MicroRNA and mesial temporal lobe epilepsy with hippocampal sclerosis: Whole miRNome profiling of human hippocampus

Summary

Objective

Mesial temporal lobe epilepsy (mTLE) is a severe neurological disorder characterized by recurrent seizures. mTLE is frequently accompanied by neurodegeneration in the hippocampus resulting in hippocampal sclerosis (HS), the most common morphological correlate of drug resistance in mTLE patients. Incomplete knowledge of pathological changes in mTLE+HS complicates its therapy. The pathological mechanism underlying mTLE+HS may involve abnormal gene expression regulation, including posttranscriptional networks involving microRNAs (miRNAs). miRNA expression deregulation has been reported in various disorders, including epilepsy. However, the miRNA profile of mTLE+HS is not completely known and needs to be addressed.

Methods

Here, we have focused on hippocampal miRNA profiling in 33 mTLE+HS patients and nine postmortem controls to reveal abnormally expressed miRNAs. In this study, we significantly reduced technology-related bias (the most common source of false positivity in miRNA profiling data) by combining two different miRNA profiling methods, namely next generation sequencing and miRNA-specific quantitative real-time polymerase chain reaction.

Results

These methods combined have identified and validated 20 miRNAs with altered expression in the human epileptic hippocampus; 19 miRNAs were up-regulated and one down-regulated in mTLE+HS patients. Nine of these miRNAs have not been previously associated with epilepsy, and 19 aberrantly expressed miRNAs potentially regulate the targets and pathways linked with epilepsy (such as potassium channels, γ-aminobutyric acid, neurotrophin signaling, and axon guidance).

Significance

This study extends current knowledge of miRNA-mediated gene expression regulation in mTLE+HS by identifying miRNAs with altered expression in mTLE+HS, including nine novel abnormally expressed miRNAs and their putative targets. These observations further encourage the potential of microRNA-based biomarkers or therapies.

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Diagnostic performance of a newly developed salivary cortisol and cortisone measurement using an LC–MS/MS method with simple and rapid sample preparation

Abstract

Background

Late-night salivary cortisol level is one of the first-line tests recommended by the Endocrine Society for the diagnosis of endogenous hypercortisolism. Most routine laboratories measure cortisol levels using immunoassay tests which fail to determine low cortisol levels accurately due to the numerous interfering substances. A liquid chromatography–tandem mass spectrometry (LC–MS/MS) method with simple and rapid sample preparation was developed for the simultaneous measurement of cortisol and cortisone and its performance in the diagnosis of endogenous hypercortisolism was evaluated.

Methods

324 late-night saliva samples were analyzed from which 272 samples were derived from patients with a suspected diagnosis of endogenous hypercortisolism. Salivary cortisol levels were assayed using an electrochemiluminescent immunoassay (ECLIA, Cortisol II, Roche), and simultaneous measurement of cortisol and cortisone was performed using an LC–MS/MS method.

Results

A strong correlation between cortisol results measured using ECLIA and LC–MS/MS (r ² = 0.892) was demonstrated. Receiver operating characteristics (ROC) analysis showed good diagnostic performance of cortisol and cortisone levels assayed using LC–MS/MS method and for cortisol measured using ECLIA.

Conclusions

Late-night salivary cortisol and cortisone are useful parameters for the diagnosis of hypercortisolism. Using samples obtained from patients where the diagnosis of hypercortisolism is extremely challenging cut-off values for midnight salivary cortisol and cortisone measured by LC–MS/MS method were established.

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Beveled posteromedial corner of the radial head: a three-dimensional micro-computed tomography modeling study

Abstract

The posteromedial quadrant of the radial head is known to be different from the other quadrants. However, the explanation of this unique anatomical feature remains elusive. Hence, this study was designed to address this unique anatomical variance using three-dimensional μCT (micro-computed tomography) analysis. Nine fresh cadaveric radial heads were scanned using μCT. Three-dimensional subchondral bone and cartilage models were rendered. Both models were separated into the four quadrants at both the periphery (rim) and the articulating dish (fovea): anteromedial (AM), posteromedial (PM), posterolateral (PL), and anterolateral (AL). Each quadrant was analyzed in terms of (1) subchondral bone porosity (SBP), (2) mean subchondral bone thickness (MSBT), and (3) mean cartilage thickness (MCT). There was a significant difference between the fovea and the rim in terms of its microarchitectural features. Although within the fovea, the PM quadrant did not differ significantly from the other quadrants, a significant difference was found within the rim. In terms of SBP, PM, AM, PL and AL were calculated as 33, 37, 36 and 35%, respectively. In terms of MSBT, PM, AM, PL and AL were calculated as 0.11, 0.10, 0.09, and 0.09 mm, respectively. In terms of MCT, PM, AM, PL and AL were calculated 1.09, 0.81, 0.84 and 0.83 mm, respectively. The PM corner of the radial head between the 8 and 9 o'clock positions, was beveled. This might explain why the PM quadrant of the rim differed significantly from the other quadrants in terms of its microarchitectural features.

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Prognostic significance of Daxx NCR (Nuclear/Cytoplasmic Ratio) in gastric cancer

Abstract

In addition to regulating apoptosis via its interaction with the death domain of Fas receptor, death domain associated protein 6 (Daxx) is also known to be involved in transcriptional regulation, suggesting that the function of Daxx depends on its subcellular localization. In this study, we aimed to explore Daxx subcellular localization in gastric cancer (GC) cells and correlate the findings with clinical data in GC patients. Seventy pairs of tissue samples (GC and adjacent normal tissue) were analyzed immunohistochemically for Daxx expression and localization (nuclear and cytoplasmic). The Daxx Nuclear/Cytoplasmic ratio (Daxx NCR) values in tissue microarray data with 522 tumor samples were further analyzed. The defined Prior cohort (n = 277, treatment between 2006 and 2009) and Recent cohort (n = 245, treatment between 2010 and 2011) were then used to examine the relationship between Daxx NCR and clinical data. The Daxx NCR was found to be clinically informative and significantly higher in GC tissue. Using Daxx NCR (risk ratio = 2.0), both the Prior and Recent cohorts were divided into high- and low-risk groups. Relative to the low-risk group, the high-risk patients had a shorter disease free survival (DFS) and overall survival (OS) in both cohorts. Importantly, postoperative chemotherapy was found having differential effect on high- and low-risk patients. Such chemotherapy brought no survival benefit, (and could potentially be detrimental,) to high-risk patients after surgery. Daxx NCR could be used as a prognosis factor in GC patients, and may help select the appropriate population to benefit from chemotherapy after surgery.

Daxx NCR can be used as a prognosis factor in GC patients, and may provide an alternative view on adjuvant chemotherapy in patients with gastric cancer.

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Superficial hemangioma is better treated by topical 5-aminolevulinic followed by 595-nm pulsed dye laser therapy rather than 595-nm laser therapy alone

Abstract

The aim of this study was to compare the efficacy and adverse effects of a 595-nm pulsed dye laser therapy alone (PDL alone) with a 5-aminolevulinic (5-ALA) local application followed by a 595-nm PDL (5-ALA PDL) in the treatment of superficial hemangioma (SH). A prospectively randomized study in 181 patients with SH was carried out over a period of 24 months. One hundred and ninety-three patients were seen. One hundred and eighty-one patients with SH were enrolled, of which 165 completed final follow-up. One hundred and nineteen patients received PDL alone and 46 received 5-ALA PDL. The patients were assessed clinically and the patient's parents were given a satisfaction questionnaire. Baseline patient data (gender, lesion size, lesion site, treatment times, cure rate, and adverse reactions) were recorded and the results of the treatment of the two groups were analyzed and compared. Complete clearing of the lesion (recovery grade 4) was achieved in 44/119 (37.0%) of the PDL alone group and 31/46 (67.4%) of the 5-ALA PDL group (X ² = 10.30, p < 0.001). Atrophic scars, hyper- and hypopigmentation occurred in both groups (X ² = 3.32, p = 0.564). The patients' parents' satisfaction was greater in the 5-ALA PDL group. The clinical outcome of 5-ALA PDL was superior to that of PDL alone in the treatment of SH and only minor adverse events occurred in each group.

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Diagnostic performance of a newly developed salivary cortisol and cortisone measurement using an LC–MS/MS method with simple and rapid sample preparation

Abstract

Background

Late-night salivary cortisol level is one of the first-line tests recommended by the Endocrine Society for the diagnosis of endogenous hypercortisolism. Most routine laboratories measure cortisol levels using immunoassay tests which fail to determine low cortisol levels accurately due to the numerous interfering substances. A liquid chromatography–tandem mass spectrometry (LC–MS/MS) method with simple and rapid sample preparation was developed for the simultaneous measurement of cortisol and cortisone and its performance in the diagnosis of endogenous hypercortisolism was evaluated.

Methods

324 late-night saliva samples were analyzed from which 272 samples were derived from patients with a suspected diagnosis of endogenous hypercortisolism. Salivary cortisol levels were assayed using an electrochemiluminescent immunoassay (ECLIA, Cortisol II, Roche), and simultaneous measurement of cortisol and cortisone was performed using an LC–MS/MS method.

Results

A strong correlation between cortisol results measured using ECLIA and LC–MS/MS (r ² = 0.892) was demonstrated. Receiver operating characteristics (ROC) analysis showed good diagnostic performance of cortisol and cortisone levels assayed using LC–MS/MS method and for cortisol measured using ECLIA.

