Spatializing Emotion: No Evidence for a Domain-General Magnitude System

Abstract

People implicitly associate different emotions with different locations in left-right space. Which aspects of emotion do they spatialize, and why? Across many studies people spatialize emotional valence, mapping positive emotions onto their dominant side of space and negative emotions onto their non-dominant side, consistent with theories of metaphorical mental representation. Yet other results suggest a conflicting mapping of emotional intensity (a.k.a., emotional magnitude), according to which people associate more intense emotions with the right and less intense emotions with the left — regardless of their valence; this pattern has been interpreted as support for a domain-general system for representing magnitudes. To resolve the apparent contradiction between these mappings, we first tested whether people implicitly map either valence or intensity onto left-right space, depending on which dimension of emotion they attend to (Experiments 1a, b). When asked to judge emotional valence, participants showed the predicted valence mapping. However, when asked to judge emotional intensity, participants showed no systematic intensity mapping. We then tested an alternative explanation of findings previously interpreted as evidence for an intensity mapping (Experiments 2a, b). These results suggest that previous findings may reflect a left-right mapping of spatial magnitude (i.e., the size of a salient feature of the stimuli) rather than emotion. People implicitly spatialize emotional valence, but, at present, there is no clear evidence for an implicit lateral mapping of emotional intensity. These findings support metaphor theory and challenge the proposal that mental magnitudes are represented by a domain-general metric that extends to the domain of emotion.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ze88TR

Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis

Objectives/Hypothesis

The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature.

Methods

A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression.

Results

The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score.

Conclusions

Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 2017

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

Determining Candidate Single Nucleotide Polymorphisms in Acquired Laryngotracheal Stenosis

Objectives/Hypothesis

Despite wide adoption of strategies to prevent injury from prolonged intubation and tracheotomy, acquired laryngotracheal stenosis (ALTS) has not disappeared. ALTS' persistence may be due to patient factors that confer unique susceptibility for some. We sought to identify genetic markers in genes associated with wound healing that could be associated with ALTS.

Study Design

Case-control study.

Methods

One hundred thirty-eight patients were recruited, 53 patients with ALTS and 85 control patients who underwent intubation or tracheotomy without evidence of ALTS. The patients' DNA was isolated from whole blood. Custom primers were designed, and the TaqMan assay employing allele-specific polymerase chain reaction was used to interrogate single nucleotide polymorphisms (SNPs) rs1799750, rs522616, rs2276109, rs2569190, rs1800469, and rs1024611 of candidate wound healing genes MMP1, MMP3, MMP12, CD14, TGFβ1, and MCP1, respectively. A logistic regression model was used to examine the association of candidate gene polymorphisms with the presence or absence of ALTS.

Results

All 138 patients were successfully genotyped. No significant association was found between candidate SNPs and development of ALTS in the overall group. However, subgroup analysis within each ethnicity identified SNPs that are associated with ALTS depending upon the ethnic background.

Conclusions

Patient factors such as variations in wound healing due to functional SNPs may shed light on the development of ALTS. There may be a difference in susceptibility to developing ALTS in different ethnic backgrounds. These preliminary findings need to be corroborated in larger population studies.

Level of Evidence

3b Laryngoscope, 2017

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2B2suAh

Detection of Hepatitis C antibodies without viral transmission in Hepatitis C negative recipients receiving kidneys from Hepatitis C positive donors treated with Direct Acting Anti-Viral Therapy

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hUa9RZ

Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Background Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation. Methods The Potential Donor Audit (PDA) of patients (

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

Analysis of biomarkers within the initial 2 years posttransplant and 5-year kidney transplant outcomes: results from Clinical Trials in Organ Transplantation-17

ABSTRACT Background An early posttransplant biomarker/surrogate marker for kidney allograft loss has the potential to guide targeted interventions. Previously published findings, including results from the Clinical Trials in Organ Transplantation (CTOT)-01 study, showed that elevated urinary chemokine CXCL9 levels and elevated frequencies of donor-reactive interferon gamma-(IFNγ)-producing T cells by enzyme linked immunosorbent spot (ELISPOT) assay associated with acute cellular rejection within the first year and with lower 1-year posttransplant estimated glomerular filtration rate (eGFR). How well these biomarkers correlate with late outcomes, including graft loss, is unclear. Methods In CTOT-17, we obtained 5-year outcomes in the CTOT-01 cohort and correlated them with a) biomarker results and b) changes in eGFR (Chronic Kidney Disease Epidemiology Collaboration formula) over the initial 2 years posttransplant using univariable analysis and multivariable logistic regression. Results Graft loss occurred in 14/184 subjects (7.6%) 2 to 5 years posttransplant. Neither IFNγ ELISPOTs nor urinary CXCL9 were informative. In contrast, a ≥40% decline in eGFR from 6 months to 2 years posttransplant independently correlated with thirteen-fold odds of 5-year graft loss [adjusted odds ratio (aOR) 13.1; 95% CI 3.0-56.6], a result that was validated in the independent Genomics of Chronic Allograft Rejection cohort (n=165, aOR: 11.2). Conclusions We conclude that while pre and early posttransplant ELISPOT and chemokine measurements associate with outcomes within 2-years posttransplant, changes in eGFR between 3 months or 6 months and 24 months are better surrogates for 5-year outcomes, including graft loss. Corresponding author: Peter S Heeger, MD, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, USA, Email: peter.heeger@mssm.edu, Phone: 212 241 6324, Fax: 212 987 0389 Authorship Geovani Faddoul, M.D. Participated in data analysis and writing/editing of the manuscript Girish N Nadkarni, M.D. Participated in data analysis and writing/editing of the manuscript Nancy D. Bridges, M.D. Participated in study design and writing/editing of the manuscript Jens Goebel, M.D. Participated in writing/editing of the manuscript Donald E. Hricik, M.D. Participated in study design, data analysis and writing/editing of the manuscript Richard Formica, M.D. Participated in study design and writing/editing of the manuscript Madhav C Menon, M.D. Participated in study design, data analysis and writing/editing of the manuscript Yvonne Morrison, Participated in study design and writing/editing of the manuscript Barbara Murphy, M.D. Participated in study design and writing/editing of the manuscript Kenneth Newell, M.D. Participated in study design and writing/editing of the manuscript Peter Nickerson, M.D. Participated in study design and writing/editing of the manuscript Emilio D. Poggio, M.D. Participated in study design and writing/editing of the manuscript David Rush, M.D. Participated in study design and writing/editing of the manuscript Peter S. Heeger, M.D. Participated in study design, data analysis and writing/editing of the manuscript Disclosure The authors of this manuscript have no conflicts of interest to disclose. Funding The study was supported by National Institutes of Health U01 grant AI63594 awarded to P Heeger and K23DK107908 to G Nadkarni Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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

Heme Oxygenase 1 Attenuates Hypoxia-Reoxygenation Injury in Mice Liver Sinusoidal Endothelial Cells

ABSTRACT Background Heme oxygenase 1 (HO-1), a heat shock protein, can be involved in the resolution of inflammation by modulating cytokine expression and apoptotic cell death. Based on recent evidence that liver sinusoidal endothelial cells (LSECs) is the critical target in early period of liver ischemia-reperfusion injury (IRI), this study aims to clarify whether overexpression of HO-1 gene provides a protective effect on mice LSECs. Method LSECs were transfected with adenovirus vectors encoding mice HO-1 gene (Ad-HO-1) or green fluorescent protein (Ad-EGFP). Controls were not infected with any vector. LSECs were then treated with hypoxic or normoxic culture. We used low serum culture medium and hypoxia-reoxygenation (H-R) conditions to cause IRI in vitro. The transfection efficiency of HO-1 gene in LSECs, after 48 hours of transfection, and the effect of HO-1 on the model of H-R injury in LSECs were observed. Results Transfection of LSECs with Ad-HO-1 was at an optimal dose (MOI=80) to markedly express HO-1 mRNA and protein. Groups of overexpressed HO-1 showed lower levels of inflammatory factor mediators IL-6 and TNF-α. Survival rate of the cells after H-R injury was higher and attributed to overexpressed HO-1. In contrast, the control adenovirus expressing the EGFP failed to induce HO-1 expression, and stimulated cell apoptosis. HO-1 expression was down-regulated in all H-R groups compared to normoxia groups, which may be related to the disruption of the LSEC structure. Conclusion Up-regulation of HO-1 can attenuate H-R injury in LSECs by inhibiting proinflammatory cytokine release and diminishing apoptotic cell death. Corresponding author: Zhong Zeng, MD, PhD, Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical College, 295 Xichang Road, Kunming 650032, Yunnan Province, China. Telephone: +86-871-65359202; Fax: +86-871-65359202; Email: zzong@medmail.com.cn Authorship: Siming Qu, Bo Yuan, and Zhong Zeng contributed equally to this work; Siming Qu and Bo Yuan performed the majority of experiments; Hongbin Zhang participated in the performance of the research; Hanfei Huang participated in data analysis; Shikun Yang, Jie Lin, Li Jin, and Pu Wu participated in the writing of the paper. Disclosure: The authors declare no conflicts of interest. Funding: National Nature Science Foundation of China, No. 81660113 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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

