Recovering Wood and McCarthy’s ERP-prototypes by means of ERP-specific procrustes-rotation

Publication date: 1 February 2018
Source:Journal of Neuroscience Methods, Volume 295
Author(s): André Beauducel
BackgroundThe misallocation of treatment-variance on the wrong component has been discussed in the context of temporal principal component analysis of event-related potentials. There is, until now, no rotation-method that can perfectly recover Wood and McCarthy's prototypes without making use of additional information on treatment-effects.New methodIn order to close this gap, two new methods: for component rotation were proposed. After Varimax-prerotation, the first method identifies very small slopes of successive loadings. The corresponding loadings are set to zero in a target-matrix for event-related orthogonal partial Procrustes- (EPP-) rotation. The second method generates Gaussian normal distributions around the peaks of the Varimax-loadings and performs orthogonal Procrustes-rotation towards these Gaussian distributions. Oblique versions of this Gaussian event-related Procrustes- (GEP) rotation and of EPP-rotation are based on Promax-rotation.ResultsA simulation study revealed that the new orthogonal rotations recover Wood and McCarthy's prototypes and eliminate misallocation of treatment-variance. In an additional simulation study with a more pronounced overlap of the prototypes GEP Promax-rotation reduced the variance misallocation slightly more than EPP Promax-rotation.Comparison with Existing Method(s): Varimax- and conventional Promax-rotations resulted in substantial misallocations of variance in simulation studies when components had temporal overlap. A substantially reduced misallocation of variance occurred with the EPP-, EPP Promax-, GEP-, and GEP Promax-rotations.ConclusionsMisallocation of variance can be minimized by means of the new rotation methods: Making use of information on the temporal order of the loadings may allow for improvements of the rotation of temporal PCA components.



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The effect of monitor raster latency on VEPs, ERPs and Brain–Computer Interface performance

Publication date: 1 February 2018
Source:Journal of Neuroscience Methods, Volume 295
Author(s): Sebastian Nagel, Werner Dreher, Wolfgang Rosenstiel, Martin Spüler
BackgroundVisual neuroscience experiments and Brain–Computer Interface (BCI) control often require strict timings in a millisecond scale. As most experiments are performed using a personal computer (PC), the latencies that are introduced by the setup should be taken into account and be corrected. As a standard computer monitor uses a rastering to update each line of the image sequentially, this causes a monitor raster latency which depends on the position, on the monitor and the refresh rate.New methodWe technically measured the raster latencies of different monitors and present the effects on visual evoked potentials (VEPs) and error-related potentials (ERPs). Additionally we present a method for correcting the monitor raster latency and analyzed the performance difference of a code-modulated VEP BCI speller by correcting the latency.Comparison with existing methodsThere are currently no other methods validating the effects of monitor raster latency on VEPs and ERPs.ResultsThe timings of VEPs and ERPs are directly affected by the raster latency. Furthermore, correcting the raster latency resulted in a significant reduction of the target prediction error from 7.98% to 4.61% and also in a more reliable classification of targets by significantly increasing the distance between the most probable and the second most probable target by 18.23%.ConclusionsThe monitor raster latency affects the timings of VEPs and ERPs, and correcting resulted in a significant error reduction of 42.23%. It is recommend to correct the raster latency for an increased BCI performance and methodical correctness.



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Development of a Laboratory Method for the Comparison of Settling Processes of Road-Deposited Sediments with Artificial Test Material

Abstract

Sediments deposited on road surfaces are contaminated with pollutants; the load of pollution increases from coarse to fine particles. When it rains, different fractions of the road-deposited sediments are washed off depending on the rain intensity, the slope of the catchment, and other site-specific factors. This road runoff is often treated using settling processes implemented in different types of manufactured treatment devices. These devices can be tested with well-defined artificial test materials to determine the removal efficiencies of particulate matter in a reproducible manner. However, the suitability of the currently deployed artificial test materials to represent the settling behavior of real runoff particle collectives is largely unknown. In this study, a laboratory method to measure and compare the settling behavior of artificial and real particle collectives with a reproducible particle size composition was developed. The particle collectives were obtained from different road surfaces, fractionated into sieve classes, and then recomposed into a defined particle size distribution that represented the road runoff. The settling velocity was analyzed in a modified settling column setup under constant conditions. The resulting data form a cumulative curve of the settling velocities for both artificial and real particle collectives. The main result from this work is that the tested artificial material and the recomposed real particle collectives have comparable settling behaviors despite different losses on ignition and densities.

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Re: Sentinel node biopsy in desmoplastic thin melanoma: histogenetic recommendations

Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Jonathan A. Dunne, Barry W.E.M. Powell




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Updated anatomy of the buccal space and its implications for plastic, reconstructive and aesthetic procedures

Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Thilo L. Schenck, Konstantin C. Koban, Alexander Schlattau, Konstantin Frank, Anthony P. Sclafani, E. Riccardo Giunta, Malcolm Z. Roth, Alexander Gaggl, Robert H. Gotkin, Sebastian Cotofana
BackgroundThe buccal space an integral deep facial space which is involved in a variety of intra- and extra-oral pathologies and provides a good location for the harvest of the facial artery. The age-related anatomy of this space was investigated and compared to previous reports.MethodsWe conducted anatomic dissections in 102 fresh frozen human cephalic specimens (45 males, 57 females; age range 50 – 100 years) and performed additional computed tomographic, magnetic resonance and 3-D surface volumetric imaging studies to visualize the boundaries and the contents of the buccal space after injection of contrast enhancing material.ResultsThe mean vertical extent of contrast agent injected into the buccal space was 25.2 ± 4.3 mm and did not significantly differ between individuals of different of age (p = 0.77) or gender (p = 0.13). The maximal injected volume was 10.02cc [range: 3.09 – 10.02] without significant influence of age (p = 0.13) or gender (p = 0.81). The change in surface volume was 3.64 ± 1.04 cc resulting in a mean surface-volume-coefficient of 0.87 ± 0.12 without being statistically influenced by age (p = 0.53) or gender (p = 0.78).ConclusionsThe facial artery was constantly identified within the buccal space whereas the facial vein was found to course within its posterior boundary. The buccal space did not undergo age-related changes in volume or size which highlights this space is a reliable and predictable landmark for various plastic, reconstructive and aesthetic procedures.



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Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant

Publication date: Available online 1 December 2017
Source:Journal of Voice
Author(s): Anna Rzepakowska, Ewelina Sielska-Badurek, Raul Cruz, Maria Sobol, Ewa Osuch-Wójcikiewicz, Kazimierz Niemczyk
The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.



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EJC's biennial report on metastatic soft tissue sarcoma: State of the art and future perspectives

Publication date: January 2018
Source:European Journal of Cancer, Volume 88
Author(s): Melissa Vos, Stefan Sleijfer
In the last decade the limited treatment options for patients with metastatic soft tissue sarcoma have expanded considerably. With the addition of olaratumab to first-line treatment with doxorubicin, the introduction of several new agents in second-line treatment and beyond and other promising agents in the pipeline, perspectives of patients with metastatic soft tissue sarcoma are improving. Due to increasing insight into the biology of the different soft tissue sarcoma subtypes, choice of treatment has become much more histology-driven, although more prognostic and predictive factors are needed to further personalise therapy. This report summarises the current state of the art and discusses the promising developments in the treatment of patients with metastatic soft tissue sarcoma.



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Perceptions of the dental profession: a comparative analysis through scale development

Dentistry is a science-based profession that has a close interaction with people and society. However, despite this close interaction, perceptions of the dental profession by both patients and dental professionals have received little research attention. The purpose of this study was to compare the perceptions of dentists, dental students, and patients toward the dental profession through the development and testing of the Dental Profession Perceptions Scale (DPPS). The DPPS contains a total of 17 items measured on a 5-point Likert response scale. The DPPS showed excellent internal reliability (Cronbach's α = 0.92) and test–retest reliability (r = 0.93). Explanatory and confirmatory factor analyses of the DPPS showed that dentists', dental students', and patients' perceptions of the dental profession could be grouped according to 'status', 'human', and 'scientific' factors. There were no statistically significant differences between participants' DPPS total or sub-scale scores according to dental group, gender, or income. The DPPS developed can be used in future studies as a psychometrically sound measuring tool. Further studies should examine the factors that may affect the perceptions of the dental profession in different societies and cultures.

