Pre-optimization of spinal surgery patients: Development of a neurosurgical Enhanced Recovery After Surgery (ERAS) protocol

Publication date: Available online 8 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Zarina S. Ali, Tracy S. Ma, Ali K. Ozturk, Neil R. Malhotra, James M. Schuster, Paul J. Marcotte, M.Sean Grady, William C. Welch
ObjectiveDespite surgical, technological, medical, and anesthetic improvements, patient outcomes following elective neurosurgical procedures can be associated with high morbidity. Enhanced recovery after surgery (ERAS) protocols are multimodal care pathways designed to optimize patient outcomes by addressing pre-, peri-, and post-operative factors. Despite significant data suggesting improved patient outcomes with the adoption of these pathways, development and implementation has been limited in the neurosurgical population.Methods/ResultsThis study protocol was designed to establish the feasibility of a randomized controlled trial to assess the efficacy of implementation of an ERAS protocol on the improvement of clinical and patient reported outcomes and patient satisfaction scores in an elective inpatient spine surgery population. Neurosurgical patients undergoing spinal surgery will be recruited and randomly allocated to one of two treatment arms: ERAS protocol (experimental group) or hospital standard (control group). The experimental group will undergo interventions at the pre-, peri-, and post-operative time points, which are exclusive to this group as compared to the hospital standard group.ConclusionsThe present proposal aims to provide supporting data for the application of these specific ERAS components in the spine surgery population and provide rationale/justification of this type of care pathway. This study will help inform the design of a future multi-institutional, randomized controlled trial.Resultsof this study will guide further efforts to limit post-operative morbidity in patients undergoing elective spinal surgery and to highlight the impact of ERAS care pathways in improving patient reported outcomes and satisfaction.



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Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature

Publication date: Available online 9 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): T Mark Campbell, Bahareh Bahram Ghaedi, Elizabeth Tanjong Ghogomu, Vivian Welch
ObjectiveTo determine whether shoe lifts effectively treat leg length discrepancy (LLD)-associated morbidities in adults with common painful musculoskeletal conditions.Data SourcesTRIP, CENTRAL, PubMed, PEDro and National Guideline Clearinghouse databases. The search was performed in September 2017, limited to English-only, and had no time constraints.Study SelectionTwo reviewers independently determined study eligibility. Inclusion criteria were: (1) participants ≥18 years-old with musculoskeletal-related complaints and LLD, (2) a shoe lift intervention was used, and (3) the study reported on pain, function, range of motion, patient satisfaction, quality of life, or adverse events. Randomized controlled trials (RCTs), controlled intervention, cohort, before-and-after, case-series and case report studies were included. Three-hundred-and-nineteen articles were screened and nine guidelines reviewed.Data ExtractionWe extracted data pertaining to participant demographic characteristics, study setting, recruitment, randomization, method of LLD measurement, shoe lift characteristics, treatment duration, and outcome measures. We included ten studies, including one RCT.Data SynthesisLLD was associated with low back pain, scoliosis, and osteoarthritis of the hip and knee. Description of LLD correction strategy was often inadequate. Study quality was very low or poor. In non-RCT studies reporting on the proportion of participants who improved with a shoe lift, 88±3% of 349 participants treated had partial or complete pain relief (effect size range 66.7-100%). All 22 RCT participants receiving treatment experienced pain relief (mean pain reduction 27±9mm on a 150mm visual analogue scale). Two of nine guidelines recommended shoe lift use based on consensus, and were of moderate-to-high quality.ConclusionsThere is low-quality evidence that shoe lifts reduce pain and improve function in patients with LLD and common painful musculoskeletal conditions. High quality research evaluating a threshold LLD to correct and a strategy to do so is necessary. Developing an appropriate comparison group to test clinically-relevant outcome measures would make a valuable contribution in this regard.



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Health-related quality of life in elderly hearing aid users vs. non-users

Publication date: Available online 8 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eman A. Said
Background and aimPresbycusis, is usually a harbinger of aging. The negative consequences are not limited to an auditory impairment but influences a range of psychosocial and physical health concerns. The cornerstone of audiologic intervention is the use hearing aids. Optimal management should include an evaluation of quality of life (QoL) status and its assessment. Aim of this work: To quantify the quality of life of hearing impaired elderly individuals (HIEI) and to assess hearing aids impact on QoL.SubjectsElderly patients (1 2 7) above 60 years had sensorineural hearing loss ranged from mild to severe degree of hearing loss, only 24 of them (21.1%) were fitted with monaural hearing aid.MethodsEach subject of this study underwent basic audiologic evaluation, speech perception in noise, aided tonal sound field threshold and aided speech tests. Generic WHOQOL-BREF and hearing handicap inventory for the elderly (HHIE).ResultsThere were significant lower aided tonal sound field thresholds (ATSFTs) at 0.5, 1, 2 and 4 kHz of hearing aid users when compared with values of non-users at all tested frequencies. Hearing aid users perform better in all domains of WHO QOL-BREF with significant reductions in emotional, social and total scores of HHIE in users group compared with non-users indicated improvement in their QOL. There were no significant differences between scores of males and scores of females. The severity of the hearing loss had statistically significant effects on these scores for non-users but not in users group.



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Outcome and complications after treatment of facial fractures at different times in polytrauma patients

Publication date: Available online 8 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rene Rothweiler, Joerg Bayer, Joern Zwingmann, Norbert P. Suedkamp, Johannes Kalbhenn, Rainer Schmelzeisen, Ralf Gutwald
Finding the correct point of time for operative treatment of facial fractures in multiply injured people remains one of the most important challenges in modern emergency medicine. Findings relating to pathophysiological mechanisms after severe trauma argue against the early operative treatment of non-life-threatening injuries. Our retrospective analysis investigated the effects on complications and outcome of different time points for operative treatment of maxillofacial fractures in multiply injured patients.Over a period of 10 years (2003–2012) we could identify 1543 patients, of whom 553 had fractures of the facial skull. 168 of the facial fracture patients were operated on, 97 at a time later than 72 hours. Despite the delayed time of operation, the patients showed fewer complications (21.6% vs 25.4%). This resulted in fewer additional stays in hospital (9.3% vs 11.3%), and also in fewer plate removals (23.7% vs 33.8%). We conclude that delayed operative fracture treatment does not lead to more complications. The optimal time for operative treatment has to be determined individually as the earliest point at which no adverse effects from comorbidities are expected.