Conclusions

Late-night salivary cortisol and cortisone are useful parameters for the diagnosis of hypercortisolism. Using samples obtained from patients where the diagnosis of hypercortisolism is extremely challenging cut-off values for midnight salivary cortisol and cortisone measured by LC–MS/MS method were established.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uI4OCx

AMBIGUITY IN A MASCULINE WORLD: Being a BRCA1/2 mutation carrier and a man with prostate cancer

Abstract

Background

Increased risk of prostate cancer(PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

Methods

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a Framework approach. 'Masculinity theory' was used to report the impact of having both a BRCA1/2 mutation and PCa.

Results

Eleven of 15 eligible men were interviewed. The umbrella concept of 'Ambiguity in a Masculine World' was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as 'on the back burner' but 'a bonus' enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical 'ideal' masculine responses such as stoicism and control while creating new 'masculinities' when faced with the vicissitudes of having two gendered conditions.

Conclusion

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

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Epithelial-to-Mesenchymal and Mesenchymal-to-Epithelial Transition in Mesenchymal Tumors: A Paradox in Sarcomas?

The epithelial-to-mesenchymal transition (EMT) is a reversible process comprised of various subprograms via which epithelial cells reduce their intercellular adhesions and proliferative capacity while gaining a mesenchymal phenotype with increased migratory and invasive properties. This process has been well described in several carcinomas, which are cancers of epithelial origin, and is crucial to metastatic tumor cell dissemination and drug resistance. In contrast, the precise role of EMT-related processes in tumors originating from mesenchymal tissues, such as bone and soft-tissues sarcomas, is still largely unclear. In fact, although the existence of the EMT in sarcomas appears paradoxical because these cancers are, by definition, mesenchymal ab initio, accumulating evidence suggests that many sarcomas can undergo EMT-related processes, which may be associated with aggressive clinical behavior. These processes may be especially operative in certain sarcoma subtypes, such as carcinosarcomas displaying a biphenotypic morphology with characteristics of both mesenchymal and epithelial tumors. In this review, we discuss findings regarding the potential existence of EMT-related processes in sarcomas and propose that sarcomas can reside in a metastable state, enabling them to become either more mesenchymal or epithelial under specific conditions, which likely has important clinical implications. Cancer Res; 77(17); 1–6. ©2017 AACR.

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Transglutaminase 2 Is a Direct Target Gene of YAP-TAZ—Response

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Transglutaminase 2 Is a Direct Target Gene of YAP/TAZ—Letter

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De Novo Lipid Synthesis facilitates Gemcitabine Resistance Through Endoplasmic Reticulum Stress In Pancreatic Cancer

Pancreatic adenocarcinoma is moderately responsive to gemcitabine-based chemotherapy, the most widely used single agent therapy for pancreatic cancer. While the prognosis in pancreatic cancer remains grim in part due to poor response to therapy, previous attempts at identifying and targeting the resistance mechanisms have not been very successful. By leveraging TCGA dataset, we identified lipid metabolism as the metabolic pathway that most significantly correlated with poor gemcitabine response in pancreatic cancer patients. Furthermore, we investigated the relationship between alterations in lipogenesis pathway and gemcitabine resistance by utilizing tissues from the genetically engineered mouse model and human pancreatic cancer patients. We observed a significant increase in fatty acid synthase (FASN) expression with increasing disease progression in a spontaneous pancreatic cancer mouse model, and a correlation of high FASN expression with poor survival in patients and poor gemcitabine responsiveness in cell lines. We observed a synergistic effect of FASN inhibitors with gemcitabine in pancreatic cancer cells in culture and orthotopic implantation models. Combination of gemcitabine and the FASN inhibitor orlistat significantly diminished stemness, in part due to induction of ER stress that resulted in apoptosis. Moreover, direct induction of ER stress with thapsigargin caused a similar decrease in stemness and showed synergistic activity with gemcitabine. Our in vivo studies with orthotopic implantation models demonstrated a robust increase in gemcitabine responsiveness upon inhibition of fatty acid biosynthesis with orlistat. Altogether, we demonstrate that fatty acid biosynthesis pathway manipulation can help overcome the gemcitabine resistance in pancreatic cancer by regulating ER stress and stemness.

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Targeting a single alternative polyadenylation site coordinately blocks expression of androgen receptor mRNA splice variants in prostate cancer

Prostate cancer is the second leading cause of male cancer deaths due to disease progression to castration resistant prostate cancer (CRPC). Androgen receptor (AR) splice variants including AR-V7 function as constitutively active transcription factors in CRPC cells, thereby promoting resistance to AR-targeted therapies. To date, there are no AR variant specific treatments for CRPC. Here we report that the splicing of AR variants AR-V7 as well as AR-V1 and AR-V9 is regulated coordinately by a single polyadenylation signal in AR intron 3. Blocking this signal with morpholino technology or silencing of the polyadenylation factor CPSF1 caused a splice switch that inhibited expression of AR variants and blocked androgen-independent growth of CRPC cells. Our findings support the development of new therapies targeting the polyadenylation signal in AR intron 3 as a strategy to prevent expression of a broad array of AR variants in CRPC.

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Pleural epithelioid angiosarcoma with lymphatic differentiation arisen after radiometabolic therapy for thyroid carcinoma: immunohistochemical findings and review of the literature

Pleural angiosarcoma is a rare tumor that causes diffuse pleural thickening and effusion, mimicking mesothelioma. Immunohistochemistry is needed to highlight endothelial differentiation. We describe the first ...

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Expression of HLA-DR genes in gliomas: correlation with clinicopathological features and prognosis

Abstract

Background

Human leukocyte antigen (HLA)-DR is a classical major histocompatibility complex (MHC) class II molecule encoded by five genes: HLA-DRA, HLA-DRB1, HLA-DRB3, HLA-DRB4 and HLA-DRB5. The current study aimed to investigate the role of these genes in gliomas by analyzing microarray data.

Methods

We enrolled 305 patients with histologically confirmed gliomas, and performed microarray data analysis along with studying their clinical characteristics. A new variable, termed HLA-DR score, was defined to explain the expression information of all five HLA-DR genes by factor analysis. HLA-DR scores in each grade of glioma and normal brain tissue were compared using one-way ANOVA. Lastly, correlations of HLA-DR scores with progression-free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier and Cox analysis.

Results

Our study indicated that an increased HLA-DR score, i.e. overexpression of HLA-DR genes, was correlated with a more aggressive glioma tumor grade (p < 0.001, One-way ANOVA). Moreover, the HLA-DR score was significantly higher in astrocytic tumors than oligodendroglial tumors (−0.718 ± 3.177 versus −2.975 ± 2.662, t-test) in low-grade gliomas (LGGs). Kaplan-Meier analysis of both PFS (p = 0.046, log-rank test; p = 0.021, Breslow test) and OS (p = 0.029, Breslow test) showed significant differences in the clinical outcomes between LGG patients with high versus low HLA-DR scores. Finally, the HLA-DR score was further identified to be an independent prognostic factor of clinical outcomes by multivariate analysis (p = 0.042 and p = 0.025, for PFS and OS, respectively) in LGG patients.

Conclusion

Expression of HLA-DR genes can be used to predict the tumor grade in gliomas, and the histological subtype in LGG. Furthermore, they are also an independent predictor for LGG patient survival.

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PPAR{gamma} Ligand-induced Annexin A1 Expression Determines Chemotherapy Response via Deubiquitination of Death Domain Kinase RIP in Triple Negative Breast Cancers

Metastatic breast cancer is still remain incurable so far, new specifically targeted and more effective therapies for triple negative breast cancer (TNBC) are required in the clinic. In this study, our clinical data has established that basal and claudin-low subtypes of breast cancer (TNBC types) express significantly higher levels of Annexin A1 (ANXA1) with poor survival outcomes. Using human cancer cell lines which model the TNBC subtype, we observed a strong positive correlation between expression of ANXA1 and Peroxisome Proliferator-Activated Receptor gamma (PPAR). A similar correlation between these two markers was also established in our clinical breast cancer patients' specimens. To establish a link between these two markers in TNBC, we show de novo expression of ANXA1 is induced by activation of PPAR both in vitro and invivo and it has a predictive value in determining chemo-sensitivity to PPAR ligands. Mechanistically, we show for the first time PPAR-induced ANXA1 protein directly interacts with Receptor Interacting Protein-1 (RIP1), promoting its deubiquitination and thereby activating the caspase 8-dependent death pathway. We further identified this underlying mechanism also involved a PPAR-induced ANXA1-dependent autoubiquitination of cIAP1, the direct E3 ligase of RIP1, shifting cIAP1 towards proteosomal degradation. Collectively, our study provides first insight for the suitability of using drug-induced expression of ANXA1 as a new player in RIP1-induced death machinery in TNBCs. Hitherto, presenting itself both as an inclusion criterion for patient selection and surrogate marker for drug response in future PPAR chemotherapy trials.

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Efficacy of fractional lasers in treating alopecia: a literature review

Abstract

Hair loss stemming from different types of alopecia, such as androgenic alopecia and alopecia areata, negatively affects over half the population and, in many circumstances, causes serious psychosocial distress. Current treatment options for alopecia, such as minoxidil, anthralin, and intralesional corticosteroids, vary efficacy and side effect profiles. It is known that low-level laser/light therapies (LLLT), or photobiomodulations, such as the US FDA-cleared HairMax Lasercomb®, He-Ne laser, and excimer laser, are relatively affordable, user-friendly, safe, and effective forms of treatment for hair loss. While less is known about the effectiveness of fractional lasers for combating hair loss, research suggests that by creating microscopic thermal injury zones, fractional lasers may cause an increase in hair growth from a wound healing process, making them potential therapeutic options for alopecia. A literature review was performed to evaluate the effectiveness of fractional lasers on hair regrowth. The specific fractional laser therapies include the 1550-nm nonablative fractional erbium-glass laser, the ablative fractional 2940-nm erbium:YAG laser, and the ablative fractional CO₂ fractional laser. Additional randomized controlled trials are necessary to further evaluate the effectiveness of the lasers, as well as to establish appropriate parameters and treatment intervals.

