Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Abstract

Background

The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer.

Methods

We conducted a retrospective chart review of patients with aerodigestive tract cancers from 2010 to 2015. Data included inpatient and postdischarge costs, demographics, tumor characteristics, surgical treatment, length of stay (LOS), time spent in the intensive care unit (ICU), and readmissions.

Results

Five hundred ninety patients were included in this study. There was a $7624 inpatient cost savings (P = .002) for those G-tubes placed preoperatively ($26 060) versus postoperatively ($33 754). Postdischarge costs did not differ significantly between groups (P = .60). There was a $9248 total costs savings (P = .009) for those patients with G-tubes placed preoperatively ($39 751) versus postoperatively ($48 999), despite patients with preoperative G-tubes having lower body mass index (BMI; P = .009), higher Association of Anesthesiologist (ASA) class (P = .02), more preoperative radiation (P < .001), and more free tissue transfer reconstruction (P = .007).

Conclusion

There is potential for savings by placing G-tubes preoperatively, possibly driven by decreased LOS, despite data suggesting that patients with G-tubes placed preoperatively are higher risk.

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Usability of advanced pneumatic compression to treat cancer-related head and neck lymphedema: A feasibility study

Abstract

Background

This functional usability study assessed ease of use, fit, comfort, and potential clinical benefits of advanced pneumatic compression treatment of cancer-related head and neck lymphedema.

Methods

Patient-reported comfort and other treatment aspects were evaluated and multiple face and neck measurements were obtained on 44 patients with head and neck lymphedema before and after 1 treatment session to assess usability and treatment-related lymphedema changes.

Results

A majority of the patients (82%) reported the treatment was comfortable; most patients (61%) reported feeling better after treatment, and 93% reported that they would be likely to use this therapy at home. One treatment produced overall small but highly statistically significant reductions in composite metrics (mean ± SD) of the face (82.5 ± 4.3 cm vs 80.9 ± 4.1 cm; P < .001) and neck (120.4 ± 12.2 cm vs 119.2 ± 12.1 cm; P < .001) with no adverse events.

Conclusion

Results found the treatment to be safe, easy to use, and well tolerated while demonstrating edema reduction after a single initial treatment.

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Ritanserin, a serotonin-2 receptor antagonist, inhibits functional recovery after cerebral infarction

It has been suggested that serotonin (5-HT) may be implicated in functional recovery after stroke; however, the underlying molecular mechanisms remain unknown. Here, the role of 5-HT was verified using ritanserin, a potent 5-HT2A receptor antagonist, and protein expression and modification were analyzed to further understand the association between paralysis recovery and molecular mechanisms in the brain. Experimental cerebral cortex infarctions were induced by photothrombosis in rats. Voluntary exercise was initiated 2 days after surgery. Motor performance was then measured using the rotarod test. Differences in protein expression and phosphorylation in the perilesional cortex were analyzed using western blot. In behavioral evaluations, performance in the rotarod test was significantly increased by exercise. However, there was a significantly lower value in time until falling after combined exercise and ritanserin administration compared with that of exercise alone. Protein expression analysis revealed that phosphorylation of protein kinase C (PKC) α, PKCε, and growth-associated protein 43 (GAP43) was significantly upregulated by exercise. These effects were attenuated by ritanserin administration. These data suggest that 5-HT may be related to the underlying mechanisms of exercise-dependent paralysis recovery, that is, exercise-dependent plasticity through the phosphorylation of PKC and GAP43. Correspondence to Kenmei Mizutani, PhD, Joint Research Support Promotion Facility, Center for Research Promotion and Support, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan Tel: +81 562 932 468; fax: +81 592 520 710; e-mail: kenmei@fujita-hu.ac.jp Received October 12, 2017 Accepted October 14, 2017 © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

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DFD-01 Reduces Transepidermal Water Loss and Improves Skin Hydration and Flexibility

Abstract

Introduction

In plaque psoriasis, the benefit of topical steroids is well established. The vehicle formulation of topical steroids may also provide benefit in addition to the effects of the steroid itself. DFD-01 (betamethasone dipropionate spray, 0.05%) is a formulation composed of a topical steroid in an emollient-like vehicle that enhances penetration to the target site of inflammation in the skin. The aim of this study was to assess the effect of DFD-01 and its vehicle on skin hydration and barrier function in compromised skin and to evaluate its effect on flexibility in healthy skin.

Methods

Eighteen healthy white volunteers were enrolled in each of two studies. In Study 1, dry shaving of volar forearms created a compromised skin barrier, through which transepidermal water loss (TEWL) was measured using an evaporimeter. Capacitance, a measure of epidermal hydration, was also measured at baseline and at 1, 2 and 4 h after application of DFD-01 or its vehicle formulation. In Study 2, intact skin flexibility was tested with a cutometer before and at 1, 2 and 4 h after application of DFD-01 or vehicle.

Results

In Study 1, both DFD-01 and its vehicle were effective at reducing TEWL through the compromised stratum corneum. Capacitance measurements confirmed this finding; razor-chafed skin treated with either DFD-01 or vehicle exhibited levels of skin hydration similar to unshaved control skin. Study 2 found softening and greater flexibility of normal skin treated with either DFD-01 or vehicle compared with nontreated control skin samples.

Conclusions

These tests suggest that the DFD-01 formulation and its vehicle are each effective at retaining moisture within a damaged skin barrier and for softening and increasing the flexibility of intact skin.

Funding

Dr. Reddy's Laboratories.

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Reviewers 2017

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miR-140-5p-mediated regulation of the proliferation and differentiation of human dental pulp stem cells occurs through the lipopolysaccharide/toll-like receptor 4 signaling pathway

Human dental pulp stem cells (DPSCs) are oral mesenchymal stem cells with potential to differentiate into various cell types. Recent studies of DPSCs have focused on microRNAs (miRNAs), a class of small noncoding RNAs that play crucial roles in regulating DPSC phenotypes. In the current study, the expression of miR-140-5p was significantly decreased during lipopolysaccharide (LPS)-mediated differentiation of DPSCs in vitro. Overexpression of miR-140-5p enhanced proliferation of DPSCs and inhibited DPSC differentiation, whereas suppression of miR-140-5p produced the opposite effect. Moreover, the expression of toll-like receptor 4 (TLR-4), a critical regulator of DPSCs, was negatively correlated with the levels of miR-140-5p. A luciferase reporter analysis confirmed that miR-140-5p could regulate TLR-4 by directly binding to the 3′-untranslated region (3′-UTR) of the TLR4 mRNA. Additionally, we suppressed TLR-4 expression by treating cells with a TLR-4 inhibitor, CLI-095, and demonstrated that the effect of the miR-140-5p inhibitor on DPSC proliferation and differentiation could be partially reversed by blocking TLR-4. Taken together, our data suggest that miR-140-5p is a novel miRNA that regulates DPSC proliferation and differentiation.

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Volume content for 2017

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Author Guidelines

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Oral health-related quality of life, measured using the five-item version of the Oral Health Impact Profile, in relation to socio-economic status: a population survey in Sweden

Oral health-related quality of life (OHRQoL) is an important patient-reported outcome measure in dental research. This study was conducted to analyse the association between OHRQoL, as measured using the five-item version of the Oral Health Impact Profile (OHIP-5), and different socio-economic indices. A national survey of randomly selected adult individuals in Sweden (n = 3,500) was performed using telephone interviews. The questions asked for the purpose of this study were defined by the items of the OHIP-5, just as questions were asked regarding socio-economic variables, including education, income, and economic resources. Poor OHRQoL, as identified by an OHIP-5 score of 3 or higher on at least two of the five items, was statistically significantly associated in multivariate analysis with low income (OR = 1.84) and having no economic resources (OR = 2.19). The statistical models were adjusted for age, gender, ethnicity, marital status, dental-care utilization, dental anxiety, and smoking. The OHIP-5 may be used in larger epidemiological surveys because it demonstrates the ability to discriminate for a range of important areas of measurement in dental public health, including social determinants.