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Orbital volume and shape in Treacher Collins syndrome

Publication date: Available online 8 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Julie Levasseur, Johan Nysjö, Ronak Sandy, Jonathan A. Britto, Nicolas Garcelon, Samer Haber, Arnaud Picard, Pierre Corre, Guillaume A. Odri, Roman H. Khonsari
Orbito-palpebral reconstruction is a challenge in Treacher Collins syndrome (TCS). This study investigates orbital phenotypes in TCS using cephalometry and orbital shape analysis.Eighteen TCS and 52 control patients were included in this study, using the Dr Warehouse database. Orbital cephalometry was based on 20 landmarks, 10 planes, 16 angles, and 22 distances. Orbits were segmented. Registration-based, age-specific mean models were generated using semi-automatic segmentation, and aligned and compared using color-coded distance maps – maximum absolute distance (MAD), Hausdorff distance (HD), and Dice similarly coefficient (DSC). Symmetry was assessed by mirroring and DSC computing.Central orbital depth (COD) and medial orbital depth (MOD) allowed 100% of orbits to be classified. COD and lateral orbital depth (LOD) were different from the controls. MAD between TCS and controls was ≤ 1.5 mm, while for HD it was > 1.5 mm, and for DSC < 1. TCS orbits were more asymmetrical than controls, and orbital volumes were smaller when age was considered as a confounding factor, and had a trend for normalization with age.This report emphasizes the importance of combining different morphometric approaches in the phenotype characterization of non-trivial structures such as the orbit, and supports composite skeletal and soft-tissue strategies for the management of the peri-orbital region.



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Outcome and complications after treatment of facial fractures at different times in polytrauma patients

Publication date: Available online 8 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rene Rothweiler, Joerg Bayer, Joern Zwingmann, Norbert P. Suedkamp, Johannes Kalbhenn, Rainer Schmelzeisen, Ralf Gutwald
Finding the correct point of time for operative treatment of facial fractures in multiply injured people remains one of the most important challenges in modern emergency medicine. Findings relating to pathophysiological mechanisms after severe trauma argue against the early operative treatment of non-life-threatening injuries. Our retrospective analysis investigated the effects on complications and outcome of different time points for operative treatment of maxillofacial fractures in multiply injured patients.Over a period of 10 years (2003–2012) we could identify 1543 patients, of whom 553 had fractures of the facial skull. 168 of the facial fracture patients were operated on, 97 at a time later than 72 hours. Despite the delayed time of operation, the patients showed fewer complications (21.6% vs 25.4%). This resulted in fewer additional stays in hospital (9.3% vs 11.3%), and also in fewer plate removals (23.7% vs 33.8%). We conclude that delayed operative fracture treatment does not lead to more complications. The optimal time for operative treatment has to be determined individually as the earliest point at which no adverse effects from comorbidities are expected.



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Orbital volume and shape in Treacher Collins syndrome

Publication date: Available online 8 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Julie Levasseur, Johan Nysjö, Ronak Sandy, Jonathan A. Britto, Nicolas Garcelon, Samer Haber, Arnaud Picard, Pierre Corre, Guillaume A. Odri, Roman H. Khonsari
Orbito-palpebral reconstruction is a challenge in Treacher Collins syndrome (TCS). This study investigates orbital phenotypes in TCS using cephalometry and orbital shape analysis.Eighteen TCS and 52 control patients were included in this study, using the Dr Warehouse database. Orbital cephalometry was based on 20 landmarks, 10 planes, 16 angles, and 22 distances. Orbits were segmented. Registration-based, age-specific mean models were generated using semi-automatic segmentation, and aligned and compared using color-coded distance maps – maximum absolute distance (MAD), Hausdorff distance (HD), and Dice similarly coefficient (DSC). Symmetry was assessed by mirroring and DSC computing.Central orbital depth (COD) and medial orbital depth (MOD) allowed 100% of orbits to be classified. COD and lateral orbital depth (LOD) were different from the controls. MAD between TCS and controls was ≤ 1.5 mm, while for HD it was > 1.5 mm, and for DSC < 1. TCS orbits were more asymmetrical than controls, and orbital volumes were smaller when age was considered as a confounding factor, and had a trend for normalization with age.This report emphasizes the importance of combining different morphometric approaches in the phenotype characterization of non-trivial structures such as the orbit, and supports composite skeletal and soft-tissue strategies for the management of the peri-orbital region.



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Dosimetric effects of saline- versus water-filled balloon applicators for IORT using the model S700 electronic brachytherapy source

Publication date: Available online 8 December 2017
Source:Brachytherapy
Author(s): Gage Redler, Alistair Templeton, Heming Zhen, Julius Turian, Damian Bernard, James C.H. Chu, Katherine L. Griem, Yixiang Liao
PurposeThe Xoft Axxent Electronic Brachytherapy System (Xoft, Inc., San Jose, CA) is a viable option for intraoperative radiation therapy (IORT) treatment of early-stage breast cancer. The low-energy (50-kVp) X-ray source simplifies shielding and increases relative biological effectiveness but increases dose distribution sensitivity to medium composition. Treatment planning systems typically assume homogenous water for brachytherapy dose calculations, including precalculated atlas plans for Xoft IORT. However, Xoft recommends saline for balloon applicator filling. This study investigates dosimetric differences due to increased effective atomic number (Zeff) for saline (Zeff = 7.56) versus water (Zeff = 7.42).MethodsBalloon applicator diameters range from 3 to 6 cm. Monte Carlo N-Particle software is used to calculate dose at the surface (Ds) of and 1 cm away (D1cm) from the water-/saline-filled balloon applicator using a single dwell at the applicator center as a simple estimation of the dosimetry and multiple dwells simulating the clinical dose distributions for the atlas plans.ResultsSingle-dwell plans show a 4.4–6.1% decrease in Ds for the 3- to 6-cm diameter applicators due to the saline. Multidwell plans show similar results: 4.9% and 6.4% Ds decrease, for 4-cm and 6-cm diameter applicators, respectively. For the single-dwell plans, D1cm decreases 3.6–5.2% for the 3- to 6-cm diameter applicators. For the multidwell plans, D1cm decreases 3.3% and 5.3% for the 4-cm and 6-cm applicators, respectively.ConclusionsThe dosimetric effect introduced by saline versus water filling for Xoft balloon applicator–based IORT treatments is ∼5%. Users should be aware of this in the context of both treatment planning and patient outcome studies.



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Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection Without Antithrombotic Use

Publication date: Available online 8 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Hyangkyoung Kim, Hojong Park, Sang Jun Park, Bong Won Park, Jae Chol Hwang, Young Woo Seo, Hong Rae Cho
ObjectivesThis study aimed to show the intention to treat results of treatment for spontaneous isolated superior mesenteric artery dissection (SISMAD) without anticoagulation or antiplatelet agents and the follow-up results of SISMAD according to the configuration on computed tomography (CT) scans.DesignRetrospective, observational single centre studyMethodsAll cases of SISMAD were enrolled consecutively from 2006 onwards. There were 25 symptomatic and four asymptomatic patients in whom SISMAD was found incidentally. The SISMAD patients were treated using a consistent therapeutic strategy without antithrombotics. SISMAD was categorized into four types based on the configuration on CT scans by Yun's classification. Follow-up CT was performed at 3 months, 6 months, and yearly thereafter.ResultsThe median follow-up duration was 57 months (13–129 months). Improvement or complete resolution on CT scans, with no symptom recurrence, was seen in 27 patients. The non-invasive approach failed in three cases and two patients underwent further intervention. No patient died during the follow-up.ConclusionsWeighing the risks versus benefits of antithrombotics and considering the benign nature of SISMAD, conservative treatment without antithrombotics might be sufficient in patients without evidence of bowel ischaemia or infarction on initial CT scan.



