Optimal sensor placement in electromagnetic articulography recording for speech production study

Publication date: January 2018
Source:Computer Speech & Language, Volume 47
Author(s): Ashok Kumar Pattem, Aravind Illa, Amber Afshan, Prasanta Kumar Ghosh
Electromagnetic articulography (EMA) is one of the technological solutions, widely used to measure the articulatory movement useful for speech production research. EMA is typically used to track articulatory flesh points by placing sensors, often heuristically, on the key articulators including lips, jaw, tongue and velum in the mid-sagittal plane. In this work, we address the problem of optimal placement of EMA sensors by posing it as the optimal selection of points for minimizing the reconstruction error of the air-tissue boundaries in the real-time magnetic resonance imaging (rtMRI) video frames of vocal tract (VT) in the mid-sagittal plane. We propose an algorithm for optimal placement of EMA sensors using dynamic programming. Experiments are performed using rtMRI video frames for read speech from four subjects with upper and lower lips as two fixed points. One optimal sensor on the upper VT boundary is found to be at an average distance of 21.41(±25.54) mm from the velum tip. Similarly, for the lower VT boundary, one optimal sensor is found at the lower incisor at a distance of 26.37(±8.08) mm from lower lip and three optimal sensors on tongue – at tongue tip (19.93(±11.45) mm from tongue base) and 38.2(±11.52) mm and 80.51(±13.51) mm away from the tongue tip.



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Orthodontically induced osteocyte apoptosis under different force magnitudes in rats: an immunohistochemical study

We investigated the effect of different force magnitudes on osteocyte apoptosis in a model of orthodontic tooth movement. Forty-nine male Sprague Dawley rats (7–9 wk of age) were divided into light- and heavy-force groups (n = 21 each group) and a control group (n = 7). A coil spring delivered pressure (either 10–15 g or 20–25 g) to the left maxillary first molar. The rats were sacrificed 1, 3, or 5 d after placement of the appliance. Sections of the maxillary first molars were immunostained for caspase-3. Upon force application, the number of apoptotic osteocytes significantly increased in the pressure side at 1 d and remained the same at 3 d and 5 d. However, there was no significant difference in the number of apoptotic osteocytes between the two force groups. We conclude that osteocyte apoptosis appears to increase under orthodontic loading, reaching a plateau after 1 d. However, osteocyte apoptosis seems to be independent of the magnitude of orthodontic forces tested.

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The Clinical Implications of Fatty Pancreas: A Concise Review

Abstract

Fatty pancreas is a newly recognized condition which is poorly investigated until today as compared to nonalcoholic fatty liver disease. It is characterized by pancreatic fat accumulation and subsequent development of pancreatic and metabolic complications. Association of fatty pancreas have been described with type 2 diabetes mellitus, acute and chronic pancreatitis and even pancreatic carcinoma. In this review article, we provide an update on clinical implications, pathogenesis, diagnosis, treatment and outcomes.

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Endoscopic DCR using bipedicled interlacing mucosal flaps

Objective

Obstruction of the nasolacrimal duct is a relatively common condition that affects patients of all ages, races, and sexes. The surgical gold standard for complete nasolacrimal duct obstruction and dacryocystitis is dacryocystorhinostomy (DCR). The purpose of this study was to describe a novel, bipedicled interlacing mucosal sparing flap technique for endoscopic DCR (eDCR).

Methods

A posteriorly based mucosal flap over the fundus is combined with a novel, anteriorly based mucosal flap over the intraosseus portion of the nasolacrimal duct (NLD). This exposes a wide area of the maxillary bone, allowing for exposure and identification of the NLD/sac complex in a safer, more inferior position. The interlacing mucosal flaps may be replaced at the conclusion of the procedure, thereby minimizing bone exposure and maintaining excellent long-term patency.

Results

The authors have utilized this technique in 55 procedures with 100% positive identification of the NLD and lacrimal sac, 0% complication rate, 100% anatomical patency rate, and 96.4% success rate after a minimal follow-up of 6 months.

Discussion

The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.

Conclusion

The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.

Level of Evidence

N/A Laryngoscope, 2017

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Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender

Objectives

To evaluate gender-based differences in narrative letters of recommendation (NLORs) and standardized letters of recommendation (SLORs) submitted for applicants to an otolaryngology head and neck surgery (OHNS) residency program.

Study Design

Retrospective review.

Methods

Nine hundred fifty-eight letters of recommendation (LORs) submitted to one OHNS program in 2013 to 2014 were analyzed.

Results

NLORs (n = 590) and SLORs (n = 368) were reviewed. Male writers composed over 85% of all LORs. Compared with male writers, female writers of LORs were more likely to compose a letter of minimal assurance (P < 0.025). Female writers of SLORs were more likely to rank applicants higher in communication skills (P < 0.035) and match potential (P < 0.045). Analysis of LORs by applicant gender revealed that female applicants were more likely than male applicants to be described as team players (P < 0.025) and less likely to receive a letter of minimal assurance (P < 0.001). Compared with SLORs, NLORs written for male applicants were more likely to reference their leadership potential (P < 0.001). Female applicants were less likely to be described as "bright" (P < 0.001) and more likely to have their appearance mentioned (P < 0.03) in NLORs when compared to SLORs.

Conclusion

Although we found that SLORs reduce gender biases compared to NLORs, there remain significant differences in how female and male applicants are described. Greater awareness of historical biases likely has contributed to more equitable letter writing, although impactful gender biases remain when reviewing applicants.

Level of Evidence

NA. Laryngoscope, 2017

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Tumor- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systematic review.

Abstract

Background:Immune checkpoint inhibitor (ICI) monoclonal antibodies (mAbs) targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or its ligand (PD-L1) produce unique toxicity profiles. The objective of this review was to identify patterns and incidence of immune related adverse events (irAE) based on tumor type and ICI class.Methods:MEDLINE, EMBASE and COCHRANE databases were searched to identify prospective monotherapy trials of ICIs from 2003 to November 2015. Paired reviewers selected studies for inclusion and extracted data. Odds ratio (OR), chi-squared tests and multivariable regression models were used to analyze for effect size and associations.Results:We identified 48 trials (6938 patients), including 26 CTLA-4, 17 PD-1, 2 PD-L1 trials, and 3 studies tested both CTLA-4 and PD-1. Grade 3/4 irAE were more common with CTLA-4 mAbs compared with PD-1 (31% vs 10%). All grades colitis (OR 8.7, CI 5.8-12.9), hypophysitis (6.5, 3.0-14.3) and rash (2.0, 1.8-2.3) were more frequent with CTLA-4 mAbs; whereas pneumonitis (6.4, 3.2-12.7), hypothyroidism (4.3, 2.9-6.3), arthralgia (3.5, 2.6-4.8) and vitiligo (3.5, 2.3-5.3) were more common with PD-1 mAbs. Comparison of irAE from the 3 most studied tumor types in PD-1 mAbs trials [melanoma (n = 2048), non-small cell lung cancer (n = 1030) and renal cell carcinoma (n = 573)] showed melanoma patients had a higher frequency of gastrointestinal and skin irAE and lower frequency of pneumonitis.Conclusions:CTLA-4 and PD-1 mAbs have distinct irAE profiles. Different immune microenvironments may drive histology-specific irAE patterns. Other tumor-dependent irAE profiles may be identified as data emerge from ICI trials.

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Paradigm shifts in staging of thyroid cancer

Kim et al. from Korea [1] have done a remarkable job on retrospective review of their large number of patients with thyroid carcinoma first staging them according to the 7th edition of the AJCC/UICC staging system of thyroid cancer and re-staging them according to the most recent, 8th edition and changes implemented in the 8th edition. They have also done a comparative analysis of cause specific survival (CSS) and implications of the new and revised staging system [2]. The revised staging system was published in January of 2017, however, officially it will be implemented in January 2018 at which time the staging system of thyroid cancer will change worldwide.

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Editorial Board/Aims & Scope

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Prognostic factors and occult nodal disease in mucoepidermoid carcinoma of the oral cavity and oropharynx: An analysis of the National Cancer Database

Salivary gland malignancies are rare and account for only 3% of head and neck cancers [1]. Despite their rarity, these neoplasms are heterogeneous and are classified into 24 different histologic subtypes by the World Health Organization [2]. Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy and is most often located in the parotid gland followed by the minor salivary glands throughout the upper aero-digestive tract, most notably in the oral cavity (OC) and oropharynx (OP) [3,4].

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Outcome following radiotherapy for head and neck basal cell carcinoma with ‘aggressive’ features

Basal cell carcinoma (BCC) is a malignant neoplasm derived from the basal layer of the epidermis [1]. It is the most common cancer type in western countries and the incidence is rising [2]. Most BCCs (80–90%) occur in elderly patients and frequently on sun-exposed body parts such as the head and neck, which is also the most common site [3,4]. Head and neck BCC (HN-BCC) are generally slow growing. However, a subset of HN-BCC may behave more aggressively and lead to greater morbidity and mortality [5].

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Tube feeding during treatment for head and neck cancer – Adherence and patient reported barriers

Treatment fidelity is important to assess in intervention research trials as it refers to the extent to which interventions are delivered as intended according to the study protocol [1]. It is particularly important for intervention research trials which encompass behavioural change, so that the efficacy of the intervention can be considered in the correct context and inappropriate rejection of potentially effective interventions can be minimised [2]. Treatment fidelity has been described as having at least four core components including: study design and protocol to outline how the intervention should be organised and delivered; training and supervision of those delivering the intervention to ensure consistency; monitoring of intervention delivery to determine whether the intervention was delivered as intended; and monitoring of intervention receipt to determine whether the intervention was received and understood [1,3].

