The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: a randomized crossover control trial

Abstract

Background

Recalcitrant chronic rhinosinusitis without polyposis (CRSsP) is a challenging condition to manage as traditional medical therapies and surgery fail to provide satisfactory clinical improvements. Colloidal silver (CS), a widely used naturopathic agent, has recently shown anti-biofilm properties both in vitro and within a rhinosinusitis animal model. To date, no trials involving humans have been published in world literature. The purpose of this study was to assess the efficacy of CS as a topical nasal spray in patients with refractory CRSsP.

Methods

A prospective cohort study was conducted using a convenience sample of 20 randomized patients with crossover methodology, comparing nasal sprays with CS versus saline. Patients sprayed twice daily for six weeks with the first intervention and then switched to the second for the next six weeks, with measurements made at baseline and each time point. Primary outcomes were changes in SNOT-22 and Lund-Kennedy (LK) endoscopic scores. All analysis was non-parametric and was conducted using STATA 14.

Results

Twenty-two patients were enrolled in the study with 20 completing the entire protocol. Mean 6-week change in SNOT-22 scores were −2.8 and 1.0 for saline and CS, respectively (p = 0.373). Similarly, mean 6-week change in LK scores were −1.4 and −1.1 for saline and CS, respectively (p = 0.794). Significant period effects were observed with the SNOT-22 score between the randomized groups. No participants experienced negative health effects directly attributable to the administration of intranasal CS.

Conclusion

Commercially available CS nasal spray did not demonstrate any meaningful subjective or objective improvements in patients with recalcitrant CRSsP.

Trial registration

NCT02403479. Registered on March 1, 2015.

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Pain: A Sociological Introduction

Pain in one form or another is probably the most common symptom presented to medical and healthcare professionals. Long a subject of biomedical interest, more recent biopsychosocial theories have extended the study of pain as a concept which is highly individual in the way it is experienced. Today's landscape offers a broad array of approaches to understanding pain and, crucially, to alleviating its impact. This concise and accessible volume aims to Read More...

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Health-care lifeline: St. Vincent de Paul clinic aids metro Phoenix poor, uninsured

St. Vincent de Paul will expand its south Phoenix clinic in 2018. The expansion, funded by community donors, will boost the number of people served.

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Cohort Profile: The Yazd Health Study (YaHS): a population-based study of adults aged 20–70 years (study design and baseline population data)

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Review of a licensed dengue vaccine: Inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs

Publication date: Available online 24 November 2017
Source:Journal of Clinical Epidemiology
Author(s): Antonio L. Dans, Leonila F. Dans, Mary Ann D. Lansang, Maria Asuncion A. Silvestre, Gordon H. Guyatt
Severe life-threatening dengue fever usually occurs when a child is infected by dengue virus a 2^nd time. This is caused by a phenomenon called antibody dependent enhancement or ADE. Since dengue vaccines can mimic a first infection in seronegative children (those with no previous infection), a natural infection later in life could lead to severe disease. The possibility that dengue vaccines can cause severe dengue through ADE has led to serious concern regarding the safety of mass vaccination programs.A published meta-analysis addressed this safety issue for a new vaccine against dengue fever - Dengvaxia ™. The trials in this meta-analysis have been used to campaign for mass vaccination programs in developing countries. We discuss the results of this paper and point out problems in the analyses.Reporting the findings in an Asian trial (CYD14), the authors show a 7-fold rise in one outcome – hospitalization for dengue fever in children < 5 years old. However, they fail to point out two signals of harm for another outcome – hospitalization for severe dengue fever (as confirmed by an independent data monitoring committee):1. in children younger than 9 years, the relative risk was 8.5 [95% CI 0.5, 146.8], and2. in the overall study group, the relative risk was 5.5 [95% CI: 0.9, 33]The authors conduct a subgroup analysis to support claims that the vaccine is probably safe among children aged 9 years or more. This subgroup analysis has limited credibility because: 1) it was a post-hoc analysis; 2) it was one of a large number of subgroup analyses; 3) the test of interaction was not reported; but was insignificant (p=0.14); and 4) there is no biological basis for a threshold age of 9 years. The more likely explanation for the higher risk in younger children is ADE, that is, more frequent seronegativity, rather than age itself.The selective reporting and inappropriate subgroup claims mask the potential harm of dengue mass vaccination programs. Countries planning public use of the vaccine must conduct diligent post-marketing surveillance, secure informed consent from parents of potential recipients and closely monitor the results of ongoing long-term follow-up of clinical trial participants.



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Dental fee guide introduced

Dr. Chris Baba checks on a patient at Sun City Dental. On Wednesday, Health Minister Sarah Hoffman announced a new dental fee guide in Alberta.--NEWS PHOTO EMMA BENNETT For the first time since the 1990s, Alberta is getting a dental fee guide that will be a tool to bring costs more in line with other provinces, Alberta Health announced Wednesday.

