Πέμπτη 25 Μαρτίου 2021

Fat and Fibrin Glue: Quo Vadis?

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Turk Neurosurg. 2021;31(2):238-246. doi: 10.5137/1019-5149.JTN.29712-20.2.

ABSTRACT

AIM: To analyze the effectiveness of fat and fibrin glue to prevent postoperative cerebrospinal fluid (CSF) leak in pituitary surgery.

MATERIAL AND METHODS: Two hundred and eleven patients affected by pituitary adenoma entered this study. Patients that underwent a microscopic transsphenoidal approach between January 2013 and April 2019 were included. All the patients that developed intraoperative CSF leak were treated with fat and fibrin glue. The presence or absence of postoperative CSF leak was considered as a parameter to test the effectiveness of the intraoperative reconstruction technique used.

RESULTS: Postoperative CSF leak was observed in 5 patients (2.4%). Among patients with an intraoperative low- grade CSF leak (1 or 2), 97.9% did not develop a postoperative CSF leak. In contrast, those who presented an intraoperative CSF leak of grade 3 , had a worse prognosis.

CONCLUSION: Fat and fibrin glue is currently an effective method in the treatment of low-grade intraoperative CSF leak. In case of intraoperative CSF leak of grade 3, it should be used combined with the nasoseptal flap technique to obtain a safer reconstruction.

PMID:33624276 | DOI:10.5137/1019-5149.JTN.29712-20.2

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Herpes simplex virus 1 proteins can induce skin inflammation in an atopic dermatitis‐like mouse model

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Abstract

Herpes simplex virus type 1 (HSV‐1) can induce in certain individuals with atopic dermatitis (AD) severe cutaneous infections that can spread throughout the entire body, a condition named as AD complicated by eczema herpeticum (ADEH). It has been recently found that ADEH patients can produce specific IgE against HSV‐1 proteins, which may contribute to lower protection against HSV‐1. However, little is known about the capacity of these HSV‐1 proteins to produce an inflammatory response at the skin level. In this study, using a mouse model of AD‐like dermatitis, three HSV‐1 proteins (glycoprotein D ‐gD‐, glycoprotein B ‐gB‐ and VP22) were applied on tape‐stripped back skin mice in three exposures periods. Ovalbumin (OVA) and 0.9% NaCl were used as positive and negative controls, respectively. Skin samples were obtained for analysis of specific cell components of skin infiltration. The results showed that the viral protein gD induced a statistically significant increase in the number of dermal infiltrating CD3+, CD4+ cells and mast cells compared with the negative control group. gD was also able to induce epidermal thickening and epidermal infiltration of T cells closely related to the one produced in mice sensitized with OVA. However, VP22 and gB contributed to a lesser extent to skin inflammation. These results showed that proteins from HSV‐1, especially gD, can have per se an important T cell and mast cell‐driven inflammatory potential at the skin level.

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Increased angiogenesis and migration of dermal microvascular endothelial cells from patients with psoriasis

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Abstract

Psoriasis displays both increased angiogenesis and microvascular dilation in the skin, while human dermal microvascular endothelial cells (HDMECs) are involved in angiogenesis and microvascular dilation. Whether the functions of HDMECs are altered in psoriatic skin versus healthy skin remain unknown. Here, we isolated HDMECs from the skin of 10 patients with psoriasis and 10 healthy subjects and compared angiogenesis, proliferation, migration and cell metabolism between psoriatic HDMECs and normal HDMECs. We found that the morphology of primary HDMECs was comparable between psoriatic HDMECs and normal HDMECs. After passage, psoriatic HDMECs displayed larger cell size and wider intercellular space. In addition to DiI‐Ac‐LDL (DiI‐labelled acetylated low‐density lipoprotein) uptake, expression levels of CD31, vWF (von Willebrand factor) and LYVE‐1 were comparable in psoriatic HDMECs versus normal HDMECs. However, psoriatic HDMECs exhibited increased tube formation (numbers of nodes and meshes, p < 0.05) and migration (numbers of migrated cells, p < 0.001) and reductions in proliferation (growth rates, p < 0.05) and energy metabolism (oxygen consumption rate and extracellular acidification rate, p < 0.05) compared with normal HDMECs. Therefore, psoriatic HDMECs display an increased angiogenesis and migration and decreased proliferation and metabolic activity, suggesting a pathogenic role of HDMECs in psoriasis.

