External Beam Radiation Therapy for Amyloidosis of the Urinary Bladder

Publication date: Available online 16 August 2017
Source:Practical Radiation Oncology
Author(s): Christopher T. Cooper, Bruce D. Greene, Jeffrey E. Fegan, Douglas Rovira, Morie A. Gertz, David M. Marcus




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A multi-institutional phase II trial of prostate stereotactic body radiation therapy (SBRT) utilizing continuous real-time evaluation of prostate motion with patient reported quality of life

Publication date: Available online 16 August 2017
Source:Practical Radiation Oncology
Author(s): William C. Jackson, Robert T. Dess, Dale W. Litzenberg, Pin Li, Matthew Schipper, Seth A. Rosenthal, Garrick C. Chang, Eric M. Horwitz, Robert A. Price, Jeff M. Michalski, Hiram A. Gay, John T Wei, Mary Feng, Felix Y. Feng, Howard M. Sandler, Robert E. Wallace, Daniel E. Spratt, Daniel A. Hamstra
PurposeThe use of stereotactic body radiation therapy (SBRT) for prostate cancer has been reported predominantly from single institutional studies while concerns for broader adoption exist.Methods and MaterialsFrom 2011–2013, 66 men were accrued to a phase II trial at five centers. SBRT consisted of 5 fractions of 7.4 Gy to 37 Gy using conventional linear accelerators. Electromagnetic transponders were utilized for motion management. Health-related quality of life (HRQOL) was evaluated via the EPIC-26 questionnaire. Acute and late toxicities were collected by common terminology criteria for adverse events (CTCAE) version 4.0. Linear mixed modeling was performed to assess changes in HRQOL over time.ResultsMedian follow-up was 36 months. All men had low or intermediate-risk disease. There have been zero biochemical recurrences. No grade 3 urinary or bowel toxicity was reported. Twenty-three percent of patients had acute grade 2 urinary toxicity, with 9% late grade 2 urinary toxicity. Four and 5% experienced acute or late grade 2+ bowel toxicity, respectively. Urinary bother and bowel HRQOL transiently decreased during the first 6–12 months post-SBRT, and then returned to baseline. In men with good erectile function at baseline, sexual HRQOL declined during the first 6 months and stabilized thereafter. On linear mixed modeling the strongest predictor of sustained bowel and sexual HRQOL was baseline HRQOL.ConclusionsIn this multi-institutional phase II clinical trial utilizing continuous real-time evaluation of prostate motion, prostate SBRT has excellent intermediate-term tumor control with mild and expected treatment-related side effects.



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Measuring Safety Culture: Application of The Hospital Survey on Patient Safety Culture to Radiotherapy Departments Worldwide

Publication date: Available online 16 August 2017
Source:Practical Radiation Oncology
Author(s): Sarah Leonard, Anita O'Donovan
BackgroundMinimising errors and improving patient safety has gained prominence worldwide in high risk disciplines such as radiotherapy. Patient safety culture has been identified as an important factor in reducing the incidence of adverse events and improving patient safety in the healthcare setting.PurposeThe aim of distributing the Hospital Survey on Patient Safety Culture (HSPSC) to radiotherapy departments worldwide was to assess the current status of safety culture, identify areas for improvement and areas that excel, examine factors which influence safety culture and to raise staff awareness.Materials and MethodsThe safety culture in radiotherapy departments worldwide was evaluated by distributing the HSPSC. A total of 266 participants were recruited worldwide from radiotherapy departments and included radiation oncologists, radiation therapists, physicists and dosimetrists.ResultsThe positive percent scores for the 12 dimensions of the HSPSC varied from 50% to 79%. The highest composite score amongst the 12 dimensions was teamwork within units and the lowest composite score was handoffs and transitions.ConclusionThe results indicated that health care professionals in radiotherapy departments felt positively towards patient safety. The HSPSC was successfully applied to radiotherapy departments and provided a valuable insight into areas of potential improvement such as teamwork across units, staffing and handoffs and transitions. Managers and policy makers in radiotherapy may use this assessment tool for focused improvement efforts towards patient safety culture.



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High-Intensity Exercise Enhances Conduit Artery Vascular Function in Older Adults.

Purpose: Modulation of vascular function follows an exercise intensity-dependent pattern in young adults. This study aimed to investigate the potential intensity-dependent effects of an acute bout of exercise on conduit and resistance artery function in healthy older adults. Methods: Eleven healthy older adults (5 males/6 females, 66+/-1 years) completed 30 minutes of recumbent cycling at 50-55% (low-intensity) and 75-80% (high-intensity) of their age-predicted maximal heart rate on two separate study visits. Doppler ultrasound measures of brachial artery flow-mediated dilation (FMD) and reactive hyperemia (RH) were taken at baseline, ten minutes post-exercise, and one hour post-exercise. Additionally, cardiovascular hemodynamics and brachial shear rate were measured every five minutes during exercise. Results: Brachial artery FMD was enhanced ten minutes after high-intensity (4.8+/-0.2 to 9.1+/-0.3%, P0.05). Conclusion: Our data indicate that high-intensity exercise acutely enhances conduit artery function in healthy older adults. Additionally, an acute bout of exercise enhances resistance artery function independent of intensity. (C) 2017 American College of Sports Medicine

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Masthead

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Association between serum osteocalcin and body mass index: a systematic review and meta-analysis

Abstract

Purpose

Osteocalcin is considered as a bone-derived hormone affecting on the body fat distribution and body mass index. Several cross-sectional studies have investigated the association between serum osteocalcin and body mass index. The aim of this study was to summarize the evidence on the relationship between serum osteocalcin and body mass index.

Methods

We conducted a complete search up to November 2016 in PubMed and SCOPUS and reviewed reference list of all relevant articles and reviews. The DerSimonian–Laird method were used to pool effect sizes of eligible studies. The potential sources of heterogeneity were assessed using the standard χ ² test.To find possible the sources of between-study heterogeneity, we carried out subgroup analyses based on sex, and type of study population.

Results

There was a significant inverse association in the overall result of this study between serum osteocalcin levels and BMI(r = −0.161; 95% CI: −0.197, −0.124, p < 0.000). In the subgroup analysis to find the sources of significant heterogeneity between-study, we observed that the type of the study population may be the source of between-study heterogeneity and the most correlation was seen in metabolic syndrome studies (r = −0.265; p = 0.000).

Conclusion

Findings from the available data indicated an overall significant inverse association between serum osteocalcin and body mass index. Further studies based on the type of study population are needed to better clarify these associations.

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Change in Care Transition Practice for Patients with Non-Specific Chest Pain after ED Evaluation 2006-2012

Abstract

Objectives

From 2005-2010 healthcare financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with non-specific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Diagnostic advances and reimbursement limitations on the use of inpatient admission are encouraging the use of alternative ED care transition practices. In the setting of these health care changes, we hypothesized there is a decline in inpatient admission rates for patients with non-specific CP after ED evaluation.

Methods

We retrospectively used the Nationwide ED Sample (NEDS) to quantify total and annual inpatient hospital admission rates from 2006-2012 for patients with a final ED diagnosis of non-specific CP. We assessed the change in admission rates over time, and stratified by facility characteristics including: safety-net hospital status, US geographic region, urban/teaching status, trauma-level designation, and hospital funding status.

Results

The admission rate for all patients with a final ED diagnosis of non-specific CP declined from 19.2% in 2006 to 11.3% in 2012. Variability across regions was observed, while metropolitan teaching hospitals and trauma centers reflected lower admission rates.

Conclusion

There was a 41.1% decline in inpatient-hospital admission for patients with non-specific CP after ED evaluation. This reduction is temporally associated with national policy changes affecting reimbursement for inpatient admissions.

This article is protected by copyright. All rights reserved.

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Patient and System Factors Related to Missed Opportunities for Screening in an EMR-driven, Opt-out HIV Screening Program in the Emergency Department

Abstract

Objective

Emergency Departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and non-targeted, EMR-driven, opt-out, HIV screening program.

Methods

This was a retrospective, cross sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between 11/18/2014 and 7/15/2015. The HIV screening workflow included three sequential events, all of which were required to get screened for HIV at the ED visit. The events were having a blood draw, being informed of the HIV screening policy by an ED nurse at the point of blood draw, and the patient consenting to the HIV test. Each event represented a dichotomous outcome and its association with six patient factors (age, gender, race/ethnicity, marital status, preferred language, and Emergency Severity Index (ESI)) and two health system factors (ED crowding and program phase) was investigated using multivariable modeling.

Results

A total of 15,918 ED visits were analyzed. Blood was drawn in 8,388 of 15,918 visits (53%). Of 8,388 visits where blood was drawn, there were 5,947 (71%) visits where ED nurses documented informing patients of the HIV screening policy. Of those visits, patient consent to the HIV test was documented at 3,815 (64%) visits. Patients between 13-19 years of age were significantly less likely to have blood drawn, to be informed of the screening policy, and to consent to the HIV test compared to other age groups. Both ED crowding and a patient's ESI were associated with decreased odds of having a blood draw and being informed of HIV screening by an ED nurse, but showed no association with patients consenting to the HIV test.

Conclusion

Many patients, particularly adolescents and young adults, are missed in ED HIV screening programs that require blood draw and depend on providers to obtain consent for testing. To ensure these patients are reached, future ED screening programs should strive to develop innovative workflows that allow for blood draws for HIV screening only and streamline the processes of obtaining informed consent and ordering tests for all eligible patients.

This article is protected by copyright. All rights reserved.

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Effect of Maternal Antibody Transfer on Antibody Dynamics and Control of Porcine Circovirus Type 2 Infection in Offspring

Viral Immunology , Vol. 0, No. 0.


