An Evaluation of Different Bridging Techniques for Short Nerve Gaps

Background: In this study, we investigated sensory and motor outcomes for different bridging techniques for short nerve gaps. Material and Methods: This study was conducted in the Postdoctoral Department of Burns, Plastic, and Reconstructive Surgery of our institution from August 2014 to May 2017. All patients with posttraumatic short nerve gaps of 3 cm or less of median, ulnar, and/or both in forearm and wrists were included in the study. Patients with known causes of neuropathies were excluded. Groups 1, 2, 3, and 4 included 9 patients each, and the nerve gap was managed with reverse sural nerve autograft, inside-out vein conduit autograft, reverse sural nerve with covering inside-out vein autograft, and inside-out great saphenous vein autograft filled with denervated gastrocnemius skeletal muscle autograft, respectively. All the patients were followed-up and examined for sensory and motor recovery with a 2-point discrimination test (2PD) at finger tips in the distribution of reconstructed nerves and medical research council scale (MRCS) for muscle power innervated by the reconstructed nerves. The 2PD and MRCS muscles were compared between the groups using SPSS version 23 through 1-way analysis of variance. Results: All the patients in each group recovered either completely or partially. The 2PD and MRCS muscle power means were compared between the groups. On comparing the mean 2PD and mean MRCS muscle power were compared between the groups using 1-way analysis of variance test. All the groups have been found statistically comparable in spite of the apparent clinical difference. Conclusions: Although the nerve autograft is the criterion standard for managing the nerve gaps, the vein conduit is a viable alternative to nerve autograft for bridging the nerve gaps 3 cm or less, whereas filled conduit needs more study. However, more patients need to be studied to complete a relevant statistical study.

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Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869–1919)

Introduction: During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. Methods: This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. Results: Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. Conclusions: Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.

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Response to the letter to the editor: “Understanding the impact of preservation methods on the integrity and functionality of placental allografts”

No abstract available

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Microsurgery Fellowship at St Vincent's Hospital, Sydney, Australia: The Ultimate Hidden Gem

No abstract available

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Significance of the Lateral Thoracic Artery in Pectoralis Major Musculocutaneous Flap Reconstruction: Quantitative Assessment of Blood Circulation Using Indocyanine Green Angiography

Abstract: Free tissue transfer is the preferred reconstruction option in most major head and neck reconstructions. The pectoralis major muscle musculocutaneous (PMMC) flap is commonly used in salvage of necrotic free flaps and is the first choice for patients who are not candidates for free flaps. The lateral thoracic artery (LTA), which is thought to contribute to blood perfusion of the inferior and lateral mammary area, is not preserved in a conventionally harvested PMMC flap. With regard to blood supply, it has been suggested that the LTA should be preserved, in addition to the pectoral branch of the thoracoacromial artery, when a skin island is designed in the lower chest to attain a pedicle length sufficient for head and neck reconstruction. However, an effect on hemodynamic improvement using the LTA has not been shown quantitatively. In this study, we examined 8 patients with oral cancer who underwent reconstruction procedures with a bipedicle PMMC flap that included the LTA, in addition to the thoracoacromial artery. Intraoperative indocyanine green angiography was performed to examine circulation to the PMMC flap with or without LTA clamping after harvesting. After image processing, data were analyzed using a new quantitative perfusion assessment system with parameters that we recently established for assessment of peripheral arterial disease of the lower limbs. All patients had good clinical courses with whole-flap survival, no vascular insufficiency of the skin island, and no fistula formation. Intraoperative indocyanine green angiography showed an increased inflow rate into the skin island in an LTA-declamped condition in all cases, implying that the preserved LTA increased the blood supply to skin islands in the pectoralis major muscle. We conclude that preserving the LTA in a PMMC flap can increase blood perfusion and stabilize the vascularity of the flap, making the reconstruction more effective and reliable than with use of a conventionally harvested flap. Therefore, it is worthwhile to preserve the LTA as a major contributor to a lateral and distal PMMC flap.

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Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy

Introduction: Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. Methods: This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. Results: There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. Conclusions: Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

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Reverse Distal Transverse Palmar Arch in Distal Digital Replantation

Background: Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Methods: Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Results: Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5–5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. Conclusions: The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

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Does the Sequence of Tattooing and Nipple Reconstruction Affect Nipple Projection?

Background: In nipple reconstruction, the maintenance of adequate projection is one of the most important and challenging aspects. However, no reports have evaluated whether tattooing after nipple reconstruction affects nipple projection. This study aimed to test our hypothesis that tattooing after reconstruction adversely affects nipple projection. Method: Between September 2001 and July 2009, 384 nipples were reconstructed using the modified top hat technique after breast reconstruction with a transverse rectus abdominis musculocutaneous flap. Of these, 320 were reconstructed before tattooing, and 64 were reconstructed after tattooing. Projection at 6 months and 1 year was compared with that measured immediately after the operation, and projection was compared between the nipples reconstructed after tattooing and those reconstructed before tattooing. Results: After 6 months, the mean loss of projection was 52.5% in the tattoo-after group and 55.1% in the tattoo-before group. After 1 year, it was 59.2% in the tattoo-after group and 58.6% in the tattoo-before group. There were no significant differences between the groups regarding the sequence of the procedures. The additional tattoo and retattoo rate was 20% in the tattoo-before group and 1% in the tattoo-after group. Conclusions: These findings showed that the sequence of nipple reconstruction and tattooing had no significant effect on the projection of the reconstructed nipple. It is easier to tattoo homogeneously before nipple reconstruction because of the flat surface but more difficult to make a smooth areolar peripheral margin and circular areolar shape when reconstructing the nipple. The sequence of tattooing and nipple reconstruction can be determined according to esthetic and clinical considerations.

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Pediatric Lower Extremity Lawn Mower Injuries and Reconstruction: Retrospective 10-Year Review at a Level 1 Trauma Center

Introduction: From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower–related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature. Methods: A retrospective review was performed at a level 1 trauma center over a 10-year period (2005–2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included. Results: Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings. Conclusions: This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these children. Increased public awareness is insufficient to decrease the incidence of these injuries. These products should have additional warning labels and meet updated changes to the design of lawn mowers to prevent these mutilating injuries successfully.

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The Classic Pitanguy Technique and Its Modifications in Mammaplasty: Ten Years of Experiences

Background: Mammaplasty surgery has been modified in the past few years, as plastic surgeons worked to improve and maintain the breast shape and especially the "bottoming out" of the gland. The classic Pitanguy's technique has been shown to be an anatomically safe technique in the management of the breast. However, as first described, cannot be applied in gigantomastia or in severe breast ptosis cases or in cases of dense breast parenchyma or for a long-lasting breast lift result. Using 2 different modifications, the Pitanguy technique can be applied for breasts of all sizes and for all cases of breast ptosis. Methods: A retrospective study of 140 patients who underwent the Pitanguy method and its 2 modifications was performed. The first modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nac. The medial flap is then advanced superiorly, rotated 90 degrees, and sutured to point A, whereas the lateral flap is placed below the medial one. The second modification describes an inferior chest wall-based flap for achieving a desirable shape that can be maintained over a long period. The inferior flap is based only in the thoracic wall vasculature, completely detached from surrounding structures, maintaining a good volume. The upper flap of the breast covers the inferior flap. Results: The follow-up included 140 patients and the follow-up period ranged from 1 to 10 years. Five patients were operated on less than 4 months ago and were not involved in this study. All patients gained natural-shaped breasts, and they were pleased with the results. Serious complications, including flap necrosis, were avoided because caution was used to preserve the internal mammary perforators while performing the Pitanguy's technique and its 2 modifications. Conclusions: The classic Pitanguy technique and its 2 modifications provide a versatile, well-vascularized pedicle that allows elevation of the nipple areola complex at the desired height. Using these 2 modifications, the Pitanguy's technique can be applied for breasts of all sizes and for all cases of breast ptosis.

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Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A National Surgical Quality Improvement Program Review

Introduction: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications. We used this database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions. Methods: Data from the years 2005 to 2014 of the American College of Surgeons NSQIP database were used. Cohorts were constructed according to International Classification of Diseases, Ninth Revision, classification and current procedural terminology codes. The outcome of 30-day return to hospital was defined as patients who were readmitted to the hospital or the operating room within 30 days. Multiple logistic regression results are presented for a prespecified set of predictors and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated using maximum likelihood estimates, along with Wald test P values. Results: A total of 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and for cervical SLNB on multivariate analysis. Age was a significant predictor for cervical and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, preoperative hematocrit, and male sex were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD procedures. Conclusions: This is the first and largest study using American College of Surgeons NSQIP to examine 30-day readmission after SLNB and LAD for melanoma in 3 commonly operated anatomical regions. We have found several significant risk factors associated with hospital readmission, which are now being used as a quality measure for hospital performance and reimbursement, that may help surgeons optimize patient selection for SLNB and LAD.

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Sweet Syndrome After Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Case Report

Abstract: We describe a case of Sweet's Syndrome after bilateral deep inferior epigastric perforator flap breast reconstruction in a patient with ductal carcinoma of the left breast.