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Dimensions of hard and soft tissue around adjacent, compared with single-tooth, zirconia implants

Preservation or regeneration of the papilla has always been a challenge around consecutive implants or with implants next to teeth, and many studies have evaluated the papilla's behaviour and patterns based on surgical technique and prosthetic design, though evidence about its behaviour around zirconia implants is scarce. The aim of this study was to evaluate papilla behaviour between implants and teeth (tooth-implant group) and between consecutive implants (implant–implant group). Ninety patients with 122 zirconia implants (Straumann® PURE Ceramic Implant) were examined at the one-year follow up.

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Recurrence of oral mucocoeles in adolescents after excision

Although mucocoeles can occur at any age, children and adolescents are most commonly affected, and excision is the most common treatment.1

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Upregulation of angiogenesis in oral lichen planus

Abstract

Objectives

Since angiogenesis is fundamental to the pathogenesis of many chronic inflammatory disorders this study investigated the expression of various vascular markers in oral lichen planus and non-specific oral mucosal inflammatory tissues.

Methods

Archival specimens of oral lichen planus (n=15) and inflamed tissues (n=13) were stained using immunohistochemistry with antibodies to CD34, vascular endothelial growth factor, vascular endothelial growth factor receptor and vasohibin. Nine representative sites at the epithelial-connective tissue junction and through the fibrous connective tissue were selected and automated analysis techniques were used to determine the extent of positivity expressed as the percentage of positive cells. Significance was denoted when p<0.05.

Results

The expression of pro-angiogenic factors was higher in lichen planus samples compared with inflamed controls. A higher level of CD34 was observed in the deeper parts of the connective tissue of OLP (p=0.04), whereas VEGF and VEGFR2 expression was higher all through the tissues (respectively p<0.02 and p<0.01). The expression of the anti-angiogenic VASH1 was higher in inflamed tissue compared with lichen planus in all sites evaluated (p<0.01).

Conclusions

The findings indicate that angiogenic factors are differentially expressed in oral lichen planus compared with inflamed controls, with increased expression of pro-angiogenic factors and decreased anti-angiogenic expression.

This article is protected by copyright. All rights reserved.

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Clinical effects of submucosal middle turbinectomy for eosinophilic chronic rhinosinusitis

The preservation or resection of the middle turbinate (MT) during endoscopic sinus surgery (ESS) currently remains a matter of debate. The present study aimed to investigate the effects of submucosal middle turbinectomy (SMT) in ESS for eosinophilic chronic rhinosinusitis (ECRS).

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Disseminated mucormycosis masquerading as rejection early after orthotopic heart transplantation

Abstract

Mucorales organisms are an uncommon cause of invasive fungal infections after solid organ transplantation but are associated with great morbidity and mortality. We report a fatal case of disseminated Cunninghamella infection early after heart transplantation. The patient developed graft dysfunction and elevated markers of myocyte injury and autopsy revealed fulminant fungal myocarditis. This case highlights the need for a high index of suspicion in immunocompromised patients who are not improving with standard antimicrobial therapy.

This article is protected by copyright. All rights reserved.

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Erratum to “Reconstruction design before tumour resection: A new concept of through-and-through cheek defect reconstruction” [Oral Oncol. 74 (2017) 123–129]

The publisher regrets that the First Author's appears incorrectly in the publication. The First Author name should appear as above.

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Sensitivity and specificity of Frontal Assessment Battery in newly diagnosed and untreated Obstructive Sleep Apnea patients

Executive dysfunction (ED) is often observed in subjects diagnosed with obstructive sleep apnea (OSA), but their assessment requires facilities that are not always available. We aim to evaluate the extent to which Frontal Assessment Battery (FAB) discriminates ED in newly diagnosed, untreated and without comorbidities OSA patients.

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Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: An IRLSSG task force report

Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide an evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children.

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Review of a licensed dengue vaccine: Inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs

Severe life-threatening dengue fever usually occurs when a child is infected by dengue virus a 2nd time. This is caused by a phenomenon called antibody dependent enhancement or ADE. Since dengue vaccines can mimic a first infection in seronegative children (those with no previous infection), a natural infection later in life could lead to severe disease. The possibility that dengue vaccines can cause severe dengue through ADE has led to serious concern regarding the safety of mass vaccination programs.

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Shared genetic etiology of hypertension and stroke: evidence from bioinformatics analysis of genome-wide association studies

Shared genetic etiology of hypertension and stroke: evidence from bioinformatics analysis of genome-wide association studies

Shared genetic etiology of hypertension and stroke: evidence from bioinformatics analysis of genome-wide association studies, Published online: 24 November 2017; doi:10.1038/s41371-017-0012-3

Shared genetic etiology of hypertension and stroke: evidence from bioinformatics analysis of genome-wide association studies

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Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling, Published online: 24 November 2017; doi:10.1038/s41371-017-0015-0

Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

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The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test, Published online: 24 November 2017; doi:10.1038/s41371-017-0011-4

The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

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Change-of-use application for Honiton dentists approved

Plans to transform a former dental surgery in Honiton into offices to carry out financial and professional services have been approved. In his application, Mr Braithwaite said: "The application area, to be known as 40A High Street, occupies the entire first floor above No.