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The core planar cell polarity gene, Vangl2, maintains apical-basal organisation of the corneal epithelium

Abstract

The role of the core planar cell polarity (PCP) pathway protein, Vangl2, was investigated in the corneal epithelium of the mammalian eye, a paradigm anatomical model of planar cell migration. The gene was conditionally knocked out in vivo and knocked down by siRNA, followed by immunohistochemical, behavioural and morphological analysis of corneal epithelial cells. The primary defects observed in vivo were of apical-basal organisation of the corneal epithelium, with abnormal stratification throughout life, mislocalisation of the cell membrane protein, Scribble, to the basal side of cells, and partial loss of the epithelial basement membrane. Planar defects in migration after wounding and in the presence of an applied electric field were noted. However, knockdown of Vangl2 also retarded cell migration in individual cells that had no contact with their neighbours, which precluded a classic PCP mechanism. It is concluded that some of the planar polarity phenotypes in PCP mutants may arise from disruption of apical-basal polarity.

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Mandibular coronoidectomy could significantly accelerate the healing process of infratemporal fossa abscess

Publication date: Available online 17 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yi-Wen Liu, Krishna Prasad Regmi, Ming-Chao Ding, Yan Li, Lei Tian, Bo-Lei Cai
PurposeThe management of an infratemporal fossa abscess (IFA), which is a specific form of severe and advanced deep fascial space infections (DFIs), is mainly based on the traditional methods. The purpose of this study is to investigate the role of mandibular coronoidectomy in accelerating IFA healing.MethodsThis research is a single center retrospective study which composed of 23 IFA patients. The predictor variables were sex, age, diabetes, severity score and mandibular coronoidectomy. The outcome variables included hospitalization time (HT), and irrigating time (IT). A compare of treatment outcomes between the improved and the traditional surgical intervention of IFA was performed.ResultsCompared to patients in NC group (who did not receive mandibular coronoidectomy; HT/IT=17.54±1.80 / 38.54±3.73 days), our results showed that patients in AC group (who accepted mandibular coronoidectomy) had significantly decreased HT/IT (7.20±1.19 / 15.10±1.27 days; P<0.01). We also found 4 (31%) patients in NC group received reoperation for osteomyelitis, but no osteomyelitis and DFIs recurrence happened to patients in AC group.ConclusionsMandibular coronoidectomy with extra intraoral drainage could significantly accelerate the healing process of IFA patients and obviously decrease the reoperation rate for osteomyelitis.



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Nanomechanical Assessment of Bone Surrounding Implants Loaded for 3 Years in a Canine Experimental Model.

Publication date: Available online 17 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rodolfo B. Anchieta, Márcia V.M. Guimarães, Marcelo Suzuki, Nick Tovar, Estevam A. Bonfante, Pablo Atria, Paulo G. Coelho
PurposeThis work evaluated bone nanomechanical properties around submerged and immediately loaded implants after 3 years in vivo. It was hypothesized that bone nanomechanical properties would significantly increase in immediately and functionally loaded implants compared to submerged.MethodsThe second, third, and fourth right premolars and the first molar of ten adult Doberman dogs were extracted. After six months, four implants were placed in one side of the mandible. The mesial implant received a cover screw and remained unloaded. The remaining three implants received fixed prostheses within 48 hours after surgery which remained in occlusal function for three years. After sacrifice, the bone was prepared for histological and nanoindentation analysis. Nanoindentation was carried out under wet conditions on bone areas within the plateaus. Indentations (n=30 per histological slide) were performed with a maximum load of 300 μN (loading rate: 60 μN/s) followed by a holding and unloading time of 10s and 2s, respectively. Elastic modulus (E) and hardness (H) were computed in GigaPascal (GPa). The amount of bone-to-implant contact (BIC) was also evaluated.ResultsThe E and H values for cortical bone regions were higher than trabecular bone regardless of load condition, but not statistically significant (p>.05). The E and H values were higher for loaded implants than submerged (p<.05), for cortical and trabecular bone. For the same load condition, the E and H values for cortical and trabecular bone were not statistically different (p>.05). The loaded and submerged implants presented (mean ± SD) 57.4 ± 12.1 % and 62 ±7.5% BIC (p>.05).ConclusionThe elastic modulus and hardness of bone around dental implants, measured by nanoindentation, were higher for immediately loaded compared to submerged implants.



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The use of antibiotics in odontogenic infections: what is the best choice? A systematic review

Publication date: Available online 17 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): João Roig Martins, Otacílio Luiz Chagas Júnior, Bibiana Dalsasso Velasques, Ângelo Niemczewski Bobrowski, Marcos Britto Correa, Marcos Antonio Torriani
PurposeOdontogenic infections are a common problem in dentistry and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to take a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the PICO format: When should antibiotics be used in dental infections (DIs), which are the most effective drugs and for how long should they be administered?MethodsThis was a systematic review using PubMed, Scopus and Cochrane databases without restriction as to the period of time researched. The variables analyzed in each studied article were number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotic administered, statistical differences between groups studied and patient's evolution after treatment.ResultsThe search included 1109 articles. After the full reading of 46 articles, 16 of them were included in the final review and 30 were excluded. A sample of 2197 dental infection cases was obtained, in which 15 different antibiotics were used, with a 98.2 % overall cure rate.ConclusionThe studies showed that antibiotics were prescribed only in situations of regional and / or systemic body manifestations. In the case of dental infections, once drainage has been performed and / or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When a real need of antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.



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Effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion

Publication date: Available online 17 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Akram S. Alyessary, Adrian U.J. Yap, Siti Adibah Othman, Mohammad T. Rahman, Zamri Radzi
PurposeThis study investigated the effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion.MethodsSixteen male New Zealand white rabbits (20-24 weeks old) were randomly divided into the following four experimental groups (n=4): group 1, conventional rapid sutural expansion; group 2, accelerated sutural expansion; group 3, accelerated sutural expansion with continuous ostectomy; and group 4, accelerated sutural expansion with discontinuous ostectomy. All sutural ostectomies were performed using a piezoelectric instrument (Woodpecker DTE, DS-II., Guangxi, China) prior to expander application under anesthesia. Modified hyrax expanders were placed across the midsagittal sutures of the rabbits and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax expanders were activated 0.5 mm/day for 12 days (group 1) or 2.5 mm initial expansion followed by 0.5 mm/day for 7 days (groups 2 to 4). After 6 weeks of retention, bone volume fraction, sutural separation and new bone formation were evaluated using micro-computed tomography and histomorphometry. Statistical analysis was performed using Kruskal-Wallis / Mann-Whitney U tests and Spearman's rho correlation (p<0.05).ResultsRanking of median sutural separation was as follows: group 1 (3.05 mm), group 2 (3.97 mm), group 4 (4.78 mm) and group 3 (5.66 mm). The least and most bone formation were observed with groups 1 (63.63%) and 3 (75.93%), respectively. Spearman's correlation showed strong, positive and significant correlation (r= 0.932, p<0.01) between the new sutural bone formation and amount of sutural separation.ConclusionPiezoelectric sutural ostectomies increase the rate of sutural separation and promotes new sutural bone formation / osteogenesis. Continuous ostectomy gave better results than discontinuous ostectomy.



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Closed approach for horizontal augmentation of the maxilla

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Michael S. Block
The narrow ridge in the anterior maxilla often requires horizontal augmentation for ideal implant placement. This article reviews the historical use of a closed, tunnel approach to augment deficient alveolar ridges and describes its application for augmentation of the narrow ridge in the anterior maxilla. The use of a tunnel approach through a vertical incision in the unattached mucosa provides access to the ridge while maintaining crestal attachments without displacement of the crestal attached gingiva. This approach is atraumatic and provides excellent access for placement of graft material for ridge augmentation.



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Down-regulation of Aquaporin 5-mediated Epithelial-Mesenchymal Transition and Anti-metastatic Effect by Natural Product Cairicoside E in Colorectal Cancer

Abstract

Epithelial-mesenchymal transition (EMT) has emerged as an important determinant role in colorectal cancer (CRC) metastasis. It has been reported that aquaporin 5 (AQP5) is closely linked to CRC metastasis. However, the effect of AQP5 on the EMT process of CRC remains unknown. The current study showed that overexpression of AQP5 activated EMT in CRC cells. Cairicoside E (CE), a natural resin glycoside compound isolated from Ipomoea cairica, showed promising cytotoxic activity in our previous report. Further investigation found that CE inhibited the expression of AQP5 and the EMT process. Moreover, the inhibitory effect of CE on EMT was reversed by overexpression of AQP5. Importantly, CE also suppressed the EMT and p-Smad2/3 induced by TGF-β1. On the other hand, overexpression of AQP5 up-regulated the p-Smad2/3, which resulted in the activation of EMT. After silencing of AQP5, CE had no significant effect on EMT markers and p-Smad2/3 induced by TGF-β1, indicating that CE inhibited the EMT through down-regulation of AQP5 and suppression of p-Smad2/3. CE also inhibited the AQP5 expression in the lung metastatic nodules of HCT-116 cells in vivo. Our findings suggested that CE may serve as a promising drug for the treatment of CRC metastasis. This article is protected by copyright. All rights reserved

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Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ola B. Al-Batayneh, Reem A. Jbarat, Susan N. Al-Khateeb
ObjectiveTo explore how application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride influences remineralization of enamel white spot lesions (WSL) in primary teeth.DesignIn this in-vitro study, artificial WSLs were created in 130 primary teeth. Teeth were divided into 4 groups (n=27) and a control group (n=22) and exposed to one of the following remineralization regimens for 10 weeks: Group-1; 500ppm fluoride dentifrice; Group-2; 10% w/v CPP-ACP; Group-3; fluoride applied first, then CPP-ACP; Group-4; CPP-ACP applied first, then fluoride, and Group-5 was control. All groups were kept in a remineralizing solution. Mineral changes (ΔF) were quantified weekly using quantitative light-induced fluorescence. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS version 20.0).ResultsRemineralization occurred in all groups to different degrees; changes from baseline were significant in groups 1–4 (P≤0.05). Group-4 showed the earliest significant remineralization (after 2 weeks) among groups, (P<0.001). Group-4 showed maximum changes in ΔF among groups; however, only differences with Groups 1 and 5 were significant (P<0.05 and P<0.01, respectively). Group-3 showed better remineralization than Groups 1, 2 and 5; however, the difference was only significant with Group-5 (P<0.001). There were no significant differences between Group 1and 2, however, only Group 2 showed better remineralization than Group 5, (P<0.01).ConclusionCombined treatment with CPP-ACP followed by fluoride exhibited the best remineralization of white spot lesions in primary teeth in this study. Combined treatment with fluoride followed by CPP-ACP showed a tendency towards better remineralization than fluoride or CPP-ACP alone.



