Numerical study of dynamic glottis and tidal breathing on respiratory sounds in a human upper airway model

Abstract

Background

Human snores are caused by vibrating anatomical structures in the upper airway. The glottis is a highly variable structure and a critical organ regulating inhaled flows. However, the effects of the glottis motion on airflow and breathing sound are not well understood, while static glottises have been implemented in most previous in silico studies. The objective of this study is to develop a computational acoustic model of human airways with a dynamic glottis and quantify the effects of glottis motion and tidal breathing on airflow and sound generation.

Methods

Large eddy simulation and FW-H models were adopted to compute airflows and respiratory sounds in an image-based mouth-lung model. User-defined functions were developed that governed the glottis kinematics. Varying breathing scenarios (static vs. dynamic glottis; constant vs. sinusoidal inhalations) were simulated to understand the effects of glottis motion and inhalation pattern on sound generation. Pressure distributions were measured in airway casts with different glottal openings for model validation purpose.

Results

Significant flow fluctuations were predicted in the upper airways at peak inhalation rates or during glottal constriction. The inhalation speed through the glottis was the predominating factor in the sound generation while the transient effects were less important. For all frequencies considered (20–2500 Hz), the static glottis substantially underestimated the intensity of the generated sounds, which was most pronounced in the range of 100–500 Hz. Adopting an equivalent steady flow rather than a tidal breathing further underestimated the sound intensity. An increase of 25 dB in average was observed for the life condition (sine-dynamic) compared to the idealized condition (constant-rigid) for the broadband frequencies, with the largest increase of approximately 40 dB at the frequency around 250 Hz.

Conclusion

Results show that a severely narrowing glottis during inhalation, as well as flow fluctuations in the downstream trachea, can generate audible sound levels.

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A Potential Role for Green Tea as a Radiation Sensitizer for Prostate Cancer

Abstract

Prostate cancer (PCa) is the most common non-cutaneous cancer in the United States. There is currently a lack of safe and effective radiosensitizers that can enhance the effectiveness of radiation treatment (RT) for Pca. Clonogenic assay, PCNA staining, Quick Cell Proliferation assay, TUNEL staining and caspase-3 activity assay were used to assess proliferation and apoptosis in DU145 Pca cells. RT-PCR/IHC were used to investigate the mechanisms. We found that the percentage of colonies, PCNA staining intensity, and the optical density value of DU145 cells were decreased (RT/GT vs. RT). TUNEL + cells and the relative caspase-3 activity were increased (RT/GT vs. RT). Compared to RT, the anti-proliferative effect of RT/GT correlated with increased expression of the anti-proliferative molecule p16. Compared to RT, the pro-apoptotic effect of RT/GT correlated with decreased expression of the anti-apoptotic molecule Bcl-2. GT enhances RT sensitivity of DU145 by inhibiting proliferation and promoting apoptosis.

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The human platysma contains numerous muscle spindles

Abstract

The mimic muscles are usually described as containing no muscle spindles. In the present publication the human platysma was reinvestigated concerning its content of corpuscular sensors. Serial sections through the platysma of seven donors revealed numerous muscle spindles but no Pacini corpuscules. The muscle spindles were located in the cranial two-thirds of the platysma, and were evenly distributed with a tendency to have more spindles in the lateral part of the muscle. Immunohistochemical staining with S46 antibodies revealed a predominance of nuclear bag fibers. The results point to an extended function of the platysma as an afferent center of the lower face mimic muscles.

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Ontogeny of hallucal metatarsal rigidity and shape in the rhesus monkey (Macaca mulatta) and chimpanzee (Pan troglodytes)

Abstract

Life history variables including the timing of locomotor independence, along with changes in preferred locomotor behaviors and substrate use during development, influence how primates use their feet throughout ontogeny. Changes in foot function during development, in particular the nature of how the hallux is used in grasping, can lead to different structural changes in foot bones. To test this hypothesis, metatarsal midshaft rigidity [estimated from the polar second moment of area (J) scaled to bone length] and cross-sectional shape (calculated from the ratio of maximum and minimum second moments of area, I_max/I_min) were examined in a cross-sectional ontogenetic sample of rhesus macaques (Macaca mulatta; n = 73) and common chimpanzees (Pan troglodytes; n = 79). Results show the hallucal metatarsal (Mt1) is relatively more rigid (with higher scaled J-values) in younger chimpanzees and macaques, with significant decreases in relative rigidity in both taxa until the age of achieving locomotor independence. Within each age group, Mt1 rigidity is always significantly higher in chimpanzees than macaques. When compared with the lateral metatarsals (Mt2–5), the Mt1 is relatively more rigid in both taxa and across all ages; however, this difference is significantly greater in chimpanzees. Length and J scale with negative allometry in all metatarsals and in both species (except the Mt2 of chimpanzees, which scales with positive allometry). Only in macaques does Mt1 midshaft shape significantly change across ontogeny, with older individuals having more elliptical cross-sections. Different patterns of development in metatarsal diaphyseal ridgidity and shape likely reflect the different ways in which the foot, and in particular the hallux, functions across ontogeny in apes and monkeys.

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Comparative hindlimb myology of foot-propelled swimming birds

Abstract

Several groups of birds have convergently evolved the ability to swim using their feet despite facing trade-offs with walking. However, swimming relative to terrestrial performance varies across these groups. Highly specialized divers, such as loons and grebes, excel at swimming underwater but struggle to stand on land, whereas species that primarily swim on the water surface, such as Mallards, retain the ability to move terrestrially. The identification of skeletal features associated with a swimming style and conserved across independent groups suggests that the hindlimb of foot-propelled swimming birds has adapted to suit the physical challenges of producing propulsive forces underwater. But in addition to skeletal features, how do hindlimb muscles reflect swimming ability and mode? This paper presents the first comparative myology analysis associated with foot-based swimming. Our detailed dissections of 35 specimens representing eight species reveal trends in hindlimb muscle size and attachment location across four independent lineages of extant swimming birds. We expand upon our dissections by compiling data from historical texts and provide a key to any outdated muscle nomenclature used in these sources. Our results show that highly diving birds tuck the femur and proximal tibiotarsus next to the ribcage and under the skin covering the abdomen, streamlining the body. Several hindlimb muscles exhibit dramatic anatomical variation in diving birds, including the flexor cruris lateralis (FCL) and iliofibularis (IF), which reduce in size and shift distally along the tibiotarsus. The femorotibialis medius (FTM) extends along an expanded cnemial crest. The resulting increased moment arms of these muscles likely help stabilize the hip and knee while paddling. Additionally, distal ankle plantarflexors, including the gastrocnemius and digital flexors, are exceptionally large in diving birds in order to power foot propulsion. These patterns exist within distantly related lineages of diving birds and, to a lesser extent, in surface swimmers. Together, our findings verify conserved muscular adaptations to a foot-propelled swimming lifestyle. The association of muscle anatomy with skeletal features and biomechanical movement demands can inform functional interpretation of fossil birds and reveal selective pressures underlying avian diversification.