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Identification of gut microbiota signatures in symptomatic dermographism

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Abstract

Symptomatic dermographism (SD) is a recurrent inflammatory skin disease related to immunity; however, the details remain elusive. In view of the important role of gut microbiota in immune regulation, the purpose of this study is to investigate the alterations of gut microbiota in SD and explore the potential bacterial biomarkers for diagnosis. A case‐control study including SD patients and normal controls (NCs) was carried out. Gut microbiota of the participants was analysed by the 16S rDNA sequencing of faecal samples. The linear discriminant analysis effect size and the receiver operating characteristic curve (ROC) analysis were used to identify the bacterial biomarkers. Forty‐four participants were included in this study. The alpha‐diversity and beta‐diversity of gut microbiota differed significantly between SD patients and NCs. The abundance of Verrucomicrobia, Ruminococcaceae and their subordinate taxa were reduced in SD patients, while Enterobacteriales and its subor dinate taxon exhibited higher relative abundance compared with NCs. Subdoligranulum and Ruminococcus bromii showed a potential diagnostic value for SD, and Prevotella stercorea was negatively relevant to duration of SD. Furthermore, the pyruvate, butyric acid and histamine metabolism pathway were likely to be involved in the pathogenesis of SD. Our results revealed that the gut microbiota of SD patients experienced obvious changes, and Verrucomicrobia, Ruminococcaceae and Enterobacteriales were microbiota signatures for SD.

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Epigenetic‐modifying therapies: an emerging avenue for the treatment of inflammatory skin diseases

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Abstract

Epigenetic modifications include DNA methylation, histone modifications, and the actions of microRNAs. These mechanisms coordinate in complex networks to control gene expression, thereby regulating key physiological processes in the skin and immune system. Recently, researchers have turned to the epigenome to understand the pathogenesis of inflammatory skin diseases. In psoriasis and atopic dermatitis, epigenetic modifications contribute to key pathogenic events such as immune activation, T cell polarization, and keratinocyte dysfunction. These discoveries have introduced new possibilities for the treatment of skin diseases; unlike genetics, epigenetic alterations are readily modifiable and potentially reversible. In this viewpoint essay, we summarize the current state of epigenetics research in inflammatory skin diseases and propose that targeting the histone machinery is a promising avenue for the development of new therapies for psoriasis and atopic dermatitis. Expanding on the progress that has already been made in the field of cancer epigenetics, we discuss existing epigenetic‐modifying tools that can be applied to the treatment of inflammatory skin diseases and consider future directions for investigation in order to allow for the widespread clinical application of such therapies.

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Dysregulated epigenetic modifications in psoriasis

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Abstract

The observed incidence of psoriasis has been gradually increasing over time1, but the underlying pathogenic factors have remained unclear. Recent studies suggest the importance of epigenetic modification in the pathogenesis of psoriasis. Aberrant epigenetic patterns including changes in DNA methylation, histone modifications, and non‐coding RNA expression are observed in psoriatic skin. Reversing these epigenetic mechanisms have showed improvement in psoriatic phenotypes, making epigenetic therapy a potential avenue for psoriasis treatment. Here, we summarize relevant evidence for epigenetic dysregulation contributing to psoriasis susceptibility and pathogenesis, and the factors responsible for epigenetic modifications, providing directions for potential future clinical avenues.

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Patterns of care, toxicity and outcome in the treatment of salivary gland carcinomas: long-term experience from a tertiary cancer center

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Eur Arch Otorhinolaryngol. 2021 Mar 24. doi: 10.1007/s00405-021-06652-5. Online ahead of print.

ABSTRACT

BACKGROUND: Salivary gland carcinomas (SGC) cover a heterogeneous group of malignancies with a lack of data of high-level evidence.

METHODS: Clinical data of 127 patients treated for SGC at a university cancer center between 2002 and 2017 were analyzed retrospectively. The association of clinicopathological characteristics, treatment modalities, adverse events, and outcome was assessed.