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Amelogenin induces M2 macrophage polarisation via PGE2/cAMP signalling pathway

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Kensuke Yamamichi, Takao Fukuda, Terukazu Sanui, Kyosuke Toyoda, Urara Tanaka, Yuki Nakao, Karen Yotsumoto, Hiroaki Yamato, Takaharu Taketomi, Takeshi Uchiumi, Fusanori Nishimura
ObjectivesAmelogenin, the major component of the enamel matrix derivative (EMD), has been suggested as a bioactive candidate for periodontal regeneration. Apart from producing a regenerative effect on periodontal tissues, amelogenin has also been reported to have an anti-inflammatory effect. However, the precise molecular mechanisms underlying these effects remain unclear. In the present study, we examined the immunomodulatory effects of amelogenin on macrophages.DesignHuman phorbol 12-myristate 13-acetate (PMA)-differentiated U937 macrophages and CD14+ peripheral blood-derived monocytes (PBMC)-derived macrophages were stimulated with recombinant amelogenin (rM180). After performing a detailed microarray analysis, the effects of rM180 on macrophage phenotype and signal transduction pathways were evaluated by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, confocal microscopy and flow cytometry.ResultsThe microarray analysis demonstrated that rM180 increased the expression of anti-inflammatory genes in lipopolysaccharide (LPS)-challenged macrophages after 24h, while it temporarily up-regulated inflammatory responses at 4h. rM180 significantly enhanced the expression of M2 macrophage markers (CD163 and CD206). rM180-induced M2 macrophage polarisation was associated with morphological changes as well as vascular endothelial growth factor (VEGF) production. rM180 enhanced prostaglandin E2 (PGE2) expression, and the activation of the cAMP/cAMP-responsive element binding (CREB) signaling pathway was involved in amelogenin-induced M2 macrophage polarisation. Blocking of PGE2 signaling by indomethacin specifically abrogated rM180 with or without LPS-induced M2 shift in PBMC-derived macrophages.ConclusionAmelogenin could reprogram macrophages into the anti-inflammatory M2 phenotype. It could therefore contribute to the early resolution of inflammation in periodontal lesions and provide a suitable environment for remodeling-periodontal tissues.



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Association between serum osteocalcin and body mass index: a systematic review and meta-analysis

Abstract

Purpose

Osteocalcin is considered as a bone-derived hormone affecting on the body fat distribution and body mass index. Several cross-sectional studies have investigated the association between serum osteocalcin and body mass index. The aim of this study was to summarize the evidence on the relationship between serum osteocalcin and body mass index.

Methods

We conducted a complete search up to November 2016 in PubMed and SCOPUS and reviewed reference list of all relevant articles and reviews. The DerSimonian–Laird method were used to pool effect sizes of eligible studies. The potential sources of heterogeneity were assessed using the standard χ ² test.To find possible the sources of between-study heterogeneity, we carried out subgroup analyses based on sex, and type of study population.

Results

There was a significant inverse association in the overall result of this study between serum osteocalcin levels and BMI(r = −0.161; 95% CI: −0.197, −0.124, p < 0.000). In the subgroup analysis to find the sources of significant heterogeneity between-study, we observed that the type of the study population may be the source of between-study heterogeneity and the most correlation was seen in metabolic syndrome studies (r = −0.265; p = 0.000).

Conclusion

Findings from the available data indicated an overall significant inverse association between serum osteocalcin and body mass index. Further studies based on the type of study population are needed to better clarify these associations.

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A Novel Absorbable Radiopaque Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum in Radiotherapy of Pancreatic Cancer

Publication date: Available online 14 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Avani D. Rao, Ziwei Feng, Eun Ji Shin, Jin He, Kevin M. Waters, Stephanie Coquia, Robert DeJong, Lauren M. Rosati, Lin Su, Dengwang Li, Juan Jackson, Stephen Clark, Jeffrey Schultz, Danielle Hutchings, Seong-Hun Kim, Ralph H. Hruban, John Wong, Amol Narang, Joseph M. Herman, Kai Ding
Purpose/Objectives: We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase space between the head of the pancreas (HOP) and duodenum in a human cadaveric model.Materials/MethodsUsing three human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum via open laparotomy in one case and endoscopic-ultrasound (EUS) guidance in two cases. Cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and post-spacer injection stereotactic body radiotherapy (SBRT) plans of the two cadavers with EUS, the delivery method which appears to be most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated unresectable pancreatic cancer patients each with 6 different HOP-duodenum separation distances. Duodenal volume receiving 15 Gy (V15), 20 Gy (V20) and 33 Gy (V33) was assessed for each iteration.ResultsIn the three cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP-duodenum separation was achieved, respectively. In the two EUS cases, V20 decreased from 3.86 cc→0.36 cc and 3.75 cc→1.08 cc (treatment constraint: <3 cc), and V15 decreased from 7.07 cc→2.02 cc and 9.12 cc→3.91 cc (treatment constraint: <9 cc), respectively. PTV coverage improved or was comparable between the pre- and post-injection studies. Modeling studies demonstrated that separation of 8 mm was sufficient to consistently reduce V15, V20 and V33 to acceptable clinical constraints.ConclusionsCurrently, dose-escalation is limited due to radiosensitive structures adjacent to the pancreas. We demonstrated the feasibility of hydrogel separation of the HOP and duodenum. Future studies will evaluate the safety and efficacy of this technique with the potential for more effective dose-escalation using SBRT or intensity-modulated radiotherapy to improve outcomes in unresectable pancreatic cancer patients.

Teaser

We demonstrated the feasibility of an endoscopic ultrasound-guided injectable hydrogel separation technique using a cadaveric model to increase the space between the head of the pancreas and duodenum. Using modeling studies, we identified the minimum distance of this separation for optimal sparing of the duodenum, setting the foundation for future clinical trials utilizing this technique to enable dose-escalation with either stereotactic or intensity-modulated radiotherapy for patients with unresectable pancreatic cancer.


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Hypoalbuminemia is a Predictive Factor for Fistula Formation in Recurrent Cervical Cancer.

Objective: Antivascular endothelial growth factor monoclonal antibodies inhibit tumor angiogenesis, consequently impeding the recruitment of new vasculature to existing and new tumor lesions. We sought to evaluate toxicities in women with recurrent cervical cancer after receiving bevacizumab combination chemotherapy. Methods: A review was conducted of women with recurrent and metastatic cervical cancer who were treated with salvage chemotherapy with or without bevacizumab between 2005 and 2015. Clinicopathologic data and reasons for treatment discontinuation were recorded. Patients that were excluded had other histology than squamous or adenocarcinoma, received 1 cycle of salvage chemotherapy, single agent bevacizumab, currently on treatment, or noncompliant. Statistical analysis was performed using the Fishers Exact Test, logistic regression, and Kaplan-Meier Survival Analysis. Results: A total of 74 patients were included in analysis. Twenty-six patients were treated with bevacizumab (BEV) and chemotherapy and 48 patients with chemotherapy alone (chemotherapy). The progression free survival was significant with median 12 months versus 7 months for the BEV cohort (P

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Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

Abstract

Purpose

Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism.

Methods

In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUC_COR) during insulin tolerance test (ITT).

Results

A cortisol peak <18 µg/dl was shown in 22 and 31% of GHD children at baseline and after GHT, respectively. At baseline, GHD children had lower fasting glucose (p < 0.001) and ISI-Matsuda (p = 0.042), with concomitant higher Homa-IR (p = 0.006) and morning cortisol (p = 0.012) than controls. Morning cortisol was negatively correlated with GH (p < 0.001), fasting glucose (p < 0.001) and ISI-Matsuda (p < 0.001) and positively with Homa-IR (p = 0.010). Both cortisol peak and AUC_COR were negatively correlated with GH (all p < 0.001) and ISI-Matsuda (p = 0.016 and p = 0.001, respectively). After 12 months of GHT, a significant increase in fasting glucose (p < 0.001), and Homa-IR (p = 0.011) was documented, with a concomitant decrease in morning cortisol (p = 0.002), AUC_COR (p = 0.038), total (p = 0.003) and LDL-cholesterol (p = 0.016). No significant correlations were found among cortisol levels and all parameters were investigated.

Conclusions

Cortisol levels correlate with GH secretion and with many metabolic parameters in GHD children, while the metabolic effects during GHT are mainly due to GHT per se and less to cortisol reduction.

