Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

To clarify pre- and postoperative C-reactive protein (CRP) levels in patients with facial fractures and to investigate the influence of perioperatively administered dexamethasone on postoperative CRP levels. Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone (OradexonA (R)), whereas patients in the control group received no glucocorticoid. The analysis included patients who had CRP measured pre- and postoperatively. A total of 73 adult patients with facial fractures were included in the final analysis. Mean CRP level was elevated preoperatively and the level increased further after surgery. However, postoperative CRP rise was significantly impeded by dexamethasone (p <0.001), regardless of gender, age, treatment delay, site of fracture, surgical approach, and duration of surgery. CRP rise halved on the 1st postoperative day when dexamethasone was used. In addition, dexamethasone resulted in a CRP decrease on the 2nd postoperative day, whereas the CRP rise continued in the control group. CRP rise is a normal body response after facial fracture and surgery that can be markedly reduced with dexamethasone. CRP changes should be considered with caution if perioperative dexamethasone is used.Peer reviewe

Analgesic Effect of Perioperative Systemic Dexamethasone on Blowout Fracture Surgery

Purpose: To clarify the effect of systemic dexamethasone (DXM) on pain and postoperative opioid (oxycodone) consumption after blowout fracture surgery. Materials and Methods: A prospective randomized observer-blinded trial of 20 patients who had a blowout fracture requiring surgical intervention was conducted. Patients were randomly assigned to receive a total dose of intravenous DXM 30 mg perioperatively or no DXM (controls). Pain was assessed postoperatively using a 10-cm visual analog scale (VAS) each time analgesics (acetaminophen every 6 hours or oxycodone upon request) were administered. The VAS area under the curve (VAS AUC) for 24 hours postoperatively represented the outcome. Data were analyzed using chi(2) test, Student t test, 2-tailed Mann-Whitney U test, and linear regression, with a P value less than .05 indicating significance. Results: Patients with blowout fracture receiving perioperative systemic DXM exhibited a significantly lower average VAS AUC (P = .04). After controlling for other confounding variables, this result remained significant (P = .03). Conclusions: DXM appears to decrease postoperative pain and thus is recommended as a pre-emptive analgesic in blowout fracture surgery. (C) 2017 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial SurgeonsPeer reviewe

Associated Injuries Are Frequent and Severe Among Geriatric Patients With Zygomatico-Orbital Fractures

Purpose: Associated injuries (AIs) are hypothesized to be frequent in geriatric zygomatico-orbital (ZMO) fractures. The study aim was to determine the relation between ZMO fractures and AIs in geriatric patients compared with younger adult patients. Patients and Methods: A retrospective case-and-control study was carried out on geriatric patients at least 65 years of age (n = 93) and younger adult patients 20 to 30 years of age (n = 68) diagnosed with pure unilateral ZMO fractures. The main exposure was age, the primary outcome was AI outside the face, and the secondary outcomes were type and severity of AI, ocular injuries, restriction of mandibular movement, and ZMO buttress asymmetry. The confounding variables were gender, trauma mechanism, type of ZMO fracture, and dislocation. Statistical analyses included chi(2) tests, risk evaluation with 2 x 2 tables, and logistic regression analysis. Results: AIs outside the face, and particularly brain injuries, were significantly more frequent in the geriatric group than in the control group (P <.001). The significant predictors of AIs outside the face were fall from a height (66.7%), motor vehicle accidents (66.7%), and absence of ZMO dislocation (59.5%; P <.001). The adjusted risk of brain injury was 2.5-fold in the absence of dislocation. The geriatric group had a more than 5-fold higher risk of brain injuries compared with the younger control group (P = .003). Conclusions: AIs in general, and particularly brain injuries, are frequent in geriatric ZMO fractures. Intra- cranial injuries should be ruled out, particularly in geriatric patients diagnosed with a non-dislocated ZMO fracture. (C) 2018 American Association of Oral and Maxillofacial SurgeonsPeer reviewe

