Management of patients with ocular manifestations in vesiculobullous disorders affecting the mouth

Abstract

Pemphigoid and pemphigus diseases as well as Stevens-Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon, eyelid malposition, ocular surface scarring and severe visual loss.

In addition to diagnostic assessments, ophthalmologists must treat the dry eye and Meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants. Topical anti-inflammatory therapy is used to treat acute inflammatory exacerbations of the ocular surface but it cannot prevent scarring alone. Intralesional antimetabolite therapy can cause regression of conjunctival pathology in selected cases. Hence, patients with vesiculobullous disorders should be managed by a multidisciplinary team representing ophthalmology, dermatology, otolaryngology, oral medicine and pathology, internal medicine and intensive care. Systemic treatments including corticosteroids, azathioprine, cyclophosphamide, cyclosporine and mycophenolate mofetil help control inflammation. Intravenous immunoglobulins, plasmapheresis and targeted antibody therapy can be used in selected, severe and treatment-resistant cases. Local surgical management may include debridement of pseudomembranes, lysis of symblepharon, amniotic and mucous membrane grafting as well as reconstructive procedures. Prospective, multi-center, international studies are recommended to further support evidence-based practice.

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The Autoimmunity-Oral Microbiome Connection

Abstract

To date there is a major effort in deciphering the role of complex microbial communities, especially the oral and gut microbiomes, in the pathogenesis of various diseases. Increasing evidence indicates a key role for the oral microbiome in autoimmune diseases. In this review article, we discuss links of the oral microbiota to a group of autoimmune diseases, i.e., Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), Crohn's disease (CD), and rheumatoid arthritis (RA). We particularly focus on factors that affect the balance between the immune system and the composition of microbiota leading to dysbiosis, loss of tolerance and subsequent autoimmune disease progression and maintenance.

This article is protected by copyright. All rights reserved.

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New opportunities and challenges in the assessment of drugs for atopic diseases

Abstract

Atopic conditions (atopic dermatitis, rhinitis and asthma) belong to the most common non communicable diseases and are driven by chronic inflammatory reactions. They have a strong impact on the quality of life and represent a substantial and growing socio-economic burden. Interestingly, there is an increasing interest in the development of new therapeutic options with a number of biologics and small molecules targeting potential key mechanisms in atopic conditions. However, besides the safety issue, most of the new active substances are still evaluated according to the traditional efficacy paradigm focusing on the success in treating exacerbations and flares. Instead, the future approaches in drug development and assessment should rather concentrate on the long term control of these diseases and consider their potential as disease modifying strategies in the era of precision medicine. To reach this goal, a number of unsolved issues have to be addressed and consensually accepted by the stakeholders in this field. Thus, a successful and rapid development of new treatments requests a paradigm shift and a new way of thinking in the mind of physicians, pharmaceutical industry, regulators and HTAs. This seems mandatory in order to optimize drug development and to facilitate the accessibility of new therapies to the growing population of patients suffering from atopic conditions on a global level.

This article is protected by copyright. All rights reserved.

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Patching it together: Epicutaneous vaccination with heat labile Escherichia coli toxin against birch pollen allergy

Abstract

Immunotherapy has been employed with great success in the form of vaccination to combat viral, bacterial, and parasitic infection. In this issue of Allergy, Cabauatan et al. describe a novel method of allergen specific immunotherapy using epicutaneous patch vaccination with the recombinant birch pollen antigen Bet v 1 in combination with a heat-labile Escherichia coli toxin (LT) as adjuvant. Patch vaccination with rBet v 1 + LT augmented production of IgG instead of IgE antibodies, inhibiting rBet v 1 sensitization in outbred guinea pigs. Sera from these animals blocked allergen binding to IgE derived from allergic patients. This study represents a novel approach to elicit allergen-specific blocking IgG antibodies. Epicutaneous patch vaccination is a safe, standardized, needle-free approach. Further research into this and other strategies is warranted to improve our current vaccine paradigms in order to better protect against allergic disease.

This article is protected by copyright. All rights reserved.

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New opportunities and challenges in the assessment of drugs for atopic diseases

Abstract

Atopic conditions (atopic dermatitis, rhinitis and asthma) belong to the most common non communicable diseases and are driven by chronic inflammatory reactions. They have a strong impact on the quality of life and represent a substantial and growing socio-economic burden. Interestingly, there is an increasing interest in the development of new therapeutic options with a number of biologics and small molecules targeting potential key mechanisms in atopic conditions. However, besides the safety issue, most of the new active substances are still evaluated according to the traditional efficacy paradigm focusing on the success in treating exacerbations and flares. Instead, the future approaches in drug development and assessment should rather concentrate on the long term control of these diseases and consider their potential as disease modifying strategies in the era of precision medicine. To reach this goal, a number of unsolved issues have to be addressed and consensually accepted by the stakeholders in this field. Thus, a successful and rapid development of new treatments requests a paradigm shift and a new way of thinking in the mind of physicians, pharmaceutical industry, regulators and HTAs. This seems mandatory in order to optimize drug development and to facilitate the accessibility of new therapies to the growing population of patients suffering from atopic conditions on a global level.

This article is protected by copyright. All rights reserved.

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Patching it together: Epicutaneous vaccination with heat labile Escherichia coli toxin against birch pollen allergy

Abstract

Immunotherapy has been employed with great success in the form of vaccination to combat viral, bacterial, and parasitic infection. In this issue of Allergy, Cabauatan et al. describe a novel method of allergen specific immunotherapy using epicutaneous patch vaccination with the recombinant birch pollen antigen Bet v 1 in combination with a heat-labile Escherichia coli toxin (LT) as adjuvant. Patch vaccination with rBet v 1 + LT augmented production of IgG instead of IgE antibodies, inhibiting rBet v 1 sensitization in outbred guinea pigs. Sera from these animals blocked allergen binding to IgE derived from allergic patients. This study represents a novel approach to elicit allergen-specific blocking IgG antibodies. Epicutaneous patch vaccination is a safe, standardized, needle-free approach. Further research into this and other strategies is warranted to improve our current vaccine paradigms in order to better protect against allergic disease.

This article is protected by copyright. All rights reserved.

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New opportunities and challenges in the assessment of drugs for atopic diseases

Abstract

Atopic conditions (atopic dermatitis, rhinitis and asthma) belong to the most common non communicable diseases and are driven by chronic inflammatory reactions. They have a strong impact on the quality of life and represent a substantial and growing socio-economic burden. Interestingly, there is an increasing interest in the development of new therapeutic options with a number of biologics and small molecules targeting potential key mechanisms in atopic conditions. However, besides the safety issue, most of the new active substances are still evaluated according to the traditional efficacy paradigm focusing on the success in treating exacerbations and flares. Instead, the future approaches in drug development and assessment should rather concentrate on the long term control of these diseases and consider their potential as disease modifying strategies in the era of precision medicine. To reach this goal, a number of unsolved issues have to be addressed and consensually accepted by the stakeholders in this field. Thus, a successful and rapid development of new treatments requests a paradigm shift and a new way of thinking in the mind of physicians, pharmaceutical industry, regulators and HTAs. This seems mandatory in order to optimize drug development and to facilitate the accessibility of new therapies to the growing population of patients suffering from atopic conditions on a global level.

This article is protected by copyright. All rights reserved.

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Patching it together: Epicutaneous vaccination with heat labile Escherichia coli toxin against birch pollen allergy

Abstract

Immunotherapy has been employed with great success in the form of vaccination to combat viral, bacterial, and parasitic infection. In this issue of Allergy, Cabauatan et al. describe a novel method of allergen specific immunotherapy using epicutaneous patch vaccination with the recombinant birch pollen antigen Bet v 1 in combination with a heat-labile Escherichia coli toxin (LT) as adjuvant. Patch vaccination with rBet v 1 + LT augmented production of IgG instead of IgE antibodies, inhibiting rBet v 1 sensitization in outbred guinea pigs. Sera from these animals blocked allergen binding to IgE derived from allergic patients. This study represents a novel approach to elicit allergen-specific blocking IgG antibodies. Epicutaneous patch vaccination is a safe, standardized, needle-free approach. Further research into this and other strategies is warranted to improve our current vaccine paradigms in order to better protect against allergic disease.

This article is protected by copyright. All rights reserved.