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Long-term Voice Outcome Following Radiation Versus Laser Microsurgery in Early Glottic Cancer

Publication date: Available online 8 December 2017
Source:Journal of Voice
Author(s): Yue Ma, Rebecca Green, Daniel McCabe, Leanne Goldberg, Peak Woo
ObjectivesLong-term voice outcome (LTVO) after radiation (XRT) or trans-oral laser microsurgery (TLM) is unclear. This study is a multi-modality analysis of LTVO following XRT or TLM in patients with early glottic cancer. We hypothesize that as compared with TLM, LTVO is worse in the XRT group because of progressive fibrosis in the glottic tissueMaterial and MethodsOne hundred and two patients with early glottic carcinoma (carcinoma in situ, T1, T2) were included. Multi-modality voice analyses were performed with self-perception using Voice Handicap Index-10, objective analysis using Analysis of Dysphonia in Speech and Voice Software (Cepstral Spectral Index of Dysphonia score for Consensus Auditory-Perceptual Evaluation of Voice sentences), and perceptual rating by two blinded speech language pathologists (GRBAS scale).ResultsFifty-five patients received TLM (mean follow-up = 52 months) and 47 patients had XRT (mean follow-up = 65 months). There is no difference between the two groups in sex, age, stage, and follow-up time. Intraclass correlation coefficient between raters was high at 0.94. Controlling for age and stage, XRT increases total GRBAS score by 1.38 points (P = 0.006) and increases Cepstral Spectral Index of Dysphonia score by 13.7 points (P < 0.001) when compared with the TLM group. No significant differences were found in the Voice Handicap Index score between the XRT and the TLM groups.ConclusionsThis is the first multi-modality voice analysis to suggest TLM results in better LTVO than XRT in GRBAS score and objective voice analysis but not in self-perception. These differences may reflect the progressive effects of XRT on glottic tissue. A randomized controlled study is required to confirm our findings.



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Issue Information

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Erratum

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Issue Information

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Erratum

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An in vivo 11C-PK PET study of microglia activation in Fatal Familial Insomnia

Abstract

Objective

Postmortem studies reported significant microglia activation in association with neuronal apoptosis in Fatal Familial Insomnia (FFI), indicating a specific glial response, but negative evidence also exists. An in vivo study of local immune responses over FFI natural course may contribute to the understanding of the underlying pathogenesis.

Methods

We included eight presymptomatic subjects (mean ± SD age:44.13 ± 3.83 years) carrying the pathogenic D178N-129^met FFI mutation, one symptomatic patient (male, 45 yrs. old), and nine healthy controls (HC) (mean ± SD age: 44.00 ± 11.10 years.) for comparisons. ¹¹C-(R)-PK11195 PET allowed the measurement of Translocator Protein (TSPO) overexpression, indexing microglia activation. A clustering algorithm was adopted to define subject-specific reference regions. Voxel-wise statistical analyses were performed on ¹¹C-(R)-PK11195 binding potential (BP) images both at the group and individual level.

Results

The D178N-129^met/val FFI patient showed significant ¹¹C-(R)-PK11195 BP increases in the midbrain, cerebellum, anterior thalamus, anterior cingulate cortex, orbitofrontal cortex, and anterior insula, bilaterally. Similar TSPO increases, but limited to limbic structures, were observed in four out of eight presymptomatic carriers. The only carrier with the codon 129^met/val polymorphism was the only one showing an additional TSPO increase in the anterior thalamus.

Interpretation

In comparison to nonprion neurodegenerative diseases, the observed lack of a diffuse brain TSPO overexpression in preclinical and the clinical FFI cases suggests the presence of a different microglia response. The involvement of limbic structures might indicate a role for microglia activation in these key pathologic regions, known to show the most significant neuronal loss and functional deafferentation in FFI.

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PI3K in cancer: its structure, activation modes and role in shaping tumor microenvironment

Future Oncology, Ahead of Print.


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Can we predict the response to therapy in soft tissue sarcoma?

Future Oncology, Ahead of Print.


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Therapy sequencing strategies in multiple myeloma: who, what and why?

Future Oncology, Ahead of Print.


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Osteoblast-like cells in human cancers: new cell type and reliable markers for bone metastasis

Future Oncology, Ahead of Print.


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Nonprogression with avelumab treatment associated with gains in quality of life in metastatic Merkel cell carcinoma

Future Oncology, Ahead of Print.


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Long-term Voice Outcome Following Radiation Versus Laser Microsurgery in Early Glottic Cancer

Publication date: Available online 8 December 2017
Source:Journal of Voice
Author(s): Yue Ma, Rebecca Green, Daniel McCabe, Leanne Goldberg, Peak Woo
ObjectivesLong-term voice outcome (LTVO) after radiation (XRT) or trans-oral laser microsurgery (TLM) is unclear. This study is a multi-modality analysis of LTVO following XRT or TLM in patients with early glottic cancer. We hypothesize that as compared with TLM, LTVO is worse in the XRT group because of progressive fibrosis in the glottic tissueMaterial and MethodsOne hundred and two patients with early glottic carcinoma (carcinoma in situ, T1, T2) were included. Multi-modality voice analyses were performed with self-perception using Voice Handicap Index-10, objective analysis using Analysis of Dysphonia in Speech and Voice Software (Cepstral Spectral Index of Dysphonia score for Consensus Auditory-Perceptual Evaluation of Voice sentences), and perceptual rating by two blinded speech language pathologists (GRBAS scale).ResultsFifty-five patients received TLM (mean follow-up = 52 months) and 47 patients had XRT (mean follow-up = 65 months). There is no difference between the two groups in sex, age, stage, and follow-up time. Intraclass correlation coefficient between raters was high at 0.94. Controlling for age and stage, XRT increases total GRBAS score by 1.38 points (P = 0.006) and increases Cepstral Spectral Index of Dysphonia score by 13.7 points (P < 0.001) when compared with the TLM group. No significant differences were found in the Voice Handicap Index score between the XRT and the TLM groups.ConclusionsThis is the first multi-modality voice analysis to suggest TLM results in better LTVO than XRT in GRBAS score and objective voice analysis but not in self-perception. These differences may reflect the progressive effects of XRT on glottic tissue. A randomized controlled study is required to confirm our findings.



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Multiple gastrointestinal stromal tumors involving extragastrointestinal sites in neurofibromatosis type 1

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Benign mesothelial nodules reflux within acquired cutaneous lymphangiectasia associated with huge ovarian clear cell carcinoma

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Spheroid-type of AL amyloid deposition associated with colonic adenocarcinoma: A case report with literature review

We report a colonic adenocarcinoma associated with diffuse submucosal deposition of a peculiar spheroid-type amyloid identified in the colon, terminal ileum, and appendix. A 65-year-old woman with past medical histories of hypertension, and chronic obstructive pulmonary disease, presented to the emergency room with cramping abdominal pain and nausea. A computed tomography (CT) scan of abdomen showed right colonic volvulus. Emergency right hemicolectomy was performed. The specimen showed colonic adenocarcinoma with focal submucosal invasion (pT1) arising from a villotubular adenoma. A diffuse submucosal spheroid-type amyloid deposition (resembling corpora amylacea-like structures with Liesegang ring formation) was identified in the colon, ileum, and appendix. Electron microscopy examination of this unusual spheroidal-type material further confirmed the presence of amyloid fibrils. Analysis by liquid chromatography–mass spectrometry detected AL (lambda) type amyloidosis in this specimen. Tests for monoclonal gammopathy were not performed because patient consent was not obtained. In tissue section evaluation, however, no plasma cell neoplasm was identified. Cases with isolated AL amyloid deposition in the gastrointestinal tract have been reported rarely, and there is no case report of colonic adenocarcinoma associated with primary amyloid deposition in the English literature.

