Trying-out a walking help: Participation through situated learning in the adjustment and assessment of welfare technology.

Related Articles

Trying-out a walking help: Participation through situated learning in the adjustment and assessment of welfare technology.

Clin Linguist Phon. 2016 Sep 2;:1-20

Authors: Krummheuer AL, Raudaskoski PL

Abstract
This article contributes to the discussion of how people with limited communication means become active participants in the assessment of welfare technologies. The article combines ethnomethodology with insights from Science and Technology Studies and emphasises the situated and multimodal practices that constitute the trial as a joint activity in which the impaired person becomes a competent participant and independent walker. The analysis is based on video recordings from a case study in which a person with brain injury is trying out a new type of walking help. The trial is understood as a situated learning process in which the participants prepare, enact and assess the performance of the technology-supported walking. The article distinguishes two iterative phases in which the impaired person is constituted as an independent walker: the adjustment and assessment of a body-device relation and, further, the performance and assessment of the activity the user can perform.

PMID: 27589587 [PubMed - as supplied by publisher]

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Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging.

Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging.

Korean J Radiol. 2016 Sep-Oct;17(5):641-9

Authors: Xu XQ, Choi YJ, Sung YS, Yoon RG, Jang SW, Park JE, Heo YJ, Baek JH, Lee JH

Abstract
OBJECTIVE: To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck.
MATERIALS AND METHODS: We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D(*)), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D(*) and model-free parameters from the DCE-MRI (wash-in, Tmax, Emax, initial AUC60, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis.
RESULTS: No correlation was found between f or D(*) and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D(*) (p > 0.05, respectively).
CONCLUSION: Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

PMID: 27587952 [PubMed - in process]

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Periodontal conditions in juvenile idiopatic arthritis.

Periodontal conditions in juvenile idiopatic arthritis.

Minerva Stomatol. 2016 Sep 2;

Authors: Maspero C, Giannini L, Carletti V, Galbiati G, Prevedello C, Farronato G

Abstract
BACKGROUND: The possible relationship between periodontitis and Juvenile Idiopathic Arthritis is now mostly unknown but there are common characteristics in both diseases. The purpose of this study is to evaluate Etanercept (Enbrel®) effects on periodontal conditions of children affected by Juvenile Idiopathic Arthritis.
METHODS: For this study three group of patients were selected. The first one is represented by Juvenile Idiopathic Arthritis subjects in pharmacologic therapy with Etanercept(Enbrel ®). The second one was composed by subjects in pharmacologic therapy with other drugs and the third one by healthy subjects. Twenty subjects for each group were selected. For each subject two periodontal scores were taken: plaque index and bleeding on probing. In order to check the reliability of the method a second registration has been performed in all the 3 groups after one month. A statistic Kruskal-Wallis test has been performed.
RESULTS: Plaque index average is 48% in first group, 37% in second group and 20% in control group. Bleeding index average is 5% in first group, 5% in second group and 9% in control group.
CONCLUSIONS: Most probably Etanercept reduces periodontal inflammation in children affected by Juvenile Idiopathic Arthritis as the other therapy.

PMID: 27588378 [PubMed - as supplied by publisher]

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Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

Int J Audiol. 2016 Sep 2;:1-20

Authors: Rönnberg J, Lunner T, Ng EH, Lidestam B, Zekveld AA, Sörqvist P, Lyxell B, Träff U, Yumba W, Classon E, Hällgren M, Larsby B, Signoret C, Pichora-Fuller MK, Rudner M, Danielsson H, Stenfelt S

Abstract
OBJECTIVE: The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model.
STUDY SAMPLE: Participants were 200 hard-of-hearing hearing-aid users, with a mean age of 60.8 years. Forty-three percent were females and the mean hearing threshold in the better ear was 37.4 dB HL.
DESIGN: LEVEL1 factor analyses extracted one factor per test and/or cognitive function based on a priori conceptualizations. The more abstract LEVEL 2 factor analyses were performed separately for the three classes of test variables.
RESULTS: The HEARING test variables resulted in two LEVEL 2 factors, which we labelled SENSITIVITY and TEMPORAL FINE STRUCTURE; the COGNITIVE variables in one COGNITION factor only, and OUTCOMES in two factors, NO CONTEXT and CONTEXT. COGNITION predicted the NO CONTEXT factor to a stronger extent than the CONTEXT outcome factor. TEMPORAL FINE STRUCTURE and SENSITIVITY were associated with COGNITION and all three contributed significantly and independently to especially the NO CONTEXT outcome scores (R(2) = 0.40).
CONCLUSIONS: All LEVEL 2 factors are important theoretically as well as for clinical assessment.