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A phase I/II pharmacokinetics/pharmacodynamics study of irinotecan combined with S−1 for recurrent/metastatic breast cancer in patients with selected UGT1A1 genotypes (the JBCRG-M01 study)

Abstract

S-1 and irinotecan combination is attractive for breast cancer refractory to anthracyclines and taxanes. Patients with advanced human epidermal growth factor receptor 2 (HER2)-negative breast cancer previously treated with anthracyclines and taxanes were eligible. Patients with brain metastases and homozygous for UGT1A1 *6 or *28 or compound heterozygous (*6/*28) were excluded. A dose-escalation design was chosen for the phase I portion (level 1: irinotecan 80 mg/m² days 1–8 and S-1 80 mg/m² days 1–14 every 3 weeks; level 2: irinotecan 100 mg/m² and S-1 80 mg/m²). Study objectives included determination of the recommended dose for phase II, response rate, progression-free survival (PFS), and safety. Pharmacokinetics and CD34⁺ circulating endothelial cells (CECs) as pharmacodynamics were also analyzed. Thirty-seven patients were included. One patient at each level developed dose-limiting toxicities; therefore, level 2 was the recommended dose for phase II. Diarrhea was more common in patients possessing a *6 or *28 allele compared with wild-type homozygous patients (46% and 25%). Among 29 patients treated at level 2, PFS was longer for UGT1A1 wt/*6 and wt/*28 patients than for wt/wt patients (12 vs. 8 months, P = 0.06). PFS was significantly longer in patients with a larger-than-median SN-38 area under the curve (AUC) than in those with a smaller AUC (P = 0.039). There was an association between clinical benefit and reduction in baseline CD34⁺ CECs by S-1 (P = 0.047). The combination of irinotecan and S-1 is effective and warrants further investigation.

S-1 and irinotecan combination is an attractive option for advanced human epidermal growth factor receptor 2-negative breast cancer refractory to anthracyclines and taxanes. This study determined the recommended dose and safety/efficacy profile of this combination and demonstrated the association between clinical efficacy and pharmacogenomics/pharmacokinetics/pharmacodynamics profile.

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Clinicopathological characteristics and survival outcomes in pleomorphic lobular breast carcinoma of the breast: a SEER population-based study

Abstract

The purpose of this study was to explore the clinicopathological features and survival outcome of pleomorphic lobular carcinoma (PLC) of breast, we identified 131 PLC patients and 460,109 invasive ductal carcinoma (IDC) patients in the Surveillance, Epidemiology, and End Result (SEER) database. PLCs presented with increased lymph node involvement, older age, higher AJCC stage and grade, and lower median survival months (PLC 84 ± 51.03 vs. IDC 105.2 ± 64.39 P < 0.01). Compared to IDC patients, PLC patients were more inclined to be treated with mastectomy. In univariate analysis, PLC patients showed a worse disease-specific survival (DSS) than that of IDC patients (hazard ratio = 0.691, 95% confidence interval 0.534–0.893, P < 0.01). In multivariate analysis, we took into account other prognostic factors and found that the histology types were no longer an independent prognostic factor (P = 0.120). DSS have no difference between matched IDC and PLC groups (P = 0.615). This result may be due to PLCs presenting higher tumor stage, higher tumor grade, and higher rate of LN metastasis than IDCs. Our conclusion is that PLC and IDC have many different characteristics, but there is not enough difference on the DSS.

PLC and IDC have many different characteristics, but there is not enough difference on the DSS.

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Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD. Correspondence to Sanjiv Sur, Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA. E-mail: Sasur@utmb.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD. Correspondence to Dr Vicente Plaza, MD, PhD, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, E-08025 Barcelona, Spain. Tel: +34 93 5565972; fax: +34 93 5565601; e-mail: vplaza@santpau.cat Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated. Correspondence to Pedro Giavina-Bianchi, MD, PhD, Clinical Immunology and Allergy Division, University of São Paulo, R. Prof. Artur Ramos 178 ap.211A, Jd. América, São Paulo CEP:01454-904, SP, Brazil. Tel: +55 11 30713189; fax: +55 11 30713189; e-mail: pbianchi@usp.br Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Central mucoepidermoid carcinoma arising from glandular odontogenic cyst confirmed by analysis of MAML2 rearrangement: A case report

Central mucoepidermoid carcinoma (MEC) poses a diagnostic challenge because of its rarity and histological overlap with glandular odontogenic cyst (GOC). In MEC of both salivary glands and jaws, MAML2 arrangement has been well known as the specific gene alteration. We report a case of central MEC arising from GOC diagnosed by MAML2 fusion gene. A 57-year-old male presented a multilocular cystic lesion in left molar region of the mandible. Histopathologically, multiple cysts lined by thin cuboidal or non-keratinized squamous epithelium with small duct-like structures, mucous cells and ciliated cells were present. It was diagnosed as GOC. The recurrent lesion after nine years showed the proliferation of many cystic and solid nests composed of epidermoid, mucous and intermediated cells. Nested PCR revealed CRTC3-MAML2 fusion gene in the recurrent lesion, but not in the primary one. Similarly, MAML-2 rearrangement by FISH analysis was positive in the recurrent lesion, while negative for the primary one, thus confirming the diagnosis of central MEC arising from GOC. Analysis of MAML2 rearrangement can be used as a supportive evidence to distinguish central MEC from GOC.

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Image analysis is an excellent tool for quantifying Ki-67 to predict the prognosis of gastrointestinal stromal tumor patients

We investigated the quantification of Ki-67 staining using digital image analysis (IA) as a complementary prognostic factor to the modified National Institutes of Health (NIH) classification in patients with gastrointestinal stromal tumor (GIST). We examined 92 patients, focusing on the correlation between age, sex, primary tumor site, tumor size, predominant histologic type, mitotic index, modified NIH classification (low/intermediate vs high), Ki-67 quantitation, and recurrence-free survival (RFS). We compared two IA processes for whole slide imaging (WSI) and manually captured image (MCI) methods. A Ki-67 quantitation cutoff was determined by receiver operator characteristics curve analysis. In the survival analysis, the high-risk group of a modified NIH classification, a mitotic count >5 per 20 high-powered fields, and Ki-67 cutoffs of ≥6% and ≥8% obtained by IA of the WSI and MCI methods, respectively, had an adverse impact on RFS. On multivariate analysis, each Ki-67 quantitation method strongly predicted prognosis, more strongly than the modified NIH classification. In addition, Ki-67 quantitation using IA of the MCI method could stratify low or intermediate risk and high risk GIST patients. Thus, IA is an excellent tool for quantifying Ki-67 to predict the prognosis of GIST patients, and this semiautomated approach may be preferable for patient care.

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Reading Emotion From Mouse Cursor Motions: Affective Computing Approach

Abstract

Affective computing research has advanced emotion recognition systems using facial expressions, voices, gaits, and physiological signals, yet these methods are often impractical. This study integrates mouse cursor motion analysis into affective computing and investigates the idea that movements of the computer cursor can provide information about emotion of the computer user. We extracted 16–26 trajectory features during a choice-reaching task and examined the link between emotion and cursor motions. Participants were induced for positive or negative emotions by music, film clips, or emotional pictures, and they indicated their emotions with questionnaires. Our 10-fold cross-validation analysis shows that statistical models formed from "known" participants (training data) could predict nearly 10%–20% of the variance of positive affect and attentiveness ratings of "unknown" participants, suggesting that cursor movement patterns such as the area under curve and direction change help infer emotions of computer users.

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Models of Chinese Reading: Review and Analysis

Abstract

Our understanding of the cognitive processes involved in reading has been advanced by computational models that simulate those processes (e.g., see Reichle, 2015). Unfortunately, most of these models have been developed to explain the reading of English and other alphabetic languages, with relatively fewer efforts to examine whether or not the assumptions of these models also explain what has been learned from other languages and, in particular, non-alphabetic writing systems like Chinese (e.g., see Li, Zang, Liversedge, & Pollatsek, 2015). In this article, we will review those computational models that have been developed to explain the reading of Chinese, with the goal of comparing their theoretical assumptions to those of models that explain the reading of English. Our analysis indicates that there are both points of convergence and divergence between the theoretical assumptions of Chinese versus English models, suggesting that the cognitive systems supporting reading may be differentially influenced by features of the languages and/or writing systems, or that certain theoretical assumptions developed to explain the reading of one language might be adapted to explain the reading of others.

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Interaction of zearalenone with bovine serum albumin as determined by fluorescence quenching

Abstract

The major aim of this study was to examine the binding of zearalenone (ZEN) to bovine serum albumin (BSA) by measuring the quenching of the intrinsic fluorescence of the protein under aqueous conditions. The results suggest that ZEN has a strong ability to quench the intrinsic fluorescence of BSA through a static mechanism. The hydrophobicity of the microenvironment around the tyrosine (Tyr) residues in BSA was increased in the presence of ZEN. The quenching constants, ratio of protein with ZEN, and thermodynamic parameters were determined. The collaborative action of hydrophobic and electrostatic interactions was involved in the binding process and the formation of the complex was mainly enthalpy-driven. The average binding distance between ZEN and BSA was calculated to be 2.20 nm. This is much closer in magnitude than the distance reported for the binding of most toxins to HSA and most pharmaceuticals to BSA, indicating a strong affinity.

