A decade of ISHAM Working Groups

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Malassezia ecology, pathophysiology, and treatment

Abstract

Malassezia are lipid dependent basidiomycetous yeasts that inhabit the skin and mucosa of humans and other warm-blooded animals, and are a major component of the skin microbiome. They occur as skin commensals, but are also associated with various skin disorders and bloodstream infections. The genus currently comprises 17 species and has recently been assigned its own class, Malasseziomycetes. Importantly, multiple Malassezia species and/or genotypes may cause unique or similar pathologies and vary in their antifungal susceptibility. In addition to culture-based approaches, culture-independent methods have added to our understanding of Malassezia presence and abundance and their relationship to pathogenicity. Moreover, these novel approaches have suggested a much wider-spread presence, including other human body parts and even other ecosystems, but their role in these arenas requires further clarification. With recent successful transformation and genetic engineering of Malassezia, the role of specific genes in pathogenesis can now be studied. We suggest that characterizing the metabolic impact of Malassezia communities rather than species identification is key in elucidation of pathophysiological associations. Finally, the increasing availability of genome sequences may provide key information aiding faster diagnostics, and understanding of the biochemical mechanisms for Malassezia skin adaptation and the design of future drugs.

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Diagnosis of aspergillosis by PCR: Clinical considerations and technical tips

Abstract

Standardization of Aspergillus polymerase chain reaction (PCR) protocols has progressed, and analytical validity of blood-based assays has been formally established. It remains necessary to consider how the tests can be used in practice to maximize clinical utility. To determine the optimal diagnostic strategies and influence on patient management, several factors require consideration, including the patient population, incidence of invasive aspergillosis (and other fungal disease), and the local antifungal prescribing policy. Technical issues such as specimen type, ease of sampling, frequency of testing, access to testing centers, and time to reporting will also influence the use of PCR in clinical practice. Interpretation of all diagnostic tests is dependent on the clinical context and molecular assays are no exception, but with the proposal to incorporate Aspergillus PCR into the second revision of the consensus guidelines for defining invasive fungal disease the acceptance and understanding of molecular tests should improve.

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Scedosporium and Lomentospora: an updated overview of underrated opportunists

Abstract

Species of Scedosporium and Lomentospora are considered as emerging opportunists, affecting immunosuppressed and otherwise debilitated patients, although classically they are known from causing trauma-associated infections in healthy individuals. Clinical manifestations range from local infection to pulmonary colonization and severe invasive disease, in which mortality rates may be over 80%. These unacceptably high rates are due to the clinical status of patients, diagnostic difficulties, and to intrinsic antifungal resistance of these fungi. In consequence, several consortia have been founded to increase research efforts on these orphan fungi. The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxonomy, environmental distribution, epidemiology, pathology, virulence factors, immunology, diagnostic methods, and therapeutic strategies.

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Black yeasts in the omics era: Achievements and challenges

Abstract

Black yeasts (BY) comprise a group of polyextremotolerant fungi, mainly belonging to the order Chaetothyriales, which are capable of colonizing a wide range of extreme environments. The tolerance to hostile habitats can be explained by their intrinsic ability to survive under acidic, alkaline, and toxic conditions, high temperature, low nutrient availability, and osmotic and mechanical stress. Occasionally, some species can cause human chromoblastomycosis, a chronic subcutaneous infection, as well as disseminated or cerebral phaeohyphomycosis. Three years after the release of the first black yeast genome, the number of projects for sequencing these organisms has significantly increased. Over 37 genomes of important opportunistic and saprobic black yeasts and relatives are now available in different databases. The whole-genome sequencing, as well as the analysis of differentially expressed mRNAs and the determination of protein expression profiles generated an unprecedented amount of data, requiring the development of a curated repository to provide easy accesses to this information. In the present article, we review various aspects of the impact of genomics, transcriptomics, and proteomics on black yeast studies. We discuss recent key findings achieved by the use of these technologies and further directions for medical mycology in this area. An important vehicle is the Working Groups on Black Yeasts and Chromoblastomycosis, under the umbrella of ISHAM, which unite the clinicians and a highly diverse population of fundamental scientists to exchange data for joint publications.

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Sporotrichosis between 1898 and 2017: The evolution of knowledge on a changeable disease and on emerging etiological agents.

Abstract

The description of cryptic species with different pathogenic potentials has changed the perspectives on sporotrichosis. Sporothrix schenckii causes a benign chronic subcutaneous mycosis, Sporothrix brasiliensis is highly virulent, and Sporothrix globosa mainly causes fixed cutaneous lesions. Furthermore, S. brasiliensis is the prevalent species related to cat-transmitted sporotrichosis. Sources of infection, transmission, and distribution patterns also differ between species, and variability differs between species because of different degrees of clonality. The present review article will cover several aspects of the biology of clinically relevant agents of sporotrichosis, including epidemiological aspects of emerging species. Genomic information of Sporothrix spp. is also discussed. The cell wall is an essential structure for cell viability, interaction with the environment, and the host immune cells and contains several macromolecules involved in virulence. Due to its importance, aspects of glycosylation and cell wall polysaccharides are reviewed. Recent genome data and bioinformatics analyses helped to identify specific enzymes of the biosynthetic glycosylation routes, with no homologs in mammalian cells, which can be putative targets for development of antifungal drugs. A diversity of molecular techniques is available for the recognition of the clinically relevant species of Sporothrix. Furthermore, antigens identified as diagnostic markers and putative vaccine candidates are described. Cell-mediated immunity plays a key role in controlling infection, but Sporothrix species differ in their interaction with the host. The adaptive branch of the immune response is essential for appropriate control of infection.

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Triazole resistance surveillance in Aspergillus fumigatus

Abstract

Triazole resistance is an increasing concern in the opportunistic mold Aspergillus fumigatus. Resistance can develop through exposure to azole compounds during azole therapy or in the environment. Resistance mutations are commonly found in the Cyp51A-gene, although other known and unknown resistance mechanisms may be present. Surveillance studies show triazole resistance in six continents, although the presence of resistance remains unknown in many countries. In most countries, resistance mutations associated with the environment dominate, but it remains unclear if these resistance traits predominately migrate or arise locally. Patients with triazole-resistant aspergillus disease may fail to antifungal therapy, but only a limited number of cohort studies have been performed that show conflicting results. Treatment failure might be due to diagnostic delay or due to the limited number of alternative treatment options. The ISHAM/ECMM Aspergillus Resistance Surveillance working group was set up to facilitate surveillance studies and stimulate international collaborations. Important aims are to determine the resistance epidemiology in countries where this information is currently lacking, to gain more insight in the clinical implications of triazole resistance through a registry and to unify nomenclature through consensus definitions.

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Fusarium metavorans sp. nov.: The frequent opportunist ‘FSSC6’

Abstract

The Fusarium solani species complex (FSSC) is the most common group of fusaria associated with superficial and life-threatening infections in humans. Here we formally introduce Fusarium metavorans sp. nov., widely known as FSSC6 (Fusarium solani species complex lineage 6), one of the most frequent agents of human opportunistic infections. The species is described with multilocus molecular data including sequences of internal transcribed spacer region (ITS), portions of the translation elongation factor 1-a gene (TEF1), and the partial RNA polymerase II gene (rPB2). A phylogenetic approach was used to evaluate species delimitation. Topologies of the trees were concordant. Phylogenetic analyses suggest that the FSSC consists of three major clades encompassing a large number of phylogenetic species; Fusarium metavorans corresponds to phylogenetic species 6 within FSSC clade 3. The species has a global distribution and a wide ecological amplitude, also including strains from soil and agents of opportunistic plant disease; it was also isolated from the gut of the wood-boring cerambycid beetle Anoplophora glabripennis.