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Cardiovascular risk and severity factors in patients admitted to hospital for spontaneous epistaxis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectivesTo assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis.Material and methodsA single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished.ResultsThere were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion.ConclusionThe real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.



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Impact of allergy on phenotypic and endotypic profiles of nasal polyposis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Mortuaire, I. Gengler, M. Balden, M. Capron, G. Lefèvre
ObjectivesTo assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsA single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.ResultsPhenotype and endotype profiles were comparable in patients with (n=15) or without (n=42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.ConclusionsThe present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.



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Effects of acrylamide on oxidant/antioxidant parameters and CYP2E1 expression in rat pancreatic endocrine cells

Publication date: Available online 8 December 2017
Source:Acta Histochemica
Author(s): Jelena Marković, Milena Stošić, Danijela Kojić, Milica Matavulj
Oxidative stress is one of the principle mechanism of acrylamide-induced toxicity. Acrylamide is metabolized by cytochrome P450 2E1 (CYP2E1) to glycidamide or by direct conjugation with glutathione. Bearing in mind that up to now the effects of acrylamide on oxidative stress status and CYP2E1 level in endocrine pancreas have not been studied we performed qualitative and quantitative immunohistochemical evaluation of inducible nitric oxide synthase (iNOS), superoxide dismutase 1 (SOD1), superoxide dismutase 2 (SOD2), catalase (CAT) and CYP2E1 expression in islets of Langerhans of rats subchronically treated with 25 or 50mg/kg bw of acrylamide. Since the majority of cells (>80%) in rodent islets are beta cells, in parallel studies, we employed the Rin-5F beta cell line to examine effects of acrylamide on redox status and the activity of CAT, SOD and glutathione-S-transferase (GST), their gene expression, and CYP2E1, NF-E2 p45-related factor 2 (Nrf2) and iNOS expression. Immunohistochemically stained pancreatic sections revealed that acrylamide induced increase of iNOS and decrease of CYP2E1 protein expression, while expression of antioxidant enzymes was not significantly affected by acrylamide in islets of Langerhans. Analysis of Mallory-Azan stained pancreatic sections revealed increased diameter of blood vessels lumen in pancreatic islets of acrylamide-treated rats. Increase in the GST activity, lipid peroxidation and nitrite level, and decrease in GSH content, CAT and SOD activities was observed in acrylamide-exposed Rin-5F cells. Level of mRNA was increased for iNOS, SOD1 and SOD2, and decreased for GSTP1, Nrf2 and CYP2E1 in acrylamide-treated Rin-5F cells. This is the first report of the effects of acrylamide on oxidant/antioxidant parameters and CYP2E1 expression in pancreatic endocrine cells.



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Neurons and satellite glial cells in adult rat lumbar dorsal root ganglia express connexin 36

Publication date: Available online 8 December 2017
Source:Acta Histochemica
Author(s): E. Martha Pérez Armendariz, Monica Norcini, Beatriz Hernández-Tellez, Andrés Castell-Rodríguez, Cristina Coronel-Cruz, Raquel Guerrero Alquicira, Alexandra Sideris, Esperanza Recio-Pinto
Previous studies have shown that following peripheral nerve injury there was a downregulation of the gap junction protein connexin 36 (Cx36) in the spinal cord; however, it is not known whether Cx36 protein is expressed in the dorsal root ganglia (DRGs), nor if its levels are altered following peripheral nerve injuries. Here we address these aspects in the adult rat lumbar DRG. Cx36 mRNA was detected using qRT-PCR, and Cx36 protein was identified in DRG sections using immunohistochemistry (IHC) and immunofluorescence (IF). Double staining revealed that Cx36 co-localizes with both anti-β-III tubulin, a neuronal marker, and anti-glutamine synthetase, a satellite glial cell (SGC) marker. In neurons, Cx36 staining was mostly uniform in somata and fibers of all sizes and its intensity increased at the cell membranes. This labeling pattern was in contrast with Cx36 IF dots mainly found at junctional membranes in islet beta cells used as a control tissue. Co-staining with anti-Cx43 and anti-Cx36 showed that whereas mostly uniform staining of Cx36 was found throughout neurons and SGCs, Cx43 IF puncta were localized to SGCs. Cx36 mRNA was expressed in normal lumbar DRG, and it was significantly down-regulated in L4 DRG of rats that underwent sciatic nerve injury resulting in persistent hypersensitivity. Collectively, these findings demonstrated that neurons and SGCs express Cx36 protein in normal DRG, and suggested that perturbation of Cx36 levels may contribute to chronic neuropathic pain resulting from a peripheral nerve injury.



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Circulating allergen-specific Th2 lymphocytes: CCR4+ rather than CLA+ is the predominant phenotype in peanut allergic subjects

Publication date: Available online 8 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Lars H. Blom, Nanna Juel-Berg, Lau Fabricius Larsen, Kirsten S. Hansen, Lars K. Poulsen

Teaser

The skin and airway homing chemokine CCR4, but not CLA, emerged as the primary discriminating homing factor, of Th2 lymphocytes, suggesting that peanut sensitization occurs both via the skin and airways.


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Neutrophil-lymphocyte ratio kinetics in patients with advanced solid tumours on phase I trials of PD-1/PD-L1 inhibitors

Publication date: January 2018
Source:European Journal of Cancer, Volume 89
Author(s): Malaka Ameratunga, Maxime Chénard-Poirier, Irene Moreno Candilejo, Manuel Pedregal, Andrew Lui, David Dolling, Caterina Aversa, Alvaro Ingles Garces, Joo Ern Ang, Udai Banerji, Stan Kaye, Hui Gan, Bernard Doger, Victor Moreno, Johann de Bono, Juanita Lopez
BackgroundAlthough the neutrophil-lymphocyte ratio (NLR) is prognostic in many oncological settings, its significance in the immunotherapy era is unknown. Mechanistically, PD-1/PD-L1 inhibitors may alter NLR. We sought to characterise NLR kinetics in patients with advanced solid tumours treated with PD-1/PD-L1 inhibitors.MethodsElectronic records of patients treated with PD-1/PD-L1 inhibitors on phase I trials across three sites were reviewed. A high NLR (hNLR) was predefined as >5. Univariate logistic regression models were used for toxicity, response analyses and Cox models for overall survival (OS) and progression-free survival analyses. Landmark analyses were performed (cycle two, three). Longitudinal analysis of NLR was performed utilising a mixed effect regression model.ResultsThe median OS for patients with hNLR was 8.5 months and 19.4 for patients with low NLR, (hazard ratio [HR] = 1.85, 95% confidence interval [CI] 1.15–2.96, p = 0.01). On landmark analysis, hNLR was significantly associated with inferior OS at all time points with a similar magnitude of effect over time (p < 0.05). On multivariate analysis, NLR was associated with OS (HR 1.06, 95% CI 1.01–1.11, p = 0.01). NLR did not correlate with increased immune toxicity. Longitudinally, NLR correlated with response: NLR decreased by 0.09 (95% CI: −0.15 to −0.02; p = 0.01) per month in responders compared with non-responders.ConclusionshNLR at baseline and during treatment is adversely prognostic in patients with advanced malignancies receiving PD-1/PD-L1 blockade. Importantly, NLR reduced over time in responders to immunotherapy. Taken together, these data suggest that baseline and longitudinal NLR may have utility as a unique biomarker to aid clinical decision-making in patients receiving immunotherapy.