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Prolonged use of alendronate alters the biology of cranial repair in estrogen-deficient rats’ associated simultaneous immunohistochemical expression of TGF-β1+, α-ER+, and BMPR1B-

Abstract

Objectives

TGF-β1 is a cytokine that may induce both osteoneogenesis through Runx-2 or fibrosis via the transcription of α-smooth muscle actin (α-SMA). Because it has been previously known that alendronate increases the level of TGF-β1 and that under the usual condition of bone metabolism the estrogen may prevent the fibrotic effect of TGF-β1, the aim of this study was to evaluate if alendronate alters the cellular differentiation process post calvarial surgery in estrogen-deficient specimens.

Materials and methods

A transosseous defect that was 5 mm in diameter was created on the calvarium of each of 32 female rats with previous ovarian-salpingo-oophorectomy. All defects were treated with autografts, and 16 rats received the administration of 1 mg/kg of alendronate three times a week until euthanasia on the 15th and 60th day post surgery. Histomorphometric and immunohistochemical analyses of the expression of TGF-β1, estrogen receptor alpha nuclear (α-ER), α-SMA, BMPR1B, and Runx-2 were performed, and ELISA was used to measure the level of estrogen.

Results

All animals demonstrated low levels of estrogen post ovarian-salpingo-oophorectomy. The histological results demonstrated larger bone matrix deposition in specimens treated with alendronate on the 15th day post surgery. The result was associated with a higher co-expression of TGF-β1, BMPR1B, and Runx-2 when compared with the control group. In addition, on the 60th day post surgery, the increase of bone matrix deposition from 15th to 60th day was discrete in specimens treated with alendronate compared with the control group. This result coincided with the intense simultaneous expression of TGF-β1, α-ER, and α-SMA, whereas the expression of BMPR1B and Runx-2 decreased.

Conclusion

The prolonged administration of alendronate altered the cranial repair in ovarian-salpingo-oophorectomized specimens due to the simultaneous occurrence of low estrogen and the presence of TGF-β1+/α-ER+ inducing the presence of α-SMA⁺, whereas BMPR1B and Runx-2 were suppressed.

Clinical relevance

The prolonged administration of alendronate alters osteoneogenesis and induces an unusual microenvironment in the bone that seems to imitate the physiological tissue damage that culminates in the loss of the functional layer of endometrium.

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Radiation therapy improves disease-specific survival in women with Stage II endometrioid endometrial cancer—Brachytherapy may be sufficient

Publication date: Available online 2 December 2017
Source:Brachytherapy
Author(s): Chika R. Nwachukwu, Rie Von-Eyben, Elizabeth A. Kidd
PurposeTo evaluate disease-specific survival (DSS) outcomes in Stage II endometrioid endometrial cancer (EC) patients based on pathology and treatment information including adjuvant radiotherapy and lymph node assessment.Methods and MaterialsUsing the Surveillance, Epidemiology, and End Results database, 2877 patients with Stage II EC diagnosed between 2004 and 2012 treated with radiation were identified. DSS was determined for different modalities of radiation. Kaplan–Meier estimates of survival and Cox regression modeling were used to explore the risk associated with various factors on DSS.ResultsThe 4-year DSS for the study population was 90%. Radiation was associated with improved 4-year DSS when compared to no radiotherapy (p = 0.03). Patients with Grade 2 and 3 tumors had improved 4-year DSS with radiation (94% vs. 90%, p = 0.02 and 81% vs. 73%, p = 0.15), respectively, but no differences in DSS when vaginal brachytherapy alone was compared with external beam alone or both. Patients with Grade 2 (p = 0.002) and Grade 3 (p < 0.001) tumors without a lymph node dissection (LND) had worse DSS compared to patients with any LND. Patients with Grade 3 tumors without an LND who received radiation showed improved DSS (p = 0.008). Multivariable analysis revealed that age >60 years (p < 0.001), Grade 3 (p < 0.001), no radiotherapy (p = 0.05), and no LNDs (p < 0.001) were significant prognostic factors for worse DSS.ConclusionsAdjuvant radiation, whether delivered by brachytherapy or external beam radiation, is associated with improved DSS in Stage II EC patients with high-grade tumors, therefore brachytherapy may be sufficient.



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Initial clinical assessment of “center-specific” automated treatment plans for low-dose-rate prostate brachytherapy

Publication date: Available online 1 December 2017
Source:Brachytherapy
Author(s): Mustafa Ege Babadagli, John Doucette, Nawaid Usmani, John Amanie, Albert Murtha, Don Yee, Mohammad Jamaluddin, Ron S. Sloboda
PurposeTo report results of an initial pilot study assessing iodine-125 prostate implant treatment plans created automatically by a new seed-placement method.Methods and MaterialsA novel mixed-integer linear programming method incorporating spatial constraints on seed locations in addition to standard dose–volume constraints was used to place seeds. The approach, described in detail elsewhere, was used to create treatment plans fully automatically on a retrospective basis for 20 patients having a wide range of prostate sizes and shapes. Corresponding manual plans used for patient treatment at a single institution were combined with the automated plans, and all 40 plans were anonymized, randomized, and independently evaluated by five clinicians using a common scoring tool. Numerical and clinical features of the plans were extracted for comparison purposes.ResultsA full 51% of the automated plans were deemed clinically acceptable without any modification by the five practitioners collectively versus 90% of the manual plans. Automated plan seed distributions were for the most part not substantially different from those for the manual plans. Two observed shortcomings of the automated plans were seed strands not intersecting the prostate and strands extending into the bladder. Both are amenable to remediation by adjusting existing spatial constraints.ConclusionsAfter spatial and dose–volume constraints are set, the mixed-integer linear programming method is capable of creating prostate implant treatment plans fully automatically, with clinical acceptability sufficient to warrant further investigation. These plans, intended to be reviewed and refined as necessary by an expert planner, have the potential to both save planner time and enhance treatment plan consistency.



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Improved rectal dosimetry with the use of SpaceOAR during high-dose-rate brachytherapy

Publication date: Available online 2 December 2017
Source:Brachytherapy
Author(s): Susan Y. Wu, Lauren Boreta, Ashley Wu, Joey P. Cheung, J. Adam M. Cunha, Katsuto Shinohara, Albert J. Chang
PurposeHydrogel spacers have been suggested to limit rectal radiation dose with improvements in clinical outcomes in patients undergoing external beam radiation treatment for prostate cancer. No studies to date have assessed the utility and dosimetric effect of SpaceOAR (Augmenix, Inc, Waltham, MA), the only Food and Drug Administration–approved hydrogel rectal spacer, for high-dose-rate (HDR) brachytherapy.MethodsEighteen consecutive patients scheduled for HDR brachytherapy in the treatment of prostate cancer underwent transperineal ultrasound-guided placement of 10 cc of SpaceOAR hydrogel following catheter implantation. Treatment plans were generated using an inverse planning simulated annealing algorithm. Rectal dosimetry for these 18 patients was compared with the 36 preceding patients treated with HDR brachytherapy without SpaceOAR.ResultsFifty-four plans were analyzed. There was no difference in age, pretreatment prostate-specific antigen, Gleason score, clinical stage, prostate volume, or contoured rectal volume between those who received SpaceOAR and those who did not. Patients who received SpaceOAR hydrogel had significantly lower dose to the rectum as measured by percent of contoured organ at risk (median, V80 < 0.005% vs. 0.010%, p = 0.003; V75 < 0.005% vs. 0.14%, p < 0.0005; V70 0.09% vs. 0.88%, p < 0.0005; V60 = 1.16% vs. 3.08%, p < 0.0005); similar results were seen for rectal volume in cubic centimeters. One patient who received SpaceOAR developed a perineal abscess 1 month after treatment.ConclusionsTransperineal insertion of SpaceOAR hydrogel at the time of HDR brachytherapy is feasible and decreases rectal radiation dose. Further investigation is needed to assess the clinical impact of this dosimetric improvement and potential toxicity reduction.