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Contents List

Publication date: January 2018
Source:Gait & Posture, Volume 59





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Editorial Board

Publication date: January 2018
Source:Gait & Posture, Volume 59





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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial (equivalence margin = 7.4 min). SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003). Correspondence to De Q. Tran, MD, FRCPC, Professor, Department of Anaesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, Montreal, QC, Canada H3G-1A4 Tel: +1 514 934 1934x43261; fax: +1 514 934 8249; e-mail: de_tran@hotmail.com © 2017 European Society of Anaesthesiology

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Molecular testing on endobronchial ultrasound (EBUS) fine needle aspirates (FNA): Impact of triage

Abstract

Background

Endobronchial ultrasound (EBUS)-guided fine needle aspiration (FNA) is performed to diagnose and stage lung cancer. Multiple studies have described the value of Rapid On-Site Evaluation (ROSE), but often the emphasis is upon diagnosis than adequacy for molecular testing (MT). The aim was to identify variable(s), especially cytology-related, that can improve MT.

Methods

A search for EBUS-FNAs with ROSE was conducted for lung adenocarcinomas or when this diagnosis could not be excluded. All such cases underwent reflex MT on cell blocks. The impact of cytology-related variables [i.e., number of pass(es), dedicated pass(es) directly into media, cytotechnologist (CT), laboratory technician (LT) and triage with 1 or >1 cytologist] was evaluated. The latter category was divided into Group A [ROSE, triage and slide preparation by cytopathologist (CP) and CT at start of the procedure] and Group B (ROSE only by CT or by CT/CP after start of procedure; triage and slide preparation by CT or clinical staff). The impact of all these variables on MT was assessed.

Results

A total of 100 cases were identified, and 79 had sufficient tissue for MT. Of all variables evaluated, MT was positively affected by performing a direct dedicated pass (P = 0.013) and ROSE by Group A (P = 0.033).

Conclusions

ROSE with appropriate triage, including performing a dedicated pass and proper slide preparation, improves MT, and this is enhanced by having >1 cytologist at the start of the procedure. In the era of personalized medicine, "adequate" should denote sufficient tissue for diagnosis and MT.

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Cytologic findings of an adult rhabdomyoma in the parapharyngeal space: A report of a case and review of the literature

Adult extracardiac rhabdomyomas are rare benign mesenchymal tumor arising from skeletal muscle. While they are often located in the larynx and pharynx, the incidence in the parapharyngeal area is extremely rare with only 1 documented cytology case report to date. We report a case of an adult extracardiac rhabdomyoma in the parapharyngeal space diagnosed cytologically with subsequent histologic confirmation. The patient is a 57-year-old man with history of weight loss, hematuria, dysphagia, and airway encroachment. Computerized tomography of his abdomen showed a large left renal mass. While the patient was in the operating room for the resection of his renal mass, a fine-needle aspiration from left the parapharyngeal mass was performed. The smears showed uniform bland polygonal cells with abundant eosinophilic cytoplasm and peripherally located nuclei. Immunohistochemical stains performed on the cell block showed the tumor cells were desmin positive and negative for S-100 and PAX-8, supporting the diagnosis of an adult rhabdomyoma. Subsequent resection of the mass confirmed the diagnosis of an adult extracardiac rhabdomyoma.

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Ischemia reperfusion injury in aged livers - the energy metabolism, inflammatory response and autophagy

Abstract Due to the lack of adequate organs, the number of patients with end-stage liver diseases, acute liver failure or hepatic malignancies waiting for liver transplantation is constantly increasing. Accepting aged liver grafts is one of the strategies expanding the donor pool to ease the discrepancy between the growing demand and the limited supply of donor organs. However, recipients of organs from old donors may show an increased post-transplantation morbidity and mortality due to enhanced ischemia reperfusion injury. Energy metabolism, inflammatory response and autophagy are three critical processes which are involved in the ageing progress as well as in hepatic ischemia reperfusion injury. Compared to young liver grafts, impairment of energy metabolism in aged liver grafts leads to lower ATP production and an enhanced generation of free radicals, both aggravating the inflammatory response. The aggravated inflammatory response determines the extent of hepatic ischemia reperfusion injury and augments the liver damage. Autophagy protects cells by removal of damaged organelles including dysfunctional mitochondria, a process impaired in ageing and involved in ischemia reperfusion related apoptotic cell death. Furthermore, autophagic degradation of cellular compounds relieves intracellular ATP level for the energy depressed cells. Strategies targeting the mechanisms involved in energy metabolism, inflammatory response and autophagy might be especially useful to prevent the increased risk for ischemia reperfusion injury in aged livers after major hepatic surgery. CORRESPONDING AUTHOR: Uta Dahmen, M.D., Experimental Transplantation Surgery, Department of General, Visceral, and Vascular Surgery, Friedrich Schiller University of Jena, Drackendorfer Straße 1, 07747 Jena, Germany. Telephone: +49-03641-932 5350; FAX: +49-03641-932 5352; E-mail: Uta.Dahmen@med.uni-jena.de AUTHORSHIP Kan C. (Chunyi.Kan@med.uni-jena.de) contributed to conception and design as well as participated in writing the article; Ungelenk L. (Luisa.Ungelenk@med.uni-jena.de) participated in the critical revision of the article; Lupp A. (Amelie.Lupp@med.uni-jena.de) participated in the critical revision of the article; Dirsch O. (Olaf.Dirsch@gmail.com) contributed to conception, design and obtain funding as well as participated in the critical revision of the article. Dahmen U. (Uta.Dahmen@med.uni-jena.de) contributed to conception, design and obtain funding as well as participated in the critical revision of the article. DISCLOSURE The authors disclose no conflicts of interest. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD. Correspondence to Sanjiv Sur, Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA. E-mail: Sasur@utmb.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD. Correspondence to Dr Vicente Plaza, MD, PhD, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, E-08025 Barcelona, Spain. Tel: +34 93 5565972; fax: +34 93 5565601; e-mail: vplaza@santpau.cat Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated. Correspondence to Pedro Giavina-Bianchi, MD, PhD, Clinical Immunology and Allergy Division, University of São Paulo, R. Prof. Artur Ramos 178 ap.211A, Jd. América, São Paulo CEP:01454-904, SP, Brazil. Tel: +55 11 30713189; fax: +55 11 30713189; e-mail: pbianchi@usp.br Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Radiotherapy for Gastric Bleeding from Tumor Invasion of Recurrent Colon Cancer with Liver Metastasis After Resection

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Is Lipidomic the Answer to the Search of a Biomarker for Organ Preservation Protocol in Head and Neck Squamous Cell Carcinoma?

Abstract

In the last decade organ preservation protocols based on chemoradiotherapy (CRT) has been showing the possibility of preserving function without jeopardizing survival for locally advanced head and neck squamous cell carcinoma (HNSCC). Still, only a percentage of the patients will benefit from this approach and, to date, no biomarkers are known to correctly predict these patients. More recently, modern mass spectrometry method has been used to determine metabolic profiles, and lipidomics, in particular, emerged as a new field of study in oncology and other diseases. This study aimed to analyze the lipid profile on saliva from patients undergoing to a prospective, single center, open-label, non-randomized phase II trial for organ preservation on HNSCC. The lipid analysis was performed using matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). Multivariate statistical analyses based on principal component analysis and orthogonal partial least square-discriminant analysis were applied to MALDI-TOF-MS data to visualize differences between the lipid profiles and identify potential biomarkers. The results assisted on distinguishing complete responders from non-responders to the treatment protocol. In conclusion, we demonstrated that a group of lipids is differentially abundant in saliva from HNSCC patients submitted to an organ preservation protocol, being able to differentiate responders from non-responders. These results suggest the potential use of lipid biomarkers to identify patients who may benefit from this treatment. Also, we showed that saliva testing might be routinely used in clinical practice, for being a non-invasive alternative to blood testing, besides inexpensive and easy to obtain.

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Transforaminal intrathecal delivery of nusinersen using cone-beam computed tomography for children with spinal muscular atrophy and extensive surgical instrumentation: early results of technical success and safety

Abstract

Background

Nusinersen, the only treatment approved by the United States Food and Drug Administration for spinal muscular atrophy (SMA), is delivered intrathecally. Many children with SMA have extensive spinal instrumentation and deformities, often precluding the use of standard approaches for gaining intrathecal access. Furthermore the anatomical distortion that often occurs with rotoscoliosis can complicate the use of fluoroscopic guidance. Compared to fluoroscopy, CT affords superior guidance for complex needle placements. This opens up alternatives to the posterior (interlaminar) technique, including transforaminal and caudal approaches.

