Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system

Abstract

Background

The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.

Methods

In a retrospective sample of more than 60 pedicled perforator flaps over a 36-month period, a variety of defects in all regions of the body were reconstructed. Pre-operative planning was based on either Doppler vascular studies or CT angiography.

Results

The overall complete flap survival rate was 89%, with a tip necrosis rate of 8.1% and a partial flap necrosis rate of 3.3%. The risk factors identified were smoking, nicotine patches, vasopressor use and pro-thrombotic states.

Conclusions

It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.

Level of Evidence: Level IV, therapeutic study.

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Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients

Abstract

Background

Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed.

Methods

PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched.

Results

A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0–16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively.

Conclusions

The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

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Short sleep and risk of proteinuria in 3-year-olds in Japan: A population-based cohort study

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): Hongyan Chen, Maki Shinzawa, Hironobu Tokumasu, Shiro Tanaka, Koji Kawakami
ObjectiveTo examine whether short sleep at 18 months of age is associated with risk of proteinuria at 3 years of age.MethodsA population-based cohort study using municipal health check-up data from 62,623 children born between March 1, 2004, and April 30, 2011, and followed to 3 years via questionnaire in Kobe City, Japan. Sleep duration was calculated from wake time and bedtime at the 18-month health check-up by standardized parent-reported questionnaires. Proteinuria, defined as dipstick urinary protein of ≥1+, was measured by dipstick urinalysis at 3 years. Multivariable logistic regression was used to generate adjusted olds ratios.ResultsIn total, 2253 (3.6%) children had short nighttime sleep (≤8 hours) at 18 months. At 3 years, 765 (1.2%) children had proteinuria. The adjusted odds ratio for proteinuria among children with 8 hours of sleep or less versus those with normal sleep of 10 hours per night was 1.50 (95% confidence interval, 1.07-2.11; P =0.02). Odds ratios of the same direction but weaker magnitude were observed for children with bedtime at 22:00 or later, and those with wake time at 6:00 or earlier.ConclusionsShort sleep at 18 months was associated with risk of proteinuria at 3 years. Future research is warranted to examine whether sleep programs targeting early childhood may have additional potential health benefits for kidney development.



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A standardized test to document cataplexy

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): Stefano Vandi, Fabio Pizza, Elena Antelmi, Giulia Neccia, Martina Iloti, Alice Mazzoni, Patrizia Avoni, Giuseppe Plazzi
Objective/Background: Cataplexy is the pathognomonic symptom of narcolepsy type 1 (NT1). Since it is considered difficult to be directly observed or documented by clinicians, its diagnosis relies mainly on history taking. Our study aimed at testing the feasibility of a standardized video recording procedure under emotional stimulation to document cataplexy in the diagnostic work-up of suspected hypersomnia of central origin.Patients/MethodsTwo-hundred-eight consecutive patients underwent the diagnostic work-up and reached the final diagnosis of NT1 (n=133), idiopathic hypersomnia or narcolepsy type 2 (IH/NT2 group, n=33), or subjective excessive daytime sleepiness (sEDS group, n=42). All subjects underwent a standardized video recording procedure while watching funny movies selected according to individual preferences, and a technician blind to clinical features reviewed the recordings to identify hypotonic phenomena that were finally confirmed by patients.ResultsThe video recording under emotional stimulation captured hypotonic phenomena in 72.2%, 9.1% and 4.8% of NT1, IH/NT2, and sEDS subjects (p<0.0001), respectively. When tested against CSF hypocretin deficiency, the documentation of a hypotonic episode at the test showed an area under the ROC curve of 0.823±0.033 (p<0.0001). NT1 patients under anticataplectic medications showed less frequently hypotonic episodes than untreated ones (48.0% vs 77.8%, p=0.003).ConclusionsA standardized video recording procedure under emotional stimulation can help in the characterization of suspected hypersomnia of central origin. Further multi-center studies are warranted to extend the present findings and integrate a shared procedure for the laboratory work-up of narcolepsy.



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Clinical significance of periodic limb movements during sleep: The HypnoLaus study

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): José Haba-Rubio, Helena Marti-Soler, Nadia Tobback, Daniela Andries, Pedro Marques-Vidal, Peter Vollenweider, Martin Preisig, Raphael Heinzer
ObjectivePeriodic limb movements during sleep (PLMS) are prevalent in the general population, but their impact on sleep and association with cardiometabolic disorders are a matter of debate.MethodsData from 2162 participants (51.2% women, mean age 58.4±11.1 years) of the population-based HypnoLaus study (Lausanne, Switzerland) were collected. Subjective sleep complaints and habits were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale (ESS). Participants underwent a full polysomnography (PSG) at home and were evaluated for the presence of hypertension, diabetes and metabolic syndrome.ResultsParticipants with a PLMS index (PLMSI) >15/h (28.6% of the sample) had longer subjective sleep latency (18.6±17.2 vs. 16.1±14.3 min, p=0.014) and duration (7.1±1.2 vs. 6.9±1.1 h, p<0.001) than participants with PLMSI ≤15/h. At the PSG they spent more time in stage N2 sleep (49.0±11.2 vs. 45.5±9.8%, p<0.001), less in stage N3 (17.6±8.2 vs. 20.6±8.4%, p<0.001) and in REM sleep (20.3±6.4 vs. 22.4±6.0%, p<0.001), exhibited longer REM latency (104.2±70.2 vs. 91.7±58.6 min, p<0.001) and higher arousal index (26.5±12.3 vs. 19.2±9.7 n/h, p<0.001). Participants with a PLMSI>15/h had a lower ESS scores and higher prevalence of hypertension, diabetes and metabolic syndrome. Multivariate analysis adjusting for confounding factors confirmed the independent association of PLMSI>15/h with subjective sleep latency and duration, as well as with objective sleep structure disturbances. However, the associations with sleepiness and cardiovascular risk factors disappeared.ConclusionsIn our large middle-age European population-based sample, PLMSI>15/h was associated with subjective and objective sleep disturbances, but not with sleepiness, hypertension, diabetes or metabolic syndrome.



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Actigraphy: A useful tool to monitor sleep-related hypermotor seizures

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): L. Pérez-Carbonell, C. Silva, N. Matos, C. Gaig, A. Iranzo, J. Santamaria




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Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): Suzanne Lippman, Hannah Gardener, Tatjana Rundek, Azizi Seixas, Mitchell S.V. Elkind, Ralph L. Sacco, Clinton B. Wright, Alberto R. Ramos
ObjectivesTo evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years).MethodsThe data from a subsample of the racially/ethnically diverse Northern Manhattan Study were analyzed. Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression Scale (CES-D), approximately 5 years apart. The presence of depressive symptoms was defined as a CES-D score ≥16 or use of antidepressants. Self-reports of short (<6 hours), intermediate (6–8 hours) and long (≥9 hours) sleep were assessed prior to the initial CES-D. Logistic regression was used to evaluate the cross-sectional associations between short and long sleep durations with depressive symptoms, using intermediate sleep as the reference. The prospective association between sleep duration and depression in a sample of participants without depressive symptoms at first CES-D was also analyzed. All models were adjusted for demographic, behavioral, and vascular risk factors.ResultsThe initial sample consisted of 1110 participants: 62% women, 69% Hispanic, 17% black, 14% white. Short sleep was reported by 25%, intermediate sleep by 65%, and long sleep by 9%. Depressive symptoms were described in 25% of the initial sample. Short sleep, but not long sleep, was associated with depressive symptoms at baseline (adjusted OR 1.8, 95% CI 1.3–2.6), and at follow-up (adjusted OR 1.9, 95% CI 1.1–3.5; median follow-up = 5.1 years).ConclusionShort sleep duration had a cross-sectional and prospective association with depressive symptoms in an urban multi-ethnic cohort of older adults.



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Impact on sleep and mood in infants and mothers

Publication date: Available online 10 October 2017
Source:Sleep Medicine
Author(s): Jodi A. Mindell, Christina Lee, Erin S. Leichman, Katie N. Rotella
Establishment of a consistent bedtime routine is often recommended to families with young children with sleep difficulties. However, there are limited studies assessing specific bedtime routines in the treatment of infant and toddler sleep disturbances. Thus, the purpose of this study was to examine the impact of a massage-based bedtime routine on infant sleep, maternal sleep, and maternal mood. 123 mothers and their 3- to 18-month-old infant were randomly assigned to a routine (1-week baseline of usual bedtime routine, 2-weeks intervention) or control group (3-weeks of their usual bedtime routine). All mothers completed the Brief Infant Sleep Questionnaire (BISQ) on a weekly basis, as well as measures of maternal sleep and mood (e.g., Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Edinburgh Postnatal Depression Scale). This bedtime routine resulted in improvements in child and mother night wakings, maternal perceptions of child sleep and mood (i.e., sleep problem, bedtime ease, morning mood), and improvements in maternal sleep quality. No comparative changes were seen in the control group. Interestingly, other than number of night wakings for both the child and the mother, there were no changes in other sleep patterns including sleep onset latency, duration of night wakings, longest stretch of sleep, or sleep duration. This study provides support for recommending a massage-based routine in those families, with the codicil that improvements in maternal perceptions and maternal sleep will be noted, with few improvements in sleep itself other than night wakings.