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Nomogram for risk prediction of malignant transformation in oral leukoplakia patients using combined biomarkers

The International Agency for Research on Cancer in 2014 reported that an estimated 529,000 new cancer cases in the oral cavity, lip and pharynx occurred worldwide in 2012, with 292,000 deaths. When the main subsites are examined separately, they do not rank highly; combined, however, they would rank as the seventh most frequent type of cancer and the ninth most common cause of cancer death [1]. The most common oral cancer, oral squamous cell carcinoma (OSCC) may arise from potentially malignant oral disorders (PMODs) such as oral leukoplakia (OL) and oral submucous fibrosis, with a variable transformation rate [2].

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Dual peptide-mediated targeted delivery of bioactive siRNAs to oral cancer cells in vivo

Oral and pharyngeal cancer is the ninth most common cancer worldwide [1], and in the U.S.A. it is estimated that about 50,000 new cases and approximately 10,000 deaths occur annually due to cancer of the oral cavity and pharynx [2]. Although significant advances have been made in cancer treatment, the prognosis for oral cancer remains poor in comparison to other cancer types, including breast, skin, and prostate [2]. Moreover, the five-year survival rate for all stages of oral cancer is 64% and has only modestly improved over the past few decades [2,3].

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Evaluation of the Xpert® HPV assay in the detection of Human Papillomavirus in formalin-fixed paraffin-embedded oropharyngeal carcinomas

Over the last few decades, it has become clear that Human Papillomavirus (HPV) does not only cause ano-genital cancers, but also represents the etiological agent of a subset of Head and Neck Squamous Cell Carcinomas (HNSCC) [1]. The majority of the HPV-driven HNSCC are oropharyngeal squamous cell carcinomas (OPSCC) which arise at the tonsils or base of the tongue. Recently, a significant increase in the incidence of HPV-related OPSCC was observed in the US [2] and several European countries [3,4].

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Patterns of fractionation for patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy in the United States

External beam radiotherapy (EBRT) offers an effective definitive intervention with the promise of anatomic and functional preservation to patients with early-stage larynx cancer [1–4]. While conventional fractionation (CFxn) at 1.8–2.0 Gray (Gy) per day has been the predominant schedule in most series, developments in radiobiology [5–7] have sparked interest in alternative fractionation schedules as a means of improving local control.

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Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation

Head and neck cancer accounts for approximately 500,000 cases annually worldwide, with over 62,000 Americans diagnosed each year and almost 13,000 dying from the disease [1,2]. It is well-recognized that the immune system plays a major role in anti-tumor surveillance in healthy individuals, a finding that is confirmed by the increased incidence of cancer diagnosis in some acquired (such as after organ transplant) or hereditary (such as GATA2 deficiency) immunodeficiency states [3]. Our understanding of the interactions between immunity and tumorigenesis is growing at a fast rate such that modulating the immune system has been the largest breakthrough in cancer therapy in the last decade [4].

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Trials in head and neck oncology: Evolution of perioperative adjuvant therapy

Over the past 50years, the treatment of head and neck cancer has evolved considerably. Some management decisions are based on meta-analyses of well-designed randomized trials, others are based on limited prospective studies, and still others are founded on retrospective evidence or on tradition alone. Although the National Comprehensive Cancer Network guidelines [1] provide a broad discussion of current management, it is critical to understand the evolution and development of those treatment paradigms.

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Outcomes of oral cavity cancer patients treated with surgery followed by postoperative intensity modulated radiation therapy

Locally advanced oral cavity squamous cell carcinoma (OCSCC) is standardly treated with surgery. Adjuvant postoperative radiation therapy is recommended for patients with adverse features including: stage IV disease, inadequate margins, and invasion of tumor into perineural spaces, lymphovascular spaces or bone. Over the last decade, the addition of chemotherapy to adjuvant radiation was recommended, particularly for patients who have 'high risk' pathologic features which include extracapsular nodal extension (ECE) and/or a positive surgical margin.

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Validation and comparison of the 7th and 8th edition of AJCC staging systems for non-metastatic nasopharyngeal carcinoma, and proposed staging systems from Hong Kong, Guangzhou, and Guangxi

Proper classification and staging of cancer is essential for the physician to assign proper treatment, evaluate results of management and clinical trials, and to serve as the standard for local, regional and international reporting on cancer incidence and outcome.

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Conditional relative survival of oral cavity cancer: Based on Korean Central Cancer Registry

There were an estimated 300,383 global cases of lip and oral cavity cancer in 2012, with more than half of the patients located in Asia [1]. In Korea, the incidence of oral cavity cancer has been dynamically changing, with an increasing incidence among women, as well as an increasing incidence of tongue cancer among young adults [2]. Although oral cavity cancer does not account for a large proportion of all Korean cancer cases, the cancer is associated with significant effects on physiological function, facial esthetics, and survival.

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A comprehensive study of smoking-specific microRNA alterations in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC) affects more than 650,000 people annually, with 5-year mortality rates exceeding 50% [1,2]. Because HNSCCs are linked to several distinct risk factors, including tobacco use, alcohol consumption, and HPV infection [3], and arise in a number of different sites within the head and neck region, they collectively exhibit significant heterogeneity at the molecular and genetic level and disparate response to treatment and clinical outcome.

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The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma

Oral squamous cell carcinoma is one of the most common malignancies worldwide (OSCC) [1]. The annual incidence is 263.000 and 128.000 deaths are registered per year [1]. Despite major advances in diagnostic and therapeutic techniques, the prognosis of patients with oral squamous cell carcinoma has not improved in the last three decades and still remains below 50% [2,3].

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The notochord in Atlantic salmon (Salmo salar L.) undergoes profound morphological and mechanical changes during development

Abstract

We present the development of the notochord of the Atlantic salmon (Salmo salar L.), from early embryo to sexually mature fish. Over the salmon's lifespan, profound morphological changes occur. Cells and gross structures of the notochord reorganize twice. In the embryo, the volume of the notochord is dominated by large, vacuolated chordocytes; each cell can be modeled as a hydrostat organized into a larger cellular-hydrostat network, structurally bound together with desmosomes. After the embryo hatches and grows into a fry, vacuolated chordocytes disappear, replaced by extracellular lacunae. The formation of mineralized, segmental chordacentra stiffens the notochord and creates intervertebral joints, where tissue strain during lateral bending is now focused. As development proceeds towards the parr stage, a process of devacuolization and intracellular filament accumulation occur, forming highly dense, non-vacuolated chordocytes. As extracellular lacunae enlarge, they are enclosed by dense filamentous chordocytes that form transverse intervertebral septa, which are connected to the intervertebral ligaments, and a longitudinal notochordal strand. In the vertebral column of pelagic adults, large vacuolated chordocytes reappear; cells of this secondary population have a volume up to 19 000 times larger than the primary vacuolated chordocytes of the early notochord. In adults the lacunae have diminished in relative size. Hydrostatic pressure within the notochord increases significantly during growth, from 525 Pa in the alevins to 11 500 Pa in adults, at a rate of increase with total body length greater than that expected by static stress similarity. Pressure and morphometric measurements were combined to estimate the stress in the extracellular material of the notochordal sheath and intervertebral ligaments and the flexural stiffness of the axial skeleton. The functional significance of the morphological changes in the axial skeleton is discussed in relation to the different developmental stages and locomotor behavior changes over the lifespan of the fish.

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Optimizing Outcomes of Postmastectomy Breast Reconstruction

What does the current evidence tell us about the benefits of acellular dermal matrix in breast reconstruction?
ePlasty, Open Access Journal of Plastic Surgery

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Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews

The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we...

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Editorial Board

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Effect of Booster Vaccination with Inactivated Porcine Epidemic Diarrhea Virus on Neutralizing Antibody Response in Mammary Secretions

Viral Immunology , Vol. 0, No. 0.


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Platelets Modulate Innate Immune Response Against Human Respiratory Syncytial Virus In Vitro

Viral Immunology , Vol. 0, No. 0.


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Role of Ultrasound in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Adolescents with moyamoya disease: clinical features, surgical treatment and long-term outcomes

Abstract

Background

This study aimed to elucidate the clinical features, surgical treatment and long-term outcomes of adolescent patients with moyamoya disease.

Methods

We reviewed consecutive patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015 to identify adolescent patients with moyamoya disease. Clinical features, surgical treatment and long-term outcomes were analyzed. Follow-up was performed by face-to-face or structured telephone interviews. Outcome measures were future stroke events. We performed univariate and multivariate time-to-event analyses to identify risk factors associated with future stroke events.

Results

A total of 95 adolescent patients with moyamoya disease (age at onset, 13.1 ± 2.3 years) were included in this study. During follow-up, 12 patients (12.6%) had stroke events. We found that the patients who underwent direct/combined bypass had a significantly lower risk of future strokes [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.03–0.74; P = 0.019] compared to patients who underwent indirect bypass.

Conclusions

Our results demonstrate that direct/combined bypass can be more effective in preventing future strokes than indirect bypass in adolescent patients with moyamoya disease.

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Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury

Abstract

Background

Despite various treatments to control intracranial pressure (ICP) after brain injury, patients may present a late onset of high ICP or a poor response to medications. External lumbar drainage (ELD) can be considered a therapeutic option if high ICP is due to communicating external hydrocephalus. We aimed at describing the efficacy and safety of ELD used in a cohort of traumatic or non-traumatic brain-injured patients.

