Digital Workflow for Computer-guided Implant Surgery in Edentulous Patients: A Case Report

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ji-Hyeon Oh, Xueyin An, Seung-Mi Jeong, Byung-Ho Choi
The purpose of this article was to describe a fully digital workflow used to perform computer-guided flapless implant placement in an edentulous patient without the use of conventional impressions, models or a radiographic guide. Digital data for the workflow were acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The image fusion of the intraoral scan data and the CBCT data was performed by matching resin markers placed in the patient's mouth. The definitive digital data were then used to design a prosthetically-driven implant position, surgical template, and computer-aided design/computer-aided manufacturing (CAD/CAM) fabricated fixed dental prosthesis. We believe this is the first published case describing such a technique in computer-guided flapless implant surgery for edentulous patients.



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Benchmarking: an effective tool to demystify the academic career

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gino Inverso, John R. Zuniga, Neeraj H. Panchal




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Does dexamethasone facilitate neurosensory function regeneration after zygomatic fracture? A randomized and controlled trial

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Aleksi Haapanen, Hanna Thorén, Satu Apajalahti, Anna Liisa Suominen, Johanna Snäll
PurposeThis study sought to clarify the rate of neurosensory disturbance (NSD) after zygomatic complex (ZC) fractures in general, and the effect of perioperatively administered dexamethasone on neurosensory recovery.MethodsThis was a single-blinded randomized study aiming to clarify the benefits of perioperative dexamethasone after surgery. The patients were randomly assigned to receive either dexamethasone (up to a total dose of 10 mg or 30 mg) or to act as a control (no glucocorticoid treatment). The outcome variable was NSD, the presence of which was established when patients experienced any sensory disturbance of the infraorbital nerve. Other predictor variables included in the analysis were age, gender, timespan from accident to surgery, surgical approach to the fracture line, and the relation of the fracture to the infraorbital foramen. The statistical significance of associations was evaluated with chi-squared tests.Results64 patients were included in the analyses. Of the patients in the dexamethasone group (either 10 mg or 30 mg), 58.3% had NSD six months post-operatively, whereas in the control group 66.7% of the patients suffered from NSD. This finding was not statistically significant (p=0.565). At the one-month interval, the patients without a fracture through the infraorbital foramen (IOF) had less NSD (p=0.009); this finding was not significant at three and six months postoperatively. Age, gender, injury mechanism, surgical approach, or timespan from accident to surgery were not significant predictors for NSD. In total, 64.4% of the patients still suffered from NSD at six months post operatively.ConclusionThis study showed no benefits of short-term high-dose dexamethasone administration in the neurosensory recovery of patients with ZC fractures. The type of primary trauma is the main cause for NSD, but the precise predictors remain unknown.



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Surgical staples:-A superior alternative to sutures for skin closure after neck dissection:-A single-blindprospective randomized clinical study

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shrenik Oswal, Rajiv Borle, Nitin Bhola, Anendd Jadhav, Sanidhya Surana, Rajesh Oswal
PurposeTo evaluate the efficacy of staples in skin closure following neck dissection in patients with oral squamous cell carcinoma. We hypothesize that use of staples results in better wound closure, when compared with non-absorbable monofilament sutures.MethodsA prospective single blind, randomized clinical trial was performed to compare various parameters including time taken, inflammatory changes, pain, cost efficacy, complications and esthetic outcome of skin closure with surgical staples and non-absorbable monofilament sutures and to determine its statistical significance using chi- square and Mann Whitney U tests.ResultIn a study of 124 patients the mean skin closure time was 29.2+4 mins with sutures (n=61) and 5.3 + 1.29 mins with staples (n=63), which was significant (p=.01).The mean pain scores during removal using visual analogue scale (VAS) were 5.08+1.29 and 3.15+ 0.89 with sutures and staples, respectively. Post-operative complications, like gaping and stitch abscess with purulent discharge, were noted.ConclusionStaples provided better esthetics with fewer complications, faster closure, minimal pain on removal and faster healing when compared to sutures. The slowest closure time in staples group was four times faster than the fastest closure time in sutures group. However, staples cost five times more than sutures.



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Initial manifestation of acquired hemophilia A (AHA) after a routine tooth extraction. A case report and literature review

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicholas A. Bennetts, James E. Mergelmeyer, Eric J. Reimer, James C. Melville
Although surgical treatment of patients on anticoagulation regimens is a common practice among oral and maxillofacial surgeons, unexpected and unknown coagulopathies can have devastating and catastrophic consequences for the most routine of procedures. Acquired hemophila A (AHA) is an extremely rare life-threatening bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. The effects of acquired hemophilia A can produce catastrophic bleeding and hematomas. The effect of this uncontrolled hemorrhage post dental-alveolar surgery can mimic severe head and neck infection by causing dysphagia, odynophagia, and acute airway complications. This report describes the case of a 64 year old female who was diagnosed with acquired hemophilia A (AHA) after a routine extraction of tooth #17.



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TheCervicofacialFlapinCheekReconstruction:aGuideforFlapDesign

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): AlHaitham AlShetawi, Anastasiya Quimby, Rui Fernandes
PurposeThecervicofacial(CF)flapisarandompatternflapthatprovidesexcellentmatchforcheekreconstruction.ThedesignoftheCFflapvariesbetweendifferentcheeksubunits.Inthisstudy,wereviewourexperiencewiththisflapandpresentaguideforflapdesignfordifferentcheeksubunits.MaterialsandMethodsPatientswhohadcheekreconstructionwerescreenedusingthedatabaseofthesurgicalproceduresbetween2011-2016.74patientswereidentified.Dataregardingpatientdemographics,diagnosis,defecttypeandoutcomewereretrospectivelyreviewed.Patientswhodidnothavecleardescriptionofthedefectand/orflapdesignwereexcludedfromthestudy.Wedividedthecheekintothreezonesandcreatedaguideforflapdesignforeachzone.Results28patientswithCFflapforcheekreconstructionmettheinclusioncriteria(21males[75%]and7females[25%];meanage57[range8-88years]).57%hadzoneAdefect,18%hadzoneB1defect,14%hadzoneB2defect,and11%hadmultiplezones.Themeanfollow-upwas4.6months(0-17months).93%hadsuccessfuloutcome.Only2patientsexperiencedwoundcomplications.ConclusionTheCFflapisaversatileflapthatprovidesexcellentskincolor,thicknessandtexturematchincheekreconstruction.Planningtheflapdesignisessentialtoachieveagoodoutcome.OuralgorithmprovidesastraightforwardmethodtoreliablydesigntheCFflapforcheekreconstruction.



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A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: Is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx?

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nawaf Aslam-Pervez, Steven J. Caldroney, Amal Isaiah, Joshua E. Lubek
PurposeThe submental artery island pedicled flap (SMIF) is an underutilized alternative for reconstruction of head and neck defects following tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients reconstructed with a SMIF versus those reconstructed using the forearm free flap (FFF).MethodRetrospective cohort study of all patients with oral cavity/oropharyngeal defects reconstructed with a SMIF versus a cohort of FFF patients with similar volume defects were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by ANOVA and Fisher's exact test.ResultsAverage age was 61.8 years (SMIF) vs. 57.9 years (FFF). Most common defect was located in tongue with squamous cell carcinoma the most common pathology identified. Flap volumes were similar 38.79 (SMIF) vs. 39.77 mL (FFF). Significant comparative outcomes identified with SMIF reconstruction vs. FFF included; shorter anesthesia times (815 vs. 1209 min; P < 0.001), operative times (653 vs. 1031 min; P < 0.001) and blood loss (223 vs. 398 mL; P= 0.04). Post-operative ECOG performance score increased greater for FFF than for SMIF (+0.33 vs. +1.25; P=0.0019). Recipient site complication rates were lower for the FFF (0.17/patient vs. 0.42/patient), but were not statistically significant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5 months.ConclusionsThis is the first study to compare the submental artery island flap versus the forearm free flap for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option as compared to the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay and donor site morbidity.



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Hidden Markov Modeling of Frequency-Following Responses to Mandarin Lexical Tones

Publication date: Available online 12 August 2017
Source:Journal of Neuroscience Methods
Author(s): Fernando Llanos, Zilong Xie, Bharath Chandrasekaran
BackgroundThe frequency-following response (FFR) is a scalp-recorded electrophysiological potential reflecting phase-locked activity from neural ensembles in the auditory system. The FFR is often used to assess the robustness of subcortical pitch processing. Due to low signal-to-noise ratio at the single-trial level, FFRs are typically averaged across thousands of stimulus repetitions. Prior work using this approach has shown that subcortical encoding of linguistically-relevant pitch patterns is modulated by long-term language experience.New methodWe examine the extent to which a machine learning approach using hidden Markov modeling (HMM) can be utilized to decode Mandarin tone-categories from scalp-record electrophysiolgical activity. We then assess the extent to which the HMM can capture biologically-relevant effects (language experience-driven plasticity). To this end, we recorded FFRs to four Mandarin tones from 14 adult native speakers of Chinese and 14 of native English. We trained a HMM to decode tone categories from the FFRs with varying size of averages.Results and comparisons with existingmethods Tone categories were decoded with above-chance accuracies using HMM. The HMM derived metric (decoding accuracy) revealed a robust effect of language experience, such that FFRs from native Chinese speakers yielded greater accuracies than native English speakers. Critically, the language experience-driven plasticity was captured with average sizes significantly smaller than those used in the extant literature.ConclusionsOur results demonstrate the feasibility of HMM in assessing the robustness of neural pitch. Machine-learning approaches can complement extant analytical methods that capture auditory function and could reduce the number of trials needed to capture biological phenomena.