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Identifying the Best Sleep Measure to Screen Clinical Insomnia in a Psychiatric Population

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): Lee Seng Esmond Seow, Edimansyah Abdin, Shi Hui Sherilyn Chang, Siow Ann Chong, Mythily Subramaniam
BackgroundInsomnia symptoms are highly prevalent among patients with psychiatric disorders and this mandates the need to identify the best self-administered sleep measure to screen for insomnia disorder among them.Methods400 psychiatric outpatients completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Functional Outcomes of Sleep Questionnaire (FOSQ) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) in a cross-sectional study. The sensitivity, specificity, positive and negative predictive values of these six sleep scales were assessed and compared in relation to both ICD-10 and DSM-5 insomnia disorder status established using the interviewer-administered Brief Insomnia Questionnaire (BIQ).ResultsReceiver Operator Characteristic (ROC) curves with the Area Under the Curve (AUC) revealed the ISI to be the most accurate measure to discriminate cases and non-cases on both ICD-10 (AUC=0.88, 95% CI= 0.84-0.92) and DSM-5 (AUC= 0.82, 95% CI= 0.78-0.86) criteria with 'good' accuracy The cut-off scores of >14 and >11 for the ISI provided optimal sensitivity and specificity for the detection of ICD-10 and DSM-5 insomnia respectively.DiscussionWith the new callings from DSM-5 to treat sleep symptoms in the presence of a co-existing mental condition, early detection of psychiatric patients with clinically significantly insomnia using simple but accurate self-report sleep measure becomes important. Our study suggests that the ISI could be used as a potential screening tool for comorbid insomnia disorder in patients with mental disorders.



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The impact of sleep disordered breathing on cardiovascular health in overweight children

Publication date: Available online 9 October 2017
Source:Sleep Medicine
Author(s): Rosemary SC. Horne, Genevieve Shandler, Knarik Tamanyan, Aidan Weichard, Alexsandria Odoi, Sarah N. Biggs, Margot J. Davey, Gillian M. Nixon, Lisa M. Walter
BackgroundUp to 50% of overweight/obese children have obstructive sleep apnea (OSA) compared to up to 6% of normal weight children. We compared cardiovascular variables between normal weight and overweight/obese children with and without OSA, and controls.MethodsSeventy-four referred children and 24 normal weight non-snoring controls (8-18 years) were recruited. Referred children were grouped according to their obstructive apnea hypopnea index (OAHI): OSA (>1 event/h) or primary snoring (PS ≤1 event/h) and whether they were normal weight (BMI z-score <1.04) or overweight/obese (BMI z-score ≥ 1.04). Wake blood pressure and heart rate and pulse transit time (PTT, an inverse continuous surrogate measure of blood pressure) during sleep were recorded.ResultsWake blood pressure was higher in the overweight/obese OSA group compared to the control, normal weight PS and overweight/obese PS groups (P<0.05 for all). During sleep, blood pressure and heart rate were elevated in the overweight/obese OSA group compared to non-snoring controls (p<0.05). More children who were overweight/obese had reduced blood pressure and heart rate dipping from wake to sleep compared to normal weight children. BMI z-score predicted heart rate and PTT when asleep and both age and BMI z-score predicted blood pressure when awake.ConclusionThis study showed that BMI has both combined and independent effects on blood pressure and heart rate in children with OSA. We have previously shown that treatment of OSA reduces blood pressure and suggest that treatment of OSA in the growing number of overweight/obese children may improve cardiovascular outcomes.



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A Demonstrative Tactile Method to Guide Mandibular Movements

Abstract

Dental practitioners often require patients to perform specific mandibular movements (protrusive, retrusive, and lateral) in order to make centric relation and eccentric records. Occasionally, patients are unable to comprehend and perform the desired movements, even after repeated instructions. This article describes a quick, simple, and easy-to-follow technique to help guide patients with their mandibular movements.

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miRNA Genetic Variants: as Potential Diagnostic Biomarkers For Oral Cancer

Publication date: Available online 10 October 2017
Source:Pathology - Research and Practice
Author(s): Divya Tandon, Jayant Dewangan, Sonal Srivastava, Vivek Kumar Garg, Srikanta Kumar Rath
MicroRNAs (miRNAs) comprise a novel class of small, non-coding endogenous RNAs that have a role in the plethora of regulatory activities by directing their target mRNAs for degradation or translational repression. Single nucleotide polymorphisms (SNPs) in miRNA genes can lead to alteration in mRNA expression, resulting in serious consequences. Detection of miRNA-polymorphisms can potentially improve diagnosis, treatment, prognosis in patients and has extreme implications in the fields of pharmacogenomics and personalization of medicine. The aim of this study is to investigate the association between miR-499 A/G and miR-149 C/T polymorphisms with susceptibility to development of Oral Squamous Cell Carcinoma (OSCC). 200 histopathologically diagnosed and confirmed samples from OSCC patients and 200 control samples from the general population were recruited for the study. All OSCC patients were graded based on their differentiation, and genetic analysis was performed by PCR-RFLP and sequencing. qRT-PCR was carried out to compare the expression of miR-499 and miR-149 in different grades of various stages of OSCC patients concerning to the controls. Further Immunohistochemistry (IHC) was performed to study the target gene of miR-499. The study shows a probable association of miR-499 A/G and miR-149 C/T with susceptibility of OSCC. Random sequencing analysis and Immunohistochemistry contribute to the result that miR-499 A/G increases the susceptibility of OSCC by targeting SOX-6. PCR- Restriction Fragment Length Polymorphism (RFLP) and multivariable logistic analysis revealed that there is a significant association between miR-149 CT+TT and CT and susceptibility of OSCC. Our study suggests that miR-499 A/G and miR-149 C/T polymorphisms may play crucial roles in susceptibility and development of OSCC in Indian population.



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DNMT1 is associated with cell cycle and DNA replication gene sets in diffuse large B-cell lymphoma

Publication date: Available online 9 October 2017
Source:Pathology - Research and Practice
Author(s): Suet Kee Loo, Suzina Sheikh Ab. Hamid, Mustaffa Musa, Kah Keng Wong
Dysregulation of DNA (cytosine-5)-methyltransferase 1 (DNMT1) is associated with the pathogenesis of various types of cancer. It has been previously shown that DNMT1 is frequently expressed in diffuse large B-cell lymphoma (DLBCL), however its functions remain to be elucidated in the disease. In this study, we gene expression profiled (GEP) shDNMT1-treated germinal center B-cell-like DLBCL (GCB-DLBCL)-derived cell line (i.e. HT) compared with non-silencing shRNA (control shRNA)-treated HT cells. Independent gene set enrichment analysis (GSEA) performed using GEPs of shRNA-treated HT cells and primary GCB-DLBCL cases derived from two publicly-available datasets (i.e. GSE10846 and GSE31312) produced three separate lists of enriched gene sets for each gene sets collection from Molecular Signatures Database (MSigDB). Subsequent Venn analysis identified 268, 145 and six consensus gene sets from analyzing gene sets in C2 collection (curated gene sets), C5 sub-collection [gene sets from gene ontology (GO) biological process ontology] and Hallmark collection, respectively to be enriched in positive correlation with DNMT1 expression profiles in shRNA-treated HT cells, GSE10846 and GSE31312 datasets [false discovery rate (FDR)<0.05]. Cell cycle progression and DNA replication were among the significantly enriched biological processes (FDR<0.05). Expression of genes involved in the activation of cell cycle and DNA replication (e.g. CDK1, CCNA2, E2F2, PCNA, RFC5 and POLD3) were highly correlated (r>0.8) with DNMT1 expression and significantly downregulated (log fold-change <−1.35; p<0.05) following DNMT1 silencing in HT cells. These results suggest the involvement of DNMT1 in the activation of cell cycle and DNA replication in DLBCL cells.