Objective

This study describes the early results of technical success, complications and radiation dose of intrathecal delivery of nusinersen using cone-beam CT guidance with two-axis fluoroscopic navigational overlay.

Materials and methods

We conducted a retrospective review of 15 consecutive nusinersen injections performed in four children with SMA and extensive spinal hardware precluding standard posterior lumbar puncture techniques. These children were treated using transforaminal thecal access employing cone-beam CT with navigational overlay. We analyzed results including technical success, complications and total fluoroscopy time.

Results

All procedures were technically successful. No major complications and one minor complication were reported; the minor complication was a post-procedural neuropathic headache that was attributed to procedural positioning and was treated successfully with gabapentin. The average procedural fluoroscopy time and air kerma were 1.9 min and 55.8 mGy, respectively.

Conclusion

Cone-beam CT guidance with two-axis navigational overlay is a safe, effective method for gaining transforaminal intrathecal access in children with spinal abnormalities and hardware precluding the use of standard techniques.

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Effect of noisy galvanic vestibular stimulation on center of pressure sway of static standing posture

Publication date: Available online 17 October 2017
Source:Brain Stimulation
Author(s): Yasuto Inukai, Naofumi Otsuru, Mitsuhiro Masaki, Kei Saito, Shota Miyaguchi, Sho Kojima, Hideaki Onishi
BackgroundThe vestibular system is involved in the control of standing balance. Galvanic vestibular stimulation (GVS) is a noninvasive technique that can stimulate the vestibular system. In recent years, noisy GVS (nGVS) using noise current stimulation has been attempted, but it has not been clarified whether it affects postural sway in open-eye standing.ObjectiveThe purpose of this study was to clarify the influence of nGVS on the center of pressure (COP) sway measurement in open-eye standing postural control and identify the responders of nGVS.MethodsnGVS (0.1–640 Hz) was delivered at 0.4 and 1.0 mA over the bipolar mastoid. COP sway root mean square area, sway path length, medio-lateral (ML) mean velocity, and antero-posterior (AP) mean velocity before and during nGVS in an open-eye standing posture was measured.ResultsnGVS at 0.4 and 1.0 mA significantly reduced sway path length, mean velocity. The stimulation effect of nGVS was also large in subjects with a long sway path. For subjects with high COP sway of Baseline, nGVS was effective even with stimulation for a short duration (5 s).ConclusionsThese findings suggest that nGVS improves postural sway in an open-eye standing posture among young subjects.



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Global structural integrity and effective connectivity in patients with disorders of consciousness

Publication date: Available online 11 November 2017
Source:Brain Stimulation
Author(s): Olivier Bodart, Enrico Amico, Francisco Gomez, Adenauer G. Casali, Sarah Wannez, Lizette Heine, Aurore Thibaut, Jitka Annen, Melanie Boly, Silvia Casarotto, Mario Rosanova, Marcello Massimini, Steven Laureys, Olivia Gosseries
BackgroundPrevious studies have separately reported impaired functional, structural, and effective connectivity in patients with disorders of consciousness (DOC). The perturbational complexity index (PCI) is a transcranial magnetic stimulation (TMS) derived marker of effective connectivity. The global fractional anisotropy (FA) is a marker of structural integrity. Little is known about how these parameters are related to each other.ObjectiveWe aimed at testing the relationship between structural integrity and effective connectivity.MethodsWe assessed 23 patients with severe brain injury more than 4 weeks post-onset, leading to DOC or locked-in syndrome, and 14 healthy subjects. We calculated PCI using repeated single pulse TMS coupled with high-density electroencephalography, and used it as a surrogate of effective connectivity. Structural integrity was measured using the global FA, derived from diffusion weighted imaging. We used linear regression modelling to test our hypothesis, and computed the correlation between PCI and FA in different groups.ResultsGlobal FA could predict 74% of PCI variance in the whole sample and 56% in the patients' group. No other predictors (age, gender, time since onset, behavioural score) improved the models. FA and PCI were correlated in the whole population (r = 0.86, p < 0.0001), the patients, and the healthy subjects subgroups.ConclusionWe here demonstrated that effective connectivity correlates with structural integrity in brain-injured patients. Increased structural damage level decreases effective connectivity, which could prevent the emergence of consciousness.



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International randomized-controlled trial of transcranial Direct Current Stimulation in depression

Publication date: Available online 27 October 2017
Source:Brain Stimulation
Author(s): Colleen K. Loo, Mustafa M. Husain, William M. McDonald, Scott Aaronson, John P. O'Reardon, Angelo Alonzo, Cynthia Shannon Weickert, Donel M. Martin, Shawn M. McClintock, Adith Mohan, Sarah H. Lisanby
BackgroundEvidence suggests that transcranial Direct Current Stimulation (tDCS) has antidepressant effects in unipolar depression, but there is limited information for patients with bipolar depression. Additionally, prior research suggests that brain derived neurotrophic factor (BDNF) Val66Met genotype may moderate response to tDCS.ObjectiveTo examine tDCS efficacy in unipolar and bipolar depression and assess if BDNF genotype is associated with antidepressant response to tDCS.Methods130 participants diagnosed with a major depressive episode were randomized to receive active (2.5 milliamps (mA), 30 min) or sham (0.034 mA and two 60-second current ramps up to 1 and 0.5 mA) tDCS to the left prefrontal cortex, administered in 20 sessions over 4 weeks, in a double-blinded, international multisite study. Mixed effects repeated measures analyses assessed change in mood and neuropsychological scores in participants with at least one post-baseline rating in the unipolar (N = 84) and bipolar (N = 36) samples.ResultsMood improved significantly over the 4-week treatment period in both unipolar (p = 0.001) and bipolar groups (p < 0.001). Among participants with unipolar depression, there were more remitters in the sham treatment group (p = 0.03). There was no difference between active and sham stimulation in the bipolar sample. BDNF genotype was unrelated to antidepressant outcome.ConclusionsOverall, this study found no antidepressant difference between active and sham stimulation for unipolar or bipolar depression. However, the possibility that the low current delivered in the sham tDCS condition was biologically active cannot be discounted. Moreover, BDNF genotype did not moderate antidepressant outcome.Clinical Trials Registrationwww.clinicaltrials.gov, NCT01562184.



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Report of seizure induced by 10 Hz rTMS over M1

Publication date: Available online 8 November 2017
Source:Brain Stimulation
Author(s): Valentina Bruno, Carlotta Fossataro, Francesca Garbarini




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Number of pulses or number of sessions? An open-label study of trajectories of improvement for once-vs. twice-daily dorsomedial prefrontal rTMS in major depression

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Laura Schulze, Kfir Feffer, Christopher Lozano, Peter Giacobbe, Zafiris J. Daskalakis, Daniel M. Blumberger, Jonathan Downar
BackgroundRepetitive transcranial magnetic stimulation (rTMS) shows efficacy in the treatment of major depressive episodes (MDEs), but can require ≥4–6 weeks for maximal effect. Recent studies suggest that multiple daily sessions of rTMS can accelerate response without reducing therapeutic efficacy. However, it is unresolved whether therapeutic effects track cumulative number of pulses, or cumulative number of sessions.ObjectiveThis open-label study reviewed clinical outcomes over a 20–30 session course of high-frequency bilateral dorsomedial prefrontal cortex (DMPFC)-rTMS among patients receiving 6000 pulses/day delivered either in twice-daily sessions 80 min apart (at 20 Hz) or single, longer, once-daily sessions (at 10 Hz).MethodsA retrospective chart review identified 130 MDD patients who underwent 20–30 daily sessions of bilateral DMPFC-rTMS (Once-daily, n = 65; Twice-daily, n = 65) at a single Canadian clinic.ResultsMixed-effects modeling revealed significantly faster improvement (group-by-time interaction) for twice-daily versus once-daily DMPFC-rTMS. Across both groups, the pace of improvement showed a consistent relationship with number of cumulative sessions, but not with cumulative number of pulses. Although the twice-daily group completed treatment in half as many days, final clinical outcomes did not differ significantly between groups on dichotomous measures (response/remission rates: once-daily, 35.4%/33.8%; twice-daily, 41.5%/35.4%), or continuous measures, or on overall response distribution.ConclusionsTwice-daily rTMS appears feasible, tolerable, and capable of achieving comparable results to once-daily rTMS, while also reducing course length approximately twofold. Therapeutic gains tracked the cumulative number of sessions, not pulses. Future randomized studies comparing once-daily to multiple-daily rTMS sessions, while controlling for number of pulses, may be warranted.



