Manual physical balance assistance of therapists during gait training of stroke survivors: characteristics and predicting the timing

During gait training, physical therapists continuously supervise stroke survivors and provide physical support to their pelvis when they judge that the patient is unable to keep his balance. This paper is the ...

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The Prevalence of Musculoskeletal Complaints and Pain Intensity in Furniture Industry Workers in Brazil

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Vinicius Tieppo Francio, Luana Tasca, Chris Towery, Saeid Davani, Travis Allen




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Ed Board page

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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2017 ACRM Annual Conference Late-Breaking Research Abstracts

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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Table of Contents

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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Editors' Selections From This Issue: Volume 98 / Number 12 / December 2017

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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Utilization of Spinal Manipulation in a Case of Adolescent Idiopathic Scoliosis (AIS)

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Vinicius Tieppo Francio, Chris Towery, Saeid Davani, Travis Allen




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Masthead

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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Exploring Disability Compensation Among Veterans with Spinal Cord Injury

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Denise Fyffe, Carol Gibson-Gill, Joyce Williams, Ashleigh Quinn




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Outcomes Among Patients with HIV/AIDS in the Inpatient Rehabilitation Facility Population, Years 2011 to 2014

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Margaret DiVita, Sarah Beshers, Rebecca Gordon, Madison Terrillion, Jacqueline Mix




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Physical Therapy Treatment of a Patient Diagnosed with Sporadic Inclusion Body Myositis: A Case Study

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Trent Jackman, Tyler Harrigfeld




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Archives Manuscript Reviewers

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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Information/Education Pages (I/EPs)

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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RCT of Peer-Led Phone-Based Empowerment Intervention for Persons with Chronic Spinal Cord Injury Improves Health Self-Management

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Bethlyn Houlihan, Miriam Brody, Sarah Skeels, Diana Pernigotti, Judi Zazula, Sam Burnett, Christa Green, Subramani Seetharama, Stathis Hasiotis, Timothy Belliveau, David Rosenblum, Alan Jette




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Differential Item Functioning on Physical Disability Measure Across Direct and Proxy Interview

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Ickpyo Hong, Mi Jung Lee, Catherine Hay, Timothy Reistetter




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Toward the Evaluation of Daily Wheelchair Usage with Upper Limb Pattern Classifier: A Pilot Study

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Pin-Wei Chen, Kerri Morgan




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Withdrawn

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12





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The Effect of Swimming on the Rehabilitation of a Reverse Shoulder Arthroplasty: A Case Study

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Margaret McDowell, Chelsea Griffiths, Mariana Dawida, Tadeusz Laska




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Prevalence and Patterns of Spasticity Severity and Medication Use in Individuals with Spinal Cord Injury

Publication date: December 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 12
Author(s): Nicole DiPiro, Chao Li, James Krause




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Liposuction as an effective treatment for lower extremity lymphoedema: a single surgeon's experience over nine years

Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): C.J. Stewart, D.A. Munnoch
BackgroundLymphoedema is a chronic, debilitating condition caused by a compromised lymphatic system. In recent years, the success of treating upper extremity lymphoedema with liposuction has been translated to patients with lower extremity lymphoedema (LEL), yet there remains a paucity of clinical evidence firmly supporting its use within this patient group.Methods69 patients with LEL (72 legs) were consecutively treated with liposuction by a single surgeon. Compression garments were applied in theatre and continued post-operatively.ResultsMean preoperative volume of oedema was 4372 mL (range 229 -15166 mL), and mean volume of aspirate was 4550 mL (range 575 – 12150 mL). There were no major surgical complications. An average reduction in volume of leg oedema of 85% was found at 3 months (n=72), 88% at 1year (n=60), 94% at 2 years (n=41) and 90% at 5 years (n=15).ConclusionsWe have demonstrated that liposuction combined with continuous compression therapy (CCT) is a safe and effective technique for treatment of primary and secondary LEL, with a significant reduction of the original excess limb volume. Male patients with primary lymphoedema have the poorest outcomes. Limbs with secondary lymphoedema respond best to this treatment.



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Skin tattooing following correction of prominent ears

Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): T.M. Noblet, P.C. Jackson, I.M. Smith




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Psychosocial predictors of body image dissatisfaction in patients referred for NHS aesthetic surgery

Publication date: Available online 2 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Stuart .J. Moulton, Csilla. Gullyas, Fiona. J. Hogg, Kevin. G. Power
BackgroundA limited number of studies have researched psychosocial predictors of body image dissatisfaction exclusively within the National Health Service (NHS) aesthetic surgery patient populations, despite aesthetic surgery being offered on an exceptional basis. The Adult Exceptional Aesthetic Referral Protocol (AEARP) defines criteria for aesthetic surgery under the NHS in Scotland. The protocol requires psychological assessment prior to surgery for the majority of aesthetic surgery procedures offered. It is therefore important to establish psychological predictors of body image dissatisfaction to aid with assessment and provision of psychological therapy for this patient group.Method334 consecutive potential aesthetic surgery patients referred for psychological assessment under the AEARP completed psychosocial self-report assessment measures as part of routine practice. Multiple regression analysis using the forced entry method was used to investigate psychosocial predictors of body image dissatisfaction.ResultsMultiple regression analysis indicated that younger age, greater symptoms of depression, lower levels of self-esteem and greater interpersonal sensitivity significantly predicted higher levels of self reported body image dissatisfaction. Symptoms of anxiety did not significantly predict body image dissatisfaction.ConclusionsThis study indicates that both self perception and perception of self in relation to others, especially fear of being judged by others, significantly relates to body image dissatisfaction in this patient group. Psychological assessment of patients' suitability for aesthetic surgery should consider factors such as the patient's interpersonal functioning. Psychological intervention targeted at symptoms of depression, difficulties with self-esteem and interpersonal functioning may be of significant benefit to patients either prior to undergoing surgery or as an alternative to aesthetic surgery.



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Health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancer

Heath-related quality of life (HRQoL) among survivors with unresectable locally-advanced non-small cell lung cancer (LA-NSCLC) treated with radiotherapy and chemotherapy still is not clear. The current study w...

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Food Allergy: Update on Prevention and Tolerance

Publication date: Available online 27 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): George Du Toit, Hugh Sampson, Marshall Plaut, Wesley Burks, Cezmi Akdis, Gideon Lack
Of the many possible hypotheses which explain the recent rise in childhood food allergy, the dual allergen exposure hypothesis has been the most extensively investigated. This chapter serves as a review and update on the prevention of food allergy, and focuses on recently published Randomized Controlled Trials (RCTs) exploring the efficacy of oral tolerance induction in infancy for the prevention of food allergy. As a result of these RCTs, National Institutes of Health (NIH) recommendations now actively encourage the early introduction of peanut for the prevention of peanut allergy and other countries/settings recommend the inclusion of potential common food allergens including peanut and egg in complementary feeding regimens commencing at approximately 6 months of age, but not before 4 months.^1-3 Further studies which explore the efficacy of oral tolerance induction to other common food allergens, and which focus on optimal timing, duration and adherence are required.



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Dual loss of p110δ PI3-kinase and SKAP (KNSTRN) expression leads to combined immunodeficiency and multisystem syndromic features

Publication date: Available online 26 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nigel Sharfe, Ariana Karanxha, Harjit Dadi, Daniele Merico, David Chitayat, Jo-Anne Herbrick, Spencer Freeman, Sergio Grinstein, Chaim M Roifman
BackgroundWe previously reported a novel syndrome characterized by combined immunodeficiency associated with severe developmental defects - subsequently known as Roifman-Chitayat Syndrome (RCS; OMIM 613328). Linkage analysis identified two disease-associated loci.ObjectiveTo identify the genetic defect in these patients and characterize their immunological cellular abnormalities.MethodsGenetic, immunological, protein and cellular functional analyses were used to identify and characterize patient genetic deficiencies and aberrant patient cell behaviour.ResultsDeleterious variants were found at both loci identified by linkage analysis: a homozygous stop codon in PI3-kinase p110δ (PIK3CD) and a homozygous frame shift mutation in SKAP (KNSTRN), both ablating protein expression. RCS patients display aberrant B cell development, similar to p110δ deficient mice, but also aberrant T cell spreading, cell-cell interaction and migration. Patients also display significant developmental abnormalities not seen in p110δ knockouts (e.g. optic nerve atrophy, skeletal anomalies) that we ascribe to loss of SKAP. Aberrant SKAP expression can prolong anaphase and this may contribute to developmental defects. However, we also identified MAP4 microtubule-binding protein as a novel SKAP-binding partner and show it undergoes re-localization in patient T cells, with associated areas of aberrant microtubule hyper-stabilization, likely contributing not only to the altered properties of RCS lymphoid cells but also developmental defects.ConclusionsThe complex Roifman-Chitayat Syndrome presentation, with combined developmental and immunological defects, is associated with a combined deficiency of two genes products, PI3-kinase p110δ and SKAP, both of which appear to play a significant role in the disease.