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The Boreds

No abstract available

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Analysis of Mechanical Behavior of Dermal Fibroblasts Obtained From Various Anatomical Sites in Humans

Purpose: Facial skin fibroblasts imposed with cyclic stretch at 10% magnitude display considerable mechanotransduction properties and biochemical reactions in our previous study. However, it is poorly understood how these shared traits are fully parallel to the common features across all fibroblasts derived from different skin-based anatomical regions in response to cyclic stretch stimulation. Thus, the purpose of this study was to evaluate the effects of various cyclic stretches on fibroblasts derived from multiple anatomical skin sites of human bodies, and the optimal stretch magnitude was defined based on the changes to cell mechanical behavior. Methods: Fibroblasts from skin areas of the scalp, anterior chest, suprapubic, axilla, and planta were cultured and characterized in vitro. Cyclic stretch at 0%, 5%, 10%, 15%, and 20% magnitudes was imposed at a loading frequency of 0.1 Hz for 48 hours, and thereafter, the mechanical behavior and biochemical reaction of the dermal fibroblasts were analyzed. Results: Dermal fibroblasts from various anatomical sites preconditioned with varying cyclic stretch led to an evident increase in the cell proliferation ability, the expression of integrin β1 and p130 Crk-associated substrate messenger RNA and protein, and the productions of type I collagen and transforming growth factor β1, most importantly in a strain magnitude-dependent manner with the peak appearing in the range of 10% to 15% magnitude cyclic stretch. Conclusions: These findings may facilitate the subsequent studies on the conversion of normal skin fibroblasts into hypertrophic scar cells, which should be considered in an interpretation of the mechanisms of hypertrophic scarring and skin mechanics.

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Free Lateral Digital Flap for Reconstruction of the Fingers

Background: The region between the proximal interphalangeal (PIP) and the metacarpophalangeal (MP) creases has greater laxity than other regions in the fingers, allowing for primary closure of the donor site. We postulated if we could consistently locate perforators from the region between the PIP and the MP crease on the radial side of the middle and ring fingers, on which a scar would be less conspicuous than one on the radial side of the index finger, these regions would be ideal donor sites for digital reconstruction using very small flaps. Methods: In 20 fingers (10 middle fingers and 10 ring fingers) from 5 volunteers, perforators from the radial proper digital artery were visualized between the PIP and the MP creases using ultrasonography. Based on this information, and to evaluate its feasibility, a free lateral digital flap was used for reconstruction of small digital defects in 3 cases. Results: Of the 20 fingers, 19 had at least 1 digital artery perforator (DAP) arising from the radial proper digital artery between the PIP and MP creases. The average distance from the PIP crease to the DAP was 9.0 mm. The average diameter of the DAP was 0.37 mm. In all clinical cases, flaps survived completely with pleasing cosmesis. There were no donor site complications. Conclusions: With their consistent anatomy and relatively low donor site morbidity, free lateral digital flaps from the radial side of the middle or ring fingers may be a reliable option for reconstruction of the volar surface of the digits.

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Acute-Onset Quadriplegia With Recovery After High-Voltage Electrical Injury

Abstract: Although uncommon, electrical injuries are associated with significant morbidity and mortality. There have been several reports of neurological sequelae secondary to electrical injury; however, the neurophysiology is still not completely understood. These neurological complications pose the greatest risk for permanent disability. We present a case of acute-onset quadriplegia after high-voltage electrical injury without radiographic evidence. Two months after the injury, the patient went on to regain partial sensorimotor function. Only a few case reports in the literature exist describing neurological recovery after electrical burn-induced quadriplegia. These cases are reviewed.

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The Use of Bilayered Fascia Lata With an Interpositional Omental Flap for Autologous Repair of Contaminated Abdominal Fascial Defects

Introduction: Contaminated abdominal fascial defects, such as those seen in enterocutaneous fistula, or wound dehiscence with mesh exposure, are a significant source of morbidity and present unique reconstructive challenges. We present our technique of using the fascia lata, augmented with an interpositional omental flap, for complete autologous reconstruction of contaminated fascial defects, and the postoperative results of 3 cases. Methods: Three patients with contaminated abdominal defects underwent wound debridement/fistula resection and immediate reconstruction with fascia lata and omentum flap. Defect size ranged from 15 × 8 cm (120 cm2) to 25 × 12 cm (300 cm2). The fascia lata graft was inset using an underlay technique, and the omentum was tunneled through a subcostal slit in the semilunar line to augment the vascularity of the subcutaneous plane and protect the graft. Skin coverage was achieved by undermining and direct closure or local myocutaneous flaps. Results: Three patients underwent abdominal wall reconstruction with our technique. The median follow-up was 12 months. There were no recurrent infections, fistulae, or herniae. All patients experienced full functional recovery with return to independent activities of daily living by 6 months postoperatively. Conclusions: Since the use of synthetic material is contraindicated in contaminated abdominal fascial defects. We propose that our combination of fascia lata and an interpositional omental flap is a useful technique for the reconstruction of these challenging defects.

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Lesions Associated With Calcium Gluconate Extravasation: Presentation of 5 Clinical Cases and Analysis of Cases Published

Introduction: Calcium gluconate extravasation is a process, which, while not common, occurs more frequently in neonatal intensive care units. The aim of this study is to present a number of cases of calcium gluconate extravasation, which have occurred in our hospital, and to carry out a review of those clinical cases published in the literature to obtain relevant epidemiological data. Methods: Data were gathered on the medical histories of 5 patients who presented lesions secondary to calcium gluconate extravasation in our center. A review of the literature was also performed to include clinical cases of calcium gluconate extravasation already published. Results: Data were collected on 60 cases published in 37 articles. Most patients (55%) were neonates. The average age of these neonates was 8 days. The commonest location of injuries was the back of the hand and wrist (42%). The 2 most frequent symptoms were the appearance of erythema (65%) and swelling/edema (48%) followed by the appearance of skin necrosis (47%), indurated skin (33%), and yellow-white plaques or papules (33%). Most cases are cured within a period of 3 to 6 months. Fifty percent of patients required surgery, and in 13% of cases, skin grafts were performed. The most frequent histological finding was the presence of calcium deposits. Other histological findings described were the presence of necrosis, lymphohistiocytic infíltrate, and granulomas. Most histological findings were located in the dermis. Most x-rays showing calcium deposits had been performed at 3 to 4 weeks. Conclusions: Calcium gluconate extravasation is a process, which, although infrequent, is associated with serious skin and soft-tissue lesions, mainly affecting infants. Further studies are needed to determine possible specific procedures to be carried out in these cases.

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Impact of Abdominal Lipectomy on Post-Sleeve Gastrectomy Surgery Weight Loss

Background: Abdominal lipectomy after bariatric surgery is recommended because of residual excess skin resulting in difficulty with maintaining hygiene, recurrent infections, and functional impairment, interfering with daily activities. There is a dearth of literature examining weight loss outcomes in patients undergoing abdominal lipectomy post sleeve gastrectomy (SG). The purpose of this study was to examine whether post-SG patients who received abdominal lipectomy achieved greater percent excess weight loss (%EWL) than post-SG patients who did not receive abdominal lipectomy. Methods: Retrospective study of patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 was conducted. The cohort was divided into 2 groups: patients who underwent abdominal lipectomy after SG (PS-SG) and patients who underwent SG alone (SG). Demographics, comorbidities, and %EWL were examined. Results: Twenty-nine patients were included in the PS-SG group versus 287 patients in the SG group. Significant differences were found in %EWL at 24 (P

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Chemotherapy Extravasation Management: 21-Year Experience

Abstract: Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. Evidence-based standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Our aim was to explore the prevention and treatment of extravasation injuries, proposing a standard therapeutic protocol together with a review of the literature. From January 1994 to December 2015, 545 cases were reviewed (age range, 5–87 years; 282 men and 263 women). Our therapeutic protocol consisted of local infiltration of saline solution and topical occlusive applications of corticosteroids. The infiltrations were administrated 3 to 6 times a week depending on damage severity. Our protocol allowed us to prevent ulceration in 373 cases. Only 27 patients required surgery (escarectomy, skin graft, regional, and free flap). Numerous treatments have been proposed in literature. The antidotes have been discussed controversially and are not considered standard methods for treatment, especially when polychemotherapy is administrated and the identification of the responsible drug is not possible. We proposed the use of saline solution injection to dilute rapidly the drug, thus reducing its local toxic effects. This method is easy to use and always reproducible even when the drug is not known or when it is administrated in combination with other drugs. It is possible to perform it in ambulatory regimen, and, overall, it represents a standard method.

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Editorial Board/Reviewing Committee

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Identification and management of inverted or everted edges of traumatic tympanic membrane perforations

Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Zhengcai Lou, Zi-Han Lou
IntroductionMost of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial.ObjectiveWe investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations.MethodsThe clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes.ResultsIn total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period.ConclusionThis study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.