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Effects of bilateral discectomy and bilateral discopexy on Black Merino Sheep rumination kinematics: TEMPOJIMS - pilot blinded, randomized preclinical study

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): D.F. Ângelo, F. Monje, R. González, L. Monico, C. Moura, L. Francisco, D. Sanz, N. Alves, F. Salvado, P. Morouço
BackgroundThe potential for temporomandibular interposal materials is immense, but in order to progress in translational medicine, preclinical trials are essential. This temporomandibular joint interposal material study (TEMPOJIMS) is the first randomized, blinded, and controlled preclinical study (in line with the ARRIVE guidelines) of the TMJ domain.The normal process used by ruminants to break down dry matter involves initial chewing and rumination. This investigation focused on evaluating changes to this process after bilateral discectomy and discopexy.MethodsThis study was conducted using nine black Merino sheep to evaluate changes in chewing after bilateral discectomy and bilateral discopexy, by comparing with a sham surgery control group. The outcomes evaluated were: (1) absolute masticatory time; (2) ruminant time per cycle; (3) ruminant kinematics, and (4) ruminant area. After baseline evaluation and surgical interventions, the outcomes were recorded over 3 successive days, every 30 days, for 6 months.ResultsThe first month after intervention seemed to be the critical period for significant kinematic changes in the discectomy and discopexy groups. However, 6 months after the bilateral interventions, no significant changes were noticed when compared with the control group.ConclusionsThe introduction of kinematic evaluation presents a new challenge that may contribute to the improvement of future studies of the TMJ domain.



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Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Caio César da Silva Barros, Hellen Bandeira de Pontes Santos, Israel Leal Cavalcante, Larissa Santos Amaral Rolim, Leão Pereira Pinto, Lélia Batista de Souza
PurposeTo evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts.Material and MethodsAll NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists.ResultsAmong 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37±1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common.ConclusionKnowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.



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Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant

Publication date: Available online 1 December 2017
Source:Journal of Voice
Author(s): Anna Rzepakowska, Ewelina Sielska-Badurek, Raul Cruz, Maria Sobol, Ewa Osuch-Wójcikiewicz, Kazimierz Niemczyk
The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.



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Identification of patterns of factors preceding severe or life-threating asthma exacerbations in a nationwide study

Abstract

Background

Reducing near-fatal asthma exacerbations is a critical problem in asthma management.

Objectives

To determine patterns of factors preceding asthma exacerbations in a real-world setting.

Methods

In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the two-week period before admission.

Results

Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low BMI and tendency to depression who had stopped anti-asthma medications, smoked, were hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly-rapid worsening within 48 hours, mostly middle-aged and older, relatively good ICS or ICS/LABA compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these three clusters.

Conclusion

To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increased standard therapy or new anti-type 2 response-targeted therapies should be considered for cluster C.

This article is protected by copyright. All rights reserved.

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Effects of bilateral discectomy and bilateral discopexy on Black Merino Sheep rumination kinematics: TEMPOJIMS - pilot blinded, randomized preclinical study

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): D.F. Ângelo, F. Monje, R. González, L. Monico, C. Moura, L. Francisco, D. Sanz, N. Alves, F. Salvado, P. Morouço
BackgroundThe potential for temporomandibular interposal materials is immense, but in order to progress in translational medicine, preclinical trials are essential. This temporomandibular joint interposal material study (TEMPOJIMS) is the first randomized, blinded, and controlled preclinical study (in line with the ARRIVE guidelines) of the TMJ domain.The normal process used by ruminants to break down dry matter involves initial chewing and rumination. This investigation focused on evaluating changes to this process after bilateral discectomy and discopexy.MethodsThis study was conducted using nine black Merino sheep to evaluate changes in chewing after bilateral discectomy and bilateral discopexy, by comparing with a sham surgery control group. The outcomes evaluated were: (1) absolute masticatory time; (2) ruminant time per cycle; (3) ruminant kinematics, and (4) ruminant area. After baseline evaluation and surgical interventions, the outcomes were recorded over 3 successive days, every 30 days, for 6 months.ResultsThe first month after intervention seemed to be the critical period for significant kinematic changes in the discectomy and discopexy groups. However, 6 months after the bilateral interventions, no significant changes were noticed when compared with the control group.ConclusionsThe introduction of kinematic evaluation presents a new challenge that may contribute to the improvement of future studies of the TMJ domain.



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Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Caio César da Silva Barros, Hellen Bandeira de Pontes Santos, Israel Leal Cavalcante, Larissa Santos Amaral Rolim, Leão Pereira Pinto, Lélia Batista de Souza
PurposeTo evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts.Material and MethodsAll NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists.ResultsAmong 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37±1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common.ConclusionKnowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.



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Selected Abstracts from the December Issues of the Journal of Vascular Surgery

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Contents

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Acknowledgement of Reviewers

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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One year on: Test your knowledge from the previous year

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Metformin and Abdominal Aortic Aneurysm

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6
Author(s): Robert J. Hinchliffe




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Editorial Board

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Forthcoming Events

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Towards a Contrast free Approach at EVAR: a New Look at an Old Tool - CO2 Angiography

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6
Author(s): Arindam Chaudhuri, Ramita Dey




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Spanish Translated Abstracts

Publication date: December 2017
Source:European Journal of Vascular and Endovascular Surgery, Volume 54, Issue 6





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Lessons from Fukushima: Latest Findings of Thyroid Cancer After the Fukushima Nuclear Power Plant Accident

Thyroid , Vol. 0, No. 0.


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US oncology-wide incidence, duration, costs and deaths from chemoradiation mucositis and antimucositis therapy benefits

Future Oncology, Ahead of Print.


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Emotional distress and subjective impact of the disease in young women with breast cancer and their spouses

Future Oncology, Ahead of Print.


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Perceptions and Attitudes of Cancer Patients and Caregivers Towards Enrollment in Clinical Trials in Lebanon

Abstract

The rates of participation in oncology clinical trials (CTs) are relatively lower in the Middle East compared to other areas in the world. Many social and cultural factors underlie the patients' reluctance to participate. To probe the knowledge, attitudes, and perceptions of patients with cancer and their caregivers regarding participation in CTs at our tertiary referral center in Lebanon, we interviewed 210 patients and caregivers visiting the outpatient clinics in the Naef Basile Cancer Institute at the American University of Beirut. A questionnaire was derived from literature and administered in Arabic. The study was approved by the Institutional Review Board (IRB). Two hundred individuals agreed to answer the questionnaire. The majority of participants (90.5%) were Lebanese with the remaining being non-Lebanese Arabs. Eighty-nine participants (45%) were aware of the concepts of CTs. Eighty-two respondents (41%) would participate in phase I CTs. Twenty-nine individuals (14.5%) agree to be enrolled in CTs with the approval of their family members only. One hundred twenty-nine subjects (64.5%) stated that they would refuse enrollment in a CT where they might receive placebo. Eighty-eight (44%) of participants considered that medical records could be reviewed for research without consent while 54% agreed that samples collected during clinical workup could be used for research without the consent of the patient. There are several social and demographic correlates for participation in CTs. Raising awareness and overcoming barriers of misconception are keys to promote participation in CTs in Lebanon.

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Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor)

Publication date: Available online 1 December 2017
Source:American Journal of Otolaryngology
Author(s): Tam-Lin Chow




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Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma

Publication date: Available online 2 December 2017
Source:Auris Nasus Larynx
Author(s): Daisuke Sano, Kenichiro Yabuki, Hideaki Takahashi, Yasuhiro Arai, Yoshihiro Chiba, Teruhiko Tanabe, Goshi Nishimura, Nobuhiko Oridate
ObjectiveThe purpose of this study is to validate the concept of lymph node ratio (LNR) in head and neck squamous cell carcinoma (HNSCC).MethodsA total of 63 patients with HNSCC who underwent resection of the primary tumor combined with neck dissection in our institution were analyzed in this study. LNR was defined as the number of positive lymph nodes divided by the total number of lymph nodes excised. LNR was categorized into two groups (<0.068 and ≥0.068) according to the results of receiver-operating characteristic plots for determination of the cut-off value.ResultsLNR≥0.068 was associated with poor overall survival (OS), progression-free survival (PFS) and locoregional recurrence-free survival (LRFS) after resection of the primary tumor combined with neck dissection in patients with HNSCC. Univariate and multivariate data analysis showed that LNR≥0.068 was an independent prognostic factor for OS, PFS and LRFS. Both pathological T stage status (pT3 or 4) and ≥3 positive LNs were also an independent prognostic factors for PFS in patients with HNSCC in our univariate and multivariate analysis.ConclusionThese results suggested that LNR could be useful tools in identifying HNSCC patients with poor outcomes.