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New opportunities and challenges in the assessment of drugs for atopic diseases

Abstract

Atopic conditions (atopic dermatitis, rhinitis and asthma) belong to the most common non communicable diseases and are driven by chronic inflammatory reactions. They have a strong impact on the quality of life and represent a substantial and growing socio-economic burden. Interestingly, there is an increasing interest in the development of new therapeutic options with a number of biologics and small molecules targeting potential key mechanisms in atopic conditions. However, besides the safety issue, most of the new active substances are still evaluated according to the traditional efficacy paradigm focusing on the success in treating exacerbations and flares. Instead, the future approaches in drug development and assessment should rather concentrate on the long term control of these diseases and consider their potential as disease modifying strategies in the era of precision medicine. To reach this goal, a number of unsolved issues have to be addressed and consensually accepted by the stakeholders in this field. Thus, a successful and rapid development of new treatments requests a paradigm shift and a new way of thinking in the mind of physicians, pharmaceutical industry, regulators and HTAs. This seems mandatory in order to optimize drug development and to facilitate the accessibility of new therapies to the growing population of patients suffering from atopic conditions on a global level.

This article is protected by copyright. All rights reserved.

http://ift.tt/2e9jQIz

Patching it together: Epicutaneous vaccination with heat labile Escherichia coli toxin against birch pollen allergy

Abstract

Immunotherapy has been employed with great success in the form of vaccination to combat viral, bacterial, and parasitic infection. In this issue of Allergy, Cabauatan et al. describe a novel method of allergen specific immunotherapy using epicutaneous patch vaccination with the recombinant birch pollen antigen Bet v 1 in combination with a heat-labile Escherichia coli toxin (LT) as adjuvant. Patch vaccination with rBet v 1 + LT augmented production of IgG instead of IgE antibodies, inhibiting rBet v 1 sensitization in outbred guinea pigs. Sera from these animals blocked allergen binding to IgE derived from allergic patients. This study represents a novel approach to elicit allergen-specific blocking IgG antibodies. Epicutaneous patch vaccination is a safe, standardized, needle-free approach. Further research into this and other strategies is warranted to improve our current vaccine paradigms in order to better protect against allergic disease.

This article is protected by copyright. All rights reserved.

http://ift.tt/2dEF9iC

Concurrent validity and reliability of wireless instrumented insoles measuring postural balance and temporal gait parameters

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Michiel S. Oerbekke, Mirelle J. Stukstette, Kurt Schütte, Rob A. de Bie, Martijn F. Pisters, Benedicte Vanwanseele
BackgroundThe OpenGo seems promising to take gait analysis out of laboratory settings due to its capability of long-term measurements and mobility. However, the OpenGo's concurrent validity and reliability need to be assessed to determine if the instrument is suitable for validation in patient samples.MethodsTwenty healthy volunteers participated. Center of pressure data were collected under eyes open and closed conditions with participants performing unilateral stance trials on the gold standard (AMTI OR6-7 force plate) while wearing the OpenGo. Temporal gait data (stance time, gait cycle time, and cadence) were collected at a self-selected comfortable walking speed with participants performing test-retest trials on an instrumented treadmill while wearing the OpenGo. Validity was assessed using Bland-Altman plots. Reliability was assessed with Intraclass Correlation Coefficient (2,1) and smallest detectable changes were calculated.FindingsNegative means of differences were found in all measured parameters, illustrating lower scores for the OpenGo on average. The OpenGo showed negative upper limits of agreement in center of pressure parameters on the mediolateral axis. Temporal reliability ICCs ranged from 0.90–0.93. Smallest detectable changes for both stance times were 0.04 (left) and 0.05 (right) seconds, for gait cycle time 0.08s, and for cadence 4.5 steps per minute.InterpretationThe OpenGo is valid and reliable for the measurement of temporal gait parameters during walking. Measurements of center of pressure parameters during unilateral stance are not considered valid. The OpenGo seems a promising instrument for clinically screening and monitoring temporal gait parameters in patients, however validation in patient populations is needed.



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Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Tsuyoshi Goto, Toshinori Sakai, Tetsuya Enishi, Nori Sato, Koji Komatsu, Koichi Sairyo, Shinsuke Katoh
Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system^® with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.



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Concurrent validity and reliability of wireless instrumented insoles measuring postural balance and temporal gait parameters

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Michiel S. Oerbekke, Mirelle J. Stukstette, Kurt Schütte, Rob A. de Bie, Martijn F. Pisters, Benedicte Vanwanseele
BackgroundThe OpenGo seems promising to take gait analysis out of laboratory settings due to its capability of long-term measurements and mobility. However, the OpenGo's concurrent validity and reliability need to be assessed to determine if the instrument is suitable for validation in patient samples.MethodsTwenty healthy volunteers participated. Center of pressure data were collected under eyes open and closed conditions with participants performing unilateral stance trials on the gold standard (AMTI OR6-7 force plate) while wearing the OpenGo. Temporal gait data (stance time, gait cycle time, and cadence) were collected at a self-selected comfortable walking speed with participants performing test-retest trials on an instrumented treadmill while wearing the OpenGo. Validity was assessed using Bland-Altman plots. Reliability was assessed with Intraclass Correlation Coefficient (2,1) and smallest detectable changes were calculated.FindingsNegative means of differences were found in all measured parameters, illustrating lower scores for the OpenGo on average. The OpenGo showed negative upper limits of agreement in center of pressure parameters on the mediolateral axis. Temporal reliability ICCs ranged from 0.90–0.93. Smallest detectable changes for both stance times were 0.04 (left) and 0.05 (right) seconds, for gait cycle time 0.08s, and for cadence 4.5 steps per minute.InterpretationThe OpenGo is valid and reliable for the measurement of temporal gait parameters during walking. Measurements of center of pressure parameters during unilateral stance are not considered valid. The OpenGo seems a promising instrument for clinically screening and monitoring temporal gait parameters in patients, however validation in patient populations is needed.



http://ift.tt/2d8wmq1

Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Tsuyoshi Goto, Toshinori Sakai, Tetsuya Enishi, Nori Sato, Koji Komatsu, Koichi Sairyo, Shinsuke Katoh
Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system^® with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.



http://ift.tt/2dRf5iB

Vibration energy analysis of a plate for defect imaging with a scanning laser source technique

Vibration energies generated by laser irradiation to a plate with a crack were calculated by the semi-analytical finite element method to elucidate the principle of defect imaging using a scanning laser source. For normal incidence in the ablation regime, the incident energy increases when the incident source is located in the vicinity of the crack, owing to the effect of the non-propagating A1 modes. For dipole loading in the thermoelastic regime, the vibration energies are completely different, depending on the position of the crack opening. If the crack opening is located opposite the incident source, the vibration energy increases abruptly in the vicinity of the crack, which is affected by the higher-order non-propagating modes as well as the A1 modes. When the crack opening and the incident source are located on the same side, the generated energy approaches zero as the source moves closer to the crack. The energy reduction around the crack is caused by the superposition of the incident wave from dipole loading and the phase-inverted reflected wave. The results of experiments conducted to verify the energy variations in the vicinity of a crack were in good agreement with the numerical results for dipole loading.

http://ift.tt/2dRfBgu

Speech intelligibility in virtual restaurants

Speech reception thresholds (SRTs) for a target voice on the same virtual table were measured in various restaurant simulations under conditions of masking by between one and eight interferers at other tables. Results for different levels of reverberation and different simulation techniques were qualitatively similar. SRTs increased steeply with the number of interferers, reflecting progressive failure to perceptually unmask the target speech as the acoustic scene became more complex. For a single interferer, continuous noise was the most effective masker, and a single interfering voice of either gender was least effective. With two interferers, evidence of informational masking emerged as a difference in SRT between forward and reversed speech, but SRTs for all interferer types progressively converged at four and eight interferers. In simulation based on a real room, this occurred at a signal-to-noise ratio of around −5 dB.

http://ift.tt/2d8vQsa

Derivation of acoustoelastic Lamb wave dispersion curves in anisotropic plates at the initial and natural frames of reference

The propagation speed of ultrasonic waves in pre-stressed media can be evaluated either at the natural or initial frames of reference. In this paper general equations that can be applied to the partial wave technique are presented in order to obtain the dispersion spectra of acoustoelastic Lamb waves in anisotropic plates in either frame of reference. Employing these equations, dispersion curves for the fundamental modes in a pre-stressed transversely isotropic aluminum plate were numerically obtained in both reference frames under longitudinal and transverse loading with the material transverse axis along each of the Cartesian directions, as well as the propagation along a non-principal direction. Results confirm that due to the material natural anisotropy, the speed variation depends not only on the pre-stress direction but also on the material orientation as well as on the polarization of the propagating mode. Similar to bulk waves, the relationship between the speed at the natural and initial frames is a function of the load direction.

