Impaired polymorphonuclear neutrophils in the oral cavity of edentulous individuals

Oral health is characterized by functional oral polymorphonuclear neutrophils (oPMNs). Edentulism might be associated with a loss of oPMNs because these cells enter the oral cavity primarily through the gingival crevices. The main aim of this study was to investigate the numbers of oPMNs in rinse samples obtained from edentulous (n = 21) and dentate (n = 20) subjects. A second study aim was to investigate possible differences between oPMNs and peripheral blood polymorphonuclear neutrophils (cPMNs). Apoptosis/necrosis and cell-activation markers (CD11b, CD63 and CD66b) were analyzed using flow cytometry. Reactive oxygen species (ROS) production was determined either without stimulation (constitutive) or in response to 10 μM phorbol myristate acetate or Fusobacterium nucleatum. The edentulous subjects presented with lower oPMN counts and higher percentages of apoptotic/necrotic oPMNs compared with dentate subjects. Furthermore, oPMNs from edentulous donors expressed low levels of all three activation markers and low constitutive ROS. In contrast, oPMNs from dentate subjects expressed high levels of all three activation markers and a higher level of constitutive ROS than cPMNs. When challenged, oPMNs from edentulous subjects showed no upregulation in ROS production, whereas oPMNs from dentate subjects retained their ability to respond to stimulation. The functional characteristics of cPMNs were comparable between edentulous and dentate subjects. This study demonstrates that despite having functional cPMNs, edentulous subjects have low oPMN numbers that are functionally impaired.

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Guided bone regeneration: materials and biological mechanisms revisited

Guided bone regeneration (GBR) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non-osteogenic tissues from interfering with bone regeneration is a key principle of GBR. Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE/PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR, instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.

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Long-term survival in a patient with Virchow’s lymph node metastasis of cecal cancer

Abstract

The patient was a 53-year-old male with a chief complaint of bloody stool. To treat the cecal colon cancer, right hemicolectomy was performed. Histological examination showed moderately differentiated adenocaricinoma, SE, N3, H0, P0, M0 Stage IIIb by Japanese Classification of the Colorectal Carcinoma. After the operation, the patient received a chemotherapy with 6 cycles of Capecitabine regimen. After 1 year later, computed tomography detected swelling of Virchow's lymph node and tumor in the thyroid gland. By fine-needle aspiration cytology, thyroid gland tumor was diagnosed as papillary cancer and Virchow's lymph node was detected adenocarcinoma which was metastasis of cecal cancer. Total thyroidectomy and cervical lymph node dissection were performed. After the operation, the patient received chemotherapy with 6 cycles of FOLFOX regimen. And the patient had taken UFT/LV for 30 months. Now he has no recurrence and keeps his quality of life high. He has been alive for 80 months since the first operation. Virchow lymph node dissection can be one of the options of treatment of metastasis.

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Skin suturing and cortical surface viral infusion improves imaging of neuronal ensemble activity with head-mounted miniature microscopes

Publication date: Available online 19 August 2017
Source:Journal of Neuroscience Methods
Author(s): Xinjian Li, Vania Y. Cao, Wenyu Zhang, Surjeet S. Mastwal, Qing Liu, Stephani Otte, Kuan Hong Wang
BackgroundIn vivo optical imaging of neural activity provides important insights into brain functions at the single-cell level. Cranial windows and virally delivered calcium indicators are commonly used for imaging cortical activity through two-photon microscopes in head-fixed animals. Recently, head-mounted one-photon microscopes have been developed for freely behaving animals. However, minimizing tissue damage from the virus injection procedure and maintaining window clarity for imaging can be technically challenging.New methodWe used a wide-diameter glass pipette at the cortical surface for infusing the viral calcium reporter AAV-GCaMP6 into the cortex. After infusion, the scalp skin over the implanted optical window was sutured to facilitate postoperative recovery. The sutured scalp was removed approximately two weeks later and a miniature microscope was attached above the window to image neuronal activity in freely moving mice.ResultsWe found that cortical surface virus infusion efficiently labeled neurons in superficial layers, and scalp skin suturing helped to maintain the long-term clarity of optical windows. As a result, several hundred neurons could be recorded in freely moving animals.Comparison with existing methodsCompared to intracortical virus injection and open-scalp postoperative recovery, our methods minimized tissue damage and dura overgrowth underneath the optical window, and significantly increased the experimental success rate and the yield of identified neurons.ConclusionOur improved cranial surgery technique allows for high-yield calcium imaging of cortical neurons with head-mounted microscopes in freely behaving animals. This technique may be beneficial for other optical applications such as two-photon microscopy, multi-site imaging, and optogenetic modulation.



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Corrigendum to ‘A system to measure the pupil response to steady lights in freely behaving mice’ [J. Neurosci. Methods 273 (2016) 74–85]

Publication date: Available online 19 August 2017
Source:Journal of Neuroscience Methods
Author(s): Mark Bushnell, Yumiko Umino, Eduardo Solessio




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A high-sensitive nano-modified biosensor for dynamic monitoring of glutamate and neural spike covariation from rat cortex to hippocampal sub-regions

Publication date: Available online 19 August 2017
Source:Journal of Neuroscience Methods
Author(s): Guihua Xiao, Yilin Song, Song Zhang, Lili Yang, Shengwei Xu, Yu Zhang, Huiren Xu, Fei Gao, Ziyue Li, Xinxia Cai
BackgroundHippocampus is a critical part of brain tissue involved in many cognitive neural activities. They are controlled by various neurotransmitters such as glutamate (Glu), and affected by electrophysiology.New methodHerein, we fabricated a 16-site (25μm in diameter) microelectrode array (MEA) biosensor applied in dual-mode tests including Glu and neural spike measurements.MethodsAll the 16 recording sites were electrodeposited with platinum nanoparticles (PtNPs) and 8 sites were used for electrical recording. Glutamate oxidase enzyme (Gluox) and 1,3-Phenylenediamine (mPD) layer were specially modified on the other 8 sites for Glu recording. The dual-mode MEA was implanted from cortex to hippocampus of anesthetized rat to record Glu content and firing rate.ResultsThe electrical sites showed much lower impedance. The Glu sites showed much higher sensitivity(7.807 pA/μM), and ideal selectivity to the major molecules in brain. The post calibration sensitivity (3.935 pA/μM) maintained on a positive level. Different Glu content peaks including cortex (18.32μM) and hippocampal CA1 (4.39μM), CA3 (10.16μM), dentate gyrus (DG, two layers: 5.36μM and 10.34μM) have detected. The corresponded firing rate was recorded, too.Comparison with existingmethods This modification showed much lower impedance and much higher sensitivity. We obtained more neuron activities simultaneously by dual-mode recording. The covariation of Glu and neural spike signals was discovered in the specific hippocampus sub-region.ConclusionsThe covariation between Glu and firing rate changes were synchronous, and effected by regions. The dual-mode signals were useful to find the neurology disease mechanism.



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Reputation Management and Content Control: An Analysis of Radiation Oncologists’ Digital Identities

Publication date: Available online 19 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Arpan V. Prabhu, Christopher Kim, Eison De Guzman, Eric Zhao, Evan Madill, Jonathan Cohen, David R. Hansberry, Nitin Agarwal, Dwight E. Heron, Sushil Beriwal
IntroductionGoogle is the most popular search engine in the United States, and patients are increasingly relying on online webpages to seek information about individual physicians. This study aims to characterize what patients find when they search for radiation oncologists online.Material & MethodsThe Centers for Medicare and Medicaid Services (CMS) Physician Comparable Downloadable File was used to identify all Medicare-participating radiation oncologists in the United States and Puerto Rico. Each radiation oncologist was characterized by medical school education, year of graduation, city of practice, gender, and affiliation to an academic institution. Using a custom Google-based search engine, up to the top 10 search results for each physician were extracted and categorized as relating to: (1) physician, hospital, or healthcare system, (2) third-party, (3) social media, (4) academic journal articles, or (5) other.ResultsAmongst all U.S. health care providers within CMS, 4,443 self-identified as being radiation oncologists and yielded 40,764 search results. Of these, 1,161 (26.1%) and 3,282 (73.9%) were classified as academic and nonacademic radiation oncologists, respectively. At least one search result was obtained for 4,398 physicians (99.0%). Physician, hospital and healthcare-controlled websites (16,006; 39.3%) and third-party websites (10,494; 25.7%) were the two most observed domain types. Social media platforms accounted for 2,729 (6.7%) hits, and peer-reviewed academic journal websites accounted for 1,397 (3.4%) results. About 6.8% and 6.7% of the top ten links were social media websites for academic and nonacademic radiation oncologists, respectably.ConclusionsMost radiation oncologists lack self-controlled online content when patients search within the first page of Google search results. With the strong presence of third-party websites and lack of social media, opportunities exist for radiation oncologists to increase their online presence to improve patient-provider communication and better the image of the overall field. We discuss strategies to improve online visibility.

Teaser

The authors identified all Medicare-participating radiation oncologists in the United States and Puerto Rico and developed a customized Google-based search engine. Up tothe top 10 search results for each physician were extracted and categorized. Results for academic and nonacademic radiation oncologists were compared. Most radiation, oncologists lacked self-controlled online content in the first page of Google search results. Strategies for radiation oncologists to improve their digital presence are discussed.


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Treatment with lacosamide impedes generalized seizures in a rodent model of cortical dysplasia

Summary

Objective

Epilepsy is a common neurologic disorder resulting in spontaneous, recurrent seizures. About 30–40% of patients are not responsive to pharmacologic therapies. This may be due to the differences between individual patients such as etiology, underlying pathophysiology, and seizure focus, and it highlights the importance of new drug discovery and testing in this field. Our goal was to determine the efficacy of lacosamide (LCM), a drug approved for the treatment of focal seizures, in a model of generalized epilepsy with cortical dysplasia (CD). We sought to compare LCM to levetiracetam (LEV), a drug that is currently used for the treatment of both partial and generalized epilepsy and to test its proficiency.