Teaser

Patients with Roifman-Chitayat syndrome suffer repeated infections due to combined immunodeficiency and display a wide array of syndromic features encompassing developmental delay, optic nerve atrophy and skeletal anomalies. We show here for the first time that complete SKAP and PI3K p110δ deficiencies lead to this complex syndrome.


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Self-reported adverse food reactions and anaphylaxis in the SchoolNuts study: A population-based study of adolescents

Publication date: Available online 23 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Vicki L. McWilliam, Jennifer J. Koplin, Michael J. Field, Mari Sasaki, Shyamali C. Dharmage, Mimi L.K. Tang, Susan M. Sawyer, Rachel L. Peters, Katrina J. Allen
BackgroundAdolescents are at the highest risk of death from anaphylaxis, yet few population-based studies have described the frequencies and risk factors for allergic reactions caused by accidental allergen ingestion in this group.MethodsWe describe the prevalence, frequency, and associated risk factors for recent adverse food reactions in 10- to 14-year-olds in Melbourne, Australia, recruited from a stratified, random, population-based sample of schools (SchoolNuts, n = 9663; 48% response rate). Self-reported food allergy and adverse reaction details, including anaphylaxis, were identified by using a student questionnaire over the past year.ResultsOf 547 students with possible IgE-mediated food allergy, 243 (44.4%; 95% CI, 40.3% to 48.7%) reported a reaction to a food. Fifty-three (9.7%; 95% CI, 7.2% to 12.2%) students reported 93 anaphylaxis episodes. Peanut and tree nuts were the most common food triggers. Among students with current IgE-mediated food allergy, those with resolved or current asthma (adjusted odds ratio [aOR], 1.9 [95% CI, 1.1-1.3] and 1.7 [95% CI, 1.1-2.6]) and those with more than 2 food allergies (aOR, 1.9 [95% CI, 1.1-3.1]) were at greatest risk of any adverse food reaction, and those with nut allergy were most at risk of severe reactions (aOR, 2.9 [95% CI, 1.1-4.4]). Resolved or current asthma was not associated with increased risk of severe reactions (aOR, 0.8 [95% CI, 0.3-2.2] and 1.6 [95% CI, 0.7-3.7]).ConclusionsAdolescents with food allergy are frequently exposed to food allergens. Those with asthma and more than 2 food allergies were at the greatest risk for adverse food reactions. Those with nut allergies were most at risk of severe reactions.



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Food Allergy in the developing world

Publication date: Available online 22 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Agnes SY. Leung, Gary WK. Wong, Mimi LK. Tang




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Food Allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention and management

Publication date: Available online 21 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Scott H. Sicherer, Hugh A. Sampson
This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis and treatment that have occurred over the four years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as ∼10% have been documented. Genetic, epigenetic and environmental risk factors are being increasingly elucidated, opening the potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology are revealing a complex interplay of epithelial barrier, mucosal and systemic immune response, route of exposure and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on the medical history, tests for sensitization, and oral food challenges, but emerging use of component resolved diagnostics are improving diagnostic accuracy. Additional novel diagnostics such as basophil activation tests, determination of epitope binding, DNA methylation signatures and bioinformatics approaches will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, giving immense hope that better treatment will be imminently and widely available, while numerous additional promising treatments are in the preclinical and clinical pipeline.



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Bedroom allergen exposures in US households

Publication date: Available online 30 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Päivi M. Salo, Jesse Wilkerson, Kathryn M. Rose, Richard D. Cohn, Agustin Calatroni, Herman E. Mitchell, Michelle L. Sever, Peter J. Gergen, Peter S. Thorne, Darryl C. Zeldin
BackgroundBedroom allergen exposures contribute to allergic disease morbidity because people spend considerable time in bedrooms, where they come into close contact with allergen reservoirs.ObjectiveWe investigated participant and housing characteristics, including sociodemographic, regional, and climatic factors, associated with bedroom allergen exposures in a nationally representative sample of the US population.MethodsData were obtained from National Health and Nutrition Examination Survey 2005-2006. Information on participant and housing characteristics was collected by using questionnaires and environmental assessments. Concentrations of 8 indoor allergens (Alt a 1, Bla g 1, Can f 1, Fel d 1, Der f 1, Der p 1, Mus m 1, and Rat n 1) in dust vacuumed from nearly 7000 bedrooms were measured by using immunoassays. Exposure levels were classified as increased based on percentile (75th/90th) cutoffs. We estimated the burden of exposure to multiple allergens and used multivariable logistic regression to identify independent predictors for each allergen and household allergen burden.ResultsAlmost all participants (>99%) had at least 1 and 74.2% had 3 to 6 allergens detected. More than two thirds of participants (72.9%) had at least 1 allergen and 18.2% had 3 or more allergens exceeding increased levels. Although exposure variability showed significant racial/ethnic and regional differences, high exposure burden to multiple allergens was most consistently associated with the presence of pets and pests, living in mobile homes/trailers and older and rental homes, and living in nonmetropolitan areas.ConclusionsExposure to multiple allergens is common. Despite highly variable exposures, bedroom allergen burden is strongly associated with the presence of pets and pests.

Graphical abstract

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Obesity, asthma, and vitamin D deficiency in pregnancy: Cause or consequence?

Publication date: Available online 21 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcos Pereira-Santos, Lucas Luê Bispo Pereira, Denise Santana de Oliveira




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Reply

Publication date: Available online 21 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hooman Mirzakhani, Scott T. Weiss, Augusto A. Litonjua




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Endolysosomal protease susceptibility of Amb a 1 as a determinant of allergenicity

Publication date: Available online 20 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Martin Wolf, Lorenz Aglas, Teresa E. Twaroch, Markus Steiner, Sara Huber, Michael Hauser, Maria A. Parigiani, Heidi Hofer, Christof Ebner, Barbara Bohle, Peter Briza, Angela Neubauer, Frank Stolz, Michael Wallner, Fatima Ferreira
In the absence of extrinsic adjuvants, purified Amb a 1 induced a strong Th2-polarized immune response in mice. This high allergenic activity seems to be linked to the allergen's susceptibility to endolysosomal proteolysis.



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Enhancement of cutaneous immunity during ageing by blocking p38 MAPkinase induced inflammation

Publication date: Available online 17 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Milica Vukmanovic-Stejic, Emma S. Chambers, Mayte Suarez- Farinas, Daisy Sandhu, Judilyn Fuentes-Duculan, Neil Patel, Elaine Agius, Katie E. Lacy, Carolin T. Turner, Anis Larbi, Veronique Birault, Mahdad Noursadeghi, Neil A. Mabbott, Malcolm H.A. Rustin, James Krueger, Arne N. Akbar
BackgroundImmunity declines with age that leads to re-activation of varicella zoster virus (VZV). In humans, age associated immune changes are usually measured in blood leukocytes however this may not reflect alterations in tissue-specific immunity.ObjectivesWe used a VZV antigen challenge system in the skin to investigate changes in tissue specific mechanisms involved in the decreased response to this virus during ageing.MethodsWe assessed cutaneous immunity by the extent of erythema and induration after intradermal VZV antigen injection. We also performed immune histology and transcriptomic analyses on skin biopsies taken from the site of challenge in young (<40 yrs) and old (>65 yrs) subjects.ResultsOld humans exhibited decreased erythema and induration, CD4⁺ and CD8⁺ T cell infiltration and attenuated global gene activation at the site of cutaneous VZV antigen challenge compared to young subjects. This was associated with elevated sterile inflammation in the skin in the same subjects, related to p38 MAPK-related pro-inflammatory cytokine production (p <0.0007). We inhibited systemic inflammation in old subjects by pre-treatment with an oral small molecule p38 MAP kinase inhibitor (Losmapimod), which reduced both serum C reactive protein (CRP) and peripheral blood monocyte secretion of IL-6 and TNF-α. In contrast, cutaneous responses to VZV antigen challenge was significantly increased in the same individuals (p <0.0006).ConclusionExcessive inflammation in the skin early after antigen challenge retards antigen-specific immunity. However this can be reversed by inhibition of inflammatory cytokine production that may be utilized to promote vaccine efficacy and the treatment of infections and malignancy during ageing.

Graphical abstract

Teaser

Capsule summary: Elevated cutaneous inflammation retards VZV-specific immunity. Inhibiting inflammatory cytokine production with p38 MAPkinase inhibitors enhances VZV-specific cutaneous immunity. Targeting inflammation may be used to promote vaccine efficacy and the treatment of malignancy during ageing.