Methods

In this multicentre retrospective analysis, patients had a delayed onset of high ICP after the initial injury and/or a poor response to ICP treatments. ELD was considered in the presence of radiological signs of communicating external hydrocephalus. Changes in ICP values and side effects following the ELD procedure were reported.

Results

Thirty-three patients with a median age of 51 years (25-75th percentile: 34–61 years) were admitted after traumatic (n = 22) or non-traumatic (n = 11) brain injuries. Their initial Glasgow Coma Scale score was 8 (4–11). Eight patients underwent external ventricular drainage prior to ELD. Median time to ELD insertion was 5 days (4–8) after brain insult. In all patients, ELD was dramatically effective in lowering ICP: 25 mmHg (20–31) before versus 7 mmHg (3–10) after (p < 0.001). None of the patients showed adverse effects such as pupil changes or intracranial bleeding after the procedure. One patient developed an ELD-related infection.

Conclusions

These findings indicate that ELD may be considered potentially effective in controlling ICP, remaining safe if a firm diagnosis of communicating external hydrocephalus has been made.

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RCT vs register

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Chordoma

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Toe-to-finger combined with free flap transfer for primary one-stage post-traumatic reconstruction of the complex fingerless hand

Toe-to-finger transplantation is intimately related to the development of microsurgical free tissue transplantation, which is one of the most important advances in the history of reconstructive surgery. It is also generally acknowledged that a mangled hand with massive tissue loss and amputation of multiple digits presents a challenge for plastic and reconstructive surgeons. In this retrospective study we reviewed 11 cases of primary one-stage post-traumatic reconstruction of complex fingerless hands using a combination of toe-to-finger and free tissue transplantation performed in Shanghai Jiao Tong University affiliated Sixth People's Hospital and Shanghai Jiao Tong University School of Medicine affiliated Ninth People's Hospital from January 2001 to November 2014.

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The merits of decision modelling in the earliest stages of the IDEAL framework – an innovative case in DIEP flap breast reconstructions

IDEAL framework aims at improving the evidence base of available surgical innovations. However, the development of such innovations and collection of evidence is costly. Surgical innovation can provide more value for money if innovations are evaluated in an early stage, where evaluations can inform the decision whether to stop or further develop an innovation. We illustrate how decision modelling can be readily adopted at the earliest stages (0-1) of the IDEAL framework, using an innovation in bilateral DIEP flap breast reconstruction as an example.

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Cognitive Event-Related Potentials during the Sub-Acute Phase of Severe Traumatic Brain Injury and Their Relationship to Outcome

Journal of Neurotrauma , Vol. 0, No. 0.


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Vitronectin Regulates the Fibrinolytic System during the Repair of Cerebral Cortex in Stab-Wounded Mice

Journal of Neurotrauma , Vol. 0, No. 0.


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Cognitive and Occupational Function in Survivors of Adolescent Cancer

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.


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Am I a 6 or a 10? Mate Value Among Young Adult Survivors of Childhood Cancer and Healthy Peers

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.


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Histomorphometric and osteocytic characteristics of cortical bone in male subtrochanteric femoral shaft

Abstract

The histomorphometric properties of the subtrochanteric femoral region have rarely been investigated. The aim of this study was to investigate the age-associated variations and regional differences of histomorphometric and osteocytic properties in the cortical bone of the subtrochanteric femoral shaft, and the association between osteocytic and histological cortical bone parameters. Undecalcified histological sections of the subtrochanteric femoral shaft were obtained from cadavers (n = 20, aged 18–82 years, males). They were cut and stained using modified Masson-Goldner stain. Histomorphometric parameters of cortical bone were analysed with ×50 and ×100 magnification after identifying cortical bone boundaries using our previously validated method. Within cortical bone areas, only complete osteons with typical concentric lamellae and cement line were selected and measured. Osteocytic parameters of cortical bone were analyzed under phase contrast microscopy and epifluorescence within microscopic fields (0.55 mm² for each). The cortical widths of the medial and lateral quadrants were significantly higher than other quadrants (P < 0.01). Osteonal area per cortical bone area was lower and cortical porosities were higher in the posterior quadrant than in the other quadrants (P < 0.05). Osteocyte lacunar number per cortical bone area was found higher in the young subjects (≤ 50 years) than in the older ones (> 50 years) both before and after adjustments for body height and weight (P < 0.05). Moreover, significant but low correlations were found between the cortical bone and osteocytic parameters (0.20 ≤ R² ≤ 0.35, P < 0.05). It can be concluded that in healthy males, the cortical histomorphometric parameters differ between the anatomical regions of the subtrochanteric femoral shaft, and are correlated with the osteocytic parameters from the same site. These findings may be of use when discussing mechanisms that predispose patients to decreasing bone strength.

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Cognitive Event-Related Potentials during the Sub-Acute Phase of Severe Traumatic Brain Injury and Their Relationship to Outcome

Journal of Neurotrauma , Vol. 0, No. 0.


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Vitronectin Regulates the Fibrinolytic System during the Repair of Cerebral Cortex in Stab-Wounded Mice

Journal of Neurotrauma , Vol. 0, No. 0.


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Anaphylaxis associated with omalizumab administration: Risk factors and patient characteristics

Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Phillip L. Lieberman, Ilisten Jones, Richa Rajwanshi, Karin Rosén, Dale T. Umetsu




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MicroRNA-150 controls differentiation of intraepithelial lymphocytes via TGF-β receptor II regulation

Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sang-Hwan Seo, Min Seong Jang, Doo-Jin Kim, Seok-Min Kim, Se-Chan Oh, Cho-Rok Jung, Yunji Park, Sang-Jun Ha, Haiyoung Jung, Young-Jun Park, Suk Ran Yoon, Inpyo Choi, Tae-Don Kim
BackgroundIntraepithelial lymphocytes (IELs) in the intestines play pivotal roles in maintaining the integrity of the mucosa, regulating the immune cells, and protecting against pathogenic invasion. Although several extrinsic factors such as transforming growth factor-β (TGF-β) have been identified to contribute to IEL generation, intrinsic regulatory factors have not been fully determined.ObjectiveHere, we investigated the regulation of IEL differentiation and the underlying mechanisms in mice.MethodsWe analyzed IELs and the expression of molecules associated with IEL differentiation in wildtype control and microRNA-150-knockout mice. Methotrexate (MTX) was administered to mice lacking microRNA (miR)-150 and control mice.ResultsmiR-150 deficiency reduced the IEL population in the small intestine and increased susceptibility to MTX-induced mucositis. Evaluation of expression of IEL differentiation-associated molecules showed that miR-150-deficient IELs exhibited decreased expression of TGF-β receptor II (TGF-βRII), CD103, CD8αα, and RUNX3 in all the IEL subpopulations. The reduced expression of TGF-βRII in miR-150-deficient IELs was caused by the increased expression of c-Myb/miR-20a. Restoration of miR-150 or inhibition of miR-20a recovered the TGF-βRII expression.ConclusionmiR-150 is an intrinsic regulator of IEL differentiation through TGF-βRII regulation. miR-150-mediated IEL generation is crucial for maintaining intestinal integrity against anticancer drug-induced mucositis.

Graphical abstract

Teaser

miR-150 deficiency reduces IEL population in the small intestine, resulting in increased susceptibility to anti-cancer drug-induced damage in the intestinal epithelial cells.


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More Than a Decade Follow-up in Severe or Difficult-to-Treat Asthma: TENOR II

Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Bradley E. Chipps, Tmirah Haselkorn, Brandee Paknis, Benjamin Ortiz, Eugene R. Bleecker, Farid Kianifard, Aimee J. Foreman, Stanley J. Szefler, Robert S. Zeiger
BackgroundThe Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe/difficult-to-treat asthma, despite standard-of-care treatment.ObjectiveTo determine the long-term natural history of disease and outcomes in patients in TENOR I, after more than a decade.MethodsTENOR I was a multicenter, observational study (2001–2004) of 4756 patients with severe/difficult-to-treat asthma. TENOR II was a follow-up study of TENOR I patients using a single, cross-sectional visit in 2013/2014. Overall, the sites participating in TENOR II originally enrolled 1230 patients in TENOR I. Clinical and patient-reported outcomes were assessed, including very poorly controlled (VPC) asthma based on National Heart, Lung, and Blood Institute (NHLBI) guidelines.ResultsA total of 341 (27.7%) patients were enrolled in TENOR II and were representative of the TENOR I cohort. Most frequent comorbidities were rhinitis (84.0%), sinusitis (47.8%) and gastroesophageal reflux disease (46.3%). Mean (SD) percent predicted pre- and post-bronchodilator FEV1 were 72.7% (21.4%) and 78.2% (20.7%), respectively. A total of 231/317 (72.9%) tested positive for ≥1 allergen-specific IgE. Mean (SD) blood eosinophil count was 200 μL (144). Eighty-eight (25.8%) patients experienced an asthma exacerbation in the prior 3 months requiring hospital attention and/or oral corticosteroids. Over half (197/339; 58.1%) had VPC asthma. Medication use suggested undertreatment.ConclusionTENOR II provides longitudinal data to characterize disease progression, heterogeneity and severity in severe/difficult-to-treat asthma. Findings show continued morbidity, including a high degree of comorbid conditions, allergic sensitization, exacerbations and VPC asthma, including reduced lung function.

Teaser

More than a decade after TENOR I, substantial disease burden, including high rates of comorbidities, allergic sensitization, poorly controlled asthma, and exacerbations were observed in patients with severe or difficult-to-treat asthma in TENOR II, despite standard-of-care therapy.


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FPIES: not so rare after all!

Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Anna Nowak-Wegrzyn, Jonathan M. Spergel




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Comparison between autogenous iliac bone and freeze-dried bone allograft for repair of alveolar clefts in the presence of plasma rich in growth factors: A randomized clinical trial

This study aimed to compare the effectiveness of alveolar cleft repair using iliac bone and freeze-dried bone allograft (FDBA) in the presence of plasma rich in growth factors (PRGF).

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Cementoblastoma: an updated analysis of 258 cases reported in the literature

To investigate the recurrence rate of cementoblastomas for different variables aside from the clinical/radiologic features.

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Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification

BACKGROUND

Fine-needle aspiration (FNA) cytology of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. The aims of this study were to evaluate the diagnostic accuracy of salivary gland FNA and to apply the proposed Milan system for reporting salivary gland lesions.

METHODS

A retrospective audit of FNA specimens of salivary gland lesions reported from 2014 to 2016 was performed. A correlation with the follow-up histopathology, wherever it was available, was performed. The aspirates were then categorized according to the Milan system as follows: nondiagnostic, nonneoplastic, atypical, benign neoplasm, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, or positive for malignancy. Furthermore, the risk of malignancy and the risk of high-grade malignancy were calculated for all diagnostic categories.

RESULTS

A total of 631 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 94 cases (14.9%). FNA had a sensitivity of 79.4% and a specificity of 98.3% with an overall diagnostic accuracy of 91.4% for differentiating malignant tumors from benign tumors. The overall risk of malignancy was 17.4% for the nonneoplastic category, 100% for the atypical category, 7.3% for the benign neoplasm category, 50% for the NUMP category, and 96% for the positive-for-malignancy category.

CONCLUSIONS

Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017. © 2017 American Cancer Society.

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Double-blind, randomized phase 3 trial of low-dose 13-cis retinoic acid in the prevention of second primaries in head and neck cancer: Long-term follow-up of a trial of the Eastern Cooperative Oncology Group-ACRIN Cancer Research Group (C0590)

BACKGROUND

13-Cis retinoic acid (13-CRA) is a synthetic vitamin A derivative. High-dose 13-CRA in patients with squamous cell cancers of the head and neck (SCCHNs) reduces the incidence of second primary tumors (SPTs). The authors report long-term results from a phase 3 randomized trial that compared treatment with low-dose 13-CRA versus placebo for patients who had early stage SCCHN, with a focus on the development of SPTs and overall survival (OS).

METHODS

In total, 176 patients who received treatment for stage I/II SCCHN were randomized to receive either low-dose 13-CRA (weight-based dose of 7.5 mg or 10 mg) or placebo for 2 years. A competing-risk approach and the log-rank test were used to compare the time to SPT and OS, respectively, between groups.

RESULTS

13-CRA neither significantly reduced the cumulative incidence of SPT (P = .61) nor improved the time to SPT (hazard ratio [HR] for 13-CRA/placebo; 0.86; P = .61). Despite limited power, there was a trend toward improved OS for the 13-CRA arm (HR, 0.75; P = .14), particularly among patients whose index tumor was surgically excised (N = 26; HR, 0.50; P = .057) and among women (N = 39; HR, 0.44; P = .065) and never/former smokers (N = 129; HR, 0.61; P = .055), with a median follow-up of 16 years. The main 13-CRA related toxicities were dry skin and cheilitis.

CONCLUSIONS

Treatment with low-dose 13-CRA for 2 years did not decrease the incidence of SPT; subset analysis indicates a potential survival advantage among patients who are women and never/former smokers. More targeted interventions based on clinical risk factors and molecular characterization of tumors may yield greater success in future prevention trials. Cancer 2017. © 2017 American Cancer Society.

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Akt/FoxM1 signaling pathway-mediated upregulation of MYBL2 promotes progression of human glioma

MYB-related protein B (B-MYB/MYBL2), a member of the myeloblastosis family of transcription factors, has been reported for its role in the genesis and progression of tumors. Forkhead box M1 (FoxM1), another tr...

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Percutaneous Rupture of Zygapophyseal Joint Synovial Cysts: a Prospective Assessment of Nonsurgical Management

Although lumbar zygapophyseal joint synovial cysts are fairly well recognized, they are an uncommon cause of lumbosacral radicular pain. Non-operative treatments include percutaneous aspiration of the cysts under computed tomography or fluoroscopic guidance with a subsequent corticosteroid injection. However, there are mixed results in terms of long-term outcomes and cyst reoccurrence. This study prospectively evaluates percutaneous ruptures of zygapophyseal joint (Z-joint) synovial cysts for the treatment of lumbosacral radicular pain.

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Subacute Progressive Myelopathy: Transverse Myelitis or Subacute Combined Degeneration? A Case Report

Evolving subacute myelopathies have many possible etiologies. This is a report of a patient who presented with progressive paresthesias, proprioceptive loss, and gait disturbance with acute myelitis seen on Magnetic Resonance Imaging initially concerning for transverse myelitis. However, she also had vitamin B12 deficiency and her clinical course ultimately suggested a diagnosis more compatible with subacute combined degeneration. The clinical features, laboratory and imaging findings and prognosis of the two disorders are compared.

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Fibrin-associated diffuse large B-cell lymphoma in a hemorrhagic cranial arachnoid cyst

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Motor unit remodelling in multifocal motor neuropathy: the importance of axonal loss

To estimate the degree of axonal loss in patients diagnosed with multifocal motor neuropathy (MMN) using a novel assessment of motor unit numbers and size.

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Voice-Specialized Speech-Language Pathologist's Criteria for Discharge from Voice Therapy

No standard protocol exists to determine when a patient is ready and able to be discharged from voice therapy. The aim of the present study was to determine what factors speech-language pathologists (SLPs) deem most important when discharging a patient from voice therapy. A second aim was to determine if responses differed based on years of voice experience.

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Factors Affecting Voice Therapy Completion in Singers

The purpose of this study was to determine (a) which factors may affect singers' completing voice therapy, and (b) develop predictive profiles to capture those singers at risk for dropping out of voice therapy.

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Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view () could be assumed to decrease PTH compared to traditional tonsillectomy (). Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery or thereafter ). The findings at resection site and pain were measured. Results. 869 patients were included (183 ; 686 ). PTH requiring RTT was not seen in the group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (). Postoperative edema and local infection at resection site were proven to be predictive of PTH (). Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the group. Benefit for was observed in high-volume and long experienced surgeons.

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Seismocardiography-Based Cardiac Computed Tomography Gating Using Patient-Specific Template Identification and Detection

To more accurately trigger cardiac computed tomography angiography (CTA) than electrocardiography (ECG) alone, a sub-system is proposed as an intermediate step toward fusing ECG with seismocardiography (SCG). Accurate prediction of quiescent phases is crucial to prospectively gating CTA, which is susceptible to cardiac motion and, thus, can affect the diagnostic quality of images. The key innovation of this sub-system is that it identifies the SCG waveform corresponding to heart sounds and determines their phases within the cardiac cycles. Furthermore, this relationship is modeled as a linear function with respect to heart rate. For this paper, B-mode echocardiography is used as the gold standard for identifying the quiescent phases. We analyzed synchronous ECG, SCG, and echocardiography data acquired from seven healthy subjects (mean age: 31; age range: 22–48; males: 4) and 11 cardiac patients (mean age: 56; age range: 31–78; males: 6). On average, the proposed algorithm was able to successfully identify 79% of the SCG waveforms in systole and 68% in diastole. The simulated results show that SCG-based prediction produced less average phase error than that of ECG. It was found that the accuracy of ECG-based gating is more susceptible to increases in heart rate variability, while SCG-based gating is susceptible to high cycle to cycle variability in morphology. This pilot work of prediction using SCG waveforms enriches the framework of a comprehensive system with multiple modalities that could potentially, in real time, improve the image quality of CTA.

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Prevention of Mandible Reconstruction Plate Exposure by Costal Cartilage Wrapping.

After mandibulectomy in cancer surgery, reconstruction is often performed with a reconstruction plate covered with a soft-tissue free flap in patients in poor condition. However, the rate of complications for mandibular reconstruction is higher with a reconstruction plate than with vascularized bone grafts. We have developed a costal cartilage wrapping method to prevent exposure of the mandible reconstruction plate. The eighth costal cartilage was removed and split into 2 pieces to wrap around the reconstruction plate. In our case, the artificial plate wrapped with costal cartilage graft was not exposed and the skin over the plate did not become atrophic over 27 months follow-up even after irradiation. Wrapping around an artificial reconstruction plate with autologous costal cartilage grafts may be more effective than using only a flap covering to prevent exposure of the plate after tumor ablation and radiation therapy. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Prioritization for Plastic Surgery Procedures Aimed to Improve Quality of Life: Moral Considerations.