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The use of breast imaging for predicting response to neoadjuvant lapatinib, trastuzumab and their combination in HER2-positive breast cancer: Results from Neo-ALTTO

Publication date: January 2018
Source:European Journal of Cancer, Volume 89
Author(s): S. Di Cosimo, C. Campbell, H.A. Azim, G. Galli, G. Bregni, G. Curigliano, C. Criscitiello, M. Izquierdo, L. de la Pena, D. Fumagalli, L. Fein, J. Vinholes, W.M.J. Ng, M. Colleoni, A. Ferro, B.J. Naume, A. Patel, J. Huober, M.J. Piccart-Gebhart, J. Baselga, E. de Azambuja
AimTo determine the value of mammography and breast ultrasound (US) in predicting outcomes in HER2 positive breast cancer patients (pts) within Neo-ALTTO trial.Patients and methodsMammography and US were required at baseline, week 6 and surgery. Two independent blinded investigators reviewed the measurements and assigned the corresponding response category. Pts showing complete or partial response according to RECIST (v1.1) were classified as responders. The association between imaging response at week 6 or prior to surgery was evaluated with respect to pathological complete response (pCR) and event-free Survival (EFS).ResultsOf the 455 pts enrolled in the trial, 267 (61%) and 340 (77%) had evaluable mammography and US at week 6; 248 (56%) and 309 (70%) pts had evaluable mammography and US prior to surgery. At week 6, 32% and 43% of pts were classified as responders by mammography and US, respectively. pCR rates were twice as high for responders than non-responders (week 6: 46% versus 23% by US, p < 0.0001; 41% versus 24% by mammography, p = 0.007). Positive and negative predictive values of mammography and US prior to surgery were 37% and 35%, and 82% and 70%, respectively. No significant correlation was found between response by mammography and/or US at week 6/surgery and EFS.ConclusionsMammography and US were underused in Neo-ALTTO although US had the potential to assess early response whereas mammography to detect residual disease prior to surgery. Our data still emphasise the need for further imaging studies on pts treated with neoadjuvant HER2-targeted therapy.



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Comparing granulocyte colony–stimulating factor filgrastim and pegfilgrastim to its biosimilars in terms of efficacy and safety: A meta-analysis of randomised clinical trials in breast cancer patients

Publication date: January 2018
Source:European Journal of Cancer, Volume 89
Author(s): Edoardo Botteri, Andriy Krendyukov, Giuseppe Curigliano
BackgroundGranulocyte colony–stimulating factors (G-CSFs) are widely used to prevent neutropenia in cancer patients undergoing myelosuppressive chemotherapy. Several biosimilar medicines of G-CSF are now available, with their development involving a step-wise series of comparisons to demonstrate similarity to reference biologics. Randomised clinical trials (RCTs) are considered confirmatory, and for G-CSF biosimilars, patients with breast cancer (BC) undergoing myelosuppressive chemotherapy are the most sensitive population in which to confirm similarity. This meta-analysis aimed to compare the clinical efficacy and safety of approved or proposed G-CSF biosimilars (filgrastim or pegfilgrastim) with reference G-CSF in patients with BC.MethodsA Medline literature search up to March 2017 identified RCTs comparing biosimilar G-CSF to reference in BC patients. The primary efficacy end-point was mean difference in duration of severe neutropenia (DSN). Secondary efficacy end-points were differences in depth of absolute neutrophil count (ANC) nadir, time to ANC recovery and incidence of febrile neutropenia. Safety analyses included calculation of risk ratios for bone pain events, myalgia events and serious adverse events. Random effect models were fitted to obtain the pooled estimates of the mean difference for continuous outcomes and the risk ratio for dichotomous outcomes and their corresponding 95% confidence intervals (CIs).FindingsEight eligible RCTs were included in this meta-analysis. Overall difference in DSN between reference and biosimilar medicines was not statistically significant (0·06 d [95% CI −0·05, 0·17]). The analysis of secondary efficacy end-points showed no significant differences between reference biologics and biosimilar medicines, as well as the analysis of bone pain events, myalgia events and serious adverse events.



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Positron emission tomography/computed tomography evaluation of oncolytic virus therapy efficacy in melanoma

Publication date: Available online 8 December 2017
Source:European Journal of Cancer
Author(s): Viola Franke, Bernies van der Hiel, Bart A. van de Wiel, Willem M.C. Klop, Sylvia ter Meulen, Alexander C.J. van Akkooi




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RELN signaling modulates glioblastoma growth and substrate-dependent migration

Abstract

Glioblastoma (GBM) represents the most common and most malignant type of primary brain tumor and significantly contributes to cancer morbidity and mortality. Invasion into the healthy brain parenchyma is a major feature of glioblastoma aggressiveness. Reelin (RELN) is a large secreted extracellular matrix glycoprotein that regulates neuronal migration and positioning in the developing brain and sustains functionality in the adult brain. We here show that both RELN and its main downstream effector DAB1 are silenced in glioblastoma as compared to non-neoplastic tissue and mRNA expression is inversely correlated with malignancy grade. Furthermore, RELN expression is positively correlated with patient survival in two large, independent clinically annotated datasets. RELN silencing occurs via promoter hypermethylation as shown by both database mining and bisulfite sequencing of the RELN promoter. Consequently, treatment with 5'-Azacytidine and trichostatin A induced RELN expression in vitro. On the functional level, we found RELN to regulate glioblastoma cell migration both in a DAB1 (tyrosine phosphorylation)-dependent and -independent fashion, depending on the substrate provided. Moreover, stimulation of RELN signaling strongly reduced proliferation in glioblastoma cells. This phenotype depends on DAB1 stimulation by RELN, as a mutant that lacks all RELN induced tyrosine phosphorylation sites (DAB1-5F) failed to induce a growth arrest. Proteomic analyzes revealed that these effects are mediated by a reduction in E2F targets and dephosphorylation of ERK1/2. Taken together, our data establish a relevance of RELN signaling in glioblastoma pathology and thereby might unearth novel, yet unrecognized treatment options. This article is protected by copyright. All rights reserved.