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Vascular endothelial specific IL-4Rα–ABL1 kinase signaling axis regulates severity of IgE-mediated anaphylactic reactions

Publication date: Available online 17 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Amnah Yamani, David Wu, Lisa Waggoner, Taeko Noah, Anthony J. Koleske, Fred Finkelman, Simon P. Hogan
BackgroundSevere IgE-mediated, food-induced anaphylactic reactions are characterized by pulmonary venous vasodilatation and fluid extravasation, which is thought to lead to the life-threatening anaphylactic phenotype. The underlying immunological and cellular processes involved in driving fluid extravasation and the severe anaphylactic phenotype are not fully elucidated.ObjectiveTo define the interaction and requirement of IL-4 and vascular endothelial (VE) IL-4Rα chain signaling in histamine-ABL1–mediated VE dysfunction and fluid extravasation in the severity of IgE-mediated anaphylactic reactions in mice.MethodsMice deficient in VE IL-4Rα and models of passive and active oral antigen– and IgE-induced anaphylaxis were employed to define the requirements of VE IL-4Rα and ABL1 pathway in severe anaphylactic reactions. Human VE cell line (EA.hy926 cells) and pharmacologic (imatinib) and genetic approaches (shRNA knockdown of IL4RA and ABL1) were used to define the requirement of this pathway in VE barrier dysfunction.ResultsIL-4 exacerbation of histamine-induced hypovolemic shock in mice was dependent on VE expression of the IL-4Rα. IL-4 and histamine induced ABL1 activation in human VE cells and VE barrier dysfunction was ABL1 dependent. Development of severe IgE-mediated hypovolemia and shock required VE-restricted ABL1 expression. Treatment of mice with a history of food-induced anaphylaxis with the ABL kinase inhibitor imatinib protected the mice from developing severe IgE-mediated anaphylaxis.ConclusionIL-4 amplifies IgE- and histamine-induced VE dysfunction, fluid extravasation, and severity of anaphylaxis via a VE IL-4Rα-ABL1–dependent mechanism. These studies implicate an important contribution by the VE compartment in the severity of anaphylaxis and identify a new

Graphical abstract

Teaser

Capsule Summary: IL-4-Histamine induced vascular endothelial cell ABL1 kinase signaling controls severity of IgE-mediated anaphylactic reactions.


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Drug hypersensitivity: we need to do more

Publication date: Available online 16 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Werner J. Pichler, Daniel Yerly




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

Publication date: Available online 2 December 2017
Source:American Journal of Otolaryngology
Author(s): Gautam Bir Singh, Medozhanuo Solo, Ravinder Kaur, Rubeena Arora, Sunil Kumar
Aims & objectivesTo detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance.Study designProspective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital.Materials & methodsForty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed.ResultsOut of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established.ConclusionsThere is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.



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Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”

Publication date: Available online 2 December 2017
Source:American Journal of Otolaryngology
Author(s): Katharina Stölzel




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Primary cutaneous histiocytic sarcoma: A report of five cases with primary cutaneous involvement and review of the literature

Publication date: Available online 2 December 2017
Source:Annals of Diagnostic Pathology
Author(s): Cynthia M. Magro, Najiyah Kazi, Aimee E. Sisinger
IntroductionHistiocytic sarcoma is an extremely rare hematologic malignancy of histiocytic origin. Five cases of primary cutaneous histiocytic sarcoma are presented.Materials and methodsCases of primary cutaneous histiocytic sarcoma were identified using a natural language search from the dermatopathology data base of Cornell University.ResultsThere was a male predominance (4 males and 1 female) ranging in age from 33years to 92years (mean age of 73years); all presented with a solitary nodule which involved the head and neck area in four and thigh in one. The 73-year-old male had chronic myeloproliferative disorder. Biopsies showed a nonepitheliotropic dermal-based atypical large cell histiocytoid appearing infiltrate dermis showing positivity for common leukocyte antigen, CD4, CD14, CD68, CD163, CD2, CD11c, and lysozyme. Markers of terminal histiocytic differentiation such as S100, langerin, MXA, and CD83 were not seen. In two of the cases there was evidence of extracutaneous dissemination. The treatment in three of the cases was wide excision; there was no evidence of recurrent or metastatic disease. One case was given palliative radiation; the patient died. The other patient with underlying myelodysplastic syndrome died within a few weeks of initial cutaneous presentation.ConclusionHS must be differentiated from other malignant histiocytoid lesions. Staining for common leukocyte antigen and CD163 are the most reliable markers allowing this distinction. Patients who present with primary involvement of the skin may have a variable favorable outcome but only if treated relatively early in the course of the disease with complete excision.



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Growth response to growth hormone treatment in patients with SHOX deficiency can be predicted by the Cologne prediction model

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


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Allergic and non-allergic skin reactions associated with growth hormone therapy: elucidation of causative agents

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


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Relationships between MRI fat distributions and sleep apnea and obesity hypoventilation syndrome in very obese patients

Abstract

Purpose

Obesity is associated with both obstructive sleep apnea (OSA) and obesity hypoventilation. Differences in adipose tissue distribution are thought to underlie the development of both OSA and hypoventilation. We explored the relationships between the distribution of upper airway, neck, chest, abdominal and muscle fat in very obese individuals.

Methods

We conducted a cross-sectional cohort study of individuals presenting to a tertiary sleep clinic or for assessment for bariatric surgery. Individuals underwent magnetic resonance (MR) imaging of their upper airway, neck, chest, abdomen and thighs; respiratory polygraphy; 1 week of autotitrating CPAP; and morning arterial blood gas to determine carbon dioxide partial pressure and base excess.

Results

Fifty-three individuals were included, with mean age of 51.6 ± 8.4 years and mean BMI of 44.3 ± 7.9 kg/m²; there were 27 males (51%). Soft palate, tongue and lateral wall volumes were significantly associated with the AHI in univariable analyses (p < 0.001). Gender was a significant confounder in these associations. No significant associations were found between MRI measures of adiposity and hypoventilation.

Conclusions

In very obese individuals, our results indicate that increased volumes of upper airway structures are associated with increased severity of OSA, as previously reported in less obese individuals. Increasingly large upper airway structures that reduce pharyngeal lumen size are likely to lead to OSA by increasing the collapsibility of the upper airway. However, we did not show any significant association between regional fat distribution and propensity for hypoventilation, in this population.

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Relationships between MRI fat distributions and sleep apnea and obesity hypoventilation syndrome in very obese patients

Abstract

Purpose

Obesity is associated with both obstructive sleep apnea (OSA) and obesity hypoventilation. Differences in adipose tissue distribution are thought to underlie the development of both OSA and hypoventilation. We explored the relationships between the distribution of upper airway, neck, chest, abdominal and muscle fat in very obese individuals.

Methods

We conducted a cross-sectional cohort study of individuals presenting to a tertiary sleep clinic or for assessment for bariatric surgery. Individuals underwent magnetic resonance (MR) imaging of their upper airway, neck, chest, abdomen and thighs; respiratory polygraphy; 1 week of autotitrating CPAP; and morning arterial blood gas to determine carbon dioxide partial pressure and base excess.

Results

Fifty-three individuals were included, with mean age of 51.6 ± 8.4 years and mean BMI of 44.3 ± 7.9 kg/m²; there were 27 males (51%). Soft palate, tongue and lateral wall volumes were significantly associated with the AHI in univariable analyses (p < 0.001). Gender was a significant confounder in these associations. No significant associations were found between MRI measures of adiposity and hypoventilation.

Conclusions

In very obese individuals, our results indicate that increased volumes of upper airway structures are associated with increased severity of OSA, as previously reported in less obese individuals. Increasingly large upper airway structures that reduce pharyngeal lumen size are likely to lead to OSA by increasing the collapsibility of the upper airway. However, we did not show any significant association between regional fat distribution and propensity for hypoventilation, in this population.

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Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery

Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.

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Intestinal permeability and Ménière's disease

Ménière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage.

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Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre–post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS).

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Factors influencing recurrent emergency department visits for epistaxis in the elderly

Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.

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Risk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications

Balancing the risks for thromboembolism and postpolypectomy bleeding in patients requiring anticoagulation and antiplatelet agents is challenging. We investigated the incidence and risk factors for postpolypectomy bleeding on anticoagulation, including heparin bridge, and other antithrombotic therapy.

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Sex Differences in Sleep-Disordered Breathing After Stroke: Results from the BASIC Project

Sleep-disordered breathing (SDB), an independent risk factor for stroke, is associated with worse post-stroke outcomes. Differences in the relationship between SDB and stroke may exist for women versus men. In this population-based study, we compared the prevalence of both pre- and post-stroke SDB by sex. We also explored whether menopausal status is related to post-stroke SDB.

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Adipose-derived stem cells for treatment of chronic cutaneous ulcers in patients with critical limb ischemia: a pilot study

Abstract

Background

Therapeutic approaches based on stem cells have recently been introduced to treat chronic ulcers, with good results. The aim of this study was to evaluate whether the topical application of adipose-derived stem cells (ASCs) with platelet-rich plasma (PRP) for the treatment of ischemic cutaneous ulcers modified the skin perfusion of the treated areas.

Methods

Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO₂) values were recorded for a 3-month period in seven arteriopathic and diabetic patients with ischemic ulcers of the lower limb candidates to amputation, who had been previously treated with single co-administered perilesional and intralesional injections of ASCs+PRP.