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Combined Detection of Insulin-Like Growth Factor-Binding Protein 7 Promoter Methylation Improves the Diagnostic Efficacy of AFP in Hepatitis B Virus-associated Hepatocellular Carcinoma

Publication date: Available online 9 October 2017
Source:Pathology - Research and Practice
Author(s): Li-Ping Tao, Xiao-Peng Fan, Yu-Chen Fan, Jing Zhao, Shuai Gao, Kai Wang
This study quantitatively assessed serum insulin-like growth factor-binding protein 7 (IGFBP7) promoter methylation in hepatocellular carcinoma (HCC), and explored its clinical value. A total of 80 patients with hepatitis B virus-associated HCC, 35 patients with chronic hepatitis B (CHB), and 20 healthy controls (HC) were enrolled. MethyLight was used to quantitatively assess the methylation levels of serum IGFBP7 promoter. A logistic regression model was established for the combined evaluation of AFP and serum IGFBP7 promoter methylation. The results showed that mean methylation levels of serum IGFBP7 promoter were significantly higher in HCC (5.33%, interquartile range [IQR] 1.14–15.70%) patients than in individuals with CHB (1.54%, IQR 0.64–2.45%; P<0.01) and HC (0.63%, IQR 0.22–0.98%; P<0.01). In HCC subgroups, patients with vascular invasion, tumor size >3cm and advanced tumor node metastasis (TNM) showed higher methylation levels compared with the remaining groups (P<0.05). Compared with AFP alone, combined determination based on logistic regression analysis significantly improved the area under the receiver operating characteristic (ROC) curve (AUC) (0.759 vs 0.623, P<0.05). In addition, the Youden index was increased from 5.71%, 11.25% and 15.18%, when considering AFP alone at cut-off values of 20, 200, and 400ng/mL, respectively, to 45.71% with IGFBP7 promoter methylation taken into consideration (all P<0.05). These results suggested that combined quantitative measurement of serum IGFBP7 promoter methylation could enhance the diagnostic ability of AFP in distinguishing hepatitis B virus-associated HCC from CHB.



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PATHOBIOLOGY OF HER 2 POSITIVE SMALL INVASIVE (T1a,b) BREAST CANCER: A WOLF IN SHEEP'S CLOTHING

Publication date: Available online 9 October 2017
Source:Pathology - Research and Practice
Author(s): Joško Bezić, Ivana Šamija Projić, Petar Projić, Kristina Meljanac Salopek, Piero Marin Živković, Joško Božić, Snježana Tomić
Small invasive breast cancers (cancers with maximum diameter <1cm, T1a,b) become more prevalent form of breast cancer as a result of the introduction of breast cancer mammographic screening programs. Although associated with an excellent prognosis, T1a,b breast cancers are heterogeneous group of tumors with prognostically unfavorable subset of cases, primarily those with axillary lymph node metastases. To determine if the HER2 overexpression is associated with the prognostically unfavorable traditional clinicopathological features in this group of breast cancers, clinicopathological features (age, tumor size, histological type, histological grade, nodal status, hormone receptor status, proliferation index, lymphovascular invasion, ploidy) of 38 HER2 positive T1a,b cancers were compared with those of the control group consisting of 315 HER2 negative T1a,b cancers. The comparison of clinicopathological features was made using χ² and t-test. HER2 positive T1a,b breast cancers were significantly associated with higher tumor grades (p<0.001), negative hormone receptors (p=0.008), presence of lymphovascular invasion (p=0.025), high proliferation index (p<0.001), and abnormal DNA content (p=0.04). We also noticed the higher frequency of lymph node positive cases in the HER2 positive group of cancers (p=0.05). There were no differences in age, tumor size and histological type between investigated groups. Our group of HER2 positive T1a,b breast cancers was associated with many unfavorable traditional prognostic factors, demonstrating that this subtype of early breast cancer has an aggressive biological phenotype which may have potential benefit from adjuvant chemo and immunotherapy.



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The correlation between XIAP gene polymorphisms and esophageal squamous cell carcinoma susceptibility and prognosis in a Chinese population

Publication date: Available online 9 October 2017
Source:Pathology - Research and Practice
Author(s): Hai Peng, Li-Guo Wang, Xue-Zhi Wang, Ai-Jun Liu
ObjectiveThis study aims to explore the correlation between X-linked inhibitor of apoptosis protein (XIAP) gene polymorphisms (rs8371 and rs9856) with the susceptibility and prognosis of esophageal squamous cell carcinoma (ESCC), providing a potential treatment for ESCC.MethodA total of 170 ESCC patients (case group) and 191 healthy people (control group) were enrolled in our study. Genotyping was conducted on the basis of the ligase detection reaction (LDR). The expressions of XIAP polymorphisms were detected. The patients were followed up every three months until death or the last follow-up day. The overall survival (OS) and progression free survival (PFS) were recorded by Kaplan-Meier survival curve, and the relationship between XIAP gene polymorphism and risk and prognosis of ESCC was assessed by Cox multivariate analysis.ResultTT+CT genotype and T allele frequencies of XIAP rs8371 and rs9856 in the case group were significantly lower compared to those of the control group (all P<0.05), suggesting that TT+CT genotype of XIAP rs8371 and rs9856 was associated with ESCC susceptibility. XIAP rs8371 and rs9856 polymorphisms were associated with tumor node metastasis (TNM) staging, depth of invasion and lymph node metastasis. The OS and PFS of TT+CT genotype carriers of rs8371 were longer than those of CC genotype carriers. Smoking, alcohol, TNM staging, depth of invasion, and lymph node metastasis were significantly associated with the OS and PFS in ESCC patients. Higher TNM staging, depth of invasion, and presence of lymph node metastasis were independent risk factors, while XIAP rs8371 was an independent protective factor for the prognosis of ESCC patients.ConclusionThe present study demonstrates that XIAP rs8371 and rs9856 are associated with susceptibility to ESCC, and rs8371 polymorphisms might serve as an indicator for improved clinical efficacy and prognosis of ESCC patients.



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Comparative Assessment of three Methods to Analyze MGMT Methylation Status in a Series of 350 Gliomas and Gangliogliomas

Publication date: Available online 10 October 2017
Source:Pathology - Research and Practice
Author(s): Leiming Wang, Zhuo Li, Cuicui Liu, Li Chen, Li Liu, Zeliang Hu, Lihong Zhao, Dehong Lu, Lianghong Teng
MGMT promoter methylation is considered as a prognostic and predictive biomarker indicating response to chemotherapy and radiotherapy in glioblastoma. A number of different methods and platforms including pyrosequencing (PSQ), quantitative methylation-specific PCR (qMSP) and immunohistochemistry (IHC), methylation-sensitive high resolution melting (MS-HRM) and NGS (Next Generation Sequencing) have been used to detect MGMT promoter methylation in gliomas. However, controversy remains about the most appropriate method to use for analyzing MGMT status. The MGMT promoter methylation status of a total of 350 gliomas and gangliogliomas was examined using PSQ, qMSP and IHC in parallel. Using PSQ as a recommended standard method, the sensitivity, specificity, positive/negative predictive value and correlation with the other assays were calculated. Among 350 glioma- and ganglioglioma cases, the MGMT promoter tested positive for methylation in 53.1%, 55.4%, and 70.3% of the cases by PSQ, qMSP and IHC, respectively. The sensitivity and specificity of qMSP were 97.8% and 92.7%, respectively. Twelve cases that tested positive for methylation using qMSP were negative according to PSQ, and four cases that were negative according to qMSP tested positive according to PSQ. The concordance rate between PSQ and qMSP was 90.8%. The sensitivity and specificity of IHC for the detection of MGMT at the protein level were 84.4% and 45.7%, respectively. The concordance rate between PSQ and IHC was 30.8%.This study demonstrated that qMSP is an effective and rapid detection method for routine use in pathology laboratories for the identification of MGMT promoter methylation. A combination of IHC and qMSP assays can provide high sensitivity and specificity for the prediction of MGMT status. A few cases that tested negative with PSQ did harbor MGMT promoter methylation, as confirmed by qMSP and sequencing, and this subgroup of patients may benefit from temozolomide.



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Synergy between air pollution and urban meteorological changes through aerosol-radiation-diffusion feedback―A case study of Beijing in January 2013

Publication date: Available online 10 October 2017
Source:Atmospheric Environment
Author(s): Mizuo Kajino, Hiromasa Ueda, Zhiwei Han, Rei Kudo, Yayoi Inomata, Hidenori Kaku
The interactions of aerosol-radiation-stratification-turbulence-cloud processes during a severe haze event in Beijing in January 2013 were studied using a numerical model. For the clear days, solar radiation flux was reduced by approximately 15% and surface temperature was slightly decreased from 0 to 0.5 K throughout the day and night, except for a 1.4 K decrease around sunrise when fog was presented. The longwave radiation cooling was intensified by the fog or drizzle droplets near the top of the fog layer. Thus, in Beijing, both in the daytime and at night, the surface air temperature was decreased by air pollutants. In the presence of the low-level stratus and light precipitation, the modification of meteorology by aerosols was amplified and changed the wind speed and direction much more significantly compared to clear days. The non-linear effect (or positive feedback) of pollutant emission control on the surface air concentration was newly assessed―severe air pollution leads to the intensification of stable stratification near the surface at night and delays the evolution of the mixing layer, which in turn causes more severe air pollution. The non-linear effect was not significant for the current emission levels in the current case, approximately 10%. In another word, the mixing ratio of aerosols became higher by 10% due to their radiation effects.



