The importance of the nasal septum in the deviated nose

The nasal septum plays an important role in both the appearance and function of the nose. Deviation of the nose is common and correction requires a focused, anatomically based treatment. Reconstruction and support of the septum is a necessary component to a straight nose. The "four R's" of nasal septal repair--resection, reposition, reconstruction, and replacement--can be used to straighten the septum and maximize nasal appearance and function.     

Concurrent lymphocytic hypophysitis and pituitary adenoma. Case report and review of the literature

Lymphocytic hypophysitis (LyH) is an uncommon intrasellar lesion characterized by lymphocytic infiltration of the adenohypophysis. Evidence suggests that the cause is autoimmune, and the symptoms are usually related to either a mass effect or endocrine dysfunction. Lymphocytic hypophysitis has been described rarely in the setting of other simultaneous pathological processes that involve the pituitary and sella turcica, and is postulated to arise from an intrinsic inflammatory response. The authors report the case of a 43-year-old woman who presented with a 2-month history of galactorrhea and pseudohyperprolactinemia secondary to a 10-mm lesion within an enlarged pituitary gland. She was nulliparous and had no contributory medical history. Serial neuroimaging performed over a 2-year period demonstrated lesion growth, and visual deficits had developed; together these warranted surgical intervention. A transsphenoidal resection was performed. Microscopic and immunohistopathological examinations revealed a nonsecreting pituitary adenoma with concurrent lymphocytic adenohypophysitis. This is the first documented case of LyH in the setting of a null-cell pituitary adenoma. The authors review the related literature and outline potential mechanisms for the concurrent development of LyH and a pituitary adenoma.     

Safety and efficacy of adalimumab (D2E7) in Crohn's disease patients with an attenuated response to infliximab

OBJECTIVES: Although infliximab is highly effective in the treatment of Crohn's disease (CD), attenuated response to infliximab may develop over time in a subgroup of patients. The aim of our study was to examine the safety and efficacy of adalimumab (D2E7), a fully humanized anti-TNF-alpha Ab, in CD patients who had experienced an attenuated response to infliximab. METHODS: Fifteen patients with active CD who experienced an attenuated response to infliximab were treated with adalimumab over a 6-month period. Patients, received a loading dose of 80 mg subcutaneously followed by 40 mg every 2 wk. The clinical response to adalimumab was classified as complete response, partial response, or nonresponse. RESULTS: Two patients received the loading dose of adalimumab but did not have adequate follow-up evaluations. Of the remaining 13 patients, 7 (54%) had a complete response, 4 (31%) had a partial response, and 2 (15%) were nonresponders. In six patients, the maintenance dose was increased in order to maintain clinical response. Eight of 11 (73%) patients on concurrent corticosteroids were able to discontinue or significantly decrease the dose of the steroids. Adalimumab was well tolerated without signs or symptoms of allergic reaction except in two patients who developed an injection site reaction. CONCLUSIONS: Our preliminary data suggest that adalimumab may be a safe and effective therapy for patients with CD who have experienced an attenuated response to infliximab.     

The effects of caffeine on the maxillary composition in the newborn rat

Summary The possible influence of caffeine on maxillary structure was studied. Seventeen pregnant rats at days 9 of gestation were randomly divided into two groups. The dams of group 1 received a 20% protein diet ad libitum throughout the experimental period. The dams of group 2 were pair-fed, with group 1, a 20% protein diet supplemented with 2 mg/100 g body weight (B.W.) caffeine. At birth, pups were mixed within the same group and 8 randomly selected pups were assigned to each dam and continuously fed the respective diet. On day 22, 11 male pups from the control and 12 males from the caffeine group were randomly selected, separated from the dams, and continued to be fed their respective diets. On day 44, a rubber elastic band was inserted between the first and second maxillary right molars. The size of the elastic band was increased throughout the next 5 days. Animals were sacrificed at day 49 and the composition of the maxillas was analyzed. After pulverization, organic and inorganic contents of the bones were measured. Zinc (Zn) and hydroxyproline concentration of the caffeine group showed a significant decrease when compared with those of the controls. However, Ca, P, Mg, and hexosamine concentration showed no difference between the groups. The interdental space measured occlusally and laterally with the visual method, and occlusally in histological sections showed no significant difference between the control and caffeine groups, although variation of the space in the caffeine group was less than in the control group. The present study suggests that caffeine intake during the gestational and lactational period by their dams and the growing period of pups affect the maxillary composition of their offspring.     