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Accelerated HF-rTMS in the elderly depressed: A feasibility study

Publication date: Available online 31 October 2017
Source:Brain Stimulation
Author(s): Alexandre Dardenne, Chris Baeken, Cleo L. Crunelle, Chris Bervoets, Frieda Matthys, Sarah C. Herremans




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tDCS changes in motor excitability are specific to orientation of current flow

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Vishal Rawiji, Matteo Ciocca, André Zacharia, David Soares, Dennis Truong, Marom Bikson, John Rothwell, Sven Bestmann
BackgroundMeasurements and models of current flow in the brain during transcranial Direct Current Stimulation (tDCS) indicate stimulation of regions in-between electrodes. Moreover, the folded cortex results in local fluctuations in current flow intensity and direction, and animal studies suggest current flow direction relative to cortical columns determines response to tDCS.MethodsHere we test this idea by using Transcranial Magnetic Stimulation Motor Evoked Potentials (TMS-MEP) to measure changes in corticospinal excitability following tDCS applied with electrodes aligned orthogonal (across) or parallel to M1 in the central sulcus.ResultsCurrent flow models predicted that the orthogonal electrode montage produces consistently oriented current across the hand region of M1 that flows along cortical columns, while the parallel electrode montage produces non-uniform current directions across the M1 cortical surface. We find that orthogonal, but not parallel, orientated tDCS modulates TMS-MEPs. We also show modulation is sensitive to the orientation of the TMS coil (PA or AP), which is thought to select different afferent pathways to M1.ConclusionsOur results are consistent with tDCS producing directionally specific neuromodulation in brain regions in-between electrodes, but shows nuanced changes in excitability that are presumably current direction relative to column and axon pathway specific. We suggest that the direction of current flow through cortical target regions should be considered for targeting and dose-control of tDCS.



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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression

Publication date: Available online 19 October 2017
Source:Brain Stimulation
Author(s): Kfir Feffer, Hyewon Helen Lee, Farrokh Mansouri, Peter Giacobbe, Fidel Vila-Rodriguez, Sidney H. Kennedy, Zafiris J. Daskalakis, Daniel M. Blumberger, Jonathan Downar
BackgroundPredicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80–90%. This approach has recently been extended to ECT, but never before to rTMS.ObjectiveTo assess the accuracy of 2-week clinical response in predicting rTMS treatment outcome.MethodsWe reviewed clinical symptom scores for 101 patients who underwent 20 sessions of dorsomedial prefrontal rTMS for unipolar major depression in a naturalistic retrospective case series, defining nonresponders both at the conventional <50% improvement criterion and at a more stringent <35% criterion.ResultsPatients achieving <20% improvement at session 10 were correctly predicted as nonresponders with NPVs of 88.2% by the conventional and 80.4% by the stringent criterion. Achieving <10% improvement at session 10 predicted nonresponse with NPVs of 89.5% and 86.8% by conventional and stringent criteria, respectively. Using the least-depressed score of either session 5 or 10, <20% improvement predicted nonresponse with NPVs of 91.3% and 82.6%, and <10% improvement predicted nonresponse with NPVs of 93.5% and 93.5%, by conventional and stringent criteria.ConclusionFor DMPFC-rTMS, a '<20% improvement at 2 weeks' rule concurred with previous pharmacotherapy and ECT studies on predicting nonresponse, and could prove useful for treatment decision-making in clinical settings.



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Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study

Publication date: Available online 7 November 2017
Source:Brain Stimulation
Author(s): Wang-Sheng Lin, Chen-Liang Chou, Miao-Hsiang Chang, Yuh-Mei Chung, Fu-Gong Lin, Po-Yi Tsai
Background & aimsStroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS.MethodWe conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration–Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures–Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters.ResultsTMSreal exhibited significant improvement in all swallowing outcomes—neurophysiological, radiological, and functional—compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05).ConclusionsOur results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation.Clinical trial registrationURL: http://ift.tt/1xHjpsE. Unique identifier: NCT02893033.



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Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study

Publication date: Available online 11 November 2017
Source:Brain Stimulation
Author(s): Lana Donse, Frank Padberg, Alexander T. Sack, A. John Rush, Martijn Arns
BackgroundRepetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, rTMS + PT may exert enhanced antidepressant effects compared to the respective monotherapies.ObjectiveThe current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS + PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission.MethodsA total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission.Major findings and conclusions1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS + PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS + PT.



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Masthead

Publication date: November–December 2017
Source:Brain Stimulation, Volume 10, Issue 6





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Editorial Board

Publication date: November–December 2017
Source:Brain Stimulation, Volume 10, Issue 6





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Table of Contents

Publication date: November–December 2017
Source:Brain Stimulation, Volume 10, Issue 6





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Safety of repeated sessions of transcranial direct current stimulation: A systematic review

Publication date: Available online 31 October 2017
Source:Brain Stimulation
Author(s): Stevan Nikolin, Christina Huggins, Donel Martin, Angelo Alonzo, Colleen K. Loo
BackgroundRepeated sessions of transcranial direct current stimulation (tDCS) are increasingly used for therapeutic applications. However, adverse events (AEs) associated with repeated sessions have not been comprehensively evaluated.ObjectiveThe aim of this study was therefore to evaluate the safety of repeated sessions of tDCS, examining AE risk relative to tDCS exposure. Further, to identify whether certain participant populations are particularly at risk from tDCS.MethodsA systematic review and meta-analysis included sham-controlled studies (up to June 2017) involving two or more tDCS sessions, spaced not more than a day apart. Data was extracted on AEs reported, total tDCS exposure (cumulative charge), and diagnostic groups (Healthy, Pain Disorder, Stroke, Neurocognitive Disorder, Neuropsychiatric Disorder, and Other). Univariate simple linear meta-regression analyses examined AE likelihood, comparing active and sham tDCS, with increasing exposure. Rates of AEs were compared for diagnostic groups.Results158 studies (total 4130 participants) met inclusion criteria and were included for quantitative analyses. The incidence of AEs (examined per session, by proportion of participants, and by the number of studies reporting AEs) did not increase with higher levels of tDCS exposure. Furthermore, AE rates were not found to be greater for any diagnostic group.ConclusionsLittle evidence was found to suggest that repeated sessions of active tDCS pose increased risk to participants compared to sham tDCS within the limits of parameters used to date. Increased risks associated with greater levels of exposure to tDCS, or rare and under-reported AEs, however, cannot be ruled out.



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Information for Authors

Publication date: November–December 2017
Source:Brain Stimulation, Volume 10, Issue 6





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Responders to rTMS for depression show increased fronto-midline theta and theta connectivity compared to non-responders

Publication date: Available online 27 October 2017
Source:Brain Stimulation
Author(s): N.W. Bailey, K.E. Hoy, N.C. Rogasch, R.H. Thomson, S. McQueen, D. Elliot, C.M. Sullivan, B.D. Fulcher, Z.J. Daskalakis, P.B. Fitzgerald
BackgroundRepetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, but only some individuals respond. Predicting response could reduce patient and clinical burden. Neural activity related to working memory (WM) has been related to mood improvements, so may represent a biomarker for response prediction.Primary hypothesesWe expected higher theta and alpha activity in responders compared to non-responders to rTMS.MethodsFifty patients with treatment resistant depression and twenty controls performed a WM task while electroencephalography (EEG) was recorded. Patients underwent 5–8 weeks of rTMS treatment, repeating the EEG at week 1 (W1). Of the 39 participants with valid WM-related EEG data from baseline and W1, 10 were responders. Comparisons between responders and non-responders were made at baseline and W1 for measures of theta (4–8 Hz), upper alpha (10–12.5 Hz), and gamma (30–45 Hz) power, connectivity, and theta-gamma coupling. The control group's measures were compared to the depression group's baseline measures separately.ResultsResponders showed higher levels of WM-related fronto-midline theta power and theta connectivity compared to non-responders at baseline and W1. Responder's fronto-midline theta power and connectivity was similar to controls. Responders also showed an increase in gamma connectivity from baseline to W1, with a concurrent improvement in mood and WM reaction times. An unbiased combination of all measures provided mean sensitivity of 0.90 at predicting responders and specificity of 0.92 in a predictive machine learning algorithm.ConclusionBaseline and W1 fronto-midline theta power and theta connectivity show good potential for predicting response to rTMS treatment for depression.