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Widespread functional opsin transduction in the rat cortex via convection-enhanced delivery optimized for horizontal spread

Publication date: Available online 12 August 2017
Source:Journal of Neuroscience Methods
Author(s): Zeyang Yu, Arto Nurmikko, Ilker Ozden
BackgroundWidespread opsin expression in the cortex of rats, where transgenic models have not been established, is not practical to achieve with the traditional diffusion-based virus transduction methods (DBD).New MethodWe developed protocols for convection-enhanced delivery (CED) of virus for optogenetic transduction of the rat cortex. Targeting the motor forelimb area as an example, we performed dual-site CED (6 μL of virus per site, 3 mm pitch between sites) in the rat motor cortex.ResultsWe identified injection parameters optimized for horizontal spread of infusate in the agarose gel model and then demonstrated in vivo widespread opsin expression over the cortical area (7.4±1.0mm in the AP direction, 4.4±1.1mm in the ML direction, N=13 rats) using CED. The optogenetic transduction was also functionally robust, in which both optical modulation of neuronal activity and elicitation of overt motor responses was reliably observed.Comparison with Existing Method(s)CED led to about 24-fold increase in the volume of opsin expression, compared with the conventional DBD method. The total injection time was also reduced by at least 10 times, if similar extent of expression were to be achieved with the conventional DBD method.ConclusionsCED is a reliable and effective method of virus delivery for optogenetic transduction of planar superficial structures, such as the cortex in rats.



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Comparing brain graphs in which nodes are regions of interest or independent components: a simulation study

Publication date: Available online 12 August 2017
Source:Journal of Neuroscience Methods
Author(s): Qingbao Yu, Yuhui Du, Jiayu Chen, Hao He, Jing Sui, Godfrey Pearlson, Vince D. Calhoun
BACKGROUNDA key challenge in building a brain graph using fMRI data is how to define the nodes. Spatial brain components estimated by independent components analysis (ICA) and regions of interest (ROIs) determined by brain atlas are two popular methods to define nodes in brain graphs. It is difficult to evaluate which method is better in real fMRI data.NEW METHODHere we perform a simulation study and evaluate the accuracies of a few graph metrics in graphs with nodes of ICA components, ROIs, or modified ROIs in four simulation scenarios.RESULTSGraph measures with ICA nodes are more accurate than graphs with ROI nodes in all cases. Graph measures with modified ROI nodes are modulated by artifacts. The correlations of graph metrics across subjects between graphs with ICA nodes and ground truth are higher than the correlations between graphs with ROI nodes and ground truth in scenarios with large overlapped spatial sources. Moreover, moving the location of ROIs would largely decrease the correlations in all scenarios.COMPARISON WITH EXISTING METHOD (S)Evaluating graphs with different nodes is promising in simulated data rather than real data because different scenarios can be simulated and measures of different graphs can be compared with a known ground truth.CONCLUSIONSince ROIs defined using brain atlas may not correspond well to real functional boundaries, overall findings of this work suggest that it is more appropriate to define nodes using data-driven ICA methods: than ROI approaches in real fMRI data.



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Editorial Board/Reviewing Committee

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Sleep Location and Parent-Perceived Sleep Outcomes in Older Infants

Initial studies indicate more independent and consolidated sleep in infants in the first few months who sleep separately. Little is known, however, about the relationship of sleep location (separate room, room-sharing, bed-sharing) with sleep outcomes in older infants (ages 6 to 12 months). It was expected that those who sleep in a separate room would have better parent-perceived sleep outcomes and more positive sleep health behaviors.

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Preoperative Signs and Symptoms as Prognostic Markers in Nasal Septoplasty

Identification of preoperative signs and symptoms that may predict the outcome of surgery is important, for both patient selection and the development of interventions for improving outcomes. The purpose of this study was to assess the value of some selected preoperative signs and symptoms for predicting outcomes of nasal septoplasty. Patients undergoing septoplasty with or without turbinoplasty responded to the Nasal Surgical Questionnaire (NSQ) preoperatively and six months postoperatively. The questionnaire contains visual analogue scales (VAS) for nasal obstruction during the day and at night. We compared preoperative and postoperative VAS scores in patients with unilateral versus bilateral septal deviation and patients with low versus high preoperative scores. Of 446 patients undergoing septoplasty from September 2014 to December 2015 who had responded to the preoperative NSQ, 286 (64.1%) also returned the postoperative version. There was greater improvement in obstruction in patients with preoperative unilateral compared to bilateral septal deviation (day scores, ). The grade of deviation and the presence of concomitant bony conchal hypertrophy did not influence results. Patients with lower preoperative VAS scores obtained better end results than those with higher scores (). Type of septal deviation and preoperative VAS scores may aid in predicting outcome of nasal surgery.

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Malignant transformation of oral leukoplakia in a patient with dyskeratosis congenita

Publication date: Available online 12 August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michelle Bongiorno, Shayna Rivard, Daniel Hammer, Joshua Kentosh
Dyskeratosis congenita (DC) is a rare, inherited, bone marrow failure syndrome caused by premature telomere shortening. The classic mucocutaneous triad of clinical features is reticulated skin pigmentation, nail dysplasia, and oral leukoplakia. Multiple somatic features are also common including bone marrow failure, pulmonary fibrosis, and liver disease. DC significantly increases the risk for malignant transformation, including myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), head and neck squamous cell carcinoma (HNSCC), and anogenital cancer. This case describes a 23 year old female with malignant transformation of oral leukoplakia to squamous cell carcinoma (SCC) demonstrated in a series of biopsies of the same site. Increased surveillance, proper biopsy technique, and a multi-disciplinary approach are critical in DC patients to ensure rapid diagnosis and treatment.



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Comparaison des effets des corticostéroïdes par voie nasale et du montélukast sur les fonctions olfactives chez les patients atteints de rhinite allergique

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Dalgic, M.E. Dinc, S. Ulusoy, D. Dizdar, A. Is, M. Topak
ObjectifLe dysfonctionnement olfactif est l'une des comorbidités associées à la rhinite allergique (RA) et celle-ci est l'une des causes les plus fréquentes de troubles olfactifs. Notre objectif était d'évaluer les effets des corticostéroïdes par voie nasale et des antagonistes des leucotriènes utilisés dans la rhinite allergique, sur les fonctions olfactives à l'aide du test Sniffin' Sticks.MéthodesTrente patients atteints de rhinite saisonnière ont été inclus dans cette étude. Les patients ont été randomisés en trois groupes de 10 patients ; le groupe 1 a été traité par montélukast sodique et furoate de mométasone, le groupe 2 a été traité uniquement par montélukast, et le groupe 3 uniquement par furoate de mométasone. Les fonctions olfactives des patients ont été déterminées à l'aide du test olfactif Sniffin' Sticks avant et après un mois de traitement.RésultatsLes valeurs de seuil, de discrimination, d'identification et de TDI (somme du seuil, de la discrimination et de l'identification) n'étaient pas significativement différentes entre les groupes avant le traitement. Pour les patients du groupe 1 et du groupe 3, des différences statistiquement significatives ont été observées en termes de valeurs de seuil, de discrimination, d'identification et de TDI avant et après le traitement (p<0,05) (test des rangs signés de Wilcoxon). Pour les patients du groupe 2, aucune différence significative n'a été observée concernant les valeurs de seuil, de discrimination, d'identification et de TDI avant et après le traitement (p>0,05).ConclusionLes résultats de notre étude montrent que le furoate de mométasone (FM) est plus efficace que le montélukast en terme d'amélioration de la fonction olfactive. Bien que le montélukast se soit avéré efficace pour traiter les symptômes de RA, son effet sur la fonction olfactive n'a pas été démontré dans cette étude.



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La chondroplastie par injection : remodelage enzymatique des greffes de cartilage

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J.R. Gandy, A. Foulad, K.K. Chao, B.J.F. Wong
ObjectifDévelopper une technique d'injection d'enzymes assouplissant sélectivement le tissu cartilagineux pour le remodelage des structures cartilagineuses de la tête et du cou.Matériel et méthodesÀ partir d'oreilles de lapin, deux groupes ont été formés : (1) le groupe « oreille de lapin entière » et (2) le groupe « greffon composite » (échantillons de 2,5mm×3,0cm prélevés dans la région centrale du pavillon). Des injections séquentielles sous-périchondrales utilisant trois enzymes (hyaluronidase, pronase et collagénase de type II) ont été réalisées sur les échantillons de chaque groupe. Dans les échantillons témoins, une solution saline tamponnée au phosphate a été injectée de la même façon. Les oreilles entières ont ensuite été photographiées, maintenues en position anatomique verticale, pour évaluer leur déformation lors d'une compression afin de juger de l'intégrité du cartilage. De plus, une photographie à contre-jour a été réalisée pour tous les échantillons afin d'évaluer davantage les effets des enzymes, de manière à ce qu'une zone d'intensité lumineuse plus forte représente une augmentation du remodelage cartilagineux.RésultatsL'application des enzymes digestives a entraîné une réduction marquée de la résistance de la matrice des tissus cartilagineux, tout en préservant les couches superficielles sus-jacentes. Les pavillons entiers traités par les enzymes ont été remodelés au niveau du site d'injection des enzymes. Les images à contre-jour ont révélé une augmentation de l'intensité lumineuse locale dans les zones de digestion enzymatique. Il n'y a pas eu de destruction évidente de la peau sus-jacente lors de l'inspection visuelle.ConclusionCette étude démontre la faisabilité de la chondroplastie par injection comme une potentielle méthode alternative à la chirurgie conventionnelle pour le remodelage du cartilage auriculaire. Les injections séquentielles de hyaluronidase, de pronase et de collagénase de type II dans l'espace sous-périchondral peuvent être réalisées pour remodeler et assouplir les structures cartilagineuses avec une atteinte minimale des tissus environnants. Les études futures devront inclure des tests de viabilité des chondrocytes et l'optimisation des techniques d'injection.