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Candida vaginitis: virulence, host response and vaccine prospects

Abstract

Vulvovaginal candidiasis is a common mucosal infection affecting a large proportion of women with some of them affected by recurrent often intractable forms of the disease. Thus, there is an increasing interest in understanding the pathogenesis of this disease. The aim of our work was to characterize, in animal models of vaginal candidiasis, the components of the host-fungus interaction at the mucosal level.The evidence of an immune response in the vaginal compartment was very encouraging to identify the proper targets for new strategies for vaccination or immunotherapy of vaginal candidiasis. Aspartyl-proteinase (Sap2), which is an important immunodominant antigens and virulence factors of C.albicans acting in mucosal infections, was assembled with virosomes and a vaccine PEV7 was obtained. The results obtained in the mouse model and in the clinical trial conducted by Pevion on women have evidenced that the vaccine PEV7, intravaginally administered, has an encouraging therapeutic potential for the treatment of recurrent vulvovaginal candidiasis. This opens the way to a modality for anti-Candida protection at mucosal level.

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Closing the mycetoma knowledge gap

Abstract

On 28th May 2016, mycetoma was recognized as a neglected tropical disease by the World Health Organization. This was the result of a 4-year journey starting in February 2013 with a meeting of global mycetoma experts. Knowledge gaps were identified and included the incidence, prevalence, and mapping of mycetoma; the mode of transmission; the development of methods for early diagnosis; and better treatment. In this review, we review the road to recognition, the ISHAM working group meeting in Argentina, and we address the progress made in closing the knowledge gaps since 2013. Progress included adding another 9000 patients to the literature, which allowed us to update the prevalence map on mycetoma. Furthermore, based on molecular phylogeny, species names were corrected and four novel mycetoma causative agents were identified. By mapping mycetoma causative agents an association with Acacia trees was found. For early diagnosis, three different isothermal amplification techniques were developed, and novel antigens were discovered. To develop better treatment strategies for mycetoma patients, in vitro susceptibility tests for the coelomycete agents of black grain mycetoma were developed, and the first randomized clinical trial for eumycetoma started early 2017.

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Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis

Abstract

Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.

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Fungal infections in animals: a patchwork of different situations

Abstract

The importance of fungal infections in both human and animals has increased over the last decades. This article represents an overview of the different categories of fungal infections that can be encountered in animals originating from environmental sources without transmission to humans. In addition, the endemic infections with indirect transmission from the environment, the zoophilic fungal pathogens with near-direct transmission, the zoonotic fungi that can be directly transmitted from animals to humans, mycotoxicoses and antifungal resistance in animals will also be discussed. Opportunistic mycoses are responsible for a wide range of diseases from localized infections to fatal disseminated diseases, such as aspergillosis, mucormycosis, candidiasis, cryptococcosis and infections caused by melanized fungi. The amphibian fungal disease chytridiomycosis and the Bat White-nose syndrome are due to obligatory fungal pathogens. Zoonotic agents are naturally transmitted from vertebrate animals to humans and vice versa. The list of zoonotic fungal agents is limited but some species, like Microsporum canis and Sporothrix brasiliensis from cats, have a strong public health impact. Mycotoxins are defined as the chemicals of fungal origin being toxic for warm-blooded vertebrates. Intoxications by aflatoxins and ochratoxins represent a threat for both human and animal health. Resistance to antifungals can occur in different animal species that receive these drugs, although the true epidemiology of resistance in animals is unknown, and options to treat infections caused by resistant infections are limited.

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Aspergillus terreus: Novel lessons learned on amphotericin B resistance

Abstract

The polyene antifungal amphotericin B (AmB) exerts a powerful and broad activity against a vast array of fungi and in general displays a remarkably low rate of antimicrobial resistance. Aspergillus terreus holds an exceptional position among the Aspergilli due to its intrinsic AmB resistance, in vivo and in vitro. Until now, the underlying mechanisms of polyene resistance were not well understood. This review will highlight the molecular basis of A. terreus and AmB resistance recently gained and will display novel data on the mode of action of AmB. A main focus is set on fundamental stress response pathways covering the heat shock proteins (Hsp) 90/Hsp70 axis, as well as reactive oxygen species detoxifying enzymes in response to AmB. The effect on main cellular functions such as fungal respiration will be addressed in detail and resistance mechanisms will be highlighted. Based on these novel findings we will discuss new molecular targets for alternative options in the treatment of invasive infections due to A. terreus.

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New insights in dermatophyte research

Abstract

Dermatophyte research has renewed interest because of changing human floras with changing socioeconomic conditions, and because of severe chronic infections in patients with congenital immune disorders. Main taxonomic traits at the generic level have changed considerably, and now fine-tuning at the species level with state-of-the-art technology has become urgent. Research on virulence factors focuses on secreted proteases now has support in genome data. It is speculated that most protease families are used for degrading hard keratin during nitrogen recycling in the environment, while others, such as Sub6 may have emerged as a result of ancestral gene duplication, and are likely to have specific roles during infection. Virulence may differ between mating partners of the same species and concepts of zoo- and anthropophily may require revision in some recently redefined species. Many of these questions benefit from international cooperation and exchange of materials. The aim of the ISHAM Working Group Dermatophytes aims to stimulate and coordinate international networking on these fungi.

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Challenges in the diagnosis and treatment of mucormycosis

Abstract

The diagnosis and treatment of mucormycosis are challenging. The incidence of the disease seems to be increasing. Hematological malignancies are the most common underlying disease in countries with high income and uncontrolled diabetes in developing countries. Clinical approach to diagnosis lacks sensitivity and specificity. Radiologically, multiple (≥10) nodules and pleural effusion are reportedly associated with pulmonary mucormycosis. Another finding on computerized tomography (CT) scan, which seems to indicate the presence of mucormycosis, is the reverse halo sign. Microscopy (direct and on histopathology) and culture are the cornerstones of diagnosis. Molecular assays can be used either for detection or identification of mucormycetes, and they can be recommended as valuable add-on tools that complement conventional diagnostic procedures. Successful management of mucormycosis is based on a multimodal approach, including reversal or discontinuation of underlying predisposing factors, early administration of active antifungal agents at optimal doses, complete removal of all infected tissues, and use of various adjunctive therapies. Our armamentarium of antifungals is slightly enriched by the addition of two newer azoles (posaconazole and isavuconazole) to liposomal amphotericin B, which remains the drug of choice for the initial antifungal treatment, according to the recently published guidelines by ECIL-6, as well as those published by ECMM/ESCMID. Despite the efforts for better understanding of the pathogenesis, early diagnosis and aggressive treatment of mucormycosis, the mortality rate of the disease remains high.

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Editorial Board

Publication date: July 2018
Source:Computer Speech & Language, Volume 50





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Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic

Publication date: Available online 10 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kimberly J. Waddell, Catherine E. Lang
ObjectiveTo compare self-reported with sensor-measured upper limb (UL) performance in daily life for individuals with chronic (≥6mo) UL paresis poststroke.DesignSecondary analysis of participants enrolled in a phase II randomized, parallel, dose-response UL movement trial. This analysis compared the accuracy and consistency between self-reported UL performance and sensor-measured UL performance at baseline and immediately post an 8-week intensive UL task-specific intervention.SettingOutpatient rehabilitation.ParticipantsCommunity-dwelling individuals with chronic (≥6mo) UL paresis poststroke (N=64).InterventionsNot applicable.Main Outcome MeasuresMotor Activity Log amount of use scale and the sensor-derived use ratio from wrist-worn accelerometers.ResultsThere was a high degree of variability between self-reported UL performance and the sensor-derived use ratio. Using sensor-based values as a reference, 3 distinct categories were identified: accurate reporters (reporting difference ±0.1), overreporters (difference >0.1), and underreporters (difference <−0.1). Five of 64 participants accurately self-reported UL performance at baseline and postintervention. Over half of participants (52%) switched categories from pre-to postintervention (eg, moved from underreporting preintervention to overreporting postintervention). For the consistent reporters, no participant characteristics were found to influence whether someone over- or underreported performance compared with sensor-based assessment.ConclusionsParticipants did not consistently or accurately self-report UL performance when compared with the sensor-derived use ratio. Although self-report and sensor-based assessments are moderately associated and appear similar conceptually, these results suggest self-reported UL performance is often not consistent with sensor-measured performance and the measures cannot be used interchangeably.