Isolated Orbital Fractures Are Severe Among Geriatric Patients

Purpose: The purpose of the present study was to clarify the reasons for, types of, and degree of involvement of the orbital wall and the severity of orbital fractures in geriatric patients and to compare the differences between geriatric and younger adult patients. Materials and Methods: A retrospective case-control study of geriatric patients aged at least 65 years (n = 72) and younger controls aged 20 to 50 years (n = 58) with a diagnosis of a unilateral isolated orbital fracture was designed and implemented. The main exposure was age, the primary outcome was the isolated orbital fracture type, and the secondary outcomes were the associated orbital zones, fracture area (cm(2)), degree of dislocation (mm), involvement of anatomic landmarks, diplopia, altered ocular position, restricted eyemovement, and ocular injuries. The confounding variables were gender, trauma mechanism, and alcohol abuse. The statistical methods included chi(2) tests and logistic regression analyses. Results: Among the geriatric patients, the great majority of isolated orbital fractures had been caused by falls (66.7%; P Conclusions: Falling is the most common mechanism of elderly orbital fractures. Isolated orbital fractures are extensive and mainly affect the globe supporting the middle and posterior parts of the orbital floor among geriatric patients. (C) 2017 American Association of Oral and Maxillofacial SurgeonsPeer reviewe

Complete remission after the first cycle of induction chemotherapy determines the clinical efficacy of relapse-preventive immunotherapy in acute myeloid leukaemia

No abstract availabl

Anthracycline-based consolidation may determine outcome of post-consolidation immunotherapy in AML

Consolidation chemotherapy in acute myeloid leukemia (AML) aims at eradicating residual leukemic cells and mostly comprises high-dose cytarabine with or without the addition of anthracyclines, including daunorubicin. Immunogenic cell death (ICD) may contribute to the efficacy of anthracyclines in solid cancer, but the impact of ICD in AML is only partly explored. We assessed aspects of ICD, as reflected by calreticulin expression, in primary human AML blasts and observed induction of surface calreticulin upon exposure to daunorubicin but not to cytarabine. We next assessed immune phenotypes in AML patients in complete remission (CR), following consolidation chemotherapy with or without anthracyclines. These patients subsequently received immunotherapy with histamine dihydrochloride (HDC) and IL-2. Patients who had received anthracyclines for consolidation showed enhanced frequencies of CD8(+) T-EM cells in blood along with improved survival. We propose that the choice of consolidation therapy prior to AML immunotherapy may determine clinical outcome

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery : A Prospective Double-Blind Randomized Trial

Peer reviewe

Efficacy and Safety of Dapagliflozin in Patients With Inadequately Controlled Type 1 Diabetes (the DEPICT-2 Study): 24-Week Results From a Randomized Controlled Trial

OBJECTIVE: This 24-week, double-blinded, phase 3 clinical trial (DEPICT-2; ClinicalTrials.gov, NCT02460978) evaluated efficacy and safety of dapagliflozin as adjunct therapy to adjustable insulin in patients with inadequately controlled type 1 diabetes (HbA1c 7.5-10.5%). RESEARCH DESIGN AND METHODS: Patients were randomized 1:1:1 to dapagliflozin 5 mg (n = 271), dapagliflozin 10 mg (n = 270), or placebo (n = 272) plus insulin. Insulin dose was adjusted by investigators according to self-monitored glucose readings, local guidance, and individual circumstances. RESULTS: Baseline characteristics were balanced between treatment groups. At week 24, dapagliflozin significantly decreased HbA1c (primary outcome; difference vs. placebo: dapagliflozin 5 mg -0.37% [95% CI -0.49, -0.26], dapagliflozin 10 mg -0.42% [-0.53, -0.30]), total daily insulin dose (-10.78% [-13.73, -7.72] and -11.08% [-14.04, -8.02], respectively), and body weight (-3.21% [-3.96, -2.45] and -3.74% [-4.49, -2.99], respectively) (P 70 to ≤180 mg/dL) versus placebo were significantly improved. More patients receiving dapagliflozin achieved a reduction in HbA1c ≥0.5% without severe hypoglycemia compared with placebo. Adverse events were reported for 72.7%, 67.0%, and 63.2% of patients receiving dapagliflozin 5 mg, dapagliflozin 10 mg, and placebo, respectively. Hypoglycemia, including severe hypoglycemia, was balanced between groups. There were more adjudicated definite diabetic ketoacidosis (DKA) events with dapagliflozin: 2.6%, 2.2%, and 0% for dapagliflozin 5 mg, dapagliflozin 10 mg, and placebo, respectively. CONCLUSIONS: Dapagliflozin as adjunct therapy to adjustable insulin in patients with type 1 diabetes was well tolerated and improved glycemic control with no increase in hypoglycemia versus placebo but with more DKA events.status: publishe