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Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

Publication date: Available online 9 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): F. Picard, J. Niddam, A. De Runz, M. Chaouat, M. Mimoun, D. Boccara
IntroductionThe sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery.Material and methodsWe conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time.ResultsPain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05).ConclusionLocal instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5.Level of evidenceLevel II.



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The anterolateral thigh perforator flap in pharyngo-esophageal reconstruction

Publication date: Available online 9 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M.K. De Frémicourt, S. Temam, F. Janot, F. Kolb, Q. Qassemyar
Today's customary techniques for pharyngo-esophageal reconstruction are jejunum and radial forearm free flaps. In this type of reconstruction, the jejunum flap is considered as the reference, but when its harvesting is not possible, the radial forearm flap is used. Since perforator flaps have begun to be developed, the anterolateral thigh flap (ATF) has become increasingly prominent in pharyngo-esophageal reconstruction. The aim of our study was to describe the use of the anterolateral perforator flap in pharyngo-esophageal reconstruction (indications, harvesting method, flap design) and to discuss its advantages and drawbacks as regards oral feeding and esophageal speech.



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An operating principle of the turtle utricle to detect wide dynamic range

Publication date: Available online 9 October 2017
Source:Hearing Research
Author(s): Jong-Hoon Nam
The utricle encodes both static information such as head orientation, and dynamic information such as vibrations. It is not well understood how the utricle can encode both static and dynamic information for a wide dynamic range (from <0.05 to >2 times the gravitational acceleration; from DC to > 1000 Hz vibrations). Using computational models of the hair cells in the turtle utricle, this study presents an explanation on how the turtle utricle encodes stimulations over such a wide dynamic range. Two hair bundles were modeled using the finite element method—one representing the striolar hair cell (Cell S), and the other representing the medial extrastriolar hair cell (Cell E). A mechano-transduction (MET) channel model was incorporated to compute MET current (iMET) due to hair bundle deflection. A macro-mechanical model of the utricle was used to compute otoconial motions from head accelerations (aHead). According to known anatomical data, Cell E has a long kinocilium that is embedded into the stiff otoconial layer. Unlike Cell E, the hair bundle of Cell S falls short of the otoconial layer. Considering such difference in the mechanical connectivity between the hair cell bundle and the otoconial layer, three cases were simulated: Cell E displacement-clamped, Cell S viscously-coupled, and Cell S displacement-clamped. Head accelerations at different amplitude levels and different frequencies were simulated for the three cases. When a realistic head motion was simulated, Cell E was responsive to head orientation, while the viscously-coupled Cell S was responsive to fast head motion imitating the feeding strike of a turtle.



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Cover

The cover image, by Tim Joda et al., is based on the Original Article Time efficiency, difficulty, and operator's preference comparing digital and conventional implant impressions: a randomized controlled trial, DOI: 10.1111/clr.12982.

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The fine print behind the big picture

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Narrow- and regular-diameter implants in the posterior region of the jaws to support single crowns: A 3-year split-mouth randomized clinical trial

Abstract

Objectives

The objective of this 3-year split-mouth randomized controlled clinical study was to compare narrow-diameter implants (NDIs) to regular-diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates.

Material and Methods

A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty-one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri-implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated.

Results

Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1-year (p = .794) and 3-year (p = .598) time intervals. The mean peri-implant bone loss at 3-year follow-up was −0.58 ± 0.39 mm (95% CI: −0.751 to −0.409) and −0.53 ± 0.46 mm (95% CI: −0.731 to −0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3-year follow-up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3-year follow-up. At the 3-year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs.

Conclusion

The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.

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Value of a molecular screening program to support clinical trial enrollment in Asian cancer patients: The Integrated Molecular Analysis of Cancer (IMAC) Study

Abstract

The value of precision oncology initiatives in Asian contexts remains unresolved. Here we review the institutional implementation of prospective molecular screening to facilitate accrual of patients into biomarker-driven clinical trials, and to explore the mutational landscape of advanced tumors occurring in a prospective cohort of Asian patients (n = 396) with diverse cancer types. Next-generation sequencing (NGS) and routine clinicopathological assays such as immunohistochemistry, copy number analysis, and in situ hybridization tests were performed on tumor samples. Actionable biomarker results were used to identify eligibility for early-phase, biomarker-driven clinical trials. Overall, NGS was successful in 365 of 396 patients (92%), achieving a mean depth of 1,943× and coverage uniformity of 96%. The median turnaround time from sample receipt to return of genomic results was 26.0 days (IQR, 19.0-39.0 days). Reportable mutations were found in 300 of 365 patients (82%). Ninety-one percent of patients at study enrollment indicated consent to receive incidental findings and willingness to undergo genetic counseling if required. The most commonly mutated oncogenes included KRAS (19%), PIK3CA (16%), EGFR (5%), BRAF (3%), and KIT (3%); while the most frequently mutated tumor suppressor genes included TP53 (40%), SMARCB1 (12%), APC (8%), PTEN (6%), and SMAD4 (5%). Among 23 patients enrolled in genotype-matched trials, median progression-free survival was 2.9 months (IQR, 1.5 to 4.0 months). Nine of 20 evaluable patients (45%; 95% CI, 23.1% to 68.5%) derived clinical benefit, including 3 partial responses and 6 with stable disease lasting ≥ 8 weeks. This article is protected by copyright. All rights reserved.

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FAT1 modulates EMT and stemness genes expression in hypoxic glioblastoma

Abstract

Glioblastoma (GBM) is characterized by the presence of hypoxia, stemness and local invasiveness. We have earlier demonstrated that FAT1 promotes invasiveness, inflammation and upregulates HIF-1α expression and its signalling in hypoxic GBM. Here, we have identified the role of FAT1 in regulating EMT (Epithelial-Mesenchymal Transition) and stemness characteristics in GBM. The expression of FAT1, EMT (Snail/LOX/Vimentin/N-cad), stemness (SOX2/OCT4/Nestin/REST) and hypoxia markers (HIF-1α/VEGF/PGK1/CA9) was upregulated in ≥39% of GBM tumors (n=31) with significant positive correlation (p≤0.05) of the expression of FAT1 with LOX/Vimentin/SOX2/HIF-1α/PGK1/VEGF/CA9. Furthermore, positive correlation (p≤0.01) of FAT1 with Vimentin/N-cad/SOX2/REST/HIF-1α has been observed in TCGA GBM-dataset (n=430). Analysis of cells (U87MG/A172) exposed to severe hypoxia (0.2%O₂) revealed elevated mRNA expression of FAT1, EMT (Snail/LOX/Vimentin/N-cad), stemness (SOX2/OCT4/Nestin/REST) and hypoxia markers (HIF-1α/PGK1/VEGF/CA9) as compared to their normoxic (20%O₂) counterparts. FAT1 knockdown in U87MG/A172 maintained in severe hypoxia and in normoxic primary glioma cultures led to significant reduction of EMT/stemness markers as compared to controls. HIF-1α knockdown in U87MG cells markedly reduced the expression of all the EMT/stemness markers studied except for nestin and SOX2 which were more under the influence of FAT1. This indicates FAT1 has a novel regulatory effect on EMT/stemness markers both via or independent of HIF-1α. The functional relevance of our study was corroborated by significant reduction in the number of soft-agar colonies formed in hypoxic-siFAT1 treated U87MG cells. Hence, this study for the first time reveals FAT1 as a novel regulator of EMT/stemness in hypoxic GBM and suggests FAT1 as a potential therapeutic candidate. This article is protected by copyright. All rights reserved.

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Issue Information

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Proteomics of Periodontal Pocket

Abstract

Purpose of Review

This study aims to present and evaluate the findings of the literature referring to proteomic analysis of the periodontal pocket aimed to identify potential biomarkers for periodontal disease.

Recent Findings

A comprehensive examination of data from "shotgun" proteomic analysis has shown that a number of human proteins, previously not extensively investigated in the literature, have emerged as new candidates. Proteins relevant to various biological functions such as actin, profilin, hemoglobin, plastins, alpha-amylase, matrix metalloproteinases, keratins, histones, annexins, antimicrobial peptides including histatins, S-100A9, cathelicidin-related peptide-37 (LL-37), human neutrophil peptides (HNP)-1, -2, and -3, statherin, and cystatins are commonly identified in gingival crevicular fluid (GCF) by proteomic analysis and are upregulated in periodontal disease and therefore could serve as biomarkers.

Conclusions

Proteomic analysis has provided a new insight into the search for biomarkers of periodontal disease presence, progression, prognosis, and endpoints of treatment. Data derived should be validated by larger scale studies, including significant subject samples. These second-stage studies should focus on evaluating the importance of these proposed new biomarkers using standardized procedures.