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Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing

Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Kamal Abulebda, Vinit J. Patel, Sheikh S. Ahmed, Alvaro J. Tori, Riad Lutfi, Samer Abu-Sultaneh
IntroductionThe use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test.ObjectiveThe aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing.MethodsPatients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed.Results73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia.ConclusionBoth sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.



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Training and Assessing Critical Airway, Breathing and Hemorrhage Control Procedures for Trauma Care: Live Tissue versus Synthetic Models.

Related Articles

Training and Assessing Critical Airway, Breathing and Hemorrhage Control Procedures for Trauma Care: Live Tissue versus Synthetic Models.

Acad Emerg Med. 2017 Oct 27;:

Authors: Hart D, Rush R, Rule G, Clinton J, Beilman G, Anders S, Brown R, McNeil MA, Reihsen T, Chipman J, Sweet R, University of Minnesota Combat Casualty Training Consortium (UMN CCTC)

Abstract
INTRODUCTION: Optimal teaching and assessment methods and models for emergency airway, breathing and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus Live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing 7 procedures: Junctional hemorrhage control, Tourniquet (TQ) placement, Chest seal, Needle thoracostomy (NCD), Nasopharyngeal airway (NPA), Tube thoracostomy, and Cricothyrotomy (Cric).
METHODS: Army combat medics were randomized to one of four groups: 1) Live tissue trained - live tissue tested (LT-LT), 2) live tissue trained - synthetic training model tested (LT-STM), 3) synthetic training model trained - live tissue tested (STM-LT), 4) synthetic training model trained - synthetic training model tested (STM-STM). Participants trained in small groups for 3-4 hours and were evaluated individually. LT-LT was the "control" to which other groups were compared, as this is the current military pre-deployment standard. The mean procedural scores (PS) were compared using a pairwise t-test with a Dunnett's correction. Logistic regression was used to compare critical fails (CF) and skipped tasks.
RESULTS: There were 559 subjects included. Junctional hemorrhage control revealed no difference in CFs, but LT tested subjects (LT-LT and STM-LT) skipped this task more than STM tested subjects (LT-STM and STM-STM) (p<0.05), and STM-STM had higher PS than LT-LT (p<0.001). For TQ, both STM tested groups (LT-STM and STM-STM) had more CFs than LT-LT (p<0.001) and LT-STM had lower PS than LT-LT (p<0.05). No differences were seen for chest seal. For NCD, LT-STM had greater CFs than LT-LT (p=0.001), and lower PSs (p=0.001). There was no difference in CFs for NPA, but all groups had worse PS versus LT-LT (p<0.05). For Cric, we were underpowered; STM-LT trended towards more CFs (p=0.08), and STM-STM had higher PSs than LT-LT (p<0.01). Tube thoracostomy revealed STM-LT had higher CFs than LT-LT (p<0.05), but LT-STM had lower PS (p<0.05). An interaction effect (making the subjects who trained and tested on different models more likely to CF) was only found for Tourniquet, chest seal and Cric, however, of these 3 procedures, only TQ demonstrated any significant difference in CF rates.
CONCLUSION: Training on STM or LT did not demonstrate a difference in subsequent performance for 5 of 7 procedures (junctional hemorrhage, TQ, chest seal, NPA and NCD). Until synthetic training models are developed with improved anthropomorphic and tissue fidelity, there may still be a role for LT for training tube thoracostomy and potentially cricothyrotomy. For assessment, our STM appears more challenging for TQ and potentially for NCD than LT. For junctional hemorrhage, the increased "skips" with LT may be explained by the differences in anatomic fidelity. While these results begin to uncover the effects of training and assessing these procedures on various models, further study is needed to ascertain how well performance on an STM or LT model translates to the human model. This article is protected by copyright. All rights reserved.

PMID: 29077240 [PubMed - as supplied by publisher]

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Editorial Board / Subscription Information

Publication date: November 2017
Source:Journal of Phonetics, Volume 65





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Acknowledgements for the 2017 Volumes

Publication date: November 2017
Source:Journal of Phonetics, Volume 65





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Chemical affinity of 10-methacryloyloxydecyl dihydrogen phosphate to dental zirconia: Effects of molecular structure and solvents

Publication date: Available online 14 October 2017
Source:Dental Materials
Author(s): Ying Chen, Zhicen Lu, Mengke Qian, Huaiqin Zhang, Chen Chen, Haifeng Xie, Franklin R. Tay
ObjectivesTo examine whether solvents and changing the molecular structure of 10-Methacryloyloxydecyl dihydrogen phosphate (10-MDP) affect its chemical affinity to Yttria-stabilized tetragonal zirconia polycrystals (Y-TZP).MethodsThe present work investigated the chemical affinity between Y-TZP and 10-MDP dissolved in different solvents (acetone/ethanol/water or mixture) using X-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and thermodynamic calculations. Shear bond strength (SBS) tests were used to evaluate the influence of different solvents on 10-MDP bonding. In addition, several phosphate ester monomer variants were created by changing the 10-MDP molecular structure. Changes included extending/shortening the spacer chain-length, and installing hydroxyl or carboxyl groups as side chains at different positions along the spacer chain. The thermodynamic parameters of the complexes formed between the 10-MDP variants and tetragonal zirconia were evaluated.ResultsThe acquired data indicated that solvent is necessary for the formation of Zr–O–P bonds between 10-MDP and Y-TZP. Solvents affected the chemical affinity of 10-MDP to Y-TZP; acetone facilitated the best bonding, followed by ethanol. Changing the molecular structure of 10-MDP affected its chemical affinity to Y-TZP. The variants 15-MPDP, 12-MDDP, 6-hydroxyl-10-MDP and 6-carboxy-10-MDP all exhibited higher thermodynamic stability than 10-MDP when coordinated with tetragonal zirconia. In contrast, 2-MEP, 5-MPP, 10-hydroxyl-MDP, 10-carboxy-MDP, 5,6-dihydroxyl-10-MDP and 5,6-dicarboxy-10-MDP exhibited lower thermodynamic stability.Significance10-MDP coordinates with zirconia through dissociating in solvents. Changing the molecular structure of 10-MDP theoretically affects its chemical affinity to Y-TZP.

Graphical abstract

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Editorial Board

Publication date: November 2017
Source:Dental Materials, Volume 33, Issue 11





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Zirconia-incorporated zinc oxide eugenol has improved mechanical properties and cytocompatibility with human dental pulp stem cells

Publication date: Available online 14 October 2017
Source:Dental Materials
Author(s): Soo Kyung Jun, Hae-Won Kim, Hae-Hyoung Lee, Jung-Hwan Lee
ObjectiveZinc oxide eugenol (ZOE) is widely used as a therapeutic dental restorative material. However, ZOE has poor mechanical properties and high cytotoxicity toward human dental pulp stem cells (hDPSCs) due to the release of Zn ions. In this study, zirconia-incorporated ZOE (ZZrOE) was developed to reduce the cytotoxicity and improve the mechanical properties of ZOE with sustained therapeutic effects on inflamed hDPSCs in terms of inflammatory gene expression levels compared with those of the original material.MethodsAfter the setting time and mechanical properties of ZZrOE incorporating varying amounts of zirconia (0, 5, 10, and 20wt% in powder) were characterized, the surface morphology and composition of the resulting ZZrOE materials were investigated. The ions and chemicals released into the cell culture medium from ZOE and ZZrOE (3cm²/mL) were measured by inductively coupled plasma atomic emission spectroscopy and gas chromatography, respectively. After testing cytotoxicity against hDPSCs using the above extracts, the therapeutic effects on lipopolysaccharide-inflamed hDPSCs in terms of compromising the upregulation of inflammatory response-related mRNA expression were tested using real-time PCR.ResultsZZrOE 20% exhibited increased compressive strength (∼45%), 3-point flexural strength (∼150%) and hardness (∼75%), as well as a similar setting time (∼90%), compared with those of ZOE. After the rough surface of ZZrOE was observed, significantly fewer released Zn ions and eugenol (∼40% of that from ZOE) were detected in ZZrOE 20%. ZZrOE showed less cytotoxicity because of the lower amount of Zn ions released from ZOE while showing sustained inhibition of inflammatory marker (e.g., interleukin 1β, 6 and 8) mRNA levels.SignificanceThe improved mechanical properties and cytocompatibility, as well as the sustained therapeutic effects on inflamed hDPSCs, were investigated in ZZrOE compared with those of ZOE. Therefore, ZZrOE has the potential to be used as an alternative to ZOE as a dental restorative material.