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Immunological Reactivity Using Monoclonal and Polyclonal Antibodies of Autoimmune Thyroid Target Sites with Dietary Proteins

Many hypothyroid and autoimmune thyroid patients experience reactions with specific foods. Additionally, food interactions may play a role in a subset of individuals who have difficulty finding a suitable thyroid hormone dosage. Our study was designed to investigate the potential role of dietary protein immune reactivity with thyroid hormones and thyroid axis target sites. We identified immune reactivity between dietary proteins and target sites on the thyroid axis that includes thyroid hormones, thyroid receptors, enzymes, and transport proteins. We also measured immune reactivity of either target specific monoclonal or polyclonal antibodies for thyroid-stimulating hormone (TSH) receptor, 5′deiodinase, thyroid peroxidase, thyroglobulin, thyroxine-binding globulin, thyroxine, and triiodothyronine against 204 purified dietary proteins commonly consumed in cooked and raw forms. Dietary protein determinants included unmodified (raw) and modified (cooked and roasted) foods, herbs, spices, food gums, brewed beverages, and additives. There were no dietary protein immune reactions with TSH receptor, thyroid peroxidase, and thyroxine-binding globulin. However, specific antigen-antibody immune reactivity was identified with several purified food proteins with triiodothyronine, thyroxine, thyroglobulin, and 5′deiodinase. Laboratory analysis of immunological cross-reactivity between thyroid target sites and dietary proteins is the initial step necessary in determining whether dietary proteins may play a potential immunoreactive role in autoimmune thyroid disease.

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Incidence of Discomfort During Pure-Tone Audiometry and Measurement of Uncomfortable Loudness Levels Among People Seeking Help for Tinnitus and/or Hyperacusis

Purpose

The aim of this study was to assess the proportion of patients seen in a tinnitus and hyperacusis therapy clinic for whom presentation levels based on the British Society of Audiology (BSA)–recommended procedures for pure-tone audiometry and determination of uncomfortable loudness levels (ULLs) exceed ULLs, leading to discomfort during administration of these procedures.

Method

This was a retrospective cross-sectional study of 362 consecutive patients who attended a National Health Service audiology clinic for tinnitus and/or hyperacusis rehabilitation.

Results

For 21% of the patients, presentation levels based on the BSA procedure for pure-tone audiometry exceeded the ULL for at least 1 of the measured frequencies (excluding the first frequency tested, 1 kHz): 0.25, 0.5, 2, 3, 4, 6, and 8 kHz. For 24% of patients, the starting presentation level of 60 dB hearing level recommended for determination of ULLs exceeded the ULL for at least 1 frequency.

Conclusion

The starting presentation levels used for pure-tone audiometry and measurement of ULLs should be lower than those recommended by the BSA for people with tinnitus and hyperacusis.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_AJA-17-0011/2649301/Incidence-of-Discomfort-During-PureTone-Audiometry

Outcome of hearing preservation related to tumor morphologic analysis in acoustic neuromas treated by gamma knife radiosurgery

Gamma Knife radiosurgery (GKRS) is an important part of the neurosurgical armamentarium in the treatment of acoustic neuromas. However, the treatment outcome related to the morphology of the tumor has not been...

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Classification of chronic radiation-induced ulcers in the chest wall after surgery in breast cancers

To explore the methods of clinical classification in chronic radiation-induced ulcers in the chest wall (CRUCWs).

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Factors affecting survival after concurrent chemoradiation therapy for advanced hepatocellular carcinoma: a retrospective study

Concurrent chemoradiation therapy (CCRT) followed by hepatic arterial infusional chemotherapy (HAIC) was reported to be effective for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. Howeve...

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Intensity-modulated versus 3-dimensional conformal radiotherapy in the definitive treatment of esophageal cancer: comparison of outcomes and acute toxicity

Though the vast majority of seminal trials for locally advanced esophageal cancer (EC) utilized three-dimensional conformal radiotherapy (3DCRT), the advanced and highly conformal technology known as intensity...

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Key Word Signing Usage of Adults With Intellectual Disabilities: Influence of Communication Partners' Sign Usage and Responsivity

Purpose

In services for adults with intellectual disabilities, various staff members may have different key word signing (KWS) skills and conversational style. Little is known about how these clients use KWS with different staff members. Therefore, we observed staff–client conversations and examined how clients' KWS usage was shaped by staff members' KWS usage and conversational style.

Method

Three 10-min dyadic conversations between an adult with moderate or severe intellectual disabilities (N = 15) and three familiar staff members were filmed and transcribed. The KWS usage and conversational responsivity in the transcriptions was analyzed at group (using generalized estimating equations), subgroup, and individual levels.

Results

Clients appeared to produce significantly more KWS as partners imitated more signs and as partners were more responsive. There was a negative interaction between these two factors. Subgroup analyses showed that spontaneity of clients' KWS usage was a continuum.

Conclusion

Findings suggest that staff can encourage clients' KWS usage by imitating manual signs but that clients' response efficiency should also be taken into account.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/853/2646495/Key-Word-Signing-Usage-of-Adults-With-Intellectual

Tutorial: Speech Assessment for Multilingual Children Who Do Not Speak the Same Language(s) as the Speech-Language Pathologist

Purpose

The aim of this tutorial is to support speech-language pathologists (SLPs) undertaking assessments of multilingual children with suspected speech sound disorders, particularly children who speak languages that are not shared with their SLP.

Method

The tutorial was written by the International Expert Panel on Multilingual Children's Speech, which comprises 46 researchers (SLPs, linguists, phoneticians, and speech scientists) who have worked in 43 countries and used 27 languages in professional practice. Seventeen panel members met for a 1-day workshop to identify key points for inclusion in the tutorial, 26 panel members contributed to writing this tutorial, and 34 members contributed to revising this tutorial online (some members contributed to more than 1 task).

Results

This tutorial draws on international research evidence and professional expertise to provide a comprehensive overview of working with multilingual children with suspected speech sound disorders. This overview addresses referral, case history, assessment, analysis, diagnosis, and goal setting and the SLP's cultural competence and preparation for working with interpreters and multicultural support workers and dealing with organizational and government barriers to and facilitators of culturally competent practice.

Conclusion

The issues raised in this tutorial are applied in a hypothetical case study of an English-speaking SLP's assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/691/2629126/Tutorial-Speech-Assessment-for-Multilingual

Measuring Explicit Word Learning of Preschool Children: A Development Study

Purpose

The purpose of this article is to present preliminary results related to the development of a new measure of explicit word learning. The measure incorporated elements of explicit vocabulary instruction and dynamic assessment and was designed to be sensitive to differences in word learning skill and to be feasible for use in clinical settings.

Method

The explicit word learning measure included brief teaching trials and repeated fine-grained measurement of semantic knowledge and production of 3 novel words (2 verbs and 1 adjective). Preschool children (N = 23) completed the measure of explicit word learning; standardized, norm-referenced measures of expressive and receptive vocabulary; and an incidental word learning task.

Results

The measure of explicit word learning provided meaningful information about word learning. Performance on the explicit measure was related to existing vocabulary knowledge and incidental word learning.

Conclusions

Findings from this development study indicate that further examination of the measure of explicit word learning is warranted. The measure may have the potential to identify children who are poor word learners.

Supplemental Material

http://ift.tt/2tuNXz3

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/961/2643506/Measuring-Explicit-Word-Learning-of-Preschool

Case History Risk Factors for Specific Language Impairment: A Systematic Review and Meta-Analysis

Purpose

Research suggests that the best approach to early identification of children with specific language impairment (SLI) should include assessment of risk factors. However, previous attempts to develop a list for this purpose have been unsuccessful. In this study, systematic review and meta-analytic procedures were used to determine whether any case history factors can be used to identify toddlers at risk of developing SLI.

Method

Epidemiological studies that examined the association between risk factors and SLI were identified. Results across studies were aggregated to determine more precisely the strength of association between each risk factor and the development of SLI. The clinical significance of these factors was established via comparison to late talker status.

Results

Eleven risk factors were found to be statistically significant predictors of SLI. Among these, maternal education level, 5-min Apgar score, birth order, and biological sex met criteria for clinical significance.

Conclusions

At least 4 case history factors are as predictive as late talker status in the context of early identification of toddlers at risk for SLI. The findings of this review highlight the importance of taking a child's genetic and environmental context into consideration when deciding whether further evaluation and early intervention services are warranted.

Supplemental Materials

http://ift.tt/2tjCLFj

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/991/2643340/Case-History-Risk-Factors-for-Specific-Language

Language Sampling With Adolescents: Building a Normative Database With Fables

Purpose

The goal of the study was to create a language sampling task appropriate for adolescents and to contribute normative data from speakers with typical language development.

Method

Thirty adolescents (mean age = 14 years, 1 month) participated in an interview that involved the retelling and interpretation of 4 Greek fables. Each speaker's performance on the task was audio-recorded, transcribed verbatim, and entered into the Systematic Analysis of Language Transcripts computer program (Miller & Iglesias, 2015). Samples were analyzed statistically for language productivity and syntactic complexity. In addition, each participant's perspective on the moral messages of the fables was examined informally.

Results

The Fables task was effective in prompting adolescents to use complex language and in encouraging them to express their opinions about the moral messages. Although boys and girls did not differ in their performance on the task, some fables were more effective than others at eliciting spoken language and complex syntax. Moreover, the adolescents tended to agree with the moral messages of the fables and appeared to find them relevant to their lives.