Methods

Pregnant rats were irradiated to produce pups with malformed cortices in a model of CD, which will be referred to as the "first hit." Adult animals, developed normally (NL) and irradiated (XRT), were surgically implanted with electroencephalography (EEG) electrodes. Baseline EEG was recorded on all rats prior to pretreatments with either LCM, LEV, or placebo (PBO). After 30 min, all rats were injected with a subconvulsive dose of pentylenetetrazole (PTZ), a γ-aminobutyric acid receptor A (GABA_A) antagonist used to provoke generalized seizures as a "second hit."

Results

LCM and LEV were both effective against seizures induced by PTZ. XRT rats had a higher seizure incidence with longer and more severe seizures than NL rats. Seizure duration was decreased with both LCM and LEV in all animals. In XRT rats, there was a significant reduction in acute seizure incidence and severity with both LCM and LEV after PTZ injection.

Significance

Our results suggest that LCM could be used as a potential treatment option for generalized epilepsy with CD as the underlying pathology.

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Effect of different dental burs for experimental induction of pulpitis in mice

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Xilin Shi, Zhengmao Li, Ying He, Qianzhou Jiang, Xuechao Yang
ObjectiveTo evaluate the effect of using different dental burs on the development of pulpal inflammation after pulpal exposure in mice.DesignEighty-eight C57BL/6 mice were randomly assigned to group A (n=40), group B (n=40) and control group (n=8). The pulps of the maxillary first molars were occlusally exposed using ¼ round burs and polishing burs in group A and B respectively. Animals were sacrificed randomly at 0h, 4h, 8h, 12h and 24h after pulpal exposure. Micro-CT scanning was used to determine the success rate of sample preparation. Pulpal tissue changes were evaluated by histopathologic and immunohistochemical analyses.ResultsThe success rates of sample preparations were 85% in group A and 90% in group B. The mean maximum diameter of pulpal exposure area was 625.6±30.6μm in group A and 402.7±18.0μm in group B (p<0.05). In addition, the mean of the minimum remaining dentine thickness at the marked region of interest was 133.2±29.9μm in group A and 261.4±16.3μm in group B (p<0.05). Histopathologic staining demonstrated more signs of inflammation in both groups, as the duration of pulpal exposure increases. However, the rate of inflammatory progress was higher in group A, even spreading to the root pulp tissue within a few hours. For group B, the progress was relatively slow.ConclusionsPulpal exposure with different sizes of dental burs affects changes in the development of pulpal inflammation in mice.



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Neurobiology of autoimmune encephalitis

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): Masaki Fukata, Norihiko Yokoi, Yuko Fukata
Autoimmune encephalitis presenting with amnesia, seizures, and psychosis is highly topical in basic and clinical neuroscience. Recent studies have identified numerous associated autoantibodies, targeting cell-surface synaptic proteins including neurotransmitter receptors (e.g. NMDA receptors (NMDARs)) and a secreted protein, LGI1. In vitro and in vivo analyses of the influence of the autoantibodies have begun to clarify their causal roles. Of particular interest is the generation of recombinant monoclonal antibodies from patients' B cells with anti-NMDAR encephalitis. Patient monoclonal antibodies could be useful to reveal their direct, detailed pathogenicity. Such identification and characterization of autoantibodies could create new categories of neurological diseases and promote the understanding of patho-physiologic roles of target proteins in human brain function.



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New insights into olivo-cerebellar circuits for learning from a small training sample

Publication date: October 2017
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Isao T Tokuda, Huu Hoang, Mitsuo Kawato
Artificial intelligence such as deep neural networks exhibited remarkable performance in simulated video games and 'Go'. In contrast, most humanoid robots in the DARPA Robotics Challenge fell down to ground. The dramatic contrast in performance is mainly due to differences in the amount of training data, which is huge and small, respectively. Animals are not allowed with millions of the failed trials, which lead to injury and death. Humans fall only several thousand times before they balance and walk. We hypothesize that a unique closed-loop neural circuit formed by the Purkinje cells, the cerebellar deep nucleus and the inferior olive in and around the cerebellum and the highest density of gap junctions, which regulate synchronous activities of the inferior olive nucleus, are computational machinery for learning from a small sample. We discuss recent experimental and computational advances associated with this hypothesis.



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Diffuse Idiopathic Skeletal Hyperostosis Involving Cervical and Lumbar Spine Presenting with Dysphagia: A Case Report.

Diffuse Idiopathic Skeletal Hyperostosis Involving Cervical and Lumbar Spine Presenting with Dysphagia: A Case Report.

Iran J Otorhinolaryngol. 2017 Jul;29(93):233-236

Authors: Sinha R, Aggarwal N, Dutta S, Choudhury A, Ghosh SK, Guha D

Abstract
INTRODUCTION: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a very rare cause of dysphagia when it occurs in the cervical spine. It can also affect the lumbar region where it causes deformity.
CASE REPORT: In this article, a rare case of Diffuse Idiopathic Skeletal Hyperostosis involving both the cervical and lumbar spine, presenting with dysphagia and spinal stiffness leading to a stooping posture, is reported.
CONCLUSION: Cases of simultaneous involvement of cervical and lumbar vertebrae by Diffuse Idiopathic Skeletal Hyperostosis, presenting with symptoms of both area involvement, are rarely reported in the English literature. When investigating a case of dysphagia, a high level of suspicion is required to diagnose such a condition.

PMID: 28819624 [PubMed]

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Pharyngocutaneous Fistula as a Rare Late Postoperative Complication Following Submandibulectomy: A Case Report.

Pharyngocutaneous Fistula as a Rare Late Postoperative Complication Following Submandibulectomy: A Case Report.

Iran J Otorhinolaryngol. 2017 Jul;29(93):229-231

Authors: Mashali L, Araghi S

Abstract
INTRODUCTION: Submandibular gland excision is the gold standard treatment for submandibular gland disease. Although submandibulectomy is a relatively standardized surgical procedure, complications are frequently reported. These complications include nerve paralysis or paresis, aesthetic sequelae, hematoma, salivary fistulas or sialoceles, wound infections, hypertrophic scars and inflammations caused by residual lithiasis in the salivary duct.
CASE REPORT: We report a case of a rare complication of submandibular gland excision, pharyngocutaneous fistula, which appeared 6 years after previous surgery. The patient underwent surgery, during which a fistula tract from the skin to the pharynx was found and excised.
CONCLUSION: The authors believe that inappropriate execution of the surgical procedure could result in postoperative complications.

PMID: 28819623 [PubMed]

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Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection.

Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection.

Iran J Otorhinolaryngol. 2017 Jul;29(93):225-228

Authors: Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M

Abstract
INTRODUCTION: Pyolaryngocele is a very rare and serious complication of laryngocele. It can present as deep neck space infection and mislead the diagnosis. Our aim is to bring this unusual entity to the attention of surgeons and describe its clinical features.
CASE REPORT: We report a case of a 45-year-old male patient with a five-week history of neck swelling, dysphonia, dyspnea and odynophagia. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of a high dose antibiotic and an excision of the residual laryngocele via an external approach.
CONCLUSION: A pyolaryngocele is an unusual complication of laryngocele, which becomes secondarily infected, causing many symptoms. Removing the laryngocele is still the best treatment option to prevent this complication and recurrence.

PMID: 28819622 [PubMed]

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An Unusual Cause of Postaural Swelling: Kimura's Disease.

An Unusual Cause of Postaural Swelling: Kimura's Disease.

Iran J Otorhinolaryngol. 2017 Jul;29(93):221-224

Authors: Prasad P, Tandon S, Batra V, Singh I

Abstract
INTRODUCTION: Kimura's disease (KD) is an allergic inflammatory disorder of unknown etiology endemic in Orientals. Kimura's disease was first mentioned by Kimm and Szeto in China in 1937. Kimura's disease is commonly encountered in Asia and is mostly reported in Japan, China, Singapore and Honkong. However, only a few cases have been reported in the Indian subcontinent.
CASE REPORT: A case of Kimura's disease in a young male managed by surgery is reported in addition to a literature review.
CONCLUSION: Diagnosis is made on the basis of histopathological analysis, clinical presentation, and laboratory investigations. Long term follow-up is required as Kimura's disease is prone for recurrence.

PMID: 28819621 [PubMed]

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Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients.

Iran J Otorhinolaryngol. 2017 Jul;29(93):215-219

Authors: Ballivet-de-Régloix S, Crambert A, Maurin O, Bonfort G, Marty S, Pons Y

Abstract
INTRODUCTION: We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract.
MATERIALS AND METHODS: From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed.
RESULTS: Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days.
CONCLUSION: From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

PMID: 28819620 [PubMed]

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Is the Persian Version of the "Olfactory Disorder Questionnaire" Reliable and Valid?

Is the Persian Version of the "Olfactory Disorder Questionnaire" Reliable and Valid?