Graphical abstract

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3D printed versus conventionally cured provisional crown and bridge dental materials

Publication date: Available online 27 October 2017
Source:Dental Materials
Author(s): Anthony Tahayeri, MaryCatherine Morgan, Ana P. Fugolin, Despoina Bompolaki, Avathamsa Athirasala, Carmem S. Pfeifer, Jack L. Ferracane, Luiz E. Bertassoni
ObjectivesTo optimize the 3D printing of a dental material for provisional crown and bridge restorations using a low-cost stereolithography 3D printer; and compare its mechanical properties against conventionally cured provisional dental materials.MethodsSamples were 3D printed (25×2×2mm) using a commercial printable resin (NextDent C&B Vertex Dental) in a FormLabs1+ stereolithography 3D printer. The printing accuracy of printed bars was determined by comparing the width, length and thickness of samples for different printer settings (printing orientation and resin color) versus the set dimensions of CAD designs. The degree of conversion of the resin was measured with FTIR, and both the elastic modulus and peak stress of 3D printed bars was determined using a 3-point being test for different printing layer thicknesses. The results were compared to those for two conventionally cured provisional materials (Integrity^®, Dentsply; and Jet^®, Lang Dental Inc.).ResultsSamples printed at 90° orientation and in a white resin color setting was chosen as the most optimal combination of printing parameters, due to the comparatively higher printing accuracy (up to 22% error), reproducibility and material usage. There was no direct correlation between printing layer thickness and elastic modulus or peak stress. 3D printed samples had comparable modulus to Jet^®, but significantly lower than Integrity^®. Peak stress for 3D printed samples was comparable to Integrity^®, and significantly higher than Jet^®. The degree of conversion of 3D printed samples also appeared higher than that of Integrity^® or Jet^®.SignificanceOur results suggest that a 3D printable provisional restorative material allows for sufficient mechanical properties for intraoral use, despite the limited 3D printing accuracy of the printing system of choice.



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Incorporation of antibacterial agent derived deep eutectic solvent into an active dental composite

Publication date: Available online 23 October 2017
Source:Dental Materials
Author(s): Jing Wang, Xiaoqing Dong, Qingsong Yu, Sheila N. Baker, Hao Li, Nathaniel E. Larm, Gary A. Baker, Liang Chen, Jingwen Tan, Meng Chen
ObjectiveTo incorporate an antibacterial agent derived deep eutectic solvent (DES) into a dental resin composite, and investigate the resulting mechanical properties and antibacterial effects.MethodThe DES was derived from benzalkonium chloride (BC) and acrylic acid (AA) and was incorporated into the dental resin composite through rapid mixing. A three-point bending test was employed to measure the flexural strength of the composite. An agar diffusion test was used to investigate antibacterial activity. Artificial (accelerated) aging was undertaken by immersing the composites in buffer solutions at an elevated temperature for up to 4 weeks. UV–vis spectrophotometry and NMR analysis were conducted to study BC release from the composite. Finally, the biocompatibility of the composite materials was evaluated using osteoblast cell culture for 7 days. Results were compared to those of a control composite which contained no BC.ResultThe DES-incorporated composite (DES-C) displayed higher flexural strength than a similar BC-incorporated composite BC (BC-C) for the same level of BC. The inclusion of BC conferred antibacterial activity to both BC-containing composites, although BC-C produced larger inhibition halos than DES-C at the same loading of BC. Control composites which contained no BC showed negligible antibacterial activity. After artificial aging, the DES-C composite showed better maintenance of the mechanical properties of the control compared with BC-C, although a decrease was observed during the three-point bending test, particularly upon storage at elevated temperatures. No BC release was detected in the aged solutions of DES-C, whereas the BC-C showed a linear increase in BC release with storage time. Significantly, cell viability results indicated that DES-C has better biocompatibility than BC-C.SignificanceThe incorporation of a BC-based DES into a dental resin composite provides a new strategy to develop antibacterial dental materials with better biocompatibility and longer effective lifetimes without sacrificing the intrinsic mechanical properties of the composite structure.

Graphical abstract

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Corrosion behavior of titanium in response to sulfides produced by Porphyromonas gingivalis

Publication date: Available online 20 October 2017
Source:Dental Materials
Author(s): Rino Harada, Eitoyo Kokubu, Hideaki Kinoshita, Masao Yoshinari, Kazuyuki Ishihara, Eiji Kawada, Shinji Takemoto
ObjectiveTo investigate the effects of sulfides produced by Porphyromonas gingivalis (P. gingivalis) on the corrosion behavior of titanium.MethodsCommercially pure titanium disks were mirror-polished and immersed in culture medium (BHI), spent medium after culturing P. gingivalis (BHI-S), and culture medium with P. gingivalis (BHI-P), and incubated aerobically at 37°C for 3–14 days. Titanium corrosion was evaluated through surface observation (using scanning electron microscope: SEM), color change (ΔE*ab), glossiness (Gs(20°)), chemical composition and state (using X-ray photoelectron spectroscopy: XPS), and titanium release.ResultsΔE*ab and Gs(20°) did not significantly differ among specimens placed in test mediums for the study duration (p>0.05). SEM images of specimens showed no signs of localized or overall corrosion. XPS analysis indicated showed clear titanium metal state peaks on all specimens in addition to sulfide and sulfate on BHI-S and BHI-P specimens. Valency fraction of titanium decomposed from Ti2p spectrum of BHI-S and BHI-P specimens indicated no progression of oxidation. No significant levels of titanium release were found regardless of the mediums' sulfide content. Results suggested that sulfides produced by P. gingivalis attached on the surface of titanium specimens but did not cause titanium corrosion over the immersion period of 14 days.SignificanceIt is imperative for dental practitioners to be aware of any elements which may influence the clinical success of titanium implants.

Graphical abstract

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Cuspal flexure of composite-restored typodont teeth and correlation with polymerization shrinkage values

Publication date: Available online 20 October 2017
Source:Dental Materials
Author(s): Taylor Enochs, Anne E. Hill, Cassandra E. Worley, Crisnicaw Veríssimo, Daranee Tantbirojn, Antheunis Versluis
ObjectiveThe relationship between post-gel shrinkage, total shrinkage, and cuspal flexure was examined. Cuspal flexure was measured on restored typodont teeth, which offered a standardized tooth shape for comparison of shrinkage stress effects among restorative composites.MethodsSix restorative composites were compared (Filtek LS, Venus Flowable, Tetric EvoCeram, Filtek Flowable, Esthet-X, and Filtek Supreme). Total shrinkage was determined from changes in projected surface area before and after polymerization (n=10). Post-gel shrinkage was determined with a biaxial strain gauge that measured strain development during polymerization (n=10). Cuspal flexure was determined using typodont maxillary second premolars with standard MOD slot preparation (n=10). Flexure was determined by comparing the three-dimensionally scanned cuspal surfaces before and after restoration. Restoration bonding to the typodont cavity was achieved by sandblasting and adhesive application. Bond integrity was verified by measuring dye penetration. Results were analyzed using ANOVA and Student–Newman–Keuls post hoc test (significance level 0.05). Pearson was used for correlations.ResultsTotal and post-gel shrinkage were significant different for all composites (t-test; P<0.001). Depending on the composite, only 9–41% of the total shrinkage was recorded as post-gel shrinkage. Bond integrity of restored typodont teeth was 96–99%. Cuspal flexure correlated strongly with post-gel shrinkage, but there was no correlation with total shrinkage.SignificanceCuspal flexure of restored typodont teeth showed the effect of shrinkage stress caused by polymerizing composite restorations, ensuring standardization while maintaining the effects of tooth/cavity geometry. Post-gel shrinkage gave a good indication to screen composites for the stress they may generate; total shrinkage had no direct correlation with stress.



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Collagenous matrix supported by a 3D-printed scaffold for osteogenic differentiation of dental pulp cells

Publication date: Available online 18 October 2017
Source:Dental Materials
Author(s): Farahnaz Fahimipour, Erfan Dashtimoghadam, Morteza Rasoulianboroujeni, Mostafa Yazdimamaghani, Kimia Khoshroo, Mohammadreza Tahriri, Amir Yadegari, Jose A. Gonzalez, Daryoosh Vashaee, Douglas C. Lobner, Tahereh S. Jafarzadeh Kashi, Lobat Tayebi
ObjectiveA systematic characterization of hybrid scaffolds, fabricated based on combinatorial additive manufacturing technique and freeze-drying method, is presented as a new platform for osteoblastic differentiation of dental pulp cells (DPCs).MethodsThe scaffolds were consisted of a collagenous matrix embedded in a 3D-printed beta-tricalcium phosphate (β-TCP) as the mineral phase. The developed construct design was intended to achieve mechanical robustness owing to 3D-printed β-TCP scaffold, and biologically active 3D cell culture matrix pertaining to the Collagen extracellular matrix. The β-TCP precursor formulations were investigated for their flow-ability at various temperatures, which optimized for fabrication of 3D printed scaffolds with interconnected porosity. The hybrid constructs were characterized by 3D laser scanning microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and compressive strength testing.ResultsThe in vitro characterization of scaffolds revealed that the hybrid β-TCP/Collagen constructs offer superior DPCs proliferation and alkaline phosphatase (ALP) activity compared to the 3D-printed β-TCP scaffold over three weeks. Moreover, it was found that the incorporation of TCP into the Collagen matrix improves the ALP activity.SignificanceThe presented results converge to suggest the developed 3D-printed β-TCP/Collagen hybrid constructs as a new platform for osteoblastic differentiation of DPCs for craniomaxillofacial bone regeneration.