Analyse der Resorptionsbildungsgeschwindigkeit des menschlichen Alveolarknochens in organotypischer Kultur,entnommen vor und während der Durchführung einer Zahnbewegung

Zusammenfassung 1. Die Erneuerungsrate des Alveolarknochens, der etwa von 11- bis 13jährigen Knaben entnommen wurde, wurde quantitativ erfaßt durch: a) eine histomorphometrische Analyse der Osteoblasten, des Osteoids der mineralisiertén Matrix, der Osteoklasteh, der mononukleären knochenresorbierenden Zellen, der Howshipschen Lakunen usw. b) das Studium der⁴⁵Ca-Aufnahme in organotypischer Kultur (Geschwindigkeit der Knochenmineralisation), der alkalischen Phosphataseaktivität (Knochenneubildungsrate) und der sauren Phenylphosphataseaktivität (Intensität der Vorgänge, die an Knochenresorption gebunden sind).2. Die Neubildungsrate des Alveolarknochens nach Extraktionen der ersten Prämolaren im Unterkiefer ist in Fällen mit anteriorer Wachstumsrotation größer als bei denen mit posteriorer Wachstumsrichtung der Mandibula. Die statistische Auswertung zeigte einen hoch signifikanten Unterschied. Die Resorptionsrate des Alveolarknochens ist in Fällen mit anteriorer Wachstumsrichtung geringgradig erhöht im Vergleich zu den Fällen mit posteriorer Wachstumsrichtung. Dieser Unterschied ist aber statistisch nicht signifikant (sondern nur eine Tendenz anzeigend).3. Die Auswertung der Einzelfälle zeigt, daß die Wachstumsrate des Kondylenknorpels als Antwort auf eine orthopädische oder orthodontische Stimulation hin mit der Neubildungsrate des Alveolarknochens der Mandibula eine größere und getreuere Korrelation aufweist als mit den verschiedenen, unterschiedlich ausgeprägten Wachstumsrotationen.4. Die Knochenneubildungs- und die Resorptionsgeschwindigkeit sind beide beim Alveolarknochen, der zwischen dem 1. April und 1. Juli entnommen wurde, signifikant höher als beim Alveolarknochen, der zwischen dem 15. Oktober und 15. Januar entnommen wurde.5. Die Erhöhung der Resorptionsrate als Antwort auf eine orthodontische Kraft ist auch bedingt durch die Ankunft von mehr- oder einkernigen Zellen, dieaußerhalb des Knochens gebildet wurden (vom Typ der zirkulierenden Monozyten). Da knochenresorbierende Zellen von außerhalb des Knochens zugeführt werden, soll man in der Orthodontie leichte Kräfte (und nicht starke), intermittierende und unterbrochene (und nicht kontinuierliche) Kräfte anwenden: also Kräfte, die die lokale Blutzirkulation nur wenig stören.6. Die Zunahme der Wachstumsrate des Alveolarknochens als Antwort auf eine orthodontische Therapie bedingt notwendigerweise eine Beteiligung von Osteoblastenvorläufern, die ihren Ursprungaußerhalb des Knochens haben. Tatsächlich ist die Zunahme der Zellteilung bei den Präosteoblasten nicht groß genug, um die starke Zunahme der Osteoblastenanzahl im ganzen zu erklären.7. Bei Bewegung eines Zahnes unter physiologischen Bedingungen hat sich weniger die Knochenresorptions- als die Knochenneubildungsrate alslimitierender Faktor herausgestellt.