PMID: 27589015 [PubMed - as supplied by publisher]

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Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

Int J Audiol. 2016 Sep 2;:1-20

Authors: Rönnberg J, Lunner T, Ng EH, Lidestam B, Zekveld AA, Sörqvist P, Lyxell B, Träff U, Yumba W, Classon E, Hällgren M, Larsby B, Signoret C, Pichora-Fuller MK, Rudner M, Danielsson H, Stenfelt S

Abstract
OBJECTIVE: The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model.
STUDY SAMPLE: Participants were 200 hard-of-hearing hearing-aid users, with a mean age of 60.8 years. Forty-three percent were females and the mean hearing threshold in the better ear was 37.4 dB HL.
DESIGN: LEVEL1 factor analyses extracted one factor per test and/or cognitive function based on a priori conceptualizations. The more abstract LEVEL 2 factor analyses were performed separately for the three classes of test variables.
RESULTS: The HEARING test variables resulted in two LEVEL 2 factors, which we labelled SENSITIVITY and TEMPORAL FINE STRUCTURE; the COGNITIVE variables in one COGNITION factor only, and OUTCOMES in two factors, NO CONTEXT and CONTEXT. COGNITION predicted the NO CONTEXT factor to a stronger extent than the CONTEXT outcome factor. TEMPORAL FINE STRUCTURE and SENSITIVITY were associated with COGNITION and all three contributed significantly and independently to especially the NO CONTEXT outcome scores (R(2) = 0.40).
CONCLUSIONS: All LEVEL 2 factors are important theoretically as well as for clinical assessment.

PMID: 27589015 [PubMed - as supplied by publisher]

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Optimization of rotational arc station parameter optimized radiation therapy.

Optimization of rotational arc station parameter optimized radiation therapy.

Med Phys. 2016 Sep;43(9):4973

Authors: Dong P, Ungun B, Boyd S, Xing L

Abstract
PURPOSE: To develop a fast optimization method for station parameter optimized radiation therapy (SPORT) and show that SPORT is capable of matching VMAT in both plan quality and delivery efficiency by using three clinical cases of different disease sites.
METHODS: The angular space from 0° to 360° was divided into 180 station points (SPs). A candidate aperture was assigned to each of the SPs based on the calculation results using a column generation algorithm. The weights of the apertures were then obtained by optimizing the objective function using a state-of-the-art GPU based proximal operator graph solver. To avoid being trapped in a local minimum in beamlet-based aperture selection using the gradient descent algorithm, a stochastic gradient descent was employed here. Apertures with zero or low weight were thrown out. To find out whether there was room to further improve the plan by adding more apertures or SPs, the authors repeated the above procedure with consideration of the existing dose distribution from the last iteration. At the end of the second iteration, the weights of all the apertures were reoptimized, including those of the first iteration. The above procedure was repeated until the plan could not be improved any further. The optimization technique was assessed by using three clinical cases (prostate, head and neck, and brain) with the results compared to that obtained using conventional VMAT in terms of dosimetric properties, treatment time, and total MU.
RESULTS: Marked dosimetric quality improvement was demonstrated in the SPORT plans for all three studied cases. For the prostate case, the volume of the 50% prescription dose was decreased by 22% for the rectum and 6% for the bladder. For the head and neck case, SPORT improved the mean dose for the left and right parotids by 15% each. The maximum dose was lowered from 72.7 to 71.7 Gy for the mandible, and from 30.7 to 27.3 Gy for the spinal cord. The mean dose for the pharynx and larynx was reduced by 8% and 6%, respectively. For the brain case, the doses to the eyes, chiasm, and inner ears were all improved. SPORT shortened the treatment time by ∼1 min for the prostate case, ∼0.5 min for brain case, and ∼0.2 min for the head and neck case.
CONCLUSIONS: The dosimetric quality and delivery efficiency presented here indicate that SPORT is an intriguing alternative treatment modality. With the widespread adoption of digital linac, SPORT should lead to improved patient care in the future.