Comparison of BQ123, Epoprostenol, and Verapamil as Vasodilators During Normothermic Ex Vivo Liver Machine Perfusion

Background The optimal vasodilator to avoid hepatic artery (HA) vasospasm during normothermic ex vivo liver perfusion (NEVLP) is yet to be determined. We compared safety and efficacy of BQ123 (endothelin1 antagonist), Epoprostenol (prostacyclin analogue), and Verapamil (calcium channel antagonist). Methods Livers from porcine heart beating donors were perfused for 3 hours and transplanted into recipient pigs. Four groups were compared: Group 1: livers perfused with a dose of 1.25 mg of BQ123 at baseline and at 2 hours of perfusion, Group 2: Epoprostenol at a continuous infusion of 4mg/hr, Group 3: Verapamil 2.5mg at baseline and at 2 hours of perfusion, Group 4: No vasodilator used during ex vivo perfusion. Liver injury and function were assessed during perfusion, and daily post transplantation until postoperative day 3. All groups were compared to a cold storage group for post operative graft function. Results Hepatic artery flow during NEVLP was significantly higher in BQ123 compared to Verapamil, Epopostenol, and no vasodilator treated livers. AST levels were significantly lower with BQ123 and Verapamil compared to Epoprostenol and control group during perfusion. Peak AST levels were lower in pigs receiving BQ123 and Verapamil perfused grafts compared to Epoprostenol and control group. INR, alkaline phosphatase, and total bilirubin levels were lower in the BQ123 and Verapamil groups compared to Epoprostenol group. Cold storage group had increased markers of ischemia reperfusion injury and slower graft function recovery compared to machine perfused grafts. Conclusion The use of BQ123, Epoprostenol, and Verapamil during NEVLP is safe. Livers perfused with BQ123 and Verapamil have higher HA flow and reduced hepatocyte injury during perfusion compared to Epoprostenol. Hepatic artery flow is significantly reduced in the absence of vasodilators during NEVLP. Authors Contributions. Juan Echeverri: Conception and design of the study, completion of experiments, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Nicolas Goldaracena: Completion of experiments, acquisition of data, data analysis and interpretation, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Johan Moritz Kaths: Completion of experiments, acquisition of data, data analysis and interpretation, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Ivan Linares: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Roizar Rosales: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Dagmar Kollmann: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Matyas Hamar: Acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Peter Urbanellis: Analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Sujani Ganesh: Acquisition of data, analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Oyedele Adeyi: Analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Mahmood Tazari: Statistical analysis and interpretation of data, revised manuscript critically, final approval for publication, and agreement to be accountable for all aspects of the work. Markus Selzner: Conception and design of the study, completion of experiments, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Nazia Selzner: Conception and design of the study, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Disclosure: The authors declare no conflicts of interest. Correspondence: Nazia Selzner, MD, PhD, Toronto General Hospital, NCSB 11C-1244, 585 University Avenue, Toronto, ON M5G2N2, Phone: 1-416-340-5230, Fax: 1-416-340-5242, e-mail: nazia.selzner@uhn Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hTdr8b

Myeloid-Derived Suppressor Cells and their Potential Application in Transplantation

Abstract Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immunosuppressive cells of the myeloid lineage upregulated by mediators of inflammation such as IL-2, GCSF, and S100A8/A9. These cells have been studied extensively by tumor biologists. Because of their robust immunosuppressive potential, MDSCs have stirred recent interest among transplant immunologists as well. MDSCs inhibit T cell responses through, among other mechanisms, the activity of arginase-1 and iNOS, and the expansion of T regulatory (Treg) cells. In the context of transplantation, MDSCs have been studied in several animal models, and to a lesser degree in humans. Here, we will review the immunosuppressive qualities of this important cell type and discuss the relevant studies of MDSCs in transplantation. It may be possible to exploit the immunosuppressive capacity of MDSCs for the benefit of transplant patients. Disclosure: The authors have no financial disclosures. Grant support: This work was supported by a grant (to JRS) from the American Surgical Association Foundation and by the Living Legacy Foundation of Maryland. Author contributions: JRS – read the literature, developed the concept/hypotheses, wrote the manuscript, lead the project, revised the paper YSL – read the literature, contributed to hypotheses, edited the paper ED – read the literature, edited the paper, contributed to manuscript's structure JSB – read the literature, edited the paper, contributed to manuscript's structure, mentored the project Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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

Association of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist: From the Functional Assessment in Liver Transplantation (FrAILT) Study.

ABSTRACT Background Frailty is a syndrome of decreased physiologic reserve that results from compromise of multiple physiologic systems including cardiovascular. We aimed to determine the association between the frail phenotype and cardiac abnormalities in liver transplant (LT) candidates through evaluation of transthoracic echocardiography (TTE) indices. Methods Included were consecutive outpatients listed for LT who underwent a frailty assessment from 1/1/14-6/30/16 (using the Liver Frailty Index) and a 2-dimensional/doppler TTE exam. Patients were categorized as robust, intermediate frail, or frail by the Liver Frailty Index based on scores of 34cc/m2 (p= 0.001). In linear regression adjusted for age, sex, hypertension and diabetes, the Liver Frailty Index was positively associated with LA dimension (coeff 0.20, 95%CI 0.07-0.34), LAVIcc/m2 (coeff 0.01, 95%CI 0.005-0.02), ejection fraction (coeff 1.59, 95%CI 0.32-2.85) and pulmonary artery systolic pressure (coeff 0.01, 95%CI 0.003-0.02) and negatively associated with LV hypertrophy (coeff -0.22, 95%CI -0.37, -0.06). Conclusion In LT candidates, frailty is associated with cardiac structural and functional changes, independent of known risk factors. Our study provides evidence to support that measures of frailty in cirrhotic patients encompass abnormalities of the cardiovascular system and may inform assessments of cardiovascular reserve in this population. CORRESPONDENCE INFORMATION: Jennifer C. Lai, MD, MBA, Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, 513 Parnassus Avenue, UCSF Box 0538, San Francisco, CA 94143, Email: Jennifer.lai@ucsf.edu, Academic office: (415) 476-2777 AUTHORSHIP Puchades:Study concept and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Chau: Study design; acquisition of data, interpretation of data; critical revision of the manuscript for important intellectual content. Dodson: Study design; interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Mohamad: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Mustain: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lebsack: Study design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Aguilera: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Prieto: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lai: Study concept and design; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; statistical analysis and study supervision. DISCLOSURE: The authors of this manuscript have no conflicts of interest to disclose. FUNDING: This study was funded by the Spanish Transplantation Society (Puchades), an American College of Gastroenterology Junior Faculty Development Award (Lai), P30AG044281 (UCSF Older Americans Independence Center; Lai), and K23AG048337 (Paul B. Beeson Career Development Award in Aging Research; Lai). These funding agencies played no role in the analysis of the data or the preparation of this manuscript. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hU6HGW

Rituximab and Therapeutic Plasma Exchange in Recurrent Focal Segmental Glomerulosclerosis Postkidney Transplantation

Background Focal segmental glomerulosclerosis (FSGS) is a common cause of end stage renal disease (ESRD) with a high rate of recurrence after kidney transplantation. Several factors such as white race, rapid progression, and previous allograft failure due to recurrence were found to be risks of recurrence. Data are limited on the benefits of rituximab and/or therapeutic plasma exchange (TPE) in preventing recurrence. In this study, we sought to assess the efficacy of rituximab and TPE for the prevention and treatment of recurrent FSGS post kidney transplantation. Methods We enrolled 66 patients with FSGS in this prospective observational study and followed their outcomes. Patients with high risk for recurrence received preventative therapy with TPE and/or rituximab. Results Twenty three of the thirty seven (62%) who received preventative therapy developed recurrence compared to fourteen recurrences out of the twenty seven (51%) who did not receive any therapy (p=0.21). There was a trend for less relapse when rituximab was used as a therapy for recurrent FSGS, (6/22 versus 9/18, p=0.066). We utilized a clinical score of 5 values to assess the prediction of FSGS recurrence. A score of 3 or more had a predictive Receiver Operating Characteristic (ROC) curve of 0.72. Treatment with TPE and/or rituximab resulted in better allograft survival than historical studies. Allograft failure due to recurrent FSGS occurred in only 6 patients (9%). Conclusion Preventative therapies do not decrease the recurrence rate of recurrent FSGS. However, prompt treatment of recurrence with these therapies may result in improved outcomes. Corresponding Author: Nada Alachkar, MD, 600 Wolfe St. Brady 502, Baltimore, MD. Email: nalachk1@jhmi.edu Authorship Page: Sami Alasfar: data collection, data analysis and interpretation, drafting the article Dany Matar: data collection Robert A Montgomery: critical revision of the article Niraj Desai: critical revision of the article Bonnie Lonze: critical revision of the article Vikas Vujjini: data collection Michelle M. Estrella: critical revision of the article John Manllo Dieck: data collection, critical revision of the article Gebran Khneizer: data collection Sanja Sever: critical revision of the article Jochen Reiser: critical revision of the article Nada Alachkar: design of the work, data collection, data analysis and interpretation, drafting the article, final approval of the version to be published Disclosures: JR and SS are cofounders and stock holders of Trisaq, a biotechnological company developing novel therapeutics for chronic kidney diseases and FSGS, and have pending and issued patents in the therapeutic and diagnostic space regarding kidney diseases. Sources of support: NIH R01DK101350-04, Nada Alachkar Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2jM0SMg

Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: Long-term results after 7 years of a randomized clinical trial

Background The VIPP study compared valganciclovir prophylaxis with preemptive treatment regarding efficacy, safety and long-term graft outcome in CMV-positive (R+) renal transplant recipients. Methods Multicenter, open-label, randomized clinical study with a 12-month study phase and a follow-up of up to 84 months. Patients in the prophylaxis group received 2x450 mg/day oral valganciclovir for 100 days adjusted to renal function. Preemptive treatment with 2x900 mg/day valganciclovir was initiated at a viral load of ≥400 CMV copies/mL (PCR) and maintained over ≥14 days, followed by secondary prophylaxis. Patients were stratified by donor CMV IgG serostatus (D+/R+, D-/R+). Results The 12-month-results were reported previously (Witzke et al Transplantation 2012). The intent-to-treat/safety population comprised 148 patients in the prophylaxis (61.5% D+/R+) and 151 patients in the preemptive group (52.3% D+/R+). Overall, 47% patients completed the follow-up. Significantly fewer patients in the prophylaxis compared to preemptive group experienced a CMV infection or disease up to month 84 (11.5% [95% CI: 6.8%,17.8%] vs. 39.7% [31.9%,48.0%], p

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

SIRT2 and Akt mediate NAD+-induced and NADH-induced increases in the intracellular ATP levels of BV2 microglia under basal conditions

NAD+ replenishment can restore ATP levels and rescue premature aging in Cockayne syndrome mice. However, there has been no mechanistic study regarding the effects of NAD+ and NADH on intracellular ATP levels under basal conditions. In our current study, we used BV2 microglia to test our hypothesis that NAD+ and NADH can increase intracellular ATP levels under basal conditions. We found that both NAD+ and NADH significantly increased the intracellular ATP levels of BV2 microglia, which were attenuated by SIRT2 siRNA, the SIRT2 inhibitor AGK2, and the phosphatidylinositol 3-kinase/Akt inhibitor LY294002. Our study has also suggested that SIRT2 mediates the NAD+-induced and NADH-induced increase in Akt phosphorylation in BV2 microglia. Collectively, our study has suggested that SIRT2 mediates both NAD+-induced and NADH-induced increases in the intracellular ATP levels of BV2 microglia by modulating Akt phosphorylation. Correspondence to Weihai Ying, PhD, School of Biomedical Engineering, Med-X Research Institute, Division of Disease Studies, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, People's Republic of China Tel: +86 216 293 3075; fax: +86 216 293 2302; e-mail: weihaiy@sjtu.edu.cn Received May 5, 2017 Accepted July 17, 2017 © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2mSZMQ4

The anger expression trait affects conflict monitor: a Go/No-go event-related potential study

The Anger-Out and Anger-In is the emotional expression of anger in two main ways. To explore the time course of inhibitory control in individuals with different anger expression trait, we recorded and analyzed event-related potential data relevant to the Go/No-go task. Although the No-go effect of P3 closely related to the actual inhibition of the motor system was similar between two groups, the No-go effect of N2 related to conflict monitoring was smaller in the Anger-In than that in the Anger-Out group. These data suggest the reduced early stage of inhibitory processes in Anger-In individuals, implicating the dysfunction of conflict monitoring and providing new electrophysiological evidence for the theory of anger expression. Correspondence to Xianghong Zhan, PhD, Henan University of Traditional Chinese Medicine, Jinshui East Road 168, Zheng Zhou 450008, China Tel/fax: +86 371 659 62406; e-mails: zhan20150103@163.com, zxh371@163.com Received September 10, 2017 Accepted October 22, 2017 © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zr5wGo

Procedural sedation and analgesia for adults in Europe: Safety first

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zrV01A

Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review

BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) 25% of baseline), or that a recovery time longer than 15 min be accepted. Correspondence to Thomas Fuchs-Buder, MD, Department of Anaesthesia and Critical Care, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-Les-Nancy, France. Cedex E-mail: t.fuchs-buder@chru-nancy.fr © 2017 European Society of Anaesthesiology

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

Minimally Invasive Brow Lifting Techniques

This article reviews the efficacy of several minimally invasive browpexy techniques to address brow ptosis. How do they measure up?
Current Opinion in Ophthalmology

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

A Technique to Correct Anterior-Posterior Tooth Discrepancy for a Maxillary Immediate Complete Denture

Abstract

This article describes a chairside technique to correct inappropriate occlusal vertical dimension as well as the inaccurate anterior-posterior tooth set-up of a maxillary immediate complete denture. When fabricating an immediate denture, the inability of a wax-denture trial and the potential for unpredictable complications during surgery, compromised esthetics and function of an immediate complete denture may pose a clinical problem, which needs instant correction. The technique described can provide an alternative method to correct and deliver a definitive immediate complete denture on the day of surgery.

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

Speckled acral hypopigmentation in an adolescent

Abstract

We report a case of speckled acral hypopigmentation in a 12-year-old girl. She presented with asymptomatic hypopigmented macules on the hands and feet. This rare entity is a proposed variant of reticulate acropigmentation and of unknown etiology.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2jKVGZ8

Urticarial vasculitis after meningococcal serogroup B vaccine in a 6-year-old girl

Abstract

The first vaccine that shows significant potential in providing broad coverage against serogroup B meningococcal disease has recently been approved. Because of its newness, potential adverse events need to be reported. Here we report a case of urticarial vasculitis, a rare disease in children, in probable relationship with the novel vaccine.

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

Erythromelanosis follicularis faciei et colli: A clinicoepidemiologic study

Abstract

We describe 25 cases of erythromelanosis follicularis faciei et colli from India. The male:female ratio was 5.25:1 and the average age of onset was 12.3 years. The cheeks, preauricular area, and submandibular region were the sites most commonly affected. Keratosis pilaris was seen in 22 (88%) of the patients.

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

Comparison of prostate distortion by inflatable and rigid endorectal MRI coils in permanent prostate brachytherapy imaging

Publication date: Available online 21 November 2017
Source:Brachytherapy
Author(s): Geoffrey V. Martin, Rajat J. Kudchadker, Teresa L. Bruno, Steven J. Frank, Jihong Wang
PurposeTo study the deformation of the prostate by a rigid reusable endorectal coil and a balloon-type endorectal coil (BTC) during MRI of the prostate in brachytherapy imaging.Methods and MaterialsThe prostate gland was contoured on 157 MRI scans from 52 prostate cancer patients undergoing brachytherapy. The curvature of the posterior prostate surface deformation was computed as a measure of prostate distortion and compared between scans with a BTC, rigid endorectal coil (REC), or no endorectal coil. For the nine patients who had MRIs with all three endorectal scenarios, a mean prostate deformation vector was also calculated between scenarios using deformable image registration. These measures of prostate distortion were compared with the prostate anterior-to-posterior to left-to-right ratio (AP/LR) on the largest prostate axial slice.ResultsSignificant differences in prostate curvature were found between scans without an endorectal coil versus a REC versus a BTC (p < 0.001). The mean prostate deformation was 3.9 mm due to the BTC and 2.0 mm for the REC (p = 0.012). The mean AP/LR ratio was 0.62 with a BTC versus 0.76 without a coil or 0.73 with a REC (p < 0.001), but no difference existed between scans with a REC versus no coil (p = 0.7). The AP/LR ratio showed moderate correlation with prostate curvature (r = 0.48), and with mean prostate deformation (r = −0.64 to 0.68).ConclusionsThe REC caused minimal deformation of the prostate compared with a BTC with adequate MR image quality, and calculation of the cross-sectional AP/LR ratio on the largest axial prostate slice can serve as a simple measure of prostate distortion.