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Images et comptes cellulaires de cochlées intactes et transparentes de gerbille de Mongolie par microscopie confocale à balayage laser

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Risoud, J. Sircoglou, G. Dedieu, M. Tardivel, C. Vincent, N.-X. Bonne
ObjectifsRéaliser le protocole de clarification sur des cochlées de gerbilles de Mongolie et évaluer la possibilité de quantifier et d'analyser la cytoarchitecture tri-dimensionelle (3D) de ces cochlées transparisées.Matériels et méthodesLes oreilles internes fraîchement disséquées étaient préparées suivant un protocole de 13jours : fixation, microdissection, post-fixation, décalcification, pré-traitement (amplification du signal, perméabilisation et blocage), marquage fluorescent (immunomarquage indirect et marquage direct), déshydratation, transparisation en solution de Spalteholz (méthyl salicylate et benzoate de benzyl [MSBB]) et montage. L'acquisition des images était réalisée par microscopie confocale à balayage laser. Le logiciel ImageJ était utilisé pour mesurer la longueur analysée de l'organe de Corti analysée et compter les cellules ciliées internes et externes.RésultatsQuatre cochlées ont été imagées. Les reconstructions 3D permettaient l'analyse de grandes longueurs d'organes de Corti. La longueur moyenne d'organe de Corti analysée était de 1269 (±346) μm. Le nombre moyen de cellules ciliées par longueur d'organe de Corti était : 142 (±44) cellules ciliées internes et 400 (±122) cellules ciliées externes.ConclusionLa transparisation cochléaire par le MSBB peut être réalisée chez la gerbille de Mongolie, permettant d'obtenir des images en haute résolution d'oreilles internes marquées en immunofluorescence. Ceci constitue, à notre connaissance, la première application de cette technique dans cette espèce. Elle permet ainsi des comptes cellulaires, sans dissection traumatique, sur de grandes longueurs d'organe de Corti.



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Lobectomie thyroïdienne en ambulatoire ? Analyse rétrospective de faisabilité

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H. Yakhlef, Y. Marboeuf, A. Piquard, O. Saint Marc
ButsLa prise en charge en ambulatoire constitue un enjeu majeur de la politique de santé publique. La réalisation des thyroïdectomies totales en ambulatoire reste discutée, mais qu'en est-il pour les hémi-thyroïdectomies ? Le but de notre étude est d'évaluer notre expérience concernant la prise en charge ambulatoire des hémi-thyroïdectomies.Matériels et méthodesIl s'agit d'une étude analytique rétrospective multicentrique, réalisée sur deux centres hospitaliers entre le premier janvier 2009 et le 31 décembre 2013. La prise en charge ambulatoire des hémi-thyroïdectomies n'était pas permise si : le score ASA était supérieur à 2, le patient était sous anticoagulant, le risque de totalisation était présent et en cas d'association d'un autre acte chirurgical nécessitant une surveillance>12h. Les critères suivants ont été recensés : âge, poids, sexe, complications postopératoires, taux d'admission et d'hospitalisation non programmés.ObjectifsAnalyser le taux de reprise pour hématome ainsi que le taux d'admission et d'hospitalisation non programmés.RésultatsSur 294 hémi-thyroïdectomies réalisées durant cette période, 130 l'ont été en ambulatoire (soit environ 44 %). Nous n'avons pas retrouvé d'obstacle médical à la prise en charge ambulatoire chez environ 64 % des patients pris en charge en hospitalisation conventionnelle. L'âge moyen en ambulatoire était de 44 ans. Huit totalisations ont été réalisées en ambulatoire. Seuls 2 patients initialement prévus en ambulatoire ont finalement passé une nuit d'hospitalisation pour surveillance, sans aucune reprise. Tous les patients étaient satisfaits voire très satisfaits de la prise en charge ambulatoire.ConclusionDans notre pratique, la réalisation d'une hémi-thyroïdectomies en ambulatoire est une procédure fiable et sûre.



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Dysplasie fibreuse osseuse cranio-faciale : à propos de 10 cas

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Couturier, O. Aumaître, L. Gilain, B. Jean, T. Mom, M. André
ObjectifsLa dysplasie fibreuse osseuse (DFO) est une maladie osseuse bénigne, congénitale, sporadique et rare dans laquelle l'os est remplacé par du tissu fibro-osseux renfermant une ostéogenèse immature. Une évolution sarcomateuse est exceptionnelle. Les lésions sont soit uniques (forme monostotique), soit multiples (forme polyostotique). La DFO peut être associée à une hyperpigmentation maculaire cutanée et à une endocrinopathie dans le cadre du syndrome de McCune-Albright ou à des myxomes dans le syndrome de Mazabraud.MéthodesNous rapportons dix observations de patients suivis pour une DFO cranio-faciale dans notre centre entre 2010 et 2015.RésultatsL'âge moyen était de 43 ans (10–72 ans). Les symptômes cliniques étaient des céphalées (n=3), et des troubles neurosensoriels (uvéite antérieure à répétition [n=1], une baisse progressive de l'acuité visuelle épiphora et syndrome vestibulaire [n=1] et hypoacousie [n=1]). Tous présentaient une forme monostotique. La lésion de DFO était frontale (n=1), fronto-ethmoïdale (n=1), ethmoïdale (n=1), sphénoïdale (n=5), temporale (n=1) et étendue (fronto-ethmoïdo-sphénoïdale ; n=1). Cinq patients ont été traités par pamidronate, un bisphosphonate injectable : trois ont évolué favorablement entre 1 et 6 mois après le début du traitement (disparition des céphalées ou du syndrome vestibulaire), les 2 autres étaient cliniquement stables. Deux patients ont été opérés.ConclusionLe diagnostic de DFO cranio-faciale doit être évoqué devant des céphalées, des névralgies faciales, des atteintes sensorielles, des troubles fonctionnels ou des complications infectieuses de la sphère ORL. Une approche médico-chirurgicale est utile à la prise en charge de ces patients.



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Editorial Board

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4





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Mélanomes muqueux des cavités nasosinusiennes : revue de la littérature à propos d’une série de 44 cas

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Dréno, M. Georges, F. Espitalier, C. Ferron, A. Charnolé, B. Dréno, O. Malard
ObjectifsLes mélanomes muqueux des fosses nasales et des sinus sont des tumeurs rares : ils représentent 4 % des tumeurs des cavités nasosinusiennes. L'objectif de cette étude est d'évaluer les caractéristiques cliniques de cette pathologie, ses modalités d'évolution, sa prise en charge thérapeutique et d'identifier des facteurs pronostiques.Matériel et méthodesÉtude rétrospective à partir d'une série de 44 patients traités pour un mélanome muqueux des cavités nasosinusiennes, dans le service d'ORL et de chirurgie cervicofaciale du CHU de Nantes entre 1988 et 2015.RésultatsL'âge moyen des patients était de 71,2 ans. Les 2 principaux signes rhinologiques lors du diagnostic étaient l'épistaxis et l'obstruction nasale unilatérale. Au moment de la prise en charge, 25 % des patients étaient classés T4. Un traitement chirurgical a été effectué chez 42 patients. Une radiothérapie postopératoire a été délivrée dans 19 cas et une immunothérapie adjuvante dans 14 cas. La durée moyenne de suivi était de 50 mois. Le taux de survie globale cumulée était de 71,5 % à 1 an, 33 % à 5 ans. Cliniquement, la présence de céphalées, d'algies faciales ou d'anesthésie du V2 étaient des facteurs significatifs de mauvais pronostic. L'atteinte exclusive des fosses nasales était également de meilleur pronostic sur la survie globale que l'atteinte sinusienne. La réalisation d'une radiothérapie adjuvante augmentait de façon non significative le contrôle local.ConclusionsLes mélanomes muqueux des cavités nasosinusiennes sont des tumeurs de mauvais pronostic en raison de leur potentiel métastatique élevé. L'exérèse chirurgicale suivie d'une radiothérapie est le traitement principal. Il n'existe pas actuellement de consensus concernant l'intérêt des nouveaux traitements adjuvants médicamenteux dans cette indication contrairement au traitement du mélanome cutané primitif.



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Imagerie morphologique et fonctionnelle des paragangliomes cervicaux

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J.-P. Guichard, N. Fakhry, J. Franc, P. Herman, C.-A. Righini, D. Taieb
ObjectifFaire une mise au point sur les techniques d'imagerie dans la localisation et la caractérisation des paragangliomes (PGL) cervicaux.Matériel et méthodesAnalyse de la littérature à partir de la base de données PubMed/Medline.RésultatsLes PGL cervicaux sont des tumeurs hypervasculaires provenant essentiellement des paraganglions situés au niveau de la bifurcation carotidienne (glomus carotidien) et ou associés au nerf vague. L'imagerie morphologique est indiquée pour confirmer le diagnostic, rechercher une multifocalité et évaluer l'extension locorégionale. L'angio-IRM est la technique non invasive de choix. Le scanner et notamment l'angioscanner constitue une excellente alternative pour le diagnostic et le bilan d'extension. L'artériographie conventionnelle reste utile en préopératoire pour l'embolisation et le test de clampage. L'imagerie fonctionnelle permet la localisation et la caractérisation des PGL. La scintigraphie des récepteurs à la somatostatine constitue l'imagerie de référence dans le bilan des PGL sporadiques. Ces dernières années, les indications de la TEP se sont étendues parallèlement au développement des nouveaux traceurs telle que la TEP à la [18F]-FDOPA ou utilisant des analogues de la somatostatine marqués au gallium-68.ConclusionL'imagerie est fondamentale dans bilan des PGL du cou et combine des examens d'imagerie morphologique et fonctionnelle.



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La chirurgie ambulatoire en otologie

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): A. Uziel
L'auteur fait une mise au point sur la chirurgie ambulatoire en otologie qui s'est considérablement développée dans le monde et en France ces dernières années. La chirurgie de l'oreille se prête bien à une hospitalisation de courte durée en raison de la rapidité des actes et des possibilités de contrôle de la douleur. L'article discute de l'intérêt de ce mode de prise en charge (pour le patient, le chirurgien et l'établissement de santé), des contraintes organisationnelles et de sécurité, et des critères de non-éligibilité. La chirurgie ambulatoire en otologie est maintenant passée du stade d'alternative au stade de règle.