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Family Physicians’ Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening

Abstract

The purpose of this study was to assess family physicians' knowledge, attitudes, and practices toward colorectal cancer (CRC) screening. The population in this cross-sectional study consisted of 290 family physicians working in Samsun, Turkey, contacted between 15 June and 15 July 2015 and agreeing to participate. A questionnaire prepared by the authors on the basis of the relevant literature was applied at face-to-face interviews. The first part of the questionnaire inquired into sociodemographic information, while the second contained questions evaluating family physicians' knowledge, attitudes, and practices toward CRC screening. Physicians completed the questionnaire in approximately 10 min. 65.9 % of the family physicians in the study were men. Mean age of the participants was 43.40 ± 6.54 years, and mean number of years in service was 18.43 ± 6.42. The average number of patients seen by physicians on a daily basis was 51–99. CRC screening was performed by 83.1 % of physicians. The fecal occult blood test (FOBT) was recommended at the correct frequency by 30.7 % of physicians and colonoscopy by 11.7 %. A further 68.6 % of physicians followed no CRC guideline. Only 3.8 % of those reporting using a guideline were able to name it. The great majority of physicians in this study apply CRC screening. However, family physicians lack sufficient information concerning the ages at which screening tests should be started and concluded and how frequently they should be performed. They also do not attach sufficient importance to CRC guidelines. This results in excessive demand for screening tests.

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Lessons Learned from Native C.I.R.C.L.E., a Culturally Specific Resource

Abstract

Cancer is now the second leading cause of death among American Indians and Alaska Natives (AIAN), and trends in cancer-related mortality over the past 2 decades show inferior control in AIAN compared to non-Hispanic Whites. The American Indian/Alaska Native Cancer Information Resource Center and Learning Exchange (Native C.I.R.C.L.E.) was developed in the year 2000 as part of a comprehensive network of partnerships to develop, maintain, and disseminate culturally appropriate cancer and other health information materials for AIAN educators and providers. Now, in its 15th year of existence, enough data has been accumulated by Native C.I.R.C.L.E. to analyze trends in the distribution of culturally relevant cancer information materials and compare access to both printed (hard copy) and online materials. The amount of culturally appropriate materials available since its creation has increased more than 10-fold. Print materials are now distributed throughout the world, and the number of materials requested from print and downloads combined are in the thousands on a monthly basis. Native C.I.R.C.L.E. is in the process of expanding its access and capabilities to target more of the lay AIAN public in order to address the digital divide.

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Barriers to Completing Delayed Breast Reconstruction Following Mastectomy: a Critical Need for Patient and Clinician Education

Abstract

Rates of breast reconstruction following mastectomy vary widely, and little is known about why women who originally express an interest in breast reconstruction do not receive it. Improved documentation of clinical decision-making is one of the potential benefits of the electronic health record (EHR), and may serve as a tool to enhance patient-centered, clinical outcomes research. The goals of this study were to explore patterns in delayed reconstruction (DR), identify barriers to follow through, and to determine the adequacy of EHR documentation in providing information about decision-making for breast reconstruction. Retrospective EHR review of women undergoing mastectomy, 2008–2012, was conducted in an academic medical center in New England. Data included patient demographics, cancer stage, co-morbidity index, post-mastectomy reconstruction status, and documented decision-making regarding reconstruction. Of 367 women who had undergone a total mastectomy, 219 did not receive immediate reconstruction. Of these, 24.6 % expressed no interest in DR, 21.9 % expressed interest but were still pending the procedure, and 5.9 % had completed DR. Of decision-making regarding breast reconstruction, 47.5 % lacked documentation. Median follow-up was 34 months. Reasons for not following through with DR included poor timing (25 %), indecision (17 %), desired method of reconstruction not available at treating facility (10 %), persistent obesity (8.3 %), continued smoking (4 %), and reason not specified (35 %). Many women do not receive breast reconstruction despite expressing an initial interest in the procedure. Reasons were multi-factorial and the extent of documentation was inconsistent. Further exploration of potential barriers to breast reconstruction as well as opportunities to enhance shared decision-making may serve to improve patient experience and satisfaction following mastectomy.

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Reflections on Writing an Engaging Patient Blog

Abstract

Blogs can be a novel way to engage patients in a virtual manner. This reflections article provides highlights on how to get started writing a patient blog as well as practical tips to make your patient blog successful. Empowering patients to learn and share through a blog may bring a new level of insight to your education practice.

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Cultural Competency Training to Increase Minority Enrollment into Radiation Therapy Clinical Trials—an NRG Oncology RTOG Study

Abstract

Despite initiatives to increase the enrollment of racial and ethnic minorities into cancer clinical trials in the National Cancer Institute National Cancer Clinical Trials Network (NCCTN), participation by Latino and African American populations remain low. The primary aims of this pilot study are (1) to develop a Cultural Competency and Recruitment Training Program (CCRTP) for physician investigators and clinical research associates (CRAs), (2) to determine if the CCRTP increases cultural competency scores among physician investigators and CRAs, and (3) to determine the impact of the CCRTP on minority patient recruitment into NRG Oncology Radiation Therapy Oncology Group (RTOG) clinical trials. Sixty-seven CRAs and physicians participated in an in-person or online 4-h CRRTP training. Five knowledge and attitude items showed significant improvements from pre- to post-training. A comparison between enrolling sites that did and did not participate in the CCRTP demonstrated a pre to 1-year post-incremental increase in minority accrual to clinical trials of 1.2 % among participating sites. While not statistically significant, this increase translated into an additional 300 minority patients accrued to NCCTN clinical trials in the year following the training from those sites who participated in the training.

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The Content and Quality of Health Information on the Internet for Patients and Families on Adult Kidney Cancer

Abstract

The Internet is one of the major sources for health information for patients and their families, particularly when patients face serious life-threatening conditions such as kidney cancer in adults. In this study, we evaluate the content and quality of health information on adult kidney cancer using several validated instruments. We accessed the three most popular search engines (Google, Yahoo, Bing), using two terms: "kidney cancer" and "renal cell carcinoma," and reviewed the top 30 hits. After exclusion of duplicated websites, websites targeting health care professionals, and unrelated websites, 35 websites were included. Content was assessed using a 22-item checklist adapted from the American Cancer Society. We assessed website quality using the DISCERN questionnaire, HONcode and JAMA benchmark criteria, readability using three readability scores, and ALEXA for global traffic ranking systems. The average website had 16 of 22 content items while 6 websites fulfilled all 22 items. Among all websites, the average DISCERN quality score was 42 out of 80, 15 (42.8 %) of websites had HONcode certification, and only 3 (8.5 %) fulfilled all JAMA benchmark criteria. The average website readability was at the ninth grade reading level. The content and quality of health-related information on the Internet for adult kidney cancer are variable in comprehensiveness and quality. Many websites are difficult to read without a high school education. A standardized approach to presenting cancer information on the Internet for patients and families may be warranted.

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The Perceptions and Expectations of Older Women in the Establishment of the Senior Women’s Breast Cancer Clinic (SWBCC): a Needs Assessment Study

Abstract

This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment.

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Does non-contact low-frequency ultrasound (NLFU) therapy contribute to wound healing at the molecular level?