Results

Significant differences were found between pretreatment (T0) and 3 month post-treatment (T3) values regarding both LDF values (basal mean values: T0 30.7; T3 50.4; declivous mean values: T0 23; T3 38.9;) and tcpO₂ levels (basal mean values: T0 6.7; T3 45.9; declivous mean values: T0 17.6; T3 47.3).

Conclusions

According to the values of LDF and TcpO₂, the multidisciplinary treatment of severe ulcers with ACSs+PRP associated or not with revascularization therapy allowed a perilesional improvement of oxygenation and perfusion such to avoid limb amputation, with complete wound healing. Early treatment with ASCs associated or not with reperfusion therapy is an effective treatment even in severe ulcers in advanced stage once treated with amputation of limb.

Level of evidence: Level V, therapeutic study

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Adipose-derived stem cells for treatment of chronic cutaneous ulcers in patients with critical limb ischemia: a pilot study

Abstract

Background

Therapeutic approaches based on stem cells have recently been introduced to treat chronic ulcers, with good results. The aim of this study was to evaluate whether the topical application of adipose-derived stem cells (ASCs) with platelet-rich plasma (PRP) for the treatment of ischemic cutaneous ulcers modified the skin perfusion of the treated areas.

Methods

Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO₂) values were recorded for a 3-month period in seven arteriopathic and diabetic patients with ischemic ulcers of the lower limb candidates to amputation, who had been previously treated with single co-administered perilesional and intralesional injections of ASCs+PRP.

Results

Significant differences were found between pretreatment (T0) and 3 month post-treatment (T3) values regarding both LDF values (basal mean values: T0 30.7; T3 50.4; declivous mean values: T0 23; T3 38.9;) and tcpO₂ levels (basal mean values: T0 6.7; T3 45.9; declivous mean values: T0 17.6; T3 47.3).

Conclusions

According to the values of LDF and TcpO₂, the multidisciplinary treatment of severe ulcers with ACSs+PRP associated or not with revascularization therapy allowed a perilesional improvement of oxygenation and perfusion such to avoid limb amputation, with complete wound healing. Early treatment with ASCs associated or not with reperfusion therapy is an effective treatment even in severe ulcers in advanced stage once treated with amputation of limb.

Level of evidence: Level V, therapeutic study

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Accuracy of computer-assisted orthognathic surgery

The purpose of this study was to retrospectively evaluate the difference between the planned and the actual movements of the jaws, using three-dimensional (3D) software for PC-assisted orthognathic surgery, to establish the accuracy of the procedure.

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Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Int J Audiol. 2017 Dec 01;:1-8

Authors: McGinnity S, Beach EF, Mulder J, Cowan R

Abstract
OBJECTIVE: This study investigated clinical care delivered to musicians in Australia by audiologists and manufacturers of musicians' hearing protectors (MHP).
DESIGN: Audiologists with experience treating musicians were invited to complete a survey on their service delivery. A second survey was administered to manufacturers of MHPs.
STUDY SAMPLE: Four manufacturers of MHP and 31 audiologists completed the surveys. Post hoc analyses were performed comparing the responses of audiologists with more versus less clinical experience; and those with and without musical training.
RESULTS: There was considerable variation in the audiological care provided to musicians. Only one-third of audiologists performed pure-tone audiometry prior to MHP fitting, and there was little consistency across the sample in relation to impression taking, preferred attenuation or selection of canal length. There was also significant variation in the manufacturers' approach to MHP, each of whom provided different recommendations regarding preferred impression techniques and material viscosity.
CONCLUSIONS: The results of this study reveal lack of consistency across the hearing healthcare sector with respect to care of musicians' hearing, with potential to impact upon the satisfaction with, and usage of, MHP. There is need for evidence-based, best practice guidelines and training to support clinical audiologists in providing optimal care.

PMID: 29192525 [PubMed - as supplied by publisher]

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Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Int J Audiol. 2017 Dec 01;:1-12

Authors: Xue L, Le Bot G, Van Petegem W, van Wieringen A

Abstract
OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities.
DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round.
STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round.
RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified.
CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

PMID: 29192519 [PubMed - as supplied by publisher]

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Prediction of Vestibular Imbalance in Acute Peripheral Vestibulopathy by Measuring Horizontal Ocular Deviation on Magnetic Resonance Imaging.

Prediction of Vestibular Imbalance in Acute Peripheral Vestibulopathy by Measuring Horizontal Ocular Deviation on Magnetic Resonance Imaging.

Otol Neurotol. 2017 Nov 29;:

Authors: Yang YJ, Kim KW, Choi JE, Lee MY, Yoo DS, Jung JY

Abstract
OBJECTIVES: The aim of the study is to evaluate whether horizontal ocular deviation (OD) from MR imaging in the emergency room (ER) reflects vestibular imbalance, by comparing the horizontal OD in patients with acute vestibulopathy to controls.
STUDY DESIGN: Retrospective review.
PATIENTS AND METHODS: A total of 69 patients with acute unilateral peripheral vestibulopathy and 30 healthy subjects were included. Horizontal OD was quantified by using the axial T2-weighted fast-spin echo (FSE) images of the brain at 1.5 T. In the study group, the results of VFTs (videonystagmography [VNG], caloric test, rotary chair test, and cervical vestibular evoked myogenic potentials [cVEMP]) were also reviewed. The averaged angle of right and left horizontal ODs was compared between patients with acute unilateral vestibulopathy and healthy controls. Also, the correlation between horizontal OD and results of VFTs was analyzed in the study group.
RESULTS: The averaged angle of horizontal OD in study group (23.7° ± 11.6°) was significantly greater than that of control group (4.27° ± 3.7°) (p < 0.05). Horizontal OD significantly correlated with slow phase velocity of spontaneous nystagmus (SN), the value of caloric paresis (CP) on caloric testing, rotary chair gain, asymmetry ratio of rotary chair test and interaural difference (IAD) of cVEMP, regardless of time intervals between magnetic resonance imaging (MRI) and VFTs.
CONCLUSIONS: Horizontal OD significantly correlated with parameters of VFT which reflect the vestibular imbalance. Therefore, horizontal OD can be used as an indicator of unilateral peripheral vestibular weakness.

PMID: 29194214 [PubMed - as supplied by publisher]

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Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Int J Audiol. 2017 Dec 01;:1-8

Authors: McGinnity S, Beach EF, Mulder J, Cowan R

Abstract
OBJECTIVE: This study investigated clinical care delivered to musicians in Australia by audiologists and manufacturers of musicians' hearing protectors (MHP).
DESIGN: Audiologists with experience treating musicians were invited to complete a survey on their service delivery. A second survey was administered to manufacturers of MHPs.
STUDY SAMPLE: Four manufacturers of MHP and 31 audiologists completed the surveys. Post hoc analyses were performed comparing the responses of audiologists with more versus less clinical experience; and those with and without musical training.
RESULTS: There was considerable variation in the audiological care provided to musicians. Only one-third of audiologists performed pure-tone audiometry prior to MHP fitting, and there was little consistency across the sample in relation to impression taking, preferred attenuation or selection of canal length. There was also significant variation in the manufacturers' approach to MHP, each of whom provided different recommendations regarding preferred impression techniques and material viscosity.
CONCLUSIONS: The results of this study reveal lack of consistency across the hearing healthcare sector with respect to care of musicians' hearing, with potential to impact upon the satisfaction with, and usage of, MHP. There is need for evidence-based, best practice guidelines and training to support clinical audiologists in providing optimal care.

PMID: 29192525 [PubMed - as supplied by publisher]

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AD6RtF

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Int J Audiol. 2017 Dec 01;:1-12

Authors: Xue L, Le Bot G, Van Petegem W, van Wieringen A

Abstract
OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities.
DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round.
STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round.
RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified.
CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

PMID: 29192519 [PubMed - as supplied by publisher]

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Long-term patterns of fasting blood glucose levels and pancreatic cancer incidence

Abstract

Background

Whether type 2 diabetes is cause or consequence, or both, of pancreatic cancer (PaC) remains unresolved. Leveraging repeated measurements of fasting blood glucose (FBG), we examined the temporal relationship between hyperglycemia and PaC incidence.

Methods

We conducted a nested case–control study of 278 cases and 826 matched-controls from the Korean National Health Insurance Service-Health Screening Cohort. Over 11 years before index date (date of PaC diagnosis for cases), all participants had at least one FBG measurement in each of the three time windows: − 11 to − 8, − 7 to − 4, and − 3 to 0 years. Using conditional logistic regression, we estimated odds ratios(ORs) of PaC and 95% confidence intervals (CIs) for hyperglycemia in the overall period and at each interval; for major long-term patterns of FBG across the three intervals (recent-onset, medium-term, and long-standing hyperglycemia).