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Effects of obstruent voicing on vowel F0: Evidence from “true voicing” languagesa)

This study investigates consonant-related F0 perturbations ("CF0") in French and Italian by comparing the effects of voiced and voiceless obstruents on F0 to those of voiced sonorants. The voiceless obstruents /p f/ in both languages are found to have F0-raising properties similar to American English voiceless obstruents, while F0 following the (pre)voiced obstruents /b v/ in French and Italian patterns together with /m/, again similar to English [Hanson (2009). J. Acoust. Soc. Am. 125(1), 425–441]. In both languages, F0 is significantly depressed, relative to sonorants, during the closure for voiced obstruents, but cannot be differentiated from sonorants following the release of oral constriction. These findings are taken as support for a model on which F0 perturbations are fundamentally the result of laryngeal maneuvers initiated to sustain or inhibit phonation, regardless of other language-particular aspects of phonetic realization.

http://ift.tt/2d8uVb6

Erratum: A systematic rationale for defining the significance of aircraft noise impacts [J. Acoust. Soc. Am. 136, 1129–1138 (2014)]

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Evening choruses in the Perth Canyon and their potential link with Myctophidae fishes

An evening chorus centered at near 2.2 kHz was detected across the years 2000 to 2014 from seabed receivers in 430–490 m depth overlooking the Perth Canyon, Western Australia. The chorus reached a maximum level typically 2.1 h post-sunset and normally ran for 2.1 h (between 3 dB down points). It was present at lower levels across most of the hours of darkness. Maximum chorus spectrum levels were 74–76 dB re 1 μPa²/Hz in the 2 kHz 1/3 octave band, averaging 6–12 dB and up to 30 dB greater than pre-sunset levels. The chorus displayed highest levels over April to August each year with up to 10 dB differences between seasons. The spatial extent of the chorus was not determined but exceeded the sampling range of 13–15 km offshore from the 300 m depth contour and 33 km along the 300 m depth contour. The chorus comprised short damped pulses. The most likely chorus source is considered to be fishes of the family Myctophidae foraging in the water column. The large chorus spatial extent and its apparent correlation with regions of high productivity suggest it may act as an acoustic beacon to marine fauna indicating regions of high biomass.

http://ift.tt/2d8vORb

Concurrent validity and reliability of wireless instrumented insoles measuring postural balance and temporal gait parameters

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Michiel S. Oerbekke, Mirelle J. Stukstette, Kurt Schütte, Rob A. de Bie, Martijn F. Pisters, Benedicte Vanwanseele
BackgroundThe OpenGo seems promising to take gait analysis out of laboratory settings due to its capability of long-term measurements and mobility. However, the OpenGo's concurrent validity and reliability need to be assessed to determine if the instrument is suitable for validation in patient samples.MethodsTwenty healthy volunteers participated. Center of pressure data were collected under eyes open and closed conditions with participants performing unilateral stance trials on the gold standard (AMTI OR6-7 force plate) while wearing the OpenGo. Temporal gait data (stance time, gait cycle time, and cadence) were collected at a self-selected comfortable walking speed with participants performing test-retest trials on an instrumented treadmill while wearing the OpenGo. Validity was assessed using Bland-Altman plots. Reliability was assessed with Intraclass Correlation Coefficient (2,1) and smallest detectable changes were calculated.FindingsNegative means of differences were found in all measured parameters, illustrating lower scores for the OpenGo on average. The OpenGo showed negative upper limits of agreement in center of pressure parameters on the mediolateral axis. Temporal reliability ICCs ranged from 0.90–0.93. Smallest detectable changes for both stance times were 0.04 (left) and 0.05 (right) seconds, for gait cycle time 0.08s, and for cadence 4.5 steps per minute.InterpretationThe OpenGo is valid and reliable for the measurement of temporal gait parameters during walking. Measurements of center of pressure parameters during unilateral stance are not considered valid. The OpenGo seems a promising instrument for clinically screening and monitoring temporal gait parameters in patients, however validation in patient populations is needed.



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via IFTTT

Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report

Publication date: Available online 6 October 2016
Source:Gait & Posture
Author(s): Tsuyoshi Goto, Toshinori Sakai, Tetsuya Enishi, Nori Sato, Koji Komatsu, Koichi Sairyo, Shinsuke Katoh
Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system^® with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.



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Editorial Board

Publication date: October 2016
Source:Clinical Immunology, Volume 171





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Editorial Board

Publication date: October 2016
Source:Clinical Immunology, Volume 171





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Immediate Trans-oral Allogeneic bone grafting for large mandibular defects. Less morbidity, more bone. A paradigm in benign tumor mandibular reconstruction?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James C. Melville, Nader N. Nassari, Issa A. Hanna, Jonathan W. Shum, Mark E. Wong, Simon Young
Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous bone grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. Predictable results have been obtained with using a combination of 100% cadaver bone, bone marrow aspirate concentrate (BMAC) and rhBMP-2 in immediate reconstruction for benign tumor extirpations via the extra-oral approach. In light of these successful outcomes, the same combination was evaluated with an intraoral approach. This study aims to evaluate the success of immediate mandibular reconstruction via intra-oral approach without any autogenous bone harvesting.Patients and MethodsThe aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC via trans-oral approach for immediate reconstruction of continuity defects resulted from benign tumor surgery. A retrospective chart review was performed of all patients undergoing bone graft reconstruction at UTHealth oral & maxillofacial surgery, between December 2014 to January 2016. Inclusion criteria are the following: biopsy proven benign tumors, ASA I/II health status and adequate intraoral soft tissue for primary closure determined during initial consultation.Results5 patients who underwent this procedure at University of Texas Health Sciences Center at Houston (UTHealth) Oral &Maxillofacial surgery, between December 2014 to January 2016, are presented. We report a 100% success rate. All patients demonstrated excellent bone quality both clinically as well as radiographically for endosseous dental implant placement. With the trans-oral approach and no autogenous bone harvesting, the average operating time was 3.4 hours and hospital stay was 2.4 days.ConclusionsComposite allogeneic tissue engineering is effective and predictable technique for immediate reconstruction of continuity defects from ablative benign tumor surgery. Overall, we had no donor site morbidity, less intraoperative time, fewer admission days and overall reduction in total costs compared to traditional methods.



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Do antibiotics decrease the risk of inflammatory complications after third molar removal in community practices?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Melanie S. Lang, Martin L. Gonzalez, Thomas B. Dodson
PurposeThe role of antibiotic use in third molar (M3) surgery is controversial. The purpose of this study was to measure the association between antibiotic use and postoperative inflammatory complications following M3 surgery in the community office-based ambulatory private practice setting.Materials and MethodsThe investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who had at least one M3 removed in a private practice setting by oral and maxillofacial surgeons participating in a practice-based research collaborative between June, 2011 and May, 2012.The predictor variable was antibiotic use of any type, categorized as yes or no. The primary outcome variable was the presence or absence of an inflammatory complication, i.e. surgical site infection (SSI) or alveolar osteitis (AO), after M3 removal.Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between antibiotic use and inflammatory complications after M3 removal with statistical significance set at p-value ≤0.05.ResultsThe study sample was composed of 2954 subjects. Three-quarters (75.2%) of the sample received antibiotics in some form. The overall inflammatory complication (AO or SSI) frequencies in the antibiotic and non-antibiotic groups were 5.0 and 7.5%, respectively (p=0.012). After adjusting for differences between the two groups, statistical significance between the groups persisted.ConclusionsThe results of this study suggest that antibiotic therapy, regardless of type, dose, frequency or pattern of delivery, was associated with a decreased risk of inflammatory complications after M3 removal.



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Is Treating Oral & Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dean M. DeLuke, Vickas Agarwal, Trevor Holleman, Caroline K. Carrico, Daniel M. Laskin
PurposeOver the past two decades there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. While many factors may influence the decision not to take trauma call, one primary disincentive is the perception that managing facial trauma may be profitable for the hospital, but is not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the VCU Medical Center.Materials and MethodsIn this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery (OMS) between June 2011 and July 2014. Cost and reimbursement data were analyzed for these patients from both the VCU Health System (VCUHS) and the VCU Department of OMS. For the hospital, actual cost data was provided, and for the surgeon it was calculated based on an average overhead of 50 percent. For uniformity, patients were excluded if they remained in the hospital for more than a 23-hour observation period. Patients under the age of 18 were also excluded.ResultsA total of 169 patients met the inclusion criteria. There was a statistically significant difference in both the percent of costs recouped and the actual profit. The average percent of costs recouped was 230% for the VCUHS, while OMS only recouped 47% of costs.This amounts to an average profit per case of $3461 for the hospital versus a loss of $1162 for the surgeon.ConclusionsThe results of this study indicate that in our medical center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. While the results are limited to outpatient management at one academic institution, they suggest that hospitals in some settings may be in a position to incentivize surgeons for trauma management.