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Electroconvulsive therapy, depression, the immune system and inflammation: A systematic review

Publication date: Available online 19 October 2017
Source:Brain Stimulation
Author(s): Antoine Yrondi, Marie Sporer, Patrice Péran, Laurent Schmitt, Christophe Arbus, Anne Sauvaget
BackgroundThe management and treatment of major depressive disorder are major public health challenges, the lifetime prevalence of this illness being 4.4%–20% in the general population. Major depressive disorder and treatment resistant depression appear to be, in part, related to a dysfunction of the immune response. Among the treatments for depression ECT occupies an important place. The underlying cerebral mechanisms of ECT remain unclear.Objectives/HypothesisThe aim of this review is to survey the potential actions of ECT on the immuno-inflammatory cascade activated during depression.MethodsA systematic search of the literature was carried out, using the bibliographic search engines PubMed and Embase. The search covered articles published up until october 2017.The following MESH terms were used: Electroconvulsive therapy AND (inflammation OR immune OR immunology).ResultsOur review shows that there is an acute immuno-inflammatory response immediately following an ECT session. There is an acute stress reaction. Studies show an increase in the plasma levels of cortisol and of interleukins 1 and 6. However, at the end of the course of treatment, ECT produces, in the long term, a fall in the plasma level of cortisol, a reduction in the levels of TNF alpha and interleukin 6.LimitationsOne of the limitations of this review is that a large number of studies are relatively old, with small sample sizes and methodological bias.ConclusionAdvances in knowledge of the immuno-inflammatory component of depression seem to be paving the way towards models to explain the mechanism of action of ECT.



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Stochastic resonance in the human vestibular system – Noise-induced facilitation of vestibulospinal reflexes

Publication date: Available online 31 October 2017
Source:Brain Stimulation
Author(s): M. Wuehr, J.C. Boerner, C. Pradhan, J. Decker, K. Jahn, T. Brandt, R. Schniepp
BackgroundThere is strong evidence that the presence of noise can enhance information processing in sensory systems via stochastic resonance (SR).ObjectivesTo examine the presence of SR in human vestibulospinal reflex function.MethodsHealthy subjects were stimulated with 1 Hz sinusoidal GVS of varying amplitudes (0–1.9 mA). Coherence between GVS input and stimulation-induced motion responses was determined and psychometric function fits were subsequently used to determine individual vestibulospinal reflex thresholds. This procedure was repeated with additional application of imperceptible white noise GVS (nGVS).ResultsnGVS significantly facilitated the detectability of weak subthreshold vestibular inputs (p < 0.001) and thereby effectively lowered the vestibulospinal threshold in 90% of participants (p < 0.001, mean reduction: 17.5 ± 14.6%).ConclusionThis finding provides evidence for the presence of SR-dynamics in the human vestibular system and gives a functional explanation for previously observed ameliorating effects of low-intensity vestibular noise stimulation on balance control in healthy subjects and patients with vestibular hypofunction.



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Simultaneous aerobic exercise and rTMS: Feasibility of combining therapeutic modalities to treat depression

Publication date: Available online 31 October 2017
Source:Brain Stimulation
Author(s): Ryan E. Ross, Catherine J. VanDerwerker, Jennifer H. Newton, Mark S. George, E. Baron Short, Gregory L. Sahlem, A.J. Manett, James B. Fox, Chris M. Gregory




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Sensory percepts induced by microwire array and DBS microstimulation in human sensory thalamus

Publication date: Available online 27 October 2017
Source:Brain Stimulation
Author(s): Brandon D. Swan, Lynne B. Gasperson, Max O. Krucoff, Warren M. Grill, Dennis A. Turner
BackgroundMicrostimulation in human sensory thalamus (ventrocaudal, VC) results in focal sensory percepts in the hand and arm which may provide an alternative target site (to somatosensory cortex) for the input of prosthetic sensory information. Sensory feedback to facilitate motor function may require simultaneous or timed responses across separate digits to recreate perceptions of slip as well as encoding of intensity variations in pressure or touch.ObjectivesTo determine the feasibility of evoking sensory percepts on separate digits with variable intensity through either a microwire array or deep brain stimulation (DBS) electrode, recreating "natural" and scalable percepts relating to the arm and hand.MethodsWe compared microstimulation within ventrocaudal sensory thalamus through either a 16-channel microwire array (∼400 kΩ per channel) or a 4-channel DBS electrode (∼1.2 kΩ per contact) for percept location, size, intensity, and quality sensation, during thalamic DBS electrode placement in patients with essential tremor.ResultsPercepts in small hand or finger regions were evoked by microstimulation through individual microwires and in 5/6 patients sensation on different digits could be perceived from stimulation through separate microwires. Microstimulation through DBS electrode contacts evoked sensations over larger areas in 5/5 patients, and the apparent intensity of the perceived response could be modulated with stimulation amplitude. The perceived naturalness of the sensation depended both on the pattern of stimulation as well as intensity of the stimulation.ConclusionsProducing consistent evoked perceptions across separate digits within sensory thalamus is a feasible concept and a compact alternative to somatosensory cortex microstimulation for prosthetic sensory feedback. This approach will require a multi-element low impedance electrode with a sufficient stimulation range to evoke variable intensities of perception and a predictable spread of contacts to engage separate digits.



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Clarion call for histopathological clot analysis in “cryptogenic” ischemic stroke: implications for diagnosis and treatment

Abstract

Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging. Retrospective gram stain of his clot confirmed a diagnosis of infective endocarditis. This raises an important issue regarding need for more routine histopathological analysis of clot retrieved after EVT in "cryptogenic" stroke patients particularly those with valvular heart disease.

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Everolimus for treatment of tuberous sclerosis complex-associated neuropsychiatric disorders

Abstract

Objective

To evaluate if short-term treatment with everolimus was safe and could improve neurocognition and behavior in children with TSC.

Methods

This was a prospective, double-blind randomized, placebo-controlled two-center phase II study. Participants diagnosed with TSC and age 6–21 years were treated with 4.5 mg/m² per day of oral everolimus (n = 32) or matching placebo (n = 15) taken once daily for 6 months. For efficacy, a comprehensive neurocognitive and behavioral evaluation battery was performed at baseline, 3 months, and 6 months. For safety, adverse events recorded continuously via patient diary were categorized and graded per NCI Common Toxicity Criteria for Adverse Events, version 3.0 (CTCAE 3.0). Analyses were performed on the intention-to-treat population (n = 47).

Results

Nearly all assessment measures failed to demonstrate significant differences between the two groups at the end of 6 months. Only one measure each of executive function (Cambridge Neuropsychological Test Automated Battery Stockings of Cambridge) favoring placebo (P = 0.025) and social cognition (Social Responsiveness Scale Social Cognition Subscale) favoring everolimus (P = 0.011) was observed. A total of 473 adverse events (AE) were reported. The average number of total AE per subject was similar for both placebo and everolimus. Most were mild or moderate in severity and serious AE were rare.

Interpretation

While safe, oral everolimus administered once daily for 6 months did not significantly improve neurocognitive functioning or behavior in children with TSC.

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Issue Information

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Functional Outcomes of Acute Inpatient Rehabilitation In Patients With Chronic Graft-Versus Host Disease

Growing numbers of allogeneic stem cell transplants (HSCT) and improved post-transplant care have led to an increase of individuals with chronic graft versus host disease (cGVHD). Although cGVHD leads to functional impairment for many, there is limited literature regarding the benefits of acute inpatient rehabilitation for cGVHD patients.

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Posterior Nutcracker Phenomenon in a Patient with Left Atrial Isomerism

THORAC CARDIOV SURG Reports 2017; 06: e35-e36
DOI: 10.1055/s-0037-1608622

Background Nutcracker phenomenon (NCP) can occur due to various anatomical anomalies. Anterior and posterior NCP are defined in the literature. Posterior NCP combined with left atrial isomerism is a rare condition. Case description We present a rare case of an asymptomatic posterior NCP involving the azygos vein in a patient with a complex cardiovascular pathology with left atrial isomerism, left ventricular outflow tract obstruction, interrupted inferior vena cava, and azygos continuation. Conclusion Detection of the NCP especially involving such a rare anatomical anomaly as an azygos continuation has a crucial importance for diagnostic and surgical procedures.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Defining the Role of Free Flaps in Partial Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0037-1607363

Background Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer. Methods A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction. Results There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap. Conclusion Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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EMCrit Podcast 212 – Thoughts on Deliberate Practice and Expertise

My thoughts on the recent interview with Anders Ericcson

EMCrit by Scott Weingart.