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Risk of inferior alveolar nerve injury with coronectomy versus surgical extraction of mandibular third molars - A comparison of two techniques and review of the literature

Abstract

Background

The removal of mandibular third molar teeth is one of the most common oral surgical procedures. In a significant number of patients it carries a degree of associated morbidity, including damage to the inferior alveolar nerve (IAN). For this reason, practitioners desire the most up-to-date guidance on the most appropriate technique, informed by the best available evidence that will produce the lowest incidence of iatrogenic complications.

Objective

Perform a systematic review comparing the effect of coronectomy versus complete surgical extraction of mandibular third molar teeth on the risk of IAN injury and other complications in adults.

Data Sources

Studies were identified through Embase (1980-2015) and Ovid MEDLINE (1946-2015) database searches. Search terms included coronectomy, partial root removal, deliberate vital root retention, odontectomy, surgical removal, surgical extraction, complete tooth extraction, and extract*. Limits included humans, English language, and randomized controlled trials (RCTs).

Inclusion criteria

Only RCTs comparing IAN damage associated with surgical extraction of mandibular third molars versus coronectomy were included.

Results

From our database searches, we identified two unique RCTs matching the inclusion criteria. Both evaluated patients who had specific radiographic signs of intimate relationships with the IAN. Upon detailed analysis, the studies were noted to exhibit a high risk of bias in many categories, thereby rendering their results inconclusive.

Conclusion

Although evidence from two RCTs suggests that coronectomy can reduce the risk of IAN injury compared to surgical removal of high-risk mandibular third molars, the quality of evidence is insufficient to provide definitive conclusions regarding the preferred technique.

This article is protected by copyright. All rights reserved.

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Torsional fatigue resistance of pathfinding instruments manufactured from several NiTi alloys

Abstract

Aim

To evaluate the torsional properties of pathfinding nickel-titanium (NiTi) rotary instruments manufactured from several NiTi alloys, ProGlider (M-wire), Hyflex GPF (conventional NiTi Wire and controlled memory wire), Logic (conventional NiTi wire and controlled memory wire) and Mtwo (conventional NiTi wire).

Methodology

A total of 56 NiTi instruments from Glidepath rotary systems (n = 8) were used Logic (size 25, .01 taper), Logic CM (size 25, .01 taper), ProGlider (size 16, .02 taper), Hyflex GPF (size 15, .01 taper), Hyflex GPF CM (size 15, .02 taper; size 20, .02 taper) and Mtwo (size 10, .04 taper). The torsion tests were performed based on ISO 3630-1 (1992). Three millimetres of each instrument tip was clamped to a small load cell by a lever arm linked to the torsion axis. Data were analysed using a one way analysis of variance (ANOVA) and Tukey test with a significance level at a=5%.

Results

The Logic size 25, .01 taper had significantly higher torsional strength values (P<0.05). The ProGlider was significantly different when compared with Hyflex GPF size 15, .01 taper and size 15, .02 taper (P<0.05). The Logic CM size 25, .01 taper had significantly higher torsional strength than Hyflex GPF size 15, .01 taper and size 15, .02 taper (P<0.05). No difference was found among Mtwo size 10, .04 taper and Hyflex GPF groups (size 15, .01 taper; size 15, .02 taper; size 20, .02 taper). In relation to the angle of rotation, Logic CM size 25, .01 taper and Hyflex GPF size 15, .01 taper had the highest values angle (P<0.05). The ProGlider had the lowest angle values in comparison of all the groups (P<0.05) followed by Mtwo size 10, .04 taper. The Logic size 25, .01 taper had significantly higher angle of rotation values than ProGlider and Mtwo size 10, .04 taper (P<0.05).

Conclusion

The Logic size 25, .01 taper instrument made of conventional NiTi alloy had the highest torsional strength of all instruments tested. In addition, the ProGlider instrument manufactured from M-Wire alloy had the lowest angle of rotation to fracture in comparison with the other instruments.

This article is protected by copyright. All rights reserved.

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A new dental option planned to help low-income residents

Increased access to dental care could be on the horizon for low-income residents of Pipestone County and surrounding counties who are insured through state health care programs such as MnCare and Medical Assistance. Caring Hands Dental Clinic, an Alexandria-based nonprofit organization that provides dental care to people with state insurance programs, plans to open an office in Pipestone within the next two years.

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AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma

Abstract

This article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat different approaches to diagnosis and management that diverge from the focus of this article.

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What intrinsic and extrinsic factors explain the stoichiometric diversity of aquatic heterotrophic bacteria?

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Meta-analysis of induction chemotherapy as selection marker for chemoradiation in the head and neck

Objective

Many trials incorporate induction chemotherapy (IC) in selecting for organ preservation in head and neck squamous cell carcinomas (HNSCC). However, few studies examine IC response in predicting for chemoradiation therapy (CRT) response. This meta-analysis aims to determine the predictive accuracy of IC for subsequent response to CRT and overall survival (OS).

Data sources

Medline, EMBASE, Cochrane register.

Methods

A systematic search identified studies from database inception to October 2016 that used IC prior to CRT as definitive treatment for advanced HNSCC. The sensitivities and specificities of IC response predicting for complete CRT response were calculated, and the results were pooled in a summary receiver operating curve. One-, 2- and 5-year OS data were extracted.