Abstract

Non-contact low frequency ultrasound (NLFU) is used to treat various types of chronic wounds including venous, diabetic and pressure ulcers. The objective for this sub study of the IN BALANCE RCT VLU trial was to characterize and compare the NLFU treatment group and patients receiving standard of care (SOC) with respect to the effect of the assigned study treatment on content/quantity of inflammatory cytokines and fibrinogen as well as bacteria. Higher mean wound area reduction was observed in the NLFU treatment group (67.0%) compared to the SOC group (41.6%, p<0.05). Hypertension, diabetes type II, coronary artery disease, and anaemia were identified as the most common co-morbidities of the CVLU patients included in the study. Pseudomonas, Corynebacterium, and unclassified Enterobacteriaceae were dominant in the highest number of samples. Anaerococcus, Peptoniphilus, and Finegoldia, had the highest median proportion in the samples overall. Peptoniphilus abundance decreased more in the NLFU treatment group relative to SOC; similar trends were observed for Anaerococcus and Finegoldia. Progression of mediators like TNF-alpha, IL-1beta, IL-6, IL-8, and IL-10 as well as PF4, TGF-beta, and fibrinogen was monitored and trends for several of the mediators were identified. Fibrinogen amounts were significantly reduced over time in the NLFU treatment group (p<0.05). IL-8 levels declined in wound fluid from NLFU responders as well as SOC responders. Bacterial load (total bacterial abundance) determined local parameters of ulcer inflammation. If a bioburden of ≥ 10E⁵ was found compared to < 10E⁵, levels of IL-1beta, IL-8, and TNF-alpha were significantly higher. In conclusion, NLFU treatment is an effective adjuvant tool for CVLU therapy. This study demonstrates that it improves wound healing by equally inhibiting abundant levels of pro-inflammatory cytokines as well as by reducing the overall bacterial burden. This article is protected by copyright. All rights reserved.

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Low-level laser therapy prevents endothelial cells from TNF-α/cycloheximide-induced apoptosis

Abstract

Low-level laser therapy (LLLT), widely used in physiotherapy, has been known to enhance wound healing and stimulate cell proliferation, including fibroblast and endothelial cells. Applying LLLT can increase cell proliferation in many kinds of cells including fibroblasts and endothelial cells. However, the protective mechanisms of LLLT on endothelial apoptosis remain unclear. We hypothesized LLLT can protect endothelial cells from inflammation-induced apoptosis. Human endothelial cell line, EA.hy926 cells, and TNF-α/cycloheximide (TNF/CHX) were used to explore the protective effects of LLLT (660 nm) on inflammation-induced endothelial apoptosis. Cell viability, apoptosis, caspase-3/7/8/9 activity, MAPKs signaling, NF-κB activity, and inducible/endothelial nitric oxide synthase (iNOS/eNOS) expression were measured. Our results showed that LLLT increased EA.hy926 cell proliferation, attenuated the TNF/CHX-induced apoptosis, and reduced the TNF/CHX-mediated caspase-3/7/8/9 activation. In addition, LLLT increased ERK MAPK phosphorylation and suppressed the TNF/CHX-increased p38 MAPK, JNK, IKK phosphorylation, NF-κB translocation, and iNOS expression. The caspases-3 cleavage and cell death were not increased in cells treating with ERK inhibitor U0126, which implicated that ERK is not to be responsible for the protective effects of LLLT. After treating with p38 mitogen-activated protein kinase (MAPK) activator, the protection of LLLT in cell apoptosis was no longer existed, showing that LLLT protected the endothelial cells by suppressing p38 MAPK signaling. Our results provide a new insight into the possible molecular mechanisms in which LLLT protects against inflammatory-induced endothelial dysfunction.

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Editorial Board/Aims & Scope

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Reconstruction Special Edition, Issue 1

The following four articles are the first part of a special series highlighting important aspects of Head and Neck Reconstruction. These peer-reviewed papers are grouped into four different categories: 1) Quality and Value; 2) Uncommon but versatile microvascular free flaps 3) Subsite reconstruction; and 4) Perioperative considerations.

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Reflections: Paul Bernard Chretien, MD (1931-2017)

The field of head and neck oncology and tumor immunology has lost one of its giants. Paul B. Chretien, MD died peacefully at home in Rockville, Maryland on August 16th, 2017 at age 86 after a prolonged decline in health. He was a true pioneer of head and neck tumor immunology and in the early 1970's, adapted the emerging discoveries of the differing immune functions of T and B lymphocytes to the study of head and neck cancer patients. Working at the National Cancer Institute Surgery Branch as a Senior Investigator (1966-1972), and Chief of the Tumor Immunology Section (1972-1980), he was the first to characterize deficiencies in T lymphocyte numbers and function in patients with head and neck cancer.

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A high ratio of IL-12Rβ2-positive tumor-infiltrating lymphocytes indicates favorable prognosis in laryngeal cancer

An estimated 13,430 newly diagnosed laryngeal cancer (LC) cases and 3620 deaths were in the U.S in 2016 [1], while the National Central Cancer Registry of China Report showed that about 26,400 new LC cases and 14,500 cancer deaths occurred in China in 2015, with increasing incidence and mortality in recent years [2]. In LC, tumor-infiltrating lymphocytes (TILs) are frequently found [3], and various laryngeal TILs and cytokines integrate with the immune system to either kill or promote tumors and thereby have roles in the elimination, equilibrium, and escape phases of cancer immunoediting and tumor progression [4,5].

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Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

Head and neck squamous cell carcinoma (HNSCC) represents the sixth most common malignant tumor worldwide, with over 600.000 new cases diagnosed per year [1]. In last 15 years, human papilloma virus (HPV) infection has been recognized to account for a distinct epidemiologic trend occurring mainly in western countries, leading to a rising incidence of oropharyngeal cancer (OPC) particularly in male patients in their 5 th decade of life [2,3]. Next to the pathogenesis of HPV-driven OPC [4], the development of HNSCC is still largely the result of a chronic exposure to tobacco and alcohol – induced field cancerization [5] of the upper aerodigestive mucosal tract.

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Percutaneous endoscopic gastrostomy feeding of locally advanced oro-pharygo-laryngeal cancer patients

Dysphagia is present in 5–57% of patients at the time of head and neck cancer [HNC] diagnosis [1,2], more than half of whom have experienced major weight loss, as a consequence not only of tumor-associated catabolism [3], but also due to tumor size and location itself, and functional limitations in chewing and swallowing [2,4–7].

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The effect of home-based program and outpatient physical therapy in patients with head and neck cancer: A randomized, controlled trial

More than 500,000 cases are diagnosed as head and neck cancer (HNC) annually worldwide [1,2]. In Taiwan, HNC is one of the top five increasing cancers over the past decade and the fifth most common cancer [3]. More than half of the patients with HNC survive more than 5 years [4], but this is accompanied by treatment-related complications and subsequent profound disability [5]. HNC treatments, including surgical dissection, chemotherapy, and radiation therapy, contribute to complications involving shoulder dysfunction, pain in the upper extremities, and physical inactivity [6–9].

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Reconstruction design before tumour resection: A new concept of through-and-through cheek defect reconstruction

Oral cancer is one of the most common cancers in the world and accounts for nearly 3% of all cancers [1–4]. Because of the high prevalence of betel quid chewing and smoking, the incidence of buccal squamous cell carcinoma (BSCC), together with other cancers of the oral cavity, has been increasing in China and other regions and countries of Asia [5]. Surgery is still the most important treatment modality [5–8]. Due to the anatomic complexity of the oral commissure and cheek, the result of tumour excision in this area is a great challenge to plastic surgeons.