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Sarcopenia in Peripheral Arterial Disease: Prevalence and Impact on Functional Status

Publication date: Available online 11 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Odessa Addison, Steven J. Prior, Rishi Kundi, Monica C. Serra, Leslie I. Katzel, Andrew W. Gardner, Alice S. Ryan
ObjectivesTo determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD) and to compare to a subset of the group to age, race, sex, and body mass index (BMI)-matched non-PAD control counterparts. We also sought to compare the functional status of those with PAD with and without sarcopenia.DesignCohort study.SettingA Veterans Affairs medical center.ParticipantsSedentary, community dwelling men age 50+ years with a confirmed diagnosis of PAD (N=108; 44% black; BMI 27.8 ± 0.4 kg/m²; ABI:0.62 ± 0.01; mean ±SEM).InterventionsNot applicable.Main OutcomesDual-energy x-ray absorptiometry scans were used to assess appendicular lean mass (ALM) and determine the prevalence of sarcopenia by ALM/height² (ALM/ht²). Treadmill tests were used to determine claudication onset time (COT), peak walking time (PWT), and claudication recovery time (CRT). Six-minute walk distance (6MWD) was also measured.ResultsSarcopenia prevalence in our PAD cohort was 25%. The PAD subset (N=42) matched with control counterparts for race, sex, age, and BMI had higher prevalence rates compared with their non-PAD counter parts (23.8% vs 2.4%, P<0.05). Individuals with sarcopenia (N=28) had lower 6MWD (p<0.05; 326± 18.8 vs 380 ± 9.7 meters) and higher CRT (p<0.05; 592 ± 98 vs 395 ± 29 seconds) compared to individuals with PAD but without sarcopenia (N=80). There was no difference in COT or PWT between the PAD groups.ConclusionsMen with PAD demonstrate a high prevalence of sarcopenia. Those with sarcopenia and PAD demonstrate decreased mobility function.



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Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial.

Publication date: Available online 11 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bodes Pardo Gema., Lluch Girbés Enrique., Roussel Nathalie A., Gallego Izquierdo Tomás., Jiménez Penick Virginia., Pecos Martín Daniel.
AimTo assess the effect of a pain neurophysiology education program plus therapeutic exercise for patients with chronic low back pain (CLBP).DesignSingle-blind randomized controlled trial.SettingPrivate clinic (Clínica Bonn) and Alcalá de Henares University, Madrid, Spain.Participants56 patients with CLBP for 6 months or more.InterventionParticipants were randomized to receive either a therapeutic exercise (TE) program consisting of motor control, stretching, and aerobic exercises (TE group, n=28) or the same therapeutic exercise program in addition to a pain neurophysiology education program (PNE+TE group, n=28), conducted in two 30 to 50 minute sessions in groups of 4 to 6 participants.Main outcomes measuresThe primary outcome was pain intensity rated on the Numeric Pain Rating Scale which was completed immediately following treatment and at a 1-month and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and the Patient Global Impression of Change.ResultsAt the 3-month follow-up, a large change in pain intensity (-2.2 (-2.93,-1.28), p<0.001; d=1.37) was observed for the PNE+TE group, and a moderate effect size was observed for the secondary outcome measures.ConclusionCombining pain neurophysiology education plus therapeutic exercise resulted in significantly better results for participants with CLBP, with a large effect size, compared to therapeutic exercise alone.



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A systematic review on the effect of serious games and wearable technology used in rehabilitation of patients with traumatic bone and soft tissue injuries

Publication date: Available online 11 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Henriëtte A.W. Meijer, Maurits Graafland, J. Carel Goslings, Marlies P. Schijven
ObjectiveTo determine the effects on functional outcomes and treatment adherence of wearable technology and serious games (i.e., interactive computer applications with specific purposes useful in the 'real world') currently applied in physical rehabilitation of patients after traumatic bone and soft tissue injuries.Data SourcesPubMed, Embase, the Cochrane Library and CINAHL were searched without publication date restrictions for the terms 'wearable', 'serious game', 'videogame' or 'mobile application', and 'rehabilitation', 'exercise therapy' or 'physiotherapy'.Study SelectionThe search yielded 2704 eligible articles, which were screened by two independent reviewers. Studies comparing a serious game to standard therapy were included.Data ExtractionMethodology and results of the studies were critically appraised in conformity with PRISMA guidelines.Data SynthesisTwelve articles were included, all of which tested 'off-the-shelf' games. No studies on 'wearable-controlled' games, or games specifically developed for rehabilitation could be included. Medical conditions included post-operative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only two studies found beneficial effects of serious games over conventional therapy. One of three studies reporting pain scores found beneficial effects of a serious game compared to physiotherapy. One out of five trials reporting treatment adherence found a statistically significant advantage in the game-group compared to conventional physiotherapy. Due to heterogeneity in study design and outcome measures, pooling of data was not possible.ConclusionsSerious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injury. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence.



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Cancer stem cell and its niche in malignant progression of oral potentially malignant disorders

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Subin Surendran, Gangotri Siddappa, Amrutha Mohan, Wesley Hicks, Vijayvel Jayaprakash, Christina Mimikos, Mohammed Mahri, Fatima Almarzouki, Kayla Morrell, Ravindra Ravi, Sindhu Govindan, C.N. Sushma, Nisheena Raghavan, Praveen Birur, Jeyaram Ilayaraja, Mihai Merzianu, Mary Reid, Amritha Suresh, Moni Abraham Kuriakose
ObjectiveThe purpose of this study was to determine association between cancer stem cells (CSCs) and their niche with progression of oral potentially malignant disorders.Materials and methodsPatients with histologically confirmed oral potentially malignant disorders, stratified into high/low risk lesions based on the degree of dysplasia and oral cancer were included in this study. Immunohistochemical profiling of markers of CSCs (CD44), endothelial cells (CD31) and CSC-vascular niche cross-talk (CXCR4 and SDF1) were carried out. Statistical analysis was performed to correlate the relationship of markers with histopathology grade (ANOVA, and χ² test, unpaired t test) using GraphPad InStat v3.06.ResultsThe study included 550 samples (349 patients) and analysis showed progressive increase in expression levels of CSC and its niche markers with increase in grade of dysplasia as compared to the normal cohort (p < 0.05). Co-expression analysis revealed that, in comparison to the normal cohort, a larger percentage of patients showed increased expression of CD31 and CD44 (CD31^high/CD44^high; p < 0.05) and of CXCR4 and SDF1 (CXCR4^high/SDF1^high; p = 0.04), suggesting an association of the CSCs and the vascular niche. Further, distribution of patients with CD44^high/CXCR4^high (p < 0.05) and CD31^high/SDF1^high (p = 0.01) was significantly increased in the high-risk group (18%), suggesting a correlation between CD44⁺/CXCR4⁺ cells, the vascular niche and progression of oral dysplastic lesions.ConclusionThe increased expression of CSCs, the vascular niche and their cross talk markers are associated with increase in severity of dysplasia suggesting their role in the progression of oral potentially malignant disorders and may hence be used in identifying high-risk OPMD.



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Evaluating the association between household air pollution and oral cancer

Publication date: Available online 12 November 2017
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil, Sachin C. Sarode, Gargi S. Sarode, Chandini Rajkumar




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The utility of oral brush cytology in the early detection of oral cancer and oral potentially malignant disorders: A systematic review

Abstract

Objectives

This systematic review aimed to analyze the published evidence for the use of oral brush cytology for the early detection of oral cancer and oral potentially malignant disorders (OPMDs).

Methods

Literature was systematically searched through several databases: MEDLINE, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science. Additional review was performed through cross checks on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of oral brush cytology on human tissues and its applications in the diagnosis, screening or surveillance of oral cancer or OPMDs.

Results

The search strategy resulted in 343 abstracts or full-text articles, of which 36 met the inclusion criteria. The year of publication ranged from 1994 to 2017, and a total of 4302 samples from OPMDs, oral squamous cell carcinoma, and healthy controls have been investigated. Baby toothbrush, Cytobrush, OralCDx^®, and Orcellex^® are the brushes that were used to obtain transepithelial mucosal samples for conventional and liquid-based cytology evaluation.

Conclusions

Findings from this paper indicate that meaningful evidence-based recommendations for the implementation of a minimally-invasive technique to be utilized as an adjunctive tool for screening and early detection of oral cancer and OPMDs are complicated from the reported studies in the literature. There is need for well-designed clinical studies to assess the accuracy of oral brush cytology utilizing validated cytological assessment criteria for the diagnosis and prediction of OPMDs.

This article is protected by copyright. All rights reserved.

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High-definition transcranial direct current stimulation of the dorsolateral prefrontal cortex for tinnitus modulation: a preliminary trial.

High-definition transcranial direct current stimulation of the dorsolateral prefrontal cortex for tinnitus modulation: a preliminary trial.