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

Minimally Invasive Genioplasty Procedure

Summary: In this technical note, we present a new surgical approach for genioplasty in which a minimally invasive procedure is used to perform the chin osteotomy. The main goal was to reduce postoperative functional recovery time and possible complications, especially reduction of lip incompetence, chin ptosis, and muscle dysfunction, by retaining the intactness of the mentalis muscles. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication April 24, 2017; accepted September 29,2017. Drs. Nadjmi and Van Roy contributed equally to this work. Presented at the 23rd International Conference on Oral and Maxillofacial Surgery, March 31 to April 03, 2017, Hong Kong, China. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Nasser Nadjmi, MD, DDS, PhD, EFOMFS, Harmoniestraat 68, 2018 Antwerp, Belgium, E-mail: nasser@nadjmi.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Use of Indocyanine Green for Sentinel Lymph Node Biopsy: Case Series and Methods Comparison

Introduction: Sentinel lymph node biopsy is indicated for patients with biopsy-proven thickness melanoma greater than 1.0 mm. Use of lymphoscintigraphy along with vital blue dyes is the gold standard for identifying sentinel lymph nodes intraoperatively. Indocyanine green (ICG) has recently been used as a method of identifying sentinel lymph nodes. We herein describe a case series of patients who have successfully undergone ICG-assisted sentinel lymph node biopsy for melanoma. We compare 2 imaging systems that are used for ICG-assisted sentinel lymph node biopsy. Methods: Fourteen patients underwent ICG-assisted sentinel lymph node biopsy for melanoma using the SPY Elite system (Novadaq, Mississigua, Canada) and the Hamamatsu PDE-Neo probe system (Mitaka USA, Park City, Utah). We analyzed costs for 2 systems that utilize ICG for sentinel lymph node biopsies. Results: Intraoperative use of ICG for sentinel lymph node biopsies was successful in correctly identifying sentinel lymph nodes. There was no difference between the Hamamatsu PDE-Neo probe and SPY Elite systems in the ability to detect sentinel lymph nodes; however, the former was associated with a lower operating cost and ease of use compared with the latter. Conclusion: ICG-assisted sentinel lymph biopsy using the SPY Elite or the Hamamatsu PDE-Neo probe systems for melanoma are comparable in terms of sentinel node detection. The Neo probe system delivers pertinent clinical data with the advantages of lower cost and ease of operation. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication June 3, 2017; accepted September 22,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Deepak Narayan, MD, FRCS, MBBS, Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street Boardman Building, New Haven, CT 06520 E-mail: deepak.narayan@yale.edu Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Make Surgeons’ Position More Comfortable

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zqN3tE

STRATAFIX for Abdominal Wall Repair following Abdominal Flap Harvest

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2mQaU09

Gluteal Black Market Silicone–induced Renal Failure: A Case Report and Literature Review

Summary: Very few cases of successful surgical treatment for renal failure due to gluteal silicone injections have been reported in the literature. The silicone toxicity and subsequent renal failure seem to follow repetitive silicone injections and silicone injections in large quantities. This is a case of a 31-year-old woman who developed renal failure after 6 years of gluteal silicone injections who underwent radical resection of bilateral gluteal regions in an attempt to mitigate her impending complete renal failure. A systematic review of the literature was conducted using PubMed database and with assistance from medical library staff to conduct keyword searches for "Silicone," "Renal failure," "Silicone emboli syndrome," "Silicone granuloma," and "Silicone end organ toxicity." The search results were reviewed by the authors and selected based on the relevance to the case report presented. Extensive literature relating to silicone granulomas and their systemic effects supports the use of steroids for immediate treatment and eventual surgical resection for cure of the various silicone-related end-organ toxicities including renal failure. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication June 29, 2017; accepted September 29,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Andrea Matson, DO, PGY-2, Department of Surgery, Mountain Vista Medical Center, 10238 East Hampton Avenue Suite 301C, Mesa, AZ 85209, E-mail: Andrea_Matson@iasishealthcare.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review

Background: Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team. Methods: A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented. Results: Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps. Conclusions: Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication April 15, 2017; accepted September 21,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Feras Alshomer, MBBS, MSc, Plastic and Reconstructive Surgery Section, Surgery Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, E-mail: Dr.fshomer@gmail.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Feasibility of Bone Perfusion Evaluation in Cadavers Using Indocyanine Green Fluorescence Angiography

Summary: Bone perfusion evaluation methods in cadaver studies have yet to be established. The aim of this report was to introduce and validate the feasibility of indocyanine green (ICG) fluorescence angiography for evaluation of bone perfusion in the femoral medial condyle in cadavers. In 4 fresh nonembalmed cadavers (2 female), the descending genicular artery was dissected and carefully cannulated bilaterally. A 10 mL solution containing 5 mL ICG solution and 5 mL methylene blue solution was injected into the descending genicular artery. After the injection, the medial femoral condyle was cut with an oscillating saw. A photograph was taken of the cut ends of the bone. The cut ends of the bones were observed using a near-infrared camera. Images corresponding to the previously taken photographs of the cut ends were captured for comparative analysis. After injection of methylene blue and ICG, the blue dye could be seen in the periosteum in all specimens, but not inside the cortex or the cancellous region of the bone. When observed with ICG fluorescence angiography, however, the cancellous region was highlighted through small perforators penetrating the periosteum. Perfusion inside the medial femoral condyle in cadavers was confirmed using ICG fluorescence angiography. Our method can be especially beneficial in confirming the bone perfusion of a new bone flap based on a particular artery, both in cadavers as well as in patients, because ICG can be injected into specific arteries. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication July 11, 2017; accepted September 26,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Hidehiko Yoshimatsu, MD, Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135–8550 Japan, E-mail: hidehiko.yoshimatsu@gmail.com Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Background: There have been many studies examining risk factors for complications in expander-based breast reconstruction after mastectomy, and some patient factors have been identified as risk factors. However, most of the previous studies were based on Caucasian patients. Methods: Asian patients who had a tissue expander placed for immediate breast reconstruction between January 2006 and December 2015 (363 patients and 371 expanders) were analyzed retrospectively. Univariate and multivariate analyses were performed to elucidate risk factors for complications. Results: The rate of skin necrosis was significantly higher in nipple-sparing mastectomy than in other types of mastectomies (12 patients among 107 patients, P = 0.001). The weight of the resected specimen was significantly higher in the group with complications than in the group without complications (444 g compared with 363 g, P = 0.027). Other factors (age, body mass index, smoking, expander type, preoperative chemotherapy, axillary dissection) had no significant effect on complications. Multivariate analysis with a logistic regression showed that a large breast (over 500 g) was the only significant risk factor for complications, with an odds ratio of 3.20 and a 95% confidence interval of 1.33–7.54 (P = 0.010). Conclusion: In this series of Asian patients, breast size, rather than body mass index, is the most important predictor for complications in expander-based breast reconstruction. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication July 20, 2017; accepted September 22,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Hirotaka Suga, MD, Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181–8611, Japan., E-mail: sugah-tky@umin.ac.jp Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

Non-BRCA1/2 Breast Cancer Susceptibility Genes: A New Frontier with Clinical Consequences for Plastic Surgeons

Summary: Twenty percent of breast cancer cases may be related to a genetic mutation conferring an increased risk of malignancy. The most common and prominent breast cancer susceptibility genes are BRCA1 and BRCA2, found in nearly 40% of such cases. However, continued interest and investigation of cancer genetics has led to the identification of a myriad of different breast cancer susceptibility genes. Additional genes, each with unique significance and associated characteristics, continue to be recognized. Concurrently, advanced genetic testing, while still controversial, has become more accessible and cost-effective. As oncologic and reconstructive advances continue to be made in prophylactic breast reconstructive surgery, patients may present to plastic surgeons with an increasingly more diverse array of genetic diagnoses to discuss breast reconstruction. It is therefore imperative that plastic surgeons be familiar with these breast cancer susceptibility genes and their clinical implications. We, therefore, aim to review the most common non-BRCA1/2 breast cancer susceptibility genetic mutations in an effort to assist plastic surgeons in counseling and managing this unique patient population. Included in this review are syndromic breast cancer susceptibility genes such as TP53, PTEN, CDH1, and STK11, among others. Nonsyndromic breast cancer susceptibility genes herein reviewed include PALB2, CHEK2, and ataxia telangiectasia mutated gene. With this knowledge, plastic surgeons can play a central role in the diagnosis and comprehensive treatment, including successful breast reconstruction, of all patients carrying genetic mutations conferring increased risk for breast malignancies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 21 November 2017. Received for publication September 11, 2017; accepted September 22,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Nolan S. Karp, MD, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 305 East 47th Street, Suite 1A, New York, NY 10017, E-mail: Nolan.Karp@nyumc.org Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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

The Boomerang-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of Circular Defect of Cervical Skin

Summary: We report on a patient with a recurrence of oral cancer involving a cervical lymph node. The patient's postexcision cervical skin defect was nearly circular in shape, and the size was about 12 cm in diameter. The defect was successfully reconstructed with a boomerang-shaped pectoralis major musculocutaneous flap whose skin paddle included multiple intercostal perforators of the internal mammary vessels. This flap design is effective for reconstructing an extensive neck skin defect and enables primary closure of the donor site with minimal deformity. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication March 31, 2017; accepted September 29,2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. Article Processing Charge was paid for by the authors. Shimpei Miyamoto, MD, Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan, E-mail: shimiyam@ncc.go.jp; s-miya@hh.iij4u.or.jp Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2mRVuZ6