Background: Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions. Methods: We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non-life-threatening conditions. Results: A specific anatomical feature is not always an indicator of patient's well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care. A policy should identify who preoperatively are the worst-off and come to some plausible measure of how much they can be expected to benefit from an operation. Policies that do not track these principles in any reliable way can cause discrimination. Conclusions: A patient-centered operating system and patient's informed preferences might be implemented in the process of prioritizing health. In circumstances when the effectiveness of a specific treatment is unproven, professionals should not make assumptions based on their own values. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Prévention des insatisfactions postopératoires et des éventuelles complications médico-juridiques

Publication date: Available online 7 August 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): G. Flageul, R. Pessis
L'objectif de ce travail est de mieux comprendre les motifs d'insatisfactions postopératoires et ce qui fait le lit des complications médico-juridiques. Au-delà de la compétence technique, il est essentiel d'observer une très grande rigueur dans l'écoute des réelles motivations afin de poser des indications opératoires les plus justes possibles et notamment de savoir dépister et ne jamais opérer certain(e)s patient(e)s qui, quoi qu'on fasse, seront toujours insatisfait(e)s. La qualité de l'information constitue un des éléments essentiel de la prévention : l'information fait partie du soin et il n'y a pas de réussite thérapeutique sans une réussite de la relation entre un soignant et un soigné. Avant l'intervention, il est indispensable de préconstituer une preuve écrite de la bonne délivrance de l'information par la signature d'un reçu et d'un document de consentement éclairé. Cependant, l'information ne s'arrête pas au moment du geste opératoire et il faut savoir délivrer, à propos d'éventuelles complications postopératoires, une information complète et sans retard. Par ailleurs, la médecine esthétique bien comprise et rigoureusement mise en œuvre, contribue à la prévention des complications chirurgicales et médico-juridiques, en diminuant la lourdeur de certains gestes chirurgicaux. La question de l'e-réputation ne doit, en aucune manière, être négligée. De ce point de vue, la prévention consiste à maîtriser le plus possible son environnement Internet. En effet, là où naguère, devant un(e) patient(e) insatisfait(e) ne nous attendait que la crainte d'un mauvais bouche-à-oreille ou du procès, s'ajoute désormais le risque d'atteinte à l'e-réputation dont les conséquences peuvent être fort dommageables. À l'heure où l'usage intensif d'Internet permet à n'importe qui de sortir de l'anonymat, il nous faut, de notre côté, également maîtriser ces outils au risque de voir sacrifier notre expertise au sacre des amateurs.The purpose of this work is to better understand the reasons for post-surgical instability and what makes up the bed of medico-legal complications. Beyond technical competence, it is essential to observe a very high degree of rigor in listening to the real motivations in order to give the most accurate possible surgical indications and in particular to know to detect and never to operate certain patients who, whatever we do, will always be dissatisfied. The quality of information is one of the essential elements of prevention: information is part of the care and there is no therapeutic success without a successful relationship between a caregiver and a carereceiver. Before the surgery, it is essential to pre-establish written proof of the proper delivery of the information by signing a receipt and an informed consent document. However, the information does not stop at the time of the operative gesture and it is necessary to be able to provide complete and timely information about any post-surgical complications. Furthermore, aesthetic medicine is well understood and rigorously implemented, contributes to the prevention of surgical and medico-legal complications, reducing the heaviness of certain surgical gestures. The question of e-reputation should in no way be neglected. From this point of view, prevention consists in controlling as much as possible the Internet environment. Indeed, where, in the past, in the presence of a dissatisfied patient awaited us, the fear of word-of-mouth or trial is added to the risk of harm E-reputation whose implications can be very damaging. At a time when the intensive use of the Internet allows anyone to get out of anonymity, we must also control these tools at the risk of sacrificing our expertise at the coronation of amateurs.



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Oral administration of geranylgeranylacetone to protect vestibular hair cells

Publication date: Available online 7 August 2017
Source:Auris Nasus Larynx
Author(s): Shinpei Nagato, Kazuma Sugahara, Yoshinobu Hirose, Yousuke Takemoto, Makoto Hashimoto, Hironori Fujii, Hiroshi Yamashita
ObjectiveWe recently reported that the heat shock response played a major role in the protection of hair cells against stress. Oral administration of the heat shock inducer, geranylgeranylacetone (GGA) protected hair cells against intense noise. In our present study, we investigated the effect of GGA on vestibular hair cell death induced by an aminoglycoside.MethodsWe used CBA/N mice aged 4–6 weeks. The mice were divided into two groups, GGA and control. Mice in the GGA group were fed a diet containing GGA (0.5%) for 4 weeks, and those in the control group were fed a standard diet. Immunohistochemical analyses for Hsp70 were performed in four animals. The utricles of the remaining animals were cultured in medium for 24h with neomycin to induce hair cell death. After fixation, the vestibular hair cells were immunohistochemically stained against calmodulin, and hair cell survival was evaluated.ResultsThe vestibular hair cells of mice in the GGA group expressed Hsp70. In addition, after exposure to neomycin, vestibular hair cell survival was higher in the GGA group than in the control group.ConclusionOur results demonstrated the oral administration of GGA induced the heat shock response in the vestibule and could protect sensory cells.



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The multicultural evolution of beauty in facial surgery

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The relationship of the medial roof and the posterior wall of the maxillary sinus to the sphenoid sinus: a radiologic study

Abstract Introduction: The medial maxillary sinus roof is a ridge formed by the superior margin of the maxillary sinus antrostomy. The posterior wall of the maxillary sinus is always included in operative fields. Objective: To perform a radiologic study assessing the utility of the medial maxillary sinus roof and the posterior wall of the maxillary sinus as fixed landmarks for providing a safe route of entry into the sphenoid sinus. Methods: We reviewed 115 consecutive paranasal sinus Computed Tomographic scans (230 sides) of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest point of the medial maxillary sinus roof, the sphenoid ostium and anterior sphenoid roof and floor were measured. Then the vertical distances from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor were calculated. The coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was determined. Results: The average height of the highest point of the medial maxillary sinus roof relative to the nasal floor was measured to be 33.83 ± 3.40 mm. The average vertical distance from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor was 1.79 ± 3.09 mm, 12.02 ± 2.93 mm, and 6.18 ± 2.88 mm respectively. The average coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was 0.78 mm. The sphenoid ostium was behind the coronal plane of the posterior wall of the maxillary sinus most frequently in 103 sides (44.4%). It was in the same coronal plane in 68 sides (29.3%) and in front of the plane in 61 sides (26.3%). Conclusions: The medial maxillary sinus roof and the posterior wall of the maxillary sinus can be used as a reliable landmark to localize and to enable a safe entry into the sphenoid sinus.

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Resumo Introdução: O teto medial do seio maxilar é uma crista formada pela margem superior da antrostomia do seio maxilar. A parede posterior do seio maxilar é sempre incluída em campos cirúrgicos. Objetivo: Fazer estudo radiológico para avaliar a utilidade do teto medial do seio maxilar e da parede posterior do seio maxilar como referências anatômicas fixas para fornecer uma via segura de abordagem ao seio esfenoidal. Método: Foram analisados 115 exames de tomografia computadorizada consecutivos dos seios paranasais (230 lados) de pacientes adultos coreanos feitos de janeiro de 2014 a dezembro de 2014. Com o uso do assoalho nasal como ponto de referência, as distâncias verticais entre o teto medial do seio maxilar e o óstio esfenoidal e entre o teto e o assoalho esfenoidal anterior foram medidos. Em seguida, as distâncias verticais do ponto mais alto do teto medial do seio maxilar e o óstio esfenoidal e entre o teto e ao assoalho esfenoidal anterior foram medidas. A distância coronal da parede posterior do seio maxilar ao óstio esfenoidal foi determinada. Resultados: A altura média do ponto mais alto do teto medial do seio maxilar em relação ao assoalho nasal foi medida como 33,83 ± 3,40 mm. A distância vertical média do ponto mais alto do teto medial do seio maxilar até o óstio esfenoidal e do teto ao assoalho esfenoidal anterior foi de 1,79 ± 3,09 mm, de 12,02 ± 2,93 mm e 6,18 ± 2,88 mm, respectivamente. A distância coronal média da parede posterior do seio maxilar ao óstio esfenoidal foi de 0,78 mm. O óstio esfenoidal estava por trás do plano coronal da parede posterior do seio maxilar com mais frequência em 103 lados (44,4%). O mesmo se encontrava no plano coronal em 68 lados (29,3%) e na frente do plano em 61 lados (26,3%). Conclusões: O teto medial do seio maxilar e a parede posterior do seio maxilar podem ser usados como pontos de referência confiáveis para localizar e possibilitar uma abordagem segura ao seio esfenoidal.

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The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships

Abstract Introduction: The sphenoid sinus is an important structure in ventral skull base surgeries that is surrounded by several vital anatomical structures including the internal carotid arteries, optic nerve and cranial nerves inside the cavernous sinus. In addition, the foramen rotundum is a small canal deeply situated in the base of the skull, which represents the way for exit of the maxillary nerve. Understanding of the sphenoid bone anatomical relationships is central to the expanded endonasal approaches to the skull base. Objective: To record and analyze the measurement indexes of the sphenoid sinus and foramen rotundum in the coronal plane of normal computer tomography scans. Methods: Patients underwent paranasal sinuses computer tomography scan from June 2014 to November 2015 were retrospectively entered this cross-sectional study. We obtained several morphometric measurements from both the right and left sides using computer software. We also classified foramen rotundum and vidian canal types and determined position of the foramen rotundum regarding to base of lateral pterygoid plate. Results: One-hundred patients with the mean age of 38.56 ± 18.51 years entered this study. Mean bilateral FR distances were 38.48 ± 3.87 mm. Average right and left FRs distances to midline were 19.00 ± 2.07 and 19.34 ± 2.17 mm, respectively (p = 0.03). Twenty-eight cases (28%) had type I vidian canal, 48% and 24% had type II and III vidian canals, respectively. Four patients (4%) had type I rotundum foramen, 28% and 44% had type IIa and IIb, respectively and 24% had type III rotundum foramen. The position of foramen rotundums regarding to the base of lateral pterygoid plate was online in 50% of cases, medially placed in 47% and laterally placed in 3% of cases. Conclusion: The results of this study can be used to provide a better anatomical understanding of the area, which is necessary for endoscopic skull base surgeons.