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Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution

Mucosal melanoma is a rare malignant neoplasm, accounting for only 0.8–3.7% of all melanomas [1,2]. The most common site of mucosal melanoma is the upper aerodigestive tract, which accounts for 55% of all cases [1]. Several studies have reported that MMHN is more common in some parts of African countries and Japan than in Western countries [3,4]. The most common primary sites of MMHN are the sinonasal cavity and oral cavity. Although rare, MMHN is a very aggressive malignancy, with 5-year OS ranges from 20% to 40% [5–8].

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A pilot study of Merkel cell polyomavirus in squamous cell carcinoma of the tongue

The oral tongue and the floor of the mouth are the most common sites of squamous cell carcinoma (SCC) within the oral cavity, accounting for more than 50% of cases [1,2]. The increasing incidence of oral tongue SCC in young patients (ages 20–44years) who have a lower incidence and duration of tobacco and alcohol exposure suggests that genetic, environmental or viral factors may contribute to the pathogenesis of oral tongue SCC [3–6]. The tongue has a significantly different histologic makeup with a rich lymphatic supply compared to the other areas of the oral cavity.

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Synchronous, bilateral tonsillar carcinomas: Patient characteristics and human papillomavirus genotypes

The incidence of oropharyngeal squamous cell carcinomas (OPSCCs) is increasing in the Western world [1–3]. The increase is primarily driven by increasing numbers of human papillomavirus positive (HPV+) OPSCCs [1–3]. The subgroup of patients with HPV+ OPSCC has markedly better overall and progression-free survival than HPV-negative (HPV−) patients [4].

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The incidence and management of non-head and neck incidentalomas for the head and neck surgeon

A wide variety of imaging studies are employed for the staging or follow-up of head and neck cancer patients. It is not uncommon to encounter incidental findings outside of the head and neck region. Some of these "incidentalomas" (INs) represent distant metastatic disease, separate malignancies or non-malignant processes that can have significant clinical consequences if left untreated.

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Liquid biopsy: An emerging prognostic and predictive tool in Head and Neck Squamous Cell Carcinoma (HNSCC). Focus on Circulating Tumor Cells (CTCs)

Head and Neck Squamous Cell Carcinoma (HNSCC) is sixth most common malignancy worldwide, accounting for approximately 6% of all cases and is responsible for an estimated 1–2% of all cancer deaths [1]. HNSCC has been historically associated with tobacco and alcohol use; however, in the past decade, infection with high-risk human papillomaviruses (HPV) and especially type 16 has been implicated in the pathogenesis of a subset of HNSCCs, mainly those arising from the oropharynx. HPV-associated oropharyngeal cancer represents a distinct biological and clinical entity with a more favorable prognosis [2,3].

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40-year incidence trends for oropharyngeal squamous cell carcinoma in the United States

There were an estimated 61,760 incident cases of head and neck cancer (oral cavity, pharynx, oral cavity, and larynx) in the United States in 2016, accounting for about 3.7% of all new cancer cases [1]. Among oral cavity and pharynx cancer, oral cavity cancer rates are decreasing mostly due to decreases in smoking and alcohol use [2,3]. However, cancers of the base of tongue, tonsil, and oropharynx (oropharyngeal cancer) are increasing because of increases in human papillomavirus (HPV) infection.

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A failure-type specific risk prediction tool for selection of head-and-neck cancer patients for experimental treatments

Head-and-neck squamous cell carcinoma carcinoma (HNSCC) is a disease where the prognosis varies substantially between patients. Human papilloma virus (HPV) positive oropharyngeal carcinoma is, in relative terms, a favorable subtype with a 3-year overall survival (OS) of around 80% [1]. It has been suggested that treatment de-intensification would be possible in this group without compromising the treatment effect, and several such studies are ongoing [2]. This begs the question whether we can identify subset of HPV positive patients where de-intensification may be detrimental for long term survival due to a – for the group – unfavorable disease characteristics.

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Prognostic value of c-MET in head and neck cancer: A systematic review and meta-analysis of aggregate data

Squamous cell carcinoma of the head and neck (SCCHN), affecting the lips, oral cavity, pharynx, and larynx, accounts for over 650,000 new cases and 350,000 cancer deaths worldwide each year. While early stage disease is usually amenable to either surgery or radiotherapy, both with curative intents, the majority of patients still present with advanced stages. In the latter category, prognosis remains dismal because recurrences and distant metastases occur frequently, and novel treatment options are urgently needed [1,2].

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Frequent oncogenic BRAF V600E mutation in odontogenic keratocyst

Since the term odontogenic keratocyst (OKC) has been re-classified several times between cyst and tumor due to a debate over biological behaviors and oncogenic mutation of OKC [1,2]. Although a number of treatment methods have been developed in addition to simple enucleation, surgical approaches are often limited owing to the high recurrence of OKC as well as its locally destructive behavior [3]. While many targeted therapeutics for oncogenic mutation have become widely available recently, the molecular background of OKC and non-invasive therapeutic approaches based on oncogenic mutation have not been widely studied.

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Extracapsular extension is associated with worse distant control and progression-free survival in patients with lymph node-positive human papillomavirus-related oropharyngeal carcinoma

The presence of extracapsular extension (ECE) in lymph node-positive head and neck squamous cell carcinoma (HNSCC) leads to poor locoregional control (LRC), distant control (DC) and overall survival (OS) [1–8]. Due to its poor prognosis, histologically identified ECE is an indication for more aggressive adjuvant treatment, with both an increased dose of post-operative radiotherapy (RT) and concurrent chemotherapy [9]. Evidence supporting this approach largely stems from two contemporaneous, separately designed and run, phase III randomized trials, EORTC 22931 and RTOG 95–01, and the meta-analysis of their pooled data [10–12].

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Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer☆

Head and neck cancer (HNC) is common and its frequency is increasing, with over 61,000 cases in the United States per year [1–3]. After definitive treatment, approximately 30–40% will progress [4–6]. Platinum-based systemic chemotherapy is the first treatment for patients with incurable recurrent or metastatic disease. Until recently, no agent has demonstrated efficacy following progression after standard platinum-based regimens, with most data suggesting a median survival of 5–6months regardless of regimen [7–9].

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Rational Approach to Allergy Testing

Allergy testing is commonly used when symptoms of allergic rhinitis are refractory to symptoms and there is potential for treatment with institution of avoidance measures or immunotherapy. Once the decision for testing has been made, the method of testing by either in vivo skin testing by prick/puncture or intradermal testing or in vitro testing of serum-specific IgE is dictated by factors in the clinical history and an informed decision by the patient. Because there is no perfect testing method, understanding the benefits and limitations of each method is important in selecting the best testing option for each patient.

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Clinical Applications of Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is effective for the treatment of allergic rhinitis and allergic asthma in adults and children. In a limited number of studies, SLIT efficacy has been demonstrated for the treatment of food allergy. SLIT has a higher safety profile versus subcutaneous immunotherapy, although some systemic reactions have been reported. Appropriate patient selection, meticulous patient education, and routine follow-up are key for the safe and effective administration of SLIT. With organization and attention to detail, adding SLIT to one's practice can provide a highly valued patient service.