Iran J Otorhinolaryngol. 2017 Jul;29(93):209-213

Authors: Jalessi M, Kamrava SK, Amini E, Rafiei F, Nasouti MA, Moosavi N, Farhadi M

Abstract
INTRODUCTION: The Questionnaire for Olfactory Dysfunction (QOD) is a self-reporting olfactory-related quality of life questionnaire. The aim of this study was to determine the reliability and validity of the Persian version of this questionnaire.
MATERIALS AND METHODS: One hundred and thirteen patients with olfactory problems were enrolled in this study. The English version of the QOD was first translated into Persian. The reliability was then tested by determining the Cronbach alpha coefficient to assess internal consistency. The QOD was reviewed by a panel of experts, followed by calculating the content validity index to determine the content validity.
RESULTS: Based on the reliability analysis, the total Cronbach alpha was 0.88. The items in the "life quality" and "parosmia" domains had a good internal consistency in total, as well as in both genders and in different age subgroups. For the "sincerity" domain, however, low internal consistency was revealed (Cronbach alpha = 0.25). When questions related to the sincerity domain were omitted, the Cronbach alpha reached 0.89. The overall scale validity index for clarity and relevance were 0.88 and 0.87, respectively.
CONCLUSION: The Persian version of the QOD seems to be a reliable and valid tool for the assessment of quality of life in patients with olfactory dysfunction. The "sincerity" domain cannot be used separately or should be substantially modified in order to be applicable to the Iranian population. However, there is no need to change the whole format of the questionnaire.

PMID: 28819619 [PubMed]

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Serum Levels of Cyfra 21 in Patients with Benign and Malignant Salivary Gland Tumors.

Serum Levels of Cyfra 21 in Patients with Benign and Malignant Salivary Gland Tumors.

Iran J Otorhinolaryngol. 2017 Jul;29(93):203-208

Authors: Jeiroodi N, Aslani SM, Khademi B, Malekzadeh M, Jaafari-Ashkavandi Z

Abstract
INTRODUCTION: Cyfra 21 is a serum-soluble fragment of cytokeratin19. Increased Cyfra 21 serum levels and their benefit as a tumor marker have been shown in some malignancies. This study aimed to evaluate the serum levels of Cyfra 21 in patients with benign and malignant salivary gland tumors.
MATERIALS AND METHODS: In this cross-sectional study, the serum level of Cyfra 21 in 44 patients with malignant salivary gland tumors and 16 cases of pleomorphic adenoma were compared with 28 healthy controls using enzyme-linked immunosorbent assay (ELISA). Data were analyzed statistically using the Kruskal Wallis test, analysis of variance (ANOVA) and Spearman's correlation tests.
RESULTS: Mean serum levels of Cyfra 21 were 0.135 ± 0.285 ng/ ml in the control group, 0.167 ± 0.142 ng/ ml in patients with pleomorphic adenoma and 1.059 ± 3.251 ng/ml in patients with malignant salivary gland tumors. There was no significant difference among groups. Cyfra 21 levels did not correlate with location of tumor, clinical stage or cigarette smoking.
CONCLUSION: Results of the present study showed no significant difference in Cyfra 21 serum level in salivary gland tumors compared with normal individuals. In addition, Cyfra 21 serum level was not sufficiently sensitive to function as a tumor marker in salivary gland tumors.

PMID: 28819618 [PubMed]

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The Antioxidant Effect of Curcumin on Cochlear Fibroblasts in Rat Models of Diabetes Mellitus.

The Antioxidant Effect of Curcumin on Cochlear Fibroblasts in Rat Models of Diabetes Mellitus.

Iran J Otorhinolaryngol. 2017 Jul;29(93):197-202

Authors: Haryuna TS, Munir D, Maria A, Bashiruddin J

Abstract
INTRODUCTION: The aim of this study was to investigate the potential of curcumin as an antioxidant to increase the expression of superoxide dismutase (SOD) in fibroblasts of the cochlear lateral wall in rat models of diabetes mellitus.
MATERIALS AND METHODS: Twenty-four male Wistar rats Rattus norvegicus were randomly divided into six groups: group 1 as the control group; group 2 as the diabetic group; group 3 and 4 as the diabetic groups that received curcumin therapy of 200 and 400 mg/kg b.w. for 3 days, respectively; and group 5 and 6 as the diabetic groups that received curcumin therapy of 200 and 400 mg/kg b.w. for 8 days, respectively. All rats underwent termination and necropsy procedure on their temporal bones for immunohistochemical assay to determine the expression of SOD.
RESULTS: The decreased expression of SOD was detected in the diabetic group (without curcumin treatment). The treatment of curcumin at doses of 200 and 400 mg/kg b.w. for 3 and 8 days led to significant differences (P<0.05) in the expression of the SOD compared to diabetic group (without curcumin treatment). No significant differences were found in terms of dose and duration of curcumin administration on the expression of SOD.
CONCLUSION: Curcumin may act as an antioxidant against oxidative stress due to diabetes mellitus via increased expression of SOD on cochlear fibroblasts in rat models of diabetes mellitus.

PMID: 28819617 [PubMed]

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Maternal Risk Factors Associated with the Development of Cleft Lip and Cleft Palate in Mexico: A Case-Control Study.

Maternal Risk Factors Associated with the Development of Cleft Lip and Cleft Palate in Mexico: A Case-Control Study.

Iran J Otorhinolaryngol. 2017 Jul;29(93):189-195

Authors: Angulo-Castro E, Acosta-Alfaro LF, Guadron-Llanos AM, Canizalez-Román A, Gonzalez-Ibarra F, Osuna-Ramírez I, Murillo-Llanes J

Abstract
INTRODUCTION: Cleft lip and palate, the most common developmental deformity, is seen worldwide and the etiology involves a combination of genetic and environmental factors. The purpose of this study was to determine the maternal risk factors associated with the development of cleft lip and cleft palate.
MATERIALS AND METHODS: We conducted a case control study at the Women's Hospital in Culiacan, Mexico. Medical records were analyzed, including patients who delivered babies with and without cleft lip and cleft palate from January 2010 to December 2015. Multiple variables were analyzed, including gestational age, weight at birth, the use of folic acid and multivitamins during pregnancy, smoking, alcohol abuse, the use of recreational drugs, history of sexually transmitted infections, marital status, socioeconomic status, education, and nutritional status.
RESULTS: We found that the maternal risk factors with the strongest association for the development of cleft lip and cleft palate were the following: patients who were not taking folic acid during pregnancy [OR 3.27, 95% CI 1.32-8.09], P=0.00; patients who were not taking vitamin supplementation during pregnancy [OR 2.6, 95% CI 1.19-7.27], P=0.02; smoking during pregnancy [OR 2.05, 95% CI 1.23-3.41], P=0.01; and alcohol abuse during pregnancy [OR 1.90, 95% CI 1.17-3.08], P=0.03.
CONCLUSIONS: The main risk factors associated with the development of cleft lip and cleft palate in a Mexican population at the Women's hospital in Culiacan, Sinaloa, Mexico were smoking, alcohol abuse, and patients not taking folic acid and multivitamins during pregnancy.

PMID: 28819616 [PubMed]

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Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction.

Iran J Otorhinolaryngol. 2017 Jul;29(93):183-188

Authors: Bayat A, Saki N

Abstract
INTRODUCTION: Although vestibular rehabilitation therapy (VRT) methods are relatively popular in treating patients with body balance deficits of vestibular origin, only limited studies have been conducted into customized exercises for unilateral vestibular hypofunction (UVH). Furthermore, very little evidence is available on the outcomes of VRT in the elderly population with chronic UVH.
MATERIALS AND METHODS: A total of 21 patients, aged 61 to 74 years, with UVH participated in this study. The dizziness handicap inventory (DHI) was performed immediately before, and 2 and 8 weeks after treatment.
RESULTS: All patients showed a reduction in DHI scores during the study. The average decrease in DHI score was 25.98 points after 2 weeks' intervention (P<0.001) and 32.54 points at the end of the study. This improvement was observed in all DHI subscores, and was most profound in the functional aspect. The correlation between the degree of final recovery and canal paresis was not significant (P>0.05). There were no relationships between the scores and gender.
CONCLUSION: Our study demonstrates that VRT is an effective method for the management of elderly patients with UVH, and shows maximal effect on functional aspects.

PMID: 28819615 [PubMed]

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Failure modes and effects analysis for ocular brachytherapy

Publication date: Available online 18 August 2017
Source:Brachytherapy
Author(s): Yongsook C. Lee, Yongbok Kim, Jason Wei-Yeong Huynh, Russell J. Hamilton
PurposeThe aim of the study was to identify potential failure modes (FMs) having a high risk and to improve our current quality management (QM) program in Collaborative Ocular Melanoma Study (COMS) ocular brachytherapy by undertaking a failure modes and effects analysis (FMEA) and a fault tree analysis (FTA).Methods and MaterialsProcess mapping and FMEA were performed for COMS ocular brachytherapy. For all FMs identified in FMEA, risk priority numbers (RPNs) were determined by assigning and multiplying occurrence, severity, and lack of detectability values, each ranging from 1 to 10. FTA was performed for the major process that had the highest ranked FM.ResultsTwelve major processes, 121 sub-process steps, 188 potential FMs, and 209 possible causes were identified. For 188 FMs, RPN scores ranged from 1.0 to 236.1. The plaque assembly process had the highest ranked FM. The majority of FMs were attributable to human failure (85.6%), and medical physicist–related failures were the most numerous (58.9% of all causes). After FMEA, additional QM methods were included for the top 10 FMs and 6 FMs with severity values > 9.0. As a result, for these 16 FMs and the 5 major processes involved, quality control steps were increased from 8 (50%) to 15 (93.8%), and major processes having quality assurance steps were increased from 2 to 4.ConclusionsTo reduce high risk in current clinical practice, we proposed QM methods. They mainly include a check or verification of procedures/steps and the use of checklists for both ophthalmology and radiation oncology staff, and intraoperative ultrasound-guided plaque positioning for ophthalmology staff.