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Periodontal Abscess: a Review and the Role of Antimicrobial Therapy

Abstract

Purpose of Review

The aim was to summarize current knowledge about periodontal abscesses and describe recent research on antimicrobial treatment.

Recent Findings

For periodontal abscess treatment, antimicrobial therapy is implemented as an adjunct modality to subgingival debridement and/or abscess drainage. Among available systemic antimicrobial agents, amoxicillin (plus clavulanate), metronidazole, and azithromycin are often used with good clinical results. In our studies of patients with acute periodontal lesions, systemic administration of a new fluoroquinolone, sitafloxacin, yielded a significant improvement in clinical parameters, and was effective against subgingival bacteria, with no significant impact on the antimicrobial susceptibility of periodontal bacteria.

Summary

Plaque control during initial periodontal therapy or maintenance care is critical for the prevention and treatment of periodontal abscesses. In the case of acute periodontal abscesses, drainage is considered first. When drainage is not possible or insufficient, antimicrobial therapy should then be considered. Microbiological testing can contribute to the successful treatment.

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In vivo detection of HSP90 identifies breast cancers with aggressive behavior

Purpose: Heat shock protein 90 (Hsp90), a chaperone to numerous molecular pathways in malignant cells, is elevated in aggressive breast cancers (BC). We hypothesized that identifying breast cells with elevated Hsp90 activity in situ could result in early detection of aggressive BC. Experimental Design: We exploited the uptake of a Hsp90 inhibitor by malignant cells to create an imaging probe (HS131) of Hsp90 activity by linking it to a near infrared (nIR) dye. HS131 uptake into cells correlated with cell membrane expression of Hsp90 and was used to image molecular subtypes of murine and human BC in vitro and in murine models. Results: HS131 imaging was both sensitive and specific in detecting the murine 4T1 BC cell line, as well as subclones with differing metastatic potential. Highly metastatic subclones (4T07) had high HS131 uptake, but subclones with lower metastatic potential (67NR, 168FARN) had low HS131 uptake. We generated isogenic cell lines to demonstrate that overexpression of a variety of specific oncogenes resulted in high HS131 uptake and retention. Finally, we demonstrated that HS131 could be used to detect spontaneous tumors in MMTV-neu mice, as well as primary and metastatic human BC xenografts. HS131 could image invasive lobular BC, a histologic subtype of BC which is often undetectable by mammography. Conclusions: An HSP90-targeting nIR probe is sensitive and specific in imaging all molecular subtypes of murine and human BC, with higher uptake in aggressive and highly metastatic clones. Clinical studies with Hsp90-targeting nIR probes will be initiated shortly.

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Positive experiences related to living with tinnitus: A cross-sectional survey

Abstract

Objective

The aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the UK.

Design

A cross-sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.

Setting

The study was UK wide and data collection was online.

Participants

Participants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88).

Main outcome measures

Tinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults-Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open-ended question format.

Results

Around a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned: (1) coping; (2) personal development; (3) support, and to a lesser extent (4) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus.

Conclusions

This study has identified that personal development and a positive outlook is possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus.

The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability.

This article is protected by copyright. All rights reserved.

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A Collaborative Model for Accelerating the Discovery and Translation of Cancer Therapies

Preclinical studies using genetically engineered mouse models (GEMM) have the potential to expedite the development of effective new therapies; however, they are not routinely integrated into drug development pipelines. GEMMs may be particularly valuable for investigating treatments for less common cancers, which frequently lack alternative faithful models. Here, we describe a multicenter cooperative group that has successfully leveraged the expertise and resources from philanthropic foundations, academia, and industry to advance therapeutic discovery and translation using GEMMs as a preclinical platform. This effort, known as the Neurofibromatosis Preclinical Consortium (NFPC), was established to accelerate new treatments for tumors associated with neurofibromatosis type 1 (NF1). At its inception, there were no effective treatments for NF1 and few promising approaches on the horizon. Since 2008, participating laboratories have conducted 95 preclinical trials of 38 drugs or combinations through collaborations with 18 pharmaceutical companies. Importantly, these studies have identified 13 therapeutic targets, which have inspired 16 clinical trials. This review outlines the opportunities and challenges of building this type of consortium and highlights how it can accelerate clinical translation. We believe that this strategy of foundation–academic–industry partnering is generally applicable to many diseases and has the potential to markedly improve the success of therapeutic development. Cancer Res; 1–6. ©2017 AACR.

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Moonshot Acceleration Factor: Medical Imaging

Medical imaging is essential to screening, early diagnosis, and monitoring responses to cancer treatments and, when used with other diagnostics, provides guidance for clinicians in choosing the most effective patient management plan that maximizes survivorship and quality of life. At a gathering of agency officials, patient advocacy organizations, industry/professional stakeholder groups, and clinical/basic science academicians, recommendations were made on why and how one should build a "cancer knowledge network" that includes imaging. Steps to accelerate the translation and clinical adoption of cancer discoveries to meet the goals of the Cancer Moonshot include harnessing computational power and architectures, developing data sharing policies, and standardizing medical imaging and in vitro diagnostics. Cancer Res; 1–4. ©2017 AACR.

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IL-10 release upon PD-1 blockade sustains immunosuppression in ovarian cancer.

Ligation of PD-1 in the tumor microenvironment is known to inhibit effective adaptive anti-tumor immunity. Blockade of PD-1 in humans has resulted in impressive, durable regression responses in select tumor types. However, durable responses have been elusive in ovarian cancer patients. PD-1 was recently shown to be expressed on and thereby impair the functions of tumor-infiltrating murine and human myeloid dendritic cells (TIDC) in ovarian cancer. In the present work, we characterize the regulation of PD-1 expression and the effects of PD-1 blockade on TIDC. Treatment of TIDC and bone marrow-derived DC with IL-10 led to increased PD-1 expression. Both groups of DC also responded to PD-1 blockade by increasing production of IL-10. Similarly, treatment of ovarian tumor-bearing mice with PD-1 blocking antibody resulted in an increase in IL-10 levels in both serum and ascites. While PD-1 blockade or IL-10 neutralization as monotherapies were inefficient, combination of these two led to improved survival and delayed tumor growth; this was accompanied by augmented anti-tumor T and B cell responses and decreased infiltration of immunosuppressive MDSC. Taken together, our findings implicate compensatory release of IL-10 as one of the adaptive resistance mechanisms that undermine the efficacy of anti-PD-1 (or anti-PD-L1) monotherapies and prompts further studies aimed at identifying such resistance mechanisms.

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Sleeping Beauty insertional mutagenesis in mice identifies drivers of steatosis-associated hepatic tumor

Hepatic steatosis is a strong risk factor for the development of hepatocellular carcinoma (HCC), yet little is known about the molecular pathology associated with this factor. In this study, we performed a forward genetic screen using Sleeping Beauty (SB) transposon insertional mutagenesis in mice treated to induce hepatic steatosis, and compared the results to human HCC data. In humans, we determined that steatosis increased the proportion of female HCC patients, a pattern also reflected in mice. Our genetic screen identified 203 candidate steatosis-associated HCC genes, many of which are altered in human HCC and are members of established HCC-driving signaling pathways. The protein kinase A/cyclic AMP signaling pathway was altered frequently in mouse and human steatosis-associated HCC. We found that activated PKA expression drove steatosis-specific liver tumorigenesis in a mouse model. Another candidate HCC driver, the N-acetyltransferase NAT10, which we found to be overexpressed in human steatosis-associated HCC and associated with decreased survival in human HCC, also drove liver tumorigenesis in a steatotic mouse model. This study identifies genes and pathways promoting HCC that may represent novel targets for prevention and treatment in the context of hepatic steatosis, an area of rapidly growing clinical significance.

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Bacteremia after supragingival scaling and dental extraction: culture and molecular analyses

Abstract

Objective

To study the incidence and magnitude of bacteremia after dental extraction and supragingival scaling.

Subjects and Methods

Blood samples were taken before and 5 and 30 minutes after dental extraction and supragingival scaling from individuals at high (n=42) or negligible risk (n=53) for infective endocarditis. The former received prophylactic antibiotic therapy. Samples were subjected to aerobic and anaerobic culture and quantitative real-time polymerase chain reaction to determine the incidence of bacteremia and total bacterial levels.

Results

Patients who did not receive prophylactic antibiotic therapy had a higher incidence of positive blood cultures (26% 5 min after extraction) than patients who received prophylactic antibiotic therapy (0% 5 min after extraction; P=.01). Molecular analysis did not reveal significant differences in the incidence or magnitude of bacteremia between the two patient groups either 5 or 30 minutes after each of the procedures evaluated. Extraction was associated with higher incidence of bacteremia than supragengival scaling by molecular analysis (P=.05).