Conclusion

The Fables task has potential for clinical use with adolescents. Research is necessary to expand the normative database to include larger and more diverse groups of adolescents.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/908/2645245/Language-Sampling-With-Adolescents-Building-a

Teaching Transnasal Endoscopy to Graduate Students Without a Hospital or Simulation Laboratory: Pool Noodles and Cadavers

Purpose

This study reports on a training opportunity in endoscopy in which speech-language pathology graduate students use inanimate objects and cadavers. Best practices for transnasal endoscopy in vivo require a physician to be nearby, but many graduate programs do not have this access.

Method

Endoscopy was offered as a graduate elective. Students (13 women) initially learned to manipulate the endoscope through the lumen of a swimming pool noodle that was embedded with trinkets. Endoscopic examination of inanimate objects became increasingly complex, followed by endoscopic examination of a cadaver.

Results

Pre- and postexamination measures and qualitative data from the 13 students revealed that students increased in confidence and in interest in this aspect of the field. All students met practical competencies for handling the endoscope, passing the endoscope on a narrow tube, and visualizing objects. Some students had the opportunity to pass the endoscope on a peer and did so successfully.

Conclusion

For programs with a cadaver lab available, this protocol offers an affordable option compared with purchasing a simulator. For those with neither a cadaver lab nor a simulation lab, passing the endoscope on inanimate objects alone is beneficial to student development and learning.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/709/2634869/Teaching-Transnasal-Endoscopy-to-Graduate-Students

Reporting of Socioeconomic Status in Pediatric Language Research

Purpose

This study examined language-focused research articles published in 3 American Speech-Language-Hearing Association journals to: (a) determine the proportion that reported the socioeconomic status (SES) of pediatric participants and (b) identify the indicators used to represent SES in these articles.

Method

Researchers reviewed articles published from 2000–2015 in Language, Speech, and Hearing Services in Schools, the American Journal of Speech-Language Pathology, and the Journal of Speech, Language, and Hearing Research (language section) that involved pediatric participants and focused on language development, as well as on assessment and intervention for language disorders.

Results

For the 3 journals combined, 417 out of the total 652 (64%) pediatric language articles reported SES of the participants. Over the 16-year period there was an increase in SES reporting of 31.8% (55.6% to 73.3%). The types of SES indicators used represented education, income, and occupation.

Conclusion

Although SES reporting for pediatric participants in language-based studies increased over the 16-year period examined, over 1 quarter of studies published in the 3 journals combined still do not report SES. This is a concern. When determining the generalizability of research findings to specific children, it is important for speech-language pathologists to be able to identify the SES background of research participants.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/1042/2648891/Reporting-of-Socioeconomic-Status-in-Pediatric

A Collaborative Model for Return to Academics After Concussion: Athletic Training and Speech-Language Pathology

Purpose

In this article, we describe an academic concussion management protocol designed for grades Pre-K to 12, called Cognitive Return to Exertion (CoRTEx). Collaboration between the speech-language pathologist (SLP) and athletic trainer (AT) is highlighted.

Method

A description of CoRTEx is provided, and the need for collaboration is emphasized. A case study illustrates an example of how CoRTEx can be implemented at the individual student level.

Results

A total of 165 students went through CoRTEx from the pilot in April 2014 through December 2016. Referrals to CoRTEx were highest for football, blows to the head, and soccer. Anecdotal evidence suggests that CoRTEx provided necessary support for students and their families, although research is needed to provide objective data.

Conclusions

CoRTEx and other similar protocols can be used as models for SLPs to create their own academic concussion management protocols. For cases in which the injured student is an athlete, the SLP–AT collaboration is critical to carefully coordinate return to academics and return to play so that students are successful in school, as well as ready to safely return to sport. Suggestions are made for designing research studies that can provide empirical evidence for the efficacy of such academic concussion management protocols.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/716/2648884/A-Collaborative-Model-for-Return-to-Academics

Speech-Language Pathologists' Use of Intelligibility Measures in Adults With Dysarthria

Purpose

Speech-language pathologists (SLPs) who work with adults with dysarthria were surveyed to investigate trends of clinical practice for assessing speech intelligibility.

Method

Two hundred ninety-six SLPs responded to an online survey October 22–November 30, 2015.

Results

Findings showed that 35% of SLPs lacked access to any standardized assessments of intelligibility, with 66% of these implicating cost as the main reason. Work settings played a role, as all SLPs working in Veterans Affairs hospitals and 97% of SLPs working in university or research clinics reported access to at least one formal assessment. Even with access to formal tools to measure intelligibility, most SLPs preferred less formal measures. It is surprising to note that many SLPs reported using physical examinations (e.g., of cranial nerves and oral mechanisms) to measure speech intelligibility.

Conclusions

Results indicate the need to increase SLP familiarity with, and access to, currently available standardized assessments, as well as to improve education regarding the fundamental need to rate speech to assess intelligibility. Clinicians may also benefit from new standardized methods to objectively assess intelligibility that are accessible, practical, and efficient.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/873/2648032/SpeechLanguage-Pathologists-Use-of-Intelligibility

Variability of the Pressure Measurements Exerted by the Tip of Laryngoscope During Laryngeal Sensory Testing: A Clinical Demonstration

Purpose

Clinicians often test laryngeal sensation by touching the laryngeal mucosa with the tip of a flexible laryngoscope. However, the pressure applied to the larynx by using this touch method is unknown, and the expected responses elicited by this method are uncertain. The variability in pressure delivered by clinicians using the touch method was investigated, and the subject responses to the touches were also reported.

Methods

A fiberoptic pressure sensor passed through the working channel of a laryngoscope, with its tip positioned at the distal port of the channel. Two examiners each tested 8 healthy adults. Each examiner touched the mucosa covering the left arytenoid 3 times. The sensor recorded the pressure exerted by each touch. An investigator noted subject responses to the touches. From the recorded videos, the absence or presence of the laryngeal adductor reflex in response to touch was judged.

Results

Pressure values obtained for 46 of the 48 possible samples ranged from 17.9 mmHg to the measurement ceiling of 350.0 mmHg. The most frequently observed response was positive subject report followed by the laryngeal adductor reflex.

Conclusion

Pressure applied to the larynx by using the touch method was highly variable, indicating potential diagnostic inaccuracy in determining laryngeal sensory function.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/729/2645949/Variability-of-the-Pressure-Measurements-Exerted

Language Samples From Children Who Use Speech-Generating Devices: Making Sense of Small Samples and Utterance Length

Purpose

Mean length of utterance in morphemes (MLUm) is underreported in people who use augmentative and alternative communication (AAC). MLUm is difficult to measure in people who use AAC because of 2 challenges described in literature: the challenge of small language samples (difficulty collecting representative samples) and the challenge of transcribing short utterances (difficulty transcribing 1-morpheme utterances). We tested solutions to both challenges in a corpus of language samples from children who use speech-generating devices.

Method

The first challenge was addressed by adjusting the length of the sampling window to obtain representative language samples. The second challenge was addressed by using mean syntactic length (MSL) as an alternative to MLUm.

Results

A 24-hour sample window consistently failed to yield representative samples. An extended 1-month sample window consistently yielded representative samples. A significant positive prediction of MLUm by MSL was found in a normative sample. Observed measures of MSL were used to predict MLUm in representative language samples from children who use AAC.

Conclusions

Valid measures of utterance length in people who use AAC can be obtained using extended sampling windows and MSL. Research is needed to characterize the strengths and limitations of both solutions.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/939/2648883/Language-Samples-From-Children-Who-Use

Typical Toddlers' Participation in “Just-in-Time” Programming of Vocabulary for Visual Scene Display Augmentative and Alternative Communication Apps on Mobile Technology: A Descriptive Study

Purpose

Augmentative and alternative communication (AAC) promotes communicative participation and language development for young children with complex communication needs. However, the motor, linguistic, and cognitive demands of many AAC technologies restrict young children's operational use of and influence over these technologies. The purpose of the current study is to better understand young children's participation in programming vocabulary "just in time" on an AAC application with minimized demands.

Method

A descriptive study was implemented to highlight the participation of 10 typically developing toddlers (M age: 16 months, range: 10–22 months) in just-in-time vocabulary programming in an AAC app with visual scene displays.

Results

All 10 toddlers participated in some capacity in adding new visual scene displays and vocabulary to the app just in time. Differences in participation across steps were observed, suggesting variation in the developmental demands of controls involved in vocabulary programming.

Conclusions

Results from the current study provide clinical insights toward involving young children in AAC programming just in time and steps that may allow for more independent participation or require more scaffolding. Technology designed to minimize motor, cognitive, and linguistic demands may allow children to participate in programming devices at a younger age.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/737/2631566/Typical-Toddlers-Participation-in-JustinTime

Clinically Available Assessment Measures for Lingual and Labial Somatosensation in Healthy Adults: Normative Data and Test Reliability

Purpose

High-quality orofacial somatosensory inputs are essential for achieving rapid and accurate motor outputs. Little somatosensory testing is currently being completed in clinical settings. The purpose of this study is to assess the feasibility and test–retest reliability of clinical assessment tools for orofacial somatosensory testing in healthy young adults.

Method

A total of 45 healthy young adults (ages 20–41 years) was recruited. Participants reported basic health information, completed pure-tone hearing thresholds, and were assessed using two-point discrimination discs and Von Frey hair detection and discrimination thresholds for bilateral lip and tongue. A subsample of participants (n = 18; 40%) returned to complete reliability testing.

Results

Descriptive results are presented for the normative group as well as the reliability group. Difference scores between Tests 1 and 2 for each testing measure and location show high agreement.