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Procesos fonológicos en una prueba de repetición de no-palabras en niños con trastorno específico del lenguaje

Publication date: Available online 19 August 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ana Susana Mejía Villalobos, Donna Jackson-Maldonado
El análisis de los procesos fonológicos se ha centrado en muestras provenientes de habla espontánea y en edades muy tempranas. Actualmente, existen muy pocos estudios que describan estos procesos fonológicos en español en edades tardías y que se basen en tareas que involucren una alta carga de procesamiento de la memoria de trabajo como lo es en una prueba de repetición de no-palabras (RNP) en poblaciones con trastorno específico del lenguaje (TEL). Este trabajo contrasta el tipo y ocurrencia de los errores fonológicos entre niños mexicanos con TEL y niños con desarrollo típico (DT) de edad escolar en una prueba de RNP. Participaron en el estudio 16 niños de 5 a 6 años, 8 niños con DT y 8 con TEL. Los resultados mostraron patrones generales de los procesos fonológicos en ambos grupos. Se encontró una distribución similar de los procesos en los grupos TEL y DT. Estos resultados coinciden con otros estudios en otras lenguas y en otras poblaciones en tipo y ocurrencia de procesos: los grupos de niños con TEL presentaron un mayor número de procesos fonológicos. Los procesos más frecuentes en los grupos fueron los de asimilación, modificación de la estructura silábica y los de procesos múltiples. Los procesos que distinguieron las poblaciones de niños con DT y TEL fueron los procesos múltiples, seguidos por los procesos que modifican la estructura silábica. Se muestra que, efectivamente, hay persistencia de los procesos fonológicos en etapas escolares, cuando la tarea exige un mayor nivel de procesamiento.Phonological processes have been extensively studied in spontaneous speech samples and in early stages of development. However, there are very few studies that have addressed these processes in Spanish at later ages in tasks involving a high processing load of the working memory such as a test of non-word repetition (NWR) in children with specific language impairment (SLI). This paper contrasts the occurrence of phonological errors among Mexican children with SLI and typically developing children (TD) using a NWR task. The study included 16 children aged 5-6 years: 8 children with SLI and 8 with TD. The results showed general patterns in the behavior of phonological processes in both groups. Also, a similar distribution of processes was in the SLI and TD groups. These results support studies in other languages both in type and tokens of processes: the SLI group had a higher number of phonological processes. The most productive processes in both groups were assimilation, processes with modification of the syllabic structure and multiple processes. The TD and SLI groups could be distinguished by phonological processes. Among those processes that showed differences between groups were multiple processes, followed by processes that modify the syllabic structure. We show that phonological processes are persistent into the school years when children are presented with a task that involves a greater processing load.



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Conchal contractility after inferior turbinate hypertrophy treatment: A prospective, randomized clinical trial

The aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters.

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Low-grade albuminuria is associated with poor memory performance in the nondemented Chinese elderly with type 2 diabetes

Abstract

Recent studies have correlated cognitive function with albuminuria. We investigated the association between low-grade albuminuria and cognitive performance in nondemented elderly with type 2 diabetes in Fuzhou, China. Between January, 2013 and December, 2014, a retrospective study was performed in 815 patients with type 2 diabetes (398 female and 417 male patients), ages ≥60 years, with normal urinary albumin to creatinine ratios (UACR <30 mg/g). Patients were stratified into tertiles based on UACR levels (lowest tertile, UACR <5.8 mg/g; highest tertile, UACR ≥18.1 mg/g). Cognitive function was measured using the Mini Mental State Examination. UACR tertiles correlated directly (p < 0.05) with age, duration of diabetes, systolic blood pressure (SBP), and pulse wave velocity (PWV). Patients in the second and highest tertiles performed significantly worse on memory and language than those in the lowest UACR tertile (p < 0.05). The association between UACR and memory loss was stronger in patients younger than 70 years of age and in those with a history of diabetes for less than 10 years. Low-grade albuminuria is associated with poor memory performance, especially in the youngest old (60–69 years) and in those with shorter duration of diabetes (< 10 years). Type 2 diabetics with urinary albumin excretion in the upper normal range were also at risk for declining memory performance.

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Trends in antibiotic prescribing by dental practitioners in Germany

To analyze the structure of antibiotic prescriptions by dentists in Germany during a time-period of four years in relation to medical antibiotic prescriptions.

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Long-term therapy with intravenous zoledronate increases the number of nonattached osteoclasts

Bisphosphonates (BPs) are antiresorptive drugs that are being used clinically to treat bone-related diseases, such as osteoporosis or cancer with bone metastasis (Williams et al., 2014). Users of these drugs are known to be at higher risk of developing osteonecrosis of the jaw (ONJ), which was first described by Marx (2003).

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Determining the fate of cranial sutures after surgical correction of non-syndromic craniosynostosis

"Secondary craniosynostosis" (SCS) refers to a loss of sutures after corrective vault reconstruction. There are no prior studies that comprehensively review SCS in various types of non-syndromic craniosynostosis. We assessed idiopathic and iatrogenic SCS using 3-dimensional computed tomography (3D CT). We also performed a systematic review to estimate the overall incidence of SCS in each craniosynostosis type, and to characterize its clinical features.

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Perinatal complications in patients with unisutural craniosynostosis: An international multicentre retrospective cohort study

Craniosynostosis may lead to hampered fetal head moulding and birth complications. To study the interaction between single suture craniosynostosis and delivery complications, an international, multicentre, retrospective cohort study was performed.

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Effects of low-level laser therapy and platelet concentrate on bone repair: Histological, histomorphometric, immunohistochemical, and radiographic study

Low-level laser therapy (LLLT) can increase bone metabolism, cell proliferation, and maturation, and reduce inflammation, while platelet concentrate (PC) assists bone healing process by releasing proteins and growth factors. Here, we evaluated the efficacy of combined LLLT and PC therapy in the healing of critical-size bone defects.

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Cranium Bifidum Occultum Associated with Hypertelorism Treated with Posterior Vault Reconstruction and Orbital Box Osteotomies: Case Report and Technical Note

Publication date: November 2017
Source:World Neurosurgery, Volume 107
Author(s): Rimal H. Dossani, David M. Yates, Piyush Kalakoti, Anil Nanda, Christina Notarianni, Jennifer Woerner, Ghali E. Ghali
Cranium bifidum occultum is a disorder of skull ossification presenting as an enlarged posterior fontanelle in the upper posterior angle of the parietal bone near the intersection of the sagittal and lambdoid sutures. The standard treatment for cranium bifidum occultum is observation. We present a case of a 5-year-old boy who presented with a 15 × 4.5 cm midline posterior cranial vault defect consistent with diagnosis of cranium bifidum occultum associated with orbital hypertelorism and a widened nose. The patient underwent posterior vault reconstruction for correction of cranium bifidum occultum defect followed by bifrontal craniotomy and orbital box osteotomies for correction of orbital hypertelorism and nasal deformity. To our knowledge, this is the first reported case describing surgical treatment for cranium bifidum occultum associated with orbital hypertelorism.



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Physiological Mechanisms in Combined Electric–Acoustic Stimulation

Objective: Electrical stimulation is normally performed on ears that have no hearing function, i.e., lack functional hair cells. The properties of electrically-evoked responses in these cochleae were investigated in several previous studies. Recent clinical developments have introduced cochlear implantation (CI) in residually-hearing ears to improve speech understanding in noise. The present study documents the known physiological differences between electrical stimulation of hair cells and of spiral ganglion cells, respectively, and reviews the mechanisms of combined electric and acoustic stimulation in the hearing ears. Data Sources: Literature review from 1971 to 2016. Conclusions: Compared with pure electrical stimulation the combined electroacoustic stimulation provides additional low-frequency information and expands the dynamic range of the input. Physiological studies document a weaker synchronization of the evoked activity in electrically stimulated hearing ears compared with deaf ears that reduces the hypersynchronization of electrically-evoked activity. The findings suggest the possibility of balancing the information provided by acoustic and electric input using stimulus intensity. Absence of distorting acoustic–electric interactions allows exploiting these clinical benefits of electroacoustic stimulation.

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Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes

Objective: Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes. Methods: Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual ("sound" photo [photograph with imaginative sound] and "nonsound" photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared. Results: N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. "Sound" photo stimuli evoked a stronger N1 than "nonsound" photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to "sound" photo stimuli stronger than those to "nonsound" photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies. Conclusion: The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.

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What Does Music Sound Like for a Cochlear Implant User?

Objective: Cochlear implant research and product development over the past 40 years have been heavily focused on speech comprehension with little emphasis on music listening and enjoyment. The relatively little understanding of how music sounds in a cochlear implant user stands in stark contrast to the overall degree of importance the public places on music and quality of life. The purpose of this article is to describe what music sounds like to cochlear implant users, using a combination of existing research studies and listener descriptions. We examined the published literature on music perception in cochlear implant users, particularly postlingual cochlear implant users, with an emphasis on the primary elements of music and recorded music. Additionally, we administered an informal survey to cochlear implant users to gather first-hand descriptions of music listening experience and satisfaction from the cochlear implant population. Conclusion: Limitations in cochlear implant technology lead to a music listening experience that is significantly distorted compared with that of normal hearing listeners. On the basis of many studies and sources, we describe how music is frequently perceived as out-of-tune, dissonant, indistinct, emotionless, and weak in bass frequencies, especially for postlingual cochlear implant users—which may in part explain why music enjoyment and participation levels are lower after implantation. Additionally, cochlear implant users report difficulty in specific musical contexts based on factors including but not limited to genre, presence of lyrics, timbres (woodwinds, brass, instrument families), and complexity of the perceived music. Future research and cochlear implant development should target these areas as parameters for improvement in cochlear implant-mediated music perception.

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Can Preoperative CT Scans Be Used to Predict Facial Nerve Stimulation Following CI?