PMID: 27587028 [PubMed - in process]

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A parametric vocal fold model based on magnetic resonance imaging.

A parametric vocal fold model based on magnetic resonance imaging.

J Acoust Soc Am. 2016 Aug;140(2):EL159

Authors: Wu L, Zhang Z

Abstract
This paper introduces a parametric three-dimensional body-cover vocal fold model based on magnetic resonance imaging (MRI) of the human larynx. Major geometric features that are observed in the MRI images but missing in current vocal fold models are discussed, and their influence on vocal fold vibration is evaluated using eigenmode analysis. Proper boundary conditions for the model are also discussed. Based on control parameters corresponding to anatomic landmarks that can be easily measured, this model can be adapted toward a subject-specific vocal fold model for voice production research and clinical applications.

PMID: 27586774 [PubMed - in process]

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β-Defensin-2 is overexpressed in human vocal cord polyps.

β-Defensin-2 is overexpressed in human vocal cord polyps.

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Gu J, Huang Y

Abstract
The objective of the study is to investigate the expression of human β-defensin-1 (hBD-1) and human β-defensin-2 (hBD-2) in vocal cord polyps using tissue microarray. Tissue specimens from vocal cord polyps (N = 51), vocal cord nodules (N = 26), and healthy vocal cords (N = 8) were retrieved from the biobank of the Department of Pathology of Tianjin Tianhe Hospital between 2003 and 2006 and immunostained on tissue microarrays for the quantitative analysis of hBD-1 and hBD-2 expression. hBD-1 expression did not differ significantly between healthy vocal cords, vocal cord nodules, and vocal cord polyps (p = 0.904). In contrast, hBD-2 expression was significantly higher in vocal cord polyps compared to vocal cord nodules and healthy vocal cords (p < 0.001). The expression of hBD-2, but not hBD-1, is elevated in vocal cord polyp epithelium. This suggests that hBD-1 has a more constitutive role in host defense in the vocal cords, whereas hBD-2 expression may be a result of local inflammation or the presence of invading pathogens.

PMID: 27586391 [PubMed - as supplied by publisher]

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The endoscopic anatomy of the middle ear approach to the fundus of the internal acoustic canal.

The endoscopic anatomy of the middle ear approach to the fundus of the internal acoustic canal.

J Neurosurg. 2016 Sep 2;:1-10

Authors: Komune N, Matsuo S, Miki K, Rhoton AL

Abstract
OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal. RESULTS In the middle ear cavity, the cochleariform process is one of the key landmarks for accessing the fundus of the internal acoustic canal. The triangle formed by the anterior and posterior edges of the overhang of the round window and the cochleariform process provides a landmark to start drilling the bone to access the fundus of the internal acoustic canal. CONCLUSIONS The external acoustic canal and middle ear cavity combined, using endoscopic guidance, can provide a route to the fundus of the internal acoustic canal. A triangular landmark crossing the promontory has been described for reaching the meatal fundus. This transcanal approach requires an understanding of the relationship between the middle ear cavity and the fundus of the internal acoustic canal and provides a potential new area of cooperation between otology and neurosurgery for accessing pathology in this and the bordering skull base.

PMID: 27588594 [PubMed - as supplied by publisher]

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Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes.

Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes.