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Resumo Introdução: O seio esfenoidal (SE) é uma estrutura importante em cirurgias da base do crânio, que está cercada por várias estruturas anatômicas vitais, como as artérias carótidas internas, o nervo óptico e os nervos cranianos no interior do seio cavernoso. Além disso, o forame redondo (FR) é um pequeno canal profundamente situado na base do crânio, que representa a forma de saída do nervo maxilar. Compreender as relações anatômicas do osso esfenoidal é fundamental para as abordagens endonasais expandidas da base do crânio. Objetivo: Registrar e analisar os índices de medição do SE e FR no plano coronal de exames normais de tomografia computadorizada (TC). Método: Os pacientes que foram submetidos a TC dos seios paranasais (SPN) de junho de 2014 a novembro 2015 foram retrospectivamente incluídos neste estudo transversal. Obtivemos várias medidas morfométricas de ambos os lados, direito e esquerdo, com o uso do software de computador. Também classificamos os tipos de FR e canal pterigoideo (CP) e determinamos a posição do FR em relação à base da placa pterigoide lateral. Resultados: Cem pacientes com a média de 38,56 ± 18,51 anos foram incluídos neste estudo. As distâncias médias bilaterais de FR foram de 38,48 ± 3,87 mm. As distâncias médias direita e esquerda dos FR até a linha média foram de 19,00 ± 2,07 e 19,34 ± 2,17 mm, respectivamente (p = 0,03). Vinte e oito casos (28%) tinham canal pterigoideo do tipo I, 48% e 24% canais pterigoideos de tipo II e III, respectivamente. Quatro pacientes (4%) tinham forame redondo do tipo I, 28% e 44% do tipo II-a e II-b, respectivamente, e 24% forame redondo do tipo III. A posição dos FR em relação à base da placa pterigoide lateral era em linha em 50% dos casos, medialmente posicionados em 47% e lateralmente posicionados em 3% dos casos. Conclusão: Os resultados deste estudo podem ser usados para promover uma melhor compreensão anatômica da área, necessária para cirurgias endoscópicas da base do crânio.

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Endoscopic repair of cerebrospinal fluid rhinorrhea

Abstract Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

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Resumo Introdução: A liquorreia nasal indica uma fístula liquórica (FL), uma comunicação aberta entre o líquido cerebrospinal intracraniano e a cavidade nasal. Pode ser traumática e espontânea. Objetivo: Avaliar o desfecho do reparo endoscópico da fístula liquórica nasal com o uso de fluoresceína. Método: Este estudo retrospectivo incluiu 30 pacientes de ambos os sexos, com idade média de 48,7 anos, tratados de 2007 a 2015. Todos os pacientes foram submetidos à administração lombar de solução de fluoresceína de sódio a 5% no pré-operatório. A fístula foi fechada com enxerto de três camadas e cola de fibrina. Resultados: As fístulas de líquido cerebrospinal foram comumente localizadas no seio etmoidal (37%) e esfenoidal (33%). A maioria dos pacientes apresentou fístulas liquóricas traumáticas (2/3). A taxa de sucesso relatada para a primeira tentativa de reparo foi de 97%. Complicações ocorreram em três pacientes: um apresentou hidrocefalia aguda; um, síndrome reversível de encefalopatia no quinto dia de pós-operatório com perda bilateral da visão; e um foi diagnosticado com hidrocefalia dois anos após o reparo de fístula liquórica. Conclusão: O diagnóstico endoscópico e o reparo de fístulas liquóricas nasais com uso de fluoresceína intratecal têm alta taxa de sucesso e baixo índice de complicações.

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Prophylactic treatment of vestibular migraine

Abstract Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

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Resumo Introdução: A migrânea vestibular (MV) é aceita atualmente como uma causa comum de vertigem episódica. O tratamento da MV envolve duas situações: as crises de sintomas vestibulares e o período intercrise. Para esse último, pode-se usar algum método de profilaxia. A recomendação atual é que se usem os mesmos medicamentos profiláticos usados para a enxaqueca, o que inclui os β-bloqueadores, antidepressivos e anticonvulsivantes. A recente definição diagnóstica da migrânea vestibular torna escasso o número de estudos sobre seu tratamento. Objetivo: Avaliar a eficácia do tratamento profilático usado em pacientes em um ambulatório de MV. Método: Revisão de prontuários de pacientes com MV pelos critérios da Bárány Society/International Headeache Society de 2012. Foram pesquisados os medicamentos usados e resposta ao tratamento obtida através da escala visual analógica (EVA) para tontura e cefaleia. Foram comparados os escores da EVA pré e pós-tratamento (a melhoria foi avaliada em conjunto e individualmente por droga usada). Também foram pesquisadas relações com subgrupos clínicos dos pacientes. Resultados: De 88 prontuários estudados, 47 foram elegíveis. Incluíram-se os pacientes que preenchiam os critérios diagnósticos para MV, foram excluídos os prontuários ilegíveis e aqueles de pacientes com outro distúrbio causador de tontura e/ou cefaleia que não preenchiam critérios de 2012 para MV. Apresentaram melhoria com a profilaxia 80,9% dos pacientes (p < 0,001). Amitriptilina, flunarizina, propranolol e topiramato apresentaram melhoria para sintomas vestibulares (p < 0,001) e para cefaleia (p < 0,015). Os quatro medicamentos foram eficazes de forma estatisticamente significante. Houve relação estatística positiva entre tempo de sintoma vestibular e melhoria clínica. Não houve benefício adicional para hipertensos que usaram anti-hipertensivos como profilaxia ou para os deprimidos que usaram antidepressivos em relação ao uso dos outros profiláticos. A associação de medicamentos não mostrou resultados estatisticamente significantes do uso de um medicamento isolado. Conclusões: Os medicamentos profiláticos usados para MV melhoram os sintomas dessa doença, porém não há diferença estatisticamente significante entre as respostas dos medicamentos profiláticos. O tempo de sintoma vestibular parece aumentar a melhoria obtida com o tratamento profilático.

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Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results

Abstract Introduction: Same-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. Objective: To evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. Methods: From February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5 cm × 1.5 cm cartilage seemed to be enough for tympanoplasty in both sides. Results: Nine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88 dB preoperatively to 9.16 dB postoperatively (p < 0.05). Conclusion: Bilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.

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Resumo Introdução: O fechamento no mesmo dia de perfuração bilateral da membrana timpânica é um procedimento rápido e mais confortável para os pacientes. Entretanto, a timpanoplastia ou miringoplastia convencional bilateral executada no mesmo procedimento tem sido raramente feita devido ao risco teórico de complicações pós-operatórias. Objetivo: Avaliar as vantagens e os resultados da timpanoplastia bilateral simultânea com cartilagem por via endoscópica em pacientes com perfuração bilateral da membrana timpânica. Método: De fevereiro de 2012 a março de 2013, pacientes com perfuração seca bilateral da membrana timpânica que tinham algum grau de perda de audição correspondente ao tamanho e à localização da perfuração foram incluídos no estudo. Não houve suspeita de cadeia ossicular interrompida, envolvimento do mastoide ou outra doença da orelha média ou interna. Timpanoplastia com cartilagem transcanal foi executada por via endoscópica com a técnica de underlay (medial). O enxerto foi colhido de cartilagem da concha superior (cymba) em apenas uma orelha com preservação do pericôndrio em um lado. Um enxerto de 1,5 × 1,5 centímetro de cartilagem pareceu ser o suficiente para a timpanoplastia em ambos os lados. Resultados: Nove pacientes (quatro homens e cinco mulheres) com média de 37,9 anos foram submetidos à timpanoplastia bilateral com cartilagem transcanal em uma cirurgia feita em etapa única. O tempo médio de acompanhamento foi de 15,8 meses. Não foram detectadas complicações, inclusive perda de audição, otorreia e complicações como bolsa de retração ou deslocamento de enxerto durante o período de seguimento. A taxa de sucesso do enxerto foi de 94,44% (apenas um caso de fechamento unilateral incompleto). A média do gap aéreo-ósseo em geral melhorou de 13,88 dB no pré-operatório para 9,16 dB no pós-operatório (p < 0,05). Conclusão: Timpanoplastia bilateral com cartilagem transcanal por via endoscópica pode ser considerada como um procedimento minimamente invasivo, seguro e que pode ser executado em uma única cirurgia. Isso reduz os custos e tempo de operação e é prático, com um baixo índice de complicações pós-operatórias.

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Rhinoseptoplasty in children

Abstract Introduction: Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later. Objective: To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation. Methods: Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M = 11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010. Results: Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%). Conclusion: Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.

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Resumo Introdução: Desvio do septo e/ou da pirâmide nasal em crianças, se não tratado, pode apresentar problemas estéticos ou funcionais após anos, devendo ser corrigido o quanto antes. Objetivo: Relatar experiência cirúrgica no tratamento de crianças com desvio de septo nasal e/ou pirâmide nasal. Método: Revisão de prontuários de 202 crianças, 124 (61,4%) do gênero masculino e 78 (38,6%) do feminino, entre quatro e 16 anos (M = 11 anos), submetidas a rino e/ou septoplastia de janeiro de 1994 a janeiro de 2010, no Serviço de Otorrinopediatria do Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. Resultados: Septoplastia feita em 157 casos (77,7%); rinosseptoplastia em 23 casos (11,4%) e rinoplastia em 22 casos (10,9%). Conclusão: Alterações nasais devem ser corrigidas em crianças, para proporcionar crescimento harmônico e evitar as graves sequelas encontradas no respirador bucal.