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Noisy vestibular stimulation increases gait speed in normals and in bilateral vestibulopathy

Publication date: Available online 10 March 2018
Source:Brain Stimulation
Author(s): Shinichi Iwasaki, Chisato Fujimoto, Naoya Egami, Makoto Kinoshita, Fumiharu Togo, Yoshiharu Yamamoto, Tatsuya Yamasoba
BackgroundGalvanic vestibular stimulation delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information.Objective/Hypothesis: To examine the effect of an imperceptible level of noisy GVS on dynamic locomotion in normal subjects as well as in patients with bilateral vestibulopathy.MethodsWalking performance of 19 healthy subjects and 12 patients with bilateral vestibulopathy at their preferred speed was examined during application of noisy GVS with an amplitude ranging from 0 to 1000 μA. The gait velocity, stride length and stride time were analyzed.ResultsNoisy GVS had significant effects on gait velocity, stride length and stride time in healthy subjects as well as in patients with bilateral vestibulopathy (p < 0.05). The optimal amplitude of noisy GVS improved gait velocity by 10.9 ± 1.2%, stride length by 5.7 ± 1.2% and stride time by 4.6 ± 7% (p < 0.0001) compared to the control session in healthy subjects. The optimal stimulus improved gait velocity by 12.8 ± 1.3%, stride length by 8.3 ± 1.1% and stride time by 3.7 ± 7% (p < 0.0001) in patients with bilateral vestibulopathy. The improved values of these parameters of locomotion by noisy GVS in the patients were not significantly different from those in healthy subjects in the control condition (p > 0.4).ConclusionNoisy GVS is effective in improving gait performance in healthy subjects as well as in patients with bilateral vestibulopathy.



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Intradural spinal tumors: 10 – years surgical experience in a single institution

Publication date: Available online 10 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Pablo David Guerrero-Suarez, Ernesto Magdaleno-Estrella, Paola Guerrero-López, Arturo Isaac Vargas-Figueroa, Jaime Jesús Martínez-Anda
ObjectivesThe aim of the study is to present the therapeutic results of intradural tumour management over a 10 years period in a single institution.Patients and methodsThe study consists in a prospective case series of patients treated at the neurosurgery service of the Social Security Institute of Mexico State and Provinces (ISSSEMYM), between January 2006 and December 2016. All patients were provided with information about the procedure and signed informed consent and institutional board approved files review for this study.ResultsThirty-five patients with intradural tumour were treated between 2006 - 2016. Most frequent lesions were extramedullary (30 patients, 85.7%). Most frequent tumor was Schwannoma, with thoracic / thoraco – lumbar location, being the most frequent location. All patients underwent surgical treatment, with total gross resection accomplished in 19 patients (54.3%). Surgical complication rate was 11.4%. Spine instrumentation was necessary in 26 patients (74.3%) because of bone destruction by the tumor, or bone removal for approach. All patients with intramedullary lesions and 5 patients (16.7%) with extramedullary lesions received post – operative radiotherapy. During the follow – up, 8.5% of patients had recurrence / progression of residual disease.ConclusionsMicrosurgery is the treatment of choice for intradural spinal tumors, and gross total resection with low morbidity must be the surgical goal. When this is not possible, partial resection and adjuvant therapy with radiosurgery are a valid option. Patients most be long followed – up because of recurrence risk or disease progression.



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Arachnoid isolation sign: A predictive imaging feature of spinal meningioma on CT-myelogram

Publication date: Available online 10 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Masato Anno, Nobuhiro Hara, Takashi Yamazaki
ObjectNumerous studies have demonstrated the imaging features to differentiate spinal meningioma and schwannoma. However, diagnosis can be controversial among clinicians. The purpose of our study was to evaluate the diagnostic value of a novel imaging finding of meningioma on CT-myelogram (CTM).Patients and MethodsImaging findings of patients who underwent surgeries for spinal cord tumors between April 2005 to May 2015 were retrospectively reviewed. Our inclusion criteria were as follows: 1) intradural extramedullary tumor, 2) both magnetic resonance imaging (MRI) and CTM were available. The exclusion criterion was a tumor that showed invasion to extradural space.ResultsThirty spinal meningiomas and schwannomas were identified (eight meningiomas and 22 schwannomas). Among these, two meningiomas showed a characteristic imaging phenomenon on CTM: they were diagnosed as intradural tumors on MR imaging while on CTM, they were isolated by the contrast agent in subarachnoidal space from the intact spinal cord. We named this imaging feature, the arachnoid isolation sign (AIS). None of the schwannomas showed this imaging feature.ConclusionWe identified a unique imaging feature of spinal meningioma on CTM. The sensitivity and specificity were 25% and 100%, respectively. In the current case, its diagnostic value was the same as the calcification on CT. Although the number is still small, the AIS may be useful to discern a spinal meningioma from schwannoma.



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Surgery for brain metastases: An analysis of outcomes and factors affecting survival

Publication date: Available online 10 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Masillamany Sivasanker, Venkatesh S Madhugiri, Aliasgar V Moiyadi, Prakash Shetty, T S Subi
ObjectivesFor patients who develop brain metastases from solid tumors, age, KPS, primary tumor status and presence of extracranial metastases have been identified as prognostic factors. However, the factors that affect survival in patients who are deemed fit to undergo resection of brain metastases have not been clearly elucidated hitherto.Patients and MethodsThis is a retrospective analysis of a prospectively maintained database. All patients who underwent resection of intracranial metastases from solid tumors were included. Various patient, disease and treatment related factors were analyzed to assess their impact on survival.ResultsOverall, 124 patients had undergone surgery for brain metastases from various primary sites. The median age and pre-operative performance score were 53 years and 80 respectively. Synchronous metastases were resected in 17.7% of the patients. The postoperative morbidity and mortality rates were 17.7% and 2.4% respectively. Adjuvant whole brain radiation was received by 64 patients. At last follow-up, 8.1% of patients had fresh post-surgical neurologic deficits. The median progression free and overall survival were 6.91 was 8.56 months respectively.ConclusionsSurgical resection of for brain metastases should be considered in carefully selected patients. Gross total resection and receiving adjuvant whole brain RT significantly improves survival in these patients.



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Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: review of the literature and report of a further case

Publication date: Available online 10 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Nabeel Alshafai, Rodolfo Maduri, Mrigank Shail, Domenico Chirchiglia, David Meyronet, Francesco Signorelli
Hemangioblastomas (HBLs) are challenging vascular tumours with rare suprasellar location Surgery is recommended in patients with visual impairment, endocrine disorders or hydrocephalus. Surgical removal of pituitary stalk HBLs is challenging due to their location and high vascularity.Our narrative review was guided by the question: "what is the more suitable surgical approach to excise a suprasellar HBL?". Pertinent English literature was scrutinized from database inception to October 2016.Eighteen articles matched our selection criteria. Among the surgically treated patients, 4 were treated through a trans-sphenoidal (TS) approach, 13 through a transcranial approach (2 of them after TS failure). Five other cases were treated with radiotherapy (adjuvant in 3 cases) and 9 patients were managed with simple observation and/or medical treatment. We add a case of complete suprasellar HBL resection through an orbito-zygomatic (OZ) craniotomy with extradural anterior clinoidectomy (EAC).To achieve satisfactory oncologic results with acceptable morbidity for symptomatic suprasellar HBLs, complete tumour removal with pituitary stalk sparing should be attempted through an OZ craniotomy with EAC that provides adequate exposure of the tumour, its vascular supply and the adjacent neural structures.



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Assessing Key Stakeholders’ Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans

Abstract

Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for head and neck cancer as it is a disease prone to long-term side effects requiring management from multiple providers. We conducted telephone-based, qualitative interviews. We purposively sampled head and neck cancer survivors (n = 4), primary care physicians in the community (n = 5), and providers affiliated with a large academic medical center (n = 5) who treat head and neck cancer, cancer specialists (n = 6), and nurse practitioners/supportive care staff (n = 5). Interviews were recorded, transcribed, and analyzed using direct content analysis. Few participants reported personal experience with SCPs, but most supported the concept. Several key themes emerged: (1) perceived ambiguity regarding roles and responsibilities for SCPs, (2) a need to tailor the content and language based on the intended recipient, (3) documentation process should be as automated and streamlined as possible, (4) concerns about using the SCP to coordinate with outside providers, and (5) that SCPs would have added value as a "living document." We also report SCP-related issues that are unique to serving patients diagnosed with head and neck cancer. Effort is needed to tailor SCPs for different recipients and optimize their potential for successful implementation, impact on care outcomes, and sustainability. Many cancer survivors may not receive a SCP as part of routine care. Survivors could engage their health care team by requesting a SCP.