Conclusions

Molecular methods revealed that dental extraction and supragingival scaling were associated with similar incidence of bacteremia in groups receiving or not prophylactic antibiotic therapy. However, blood culture revealed that antibiotic therapy reduced viable cultivable bacteria in the bloodstream in the extraction group.

This article is protected by copyright. All rights reserved.

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Landmarks for the preservation of the middle temporal artery during mastoid surgery: Cadaveric dissection study

The middle temporal artery flap is a vascularized periosteal flap that is highly useful for otologic reconstruction including the middle cranial fossa, mastoidectomy defect, and external auditory canal. The course of the artery is close to the external auditory canal and is easily injured during preliminary exposure and elevation of flaps.

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The role of explorative tympanotomy in patients with sudden sensorineural hearing loss with and without perilymphatic fistula

The purpose of this study was to describe the role of explorative tympanotomy in patients with Profound Sudden Sensorineural Hearing Loss (SSNHL) without clinical evidence of perilymphatic or labyrinthine fistula and to compare intraoperative findings with the postoperative hearing outcome.

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Outcome of spray cryotherapy plus functional endoscopic sinus surgery on management of healing in nasal polyposis

Nasal Polyposis is a benign tumor in nasal or paranasal mucosa, which confronts difficulties in management of healing after treatments with surgery. The aim of this study was to evaluate the effects of Spray Cryotherapy (SCT) on management of healing in patients with nasal polyposis who undergone functional endoscopic sinus surgery.

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Endoscopic versus microscopic approach in attic cholesteatoma surgery

Compare the outcomes of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in a group of patients affected by attic cholesteatoma.

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Payer database and geospatial analysis to evaluate practice patterns in treating allergy in North Carolina

The objective of this study was to characterize the delivery of allergy care in North Carolina using a large payer charge database and visualization techniques.

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Write your first article, but …

Publication date: Available online 9 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Rubin, H. Maisonneuve, C. Martin, O. Laccourreye




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Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003-2015

Pediatric Rehabilitation Medicine (PRM) physicians enter the field via several pathways. It is unknown if different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination.

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Vertical Maxillary Measurements using a Virtual External Reference Point in Orthognathic Surgery: Technical Innovation.

It is extremely important to achieve vertical position of the upper jaw in orthognathic surgery. A common method used is measuring distances at surgery using external reference points. Unfortunately, surgeons have been making mistakes when calculating the goal distance of our external reference systems. A possible explanation is that when the author measure the baseline and goal vertical distances, the author usually do not consider the variations produced by the triangulation effect generated due the horizontal or/and transverse movements of the maxilla. A method is proposed to fix this phenomenon in an easy way through the virtual customization of the ERP in computer-assisted surgical simulation. The technique entails creating, in the planning software, the same reference system one will use at surgery. In this virtual system, one measures the difference between the baseline and target distances, and then uses them at surgery. (C) 2017 by Mutaz B. Habal, MD.

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Trapezius flaps for reconstruction of head and neck defects following oncological resection-a systematic review

Head and neck (H&N) cancer is the sixth most common malignancy worldwide, with a reported incidence of 500,000 cases annually (Jemal et al., 2011). Surgical resection with subsequent reconstruction is the cornerstone of H&N cancer treatment. The spectrum of composite tissue defects following oncological resection creates challenging reconstructions. Microvascular free tissue transfer (MFTT) is the gold standard in reconstruction of H&N defects (Urken et al., 1994), and yet not all patients with H&N cancer are suitable candidates.

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Impact on sleep and mood in infants and mothers

Establishment of a consistent bedtime routine is often recommended to families with young children with sleep difficulties. However, there are limited studies assessing specific bedtime routines in the treatment of infant and toddler sleep disturbances. Thus, the purpose of this study was to examine the impact of a massage-based bedtime routine on infant sleep, maternal sleep, and maternal mood. 123 mothers and their 3- to 18-month-old infant were randomly assigned to a routine (1-week baseline of usual bedtime routine, 2-weeks intervention) or control group (3-weeks of their usual bedtime routine).

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A standardized test to document cataplexy

/Background: Cataplexy is the pathognomonic symptom of narcolepsy type 1 (NT1). Since it is considered difficult to be directly observed or documented by clinicians, its diagnosis relies mainly on history taking. Our study aimed at testing the feasibility of a standardized video recording procedure under emotional stimulation to document cataplexy in the diagnostic work-up of suspected hypersomnia of central origin.

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Actigraphy: A useful tool to monitor sleep-related hypermotor seizures

Sleep-related hypermotor epilepsy (SHE) is a rare form of focal epilepsy characterized by repeated episodes of vigorous hyperkinetic limb movements commonly confined to sleep. Seizures are highly stereotyped within patients and usually last less than two minutes.1 Wrist-actigraphy is commonly used to estimate the sleep-waking rhythm.2 Limb accelerometer sensors have been occasionally used for the detection of epileptic events during sleep,3-6 but routine wrist-actigraphy has not been described in SHE.

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Clinical significance of periodic limb movements during sleep: The HypnoLaus study

Periodic limb movements during sleep (PLMS) are prevalent in the general population, but their impact on sleep and association with cardiometabolic disorders are a matter of debate.

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Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults

To evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years).

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Short sleep and risk of proteinuria in 3-year-olds in Japan: A population-based cohort study

To examine whether short sleep at 18 months of age is associated with risk of proteinuria at 3 years of age.

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Late-occurring nivolumab-induced cryptogenic organising pneumonia mimicking lung progression in a patient with metastatic non–small cell lung cancer

Publication date: November 2017
Source:European Journal of Cancer, Volume 85
Author(s): Linda Mahjoubi, Anas Gazzah, Aurélien Marabelle, François Le Roy Ladurie, Olivier Lambotte, Caroline Caramella, Julien Adam, Benjamin Besse, Jean-Charles Soria




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A systematic review of economic evaluation in pancreatic ductal adenocarcinoma

Publication date: November 2017
Source:European Journal of Cancer, Volume 86
Author(s): Claire Gérard, Philippe Fagnoni, Angélique Vienot, Christophe Borg, Samuel Limat, Franck Daval, François Calais, Julie Vardanega, Marine Jary, Virginie Nerich
ObjectivesThe economic evaluation (EE) of healthcare interventions has become a necessity. However, high quality needs to be ensured in order to achieve validated results and help making informed decisions. Thus, the objective of the present study was to systematically identify and review published pancreatic ductal adenocarcinoma-related EEs and to assess their quality.MethodsSystematic literature research was conducted in PubMed and Cochrane to identify published EEs between 2000 and 2015. The quality of each selected EE was assessed by two independent reviewers, using the Drummond's checklist.ResultsOur systematic review was based on 32 EEs and showed a wide variety of methodological approaches, including different perspectives, time horizon, and cost effectiveness analyses. Nearly two-thirds of EEs are full EEs (n = 21), and about one-third of EEs had a Drummond score ≥7, synonymous with 'high quality'. Close to 50% of full EEs had a Drummond score ≥7, whereas all of partial EEs had a Drummond score <7 (n = 11).ConclusionsOver the past 15 years, a lot of interest has been evinced over the EE of pancreatic ductal adenocarcinoma (PDAC) and its direct impact on therapeutic advances in PDAC. To provide a framework for health care decision-making, to facilitate transferability and to lend credibility to health EEs, their quality must be improved. For the last 4 years, a tendency towards a quality improvement of these studies has been observed, probably coupled with a context of rational decision-making in health care, a better and wider spread of recommendations and thus, medical practitioners' full endorsement.



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Assessing value in breast reconstruction - a systematic review of cost-effectiveness studies

Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high value care models.

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Intrasinusal locking technique: a novel use of the ring block technique at sinus perforations for simultaneous implant placement

Ten patients who underwent sinus lift surgery with simultaneous implant placement using the intrasinusal locking technique were evaluated retrospectively. All patients were scheduled for sinus floor elevation procedures with simultaneous implant placement. Schneiderian membrane perforation occurred during the lifting procedure, and conventional methods failed to repair the perforation. Therefore, an autogenous bone ring was placed at the base of the maxillary sinus and was locked to the alveolar crest with a dental implant.

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Management of a Circumferential Duodenal Polyp

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EUS-guided pancreatic pseudoaneurysm therapy: better to be lucky than good

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Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis

Objective

The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers.

Methods

This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse.

Conclusions

This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.

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Diet and disease modification in multiple sclerosis: a nutritional epidemiology perspective

A discussion of the role of diet in disease course in pediatric multiple sclerosis and additional considerations relevant to the design and conduct of observational nutritional epidemiology studies.