Liposomal Bupivacaine in Implant-Based Breast Reconstruction

Purpose: This study evaluates the role of liposomal bupivacaine in implant-based breast reconstruction. Methods: A prospective, randomized, single-blind trial of liposomal bupivacaine in implant-based breast reconstruction was performed. Patients in the control arm were treated with 20 mL 0.25% bupivacaine with epinephrine 1:200,000 to each breast pocket. Patients in the experimental arm were treated with 10 mL 1.3% liposomal bupivacaine delivered to each breast pocket. Pain scores were recorded over the course of patients' hospital stay. Consumption of pain medications, benzodiazepines, and anti-emetics was monitored. Length of stay and other direct cost data were collected Results: Twenty-four patients were enrolled, with 12 women randomized to each arm. Average postoperative pain scores were 3.66 for patients in the control arm and 3.68 for patients in the experimental arm. Opioid consumption was 1.43 morphine equivalent dosing/h for patients in the control arm and 0.76 morphine equivalent dosing/h for patients in the experimental arm (P = 0.017). Diazepam consumption was 0.348 mg/h for patients in the control arm and 0.176 mg/h for patients in the experimental arm (P = 0.011). Average length of hospital stay was 46.7 hours for patients in the control arm and 29.8 hours for patients in the experimental arm (P = 0.035). Average hospital charges were $18,632 for patients in the control arm and $10,828 for patients in the experimental arm (P = 0.039). Conclusions: Liposomal bupivacaine reduces opioid and benzodiazepine consumption, length of stay, and hospital charges. These data support a role for liposomal bupivacaine in implant-based breast reconstruction. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 November 2017. Received for publication September 6, 2017; accepted September 15, 2017. This project was registered with ClinicalTrials.gov, Protocol ID # 5150012. Presented at the Plastic Surgery The Meeting 2016, Los Angeles, Calif. Disclosure: Supported, in part, by a Pilot Research Grant from the Plastic Surgery Foundation (PRG 350440). The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors using funding from a Pilot Research Grant from the Plastic Surgery Foundation. Subhas C. Gupta, MD, CM, PhD, Department of Plastic Surgery, Loma Linda University, 11175 Campus St, CP 21126, Loma Linda, CA 92354, E-mail: sgupta@llu.edu Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zrAoH6

Radix Malorum Cupiditas Est: A Decade Later

No abstract available

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

An Autonomic Neuroprosthesis: Noninvasive Electrical Spinal Cord Stimulation Restores Autonomic Cardiovascular Function in Individuals with Spinal Cord Injury

Journal of Neurotrauma , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2jfeQ5l

Alterations in the Timing of Huperzine A Cerebral Pharmacodynamics in the Acute Traumatic Brain Injury Setting

Journal of Neurotrauma , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A376LZ

Should short-term use of alcohol containing mouthrinse be avoided for fear of worsening xerostomia?

Abstract

Objective

To assess the short-term effect of alcohol-containing mouthrinse versus mouthrinse without alcohol on xerostomia scores reported by xerostomia inventory (XI) scores and short version of the xerostomia inventory (SXI).

Materials and Methods

This study was a two-group parallel arm randomized controlled trial where participants were randomly allocated to twice a day for seven days use of either alcohol-containing or alcohol-free mouthrinse. Allocation was concealed. The participants, the outcome assessors and the statistician were blinded to the allocation status.

Results

163 participants completed the pre-and post-intervention data collection. There were no statistically significant differences between the study groups with respect to demographics or other measured independent variables. After adjusting for age and gender, regression coefficient (95%CI) for XI was 0.02(-1.72 to 2.29) and that for SXI was 0.03(-0.54 to 0.83). Both adjusted and unadjusted models showed no significant differences for change in XI or SXI. The mean difference in scores between the groups for XI was -0.45(-2.45 to 1.55) and for SXI was 0.05(-0.65 to 0.75).

Conclusion

There was no significant difference in the change in xerostomia levels as a result of short-term exposure to alcohol containing mouthrinse, when compared to those exposed to alcohol-free mouthrinse.

This article is protected by copyright. All rights reserved.

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

Jaw Closing Movement and Sex Differences in Temporomandibular Joint Energy Densities

Abstract

Energy densities (ED, mJ/mm³) quantify mechanical work imposed on articular cartilages during function. This cross-sectional study examined differences in temporomandibular joint (TMJ) ED during asymmetric versus symmetric jaw closing in healthy females versus males. ED component variables were tested for differences between and within sexes for two types of jaw closing. Seventeen female and 17 male subjects gave informed consent to participate. Diagnostic Criteria for Temporomandibular Disorders and images (magnetic resonance (MR), computed tomography) were used to confirm healthy TMJ status. Numerical modeling predicted TMJ loads (F_normal) consequent to unilateral canine biting. Dynamic stereometry combined MR imaging and jaw tracking data to measure ED component variables during 10 trials of each type of jaw closing in each subject's TMJs. These data were then used to calculate TMJ ED during jaw closing asymmetrically and symmetrically. Paired and Student's t-tests assessed ED between jaw closing movements and sexes, respectively. Multivariate data analyses assessed ED component variable differences between jaw closing movements and sexes (α=0.05). Contralateral TMJ ED were 3.6-fold and significantly larger (P<0.0001) during asymmetric versus symmetric jaw closing, due to significantly larger (P≤0.001) distances of TMJ stress-field translation in asymmetric versus symmetric movement. During asymmetric jaw closing, contralateral TMJ ED were two-fold and significantly larger (P=0.036) in females versus males, due to 1.5-fold and significantly smaller (P≤0.010) TMJ disc cartilage volumes under stress-fields in females versus males. These results suggest that in healthy individuals asymmetric compared to symmetric jaw closure in females compared to males have higher TMJ mechanical fatigue liabilities.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ba0Fa1

Cognitive rehabilitation and mindfulness in multiple sclerosis (REMIND-MS): a study protocol for a randomised controlled trial

Cognitive problems frequently occur in patients with multiple sclerosis (MS) and profoundly affect their quality of life. So far, the best cognitive treatment options for MS patients are a matter of debate. Th...

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

Analysis of outcomes and patient’s satisfaction following monolateral and bilateral mastectomy using BREAST-Q

Abstract

Background

Breast reconstruction plays an important role in improving the quality of life of patients with breast cancer. The aim of this study is to verify if there is a difference in patient's satisfaction and in body perception following monolateral and bilateral mastectomy with breast reconstruction.

Methods

The study population were 144 women who had undergone mastectomy and breast reconstruction at our hospital between 2005 and 2016. They filled out BREAST-Q post-operative module after almost 1 year from breast reconstruction. We administered the questionnaire electronically almost 1 year after surgery for each procedure.

Results

This cross-sectional study compared two cohorts in which 121 women underwent monolateral mastectomy and breast reconstruction with or without contralateral adjustment and 23 women underwent bilateral mastectomy and breast reconstruction. After reconstruction procedures, patients that underwent bilateral mastectomy were more satisfied than monolateral mastectomy group in satisfaction with appearance of breast (P < 0.001). In the comparison between monolateral and bilateral nipple-sparing mastectomy groups, the bilateral nipple mastectomy group was more satisfied in satisfaction with appearance of breast (P = 0.005) and physical well-being (P = 0.003). In the comparison between bilateral nipple-sparing mastectomy and no nipple-sparing mastectomy, the first group was more satisfied in psychosocial well-being (P = 0.03) and physical well-being (P = 0.03).

Conclusions

Bilateral mastectomy has a favorable post-operative surgical cosmetic outcome with a better patient's body image perception and bigger post-operative satisfaction. This is the first study that compares monolateral and bilateral mastectomy using a validated patient-reported outcome measure.

Level of Evidence: Level III, risk/prognostic study.

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

The Biology of Cancer Exosomes: Insights and New Perspectives

Exosomes are a subclass of extracellular vesicles involved in intercellular communication that are released by all cell types, including cancer cells. Cancer exosomes carry malignant information in the form of proteins, lipids, and nucleic acids that can reprogram recipient cells. Exosomes have emerged as putative biological mediators in cancer contributing to major steps of disease progression. A leading role exists for cancer exosomes in specific aspects of tumor progression: modulation of immune response, tumor microenvironment reprogramming, and metastasis. This review will address the functions attributed to cancer exosomes in these three aspects of cancer biology, highlighting recent advances and potential limitations. Finally, we explore alternative strategies to develop better models to study cancer exosomes biology. Cancer Res; 77(23); 1–9. ©2017 AACR.