RESULTS: Patients received surgery (n = 65), surgery followed by (chemo-)radiotherapy (n = 56), or primary (chemo-)radiotherapy (n = 6). Injury to the cranial nerves or their branches was the most frequent surgical complication affecting 40 patients (33.1%). Ten year overall and progression-free survival rates were 73.2% and 65.4%, respectively. Parotid tumor site, advanced tumor, and positive nodal stage remained independent negative pro gnostic factors for overall survival, loco-regional and distant tumor control in multivariate analysis.

CONCLUSIONS: Optimizing treatment strategies for SGC, depending on distinct clinicopathological factors, remains challenging due to the low incidence rates of the disease.

PMID:33760953 | DOI:10.1007/s00405-021-06652-5

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Silastic sheeting in staged ear surgery: Is there still a role for this procedure?

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Eur Arch Otorhinolaryngol. 2021 Mar 24. doi: 10.1007/s00405-021-06744-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To review long-term outcomes for chronic otitis media with and without cholesteatoma in staged canal-wall-up tympanoplasty with temporary silastic sheeting and to compare hearing and recurrence results with the literature.

METHODS: Retrospective data analysis of all patients suffering from chronic otitis media with or without cholesteatoma (COMC/COM) and treated by staged canal-wall-up (CWU) technique with silastic insertion between 1992 and 2012. Literature analysis in PubMed 1990-2017.

RESULTS: 74 cases were included in the analysis. In COMC (n = 47) a total of 2 (4%) recurrent and 14 (30%) residual cholesteatoma were documented. The postoperative hearing test showed a pure-tone-average (PTA) of 36 dB hearing level (HL) and an air-bone-gap (ABG) of 21 dB HL. A significant improvement was only observed for st age I disease (PTA 8 dB HL and ABG 9 dB HL). In COM (n = 27) postoperative PTA and ABG were significantly improved by 33 dB HL and 23 dB HL, respectively. Mean postoperative follow-up was 47 months (12-173) for COMC and 22 months (2-120) for COM.

CONCLUSIONS: The cholesteatoma recurrence rate in this study reflects contemporary published rates. Assessment of hearing outcome is difficult due to the low number of cases and very high heterogeneity of published data. Still, the staged CWU procedure with temporary silastic sheeting seems to bear some advantages in regard to hearing. The role of additional factors such as Eustachian Tube function to assess outcome should be considered. An internationally agreed upon reporting system should be followed, if various surgical approaches are to be compared.

LEVEL OF EVIDENCE: 3.

PMID:33760955 | DOI:10.1007/s00405-021-06744-2

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Vertebral Artery Compression by the Greater Cornu of the Thyroid Cartilage

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Ear Nose Throat J. 2021 Mar 24:1455613211002921. doi: 10.1177/01455613211002921. Online ahead of print.

ABSTRACT

A case of symptomatic unilateral vertebral artery compression by the greater cornu of the thyroid cartilage is described. Imaging shows ossification of the greater cornu of the thyroid cartilage with compression of an aberrant vertebral artery that enters the transverse foramen at the level of C4. Diagnostic workup and surgical treatment are described. Laryngoplas ty with a transverse cervical approach and resection of the greater cornu of the thyroid cartilage resulted in resolution of symptoms.

PMID:33759595 | DOI:10.1177/01455613211002921

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Hereditäre hämorrhagische Teleangiektasie: Symptome und diagnostische Latenz

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Laryngorhinootologie
DOI: 10.1055/a-1408-5160