Clin Neurol Neurosurg. 2016 Aug 29;150:46-53

Authors: Palejwala SK, Barry JY, Rodriguez CN, Parikh CA, Goldstein SA, Lemole GM

Abstract
Many neoplasms of the head and neck extend centripetally, gaining access to the central nervous system via nerves through the skull base foramina. Often patients with perineural spread have been excluded from aggressive interventions given the overall poor prognosis and technical difficulty when addressing the perineural components. However, in carefully selected patients combined surgical approaches can provide the greatest potential for disease control as well as neural decompression for symptom relief. We performed a retrospective chart review of 20 consecutive patients who underwent skull base approaches for resection of tumors with intracranial extension via perineural spread from 2011 to 2014. Patients were evaluated for symptom change, surgical approaches, histopathology, adjuvant therapy, outcome, and prognosis. The most common presenting symptoms were pain or cranial nerve palsies. 55% of patients underwent endoscopic endonasal approaches, 50% transcranial approaches, and 15% underwent transfacial approaches. Overall 85% of patients reported symptom improvement in the post-operative period while 40% were completely asymptomatic following surgical resection. Ultimately, we observed a 45% mortality rate with an average survival of 8 months after diagnosis. In carefully selected patients, an aggressive multidisciplinary approach using a combination of surgical avenues to the skull base for the treatment of intracranial tumor via perineural extension can improve patient quality of life.

PMID: 27588370 [PubMed - as supplied by publisher]

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Schwannoma of the trochlear nerve-an illustrated case series and a systematic review of management.

Schwannoma of the trochlear nerve-an illustrated case series and a systematic review of management.

Neurosurg Rev. 2016 Sep 1;

Authors: Torun N, Laviv Y, Jazi KK, Mahadevan A, Bhadelia RA, Matthew A, Strominger M, Kasper EM

Abstract
Schwannomas of cranial nerves in the absence of systemic neurofibromatosis are relatively rare. Among these, schwannomas of the trochlear nerve are even less common. They can be found incidentally or when they cause diplopia or other significant neurological deficits. Treatment options include observation only, neuro-ophthalmological intervention, and/or neurosurgical management via resection or sterotactic radiosurgery (SRS). In recent years, the latter has become an attractive therapeutic tool for a number of benign skull base neoplasm including a small number of reports on its successful use for trochlear Schwannomas. However, no treatment algorithm for the management of these tumors has been proposed so far. The goal of this manuscript is to illustrate a case series of this rare entity and to suggest a rational treatment algorithm for trochlear schwannomas, based on our institutional experience of recent cases, and a pertinent review of the literature. Including our series of 5 cases, a total of 85 cases reporting on the management of trochlear schwannomas have been published. Of those reported, less than half (40 %) of patients underwent surgical resection, whereas the remainder were managed conservatively or with SRS. Seventy-six percent (65/85) of the entire cohort presented with diplopia, which was the solitary symptom in over half of the cases (n = 39). All patients who presented with symptoms other than diplopia or headaches as solitary symptoms underwent surgical resection. Patients in the non-surgical group were mostly male (M/F = 3.5:1), presented at an older age and had shorter mean diameter (4.6 vs. 30.4 mm, p < 0.0001) when compared to the surgical group. Twelve patients in the entire cohort were treated with SRS, none of whom had undergone surgical resection before or after radiation treatment. Trochlear schwannoma patients without systemic neurofibromatosis are rare and infrequently reported in the literature. Of those, patients harboring symptomatic trochlear Schwannomas do not form a single homogenous group, but fall into two rather distinct subgroups regarding demographics and clinical characteristics. Among those patients in need of intervention, open microsurgical resection as well as less invasive treatment options exist, which all aim at safe relief of symptoms and prevention of progression. Both open microsurgical removal as well as SRS can achieve good long-term local control. Consequently, a tailored multidisciplinary treatment algorithm, based on the individual presentation and tumor configuration, is proposed.

PMID: 27586875 [PubMed - as supplied by publisher]

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Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Fishpool SJ, Amato-Watkins A, Hayhurst C

Abstract
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm. Outcomes examined were: length of inpatient stay; post-operative CSF leak rate; volume of gross tumour resection; and rhinological morbidity. The rhinological morbidity was measured by the completion of the 22 item sinonasal outcome test (SNOT-22) questionnaire by all 32 patients at 6 weeks and 6 months post-surgery. 32 patients were included in the study. 9 patients had functioning microadenomas and 23 macroadenomas. The median inpatient stay was 2 days. There were no post-operative CSF leaks. The rate of gross tumour resection, confirmed on post-operative MRI, was 87.5 %. The mean SNOT-22 score was 31.9 at 6 weeks and 23.4 at 6 months post-operation-a statistically significant drop. The use of the FMT graft in the reconstruction of the sella defect after endonasal endoscopic pituitary surgery provides a robust dural repair with an acceptable rhinological morbidity profile. FMT grafting as part of a defined skull base reconstructive algorithm results in a CSF leak rate of zero and allows early patient discharge without the need for nasal packing or lumbar drains.