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

Precision Oncology: Between Vaguely Right and Precisely Wrong

Precision Oncology seeks to identify and target the mutation that drives a tumor. Despite its straightforward rationale, concerns about its effectiveness are mounting. What is the biological explanation for the "imprecision?" First, Precision Oncology relies on indiscriminate sequencing of genomes in biopsies that barely represent the heterogeneous mix of tumor cells. Second, findings that defy the orthodoxy of oncogenic "driver mutations" are now accumulating: the ubiquitous presence of oncogenic mutations in silent premalignancies or the dynamic switching without mutations between various cell phenotypes that promote progression. Most troublesome is the observation that cancer cells that survive treatment still will have suffered cytotoxic stress and thereby enter a stem cell–like state, the seeds for recurrence. The benefit of "precision targeting" of mutations is inherently limited by this counterproductive effect. These findings confirm that there is no precise linear causal relationship between tumor genotype and phenotype, a reminder of logician Carveth Read's caution that being vaguely right may be preferable to being precisely wrong. An open-minded embrace of the latest inconvenient findings indicating nongenetic and "imprecise" phenotype dynamics of tumors as summarized in this review will be paramount if Precision Oncology is ultimately to lead to clinical benefits. Cancer Res; 77(23); 1–7. ©2017 AACR.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A2aCpT

NKG2D-dependent anti-tumor effects of chemotherapy and radiotherapy against glioblastoma

Purpose: NKG2D is a potent activating immune cell receptor and glioma cells express the cognate ligands (NKG2DL). These ligands are inducible by cellular stress and temozolomide (TMZ) or irradiation (IR), the standard treatment of glioblastoma, could affect their expression. However, a role of NKG2DL for the efficacy of TMZ and IR has never been addressed. Experimental Design:We assessed the effect of TMZ and IR on NKG2DL in vitro and in vivo in a variety of murine and human glioblastoma models including glioma-initiating cells and a cohort of paired glioblastoma samples from patients before and after therapy. Functional effects were studied with immune cell assays. The relevance of the NKG2D system for the efficacy of TMZ and IR was assessed in vivo in syngeneic orthotopic glioblastoma models with blocking antibodies and NKG2D knockout mice. Results:TMZ or IR induced NKG2DL in vitro and in vivo in all glioblastoma models and glioblastoma patient samples had increased levels of NKG2DL after therapy with TMZ and IR. This enhanced the immunogenicity of glioma cells in a NGK2D-dependent manner, was independent from cytotoxic or growth inhibitory effects, attenuated by O6-methylguanine-DNA-methyltransferase (MGMT) and required the DNA damage response. The survival benefit afforded by TMZ or IR relied on an intact NKG2D system and was decreased upon inhibition of the NKG2D pathway. Conclusions: The immune system may influence the activity of convential cancer treatments with particular importance of the NKG2D pathway in glioblastoma. Our data provide a rationale to combine NKG2D-based immunotherapies with TMZ and IR.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zayhD6

“HEATPAC” - a phase II randomized study of concurrent thermochemoradiotherapy versus chemoradiotherapy alone in locally advanced pancreatic cancer

Pancreatic cancer has a dismal prognosis with 5-year overall survival rate of around 5%. Although surgery is still the best option in operable cases, majority of the patients who present in locally advanced st...

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

Three methods comparison using two-dimensional software (a novel technique), tri-dimensional cone-beam computed tomography, and manual method to measure maxillary casts: Unilateral and bilateral cleft lip and palate infants up to 6 months

Faizan Ahmed Khan, Mohammadi Begum Khan, Akhter Hussain, Arjun Karra, Purumandla Usha, CH Lalitha

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):180-186

Objective: The objective of the study was to investigate any relationship between three different methods of measurements used to measure certain parameters used on the casts of infants born with cleft lip and palate (CLP). Materials and Methods: A set of 25 casts including both unilateral and bilateral CLP were used to determine the relationship among three different methods used in this study, including tri-dimensional (3D) cone-beam computed tomography, two-dimensional (2D) software, and manual method using Vernier caliper. Results: Linear regression analysis or regression curves were attempted to establish a relationship among three different methods. Statistically significant difference (P < 5%) was found for almost all the measurements analyzed. The measurements obtained by Vernier caliper were found to be close to software values than 3D values. The ability of obtaining a 3D value from a measured 2D value was determined as the linear Pearson's correlation coefficient R and the amount of scatter around the regression line as represented by 95% confidence interval. Total error of 3D value calculated from 2D measurements was obtained by regression analysis. Conclusion: Through this study, it was concluded that newer and simpler methods for measurement purpose are always accepted on a wider scale and can be employed universally. We could find that 2D measurements by Vernier caliper which is closer to software measurements (using MAKHTER Software) can be converted to 3D using a multiplication factor of 0.54.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbV2rS

From president's desk: Special issue for cleft congress 2017

Jyotsna Murthy

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):2-2



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

Epidemiologic indices of cleft lip and palate as seen among Igbos in Enugu, Southeastern Nigeria

Chukwunonso Azubuike Jac-Okereke, Ifeanyi Igwilo Onah

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):126-131

Objectives: The objective of the study was to provide more recent local data, and an estimate of the incidence of cleft lip and/or palate among Igbos. Design: The study design was a descriptive transversal study of birth records and case notes between January 2007 and December 2011 and records of clinical attendance and interviews with patients' mothers. Names and state of origin were used as inclusion criteria for Igbos. Setting: Previous local data on epidemiology are over three decades old. The National Orthopaedic Hospital, Enugu (NOHE) is an apex center for plastic surgery in southeastern Nigeria. Enugu State University of Science and Technology Teaching Hospital (ESUTTH) is the largest state-owned health facility. There are ethnoracial variations in the epidemiology of clefts. Materials and Methods: All patients born with clefts at ESUTTH and all records of clefts in the period available at NOHE hospital in the period. Within the period, 262 cleft patients were studied: 139 males and 123 females; male:female 1.13:1. Main Outcome Measure: Main outcome measures were the live birth incidence of clefts, the most frequently occurring birth order, and socioeconomic class affected. Results: There were 5810 live births with a 0.00103270223752151 birth incidence. That among Igbos was 0.0010700909577314. Infants in the first birth order and of low socioeconomic class accounted for the highest incidence. The socioeconomic status was found to be statistically significant (P = 0.0001, confidence interval: 95%) but birth order was not (P = 0.932). There was a positive family history in 9.5% with first-degree relatives accounting for 6%. The mean maternal age was 28.88 years (range: 17–47 years), and mean paternal age was 38.55 years (range: 23–58 years). Conclusion: The epidemiologic indices differ from data published over three decades ago. There are differences in cleft epidemiology within Nigeria.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbAv6F

Report of the scientific chair: Cleft 2017

Krishnamurthy Bonanthaya

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):3-3



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zcu1TO

The power of determination

Karoon Agrawal

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):1-1



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbNeq1

International Confederation for Cleft Lip and Palate and Related Craniofacial Anomalies 2017 Task Force Summary Reports

Jeffrey L Marsh

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):4-9



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

Oral health status among cleft lip and palate patients in South India: A profile

Chitta Ranjan Chowdhury, Shahnawaz Khijmatgar, Nanda P Kishore, Vikram Shetty

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):152-159

Background: Cleft lip and palate (CLP) is one of the identified anomalies in India. Many of the CLP cases have compromised oral health status which relates to their quality of life (QoL). Therefore, it is a need to assess their oral health status in terms of dental caries, periodontal disease, hypodontia, malocclusions, etc. Hence, the objective of this study is to investigate the oral health status among CLP cases. Material and Methods: A questionnaire survey was designed for a total of 300 CLP cases that came to the Nitte Meenakshi Institute of Craniofacial Surgery of Nitte University, India, were included in the study. A questionnaire was designed and pretested, and informed consent from the cases and carers was taken. Results: The average mean age of the patients with CLP was 17.48 (3–47). There were 47% males (n = 141) and 53% females (n = 159). 63% (n = 170) of them came from low socioeconomic background. Out of 300 cases, 31.0% (n = 90) had cleft lip; 1.0% (n = 3) had cleft palate, and 67.8% (n = 196) of them had both CLP. Most of the cases, i.e., 65.4% (n = 196) were unilateral CLP and 52.7% (n = 158) had right-sided clefts. The literacy status of the parents, their socioeconomic status, and occupation had a significant interrelation for the occurrence of CLP (P < 0.05). Similarly, diminutive or peg-shaped tooth, hypodontia, facial profile, and absence of lateral incisors in the line of cleft showed a significant association of this CLP condition. There was also strong interrelation between the presence of postoperative intraoral scarring in patients affected with the CLP (P < 0.05). The score for decayed missing and filled teeth (DMFT/dmft) was 5.16 for 6–12 years old and >9 in >13 years old, community periodontal index was between 0 and 2, and the simplified oral hygiene index was 0.9–1.41. There were cases of AQ3 hypodontia, hypomineralization, and malocclusion. The statistical test was performed using ANOVA. Conclusion: We conclude that, there was a moderate dental caries risk. The periodontal status was fair. There was association of occurrence of hypodontia and malocclusions in craniofacial anomalies. This affects their QoL.