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Summary 1. The alveolar bone removed during tooth extraction in eleven to thirteen year old boys was quantitatively evaluated in the following manner: a) Histomorphometric analysis of osteoblasts, osteoid, mineralized matrix, osteoclasts, mononuclear bone-resorbing cells, Howship lacunae, etc. b) In organ culture by uptake of⁴⁵Ca (bone mineralization rate), by alkaline phosphatase activity (bone formation rate) and by acid phenylphosphatase activity (bone resorption phenomena intensity).2. The formation rate of alveolar bone adjacent to the mandibular first premolar was greater in cases of anterior mandibular growth rotation than in posterior rotation. This difference was of high statistical significance. The resorption rate appeared to be only slightly greater in the anterior than in the posterior rotation cases. Although the difference did not achieve statistical significance, it was in the indicative range.3. A case by case analysis revealed that increased condylar cartilage growth rate induced by orthopedic means is better correlated with the mandibular alveolar bone formation rate than with the direction or magnitude of the growth rotation.4. Bone formation and resorption rates were both greater to a highly significant degree when alveolar bone was removed between the first day of April and the first day of July than when it was taken between the fifteenth day of October and the fifteenth day of January.5. The increased alveolar bone resorption rate produced orthodontically involves multinuclear and mononuclear cells ofextrinsic origin (circulating monocyte-type cells). This extrinsic contribution of bone resorption cell precursors might account for the effectiveness of light over heavy and intermittent over continuous forces in tooth movement, since light and intermittent forces have a less adverse effect on local circulatory conditions.6. The increased alveolar bone formation rate resulting from the orthodontically produced tooth movement, certainly involves osteoblast precursors ofextrinsic origin. Indeed, the observed acceleration of preosteoblasts division rate doesnot give reckoning, at least not in totality, for the increase in osteoblasts number.7. In the orthodontically induced tooth movement, the alveolar boneformation rate rather than the alveolar bone resorption rate appears to be thelimiting factor when the physiological conditions are respected.

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Résumé 1. Le renouvellement de l'os alvéolaire, prélevé chez des garçons âgés de 11 à 13ans, a été évalué quantitativement par: a) l'analyse histomorphométrique des ostéoblastes, de l'ostéoide de la matrice minéralisée, des ostéoclastes, des cellules mononucléées ostéorésorptives, des lacunes de Howship, etc.; b) l'étude, en culture organotypique, de l'incorporation de Ca⁴⁵ (vitesse de minéralisation osseuse), par l'activité phosphatasique alcaline (vitesse de formation osseuse) et par l'activité phénylphosphatasique acide (intensité des processus liés à la résorption osseuse).2. La vitesse deformation de l'os alvéolaire prélevé au cours de l'extraction de la première prémolaire mandibulaire est plus élevée dans les cas des «rotation de croissance» antérieure de la mandibule que dans les cas de «rotation de croissance» postérieure. L'analyse statistique a montré que cette différence est hautement significative. La vitesse de résorption de l'os alvéolaire est légèrement plus élevée dans les cas de «rotation de croissance» antérieure que dans les cas de «rotation de croissance» postérieure; mais cette différence ne s'est pas montrée statistiquement significative (elle n'est qu'«indicative»).3. L'examen des cas individuels montre que l'accélération de la croissance du cartilage condylien en réponse à une stimulation orthopédique ou orthodontique, présente une corrélation plus élevée et plus fidèle avec le taux de néoformation d'os alvéolaire de la mandibule qu'avec la variété et le degré de «rotation de croissance».4. La vitesse de formation et la vitesse de résorption sont, toutes les deux, significativement plus élevées dans l'os alvéolaire prélevé entre le ler avril et le ler juillet que dans celui prélevé entre le 15 octobre et le 15 janvier.5. L'augmentation de la vitesse de résorption osseuse en réponse à une stimulation orthodontique implique l'arrivée de cellules multinucléées ou mononucléées d'origineextrinsèque (type monocytes circulants). L'origine extrinsèque de cellules ostéorésorptives permet de mieux comprendre pourquoi on a intérêt, en orthodontie, d'applinquer des forces légères (et non fortes) et intermittentes et itératives (et non continues): en effet de telles forces compromettent moins les conditions de la circulation locale.6. L'augmentation de la vitesse de formation de l'os alvéolaire, en réponse à une thérapeutique orthodontique, implique nécessairement des précurseurs d'ostéoblastes d'origineextrinsèque. En effet, l'accélération des divisions préostéoblastiques n'estpas suffisante pour rendre compte, en totalité, de l'augmentation du nombre d'ostéoblastes.7. Lors du déplacement d'une dent dans le respect des contraintes physiologiques, c'est moins la vitesse de résorption que la vitesse denéoformation de l'os alvéolaire qui est apparue comme le facteurlimitant.