Results

Higher FBG over the past 11 years was associated with an increased odds of PaC (p _trend < .0001), with recent FBG more predictive of PaC than distant FBG. By FBG assessed in the − 3 to 0 interval, OR was 1.97 (95% CI 1.32–2.93) for 110–125 mg/dL and 3.17 (95% CI 2.09–4.80) for ≥ 126 mg/dL. By long-term patterns of FBG, compared to consistent normoglycemia, OR was 2.02 (95% CI 1.24–3.31) for long-standing hyperglycemia and 3.38 (95% CI 1.87–6.13) for recent-onset hyperglycemia. These associations were more pronounced among never-smokers than ever-smokers (p _interaction = .06).

Conclusion

Recent-onset hyperglycemia may be an early manifestation of undetected PaC, while long-lasting hyperglycemia may serve as a moderate etiologic factor for PaC.

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Direct inhibition of ACTN4 by ellagic acid limits breast cancer metastasis via regulation of β-catenin stabilization in cancer stem cells

Pharmacology-based target identification has become a novel strategy leading to the discovery of novel pathological biomarkers. Ellagic acid (EA), a dietary polyphenol compound, exhibits potent anticancer acti...

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Progressive deafness-dystonia due to SERAC1 mutations – a study of 67 cases

ABSTRACT

Objective: 3-MEthylGlutaconic aciduria, Dystonia-Deafness, Hepatopathy, Encephalopathy, Leigh-like syndrome (MEGDHEL) syndrome is caused by biallelic variants in SERAC1.

Methods: Multi centre study concerning the course of disease for each organ system, together with metabolic, neuroradiological and genetic findings.

Results: 67 individuals (39 previously unreported) from 59 families were included (age range 5 days - 33.4 years, median age 9 years). A total of 41 different SERAC1 variants were identified, including 20 that have not been reported before. With exception of two families with a milder phenotype, all affected individuals show a strikingly homogeneous phenotype and time course. Severe, reversible neonatal liver dysfunction and hypoglycemia was seen in more than 40% of all cases. Starting at a median age of six months muscular hypotonia (91%) was seen, followed by progressive spasticity (82%, median onset 15 months) and dystonia (82%, 18 months). The majority of affected individuals never learnt to walk (68%). 79% suffered hearing loss, 58% never learnt to speak, nearly all had significant intellectual disability (88%). MRI features were accordingly homogenous with bilateral basal ganglia involvement (98%), the characteristic "putaminal eye" was seen in 53%. The urinary marker 3-methylglutaconic aciduria is virtually present in all patients (98%). Supportive treatment focused on spasticity and drooling, was effective in individuals treated, hearing aids or cochlear implants did not improve communication skills.

Interpretation: MEGDHEL syndrome is as a progressive deafness-dystonia syndrome with frequent and reversible neonatal liver involvement and a strikingly homogenous course of disease. This article is protected by copyright. All rights reserved.

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Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013

Publication date: Available online 2 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P=0.001), laryngeal recurrence (P=0.026), rT1, rT2 or rT3 rather than rT4 tumor (P=0.007), previous chemotherapy (P=0.036), and neck dissection during salvage surgery (P=0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (<T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.



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Let's not twist and spin-doctor our articles

Publication date: Available online 1 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, H. Maisonneuve




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A case of unusually long survival after leptomeningeal carcinomatosis diagnosis

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Diffuse intrinsic pontine gliomas (DIPG) at recurrence: is there a window to test new therapies in some patients?

Abstract

Children with diffuse intrinsic pontine glioma (DIPG) need new and more efficient treatments. They can be developed at relapse or at diagnosis, but therefore they must be combined with radiotherapy. Survival of children after recurrence and its predictors were studied to inform the possibility to design early phase clinical trials for DIPG at this stage. Among 142 DIPG patients treated between 1998 and 2014, 114 had biopsy-proven DIPG with histone H3 status available for 83. We defined as long survivors' patients who survived more than 3 months after relapse which corresponds to the minimal life expectancy requested for phase I/II trials. Factors influencing post-relapse survival were accordingly compared between short and long-term survivors after relapse. Fifty-seven percent of patients were considered long survivors and 70% of them had a Lansky Play Scale (LPS) above 50% at relapse. Patients who became steroids-independent after initial treatment for at least 2 months had better survival after relapse (3.7 versus 2.6 months, p = 0.001). LPS above 50% at relapse was correlated with better survival after relapse (3.8 versus 1.8 months, p < 0.001). Patients with H3.1 mutation survived longer after relapse (4.9 versus 2.7 months, p = 0.007). Patients who received a second radiotherapy at the time of relapse had an improved survival (7.5 versus 4 months, p = 0.001). In the two-way ANOVA analysis, steroid-independence and LPS predicted survival best and the type of histone H3 (H3.1 or H3.3) mutated did not improve prediction. Survival of many DIPG patients after relapse over 3 months would make possible to propose specific trials for this condition. Steroid-independence, H3 mutation status and LPS should be considered to predict eligibility.

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Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Int J Audiol. 2017 Dec 01;:1-12

Authors: Xue L, Le Bot G, Van Petegem W, van Wieringen A

Abstract
OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities.
DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round.
STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round.
RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified.
CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

PMID: 29192519 [PubMed - as supplied by publisher]

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Metastatic Laryngeal Large Cell Neuroendocrine Carcinoma: A Rare Case of Presentation and Extreme Tumor Burden.

Metastatic Laryngeal Large Cell Neuroendocrine Carcinoma: A Rare Case of Presentation and Extreme Tumor Burden.

J Cutan Pathol. 2017 Dec 01;:

Authors: Dunn A, Broadfoot BG, Hunt J, Kaley JR, Atiq O, Gutta NB, Wang X, Gardner JM, Shalin SC

Abstract
Large cell neuroendocrine carcinoma (LCNEC) of the larynx is an aggressive form of neuroendocrine carcinoma that affects smokers at an average age of 60 years. LCNEC is characterized by large cells with round to ovoid nuclei distributed in a trabecular or nested growth pattern. Previously, laryngeal LCNEC and atypical carcinoid tumors were considered synonymous; however, laryngeal LCNEC has been shown to have higher mitotic rates and worse prognosis, which has led to laryngeal LCNEC to be separated from atypical carcinoid and classified as a poorly differentiated neuroendocrine carcinoma in the most recent World Health Organization classification. We present a case of a 56-year-old female who presented with painful subcutaneous skin lesions that were diagnosed as metastatic carcinoma at an outside facility. Subsequent workup revealed a primary epiglottic lesion. Over the next 4 years, she continued to develop over 100 similar subcutaneous nodules. Additional workup confirmed neuroendocrine differentiation, thus clarifying the diagnosis of metastatic large cell neuroendocrine carcinoma. Review of literature has only revealed one reported case of LCNEC with skin metastasis. This is the first reported case whereby skin metastasis was the initial presenting symptom; moreover, our case is unique with regard to the heavy metastatic burden to the skin.

PMID: 29194700 [PubMed - as supplied by publisher]

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Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy in horses.

Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy in horses.

Equine Vet J. 2017 Nov 28;:

Authors: Rossignol F, Brandenberger O, Perkins JD, Marie JP, Mespoulhès-Rivière C, Ducharme NG

Abstract
BACKGROUND: In horses, the only established method for reinnervation of the larynx is the nerve-muscle pedicle implantation, whereas in human medicine, direct nerve implantation is a standard surgical technique for selective laryngeal reinnervation in patients suffering from bilateral vocal fold paralysis.
OBJECTIVES: (1) To describe a modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy (RLN) in horses and (2) evaluate the outcomes of reinnervation using direct nerve needle-stimulation of the first cervical nerve and exercising endoscopy before and after surgery.
STUDY DESIGN: Case series.
METHODS: Nerve transplantation surgery, in which the first or second cervical nerve is tunnelled through the atrophied left cricoarytenoideus dorsalis muscle, was performed in combination with ipsilateral laser ventriculocordectomy. Ultrasound-guided stimulation of the first cervical nerve at the level of the alar foramen was used to confirm successful reinnervation postoperatively. Exercising endoscopy was performed before and after surgery. The exercising RLN grade of the left arytenoid was blindly determined at the highest stride frequency for each examination.
RESULTS: Surgery was performed in 17 client-owned animals with RLN. Reinnervation was confirmed by nerve stimulation and subsequent arytenoid abduction observed in 11 out of 12 cases between 4 and 12 months post-operatively. Fourteen horses had exercising endoscopy before and after surgery. Nine horses had an improved exercising RLN grade, 4 horses had the same exercising grade and one horse had a worse exercising grade after surgery.
MAIN LIMITATIONS: A sham-operated control group was not included and follow-up beyond 12 months and objective performance data were not obtained.
CONCLUSIONS: The modified first or second cervical nerve transplantation technique, using tunnelling and direct implantation of the donor nerve into the crico-arytenoideus dorsalis muscle, resulted in reinnervation in 11/12 of cases and improved exercising grade in 9/14 horses within 12 months after surgery. This article is protected by copyright. All rights reserved.