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Perceptions and Attitudes of Cancer Patients and Caregivers Towards Enrollment in Clinical Trials in Lebanon

Abstract

The rates of participation in oncology clinical trials (CTs) are relatively lower in the Middle East compared to other areas in the world. Many social and cultural factors underlie the patients' reluctance to participate. To probe the knowledge, attitudes, and perceptions of patients with cancer and their caregivers regarding participation in CTs at our tertiary referral center in Lebanon, we interviewed 210 patients and caregivers visiting the outpatient clinics in the Naef Basile Cancer Institute at the American University of Beirut. A questionnaire was derived from literature and administered in Arabic. The study was approved by the Institutional Review Board (IRB). Two hundred individuals agreed to answer the questionnaire. The majority of participants (90.5%) were Lebanese with the remaining being non-Lebanese Arabs. Eighty-nine participants (45%) were aware of the concepts of CTs. Eighty-two respondents (41%) would participate in phase I CTs. Twenty-nine individuals (14.5%) agree to be enrolled in CTs with the approval of their family members only. One hundred twenty-nine subjects (64.5%) stated that they would refuse enrollment in a CT where they might receive placebo. Eighty-eight (44%) of participants considered that medical records could be reviewed for research without consent while 54% agreed that samples collected during clinical workup could be used for research without the consent of the patient. There are several social and demographic correlates for participation in CTs. Raising awareness and overcoming barriers of misconception are keys to promote participation in CTs in Lebanon.

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Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: the one airway concept revisited

Abstract

Allergic rhinitis (AR), chronic rhinosinusitis (CRS) and asthma often co-exist. The one airway model proposes that disease mechanisms occurring in the upper airway may mirror lower airway events. Airway remodelling is the term used to describe tissue structural changes that occur in a disease setting and reflect the dynamic process of tissue restructuring during wound repair. Remodelling has been long identified in the lower airways in asthma and is characterized by epithelial shedding, goblet cell hyperplasia, basement membrane thickening, subepithelial fibrosis, airway smooth muscle hyperplasia and increased angiogenesis. The concept of upper airway remodelling has only recently been introduced, and data so far is limited and often conflicting, an indication that more detailed studies are needed. Whilst remodelling changes in AR are limited, CRS phenotypes demonstrate epithelial hyperplasia, increased matrix deposition and degradation along with accumulation of plasma proteins. Despite extensive research over the past years, the precise cellular and molecular mechanisms involved in airway remodelling remain incompletely defined. This review describes our current rather limited understanding of airway remodelling processes in AR, CRS and asthma, and presents mechanisms both shared and distinct between the upper and lower airways. Delineation of shared and disease-specific pathogenic mechanisms of remodelling between the sinonasal system and the lung may guide the rational design of more effective therapeutic strategies targeting upper and lower airways concomitantly and improving the health of individuals with inflammatory airway diseases.

This article is protected by copyright. All rights reserved.

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Acetylsalicylic Acid Governs the Effect of Sorafenib in RAS- Mutant Cancers

Purpose: Identify and characterize novel combinations of sorafenib with anti-inflammatory painkillers to target difficult to treat RAS-mutant cancer. Experimental Design: The cytotoxicity of acetylsalicylic acid (aspirin) in combination with the multikinase inhibitor sorafenib (Nexavar) was assessed in RAS-mutant cell lines in vitro. The underlying mechanism for the increased cytotoxicity was investigated using selective inhibitors and shRNA-mediated gene knockdown. In vitro results were confirmed in RAS-mutant xenograft mouse models in vivo. Results: The addition of aspirin but not isobutylphenylpropanoic acid (ibruprofen) or celecoxib (celebrex) significantly increased the in vitro cytotoxicity of sorafenib. Mechanistically, combined exposure resulted in increased BRAF/CRAF dimerization and the simultaneous hyper-activation of the AMPK and ERK pathways. Combining sorafenib with other AMPK activators, like metformin or A769662, was not sufficient to decrease cell viability due to sole activation of the AMPK pathway. The cytotoxicity of sorafenib and aspirin was blocked by inhibition of the AMPK or ERK pathways through shRNA or via pharmacological inhibitors of RAF (LY3009120), MEK (trametinib) or AMPK (compound C). The combination was found to be specific for RAS/RAF-mutant cells and had no significant effect in RAS/RAF-wild type keratinocytes or melanoma cells. In vivo treatment of human xenografts in NSG mice with sorafenib and aspirin significantly reduced tumor volume compared to each single-agent treatment alone. Conclusion: Combined sorafenib and aspirin exerts cytotoxicity against RAS/RAF-mutant cells by simultaneously affecting two independent pathways and represents a promising novel strategy for the treatment of RAS-mutant cancers.

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The proteasome and proteasome inhibitors in multiple myeloma

Abstract

Proteasome inhibitors are one of the most important classes of agents to have emerged for the treatment of multiple myeloma in the past two decades, and now form one of the backbones of treatment. Three agents in this class have been approved by the United States Food and Drug Administration—the first-in-class compound bortezomib, the second-generation agent carfilzomib, and the first oral proteasome inhibitor, ixazomib. The success of this class of agents is due to the exquisite sensitivity of myeloma cells to the inhibition of the 26S proteasome, which plays a critical role in the pathogenesis and proliferation of the disease. Proteasome inhibition results in multiple downstream effects, including the inhibition of NF-κB signaling, the accumulation of misfolded and unfolded proteins, resulting in endoplasmic reticulum stress and leading to the unfolded protein response, the downregulation of growth factor receptors, suppression of adhesion molecule expression, and inhibition of angiogenesis; resistance to proteasome inhibition may arise through cellular responses mediating these downstream effects. These multiple biologic consequences of proteasome inhibition result in synergistic or additive activity with other chemotherapeutic and targeted agents for myeloma, and proteasome inhibitor-based combination regimens have become established as a cornerstone of therapy throughout the myeloma treatment algorithm, incorporating agents from the other key classes of antimyeloma agents, including the immunomodulatory drugs, monoclonal antibodies, and histone deacetylase inhibitors. This review gives an overview of the critical role of the proteasome in myeloma and the characteristics of the different proteasome inhibitors and provides a comprehensive summary of key clinical efficacy and safety data with the currently approved proteasome inhibitors.

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Spondyloepiphyseal or spondylometaphyseal dysplasia in ancient Greek art

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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A case of Riley Ruvalcaba syndrome with a novel PTEN mutation accompanied by diffuse testicular microlithiasis and precocious puberty

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Building stereotypic connectivity: mechanistic insights into structural plasticity from C. elegans

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): Yishi Jin, Yingchuan B Qi
The ability of neurons to modify or remodel their synaptic connectivity is critical for the function of neural circuitry throughout the life of an animal. Understanding the mechanisms underlying neuronal structural changes is central to our knowledge of how the nervous system is shaped for complex behaviors and how it further adapts to developmental and environmental demands. Caenorhabditis elegans provides a powerful model for examining developmental processes and for discovering mechanisms controlling neural plasticity. Recent findings have identified conserved themes underlying neural plasticity in development and under environmental stress.



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Wem gehört mein Implantat?