     

Reproductive Rights Denied: The Hyde Amendment and Access to Abortion for Native American Women Using Indian Health Service Facilities

Restrictions on the use of federal funds to provide abortions have limited the access to abortion services for Native American women receiving care at Indian Health Service facilities. Current data suggest that the vast majority of Indian Health Service facilities are unequipped to provide abortions under any circumstances. Native American women experience disproportionately high rates of sexual assault and unintended pregnancy. Hyde Amendment restrictions systematically infringe on the reproductive rights of Native American women and present a pressing public health policy concern.Unlike many cultures in which access to abortion is limited, gender norms in Native American cultures traditionally support and respect women’s autonomy with regard to reproductive health decisions. In more recent times, federal regulation and deepening social problems have largely usurped Native American women’s control over their reproductive health.Active colonization of Native American communities and lands has not only marginalized traditional healing practices and resulted in devastating poverty but also disrupted traditional family structures and matriarchal gender norms, leading to high rates of sexual assault, intimate partner violence, and unintended pregnancy.1For many Native American women living in the United States, Indian Health Service (IHS) facilities are the primary source of reproductive health care.2 Made possible by the 1921 Snyder Act,2 federal funds are used to provide free health services for 1.9 million American Indians and Alaska Natives (AI/ANs) belonging to 564 federally recognized tribes in 35 states.3 Because it receives federal dollars, however, the IHS is subject to congressional regulation of the provision of abortion services, as stipulated under the Hyde Amendment.2,4,5Passed in 1976 and amended in 1993, the Hyde Amendment bans the use of federal funds for abortion services, except in cases of pregnancies resulting from rape or incest or those that pose a threat to the mother’s life.4,6 IHS regulations codified Hyde Amendment restrictions in 1982 and were then updated in 1996 to match the current amendment.7 Because the IHS is often the sole provider of reproductive health services for Native populations, Hyde Amendment restrictions effectively deny Native American women access to full-scope women’s health care that includes access to abortion.     

Correction to: Immunogenicity and safety of the mRNA-based BNT162b2 vaccine in systemic autoimmune rheumatic diseases patients

Background

The COVID-19 outbreak has led to the rapid development and administration of the COVID-19 vaccines worldwide. Data about the immunogenicity and adverse effects of the vaccine on patients with systemic autoimmune rheumatic diseases (SARDs) is emerging.

Aim

To evaluate Pfizer/BioNTech (BNT162b2) mRNA-based vaccine second-dose immunogenicity and safety, and the relation between them, in patients with SARDs.

Methods

A total of one hundred forty tow adults who received two doses of the BNT162b2 vaccine were included in the study. The SARDs group included Ninety-nine patients and the control group (forty-three participants) comprised a mixture of healthy participants and patients who were seen at the rheumatology clinic for non-SARDs. Anti-SARS-CoV-2 IgG antibodies against the Spike protein were evaluated using a SARS-CoV-2 IgG immunoassay. A level of > 150 AU/mL was considered positive. An adverse effects questionnaire was given to the participants upon their first visit to the clinic after their BNT162b2 vaccination.

Results

Of the 142 participants, 116 were seropositive (81.7%) and 26 (18.3%) were seronegative. Of the seronegative participants, 96.2% were SARDs patients. The proportion of seropositivity in the SARDs patients treated with any immunosuppressant was significantly lower (69.9%) compared to the control group and SARDs patients not receiving immunosuppressants (96.8%). A significant negative correlation between seronegativity and treatment with rituximab, mycophenolate mofetil (MMF), and prednisone was found in the SARDs group (p = 0.004, 0.044, 0.007 respectively). No fever was observed following the BNT162b2 vaccine in seronegative patients, and the frequency of musculoskeletal adverse effects upon the second dose of the BNT162b2 vaccine was significantly higher in seropositive compared to seronegative patients and in the control group compared to the SARDs patients (p = 0.045, p = 0.02 respectively).

Conclusion

A decline in the immunogenicity to the second dose of BNT162b2 mRNA is seen in patients with SARDs, especially in patients treated with rituximab, MMF, and prednisone. Adverse effects of the vaccine including fever and musculoskeletal symptoms might be a signal for the acquisition of immunity in those patients.

Key Points

• BNT162b2 mRNA vaccine is less immunogenic in SARDs patients compared to the control group.

• Rituximab, prednisone, and mycophenolate mofetil significantly reduced immunogenicity to the vaccine.

• There is a correlation between immunogenicity and adverse effects of the vaccine.