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Dominant role of microglial and macrophage innate immune responses in human ischemic infarcts

Abstract

Inflammatory mechanisms, involving granulocytes, T-cells, B-cells, macrophages and activated microglia, have been suggested to play a pathogenic role in experimental models of stroke and may be targets for therapeutic intervention. However, knowledge on the inflammatory response in human stroke lesions is limited. Here, we performed a quantitative study on the inflammatory reaction in human ischemic infarct lesions. We found increased numbers of T-lymphocytes, mainly CD8⁺ cells, but not of B-lymphocytes. Their number was very low in comparison to that seen in inflammatory diseases of the central nervous system and they did not show signs of activation. Polymorphonuclear leukocytes were present in meninges and less prominently in the perivascular space in early lesions, but their infiltration into the lesioned tissue was sparse with the exception of a single case. Microglia were lost in the necrotic core of fresh lesions, their number was increased in the surrounding penumbra, apparently due to proliferation. Using TMEM119 as a marker for the resident microglia pool, macrophages in lesions were in part derived from the original microglia pool, depending upon the lesion stage. Most microglia and macrophages revealed a pro-inflammatory activation pattern, expressing molecules involved in phagocytosis, oxidative injury, antigen presentation and iron metabolism and had partially lost the expression of P2RY12, an antigen expressed on homeostatic ("resting") microglia in rodents. At later lesion stages, the majority of macrophages showed intermediate activation patterns, expressing pro-inflammatory and anti-inflammatory markers. Microglia in the normal white matter of controls and stroke patients were already partly activated towards a pro-inflammatory phenotype. Our data suggest that the direct contribution of lymphocytes and granulocytes to active tissue injury in human ischemic infarct lesions is limited and that stroke therapy that targets pro-inflammatory microglia and macrophage activation may be effective. This article is protected by copyright. All rights reserved.

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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

Publication date: Available online 8 December 2017
Source:American Journal of Otolaryngology
Author(s): Giuseppe Magliulo, Giannicola Iannella




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Effect of abutment height on interproximal implant bone level in the early healing: A randomized clinical trial

Abstract

Objective

The aim of this randomized clinical trial was to compare the effect on the interproximal implant bone loss (IBL) of two different heights (1 and 3 mm) of definitive abutments placed at bone level implants with a platform switched design.

Material and methods

Twenty-two patients received forty-four implants (6.5–10 mm length and 3.5–4 mm diameter) to replace at least two adjacent missing teeth, one bridge set to each patient—two implants per bridge. Patients were randomly allocated, and two different abutment heights, 1 and 3 mm using only one abutment height per bridge, were used. Clinical and radiological measurements were performed at 3 and 6 months after surgery. Interproximal bone level changes were compared between treatment groups. The association between IBL and categorical variables (history of periodontitis, smoking, implant location, implant diameter, implant length, insertion torque, width of keratinized mucosa, bone density, gingival biotype and antagonist) was also performed.

Results

At 3 months, implants with a 1-mm abutment had significantly greater IBL (0.83 ± 0.19 mm) compared to implants with a 3-mm abutment (0.14 ± 0.08 mm). At 6 months, a greater IBL was observed at implants with 1-mm abutments compared to implants with 3-mm abutments (0.91 ± 0.19 vs. 0.11 ± 0.09 mm). The analysis of the relation between patient characteristics and clinical variables with IBL revealed no significant differences at any moment except for smoking.

Conclusions

Abutment height is an important factor to maintain interproximal implant bone level in early healing. Short abutments led to a greater interproximal bone loss in comparison with long abutments after 6 months. Other variables except smoking showed no relation with interproximal bone loss in early healing.

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Novel in vitro cancer models for optimizing anti-EGFR therapies

Pre-clinical models, that are able to recapitulate the biology and pathology of the original individual cancer, are needed to better investigate mechanisms of response and resistance to anticancer therapies. In this respect, novel in vitro models for metastatic colorectal cancer could be of high value.

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Dual Inhibition of PIK3C3 and FGFR as a New Therapeutic Approach to Treat Bladder Cancer

Purpose: MPT0L145 has been developed as a FGFR inhibitor exhibiting significant anti-bladder cancer activity in vitro and in vivo via promoting autophagy-dependent cell death. Here, we aim to elucidate the underlying mechanisms. Experimental Design: Autophagy flux, morphology and intracellular organelles were evaluated by western blotting, transmission electron microscope and fluorescence microscope. Molecular docking, surface plasmon resonance assay were performed to identify drug-protein interaction. Lentiviral delivery of cDNA or shRNA, and CRISPR/Cas9-mediated genome editing were used to modulate gene expression. Mitochondrial oxygen consumption rate was measured by a Seahorse XFe24 extracellular flux analyzer, and ROS level was measured by flow cytometry. Results: MPT0L145 persistently increased incomplete autophagy and phase-lucent vacuoles at the peri-nuclear region, which were identified as enlarged and alkalinized late-endosomes. Screening of a panel of lipid kinases revealed that MPT0L145 strongly inhibits PIK3C3 with a KD value of 0.53 nmol/L. Ectopic expression of PIK3C3 reversed MPT0L145-increased cell death and incomplete autophagy. Four residues (Y670, F684, I760, D761) at the ATP-binding site of PIK3C3 are important for the binding of MPT0L145. Additionally, MPT0L145 promotes mitochondrial dysfunction, ROS production and DNA damage, which may in part, contribute to cell death. ATG5-knockout rescued MPT0L145-induced cell death, suggesting simultaneous induction of autophagy is crucial to its anticancer activity. Lastly, our data demonstrated that MPT0L145 is able to overcome cisplatin resistance in bladder cancer cells. Conclusions: MPT0L145 is a first-in-class PIK3C3/FGFR inhibitor, providing an innovative strategy to design new compounds that increase autophagy, but simultaneously perturb its process to promote bladder cancer cell death.

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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan

Publication date: Available online 8 December 2017
Source:Auris Nasus Larynx
Author(s): Atsushi Fukuda, Shinya Morita, Yuji Nakamaru, Kimiko Hoshino, Keishi Fujiwara, Shigeru Akazawa, Tomohiro Sakashita, Nobuyuki Obara, Akihiro Homma
ObjectiveAlthough elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.MethodsThis is a retrospective multi-institutional study involving patients diagnosed with SSNHL who exhibited the anti-mumps IgM antibody. We compared the positive rate of anti-mumps IgM antibody and the annual average number of mumps cases per sentinel in Hokkaido between the patients in the present study and patients previously evaluated.ResultsOverall, 100 patients with SSNHL were enrolled. One case (1.0%) was positive for anti-mumps IgM antibody. Of the 69 patients evaluated in the previous study, 5 cases (7.2%) were positive for anti-mumps IgM antibody. The positive rate of the anti-mumps IgM antibody in the present cases was significantly lower than that previously reported (p=0.042). The annual average number of mumps cases per sentinel in Hokkaido of the present and previous surveillance period was 34.47 and 42.77, respectively; no significant difference was seen in these data (p=0.4519).ConclusionThe present study revealed that 1.0% of SSNHL was positive for the anti-mumps IgM antibody using the new EIA-IgM measurement kit. After the introduction of the new EIA-IgM measurement kit, anti-mumps IgM antibody positive rate with SSNHL significantly decreased, indicating that the proportion of asymptomatic mumps among etiology of SSNHL may be lower than those previously reported.