Results

Seven studies (n = 423 patients) were analyzed for response and six (n = 439) for OS. Pooled median sensitivity and specificity of IC response predicting CRT response were 0.95 (95% confidence interval [CI]: 0.72–0.98) and 0.43 (95% CI: 0.00–0.61), respectively. Patients were more likely to respond to CRT given previous response to IC (positive likelihood ratio = 1.6; 95% CI: 1.21–2.11) and less likely to respond to CRT if they failed to respond to IC (negative likelihood ratio = 0.16; 95% CI: 0.07–0.38). At 2 years, good response to IC was a statistically significant prognostic marker with a risk ratio of 1.35 (95% CI: 1.12–1.64).

Conclusion

Our data suggests that patients with poor IC response will have poorer response to CRT and should be directed to other modalities. In contrast, good IC response does not guarantee a favorable outcome to CRT; however, because these patients are likely to have better prognoses, they should be offered salvage therapies of curative intent despite treatment failure.

Level of Evidence

NA. Laryngoscope, 2017

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Shared genetic etiology of hypertension and stroke: evidence from bioinformatics analysis of genome-wide association studies

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Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

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The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

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Potential treatment for vocal fold scar with pirfenidone

Objectives/Hypothesis

Pirfenidone (PFD) is a strong antifibrotic agent that has been clinically approved in Japan for idiopathic pulmonary fibrosis. We examined the antifibrotic effects of PFD on fibroblasts isolated from scarred vocal folds (VFs) of ferrets in vitro.

Study Design

Prospective animal experiments with controls.

Methods

Scar fibroblasts (SFs) were isolated from scarred VFs that had been electrocauterized 2 weeks before harvesting (N = 4). Normal fibroblasts (NFs) were isolated from intact VFs (N = 4). SFs and NFs were incubated in the presence of 10 ng/mL transforming growth factor β1 (TGF-β1), with or without PFD. After the 48-hour incubation, mRNA expression levels of α smooth muscle actin (αSMA), TGF-β1, collagen type I, and hyaluronan synthase 2 (HAS2) were examined by real-time polymerase chain reaction. Immunohistochemistry with anti-αSMA anti-collagen type I and phosphorylated Smad (p-Smad)2/3 antibodies in SFs with or without PFD was performed. SFs and NFs were cultured in collagen gel with or without PFD for 48 hours, and the extent of gel contraction was examined quantitatively.

Results

PFD treatment significantly (P < .05) decreased mRNA expression of collagen type I, significantly increased mRNA expression of TGF-β1 and HAS2, and significantly suppressed collagen gel contraction. However, it did not have a significant effect on the expression of αSMA. The expression of p-Smad2/3 in the nucleus was faded with PFD, possibly demonstrating the suppression of translocation of p-Smad2/3 from cytoplasm to nucleus with PFD.

Conclusions

This is the first report to demonstrate the in vitro antifibrotic effects of PFD on fibroblasts isolated from scarred VFs of ferrets.

Level of evidence

NA Laryngoscope, 2017

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Teaching frontal sinus anatomy using the frontal sinus masterclass 3- D conceptualization model

Objective

Frontal sinus anatomy is complex and often is a difficult subject to both teach and learn. The traditional surgical dogma of "see one, do one, teach one" is impractical and dangerous in the frontal sinus. Based on the building block three-dimensional conceptualization module, the Frontal Sinus Masterclass (FSMC) was created to teach this anatomy.

Methods

Study was performed at two academic centers among second- to fifth-year otolaryngology residents. A pretest assessed knowledge prior to the course. Computed tomography scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy. Subsequently, the course instructor explained the anatomy using the building block method and showed a short video of the surgical dissection, pointing out relevant anatomy. Cases progressed in anatomical difficulty and inflammatory load. A posttest determined knowledge after the course.

Results

Thirty of 50 participating residents completed the pre- and posttests (14 junior, 16 senior residents). Correct identification of the frontal sinus drainage pathway increased from 42% to 63% correct (P = 0.054). Anatomical assessment increased from 61% to 68% correct (P = 0.047), and overall assessment increased from 52% to 66% correct (P = 0.016).

Conclusion

Objectively, participants of the FSMC expanded on their ability to recognize cells of the frontal recess on CT scans. Before the class, residents could answer less than half of the answers correctly, and by the end of the class they were answering over two-thirds of these complex questions correctly. Subjectively, participants reported benefit from the course and felt they would be better surgeons.

Level of Evidence

NA. Laryngoscope, 2017

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Does the diameter of the stapes prosthesis really matter? A prospective clinical study

Objectives/Hypothesis

To evaluate the influence of the diameter of stapes prosthesis on functional outcomes in stapes surgery.

Study Design

Prospective cohort study.

Methods

Fifty consecutive small fenestra stapedotomies performed using a 0.4-mm-diameter prosthesis were compared with 50 consecutive small fenestra stapedotomies carried out using a 0.6-mm-diameter piston. Audiological assessment following the recommendations of the Committee on Hearing and Equilibrium was performed 1 month after surgery. Postoperative complications between the two groups were noted.