Laryngo-Rhino-Otol 2017; 96: 855-856
DOI: 10.1055/s-0043-118618

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Helicobacter pylori siedelt gerne auf Mandel-Gewebe

Laryngo-Rhino-Otol 2017; 96: 822-823
DOI: 10.1055/s-0043-119600

Siupsinskiene N et al. Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux. J Laryngol Otol 2017; 131: 549–55 Wie häufig finden sich Helicobacter pylori Infektionen in den Gaumenmandeln und welcher Zusammenhang besteht zwischen H. pylori, den soziodemografischen Patientendaten und dem laryngopharyngealen Reflux?
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Resektion eines Zungenkarzinoms: Neuer Schwellenwert für tumorfreien Rand

Laryngo-Rhino-Otol 2017; 96: 823-824
DOI: 10.1055/s-0043-119602

Zanoni DK et al. A Proposal to Redefine Close Surgical Margins in Sqamous Cell Carcinoma of the Oral Tongue. JAMA Otolaryngol Head neck Surg 2017; 143: 555–560. doi:10.1001/jamato.2016.4238 Bei Zungenkarzinomen gilt die Resektion mit tumorfreien Rändern als Goldstandard. Als negativer Rand wird dabei traditionell ein tumorfreier Rand von mehr als 5 mm definiert. Ob diese willkürlich gesetzte Grenze aber wirklich das Risiko für Lokalrezidive widerspiegelt, ist unklar. Jetzt wurde untersucht, ab welcher Grenze das Risiko wirklich ansteigt und wo ein neuer Schwellenwert liegen könnte.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Biosimilars und das Wirtschaftlichkeitsgebot

Laryngo-Rhino-Otol 2017; 96: 828-830
DOI: 10.1055/s-0043-122250

Biosimilars unterliegen der Wirtschaftlichkeitsprüfung nach § 106 SGB V. Die konkrete Art der Prüfung hat Einfluss auf das ärztliche Verordnungsverhalten. In der Richtgrößenprüfung führt die Verordnung von Biosimilars in der Regel zwar nicht zu einem Regress, wohl aber erst einmal zur Einleitung eines Prüfverfahrens. Ab 2017 wird die Richtgrößenprüfung entfallen. Die stattdessen zu erwartenden Wirkstoffprüfungen auf regionaler Ebene können Quoten für das Verhältnis von Biosimilars zu Originalpräparaten vorgeben und bei einer Zielverfehlung zu Regressen führen. Erste Vereinbarungen auf regionaler Ebene über konkrete Prüfverfahren sind im Laufe des Jahres zu erwarten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Begutachtung von Hörschäden

Laryngo-Rhino-Otol 2017; 96: 857-874
DOI: 10.1055/s-0043-119043

Die Beurteilung von Hörschäden ist eine häufige Fragestellung in HNO-Gutachten, hierzu zählt die Bewertung von Hörschäden als Unfallfolge, z. B. durch eine Kopfverletzung oder ein akut aufgetretenes Schalltrauma. Schwerhörigkeit als Folge einer beruflich bedingten chronischen Lärmeinwirkung gehört zu den am häufigsten bewerteten Berufskrankheiten überhaupt. Dieser Beitrag beleuchtet die Schadensbewertung und entsprechende Rechtsgrundlagen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Beidseitige Stimmlippenlähmung

Laryngo-Rhino-Otol 2017; 96: 826-827
DOI: 10.1055/s-0043-121301

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Rhinoplastik

Laryngo-Rhino-Otol 2017; 96: 877-880
DOI: 10.1055/s-0043-119387

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Koebner Phenomenon Triggered by External Dacryocystorhinostomy Scar in a Patient With Psoriasis: A Case Report and Literature Review

Koebner phenomenon is the development of isomorphic pathologic lesions on a wound of a patient with preexisting cutaneous disease, most commonly psoriasis. An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. Immediate diagnosis and treatment with topical steroids led to complete recovery. Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. All surgeons should be aware of its existence and warn susceptible patients regarding its occurrence. Accepted for publication September 3, 2017. The authors have no financial or conflict of interest to disclose. Address correspondence and reprint requests to Anasua Kapoor Ganguly, M.D., F.I.C.O., Ophthalmic Plastic Surgery & Aesthetic Services, LV Prasad Eye Institute, Vijaywada, India 521137. E-mail: anasua21@yahoo.com © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Desmoplastic Melanoma of the Periorbital Region

Desmoplastic melanoma (DM) is a rare subtype of melanoma and an even smaller proportion of periocular melanomas. Here, the authors report 2 cases of DM in the periocular region. Staged according to the American Joint Committee on Cancer (AJCC) eighth edition classification, patient 1 presented with a stage IIIC (pT4apN1cM0) DM in the left lateral canthus with upper and lower eyelid and patient 2 presented with a stage IIIB (T4aN1bM0) DM in the left brow and supraorbital region with a parotid lymph node metastasis. In both patients, the lesions were amelanotic, with inflammatory appearance, and had been noted for several years before the correct diagnosis was made. In both patients, wide excision led to large surgical defects, and perineural invasion prompted adjuvant radiation therapy postoperatively. Patient 2 was treated with an immune checkpoint inhibitor for his parotid metastasis. Ophthalmologists should be aware of DM, its neurotrophic nature, and potential to metastasize with locally advanced lesions. Accepted for publication September 1, 2017. The authors have no financial or conflict of interest to disclose. Address correspondence and reprint requests to Bita Esmaeli, M.D., F.A.C.S, Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1488, Houston, TX 77030. E-mail: besmaeli@mdanderson.org © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Concerns of Anophthalmic Patients Wearing Cryolite Glass Prosthetic Eyes

Purpose: To identify the main concerns of patients experienced in wearing cryolite glass prosthetic eyes and to investigate how these have changed over time. Methods: One hundred six patients experienced in wearing prosthetic eyes for at least 2 years were asked to complete an anonymous questionnaire regarding prosthetic eye concerns at the time of initial eye loss and at the present time. Main outcome measures included changes in levels of concern over time. Results: Initially, the participants were mainly concerned about their appearance, health of the fellow eye, and coping with monocularity. Over time, there was a significant increase of the level of concern regarding the health of the remaining eye (p

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Comparison of Outcomes of 3-Snip Punctoplasty Versus Simple Punctal Dilatation With Monocanalicular Intubation for Acquired Punctal Stenosis

Purpose: To evaluate and compare the outcomes of invasive (rectangular 3-snip punctoplasty) versus minimally invasive (punctal dilatation with monocanalicular intubation) treatment modalities for the management of acquired punctal stenosis. Methods: A retrospective, comparative, interventional case series was performed on 60 eyes of 36 patients with acquired punctal stenosis. Patients were categorized in 2 groups based on the intervention as 3-snip punctoplasty (group A) and punctal dilatation with monocanalicular intubation (group B). Qualitative and quantitative assessment for epiphora and punctal stenosis grading were performed preoperatively and postoperatively. Patients with associated canalicular and nasolacrimal duct obstructions, congenital punctal disorders, eyelid malpositions, and less than 6 months' follow up were excluded. Anatomical and functional successes were recorded following stent extubation and at 6-month follow up. Statistical analyses were performed using the chi-square, Fisher exact, and the Mann–Whitney tests. A p value of

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Immune Reconstitution Inflammatory Syndrome in a Case of Nonspecific Orbital Inflammation

The immune reconstitution inflammatory syndrome is an exaggerated abnormal immune response, typically seen in HIV-positive patients following restoration of a normal CD4 count as a result of initiation of antiretroviral therapy. It has been described in relation to either occult opportunistic infections or to a paradoxical relapse of a previously successfully treated infection with negative microbiological cultures. The authors report the case of a 60-year-old HIV-positive African male who presented with 2 episodes of orbital inflammation that occurred in conjunction with improvements of CD4 count following Highly Active Antiretroviral Therapy. This phenomenon was underpinned by biopsies obtained following each episode. Interestingly, on both occasions, he responded well to corticosteroid therapy. Although the soft tissues of the orbits are a common area affected by other inflammatory diseases, it is rare for them to be involved in immune reconstitution inflammatory syndrome. To the authors' knowledge, this is the first case report of immune reconstitution inflammatory syndrome affecting the orbits exclusively. The authors believe that it is probably an underdiagnosed condition and may be erroneously labeled as idiopathic in many cases. This case report inspires us to keep an open mind when dealing with patients on antiretroviral therapy. Accepted for publication September 24, 2017. The authors have no financial or conflicts of interest to disclose. Correspondence address and reprint requests to Dr. Shoaib Ugradar, M.D., M.R.C.P., B.Sc. (Hons), The Jules Stein Eye Institute, University of California, Los Angeles, CA 90095. Email: sugradar@ucla.edu © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Cosmetic Adolescent Filler: An Innovative Treatment of the “Selfie” Complex

Purpose: "Selfie" photography is increasing among teenagers, accentuates congenital anomalies, and impacts self-confidence. Tear trough deformity is most commonly due to aging, but also occurs as a congenital anomaly and can be a major source of insecurity and embarrassment. Objective: The purpose of this study is to show the efficacy and safety of hyaluronic acid gel filler in a teenage patient with congenital tear trough deformity. Material and Method: We describe the case of a teenager who underwent hyaluronic acid gel filling to the tear trough deformity at age 14 years. Prospective follow up was assessed for 5 years. Results: The patient improved clinical appearance and self confidence. Her satisfaction level was high, and no complication occurred during entire follow up. Conclusion: In this case, hyaluronic gel acid filler was safe and effective for augmentation of congenital tear trough. The patient was satisfied and experienced increased self-esteem. Accepted for publication September 16, 2017. The authors have no conflicts of interest to disclose. We received no public or private financial support for this project. Dr Philippe Berros is a medical consultant for Galderma QMed. Address correspondence and reprint requests to Philipe Berros, M.D., Centre Medical International Monaco, Athos Place, 2 rue de la lujerneta, Monaco 98000. E-mail: drberros@gmail.com © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Accuracy and eligibility of CBCT to digitize dental plaster casts

Abstract

Objectives

Software-based dental planning requires digital casts and oftentimes cone-beam computed tomography (CBCT) radiography. However, buying a dedicated model digitizing device can be expensive and might not be required. The present study aimed to assess whether digital models derived from CBCT and models digitized using a dedicated optical device are of comparable accuracy.