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Contents

Sujana S. Chandrasekhar

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Management of Anaphylaxis

Anaphylaxis is a severe systemic reaction that can be managed appropriately with expedient diagnosis and treatment. Intramuscular epinephrine continues to be the mainstay of treatment of anaphylaxis; however, it is still underused in the community and in the medical setting. Further education and counseling of patients and health care providers is required to prevent and manage anaphylaxis successfully. In-office management of anaphylaxis includes training of staff, preparedness with the necessary supplies and medication, and an effective action plan.

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Copyright-Page

Elsevier

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Allergy for the Otolaryngologist

The diagnosis and treatment of allergic disease is an integral part of otolaryngology practice, where care for inflammatory disorders of the nose, sinuses, and upper airway is common. This issue of Otolaryngologic Clinics of North America is designed to bring the practicing otolaryngologist up to date by focusing on where developments have occurred.

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CME Accreditation Page

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Allergy as Part of the Unified Otolaryngologic Practice

The management of allergic disorders is an integral part of the specialty of otolaryngology–head and neck surgery. Its importance in the comprehensive management of the ENT patient has become more and more apparent over time. In 1985, 58% of Otolaryngology residency programs offered no formal training in allergy. That situation had improved by 2006, when 62% of programs had active allergy programs, and the remainder were adding them.1,2

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Allergy for the Otolaryngologist

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Forthcoming Issues

Congenital Vascular Lesions of the Head and Neck

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Pembrolizumab for treatment of advanced gastric and gastroesophageal junction adenocarcinoma

Future Oncology, Ahead of Print.


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Pembrolizumab for treatment of advanced gastric and gastroesophageal junction adenocarcinoma

Future Oncology, Ahead of Print.


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The relationship between esophageal acid exposure and the esophageal response to volumetric distention

Abstract

Background

Increased esophagogastric junction (EGJ) distensibility is thought to contribute to gastroesophageal reflux disease (GERD). Using the functional lumen imaging probe (FLIP), we aimed to assess the esophageal response to distension among patients undergoing esophageal pH monitoring.

Methods

25 patients (ages 22-73; 13 females) who underwent ambulatory wireless esophageal pH testing while off proton-pump inhibitors were evaluated with FLIP during sedated upper endoscopy. Esophageal reflux was quantified by total percent acid exposure time (AET; <6% was considered normal). FLIP studies were analyzed using a customized program generate FLIP topography plots to identify esophageal contractility patterns and to calculate the EGJ-distensibility index (DI). Reflux symptoms were assessed with the GERDQ. Values reflect median (interquartile range).

Results

Among all patients, the AET was 7.2% (3.7-11.1) and EGJ-DI was 4.2 (2.5-7.6) mm²/mm Hg. Repetitive antegrade contractions (RACs) were induced in 19/25 (76%) of patients; AET was lower among patients with (6.1%, 3-7.8) than without (14.9, 8.5-22.3) RACs (P = .009). Correlation was weak and insignificant between AET and EGJ-DI, GERDQ and AET, and GERDQ and EGJ-DI. Patients with abnormal AET (n = 16) and normal AET (n = 9) had similar EGJ-DI, 4.6 mm²/mm Hg (2.9-9.2) vs 3.2 (2.2-5.1), P = .207 and GERDQ, P = .138.

Conclusions

Abnormal esophageal acid exposure was associated with an impaired contractile response to volume distention of the esophagus. This supports that acid exposure is dependent on acid clearance mechanisms.

Among patients evaluated for reflux with wireless esophageal pH testing and the functional lumen imaging probe, a response to volumetric distension comprising repetitive, antegrade contractions (as in A) was associated with a reduced degree of esophageal acid exposure. The esophagogastric-junction distensibility index, however, was poorly correlated with esophageal acid exposure.

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Copyright

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1





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Contributors

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1





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Contents

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1





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Preface

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1
Author(s): Jian Farhadi, Stefan O.P. Hofer, Jaume Masia




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Contemporary Indications in Breast Reconstruction

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1
Author(s): Jian Farhadi, Stefan O.P. Hofer, Jaume Masia




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Modern Approaches to the Surgical Management of Malignant Breast Disease

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1
Author(s): Tulin D. Cil, David McCready

Teaser

The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with postoperative radiation, but has evolved to include several options that produce excellent oncologic endpoints and improved cosmesis. These options include skin- and nipple-sparing mastectomies with immediate reconstruction as well as oncoplastic procedures that allow larger excisions and better postoperative breast shape. This article provides an overview of these modern surgical approaches for breast cancer treatment.


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Neoadjuvant Chemotherapy for Breast Cancer Treatment and the Evidence-Based Interaction with Immediate Autologous and Implant-Based Breast Reconstruction

Publication date: January 2018
Source:Clinics in Plastic Surgery, Volume 45, Issue 1
Author(s): Jordi Riba, Santiago Escriva de Romani, Jaume Masia

Teaser

This article aims to determine the impact of neoadjuvant chemotherapy on immediate breast reconstruction by assessing their compatibility for oncological safety and the incidence and management of postoperative complications. A review of scientific publications published between 2009 and 2017 was undertaken. The relationship between neoadjuvant chemotherapy and immediate breast reconstruction was analyzed to compile and assess the potential interaction between the procedures. The search was limited to English language publications, but there were no limiting factors at the level of study typology. Full-text articles, including the references leading to other relevant studies, were evaluated.


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Genioglossus muscle advancement and simultaneous sliding genioplasty in the management of sleep apnoea

Genioglossus muscle advancement (GMA) was reported in 1993 as an option for the surgical treatment of obstructive sleep apnoea syndrome (OSAS), in the context of phase I of the Stanford University (Powell–Riley) protocol. The rationale for this technique is the placement of tension on the base of the tongue, thus preventing the tongue from falling back into the posterior airway space. However, in retrognathic patients undergoing phase I of the Stanford University protocol, an additional genioplasty will provide a better aesthetic outcome.

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Fluctuating asymmetry of the normal facial skeleton

The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized. The repeatability of the landmark digitization was first evaluated. A Procrustes analysis was then used to measure the fluctuating asymmetry of each CT model, after all of the models had been scaled to the average face size of the study sample.

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Changes in condylar volume and joint spaces after orthognathic surgery

The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class II deformities, by means of cone beam computed tomography (CBCT). Initial and follow-up (at least 6 months) CBCT examinations of 114 condyles (57 patients) were studied retrospectively. Linear measurements of the joint space and volumetric analysis of changes in condylar volume were performed using Dolphin 3D Imaging in association with ITK-SNAP 3.0.0 segmentation software.

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Data Science in Radiology: A Path Forward

Artificial intelligence (AI), especially deep learning, has the potential to fundamentally alter clinical radiology. AI algorithms, which excel in quantifying complex patterns in data, have shown remarkable progress in applications ranging from self-driving cars to speech recognition. The AI application within radiology, known as radiomics, can provide detailed quantifications of the radiographic characteristics of underlying tissues. This information can be used throughout the clinical care path to improve diagnosis and treatment planning, as well as assess treatment response. This tremendous potential for clinical translation has led to a vast increase in the number of research studies being conducted in the field, a number that is expected to rise sharply in the future. Many studies have reported robust and meaningful findings; however, a growing number also suffer from flawed experimental or analytical designs. Such errors could not only can result in invalid discoveries, but also may lead others to perpetuate similar flaws in their own work. This perspective article aims to increase awareness of the issue, identify potential reasons why this is happening, and provide a path forward.