Results

There were no statistically significant differences in demographic data between the two groups, and no differences in preoperative bone-conduction (BC) or air-conduction (AC) hearing thresholds for all frequencies (analysis of variance [ANOVA] and χ² tests). No differences were found in the mean preoperative BC and AC pure-tone average and air-bone gap (ABG). In the postoperative evaluation, a statistically significant difference was found for the mean AC gain (20 ± 8.7 vs. 24 ± 11.5, P = .042, ANOVA) as well as for the postoperative AC threshold at 0.125 and 0.25 kHz and the postoperative BC threshold at 0.25 kHz (P < .01, ANOVA). A postoperative ABG ≤10 dB was obtained in 90% and 94% of patients in the 0.4-mm- and 0.6-mm-diameter piston groups, respectively (difference not significant, χ² test). No postoperative dead ear and/or sensorineural hearing loss was noted in either group.

Conclusions

The 0.6-mm piston allowed a statistically significant higher AC gain compared with the 0.4-mm diameter piston. A larger diameter piston may be preferable if there are no anatomical or technical reasons that would favor a smaller prosthesis.

Level of Evidence

2b Laryngoscope, 2017

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Long-term outcomes in unilateral vocal fold paralysis patients

Objectives/Hypothesis

At presentation, unilateral vocal fold paralysis (UVFP) patients have different treatment options, including conservative management (CM), injection laryngoplasty (IL) with a temporary agent, or permanent medialization (PM). This study evaluates long-term outcomes for UVFP patients relative to intervention.

Study Design

Retrospective chart review.

Methods

A retrospective chart review was performed of UVFP patients who presented to the University of California San Francisco Voice and Swallowing Center. Videolaryngostroboscopy examinations were reviewed. Maximum glottic closure was quantified with the normalized glottic gap area (NGGA). Perceptual voice analysis was performed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) at corresponding time points.

Results

Fifty-three patients met inclusion criteria. Six underwent CM only, 20 went on to require PM, 19 underwent IL only, and eight underwent IL and subsequent PM. NGGA at presentation was similar among groups; however, the CM group was noted to have more favorable CAPE-V scores for Breathiness (P = .007) and Loudness (P = .018). All groups had similar NGGA and CAPE-V scores at last follow-up. When compared to pooled data for patients who underwent PM, the IL group was noted to have similar NGGA and CAPE-V scores at presentation. Although improvements in both groups were noted following intervention, both groups appeared similar at last follow-up with the exception of Roughness, for which the IL group retained a slightly improved outcome (13.3 vs. 18.3, P = .03).

Conclusions

At presentation, UVFP patients have similar NGGA. This finding suggests that treatment recommendations cannot be made on the size of the glottic gap alone. Furthermore, in many patients, IL results in long-term benefit with glottic closure and CAPE-V scores equivalent to that obtained with PM.

Level of Evidence

4 Laryngoscope, 2017

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Investigation of the presence of HPV on KTP laser fibers following KTP laser treatment of papilloma

Objectives

Recurrent respiratory papillomatosis is often treated with in-office laser procedures using a potassium titanyl phosphate (KTP) laser transmitted through a laser fiber. Although effective, this procedure has notable downsides, including the possibility of transmitting human papillomavirus (HPV) in the smoke plume and the high cost of these single-use fibers. The objective of this study is to determine if HPV can be detected on a laser fiber after use, with or without sterilization.

Methods

Twelve patients with laryngeal papillomas were treated with KTP laser energy transmitted via a KTP fiber. Ten fibers were sterilized in CIDEX (ASP, Irvine, California), a glutaraldehyde disinfectant, for 12 minutes, whereas two fibers were left unsterilized. Human papillomavirus DNA amplification was done on all 12 fiber samples with real-time polymerase chain reaction (PCR) using general primer mediated 5+ and 6+. Human papillomavirus genotyping detection was done using type specific probes and/or Sanger sequencing.

Results

Over 27 strains of HPV were not detected on KTP fibers after use, with or without sterilization.

Conclusion

Human papillomavirus was undetectable by PCR on KTP laser fibers that were sterilized or unsterilized after use. Further studies are needed utilizing a transmission model to determine if HPV can be incubated from this fiber after sterilization.

Level of Evidence

NA. Laryngoscope, 2017

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Relationship between degree of obstruction and airflow limitation in subglottic stenosis

Objectives

Subglottic stenosis (SGS) is one of the most common airway disorders in pediatric patients. Currently, treatment decisions rely primarily on the Cotton-Myer scale, which classifies SGS severity based on percentage reduction in airspace cross-sectional area (CSA). However, the precise relationship between upper airway resistance and subglottic CSA is unknown. We hypothesize that airway resistance can be described by the Bernoulli Obstruction Theory, which predicts that airway resistance is inversely proportional to airspace CSA ( ) in cases of severe constriction.

Methods

Computed tomography (CT) scans of six healthy subjects and five SGS patients were used to create three-dimensional models of the respiratory tract from nostrils to carina. Cylindrical segments of varying lengths and varying diameters were digitally inserted in the subglottis of the healthy subjects to create simulated SGS models. Computational fluid dynamics simulations were run, and airway resistance was computed in the simulated SGS models and actual SGS models.