Material and methods

A total of 20 plaster casts were digitized with eight CBCT and five optical model digitizers. Corresponding models were superimposed using six control points and subsequent iterative closest point matching. Median distances were calculated among all registered models. Data were pooled per scanner and model. Boxplots were generated, and the paired t test, a Friedman test, and a post-hoc Nemenyi test were employed for statistical comparison. Results were found significant at p < 0.05.

Results

All CBCT devices allowed the digitization of plaster casts, but failed to reach the accuracy of the dedicated model digitizers (p < 0.001). Median distances between CBCT and optically digitized casts were 0.064 + − 0.005 mm. Qualitative differences among the CBCT systems were detected (χ ² = 78.07, p < 0.001), and one CBCT providing a special plaster cast digitization mode was found superior to the competitors (p < 0.05).

Conclusion

CBCT systems failed to reach the accuracy from optical digitizers, but within the limits of the study, accuracy appeared to be sufficient for digital planning and forensic purposes.

Clinical relevance

Most CBCT systems enabled digitization of plaster casts, and accuracy was found sufficient for digital planning and storage purposes.

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Development of a brief assessment of activity limitations in children with food allergy

Given the increasing prevalence of food allergies (FA), affecting approximately 8% of children in the United States,1 and the increasing rates of anaphylaxis due to FA,2 parents of children with FA have lowered quality of life (QOL).3,4 Many parents report their family QOL is associated with social limitations due to FA,3 and some parents worry so much about allergen avoidance that they significantly restrict their child's school and social activities.4 Children's day-to-day social functioning is important for maintaining an acceptable QOL and coping with FA.

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Koebner Phenomenon Triggered by External Dacryocystorhinostomy Scar in a Patient With Psoriasis: A Case Report and Literature Review

Koebner phenomenon is the development of isomorphic pathologic lesions on a wound of a patient with preexisting cutaneous disease, most commonly psoriasis. An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. Immediate diagnosis and treatment with topical steroids led to complete recovery. Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. All surgeons should be aware of its existence and warn susceptible patients regarding its occurrence. Accepted for publication September 3, 2017. The authors have no financial or conflict of interest to disclose. Address correspondence and reprint requests to Anasua Kapoor Ganguly, M.D., F.I.C.O., Ophthalmic Plastic Surgery & Aesthetic Services, LV Prasad Eye Institute, Vijaywada, India 521137. E-mail: anasua21@yahoo.com © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Endoscopic Corneal Neurotization: Technique and Initial Experience

Purpose: The authors describe a minimally invasive surgical technique to re-establish corneal sensibility in a patient with neurotrophic keratopathy with the supraorbital nerve harvested endoscopically. Methods: Pedicled contralateral supraorbital nerve was harvested endoscopically through small eyelid crease and scalp incisions and transferred to the affected eye. Results: Endoscopic corneal neurotization was successfully performed with restoration of corneal sensibility and corneal epithelial integrity. Conclusions: The use of an endoscope allows for a minimally invasive approach to successful corneal neurotization with the supraorbital nerve. Accepted for publication September 28, 2017. The authors have no financial or conflicts of interest to disclose. Correspondence address and reprint requests to Ilya Leyngold, M.D., Duke Aesthetic Center, DUMC 3810, Durham, NC 27710. E-mail: ilya.leyngold@duke.edu © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Concerns of Anophthalmic Patients Wearing Cryolite Glass Prosthetic Eyes

Purpose: To identify the main concerns of patients experienced in wearing cryolite glass prosthetic eyes and to investigate how these have changed over time. Methods: One hundred six patients experienced in wearing prosthetic eyes for at least 2 years were asked to complete an anonymous questionnaire regarding prosthetic eye concerns at the time of initial eye loss and at the present time. Main outcome measures included changes in levels of concern over time. Results: Initially, the participants were mainly concerned about their appearance, health of the fellow eye, and coping with monocularity. Over time, there was a significant increase of the level of concern regarding the health of the remaining eye (p

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Comparison of Outcomes of 3-Snip Punctoplasty Versus Simple Punctal Dilatation With Monocanalicular Intubation for Acquired Punctal Stenosis

Purpose: To evaluate and compare the outcomes of invasive (rectangular 3-snip punctoplasty) versus minimally invasive (punctal dilatation with monocanalicular intubation) treatment modalities for the management of acquired punctal stenosis. Methods: A retrospective, comparative, interventional case series was performed on 60 eyes of 36 patients with acquired punctal stenosis. Patients were categorized in 2 groups based on the intervention as 3-snip punctoplasty (group A) and punctal dilatation with monocanalicular intubation (group B). Qualitative and quantitative assessment for epiphora and punctal stenosis grading were performed preoperatively and postoperatively. Patients with associated canalicular and nasolacrimal duct obstructions, congenital punctal disorders, eyelid malpositions, and less than 6 months' follow up were excluded. Anatomical and functional successes were recorded following stent extubation and at 6-month follow up. Statistical analyses were performed using the chi-square, Fisher exact, and the Mann–Whitney tests. A p value of

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Immune Reconstitution Inflammatory Syndrome in a Case of Nonspecific Orbital Inflammation

The immune reconstitution inflammatory syndrome is an exaggerated abnormal immune response, typically seen in HIV-positive patients following restoration of a normal CD4 count as a result of initiation of antiretroviral therapy. It has been described in relation to either occult opportunistic infections or to a paradoxical relapse of a previously successfully treated infection with negative microbiological cultures. The authors report the case of a 60-year-old HIV-positive African male who presented with 2 episodes of orbital inflammation that occurred in conjunction with improvements of CD4 count following Highly Active Antiretroviral Therapy. This phenomenon was underpinned by biopsies obtained following each episode. Interestingly, on both occasions, he responded well to corticosteroid therapy. Although the soft tissues of the orbits are a common area affected by other inflammatory diseases, it is rare for them to be involved in immune reconstitution inflammatory syndrome. To the authors' knowledge, this is the first case report of immune reconstitution inflammatory syndrome affecting the orbits exclusively. The authors believe that it is probably an underdiagnosed condition and may be erroneously labeled as idiopathic in many cases. This case report inspires us to keep an open mind when dealing with patients on antiretroviral therapy. Accepted for publication September 24, 2017. The authors have no financial or conflicts of interest to disclose. Correspondence address and reprint requests to Dr. Shoaib Ugradar, M.D., M.R.C.P., B.Sc. (Hons), The Jules Stein Eye Institute, University of California, Los Angeles, CA 90095. Email: sugradar@ucla.edu © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Cosmetic Adolescent Filler: An Innovative Treatment of the “Selfie” Complex

Purpose: "Selfie" photography is increasing among teenagers, accentuates congenital anomalies, and impacts self-confidence. Tear trough deformity is most commonly due to aging, but also occurs as a congenital anomaly and can be a major source of insecurity and embarrassment. Objective: The purpose of this study is to show the efficacy and safety of hyaluronic acid gel filler in a teenage patient with congenital tear trough deformity. Material and Method: We describe the case of a teenager who underwent hyaluronic acid gel filling to the tear trough deformity at age 14 years. Prospective follow up was assessed for 5 years. Results: The patient improved clinical appearance and self confidence. Her satisfaction level was high, and no complication occurred during entire follow up. Conclusion: In this case, hyaluronic gel acid filler was safe and effective for augmentation of congenital tear trough. The patient was satisfied and experienced increased self-esteem. Accepted for publication September 16, 2017. The authors have no conflicts of interest to disclose. We received no public or private financial support for this project. Dr Philippe Berros is a medical consultant for Galderma QMed. Address correspondence and reprint requests to Philipe Berros, M.D., Centre Medical International Monaco, Athos Place, 2 rue de la lujerneta, Monaco 98000. E-mail: drberros@gmail.com © 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma

The purpose of this study is to validate the concept of lymph node ratio (LNR) in head and neck squamous cell carcinoma (HNSCC).