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Is intra-articular steroid injection to the temporomandibular joint for juvenile idiopathic arthritis more effective and efficient when performed with image guidance?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Pouya M. Vakilian, Leonard B. Kaban, Zachary S. Peacock
PurposeTo compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA).MethodsThis is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital. Subjects were divided into groups according to IASI technique: (1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance, and (2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs. image-guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER) and total procedure time.ResultsForty-five subjects with 71 injected TMJs were included. Twenty-two subjects with 36 injected TMJs were in the landmark group, and 23 subjects with 35 injected joints were in the image-guided group. There were no significant differences in age, sex, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (p=1.00), increase in MIO (p=0.975), or decrease in ER (p=0.492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (p<0.008).ConclusionsWe found no significant differences in short-term outcomes but increased procedure times for the image-guided group. While specific indications for use of image guidance may exist, we cannot justify its routine use for this procedure.



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Technical Modifications for Intraoral Quadrangular Le Fort II Osteotomy

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): C. Klug, J. Cede
The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) represents a reliable surgical method in cases of midfacial deficiency with good functional, esthetic and stable long-term results.In this technical note we present 3 surgical modifications to previous reports: 1. inferior orbital rim osteotomy by angulated piezosurgical instruments thereby avoiding the use of chisels in the orbital region, 2. osteosynthetic fixation only laterally at the zygomatic buttress with 2 L-shaped miniplates thus avoiding paranasal osteosynthesis and 3. advancement step camouflage in the lateral infraorbital region with a compound mass of autologous bone chips and fibrin glue with the intention to reduce bone bloc associated side effects.13 consecutive patients presenting with midfacial deficiency and class III malocclusion were treated by means of IQLFIIO and mandibular osteotomies. In all cases osteotomy and consecutive downfracture could be conducted as planned by using the piezotome. No atypical fractures were encountered. There were no cases of infraorbital nerve anesthesia. Midfacial hypesthesia was found in 54% of operated sides after 3 months, after 6 months in 23%, after 12 months in 13%. Five months postoperative 3D scans revealed osseous healing at the infraorbital advancement step.Our results suggest that IQLFIIO can fully be conducted without chisels in the orbital region. Implementation of piezosurgery in IQLFIIO allows for safe bone cutting in the orbital region. Two miniplates and step camouflage with fibrin glue-stabilized bone chips are sufficient for osseous healing.Future studies will focus on quantitative soft to hard tissue changes that come along with IQLFIIO advancement.

Graphical abstract

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Complications of sialendoscopy in patients with Sjögren’s syndrome

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): K. Hakki Karagozoglu, Jan G. De Visscher, Tymour Forouzanfar, Erik H. van der Meij, Derk Jan Jager
PurposeRecent literature suggests that sialendoscopy of the major salivary glands could possibly alleviate symptoms of Sjögren's syndrome (SS) and restore salivary function. The aim of this study was, therefore, to evaluate our experience of sialendoscopy of the salivary glands in patients with SS.MethodsIn this retrospective case series study, the surgical data of patients with SS who had undergone sialendoscopy in the VU University Medical Center, Amsterdam between November 2014 and April 2015 were used. Outcome measures were successful entry in the salivary gland and completion of sialendoscopy as planned. Furthermore, per- and postoperative complications were scored. Descriptive analysis of the data was performed.ResultsSurgical data of sialendoscopic procedures in 26 patients with SS (24 women and 2 men; mean age 57 years (range 27-72 years) were analyzed. Sialendoscopy was successfully performed in 78 salivary glands (75%), 50 parotid and 28 submandibular glands, of the 104 salivary glands in the 26 patients. Sialendoscopy failed in 26 (25%) of the 104 sialendoscopic procedures (2 parotid and 24 submandibular glands). In 16 salivary glands the ductal orifice could not be identified. In 7 salivary glands sialendoscopy could not be performed due to partial or complete stenosis of salivary duct. In 3 salivary glands sialendoscopy was not performed because of a ductal perforation. Three patients developed a postoperative infection.ConclusionIt was found that the overall rate of complications was limited and types of complications of sialendoscopy in patients with SS could be regarded as minor. Most complications were seen in sialendoscopy of the submandibular glands in this specific patient category. Careful preoperative selection of both patients and salivary glands may contribute to a lower rate of complications and more predictable results.



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Oral surgery in patients with Glanzmann thrombasthenia: a case series

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Eleonora Segna, Andrea Artoni, Raffaele Sacco, Aldo Bruno Giannì
Glanzmann thrombasthenia is a severe defect of platelet function caused by an inherited deficiency or dysfunction of the glycoprotein IIb/IIIa complex (GPIIb/IIIa), the platelet fibrinogen receptor. Patients diagnosed with Glanzmann thrombasthenia have a lifelong spontaneous and post-traumatic mucocutaneous bleeding diathesis. Surgery is usually very challenging, requiring close co-operation between surgeons, hematologists and anesthesiologists. For anatomical reasons, oral surgery is particularly difficult due to the inherent risk of hemorrhage and the difficulty in achieving local hemostasis. In this paper we describe three successful cases of oral surgery in patients with Glanzmann thrombasthenia and report the surgical and hematological management of each case.



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Editorial Board

Publication date: October 2016
Source:Clinical Immunology, Volume 171





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Technical Modifications for Intraoral Quadrangular Le Fort II Osteotomy

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): C. Klug, J. Cede
The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) represents a reliable surgical method in cases of midfacial deficiency with good functional, esthetic and stable long-term results.In this technical note we present 3 surgical modifications to previous reports: 1. inferior orbital rim osteotomy by angulated piezosurgical instruments thereby avoiding the use of chisels in the orbital region, 2. osteosynthetic fixation only laterally at the zygomatic buttress with 2 L-shaped miniplates thus avoiding paranasal osteosynthesis and 3. advancement step camouflage in the lateral infraorbital region with a compound mass of autologous bone chips and fibrin glue with the intention to reduce bone bloc associated side effects.13 consecutive patients presenting with midfacial deficiency and class III malocclusion were treated by means of IQLFIIO and mandibular osteotomies. In all cases osteotomy and consecutive downfracture could be conducted as planned by using the piezotome. No atypical fractures were encountered. There were no cases of infraorbital nerve anesthesia. Midfacial hypesthesia was found in 54% of operated sides after 3 months, after 6 months in 23%, after 12 months in 13%. Five months postoperative 3D scans revealed osseous healing at the infraorbital advancement step.Our results suggest that IQLFIIO can fully be conducted without chisels in the orbital region. Implementation of piezosurgery in IQLFIIO allows for safe bone cutting in the orbital region. Two miniplates and step camouflage with fibrin glue-stabilized bone chips are sufficient for osseous healing.Future studies will focus on quantitative soft to hard tissue changes that come along with IQLFIIO advancement.

Graphical abstract

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Immediate Trans-oral Allogeneic bone grafting for large mandibular defects. Less morbidity, more bone. A paradigm in benign tumor mandibular reconstruction?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James C. Melville, Nader N. Nassari, Issa A. Hanna, Jonathan W. Shum, Mark E. Wong, Simon Young
Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous bone grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. Predictable results have been obtained with using a combination of 100% cadaver bone, bone marrow aspirate concentrate (BMAC) and rhBMP-2 in immediate reconstruction for benign tumor extirpations via the extra-oral approach. In light of these successful outcomes, the same combination was evaluated with an intraoral approach. This study aims to evaluate the success of immediate mandibular reconstruction via intra-oral approach without any autogenous bone harvesting.Patients and MethodsThe aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC via trans-oral approach for immediate reconstruction of continuity defects resulted from benign tumor surgery. A retrospective chart review was performed of all patients undergoing bone graft reconstruction at UTHealth oral & maxillofacial surgery, between December 2014 to January 2016. Inclusion criteria are the following: biopsy proven benign tumors, ASA I/II health status and adequate intraoral soft tissue for primary closure determined during initial consultation.Results5 patients who underwent this procedure at University of Texas Health Sciences Center at Houston (UTHealth) Oral &Maxillofacial surgery, between December 2014 to January 2016, are presented. We report a 100% success rate. All patients demonstrated excellent bone quality both clinically as well as radiographically for endosseous dental implant placement. With the trans-oral approach and no autogenous bone harvesting, the average operating time was 3.4 hours and hospital stay was 2.4 days.ConclusionsComposite allogeneic tissue engineering is effective and predictable technique for immediate reconstruction of continuity defects from ablative benign tumor surgery. Overall, we had no donor site morbidity, less intraoperative time, fewer admission days and overall reduction in total costs compared to traditional methods.