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Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis

Abstract Introduction: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.

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Resumo Introdução: Em adolescentes com rinite alérgica perene, a exposição à fumaça do cigarro de tabaco aumenta a contagem de eosinófilos na mucosa nasal. O recrutamento de eosinófilos surge da ação combinada de alguns sinais celulares e moleculares, inclusive a eotaxina. Objetivo: Avaliar o efeito da exposição à fumaça do cigarro de tabaco na contagem de células imunorreativas a eotaxina-1 e eosinófilos na mucosa nasal de crianças e adolescentes com rinite alérgica perene. Método: Em um estudo transversal, 44 pacientes foram avaliados (entre sete e 19 anos): 22 com e 22 sem exposição à fumaça do cigarro de tabaco. Depois de responder a dois questionários validados, sobre asma e alergias na infância e sobre a gravidade dos sintomas nasais, as amostras de mucosa nasal foram obtidas por meio de raspagem do terço médio das conchas inferiores. Em seguida, as contagens de células imunorreativas para eotaxina-1 e eosinófilos foram avaliadas por imuno-histoquímica. Resultados: Os pacientes com exposição à fumaça do cigarro de tabaco apresentaram contagens de células mais elevadas tanto para eotaxina-1 como para eosinófilos em comparação com os pacientes sem exposição à fumaça, sem correlação entre as duas variáveis. No entanto, ambas as contagens, de eotaxina-1 e eosinófilos foram relacionadas com a razão cotinina/creatinina. Conclusões: A exposição à fumaça do cigarro de tabaco pode aumentar a eotaxina-1 e a contagem de eosinófilos na mucosa nasal de pacientes jovens com rinite alérgica perene.

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Sulfated glycosaminoglycans in human vocal fold lamina propria

Abstract Introduction: The distribution, concentration and function of glycosaminoglycans in the various vocal fold tissues are still unclear. Objective: To evaluate the distribution and concentration of sulfated glycosaminoglycans in different layers of the human vocal fold according to gender and age. Methods: We used 11 vocal folds obtained from cadavers (7 men and 4 women) with no laryngeal lesion, less than 12 h after death, and aged between 35 and 98 years. The folds underwent glycosaminoglycans extraction from the cover and ligament, and post-electrophoresis analysis. Data were compared according to the layer, age and gender. Results: The concentration of dermatan sulfate was significantly higher in all layers. No differences were observed in the total concentrations of glycosaminoglycans in layers studied according to gender. It is significantly lower in the cover of individuals aged below 60 years. Conclusion: Dermatan sulfate, chondroitin sulfate, and heparan sulfate were observed in the human vocal folds cover and ligament of both genders, with the concentration of dermatan sulfate being significantly higher in all layers. Glycosaminoglycans concentration on the cover is significantly lower in individuals below 60 years compared with elderly.

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Resumo Introdução: A distribuição, concentração e função dos glicosaminoglicanos nos diversos tecidos da prega vocal ainda não está esclarecida. Objetivo: Avaliar a distribuição e concentração dos glicosaminoglicanos sulfatados nas diferentes camadas da prega vocal humana de acordo com o sexo e a idade. Método: Foram usadas 11 pregas vocais obtidas de cadáveres (sete homens e quatro mulheres) sem lesão de laringe, com menos de 12 horas de óbito e entre 35 e 98 anos. As pregas foram submetidas à extração de glicosaminoglicanos da cobertura e ligamento e leitura pós-eletroforese. Os dados foram comparados segundo camada, idade e sexo. Resultados: A concentração de dermatan sulfato foi significativamente maior em todas as camadas. Não foram observadas diferenças nas concentrações totais de glicosaminoglicanos nas camadas estudadas quanto ao gênero. É significantemente menor em indivíduos abaixo de 60 anos na cobertura. Conclusão: Dermatam sulfato, condroitim sulfato e heparam sulfato foram observados na cobertura e no ligamento de pregas vocais humanas, de ambos os sexos, sendo a concentração de dermatam sulfato foi significativamente maior em todas as camadas. A concentração de glicosaminoglicanos na cobertura é significativamente menor em indivíduos abaixo de 60 anos em comparação com idosos.

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Rhinitis as an associated factor for anxiety and depression amongst adults

Abstract Introduction: Anxiety and depression are frequent disorders of chronic diseases, yet there is no conclusive information to their association with rhinitis. Objective: The objective is to determine the frequency of anxiety and depression and its possible association to allergic rhinitis (AR) and non-allergic rhinitis (NAR). Methods: This is a cross-sectional study in which procured subjects with AR (n = 111), NAR (n = 34) and a control group (n = 96) from the university hospital. The presence of anxiety and depression was considered when it reached a score > 13 based on The Beck Anxiety Inventory Test and The Beck Depression Inventory II Test, respectively. The association between AR and NAR with anxiety and depression was adjusted with the Mantel-Haenszel Method and logistic regression. Results: The frequency for anxiety in AR, NAR and the control group was 45.9%, 52.9%, 10.4%, respectively (p < 0.001); depression frequency was 38.7%, 47.1%, 16.6% (p = 0.0003), respectively. Both AR and NAR were associated to anxiety and depression in women, but not to men. After adjusting the sex: AR was associated to anxiety (OR = 5.7, p < 0.001) and depression (OR = 2.5, p = 0.015), while NAR was also associated to anxiety (OR = 7.8, p < 0.001) and depression (OR = 3.3, p < 0.014). In multivariate analysis it was identified that AR, NAR and the individual's sex (women) were factors associated to anxiety and depression. Results showed that age was only associated to anxiety. Conclusion: AR and NAR are diseases associated to anxiety and depression, at least in women.

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Resumo Introdução: Ansiedade e depressão são distúrbios frequentes em doenças crônicas, embora não haja informação conclusiva sobre sua associação com a rinite alérgica. Objetivo: Determinar a frequência de ansiedade e depressão e sua possível associação a rinite alérgica (RA) e rinite não alérgica (NRA). Método: Estudo transversal, no qual indivíduos com RA (n = 111), NRA (n = 34) e um grupo controle (n = 96) foram recrutados a partir do hospital universitário. A presença de ansiedade e depressão foi considerada quando atingiu uma pontuação > 13 no Teste do Inventário de Ansiedade de Beck e no Teste II do Inventário de Depressão de Beck, respectivamente. A associação entre a RA e RNA com ansiedade e depressão foi ajustada com o Método de Mantel-Haenszel e regressão logística. Resultados: A frequência de ansiedade na RA, RNA e grupo controle foi de 45,9%, 52,9%, 10,4%, respectivamente (p < 0,001); a frequência de depressão foi de 38,7%, 47,1%, 16,6% (p = 0,0003), respectivamente. Tanto a RA como a RNA foram associadas a ansiedade e depressão em mulheres, mas não para os homens. Depois de ajustar o sexo: RA foi associada à ansiedade (OR = 5,7, p < 0,001) e depressão (OR = 2,5, p = 0,015), enquanto a RNA foi associada a ansiedade (OR = 7,8, p < 0,001) e depressão (OR = 3,3, p < 0,014). Na análise multivariada identificou-se que a RA, RNA e o sexo do indivíduo (mulheres) foram fatores associados a ansiedade e depressão. Os resultados mostraram que a idade só foi associada à ansiedade. Conclusão: RA e RNA são doenças associadas a ansiedade e depressão, pelo menos em mulheres.

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The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure

Abstract Introduction: Obstructive sleep apnea syndrome is currently a public health problem of great importance. When misdiagnosed or improperly treated, it can lead to serious consequences on patients' quality of life. The gold standard treatment for cases of obstructive sleep apnea syndrome, especially in mild to severe and symptomatic cases, is continuous positive airway pressure therapy. Compliance with continuous positive airway pressure therapy is directly dependent on the active participation of the patient, which can be influenced by several factors. Objective: The objective of this study is to describe the factors related to compliance with continuous positive airway pressure therapy, and to analyze which associated factors directly influence the efficiency of the treatment. Methods: Patients who received continuous positive airway pressure therapy through the Municipal Health Department of the city of Ribeirão Preto were recruited. A structured questionnaire was administered to the patients. Compliance with continuous positive airway pressure therapy was assessed by average hours of continuous positive airway pressure therapy usage per night. Patients with good compliance (patients using continuous positive airway pressure therapy ≥4 h/night) were compared to those with poor compliance (patients using <4 h/night). Results: 138 patients were analyzed: 77 (55.8%) were considered compliant while 61 (44.2%) were non-compliant. The comparison between the two groups showed that regular monitoring by a specialist considerably improved compliance with continuous positive airway pressure therapy (odds ratio, OR = 2.62). Conclusion: Compliance with continuous positive airway pressure therapy is related to educational components, which can be enhanced with continuous and individualized care to patients with obstructive sleep apnea syndrome.