Objectives: 1) To determine the ability of preoperative computed tomography (CT) to predict facial nerve stimulation (FNS) after cochlear implantation (CI). 2) To recognize the limitations of CT in predicting FNS. Study Design: Patient control study. Setting: Tertiary care academic medical center. Subjects: Adult patients with CI from 2003 to 2015. Methods: Patients with severe FNS (n = 4) were compared with randomly selected CI patients (n = 28). Three blinded reviewers evaluated preoperative temporal bone CT scans to measure the distance from the labyrinthine segment of the facial nerve to the basal turn of the cochlea and attempted to predict whether or not the subject had FNS after CI. Results: In total, 32 CT scans were evaluated representing 49 ears that underwent CI. The distances (mm) measured from the labyrinthine segment of the facial nerve to the basal turn of the cochlea in both the axial (0.3 ± 0.3 versus 0.6 ± 0.3) and coronal (0.4 ± 0.2 versus 0.6 ± 0.2) orientation were significantly different between the two groups (p = 0.0001 and p = 0.0034) respectively. The intraclass correlation coefficient demonstrated good (K > 0.7) reviewer correlation in both the reviewers' measurements and predictions. The sensitivity, specificity, positive predictive value, and negative predictive value for preoperative CT scans to predict FNS were 38.5, 85.1, 19.2, and 93.8% respectively. The reviewers were 23% accurate in predicting FNS. Conclusion: Based on a blinded retrospective patient-control study, CT scan measurements show a significantly reduced distance between the labyrinthine facial nerve and the basal turn of the cochlea in patients with FNS. However, it is difficult to predict who will have FNS based on these measurements.

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The Sound Quality of Cochlear Implants: Studies With Single-sided Deaf Patients

Objective: The goal of the present study was to assess the sound quality of a cochlear implant for single-sided deaf (SSD) patients fit with a cochlear implant (CI). Background: One of the fundamental, unanswered questions in CI research is "what does an implant sound like?" Conventional CI patients must use the memory of a clean signal, often decades old, to judge the sound quality of their CIs. In contrast, SSD-CI patients can rate the similarity of a clean signal presented to the CI ear and candidate, CI-like signals presented to the ear with normal hearing. Methods: For Experiment 1 four types of stimuli were created for presentation to the normal hearing ear: noise vocoded signals, sine vocoded signals, frequency shifted, sine vocoded signals and band-pass filtered, natural speech signals. Listeners rated the similarity of these signals to unmodified signals sent to the CI on a scale of 0 to 10 with 10 being a complete match to the CI signal. For Experiment 2 multitrack signal mixing was used to create natural speech signals that varied along multiple dimensions. Results: In Experiment 1 for eight adult SSD-CI listeners, the best median similarity rating to the sound of the CI for noise vocoded signals was 1.9; for sine vocoded signals 2.9; for frequency upshifted signals, 1.9; and for band pass filtered signals, 5.5. In Experiment 2 for three young listeners, combinations of band pass filtering and spectral smearing lead to ratings of 10. Conclusion: The sound quality of noise and sine vocoders does not generally correspond to the sound quality of cochlear implants fit to SSD patients. Our preliminary conclusion is that natural speech signals that have been muffled to one degree or another by band pass filtering and/or spectral smearing provide a close, but incomplete, match to CI sound quality for some patients.

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The Role of Preoperative Steroids in Atraumatic Cochlear Implantation Surgery

Hypothesis: Depth of insertion is related to the extent of tissue response and low frequency hearing loss. Intravenous steroids have greatest effect in reducing postimplantation fibrosis and hearing loss in the presence of significant electrode insertion trauma, when compared with saline treatment. Background: Experiments exploring the enhancement of cochlear implantation (CI) outcomes with glucocorticosteroids have produced mixed results, possibly due to lack of standardization of the CI model. Methods: Forty-eight normal-hearing guinea pigs were randomly implanted with a highly flexible electrode to a depth of 1.5, 3.0, or 5.0 mm. For each insertion depth, sub-cohorts received either intravenous saline ("saline") or dexamethasone ("steroid") 60 minutes before implantation. Shifts in electrocochleography thresholds at 2 to 32 kHz were determined before and 4 weeks after implantation. Cochleae were harvested and imaged. Results: Low-frequency hearing loss was greatest with 5.0 mm insertions. Fracture of the osseous spiral lamina and/or fibrotic involvement of the round window membrane exacerbated hearing loss. The extent of intracochlear fibrosis was directly related to the depth of insertion. Steroids reduced the intracochlear tissue response for deepest insertions and in apical regions of the cochlea where basilar membrane contact was prevalent. Steroids preserved no more hearing than saline at all insertion depths. Conclusion: Cochlear trauma influenced postimplantation hearing loss and steroid effect on fibrosis. Fibrosis, and to a lesser extent, postimplantation hearing loss increased proportionally to the depth of insertion. Steroids did not influence fibrosis relating to the cochleostomy, but could reduce scarring as the electrode negotiated the hook region or near the electrode tip.

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Impact of Cochlear Implantation on Cognitive Functions of Older Adults: Pilot Test Results

Background: A significant relationship between hearing loss and cognitive impairment has been previously reported. Overall, improvement in speech perception in quiet and quality of life has been observed after cochlear implantation. However, the impact of hearing loss treatment using cochlear implantation on cognitive functions is yet to be fully elucidated. Objective: To investigate the impact of cochlear implantation on cognitive and psychological functions of older adults. Study Design: Prospective patient-control study. Participants: A total of 39 participants took part in the study: 23 cochlear implant (CI) candidates (M = 69.04 ± 12.35 yr) and 16 CI recipients (M = 61.75 ± 15.62 yr). All participants completed an assessment of hearing (pure-tone thresholds and speech perception in quiet), and a computerised, nonverbal test battery of cognitive function assessment, as well as a depression, anxiety, and stress scale. Results: Independent-sample t test scores for the changes between 0 and 12 months revealed that CI recipients performed significantly better on measures of simple reaction time, cognitive flexibility, paired-associate learning, working memory, and strategy use (p 

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Cochlear Implants Meet Regenerative Biology: State of the Science and Future Research Directions

The cochlear implant, the first device to restore a human sense, is an electronic substitute for lost mechanosensory hair cells. It has been successful at providing hearing to people with severe to profound hearing loss and as of 2012, an estimated 324,000 patients worldwide have received cochlear implants. Users of cochlear implants however, suffer from difficulties in processing complex sounds such as music and in discriminating sounds in noisy environments. Recent advances in regenerative biology and medicine are opening new avenues for enhancing the efficacy of cochlear implants by improving the neural interface in the future and offer the possibility of an entirely biological solution for hearing loss in the long term. This report comprises the latest developments presented in the first Symposium on cochlear implants and regenerative biology, held at the 14th International Conference on Cochlear Implants in 2016 in Toronto, Canada.

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Development and Validation of a Modular Endoscopic Ear Surgery Skills Trainer

Objective: Endoscopic ear surgery (EES) is an emerging technique requiring single-handed dissection with limited depth perception. Current options for EES simulation and training are limited. Herein, we introduce a versatile, low-cost surgical skills trainer that aims to improve the fine motor control necessary for EES. Study Design: Prospective validation study. Setting: Surgical simulation laboratory. Participants: Seven subjects ranging in experience from medical students ("Novices") to experienced ear surgeons ("Experts") participated in the validation study. Experts (n = 3) were defined as performing >10 EES cases per year. Methods: The skills trainer was constructed from a 3" diameter polyvinyl chloride pipe cap modified with two ports for instrument passage. A wooden platform was placed inside at an appropriate working distance for ear surgery. Eight interchangeable skills modules were fabricated on wooden squares (3 cm × 3 cm) using materials such as #19 wire brads, 1.6 mm glass beads, and 26-gauge jewelry wire. The material cost of this reusable model was $15. Subjects completed each skills module in triplicate, followed by a Likert-based survey. Results: Expert performance was superior to novices in 100% (8/8) of skills modules, i.e., threading beads on a wire (43 versus 127 s, p 

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Diagnosis of Superior Semicircular Canal Dehiscence in the Presence of Concomitant Otosclerosis

Objective: To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario. Study Design: Retrospective patient series. Setting: Tertiary/quaternary referral center. Patients: Individuals with confirmed diagnoses of concurrent otosclerosis and superior semicircular canal dehiscence syndrome. Interventions: Detailed history and physical examinations were performed on these patients, as well as detailed audiovestibular testing and computed tomography imaging. Main Outcome Measures: Establishing a clear diagnosis of concurrent otosclerosis and superior semicircular canal dehiscence syndrome using a thorough diagnostic approach. Results: Three patients presented with conductive hearing loss and normal tympanic membranes. When history and physical examination yielded suspicious third window symptoms/signs, more detailed audiovestibular testing and computed tomography scan imaging were performed. All three patients were ultimately identified to have concurrent otosclerosis and superior canal dehiscence. Conservative management was the option of choice for two of these patients (trial of a hearing aid) and surgical intervention was performed to treat the otosclerosis in the remaining patient.