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Validating Multi-Dimensional Outcome Assessment Using the TBI Common Data Elements: An Analysis of the TRACK-TBI Pilot Study Sample

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


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Serial Assessment of Gray Matter Abnormalities after Sport-Related Concussion

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


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Anatomical Complications of Hysterectomy: A review

Abstract

Introduction: Hysterectomy is the most commonly performed gynecological procedure in the United States with three possible surgical approaches; vaginal, abdominal and laparoscopic. As with any surgical procedure, various anatomical complications can arise. These include injuries to anatomical structures such as the urinary bladder, ureter, intestines, rectum, anus and a multitude of nervous structures. Other complications include sexual dysfunction, vaginal cuff dehiscence and urinary incontinence.

Materials and Methods: Using standard search engines, the anatomical complications of hysterectomies are reviewed.

Conclusions: Surgeons who perform hysterectomies or are involved with post-operative hysterectomy patients should be familiar with the possible complications of this common procedure and the steps that can be taken to help reduce the risk of those complications. Clinicians should also inform their patients of the potential complications as they can affect lifestyle and comfort. This article is protected by copyright. All rights reserved.

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Magnetic Resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections

Abstract

The tensor of the vastus intermedius (TVI) is a newly described component of the extensor apparatus of the knee joint. The objective of this study was to evaluate the appearance of the TVI on magnetic resonance (MR) imaging and its association with the adjacent vastus lateralis (VL) and vastus intermedius (VI) muscles and to compare these findings with the corresponding anatomy.

MR images were analyzed from a cadaveric thigh where the TVI, as part of the extensor apparatus of the knee joint, had been dissected. The course of the TVI in relation to the adjacent VL and VI was studied.

The anatomic dissection and MR imaging revealed a multi-layered organization of the lateral extensor apparatus of the knee joint. The TVI is an intervening muscle between the VL and VI that combined into a broad flat aponeurosis in the mid-thigh and merged into the quadriceps tendon. Dorsally, the muscle fibers of the TVI joined those of the VL and VI and blended into the attachment at the lateral lip of the linea aspera. In this area, distinguishing between these three muscles was not possible macroscopically or virtually by MR imaging.

In the dorsal aspect the onion-like muscle layers of the VL, TVI and VI fuse to a hardly separable muscle mass indicating that these muscles work in conjunction to produce knee extension torque when knee joint action is performed. This article is protected by copyright. All rights reserved.

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Validating Multi-Dimensional Outcome Assessment Using the TBI Common Data Elements: An Analysis of the TRACK-TBI Pilot Study Sample

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


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Serial Assessment of Gray Matter Abnormalities after Sport-Related Concussion

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


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Omalizumab for hypersensitive reaction to seminal plasma: A case report

Publication date: Available online 15 August 2017
Source:Allergology International
Author(s): Maria Teresa Burguete-Cabanas, Oscar R. Fajardo-Ramirez, Roberta Yesaki, Raul Estrada-Maganas, Sandra Salazar-Meza, Olga Rios-Chavez, Irene Meester, Julio C. Salas-Alanis




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Successful treatment of metastatic alveolar rhabdomyosarcoma with MGMT gene promoter methylation by temozolomide-based combination chemotherapy

Abstract

A 3-year-old male presented with a large retroperitoneal mass and multiple metastases. Biopsy results suggested alveolar rhabdomyosarcoma bearing a methylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter. Serum microRNA-206 levels were elevated and remained high after three cycles of vincristine, dactinomycin, and cyclophosphamide (VAC). Replacement of vincristine, irinotecan, and temozolomide (VIT) for VAC induced a marked tumor reduction and normalization of the miR-206 levels. The patient completed 14 cycles of VIT with local radiotherapy and has been in remission for 31 months. Temozolomide could be effective for tumors with a methylated MGMT gene promoter. Individualized therapy is warranted for such patients.

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History of parvovirus B19 infection is associated with silent cerebral infarcts

Abstract

Background

The relationship between silent cerebral infarcts (SCIs) and history of parvovirus B19 (B19V) has not been systematically evaluated. As an ancillary study from the Silent Cerebral Infarct Trial (SIT) (NCT00072761), we tested the hypothesis that a history of B19V infection is associated with an increased prevalence of SCIs in children with sickle cell anemia.

Procedure

We used a retrospective cross-sectional cohort study design; each participant underwent a brain magnetic resonance imaging (MRI) scan and medical record review for prior B19V infection (n = 958).

Results

SCI was present in 30% (287 of 958) of participants and 17% (165 of 958) had a history of B19V infection. Based on prior evidence that low baseline hemoglobin (Hgb) levels are associated with increased odds of SCI, Hgb levels were divided into tertiles (<7.6 g/dl, ≥7.6–≤8.5 g/dl, ≥8.6 g/dl) and multivariable analysis was used to determine the relationship between the joint effect of prior B19V infection, Hgb levels, and SCI. Prior B19V infection and the lowest Hgb tertile were associated with increased risk of SCI (odds ratio [OR] 2.12; 95% CI, 1.17–3.84; P = 0.013); no prior B19V infection and the highest Hgb tertile were associated with a decreased risk (OR 0.56; 95% CI, 0.38–0.84; P = 0.004).

Conclusions

Efforts to decrease the incidence of B19V infection, such as the development of a B19V vaccine, may decrease SCI prevalence.

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Lack of mortality in 22 children with sickle cell anemia and severe malarial anemia

Abstract

Retrospective studies suggest that there is high mortality in children with sickle cell anemia (SCA) and severe malaria. We assessed mortality in Ugandan children with severe malarial anemia (SMA, n = 232) or cerebral malaria (CM, n = 267) by sickle cell hemoglobin genotype. Admission and 2-year follow-up mortality did not differ among children with SMA who had homozygous form of sickle cell hemoglobin (HbSS) versus normal form of adult hemoglobin (admission, 0/22, 0%, vs. 1/208, 0.5%; follow-up, 1/22, 4.5%; 7/207, 3.4%, respectively; all P > 0.6). The single child with CM and HbSS survived. The study findings highlight the need for large prospective studies of malaria-related mortality in children with SCA.

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Comment on: Acquired monosomy 7 myelodysplastic syndrome in a child with clinical features of dyskeratosis congenita and IMAGe association

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Trapezoidal mandibular osteotomy for augmentation of the airway in sleep apnoea

Publication date: Available online 14 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.T. Carneiro, E.L. de Souza Cruz, A.K. da Silva Tabosa, P.H. de Moraes




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Use of buccal cortex as interpositional graft in mandibular setbacks

Publication date: Available online 14 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ross Elledge, Rohit Chandegra, Peter Stockton




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Postoperative complications after head and neck operations that require free tissue transfer- prevalence, morbidity, and cost

Publication date: Available online 12 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. McMahon, T.P.B. Handley, A. Bobinskas, M. Elsapagh, H.S. Anwar, P.V. Ricciardo, A. McLaren, R. Davis, N. Syyed, C. MacIver, C. Wales, W.S. Hislop, E. Thomson, S. Thomson, K. Fitzpatrick, A. Rae, R. Campbell
To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive.



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Lung Ultrasound in the Critically Ill: The BLUE Protocol.

No abstract available

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Boring Is Beautiful in Preoperative Assessment.

No abstract available

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Impact of Simulator-Based Training in Focused Transesophageal Echocardiography: A Randomized Controlled Trial.

BACKGROUND: The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE. METHODS: In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators. RESULTS: A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P

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Hypothermia Risk With Intraoperative Continuous Renal Replacement Therapy.

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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Novel Immunotherapies for Multiple Myeloma

Abstract

Purpose of Review

The treatment landscape of multiple myeloma is rapidly changing; however, despite improvement in patients' survival, it still remains a largely incurable disease. One hallmark of myeloma is substantial immune dysfunction leading to an increased infection rate and the inability of immune surveillance to detect neoplastic cells. Here, we critically analyze clinical approaches to harness the immune system to overcome this defect with a focus on antibody based and adoptive cellular therapies.

Recent Findings

Clinical trials exploring these immunotherapies to treat myeloma are now well underway and show promising results. In relapsed myeloma, monoclonal antibodies directed against plasma cell antigens and immune checkpoints have already shown substantial efficacy. In parallel, trials of adoptive cellular therapy have exciting promise in myeloma, having induced dramatic responses in a handful of early study participants.

Summary

Taken together, immunotherapeutic approaches hold enormous potential in the field of multiple myeloma and in the near future can be combined with or even replace the current standard of care.

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Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

Abstract

Purpose

Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism.

Methods

In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUC_COR) during insulin tolerance test (ITT).

Results

A cortisol peak <18 µg/dl was shown in 22 and 31% of GHD children at baseline and after GHT, respectively. At baseline, GHD children had lower fasting glucose (p < 0.001) and ISI-Matsuda (p = 0.042), with concomitant higher Homa-IR (p = 0.006) and morning cortisol (p = 0.012) than controls. Morning cortisol was negatively correlated with GH (p < 0.001), fasting glucose (p < 0.001) and ISI-Matsuda (p < 0.001) and positively with Homa-IR (p = 0.010). Both cortisol peak and AUC_COR were negatively correlated with GH (all p < 0.001) and ISI-Matsuda (p = 0.016 and p = 0.001, respectively). After 12 months of GHT, a significant increase in fasting glucose (p < 0.001), and Homa-IR (p = 0.011) was documented, with a concomitant decrease in morning cortisol (p = 0.002), AUC_COR (p = 0.038), total (p = 0.003) and LDL-cholesterol (p = 0.016). No significant correlations were found among cortisol levels and all parameters were investigated.

Conclusions

Cortisol levels correlate with GH secretion and with many metabolic parameters in GHD children, while the metabolic effects during GHT are mainly due to GHT per se and less to cortisol reduction.