PMID: 27586390 [PubMed - as supplied by publisher]

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[A case of corticosteroid-responsive Lemierre syndrome with clivus osteomyelitis and a mass in the cavernous sinus-suprasellar region].

Related Articles

[A case of corticosteroid-responsive Lemierre syndrome with clivus osteomyelitis and a mass in the cavernous sinus-suprasellar region].

Rinsho Shinkeigaku. 2015;55(5):327-32

Authors: Takahashi S, Ito S, Tagashira S, Yasui K, Watanabe Y, Nakashima K

Abstract
Lemierre syndrome is a clinical syndrome that presents with internal jugular thrombophlebitis, septicemia and systemic abscess formations. In general, the condition is preceded by oropharyngeal infections. We report a case of a 73-year-old man with Lemierre syndrome, clivus osteomyelitis and a steroid-responsive mass in the cavernous sinus-suprasellar region. He complained of fever, occipital pain, diplopia and right ptosis. Administration of oral steroids ameliorated the ophthalmic symptoms for a period before he was admitted to our hospital. After admission, the severity of his headache advanced, and his ophthalmic symptoms progressed bilaterally. Brain magnetic resonance imaging showed contrast enhancement of the clivus and revealed a mass lesion contrast-enhancement effect in the cavernous sinus-suprasellar region. Fusobacterium nucleatum was detected by blood culture, and computed tomography revealed multiple bacterial emboli in both lung fields and thrombosis of the left internal jugular vein; thus, he was diagnosed with Lemierre syndrome. After venous administration of antibiotics, his fever and headache markedly improved, but the ophthalmic symptoms did not. We prescribed an oral steroid because the cavernous sinus-suprasellar lesion was probably an inflammatory granuloma caused by a para-infectious mechanism rather than by infection. After the series of treatments, his ophthalmic symptoms improved, and the cavernous sinus-suprasellar region mass lesion decreased. He was eventually discharged in a fully ambulatory state and had no ophthalmic difficulties. We thought that the osteomyelitis of clivus was caused by Lemierre syndrome and its inflammatory processes formed the granuloma in the cavernous sinus-suprasellar region. This was a case of Lemierre syndrome with a rare combination of clivus osteomyelitis and a steroid-responsive tumour in the cavernous sinus-suprasellar region that was successfully treated.

PMID: 26028195 [PubMed - indexed for MEDLINE]

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Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Fishpool SJ, Amato-Watkins A, Hayhurst C

Abstract
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm. Outcomes examined were: length of inpatient stay; post-operative CSF leak rate; volume of gross tumour resection; and rhinological morbidity. The rhinological morbidity was measured by the completion of the 22 item sinonasal outcome test (SNOT-22) questionnaire by all 32 patients at 6 weeks and 6 months post-surgery. 32 patients were included in the study. 9 patients had functioning microadenomas and 23 macroadenomas. The median inpatient stay was 2 days. There were no post-operative CSF leaks. The rate of gross tumour resection, confirmed on post-operative MRI, was 87.5 %. The mean SNOT-22 score was 31.9 at 6 weeks and 23.4 at 6 months post-operation-a statistically significant drop. The use of the FMT graft in the reconstruction of the sella defect after endonasal endoscopic pituitary surgery provides a robust dural repair with an acceptable rhinological morbidity profile. FMT grafting as part of a defined skull base reconstructive algorithm results in a CSF leak rate of zero and allows early patient discharge without the need for nasal packing or lumbar drains.

PMID: 27586390 [PubMed - as supplied by publisher]

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Effects on Swallowing When Treating Unilateral Vocal Fold Palsy.

Effects on Swallowing When Treating Unilateral Vocal Fold Palsy.