PMID: 29193393 [PubMed - as supplied by publisher]

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Association of Quantitative Metastatic Lymph Node Burden With Survival in Hypopharyngeal and Laryngeal Cancer.

Association of Quantitative Metastatic Lymph Node Burden With Survival in Hypopharyngeal and Laryngeal Cancer.

JAMA Oncol. 2017 Nov 30;:

Authors: Ho AS, Kim S, Tighiouart M, Gudino C, Mita A, Scher KS, Laury A, Prasad R, Shiao SL, Ali N, Patio C, Mallen-St Clair J, Van Eyk JE, Zumsteg ZS

Abstract
Importance: Nodal staging for laryngohypopharyngeal cancers is based primarily on size and laterality, with less value placed on absolute number of metastatic lymph nodes (LNs). We are aware of no studies to date that have specifically addressed the prognostic effect of quantitative nodal burden in larynx or hypopharynx malignancies.
Objective: To assess the independent impact of quantitative metastatic LN burden on mortality risk.
Design, Setting, and Participants: Univariate and multivariable models were constructed to evaluate the association between patients' number of metastatic LNs and their survival, adjusting for factors such as nodal size, laterality, extranodal extension, margin status, and adjuvant treatment. Participants were patients with squamous cell carcinoma of the larynx or hypopharynx undergoing upfront surgical resection for curative intent at a US hospital between 2004 and 2013, as identified in the National Cancer Database. A neck dissection of a minimum of 10 LNs was required.
Main Outcomes and Measures: Overall survival.
Results: Overall, 8351 cases were included (mean [SD] age, 61 [10.1] years; 6499 men [77.8%]; 4710 patients with metastatic LNs and 3641 with no metastatic LNs). Mortality risk escalated continuously without plateau as number of metastatic nodes increased, with the hazard per node (hazard ratio [HR], 1.19; 95% CI, 1.16-1.23; P < .001) most pronounced up to 5 positive LNs. Extranodal extension was also associated with increased mortality (HR, 1.34; 95% CI, 1.13-1.59; P < .001). Increasing number of nodes examined was associated with improved survival, albeit to a lesser degree (per 10 LNs: HR, 0.97; 95% CI, 0.96-0.98; P < .001) and without a detectable change point. Other nodal factors, including nodal size, contralateral LN involvement (TNM stage N2c), and lower LN involvement (levels 4-5), were not associated with mortality in multivariable models when accounting for number of positive LNs. A novel, parsimonious nodal staging system derived by recursive partitioning analysis exhibited greater concordance with survival than the TNM staging system outlined in the American Joint Committee on Cancer's AJCC Staging Manual, 8th edition.
Conclusions and Relevance: The number of metastatic nodes is a predominant independent factor associated with mortality in hypopharyngeal and laryngeal cancers. Moreover, standard nodal staging factors like LN size and contralaterality have no independent prognostic value when accounting for positive LN number. Deeper integration of quantitative metastatic nodal disease may simplify staging and better triage the need for adjuvant therapy.

PMID: 29192305 [PubMed - as supplied by publisher]

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Characterizing an Ultra-High-Risk Subset of Patients With Hypopharynx and Larynx Cancer: The Power of Lymph Node Burden.

Characterizing an Ultra-High-Risk Subset of Patients With Hypopharynx and Larynx Cancer: The Power of Lymph Node Burden.

JAMA Oncol. 2017 Nov 30;:

Authors: Orosco RK, Cohen EE

PMID: 29192300 [PubMed - as supplied by publisher]

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Cancer mortality trends in an industrial district of Shanghai, China, from 1974 to 2014, and projections to 2029.

Cancer mortality trends in an industrial district of Shanghai, China, from 1974 to 2014, and projections to 2029.

Oncotarget. 2017 Nov 03;8(54):92470-92482

Authors: Li M, Wang S, Han X, Liu W, Song J, Zhang H, Zhao J, Yang F, Tan X, Chen X, Liu Y, Li H, Ding Y, Du X, Yin J, Zhang R, Cao G

Abstract
We aimed to characterize the trends and projections of cancer mortalities in Yangpu, an industry restructuring district of Shanghai, China. With high-quality data from the death registration system, the authors analyzed the trends in cancer mortalities during 1974-2014 and their relationship with pollution control and socioeconomic improvements. Cancer burden was projected into 2029. During 1974-2014, cancer death accounted for 28.80% of all-cause death. The 5 leading causes of cancer death were cancers of the lung & bronchus, stomach, liver, colon & rectum, and esophagus. Age-standardized mortality of all cancers was higher in men than in women (153.1/105vs. 88.8/105, p<0.001) and increased from 1974 to 1991 and decreased thereafter. The mortalities of cancers of the larynx, bladder, liver, nasopharynx, lung & bronchus, esophagus, lip oral & pharynx, stomach, kidney, and lymphoma were significantly higher in men than in women. Age-standardized mortalities of cancers of the esophagus, stomach, leukemia, female nasopharynx, female bladder, liver, and bone decreased especially after the 1990s, those of the colon & rectum, kidney, prostate, pancreas, breast, gallbladder, and ovary increased significantly. Lung cancer, breast cancer, colorectal cancer, and pancreas cancer in women and lung cancer, colorectal cancer, prostate cancer, and stomach cancer in men will be the leading causes of cancer death in 2025-2029. Cancer-caused life loss kept increasing since 2000. Conclusively, cancers associated with pollutions and infection decreased, especially after the 1990s, while those related to metabolic syndrome increased. These trends are related to closedown of polluted industries in the 1980s and lifestyle changes.

PMID: 29190931 [PubMed]

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Aryepiglottic fold augmentation as treatment for late-onset dysphagia following surgical treatment of recurrent laryngeal neuropathy.

Related Articles

Aryepiglottic fold augmentation as treatment for late-onset dysphagia following surgical treatment of recurrent laryngeal neuropathy.

Tierarztl Prax Ausg G Grosstiere Nutztiere. 2017 Aug 10;45(4):219-225

Authors: Vidovic A, Delling U

Abstract
OBJECTIVE: Coughing and dysphagia have been described following prosthetic laryngoplasty (LP) with or without ventriculectomy/ventriculocordectomy (VE/VCE) for the treatment of recurrent laryngeal neuropathy. All previous case descriptions include patients with acute onset of clinical signs after surgery that persisted. The authors observed a late-onset of dysphagia and coughing months to years after LP ± VE/VCE. The condition was always associated with an abnormality of the aryepiglottic fold (AEF). Treatment options for those patients are limited. We suggest augmentation of the AEF as treatment for affected horses. The goal of the study was two-fold: Firstly, to describe a new condition of late-onset dysphagia in horses following LP ± VE/VCE associated with an abnormal appearance of the AEF, and secondly, to offer a minimally invasive and successful treatment for those patients.
MATERIAL AND METHODS: Six horses were presented because of dysphagia and coughing with an onset of months to years after LP ± VE/VCE. Endoscopically, the AEF always appeared thinner and more flaccid to a varying degree. The food path was traceable along the AEF into the trachea using dyed molasses. An initial injection of hyaluronic acid (HA) into the AEF led to immediate improvement of the dysphagia. The procedure was performed in the standing sedated horse. The needle was placed through the cricothyroid ligament and the injection performed under endoscopic guidance.
RESULTS: All horses tolerated the injection well. Injection of HA was successful only in the short term in all cases and repeated injections were needed for permanent resolution using either cross-linked HA, polyacrylamide hydrogel or platelet rich plasma.
CONCLUSION AND CLINICAL RELEVANCE: Horses may develop dysphagia and coughing months to years after LP ± VE/VCE as a late-onset complication. The condition seems to be associated with an abnormal appearance and function of the AEF. Successful treatment is possible by augmenting the AEF. However, careful patient selection is mandatory.

PMID: 28745776 [PubMed - indexed for MEDLINE]

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Isotopic source signatures: Impact of regional variability on the δ13CH4 trend and spatial distribution

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Aryeh I. Feinberg, Ancelin Coulon, Andrea Stenke, Stefan Schwietzke, Thomas Peter
The atmospheric methane growth rate has fluctuated over the past three decades, signifying variations in methane sources and sinks. Methane isotopic ratios (δ13CH4) differ between emission categories, and can therefore be used to distinguish which methane sources have changed. However, isotopic modelling studies have mainly focused on uncertainties in methane emissions rather than uncertainties in isotopic source signatures. We simulated atmospheric δ13CH4 for the period 1990–2010 using the global chemistry-climate model SOCOL. Empirically-derived regional variability in the isotopic signatures was introduced in a suite of sensitivity simulations. These simulations were compared to a baseline simulation with commonly used global mean isotopic signatures. We investigated coal, natural gas/oil, wetland, livestock, and biomass burning source signatures to determine whether regional variations impact the observed isotopic trend and spatial distribution. Based on recently published source signature datasets, our calculated global mean isotopic signatures are in general lighter than the commonly used values. Trends in several isotopic signatures were also apparent during the period 1990–2010. Tropical livestock emissions grew during the 2000s, introducing isotopically heavier livestock emissions since tropical livestock consume more C4 vegetation than midlatitude livestock. Chinese coal emissions, which are isotopically heavy compared to other coals, increase during the 2000s leading to higher global values of δ13CH4 for coal emissions. EDGAR v4.2 emissions disagree with the observed atmospheric isotopic trend for almost all simulations, confirming past doubts about this emissions inventory. The agreement between the modelled and observed δ13CH4 interhemispheric differences improves when regional source signatures are used. Even though the simulated results are highly dependent on the choice of methane emission inventories, they emphasize that the commonly used global mean signatures are inadequate. Regional isotopic signatures should be employed in modelling studies that try to constrain methane emission inventories.