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Do antibiotics decrease the risk of inflammatory complications after third molar removal in community practices?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Melanie S. Lang, Martin L. Gonzalez, Thomas B. Dodson
PurposeThe role of antibiotic use in third molar (M3) surgery is controversial. The purpose of this study was to measure the association between antibiotic use and postoperative inflammatory complications following M3 surgery in the community office-based ambulatory private practice setting.Materials and MethodsThe investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who had at least one M3 removed in a private practice setting by oral and maxillofacial surgeons participating in a practice-based research collaborative between June, 2011 and May, 2012.The predictor variable was antibiotic use of any type, categorized as yes or no. The primary outcome variable was the presence or absence of an inflammatory complication, i.e. surgical site infection (SSI) or alveolar osteitis (AO), after M3 removal.Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between antibiotic use and inflammatory complications after M3 removal with statistical significance set at p-value ≤0.05.ResultsThe study sample was composed of 2954 subjects. Three-quarters (75.2%) of the sample received antibiotics in some form. The overall inflammatory complication (AO or SSI) frequencies in the antibiotic and non-antibiotic groups were 5.0 and 7.5%, respectively (p=0.012). After adjusting for differences between the two groups, statistical significance between the groups persisted.ConclusionsThe results of this study suggest that antibiotic therapy, regardless of type, dose, frequency or pattern of delivery, was associated with a decreased risk of inflammatory complications after M3 removal.



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Is Treating Oral & Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dean M. DeLuke, Vickas Agarwal, Trevor Holleman, Caroline K. Carrico, Daniel M. Laskin
PurposeOver the past two decades there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. While many factors may influence the decision not to take trauma call, one primary disincentive is the perception that managing facial trauma may be profitable for the hospital, but is not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the VCU Medical Center.Materials and MethodsIn this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery (OMS) between June 2011 and July 2014. Cost and reimbursement data were analyzed for these patients from both the VCU Health System (VCUHS) and the VCU Department of OMS. For the hospital, actual cost data was provided, and for the surgeon it was calculated based on an average overhead of 50 percent. For uniformity, patients were excluded if they remained in the hospital for more than a 23-hour observation period. Patients under the age of 18 were also excluded.ResultsA total of 169 patients met the inclusion criteria. There was a statistically significant difference in both the percent of costs recouped and the actual profit. The average percent of costs recouped was 230% for the VCUHS, while OMS only recouped 47% of costs.This amounts to an average profit per case of $3461 for the hospital versus a loss of $1162 for the surgeon.ConclusionsThe results of this study indicate that in our medical center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. While the results are limited to outpatient management at one academic institution, they suggest that hospitals in some settings may be in a position to incentivize surgeons for trauma management.



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Is intra-articular steroid injection to the temporomandibular joint for juvenile idiopathic arthritis more effective and efficient when performed with image guidance?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Pouya M. Vakilian, Leonard B. Kaban, Zachary S. Peacock
PurposeTo compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA).MethodsThis is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital. Subjects were divided into groups according to IASI technique: (1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance, and (2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs. image-guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER) and total procedure time.ResultsForty-five subjects with 71 injected TMJs were included. Twenty-two subjects with 36 injected TMJs were in the landmark group, and 23 subjects with 35 injected joints were in the image-guided group. There were no significant differences in age, sex, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (p=1.00), increase in MIO (p=0.975), or decrease in ER (p=0.492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (p<0.008).ConclusionsWe found no significant differences in short-term outcomes but increased procedure times for the image-guided group. While specific indications for use of image guidance may exist, we cannot justify its routine use for this procedure.



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Immediate Trans-oral Allogeneic bone grafting for large mandibular defects. Less morbidity, more bone. A paradigm in benign tumor mandibular reconstruction?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James C. Melville, Nader N. Nassari, Issa A. Hanna, Jonathan W. Shum, Mark E. Wong, Simon Young
Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous bone grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. Predictable results have been obtained with using a combination of 100% cadaver bone, bone marrow aspirate concentrate (BMAC) and rhBMP-2 in immediate reconstruction for benign tumor extirpations via the extra-oral approach. In light of these successful outcomes, the same combination was evaluated with an intraoral approach. This study aims to evaluate the success of immediate mandibular reconstruction via intra-oral approach without any autogenous bone harvesting.Patients and MethodsThe aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC via trans-oral approach for immediate reconstruction of continuity defects resulted from benign tumor surgery. A retrospective chart review was performed of all patients undergoing bone graft reconstruction at UTHealth oral & maxillofacial surgery, between December 2014 to January 2016. Inclusion criteria are the following: biopsy proven benign tumors, ASA I/II health status and adequate intraoral soft tissue for primary closure determined during initial consultation.Results5 patients who underwent this procedure at University of Texas Health Sciences Center at Houston (UTHealth) Oral &Maxillofacial surgery, between December 2014 to January 2016, are presented. We report a 100% success rate. All patients demonstrated excellent bone quality both clinically as well as radiographically for endosseous dental implant placement. With the trans-oral approach and no autogenous bone harvesting, the average operating time was 3.4 hours and hospital stay was 2.4 days.ConclusionsComposite allogeneic tissue engineering is effective and predictable technique for immediate reconstruction of continuity defects from ablative benign tumor surgery. Overall, we had no donor site morbidity, less intraoperative time, fewer admission days and overall reduction in total costs compared to traditional methods.



http://ift.tt/2dYXZEI

Do antibiotics decrease the risk of inflammatory complications after third molar removal in community practices?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Melanie S. Lang, Martin L. Gonzalez, Thomas B. Dodson
PurposeThe role of antibiotic use in third molar (M3) surgery is controversial. The purpose of this study was to measure the association between antibiotic use and postoperative inflammatory complications following M3 surgery in the community office-based ambulatory private practice setting.Materials and MethodsThe investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who had at least one M3 removed in a private practice setting by oral and maxillofacial surgeons participating in a practice-based research collaborative between June, 2011 and May, 2012.The predictor variable was antibiotic use of any type, categorized as yes or no. The primary outcome variable was the presence or absence of an inflammatory complication, i.e. surgical site infection (SSI) or alveolar osteitis (AO), after M3 removal.Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between antibiotic use and inflammatory complications after M3 removal with statistical significance set at p-value ≤0.05.ResultsThe study sample was composed of 2954 subjects. Three-quarters (75.2%) of the sample received antibiotics in some form. The overall inflammatory complication (AO or SSI) frequencies in the antibiotic and non-antibiotic groups were 5.0 and 7.5%, respectively (p=0.012). After adjusting for differences between the two groups, statistical significance between the groups persisted.ConclusionsThe results of this study suggest that antibiotic therapy, regardless of type, dose, frequency or pattern of delivery, was associated with a decreased risk of inflammatory complications after M3 removal.



http://ift.tt/2dAJ4xH

Is Treating Oral & Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dean M. DeLuke, Vickas Agarwal, Trevor Holleman, Caroline K. Carrico, Daniel M. Laskin
PurposeOver the past two decades there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. While many factors may influence the decision not to take trauma call, one primary disincentive is the perception that managing facial trauma may be profitable for the hospital, but is not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the VCU Medical Center.Materials and MethodsIn this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery (OMS) between June 2011 and July 2014. Cost and reimbursement data were analyzed for these patients from both the VCU Health System (VCUHS) and the VCU Department of OMS. For the hospital, actual cost data was provided, and for the surgeon it was calculated based on an average overhead of 50 percent. For uniformity, patients were excluded if they remained in the hospital for more than a 23-hour observation period. Patients under the age of 18 were also excluded.ResultsA total of 169 patients met the inclusion criteria. There was a statistically significant difference in both the percent of costs recouped and the actual profit. The average percent of costs recouped was 230% for the VCUHS, while OMS only recouped 47% of costs.This amounts to an average profit per case of $3461 for the hospital versus a loss of $1162 for the surgeon.ConclusionsThe results of this study indicate that in our medical center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. While the results are limited to outpatient management at one academic institution, they suggest that hospitals in some settings may be in a position to incentivize surgeons for trauma management.