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Detection accuracy of maxillary sinus floor septa in panoramic radiographs using CBCT as gold standard: a multi-observer receiver operating characteristic (ROC) study

Abstract

Objectives

To investigate diagnostic accuracy of panoramic radiography in detecting maxillary sinus floor septa by means of a multi-observer receiver operating characteristic (ROC) analysis and a standardized protocol for reporting (STARD protocol; Clin Chem 49(1):1–6, 2003).

Material and methods

From our database, 25 cone beam computed tomographies (CBCTs) were selected with one maxillary sinus floor septum (height ≥ 2.5 mm). For the same patient, a recent panoramic radiograph (PAN) had to be available in the database. As controls, 28 CBCTs plus corresponding PANs without evidence of a sinus septum were selected. Using the CBCTs as ground truth, 17 observers from our dental school on a five-point confidence scale rated both sinuses in all 53 PANs with respect to presence/absence of a sinus septum. Areas beneath ROC curves (Az-values), sensitivity/specificity (SNT/SPF), positive/negative predictive values (PPV, NPV), and positive/negative likelihood ratios (LR+, LR−) were computed for each observer and pooled over all observers. Inter-rater reproducibility was assessed by means of the intraclass coefficient (ICC) using a two-way random effects model.

Results

A pooled Az-value of 0.839 was observed (SNT 84.6%, SPF 73.5%). PPV ranged between 0.492 and 0.824 (median 0.627) and NPV between 0.838 and 0.976 (median 0.917). A median LR+ of 3.567 was computed (LR− median 0.193). Inter-rater reliability revealed an ICC of 0.55 (95% confidence interval 0.48 to 0.62).

Conclusions

Our results indicate that PAN is a moderately accurate method for sinus elevation planning for the purpose of septum detection. Ruling out a septum by PAN seems to work more accurately than ruling in.

Clinical relevance

For the purpose of maxillary sinus floor septa detection, panoramic radiography can be relatively safely advocated, particularly for judgment of a septum-free sinus.

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Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study.

Related Articles

Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 08;:

Authors: Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, Connor NP

Abstract
Importance: It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population.
Objective: Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes.
Design, Setting, and Participants: Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months) Data were collected from an ongoing clinical trial (NCT02138214), and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics. All participants were age 21 to 73 years with a diagnosis of papillary thyroid cancer without cervical or distant metastases and had undergone total thyroidectomy. Exclusion criteria were preexisting vocal fold abnormalities (eg, polyps, nodules), neurological conditions affecting the voice or swallowing ability, and/or development of new-onset vocal fold paresis or paralysis (lasting longer than 6 months) after total thyroidectomy.
Interventions: Total thyroidectomy.
Main Outcomes and Measures: Symptoms of dysphagia and related effects on quality of life elicited through grounded theory analysis of semistructured interviews with patients after thyroidectomy designed to foster an open-ended, patient-driven discussion.
Results: Of the 26 patients included, 69% were women (n = 18); mean (SD) age, 46.4 (14.1) years; mean (SD) tumor diameter 2.2 (1.4) cm. Two weeks after thyroidectomy, 80% of participants (n = 20) reported at least 1 swallowing-related symptom when prompted by the interview cards; during the open interview, 53% of participants (n = 14) volunteered discussion of swallowing-related symptoms unprompted. However, only 8% of participants in this study (n = 2) qualified for a follow-up dysphagia evaluation, indicating that the majority of reported symptoms were subjective in nature. Six weeks and 6 months after thyroidectomy, 42% (n = 11) and 17% (n = 4) of participants, respectively, reported continued swallowing symptoms using the prompts; 12% (n = 3) discussed symptoms without prompting cards at both time points.
Conclusions and Relevance: Swallowing symptoms after thyroidectomy are underreported in the literature. This study revealed that as many as 80% of patients who have thyroidectomy may experience swallowing-related symptoms after surgery, and many develop compensatory strategies to manage or reduce the burden of these symptoms. Considering the large number of individuals who may experience subjective dysphagia, preoperative counseling should include education and management of such symptoms.

PMID: 29522149 [PubMed - as supplied by publisher]

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IDH2 mutations are commonly associated with 1p/19q codeletion in diffuse adult gliomas

Diffuse gliomas are classified according to the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System,¹ which combines histological and molecular features. Diagnosis requires the assessment of mutations in the isocitrate dehydrogenase genes (IDH1 and IDH2), key genetic alterations characterizing gliomas with favorable outcome.²

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The clinical trials landscape for glioblastoma: is it adequate to develop new treatments?

Abstract

Background

There have been few treatment advances for patients with glioblastoma (GBM) despite increasing scientific understanding of the disease. While factors such as intrinsic tumor biology and drug delivery are challenges to developing efficacious therapies, it is unclear whether the current clinical trial landscape is optimally evaluating new therapies and biomarkers.

Methods

We queried ClinicalTrials.gov for interventional clinical trials for patients with GBM initiated between January 2005 to December 2016 and abstracted data regarding phase, status, start and end dates, testing locations, endpoints, experimental interventions, sample size, clinical presentation/indication, and design to better understand the clinical trials landscape.

Results

Only approximately 8%-11% of patients with newly diagnosed GBM enroll on clinical trials with a similar estimate for all patients with GBM. Trial duration was similar across phases with median time to completion between 3 and 4 years. While 93% of clinical trials were in phases I-II, 26% of the overall clinical trial patient population was enrolled on phase III studies. Of the 8 completed phase III trials, only one reported positive results. Although 58% of the phase III trials were supported by phase II data with a similar endpoint, only 25% of these phase II trials were randomized.

Conclusions

The clinical trials landscape for GBM is characterized by long development times, inadequate dissemination of information, suboptimal go/no-go decision-making, and low patient participation.

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Alkali-Activated Boiler Fly Ash for Ni(II) Removal: Characterization and Parametric Study

Abstract

In this study, the adsorption behavior of waste boiler fly ash has been explored for purification of nickel heavy metal ion bearing water. The raw boiler fly ash (RBFA) was alkali modified to improve the adsorption characteristics. The modified boiler fly ash (MBFA) was characterized using the SEM, XRF, XRD, BET, and TGA analyzers to confirm the improved textural, mineralogical, porosity and thermal characteristics of the adsorbent. The adsorption studies were conducted in a batch mode by varying different operational parameters like pH, contact time, heavy metal ion concentration, and time. The MBFA showed higher adsorption capacity (~ 86 mg/g) as compared to RBFA (~ 64.8 mg/g) at optimized conditions. The equilibrium data for Ni(II) sorption were analyzed using Langmuir, Sips, and Freundlich isotherm models. Sips model proves to be superior with R² = 0.99. Thermodynamics of Ni(II) removal showed that the process of adsorption is endothermic and spontaneous in nature. Enthalpy calculated was 2.95 and 18.65 kJ/mol for RBFA and MBFA, respectively. The adsorption kinetics of Ni(II) by both RBFA and MBFA were modeled using pseudo-first-order, fractional order, and intra-particle diffusion equations. The results indicate that the fractional order kinetic equation and intra-particle diffusion model were suitable to describe the nickel adsorption.

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Extreme delta - with or without brushes: a potential surrogate marker of disease activity in anti-NMDA-receptor encephalitis

NMDARE is a treatable antibody-mediated neurological syndrome resulting in neuropsychiatric disturbances and seizures, which may evolve to severe encephalopathy, autonomic disturbance and orofacial dyskinesias (Dalmau et al. 2011). Clinical seizures are seen in 80% of cases (Dalmau et al. 2011) and EEG abnormalities in 90% (Titulaer et al. 2013), of which the potentially specific EEG pattern of "extreme delta brush" may carry worse prognosis (Schmitt et al. 2012) and may be associated with electrographic seizures (Veciana et al.