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COMPARISON BETWEEN BURNING MOUTH SYNDROME WITH AND WITHOUT PSYCHOLOGICAL PROBLEMS

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MOON-JONG KIM, JIHOON KIM, HONG-SEOP KHO




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A PILOT STUDY OF PD-1 AND PD-L1 EXPRESSION IN A SPECTRUM OF ORAL DYSPLASIAS AND ORAL SQUAMOUS CELL CARCINOMAS

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): S. GLASS, R. REICH, P. FREEDMAN




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Editorial Board

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3





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CHITOSAN IN THE TREATMENT OF RADIOTHERAPY INDUCED ORAL MUCOSITIS IN HEAD AND NECK CANCER PATIENTS: A RANDOMISD CLINICAL TRIAL

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): ARVIND MUTHUKRISHNAN, G. SHANMUGHAPRIYA




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HISTOCHEMICAL ASSESSMENT FOR VASCULAR ENDOTHELIAL CELLS AND PERIVASCULAR CELLS DURING ENDOCHONDRAL OSSIFICATION

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): ERIKA TSUCHIYA, TOMOKA HASEGAWA, NORIO AMIZUKA, YOSHIMASA KITAGAWA




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Information for Readers

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3





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WILLINGNESS TO PAY, HEALTH UTILITY AND QUALITY OF LIFE IN ORAL LICHEN PLANUS – A COMPARATIVE STUDY ACROSS HEATH ECONOMIES

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): RICHEAL NI RIORDAIN, CHRISTINE MCCREARY, TIM HODGSON




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EXPRESSION ANALYSIS OF CANONICAL WNT PATHWAY GENES IN ORAL SQUAMOUS CELL CARCINOMA AND THEIR POSSIBLE ROLE AS BIOMARKERS

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MADHULAXMI MARIMUTHU, P.U. ABDUL WAHAB, ANANDAN BALAKRISHNAN, SAMBANDHAM SHANMUGAM, VINOD NARAYANAN, M.R. MUTHUSEKHAR




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IMPACT OF SALIVARY FLOW RATE ON FUNGAL INFECTIONS ASSOCIATED WITH STEROID TREATMENT OF ORAL LICHEN PLANUS

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MARY HIL EDENS, MICHAEL CARPENTER, JOEL NAPENAS, MICHAEL BRENNAN




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Oral health status and risk of bacteremia following allogeneic hematopoietic cell transplantation

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): Ahmed S. Sultan, Yvette Zimering, Gloria Petruzziello, Edwin P. Alyea, Joseph H. Antin, Robert J. Soiffer, Vincent T. Ho, Stephen T. Sonis, Sook-Bin Woo, Francisco M. Marty, Nathaniel S. Treister
ObjectivesThe aim of this study was to evaluate the impact of oral health status on bacteremia risk in a cohort of patients with acute myeloid leukemia (AML) who underwent chemotherapy followed by myeloablative allogeneic hematopoietic cell transplantation (allo-HCT).Study DesignA retrospective study was conducted in patients with AML from 2007 to 2011. Oral health status was determined from a pre–allo-HCT dental evaluation. Positive blood cultures were recorded from AML induction to post–allo-HCT day +60. Organisms that caused bacteremia were classified as "of possible oral source" by a blinded microbiologist. Two-sided Fisher's exact test was used to compare the oral health status of the entire cohort with that of patients with blood cultures of potential oral source.ResultsPre–allo-HCT dental evaluations were completed in 91 (99%) of 92 patients. Of these 91 patients, 13 (14%) with dental pathology (13 of 13 [100%]) completed all required dental treatment before allo-HCT. Bacteremias occurred in 63 of 92 patients (68%), and 12 (19%) of 63 patients had positive blood cultures of potential oral source. Of these, 1 of 12 patients developed bacteremia during AML induction, and 11 of 12 developed bacteremia during allo-HCT.ConclusionsOral health status was not associated with risk of bacteremia of potential oral source either at AML induction or consolidation or at allo-HCT.



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Salivary and serum levels of tumor necrosis factor-alpha in oral lichen planus: a systematic review and meta-analysis study

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): Hamid Reza Mozaffari, Mazaher Ramezani, Mohammad Mahmoudiahmadabadi, Neda Omidpanah, Masoud Sadeghi
ObjectiveTumor necrosis factor-α (TNF-α) has a role in the progression of the oral lichen planus (OLP). The aim of this meta-analysis study was to evaluate the salivary and serum TNF-α levels in patients with OLP.Study DesignWe searched in the databases of PubMed/Medline, Science direct, Scopus, Web of Science, and Cochrane Library for studies reported from 1983 to 2016. All studies were checked for evaluation of salivary and serum levels of TNF-α in patients with OLP compared with healthy controls.ResultsTwelve studies were included in the meta-analysis. The mean difference of 7 studies reporting salivary TNF-α levels in patients with OLP versus healthy controls was 25.90 pg/mL (95% confidence interval [CI] 15.31-36.49; P < .00001) and 7 studies reporting serum TNF-α levels was 1.65 pg/mL (95% CI −0.82 to 4.11; P = .19).ConclusionsIn patients with OLP, the higher levels of TNF-α in saliva compared with serum suggest that measurement of this marker in saliva may be more useful than in serum for determining diagnostic and therapeutic aims.



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OUTCOMES AFTER PHYSICAL THERAPY FOR THE TREATMENT OF TEMPOROMANDIBULAR DISORDERS

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): YASSER KHALED, JESSICA K. QUACH, MICHAEL T. BRENNAN, JOEL J. NAPEÑAS




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THE RELATIONSHIP BETWEEN RADIOGRAPHIC DENTAL ABNORMALITIES AND AGE AT INITIAL TREATMENT OF PEDIATRIC CANCER

Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): VERA MONICA LIM, HALEY FREYMILLER, ADI SAX, ADEPITAN OWOSHO, JOSEPH HURYN, SAEHEE YOM, CHERRY ESTILO




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CXCR4 blockade with AMD3100 enhances Taxol chemotherapy to limit ovarian cancer cell growth.

The standard of care for ovarian cancer includes initial treatment with chemotherapy. Despite initial efficacy, over 70% of patients develop recurrence; thus, there is a need to identify novel approaches that can improve therapeutic outcomes. We evaluated AMD3100 (Plerixafor), an FDA-approved CXCR4 inhibitor, as a potential adjunctive therapy for low-dose Taxol (Paclitaxel) by assessing the impact on in-vitro ovarian cancer cell proliferation. Proliferation was a measure for both human TOV-112D and murine ID8 ovarian cancer cells incubated with AMD3100 and Taxol, either individually or in combination. Impact of treatment was first determined for the simultaneous administration of AMD3100 and Taxol. We next assessed a sequential application of AMD3100 pretreatment, followed by AMD3100, Taxol, or a combination to test for sensitization to Taxol. In addition, we measured the impact of AMD3100 and Taxol, individually and in combination, on colony formation, an in-vitro model assay of tumor growth. Expression data, as measured by flow cytometry, show that both ID8 and TOV-112D cells are positive for CXCR4, CXCR7, and CXCL12. Combination treatment with AMD3100 (

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Peristomal leakage of enteroatmospheric fistulas treated with lipotransfer combined to minimal-invasive scar release technique

Abstract

Lipografting is emerging as a "rescue" treatment for postoperative sequelae, soft tissue volume defects and refractory fistulas. After complicated laparotomies or colostomies, also peristomal soft tissue volume deficiencies and scarring can occur and lead to severe care problems. Currently, no satisfactory treatment is available for these sequelae resulting in general surgery. In this case report, we applied the operative approach by means of a minimal-invasive scar release combined to waterjet-assisted lipotransfer and sculpturing on the abdominal wall as a treatment of peristomal irregularities. We applied one procedure on a patient with insufficient stoma sealing on large enteroatmospheric fistulas in "frozen" open abdomen (Björk 4 classification). Clinical and aesthetic outcome were measured and evaluated via digital photographs and CT scan pre- and postoperatively. Size reduction, complete sealing of the stoma appliance and total healing of the peristomal skin damage were accomplished within 5 weeks.

Level of Evidence: Level V, therapeutic study.

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Loss of the tumor suppressor STAG2 promotes telomere recombination and extends the replicative lifespan of normal human cells

Sister chromatids are held together by cohesin, a tripartite ring with a peripheral SA1/2 subunit, where SA1 is required for telomere cohesion and SA2 for centromere cohesion. The STAG2 gene encoding SA2 is often inactivated in human cancer, but not in in a manner associated with aneuploidy. Thus, how these tumors maintain chromosomal cohesion and how STAG2 loss contributes to tumorigenesis remain open questions. Here we show that, despite a loss in centromere cohesion, sister chromatids in STAG2 mutant tumor cells maintain cohesion in mitosis at chromosome arms and telomeres. Telomere maintenance in STAG2 mutant tumor cells occurred by either telomere recombination or telomerase activation mechanisms. Notably, these cells were refractory to telomerase inhibitors, indicating recombination can provide an alternative means of telomere maintenance. STAG2 silencing in normal human cells which lack telomerase led to increased recombination at telomeres, delayed telomere shortening and postponed senescence onset. Insofar as telomere shortening and replicative senescence prevent genomic instability and cancer by limiting the number of cell divisions, our findings suggest that extending the lifespan of normal human cells due to inactivation of STAG2 could promote tumorigenesis by extending the period during which tumor-driving mutations occur.