Otolaryngol Head Neck Surg. 2016 Sep;155(3):543

Authors: Karkos P

PMID: 27587389 [PubMed - in process]

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Is There a Paradigm Shift Affecting Resident Training?

Is There a Paradigm Shift Affecting Resident Training?

Otolaryngol Head Neck Surg. 2016 Sep;155(3):542-3

Authors: Meltzer C

PMID: 27587388 [PubMed - in process]

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Education, Health Care Economics, and the Resident in the Middle.

Education, Health Care Economics, and the Resident in the Middle.

Otolaryngol Head Neck Surg. 2016 Sep;155(3):542

Authors: Naples JG

PMID: 27587387 [PubMed - in process]

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Highlights from the Current Issue: September 2016.

Highlights from the Current Issue: September 2016.

Otolaryngol Head Neck Surg. 2016 Sep;155(3):371-2

Authors: Krouse JH

PMID: 27587386 [PubMed - in process]

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Honorary Guest Lectures 2016.

Honorary Guest Lectures 2016.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P7

Authors:

PMID: 27585877 [PubMed - in process]

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2016 Honor Award Recipients.

2016 Honor Award Recipients.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P6

Authors:

PMID: 27585876 [PubMed - in process]

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2016 Distinguished Service Award Winners.

2016 Distinguished Service Award Winners.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P6

Authors:

PMID: 27585875 [PubMed - in process]

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2016 Star Reviewers.

2016 Star Reviewers.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P5

Authors:

PMID: 27585874 [PubMed - in process]

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2016 Program Advisory Committee.

2016 Program Advisory Committee.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P4

Authors:

PMID: 27585873 [PubMed - in process]

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2016 President Sujana S. Chandrasekhar, MD.

2016 President Sujana S. Chandrasekhar, MD.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P3

Authors:

PMID: 27585872 [PubMed - in process]

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Author Index.

Author Index.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P283-98

Authors:

PMID: 27585871 [PubMed - in process]

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Accreditation Information.

Accreditation Information.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P2

Authors:

PMID: 27585870 [PubMed - in process]

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Schedule at a Glance.

Schedule at a Glance.

Otolaryngol Head Neck Surg. 2016 Sep;155(1 Suppl):P1

Authors:

PMID: 27585869 [PubMed - in process]

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Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas.

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas.

J Neurosurg. 2016 Sep 2;:1-10

Authors: Gross BA, Albuquerque FC, Moon K, McDougall CG

Abstract
OBJECTIVE Many small series and technical reports chronicle the evolution of endovascular techniques for cranial dural arteriovenous fistulas (dAVFs) over the past 3 decades, but reports of large patient series are lacking. The authors provide a thorough analysis of clinical and angiographic outcomes across a large patient cohort. METHODS The authors reviewed their endovascular database from January 1996 to September 2015 to identify patients harboring cranial dAVFs who were treated initially with endovascular approaches. They extracted demographic, presentation, angiographic, detailed treatment, and long-term follow-up data, and they evaluated natural history, initial angiographic occlusion, complications, recurrence, and symptomatic resolution rates. RESULTS Across a cohort of 251 patients with 260 distinct dAVFs, the overall initial angiographic occlusion rate was 70%; recurrence or occult residual lesions were seen on subsequent angiography in 3% of cases. The overall complication rate was 8%, with permanent neurological complications occurring in 3% of cases. Among 102 patients with dAVFs without cortical venous reflux, rates of resolution/improvement of pulsatile tinnitus and ocular symptoms were 79% and 78%, respectively. Following the introduction of Onyx during the latter half of the study period, the number of treated dAVFs doubled; the initial angiographic occlusion rate increased significantly from 60% before the use of Onyx to 76% after (p = 0.01). In addition, during the latter period compared with the pre-Onyx period, the rate of dAVFs obliterated via a transarterial-only approach was significantly greater (43% vs 23%, p = 0.002), as was the number of dAVFs obliterated via a single arterial pedicle (29% vs 11%, p = 0.002). CONCLUSIONS Overall, in the Onyx era, the rate of initial angiographic occlusion was approximately 80%, as was the rate of meaningful clinical improvement in tinnitus and/or ocular symptoms after initial endovascular treatment of cranial dAVFs.