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Long Term Electroencephalography in Preterm Neonates: Safety and Quality of Electrode Types

Seizures in preterm neonates have been reported with an incidence ranging between 3.9%-48% (Hellstrom-Westas et al., 1985; Scher et al., 1993; Vesoulis et al., 2014; Lloyd et al., 2017). Seizure incidence varies with the EEG modality utilized- amplitude-integrated EEG (aEEG) versus conventional EEG. Early life seizures in sick premature neonates portend both poor short and long term outcomes. Seizures in extremely low birth weight neonates were associated with short term morbidities such as severe intraventricular hemorrhage, sepsis, meningitis and cystic periventricular leukomalacia (Davis et al., 2010).

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Renal Cell Carcinoma Brain Metastasis with Pseudoprogression and Radiation Necrosis on Nivolumab after previous treatment with Stereotactic Radiosurgery: an Illustrative Case Report and Review of the Literature

Publication date: Available online 10 March 2018
Source:Practical Radiation Oncology
Author(s): Gary D. Lewis, Eric Jonasch, Amishi Shah, Gregory N. Fuller, Andrew M. Farach, E. Brian Butler, Bin S. Teh




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Reducing X-Ray imaging for proton postmastectomy chest-wall patients

Publication date: Available online 10 March 2018
Source:Practical Radiation Oncology
Author(s): Estelle Batin, Nicolas Depauw, Rachel B. Jimenez, Shannon MacDonald, Hsiao-Ming Lu




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Contact Dermatitis in Underrepresented Minority

No abstract available

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Immune Dysregulation in the Pathogenesis of Atopic Dermatitis

Atopic dermatitis is a multifactorial disease. Epidermal barrier impairment often plays the initial role in the initiation of the disease. Immune dysregulation of the innate and adaptive immunity plays a central role in the pathogenesis of atopic dermatitis. Alteration of the epidermal microbiome-host interaction serves a catalytic role in propagating this immune response. The understanding of this disease pathogenesis is important in generating treatment options, especially those such as biologic agents that can target a specific immune pathway.

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Contact Urticaria to Ultrasound Gel: A Case Report

No abstract available

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Patch Testing for the Evaluation of Metal Hypersensitivity in the Nuss Procedure

The Nuss procedure has become the predominant reason for the use of metal implants by pediatric general and thoracic surgeons. Current guidelines recommend preimplant testing for all patients undergoing the Nuss procedure, which differs from the guidelines for all other orthopedic procedures. This review was done to further evaluate this discrepancy.

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SELF-ASSESSMENT

No abstract available

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Rubber Accelerators in Medical Examination and Surgical Gloves

Background Rubber accelerators play a significant role in glove-related occupational contact dermatitis, especially among health care workers. Currently, there is limited information readily available outlining the accelerators used in specific medical examination and surgical gloves. Objective The aim of this study was to ascertain the accelerators used in medical examination and surgical gloves for major glove manufacturers within the United States. Methods An initial Internet-based search was performed to establish relevant manufacturers and product lines, with subsequent inquiry with each corresponding company regarding accelerators used in each medical and surgical glove line. Results Eleven glove manufacturers were identified and contacted. Responses were obtained from all manufacturers, but because of legal limitations, changes in product lines, or inability to supply necessary data, only 8 companies were able to be included in the final analysis, totaling data for 190 gloves. Carbamates were the most common accelerator, used in 90.5% (172/190) of gloves, whereas thiurams were used in only 11 gloves (5.8%). Eight companies surveyed are now advertising and offering touted accelerator-free gloves. Conclusions Accelerators are used in most examination and surgical gloves; however, manufacturers are now expanding their product offerings to include accelerator-free options.

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Patch Testing in Vulvar Allergic Contact Dermatitis

No abstract available

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The Role of Cleaning Products in Epidemic Allergic Contact Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone

Background Sensitivity to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) has increased rapidly over recent years. This increase is mainly related to the extensive use of high concentrations of MI in cosmetic products, although a growing number of cases of occupational allergic contact dermatitis are caused by MCI/MI. Objective The aim of this study was to examine the association between the increase in MCI/MI sensitization and the work performed by the patients in our area. Methods A retrospective study was undertaken of the records of a total of 1179 patients who had undergone contact skin patch tests for MCI/MI from January 2005 to December 2015. A multivariate logistic regression analysis was performed to identify the factors independently associated with sensitivity to MCI/MI. Results A constant increase in MCI/MI sensitization was observed over the observation period. The only work associated with a significant increase in the prevalence of MCI/MI sensitization was cleaning, with 38.5% of the cleaning professionals with MCI/MI sensitization consulting for cosmetics-related dermatitis. Conclusions Occupational sensitization to MCI/MI in cleaning professionals is worryingly increasing. This, in turn, could possibly account for many cases of cosmetics-associated contact dermatitis. Our findings suggest that a review of the regulations with regard to isothiazolinone concentrations in industrial and household detergents is necessary.

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“A Seat at the Table”—Reflections From Two Presidents of the American Contact Dermatitis Society

No abstract available

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Prevalence of Contact Allergens in Personal Care Products for Babies and Children

Background Personal care products marketed for babies and children are often regarded as "safe" or "gentle." However, little is known about the prevalence of contact allergens in these types of products. Objective This study assessed the prevalence of important sensitizers in personal care products marketed for babies and children. A secondary objective of this study was to determine whether a product's cost correlates with content of sensitizing ingredients. Methods The ingredient lists of 533 unique personal care products were analyzed for presence of fragrance, betaines, propylene glycol, methylchloroisothiazolinone, methylisothiazolinone, formaldehyde, lanolin, and neomycin. Price per ounce was determined for each product as well. Conclusions Most personal care products for babies and children contain 1 or more sensitizers. Products containing more sensitizers tend to cost less than those without any sensitizing ingredients.

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Carmine Red: A Potentially Overlooked Allergen in Children

No abstract available

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Survey of Patch Test Business Models in the United States by the American Contact Dermatitis Society

Background Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges. Objective This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges. Methods All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement. Results A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support. Conclusions Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.

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Allergic Contact Dermatitis to Electronic Cigarette

No abstract available

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Positive Patch Test Reaction in a Patient Taking Dupilumab

No abstract available

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Trends in Eyelid Dermatitis

No abstract available

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Allergic Contact Stomatitis Associated With Sweet Vermouth

No abstract available

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Monographs in Contact Allergy: Non-Fragrance Allergens in Cosmetics (Parts 1 and 2) by Anton de Groot, CRC Press, Boca Raton, FL, 2018

No abstract available

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Contact Allergy to Cocamide Diethanolamine and Cross-reactions

No abstract available

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Reviewers for 2017

No abstract available

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A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan

Publication date: Available online 7 February 2018
Source:Auris Nasus Larynx
Author(s): Yukinobu Ishikawa, Yukiko Yanagi, Michi Suzuki, Ujimoto Konomi
ObjectiveWe used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.MethodsThis study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual's experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ).ResultsWe received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as "I want to know where we can have olfactory rehabilitation" and "I want to have rehabilitation if olfaction recovers." The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)．ConclusionPatient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy.



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Neuronal autophagy and intercellular regulation of homeostasis in the brain

Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Aditi Kulkarni, Jessica Chen, Sandra Maday
Neurons are particularly dependent on robust quality control pathways to maintain cellular homeostasis and functionality throughout their extended lifetime. Failure to regulate protein and organelle integrity is linked to devastating neurodegenerative diseases. Autophagy is a lysosomal degradation pathway that maintains homeostasis by recycling damaged or aged cellular components. Autophagy has important functions in development of the nervous system, as well as in neuronal function and survival. In fact, defects in autophagy underlie neurodegeneration in mice and humans. Here, we review the compartment-specific dynamics and functions for autophagy in neurons. Emerging evidence suggests novel pathways for the intercellular coordination of quality control pathways between neurons and glia to maintain homeostasis in the brain.