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PADI2-mediated citrullination promotes prostate cancer progression

Onset of castration-resistance prostate cancer (CRPC) after long-term androgen-deprivation therapy remains a major obstacle in the treatment of prostate cancer (PCa). The peptidylarginine deiminase PADI2 has been implicated in chronic inflammatory diseases and cancer. Here we show that PADI2 is an androgen-repressed gene and is upregulated in CRPC. PADI2 expression was required for survival and cell cycle progression of PCa cells, and PADI2 promoted proliferation of PCa cells under androgen-deprived or castration conditions in vitro and in vivo. Cytoplasmic PADI2 protected the androgen receptor (AR) against proteasome-mediated degradation and facilitated AR binding to its target genes after nuclear translocation and citrullination of histone H3 amino acid residue R26. By contrast, mutant PADI2 D180A failed to affect AR stability, nuclear translocation or transcriptional activity. PADI2 mediated AR control in a manner dependent on its enzymatic activity and nuclear localization, as correlated with increased histone H3 citrullination. Notably, co-administration of the PADI inhibitor Cl-amidine and the AR signaling inhibitor enzalutamide synergized in inhibiting CRPC cell proliferation in vitro and tumor growth in vivo. Overall, our results establish PADI2 as a key mediator for AR in PCa progression, especially CRPC, and they suggest PADI as novel therapeutic targets in this disease setting.

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Combination therapy with bispecific antibodies and PD-1 blockade enhances the antitumor potency of T cells

The DOCK-AND-LOCK (DNL®) method is a platform technology that combines recombinant engineering and site-specific conjugation to create multispecific, multivalent antibodies of defined composition with retained bioactivity. We have applied DNL® to generate a novel class of trivalent bispecific antibodies (bsAbs), each comprising an anti-CD3 scFv covalently conjugated to a stabilized dimer of different anti-tumor Fabs. Here we report the further characterization of two such constructs, (E1)-3s and (14)-3s, which activate T cells and target Trop-2- and CEACAM5-expressing cancer cells, respectively. (E1)-3s and (14)-3s, in the presence of human T cells, killed target cells grown as monolayers at subnanomolar concentrations, with a similar potency observed for drug-resistant cells. Antitumor efficacy was demonstrated for (E1)-3s co-administered with human peripheral blood mononuclear cells (PBMC) in NOD/SCID mice harboring xenografts of MDA-MB-231, a triple-negative breast cancer line constitutively expressing Trop-2 and PD-L1. Growth inhibition was observed following treatment with (E1)-3s or (14)-3s combined with human PBMC in 3D spheroids generated from target cell lines to mimic the in vivo behavior and microenvironment of these tumors. Moreover, addition of an antagonistic anti-PD-1 antibody increased cell death in 3D spheroids and extended survival of MDA-MB-231-bearing mice. These preclinical results emphasize the potential of combining T cell-redirecting bsAbs with antagonists or agonists that mitigate T cell inhibition within the tumor microenvironment to improve immunotherapy of solid cancers in patients. They also support the use of 3D spheroids as a predictive alternative to in vivo models for evaluating T cell functions.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wkY90G

Therapeutic targeting of the CBP/p300 bromodomain blocks the growth of castration-resistant prostate cancer

Resistance invariably develops to anti-androgen therapies used to treat newly diagnosed prostate cancers, but effective treatments for castration-resistant disease remain elusive. Here we report that the transcriptional co-activator CBP/p300 is required to maintain the growth of castration-resistant prostate cancer. To exploit this vulnerability, we developed a novel small-molecule inhibitor of the CBP/p300 bromodomain that blocks prostate cancer growth in vitro and in vivo. Molecular dissection of the consequences of drug treatment revealed a critical role for CBP/p300 in histone acetylation required for the transcriptional activity of the androgen receptor and its target gene expression. Our findings offer a preclinical proof of concept for small molecule therapies to target the CBP/p300 bromodomain as a strategy to treat castration-resistant prostate cancer.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uW1Rub

Trastuzumab Increases HER2 Uptake and Cross-Presentation by Dendritic Cells

Early phase clinical trials evaluating CD8+ T cell-eliciting, HER2-derived peptide vaccines administered to HER2-positive breast cancer patients in the adjuvant setting suggest synergy between the vaccines and trastuzumab, the monoclonal antibody targeting the HER2 protein. Among 60 patients enrolled on clinical trials evaluating the E75+GM-CSF and GP2+GM-CSF vaccines, there have been no recurrences in patients vaccinated after receiving trastuzumab as part of standard therapy in the per treatment analyses conducted after a median follow-up of greater than 34 months. Here we describe a mechanism by which this synergy may occur. Flow cytometry showed that trastuzumab facilitated uptake of HER2 by dendritic cells (DC), which was mediated by the Fc receptor and was specific to trastuzumab. In vitro, increased HER2 uptake by DC increased cross-presentation of E75, the immunodominant epitope derived from the HER2 protein; an observation confirmed in two in vivo mouse models. This increased E75 cross-presentation, mediated by trastuzumab treatment, enabled more efficient expansion of E75-specific cytotoxic T cells (E75-CTL). These results demonstrate a mechanism by which trastuzumab links innate and adaptive immunity by facilitating activation of antigen-specific T cells. Based on these data, we conclude that HER2-positive breast cancer patients that have been treated with trastuzumab may experience a more robust antitumor immune response by restimulation of T cells with the E75 peptide vaccine, thereby accounting for the improved disease-free survival observed with combination therapy.

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

MRE11 promotes tumorigenesis by facilitating resistance to oncogene-induced replication stress

Hypomorphic mutations in the genes encoding the MRE11/RAD50/NBS1 (MRN) DNA repair complex lead to cancer-prone syndromes. MRN binds DNA double strand breaks where it functions in repair and triggers cell cycle checkpoints via activation of the ataxia-telangiectasia mutated (ATM) kinase. To gain understanding of MRN in cancer, we engineered mice with B lymphocytes lacking MRN, or harboring MRN in which MRE11 lacks nuclease activities. Both forms of MRN deficiency led to hallmarks of cancer, including oncogenic translocations involving c-Myc and the immunoglobulin locus. These pre-neoplastic B lymphocytes did not progress to detectable B lineage lymphoma, even in the absence of p53. Moreover, Mre11 deficiencies prevented tumorigenesis in a mouse model strongly predisposed to spontaneous B cell lymphomas. Our findings indicate that MRN cannot be considered a standard tumor suppressor and instead imply that nuclease activities of MRE11 are required for oncogenesis. Inhibition of MRE11 nuclease activity increased DNA damage and selectively induced apoptosis in cells overexpressing oncogenes, suggesting MRE11 serves an important role in countering oncogene-induced replication stress. Thus, MRE11 may offer a target for cancer therapeutic development. More broadly, our work supports the idea that subtle enhancements of endogenous genome instability can exceed the tolerance of cancer cells and be exploited for therapeutic ends.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uVHL2R

{beta}-adrenergic signaling in mice housed at standard temperatures suppresses an effector phenotype in CD8+ T cells and undermines checkpoint inhibitor therapy

The immune context of tumors has significant prognostic value and is predictive of responsiveness to several forms of therapy, including immunotherapy. We report here that CD8+ T cell frequency and functional orientation within the tumor microenvironment is regulated by β2-adrenergic receptor (β-AR) signaling in host immune cells. We used three strategies - physiologic (manipulation of ambient thermal environment), pharmacologic (β-blockers), and genetic (β2-adrenergic receptor knockout mice) to reduce adrenergic stress signaling in two widely studied preclinical mouse tumor models. Reducing β-AR signaling facilitated conversion of tumors to an immunologically active tumor microenvironment with increased intra-tumoral frequency of CD8+ T cells with an effector phenotype and decreased expression of PD-1, in addition to an elevated effector CD8+ T cell to CD4+ regulatory T cell ratio (IFN-γ+CD8+:Treg). Moreover, this conversion significantly increased the efficacy of anti-PD-1 checkpoint blockade. These data highlight the potential of adrenergic stress and norepinephrine-driven β-adrenergic receptor signaling to regulate the immune status of the tumor microenvironment and supports the strategic use of clinically available β-blockers in patients to improve responses to immunotherapy.

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

Phenotypic Heterogeneity of Circulating Tumor Cells Informs Clinical Decisions between AR Signaling Inhibitors and Taxanes in Metastatic Prostate Cancer

The heterogeneity of an individual patient's tumor has been linked to treatment resistance, but quantitative biomarkers to rapidly and reproducibly evaluate heterogeneity in a clinical setting are currently lacking. Using established tools available in a CAP-accredited and CLIA-certified clinical laboratory, we quantified digital pathology features on 9,225 individual circulating tumor cells (CTCs) from 179 unique metastatic castration-resistant prostate cancer (mCRPC) patients to define phenotypically distinct cell types. Heterogeneity was quantified based on the diversity of cell types in individual patient samples using the Shannon index and associated with overall survival (OS) in the 145 specimens collected prior to initiation of second or later lines of therapy. Low CTC phenotypic heterogeneity was associated with better OS in patients treated with androgen receptor signaling inhibitors (ARSI), whereas high heterogeneity was associated with better OS in patients treated with taxane chemotherapy. Overall, the results show that quantifying CTC phenotypic heterogeneity can help inform the choice between ARSI and taxanes in mCRPC patients.