Conclusion

Two-point discrimination and Von Frey hair monofilament assessment for both detection- and discrimination-threshold estimates have high test–retest reliability in a healthy young population. These testing measures could be a way to easily complete objective somatosensory testing of the orofacial region in a clinical context.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/982/2634379/Clinically-Available-Assessment-Measures-for

Validation of the Intelligibility in Context Scale for Jamaican Creole-Speaking Preschoolers

Purpose

To describe validation of the Intelligibility in Context Scale (ICS; McLeod, Harrison, & McCormack, 2012a) and ICS–Jamaican Creole (ICS-JC; McLeod, Harrison, & McCormack, 2012b) in a sample of typically developing 3- to 6-year-old Jamaicans.

Method

One-hundred and forty-five preschooler–parent dyads participated in the study. Parents completed the 7-item ICS (n = 145) and ICS-JC (n = 98) to rate children's speech intelligibility (5-point scale) across communication partners (parents, immediate family, extended family, friends, acquaintances, strangers). Preschoolers completed the Diagnostic Evaluation of Articulation and Phonology (DEAP; Dodd, Hua, Crosbie, Holm, & Ozanne, 2006) in English and Jamaican Creole to establish speech-sound competency. For this sample, we examined validity and reliability (interrater, test–rest, internal consistency) evidence using measures of speech-sound production: (a) percentage of consonants correct, (b) percentage of vowels correct, and (c) percentage of phonemes correct.

Results

ICS and ICS-JC ratings showed preschoolers were always (5) to usually (4) understood across communication partners (ICS, M = 4.43; ICS-JC, M = 4.50). Both tools demonstrated excellent internal consistency (α = .91), high interrater, and test–retest reliability. Significant correlations between the two tools and between each measure and language-specific percentage of consonants correct, percentage of vowels correct, and percentage of phonemes correct provided criterion-validity evidence. A positive correlation between the ICS and age further strengthened validity evidence for that measure.

Conclusions

Both tools show promising evidence of reliability and validity in describing functional speech intelligibility for this group of typically developing Jamaican preschoolers.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/750/2629897/Validation-of-the-Intelligibility-in-Context-Scale

A Systematic Review of Speech Assessments for Children With Autism Spectrum Disorder: Recommendations for Best Practice

Purpose

The purpose of this systematic review was to provide a summary and evaluation of speech assessments used with children with autism spectrum disorders (ASD). A subsequent narrative review was completed to ascertain the core components of an evidence-based pediatric speech assessment, which, together with the results of the systematic review, provide clinical and research guidelines for best practice.

Method

A systematic search of eight databases was used to find peer-reviewed research articles published between 1990 and 2014 assessing the speech of children with ASD. Eligible articles were categorized according to the assessment methods used and the speech characteristics described.

Results

The review identified 21 articles that met the inclusion criteria, search criteria, and confidence in ASD diagnosis. The speech of prelinguistic participants was assessed in seven articles. Speech assessments with verbal participants were completed in 15 articles with segmental and suprasegmental aspects of speech analyzed. Assessment methods included connected speech samples, single-word naming tasks, speech imitation tasks, and analysis of the production of words and sentences.

Conclusions

Clinical and research guidelines for speech assessment of children with ASD are outlined. Future comparisons will be facilitated by the use of consistent reporting methods in research focusing on children with ASD.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/1011/2648031/A-Systematic-Review-of-Speech-Assessments-for

Discourse Characteristics in Aphasia Beyond the Western Aphasia Battery Cutoff

Purpose

This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery–Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia.

Method

Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type–token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density.

Results

Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia.

Conclusion

Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/762/2628210/Discourse-Characteristics-in-Aphasia-Beyond-the

Effect of Vitamin D Deficiency on Voice

Purpose

The purpose of this article was to investigate the relationship between low level of vitamin D, phonatory symptoms, and acoustic findings.

Method

A total of 38 subjects presenting to the endocrinology clinic were enrolled in 2 groups: 19 with vitamin D deficiency who were not on treatment, and 19 with normal vitamin D level who were on treatment. Demographic data included age, gender, and history of smoking. All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. Acoustic analysis and perceptual evaluation using the grade, roughness, breathiness, asthenia, and strain scale were performed on all subjects.

Results

The mean age of the total group was 47.29 ± 13.52 years. The difference in the mean and frequency of phonatory effort, vocal fatigue, and dysphonia, and in the mean of the acoustic variables, perceptual parameters, and the score of the Voice Handicap Index-10 was not statistically significant between patients with low vitamin D levels compared with controls.

Conclusion

The results of this study revealed no significant difference in the prevalence of phonatory symptoms in patients with vitamin D deficiency compared with patients with no vitamin D deficiency. A larger study is needed to substantiate the difference in the prevalence of phonatory systems between the 2 groups.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/865/2648030/Effect-of-Vitamin-D-Deficiency-on-Voice

Modeling Alphabet Skills as Instructive Feedback Within a Phonological Awareness Intervention

Purpose

This study evaluated the efficacy of an instructive feedback strategy for modeling letter names and sounds during presentation of positive feedback within a small-group phonological awareness intervention for preschoolers.

Method

Two experiments were conducted using multiple-baseline designs across children and behaviors. Letter name and sound identification and performance on a phonological awareness fluency measure served as the primary outcome variables. Six children completed Experiment 1. A progressive time delay was added to instructive feedback to elicit a response from the 9 children in the second experiment.

Results

In the first experiment, 6 children demonstrated gains on phonological awareness but not alphabet knowledge. With the addition of progressive time delay in the second experiment, all 9 children demonstrated gains on letter name and sound identification as well as phonological awareness skills.

Conclusions

Progressive time delay to prompt children's responses appears to bolster the effects of instructive feedback as an efficient strategy for modeling alphabet skills within a broader early literacy curriculum. Modeling alphabet skills did not detract from, and may have enhanced, phonological awareness instruction for preschoolers.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/769/2634871/Modeling-Alphabet-Skills-as-Instructive-Feedback

A Mindfulness Practice for Communication Sciences and Disorders Undergraduate and Speech-Language Pathology Graduate Students: Effects on Stress, Self-Compassion, and Perfectionism

Purpose

The purpose of the present study was to explore the effects of a mindfulness practice on participants' levels of self-compassion, perfectionism, attention, and perceived and biological stress.

Method

This was a between-groups design. Experimental participants engaged in a short mindfulness practice weekly for one academic semester; control participants did not. All participants completed three self-report scales measuring perceived stress, self-compassion, and perfectionism before and after mindfulness sessions. In addition, electrophysiological measures were taken before and after to determine changes in biological markers of stress and attention. Experimental participants also kept reflective journals that were analyzed qualitatively.

Results

Compared with control participants, by the end of the semester, experimental participants' perceived stress levels and potentially negative aspects of perfectionism decreased and biological markers of stress and self-compassion improved. Experimental participants' reflective writings indicated they perceived the sessions to be beneficial. Although the results are promising, no significant effect was found for attention.

Conclusions

Engaging in a 20-min mindfulness practice using simple yoga posture and breath work across an academic semester appears to be effective in reducing students' perceived and biological stress levels and maladaptive aspects of perfectionism and in increasing their self-compassion. These are all factors that can improve students' overall well-being.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/893/2648033/A-Mindfulness-Practice-for-Communication-Sciences

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders

Purpose

The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders.

Method

Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers.

Results

Targeted believability was 80 or higher (0–100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable.

Conclusion

Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/26/3/791/2632137/Assessing-the-Believability-of-Standardized

SKELETAL MATERIAL FROM THE CEMETERY OF THE 19th CENTURY COPENHAGEN HOSPITAL FOR THE POOR: AUTOPSIES, SURGICAL TRAINING AND ANATOMICAL SPECIMENS

Abstract

The skeletal material of 299 individual skeletons was recovered from 78 graves in central Copenhagen in 2006. The graves were part of a temporary cemetery serving the Copenhagen Hospital for the Poor in the period 1842-1858. It is known that the hospital supplied cadavers for teaching and dissection. 52 skeletons and bones were found to have cut marks and saw marks, indicative of post-mortem surgical interventions: Dissection, autopsy, anatomical specimens and surgical practice. The material was closely examined for healing at the sawn edges and signs of diseases. It was attempted to differentiate the surgical procedures from one another and give an overview of the material and historical context. We were mostly unable to attach a specific post-mortem surgical procedure to the skeletal elements; however we present some cases that most likely represent a specific surgical intervention. An excavation of similarly processed bone material from London Hospital from the same time period was used as the main reference material. The skeletal material described here offers a view upon the medical development, teaching and training amongst surgeons and anatomists in mid-19^th century.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uH1lUF

SLHS MA students receive awards from the American Speech-Language-Hearing Association!

Two SLHS MA students, Carlos Arias and Diane Guerrero, were recently selected for ASHA's Minority Student Leadership Program. This program is designed to enhance leadership skills for speech-language pathology and audiology students from historically under-represented racial and ethnic populations.  Applicants for this program were asked to discuss career goals and past experiences in working with people with communication disorders from culturally- and linguistically-diverse (CLD) populations.  SLHS has a strong focus in training all students to work with clients from CLD populations.  We are proud that two of our students have been selected for this highly competitive program.  

As part of this program, Carlos and Diane will attend the ASHA National Convention this November. They will have the opportunity to learn more about how ASHA works, strengthen leadership skills, and interact with leaders in the field– including researchers, university faculty from across the world, ASHA leaders, clinicians, and MSLP alumni.  

We are honored to have Carlos and Diane represent SLHS and SDSU!

Congratulations, Carlos and Diane!

