaucoma, the triggering event has been attributed to the posterior deviation of aqueous humor towards the astrocyte-rich prelaminar tissue of the optic nerve head. The mean calcium content in the aqueous is able to interfere with calcium-dependent adherent junctions and induce anoikis of the astrocytes. As the cerebrospinal fluid has a similar base calcium concentration, a shunt of cerebrospinal fluid through the cerebral parenchyma would be able to interfere in the astrocytic architecture with dire consequences to the metabolically dependent neurons. Here the similitude between glaucoma, amyotrophic lateral sclerosis and Alzheimer’s disease are discussed and the concept of the break in the fluid-brain barrier, as an event separated from the blood-brain barrier, is stressed.

Busting the myth: more good than harm in transgenic cells
Gonzalo Piñero, Patricia Setton-Avruj

Neural Regeneration Research 2019 14(6):967-968

Muscle secretion of toxic factors, regulated by miR126-5p, facilitates motor neuron degeneration in amyotrophic lateral sclerosis
Roy Maimon, Eran Perlson

Neural Regeneration Research 2019 14(6):969-970

Preliminary in vitro evaluation of neuroprotective and monoamine oxidase type B inhibitory effects of newly synthesized 8-aminocaffeines
Magdalena Kondeva-Burdina, Maya Georgieva, Alexandra Kasabova-Angelova, Virginia Tzankova, Alexander Zlatkov

Neural Regeneration Research 2019 14(6):971-972

Therapeutic exploitation of the S-nitrosoglutathione/S-nitrosylation mechanism for the treatment of contusion spinal cord injury
Mushfiquddin Khan, Inderjit Singh

Neural Regeneration Research 2019 14(6):973-974

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Τετάρτη 13 Φεβρουαρίου 2019

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