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Axonal transport and maturation of lysosomes

Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Shawn M Ferguson
Lysosomes perform degradative functions that are important for all cells. However, neurons are particularly dependent on optimal lysosome function due to their extremes of longevity, size and polarity. Axons in particular exemplify the major spatial challenges faced by neurons in the maintenance of lysosome biogenesis and function. What impact does this have on the regulation and functions of lysosomes in axons? This review focuses on the mechanisms whereby axonal lysosome biogenesis, transport and function are adapted to meet neuronal demand. Important features include the dynamic relationship between endosomes, autophagosomes and lysosomes as well as the transport mechanisms that support the movement of lysosome precursors in axons. A picture is emerging wherein intermediates in the lysosome maturation processes that would only exist transiently within the crowded confines of a neuronal cell body are spatially and temporally separated over the extreme distances encountered in axons. Axons may thus offer significant opportunities for the analysis of the mechanisms that control lysosome biogenesis. Insights from the genetics and pathology of human neurodegenerative diseases furthermore emphasize the importance of efficient axonal transport of lysosomes and their precursors.



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The electrical significance of axon location diversity

Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Maarten HP Kole, Romain Brette
The axon initial segment (AIS) is a unique domain of the proximal axon serving critical electrical and structural roles including the initiation of action potentials and maintenance of cellular polarity. Recent experimental and theoretical advances demonstrate that the anatomical site for initiation is remarkably diverse. The AIS location varies not only axially, along the axon, but axons also emerge variably from either the soma or proximal dendrites. Here, we review the evidence that the diversity of AIS and axon location has a substantial impact on the electrical properties and speculate that the anatomical heterogeneity of axon locations expands synaptic integration within cell types and improves information processing in neural circuits.



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Advances in understanding neural mechanisms of social dominance

Publication date: April 2018
Source:Current Opinion in Neurobiology, Volume 49
Author(s): Tingting Zhou, Carmen Sandi, Hailan Hu
Dominance hierarchy profoundly impacts social animals' survival, physical and mental health and reproductive success. As the measurements of dominance hierarchy in rodents become established, it is now possible to understand the neural mechanism mediating the intrinsic and extrinsic factors determining social hierarchy. This review summarizes the latest advances in assay development for measuring dominance hierarchy in laboratory mice. It also reviews our current understandings on how activity and plasticity of specific neural circuits shape the dominance trait and mediate the 'winner effect'.



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Disparities in Oral Cancer Awareness: a Population Survey in Tehran, Iran

Abstract

Oral cancer is a life-threatening disease with low survival rates, especially when diagnosed in an advanced stage. Lack of awareness about this cancer among the population is proposed as a possible reason for this diagnostic delay. The aim of this study was to evaluate oral cancer awareness, as well as the association of this with sociodemographic status in Tehran. In this cross-sectional population-based survey, 1800 self-administered questionnaires (collecting sociodemographic data, questions regarding oral cancer awareness and the source of information) were distributed through multistage stratified random sampling. Scores for questions ranged from 0 to 4, and totals were summed. The outcome of question responses was also analyzed separately. In total, 1312 questionnaires were available for analysis, from 788 females and 489 males (37.8 ± 9.02 years). Only 30% of the respondents were aware of oral cancer. The average score for awareness was 1.09 ± 1.6 with no significant differences between age groups and genders. Almost 6.5% of participants had complete awareness about oral cancer. A significant difference was found between mean scores in different levels of education and occupation (p = 0.0001). From 585 responses to the "source of information" question, "public media" was the most important source (almost 50%). Only 2% mentioned "dentists" as a source of information. This study indicated an alarming lack of oral cancer awareness and literacy in Tehran, Iran. Dentists should be obliged to practice their pivotal role in informing the public about oral cancer.

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Extraction of permanent maxillary teeth without palatal injection: a meta-analysis

Publication date: Available online 7 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Li Cui, Zhuyu Zhang, Ling Xu, Jiao Huang, Dongqing Yin
ObjectiveThe objective of this meta-analysis was to assess the operation success rates of extracting maxillary teeth without palatal injection.Study DesignPubMed, Cochrane Library, Embase, SinoMed and the references of the identified full-text articles were searched for relevant studies published until June 2017 that met the eligibility criteria. Experimental data were combined by meta-analysis using RevMan 5.3 soft- ware.Results7 randomized controlled trials were included in this meta-analysis. Compared with the control groups (were given the combination of buccal and palatal anesthesia recommended by the textbook, also known as routine Infiltration anesthesia), experimental group (single buccal anesthesia) for the removal of maxillary permanent teeth at conventional doses, which resulted in a reduction in the success rate (OR = 0.14, 95% CI = 0.07–0.27, P < 0.00001).ConclusionsThe results revealed that the success rate of the removal of the maxillary permanent teeth has undoubtedly been reduced by the lack of palatal injections. However, larger and higher quality tests are needed to confirm and optimize the effect of this anesthetic procedure.



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Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading

Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yunus Okcu, Jan Rustemeyer
Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3). Groups 1 (p = 0.045) and 2 (p = 0.034) showed significantly shorter delays when compared with Group 3. Significant differences in average counts of implants placed were also found between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019). The ratio of planned to placed implants was highest in Group 1. The observed differences between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019) were significant. Our results indicate an accelerating effect of CAD/CAM on graft consolidation and dental rehabilitation.



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Interdisciplinary Treatment Algorithm for Facial Arteriovenous High-flow Malformations and Review of the Literature

Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Katinka Kansy, Jens Bodem, Michael Engel, Christian Freudlsperger, Markus A. Möhlenbruch, Christian Herweh, Martin Bendszus, Jürgen Hoffmann, Steffen Kargus
IntroductionHigh-flow arteriovenous malformations (HF-AVMs) are congenital vascular malformations. Typical localizations include the face, oral cavity, and extremities.Due to the high recurrence rate of AVM after incomplete resection or embolization, a combination of both therapeutic modalities has become the preferred choice of treatment. Therefore, we have developed an interdisciplinary therapeutic treatment algorithm for facial HF-AVM and performed a systematic review of the literature.Patients and methodsIn a retrospective analysis, all patients who were treated using the interdisciplinary therapeutic treatment algorithm for facial HF-AVM between 10/2010 and 09/2014 were included in the study. Small HF-AVMs (n = 2) without prior therapy and with clearly detectable arterial blood supply were treated by surgical monotherapy. Larger, previously unsuccessfully treated HF-AVMs and lesions with complex arterial blood supply were treated using a combined therapy (n = 6). Combined therapy consisted of a preoperative embolization and a subsequent surgical resection 1–2 days later. If an extensive surgical reconstruction became necessary due to the size of the malformation, or the risk of recurrence was high due to the complex vascular anatomical situation, a second postoperative angiogram was performed to safely exclude a residual nidus, using a 'second look' prior to definitive wound closure (n = 3). HF-AVMs that did not allow for curative therapeutic intervention due to their size and localization were treated by interventional monotherapy (n = 1). Patients with suspicion of a primarily hormone-dependent growth during pregnancy were closely followed up clinically, following a 'wait and see' strategy (n = 1). In addition, a systematic literature review was performed to analyze treatment outcomes and current standards.Results13 patients with a mean age of 39 years were included in the analysis. Patients were followed up for a mean of 26.8 months (range 12–60 months). Combined treatment (n = 9) was free of recurrence in all cases (100%) after a mean follow up of 30.3 months (range 12–60 months). Surgical monotherapy (n = 2) was also successful in both cases. Non-curative, interventional monotherapy lead to significant decrease in symptoms and did not have to be repeated. A postpartum decrease of the tumor could be observed in the 'wait and see' group. However, at the end of the observational period, a hormone-independent growth occurred. Results were supported by findings of the review.ConclusionThe treatment of HF-AVMs of the head and neck remains challenging due to high recurrence rates. In our cohort, following the Heidelberg treatment algorithm both surgical monotherapy and combined surgical and interventional therapy had very high success rates. For non-curative, symptomatic therapy, interventional treatment should be discussed in terms of the risk of growth induction of HF-AVMs. Findings from the literature concerning therapeutic strategies and success rates are in line with the developed Heidelberg treatment algorithm. However, a larger sample of patients will be necessary to prove the validity of this algorithm.