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L’immunotherapie antiallergenique dans la rhinite allergique

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): G. Mortuaire, J. Michel, J.-F. Papon, O. Malard, D. Ebbo, L. Crampette, R. Jankowski, A. Coste, E. Serrano
La rhinite allergique (RA) est une pathologie fréquente dont la sévérité ou le mauvais contrôle peut aboutir à une altération significative de la qualité de vie des patients. L'immunothérapie antiallergénique (ITA) constitue à l'heure actuelle le seul traitement étiologique susceptible de modifier l'histoire naturelle de la maladie allergique. Bien connue des allergologues, cette option thérapeutique est encore insuffisamment maîtrisée par les ORL. Cette mise au point basée sur les méta-analyses et les essais les plus récents souligne l'efficacité de l'ITA sur l'amélioration des symptômes de la RA et sur la réduction de la consommation des traitements médicaux (corticoïdes, antihistaminiques). L'ITA serait aussi susceptible de réduire le risque d'apparition d'un asthme et de nouvelles sensibilisations lorsqu'elle est introduite suffisamment précocement. Les analyses immunobiologiques montrent bien une modification du profil inflammatoire après ITA en faveur d'une immunotolérance impliquant les lymphocytes T régulateurs et la production d'IgG. La voie sublinguale en gouttes apporte des résultats comparables à ceux de la voie sous-cutanée tout en proposant une utilisation plus simple réduisant le risque anaphylactique. Une standardisation des protocoles d'étude en termes de mesure de l'effet thérapeutique et de gradation des effets indésirables est néanmoins nécessaire pour améliorer les études comparatives. Les formes sublinguales en comprimés plus récemment introduites constituent une réelle opportunité pour ouvrir le champ de l'ITA aux ORL dans la RA pollinique et prochainement la RA aux acariens.



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Les clés du traitement « conservateur » des carcinomes épidermoïdes de stade « précoce » de la région amygdalienne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): O. Laccourreye, P. Castelnau-Marchand, F. Rubin, C. Badoual, P. Halimi, P. Giraud
Analyse de la littérature médicale scientifique consacrée au bilan, à l'épidémiologie, au contrôle local, à la survie ainsi qu'aux complications et séquelles après traitement conservateur des carcinomes épidermoïdes de stade « précoce » de la région amygdalienne. Analyse de la base de données PubMed (1975–2016) avec les mots clés et les associations qui suivent : « amygdale/loge amygdalienne/oropharynx » et « cancer épidermoïde » et « stade précoce (I–II ; T1-T2N0M0) » et « radiothérapie » ou « chirurgie conservatrice/oropharyngectomie/chirurgie transorale/amygdalectomie radicale ». Cette recherche électronique trouvait dix articles rétrospectifs qui analysaient spécifiquement survie et contrôle local au sein de séries de plus de 50 patients avec un recul minimum de 2 ans après traitement conservateur et aucun article prospectif, méta-analyse et/ou étude Cochrane. L'imagerie par résonance magnétique nucléaire est l'examen radiologique clef du bilan d'extension locale. L'infestation par l'human papilloma virus est un facteur de risque à rechercher systématiquement, car il favorise la radiosensibilité tumorale et expose à des secondes localisations synchrones et métachrones spécifiques. Quel que soit le traitement conservateur réalisé, des taux de contrôle local et de survie supérieure à 85 % étaient notés. La modulation d'intensité réduisait la morbidité de la radiothérapie. La chirurgie transorale avait une faible morbidité/mortalité tout en permettant la réalisation d'un évidement ganglionnaire ipsilatéral et en préservant la radiothérapie pour le traitement des secondes localisations métachrones. La chirurgie transorale semble l'option thérapeutique à privilégier dans la majorité des cas. Un suivi à vie adapté au statut HPV doit être réalisé. La mise en place de vaccination anti-HPV ne doit pas faire perdre de vue l'importance de la lutte contre le tabagisme et l'énolisme.



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Rédaction du compte-rendu opératoire après chirurgie otorhinolaryngologique et cervico-faciale

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): O. Laccourreye, F. Rubin, A. Villeneuve, P. Bonfils
Une dizaine d'articles, seulement, consacrés au compte-rendu opératoire, sont publiés dans la littérature médicale scientifique indexée alors que ce document est indispensable, tant au plan médical qu'au plan légal, à la prise en charge optimale de la personne malade opérée. Dans cette note technique, construite à partir des travaux publiés sur ce sujet, les auteurs détaillent les points clés de la rédaction de ce document après chirurgie en otrorhinolaryngologie et soulignent la nécessité de rédiger ce document dans les minutes qui suivent la fin de l'intervention, l'apport de sa standardisation, et l'importance de son enseignement lors de la formation chirurgicale.



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Sténose bilatérale des artères linguales – une complication rare et tardive de la chimio-radiothérapie

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): F. Holtz, Y. Monnier, U. Borner, L. Nisa
IntroductionL'atteinte des artères carotides suite à la radiothérapie (RT) est un facteur de risque établi pour le développement d'atteintes cérébro-vasculaires avec risque ultérieur d'accident vasculaire cérébral ou accident vasculaire cérébral transitoire. En comparaison, l'atteinte de petits vaisseaux cervicaux suite à la RT est une complication plus rarement décrite.Présentation de casNous rapportons le cas d'un patient de 61 ans qui a développé une nécrose linguale partielle 4 ans après chirurgie et radio-chimiothérapie postopératoire pour un carcinome épidermoïde du plancher buccal. Un CT-scan avec injection de contraste a confirmé l'occlusion totale à subtotale des deux artères linguales. Le débridage chirurgical de la nécrose a permis une guérison complète des lésions.DiscussionL'atteinte des petits vaisseaux est une complication possible chez les patients irradiés pour des carcinomes de la région cervico-faciale. Bien que le risque de développement de telles complications n'ait pas de rapport direct avec la dose totale de RT, de plus hautes doses semblent accélérer le développement de lésions vasculaires. Les praticiens devraient garder en tête la possibilité de telles complications, surtout auprès des survivants au-delà de 5 ans.



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Exérèse par voie endonasale d’un neurofibrome solitaire de la portion externe du nez

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H.J. Min, K.S. Kim
IntroductionLe neurofibrome solitaire développé dans la portion externe du nez est extrêmement rare et, à notre connaissance, seuls 3 cas ont été rapportés dans la littérature anglophone. Il peut se développer à partir des branches ophtalmique (V1) et maxillaire (V2) du nerf trijumeau.Cas cliniqueNous présentons un cas rare de neurofibrome solitaire développé à partir de la portion externe du nez dont l'exérèse complète a été réalisée par voie endonasale après incision cartilagineuse.ConclusionCe cas met en lumière deux points importants. Tout d'abord, nous devons garder à l'esprit que cette entité clinique est incluse dans le diagnostic différentiel des masses tissulaires développées à partir de la portion externe du nez. Ensuite, nous devons choisir la meilleure approche chirurgicale pour l'exérèse complète avec préservation de l'aspect cosmétique.



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Fracture du stapes évoquée devant une tympanométrie anormale

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): C. Aussedat, C. Bobiller, K. Gaillot, E. Lescanne, D. Bakhos
IntroductionLes fractures de l'os temporal sont fréquemment associées à des disjonctions ou des fractures ossiculaires. L'osselet le plus fréquemment impliqué est l'incus. À notre connaissance, le cas d'une fracture isolée de la branche postérieure du stapes n'a pas été rapporté.Résumé du cas cliniqueUn patient de 20 ans a consulté pour une hypoacousie gauche persistante plusieurs mois après un traumatisme crânien. Une tomodensitométrie initiale de l'os temporal montrait une fracture de l'os temporal simple, sans autre anomalie détectée. Le diagnostic a été évoqué sur les résultats de l'impédancemétrie. L'aspect de compliance augmentée a conduit à réaliser une nouvelle tomodensitométrie temporale en coupes fines, évoquant une fracture de la branche postérieure du stapes. Une exploration chirurgicale par voie endaurale a permis de confirmer le diagnostic et a permis la mise en place de ciment ionomère au niveau de la branche postérieure.DiscussionUne fracture ou une disjonction ossiculaire doit être évoquées s'il persiste une surdité de transmission associée à un aspect de compliance augmentée sur la tympanométrie, même si la tomodensitométrie de l'os temporal ne montre pas de rupture de chaîne ou une fracture ossiculaire. La réhabilitation de l'audition peut être réalisée par la mise en place d'audioprothèse ou par reconstruction ossiculaire chirurgicale.



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Une tuméfaction parotidienne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): C.A. Righini, A. Baguant, I. Atallah




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Une tumeur rare du pavillon de l’oreille

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): M. Volkan Akdoğan, O. Topal, H. Erinanç




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État de mal convulsif révélant une tumeur naso-sinusienne chez l’enfant

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): H. Dimassi, S. Kedous, I. Ben Said




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Maladie de Kimura orbitaire : un défi diagnostique moderne

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): P. Clarós, J.V. Fokouo, F. Nyada, A. Clarós




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Hidradénocarcinome du cuir chevelu d’évolution fatale : une nouvelle observation

Publication date: September 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 4
Author(s): J. Elbenaye, M. Moumine, M. Sinaa, M. Elhaouri




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Modeling the Effects of Biogenic NO X Emissions on the South African Highveld and Waterberg Regions

Abstract

The Highveld and Waterberg regions in South Africa contain extensive coal fields and therefore have a high concentration of coal-fired power stations. Previous studies assessed the impact of atmospheric deposition of S- and N-containing species from anthropogenic sources in the region but did not include the effect of biogenic emissions. This study models biogenic NO_X soil emissions for the regions and includes them in an atmospheric dispersion model to study the effects of biogenic emission on nitrogen deposition rates. Simulated sulfur deposition rates for the Highveld area are also reported on. Anthropogenic and biogenic sulfur and nitrogen emission sources were inventoried for the Highveld and Waterberg regions. Using previous work by Yienger and Levy, biogenic soil NO_X emissions were quantified by constructing models for both areas using land use data, rainfall data, and atmospheric ground level temperatures from CALMET data. A CALPUFF dispersion model was used to predict deposition rates for S- and N-containing species with and without biogenic NO_x emissions to determine the impact of biogenic emissions for the Highveld. As rainfall is highly variable in the region, meteorological data representative of high, average, and low rainfall years was used to determine the effect of rainfall on deposition rates for the various species. The biogenic NO_x made up 3.96, 4.14, and 3.34% of total released NO_x for 2001 (average rainfall), 2003 (low rainfall), and 2010 (high rainfall), respectively. Dry nitrogen deposition rates were affected most by the biogenic component, adding from 1.7 to 6.2% at various receptor locations. Wet deposition rates were affected very little (0.13 to 0.75%). Effect on total nitrogen deposition rates ranged from 0.32 to 1.77%. Biogenic emissions for the Waterberg area, being more arid, were calculated to be only 2.3% of total NO_x emissions for the area and accordingly have little effect on deposition rates.