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uMJpDZ

Very Urgent Carotid Endarterectomy is Associated with an Increased Procedural Risk: The Carotid Alarm Study

Publication date: Available online 26 July 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): A. Nordanstig, L. Rosengren, S. Strömberg, K. Österberg, L. Karlsson, G. Bergström, Z. Fekete, K. Jood
Objective/BackgroundThe aim of the Carotid Alarm Study was to compare the procedural risk of carotid endarterectomy (CEA) performed within 48 hours with that after 48 hours to 14 days following an ipsilateral cerebrovascular ischaemic event.MethodsConsecutive patients with symptomatic carotid stenosis undergoing CEA were prospectively recruited. Time to surgery was calculated as time from the most recent ischaemic event preceding surgery. A neurologist examined patients before and, after CEA. The primary endpoint was the composite endpoint of death and/or any stroke within 30 days of the surgical procedure. The study was designed to include 600 patients, with 150 operated on within 48 hours.ResultsFrom October 2010 to December 2015, 418 patients were included, of whom 75 were operated within 48 hours of an ischaemic event. The study was prematurely terminated owing to the slow recruitment rate in the group operated on within 48 hours. Patients undergoing CEA within 48 hours had a higher risk of reaching the primary endpoint than those operated on later (8.0% vs. 2.9%). Multivariate logistic regression analyses showed that CEA performed within 48 h (odds ratio [OR] 3.07; 95% confidence interval [CI] 1.04–9.09), CEA performed out of office hours (OR 3.65; 95% CI 1.14–11.67), and use of shunt (OR 4.02; 95% CI 1.36–11.93) were all independently associated with an increased risk of reaching the primary endpoint.ConclusionCEA performed within 48 hours was associated with a higher risk of complications compared with surgery performed 48 hours–14 days after the most recent ischaemic event.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w8mKq8

Individual Differences in Heparin Sensitivity and Their Effect on Heparin Anticoagulation During Arterial Vascular Surgery

Publication date: Available online 9 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): D. Veerhoek, F. Groepenhoff, M.G.J.M. van der Sluijs, J.W.B. de Wever, J.D. Blankensteijn, A.B.A. Vonk, C. Boer, C.F.W. Vermeulen
ObjectivesTo investigate whether a fixed heparin dose results in adequate heparinisation levels and consequent inhibition of haemostatic activation in all patients.MethodsThis prospective clinical pilot study included 24 patients undergoing arterial vascular surgery. Individual heparin responsiveness was assessed using the Heparin Dose Response (HDR) test, while the activated clotting time (ACT) and heparin concentration were measured to monitor the peri-procedural degree of anticoagulation. Finally, peri-operative haemostasis was evaluated with rotational thromboelastometry (ROTEM).ResultsEight patients were identified with reduced heparin sensitivity (RS group) and 16 patients with normal heparin sensitivity (NS group). Compared with the NS group, the RS group showed less prolonged ACTs after heparinisation with heparin concentrations below the calculated target heparin concentration. ROTEM revealed shorter clot formation times in the intrinsically activated coagulation test (INTEM) 3 min (114 ± 48 s vs. 210 ± 128 s) and 30 min after the initial heparin bolus (103 ± 48 s vs. 173 ± 81 s) in the RS group compared with the NS group. In the RS group, one patient developed a major thromboembolic complication.ConclusionsThis study shows that a third of the study population had reduced heparin sensitivity, which was associated with lower levels of heparinisation, and lower inhibition levels of clot initiation and clot formation. Identifying patients with reduced heparin sensitivity by monitoring the anticoagulant effect of heparin could decrease the risk of thrombotic complications after arterial vascular surgery.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x2oTA1

Reconstruction of the femoro-ilio-caval outflow by percutaneous and hybrid interventions in symptomatic deep venous obstruction

Publication date: Available online 1 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): T.M.A.J. van Vuuren, M.A.F. de Wolf, C.W.K.P. Arnoldussen, R.L.M. Kurstjens, J.H.H. van Laanen, H. Jalaie, R. de Graaf, C.H.A. Wittens
Objective/BackgroundDeep venous obstruction is relatively prevalent in patients with chronic venous disease. Endovascular treatments and hybrid interventions can be used to relieve venous outflow obstructions. This paper assesses mid-term clinical outcomes and patency rates in a large cohort after percutaneous and hybrid interventions.MethodsThis was a prospectively analysed cohort study. Patients with symptomatic deep venous obstruction who presented at a tertiary referral hospital were divided into three groups: patients who underwent percutaneous stenting for non-thrombotic iliac vein compression syndrome (IVCS group); patients with post-thrombotic syndrome (PTS) treated by percutaneous stent placement (P-PTS group); and PTS patients with obstruction involving the veins below the saphenofemoral junction in which a hybrid procedure was performed, combining stenting with open surgical disobliteration (H-PTS group). Patency rates, complications, and clinical outcomes were analysed.ResultsA total of 425 lower extremities in 369 patients were treated. At 60 months, primary patency, assisted primary patency, and secondary patency rates were 90%, 100%, and 100% for IVCS, and 64%, 81%, and 89% for the P-PTS group, respectively. The H-PTS group, showed patency rates of 37%, 62%, and 72%, respectively, at 36 months. Venous claudication subsided in 90%, 82%, and 83%, respectively. At the 24 month follow-up, mean Venous Clinical Severity Score decreased for all patients and improvement in Villalta score was seen in post-thrombotic patients. The number of complications was related to the extent of deep venous obstruction in which patients in the H-PTS group showed the highest complication rates (81%) and re-interventions (59%).ConclusionPercutaneous stent placement to treat non-thrombotic iliac vein lesions, and post-thrombotic ilio-femoral obstructions are safe, effective, and showed patency rates comparable with previous research. Patients with advanced disease needing a hybrid procedure showed a lower patency rate and more complications. However, when successful, the clinical outcome was favourable at mid-term follow-up and the procedure may be offered to selected patients.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w8kHCy

Outcomes of Pharmacomechanical Catheter-directed Thrombolysis for Acute and Subacute Inferior Vena Cava Thrombosis: A Retrospective Evaluation in a Single Institution

Publication date: Available online 8 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): K. Ye, J. Qin, M. Yin, X. Liu, X. Lu
Objective/BackgroundThe objective was to assess the mid-term results of pharmacomechanical catheter-directed thrombolysis (PCDT) for symptomatic acute and subacute inferior vena cava (IVC) thrombosis; the risk factors of early thrombosis recurrence and iliocaval patency were also evaluated.MethodsFrom January 2010 to December 2015, 54 patients (33 men; mean age 47.1 years) with symptomatic acute and subacute IVC thrombosis were treated with PCDT. Primary technical success (clot lysis ≥ 50% after PCDT), stent-assisted technical success (residual stenosis < 30% after stenting), clinical success (freedom from thrombosis recurrence within 30 days), complications, frequency of post-thrombotic syndrome (PTS; Villalta score ≥ 5), and iliocaval patency were recorded at follow-up evaluation. A multivariate regression model was used to determine predictors of early thrombosis reoccurrence and iliocaval patency.ResultsThe primary technical success and the stent-assisted technical success were 63% (n = 34/54) and 100% (n = 54/54) respectively. There were 11 patients (20%) with immediate recurrent thrombosis requiring repeat PCDT. Minor bleeding complications occurred in seven patients, and one patient with major bleeding needed a blood transfusion. The occurrence of PTS at a mean of 26 months (range 1–60 months) was 13% (7/54). The 3-year primary and secondary iliocaval patency was 63% and 81%, respectively. On multivariate analysis, active malignancy was predictive of immediate IVC thrombosis recurrence (hazard ratio [HR] 5.8, 95% confidence interval [CI] 1.7–19.8; p = .01), whereas the pre-existing filter played a protective role against iliocaval re-occlusion (HR 0.3, 95% CI 0.1–0.8; p = .01).ConclusionsPCDT is safe and effective in managing symptomatic acute and subacute IVC thrombosis. Active malignancy is predictor of thrombosis re-occurrence, whereas the presence of a filter is associated with a higher rate of iliocaval patency at mid-term follow-up.



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Patency and Clinical Outcome After Stent Placement for Chronic Obstruction of the Inferior Vena Cava

Publication date: Available online 7 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): O. Grøtta, T. Enden, G. Sandbæk, G.F. Gjerdalen, C.-E. Slagsvold, D. Bay, N.-E. Kløw, A. Rosales
Objective/backgroundThe objective was to assess the technical success, patency, and clinical outcome after stent placement for chronic obstruction of the inferior vena cava (IVC).MethodsA retrospective analysis was carried out of patients with chronic IVC obstruction verified with computed tomography and/or magnetic resonance venography, accepted for stent placement at the Norwegian National Unit for Reconstructive Deep Venous Surgery from March 2010 to September 2015. Clinical status was categorized according to the CEAP classification and symptom severity was assessed using venous clinical severity score (VCSS). Stent patency was evaluated by colour duplex ultrasound. Large -diameter Wallstents were placed in the IVC and concurrent iliac and femoral obstructions via right internal jugular and femoral vein access. Sixteen patients presented with symptoms of chronic venous disease. Four patients had symptoms assumed to be related to a reduced cardiac preload. Twelve patients had IVC occlusion and eight had stenosis. Median follow-up was 25 months (range 3–70 months).ResultsStent placement in the IVC was successful in 19 of 20 patients. Primary patency after 24 months was 67% and secondary patency 83%. Fifteen of 19 patients had open stents at final follow-up. Re-interventions were performed in four patients and included catheter directed thrombolysis in all and adjunctive stenting in three. Thirteen of 19 patients (68%) reported a sustained and significant clinical improvement. Mean VCSS improved from 8.5 (range 3–25) at baseline to 7 (range 2–23) at final follow-up (p = .007). There were no peri-procedural or long-term complications.ConclusionThe endovascular approach with stent placement for chronic IVC obstruction is a safe treatment option that should be offered to patients who otherwise have little opportunity for sustained clinical improvement.