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The best strategy for RAS wild-type metastatic colorectal cancer patients in first-line treatment: a classic and Bayesian meta-analysis

Publication date: Available online 9 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Domenico Ciliberto, Nicoletta Staropoli, Francesca Caglioti, Silvia Chiellino, Antonella Ierardi, Rossana Ingargiola, Cirino Botta, Mariamena Arbitrio, Pierpaolo Correale, Pierfrancesco Tassone, Pierosandro Tagliaferri
BackgroundAt present, there is uncertainty on the best systemic treatment in first-line setting for RAS wild-type (WT) metastatic colorectal cancer (mCRC) patients. Indeed, several chemotherapy and biologics combinations showed an improvement on survival. We performed a systematic review with a pair-wise and bayesan meta-analysis to rank the best strategy for these patients.MethodsA systematic literature search through March 2017 was performed to evaluate the association between several treatment combinations and overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity rate (TR) in RAS WT mCRC patients. Data were extracted from studies and pooled using the random-effect model for pair-wise meta-analyses and bayesan model for network meta-analysis (NMA).ResultsEight studies with a total of 2518 individuals were included in the meta-analyses. Pooled analyses for subgroups stratified by type of schedule and tumor location demonstrated that anti-EGFR + doublet had the best OS when compared to doublet ± bevacizumab (0.767; 95%CI, 0.695–0.846; P < .0001). This benefit is limited to LSCC when compared to a doublet-based schedule and doublet + bevacizumab (HRs, 0.692; 95%CI, 0.596–0.804; P < .001; 0.706; 95%CI, 0.584–0.854; P < .001; respectively). No significant differences are detected in PFS, whereas the cetuximab-based regimens showed the highest ORR and TR. In NMA our ranking showed the best performance for FOLFOX + panitumumab.ConclusionsOur study indicates that FOLFOX + panitumumab has the major probability to provide an improvement of survival with a good safety profile in patients with RAS WT mCRC with an added value from selection based on sidedness.



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Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading

Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yunus Okcu, Jan Rustemeyer
Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3). Groups 1 (p = 0.045) and 2 (p = 0.034) showed significantly shorter delays when compared with Group 3. Significant differences in average counts of implants placed were also found between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019). The ratio of planned to placed implants was highest in Group 1. The observed differences between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019) were significant. Our results indicate an accelerating effect of CAD/CAM on graft consolidation and dental rehabilitation.



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Interdisciplinary Treatment Algorithm for Facial Arteriovenous High-flow Malformations and Review of the Literature

Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Katinka Kansy, Jens Bodem, Michael Engel, Christian Freudlsperger, Markus A. Möhlenbruch, Christian Herweh, Martin Bendszus, Jürgen Hoffmann, Steffen Kargus
IntroductionHigh-flow arteriovenous malformations (HF-AVMs) are congenital vascular malformations. Typical localizations include the face, oral cavity, and extremities.Due to the high recurrence rate of AVM after incomplete resection or embolization, a combination of both therapeutic modalities has become the preferred choice of treatment. Therefore, we have developed an interdisciplinary therapeutic treatment algorithm for facial HF-AVM and performed a systematic review of the literature.Patients and methodsIn a retrospective analysis, all patients who were treated using the interdisciplinary therapeutic treatment algorithm for facial HF-AVM between 10/2010 and 09/2014 were included in the study. Small HF-AVMs (n = 2) without prior therapy and with clearly detectable arterial blood supply were treated by surgical monotherapy. Larger, previously unsuccessfully treated HF-AVMs and lesions with complex arterial blood supply were treated using a combined therapy (n = 6). Combined therapy consisted of a preoperative embolization and a subsequent surgical resection 1–2 days later. If an extensive surgical reconstruction became necessary due to the size of the malformation, or the risk of recurrence was high due to the complex vascular anatomical situation, a second postoperative angiogram was performed to safely exclude a residual nidus, using a 'second look' prior to definitive wound closure (n = 3). HF-AVMs that did not allow for curative therapeutic intervention due to their size and localization were treated by interventional monotherapy (n = 1). Patients with suspicion of a primarily hormone-dependent growth during pregnancy were closely followed up clinically, following a 'wait and see' strategy (n = 1). In addition, a systematic literature review was performed to analyze treatment outcomes and current standards.Results13 patients with a mean age of 39 years were included in the analysis. Patients were followed up for a mean of 26.8 months (range 12–60 months). Combined treatment (n = 9) was free of recurrence in all cases (100%) after a mean follow up of 30.3 months (range 12–60 months). Surgical monotherapy (n = 2) was also successful in both cases. Non-curative, interventional monotherapy lead to significant decrease in symptoms and did not have to be repeated. A postpartum decrease of the tumor could be observed in the 'wait and see' group. However, at the end of the observational period, a hormone-independent growth occurred. Results were supported by findings of the review.ConclusionThe treatment of HF-AVMs of the head and neck remains challenging due to high recurrence rates. In our cohort, following the Heidelberg treatment algorithm both surgical monotherapy and combined surgical and interventional therapy had very high success rates. For non-curative, symptomatic therapy, interventional treatment should be discussed in terms of the risk of growth induction of HF-AVMs. Findings from the literature concerning therapeutic strategies and success rates are in line with the developed Heidelberg treatment algorithm. However, a larger sample of patients will be necessary to prove the validity of this algorithm.



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Are spikes non-inferior to high-frequency oscillations?

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Changes in PGE2 signaling after submandibulectomy alter post tooth extraction socket healing

Abstract

Saliva is very important to oral health, and a salivary deficit has been shown to bring serious problems to oral health. There is scant information about the mechanisms through which salivary glands participate in post-tooth extraction socket healing. Therefore, the aim of the present study was to investigate the effect of submandibulectomy (SMx), consisting of the ablation of submandibular and sublingual glands (SMG and SLG, respectively), on PGE₂ signaling and other bone regulatory molecules, such as OPG and RANKL, involved in tooth extraction socket healing. Male Wistar rats, 70g body weight, were assigned to an experimental (subjected to SMx) or a control group (sham operated). One week later, the animals in both groups underwent bilateral extraction of the first mandibular molars. The effect of SMx on different stages of socket healing after tooth extraction (7, 14 and 30 days) was studied by evaluating some parameters of inflammation, including PGE₂ and its receptors, and of bone metabolism, as well as by performing bone biomechanical studies. SMx increased TNFα and PGE₂ content as well as COX-II expression in tooth socket tissue at almost all the studied time-points. SMx also had an effect on mRNA expression of PGE₂ receptors at the different time points, but did not significantly alter osteoprotegerin (OPG) and RANKL mRNA expression at any of the studied time points. In addition, an increase in bone mass density was observed in SMx rats compared to matched controls, and the structural and mechanical bone properties of the mandibular socket bone were also affected by SMx. Our results suggest that the SMG/SLG complex regulates cellular activation and differentiation by modulating the production of molecules intervening in tooth extraction socket repair, including the PGE₂ signaling system, which would therefore account for the higher density and resistance of the newly formed bone in SMx rat. This article is protected by copyright. All rights reserved.

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Translation and Validation of the Chinese powerlessness assessment tool

Abstract

The objectives of this study were to translate the powerlessness assessment tool (PAT) into Chinese, and to evaluate its psychometric performance. The PAT was translated into Chinese and was evaluated in patients with chronic wounds. Mean PAT scores were compared between various wound types to evaluate the scale's power to differentiate wound severity (PUSH score). There were 154 consecutive patients included in this study. All items were included, and the results of item-domain correlation (r ranged from 0.838 to 0.967) and Small-group analysis (critical ratio, P<0.05) were satisfactory. Furthermore, the Chinese PAT also showed good criterion validity when correlated with the Cardiff wound impact schedule (r=0.726, p<0.01). Exploratory factor analysis of these items extracted only two domains instead of the hypothesized three domains: Self-perception of behavioral control and decision making (9 items) and emotional responses to perceived control (3 items), explained 82.045% of the variance. Sensitivity was demonstrated between patients with different activity of daily living, wound severity (PUSH Score) and wound types. The internal consistency of all scales of the Chinese PAT was consistently high (Cronbach's alpha ranged from 0.939 to 0. 965) and split-half reliability was 0.901. In conclusion, the validated Chinese PAT has good psychometric properties, and may be used to objectively evaluate the powerlessness experience of Chinese patients with chronic wounds. This article is protected by copyright. All rights reserved.