Graphical abstract

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Zirconia surface modification by a novel zirconia bonding system and its adhesion mechanism

Publication date: Available online 16 October 2017
Source:Dental Materials
Author(s): Takahiro Murakami, Shinji Takemoto, Norihiro Nishiyama, Masahiro Aida
ObjectiveBonding to zirconia has been of great interest over the last 10–15 years. The aim of this study was to develop a zirconia bonding system and clarify its adhesion mechanism.MethodsA zirconia primer was prepared using tetra-n-propoxy zirconium (TPZr) and water. A silane primer was also prepared using γ-methacryloyloxypropyltrimethoxysilane (γ-MPS) and hydrochloric acid. After the zirconia primer was applied to the oxidized zirconia surface, the silane primer was applied to the ZrO2-functionalized layer and the resin cement was applied to the silane-modified layer. Ceramic Primer II was used as a typical MDP-based ceramic primer. Shear bond strengths were measured using a universal testing machine. To clarify the enhancing mechanism of the zirconia bonding system, X-ray photoelectron spectroscopy (XPS) analyses were performed.ResultsThe zirconia bond strength was affected by the surface wettability of zirconia, and the compositions of TPZr and water utilized in the zirconia primer. When the zirconia primer, consisting of 10μL TPZr and 13μL water, was applied to the zirconia surface that had been oxidized by H2O2 above 10%, the maximum bond strength of 8.2MPa was obtained. The mechanism of the zirconia bonding system was established as follows: the hydrolyzed zirconium species formed a more reactive ZrO2-functionalized layer on the oxidized zirconia surface, and the hydrolyzed γ-MPS species adsorbed on that layer introduces a chemical bonding to the resin.SignificanceThe novel zirconia bonding system enhanced the bonding performance of the resin, and showed a greater bond strength than an MDP-based ceramic primer.



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Cytotoxicity and DNA double-strand breaks in human gingival fibroblasts exposed to eluates of dental composites

Publication date: Available online 15 October 2017
Source:Dental Materials
Author(s): Yang Yang, Franz-Xaver Reichl, Jianwei Shi, Xiuli He, Reinhard Hickel, Christof Högg
ObjectivePreviously, single composite components were used to study cytotoxicity and induction of DNA double-strand breaks (DNA-DSBs) of dental composite resins. In the present study, cytotoxicity and induction of DNA-DSBs in human gingival fibroblasts (HGFs) were investigated with dental composite eluates consisting of multiple components. The eluates were qualified and quantified.MethodsThe composites Esthet.X^® HD, Venus^®, X-tra fil^®, CLEARFIL™ AP-X, Admira^® Fusion and QuiXfil^® were polymerized and immersed into Dulbecco's modified Eagle's medium (DMEM) for 72h. Subsequently, HGFs were incubated with the corresponding composite eluates. The cell viability of HGFs was obtained from an XTT assay. DNA-DSBs were determined using a γ-H2AX assay. The qualification and quantification of eluates were performed by gas chromatography/mass spectrometry (GC/MS).ResultsHGFs exposed to the eluates of all investigated composites showed no significant loss of cell viability, compared to negative control. Significant DNA-DSBs induction could be found in HGFs exposed to the eluates of Esthet.X^® HD (0.43±0.05 foci/cell) and Venus^® (0.39±0.04 foci/cell), compared to control (0.22±0.03 foci/cell). A total of 12 substances were detected from the investigated composite eluates. Five of them were methacrylates: tetraethyleneglycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA), hydroxypropyl methacrylate (HPMA), ethyleneglycol dimethacrylate (EGDMA) and trimethylolpropane trimethacrylate (TMPTMA). The highest concentration of HEMA (110.5μM), HPMA (86.08μM) and TMPTMA (4.50μM) was detected in the eluates of QuiXfil^®. The highest concentration of TEGDMA was 1080μM in Venus^® eluates and the highest concentration of EGDMA was 3.18μM in Esthet.X^® HD eluates.SignificanceSignificant DNA-DSBs induction can be found in HGFs exposed to the eluates of Esthet.X^® HD and Venus^®. The interactive effects among released (co)monomers and additives may influence the cytotoxicity and induction of DNA-DSBs, compared to exposure with single composite component.



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Bioactivity and fluoride release of strontium and fluoride modified Biodentine

Publication date: Available online 15 October 2017
Source:Dental Materials
Author(s): Hazel O. Simila, Natalia Karpukhina, Robert G. Hill
Biodentine™ is a novel tricalcium silicate based material used both as a coronal dentine replacement and in pulp therapy. Its multiple use in sealing perforations, pulp capping and as a temporary restoration arises from its ability to promote dentine formation and to confer an excellent marginal seal. However, there is still room for improvement of this cement as it lacks the anticariogenic effect typically conferred by fluoride ion release as seen in glass ionomer cement based dental materials. Therefore, this study was conducted to investigate the impact of bioactive glass addition to Biodentine™.Objectivewas to compare the apatite formation capacity, specificity of the apatite type formed and fluoride ion release by Biodentine™ cements that have been modified by three different compositions of bioactive glasses.MethodsHigh fluoride, high strontium and high fluoride plus strontium containing bioactive glasses were synthesized, incorporated into Biodentine™ powder and four types of cements prepared. These cements were immersed in phosphate buffered saline solution and incubated for a period of 3 and 24h, 3, 7 and 14 days. Fourier transform infra-red spectroscopy, X-ray diffraction, magic angle spinning nuclear magnetic resonance and fluoride ion release studies were performed.ResultsBioactive glass addition to Biodentine™ led to pronounced formation of apatite. Where the bioactive glass contained fluoride, fluorapatite and fluoride ion release were demonstrated.SignificanceEliciting fluorapatite formation and fluoride ion release from Biodentine™ is an important development as fluoride is known to have antibacterial and anticariogenic effects.



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Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001).

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Treatment of lower lip pits in Van der Woude syndrome: a systematic review

The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates.

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Cannula-based drug delivery to the guinea pig round window causes a lasting hearing loss that may be temporarily mitigated by BDNF

Publication date: Available online 28 October 2017
Source:Hearing Research
Author(s): Phillip J.P. Sale, Aaron Uschakov, Tasfia Saief, David P. Rowe, Carla J. Abbott, Chi D. Luu, Amy J. Hampson, Stephen J. O'Leary, David J. Sly
Sustained local delivery of drugs to the inner ear may be required for future regenerative and protective strategies. The round window is surgically accessible and a promising delivery route. To be viable, a delivery system should not cause hearing loss. This study determined the effect on hearing of placing a drug-delivery microcatheter on to the round window, and delivering either artificial perilymph (AP) or brain-derived neurotrophic factor (BDNF) via this catheter with a mini-osmotic pump. Auditory brainstem responses (ABRs) were monitored for 4 months after surgery, while the AP or BDNF was administered for the first month. The presence of the microcatheter – whether dry or when delivering AP or BDNF for 4 weeks – was associated with an increase in ABR thresholds of up to 15 dB, 16 weeks after implantation. This threshold shift was, in part, delayed by the delivery of BDNF. We conclude that the chronic presence of a microcatheter in the round window niche causes hearing loss, and that this is exacerbated by delivery of AP, and ameliorated temporarily by delivery of BDNF.



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Corrigendum to “Graph analysis of EEG resting state functional networks in dyslexic readers” [Clin. Neurophysiol. 127(9) (2016) 3165–3175]

We regret to inform you about a calculation error we recently detected in our published article: Fraga González G, Van der Molen MJW, Žarić G, Bonte M, Tijms J, Blomert L, Stam CJ, Van der Molen MW. Graph analysis of EEG resting state functional networks in dyslexic readers. Clin Neurophysiol. 2016 Sep; 127(9):3165–3175. doi:http://ift.tt/2yYuBal. Epub 2016 Jul 4. PubMed PMID: 27476025. We re-analyzed the data after discovering this error to determine the impact it had on the results.

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Revisiting interhemispheric imbalance in chronic stroke: a tDCS study

The immense burden of stroke-related disability has led to the development of noninvasive brain stimulation (NIBS) as a possible approach to augment neurorehabilitation of the paretic upper limb (Ackerley et al., 2010). Transcranial direct current stimulation (tDCS) is a polarity-dependent neuromodulatory technique that has demonstrated some benefit to motor function at the chronic stage (>6 months) post stroke, but effect sizes have varied (Jacobson et al., 2012; Kang et al., 2015).

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Frontal infraslow activity marks the motor spasms of anti-LGI1 encephalitis

The clinical and electrographic features of seizures in anti-LGI1 encephalitis are distinct from those seen in other autoimmune encephalitides or non-encephalitic epilepsies. The recognition of unusual lateralized motor spasms, which have come to be known as faciobrachial dystonic seizures (FBDS) (Irani et al., 2011a), has greatly facilitated early clinical diagnosis of the condition. Electrographically, a pattern of unusually frequent subclinical temporal lobe seizures in the absence of interictal spikes has been identified as an independent diagnostic marker (Andrade et al., 2011a,b; Steriade et al., 2016).

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Reply to “The insular cortex and QTc interval in HIV+ and HIV- individuals: Is there an effect of sympathetic nervous system activity?”