http://ift.tt/2dAIeRD

Technical Modifications for Intraoral Quadrangular Le Fort II Osteotomy

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): C. Klug, J. Cede
The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) represents a reliable surgical method in cases of midfacial deficiency with good functional, esthetic and stable long-term results.In this technical note we present 3 surgical modifications to previous reports: 1. inferior orbital rim osteotomy by angulated piezosurgical instruments thereby avoiding the use of chisels in the orbital region, 2. osteosynthetic fixation only laterally at the zygomatic buttress with 2 L-shaped miniplates thus avoiding paranasal osteosynthesis and 3. advancement step camouflage in the lateral infraorbital region with a compound mass of autologous bone chips and fibrin glue with the intention to reduce bone bloc associated side effects.13 consecutive patients presenting with midfacial deficiency and class III malocclusion were treated by means of IQLFIIO and mandibular osteotomies. In all cases osteotomy and consecutive downfracture could be conducted as planned by using the piezotome. No atypical fractures were encountered. There were no cases of infraorbital nerve anesthesia. Midfacial hypesthesia was found in 54% of operated sides after 3 months, after 6 months in 23%, after 12 months in 13%. Five months postoperative 3D scans revealed osseous healing at the infraorbital advancement step.Our results suggest that IQLFIIO can fully be conducted without chisels in the orbital region. Implementation of piezosurgery in IQLFIIO allows for safe bone cutting in the orbital region. Two miniplates and step camouflage with fibrin glue-stabilized bone chips are sufficient for osseous healing.Future studies will focus on quantitative soft to hard tissue changes that come along with IQLFIIO advancement.

Graphical abstract

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Complications of sialendoscopy in patients with Sjögren’s syndrome

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): K. Hakki Karagozoglu, Jan G. De Visscher, Tymour Forouzanfar, Erik H. van der Meij, Derk Jan Jager
PurposeRecent literature suggests that sialendoscopy of the major salivary glands could possibly alleviate symptoms of Sjögren's syndrome (SS) and restore salivary function. The aim of this study was, therefore, to evaluate our experience of sialendoscopy of the salivary glands in patients with SS.MethodsIn this retrospective case series study, the surgical data of patients with SS who had undergone sialendoscopy in the VU University Medical Center, Amsterdam between November 2014 and April 2015 were used. Outcome measures were successful entry in the salivary gland and completion of sialendoscopy as planned. Furthermore, per- and postoperative complications were scored. Descriptive analysis of the data was performed.ResultsSurgical data of sialendoscopic procedures in 26 patients with SS (24 women and 2 men; mean age 57 years (range 27-72 years) were analyzed. Sialendoscopy was successfully performed in 78 salivary glands (75%), 50 parotid and 28 submandibular glands, of the 104 salivary glands in the 26 patients. Sialendoscopy failed in 26 (25%) of the 104 sialendoscopic procedures (2 parotid and 24 submandibular glands). In 16 salivary glands the ductal orifice could not be identified. In 7 salivary glands sialendoscopy could not be performed due to partial or complete stenosis of salivary duct. In 3 salivary glands sialendoscopy was not performed because of a ductal perforation. Three patients developed a postoperative infection.ConclusionIt was found that the overall rate of complications was limited and types of complications of sialendoscopy in patients with SS could be regarded as minor. Most complications were seen in sialendoscopy of the submandibular glands in this specific patient category. Careful preoperative selection of both patients and salivary glands may contribute to a lower rate of complications and more predictable results.



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Is intra-articular steroid injection to the temporomandibular joint for juvenile idiopathic arthritis more effective and efficient when performed with image guidance?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Pouya M. Vakilian, Leonard B. Kaban, Zachary S. Peacock
PurposeTo compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA).MethodsThis is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital. Subjects were divided into groups according to IASI technique: (1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance, and (2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs. image-guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER) and total procedure time.ResultsForty-five subjects with 71 injected TMJs were included. Twenty-two subjects with 36 injected TMJs were in the landmark group, and 23 subjects with 35 injected joints were in the image-guided group. There were no significant differences in age, sex, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (p=1.00), increase in MIO (p=0.975), or decrease in ER (p=0.492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (p<0.008).ConclusionsWe found no significant differences in short-term outcomes but increased procedure times for the image-guided group. While specific indications for use of image guidance may exist, we cannot justify its routine use for this procedure.



http://ift.tt/2dYY3Em

Oral surgery in patients with Glanzmann thrombasthenia: a case series

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Eleonora Segna, Andrea Artoni, Raffaele Sacco, Aldo Bruno Giannì
Glanzmann thrombasthenia is a severe defect of platelet function caused by an inherited deficiency or dysfunction of the glycoprotein IIb/IIIa complex (GPIIb/IIIa), the platelet fibrinogen receptor. Patients diagnosed with Glanzmann thrombasthenia have a lifelong spontaneous and post-traumatic mucocutaneous bleeding diathesis. Surgery is usually very challenging, requiring close co-operation between surgeons, hematologists and anesthesiologists. For anatomical reasons, oral surgery is particularly difficult due to the inherent risk of hemorrhage and the difficulty in achieving local hemostasis. In this paper we describe three successful cases of oral surgery in patients with Glanzmann thrombasthenia and report the surgical and hematological management of each case.



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Psychiatric Comorbidity

Condition:   Otorhinolaryngologic Diseases
Intervention:   Other: Questionnaires
Sponsor:   Duke University
Not yet recruiting - verified September 2016

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Complications of sialendoscopy in patients with Sjögren’s syndrome

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): K. Hakki Karagozoglu, Jan G. De Visscher, Tymour Forouzanfar, Erik H. van der Meij, Derk Jan Jager
PurposeRecent literature suggests that sialendoscopy of the major salivary glands could possibly alleviate symptoms of Sjögren's syndrome (SS) and restore salivary function. The aim of this study was, therefore, to evaluate our experience of sialendoscopy of the salivary glands in patients with SS.MethodsIn this retrospective case series study, the surgical data of patients with SS who had undergone sialendoscopy in the VU University Medical Center, Amsterdam between November 2014 and April 2015 were used. Outcome measures were successful entry in the salivary gland and completion of sialendoscopy as planned. Furthermore, per- and postoperative complications were scored. Descriptive analysis of the data was performed.ResultsSurgical data of sialendoscopic procedures in 26 patients with SS (24 women and 2 men; mean age 57 years (range 27-72 years) were analyzed. Sialendoscopy was successfully performed in 78 salivary glands (75%), 50 parotid and 28 submandibular glands, of the 104 salivary glands in the 26 patients. Sialendoscopy failed in 26 (25%) of the 104 sialendoscopic procedures (2 parotid and 24 submandibular glands). In 16 salivary glands the ductal orifice could not be identified. In 7 salivary glands sialendoscopy could not be performed due to partial or complete stenosis of salivary duct. In 3 salivary glands sialendoscopy was not performed because of a ductal perforation. Three patients developed a postoperative infection.ConclusionIt was found that the overall rate of complications was limited and types of complications of sialendoscopy in patients with SS could be regarded as minor. Most complications were seen in sialendoscopy of the submandibular glands in this specific patient category. Careful preoperative selection of both patients and salivary glands may contribute to a lower rate of complications and more predictable results.



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Oral surgery in patients with Glanzmann thrombasthenia: a case series

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Eleonora Segna, Andrea Artoni, Raffaele Sacco, Aldo Bruno Giannì
Glanzmann thrombasthenia is a severe defect of platelet function caused by an inherited deficiency or dysfunction of the glycoprotein IIb/IIIa complex (GPIIb/IIIa), the platelet fibrinogen receptor. Patients diagnosed with Glanzmann thrombasthenia have a lifelong spontaneous and post-traumatic mucocutaneous bleeding diathesis. Surgery is usually very challenging, requiring close co-operation between surgeons, hematologists and anesthesiologists. For anatomical reasons, oral surgery is particularly difficult due to the inherent risk of hemorrhage and the difficulty in achieving local hemostasis. In this paper we describe three successful cases of oral surgery in patients with Glanzmann thrombasthenia and report the surgical and hematological management of each case.



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Psychiatric Comorbidity

Condition:   Otorhinolaryngologic Diseases
Intervention:   Other: Questionnaires
Sponsor:   Duke University
Not yet recruiting - verified September 2016

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Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India

Abstract

The present paper attempts to explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87 % were fresh/new cases. The age-group of 10–20 years was mostly involved, with multiple peaks around 50. About 82 % were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13 % had recurrent lesions that were statistically related to higher age-group (≥15 years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures.