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

Quality of care in Robin sequence

Corstiaan C Breugem, Maartje Haasnoot

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):10-15

Robin sequence is a heterogenous phenomenon with high morbidity and even mortality. The sequence is often associated with other anomalies, however it is of utmost importance to adequatly treat the upper airway obstruction. In a time where value of health care is judged by objective outcome measures, Robin sequence is in need to have these outcome measures better defined. This manuscript will summarize some important aspects that could help us to determine objective outcomes to measure treatment success.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zd20vr

Presurgical nasoalveolar molding therapy in patients with bilateral cleft lip and palate

Lourdes Martínez Motta, Jessica Sánchez Huanca

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):195-197

Infants with bilateral cleft lip and palate have an esthetic and functional involvement of the face. To obtain esthetic results, such as reducing the cleft gap and mediating premaxilla, various treatments are performed, such as presurgical orthopedics with extraoral traction headgear and nasoalveolar molding. Nasoalveolar molding (NAM) therapy has proven to be an effective method for reducing the cleft, improving the anatomy of the nose and remodeling the alveolar and nasal segments before surgical repair. This article presents two clinical cases with bilateral cleft lip and palate; case 1 treated with presurgical orthopedics with extraoral traction headgear and case 2 treated with NAM therapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbN9CJ

Facial deformity correction: A journey through small towns and rural India

Sailesh Kumar Mukul, Abhishek Singh, Sumit Singh, Priyankar Singh, Amit Kumar

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):16-19

Introduction: Craniofacial anomalies constitute a large fraction of facial deformity cases. The aim of this study is to develop a road map to extend the services for facial deformity correction in small towns and rural parts of the country. The objectives were to assess the existing services for facial deformity correction as a pilot project and to conduct strength, weakness, opportunities, threats analysis of existing care providers for facial deformity correction in Bihar. Methods: A questionnaire was generated titled "Survey on Distribution, Management, Difficulties Encountered and suggestions to improve services to manage the facial deformity cases in a conventional small surgical setup in Bihar" and was distributed among existing care providers for the facial deformity patient. Results: Less than 30% of care providers provide services at small towns and villages. Majority of care providers are centered at the district level. Discussion: The paucity of care providers for corrections of facial deformities needs to increase from mere 30%.This relates to desired increase in capacity by two folds to clear the backlog in a decade in India. Conclusion: At present, no national level policy to address the facial deformities which require to be formulated through established national and international societies and organizations.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zciwf9

Cheiloplasty by Pfeifer's Technique

Rayadurgam Venkata Kishore Kumar, Y Sivanagendra Reddy

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):113-117

Introduction: Cleft lip repair is done usually between the ages of 3rd–5th month of life. Millard's and Tennison techniques are usually used worldwide which are modified Z-plasty techniques at the superior and inferior ends of the philtrum, respectively. Wave-line incision method was introduced by Pfeifer (1970) and the available literature shows that it is an easy technique, applicable to almost all types of clefts. Hence, the study was undertaken to evaluate the results of this method. Patients and Methods: The study was carried out in a total of 701 patients, of which 572 were unilateral cleft lips and 129 were bilateral lips. According to this method, the lip skin incision modified into a wavy line, thus making it less conspicuous using the concept of "morphological order." The basis of this is that a skin incision between two points can be lengthened if both points are joined in a curve or wavelike manner rather than in a straight line. Results: The results were evaluated for white roll match, vermilion match, cupids bow, and nasal symmetry after cleft repair and found to be excellent with 93.5%, 92.4%, 94%, and 81%, respectively, in unilateral cleft lip variety, good with 75.9%, 71%, 82%, and 87.5%, in bilateral cleft lip variety. Conclusion: This method is not a new technique, but the literature is not available. The technique is found to be good and useful in all clefts, also in revision surgeries and also found to be clinically as well as statistically significant.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbN4yV

A new classification approach: Center of integral care of cleft lip palate “SUMA” center (México)

Jose Maya Behar, Daniel De Luna Gallardo, Rodrigo Morales De La Cerda, Silverio Tovar Zamudio

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):20-24

The cleft lip palate (CLP) is characterized by multiple phenotypic presentations in relation to the degree of severity and complexity that may involve its embryology. These characteristics largely determine the approach and therapeutic plan. There have been many descriptive, diagrammatic, and coding systems throughout history that have tried to define and unify the malformation. However, there are only a few that have stood the test of time. The objective of the present study is to propose a new classification of CLP ("SUMA") by an observational study implemented in 410 patients. We use the criteria proposed by Hakins (1961) for an "Ideal" classification to evaluate our system. The 406 patients (99%) fulfilled the criteria in their totality being able to be classified adequately. Proving that the "SUMA" system corresponds to a unique, descriptive, reproducible, clear, and specific tool that promises to unify the classification in the CLP.

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

Comparison of soft-tissue changes after the surgical repair of unilateral cleft lip side to noncleft lip side: An anthropometric study

Mohamed Abdul Wajid, Rohit Kulshrestha, Ramji Rastogi, Deepak Kumar, Kamlesh Singh, Mohamed Abdul Ateeq

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):139-143

Aim: The aim of this article was to compare the tissue contraction after the surgical repair of unilateral cleft lip side to noncleft lip side. Materials and Methods: Forty patients with unilateral cleft lip only were used as subjects. They were divided into two groups based on gender (20 males and 20 females). Measurements of soft-tissue landmarks of cleft side and noncleft side were compared after surgical repair of the lip to check for soft-tissue contractions. A vernier caliper was used to measure the linear measurements, and all the measurements were measured directly on the patients' lips. Results: When gender comparison was done, it was found to be significant only for oral commissure to the peak of Cupid's bow for both cleft and noncleft sides (P < 0.05). When comparison between the two sides (left and right) was done, a significant difference was observed only for subalar to peak of Cupid's bow measurement which was found to be significantly larger at noncleft as compared to cleft side in overall assessment (P = 0.005) and in females (P = 0.046); however, this difference was not statistically significant when evaluated for males alone (P = 0.060). Conclusion: Marked soft-tissue contraction was seen after surgical repair of the unilateral cleft lip, more was seen in females. This indicates that adequate planning and accurate surgical techniques and measurements should be taken while approximating the two lip flaps both in vertical and in horizontal direction before planning the surgery to get the best esthetic result for the patients.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbN2Hj

Comparison of craniodentofacial morphology of children with and without unilateral cleft lip and palate

Servet Dogan, Sultan Olmez, Ege Dogan

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):25-30

Background: This retrospective case-control study was done to investigate the cranio-dento-facial morphology of Turkish children with unilateral complete cleft lip and palate from Ege University and compare them with a normal group to highlight the effect of surgical correction on craniofacial development. Methods: 60 patients with unilateral complete cleft lip and palate were compared with 55 control children without cleft at mean ages of 13 and 15 years. The cleft lip was operated with modified Millard technique at 3 months, cleft palate was operated with von Langenbeck technique at 12 months. The patients were not given any orthopaedic or orthodontic treatment also. Angular and linear measurements of cranio-dento-facial complex were measured by using Dolphin Imaging 11.5 software programme, and the resulting data were evaluated statistically. Results: The children with unilateral complete cleft lip and palate had considerable morphological deviations when compared with the matched children without clefts. The most striking findings in the unilateral complete cleft lip and palate group: Maxillary and mandibular complex and nasal projections were retruded when compared with normal (P<0.001). Also, nasal airway dimensions were higher in control group (P<0.001). Soft tissue structure, especially upper lip thickness, upper and lower lip lengths were decreased (P<0.001, P<0.001, P<0.05, respectively) in cleft group. Maxillar anterior height was decreased (P<0.001). Besides, nasolabial angle and upper incisor inclination according to the maxillary occlusal plane (P<0.001) were increased while overjet (Mx1-Md1) were decreased (P<0.001). Conclusion: The surgical technique and the number of operations seem to be the most effective factors for maxillary retrusion in patients with unilateral complete cleft lip and palate.

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

Evaluation of dental arch relationship of patients with bilateral cleft lip and palate applying bilateral yardstick

Cristiane Lucas de Farias Luz, Terumi Okada Ozawa, Rafael Arouca, Amanda Ohashi, Daiana Broll

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):167-172

Aims: This study aims to verify the applicability and reliability of the Bilateral yardstick on the assessment of interarch relationship in patients with bilateral cleft lip and palate (BCLP) through three-dimensional (3D) virtual casts. Setting and Design: A total of 112 individuals with BCLP, aging 6–12 years old, with no associated syndromes, free from previous orthodontic treatment and from secondary bone grafting. Methods: Plaster casts from the 112 individuals were obtained, randomly numbered and scanned, generating a 3D digital image. Three calibrated orthodontists used the Bilateral yardstick to classify, in two rounds, the interarch relationship on the virtual casts. Descriptive statistics were employed to describe the frequencies of the scores of the Bilateral yardstick. Weighted Kappa statistics were calculated to determine intra- and inter-rater reliability. Results: Raters reported no difficulties in the employment of the Bilateral yardstick on 3D virtual casts. Good occlusal relationship or minor deviation was observed in 60 (53.6%) individuals. No more than 13 (11.6%) patients were classified as having a poor arch form. Intraexaminer kappa values were higher than 0.93 (confidence interval [CI] 0.88–0.98), and interexaminer agreement was higher than 0.78 (CI 0.69–0.87). Conclusion: Bilateral yardstick proved to be applicable to the assessment of dental arch relationship of patients with BCLP through 3D virtual casts. Weighted kappa values indicated good intrarater and good-to-very good agreement, supporting the reliability of this yardstick when employed to virtual casts. Further studies should be encouraged to face the actual lack of evidence in this field.