The prognosis of multiple sclerosis (MS) is generally quite heterogeneous. Several environmental influences like vitamin D status and smoking have been consistently linked with disease course; however, despite these findings, much of the variability remains unexplained. Interest in diet as an additional environmental disease modifying agent for MS is rapidly rising. Many dietary components modulate mechanisms (eg, immune/mitochondrial function and gut microbiota diversity) hypothesised to influence disease evolution over time. Recently, the Wellness Research Group sponsored by the National MS Society concluded that the state of knowledge concerning diet in people with MS is suboptimal. The panel suggests that while anecdotal support regarding the role diet may play in influencing disease course or symptoms is positive, there is a dearth of quality research studies...

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Reduction Mammoplasty Has Lasting Benefits in Adolescents

For adolescent girls with symptomatic macromastia, reduction mammoplasty can have positive and lasting benefits on quality of life (QOL) and breast-related symptoms, clinicians from Boston Children's Hospital and Harvard Medical School have found.
Reuters Health Information

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Calcium channel blockers for lung function improvement in asthma

For decades, calcium channel blockers (CCBs) have been believed to play a role in asthma treatment. However, the clinical efficacy of CCBs for lung function improvement in patients with asthma has not been qualitatively evaluated.

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Serum and sputum calprotectin, a reflection of neutrophilic airway inflammation in asthmatics after high altitude exposure

Abstract

Until recently, asthma has been characterized as a T(h)2-disorder with eosinophilic airway inflammation. However, several studies showed the existence of patients with asthma characterized by neutrophilic airway inflammation.[1] Seys et al. showed an increased proportion of sputum neutrophils in asthmatic patients after exposure to environmental conditions at high altitude (HA) and in elite athletes after intensive exercise (swimming).[2,3] As patients with neutrophilic asthma poorly respond to classic therapies such as inhaled corticosteroids, it is crucial to identify these patients to predict their medication response and to provide them with an appropriate therapy.[4]

This article is protected by copyright. All rights reserved.

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GREM2 nucleotide variants and the risk of tooth agenesis

Abstract

Objective

The etiology of tooth agenesis is multifactorial and still not fully understood. The aim of the study was to test whether variants of GREM2, encoding a BMP antagonist, are associated with the risk of this common dental anomaly in a Polish population.

Subjects and Methods

Direct sequencing of the GREM2 coding sequence including exon/intron boundaries was performed in 95 patients with both hypodontia and oligodontia. All identified GREM2 variants were then further tested in an independent group of patients (n=163) and controls (n=184).

Results

The previously described, functional GREM2 mutation (c.226C>G, p.Gln76Glu) was identified in two patients with hypodontia and associated dental anomalies, including taurodontism and microdontia. This mutation generating an allele with increased inhibitory activity was not detected in the control group. The second identified GREM2 variant, c.-1-21C>T (rs11806449), was not associated with the risk tooth agenesis. The polymorphism allele frequency in both patients and controls was 0.21 (OR=1.0, 95%CI: 0.76–1.46). The rs11806449 did not correlate either with the overall TA phenotype or hypodontia/oligodontia phenotypes.

Conclusion

Our study confirmed that GREM2 is a candidate gene for tooth agenesis, which mutations can explain, however, only a small fraction of the genetic contribution to the pathogenesis of this anomaly.

This article is protected by copyright. All rights reserved.

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Behavioral Changes in Children after Emergency Department Procedural Sedation

Abstract

Objective

The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative post-discharge behaviors. Predictors of negative behaviors were evaluated, including anxiety.

Methods

This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. The child's anxiety prior to sedation was measured with the Modified Yale Preoperative Anxiety Scale. Negative behavioral changes were measured with the Post-Hospitalization Behavior Questionnaire 1-2 weeks after discharge. Descriptive statistics and odds ratios were calculated. Chi square test was used for comparisons between groups. Multivariable logistic regression models evaluated predictors of negative behavioral change after discharge.

Results

97 patients were enrolled, 82 (85%) completed follow-up. Overall, 33 (40%) children were observed to be highly anxious pre-sedation and 18 (22%) had significant negative behavior changes after ED discharge. Independent predictors for negative behaviors were high anxiety (OR=9.0, 95% CI 2.3-35.7) and non-white race (OR= 6.5, 95% CI 1.7-25.0).

Conclusion

For children undergoing procedural sedation in the ED, two in five children have high pre-procedure anxiety and almost one in four have significant negative behaviors 1-2 weeks after discharge. Highly anxious and non-white children have increased risk of negative behavioral changes which have not been previously recognized in the ED setting.

This article is protected by copyright. All rights reserved.

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Association between the IRF6 rs2235371 polymorphism and the risk of nonsyndromic cleft lip with or without cleft palate in Chinese Han populations: A meta-analysis

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Yinlan Xia, Bo Hu, Jin Chen, Leilei Zheng, Jinlin Song
ObjectiveTo investigate the association between the risk of nonsyndromic cleft lip with or without cleft palate (NSCL/P) and the IRF6 rs2235371 (C>T) polymorphism in Chinese Han populations.DesignPubMed, Web of Science and EMBASE were searched through May 31, 2016, to select eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were applied to estimate the risk of NSCL/P associated with the IRF6 rs2235371 polymorphism. Subgroup analyses were conducted according to NSCL/P types (CLO, CPO and CLP) and the geographical location (Northern China and Southern China). Publication bias and sensitivity analyses were performed to assess the reliability of the results.ResultsA total of 1275 NSCL/P cases and 1294 controls from seven eligible case-control studies were included. In the overall analysis, a significant association between the IRF6 rs2235371 polymorphism and the risk of NSCL/P was identified under all genetic models, with the exception of the recessive model (T vs. C: OR=0.68, 95%CI=0.60-0.76, P<0.00001). A subgroup analysis by NSCL/P types indicated that the variant T allele significantly decreased the risk of CLO and CLP but not CPO. A subgroup analysis of the geographical location further showed significantly decreased susceptibility in Northern China under all genetic models, but in Southern China, only the heterozygote and dominant models showed a significantly decreased risk of NSCL/P. Funnel plot analysis and the Egger linear regression method detected no publication bias.ConclusionsThe IRF6 rs2235371 T allele decreased the risk of NSCL/P in Chinese Han populations. However, further studies with large sample sizes should be conducted to confirm this association.



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Does nasal congestion have a role in decreased resistance to regular CPAP usage?

Abstract

Nasal obstruction is known to cause resistance to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea syndrome (OSAS). In this paper, short- and long-term nasal congestion in OSAS patients receiving CPAP treatment were evaluated with acoustic rhinometry (AR). A total of 36 patients with moderate-to-severe OSAS, diagnosed with polysomnography were included in the study. Ten healthy subjects without OSAS constituted the control group. Pre-treatment nasal patency were measured with AR in all participants. 26 patients used the recommended CPAP treatment. Ten patients did not accept CPAP treatment. The AR test was repeated for all the subjects after 1 and 3 months except the 3rd month's measurements of the control group. There was no statistically significant difference between the initial minimum cross-sectional area (MCA) measurements of OSAS patients, using or not using CPAP, and the control group (P > 0.05). However, the first month MCA measurements of patients receiving CPAP were found to be significantly decreased compared with the initial values (P < 0.001). There was no significant change in the first and third months MCA values in the control group and patients who did not use CPAP (P > 0.05). No significant difference revealed in the 3rd month MCA measurements of the patients using CPAP compared with the initial values (P > 0.05). In this study, the increased nasal congestion, which is thought to be the cause of CPAP resistance, was objectively demonstrated in OSAS patients using CPAP. In addition, the nasal congestion developing at the first month was shown to disappear over time, supporting the opinion that patient compliance in CPAP treatment is expected to increase after regular device usage.

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Endoscopic electrocauterization of pyriform sinus fistula

Abstract

To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5–96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

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Pleasantness of olfactory and trigeminal stimulants in different Italian regions

Abstract

Although individuals categorize odors according to their pleasantness, experience may also influence odor perception—a phenomenon that partially explains why different populations perceive odors differently. Italy, which comprises 20 regions, is characterized by very different cultures. In the present study, we investigated for the first time how Italian regional differences can affect odor perception. 254 healthy volunteers coming from northern, central, southern Italy, and Sicily, one of the two major Italian islands, were recruited in Padua, Rome, Naples, and Syracuse, respectively. Olfactory function was tested with Sniffin' Sticks identification subtest. Subjects who had a score in the range within the mean identification value ± 1 SD, in accordance with the age classes identified in the literature, were asked to judge the odor pleasantness of 20 substances. The hedonic tone of the odorants was categorized as pleasant, neutral, unpleasant, and very unpleasant. Some odorants were appreciated more in northern Italy than in the other parts of the country, whereas others were appreciated more in the south and in Sicily than in the north. Unpleasant odorants were judged less unpleasant in central Italy. Some odorants such as strawberry and vanilla were perceived similarly in all the regional areas. Our study indicates that in Italy, hedonic perception of odorants differs probably in relation with genetic, cultural, and environmental factors. Further investigation is needed to delve deeper into the factors that influence the quality odor perception amongst humans.