The correspondence by Nagai et al. (2017a) raised several points regarding our interpretation of the lateralized effects for QTc interval length on resting functional connectivity (rsFC) of the ventromedial prefrontal cortex (VMPFC) (McIntosh et al., 2017). The authors first contend that if some form of sympathetic inhibition accounts for prolongation of the QT interval in a dog model then a similar mechanism, i.e., parasympathetic arousal, would be expected to correspond with longer QTc interval lengths in our sample of HIV+ and HIV-negative men.

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Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy.

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A rare case of bilateral vagus nerve schwanomatosis

Schwanomatosis is the third most common form of neurofibromatosis. Schwanomatosis affecting the vagus nerve is particularly rare. In this report, we describe an extremely rare case bilateral vagus nerve schwanomatosis in a 45-year-old male patient. The patient initially presented with bilateral neck tumors and hoarseness arising after thoracic surgery. We performed left neck surgery in order to diagnose and resect the remaining tumors followed by laryngeal framework surgery to improve vocal cord closure and symptoms of hoarseness.

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Morphology and Outcomes of Total Endovascular Treatment of Type B Aortic Dissection with Aberrant Right Subclavian Artery

Publication date: Available online 28 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Min Zhou, Xueqin Bai, Yong Ding, Yonggang Wang, Changpo Lin, Dong Yan, Zhenyu Shi, Weiguo Fu
ObjectivesTo characterize the morphology of type B aortic dissection with aberrant right subclavian artery (ARSA) and present early and midterm outcomes of total endovascular treatment for affected patients.MethodsFrom January 2010 to December 2015, patients with ARSA and type B aortic dissection treated with total endovascular techniques were enrolled. The angle of the aortic arch was measured on pre-operative CTA. Sixty age and gender matched normal aortic arch patients with type B aortic dissection served as controls. Primary outcomes were technical success, 30 day mortality, and late survival. Secondary outcomes included in hospital morbidity, re-intervention rate, and patency of the subclavian artery.ResultsA total of 13 patients (8 men, 5 women; mean age 58 years) were included. The mean angle of the aortic arch in patients with ARSA was significantly smaller than in normal aortic arch patients (117.2° ± 10.8° vs. 124.2° ± 9.4°, respectively; p = .024). Simple thoracic endovascular aortic repair (TEVAR) and TEVAR plus a parallel graft technique were performed in six and seven patients, respectively. Primary technique success was achieved in 11 of the 13 (84.6%) patients. A bird beak configuration occurred significantly more frequently in patients with ARSA than in normal aortic arch patients (91.7% vs. 48.3%, respectively; p = .035). The median follow-up time was 36 months. One patient received a secondary procedure because of a new onset entry tear at the distal end of the stent graft. No posterior circulation stroke, permanent spinal cord ischaemia, or ischaemia of the upper arm was observed.ConclusionsType B aortic dissection with ARSA was associated with a steep aortic arch. Total endovascular treatment for these patients was feasible and safe. Stent grafts with better flexibility and appropriate extension of the proximal landing zone with a parallel graft technique are suggested based on the observed outcomes.



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Determinants of Acute Kidney Injury and Renal Function Decline After Endovascular Abdominal Aortic Aneurysm Repair

Publication date: Available online 27 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Randolph G. Statius van Eps, Banne Nemeth, Ronne T.A. Mairuhu, Jan J. Wever, Hugo T.C. Veger, Hans van Overhagen, Lukas C. van Dijk, Bob Knippenberg
Objective/BackgroundEndovascular aneurysm repair (EVAR) may be associated with renal injury and more insight is needed into potential risk factors. The aim was to identify clinical, anatomical, and peri-procedural parameters as potential risk factors for the occurrence of acute kidney injury (AKI) and to evaluate chronic kidney disease (CKD) after EVAR.MethodsA cohort of 212 consecutive patients who underwent elective EVAR for abdominal aortic aneurysm from January 2009 to October 2016 was included. A subgroup of 149 patients with 2 years follow-up was compared with a set of 135 non-operated aneurysm patients with smaller aneurysms (similar cardiovascular risk profile) to assess CKD. Primary outcomes were AKI (Acute Kidney Injury Network criteria) and CKD measured by estimated glomerular filtration rate (Kidney Disease Improving Global Outcomes guidelines). For AKI, candidate risk factors were identified by univariate and multivariate logistic regression analysis; for chronic renal function decline, risk factors were identified using Cox regression analysis.ResultsAKI occurred in 30 patients (15%). On multivariate analysis, the use of angiotensin II blocker (odds ratio [OR] 4.08, 95% confidence interval [CI] 1.38–12.07) and peri-operative complications (OR 3.12, 95% CI 1.20–8.10) were independent risk factors for AKI, whereas statin use was a protective factor (OR 0.19, 95% CI 0.07–0.52). EVAR resulted in a significant increase (23.5%) in the occurrence of CKD compared with the control group (6.7%; p <.001). On univariate and multivariate Cox regression the risk factors: aortic neck diameter (per mm increase) (hazard ratio [HR] 1.13, 95% CI 1.02–1.25), renal artery stenosis >50% (HR 2.24, 95% CI 1.05–4.79), and the occurrence of AKI (HR 2.19, 95% CI 0.99–4.85) were significant predictors of CKD.ConclusionThis study identified use of angiotensin II blockers and peri-operative complications as risk factors for AKI. In addition, the problem of renal function decline after EVAR is highlighted, which indicates that prolonged protective measures (e.g., in those patients at high risk) over time are needed to improve patient outcomes.



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A custom-made mouthpiece incorporating tongue depressors and elevators to reduce radiation-induced tongue mucositis during carbon-ion radiotherapy for head and neck cancer

Publication date: Available online 28 October 2017
Source:Practical Radiation Oncology
Author(s): Hiroaki Ikawa, Masashi Koto, Daniel K Ebner, Ryo Takagi, Kazuhiko Hayashi, Hiroshi Tsuji, Tadashi Kamada
Here, we introduce a custom-made mouthpiece for carbon-ion radiotherapy for head and neck malignancy. The mouthpiece incorporates either a tongue depressor or elevator depending on tumor location. The risk of tongue mucositis may be reduced without compromising therapeutic efficacy through mouthpiece shaping.



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Cannula-based drug delivery to the guinea pig round window causes a lasting hearing loss that may be temporarily mitigated by BDNF

Publication date: Available online 28 October 2017
Source:Hearing Research
Author(s): Phillip J.P. Sale, Aaron Uschakov, Tasfia Saief, David P. Rowe, Carla J. Abbott, Chi D. Luu, Amy J. Hampson, Stephen J. O'Leary, David J. Sly
Sustained local delivery of drugs to the inner ear may be required for future regenerative and protective strategies. The round window is surgically accessible and a promising delivery route. To be viable, a delivery system should not cause hearing loss. This study determined the effect on hearing of placing a drug-delivery microcatheter on to the round window, and delivering either artificial perilymph (AP) or brain-derived neurotrophic factor (BDNF) via this catheter with a mini-osmotic pump. Auditory brainstem responses (ABRs) were monitored for 4 months after surgery, while the AP or BDNF was administered for the first month. The presence of the microcatheter – whether dry or when delivering AP or BDNF for 4 weeks – was associated with an increase in ABR thresholds of up to 15 dB, 16 weeks after implantation. This threshold shift was, in part, delayed by the delivery of BDNF. We conclude that the chronic presence of a microcatheter in the round window niche causes hearing loss, and that this is exacerbated by delivery of AP, and ameliorated temporarily by delivery of BDNF.



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iSepsis – Death by Fluid, Part 3

The CLASSIC trial is a exploratory RCT comparing a fluid "restrictive" with a more liberal approach to fluid management in patients with septic shock

EMCrit by Paul Marik.

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The influence of continental air masses on the aerosols and nutrients deposition over the western North Pacific

Publication date: January 2018
Source:Atmospheric Environment, Volume 172
Author(s): Jiangping Fu, Bo Wang, Ying Chen, Qingwei Ma
The air masses transported from East Asia have a strong impact on the aerosol properties and deposition in the marine boundary layer of the western North Pacific (WNP) during winter and spring. We joined a cruise between 17 Mar. and 22 Apr. 2014 and investigated the changes of aerosol composition and size distribution over the remote WNP and marginal seas. Although the secondary aerosol species (SO4²⁻, NO3⁻ and NH4⁺) in remote WNP were influenced significantly by the continental transport, NH4⁺ concentrations were lower than 2.7 μg m⁻³ in most sampling days and not correlated with non-sea-salt (nss)-SO4^2- suggesting that the ocean could be a primary source of NH4⁺. Moderate Cl⁻ depletion (23%) was observed in remote WNP, and the inverse relationship between Cl⁻ depletion percentages and nss-K⁺ in aerosols suggested that the transport of biomass burning smoke from East Asia might be a vital extra source of Cl⁻. Both Asian dust and haze events were encountered during the cruise. Asian dust carried large amounts of crustal elements such as Al and Ti to the WNP, and the dusty Fe deposition may double its background concentration in seawater. Differently, a dramatic increase of dry deposition flux of dissolved particulate inorganic nitrogen was observed during the haze event. Our study reveals that the transport of different continental air masses may have distinct biogeochemical impacts on the WNP by increasing the fluxes of different nutrient elements and potentially changing the nutrient stoichiometry.