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Resumo Introdução: Síndrome da apneia obstrutiva do sono (SAOS) é, atualmente, um problema de saúde pública de suma importância. Quando mal diagnosticada ou tratada inadequadamente, pode levar a sérias consequências na qualidade de vida do paciente. O tratamento padrão-ouro para casos de SAOS, principalmente nos casos moderados a grave e sintomáticos, é o CPAP (Continuous Positive Airway Pressure). A adesão ao CPAP depende diretamente da participação ativa do paciente, que pode ser influenciada por vários fatores. Objetivo: O objetivo deste estudo é descrever os fatores relacionados à adesão ao CPAP e analisar quais fatores associados influenciam diretamente na eficiência do tratamento. Método: Foram recrutados pacientes que receberam CPAP pela Secretaria Municipal de Saúde de Ribeirão Preto. Um questionário estruturado foi aplicado ao paciente. A adesão ao CPAP foi avaliada pela média de horas de uso do CPAP por noite. Pacientes com boa adesão (pacientes em uso de CPAP ≥4 horas/noite) foram comparados aos com má adesão (pacientes em uso < 4 horas/noite). Resultados: No estudo, 138 pacientes foram analisados: 77 (55,8%) foram considerados aderentes e 61 (44,2%) foram não aderentes. A comparação entre os dois grupos demonstrou que o seguimento regular com especialista melhorou consideravelmente a adesão ao CPAP (odds ratio, OR = 2,62). Conclusão: A adesão ao CPAP está relacionada a componentes educacionais, que podem ser aprimorados com assistência contínua e individualizada ao paciente com SAOS.

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Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system

Abstract Introduction: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. Objective: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. Methods: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). Results: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). Conclusion: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.

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Resumo Introdução: O conhecimento do local da obstrução e do padrão de colapso das vias respiratórias é essencial para determinar o tratamento cirúrgico e clínico corretos de pacientes com Síndrome de Apneia Obstrutiva do Sono (SAOS). Para este fim, vários testes e procedimentos de diagnóstico foram desenvolvidos. Objetivo: Determinar se a Endoscopia de Sono Induzido por Fármacos (DISE) ou Manobra de Müller (MM) seria mais bem-sucedida na identificação do local de obstrução e do padrão de colapso das vias respiratórias superiores em pacientes com SAOS. Método: O estudo incluiu 63 pacientes (52 do sexo masculino e 11 do sexo feminino) que foram diagnosticados com SAOS em nossa clínica. As idades variaram de 30 a 66 anos e a idade média foi de 48,5 anos. Todos os pacientes foram submetidos a DISE e MM e os resultados destes exames foram caracterizados de acordo com a região/grau de obstrução, bem como a classificação VOTE. Os resultados de cada teste foram analisados de acordo com o nível das vias respiratórias superiores e comparados por análise estatística (teste estatístico kappa de Cohen). Resultados: Houve concordância estatisticamente significativa entre os resultados da DISE e MM para os procedimentos que envolvem configuração anteroposterior (73%), lateral (92,1%) e concêntrica (74,6%) do véu palatino. Os resultados da parte lateral da orofaringe também estavam em concordância entre os testes (58,7%). Os resultados da configuração lateral da epiglote estavam em concordância entre os testes (87,3%). Não houve concordância estatisticamente significativa entre os dois exames para os procedimentos que envolvem a parte anteroposterior da língua (23,8%) e epiglote (42,9%). Conclusão: Sugere-se que a DISE apresenta várias vantagens, como segurança, facilidade de uso e confiabilidade, que superam a MM em termos da capacidade de diagnosticar locais de obstrução e o padrão de colapso da via respiratória superior. O MM pode também fornecer algum conhecimento sobre o padrão de colapso da faringe. Além disso, recomendamos o uso da classificação VOTE em combinação com DISE.

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The place of hyperbaric oxygen therapy and ozone therapy in sudden hearing loss

Abstract Introduction: It is difficult to evaluate the effect of drugs clinically used for idiopathic sudden sensorineural hearing loss, mainly because its underlying mechanism remains unknown. Objective: This study assessed the efficacy of hyperbaric oxygen therapy or ozone therapy in the treatment of idiopathic sudden sensorineural hearing loss, when either therapy was included with steroid treatment. Methods: A retrospective analysis examined 106 patients with idiopathic sudden sensorineural hearing loss seen between January 2010 and June 2012. Those with an identified etiology were excluded. The patients were divided into three treatment groups: oral steroid only (n = 65), oral steroid + hyperbaric oxygen (n = 26), and oral steroid + ozone (n = 17). Treatment success was assessed using Siegel criteria and mean gains using pre- and post-treatment audiograms. Results: The highest response rate to treatment was observed in the oral steroid + ozone therapy group (82.4%), followed by the oral steroid + hyperbaric oxygen (61.5%), and oral steroid groups (50.8%). There were no significant differences in the response to treatment between the oral steroid and oral steroid + hyperbaric oxygen groups (p < 0.355). The oral steroid + ozone group showed a significantly higher response rate to treatment than the oral steroid group (p = 0.019). There were no significant differences between the oral steroid + hyperbaric oxygen and oral steroid + ozone groups (p = 0.146). Conclusion: The efficiency of steroid treatment in patients with severe hearing loss was low. It was statistically ascertained that adding hyperbaric oxygen or ozone therapy to the treatment contributed significantly to treatment success.

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Resumo Introdução: É difícil avaliar o efeito dos fármacos clinicamente usados na surdez súbita idiopática, principalmente porque o seu mecanismo subjacente se mantém desconhecido. Objetivo: Avaliar a eficácia da oxigenoterapia hiperbárica ou ozonioterapia no tratamento de surdez súbita, quando uma ou outra terapia é incluída no tratamento com esteroides. Método: Uma análise retrospectiva examinou 106 pacientes com surdez súbita atendidos entre janeiro de 2010 e junho de 2012. Aqueles com uma etiologia identificada foram excluídos. Os pacientes foram divididos em três grupos de tratamento: apenas esteroide oral (n = 65), esteroide por via oral + oxigenoterapia hiperbárica (n = 26) e esteroides por via oral + ozônio (n = 17). O sucesso do tratamento foi avaliado com critérios de Siegel e os ganhos médios com audiogramas pré e pós-tratamento. Resultados: A taxa de resposta mais elevada para o tratamento foi observada no grupo de esteroide + ozonioterapia (82,4%), seguida por grupos de esteroide oral + oxigenoterapia hiperbárica (61,5%) e esteroide oral (50,8%). Não houve diferenças significantes na resposta ao tratamento entre os grupos de esteroide oral e esteroides + oxigenoterapia hiperbárica (p < 0,355). O grupo de esteroide oral + ozônio apresentou uma taxa de resposta significantemente mais elevada ao tratamento do que o grupo de esteroide oral (p = 0,019). Não houve diferenças significantes entre os grupos de esteroide oral + oxigenoterapia hiperbárica e esteroide oral + ozônio (p = 0,146). Conclusão: A eficiência do tratamento com esteroides em pacientes com perda auditiva grave foi baixa. Verificou-se estatisticamente que a adição de oxigenoterapia hiperbárica ou ozonioterapia ao tratamento contribuiu significantemente para o sucesso do tratamento.

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Hearing thresholds at high frequency in patients with cystic fibrosis: a systematic review

Abstract Introduction: High-frequency audiometry may contribute to the early detection of hearing loss caused by ototoxic medications. Many ototoxic drugs are widely used in the treatment of patients with cystic fibrosis. Early detection of hearing loss should allow known harmful drugs to be identified before the damage affects speech frequencies. The damage caused by ototoxicity is irreversible, resulting in important social and psychological consequences. In children, hearing loss, even when restricted to high frequencies, can affect the development of language. Objective: To investigate the efficacy and effectiveness of hearing monitoring through high-frequency audiometry in pediatric patients with cystic fibrosis. Methods: Electronic databases PubMed, MedLine, Web of Science and LILACS were searched, from January to November 2015. The selected studies included those in which high-frequency audiometry was performed in patients with cystic fibrosis, undergoing treatment with ototoxic drugs and published in Portuguese, English and Spanish. The GRADE system was chosen for the evaluation of the methodological quality of the articles. Results: During the search process carried out from January 2015 to November 2015, 512 publications were identified, of which 250 were found in PubMed, 118 in MedLine, 142 in Web of Science and 2 in LILACS. Of these, nine articles were selected. Conclusion: The incidence of hearing loss was identified at high frequencies in cystic fibrosis patients without hearing complaints. It is assumed that high-frequency audiometry can be an early diagnostic method to be recommended for hearing investigation of patients at risk of ototoxicity.

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Resumo Introdução: A audiometria de altas frequências pode contribuir para a detecção precoce de alterações auditivas causadas por medicações ototóxicas. No tratamento dos pacientes com fibrose cística, existem muitos fármacos ototóxicos amplamente utilizados. A detecção precoce de alterações auditivas deve permitir que sejam identificadas antes que o dano atinja as frequências da fala. A lesão causada pela ototoxicidade é irreversível, traz importantes consequências sociais e psicológicas. Nas crianças, a perda auditiva, mesmo restrita às altas frequências, pode afetar o desenvolvimento da linguagem. Objetivo: Investigar a eficácia e a efetividade do monitoramento da audição por meio da audiometria de altas frequências em pacientes pediátricos com fibrose cística. Método: Foram consultadas as bases de dados eletrônicas PubMed, Medline, Web of Science e Lilacs, de janeiro a novembro de 2015. Foram selecionados os estudos em que foi feita audiometria de altas frequências em pacientes com fibrose cística em tratamento com medicamentos ototóxicos e publicados em português, inglês e espanhol. Para a avaliação da qualidade metodológica dos artigos optou-se pelo uso do sistema Grade. Resultados: No processo de busca feito de janeiro de 2015 a novembro de 2015 foram encontradas 512 publicações, 250 na PubMed, 118 na Medline, 142 na Web of Science e dois na Lilacs. Desses, foram selecionados nove artigos. Conclusão: Identificou-se a ocorrência de perda auditiva em altas frequências em pacientes com fibrose cística sem queixas auditivas. Admite-se que audiometria em altas frequências possa ser um método de diagnóstico precoce a ser recomendado para investigação auditiva de pacientes em risco de ototoxicidade.

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