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Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial

Pain, swelling, and trismus are known sequelae of third molar surgery that can significantly affect the individual's quality of life (QOL). These should be minimized to improve QOL. The purpose of this study was to compare the effects of the preoperative submucosal administration of equivalent doses of two commonly used steroids on these postoperative sequelae. A randomized controlled clinical trial was conducted involving 60 subjects requiring the removal of impacted mandibular third molars. Extraction cases with a similar difficulty index were included.

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Cholinergic activity and levodopa-induced dyskinesia: a multitracer molecular imaging study

Abstract

Objective

To investigate the association between levodopa-induced dyskinesias and striatal cholinergic activity in patients with Parkinson's disease.

Methods

This study included 13 Parkinson's disease patients with peak-of-dose levodopa-induced dyskinesias, 12 nondyskinetic patients, and 12 healthy controls. Participants underwent 5-[¹²³I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine single-photon emission computed tomography, a marker of nicotinic acetylcholine receptors, [¹²³I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computed tomography, to measure dopamine reuptake transporter density and 2-[¹⁸F]fluoro-2-deoxyglucose positron emission tomography to assess regional cerebral metabolic activity. Striatal binding potentials, uptake values at basal ganglia structures, and correlations with clinical variables were analyzed.

Results

Density of nicotinic acetylcholine receptors in the caudate nucleus of dyskinetic subjects was similar to that of healthy controls and significantly higher to that of nondyskinetic patients, in particular, contralaterally to the clinically most affected side.

Interpretation

Our findings support the hypothesis that the expression of dyskinesia may be related to cholinergic neuronal excitability in a dopaminergic-depleted striatum. Cholinergic signaling would play a role in maintaining striatal dopaminergic responsiveness, possibly defining disease phenotype and progression.

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Advantages in Prognosis of Adult Patients with Ewing Sarcoma: 11-years Experiences and Current Treatment Management

Abstract

Ewing sarcoma (ES) is an exceptionally rare tumor in adults. Data regarding outcomes of adult patients with ES and experiences with age-adapted therapeutic strategies are very limited. The aim of this study was to evaluate prognostic factors and clinical outcome in a cohort of adult patients treated according to pediatric protocols in the Czech Republic. The records of 58 adult ES patients diagnosed between 2002 and 2013 were reviewed and factors relevant to prognosis and survival were analyzed. The median age of study cohort was 29 years (range, 18–59). The most frequent location was axial (36.2%), followed by involvement of extraskeletal tissues (34.5%) and bones of the extremities (29.3%). Twenty-eight (48.3%) patients had metastatic disease. In cases with localized ES, the 5-year overall survival (OS) was 76.5%. Using the log-rank test, the presence of metastasis at diagnosis, local treatment without surgery and a failure to achieve complete remission were associated with significantly shorter survival. In a multivariate Cox proportional hazard analysis, the achievement of complete remission was an independent predictor of patients's survival time. Outcomes of adults with localized ES treated according to multimodal pediatric protocols are similar to children. The achievement of complete remission is an independent predictor of survival time in ES patients. Severe hematological toxicity is foreseeable and manageable. Prognosis of patients with metastases or progression remains dismal.

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Diagnosis of human prostate carcinoma cancer stem cells enriched from DU145 cell lines changes with microscopic texture analysis in radiation and hyperthermia treatment using run-length matrix

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CRS and HIPEC for PMP—Use of the LC-CUSUM to Determine the Number of Procedures Required to Attain a Minimal Level of Proficiency in Delivering the Combined Modality Treatment

Abstract

The learning curve for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei (PMP) which peaks at 90 procedures for the surgeon may take several years to reach. The cumulative summation (CUSUM) test of the learning curve (LC-CUSUM) was used to assess the safety of the procedure (minimal level of proficiency for the surgeon) in terms of morbidity, mortality, and completeness of cytoreduction and early oncological failure before the peak of the learning curve had been reached. The limits for h0 and h1 were set based on the results of large series of such cases published before. From 2011 to 2016, 77 patients with PMP underwent CRS and HIPEC. The mean peritoneal cancer index (PCI) was 28 and 75% of the patients had a CC-0/1 resection. The grade 3–4 morbidity was 42.6% and the mortality was 5.2%. The 5-year overall survival (OS) was 62.3% and the 3-year disease-free survival (DFS) was 71%. The LC-CUSUM analysis showed that for in-hospital mortality, acceptable limits are reached after the 57th case, after the 38th case for the grade 3–4 morbidity and CC-2/3 resections both and after the 70th case for early oncological failure. The number of cases required to attain a minimal level of proficiency for each prognostic variable is different. Using the CUSUM test, surgeons can analyze their performance and determine the areas in which they need to improve before the peak of the learning curve is reached. These outcomes reflect the performance of the multidisciplinary team and not the surgeon alone.

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Oral immunization with Porphyromonas gingivalis outer membrane protein and CpG oligodeoxynucleotides attenuates P. gingivalis-accelerated atherosclerosis and inflammation

Publication date: Available online 12 August 2017
Source:Journal of Oral Biosciences
Author(s): Takashi Takeuchi, Tomomi Hashizume-Takizawa, Ryoki Kobayashi
ObjectiveIt has previously been shown that oral immunization with the 40-kDa outer membrane protein of Porphyromonas gingivalis (40k-OMP) and CpG oligodeoxynucleotides (ODN) as an adjuvant elicits protective antibody responses against alveolar bone loss caused by P. gingivalis infection. The objective of the present work was to assess the efficacy of this same oral vaccine on prevention of P. gingivalis-accelerated atherosclerosis.MethodsApolipoprotein E-deficient spontaneously hyperlipidemic (Apoe^shl) mice were orally immunized with 40k-OMP plus CpG ODN and subsequently challenged intravenously with P. gingivalis. The mice were euthanized 15 weeks later, and atheromatous lesions in the proximal aorta of each mouse were analyzed histomorphometrically. Serum concentrations of 40k-OMP-specific antibodies and cytokines as well as levels of proatherogenic factors in the aorta were determined.ResultsP. gingivalis challenge resulted in an increase in the areas of the aortic sinus covered with atherosclerotic plaque, as well as in the levels of high-sensitive C-reactive protein (hsCRP) and some cytokines and chemokines, when compared with sham-treated mice. In contrast, oral immunization with 40k-OMP plus CpG ODN induced 40k-OMP-specific serum IgG responses, and significantly reduced atherosclerotic plaque accumulation in the aortic sinus, along with hsCRP and the cytokine and chemokine levels.ConclusionsThese results suggest that oral administration of 40k-OMP plus CpG ODN may be an effective vaccine for the prevention of accelerated atherosclerosis caused by P. gingivalis infection.



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The novel autophagy inhibitor elaiophylin exerts antitumor activity against multiple myeloma with mutant TP53 in part through endoplasmic reticulum stress-induced apoptosis

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Successful treatment of advanced pancreatic liposarcoma with apatinib: A case report and literature review

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MicroRNA-137 and -195* inhibit vasculogenesis in brain arteriovenous malformations

Abstract

Objectives: Brain arteriovenous malformations (AVMs) are the most common cause of non-traumatic intracerebral hemorrhage in young adults. The genesis of brain AVM remains enigmatic. We investigated microRNA (miRNA) expression and its contribution to the pathogenesis of brain AVMs.

Methods: We used a large-scale miRNA analysis on 16 samples including AVMs, hemangioblastoma, and controls to identify a distinct AVM miRNA signature. AVM smooth muscle cells (AVMSMCs) were isolated and identified by flow cytometry and immunohistochemistry and candidate miRNAs were then tested in these cells. Migration, tube formation, and CCK-8-induced proliferation assays were used to test the miRNAs effect on phenotypic properties of AVMSMCs. A quantitative proteomics approach was used to identify protein expression changes in AVMSMCs treated with miRNA mimics.

Results: A distinct AVM miRNA signature comprising a large portion of lowly expressed miRNAs was identified. Among these miRNAs, miR-137 and miR-195* levels were significantly decreased in AVMs and constituent AVMSMCs. Experimentally elevating the level of these microRNAs inhibited AVMSMC migration, tube formation and survival in vitro and the formation of vascular rings in vivo. Proteomics showed the protein expression signature of AVMSMCs and identified downstream proteins regulated by miR-137 and miR-195* which were key signaling proteins involved in vessel development.

Interpretation: Our results indicate that miR-137 and miR-195* act as vasculogenic suppressors in AVMs by altering phenotypic properties of AVMSMCs, and that the absence of miR-137 and miR-195* expression leads to abnormal vasculogenesis. This article is protected by copyright. All rights reserved.

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Duration of tracheostomy dependence and development of tracheocutaneous fistula in children

Objective

To determine whether the risk of developing a tracheocutaneous fistula (TCF) increases with longer tracheostomy dependence times in children.

Study Design

Retrospective review of medical records.

Method

A retrospective chart review was conducted for all children who both underwent tracheotomy and were decannulated between 2002 and 2011 at a tertiary children's hospital. Charts were analyzed for duration of tracheostomy and evidence of TCF up to 12 months. Data for these criteria was available on 164 out of 182 patients.

Results

A significant difference in the duration of tracheostomy dependence between children with and without resultant TCF was determined by the Wilcoxon signed rank test (P = 0.0003). The relative risk (RR) of a persistent TCF was significantly increased when the duration of tracheostomy dependence was greater than 24 months (RR = 2.5217, P < 0.005) when compared to those decannulated before 12 months. The mean tracheostomy dependence times for children with and without TCF were 33.1 and 23.4 months, respectively. Overall, 94 children (57.3%) developed a TCF.