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Selected Abstracts from the August Issue of the Journal of Vascular Surgery

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study

Publication date: Available online 7 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): E. Baubeta Fridh, M. Andersson, M. Thuresson, B. Sigvant, B. Kragsterman, S. Johansson, P. Hasvold, M. Falkenberg, J. Nordanstig
ObjectivesThe aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD).MethodsThis was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations.ResultsA total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3–12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0–13.9) in IC patients and 48.8% (95% CI 47.7–49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation.ConclusionThe risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.



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The Impact of Compliance with Imaging Follow-up on Mortality After Endovascular Abdominal Aortic Aneurysm Repair: A Population Based Cohort Study

Publication date: Available online 29 July 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): C. de Mestral, R. Croxford, N. Eisenberg, G. Roche-Nagle
ObjectiveCompliance with regular imaging follow-up after endovascular aortic aneurysm repair (EVAR) is inconsistent, and evidence of benefit from scheduled long-term surveillance is limited. This study sought to characterize the association between post-EVAR imaging frequency and long-term survival.MethodsUsing administrative health databases for the province of Ontario, Canada, a cohort of patients was identified who underwent EVAR between 2004 and 2014. Minimum appropriate imaging follow-up (MAIFU) was defined as a CT scan or ultrasound of the abdomen within 90 days of EVAR as well as every 15 months thereafter. Multivariate time to event analyses characterized the association between compliance with MAIFU over time and all-cause mortality.Results4988 patients treated by EVAR were identified. Median follow-up was 3.4 years (IQR 2.0–5.3 years) and 90 day mortality was 1.6%. Among those who survived over 90 days, 87% (N = 4251 of 4902) underwent at least one CT scan or ultrasound of the abdomen within 90 days, but only 58% (N = 2859 of 4902) went on to meet MAIFU criteria. Infrequent imaging correlated with lower follow-up by a vascular surgeon, but not with infrequent primary care or specialist consultations. Consistently meeting MAIFU criteria was associated with a lower risk of death when compared with missing the first imaging follow-up within 90 days (HR 0.82, 95% CI 0.69–0.96, p = .014), or when compared with having first imaging follow-up within 90 days but subsequently not meeting MAIFU criteria (HR 0.78, 95% CI 0.68–0.91, p = .001). A larger proportion of the follow-up period meeting MAIFU criteria was associated with a lower risk of death.ConclusionsThese data support efforts to improve compliance with imaging surveillance after EVAR.



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Renal complications after EVAR with suprarenal versus infrarenal fixation among all users and routine users

Publication date: Available online 2 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): S.L. Zettervall, S.E. Deery, P.A. Soden, K. Shean, J.J. Siracuse, M. Alef, V.I. Patel, M.L. Schermerhorn
BackgroundPrevious studies comparing endografts with suprarenal and infrarenal fixation for endovascular abdominal aortic aneurysm repair (EVAR) have found conflicting results and did not account for differences in patient selection. This study aims to evaluate the differences in outcomes among surgeons who routinely use either suprarenal or infrarenal fixation, as well as all surgeons in the Vascular Study Group of New England (VSGNE).MethodsAll patients undergoing EVAR in the VSGNE from 2003 to 2014 were identified. All ruptured aneurysms, repairs with concomitant procedures, and infrequently used stent grafts (<50) were excluded. Suprarenal endografts included Talent, Zenith, and Endurant; infrarenal endografts included AneuRx and Excluder. Grafts were compared among surgeons who used only one type of endograft (suprarenal or infrarenal) for >80% of cases, as well as all surgeons. Multivariate regression and Cox hazard models were utilised to account for patient demographics, comorbidities, operative differences, and procedure year.ResultsThis study identified 2574 patients (suprarenal, 1264; infrarenal, 1310) with 888 endografts placed by routine users (suprarenal, 409; infrarenal, 479). There were no differences in baseline comorbidities, including the estimated glomerular filtration rate, between suprarenal and infrarenal fixation, or between patients with endografts placed by routine and non-routine users. Patients treated with suprarenal endografts received more contrast than all users (102 mL vs. 100 mL, p = .01) and routine users (110 mL vs. 88 mL, p < .01), but other vascular and operative details were similar. Among all users, patients treated with suprarenal grafts had higher rates of creatinine increase >.5 mg/dL (3.7% vs. 2.0%, p = .01), length of stay >2 days (27% vs. 19%, p < .01), and discharge to a skilled nursing facility (9.2% vs. 6.7%, p = .02). There were no differences in 30 day or 1 year mortality. Following adjustment, suprarenal stent grafts remained associated with an increased risk of renal deterioration (OR 2.0; 95% CI 1.2–3.4) and prolonged length of stay (OR 1.8; 95% CI 1.4–2.2). Among routine users, suprarenal fixation was also associated with higher rates of renal dysfunction (3.7% vs. 1.3%, p = .02; OR 2.9; 95% CI 1.1–7.8).ConclusionDespite potential differences in patient selection, endografts with suprarenal fixation among all users and routine users were associated with higher rates of renal deterioration and longer length of hospital stay. Longer-term data are needed to determine the duration and severity of renal function decline and to identify potential benefits of decreased migration or endoleak.



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Aorta Related and All-cause Mortality in Patients with Aortic Intramural Haematoma

Publication date: Available online 10 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): F.S. Schoenhoff, C. Zanchin, M. Czerny, V. Makaloski, B. Gahl, T. Carrel, J. Schmidli
ObjectivesThe prognosis of patients with intramural haematoma (IMH) of the aorta beyond the first year after diagnosis remains largely unknown. In particular, patients that do not undergo interventions are lost to follow-up. The aim was to assess medium-term outcome in IMH patients.MethodsPost hoc analysis of 63 consecutive patients presenting with IMH between 1999 and 2013 was performed. Patients meeting imaging criteria at the first presentation were included even if follow-up imaging showed evidence of intimal disruption or false lumen flow.ResultsEighteen patients presented with type A and 45 with type B IMH (29% vs. 71%, p < .001). The mean age was 71 ± 9.2 years, range 42–88 years. Follow-up was completed in 97% of patients by May 2017 and represents a mean follow-up of 6.3 ± 3.6 years. Freedom from intervention in patients with type B IMH was 40%. TEVAR was performed in 47% because of development, unmasking of an entry tear (57%), progression to acute type B dissection (24%), or subsequent dilation of the affected aortic segments (19%). Open repair was performed in 13% of type B IMH patients because of dilation of the descending aorta. In type A IMH, 89% underwent open repair. Aorta related 30 day, 6 month, 1 year, and late mortality were 1.6%, 6.3%, 6.3%, and 9.5%, respectively, for all IMH patients. All-cause 30 day, 6 month, 1 year, and late mortality were 1.6%, 6.3%, 6.3%, and 47.6%, respectively, for all IMH patients. Late mortality in type B IMH did not differ whether patients underwent TEVAR, open repair, or received best medical treatment only (26% vs. 22%, p = 1.0).ConclusionsLate aorta related mortality in IMH was low whereas all-cause mortality was substantial. Aorta related mortality in IMH patients only occurs during the first year after diagnosis. Interventions after the first year are rarely necessary.



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Editorial Board

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Contents

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Forthcoming Events

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Commentary on “A Pilot Study of Femoropopliteal Artery Revascularisation With a Low dose Paclitaxel Coated Balloon: Is Predilatation Necessary?”

Publication date: Available online 29 July 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): N. Chakfé




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Long Non-coding RNA–mRNA Correlation Analysis Reveals the Potential Role of HOTAIR in Pathogenesis of Sporadic Thoracic Aortic Aneurysm

Publication date: Available online 27 July 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): X. Guo, Q. Chang, H. Pei, X. Sun, X. Qian, C. Tian, H. Lin
Objective/BackgroundLong non-coding RNA (lncRNA) play important roles in many diseases. However, their roles in sporadic thoracic aortic aneurysm (STAA) are unclear. Therefore, the objective of this study was to construct an lncRNA–mRNA network and dissect lncRNAs that might contribute to the pathogenesis of STAA.MethodsDifferentially expressed lncRNAs and mRNAs between four ascending aortic specimens derived from STAA and four controls from patients who had undergone coronary artery bypass graft (CABG) were identified by microarray analysis. Gene Ontology (GO) enrichment and lncRNA–mRNA correlation analysis were implemented with differentially expressed genes. An lncRNA in the correlation network HOX transcript antisense intergenic RNA (HOTAIR) was selected as a candidate. HOTAIR expression was examined by quantitative real time polymerase chain reaction in STAA (n = 24) and controls (n = 24 [CABG, n = 22; heart transplant donors, n = 2]). HOTAIR expression was knocked down with siRNA in order to evaluate its role in apoptosis, cell proliferation, and expression of collagen types I and III.ResultsFive percent of lncRNAs were significantly differentially expressed in STAA patient samples compared with controls. GO enrichment analysis suggested differentially expressed genes were significantly enriched in the process of extracellular matrix organisation and leukocyte migration. lncRNA–mRNA interaction network revealed HOTAIR was associated with genes involved in extracellular matrix organisation. Moreover, HOTAIR expression was significantly decreased in STAA specimens and it negatively correlated with aortic diameter. HOTAIR knockdown induced early and late apoptosis and reduced cell proliferation. Furthermore, both mRNA and protein levels of collagen types I and III expression were suppressed after HOTAIR knockdown.ConclusionTranscriptomic and lncRNA–mRNA correlation analysis revealed HOTAIR was downregulated in STAA and associated with genes involved in extracellular matrix remodelling. In vitro experiments confirmed that knockdown of HOTAIR could induce apoptosis and suppress collagen types I and III expression in human aortic smooth muscle cells.