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Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India

Abstract

The present paper attempts to explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87 % were fresh/new cases. The age-group of 10–20 years was mostly involved, with multiple peaks around 50. About 82 % were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13 % had recurrent lesions that were statistically related to higher age-group (≥15 years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures.

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Perioperative detection of alcoholic cardiomyopathy: cases and recommendations

A high intake of alcohol is associated with cancers of the head and neck1 and the development of alcoholic cardiomyopathy, which increases the risk of perioperative morbidity and death from damage to the heart. Excessive consumption (acute or chronic) can cause cardiac arrhythmias, particularly supraventricular tachycardia, atrial fibrillation, and extrasystoles, with incidences as high as 18%–33%. Electrocardiogram (ECG) findings include non-specific ST changes and left bundle branch block.

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Heated egg yolk challenge predicts the natural course of hen’s egg allergy: a retrospective study

Children do not always outgrow hen's egg allergies in early childhood. Because egg yolks are less allergenic than egg whites, we performed an oral food challenge with heated egg yolk slightly contaminated with...

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Tumor-directed immunotherapy can generate tumor-specific T cell responses through localized co-stimulation

Abstract

The most important goals for the field of immuno-oncology are to improve the response rate and increase the number of tumor indications that respond to immunotherapy, without increasing adverse side effects. One approach to achieve these goals is to use tumor-directed immunotherapy, i.e., to focus the immune activation to the most relevant part of the immune system. This may improve anti-tumor efficacy as well as reduce immune-related adverse events. Tumor-directed immune activation can be achieved by local injections of immune modulators in the tumor area or by directing the immune modulator to the tumor using bispecific antibodies. In this review, we focus on therapies targeting checkpoint inhibitors and co-stimulatory receptors that can generate tumor-specific T cell responses through localized immune activation.

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Contemporary experience with high-dose interleukin-2 therapy and impact on survival in patients with metastatic melanoma and metastatic renal cell carcinoma

Abstract

High-dose interleukin-2 (HD IL-2) was approved for treatment of metastatic renal cell carcinoma (mRCC) in 1992 and for metastatic melanoma (mM) in 1998, in an era predating targeted therapies and immune checkpoint inhibitors. The PROCLAIM^SM registry was established to collect and analyze data for patients treated with HD IL-2 in the current era. This analysis includes 170 patients with mM and 192 patients with mRCC treated between 2005 and 2012 with survival data current as of July 27, 2015. For patients with mM, complete response (CR) was observed in 5 %, partial response (PR) in 10 %, stable disease (SD) in 22 %, and 63 % had progressive disease (PD). The median overall survival (mOS) for these patients was 19.6 months, with a median follow-up of 43.1 months. The mOS was not reached for patients achieving CR or PR, and was 33.4 months for patients with SD. For patients with mRCC, 6 % achieved CR, 9 % had PR, 22 % had SD, and 62 % had PD. The mOS was 41 months, with a median follow-up of 46.6 months. The mOS for patients who had CR and PR was not reached and was 49.6 months for patients with SD. There were no treatment-related deaths among 362 patients. The duration of mOS for patients with mM and mRCC is longer than historically reported. These data support a continued role for IL-2 in the treatment of eligible patients with mM or mRCC and warrant further evaluation of HD IL-2 in combination or sequence with other therapeutic agents.

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Perioperative detection of alcoholic cardiomyopathy: cases and recommendations

Publication date: Available online 6 October 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Pierson, G. James, A. Norman




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Clinical features of peri - implant medication - related osteonecrosis of the jaw: is there an association to peri - implantitis?

The purpose of this study was to examine the behavior of dental implants in patients diagnosed with MRONJ and to analyze the characteristics of peri – implant MRONJ. It was hypothesized that peri – implant parameters are not associated with peri – implant MRONJ.A retrospective study design was selected to address the research purpose. Patients with confirmed MRONJ and the simultaneous presence of dental implants who presented between 2010 and 2016 served as the study cohort. Predefined inclusion and exclusion criteria were applied.

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Neurocognitive function in patients with residual excessive sleepiness from obstructive sleep apnea: a prospective, controlled study

• Patients with residual excessive sleepiness (RES) are at risk for mild impairment in executive functions and verbal fluency.• The RES incidence after controlling for confounders was 7.42%.

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Lactobacillus reuteri DSM 17938 plus vitamin D3 as ancillary treatment in allergic children with asthma

Asthma is a heterogeneous disease usually characterized by chronic airway inflammation.1 Allergy and asthma prevalence has significantly increased worldwide during the past decades,2 and the hygiene hypothesis suggests that reduced exposure to microbial agents could increase the risk of allergic diseases.3 This theory has been recently revisited with an emphasis on the role of microbiota dysbiosis that promotes impaired immunologic tolerance to allergens.4 In addition, vitamin D3 deficiency has been associated with asthma and allergy inception and worsening.

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Omalizumab for the treatment of chronic spontaneous urticaria in clinical practice

Chronic spontaneous urticaria (CSU) is a skin disease that predominantly affects adults, especially women aged 20 to 40 years, and is characterized by the recurrent appearance of localized or widespread wheals, angioedema or both, without apparent external trigger.1,2 Severe CSU has a detrimental effect on the quality of life and is a frequent cause of absenteeism from school and work.3 The pathogenesis of CSU is not well understood, and it appears to have an autoimmune cause in approximately one-third of patients.

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Inflammatory responses increase secretion of MD-1 protein

Radioprotective 105 (RP105) is a type I transmembrane protein, which associates with a glycoprotein, MD-1. Monoclonal antibody (mAb)-mediated ligation of RP105/MD-1 robustly activates B cells. RP105/MD-1 is structurally similar to Toll-like receptor 4 (TLR4)/MD-2. B-cell responses to TLR2 and TLR4/MD-2 ligands are impaired in the absence of RP105 or MD-1. In addition to RP105/MD-1, MD-1 alone is secreted. The structure of MD-1 shows that MD-1 has a hydrophobic cavity that directly binds to phospholipids. Little is known, however, about a ligand for MD-1 and the role of MD-1 in vivo. To study the role of RP105/MD-1 and MD-1 alone, specific mAbs against MD-1 are needed. Here, we report the establishment and characterization of two anti-MD-1 mAbs (JR2G9, JR7G1). JR2G9 detects soluble MD-1, whereas JR7G1 binds both soluble MD-1 and the cell surface RP105/MD-1 complex. With these mAbs, soluble MD-1 was detected in the serum and urine. The MD-1 concentration was altered by infection, diet and reperfusion injury. Serum MD-1 was rapidly elevated by TLR ligand injection in mice. The quantitative PCR and supernatant-precipitated data indicate that macrophages are one of the sources of serum soluble MD-1. These results suggest that soluble MD-1 is a valuable biomarker for inflammatory diseases.

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A novel role of MMP-13 for murine DC function: its inhibition dampens T-cell activation

Dendritic cells (DCs) have been shown to express matrix metalloproteinase 13 (MMP-13), but little is known about its specific function in DCs and its role in inflammatory conditions. In the present study, we describe a novel role of MMP-13 in regulating the immunostimulatory function of murine DCs through moderating MHC-I surface presentation, endocytosis and cytokine/chemokine secretion. MMP-13 expression was confirmed in bone marrow-derived DCs at both the mRNA and the protein level and, furthermore, at the activity level. Remarkably, LPS treatment strongly enhanced MMP-13 mRNA expression as well as MMP-13 activity, indicating an important role of MMP-13 in inflammatory processes. Functionally, MMP-13 inhibition did not influence the DC migratory capacity, while endocytosis of ovalbumin was significantly decreased. Inhibition of MMP-13 lowered the capability of murine DCs to activate CD8⁺ T cells, apparently through reducing MHC-I surface presentation. Decreased surface expression of CD11c on DCs, as well as changes in the DC cytokine/chemokine profile after MMP-13 inhibition, emphasizes the influence of MMP-13 on DC function. Moreover, T-cell-targeting cytokines such as IL-12, IL-23 and IL-6 were significantly reduced. Collectively, our data reveal a novel involvement of MMP-13 in regulating DC immunobiology through moderating MHC-I surface presentation, endocytosis and cytokine/chemokine secretion. Furthermore, the reduced MHC-I surface presentation by DCs resulted in a poor CD8⁺ T-cell response in vitro. This novel finding indicates that MMP-13 might be a promising target for therapeutic intervention in inflammatory diseases.