Graphical abstract

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An assessment of the real-world driving gaseous emissions from a Euro 6 light-duty diesel vehicle using a portable emissions measurement system (PEMS)

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): José M. Luján, Vicente Bermúdez, Vicente Dolz, Javier Monsalve-Serrano
Recent investigations demonstrated that real-world emissions usually exceed the levels achieved in the laboratory based type approval processes. By means of on-board emissions measurements, it has been shown that nitrogen oxides emitted by diesel engines substantially exceed the limit imposed by the Euro 6 regulation. Thus, with the aim of complementing the worldwide harmonized light vehicles test cycle, the real driving emissions cycle will be introduced after 1 September 2017 to regulate the vehicle emissions in real-world driving situations.This paper presents on-board gaseous emissions measurements from a Euro 6 light-duty diesel vehicle in a real-world driving route using a portable emissions measurement system. The test route characteristics follow the requirements imposed by the RDE regulation. The analysis of the raw emissions results suggests that the greatest amount of nitrogen oxides and nitrogen dioxide are emitted during the urban section of the test route, confirming that lower speeds with more accelerations and decelerations lead to higher nitrogen oxides emissions levels than constant high speeds. Moreover, the comparison of the two calculation methods proposed by the real driving emissions regulation has revealed emissions rates differences ranging from 10% to 45% depending on the pollutant emission and the trip section considered (urban or total). Thus, the nitrogen oxides emissions conformity factor slightly varies from one method to the other.



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The theory-practice gap of black carbon mitigation technologies in rural China

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Weishi Zhang, Aitong Li, Yuan Xu, Junfeng Liu
Black carbon mitigation has received increasing attention for its potential contribution to both climate change mitigation and air pollution control. Although different bottom-up models concerned with unit mitigation costs of various technologies allow the assessment of alternative policies for optimized cost-effectiveness, the lack of adequate data often forced many reluctant explicit and implicit assumptions that deviate away from actual situations of rural residential energy consumption in developing countries, where most black carbon emissions occur. To gauge the theory-practice gap in black carbon mitigation – the unit cost differences that lie between what is estimated in the theory and what is practically achieved on the ground – this study conducted an extensive field survey and analysis of nine mitigation technologies in rural China, covering both northern and southern regions with different residential energy consumption patterns. With a special focus on two temporal characteristics of those technologies – lifetimes and annual utilization rates, this study quantitatively measured the unit cost gaps and explain the technical as well as sociopolitical mechanisms behind. Structural and behavioral barriers, which have affected the technologies' performance, are discussed together with policy implications to narrow those gaps.



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On-road assessment of light duty vehicles in Delhi city: Emission factors of CO, CO2 and NOX

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Jaiprakash, Gazala Habib
This study presents the technology based emission factors of gaseous pollutants (CO, CO2, and NOX) measured during on-road operation of nine passenger cars of diesel, gasoline, and compressed natural gas (CNG). The emissions from two 3-wheelers, and three 2-wheelers were measured by putting the vehicles on jacks and operating them according to Modified Indian Driving Cycle (MIDC) at no load condition. The emission factors observed in the present work were significantly higher than values reported from dynamometer study by Automotive Research Association of India (ARAI). Low CO (0.34 ± 0.08 g km⁻¹) and high NOX (1.0 ± 0.4 g km⁻¹) emission factors were observed for diesel passenger cars, oppositely high CO (2.2 ± 2.6 g km⁻¹) and low NOX (1.0 ± 1.6 g km⁻¹) emission factors were seen for gasoline powered cars. The after-treatment technology in diesel vehicles was effective in CO reduction. While the use of turbocharger in diesel vehicles to generate high combustion temperature and pressure produces more NOx, probably which may not be effectively controlled by after-treatment device. The after-treatment devices in gasoline powered Post-2010, Post-2005 vehicles can be acclaimed for reduced CO emissions compared to Post-2000 vehicles. This work presents a limited data set of emission factors from on-road operations of light duty vehicles, this limitation can be improved by further measurements of emissions from similar vehicles.

Graphical abstract

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Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Caring for musicians' ears: insights from audiologists and manufacturers reveal need for evidence-based guidelines.

Int J Audiol. 2017 Dec 01;:1-8

Authors: McGinnity S, Beach EF, Mulder J, Cowan R

Abstract
OBJECTIVE: This study investigated clinical care delivered to musicians in Australia by audiologists and manufacturers of musicians' hearing protectors (MHP).
DESIGN: Audiologists with experience treating musicians were invited to complete a survey on their service delivery. A second survey was administered to manufacturers of MHPs.
STUDY SAMPLE: Four manufacturers of MHP and 31 audiologists completed the surveys. Post hoc analyses were performed comparing the responses of audiologists with more versus less clinical experience; and those with and without musical training.
RESULTS: There was considerable variation in the audiological care provided to musicians. Only one-third of audiologists performed pure-tone audiometry prior to MHP fitting, and there was little consistency across the sample in relation to impression taking, preferred attenuation or selection of canal length. There was also significant variation in the manufacturers' approach to MHP, each of whom provided different recommendations regarding preferred impression techniques and material viscosity.
CONCLUSIONS: The results of this study reveal lack of consistency across the hearing healthcare sector with respect to care of musicians' hearing, with potential to impact upon the satisfaction with, and usage of, MHP. There is need for evidence-based, best practice guidelines and training to support clinical audiologists in providing optimal care.

PMID: 29192525 [PubMed - as supplied by publisher]

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Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

Int J Audiol. 2017 Dec 01;:1-12

Authors: Xue L, Le Bot G, Van Petegem W, van Wieringen A

Abstract
OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities.
DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round.
STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round.
RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified.
CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

PMID: 29192519 [PubMed - as supplied by publisher]

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[Stereotactic body radiation therapy for oligometastatic prostate cancer].

[Stereotactic body radiation therapy for oligometastatic prostate cancer].

Bull Cancer. 2017 Nov 27;:

Authors: Bibault JE

Abstract
INTRODUCTION: The first line treatment of metastatic prostate cancer is medical or surgical androgen-deprivation. This treatment however has significant side effects that can affect the patients' quality of life. For oligometastatic patients, a new therapeutic approach, focusing on local treatment of metastases, is emerging.
METHODS: A systematic review of studies published on Stereotactic Body Radiation Therapy (SBRT) for oligometastatic prostate cancer was performed using results from search request on MEDLINE.
RESULTS: Treatment regimens vary from a single fraction of 20Gy (bone lesions) to ten fractions for a total dose of 64Gy (visceral metastases). Local control is 95.5 to 100% at 2 years with grade 1 and 2 toxicities around 10%, without any grade 3 side effects. These retrospective studies show the feasibility and very low toxicity of SBRT for this population of patients. The effect of SBRT on disease-free or global survival and quality of life has not been assessed. Several prospective trials (STOMP & ORIOLE) are underway.
CONCLUSION: Treating patients with up to five prostate cancer metastases is efficient and has a low toxicity. Prospective trials should identify which patients, if any, really benefit from this approach.

PMID: 29191358 [PubMed - as supplied by publisher]

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Risk factors for crash involvement in older motorcycle riders.

Risk factors for crash involvement in older motorcycle riders.

Accid Anal Prev. 2017 Nov 28;111:109-114

Authors: Chen SJ, Chen CY, Lin MR

Abstract
A prospective cohort study was conducted to identify risk and protective factors for crash involvement in older motorcyclists. Over a 1-year study period from August 2013 to July 2014, study participants were recruited from local community centers of five cities in Taiwan. People aged ≥60 years who rode a motorcycle at least once per week were eligible and were invited to participate in the study. Among 256 older riders who completed the baseline assessment and at least one of the four follow-up assessments, 79 (33.7%) experienced a motorcycle crash over the study period. Results of the proportional hazards model showed that after controlling for age, gender, and riding distance, older riders who had sustained hearing impairment (hazard ratio (HR)=2.58; 95% confidence interval (CI), 1.30-5.15), rode a motorcycle at speeds of ≥41km/h (HR=2.31; 95% CI, 1.26-4.23), and had experienced a motorcycle crash in the past year (HR=1.81; 95% CI, 1.06-3.09) were more likely to be involved in a crash, compared to their counterparts. Conversely, older riders who were obese (HR=0.43; 95% CI, 0.22-0.82) were less likely to be involved in a crash than those with a normal weight, while longer functional reach distances (HR=0.96; 95% CI, 0.93-0.99) and higher Tinetti balance scores (HR=0.79; 95% CI, 0.69-0.91) were associated with a reduced risk of crash involvement. Among older people riding a motorcycle as their primary source of transportation, several factors associated with the occurrence of motorcycle crashes were identified. Restrictions and modifications of these risk factors may help design effective safety interventions for reducing crash and injury risks of this increasing riding population.