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Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Publication date: Available online 25 July 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): F. Pecoraro, M. Lachat, N.S. Cayne, D. Pakeliani, Z. Rancic, G. Puippe, F.J. Criado, T. Pfammatter, F.J. Veith, B. Krüger, T.A. Neff
PurposeReport mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB).MethodsRetrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed.ResultsForty-one patients (28.05% EuroScore II) with thoraco-abdominal aortic aneurysm (17%), arch aneurysm (39%), descending aneurysm (34%), and aneurysm extending from the arch to the visceral aorta (10%) were included. Fifteen (37%) patients were treated non-electively. Fifty-nine SABs were treated with the CPG technique: one, two, three, and four CPG were employed in 71%, 19%, 5%, and 5% of patients, respectively. The proximal landing was in zone 0 in 49% of patients, zone 1 in 17%, and zone 2 in 34%. Technical success was 95%. Peri-operative complications and neurological events were registered in six (14.6%) patients and there were 5 deaths (12%). At a median follow-up of 21.2 (mean 22, SD 18; range 0–65) months, type I/III endoleaks were registered in three (7%) cases and re-intervention in six (15%) patients. A significant aneurysm sac shrinkage (p<.001) was reported at mean follow-up and no significant aneurysm sac increase (>5 mm). The estimated 2 year survival, freedom from re-intervention, freedom from endoleak, and freedom from branch occlusion were 75%, 77%, 86%, and 96%, respectively.ConclusionThe chimney and periscope grafts technique was shown to be safe in aortic aneurysm disease involving the supra aortic branches, even in an emergency setting using off the shelf devices. Mid-term follow-up results in this high risk population are good, but longer follow-up is mandatory before this technique is used in intermediate-risk patients.



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One year on: Test your knowledge from the previous year

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Commentary on “Outcomes of Self Expanding Polytetrafluoroethylene Covered Stent versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modeling”

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2
Author(s): P. Vikatmaa




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Abstracts from Issue 35 of EJVES Short Reports

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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EJVES vol. 54, issue 2 (August 2017) - Spanish Translated Abstracts

Publication date: August 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 2





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Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms

Abstract

Introduction

Transanal minimally invasive surgery (TAMIS) is an endoscopic operating platform for local excision of rectal neoplasms. However, it may be technically demanding, and its learning curve has yet to be adequately defined. The objective of this study was to determine the number of TAMIS procedures for the local excision of rectal neoplasm required to reach proficiency.

Methods and procedures

All TAMIS cases performed from 07/2009 to 12/2016 at a single high-volume tertiary care institution for local excision of benign and malignant rectal neoplasia were identified from a prospective database. A cumulative summation (CUSUM) analysis was performed to determine the number of cases required to reach proficiency. The main proficiency outcome was rate of margin positivity (R1 resection). The acceptable and unacceptable R1 rates were defined as the R1 rate of transanal endoscopic microsurgery (TEM—10%) and traditional transanal excision (TAE—26%), which was obtained from previously published meta-analyses. Comparisons of patient, tumor, and operative characteristics before and after TAMIS proficiency were performed.

Results

A total of 254 TAMIS procedures were included in this study. The overall R1 resection rate was 7%. The indication for TAMIS was malignancy in 57%. CUSUM analysis reported that TAMIS reached an acceptable R1 rate between 14 and 24 cases. Moving average plots also showed that the mean operative times stabilized by proficiency gain. The mean lesion size was larger after proficiency gain (3.0 cm (SD 1.5) vs. 2.3 cm (SD 1.3), p = 0.008). All other patient, tumor, and operative characteristics were similar before and after proficiency gain.

Conclusions

TAMIS for local excision of rectal neoplasms is a complex procedure that requires a minimum of 14–24 cases to reach an acceptable R1 resection rate and lower operative duration.

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Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers

Abstract

Background

Laparoscopic complete mesocoloic excision (CME) with central vascular ligation for splenic flexure cancer is technically challenging because of its anatomical complexity. Although embryological and anatomical consideration should be helpful to perform CME in colorectal cancer surgery, such studies on the splenic flexure are lacking.

Methods

The splenic flexure is located embryologically between the terminal portion of the midgut and the beginning of the hindgut, and is supplied by the superior mesenteric and inferior mesenteric arteries. The mesentery of the transverse and descending colon originally is a continuous sheet, although they rotate and partially fuse to each other during development. Our surgical strategy was excision of the transverse and descending mesocolon with ligation of the left colic artery and left branch of the middle colic artery, and extraction of the specimen in an intact package wrapped by the embryological planes.

Results

We performed laparoscopic surgery according to our surgical strategy in 17 patients with splenic flexure colon cancer. There were no conversions to open surgery or serious intraoperative complications. Two patients had pathological stage (pStage) I, 5 pStage II, 9 pStage III, and 1 pStage IV disease. No patient had recurrence except for 1 with pStage IV cancer, with a median follow-up of 16 months.

Conclusions

Our laparoscopic CME technique is feasible for treatment of splenic flexure cancer. Knowledge of anatomy based on embryology is essential to perform this surgery.

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Accredited residents perform colonoscopy to the same high standards as consultants

Abstract

Background

Endoscopy remains a critical component of General Surgery and Gastroenterology training. Whilst residents need to gain experience, the quality of endoscopy which patients receive cannot be compromised. We conducted this study to compare quality indicators between consultants and residents with regards to colonoscopy.

Methods

A review of colonoscopies from a prospectively collected database was performed from September 2011 to February 2016. Quality indicators such as caecum intubation rate, adenoma detection rate, adherence to a 6-min withdrawal rule, mean number of polyps detected per colonoscope, and complications were collected and compared between the two groups.

Results

In total, out of 25,749 colonoscopies that were performed, 14,168 (55.0%) were performed by Consultants. Consultants achieved a better caecum intubation rate compared with residents (96.0% vs 94.9%, p < 0.001), and were more compliant to the 6-min withdrawal rule (74.7% vs 68.6%, p < 0.001). There were, however, no statistically significant differences in the adenoma detection rate (33.5% vs 34.5%, p = 0.098). Bleeding was a rare complication that was encountered more frequently in colonoscopies performed by consultants than for residents (0.002% vs 0.00008%, p < 0.001). There were only three (%) perforations in the entire series, and all were from colonoscopies performed by Consultants.

Conclusion

Given the proper training, residents are able to perform colonoscopy with the same level of competence as consultants. Whilst colonoscopic related complications are often tied to the difficulty of the procedures, the adherence to the 6-min withdrawal rule must be reinforced and continually educated to both residents and consultants.

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Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice

Abstract

Objective

Analysis of various parameters related to the patient, the disease, and the needed surgical maneuvers to develop guidance for preoperative selection of the appropriate and the best approach for a given patient.

Summary background data

Rapid advances in minimally invasive surgical technology are fascinating and challenging alike. It can be difficult for surgeons to keep up with new modalities that come on to the market place and to assess their true value, i.e., distinguish between fashionable trends versus scientific evidence. Laparoscopy established minimally invasive surgery and has revolutionized surgical concepts and approaches to diseases since its advent in the early 1990s. Now, with robotic surgery rapidly gaining traction in this high-tech surgical landscape, it remains to be seen how the long-term surgical landscape will be affected.

Methods

Review of the surgical evolution, published data and cost factors to reflect on advantages and disadvantages in order to develop a broader perspective on the role of various technology platforms.

Results

Advocates for robotic technology tout its advantages of 3D views, articulating wrists, lack of hand tremor, and surgeon comfort, which may extend the scope of minimally invasive surgery by allowing for operations in places that are more difficult to access for laparoscopic surgery (e.g., the deep pelvis), for complex tasks (e.g., intracorporeal suturing), and by decreasing the learning curve. But conventional laparoscopy has also evolved and offers high-definition 3D vision to all team members. It remains to be seen whether all together the robot features outweigh the downsides of higher cost, operative times, lack of tactile feedback, possibly unusual complications, inability to move the operative table with ease, and the difficulty to work in different quadrants.

Conclusions

While technical and design developments will likely address some shortcomings, the value-based impact of the various approaches will have to be examined in general and on a case-by-case basis. Value as the ratio of quality over cost depends on numerous parameters (disease, complications, patient, efficiency, finances).

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Laparoscopic colectomy reduces complications and hospital length of stay in colon cancer patients with liver disease and ascites

Abstract

Background

Ascites increases perioperative complications and risk of death, but is not an absolute contraindication for colectomy in patients with colon cancer. It remains unclear whether postoperative risks can be minimized using a laparoscopic versus open approach.

Methods

Data were retrospectively analyzed from 2152 patients with ascites who underwent laparoscopic or open partial colectomy with diagnosis of colon cancer from 2005 to 2013 using the American College of Surgeons National Surgical Quality Improvement Program database. Postoperative outcomes were analyzed using two-sample tests of proportions and two-sample T tests. Adjusted odds ratios (OR) or β coefficients for postoperative complications, hospital length of stay, and 30-day mortality were calculated using multivariable logistic or linear regression. P values <0.05 two-tailed were considered statistically significant.

Results

205 patients (9.53%) with ascites underwent laparoscopic colectomy (LC). There was no significant difference in operative time between laparoscopic versus open surgery (145 vs. 146 min, P = 0.69). LC was associated with decreased likelihood of overall complications (adjusted OR 0.7 95% CI 0.4–1.0, P = 0.046) and shorter hospital length of stay (9 days vs. 15 days, adjusted β = −4.2, 95% CI −7.7 to −0.7, P = 0.018). There was no difference in 30-day mortality (adjusted OR 0.82, 95% CI 0.50–1.35, P = 0.429).

Conclusions

Laparoscopic colectomy decreases postoperative complications and hospital length of stay in patients with colon cancer and ascites. Laparoscopic approach should be considered for patients in this high-risk population.

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