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Cover

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Table of Contents

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IL-10-producing lung interstitial macrophages prevent neutrophilic asthma

Inflammatory responses contribute to host defense against harmful organisms and allergens, whereas a failure of immune tolerance can cause chronic inflammation including asthma. The lung has several innate myeloid cell subsets. Among these subsets, there are two types of macrophages: alveolar macrophages (AMs) and interstitial macrophages (IMs). However, compared with AMs, the role of IMs in lung homeostasis remains poorly understood. In this study, we characterized AMs and IMs in healthy and inflammatory conditions. Pulmonary IMs constitutively produce the anti-inflammatory cytokine IL-10 through activation of the TLR4/MyD88 pathway in a microbiota-independent manner. In addition to IMs, Foxp3⁺ T_reg cells show persistent IL-10 expression in the lung, with IL-10-producing IMs more prevalent than Foxp3⁺ T_reg cells. IMs, but not Foxp3⁺ T_reg cells, increased IL-10 production in house dust mite (HDM)-challenged mice, a model of human asthma. HDM-challenged Il10 ^–/– mice exhibited severe lung pathology characterized by neutrophilia compared with that of wild-type mice. In addition, transplantation of wild-type IMs reduced neutrophilic inflammation, goblet cell mucus production and decreased expression of lung IL-13 and T_h17-related neutrophil-activating cytokines such as IL-17, GM-CSF, and TNF-α. Together these results demonstrate that IL-10-producing IMs negatively regulate T_h2- and T_h17-mediated inflammatory responses, helping prevent neutrophilic asthma.

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In This Issue

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Rapamycin results in Bim-mediated loss of thymic regulatory T cells during development in organ culture

Thymus-derived regulatory T cells (Tregs) are essential for the maintenance of immunological tolerance. Diverse signalling pathways contribute to thymic Treg cells (tTregs) development; however, the role of mammalian target of rapamycin (mTOR) remains unclear. Rapamycin is a well-characterized inhibitor of mTOR complex 1 signalling and a potent inducer of Treg cells in the periphery. However, the effect of rapamycin on the development of tTregs is poorly defined. Here we have used thymic organ culture to investigate the effect of rapamycin on tTreg development. We show that, contrary to its effect in the periphery, rapamycin inhibits the development of tTregs in wild-type thymi. The inhibition of tTregs by rapamycin could be rescued by a deficiency of Bim. However, rapamycin did not inhibit the development of antigen-specific TCR transgenic tTregs in response to exogenous peptide antigen, indicating that the development of thymic Foxp3⁺CD4⁺ cells was not intrinsically inhibited by rapamycin. Collectively our data demonstrate that rapamycin results in a reduction of tTregs because of Bim-mediated apoptosis of immature tTregs via a cell extrinsic mechanism. These findings are important not only for understanding the mechanism of tTreg induction but also for an appreciation of the impact of the clinical application of rapamycin.

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Temporomandibular Joint (TMJ) arthroscopic lysis and lavage: Outcomes and rate of progression to open surgery

Publication date: Available online 5 October 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Omar Breik, Vishakha Devrukhkar, George Dimitroulis
PurposeArthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ (Temporomandibular joint) diseases. The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery.Materials and methodsA retrospective cohort study of a single operator series was performed over a 6-year period from 2006-2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. The data were analyzed via Kaplan Meier method for time-to event analyses and Chi-squared tests for trend analyses. Pre-operative and post-operative Visual analogue scores and maximum inter-incisal opening results were analysed with the Student's t-test.ResultsA total of 167 patients and 216 joints underwent arthroscopy with a mean follow up of 6.9 years. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p <0.005). The highest failure rate between age groups was in the 21-30 year age group (p<0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p< 0.0001).ConclusionArthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e, Categories 1,2 and 3) disorders of the TMJ. Patients with more advanced joint disease (ie., Categories 4 & 5) gained only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery.



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Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis

Abstract

Background

Internal derangement of the temporomandibular joint (TMJ) is one of the most common forms of temporomandibular disorders. The minimally invasive treatments such as arthrocentesis as well as arthroscopic lysis and lavage are often used as a first-line surgical treatment or in conjunction with nonsurgical modalities with low morbidity and high efficacy. Sodium hyaluronate (SH) has been proposed as an alternative therapeutic agent with similar therapeutic effects.

Objective

A prospective study was carried out for evaluation of efficacy of TMJ arthrocentesis with and without injection of SH in management of internal derangements.

Material and methods

A total of 30 patients suffering from internal derangement of TMJ were selected for this study. Patients were randomly divided into the following two groups: group 1—arthrocentesis-only group and group 2—arthrocentesis + SH group. Each group constituted 15 patients.

Results

Six-month postoperative mean mouth opening (MMO) increase was 13.61 ± 1.64 and 15.53 ± 3.01 mm in group 1 and group 2, respectively. At 6 months, there was marked improvement in masticatory efficiency with mean increase of 5.07 ± 0.13 in group 1 and 6.40 ± 0.04 in group 2. Mean pain reduction was 5.27 ± 0.67 and 6.48 ± 0.44 in group 1 and group 2, respectively.

Conclusion

Although our series comprised a limited number of cases and a short follow-up period, initial results suggested that arthrocentesis with SH injection seemed to be superior to art.

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Health-Related Quality of Life in Korean Adults with Hearing Impairment: The Korea National Health and Nutrition Examination Survey 2010 to 2012

by Min Kwan Baek, Young Saing Kim, Eun Young Kim, Ae Jin Kim, Won-Jun Choi

Background

As the global population ages, disabling hearing impairment (HI) have been increased rapidly. The impact of HI on health-related quality of life (HRQoL) is of great importance to aid the development of strategic plans and to guide therapeutic interventions.

Purpose

To evaluate HRQoL in Korean adults with different degrees of HI using EuroQol five-dimensional (EQ-5D) and EQ-visual analogue scale (VAS), the preference-based generic measures of HRQoL.

Methods

Using a representative dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) from January 2010 to December 2012, EQ-5D questionnaire and EQ- VAS scores of subjects with HI were compared with those of subjects without HI. Logistic regression analysis, with adjustment for covariates, was used to evaluate the impact of HI on HRQoL scales. HI was defined according to the hearing thresholds of pure-tone averages at 0.5, 1, 2, and 3 kHz of the better hearing ear as follows; mild HI (26 to Results

Of the 16,449 Korean adults in KNHANES (age, 45.0 ± 0.2 years; male, 49.7%), 1757 (weighted prevalence, 7.6%) had mild HI and 890 (3.6%) had moderate to severe HI. Subjects with HI had impaired HRQoL as compared with subjects without HI (EQ-5D, 0.96 ± 0.00 vs. 0.88±0.00 vs. 0.86 ± 0.01 for control vs. mild HI vs. moderate to severe HI, p p p = 0.004), but EQ-5D impairment disappeared (0.86 ± 0.02 vs.0.88±0.01 for moderate to severe HI vs. control, p = 0.058).

Conclusion

After adjusting for socio-demographic and psychosocial factors and comorbidities, Korean adults with moderate to severe HI rated their health statuses lower than subjects without HI.

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Rapid Release From Listening Effort Resulting From Semantic Context, and Effects of Spectral Degradation and Cochlear Implants

People with hearing impairment are thought to rely heavily on context to compensate for reduced audibility. Here, we explore the resulting cost of this compensatory behavior, in terms of effort and the efficiency of ongoing predictive language processing. The listening task featured predictable or unpredictable sentences, and participants included people with cochlear implants as well as people with normal hearing who heard full-spectrum/unprocessed or vocoded speech. The crucial metric was the growth of the pupillary response and the reduction of this response for predictable versus unpredictable sentences, which would suggest reduced cognitive load resulting from predictive processing. Semantic context led to rapid reduction of listening effort for people with normal hearing; the reductions were observed well before the offset of the stimuli. Effort reduction was slightly delayed for people with cochlear implants and considerably more delayed for normal-hearing listeners exposed to spectrally degraded noise-vocoded signals; this pattern of results was maintained even when intelligibility was perfect. Results suggest that speed of sentence processing can still be disrupted, and exertion of effort can be elevated, even when intelligibility remains high. We discuss implications for experimental and clinical assessment of speech recognition, in which good performance can arise because of cognitive processes that occur after a stimulus, during a period of silence. Because silent gaps are not common in continuous flowing speech, the cognitive/linguistic restorative processes observed after sentences in such studies might not be available to listeners in everyday conversations, meaning that speech recognition in conventional tests might overestimate sentence-processing capability.

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