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Cognitive Evaluation of Cochlear Implanted Adults Using CODEX and MoCA Screening Tests

Objective: The relationship between hearing loss and cognitive function has already been established. The objective of our study was to determine whether the two short cognitive tests, COgnitive Disorders EXamination (CODEX) and Montreal Cognitive Assessment (MoCA), could be used in daily clinical practice to detect cognitive impairment, and its changes after cochlear implantation. Patients: Eighteen patients with severe to profound postlingual progressive hearing loss (mean age ± SEM: 64 ± 3.5 yr; range, 23–83 yr) were tested before, and 12 months after cochlear implantation, with adapted visual presentation of CODEX and MoCA tests. Auditory performance was tested under best-aided conditions in quiet and noise. Results: Twelve months after cochlear implantation, hearing performance had clearly improved (paired t tests, p 

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Significance of Endolymphatic Hydrops in Ears With Unilateral Sensorineural Hearing Loss

Objective: The purpose of this study was to investigate the existence of endolymphatic hydrops (EH) in affected and unaffected ears in patients with unilateral sensorineural hearing loss (SNHL) using contrast-enhanced magnetic resonance imaging (MRI), and to evaluate the significance of EH in various otological diseases. Study Design: Retrospective study. Setting: University hospital. Methods: One hundred eighty-two ears from 91 patients with unilateral SNHL were studied. The endolymphatic space was evaluated using 3-Tesla MRI with gadodiamide hydrate. Imaging data about the degree of EH in the cochlea and vestibule were analyzed and compared between ears with various otological diseases. Results: All affected ears with delayed endolymphatic hydrops had EH. In affected ears with definite Menière's disease, cochlear EH was observed in all ears and vestibular EH in 93% of ears, and these rates were significantly higher in the affected than in the unaffected ears. EH was also observed in the cochlea and vestibule in 66% and 41%, respectively, of the affected ears with idiopathic sudden SNHL; however, these percentages did not differ significantly from those in the unaffected ears (52% and 38%, respectively). Conclusion: MRI showed that a high percentage of ears affected by Menière's disease or delayed endolymphatic hydrops had EH. Further studies should evaluate the implications of EH in ears, especially in those with sudden SNHL, in terms of secondary or pre-existing EH.

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Vestibular Function in Adults With Epilepsy of Unknown Etiology

Objective: This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period. Background: Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients' quality of life. Methods: This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients' mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG). Results: Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities. Conclusion: Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.

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Noonan Syndrome: An Underestimated Cause of Severe to Profound Sensorineural Hearing Impairment. Which Clues to Suspect the Diagnosis?

Objective: To highlight Noonan syndrome as a clinically recognizable cause of severe to profound sensorineural hearing impairment. Study Design: New clinical cases and review. Setting: Patients evaluated for etiological diagnosis by a medical geneticist in a reference center for hearing impairment. Patients: Five patients presenting with confirmed Noonan syndrome and profound sensorineural hearing impairment. Interventions: Diagnostic and review of the literature. Results: Five patients presented with profound sensorineural hearing impairment and molecularly confirmed Noonan syndrome. Sensorineural hearing impairment has been progressive for three patients. Cardiac echography identified pulmonary stenosis in two patients and was normal for the three other patients. Short stature was found in two patients. Mild intellectual disability was found in one patient. Inconspicuous clinical features as facial dysmorphism, cryptorchidism, or easy bruising were of peculiar interest to reach the diagnosis of Noonan syndrome. Conclusion: Profound sensorineural hearing impairment can be the main feature of Noonan syndrome. Associated features are highly variable; thus, detailed medical history and careful physical examination are mandatory to consider the diagnosis in case of a sensorineural hearing impairment.

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A Smartphone Application for Customized Frequency Table Selection in Cochlear Implants

Hypothesis: A novel smartphone-based software application can facilitate self-selection of frequency allocation tables (FAT) in postlingually deaf cochlear implant (CI) users. Background: CIs use FATs to represent the tonotopic organization of a normal cochlea. Current CI fitting methods typically use a standard FAT for all patients regardless of individual differences in cochlear size and electrode location. In postlingually deaf patients, different amounts of mismatch can result between the frequency-place function they experienced when they had normal hearing and the frequency-place function that results from the standard FAT. For some CI users, an alternative FAT may enhance sound quality or speech perception. Currently, no widely available tools exist to aid real-time selection of different FATs. This study aims to develop a new smartphone tool for this purpose and to evaluate speech perception and sound quality measures in a pilot study of CI subjects using this application. Methods: A smartphone application for a widely available mobile platform (iOS) was developed to serve as a preprocessor of auditory input to a clinical CI speech processor and enable interactive real-time selection of FATs. The application's output was validated by measuring electrodograms for various inputs. A pilot study was conducted in six CI subjects. Speech perception was evaluated using word recognition tests. Results: All subjects successfully used the portable application with their clinical speech processors to experience different FATs while listening to running speech. The users were all able to select one table that they judged provided the best sound quality. All subjects chose a FAT different from the standard FAT in their everyday clinical processor. Using the smartphone application, the mean consonant–nucleus–consonant score with the default FAT selection was 28.5% (SD 16.8) and 29.5% (SD 16.4) when using a self-selected FAT. Conclusion: A portable smartphone application enables CI users to self-select frequency allocation tables in real time. Even though the self-selected FATs that were deemed to have better sound quality were only tested acutely (i.e., without long-term experience with them), speech perception scores were not inferior to those obtained with the clinical FATs. This software application may be a valuable tool for improving future methods of CI fitting.

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Outcomes and Time to Emergence of Auditory Skills After Cochlear Implantation of Children With Charge Syndrome

Objective: Review perioperative complications, benefits, and the timeframe over which auditory skills develop in children with CHARGE syndrome who receive a cochlear implant (CI). Study Design: IRB-approved retrospective chart review of children with CHARGE syndrome who had at least 12 months of cochlear implant use. Setting: Tertiary care children's hospital. Patients: Twelve children, seven males and five females. Mean age implant = 3.5 years (1.7–8.2 yr); mean duration follow-up = 4.7 years (1.5–10.1 yr). Intervention: Cochlear implantation. Main Outcome Measures: Auditory skills categorized into four levels, temporal bone imaging findings, perioperative complications, time to emergence of speech perception, expressive communication mode. Results: All children imaged with magnetic resonance imaging had cochlear nerve deficiency in at least one ear. Speech awareness threshold improved with the CI compared with aided preoperative in 83% of children, with means of 51.7 dB SAT preoperative and 27.1 dB with the CI (p ≤ 0.002). Overall, four children improved to auditory Level 2 (improved detection), three obtained Level 3 (closed-set speech perception), and three had open-set speech perception with their CIs (Level 4) that was first evident at 3.5, 3.3, and 0.8 years postimplant testing. Two children had minimal or limited improvement. One child with hypoplasia of the cochlear nerve obtained open-set levels. Conclusion: Auditory skills may develop slowly in children with CHARGE syndrome who receive a CI but most can achieve at least improved detection. In our series, half acquired some speech perception ability. Cochlear nerve deficiency is frequent, but should not be a contraindication to implantation.

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Audiologic Gain of Incus Short Process Vibroplasty With Conventional Incus Long Process Vibroplasty: A Retrospective Analysis of 36 Patients

Objective: To compare the audiological and non-audiological benefits of incus short process (SP) vibroplasty with those of conventional incus long process (LP) vibroplasty. Study Design: Retrospective analysis. Setting: Tertiary referral center. Patients: Thirty-six patients with sensorineural hearing loss were treated with the semi-implantable middle ear hearing device. Of these, 22 were treated with conventional LP vibroplasty, and 14 were treated with SP vibroplasty using SP couplers. Interventions: Implantation with the semi-implantable middle ear hearing device by different methods. Main Outcome Measures: Pre- and postoperative hearing level, word recognition score, operation time, and duration of hospital stay were compared. We also surveyed a questionnaire to assess postoperative complications. Results: The improvement in hearing gain was comparable between SP vibroplasty and conventional LP vibroplasty, except at 8 kHz, at which LP vibroplasty showed better hearing gain (p 

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The Influence of Intraoperative Testing on Surgical Decision-making During Cochlear Implantation

Objective: To review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: A total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon from 2010 to 2015. Intervention: Intraoperative electrophysiologic monitoring including evoked compound action potentials and electrical impedances. Main Outcome Measures: Whether surgical management was changed based on intraoperative testing. Results: In only 2 of 266 patients (0.8%), the back-up device was used due to findings on intraoperative testing. In three patients (1.1%), X-ray was performed intraoperatively to confirm intracochlear electrode placement, which was found to be normal in all patients. Conclusion: Our data suggest that with respect to CI in children and adults in straightforward cases (e.g., normal anatomy, nondifficult insertion, etc.), routine intraoperative evoked compound action potentials, impedances, and imaging rarely influence surgical decision-making in our clinic and may have limited usefulness in these patients. The implications of this are discussed and a review of the literature is presented.

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Reduction in Temporary and Permanent Audiological Injury Through Internal Jugular Vein Compression in a Rodent Blast Injury Model

Hypothesis: Internal jugular vein (IJV) compression influences not only intracranial but also intracochlear physiology and has demonstrated preclinical effectiveness in reducing acute audiological injury in a rodent blast model. However, the long-term effects in this model are unknown. Background: Blast wave-induced audiological injury from an improvised explosive device is a leading cause of morbidity among service members in theater but there are limitations to the current protective measures. Methods: For this study, we exposed 20 Sprague Dawley rats to a 16.8 ± 0.3 PSI (195.3 dB SPL) right-sided shock wave in which 10 had application of a custom IJV compression collar in place at the time of injury. Results: IJV compression at the time of injury was shown acutely to significantly reduce the incidence of tympanic membrane rupture and the initial temporary threshold shift on otoacoustic emissions in both the right and left ears of animals who had collar application immediately after and 7 days post injury. At 28 days from injury, collared animals demonstrated a return to baseline of otoacoustic emission values while the noncollared animals had persistent threshold shifts, signifying the presence of a permanent threshold shift only in those animals without collar application. IJV compression was also found to significantly reduce hair cell loss at the base of the cochlea secondary to mechanical trauma from the blast wind. Conclusion: Previously observed acute protective effects of IJV compression are sustained at chronic time points. IJV compression can potentially be used to reduce long-term permanent morbidity from blast-induced audiological trauma.