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Both Plastic and ENT Surgeons Can Safely Repair Orbital Floor Fracture

Reuters Health Information

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'Mini-Jupette' Graft May Cut Postprostatectomy Climacturia

For men who develop both erectile dysfunction and climacturia and/or mild urinary incontinence after radical prostatectomy, an add-on maneuver to penile prosthesis insertion can address both problems.
Medscape Medical News

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Catheterization Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Paul N. Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak Shah

Teaser

The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.


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Copyright

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Forthcoming Issues

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross




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Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross




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Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Wendy L. Gross, Lebron Cooper, Steven Boggs

Teaser

Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested.


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Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Kelly Lebak, Jason Lane, Richard Taus, Hansol Kim, Michael S. Stecker, Michael Hall, Meghan B. Lane-Fall, Mark S. Weiss

Teaser

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non–operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients.


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Safety of Non–Operating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Zachary G. Woodward, Richard D. Urman, Karen B. Domino

Teaser

Malpractice claims for non–operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Fewer malpractice claims for NORA occurred than for OR anesthesia as assessed by the relative numbers of in NORA versus OR procedures. The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.


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Implementation and Use of Anesthesia Information Management Systems for Non–operating Room Locations

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jason T. Bouhenguel, David A. Preiss, Richard D. Urman

Teaser

Non–operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety.


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Monitoring for Nonoperating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Stylianos Voulgarelis, John P. Scott

Teaser

Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring.


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Use of Anesthesiology Services in Radiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Hansol Kim, Jason Lane, Rolf Schlichter, Michael S. Stecker, Richard Taus

Teaser

In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non–operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome.


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An Anesthesiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Annie Amin, Jason Lane, Thomas Cutter

Teaser

The advent of radiology image–guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Anesthesiologists play a critical role in optimizing outcome in these patients. Knowledge by anesthesiologists of procedural goals, technology used, and inherit safety concerns of anesthetizing patients in the radiology suite are all critical to patients and proceduralists.


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A Radiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Sharath K. Bhagavatula, Jason Lane, Paul Shyn

Teaser

Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non–operating room anesthesia team. Collaboration and communication between the radiologist and anesthesiologist are key to safety and excellent patient outcomes.


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Anesthesia in the Electrophysiology Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jeff E. Mandel, William G. Stevenson, David S. Frankel

Teaser

The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.


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Cardioversions and Transthoracic Echocardiography

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Ronak Shah, Elizabeth Zhou

Teaser

Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available.


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Anesthesia for Colonoscopy and Lower Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): John Michael Trummel, Vinay Chandrasekhara, Michael L. Kochman

Teaser

Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks. There is no difference in outcome measures based on sedation received.


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IDAC-Dose 2.1, an internal dosimetry program for diagnostic nuclear medicine based on the ICRP adult reference voxel phantoms

Abstract

Background

To date, the estimated radiation-absorbed dose to organs and tissues in patients undergoing diagnostic examinations in nuclear medicine is derived via calculations based on models of the human body and the biokinetic behaviour of the radiopharmaceutical. An internal dosimetry computer program, IDAC-Dose2.1, was developed based on the International Commission on Radiological Protection (ICRP)-specific absorbed fractions and computational framework of internal dose assessment given for reference adults in ICRP Publication 133. The program uses the radionuclide decay database of ICRP Publication 107 and considers 83 different source regions irradiating 47 target tissues, defining the effective dose as presented in ICRP Publications 60 and 103. The computer program was validated against another ICRP dosimetry program, Dose and Risk Calculation (DCAL), that employs the same computational framework in evaluation of occupational and environmental intakes of radionuclides. IDAC-Dose2.1 has a sub-module for absorbed dose calculations in spherical structures of different volumes and composition; this sub-module is intended for absorbed dose estimates in radiopharmaceutical therapy. For nine specific alpha emitters, the absorbed dose contribution from their decay products is also included in the committed absorbed dose calculations.

Results

The absorbed doses and effective dose of ¹³¹I-iodide determined by IDAC-Dose2.1 were validated against the dosimetry program DCAL, showing identical results. IDAC-Dose2.1 was used to calculate absorbed doses for intravenously administered ¹⁸F-FDG and orally administered ^99mTc-pertechnetate and ¹³¹I-iodide, three frequently used radiopharmaceuticals. Using the tissue weighting factors from ICRP Publication 103, the effective dose per administered activity was estimated to be 0.016 mSv/MBq for ¹⁸F-FDG, 0.014 mSv/MBq for ^99mTc-pertechnetate, and 16 mSv/MBq for ¹³¹I-iodide.

Conclusions

The internal dosimetry program IDAC-Dose2.1 was developed and applied to three radiopharmaceuticals for validation against DCAL and to generate improved absorbed dose estimations for diagnostic nuclear medicine using specific absorbed fraction values of the ICRP computational voxel phantoms. The sub-module for absorbed dose calculations in spherical structures 1 mm to 9 cm in diameter and different tissue composition was included to broaden the clinical usefulness of the program. The IDAC-Dose2.1 program is free software for research and available for download at http://ift.tt/2iqKoVz.

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Evidence for the formal development of trauma subspecialty within plastic surgery in the united kingdom.

The Royal College of Surgeons working group on trauma recently recommended the reorganization of Plastic surgery training to incorporate a trauma subspeciality as a means to provide a sustainable workforce for trauma care provision nationally. The aim of this work was to gauge trainee opinion and aspiration in order to advice and shape the future of trauma training to meet this potential need. An online survey was conducted of UK Plastic surgical trainees to assess their interest in subspecialisiing in trauma.

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Targeted muscle reinnervation for pain control in an elective transradial amputation

Targeted muscle reinnervation (TMR) is primarily used to transfer residual nerves of the amputated upper limb to reinnervate alternate target muscle groups, for intuitive control of a myoelectric prosthesis. Furthermore, TMR can significantly reduce the incidence of neuropathic and neuroma-related pain compared with conventional amputation techniques, by providing each nerve 'somewhere to go and something to do'.We report the use of TMR in a case of elective transradial amputation for intractable severe chronic post-traumatic and end neuroma limb pain (constant VAS pain score 10/10), 2 years following a severe crush injury to his left hand.

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The liquid facelift: first hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy - a case series of 25 patients

Recently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in non-facial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients.

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Rapidly growing mycobacteria infections among “cosmetic tourists” returning to the netherlands

Medical tourism for cosmetic surgery is becoming increasingly popular1. Most cosmetic tourists travel to developing parts of the world, such as Latin America and South Asia.2 Cosmetic surgery abroad has advantages such as shorter waiting lists, anonymity and lower costs, combined with a vacation.1-2 Although this seems appealing, it also carries risks.

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Treatment of seasonal allergic rhinitis

Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappreciated health burden for individuals and society (see Burden of Disease section). Guidelines to improve care for patients with AR have been evolving in an effort to respond to the introduction of new treatment approaches, to address the availability of additional studies that compare treatment options, and to incorporate the use of more standardized, evidence-based medicine methods to analyze data and make recommendations.

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Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype.

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American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists

The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians.