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Prevention and management of vascular complications in middle ear and cochlear implant surgery

Abstract

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.

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The effect of thyroid autoantibody positivity on the functions of internal ear

Abstract

The objective of the study is to investigate if any significant difference exists in hearing thresholds and tympanometric examination results among patients whose thyroid antibody positivity was detected approximately 1 year or at least 5 years ago. Study population aged less than 40 years consisted of 17 patients who had thyroid antibody positivities for an average of 1 year (first group), 15 patients who were followed up for at least 5 years for thyroid antibody positivity (second group), and 18 volunteers (third group). Tympanometric examination results, stapes reflex, SRT, SD, and pure tone values were examined. When the second group and the third group were compared, significant results were obtained at hearing frequencies between 500 and 4000 Hz. When the first group and the third group were compared, only at 1000 Hz threshold significant results were obtained. During evaluation of hearing frequencies between 250 and 8000 Hz, significant results were not observed between the second group and the first group. When the first and the second groups were compared with the control group, significant results were obtained as for tympanometric examination findings and significant results were not observed between the second group and the first group. A significant difference was not detected as for the results of stapes reflex. Since thyroid antibody positivity affects the functions of internal ear, these patients should be more closely monitored. Since these effects become deeper in line with increased exposure to autoantibody positivity, variations in auditory responses should be more attentively monitored.

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Comparison on effectiveness of trans-septal suturing versus nasal packing after septoplasty: a systematic review and meta-analysis

Abstract

This systematic review applied meta-analytic procedures to evaluate the curative effect of trans-septal suturing versus nasal packing after septoplasty. Computerized search of the published literature in PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, WANFANG, CNKI databases. Randomized trials investigating trans-septal suturing versus nasal packing following septoplasty in patients with deviated nasal septum. Adhesion, septal hematoma, bleeding, septal perforation, infection, pain, headache, or residual septal deviation per randomized patients. 19 randomized controlled trials of 1845 subjects were included. Meta-analysis showed that postoperative pain, headache, and adhesion were significantly lower in trans-septal suturing group. Nasal packing and trans-septal suturing technique appear to be equivalent with regard to postoperative bleeding, hematoma, septal perforation, infection, and residual septal deviation. Trans-septal suturing technology is not only associated with less patient pain, headache, and lower occurrence rate of adhesion after septoplasty but it also relates to higher patient satisfaction and an improved quality of life. The suturing technology can be used as a substitute for traditional nasal packing of the first-line treatment. More well-designed studies are needed to confirm the effect of trans-septal suturing following septoplasty.

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eHealth in otorhinolaryngology: a disruptive innovation

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Reply to the letter to the editor concerning “Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty”

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Importance of adhesiolysis in revision surgery for vibrant soundbridge device failures at the short incus process

Abstract

The objectives of the study were to report a vibrant soundbridge (VSB) implant revision surgical method involving adhesiolysis at the short incus process under local anesthesia and demonstrate successful hearing performance after surgery. Three cases of VSB surgery, performed in 2016, were enrolled. All cases had diagnoses of device failure. This 'seven-incision line' exposed the floating mass transducer directly, after which the three steps (adhesiolysis, curettage, and hydrocortisone injection) were performed. Upon fitting the VSB, sound fields were evaluated immediately and at 3 months after the revision. During the revisions of surgery, all patients achieved immediate hearing gains and noticed differences in the outer devices with different amplifications. Satisfactory improvements in hearing thresholds and speech recognition abilities were confirmed by improvements of 20–30 dB in hearing loss 3 months after revision surgery. The VSB implant revision surgical method involving adhesiolysis is safe and efficient for patients who experience a VSB device failure. This method will reduce the requirement for surgery under general anesthesia, reduce the overall period of clinical therapy and, therefore, minimize patients' medical costs.

Level of Evidence 4

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Does nasal congestion have a role in decreased resistance to regular CPAP usage?

Abstract

Nasal obstruction is known to cause resistance to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea syndrome (OSAS). In this paper, short- and long-term nasal congestion in OSAS patients receiving CPAP treatment were evaluated with acoustic rhinometry (AR). A total of 36 patients with moderate-to-severe OSAS, diagnosed with polysomnography were included in the study. Ten healthy subjects without OSAS constituted the control group. Pre-treatment nasal patency were measured with AR in all participants. 26 patients used the recommended CPAP treatment. Ten patients did not accept CPAP treatment. The AR test was repeated for all the subjects after 1 and 3 months except the 3rd month's measurements of the control group. There was no statistically significant difference between the initial minimum cross-sectional area (MCA) measurements of OSAS patients, using or not using CPAP, and the control group (P > 0.05). However, the first month MCA measurements of patients receiving CPAP were found to be significantly decreased compared with the initial values (P < 0.001). There was no significant change in the first and third months MCA values in the control group and patients who did not use CPAP (P > 0.05). No significant difference revealed in the 3rd month MCA measurements of the patients using CPAP compared with the initial values (P > 0.05). In this study, the increased nasal congestion, which is thought to be the cause of CPAP resistance, was objectively demonstrated in OSAS patients using CPAP. In addition, the nasal congestion developing at the first month was shown to disappear over time, supporting the opinion that patient compliance in CPAP treatment is expected to increase after regular device usage.

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Author’s reply to a letter-to-the-editor about the paper ‘Eardrum thickening approach for the treatment of patulous Eustachian tube’

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In response to Letter to the Editor entitled “It is prudent to consider use of endoscopic tympanoplasty to treat complicated middle ear disease”

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Endoscopic electrocauterization of pyriform sinus fistula

Abstract

To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5–96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

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Open tracheostomy training: a nationwide survey among Otolaryngology-Head and Neck Surgery residents

Abstract

The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March–June 2016. Residents were categorized as 'juniors,' if they were in their post-graduate year (PGY)-1 and PGY-2; 'mid-residency' (PGY-3 and PGY-4); or 'seniors' (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 'juniors' (36%), 24 'mid-residency' (35%) and 20 'seniors' (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated 'hands-on' platforms; objective periodic surgical competence assessments; and specialist's feedback, using structured assessment forms.

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Pleasantness of olfactory and trigeminal stimulants in different Italian regions

Abstract

Although individuals categorize odors according to their pleasantness, experience may also influence odor perception—a phenomenon that partially explains why different populations perceive odors differently. Italy, which comprises 20 regions, is characterized by very different cultures. In the present study, we investigated for the first time how Italian regional differences can affect odor perception. 254 healthy volunteers coming from northern, central, southern Italy, and Sicily, one of the two major Italian islands, were recruited in Padua, Rome, Naples, and Syracuse, respectively. Olfactory function was tested with Sniffin' Sticks identification subtest. Subjects who had a score in the range within the mean identification value ± 1 SD, in accordance with the age classes identified in the literature, were asked to judge the odor pleasantness of 20 substances. The hedonic tone of the odorants was categorized as pleasant, neutral, unpleasant, and very unpleasant. Some odorants were appreciated more in northern Italy than in the other parts of the country, whereas others were appreciated more in the south and in Sicily than in the north. Unpleasant odorants were judged less unpleasant in central Italy. Some odorants such as strawberry and vanilla were perceived similarly in all the regional areas. Our study indicates that in Italy, hedonic perception of odorants differs probably in relation with genetic, cultural, and environmental factors. Further investigation is needed to delve deeper into the factors that influence the quality odor perception amongst humans.

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Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis

Abstract

Although clinical outcomes of descending necrotizing mediastinitis (DNM) and/or deep neck infection (DNI) have been extensively reported, no study has addressed delay in recovering oral ingestion after surgical interventions other than sporadic case reports. We herein compared clinical features of DNM and DNI cases over the same period, and clarified precipitating factors of delay in recovering oral ingestion by logistic regression analysis. We reviewed records of patients with DNI and DNM at our institution from August 2005 to July 2015. We extracted data on patient age, sex, complication with diabetes mellitus, gas gangrene, extension of infections, operative procedure, tracheotomy, bacterial results, and duration of empirical antibiotic therapy. Patients were categorized into three groups according to vertical spread of infection: 60 DNI patients without extension below the hyoid bone (group-A), 48 DNI patients with extension below the hyoid bone without DNM (group-B), and 10 DNM patients (group-C). Age, diabetes mellitus, and gas gangrene were significantly different among the groups. Concerning surgical intervention, tracheotomy was significantly less frequently performed in group-A (25%) than the other groups (74%) (p < 0.001). Logistic regression analyses revealed that extension of infections below the hyoid bone and tracheotomy were significantly associated with delayed oral dietary intake [odds ratios (95% confidence intervals) 2.96 (1.06–8.28) and 10.69 (3.59–31.88), respectively]. Along with DNM patients, patients who undergo tracheotomy for infections that extend below the hyoid bone should receive postoperative care with careful attention to avoid delay in recovering oral ingestion.

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