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Genetic Hearing Loss: A Comprehensive Review

Hearing loss can be attributed to a variety of inherited and environmental noises (medications, infections, etc.). In recent decades, our improved understanding of genetics, molecular biology, and audiologic pathways has led to the discovery of a variety of Hereditary Hearing Impairments (HHI). HHI can be categorized as syndromic HL and non-syndromic HL, in which HL is associated with other pathophysiological manifestations. Currently, greater than 300 syndromic HLs are recognized, while more than 100 chromosomal loci and 40 genes are attributed for non-syndromic HLs. Improved understanding of the genes impaired in HL, including their structure and function, will soon lead to improvements in screening and possibly treatments. The following is a review of genetic HL where we discuss the definition, classifications, etiology, epidemiology, recognized syndromes, genetics, diagnostics, and screening methods of HL.

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Ménière's Disease: Current and Potential New Objective Measures Using Electrocochleography

The characteristic manifestations of Ménière's disease (MD) are mainly subjective, making MD difficult for physicians to diagnose without objective confirmation. A classic electrophysiologic technique for objective diagnosis of MD is electrocochleography (ECochG) to slow stimulus rates. This review will provide information regarding the sensitivity, specificity, and limitations of the conventional click and frequency specific ECochG measures. In addition, the paper will discuss two novel, promising techniques: fast click ECochG with the use of continuous loop averaging deconvolution (CLAD) and the auditory nerve overlapped waveform (ANOW). These new techniques may offer a new way in diagnosing MD through assessing neural adaptation and function of the apical half of the cochlear spiral.

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Coordinator's Column

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A Review of Human Immunodeficiency Virus on the Auditory System

There are an increasing number of large-scale studies on the association between human immunodeficiency virus (HIV) and hearing loss; these studies include both HIV-infected adults from horizontal disease transmission to HIV-infected children from vertical disease transmission in utero. With advances in HIV treatment approaches, this disease has become a chronic health condition rather than a terminal health condition. Based on recent data in this area, mechanisms within the auditory system are at risk based on HIV status. HIV-infected children have poorer hearing compared to perinatally exposed to HIV, but uninfected children. HIV-infected children also have poorer hearing compared to HIV-unexposed, uninfected children. HIV-infected adults also have poorer hearing compared with HIV-uninfected adults. Individuals with greater HIV disease severity had poorer hearing than HIV-infected individuals with lesser HIV disease severity. Auditory brainstem response data demonstrate poor waveform morphology, lower peak amplitude, increased peak and interpeak latencies in HIV-infected individuals. Conversely, distortion product otoacoustic emission data are similar for HIV-infected and HIV-uninfected individuals status. Taken together, differences in hearing sensitivity based on HIV status may be a result of auditory neural function, although large-scale studies are currently ongoing to further examine these risk factors of HIV on the auditory system.

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SIG 6 Perspectives Vol. 19, No. 2, November 2015: Earn 0.15 CEUs

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until October 29, 2018.

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Intelligibility of Synthetic Speech for Normal-Hearing and Hearing-Impaired Listeners

This study examined the perceived intelligibility of synthetic speech. Participants were adults aged 49–69, one group with normal hearing and one group with acquired sensorineural hearing impairment. Word lists were presented in two speech types: DECtalk (a high-quality speech synthesizer) and a natural male speaker. Results revealed differences between groups, with normal-hearing listeners scoring higher than hearing-impaired listeners, and between speech types, with higher scores for natural speech than for synthesized speech. There was no significant interaction of hearing level and speech type.

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Comments on "Concomitant Speech and Language Disorders in Stuttering Children: A Critique of the Literature"

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Effects of Repair Strategies on Visual Identification of Sentences

This investigation determined whether information elicited by repair strategies enhances an individual's ability to lipread a misperceived sentence. Five groups of subjects were each assigned one of five repair strategies: (a) asking the talker to repeat a sentence, (b) simplify it, (c) rephrase it, (d) say an important keyword, and (e) speak two sentences. Subjects viewed sentences spoken by six different talkers. When a subject did not recite a sentence verbatim, the talker performed the assigned repair strategy and then repeated the original sentence. A control group of subjects saw only the original sentence repeated twice. All five test groups demonstrated a significantly greater improvement for the second presentation score (referenced to the first presentation score) than the control group. The benefits provided by the repair strategies were independent of the talker, and benefits did not differ significantly among the groups.

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The Iowa Articulation Norms Project and its Nebraska Replication

The purpose of the Iowa Articulation Norms Project and its Nebraska replication was to provide normative information about speech sound acquisition in these two states. An assessment instrument consisting of photographs and a checklist form for narrow phonetic transcription was administered by school-based speech-language pathologists to stratified samples of children in the age range 3–9 years. The resulting data were not influenced by the demographic variables of population density (rural/urban), SES (based on parental education), or state of residence (Iowa/Nebraska); however, sex of the child exerted a significant influence in some of the preschool age groups. The criteria used to determine acceptability of a production appeared to influence outcomes for some speech sounds. Acquisition curves were plotted for individual phoneme targets or groups of targets. These curves were used to develop recommended ages of acquisition for the tested speech sounds, with recommendations based generally on a 90% level of acquisition. Special considerations were required for the phonemes /n s z/.

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Spoken and Written English Errors of Postsecondary Students with Severe Hearing Impairment

This investigation compared the spoken and written English errors of 20 hearing-impaired postsecondary students with intelligible speech and poor English language. Error categories used to assess the language samples were function, content, and structure. Spoken and written performances were distinguished only by a greater number of function word errors in writing samples. A trend toward greater complexity in writing was also found. Implications for instruction are discussed.

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Taxonomies in Biology, Phonetics, Phonology, and Speech Motor Control

This article begins with a review explaining the different purposes of biological taxonomies. Taxonomic units are often dependent on the purpose for which the taxonomy has been constructed. Biological taxonomies provide an analogy that we use to emphasize some of the distinctions among the units of phonetic transcription systems, competence phonologies, and performance phonologies. The units of both phonology and phonetic transcription are considered as possible units of the speech motor system, and some of the difficulties of this assumption are explained. Although phonemic units, like units of phonetic transcription, are useful for many purposes, it is not theoretically necessary to use units derived as part of competence phonologies in systems attempting to explain phonological performance or speech motor performance. In this regard, we challenge the concept of coarticulation, because it is based on assumptions about the role of phonological or phonetic units in speech motor control. We offer an integrated perspective that has implications for research in speech motor control and deficits of the speech motor system. We see speech motor deficits as distinct from, yet possibly interacting with, phonological deficits.