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Allergy and immunology practice parameters and guidelines

It's spring break, and you're seeing a college student who has a history of moderate-to-severe spring and summer rhinoconjunctivitis. Skin testing shows remarkable wheal and flare reactions to tree and grass pollens. In addition to recommending aeroallergen avoidance measures, which initial treatment has the highest likelihood of helping this patient: intranasal corticosteroid monotherapy or intranasal corticosteroid combined with intranasal antihistamine? Previous practice parameters tended to outline treatments with good evidence of effectiveness, but they rarely provided specific recommendations for these types of questions.

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P236 Comorbidities associated with poor short-acting beta-agonist inhaler handling among united states respiratory patients

Short-acting beta-agonists (SABA), in asthma and chronic obstructive pulmonary disease (COPD) are commonly administered using pressurized metered-dose inhalers (pMDI). Hand-breath coordination is a common challenge with pMDIs demonstrated to result in worse outcomes. This study evaluated the prevalence of comorbidities potentially affecting device handling in asthma and/or COPD patients using SABAs, including albuterol multidose dry powder inhaler (MDPI), the only MDPI not requiring hand-breath coordination.

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Reliability and Validity of Speech Evaluation in Adductor Spasmodic Dysphonia: Common Mistake and Statistical Issues

I was interested to read the paper by Yanagida et al published in Journal of Voice on August 2017.1 The purposes of the authors were to evaluate speech in patients with adductor spasmodic dysphonia (ADSD) by perceptual evaluations and acoustic measures, and to examine the reliability and validity of these measures.1 Twenty-four patients with ADSD and 24 healthy volunteers were included in the study. Speech materials consisted of three sentences constructed from serial voiced syllables to elicit abductor voice breaks.

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Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review

Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies.

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Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model

Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model

Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model, Published online: 02 November 2017; doi:10.1038/bjc.2017.375

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Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma

Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma

Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma, Published online: 02 November 2017; doi:10.1038/bjc.2017.373

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Cancer incidence in English children, adolescents and young people: past trends and projections to 2030

Cancer incidence in English children, adolescents and young people: past trends and projections to 2030

Cancer incidence in English children, adolescents and young people: past trends and projections to 2030, Published online: 02 November 2017; doi:10.1038/bjc.2017.341

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Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model

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Inhibitor of DNA binding 2 is a novel therapeutic target for stemness of head and neck squamous cell carcinoma

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Cancer incidence in English children, adolescents and young people: past trends and projections to 2030

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What Neurotoxins Have Taught Us About the Brow: The Reintroduction and Review of the Transpalpebral Browpexy

Abstract

Introduction

The use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators.

Methods

A retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient.

Results

Out of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid.

Conclusion

Transpalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries

Abstract

Objective

To compare short-term results of total mesorectal excision (TME) for mid and low rectal cancer, achieved by transanal (TaTME), laparoscopic (LaTME), and open (OpTME) approaches.

Background

The impact of TaTME on the surgical treatment of mid and low rectal cancer has yet to be clarified.

Methods

This is a case-matched study, based on data from a prospectively maintained database of patients who underwent TaTME from May 2015 to March 2017, and a retrospective chart review of patients who underwent LaTME and OpTME in the previous period. Each patient in the TaTME group was matched to one LaTME and one OpTME based on sex, BMI, tumor status, and the height of the tumor from the anal verge. Primary end-points were rates of positive circumferential resection margin (CRM), distal resection margin, and the macroscopic quality of the surgical specimen. Composite of these outcomes was compared as an indication for successful surgery. Secondary end-points included intraoperative data and postoperative course and complications.

Results

Three hundred patients were included (TaTME = 100, LaTME = 100, OpTME = 100). The three groups were comparable in the baseline characteristics. TaTME resulted in lower rates of incomplete TME specimens than LaTME, but not OpTME (P = 0.016, P = 0.750, respectively). The rates of CRM involvement, mean CRM distance, and the percentages of successful surgery were comparable among the three groups (P = 0.368). The conversion to open surgery occurred only in the LaTME group. TaTME resulted in shorter operation time and less blood loss than the other two groups (P < 0.001 and P < 0.001). Hospital stay was shorter in the TaTME group (P = 0.002); complication rate and mortality were comparable among the groups.

Conclusions

TaTME had, in our hands, some obvious benefits over other approaches. The pathological results were not significantly superior to LaTME and OpTME. The procedure is however feasible and safe. Further studies are needed to evaluate the long-term oncological and quality of life outcomes.

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Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery

Abstract

Background

Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections.

Methods

Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed.

Results

Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31–74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n  = 5), and other type of surgery (n  = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6–360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2–24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy.

Conclusions

The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

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Clinical outcomes of deep invasive submucosal colorectal cancer after ESD

Abstract

Background and study aims

Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery under certain conditions. However, limited information is available on the clinical course of T1b colorectal cancer (CRC) after ESD. The aim of the study was to clarify the feasibility of ESD for T1b CRC.

Patients and methods

Three hundred and two patients with 312 T1 CRC were identified in this retrospective cohort study. All patients were treated with ESD, other endoscopic treatments, or surgery. In this study, we (I) investigated the en bloc resection rate of ESD and (II) compared the overall survival (OS) rate for patients who underwent ESD with additional surgery (Group A) and surgery without upfront endoscopic resection (Group B) for T1b CRC.

Results

No significant differences were observed in the en bloc resection rates between T1b and T1a CRC (100 vs. 98.7%), but the en bloc R0 resection rate was significantly lower in T1b CRC than in T1a CRC (64.7 vs. 97.4%). Regarding complications, perforations occurred in 2.9% of patients with T1b CRC, which was not significantly different from the rate of 5.3% in patients with T1a CRC. No significant differences were observed in the OS or recurrence-free survival (RFS) curves between Groups A and B (OS rates at 5 years: 92.3 vs. 88.9%, RFS rates at 5 years: 81.4 vs. 85.3%). Similarly, the 5-year disease-specific survival (DSS) rate of Group A was identical to that of Group B (both 100%).

Conclusions

ESD for T1b CRC before surgery is a possible strategy because of the low rate of complications and favorable long-term outcomes.

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Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center

Abstract

Background

Endoscopic submucosal dissection (ESD) and hybrid-ESD techniques are treatment modalities for colorectal neoplasia, although mostly used in the Eastern hemisphere. Only few data on ESD for colorectal neoplasia have been published in the West. We report the outcomes of colorectal ESD and hybrid ESD in a single Italian center.

Methods

We retrospectively evaluated the outcomes of all ESD and hybrid-ESD procedures for colorectal neoplasia performed over the first 2-year experience from a prospectively recorded database. Neuroendocrine tumors and adenocarcinoma with submucosal infiltration through the submucosal (SM) 2 layer or deeper were excluded. The primary outcome was the recurrence rate at the 6- to 12-month follow-up.

Results

Fifty-two patients were included in the study, of which 23 underwent ESD and 29 hybrid ESD. The mean lesion sizes for ESD and hybrid ESD were similar (25.8 vs. 25.4 mm, p = 0.940), while median procedure length was significantly longer for ESD (120 vs. 60 min, p < 0.001). ESD and hybrid ESD yielded similar en-bloc resection rate (82.6 vs. 82.8%) and R0 resection rate (34.8 vs. 31%). ESD had a lower neoplasia recurrence rate than hybrid ESD (11.7 vs. 20%) and a lower bleeding rate (0 vs. 8.7%). One perforation occurred in the hybrid-ESD cohort and two perforations in the ESD cohort, of which one required surgical intervention. Non-recurrence at follow-up was associated with R0 status, en-bloc resection, and lesion size ≤ 20 mm.