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Experience of using MOSFET detectors for dose verification measurements in an end-to-end 192Ir brachytherapy quality assurance system

Publication date: Available online 27 October 2017
Source:Brachytherapy
Author(s): Maria Persson, Josef Nilsson, Åsa Carlsson Tedgren
PurposeEstablishment of an end-to-end system for the brachytherapy (BT) dosimetric chain could be valuable in clinical quality assurance. Here, the development of such a system using MOSFET (metal oxide semiconductor field effect transistor) detectors and experience gained during 2 years of use are reported with focus on the performance of the MOSFET detectors.Methods and MaterialsA bolus phantom was constructed with two implants, mimicking prostate and head & neck treatments, using steel needles and plastic catheters to guide the ¹⁹²Ir source and house the MOSFET detectors. The phantom was taken through the BT treatment chain from image acquisition to dose evaluation. During the 2-year evaluation-period, delivered doses were verified a total of 56 times using MOSFET detectors which had been calibrated in an external ⁶⁰Co beam. An initial experimental investigation on beam quality differences between ¹⁹²Ir and ⁶⁰Co is reported.ResultsThe standard deviation in repeated MOSFET measurements was below 3% in the six measurement points with dose levels above 2 Gy. MOSFET measurements overestimated treatment planning system doses by 2–7%. Distance-dependent experimental beam quality correction factors derived in a phantom of similar size as that used for end-to-end tests applied on a time-resolved measurement improved the agreement.ConclusionsMOSFET detectors provide values stable over time and function well for use as detectors for end-to-end quality assurance purposes in ¹⁹²Ir BT. Beam quality correction factors should address not only distance from source but also phantom dimensions.



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Early outcomes and impact of a hybrid IC/IS applicator for a new MRI-based cervical brachytherapy program

Publication date: Available online 28 October 2017
Source:Brachytherapy
Author(s): Matthew M. Harkenrider, Murat Surucu, Grant Harmon, Michael L. Mysz, Steven M. Shea, Joseph Yacoub, Ari Goldberg, Margaret Liotta, Abigail Winder, Ronald Potkul, John C. Roeske, William Small
PurposeThe purpose of this study was to report early outcomes and assess the learning curve in a new MRI-based cervical brachytherapy program.MethodsWe accrued 33 patients prospectively, and only patients with ≥3 months' followup (n = 27) were assessed for disease control and toxicity. Eras were defined as first half and second half for the intracavitary (IC)-only era (n = 13 each), and the intracavitary/interstitial (IC/IS) era was separated by difference in applicator availability (n = 7). Dose to 90% of the high-risk clinical target volume (D90 HR-CTV) and minimum dose to the maximally irradiated 2 cubic centimeters (D2cc) to organs at risk were used to assess dosimetry. Statistics were performed with t tests and Kaplan–Meier method.ResultsMedian followup was 14.7 months. Median treatment duration was 50.5 vs. 57 days for patients treated with external beam radiation therapy at our institution vs. an outside institution (p = 0.03). One-year local control, noncervical pelvic control, distant metastasis–free rate, and overall survival were 84.0%, 96.0%, 78.5%, and 91.3%, respectively. When comparing the first half and second half eras of IC only, there were no differences in median D90 HR-CTV or D2cc of the bladder, rectum, or sigmoid. Comparing the entire IC era to the IC/IS era, median D90 HR-CTV trended higher from 88.0 Gy to 92.9 Gy (p = 0.11). D2cc rectum decreased from 69.3 Gy to 62.6 Gy (p = 0.01), and D2cc bladder trended lower from 87.5 Gy to 83.6 Gy (p = 0.09).ConclusionsThere was no significant difference between the first half and second half eras with IC-only MRI-based brachytherapy. Incorporation of an IC/IS applicator generated the greatest dosimetric improvement. Early results of the MRI-based brachytherapy program are favorable.



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Primary High-Grade Non-Muscle-Invasive Bladder Cancer: High NFκB Expression in Tumor Specimens Distinguishes Patients Who are at Risk for Disease Progression

Abstract

To investigate the potential prognostic role of NFκB expression in primary high-grade non-muscle-invasive bladder cancer. Patients with primary high-grade non-muscle-invasive bladder cancer who received induction and maintenance BCG therapy were retrospectively included. Recurrence and progression were histologically proven. Intensity and extent of immunochemistry were assessed. The final evaluation of the NFκB staining was done by combining intensity and extent as ΄΄product΄΄ and expressing it as ΄΄low NFκΒ expression΄΄ or ΄΄high NFκB expression΄΄. Epidemiological, pathological, clinical parameters and NFκB expression were statistically analyzed for recurrence (REC), progression (PR), recurrence-free survival (RFS) and progression-free survival (PFS). NFκB is significantly associated with disease progression (p < 0,001 in univariate analysis and p = 0,001, Odds Ratio = 14,484, 95% Confidence Interval = 3187-65,821 in multivariate analysis), but not with recurrence. The median value of NFκB expression as ΄΄product΄΄ is significantly higher for the patients with progression in comparison to patients with recurrence only (p = 0,003) and patients without recurrence or progression (p = 0,001). Patients' age is significantly associated (p = 0,001 in univariate analysis and p = 0,003, Odds Ratio = 1273, 95% Confidence Interval = 1086–1492 in multivariate analysis) with disease recurrence. High NFκB expression in primary high-grade non-muscle-invasive bladder cancer, treated with postoperative intravesical BCG immunotherapy, could represent an unfavorable prognostic factor.

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MicroRNA Expression in Laser Micro-dissected Breast Cancer Tissue Samples – a Pilot Study

Abstract

Breast cancer continues to represent a significant public health burden despite outstanding research advances regarding the molecular mechanisms of cancer biology, biomarkers for diagnostics and prognostic and therapeutic management of this disease. The studies of micro RNAs in breast cancer have underlined their potential as biomarkers and therapeutic targets; however most of these studies are still done on largely heterogeneous whole breast tissue samples. In this pilot study we have investigated the expression of four micro RNAs (miR-21, 145, 155, 92) known to be involved in breast cancer, in homogenous cell populations collected by laser capture microdissection from breast tissue section slides. Micro RNA expression was assessed by real time PCR, and associations with clinical and pathological characteristics were also explored. Our results have confirmed previous associations of miR-21 expression with poor prognosis characteristics of breast cancers such as high stage, large and highly proliferative tumors. No statistically significant associations were found with the other micro RNAs investigated, possibly due to the small sample size of our study. Our results also suggest that miR-484 could be a suitable endogenous control for data normalization in breast tissues, these results needing further confirmation by future studies. In summary, our pilot study showed the feasibility of detecting micro RNAs expression in homogenous laser captured microdissected invasive breast cancer samples, and confirmed some of the previously reported associations with poor prognostic characteristics of breast tumors.

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Clinical significance of tryptophan catabolism in Hodgkin lymphoma

Summary

Indoleamine 2,3-dioxygenase 1 (IDO) is an enzyme catabolizing tryptophan (Trp) into the kynurenine (Kyn) pathway. The purpose of the present study was to determine the clinical significance of Trp catabolism in newly-diagnosed Hodgkin Lymphoma (HL) patients. We quantified serum Trp and Kyn in 52 HL patients, and analyzed their associations with different clinical parameters including serum soluble CD30 (sCD30) concentration. IDO expression was evaluated in the patients′ affected lymph nodes. The enrolled patients comprised 22 males and 30 females (age range 15-81, median 45 years), with a 5-year overall survival (OS) of 88.6%. The OS was significantly shorter for patients with a high Kyn/Trp ratio (OS at 5 years, 60.0%-vs-92.2%), for those with stage IV disease, and for those with lymphocytopenia (< 600/mm³ and/or < 8% of the white blood cell [WBC] count). The latter two parameters are components of the international prognostic score for advanced HL. In contrast, there were no significant differences in OS according to age, serum albumin, hemoglobin, sex, WBC count, or serum sCD30 (≥ or < 285.6 ng/mL). Multivariate analysis using the three variables stage, lymphocytopenia and serum Kyn/Trp ratio demonstrated that only the latter significantly affected OS. IDO was produced by macrophages/dendritic cells, but not by HL tumor cells, and IDO levels determined by immunohistochemistry had a significant positive correlation with the serum Kyn/Trp ratio. In conclusion, quantification of serum Kyn and Trp is useful for predicting prognosis of individual HL patients.

This article is protected by copyright. All rights reserved.

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Plumbagin mediating GLUT1 suppresses the growth of human tongue squamous cell cancer

Abstract

Objective

The purpose of this study is to investigate the clinical and histopathological characteristics of GLUT1 in human tongue squamous cell carcinoma (TSCC) and the role of Plumbagin (PLB) mediating GLUT1 in the growth of TSCC.