Results

Constriction diameter had a greater impact in airway resistance than constriction length. In agreement with the Bernoulli Obstruction Theory, airway resistance in the simulated SGS models was well represented by the power law , where is a constant and the exponent b ranged from −0.85 to −1.07. The percentage reduction in airflow at a constant pressure drop was found to be directly proportional to the percentage reduction in CSA in the limit of severe constrictions, namely , where . Airway resistances in the simulated SGS models were similar to resistances in models based on CT scans of actual SGS patients, suggesting that our simulated SGS models were representative of airway resistance in actual SGS patients.

Conclusion

Our computer simulations suggest that the degree of airflow limitation in SGS patients may be estimated based on anatomic measurements alone. Future studies are recommended to test these predictions in larger cohorts.

Level of Evidence

4. Laryngoscope, 2017

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Oral sampling methods are associated with differences in immune marker concentrations

Objective

To determine whether the concentration and distribution of immune markers in paired oral samples were similar.

Study Type

Clinical research.

Study Design

Cross-sectional study.

Methods

Paired saliva and oral secretions (OS) samples were collected. The concentration of immune markers was estimated using Luminex multiplex assay (Thermo Fisher Scientific, Waltham, MA). For each sample, the concentration of respective immune markers was normalized to total protein present and log-transformed. Median concentrations of immune markers were compared between both types of samples. Intermarker correlation in each sampling method and across sampling methods was evaluated.

Results

There were 90 study participants. Concentrations of immune markers in saliva samples were significantly different from concentrations in OS samples. Oral secretions samples showed higher concentrations of immunoregulatory markers, whereas the saliva samples contained proinflammatory markers in higher concentration.

Conclusion

The immune marker profile in saliva samples is distinct from the immune marker profile in paired OS samples.

Level of Evidence

2b. Laryngoscope, 2017

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Epistaxis in children and adolescents with hereditary hemorrhagic telangiectasia

Objectives/Hypothesis

Our objective was to describe epistaxis onset and severity in pediatric hereditary hemorrhagic telangiectasia (HHT) patients and study the cumulative incidence of epistaxis by age of onset within each genetic subtype.

Study Design

Retrospective cohort chart review.

Methods

Charts were reviewed of patients age 0 to 18 years with a clinical or genetic diagnosis of HHT who were evaluated at a tertiary multidisciplinary HHT clinic from January 2010 to June 2016. The epistaxis severity score (ESS), a validated tool for assessing epistaxis severity, was used to assess epistaxis. Statistical analyses were conducted on the full HHT cohort as well as subgroups stratified by the HHT causative gene (HHT1 = ENG and HHT2 = ACVRL1).

Results

Sixty-nine pediatric subjects were identified; 60 had HHT confirmed by genetic testing, and nine (from families with known mutations) met published clinical diagnostic criteria alone. Fifty-nine (85%) had onset of epistaxis. The median age of onset of epistaxis was 5 years (interquartile range [IQR]: 2–9 years). The median ESS for the entire cohort was 1.6 (IQR: 0–2.6). The median ESS was higher in HHT1 versus HHT2 (2.3 vs. 1.1, P = .002), and age of epistaxis onset was earlier in HHT1 (3 vs. 5 years, P = .03). Sex and age were not associated with ESS.

Conclusions

Epistaxis may present early in HHT, but is typically mild in the pediatric period. Severity in the pediatric population is worse in patients with HHT1. By recognizing the significance of even mild, infrequent epistaxis in a child with a family history of HHT, and understanding that not all HHT patients have epistaxis during childhood, community providers and otolaryngologist can assist in the early detection of HHT.

Level of Evidence

4 Laryngoscope, 2017

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The impact of speech and language problems in kindergarten on academic learning and special education status in grade three

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Training dentists

With the British Army on the Western Front: A big howitzer being manhandled into position. - Otago Witness, 21.11.1917.

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The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis.

The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis.

Probiotics Antimicrob Proteins. 2017 Nov 22;:

Authors: Yoo JI, Shin IS, Jeon JG, Yang YM, Kim JG, Lee DW

Abstract
Although several studies have evaluated the inhibitory effect of probiotics on halitosis, findings are inconsistent. This systematic review and meta-analysis of randomized clinical trials (RCT) was conducted to summarize the evidence on the effect of probiotics on halitosis. RCT on any type of probiotic treatment with at least 2-week duration were identified through electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials) and hand searched between 1946 and January 17, 2017. Primary outcomes were organoleptic (OLT) scores and volatile sulfur compounds (VSC). Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Meta-analysis was conducted to synthesize the evidence. Of the 153 articles identified, three met the inclusion criteria. Meta-analysis revealed that OLT scores (SMD = - 1.93, 95% CI - 2.85 to - 1.02, P < 0.0001) were significantly lower in subjects who received probiotics than in placebo groups, but no significant difference was observed at the VSC concentration (SMD = - 0.02, 95% CI - 2.12 to 2.07, P = 0.98). Current evidence is supportive of recommending probiotics for the management of halitosis. Based on this review, transient (average of 2 weeks) dosing with probiotics (mainly Lactobacillus strains) has a moderate effect on halitosis regarding OLT scores, but we could not confirm the effects of probiotics on the VSC reduction. The available evidence is quantitatively and qualitatively insufficient for further recommendations, especially with regard to administration strategies and pretreatment. Future studies should aim for longer follow-up and standardized administration methods to prove or refute the effect of probiotics on halitosis.