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

Effect of alisertib, an investigational aurora a kinase inhibitor on the QTc interval in patients with advanced malignancies

Summary

Aims A primary objective of this study was to investigate the effect of single and multiple doses of alisertib, an investigational Aurora A kinase inhibitor, on the QTc interval in patients with advanced malignancies. The dose regimen used was the maximum tolerated dose which was also the recommended phase 3 dose (50 mg twice daily [BID] for 7 days in 21-day cycles). Methods Patients received a single dose of alisertib (50 mg) on Day 1, and multiple doses of alisertib (50 mg BID) on Days 4 through to the morning of Day 10 of the first cycle of treatment. Triplicate ECGs were collected at intervals over 10 to 24 h via Holter recorders on Days −1 (baseline), 1 and 10. Changes from time-matched baseline values were calculated for various ECG parameters including QTc, heart rate, PR and QRS intervals. Alisertib pharmacokinetics were also assessed during the study, and an exposure-QTc analysis was conducted. Results Fifty patients were included in the QTc analysis. The upper bounds of the 95% confidence intervals for changes from time-matched baseline QTcF and QTcI values were <5 ms across all study days, time points and correction methods. Alisertib did not produce clinically relevant effects on heart rate, PR or QRS intervals. There was no evidence of a concentration-QTc effect relationship. Conclusions Alisertib does not cause QTc prolongation and can be concluded to not have any clinically relevant effects on cardiac repolarization or ECG parameters at the single agent maximum tolerated dose of 50 mg BID.

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The 12th Evidence Based Management Day on “Laryngeal Cancer” London, 3 November 2016

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wV4P3x

"Med Oral Patol Oral Cir Bucal"[jour]; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Med Oral Patol Oral Cir Bucal"[jour]

These pubmed results were generated on 2017/08/17

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2uNtlpA

Morphoproteomics, E6/E7 in-situ hybridization, and biomedical analytics define the etiopathogenesis of HPV-associated oropharyngeal carcinoma and provide targeted therapeutic options

Human papillomavirus (HPV) has been identified as an etiopathogenetic factor in oropharyngeal squamous cell carcinoma. The HPV E6 and E7 oncogenes are instrumental in promoting proliferation and blocking differen...

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vI8O4Q

Signaling Pathways as Potential Therapeutic Targets in Hepatocarcinogenesis

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vI0XEd

The difference between registered natural head position and estimated natural head position in three dimensions

This study determined the intra-rater and inter-rater reliability of re-orientating three-dimensional (3D) facial images into the estimated natural head position. Three-dimensional facial images of 15 pre-surgical class III orthognathic patients were obtained and automatically re-orientated into natural head position (RNHP) using a 3D stereophotogrammetry system and in-house software. Six clinicians were asked to estimate the NHP of these patients (ENHP); they re-estimated five randomly selected 3D images after a 2-week interval.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w6H76A

Virtual quad zygoma implant placement using cone beam computed tomography: sufficiency of malar bone volume, intraosseous implant length, and relationship to the sinus according to the degree of alveolar bone atrophy

The objective of this study was to investigate the malar bone volume and length that a zygomatic implant can engage, and the relationship to the sinus according to the degree of alveolar bone atrophy. A three-dimensional evaluation was performed using cone beam computed tomography scans from 23 patients with a totally edentulous maxilla; quad zygoma implants were virtually placed. The predictor variable was the amount of malar bone volume and length that a zygomatic implant can engage. The primary outcome variable was the relationship to the sinus according to the degree of alveolar bone atrophy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w7eFlc

"Med Oral Patol Oral Cir Bucal"[jour]; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Med Oral Patol Oral Cir Bucal"[jour]

These pubmed results were generated on 2017/08/17

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2v6i4My

"Med Oral Patol Oral Cir Bucal"[jour]; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Med Oral Patol Oral Cir Bucal"[jour]

These pubmed results were generated on 2017/08/17

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2vN8EqZ

Bevacizumab as an effective treatment for radiation necrosis after radiotherapy for melanoma brain metastases.

Radiation necrosis (RN) is a potential late complication of radiotherapy for intracranial malignancy, which is often associated with significant neurological morbidity. Prolonged treatment with high-dose corticosteroids or surgical resection has been the standard care for RN, but protracted steroid use can lead to significant side effects and surgical resection is not always feasible. The antivascular endothelial growth factor monoclonal antibody bevacizumab induces clinical and radiographic improvements in RN, with overall good tolerance. However, evidence supporting its use for RN in melanoma brain metastases is minimal, likely secondary to concern for intracranial bleeding. Immunotherapy is now one of the most commonly used and effective therapies for metastatic melanoma. A higher risk of RN has been reported with immunotherapy, making alternative treatment for RN in this population a priority, especially as prolonged use of steroids may counteract the treatment efficacy of immunotherapy. We report on seven melanoma patients who developed RN after stereotactic radiosurgery with or without whole-brain radiation therapy who were treated with 2-6 doses of bevacizumab. All patients experienced improvements in symptoms and quality of life, with a concurrent improvement in imaging in six patients. Furthermore, bevacizumab was well tolerated and none of the seven patients experienced intracranial or extracranial bleeding. Our series suggests that in selected melanoma brain metastases patients, bevacizumab may be a safe and effective treatment for RN, especially for those who are undergoing immunotherapy, and should be further evaluated in a prospective setting. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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

The safety of pembrolizumab in metastatic melanoma and rheumatoid arthritis.

Immunotherapy has been in use for the treatment of melanoma since a very long time, but only recently have the cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody ipilimumab and programmed cell death-1 inhibitors such as nivolimumab and pembrolizumab been shown to induce marked improvements in survival in patients with metastatic melanoma. An important concern arises in terms of the safety of the use of these agents in patients with autoimmune diseases, solid organ transplant recipients on immunosuppression, patients with a history of previous hepatitis B or C, and patients with HIV infections as these patients were excluded from pivotal immunotherapy studies. Here, we report on the safety and efficacy of pembrolizumab in a melanoma patient with multiple medical problems including poorly controlled rheumatoid arthritis and we review the available literature on the use of immunotherapy and autoimmune diseases. The weight of evidence suggests that these patients should be offered the opportunity to benefit from immune check point inhibitors, with drugs targeting programmed cell death-1 being preferred. More research is required to study the long-term effects of immunotherapy on patients with autoimmune diseases. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v6jTZC

Radiotoxicity in robotic radiosurgery: proposing a new quality index for optimizing the treatment planning of brain metastases

As irradiated brain volume at 12 Gy (V12) is a predictor for radionecrosis, the purpose of the study was to develop a model for Cyberknife (CK) plans that is able to predict the lowest achievable V12 at a give...

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

Beyond Sentences: Using the Expression, Reception, and Recall of Narratives Instrument to Assess Communication in School-Aged Children With Autism Spectrum Disorder

Purpose

Impairments in the social use of language are universal in autism spectrum disorder (ASD), but few standardized measures evaluate communication skills above the level of individual words or sentences. This study evaluated the Expression, Reception, and Recall of Narrative Instrument (ERRNI; Bishop, 2004) to determine its contribution to assessing language and communicative impairment beyond the sentence level in children with ASD.

Method

A battery of assessments, including measures of cognition, language, pragmatics, severity of autism symptoms, and adaptive functioning, was administered to 74 8- to 9-year-old intellectually able children with ASD.

Results

Average performance on the ERRNI was significantly poorer than on the Clinical Evaluation of Language Fundamentals–Fourth Edition (CELF-4). In addition, ERRNI scores reflecting the number and quality of relevant story components included in the participants' narratives were significantly positively related to scores on measures of nonverbal cognitive skill, language, and everyday adaptive communication, and significantly negatively correlated with the severity of affective autism symptoms.

Conclusion

Results suggest that the ERRNI reveals discourse impairments that may not be identified by measures that focus on individual words and sentences. Overall, the ERRNI provides a useful measure of communicative skill beyond the sentence level in school-aged children with ASD.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2228/2648607/Beyond-Sentences-Using-the-Expression-Reception

Noise Equally Degrades Central Auditory Processing in 2- and 4-Year-Old Children

Purpose

The aim of this study was to investigate developmental and noise-induced changes in central auditory processing indexed by event-related potentials in typically developing children.

Method

P1, N2, and N4 responses as well as mismatch negativities (MMNs) were recorded for standard syllables and consonants, frequency, intensity, vowel, and vowel duration changes in silent and noisy conditions in the same 14 children at the ages of 2 and 4 years.

Results

The P1 and N2 latencies decreased and the N2, N4, and MMN amplitudes increased with development of the children. The amplitude changes were strongest at frontal electrodes. At both ages, background noise decreased the P1 amplitude, increased the N2 amplitude, and shortened the N4 latency. The noise-induced amplitude changes of P1, N2, and N4 were strongest frontally. Furthermore, background noise degraded the MMN. At both ages, MMN was significantly elicited only by the consonant change, and at the age of 4 years, also by the vowel duration change during noise.

Conclusions

Developmental changes indexing maturation of central auditory processing were found from every response studied. Noise degraded sound encoding and echoic memory and impaired auditory discrimination at both ages. The older children were as vulnerable to the impact of noise as the younger children.

Supplemental materials

http://ift.tt/2uSYZQZ

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2297/2647677/Noise-Equally-Degrades-Central-Auditory-Processing

An Exploration of the Associations Among Hearing Loss, Physical Health, and Visual Memory in Adults From West Central Alabama

Purpose

The purpose of this preliminary study was to explore the associations among hearing loss, physical health, and visual memory in adults living in rural areas, urban clusters, and an urban city in west Central Alabama.

Method

Two hundred ninety-seven adults (182 women, 115 men) from rural areas, urban clusters, and an urban city of west Central Alabama completed a hearing assessment, a physical health questionnaire, a hearing handicap measure, and a visual memory test.

Results

A greater number of adults with hearing loss lived in rural areas and urban clusters than in an urban area. In addition, poorer physical health was significantly associated with hearing loss. A greater number of individuals with poor physical health who lived in rural towns and urban clusters had hearing loss compared with the adults with other physical health issues who lived in an urban city. Poorer hearing sensitivity resulted in poorer outcomes on the Emotional and Social subscales of the Hearing Handicap Inventory for Adults. And last, visual memory, a working-memory task, was not associated with hearing loss but was associated with educational level.