J Neural Transm (Vienna). 2017 Nov 10;:

Authors: Shekhawat GS, Vanneste S

Abstract
Tinnitus is the perception of sound in the absence of its external source. Non-invasive neuromodulation techniques have been used in the past decade to investigate the impact of stimulation on tinnitus perception. The objective is to invest the impact of high-definition transcranial direct current stimulation (HD-tDCS) of dorsolateral prefrontal cortex (DLPFC) stimulation on tinnitus loudness and annoyance. Thirteen participants underwent two sessions of HD-tDCS (real and sham) in a double blind, sham controlled, randomized trial. The washout period between the real and sham stimulation session was 1 week. Tinnitus loudness and annoyance was measured using a ten-point tinnitus loudness/annoyance numeric rating scale at the baseline, after 5, 10, 15 and 20 min of stimulation. There was a significant reduction in the tinnitus loudness after the HD-tDCS of DLPFC. A comparison of the different time points (5, 10, 15 and 20 min) with the baseline measurement for tinnitus loudness showed a statistically significant reduction after 15 min (t = 1.82, p = 0.047) and 20 min (t = 1.82, p = 0.047) of stimulation using the real HD-tDCS; this effect was not observed for tinnitus annoyance. HD-tDCS of DLPFC is a safe technique for tinnitus modulation. The most common transient sensations experienced during HD-tDCS were tingling, sleepiness and scalp pain. HD-tDCS of DLPFC resulted in transient tinnitus loudness suppression after 15 min of stimulation. We propose the optimum stimulation duration for HD-tDCS of DLPFC for tinnitus suppression to be 15 min instead of 20 min.

PMID: 29127483 [PubMed - as supplied by publisher]

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Plasticity in the auditory system.

Plasticity in the auditory system.

Hear Res. 2017 Oct 31;:

Authors: Irvine DRF

Abstract
Over the last 30 years a wide range of manipulations of auditory input and experience have been shown to result in plasticity in auditory cortical and subcortical structures. The time course of plasticity ranges from very rapid stimulus-specific adaptation to longer-term changes associated with, for example, partial hearing loss or perceptual learning. Evidence for plasticity as a consequence of these and a range of other manipulations of auditory input and/or its significance is reviewed, with an emphasis on plasticity in adults and in the auditory cortex. The nature of the changes in auditory cortex associated with attention, memory and perceptual learning depend critically on task structure, reward contingencies, and learning strategy. Most forms of auditory system plasticity are adaptive, in that they serve to optimize auditory performance, prompting attempts to harness this plasticity for therapeutic purposes. However, plasticity associated with cochlear trauma and partial hearing loss appears to be maladaptive, and has been linked to tinnitus. Three important forms of human learning-related auditory system plasticity are those associated with language development, musical training, and improvement in performance with a cochlear implant. Almost all forms of plasticity involve changes in synaptic excitatory - inhibitory balance within existing patterns of connectivity. An attractive model applicable to a number of forms of learning-related plasticity is dynamic multiplexing by individual neurons, such that learning involving a particular stimulus attribute reflects a particular subset of the diverse inputs to a given neuron being gated by top-down influences. The plasticity evidence indicates that auditory cortex is a component of complex distributed networks that integrate the representation of auditory stimuli with attention, decision and reward processes.

PMID: 29126650 [PubMed - as supplied by publisher]

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[Reduced visual field due to a benign tumor of the upper eyelid].

[Reduced visual field due to a benign tumor of the upper eyelid].

HNO. 2017 Nov 10;:

Authors: Pausch NC, Wiegand S

PMID: 29127446 [PubMed - as supplied by publisher]

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Influence of coupler size on revision rate and timing of revision after free flap tissue transfer in the head and neck.

Influence of coupler size on revision rate and timing of revision after free flap tissue transfer in the head and neck.

Eur Arch Otorhinolaryngol. 2017 Nov 10;:

Authors: Kisser U, Adderson-Kisser C, Baumeister P, Reiter M

Abstract
OBJECTIVE: Microvascular coupler devices have been proven an effective alternative to standard hand-sutured anastomoses in reconstructive surgery. Until now, the influence of the coupler size on the revision rate after free flap tissue transfer in head and neck surgery has not been investigated. Neither has its influence on the timing of venous revisions.
MATERIALS AND METHODS: A retrospective mono-center cohort study was performed in order to analyze the influence of coupler size on timing and revision rate of microvascular procedures.
RESULTS: 437 patients who had undergone surgery between 2009 and 2015 were included. The statistical analysis of coupler size and revision rate due to venous complications showed a significant reduction of more than 40% in the revision rate for each additional mm in the coupler size. We observed revisions due to venous congestion until the fourth day postoperatively within our cohort. However, when the coupler size used was ≥ 3 mm, no venous congestion occurred later than 12 h after surgery.
CONCLUSION: The quantitative effects of coupler size on the revision rate in head and neck reconstruction were demonstrated for the first time. We recommend spending extra time and effort on dissecting the largest possible vein in order to be able to choose the largest possible coupler size for the venous anastomosis. As a consequence of our findings, we limit our postoperative monitoring for patients with a coupler ≥ 3 mm to 24 h, as later venous congestions are very unlikely.

PMID: 29127507 [PubMed - as supplied by publisher]

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Perhaps consider transmeatal approach for microscopic myringoplasty.

Perhaps consider transmeatal approach for microscopic myringoplasty.

Eur Arch Otorhinolaryngol. 2017 Nov 10;:

Authors: Borgstein J, Kalule CMN

PMID: 29127506 [PubMed - as supplied by publisher]

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High-resolution ultrasonography of the normal extratemporal facial nerve.

High-resolution ultrasonography of the normal extratemporal facial nerve.

Eur Arch Otorhinolaryngol. 2017 Nov 10;:

Authors: Wegscheider H, Volk GF, Guntinas-Lichius O, Moriggl B

Abstract
The technical advances in sonography of the past decade have supported the rapid improvement of high-resolution imaging, which enables the quick visualization of peripheral nerves at relatively limited costs. Recently, the possibility of visualizing the extratemporal facial nerve (FN) has been considered. This manuscript describes the first systematic evaluation in cadavers, of a novel ultrasonographic approach with this specific aim. Eight cadaveric hemifaces were evaluated by means of high-frequency ultrasound with two linear (13 and 22 MHz) and a convex transducer (6.6 MHz), to detect the extratemporal course of the FN starting from its exit at the stylomastoid foramen: the main trunk, the parotid plexus between the two parts of the parotid gland, the distal branches terminating into the orbicularis oculi and the zygomatic major muscle. Ultrasound-guided color injections and FN dissection were performed to confirm the results. The main trunk of the FN, as it exits the stylomastoid foramen, was correctly stained in 6/8 cases, the parotid plexus in 8/8 cases. The branches innervating the orbicularis oculi muscle were stained in 7/7 and the branches innervating the zygomatic major muscle in 6/7 hemifaces, after 1 was withdrawn due to insufficient image quality. Through our novel approach of high-resolution ultrasonography we could identify the various portions of the extratemporal FN, including its main trunk leaving the stylomastoid foramen, in an accurate and reproducible way. Further in vivo animal and clinical studies have been planned to confirm these initial results from cadavers.

PMID: 29127505 [PubMed - as supplied by publisher]

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Plasticity in the auditory system.

Plasticity in the auditory system.

Hear Res. 2017 Oct 31;:

Authors: Irvine DRF

Abstract
Over the last 30 years a wide range of manipulations of auditory input and experience have been shown to result in plasticity in auditory cortical and subcortical structures. The time course of plasticity ranges from very rapid stimulus-specific adaptation to longer-term changes associated with, for example, partial hearing loss or perceptual learning. Evidence for plasticity as a consequence of these and a range of other manipulations of auditory input and/or its significance is reviewed, with an emphasis on plasticity in adults and in the auditory cortex. The nature of the changes in auditory cortex associated with attention, memory and perceptual learning depend critically on task structure, reward contingencies, and learning strategy. Most forms of auditory system plasticity are adaptive, in that they serve to optimize auditory performance, prompting attempts to harness this plasticity for therapeutic purposes. However, plasticity associated with cochlear trauma and partial hearing loss appears to be maladaptive, and has been linked to tinnitus. Three important forms of human learning-related auditory system plasticity are those associated with language development, musical training, and improvement in performance with a cochlear implant. Almost all forms of plasticity involve changes in synaptic excitatory - inhibitory balance within existing patterns of connectivity. An attractive model applicable to a number of forms of learning-related plasticity is dynamic multiplexing by individual neurons, such that learning involving a particular stimulus attribute reflects a particular subset of the diverse inputs to a given neuron being gated by top-down influences. The plasticity evidence indicates that auditory cortex is a component of complex distributed networks that integrate the representation of auditory stimuli with attention, decision and reward processes.

PMID: 29126650 [PubMed - as supplied by publisher]

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