PMID: 27588586 [PubMed - as supplied by publisher]

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β-Defensin-2 is overexpressed in human vocal cord polyps.

β-Defensin-2 is overexpressed in human vocal cord polyps.

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Gu J, Huang Y

Abstract
The objective of the study is to investigate the expression of human β-defensin-1 (hBD-1) and human β-defensin-2 (hBD-2) in vocal cord polyps using tissue microarray. Tissue specimens from vocal cord polyps (N = 51), vocal cord nodules (N = 26), and healthy vocal cords (N = 8) were retrieved from the biobank of the Department of Pathology of Tianjin Tianhe Hospital between 2003 and 2006 and immunostained on tissue microarrays for the quantitative analysis of hBD-1 and hBD-2 expression. hBD-1 expression did not differ significantly between healthy vocal cords, vocal cord nodules, and vocal cord polyps (p = 0.904). In contrast, hBD-2 expression was significantly higher in vocal cord polyps compared to vocal cord nodules and healthy vocal cords (p < 0.001). The expression of hBD-2, but not hBD-1, is elevated in vocal cord polyp epithelium. This suggests that hBD-1 has a more constitutive role in host defense in the vocal cords, whereas hBD-2 expression may be a result of local inflammation or the presence of invading pathogens.

PMID: 27586391 [PubMed - as supplied by publisher]

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Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Fishpool SJ, Amato-Watkins A, Hayhurst C

Abstract
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm. Outcomes examined were: length of inpatient stay; post-operative CSF leak rate; volume of gross tumour resection; and rhinological morbidity. The rhinological morbidity was measured by the completion of the 22 item sinonasal outcome test (SNOT-22) questionnaire by all 32 patients at 6 weeks and 6 months post-surgery. 32 patients were included in the study. 9 patients had functioning microadenomas and 23 macroadenomas. The median inpatient stay was 2 days. There were no post-operative CSF leaks. The rate of gross tumour resection, confirmed on post-operative MRI, was 87.5 %. The mean SNOT-22 score was 31.9 at 6 weeks and 23.4 at 6 months post-operation-a statistically significant drop. The use of the FMT graft in the reconstruction of the sella defect after endonasal endoscopic pituitary surgery provides a robust dural repair with an acceptable rhinological morbidity profile. FMT grafting as part of a defined skull base reconstructive algorithm results in a CSF leak rate of zero and allows early patient discharge without the need for nasal packing or lumbar drains.

PMID: 27586390 [PubMed - as supplied by publisher]

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A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea?

A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea?

Eur Arch Otorhinolaryngol. 2016 Sep 1;

Authors: Binar M, Akcam T, Karakoc O, Sagkan RI, Musabak U, Gerek M

Abstract
The aim of this study was to evaluate the change in serum levels of C-reactive protein (CRP) in patients with obstructive sleep apnea (OSA) before and after expansion sphincter pharyngoplasty (ESP) and continuous positive airway pressure (CPAP) treatment. Fifty-one patients with newly diagnosed OSA were prospectively enrolled in this study. We performed ESP in twenty-three patients in the surgery group and twenty-eight patients were included in the CPAP group. Serum levels of high-sensitivity CRP (hs-CRP) were analyzed by enzyme-linked immunosorbent assays before and 3 months after treatment. The relations between CRP and the apnea hypopnea index (AHI), visual analog scale (VAS), the Epworth Sleepiness Scale (ESS), and saturation parameters were evaluated. Both surgical and CPAP treatments caused significant improvements in the clinical and laboratory parameters. However, only the patients whose postoperative AHI levels improved to final AHI of <5 (n = 6) after ESP, had significant decrease in their serum CRP levels (p = 0.028). CPAP group and the rest of the patients in the surgery group did not show statistically significant difference in CRP levels after treatment. We suggest that the successful surgical treatment for OSA-ESP in this study-, which provides OSA cure, can decrease serum levels of CRP and reduce possible cardiovascular morbidity.

PMID: 27586389 [PubMed - as supplied by publisher]

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