Conclusions

The outcomes suggest that hearing loss is associated with poor physical and emotional health but not with visual-memory skills. A greater number of adults living in rural areas experienced hearing loss compared with adults living in an urban city, and consequently, further research will be necessary to confirm this relationship and to explore the reasons behind it. Also, further exploration of the relationship between cognition and hearing loss in adults living in rural and urban areas will be needed.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2346/2648885/An-Exploration-of-the-Associations-Among-Hearing

Effects of Lexical and Somatosensory Feedback on Long-Term Improvements in Intelligibility of Dysarthric Speech

Purpose

Intelligibility improvements immediately following perceptual training with dysarthric speech using lexical feedback are comparable to those observed when training uses somatosensory feedback (Borrie & Schäfer, 2015). In this study, we investigated if these lexical and somatosensory guided improvements in listener intelligibility of dysarthric speech remain comparable and stable over the course of 1 month.

Method

Following an intelligibility pretest, 60 participants were trained with dysarthric speech stimuli under one of three conditions: lexical feedback, somatosensory feedback, or no training (control). Participants then completed a series of intelligibility posttests, which took place immediately (immediate posttest), 1 week (1-week posttest) following training, and 1 month (1-month posttest) following training.

Results

As per our previous study, intelligibility improvements at immediate posttest were equivalent between lexical and somatosensory feedback conditions. Condition differences, however, emerged over time. Improvements guided by lexical feedback deteriorated over the month whereas those guided by somatosensory feedback remained robust.

Conclusions

Somatosensory feedback, internally generated by vocal imitation, may be required to affect long-term perceptual gain in processing dysarthric speech. Findings are discussed in relation to underlying learning mechanisms and offer insight into how externally and internally generated feedback may differentially affect perceptual learning of disordered speech.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2151/2643504/Effects-of-Lexical-and-Somatosensory-Feedback-on

Judgments of Emotion in Clear and Conversational Speech by Young Adults With Normal Hearing and Older Adults With Hearing Impairment

Purpose

In this study, we investigated the emotion perceived by young listeners with normal hearing (YNH listeners) and older adults with hearing impairment (OHI listeners) when listening to speech produced conversationally or in a clear speaking style.

Method

The first experiment included 18 YNH listeners, and the second included 10 additional YNH listeners along with 20 OHI listeners. Participants heard sentences spoken conversationally and clearly. Participants selected the emotion they heard in the talker's voice using a 6-alternative, forced-choice paradigm.

Results

Clear speech was judged as sounding angry and disgusted more often and happy, fearful, sad, and neutral less often than conversational speech. Talkers whose clear speech was judged to be particularly clear were also judged as sounding angry more often and fearful less often than other talkers. OHI listeners reported hearing anger less often than YNH listeners; however, they still judged clear speech as angry more often than conversational speech.

Conclusions

Speech spoken clearly may sound angry more often than speech spoken conversationally. Although perceived emotion varied between YNH and OHI listeners, judgments of anger were higher for clear speech than conversational speech for both listener groups.

Supplemental Materials

http://ift.tt/2sQO99N

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2271/2643501/Judgments-of-Emotion-in-Clear-and-Conversational

Glottal Aerodynamic Measures in Women With Phonotraumatic and Nonphonotraumatic Vocal Hyperfunction

Purpose

The purpose of this study was to determine the validity of preliminary reports showing that glottal aerodynamic measures can identify pathophysiological phonatory mechanisms for phonotraumatic and nonphonotraumatic vocal hyperfunction, which are each distinctly different from normal vocal function.

Method

Glottal aerodynamic measures (estimates of subglottal air pressure, peak-to-peak airflow, maximum flow declination rate, and open quotient) were obtained noninvasively using a pneumotachograph mask with an intraoral pressure catheter in 16 women with organic vocal fold lesions, 16 women with muscle tension dysphonia, and 2 associated matched control groups with normal voices. Subjects produced /pae/ syllable strings from which glottal airflow was estimated using inverse filtering during /ae/ vowels, and subglottal pressure was estimated during /p/ closures. All measures were normalized for sound pressure level (SPL) and statistically tested for differences between patient and control groups.

Results

All SPL-normalized measures were significantly lower in the phonotraumatic group as compared with measures in its control group. For the nonphonotraumatic group, only SPL-normalized subglottal pressure and open quotient were significantly lower than measures in its control group.

Conclusions

Results of this study confirm previous hypotheses and preliminary results indicating that SPL-normalized estimates of glottal aerodynamic measures can be used to describe the different pathophysiological phonatory mechanisms associated with phonotraumatic and nonphonotraumatic vocal hyperfunction.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2159/2648608/Glottal-Aerodynamic-Measures-in-Women-With

Early Postimplant Speech Perception and Language Skills Predict Long-Term Language and Neurocognitive Outcomes Following Pediatric Cochlear Implantation

Purpose

We sought to determine whether speech perception and language skills measured early after cochlear implantation in children who are deaf, and early postimplant growth in speech perception and language skills, predict long-term speech perception, language, and neurocognitive outcomes.

Method

Thirty-six long-term users of cochlear implants, implanted at an average age of 3.4 years, completed measures of speech perception, language, and executive functioning an average of 14.4 years postimplantation. Speech perception and language skills measured in the 1st and 2nd years postimplantation and open-set word recognition measured in the 3rd and 4th years postimplantation were obtained from a research database in order to assess predictive relations with long-term outcomes.

Results

Speech perception and language skills at 6 and 18 months postimplantation were correlated with long-term outcomes for language, verbal working memory, and parent-reported executive functioning. Open-set word recognition was correlated with early speech perception and language skills and long-term speech perception and language outcomes. Hierarchical regressions showed that early speech perception and language skills at 6 months postimplantation and growth in these skills from 6 to 18 months both accounted for substantial variance in long-term outcomes for language and verbal working memory that was not explained by conventional demographic and hearing factors.

Conclusion

Speech perception and language skills measured very early postimplantation, and early postimplant growth in speech perception and language, may be clinically relevant markers of long-term language and neurocognitive outcomes in users of cochlear implants.

Supplemental materials

http://ift.tt/2tHGBXk

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2321/2645734/Early-Postimplant-Speech-Perception-and-Language

Applying an Integrative Framework of Executive Function to Preschoolers With Specific Language Impairment

Purpose

The first goal of this research was to compare verbal and nonverbal executive function abilities between preschoolers with and without specific language impairment (SLI). The second goal was to assess the group differences on 4 executive function components in order to determine if the components may be hierarchically related as suggested within a developmental integrative framework of executive function.

Method

This study included 26 4- and 5-year-olds diagnosed with SLI and 26 typically developing age- and sex-matched peers. Participants were tested on verbal and nonverbal measures of sustained selective attention, working memory, inhibition, and shifting.

Results

The SLI group performed worse compared with typically developing children on both verbal and nonverbal measures of sustained selective attention and working memory, the verbal inhibition task, and the nonverbal shifting task. Comparisons of standardized group differences between executive function measures revealed a linear increase with the following order: working memory, inhibition, shifting, and sustained selective attention.

Conclusion

The pattern of results suggests that preschoolers with SLI have deficits in executive functioning compared with typical peers, and deficits are not limited to verbal tasks. A significant linear relationship between group differences across executive function components supports the possibility of a hierarchical relationship between executive function skills.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2170/2645739/Applying-an-Integrative-Framework-of-Executive

Identifying the Dimensionality of Oral Language Skills of Children With Typical Development in Preschool Through Fifth Grade

Purpose

Language is a multidimensional construct from prior to the beginning of formal schooling to near the end of elementary school. The primary goals of this study were to identify the dimensionality of language and to determine whether this dimensionality was consistent in children with typical language development from preschool through 5th grade.

Method

In a large sample of 1,895 children, confirmatory factor analysis was conducted with 19–20 measures of language intended to represent 6 factors, including domains of vocabulary and syntax/grammar across modalities of expressive and receptive language, listening comprehension, and vocabulary depth.

Results

A 2-factor model with separate, highly correlated vocabulary and syntax factors provided the best fit to the data, and this model of language dimensionality was consistent from preschool through 5th grade.

Conclusion

This study found that there are fewer dimensions than are often suggested or represented by the myriad subtests in commonly used standardized tests of language. The identified 2-dimensional (vocabulary and syntax) model of language has significant implications for the conceptualization and measurement of the language skills of children in the age range from preschool to 5th grade, including the study of typical and atypical language development, the study of the developmental and educational influences of language, and classification and intervention in clinical practice.

Supplemental Materials

http://ift.tt/2uEshUx

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2185/2644885/Identifying-the-Dimensionality-of-Oral-Language

Influences of Phonological Context on Tense Marking in Spanish–English Dual Language Learners

Purpose

The emergence of tense-morpheme marking during language acquisition is highly variable, which confounds the use of tense marking as a diagnostic indicator of language impairment in linguistically diverse populations. In this study, we seek to better understand tense-marking patterns in young bilingual children by comparing phonological influences on marking of 2 word-final tense morphemes.

Method

In spontaneous connected speech samples from 10 Spanish–English dual language learners aged 56–66 months (M = 61.7, SD = 3.4), we examined marking rates of past tense -ed and third person singular -s morphemes in different environments, using multiple measures of phonological context.

Results

Both morphemes were found to exhibit notably contrastive marking patterns in some contexts. Each was most sensitive to a different combination of phonological influences in the verb stem and the following word.

Conclusions

These findings extend existing evidence from monolingual speakers for the influence of word-final phonological context on morpheme production to a bilingual population. Further, novel findings not yet attested in previous research support an expanded consideration of phonological context in clinical decision making and future research related to word-final morphology.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/60/8/2199/2646850/Influences-of-Phonological-Context-on-Tense