PMID: 29195129 [PubMed - as supplied by publisher]

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Risk factors for crash involvement in older motorcycle riders.

Risk factors for crash involvement in older motorcycle riders.

Accid Anal Prev. 2017 Nov 28;111:109-114

Authors: Chen SJ, Chen CY, Lin MR

Abstract
A prospective cohort study was conducted to identify risk and protective factors for crash involvement in older motorcyclists. Over a 1-year study period from August 2013 to July 2014, study participants were recruited from local community centers of five cities in Taiwan. People aged ≥60 years who rode a motorcycle at least once per week were eligible and were invited to participate in the study. Among 256 older riders who completed the baseline assessment and at least one of the four follow-up assessments, 79 (33.7%) experienced a motorcycle crash over the study period. Results of the proportional hazards model showed that after controlling for age, gender, and riding distance, older riders who had sustained hearing impairment (hazard ratio (HR)=2.58; 95% confidence interval (CI), 1.30-5.15), rode a motorcycle at speeds of ≥41km/h (HR=2.31; 95% CI, 1.26-4.23), and had experienced a motorcycle crash in the past year (HR=1.81; 95% CI, 1.06-3.09) were more likely to be involved in a crash, compared to their counterparts. Conversely, older riders who were obese (HR=0.43; 95% CI, 0.22-0.82) were less likely to be involved in a crash than those with a normal weight, while longer functional reach distances (HR=0.96; 95% CI, 0.93-0.99) and higher Tinetti balance scores (HR=0.79; 95% CI, 0.69-0.91) were associated with a reduced risk of crash involvement. Among older people riding a motorcycle as their primary source of transportation, several factors associated with the occurrence of motorcycle crashes were identified. Restrictions and modifications of these risk factors may help design effective safety interventions for reducing crash and injury risks of this increasing riding population.

PMID: 29195129 [PubMed - as supplied by publisher]

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Case report describing a new swallowing method to improve pharyngeal passage of a bolus by creating negative pressure in the esophagus-vacuum swallowing.

Case report describing a new swallowing method to improve pharyngeal passage of a bolus by creating negative pressure in the esophagus-vacuum swallowing.

Am J Phys Med Rehabil. 2017 Nov 29;:

Authors: Kunieda K, Kubo S, Fujishima I

PMID: 29194048 [PubMed - as supplied by publisher]

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Case report describing a new swallowing method to improve pharyngeal passage of a bolus by creating negative pressure in the esophagus-vacuum swallowing.

Case report describing a new swallowing method to improve pharyngeal passage of a bolus by creating negative pressure in the esophagus-vacuum swallowing.

Am J Phys Med Rehabil. 2017 Nov 29;:

Authors: Kunieda K, Kubo S, Fujishima I

PMID: 29194048 [PubMed - as supplied by publisher]

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Preoperative Exposure of Sigmoid Sinus Trajectory in Posterolateral Cranial Base Approaches Using a New Landmark Through a Neurosurgical Perspective.

Preoperative Exposure of Sigmoid Sinus Trajectory in Posterolateral Cranial Base Approaches Using a New Landmark Through a Neurosurgical Perspective.

J Craniofac Surg. 2017 Nov 20;:

Authors: Doğan I, Özgüral O, Eroğlu Ü, Al-Beyati ESM, Kilinç CM, Cömert A, Uğur HÇ

Abstract
The location of burr holes in posterolateral cranial base approaches should be appropriate to provide an adequate operative field, and surgical freedom is crucial for bone window opening. The aim of this study was to search for more convenient and easily detectable landmarks in comparison with current landmarks in posterolateral cranial base surgery. Twenty 3-dimensional reconstructed head and neck computed tomography angiography images (group 1) and 20 cadaver heads (group 2) were evaluated. An imaginary line connecting the angle of the mandible and the mastoid tip was extended upward. A second line passing through the lateral edge of the zygomatic arch was also extended posteriorly. The authors examined if the first line met with the sigmoid sinus throughout its course and determined the location of the intersection point of these 2 lines relative to the sigmoid-transverse sinus junction. The intersection point did not correspond to the sinus region in 3 images from group 1 and 4 specimens from group 2. The matching of the mandibula-mastoid line trajectory with the sigmoid sinus course was unacceptable in 4 images and 5 cadavers. For venous anatomy preservation and anatomic skull base fossa orientation during posterolateral cranial base approaches, upward extension of the mandibula-mastoid line can be a proper landmark for surgical planning in this region. The authors' proposed superficial anatomical line and intersection point over the skull could be used as a reliable indicator for the external projection of the sigmoid sinus and an appropriate initial burr-hole location.

PMID: 29194275 [PubMed - as supplied by publisher]

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A Stratified Algorithm for Skull Base Reconstruction With Endoscopic Endonasal Approach.

A Stratified Algorithm for Skull Base Reconstruction With Endoscopic Endonasal Approach.

J Craniofac Surg. 2017 Nov 20;:

Authors: Li Z, Ji T, Huang GD, Guo J, Yang JH, Li WP

Abstract
The authors presented our institutional experience with skull base reconstruction techniques and developed a stratified algorithm for different causes of cerebrospinal fluid (CSF) leak. This is a retrospective review of patients who were diagnosed as CSF leak treated with skull base reconstruction or who underwent endoscopic transsphenoidal surgery for sellar and parasellar lesions at our department from August 2012 to April 2017. The authors totally identified 57 (59 operations in total) patients who were divided into 3 groups according to the causes of CSF leak and different reconstruction techniques. All patients underwent skull base reconstruction with specific focus on diagnosis, reconstruction techniques and strategies, and clinical outcome. The reconstruction technique we adopted was the classical multiple-layer technique, as known as "sandwich" technique, with combination of fat tissue, septal bone, autologous fascia lata, artificial dura, and nasoseptal flap (NSF). The NSF was selectively harvested for large defects according to our protocol. The reconstruction failure rate is 4.4% (2 of 45) in patients underwent endoscopic surgery for sellar and parasellar lesions. Reconstruction for postoperative iatrogenic, traumatic, and spontaneous CSF leak achieved 100% success rate; 54.2% (32 of 59) operations were done with "sandwich" plus NSF. The overall failure rate of all reconstructions was 3.4% (2 of 59). A stratified approach with multiple-layer technique and NSF is reliable for skull base reconstruction.

PMID: 29194274 [PubMed - as supplied by publisher]

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A Population Based Analysis of Melanoma of the External Ear.

A Population Based Analysis of Melanoma of the External Ear.

Otol Neurotol. 2017 Nov 30;:

Authors: Patel TD, Chin OY, Baredes S, Eloy JA, Ying YM

Abstract
OBJECTIVE: Malignant melanoma accounts for nearly 75% of all skin cancer deaths, and the incidence is on the rise in the United States. External ear melanoma (EEM) is rare, and there is little long-term data regarding the clinical behavior of this melanoma site. This study analyzes the demographic, clinicopathologic, and survival characteristics of EEM.
METHODS: The SEER database was queried for EEM cases from 1973 to 2012 (8,982 cases). Data analyzed included patient demographics, incidence trends, and survival outcomes.
RESULTS: External ear melanoma occurred most frequently in the sixth and seventh decades of life. Mean age at diagnosis was 65.5 (±16.8) years. However, the incidence of EEM in adolescents and young adults (ages 15-39 yr) has increased by 111.9% from 1973 to 2012. There was a strong male predilection with a male-to-female ratio of 6.40:1. The most common histologic subtype was malignant melanoma, NOS (46.8%), followed by superficial spreading melanoma (21.4%), and lentigo maligna melanoma (17.9%). The majority of cases were localized at the time of presentation (88.0%), with rare distant metastasis (1.9%). The most common treatment modality was surgery alone (97.6%), followed by surgery with radiotherapy (2.3%). Ten-year disease-specific survival was better among those treated with surgery alone (90.7%), than those treated with surgery with radiotherapy (37.1%) (p < 0.0001). Increasing Breslow's thickness and presence of an ulcerating lesion were both associated with poorer survival (p < 0.0001).
CONCLUSION: This study represents the largest cohort of EEM. It has an excellent survival outcome with surgery being the treatment of choice.

PMID: 29194224 [PubMed - as supplied by publisher]

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