PMID: 29168154 [PubMed - as supplied by publisher]

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Das Ringerohr der etwas anderen Art

Zusammenfassung

Wir berichten über den Fall eines 19-jährigen Mannes mit rezidivierenden, kreisförmigen und groblamellär geschuppten Hautveränderungen. Anamnestisch war der Patient in seiner Freizeit als Ringer tätig. Nach zunächst frustraner antibiotischer Lokaltherapie konnte im Rahmen einer spezifischen dermatologischen Diagnostik eine Tinea corporis gladiatorum gesichert werden. Unter der leitliniengerechten Therapie für Dermatophytosen mittels systemischer Gabe von Fluconazol sowie einer Lokaltherapie mit Ciclopiroxolamin und Ketoconazol konnte eine schnelle Befundbesserung erwirkt werden.

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Axillary lymph node dissection in breast cancer patients after sentinel node biopsy

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A Danish national effort of BRCA1/2 variant classification

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Triple negative breast cancer – prognostic role of immune-related factors: a systematic review

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Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials

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Breast conserving surgery versus mastectomy: overall and relative survival—a population based study by the Danish Breast Cancer Cooperative Group (DBCG)

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The occurrence of fractures after adjuvant treatment of breast cancer: a DBCG register study

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Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists

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Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG)

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A multi-country assessment of factors related to smallholder food security in varying rainfall conditions

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Habitat foraging niche of a High Arctic zooplanktivorous seabird in a changing environment

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Emergence of tick-borne diseases at northern latitudes in Europe: a comparative approach

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Intraspecific variation and plasticity in mitochondrial oxygen binding affinity as a response to environmental temperature

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Sorption Hysteresis of Light Hydrocarbons and Carbon Dioxide in Shale and Kerogen

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Functional anatomy of a giant toothless mandible from a bird-like dinosaur: Gigantoraptor and the evolution of the oviraptorosaurian jaw

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Anaerobic microsites have an unaccounted role in soil carbon stabilization

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Invasive plants as potential food resource for native pollinators: A case study with two invasive species and a generalist bumble bee

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Wind-generated Electricity in China: Decreasing Potential, Inter-annual Variability and Association with Changing Climate

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Gas hydrate saturations estimated from pore-and fracture-filling gas hydrate reservoirs in the Qilian Mountain permafrost, China

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Orthrozanclus elongata n. sp. and the significance of sclerite-covered taxa for early trochozoan evolution

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Understanding heat patterns produced by vehicular flows in urban areas

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Elevated moisture stimulates carbon loss from mineral soils by releasing protected organic matter

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Recognition of a likely two phased extinction at the K-Pg boundary in Antarctica

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New Early Cretaceous palaeomagnetic and geochronological results from the far western Lhasa terrane: Contributions to the Lhasa-Qiangtang collision

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Tides in the Last Interglacial: insights from notch geometry and palaeo tidal models in Bonaire, Netherland Antilles

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No evidence for social immunity in co-founding queen associations

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Can Niche Modeling and Geometric Morphometrics Document Competitive Exclusion in a Pair of Subterranean Rodents (Genus Ctenomys) with Tiny Parapatric Distributions?

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Avoidance of seismic survey activities by penguins

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Internal fit of three-unit fixed dental prostheses produced by computer-aided design/computer-aided manufacturing and the lost-wax metal casting technique assessed using the triple-scan protocol

Suboptimal adaptation of fixed dental prostheses (FDPs) can lead to technical and biological complications. It is unclear if the computer-aided design/computer-aided manufacturing (CAD/CAM) technique improves adaptation of FDPs compared with FDPs made using the lost-wax and metal casting technique. Three-unit FDPs were manufactured by CAD/CAM based on digital impression of a typodont model. The FDPs were made from one of five materials: pre-sintered zirconium dioxide; hot isostatic pressed zirconium dioxide; lithium disilicate glass-ceramic; milled cobalt-chromium; and laser-sintered cobalt-chromium. The FDPs made using the lost-wax and metal casting technique were used as reference. The fit of the FDPs was analysed using the triple-scan method. The fit was evaluated for both single abutments and three-unit FDPs. The average cement space varied between 50 μm and 300 μm. Insignificant differences in internal fit were observed between the CAD/CAM-manufactured FDPs, and none of the FPDs had cement spaces that were statistically significantly different from those of the reference FDP. For all FDPs, the cement space at a marginal band 0.5–1.0 mm from the preparation margin was less than 100 μm. The milled cobalt-chromium FDP had the closest fit. The cement space of FDPs produced using the CAD/CAM technique was similar to that of FDPs produced using the conventional lost-wax and metal casting technique.

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Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach

An anterior open bite is a challenge to orthodontic treatment; it has a multifactorial etiology and a wide range of intervention options. Temporomandibular joint (TMJ) disorders are a risk factor for the development of malocclusions such as the anterior open bite, especially in patients who have TMJ osteoarthritis with disc displacement. Articular disc repositioning surgery is an available option for treating this pathology, and it contributes to maintaining the condyles in a more stable position.