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

Evaluation of MSX1 gene as the common candidate gene of nonsyndromic congenital hypodontia and cleft lip and palate

Ayse Tuba Altug, Asli Senol, Ozlem Nasibe Ozkepir, Haldun Dogan, Serdar Ceylaner, Erhan Ozdiler

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):31-37

Introduction and Aim: Cleft lip and palate (CLP) is complex craniofacial deformity in which both the environmental and genetic factors play a role. Congenital hypodontia is the absence of permanent teeth. As congenitally missing maxillary lateral incisors (CMML) and CLP both occur at the suture between premaxilla and maxillary posterior segments, this finding has directed us to investigate if both anomalies could be affected by the same genetic factors. Therefore, the aim of our study is to investigate if there is a common genetic pattern between the occurrence of CLP and congenitally CMMLs. Subjects and Methods: Muscle Segment Homeobox-1 (MSX1) is one of the common candidate genes of hypodontia and CLP. In this study, the role of MSX1 for CLP and CMML was evaluated. The CLP and CMML groups were consisted of 51 and 48 participants, respectively. 3cc blood samples with EDTA were collected and genomic deoxyribonucleic acids were isolated. To screen for putative mutations, two exons of MSX1 gene as well as their exon–intron boundaries were amplified by the PCR and analyzed with Sanger sequencing method. Results: In both groups, the same SNP (c. *6C>T, rs 8670) which is localized in 3'untranslated region of MSX1 gene was detected. Minor allele frequency, heterozygosity, and Chi-square test for Hardy–Weinberg equilibrium at c. *6C>T variation were computed. The expected wild-type, heterozygous, and homozygous allele frequencies of c. *6C>T variation were % 65.61, % 30.78, and % 3.61, respectively. However, the frequencies were %47.9, %45.8, and %6.3 in CMML group and %80.4, %11.8, and % 7.8 in CLP group. These frequencies were diverted from normal for both groups, and the differences between the groups were statistically significant P < 000.1 (Chi-square test). Conclusion: The existence of common polymorphisms and diversions from the normal population in the 3'untranslated region of the MSX1 gene is supporting the hypothesis of a possible relationship between CLP and CMML incisors.

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

Our unified pharyngeal flap operation

Mikihiko Kogo, Takayoshi Sakai, Takeshi Harada, Kanji Nohara, Emiko Tanaka Isomura, Tetsuya Seikai, Koichi Otsuki, Chihiro Sugiyama, Kiyoko Nakagawa, Susumu Tanaka

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):189-191



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BbMS2F

Lip prints as a genetic marker in inheritance of cleft lip and palate: A case–control study

Abhilasha Yadav, Rahul Gaikwad, Anuj Jain, Suhas Jajoo

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):38-42

Aim: The aim of the study was to study the various pattern types of lip prints in parents of cleft lip and palate (CLP) siblings to detect if any specific pattern can be considered as a genetic marker. Patients and Methods: The study included 100 participants (study group parents with children having CLP, fifty fathers and fifty mothers) and fifty participants (control group parents having children without CLP, 25 fathers and 25 mothers. The lip prints of the participants were obtained using the cellophane method and analyzed using Suzuki and Tsuchihashi classification of lip prints. The data were subjected to Chi-square test. Results: On the basis of the logistic regression, prediction of 27% of abnormal pattern in more than one-quadrant of lip can be considered as genetic marker for cleft lip (palate) deformity. Discussion: In our study, abnormal pattern Type V had been found which was considered as genetic marker for transmission of cleft lip (palate) deformity and a predominant pattern of Type II was found which was same in lines of An Egyptian study. Conclusion: A highly significant correlation was observed in lip patterns in parents with cleft anomalies.

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

Congenital hemifacial hyperplasia with “locked jaw”: Rare anomaly with a rare presentation

Parvathi Ravula, Srikanth Rangachari, K Swathi

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):201-204

Congenital hemifacial hypertrophy is a rare developmental disorder characterized by unilateral enlargement of all the facial tissues of viscerocranium involving the teeth, bone, and soft tissues. Many case reports have been reported in the literature describing the characteristic clinical and radiological features, etiology, and conditions mimicking the hemifacial hypertrophy. In general, treatment is considered for the esthetic improvement in the form of soft tissue debulking, osteotomies, or orthognathic procedures. We report a case of true hemifacial hypertrophy presented with a severe temporomandibular joint ankylosis with the jaws locked in an anterior open bite deformity and its management.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Bcs0bE

Controversy and consensus for primary repair of cleft lip nose deformity

Raj Kumar Manas, Shamendra Anand Sahu

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(3):43-49

Introduction: Correction of Cleft lip nose deformity is a difficult challenge for cleft surgeons. Though, Primary repair of cleft lip nose deformity has been accepted worldwide, there are many variations amongst surgeons involved in cleft care. To demystifying the controversy of primary correction of cleft lip nose repair, we have done an internet based survey to define consensus among surgeons. Methodology: A 15 items questionnaire was framed and sent to the all plastic surgeons of India as well as oral & maxillofacial surgeons, Head & neck, ENT & Pediatric surgeons of the country involved in cleft lip surgery. The questionnaire was categorised in the form of repairing the nose deformity with cleft lip, approach to address such deformity, secondary complications & residual deformity present and satisfactory outcome in order to make a common consensus among surgeons involved in cleft surgery. Results: Of total respondents, 91.8% were plastic surgeons and 9.3 % Oral & maxillofacial surgeons. Almost all of them(100%) felt that nose deformity is a part of cleft lip, but only 81.3% agreed for nose deformity correction at the same time of cleft lip repair. Those who performed nose correction were about 58.1%, who always addressed nose deformity whereas 38.7% performed it sometimes.68.8 % address mostly flaring of ala whereas 52.1% address depressed nasal dome also while 24% address all the deformities. The maximum group, 45.3% prefer semi-open approach; whereas almost equal group 42.1% feel closed approach is sufficient enough to address all deformities. As per age of primary correction of nose deformity, 43% do it at the age of 3-4 months along with cleft lip repair whereas 33 % wait for 6 months. Regarding extent of dissection, 31.2% believe in minimum dissection, whereas for 62.7% it varies according to deformity. 89.7% feel primary correction reduces the deformities and 54.1% people feel only 25% patients may require revision before 7 years of age. However 59.6% prefer to revise the nose correction secondarily at adolescent age. About 29.3% surgeons were satisfied with their result in almost 50-75% of their patients and equal group in their 25-50% of patients' .The main complication they encounter was residual nose deformity in about 75.8%. About 87.8% believe there is no maxillary growth disturbances following nose repair and 87.52% are in favour of doing nose correction at the time of cleft lip repair. Conclusion: To conclude, nose deformity is a part of cleft lip and should be repaired at the time of cleft lip repair. The optimum age of repair is same as for cleft lip. The approach may be "semi-open" to "closed" depending on the surgeon's expertise and experiences and extent of dissection may vary according to deformities. However, a small group of patients may require secondary correction, but it is evident that primary nasal correction reduces the deformities and it should be an integral part of cleft lip repair.

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

Building trophic specializations that result in substantial niche partitioning within a young adaptive radiation

Abstract

Dietary partitioning often accompanies the increased morphological diversity seen during adaptive radiations within aquatic systems. While such niche partitioning would be expected in older radiations, it is unclear how significant morphological divergence occurs within a shorter time period. Here we show how differential growth in key elements of the feeding mechanism can bring about pronounced functional differences among closely related species. An incredibly young adaptive radiation of three Cyprinodon species residing within hypersaline lakes in San Salvador Island, Bahamas, has recently been described. Characterized by distinct head shapes, gut content analyses revealed three discrete feeding modes in these species: basal detritivory as well as derived durophagy and lepidophagy (scale-feeding). We dissected, cleared and stained, and micro-CT scanned species to assess functionally relevant differences in craniofacial musculoskeletal elements. The widespread feeding mode previously described for cyprinodontiforms, in which the force of the bite may be secondary to the requisite dexterity needed to pick at food items, is modified within both the scale specialist and the durophagous species. While the scale specialist has greatly emphasized maxillary retraction, using it to overcome the poor mechanical advantage associated with scale-eating, the durophage has instead stabilized the maxilla. In all species the bulk of the adductor musculature is composed of AM A1. However, the combined masses of both adductor mandibulae (AM) A1 and A3 in the scale specialist were five times that of the other species, showing the importance of growth in functional divergence. The scale specialist combines plesiomorphic jaw mechanisms with both a hypertrophied AM A1 and a slightly modified maxillary anatomy (with substantial functional implications) to generate a bite that is both strong and allows a wide range of motion in the upper jaw, two attributes that normally tradeoff mechanically. Thus, a significant feeding innovation (scale-eating, rarely seen in fishes) may evolve based largely on allometric changes in ancestral structures. Alternatively, the durophage shows reduced growth with foreshortened jaws that are stabilized by an immobile maxilla. Overall, scale specialists showed the most divergent morphology, suggesting that selection for scale-biting might be stronger or act on a greater number of traits than selection for either detritivory or durophagy. The scale specialist has colonized an adaptive peak that few lineages have climbed. Thus, heterochronic changes in growth can quickly produce functionally relevant change among closely related species.

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