Hintergrund Patienten mit hereditärer hämorrhagischer Teleangiektasie (HHT) leiden unter einer systemischen Erkrankung des Gefäßbindegewebes, bei der eine Vielzahl verschiedener Symptome auftritt. Material und Methoden Die Daten aller Patienten, die sich von April 2014 bis August 2019 im Westdeutschen Morbus-Osler-Zentrum vorstellten, wurden in einer retrospektiven Studie analysiert. Ergebnisse Bei 235 Patienten konnte die Diagnose HHT als definitiv (235/282; 83 %) und bei 26 als möglich gestellt werden (26/282; 9 %). Die mittlere diagnostische Latenz zwischen Erstsymptomen und Diagnose betrug 18 Jahre. Direkte oder indirekte Blutungszeichen wurden oft als erste Symptome der Erkrankung HHT genannt (224/241; 93 %). 83 % der Patienten mit einem Grad der Behinderung gaben HHT als Hauptursache an. Insbesondere ältere, weibliche Patienten bzw. Patienten mit starker Epistaxis litten an einer chronischen Eisenmangelanämie (Eisensubstitution:148/261; 57 %; Erythrozytenkonzentrate: Mittelwert: 9 ± Standardabweichung: 41, Minimum – Maximum: 0–400, Anzahl der Patienten: 218). 10 % erhielten eine Thrombozytenaggregationshemmung oder Antikoagulation und tolerierten diese. 74 % der Patienten mit HHT pflegten ihre Nasenschleimhaut (177/238) und zeigten weniger Blutungen als Patienten ohne Nasenpflege (ESS: t-Test: 3,193; p = 0,003; Anämi e: Chi-Quadrat: 5,173; p = 0,023). Schlussfolgerungen Die Diagnoselatenz der Erkrankung HHT betrug knapp 2 Jahrzehnte. Patienten mit HHT leiden insbesondere an rezidivierenden Blutungen, die dabei meistindizierte Behandlung der ersten Wahl ist eine konsequente Nasenpflege und verschiedene koagulative Therapieoptionen. Bei Begleiterkrankungen mit Indikation zur Gerinnungshemmung lohnt es sich meist, deren Einsatz zu versuchen.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Entwicklung der Publikationsleistung der Universitätskliniken für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie während der SARS-CoV-2-Pandemie im Jahr 2020 in Deutschland

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Laryngorhinootologie
DOI: 10.1055/a-1430-7735

Einleitung Die SARS-CoV-2-Pandemie hat an den Universitätskliniken für Hals-Nasen-Ohrenheilkunde (HNO) zu tiefgreifenden Einschränkungen im Bereich der Krankenversorgung und der studentischen Lehre geführt. Die Auswirkungen auf den Bereich Forschung sind dagegen uneinheitlich. Zur Einordnung der pandemiebedingten Effekte auf die Forschung wurde die Entwicklung der Anzahl der wissenschaftlichen Publikationen der HNO-Universitätskliniken in Deutschland vor und während der Pandemie analysiert. Material und Methoden Es wurde die Publikationsleistung aus den Jahren 2015–2020 der derzeitigen 39 Klinikdirektoren mithilfe einer Literaturrecherche (PubMed) erhoben. Eingeschlossen wurden alle Nennungen der Klinikdirektoren als Erst-, Letzt- oder Co-Autor einer Arbeit. Es wurde die absolute und relative Entwicklung der Publikationsleistung jedes Autors ermittelt und statistisch ausgewertet. Ergebnisse Die Literaturrecherche ergab 2420 Publikationen. Zwischen 2015 und 2019 wurden pro Jahr durchschnittlich 368 Publikationen von allen Autoren veröffentlicht. 2020 stieg diese Zahl um 57,9 % auf 581 Publikationen an. Während zwischen 2015 und 2019 die Anzahl der monatlichen Publikationen konstant blieb, zeigte sich ab Mai 2020 ein deutlicher Anstieg bis zu einem Maximum von 74 Veröffentlichungen im September 2020. 34 Arbeiten (5,9 %) aus dem Jahr 2020 wiesen einen thematischen Bezug zur SARS-CoV-2-Pandemie auf, wobei 7 dieser Arbeiten (20,6 %) durch standortübergreifende Veröffentlichungen entstanden sind. Schlussfolgerung Im Jahr 2020 konnte die Zahl der wissenschaftlichen Publikationen auf mehr als das 1,5-fache der Veröffentlichungen der Vorjahre gesteigert werden. Diese Steigerung stand in einem deutlichen zeitlichen Zusammenhang zur Reduktion der elektiven Krankenversorgung während der SARS-CoV-2-Pandemie ab Mitte März 2020. Wahrscheinlich haben freie zeitliche Kapazitäten diese gesteigerte Publikationsleistung ermöglicht. Unsere Ergebnisse belegen das große wissenschaftliche Potenzial der universitären HNO-Kliniken, das trotz der Pandemie erfolgreich umgesetzt werden konnte.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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