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Complications of Midface Fractures

Facial plast Surg 2017; 33: 557-561
DOI: 10.1055/s-0037-1607447

The midface relies on key vertical and horizontal buttresses for proper function and appearance. Trauma to the midface can lead to untoward complications involving critical structures of this area. Many reviews focus on operative management of midface fractures with little focus on complications of the injury and operative repair. We review the current literature on the most common initial and postoperative complications of midface trauma with a specific focus on zygomaticomaxillary complex (ZMC) and Le Fort fracture patterns. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding midface fracture presentation, diagnosis, and management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Disruption of the midfacial buttress system can lead to a significant compromise in form and function. A wide variety of complications are seen in nasal bone fractures, orbital floor fractures, Le Fort, and ZMC fractures. Some fracture patterns can be managed conservatively without operative intervention; however, complications such as loss of facial width/projection, trismus, malocclusion, ocular entrapment, and significant enophthalmos should be managed with open repair. Timing and method of repair depend on patient-specific injury patterns and surgeon preference. Proper management depends on a detailed understanding of the anatomy and pathophysiology of each fracture pattern along with restoration of the patient's premorbid state. Complications of midface fractures result from disruption of the vertical and horizontal buttress support systems. Proper management and repair of midface complications requires a strong understanding of its anatomic basis and pathophysiology. Sequelae from these fractures can be serious and long lasting if not addresses appropriately. Astute diagnosis and timely management can prevent patients from suffering debilitating long-term sequelae.
[...]

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Prophylactic Measures to Prevent Soft Tissue Abnormalities after Trauma

Facial plast Surg 2017; 33: 639-642
DOI: 10.1055/s-0037-1608669

The goal of any reconstructive procedure is a complete return to premorbid form and function. Unfortunately, a return of pretraumatic form is routinely not considered during surgical planning. This leads to uncontrolled contracture of the soft tissue elements and permanent disfigurement. The goal of this article is to review interventions that improve soft tissue healing and long-term outcomes.
[...]

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Erratum: Oblique Turnover Flap for Repositioning and Flattening of the Lateral Crura: A Novel Technique to Manage Cephalic Malposition of Lower Lateral Cartilage

Facial plast Surg 2017; 33: 677-678
DOI: 10.1055/s-0037-1608956

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

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Secondary Repair of the Zygoma

Facial plast Surg 2017; 33: 571-580
DOI: 10.1055/s-0037-1608767

Secondary deformities of the zygoma are a rare entity, thanks to the adoption and refinement of open reduction and internal fixation techniques. These injuries are often difficult to treat due to the unique structural, functional, and aesthetic properties of the zygoma. Purely cosmetic defects can often be managed with implants; however, functional deficits generally require mobilization, correction, and subsequent fixation of the defect(s). Performing the necessary osteotomies to mobilize the zygoma is the most crucial part of the procedure, and had traditionally been executed without the use of computer aids. Planning for and performing this step was very difficult and frequently resulted in unsatisfactory outcomes. Recent advancements in virtual mapping and planning have obviated the need for guesswork and have resulted in improved functional and aesthetic outcomes following repositioning. This article will discuss the use of implants, osteotomies, and computer-assisted design/modeling (CAD/CAM) in addressing secondary deformities of the zygoma.
[...]

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Modern Approaches to Skin Care

Facial plast Surg 2017; 33: 653-660
DOI: 10.1055/s-0037-1607448

Recent years have seen an increased interest in minimally invasive and noninvasive cosmetic surgery and facial aesthetics. There has been a concomitant surge in the focus on skin care, which, by nature, is minimally invasive, and an exponential growth in the popularity and availability of minimally invasive dermatologic procedures and products. This review seeks to provide an overview of the most commonly employed skin care modalities, such as their mechanisms, indications for use, advantages and disadvantages, and side effects. The authors aim to provide the audience with a fundamental understanding of the options currently available to cosmetic surgeons and practitioners. Topics include retinoids, chemical peels, skin-lightening agents, lasers, microneedling, topical antioxidants, and injectables.
[...]

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

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Complications of Facial Trauma of the Fronto-orbital Region

Facial plast Surg 2017; 33: 581-590
DOI: 10.1055/s-0037-1608712

Traumatic injuries to the orbitofrontal region place some of the most important structures of the face at risk: the eyes, frontal skull, and brain. A thorough knowledge of complications from resultant trauma, and from attempted surgical corrections, is necessary to offer patients the best outcomes, ensuring proper healing with excellent long-term results.
[...]

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Broken-Line Template for Revision of Facial Scars

Facial plast Surg 2017; 33: 675-675
DOI: 10.1055/s-0037-1607449

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

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Secondary Treatment of Naso-orbital Ethmoid Injuries

Facial plast Surg 2017; 33: 591-597
DOI: 10.1055/s-0037-1608766

Central midface fractures should be treated early due to their propensity for secondary devastating and disfiguring consequences. For example, the expected sequelae to inadequately repaired naso-orbital ethmoid (NOE) injuries include shortened retruded nose, altered palpebral fissures, telecanthus, enophthalmos, and ocular dystopia, to name a few. Secondary repair of NOE fractures is indicated when primary surgical repair is not possible and for any of the aforementioned sequelae. When secondary repair of NOE fractures is necessary, these should be planned carefully while focusing on restoring facial function and aesthetics. Specific attention should focus on midface projection and intercanthal relationship. Virtual surgical planning as intraoperative navigation can be helpful for complex secondary reconstructions.
[...]

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Options in Repositioning the Asymmetric Brow from Paralysis and Trauma

Facial plast Surg 2017; 33: 627-638
DOI: 10.1055/s-0037-1607975

Brow asymmetry is a relatively common occurrence, especially in the facial plastic surgeon's office. In this article, the authors review causes of brow asymmetry, pertinent anatomy, and a litany of treatment options including nonsurgical and surgical approaches. They offer an algorithm that summarizes the various techniques for management with the goal of tailoring treatment tactics to the individual patient's needs.
[...]

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Repair of the Malpositioned Lower Lid

Facial plast Surg 2017; 33: 598-605
DOI: 10.1055/s-0037-1608711

Complications from surgical approaches to the orbit can be associated with debilitating morbidity and negative surgical outcomes. The surgeon must be familiar with the different factors that predispose a patient to these complications and be facile with techniques to avoid them. In this article, the authors discuss the surgical anatomy of the lower eyelid, as well as various complications that result from eyelid surgery, including lower lid retraction, ectropion, entropion, canthal malposition, and midface descent. They also discuss various management techniques that are employed in addressing these complications.
[...]

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Role of Camouflage in Management of Facial Trauma Deformities

Facial plast Surg 2017; 33: 643-652
DOI: 10.1055/s-0037-1608710

Facial fractures and soft tissue injuries around the eyes, nose, and mouth can be difficult to manage in the primary setting, but if untreated, the secondary correction of facial trauma is very challenging. Prevention of soft tissue contraction by restoring the skeletal framework is ideal. Staged, individualized camouflage techniques can be effective in improving outcomes.
[...]

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

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Secondary Repair of Posttraumatic Enophthalmos and Extraocular Movement Disorders

Facial plast Surg 2017; 33: 606-612
DOI: 10.1055/s-0037-1608781

Enophthalmos, or recession of the eye posteriorly and inferiorly, is a potential sequela of orbital trauma and a source of significant cosmetic and functional concern. Late enophthalmos occurs when early reconstruction of the bony orbit fails to completely restore normal orbital shape and volume, resulting in aesthetic deformity and persistent diplopia. In this article, we provide a framework for evaluation of posttraumatic enophthalmos and outline the surgical principles of secondary repair necessary to optimize globe position. With implementation of proper craniofacial exposure, osteotomy, and orbital reconstruction, surgeons may achieve significant improvement in both the aesthetic and functional sequelae of enophthalmos.
[...]