Conclusion

To our knowledge, this study represents the largest collection of data for children who have been decannulated following tracheostomy placement. These data demonstrate that the risk of developing a TCF increases with longer tracheostomy dependence times in children.

Level of Evidence

4. Laryngoscope, 2017

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Measurements of ionic concentrations along with endocochlear potential in wild-type and claudin 14 knockout mice

To examine whether the changes in endolymphatic ion concentrations were involved in hair cells degeneration in claudin-14 knockout (KO) mice (Cldn14−/−), we measured the endocochlear potential (EP) along with concentrations of K+, Na+, H+, or Ca2+ ([K]e, [Na]e, pHe, [Ca]e) in Cldn14−/−, in which hair cells were selectively damaged, and compared with measurements in wild type mice (Wt).

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Insulinoma enucleation after echoendoscopic fiducial placement

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[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Related Articles

[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Acta Med Croatica. 2016 04;70(2):111-6

Authors: Budinčević H, Marčinko Budinčević A, Kos M, Vlašić S, Bartolović J, Benko S, Ostojić V, Soldo Butković S

Abstract
Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and quality of life.

PMID: 28722839 [PubMed - indexed for MEDLINE]

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[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Related Articles

[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Acta Med Croatica. 2016 04;70(2):111-6

Authors: Budinčević H, Marčinko Budinčević A, Kos M, Vlašić S, Bartolović J, Benko S, Ostojić V, Soldo Butković S

Abstract
Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and quality of life.

PMID: 28722839 [PubMed - indexed for MEDLINE]

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Table of Contents

Publication date: July 2017
Source:Human Pathology, Volume 65





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Masthead

Publication date: July 2017
Source:Human Pathology, Volume 65





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Editorial Board

Publication date: July 2017
Source:Human Pathology, Volume 65





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Alterations of apoptosis and autophagy in developing brain of rats with epilepsy: Changes in LC3, P62, Beclin-1 and Bcl-2 levels

Publication date: Available online 12 August 2017
Source:Neuroscience Research
Author(s): Qinrui Li, Ying Han, Junbao Du, Hongfang Jin, Jing Zhang, Manman Niu, Jiong Qin
Current studies have indicated that apoptotic and autophagic signaling pathways are triggered by epileptic seizures, but the precise roles of these processes in epilepsy-induced neuronal loss remain unclear. Identifying a concrete molecular mechanism may help researchers develop relevant epilepsy therapies that are more effective than existing treatments. Autophagy is a type of conserved degradation that contributes to cellular homeostasis. The involved signaling pathways allow us to observe alterations in autophagy and apoptosis during epileptic seizures over time. This study investigated the time-dependent changes in autophagy, apoptosis and neuronal morphology in developing brain of epilepsy model rats. At 48h after epileptic seizure onset, the number of neurons in neocortex decreased, and the number of apoptotic cells in neocortex increased. The ratio of microtubule-associated protein 1 light chain 3 (LC3) II to LC3 I and Beclin-1 protein levels increased from 12h to 48h after epileptic seizure onset. P62 protein and Bcl-2 protein levels decreased from 24h to 48h after epileptic seizure onset. The changes in the levels of these autophagy and apoptosis markers indicate that autophagy starts before apoptosis in rats with epilepsy, demonstrating a potential role of autophagy in epilepsy-induced neuronal loss in developing brain.



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Comparison of Local Anesthetic Infusion Pump Bupivacaine versus Transversus Abdominis Plane (TAP) Block Liposomal Bupivacaine For Pain Management After Bilateral Deep Inferior Epigastric Perforator Free Flap Reconstruction

Publication date: Available online 12 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca Knackstedt, James Gatherwright, Amir Ghaznavi, Steven Bernard, Graham Schwarz, Andrea Moreira, Raffi Gurunluoglu, Risal Djohan




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Comparison of Local Anesthetic Infusion Pump Bupivacaine versus Transversus Abdominis Plane (TAP) Block Liposomal Bupivacaine For Pain Management After Bilateral Deep Inferior Epigastric Perforator Free Flap Reconstruction

Post-surgical analgesia can be addressed at numerous timepoints, from pre-operative "enhanced recovery protocols" to intra-operative nerve blocks or local infusion to post-operative narcotics. In order to adress this short duration of local anesthetics, an indwelling pain pump can be utilized. However, pumps can become occluded and are not guaranteed to stay in the right anatomical plane. Thus, it would be ideal to provide a means of pain control that does not require external devices and that is desirable from a cost perspecitve.

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What can neuronal populations tell us about cognition?

Publication date: October 2017
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Iñigo Arandia-Romero, Ramon Nogueira, Gabriela Mochol, Rubén Moreno-Bote
Nowadays, it is possible to record the activity of hundreds of cells at the same time in behaving animals. However, these data are often treated and analyzed as if they consisted of many independently recorded neurons. How can neuronal populations be uniquely used to learn about cognition? We describe recent work that shows that populations of simultaneously recorded neurons are fundamental to understand the basis of decision-making, including processes such as ongoing deliberations and decision confidence, which generally fall outside the reach of single-cell analysis. Thus, neuronal population data allow addressing novel questions, but they also come with so far unsolved challenges.



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Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission

Publication date: Available online 12 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Janet K. Freburger, Dongmei Li, Erin P. Fraher
ObjectivesTo determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home.DesignRetrospective cohort analysis of Medicare claims (2010-2013).SettingAcute care hospital and community.ParticipantsPatients hospitalized for stroke who were discharged home and survived the first 30 days (N=23,413; mean [SD] age of 77.6 [7.5] years).InterventionsPhysical and occupational therapist use in the home and/or outpatient setting in the first 30 days after discharge (any use, number of visits, days to first visit).Main Outcome MeasureHospital readmission 30-60 days after discharge. Covariates included demographic characteristics, proxy variables for functional status, hospitalization characteristics, comorbidities, and prior health care use. Multivariate logistic regression analyses were conducted to examine the relationship between therapist use and readmission.ResultsDuring the first 30 days after discharge, 31% of patients saw a therapist in the home, 11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative to patients who had no therapist contact, those who saw an outpatient therapist were less likely to be readmitted to the hospital (odds ratio 0.73 [059-0.90]). While the point estimates did not reach statistical significance, there was some suggestion that the greater the number of therapist visits in the home and the sooner the visits started, the lower the risk of hospital readmission.ConclusionAfter controlling for observable demographic, clinical, and health-related differences, we found that individuals who received outpatient therapy in the first 30 days after discharge home following stroke were less likely to be readmitted to the hospital in the subsequent 30 days, relative to those who received no therapy.



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Safety and Feasibility of Rehabilitation Interventions in Children Undergoing Hematopoietic Stem Cell Transplant with Thrombocytopenia

Publication date: Available online 12 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Katarzyna Ibanez, Noel Espiritu, Regine L. Souverain, Laura Stimler, Lauren Ward, Elyn R. Riedel, Rachel Lehrman, Farid Boulad, Michael Dean Stubblefield
ObjectiveTo analyze the relationship between platelet counts, the intensities of physical therapies (PT) and occupational therapies (OT) services received, and the frequency of bleeding complications in children undergoing hematopoietic stem cell transplants (HSCT) during a period of severe thrombocytopenia.DesignRetrospective review studySettingTertiary care hospitalParticipantsChildren (age <18) hospitalized for HSCT in 2010 and 2011 who received PT and OT services while markedly thrombocytopenic (platelets≤50K/mcL).InterventionsNoneMain Outcome MeasuresIntensities of PT and OT interventions, the patients' platelet counts on specific therapy days and any bleeding events (minor or major) that occurred during or briefly following rehabilitation interventions.ResultsSixty-two patients (accounting for sixty-three HSCTs) met the criteria for analysis. Fifty-six of these patients (fifty-seven HSCTs) underwent PT and/or OT while markedly thrombocytopenic. There was no correlation between the platelet count and the intensity of rehabilitation interventions. There were no major bleeding events. There was no association between minor bleeding and intensities of PT or OT interventions and no association between minor bleeding events and platelet counts. Only 5 minor bleeding events occurred during or following moderate or intensive therapy out of 346 PT and OT sessions (1.5%).ConclusionThe results of our study suggest that bleeding complications during or following mobilization and supervised exercise during PT and OT in children with severe thrombocytopenia undergoing HSCT are minor and relatively rare. These are encouraging results for both patients and rehabilitation specialists treating this population who is at high risk for developing immobility related complications.



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Frameshift Mutations in Repeat Sequences of ANK3, HACD4, TCP10L, TP53BP1, MFN1, LCMT2, RNMT, TRMT6, METTL8 and METTL16 Genes in Colon Cancers

Abstract

Diminished ANK3 contributes to cell survival by inhibiting detachment-induced apoptosis. TP53BP1 that interacts with p53 and MFN1 that encodes a mitochondrial membrane protein are considered to have tumor suppressor gene (TSG) functions. HACD4 involving fatty acid synthesis and TCPL10 with transcription regulation functions are considered TSGs. Many genes involved in DNA methylations such as LCMT2, RNMT, TRMT6, METTL8 and METTL16 are often perturbed in cancer. The aim of our study was to find whether these genes were mutated in colorectal cancer (CRC). In a genome database, we observed that each of these genes harbored mononucleotide repeats in the coding sequences, which could be mutated in cancers with high microsatellite instability (MSI-H). For this, we studied 124 CRCs for the frameshift mutations of these genes and their intratumoral heterogeneity (ITH). ANK3, HACD4, TCP10L, TP53BP1, MFN1, LCMT2, RNMT, TRMT6, METTL8 and METTL16 harbored 11 (13.9%), 3 (3.8%), 0 (0%), 5 (6.3%), 1 (1.3%), 2 (2.5%), 4 (5.1%), 3 (3.8%), 2 (2.5%) and 2 (2.5%) of 79 CRCs with MSI-H, respectively. However, we found no such mutations in microsatellite stable (MSS) cancers in the nucleotide repeats. There were ITH of the frameshift mutations of ANK3, MFN1 and TP53BP1 in 1 (6.3%), 1 (6.3%) and 1 (6.3%) cases, respectively. Our data exhibit that cancer-related genes ANK3, HACD4, TP53BP1, MFN1, LCMT2, RNMT, TRMT6, METTL8 and METTL16 harbor mutational ITH as well as the frameshift mutations in CRC with MSI-H. Also, the results suggest that frameshift mutations of these genes might play a role in tumorigenesis through their inactivation in CRC.