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EM Nerd-The Case of the Elemental Truancy

Much has been written regarding the benefits of apneic oxygenation. The physiological underpinnings are sound with minimal logistical and resource based costs. As such it has enjoyed widespread adoption throughout the Emergency Medicine and Critical Care world. Despite its popularity, the evidence supporting its use has been less inspirational. Recently, a meta-analysis published in Annals […]

EMCrit by Rory Spiegel.

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Sarcomatoid carcinoma associated with small cell carcinoma of the urinary bladder: a series of 28 cases

Publication date: Available online 19 August 2017
Source:Human Pathology
Author(s): Yuly Ramirez Urrea, Jonathan I. Epstein
The association of sarcomatoid carcinoma (SC) with small cell carcinoma (SCC) has not been systematically studied. We identified 39 consult cases between 2001–2016 with available slides for review in 28 cases. There were 19 men and 9 women [mean age: 78years (51–89)]. In 26 (92.8%) cases, the sarcomatoid component had nonspecific malignant spindle cells, 4 (14%) chondrosarcoma, 2 (7%) myxoid sarcomatous, 1 (3.5%) osteosarcoma, and 1 (3.5%) rhabdomyosarcoma. The predominant component was in 11 (39%) cases SCC, 6 (21%) urothelial carcinoma, 3 (10%) sarcomatoid, and 8 (29%) equal sarcomatoid and SCC. There were 3 morphological groups: group 1 [18/28 (64%)] showed a gradual transition from SCC to other components; group 2 [5/28 (18%) had an abrupt transition from SCC to other components; and in group 3 [5/28 (18%)], the SCC was separate from other components. In Group 1, 12 (66%) cases of SCC showed a gradual transition to sarcomatoid areas, 3 (17%) to urothelial carcinoma, and in 3 (17%) cases to multiple components including squamous cell carcinoma, urothelial carcinoma, and sarcomatoid. Mortality did not differ based on pathological Groups. The 36-month actuarial risk of death was 64.3%. The multitude of different components in these tumors is further evidence of the remarkable ability of carcinoma of the bladder to show divergent differentiation with in some cases gradual transition between SCC and other elements including sarcomatoid. Greater recognition of this entity with chemotherapy targeted to the various histological elements may have important therapeutic implications.



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Anatomical study of the palatine aponeurosis: application to posterior palatal seal of the complete maxillary denture

Abstract

The palatine aponeurosis is a thin, fibrous lamella comprising the extended tendons of the tensor veli palatini muscles, attached to the posterior border and inferior surface of the palatine bone. In dentistry, the relationship between the "vibrating line" and the border of the hard and soft palate has long been discussed. However, to our knowledge, there has been no discussion of the relationship between the palatine aponeurosis and the vibrating line(s). Twenty sides from ten fresh frozen White cadaveric heads (seven males and three females) whose mean age at death was 79 years) were used in this study. The thickness of the mucosa including the submucosal tissue was measured. The maximum length of the palatine aponeurosis on each side and the distance from the posterior nasal spine to the posterior border of the palatine aponeurosis in the midline were also measured. The relationship between the marked borderlines and the posterior border of the palatine bone was observed. The thickness of the mucosa and submucosal tissue on the posterior nasal spine and the maximum length of the palatine aponeurosis were 3.4 mm, and 12.2 mm on right side and 12.8 mm on left, respectively. The length of the palatine aponeurosis in the midline was 4.9 mm. In all specimens, the borderline between the compressible and incompressible parts corresponded to the posterior border of the palatine bone.

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Anatomical study of the palatine aponeurosis: application to posterior palatal seal of the complete maxillary denture

Abstract

The palatine aponeurosis is a thin, fibrous lamella comprising the extended tendons of the tensor veli palatini muscles, attached to the posterior border and inferior surface of the palatine bone. In dentistry, the relationship between the "vibrating line" and the border of the hard and soft palate has long been discussed. However, to our knowledge, there has been no discussion of the relationship between the palatine aponeurosis and the vibrating line(s). Twenty sides from ten fresh frozen White cadaveric heads (seven males and three females) whose mean age at death was 79 years) were used in this study. The thickness of the mucosa including the submucosal tissue was measured. The maximum length of the palatine aponeurosis on each side and the distance from the posterior nasal spine to the posterior border of the palatine aponeurosis in the midline were also measured. The relationship between the marked borderlines and the posterior border of the palatine bone was observed. The thickness of the mucosa and submucosal tissue on the posterior nasal spine and the maximum length of the palatine aponeurosis were 3.4 mm, and 12.2 mm on right side and 12.8 mm on left, respectively. The length of the palatine aponeurosis in the midline was 4.9 mm. In all specimens, the borderline between the compressible and incompressible parts corresponded to the posterior border of the palatine bone.

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O201 Interhemispheric processing in hyperkinetic movement disorders

changes in interhemispheric connectivity have been recently studied in Huntington's Disease (HD), although their significance and temporal relation with clinical features are still debated. We studied interhemispheric connectivity in healthy volunteers, early HD and in patients with idiopathic dystonia.

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P225 Effect of 30, 50 and 100Hz tetha burst stimulation on healthy individuals

Continuous tetha burst stimulation (cTBS) protocol mainly consists of 3 stimulus bursts repeating every 200ms at 50Hz and It has been interpreted that cTBS had inhibitory effects on human motor cortex. On the other hand, there are some reports that 50Hz cTBS had variability within and between subjects on cortical excitability. In addition, little was known about the effect of different cTBS modalities. The objective of this study is to investigate the effects of 50Hz, 30Hz and 100Hz cTBS on motor cortical excitability healthy subjects.

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P303 Transcranial direct current stimulation over parietal cortex and associative memory

Memory enhancement is one of the most challenging issues in neurorehabilitation. Memory functions are affected by different neurological conditions as well as by normal aging. Recent data suggest that it may be possible to improve performance on some of the memory tests by physiological modulation of the activity within a neural loop which plays crucial role in formation and maintenance of the associative memory and which consists of the hippocampus and the lateral parietal cortex.

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P233 Local and distant dysregulation of synchronization around interictal spikes in bects

High Density electroencephalography is the reference non-invasive technique to investigate the dynamics of neuronal networks in Benign Epilepsy with Centro-Temporal Spikes (BECTS). Analysis of local dynamic changes surrounding Interictal Epileptic Spikes (IES) might improve our knowledge of the mechanisms that propel neurons to the hypersynchronization of IES. Transient distant changes in the dynamics of neurons populations may also interact with neuronal networks involved in various functions that are impaired in BECTS patients.

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P267 Swallowing and brainstem reflexes before and after mandibular sagittal split osteotomy

To study the electrophysiological parameters of swallowing and related brainstem reflexes before and after bilateral mandibular sagittal split osteotomy in patients with mandibular dentoskeletal deformities.

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P319 Differences in adrenergic components of baroreflex response to valsalva maneuver in patients with postural tachycardia syndrome and healthy subjects

To evaluate differences in recently developed, non-standard adrenergic baroreflex sensitivity (BRS) indices between patients with postural tachycardia syndrome (PoTS) and healthy controls (HC).

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P286 Visual and brainstem auditory evoked potentials abnormalities in the patients with systemic lupus erythematosus

Lupus erythematosus (SLE) is a systemic disease with possible nervous system involvement, regarded as unfavorable prognostic factor. Evoked potentials (EP) are electrophysiological markers of disturbed central nervous system (CNS) function, even in subclinical stage of CNS disorders. The purpose of the study was to evaluate parameters of EP in the patients with SLE with or without neuropsychiatric manifestation (NPSLE).

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P250 Simultaneous recording of cervical and ocular vestibular-evoked myogenic potentials

To increase clinical application by reducing the testing time for recording vestibular-evoked myogenic potentials (VEMPs), we evaluated whether a simultaneous recording of ocular and cervical VEMPs after monaural and binaural stimulation can be achieved without a loss in diagnostic sensitivity and specificity.

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P216 The efficacy of repetitive transcranial magnetic stimulation in treating patients with chronic daily headache

Headache is the most prevalent pain disorder, affecting around 66% of the global population. This study aimed to investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left DLPFC in treating patients with primary chronic daily headaches (chronic tension type headache and chronic migraine).

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P311 The effectiveness of the complex repetitive peripheral magnetic stimulation (rPMS) in treatment of lumbosacral radiculopathy

In the modern society the low back pain (LBP) is the most common cause of temporary disability with estimated life time prevalence as high as 23–80% (Pedisic et al., 2013). LBP with radiculopathy is considered as the most unfavorable prognostic risk factor for the development of chronic pain syndrome and low quality of life (Konstantinou et al., 2013). The aim of this study is to evaluate the short-term efficacy of repetitive peripheral magnetic stimulation (rPMS) in the treatment of lumbosacral radiculopathy.

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P295 Effects of functional electric stimulation and task specific training on gait recovery in patients with stroke: Randomized controlled trial

This work was designed to assess the effects of functional electrical stimulation (FES) combined with task specific training on gait recovery in stroke patients.

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P277 The effects of sex hormone fluctuations in menstrual cycle on the EEG delta response

It is clear that reproductive hormones modulate the brain activity and development in human. Studies about how the reproductive hormones fluctuations alter the brain waves during menstrual cycle are insufficient. The objective in this study to explore if reproductive hormones fluctuations in the menstrual and luteal phase of cycle alter the EEG delta response.

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P259 Object dropping in Carpal Tunnel Syndrome: Clinical and electrophysiological features

Some patients with Carpal Tunnel Syndrome (CTS) complain of dropping objects. In this study, the clinical and electrophysiological features of CTS patients with (wOD) and without object dropping (w/oOD) were compared.