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

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Comparison of Absorbable and Nonabsorbable Sutures in Columellar Incision Closure in Rhinoplasty and Their Effects to Postoperative Scar

Facial plast Surg 2017; 33: 661-664
DOI: 10.1055/s-0037-1608668

Open technique septorhinoplasty (SRP) provides better surgical control and stronger anatomical assessment; however, one of its biggest disadvantages is postoperative columellar scar. In this study, the authos aimed to compare the absorbable polyglactin 910 (PG) (Vicryl Rapide 6/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 6/0; Ethicon Inc.) suture materials and their effects on the postoperative columellar scar. In this study, 89 patients (61 females and 28 males) who underwent primary open technique SRP were included; 42 patients were included in the PP group and 47 were included in the PG group. Sutures were removed in PP group on 7th postoperative day. Sutures were left to be absorbed in the PG group. Columellar scar was assessed with visual analog scale (VAS) subjectively and with the modified Stony Brook Scar Evaluation Scale (SBSES) objectively in 6th postoperative month. SBSES results in PG and PP groups were 3.88 ± 0.80 and 3.67 ± 0.80, respectively. There was no statistical significance between the two groups (p = 0.352). VAS results in PG and PP groups were 8.04 ± 0.91 and 7.71 ± 0.85, respectively. There was no statistical significance between the two groups (p = 0.200). No postoperative wound infection was seen in either of the groups. PG delivers good postoperative results in columellar scar. We recommend using PG for columellar incision closure since it provides less discomfort and anxiety for the patient, and less office time for the surgeon during the suture removal.
[...]

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The Role of Hair Transplantation for Managing Facial Trauma

Facial plast Surg 2017; 33: 613-620
DOI: 10.1055/s-0037-1608782

Oftentimes, multiple treatment modalities are indicated for the management of trauma to the face. When this trauma involves a hair-bearing area, such as the eyebrow, eyelid, or beard region, hair transplantation can be an effective modality. While most of these facial hair transplants are performed for elective cosmetic indications, advanced techniques of hair transplantation can assure aesthetic outcomes in the optimizing of appearance after trauma. Because hair regrowth requires a good recipient bed, adjuvant therapies to promote vascularization, such as fat transfer and platelet-rich plasma, can be applied in conjunction with hair transplantation. The authors review the indications and the essential techniques of graft harvesting by follicular unit extraction and follicular unit grafting, and recipient site formation and graft planting and management, and present different case examples illustrating these technique.
[...]

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

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Aesthetic Management of Upper and Midface Trauma

Facial plast Surg 2017; 33: 555-556
DOI: 10.1055/s-0037-1607974

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

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Scar Revision: Surgical and Nonsurgical Options

Facial plast Surg 2017; 33: 621-626
DOI: 10.1055/s-0037-1607446

Facial scarring represents a challenging issue for the facial plastic surgeon owing to the unpredictable and variable nature of scar formation. The psychologic, cosmetic, and functional implications of facial scars oftentimes necessitate revision. It is important for the facial plastic surgeon to be aware of the invasive and noninvasive options to best educate patients in terms of treatment modalities. As there are multiple options available with no single option touted as superior, management of expectations and patient motivation will allow for realistic treatment planning with the greatest change of success.
[...]

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Aesthetic Nasal Reconstruction Principles and Practice

Facial plast Surg 2017; 33: 676-676
DOI: 10.1055/s-0037-1608769

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

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Optimal Costal Cartilage Graft Selection According to Cartilage Shape: Anatomical Considerations for Rhinoplasty

Facial plast Surg 2017; 33: 670-674
DOI: 10.1055/s-0037-1607972

Costal cartilage grafting is a commonly used reconstruction procedure, particularly in rhinoplasty. Although costal cartilage is broadly used in reconstructive surgery, there are differing opinions regarding which costal cartilage levels provide the most ideal grafts. Grafts are typically designed to match the shape of the recipient site. The shapes of costal cartilage grafts have been described as "boat-shaped," "C-shaped," "canoe-shaped," "U-shaped," "crescent-shaped," "L-shaped," "semilunar," "straight," and "Y-shaped." The shapes of costal cartilages are thought to lend themselves to the shapes of certain grafts; however, there has been little study of the shapes of costal cartilages, and most reports have been anecdotal. Therefore, this study is aimed to detail the average shapes of the most commonly grafted cartilages (i.e., the fifth to seventh cartilages). A total of 96 cadaveric costal cartilages were analyzed through geometric morphometric analysis. The fifth costal cartilage was determined to have the straightest shape and would therefore be particularly suitable for nasal dorsum onlay grafting. The lateral portions of the sixth and, particularly, the seventh costal cartilages have the most acute curvature. Therefore, they would lend themselves to the construction of an en bloc "L"-shaped or hockey stick-shaped nasal dorsum-columellar strut graft.
[...]

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Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study

To detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance.

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Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

This study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.

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UK Gives Pfizer World's First Over-the-Counter Viagra Approval

Pfizer's big-selling erectile dysfunction drug Viagra has been given a green light for sale without a prescription in Britain, the first country to grant it over-the-counter status.
Reuters Health Information

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Skin tattooing following correction of prominent ears

We read with interest the article by Sadhra, Motahariasl and Hardwicke(1) detailing the published complications secondary to prominent ear correction. We would like to present our experience of a complication not listed in this review since we believe it carries significant morbidity.

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Case Series: Slowing Alpha Rhythm in Late-Stage ALS Patients

To this date, the cognitive abilities of patients in the final stage of Amyotrophic Lateral Sclerosis (ALS) are largely unknown. Residing in a completely locked-in state (CLIS) makes interaction by regular means impossible. Many attempts were made to establish communication through Brain-computer interfaces (BCIs), but success has been very limited (Marchetti and Priftis, 2015). It has been theorized that the loss of motor-functions leads to an extinction of both goal directed thinking and physiological control, leaving only reflex-like responses to fundamental, personal questions (Gallegos-Ayala et al., 2014; Chaudhary et al., 2017).

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Letter response: Reporting of mitotic rate in cutaneous melanoma

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Issue Information - Ed Board

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Issue Information - TOC

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GABA transporters regulate tonic and synaptic GABAA receptor-mediated currents in the suprachiasmatic nucleus neurons

GABA is a principal neurotransmitter in the hypothalamic suprachiasmatic nucleus (SCN) that contributes to intercellular communication between individual circadian oscillators within the SCN network and the stability and precision of the circadian rhythms. GABA transporters (GAT) regulate the extracellular GABA concentration and modulate GABA_A receptor (GABA_AR)-mediated currents. GABA transport inhibitors were applied to study how GABA_AR-mediated currents depend on the expression and function of GAT. Nipecotic acid inhibits GABA transport and induced an inward tonic current in concentration-dependent manner during whole cell patch-clamp recordings from SCN neurons. Application of either the selective GABA transporter 1 (GAT1) inhibitors NNC-711 or SKF-89976A, or the GABA transporter 3 (GAT3) inhibitor SNAP-5114, produced only small changes of the baseline current. Coapplication of GAT1 and GAT3 inhibitors induced a significant GABA_AR-mediated tonic current that was blocked by gabazine. GAT inhibitors decreased the amplitude and decay time constant and increased the rise time of spontaneous GABA_AR-mediated postsynaptic currents. However, inhibition of GAT did not alter the expression of either GAT1 or GAT3 in the hypothalamus. Thus GAT1 and GAT3 functionally complement each other to regulate the extracellular GABA concentration and GABA_AR-mediated synaptic and tonic currents in the SCN. Coapplication of SKF-89976A and SNAP-5114 (50 µM each) significantly reduced the circadian period of Per1 expression in the SCN by 1.4 h. Our studies demonstrate that GAT are important regulators of GABA_AR-mediated currents and the circadian clock in the SCN.

NEW & NOTEWORTHY In the suprachiasmatic nucleus (SCN), the GABA transporters GAT1 and GAT3 are expressed in astrocytes. Inhibition of these GABA transporters increased a tonic GABA current and reduced the circadian period of Per1 expression in SCN neurons. GAT1 and GAT3 showed functional cooperativity: inhibition of one GAT increased the activity but not the expression of the other. Our data demonstrate that GABA transporters are important regulators of GABA_A receptor-mediated currents and the circadian clock.

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