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Two-dimensional vs 3-dimensional comparison of alveolar bone over maxillary incisors with A-point as a reference

Our objectives were to compare, relative to A-point, (1) bone thickness over the most forward maxillary incisor (MFMI) in 2 dimensions vs 3 dimensions, and (2) bone thickness and inclination of each maxillary incisor in 3 dimensions.

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Information for readers

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Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis

Although powered toothbrushes have been reported to reduce gingivitis more than manual toothbrushes in the general population, the evidence regarding orthodontic patients has been inconclusive. Thus, we aimed to compare their effectiveness in relation to any available parameter regarding oral health in orthodontic patients with fixed appliances.

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Editorial Board

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Differences in distances between maxillary posterior root apices and the sinus floor according to skeletal pattern

The aim of this study was to evaluate the distances from the maxillary posterior root apices to the inferior wall of the maxillary sinus using cone-beam computed tomography images and the relationships between roots and maxillary sinus according to age, sex, and skeletal pattern.

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Table of Contents

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Malocclusion and health care

In an editorial in the June 2017 issue, Dr Nadia Laniado wrote the following: "A fundamental issue distinguishes the specialty of orthodontics from the rest of dentistry: malocclusion is not a disease, but it is a variation from ideal. Therefore, while the rest of dentistry is primarily concerned with the sequelae of chronic conditions, including dental caries and periodontal disease, orthodontists are treating something for which there is no bacterial etiology and no potential cure" (Laniado N.

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Erratum

Erratum to: Eliades T. Bisphenol A and orthodontics: An update of evidence-based measures to minimize exposure for the orthodontic team and patients. Am J Orthod Dentofacial Orthop 2017;152:435-41.

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Computer-aided design and manufacture of hyrax devices: Can we really go digital?

The aim of this pilot study was to illustrate the feasibility of a new digital procedure to fabricate metallic orthodontic appliances. Hyrax appliances for rapid palatal expansion were produced for 3 patients using a CAD/CAM procedure without physical impressions or printed models. The work flow consisted of intraoral scanning, digital design with incorporation of a scanned prefabricated expansion screw, direct 3-dimensional metal printing via laser melting, welding of an expansion screw, insertion, and finally activation in the patients' mouths.

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Erratum

Erratum to: Favero CS, English JD, Cozad BE, Wirthlin JO, Short MM, Kasper FK. Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models. Am J Orthod Dentofacial Orthop. 2017;152(4):557-65.

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Possible alternative treatment for mandibular asymmetry by local unilateral IGF-1 injection into the mandibular condylar cavity: Experimental study in mice

The purpose of this study was to investigate whether a local unilateral IGF-1 injection into the mandibular condylar cavity can induce unilateral endochondral mandibular growth without any systemic adverse effects.

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Residents' journal review

Reduced frictional resistance during tooth movement is believed to increase the efficiency of the orthodontic force system. The method of ligation contributes to the amount of frictional force between the archwire and bracket. Studies have shown that elastomeric ligatures tied in a figure-8 pattern had significantly more friction than conventional elastomeric or stainless steel ligation. The authors tested whether figure-8 elastomeric modules affect the rate of mandibular incisor alignment and whether there was a difference in the number of bracket failures between figure-8 and conventional groups.

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Effect of malocclusion on adults seeking orthodontic treatment

Our objective was to examine the Teen Oral Health-related Quality of Life (TOQOL) questionnaire for use in adults receiving orthodontic treatment and assess validity and reliability by age group.

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International items of interest

Upheld Internet (on own site) 08 March 2017

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Directory: AAO Officers and Organizations

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Mixed messages

The sole concern of your new patient, Jim, is his rotated maxillary right lateral incisor. He is otherwise content with his occlusal status. You suggest addressing this objective with a few aligners. He readily agrees, but advises you that his general dentist had delivered a maxillary full coverage night guard 2 months ago to address his bruxing habit, and he doesn't want to pay for a replacement. "No problem," you say. "Once we correct the tooth, we'll modify the night guard to accommodate the new position of the tooth so you can wear that night guard." You advise him to bring the night guard to the aligner delivery appointment so you can look at it.

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When things don't “ad” up

So, a patient comes to you needing whatever. He expects his insurance to cover the treatment, and so does your office. Therefore, you go ahead and treat him. Not too far down the road, everybody realizes that the insurance company will not cover the services rendered. You refuse to give the patient any more appointments until he pays the fee due for services already rendered. He disappears and ultimately reappears after an extended period of time, having dutifully worn whatever you gave him. Bad things have happened because of the unmonitored and unsupervised appliance wear.

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December 2017:152(6)

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International Items of Interest

As I begin this editorial, I will admit that most of what I will tell you is not original. I will simply use this opportunity to inform you of a new section of the Journal, and I will explain from whence it came. For the most part, the title is derived from the activities of Rodrigues Ottolengui. His accomplishments are fairly well known in orthodontics, but for those not aware, I will make a few informational comments.1

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