Conclusion

Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.

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Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease

Abstract

Background

Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCD patients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC.

Methods

Thirty-five consecutive SCD patients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCD patients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated.

Results

MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084).

Conclusion

MLC + LSPP in SCD patients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCD patients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.

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The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial

Abstract

Background

During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method.

Patients and methods

The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome.

Results

No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044).

Conclusion

All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.

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The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions.

Background and Objectives: Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program data set. The study population was divided into 2 groups: patients undergoing regional anesthesia (RA) and those undergoing GA. The primary end point for our study was 30-day mortality. The secondary end points were return to the operating room, surgical site infections, pulmonary complications, acute kidney injury, urinary tract infection, cardiac arrest, myocardial infarction, perioperative transfusions, thromboembolisms, sepsis, composite measure of postoperative complications, and days from operation to discharge. Results: Twelve thousand seven hundred twenty-three patients were identified. Older patients, white patients, patients with a higher body mass index, patients without dyspnea, patients with independent functional status, smokers, patients with sepsis, and patients with bleeding disorders were associated with receiving GA. Hispanic patients, patients with chronic obstructive pulmonary disease, and patients with congestive heart failure were associated with receiving RA. Our study did not reveal a 30-day mortality difference between RA and GA. Regional anesthesia was associated with a significantly decreased need for perioperative blood transfusions (11.8% vs 16.5%, P

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Challenging Conventions to Make a Difference in Patient Care: The 2017 Gaston Labat Award Lecture.

No abstract available

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Literature Commentary.

In this issue of Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD and Mark L. Moster, MD will discuss the following 6 articles: 1. Davoudi S, Ebrahimiadib N, Yasa C, Sevgi DD, Roohipoor R, Papavasilieou E, Comander J, Sobrin L. Outcomes in autoimmune retinopathy patients treated with rituximab. Am J Ophthalmol. 2017;180:124-132. 2. Metz LM, Li DKB, Traboulsee AL, Duquette P, Eliasziw M, Cerchiaro G, Greenfield J, Riddehough A, Yeung M, Kremenchutzky M, Vorobeychik G, Freedman MS, Bhan V, Blevins G, Marriott JJ, Grand'Maison F, Lee L, Thibault M, Hill MD, Yong VW; Minocycline in MS Study Team. Trial of minocycline in a clinically isolated syndrome of multiple sclerosis. N Engl J Med. 2017;376:2122-2133. 3. Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I; Movement Disorder Society-Endorsed PSP Study Group. Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria. Mov Disord. 2017;32:853-864. 4. Sodhi M, Sheldon CA, Carleton B, Etminan M. Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: nested case-control study. Neurology. 2017;89:792-795. 5. Suzuki S, Ishikawa N, Konoeda F, Seki N, Fukushima S, Takahashi K, Uhara H, Hasegawa Y, Inomata S, Otani Y, Yokota K, Hirose T, Tanaka R, Suzuki N, Matsui M. Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan. Neurology. 2017;89:1127-1134. 6. Hennes EM, Baumann M, Schanda K, Anlar B, Bajer-Kornek B, Blaschek A, Brantner-Inthaler S, Diepold K, Eisenkolbl A, Gotwald T, Kuchukhidze G, Gruber-Sedlmayr U, Hausler M, Hoftberger R, Karenfort M, Klein A, Koch J, Kraus V, Lechner C, Leiz S, Leypoldt F, Mader S, Marquard K, Poggenburg I, Pohl D, Pritsch M, Raucherzauner M, Schimmel M, Thiels C, Tibussek D, Vieker S, Zeches C, Berger T, Reindl M, Rostasy K; BIOMARKER Study Group. Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome. Neurology. 2017;89:900-908. (C) 2017 by North American Neuro-Ophthalmology Society

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EUNOS Meeting, September 10-13, 2017, Budapest, Hungary.

No abstract available

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The Optic Disc Drusen Studies Consortium Recommendations for Diagnosis of Optic Disc Drusen Using Optical Coherence Tomography.

Background: Making an accurate diagnosis of optic disc drusen (ODD) is important as part of the work-up for possible life-threatening optic disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) has improved the visualization of more deeply buried ODD. There is, however, no consensus regarding the diagnosis of ODD using OCT. The purpose of this study was to develop a consensus recommendation for diagnosing ODD using OCT. Methods: The members of the Optic Disc Drusen Studies (ODDS) Consortium are either fellowship trained neuro-ophthalmologists with an interest in ODD, or researchers with an interest in ODD. Four standardization steps were performed by the consortium members with a focus on both image acquisition and diagnosis of ODD. Results: Based on prior knowledge and experiences from the standardization steps, the ODDS Consortium reached a consensus regarding OCT acquisition and diagnosis of ODD. The recommendations from the ODDS Consortium include scanning protocol, data selection, data analysis, and nomenclature. Conclusions: The ODDS Consortium recommendations are important in the process of establishing a reliable and consistent diagnosis of ODD using OCT for both clinicians and researchers. (C) 2017 by North American Neuro-Ophthalmology Society

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Trunk exercises improve gait symmetry in Parkinson disease: A blind phase II randomised-controlled trial.

Objective: Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson's disease (PD). Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomised-controlled trial sought to establish whether exercise can improve step-to-step symmetry in PD. Design: Twenty-four PD patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12-weeks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12- and 24-weeks following the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763. Results: At 12-weeks, the Exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the Education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12-weeks. Conclusion: Given that step-to-step symmetry improved for the Exercise group and declined for the Education group post-intervention, active interventions appear more suited to increasing independence and quality of life for people with PD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension.

Purpose of review: To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). Recent findings: Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP. Summary: Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Updates in the management of sinonasal mucosal melanoma.

Purpose of review: Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. Recent findings: In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. Summary: Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The role of frontal sinus drillouts in nasal polyposis.

Purpose of review: Historically, the common frontal sinusotomy has been reserved only for salvage frontal sinus surgery in patients with severely recalcitrant inflammatory sinus disease. By understanding the pathophysiology of inflammatory sinus disease and the long-term role of topical medication in their treatment, the indications for Draf3 have expanded. Recent findings: A major therapeutic impact from endoscopic sinus surgery for inflammatory sinus disease is imparted by allowing sinus access to topical therapies to work. Although traditionally, the Draf3 frontal sinus procedure has been reserved for revision surgery in severe cases, advancements in technology, instrumentation, and techniques has allowed the Draf3 to evolve to efficient and safe procedure, often applied primarily in select patients. There is evidence to support the indication for Draf3 in primary surgery for severe cases. Summary: In inflammatory sinus disease, the goal of endoscopic sinus surgery is to convert the complex and limited frontal sinus outflow tracts into a simple common cavity. This allows for local, topical anti-inflammatory treatments to control the disease. When patients have broader inflammatory airway disease and asthma, the Draf3, as part of a neo-sinus cavity, is commonly applied early in surgical care. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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What Neurotoxins Have Taught Us About the Brow: The Reintroduction and Review of the Transpalpebral Browpexy

Abstract

Introduction

The use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators.

Methods

A retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient.

Results

Out of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid.

Conclusion

Transpalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis.

Level of Evidence IV

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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A4hAt7