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Snail and Axin2 expression predict the malignant transformation of oral leukoplakia

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Xianglan Zhang, Ki-Yeol Kim, Zhenlong Zheng, Hyun Sil Kim, In Ho Cha, Jong In Yook
ObjectivesOral leukoplakia (OL) has a well-documented potential risk of malignant transformation into oral squamous cell carcinoma (OSCC), although biomarker(s) predicting malignant potential are limited in capability. The aim of this cross-sectional and retrospective cohort study was to investigate the predictive role of canonical Wnt genes Axin2 and Snail (SNAI1) expression in the malignant transformation of OL lesions.Materials and methodsThe expression of epithelial-mesenchymal transition (EMT) genes Snail and Axin2, which are regulated by the canonical Wnt pathway, were determined using immunohistochemical staining in an OL cohort consisting of 154 samples of patients with long-term follow-up and then evaluated as risk factors for malignant transformation of OL.ResultsIncreased Axin2 and Snail abundance were found in 107 (69.5%) and 58 (37.7%) of OL patients, respectively. In a multivariate analysis using gender, age, lesion site, Axin2, and Snail as cofactors, both Axin2 and Snail were independent risk factors for malignant transformation with a hazard ratio of 7.47 (95% confidence interval, 2.23–25.02; P=0.001) and 4.41 (95% confidence interval, 1.78–10.93; P=0.001), respectively. A nomogram for predicting 5-, 10-, and 15-year cancer-free survival probability was developed in patients with OL by including gender, age, lesion site, Axin2, and Snail expression with ac-index of 0.760.ConclusionThe increased abundance of Snail and Axin2 is highly correlated to malignant transformation of OL, making them novel biomarker(s) predicting oral cancer development.



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Genomic characterization of tobacco/nut chewing HPV-negative early stage tongue tumors identify MMP10 asa candidate to predict metastases

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Pawan Upadhyay, Nilesh Gardi, Sanket Desai, Pratik Chandrani, Asim Joshi, Bhaskar Dharavath, Priyanca Arora, Munital Bal, Sudhir Nair, Amit Dutt
ObjectivesNodal metastases status among early stage tongue squamous cell cancer patients plays a decisive role for choice of treatment, wherein about 70% patients may be spared from surgery with accurate prediction of negative pathological lymph node status. However, there is an unmet need for prognostic biomarkers to stratify the patients who are likely to develop metastases.Materials and methodsWe performed high throughput sequencing of fifty four samples derived from HPV negative early stage tongue cancer patients habitual of chewing betel nuts, areca nuts, lime or tobacco using whole exome (n=47) and transcriptome (n=17) sequencing. Additionally the relevant alterations were validated using orthologous methods in extended early stage TSCC cohort.Results and conclusionSomatic analysis revealed a classical tobacco mutational signature C:G>A:T transversion in 53% patients that were mutated in TP53, NOTCH1, CDKN2A, HRAS, USP6, PIK3CA, CASP8, FAT1, APC, and JAK1. Similarly, significant gains at genomic locus 11q13.3 (CCND1, FGF19, ORAOV1, FADD), 5p15.33 (SHANK2, MMP16, TERT), and 8q24.3 (BOP1); and, losses at 5q22.2 (APC), 6q25.3 (GTF2H2) and 5q13.2 (SMN1) were observed in these samples. Furthermore, an integrated gene-expression analysis of 253 tongue tumors suggested an upregulation of metastases-related pathways and over-expression of MMP10 in 48% tumors that may be crucial to predict nodal metastases in early tongue cancer patients. In overall, we present the first descriptive portrait of somatic alterations underlying the genome of tobacco/nut chewing HPV-negative early tongue cancer, and identify MMP10 asa potential prognostic biomarker to stratify those likely to develop metastases.



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Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence.

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Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence.

Acta Otolaryngol. 2017 Aug 11;:1-5

Authors: Tanrivermis Sayit A, Elmali M, Kemal O, Terzi Y

Abstract
OBJECTIVE: The aim of this study is to determine the prevalence of jugular bulb-vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry.
METHODS: About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared.
RESULTS: Jugular bulb-vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n = 38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n = 18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation.
CONCLUSIONS: The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.

PMID: 28799451 [PubMed - as supplied by publisher]

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Synchronous colorectal liver metastases: focus on the elderly

Abstract

Purpose

The goal of this study was to analyze the use and the effectiveness of both surgery and different chemotherapies in patients with synchronous colorectal liver metastases (CLMs) ≥70 years compared to younger patients.

Methods

Survival was analyzed in 456 patients (24.3% ≥70 years) treated for CLM in a single center using Kaplan-Meier estimation of overall survival (OS), calculation of relative survival as estimate for disease-specific survival, and a Cox regression model.

Results

Complete surgical resections were achieved more often in patients aged <70 years (39.2 vs. 28.1%, P = 0.056), and young patients more frequently received irinotecan or platin-based chemotherapies (70.3 vs. 41.6%, P < 0.001). Three-year OS and relative survival of patients ≥70 years were significantly lower compared to younger patients (OS 34.3 vs. 43.5%, P = 0.0114). In a Cox regression model, complete surgical removal of liver metastases was the most effective treatment (HR 0.313, P < 0.001) followed by chemotherapy (irinotecan/platin-based: HR 0.371, 5-FU only: HR 0.673, P < 0.001). Having >5 liver metastases, the presence of extrahepatic metastases, high grading, and a nodal positive primary but not age ≥70 years were associated with an increased risk of death.

Conclusions

Our data support radical resection and highly effective chemotherapy in selected elderly patients with CLM.

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Does hypoglycaemia affect the improvement in QoL after the transition to insulin in people with type 2 diabetes?

Abstract

Purpose

Quality of Life (QoL) of insulin-naïve people with type 2 diabetes mellitus (T2DM) improves after transition to insulin. Little is known about the role of hypoglycaemia in this context. Secondary analyses of the Study of the Psychological Impact in Real care of Initiating insulin glargine Treatment (SPIRIT) aimed to investigate the relationship between hypoglycaemia and QoL when transitioning to insulin.

Methods

Insulin-naïve Dutch people with T2DM in suboptimal glycaemic control (HbA1c >53 mmol/mol; 7.0%) on maximum dose of oral glucose-lowering medications were included from 363 primary care practices (n = 911). Participants started insulin glargine and completed QoL-questionnaires (WHO-5 Well-being Index (WHO-5; emotional well-being), Hypoglycaemia Fear Survey-worry scale (HFS-w; hypoglycaemia fear) and Diabetes Symptom Checklist-revised (DSC-r; diabetes symptom distress) at baseline, 3 and 6 months follow-up. Linear GEE analyses were used to investigate the association between symptomatic, nocturnal, severe hypoglycaemia (number of episodes during 3 months prior to visit) and QoL over time.

Results

52.5% men participated, mean age 62.2 years (SD ± 10.92), and median HbA1c 67 mmol/mol (range 61–77) (8.3%). More symptomatic hypoglycaemic episodes were associated with higher HFS-w and DSC-r scores (P < 0.01). Experiencing multiple nocturnal or severe episodes was related to higher symptom distress as well, when compared to no episodes. These associations did not change significantly over time.

Conclusions

Hypoglycaemia is associated with lower QoL in terms of hypoglycaemia fear and diabetes symptom distress. The transition to insulin does not affect this relationship, suggesting hypoglycaemia in itself has a detrimental effect on diabetes-related QoL independent of treatment regimen.

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Does hypoglycaemia affect the improvement in QoL after the transition to insulin in people with type 2 diabetes?

Abstract

Purpose

Quality of Life (QoL) of insulin-naïve people with type 2 diabetes mellitus (T2DM) improves after transition to insulin. Little is known about the role of hypoglycaemia in this context. Secondary analyses of the Study of the Psychological Impact in Real care of Initiating insulin glargine Treatment (SPIRIT) aimed to investigate the relationship between hypoglycaemia and QoL when transitioning to insulin.

Methods

Insulin-naïve Dutch people with T2DM in suboptimal glycaemic control (HbA1c >53 mmol/mol; 7.0%) on maximum dose of oral glucose-lowering medications were included from 363 primary care practices (n = 911). Participants started insulin glargine and completed QoL-questionnaires (WHO-5 Well-being Index (WHO-5; emotional well-being), Hypoglycaemia Fear Survey-worry scale (HFS-w; hypoglycaemia fear) and Diabetes Symptom Checklist-revised (DSC-r; diabetes symptom distress) at baseline, 3 and 6 months follow-up. Linear GEE analyses were used to investigate the association between symptomatic, nocturnal, severe hypoglycaemia (number of episodes during 3 months prior to visit) and QoL over time.

Results

52.5% men participated, mean age 62.2 years (SD ± 10.92), and median HbA1c 67 mmol/mol (range 61–77) (8.3%). More symptomatic hypoglycaemic episodes were associated with higher HFS-w and DSC-r scores (P < 0.01). Experiencing multiple nocturnal or severe episodes was related to higher symptom distress as well, when compared to no episodes. These associations did not change significantly over time.

Conclusions

Hypoglycaemia is associated with lower QoL in terms of hypoglycaemia fear and diabetes symptom distress. The transition to insulin does not affect this relationship, suggesting hypoglycaemia in itself has a detrimental effect on diabetes-related QoL independent of treatment regimen.

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Languages in Drier Climates Use Fewer Vowels.

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Languages in Drier Climates Use Fewer Vowels.