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P242 Dynamic time warping distance based connectivity: A new method for resting-state FMRI functional connectivity analysis

Traditionally resting-state networks are analysed with methods implying zero-lag linear dependence between brain regions, i.e. functional connectivity strength between voxel pairs is characterized by the correlation-coefficient of the two measured signal. It is known that the shape and timing of hemodynamic response function differs between brain regions and this introduces artefacts in linear measures.

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O208 Evidence by direct current stimulation (tDCS) of cerebellum involvement in pain perception and modulation in humans

cerebellum is involved in a wide number of integrative functions; its role in pain processing has been scarcely investigated. We tried to clarify this aspect using transcranial cerebellar direct current stimulation (tcDCS) and studying changes in perceptive threshold (PT), pain intensity (VAS) and laser evoked potentials (LEPs) responses (N1 and N2/P2).

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P315 Simple correlation analysis reveals falsely interpreted interictal spikes correlated to artefactual sources: A simultaneous EEG–fMRI study

Simultaneous EEG–fMRI is increasingly used in presurgical evaluation of epilepsy patients. The MR environment causes massive gradient artefacts and cardioballistic artefacts (BCG) to the recorded EEG signal, which must be corrected for, to make the reading of the EEG possible. This study aims to see, whether residual artefacts could disturb the specialist interpreting the EEG, even after apparently successful correction of the artefacts via widely accepted methods.

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P307 TMS-based cortical mapping in double-arm transplantation

The re-adaptation process that the brain exhibits as a response to the environmental modifications resulting from prolonged or sudden limb loss can be described as a part of brain plasticity. In some cases, due to neurons synaptic interaction with neighboring neurons, motor-sensory representation of a hand can be replaced. In this study, it is aimed to develop neurophysiologic approaches for identification and discovery of structural and functional, transient and permanent plastic changes in arm-transplant cases.

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P299 Motor mapping with navigated transcranial magnetic stimulation: Does more stimuli increase the accuracy?

Motor mapping with navigated transcranial magnetic stimulation (nTMS) is widespread technique that is used both in the preoperative planning and as a sign of neuroplasticity changes. But there is no generally accepted mapping protocol. The aim of our study was to estimate the relation between mapping parameters accuracy and the number of stimuli.

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P291 Non-invasive detection of fast ripples in low-noise EEG recordings

Ripples (80–250Hz) and fast ripples (FR, 250–500Hz) are characterized by poor signal-to-noise ratio, which reduces their visibility in non-invasive recordings. While ripples are observed in scalp EEG, FR detection has been restricted to invasive recordings. We tested the detectability of FR in the scalp EEG of epilepsy patients, recorded with a low-noise amplifier, and quantified their specificity for the prospective epileptogenic zone (EZ).

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P281 The neurophysiological mechanisms linking stuttering and normal speech

This study examined underlying neurophysiological mechanisms of developmental stuttering – facilitation in the motor cortex during speech preparation served as analogue to the speech planning process.

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Guía de Práctica Clínica Para el Diagnóstico y Tratamiento del Vértigo Posicional Paroxístico Benigno. Documento de Consenso de la Comisión de Otoneurología Sociedad Española de Otorrinolaringlogía y Cirugía de Cabeza y Cuello

Publication date: Available online 19 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Paz Pérez-Vázquez, Virginia Franco-Gutiérrez, Andrés Soto-Varela, Juan Carlos Amor-Dorado, Eduardo Martín-Sanz, Manuel Oliva-Domínguez, Jose A. Lopez-Escamez
El vértigo posicional paroxístico benigno (VPPB) es la causa más frecuente de vértigo vestibular episódico. EL propósito de esta guía, encomendada por la Comisión de Otoneurología de la SEORL CCC, es disponer de un documento de consenso que sirva de guía práctica para el manejo del VPPB en la clínica diaria. El punto de partida es la clasificación elaborada por la Barany Society, con sus variantes clínicas. Incluye una descripción de las pruebas diagnósticas y de las maniobras terapéuticas para cada una de las variantes establecidas, habiéndose seleccionado aquellas con estudios con nivel adecuado de evidencia o con suficientes series de soporte. Se ha incluido también un capítulo de diagnóstico diferencial, así como un apartado de aspectos generales básicos en el manejo de los pacientes con VPPB.Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.



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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients

Abstract

As proton radiotherapy (RT) remains a limited resource, predictive estimates of the potential reduction in adverse treatment-related outcomes compared to photon RT could potentially help improve treatment selection. The aim of this study was to predict the magnitude of the neurocognitive and hearing deficits associated with proton and photon RT for children with brain tumors. The existing RT plans for 50 children treated with photon intensity modulated RT were compared with generated intensity modulated proton RT plans. The proton and photon RT dose distribution was used to estimate the Full Scale Intelligence Quotient (IQ) via a Monte Carlo model and the probability of hearing loss per ear, based on previously published dose-risk relationships. Compared to photon plans, the mean brain dose was found to be reduced in all proton plans, translating into a gain of \(~2.6 \pm 0.3_^\) IQ points for the whole cohort at 5 years post-RT for dose regimens of 54 Gy, or \(2.9 \pm 0.3_^\) IQ points for dose regimens of 59.4 Gy, where the errors shown represent statistical and systematic uncertainties. The probability of hearing loss ≥20 dB per ear was less for proton versus photon RT: overall (9 ± 4) versus (17 ± 6)%, respectively, based on dose regimens of 54 Gy, and (13 ± 5) versus (23 ± 9)% for dose regimens of 59.4 Gy. Proton RT is thus expected to reduce the detrimental effect of RT upon IQ and hearing as compared to photon RT for pediatric brain tumors.

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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients

Abstract

As proton radiotherapy (RT) remains a limited resource, predictive estimates of the potential reduction in adverse treatment-related outcomes compared to photon RT could potentially help improve treatment selection. The aim of this study was to predict the magnitude of the neurocognitive and hearing deficits associated with proton and photon RT for children with brain tumors. The existing RT plans for 50 children treated with photon intensity modulated RT were compared with generated intensity modulated proton RT plans. The proton and photon RT dose distribution was used to estimate the Full Scale Intelligence Quotient (IQ) via a Monte Carlo model and the probability of hearing loss per ear, based on previously published dose-risk relationships. Compared to photon plans, the mean brain dose was found to be reduced in all proton plans, translating into a gain of \(~2.6 \pm 0.3_^\) IQ points for the whole cohort at 5 years post-RT for dose regimens of 54 Gy, or \(2.9 \pm 0.3_^\) IQ points for dose regimens of 59.4 Gy, where the errors shown represent statistical and systematic uncertainties. The probability of hearing loss ≥20 dB per ear was less for proton versus photon RT: overall (9 ± 4) versus (17 ± 6)%, respectively, based on dose regimens of 54 Gy, and (13 ± 5) versus (23 ± 9)% for dose regimens of 59.4 Gy. Proton RT is thus expected to reduce the detrimental effect of RT upon IQ and hearing as compared to photon RT for pediatric brain tumors.

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TBK1 mutations in Italian patients with amyotrophic lateral sclerosis: genetic and functional characterisation

Background

TANK-binding kinase 1 (TBK1) gene has been recently identified as a causative gene of amyotrophic lateral sclerosis (ALS).

Methods

We sequenced the TBK1 gene in a cohort of 154 Italian patients with ALS with unclear genetic aetiology. We subsequently assessed the pathogenic potential of novel identified TBK1 variants using functional in vitro studies: expression, targeting and activity were evaluated in patient-derived fibroblasts and in cells transfected with mutated-TBK1 plasmids.

Results

We identified novel genomic TBK1 variants including two loss-of-function (LoF) (p.Leu59Phefs*16 and c.358+5G>A), two missense (p.Asp118Asn and p.Ile397Thr) and one intronic variant (c.1644–5_1644-2delAATA), in addition to two previously reported pathogenetic missense variants (p.Lys291Glu and p.Arg357Gln). Functional studies in patient-derived fibroblasts revealed that the c.358+5G>A causes aberrant pre-mRNA processing leading TBK1 haploinsufficiency. Biochemical studies in cellular models showed that the truncating variant p.Leu59Phefs*16 abolishes TBK1 protein expression, whereas the p.Asp118Asn variant severely impairs TBK1 phosphorylation activity. Conversely, the p.Ile397Thr variant displayed enhanced phosphorylation activity, whose biological relevance is not clear.

Conclusion

The observed frequency of TBK1 LoF variants was 1.3% (2/154), increasing up to 3.2% (5/154) by taking into account also the functional missense variants that we were able to classify as potentially pathogenic, supporting the relevance of TBK1 in the Italian population with ALS.

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Impulsivity in Parkinsons disease is associated with altered subthalamic but not globus pallidus internus activity

Background

A significant subset of patients with Parkinson's disease (PD) suffer from impulse control disorders (ICDs). A hallmark feature of many ICDs is the pursuit of rewarding behaviours despite negative consequences. Recent evidence implicates the subthalamic nucleus (STN) and globus pallidus internus (GPi) in reward and punishment processing, and deep brain stimulation (DBS) of these structures has been associated with changes in ICD symptoms.

Methods

We tested the hypothesis that in patients with PD diagnosed with ICD, neurons in the STN and GPi would be more responsive to reward-related stimuli and less responsive to loss-related stimuli. We studied a cohort of 43 patients with PD (12 with an ICD and 31 without) undergoing DBS electrode placement surgery. Patients performed a behavioural task in which their action choices were motivated by the potential for either a monetary reward or a monetary loss. During task performance, the activity of individual neurons was recorded in either the STN (n=100) or the GPi (n=100).

Results

The presence of an ICD was associated with significantly greater proportions of reward responsive neurons (p<0.01) and significantly lower proportions of loss responsive neurons (p<0.05) in the STN, but not in the GPi.

Conclusions

These findings provide further evidence of STN involvement in impulsive behaviour in the PD population.

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