Subjects And Methods

45 cases of TSCC samples were collected and the expression and location of GLUT1 was analyzed. The role and mechanism of PLB meditating GLUT1 in the inhibitory growth of human TSCC cell line CAL27 was investigated in vitro and vivo.

Results

The expression of GLUT1 was observed in all samples of human TSCC by immunohistochemical staining. GLUT1 expression was significantly correlated with lymph node metastasis and clinical stage in TSCC. PLB treatment decreased cell viability and colony formation, and increased cell apoptosis in association with the downregulation of GLUT1 via inhibiting PI3K/Akt pathway in vitro and PLB suppressed tumor growth in correlation with downregulation of GLUT1, compared with control group in vivo.

Conclusions

The findings demonstrated a novel anti-cancer mechanism of PLB, inhibitory TSCC growth via suppressing PI3K/Akt/GLUT1 pathway, which will supply a theoretical basis for PLB to treat TSCC.

This article is protected by copyright. All rights reserved.

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Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection

Publication date: Available online 27 October 2017
Source:Journal of Voice
Author(s): Mami Kaneko, Takuya Tsuji, Yo Kishimoto, Yoichiro Sugiyama, Tatsuo Nakamura, Shigeru Hirano
ObjectivesVocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration. The present study aimed to examine the regenerative effects of bFGF on restoration of TA muscle atrophy caused by recurrent laryngeal nerve transection.Study designProspective animal experiments with controls.MethodsTA muscle atrophy was induced by unilateral transection of the recurrent laryngeal nerve. One month after transection, different doses (200 ng, 100 ng, 10 ng) of bFGF in 50 µL were repeatedly injected into the TA muscle four times with an interval of 1 week between injections. Saline only was injected in the sham group. Larynges were harvested for histologic and immunohistochemical examination 4 weeks after the final injection.ResultsThe cross-sectional TA muscle area was significantly larger in the bFGF-treated groups compared with the sham-treated groups. Immunohistochemistry indicated that bFGF significantly increases the number of neuromuscular junctions and satellite cells in the TA muscle.ConclusionsThese results suggest that local application of bFGF to the TA muscle may improve TA muscle atrophy caused by recurrent laryngeal nerve paralysis. Furthermore, bFGF may have regenerative effects on both nerves and muscles.



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Cross-cultural Adaptation and Validation of the Italian Version of the Vocal Tract Discomfort Scale (I-VTD)

Publication date: Available online 27 October 2017
Source:Journal of Voice
Author(s): Carlo Robotti, Francesco Mozzanica, Ilaria Pozzali, Laura D'Amore, Patrizia Maruzzi, Daniela Ginocchio, Stafania Barozzi, Rosaria Lorusso, Francesco Ottaviani, Antonio Schindler
ObjectiveTo evaluate the reliability and validity of the Italian version of the VTD scale (I-VTD scale).Study DesignCross-sectional, nonrandomized, prospective study with controls.MethodsFor the item generation, a cross-cultural adaptation and translation process was performed following the back translation process (phase 1). For reproducibility analysis (phase 2), 102 patients with dysphonia were recruited (internal consistency analysis); 57 of them completed the I-VTD scale twice (test-retest reliability analysis). Seventy-three vocally healthy participants completed the I-VTD scale for normative data generation (phase 3). For validity analysis (phase 4), the scores obtained by patients with dysphonia and by vocally healthy participants were compared (construct validity analysis); in addition, 45 patients with dysphonia completed both the I-VTD scale and the Italian version of the Voice Handicap Index for criterion validity analysis. Finally, for responsiveness analysis (phase 5), a cohort of 30 patients with muscle tension dysphonia was recruited, and scores of the I-VTD scale before and after voice therapy were compared.ResultsBoth the internal consistency and the test-retest reliability of the I-VTD scale were satisfactory. The scores obtained by patients with dysphonia and vocally healthy participants were significantly different. Moderate correlations between the Italian version of the Voice Handicap Index and the I-VTD scores were found. Finally, the scores of the I-VTD scale obtained in pretreatment conditions appeared to be significantly higher than those obtained after successful voice therapy.ConclusionThe I-VTD scale appears a reliable and valid instrument for the assessment of vocal tract discomfort in Italian-speaking patients.



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The Presence of ALK Alterations and Clinical Relevance of Crizotinib Treatment in Pediatric Solid Tumors

Abstract

Soft tissue sarcomas (STS) and neuroblastomas (NBL), are childhood malignancies still associated with poor prognoses despite the overall improvement in childhood tumor survival of the past decades. Anaplastic lymphoma kinase (ALK) inhibition is promising new strategy to improve the outcome of these pediatric tumors. Eighteen histologic samples of pediatric STS and 19 NBL patients were analyzed for ALK abnormalities using fluorescent in situ hybridization (FISH) with break-apart probes and immunohistochemistry (IHC). ALK alterations were presented in 20 of the 37 sections. The presence of ALK alteration in NBL samples were detected using IHC in 84,2% of all cases compared to 21,1% FISH positivity. In STS cases the results were less different (IHC 16,7% vs FISH 22,2%). The difference can be explained by the different type of molecular alterations. FISH method detected translocation and amplification, but not the point mutation of ALK gene. IHC confirmed the diagnosis by detecting the expression of ALK protein.After ALK positivity was proven, the effectiveness and safety of the crizotinib therapy was examined in 4 patients (1 alveolar rhabdomyosarcoma (RMA), 1 embryonal rhabdomyosarcoma (RME), 1 inflammatory myofibroblastic tumor (IMT), 1 NBL). We observed continuous remission of the IMT patient, all other cases the inhibitor treatment was not curative.Our findings underline the importance of screening the ALK status parallel with both IHC and FISH. Crizotinib treatment had a long-term effect in ALK positive IMT patients, however itwas only temporary efficient in relapsed, progressive STS and NBL.

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Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection

Publication date: Available online 27 October 2017
Source:Journal of Voice
Author(s): Mami Kaneko, Takuya Tsuji, Yo Kishimoto, Yoichiro Sugiyama, Tatsuo Nakamura, Shigeru Hirano
ObjectivesVocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration. The present study aimed to examine the regenerative effects of bFGF on restoration of TA muscle atrophy caused by recurrent laryngeal nerve transection.Study designProspective animal experiments with controls.MethodsTA muscle atrophy was induced by unilateral transection of the recurrent laryngeal nerve. One month after transection, different doses (200 ng, 100 ng, 10 ng) of bFGF in 50 µL were repeatedly injected into the TA muscle four times with an interval of 1 week between injections. Saline only was injected in the sham group. Larynges were harvested for histologic and immunohistochemical examination 4 weeks after the final injection.ResultsThe cross-sectional TA muscle area was significantly larger in the bFGF-treated groups compared with the sham-treated groups. Immunohistochemistry indicated that bFGF significantly increases the number of neuromuscular junctions and satellite cells in the TA muscle.ConclusionsThese results suggest that local application of bFGF to the TA muscle may improve TA muscle atrophy caused by recurrent laryngeal nerve paralysis. Furthermore, bFGF may have regenerative effects on both nerves and muscles.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2z03AmQ

Cross-cultural Adaptation and Validation of the Italian Version of the Vocal Tract Discomfort Scale (I-VTD)

Publication date: Available online 27 October 2017
Source:Journal of Voice
Author(s): Carlo Robotti, Francesco Mozzanica, Ilaria Pozzali, Laura D'Amore, Patrizia Maruzzi, Daniela Ginocchio, Stafania Barozzi, Rosaria Lorusso, Francesco Ottaviani, Antonio Schindler
ObjectiveTo evaluate the reliability and validity of the Italian version of the VTD scale (I-VTD scale).Study DesignCross-sectional, nonrandomized, prospective study with controls.MethodsFor the item generation, a cross-cultural adaptation and translation process was performed following the back translation process (phase 1). For reproducibility analysis (phase 2), 102 patients with dysphonia were recruited (internal consistency analysis); 57 of them completed the I-VTD scale twice (test-retest reliability analysis). Seventy-three vocally healthy participants completed the I-VTD scale for normative data generation (phase 3). For validity analysis (phase 4), the scores obtained by patients with dysphonia and by vocally healthy participants were compared (construct validity analysis); in addition, 45 patients with dysphonia completed both the I-VTD scale and the Italian version of the Voice Handicap Index for criterion validity analysis. Finally, for responsiveness analysis (phase 5), a cohort of 30 patients with muscle tension dysphonia was recruited, and scores of the I-VTD scale before and after voice therapy were compared.ResultsBoth the internal consistency and the test-retest reliability of the I-VTD scale were satisfactory. The scores obtained by patients with dysphonia and vocally healthy participants were significantly different. Moderate correlations between the Italian version of the Voice Handicap Index and the I-VTD scores were found. Finally, the scores of the I-VTD scale obtained in pretreatment conditions appeared to be significantly higher than those obtained after successful voice therapy.ConclusionThe I-VTD scale appears a reliable and valid instrument for the assessment of vocal tract discomfort in Italian-speaking patients.



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