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Evaluation of the morphology of the genial tubercle using cone-beam computed tomography

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): Y. Nejaim, D. Duarte Moreira, A.B. Nolasco Fernandes, M.M.G. de Souza, F.C. Groppo, F. Haiter Neto




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Sialendoscopy for sialolithiasis in children: 4-8 years follow up

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): R. Jouan, E. Picot, R. Hermann, F. Faure, F. Marchal
Sialolithiasis is rare in children, there are no guidelines for its treatment, and there are few, if any, long term follow-up studies. We report a retrospective review of medical records of children who were treated for sialolithiasis by sialendoscopy between 1 January 2007 and 31 December 2011, and who have been followed up for 4-8 years. Personal and clinical details, including age, sex, symptoms, whether the lithiasis was parotid or submandibular, the technique of sialendoscopy and complications, were recorded. Twenty-six children (30 sides) were successfully treated by sialendoscopy between 2007 and 2011 (mean (range) age 12 (3-17) years). Stones were removed from the parotid gland in four patients and the submandibular gland in 22. The main indication for sialendoscopy was swelling of the salivary gland during meals. Twenty-six procedures were done endoscopically. Twelve were treated with a wire basket alone, 10 by the combined approach, and laser was used in eight. Four patients developed complications, but without long-term effects. During follow-up of 4-8 years there were no recurrent swellings. We conclude that endoscopic treatment of stones in childhood is an efficient and conservative option for salivary glands, has few complications and no clinical recurrence at medium to long-term follow-up.



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Treatment of intraoral ranulas with a two-incision fistula technique: the management of recurrence

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): Qingtong Zhao, Mengyu Li, Renfa Lai, Shaoyi Wang
The two-incision fistula technique for the treatment of oral ranulas has recently been introduced to clinical practice. We reviewed 52 patients who had recurrences after this treatment, and explored the possible causes and underlying mechanisms. A total of 13/53 ranulas had recurred, so we repeated the operation, and one patient had the ranula and the sublingual gland resected. We found that the thin mucous membrane cracked at the double incisions, which led to the formation of a fistula and promoted the drainage of cystic fluid. The results indicated that the recurrence of ranulas after the two-incision fistula technique can be reduced further. To avoid recurrence, the technique should be adjusted slightly, depending on the type of ranula present.



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Forehead reduction and orbital contouring in facial feminisation surgery for transgender females

Publication date: Available online 7 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Altman
Forehead reduction and orbital contouring form a considerable component of the procedures available to feminise the face in transgender females. In this paper I shall discuss the history and development of techniques to reduce bossing of the forehead and contour the orbits, and describe their classification, assessment, surgical approach, and complications.



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Outcomes of treatment for intracapsular fractures of the mandibular condyle: recommendation for a new classification

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): B.B. Ying, Q.Q. Zhang, S.S. Zhu, Y.F. Li
We know of no universally accepted classification for intracapsular condylar fractures. We propose here a new classification based on the concept of a "disc-condyle" unit, and validate the classification based on outcomes of treatment. From 1 January 2010 - 31 December 2014, 55 patients with unilateral intracapsular condylar fractures were classified into three types: type A has no reduction in mandibular height or displacement of the disc (n=7); type B has displacement of the disc with no reduction in mandibular height (n=17); and type C has reduced mandibular height with or without displacement of the disc (n=31). We treated types B and C by open reduction and fixation, while type A fractures were managed non-surgically. At six month follow-up, we found no significant differences in the vertical height of the ramus, mandibular deviation, protrusion, or lateral protrusion between the fractured and healthy sides. All patients had normal occlusion postoperatively and only one patient (type C) reported pain. Magnetic resonance imaging and computed tomography showed good osseous healing and disc-condylar relations in all cases. Our results show that this new classification of intracapsular condylar fractures is a safe and easy way to obtain satisfactory outcomes of treatment. However, it needs further independent validation.



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Use of ultrasound-activated resorbable sheets and pins in the management of fractures of the condylar neck of the mandible: a case series

Publication date: Available online 7 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N.M.H. McLeod, D. Van Gijn
The need to treat fractures of the mandibular condyle remains controversial, but when the decision to operate has been made, then multiple forms of fixation are advocated. Traditionally, metal plates and screws have been used, but this is thought to have several disadvantages, particularly in the growing skeleton. Resorbable fixation for maxillofacial fractures has not gained widespread acceptance because of technical difficulties with the materials and concern about inflammatory reactions during their resorption. Because not all patients have typical fracture patterns that fit the size and shape of metal plates, mouldable resorbable fixation materials can be useful, and ultrasound-activated resorbable sheets and pins have the necessary stability to fix fractures of the condylar neck. We present a series of patients in whom ultrasound-activated resorbable sheets and pins were used to fix condylar fractures in which the fracture pattern did not permit the use of stable metal fixation, or the age of the patient in our opinion precluded the use of metal fixation. There were no perioperative complications and no problems related to the stability of the fixation. Minor swelling relating to the resorption of the material in one case did not require any management.



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Reconstruction after resection of carcinoma of the lower lip

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): H. Imura, H. Furukawa, C. Sakuma, M. Yoshida, N. Natsume




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Quality of life after reconstruction with a free forearm flap in patients who have survived oral cancer for more than five years

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): A. Rollon-Mayordomo, J. Herce-Lopez, R. Lozano-Rosado, S. Gallana-Alvarez, C.I. Salazar-Fernandez, P. Infante-Cossio




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Editorial Board

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2





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Training Groups

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2





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WHO is in and WHO is out of the mouth, salivary glands, and jaws sections of the 4th edition of the WHO classification of head and neck tumours

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): R.A. Kennedy
This review of changes to the 4th edition of the WHO classification of head and neck tumours focuses on their impact on the surgical care of diseases that affect the salivary glands, jaws, and oral cavity. Updates to the chapter on the salivary glands include the addition of secretory carcinoma and sclerosing polycystic adenosis. The odontogenic cysts are back, and the odontogenic keratocyst is listed among them, as it has now lost its brief and confusing designation as a neoplasm. The newly-defined sclerosing odontogenic carcinoma and primordial odontogenic tumour have been added. Oropharyngeal tumours have been separated from those of the oral cavity, which reflects the importance of HPV in carcinoma of the tonsils. The problems of grading oral epithelial dysplasia persist.



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Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease?

Publication date: February 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): N. Thomas, D.E. Harper, S. Aronovich
Effusions are common among patients with disorders of the temporomandibular joint (TMJ), but publications are limited and results inconsistent about the correlation between them and important clinical variables, in particular severity of pain and degenerative disease. We organised a retrospective study of patients who presented for the evaluation and management of arthralgia of the TMJ and myofascial pain at the University of Michigan between 2011 and 2014. Inclusion criteria were: patients who had pain that was primarily arthrogenous, and coexisting myogenous pain, who had had initial non-surgical treatment, and arthroscopy of the TMJ with or without intramuscular injection of onabotulinumtoxinA (Botox,^® Allegan, Weston, Fl, USA). The primary outcome variables were pain at rest as measured by visual analogue score (VAS) and the presence of degenerative disease of the joint. The secondary outcome variables included the position of the disc and whether it was perforated, signs of synovitis, maximal interincisal opening (MIO), and duration of symptoms. We studied 47 patients (94 TMJ) who met the inclusion criteria. We found no significant differences in pain at rest before or after arthroscopy, between patients with and without effusions, or in maximal MIO or duration of symptoms between the two groups. There was, however, a significant relation between effusions and degenerative joint disease. Effusions were also associated with a lower probability of the disc being in a normal position and a higher probability of anterior disc displacement without reduction.



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