Front Psychol. 2017;8:1285

Authors: Everett C

Abstract
This study offers evidence for an environmental effect on languages while relying on continuous linguistic and continuous ecological variables. Evidence is presented for a positive association between the typical ambient humidity of a language's native locale and that language's degree of reliance on vowels. The vowel-usage rates of over 4000 language varieties were obtained, and several methods were employed to test whether these usage rates are associated with ambient humidity. The results of these methods are generally consistent with the notion that reduced ambient humidity eventually yields a reduced reliance of languages on vowels, when compared to consonants. The analysis controls simultaneously for linguistic phylogeny and contact between languages. The results dovetail with previous work, based on binned data, suggesting that consonantal phonemes are more common in some ecologies. In addition to being based on continuous data and a larger data sample, however, these findings are tied to experimental research suggesting that dry air affects the behavior of the larynx by yielding increased phonatory effort. The results of this study are also consistent with previous work suggesting an interaction of aridity and tonality. The data presented here suggest that languages may evolve, like the communication systems of other species, in ways that are influenced subtly by ecological factors. It is stressed that more work is required, however, to explore this association and to establish a causal relationship between ambient air characteristics and the development of languages.

PMID: 28798711 [PubMed]

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nab-Paclitaxel-based induction chemotherapy with or without cetuximab for locally advanced head and neck squamous cell carcinoma.

Related Articles

nab-Paclitaxel-based induction chemotherapy with or without cetuximab for locally advanced head and neck squamous cell carcinoma.

Oral Oncol. 2017 Sep;72:26-31

Authors: Adkins D, Ley J, Oppelt P, Wildes TM, Gay HA, Daly M, Rich J, Paniello RC, Jackson R, Pipkorn P, Nussenbaum B, Trinkaus K, Thorstad W

Abstract
OBJECTIVES: To explore the effect of incorporating cetuximab into induction chemotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS: Retrospective comparative analysis of two consecutive prospective phase II trials was performed: trial 1 with nab-paclitaxel/cisplatin/5-FU and cetuximab (APF-C; n=30) and trial 2 with APF (n=30). Patients were scheduled to receive chemoradiation therapy (CRT) with cisplatin. T2-4 classification oropharynx (OP)/larynx/hypopharynx SCC were included. Cumulative incidence of death of disease (CIDD), overall survival (OS), and cumulative incidence of relapse were compared between APF-C and APF.
RESULTS: No significant differences in patient or tumor characteristics were noted between the groups. Median follow-up of surviving patients was 52 (25-95) months. Relapse occurred in 5 (17%) patients treated with APF-C and in 2 (7%) treated with APF (p=0.37). In human papillomavirus (HPV)-related OPSCC (n=34), the CIDD at 52months was 3.4% with APF-C and 2.6% with APF and the two-year OSs were 94%. In HPV-unrelated HNSCC (n=25), the CIDD at 52months was 4.4% with APF-C and 3.3% with APF and two-year OSs were 83% and 92%, respectively. CIDD or OS did not differ when stratified by treatment group and HPV status (CIDD: p=0.80; OS: p=0.30).
CONCLUSION: This exploratory retrospective comparative analysis demonstrated no significant difference in CIDD, OS, or cumulative incidence of relapse between patients treated with APF-C or APF.

PMID: 28797458 [PubMed - in process]

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

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

Oral Oncol. 2017 Sep;72:110-116

Authors: Stokes WA, Stumpf PK, Jones BL, Blatchford PJ, Karam SD, Lanning RM, Raben D

Abstract
OBJECTIVES: Among patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy, recent retrospective and prospective data have suggested improved outcomes with altered fractionation over conventional fractionation (CFxn). We sought to characterize national fractionation patterns and to compare outcomes among them.
MATERIALS AND METHODS: We queried the National Cancer Database for T2N0M0 squamous cell carcinomas of the glottis diagnosed from 2004-2014 and managed with definitive radiotherapy. Dose-per-fraction and duration of radiotherapy were used to define cohorts undergoing CFxn, hypofractionation (HypoFxn), and hyperfractionation (HyperFxn). Logistic regression was performed to identify predictors of receiving altered fractionation. Cox regression and propensity-score matching (PSM) analyses were used to compare survival between schedules.
RESULTS: We abstracted 2 006 CFxn patients, 1 166 HypoFxn patients, and 161 HyperFxn patients. Fractionation patterns changed significantly from 2004 to 2014, with use of HyperFxn decreasing from 6.3% to 1.8% and use of HypoFxn increasing from 23.9% to 54.1% (p<0.001). Receipt of altered fractionation was independently associated with later year of diagnosis and higher facility volume. On Cox regression, both HypoFxn (hazard ratio [HR] for mortality 0.84, 95% confidence interval [95%CI] 0.73-0.97) and HyperFxn (HR 0.74, 95%CI 0.56-0.99) were associated with improved survival over CFxn. The survival advantage of each altered fractionation schedule over CFxn was redemonstrated on comparison of PSM groups.
CONCLUSION: Increasing utilization of HypoFxn for T2N0M0 glottic cancer is driving national practice patterns away from CFxn. Our findings support the use of altered fractionation, particularly HypoFxn, for patients undergoing definitive radiotherapy, although HyperFxn remains understudied in a prospective fashion.

PMID: 28797446 [PubMed - in process]

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

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

Oral Oncol. 2017 Sep;72:104-109

Authors: Alsidawi S, Price KA, Chintakuntlawar AV, Westin GF, Garcia JJ, Ma DJ, Okuno SH

Abstract
INTRODUCTION: Immunosuppression after solid organ transplant prevents graft rejection, but leads to increased incidence of various malignancies including head and neck squamous cell carcinoma (HNSCC). Outcomes of patients with post-transplant HNSCC are unknown.
MATERIALS AND METHODS: We retrospectively identified patients who developed HNSCC after solid organ transplant between 1995 and 2010. Adults with pathology-proven HNSCC and adequate follow up were included. Median overall survival and progression free survival were analyzed using the Kaplan-Meier method. The prognostic effect of variables was studied with Cox proportional hazards models.
RESULTS: Thirty-three patients met study inclusion criteria. The median time to diagnosis of HNSCC after transplant was 5.9years. The primary site was oral cavity in 15 patients, oropharynx in 10, larynx in 3, hypopharynx in 2, parotid in 2 and unknown in 1 patient. Eighty-eight percent underwent upfront surgical resection. Of those, sixty-six percent received adjuvant therapy. Six percent of patients had definitive chemoradiation. Treatment was well tolerated and did not lead to graft rejection. The 5-year overall survival rate was 45% and 37% for localized and locally advanced disease respectively. Seventy-five percent of patients with oropharyngeal tumors were HPV-positive and they had better outcomes (5-year overall survival rate of 67%). In multivariate analysis, age ≥60years was a negative predictor of survival (HR 2.7; 95% CI, 1.1-6.5; P=0.03).
CONCLUSIONS: Patients with post-transplant HNSCC have relatively poor survival and high risk of locoregional and distant recurrence. HPV- positive oropharyngeal tumors continue to have better outcomes in this population.

PMID: 28797445 [PubMed - in process]

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In reply: Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation.

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In reply: Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation.

Can J Anaesth. 2017 08;64(8):876-877

Authors: Kovacs G, Duggan LV, Brindley PG

PMID: 28444551 [PubMed - indexed for MEDLINE]

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Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation.

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Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation.

Can J Anaesth. 2017 08;64(8):874-875

Authors: Bowness J, Taylor A, Gifford H

PMID: 28444550 [PubMed - indexed for MEDLINE]

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Nutrient sensing by absorptive and secretory progenies of small intestinal stem cells.

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Nutrient sensing by absorptive and secretory progenies of small intestinal stem cells.

Am J Physiol Gastrointest Liver Physiol. 2017 Jun 01;312(6):G592-G605

Authors: Kishida K, Pearce SC, Yu S, Gao N, Ferraris RP

Abstract
Nutrient sensing triggers responses by the gut-brain axis modulating hormone release, feeding behavior and metabolism that become dysregulated in metabolic syndrome and some cancers. Except for absorptive enterocytes and secretory enteroendocrine cells, the ability of many intestinal cell types to sense nutrients is still unknown; hence we hypothesized that progenitor stem cells (intestinal stem cells, ISC) possess nutrient sensing ability inherited by progenies during differentiation. We directed via modulators of Wnt and Notch signaling differentiation of precursor mouse intestinal crypts into specialized organoids each containing ISC, enterocyte, goblet, or Paneth cells at relative proportions much higher than in situ as determined by mRNA expression and immunocytochemistry of cell type biomarkers. We identified nutrient sensing cell type(s) by increased expression of fructolytic genes in response to a fructose challenge. Organoids comprised primarily of enterocytes, Paneth, or goblet, but not ISC, cells responded specifically to fructose without affecting nonfructolytic genes. Sensing was independent of Wnt and Notch modulators and of glucose concentrations in the medium but required fructose absorption and metabolism. More mature enterocyte- and goblet-enriched organoids exhibited stronger fructose responses. Remarkably, enterocyte organoids, upon forced dedifferentiation to reacquire ISC characteristics, exhibited a markedly extended lifespan and retained fructose sensing ability, mimicking responses of some dedifferentiated cancer cells. Using an innovative approach, we discovered that nutrient sensing is likely repressed in progenitor ISCs then irreversibly derepressed during specification into sensing-competent absorptive or secretory lineages, the surprising capacity of Paneth and goblet cells to detect fructose, and the important role of differentiation in modulating nutrient sensing.NEW & NOTEWORTHY Small intestinal stem cells differentiate into several cell types transiently populating the villi. We used specialized organoid cultures each comprised of a single cell type to demonstrate that 1) differentiation seems required for nutrient sensing, 2) secretory goblet and Paneth cells along with enterocytes sense fructose, suggesting that sensing is acquired after differentiation is triggered but before divergence between absorptive and secretory lineages, and 3) forcibly dedifferentiated enterocytes exhibit fructose sensing and lifespan extension.

PMID: 28336548 [PubMed - indexed for MEDLINE]

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