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Tabletop Versus Microcomputer-Assisted Speech Management: Response Evocation Phase

This is the third in a series of studies on the use of microcomputers with speech-delayed children. Two repeated-measures designs (n=15) and five case studies were completed to compare tabletop management at early and late stages of the response development phase with two comparable, computer-assisted drill-and-practice activities. Discrimination of correct articulatory responses was mediated by the clinician in all modes, rather than by speech recognition hardware, but all contingent reinforcement in the computer modes was presented by animation graphics. The two computer modes were identical except for the addition of fantasy involvement in one of the modes. Findings indicated that the three modes of intervention were equally effective, efficient, and engaging. Subject-level analyses suggested that microcomputer software has excellent potential to engage children in drill-and-practice for late-phase response evocation, when the target sound is stimulable, but limited usefulness with young children at early-phase response evocation, when specific articulatory behaviors need to be cued. Discussion considers learning, child, and hardware/software factors in microcomputer-assisted speech management.

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Fast Mapping of Words in Event Contexts by Children with Down Syndrome

Fast mapping of novel words for objects was compared in 48 children and adolescents with Down syndrome (ages 5:6-20:6), who were delayed in expressive language acquisition compared to mental age, and 48 normally developing children matched for mental age (chronological ages 2:0-6:0). Normal and Down syndrome groups did not differ in their ability to infer a connection between the novel word and referent (100% vs. 100%), to comprehend the novel word after a single exposure (83% vs. 73%), and to recall the location in which they hid the novel referent (83% vs. 75%). Nor did they differ in their ability to produce the novel word correctly (at least two out of three phonemes in order: 48% vs. 40%). When retested after an hour of other activity, only the production task showed a significant, and comparable, decrement. Comparing youngest and oldest quarters of each group showed improved memory for location in both, improved comprehension in the Down syndrome group, and improved production in the control group. Adults (n=12), in contrast, performed perfectly on all tasks except the delayed word production. Neither intelligibility differences nor use of real word labels accounts for the failure to find a difference between groups. Fast mapping skills were unrelated to expressive language deficit in these children with Down syndrome.

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The Relationship between Communication Problems and Psychological Difficulties in Persons with Profound Acquired Hearing Loss

Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.

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Response to Hamre

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Generalized Learning of Receptive and Expressive Action-Object Responses by Language-Delayed Preschoolers

This study examined the effectiveness of matrix-training procedures in teaching action + object utterances in both the receptive and expressive language modalities. The subjects were 4 developmentally delayed preschool boys who failed to produce spontaneous, functional two-word utterances. A multiple baseline design across responses with a multiple probe technique was employed. Subjects were taught 4–6 of 48 receptive and 48 expressive responses. Acquisition of a word combination rule was facilitated by the use of familiar lexical items, whereas subsequent acquisition of new lexical knowledge was enhanced by couching training in a previously trained word combination pattern. Although receptive knowledge was not sufficient for the demonstration of corresponding expressive performance for most of the children, only minimal expressive training was required to achieve this objective. For most matrix items, subjects responded receptively before they did so expressively. For 2 subjects, when complete receptive recombinative generalization had not been achieved, expressive training facilitated receptive responding. The results of this study elucidate benefits to training one linguistic aspect (lexical item, word combination pattern) at a time to maximize generalization in developmentally delayed preschoolers.

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Partner Sensitivity to Communication Behavior of Young Children with Developmental Disabilities

Aspects of partner sensitivity to communication behaviors of 24 presymbolic children with developmental disabilities were examined. The children were grouped according to their movement abilities (normal vs. abnormal patterns) and communication status (intentional vs. preintentional). Participating communication partners were those with whom the children interacted on a regular basis and included their mothers, early childhood special educators, and speech-language pathologists. Procedures were developed whereby the partners served as informants in order to provide information regarding (a) recognition of the children's communicative cues and (b) consistency of cue recognition and descriptions across partners. Results indicated wide individual variability in the partners' basic recognition abilities as well as their consistency with each other. Further, the observed variations could not be attributed to the children's movement and communication abilities. It was concluded that sensitivity, as measured in the present investigation, was highly partner-child specific, with some children likely to be exposed to more optimal interactions than others.

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Patient Compliance with Cleft Palate Team Regimens

A cleft palate team's prescribed regimen requires prompt and continued compliance in order to meet the management objectives and to justify the large investment of professional time. The purposes of this clinical investigation were to determine the rate of compliance with the recommendations made by a cleft palate team for its patients and to identify variables associated with compliance. A subject was defined as the person(s) who could best respond to questions concerning the management of the team's patient. Each subject was interviewed using a questionnaire. The mean patient compliance rate was 64.4%, and noncompliance with specific recommendations ranged from 12.5% to 100%. Using Jones and Caldwell's (1981) classification, 17.1% of the patients were classified as compliers, 78% as partial compliers, and 4.9% as noncompliers. The best predictor of compliance was a set of nine variables.

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Generalization to Conversational Speech

Although changes in children's phonological systems due to treatment have been documented in single-word testing, changes in conversational speech are less well known. Single-word and conversation samples were analyzed for 10 phonologically disordered children, before and after treatment and 3 months later. Results suggest that for most of the children, there were system-changes in both single words and in conversational speech. It appears that many phonologically disordered children are able to extend their correct production to conversation without direct treatment on spontaneous speech.

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A Sindscal Analysis of Perceptual Features for Consonants Produced by Esophageal and Tracheoesophageal Talkers

This study was concerned with the perceptual responses of normal-hearing listeners to consonants produced by esophageal and tracheoesophageal (TE) talkers and a single talker who was proficient in both of these alaryngeal speech modes. The listeners' perceptual responses were analyzed using Symmetric Individual Differences Scaling (SINDSCAL) to determine whether distinctive feature differences existed between these two methods of alaryngeal speech. This a posteriori analysis revealed that primary features retrieved for both speech methods included sibilant, affricate, dental, nasal, and sonorant. Although greater perceptual weightings were observed for TE speech, these productive/perceptual features were weighted similarly for both speech methods. Some secondary group-specific feature differences were also observed, but these features did not contribute substantially to the total amount of variance accounted for in the analysis. Thus, the SINDSCAL results showed that the groups did not use different feature systems. These results are discussed in regard to the unique alaryngeal speech production methods employed by esophageal and TE talkers and the relative limitations of the alaryngeal (esophageal) voicing source they use. General clinical implications of the data are discussed.

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Comprehension Monitoring in Language-Disordered Children: A Preliminary Investigation of Cognitive and Linguistic Factors

This study provided a preliminary investigation of the relative influence of cognitive and communicative factors in comprehension monitoring. This question was approached by studying language-disordered (LD) children for whom these abilities are presumably dissociated. Their performance on an ambiguity detection task was compared to that of two groups of control children, one matched for comprehension level and the other for cognitive level. Results revealed that LD children performed similarly to the control children who were matched for level of comprehension. The LD children's performance was examined along a continuum of the relative influence of cognitive and communicative factors, given that neither type of factor alone could sufficiently account for effective comprehension monitoring. It was concluded that communicative factors, both active primary comprehension and social communicative knowledge, had a stronger influence than the cognitive factors in our particular comprehension monitoring task.

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Normative Data in Quiet, Broadband Noise, and Competing Message for Northwestern University Auditory Test No. 6 by a Female Speaker

Two descriptive experiments were performed on a version of the Northwestern University Auditory Test No. 6 (NU No. 6) recorded by a female speaker that is included on an audio compact disc recently produced by the Department of Veterans Affairs. In Experiment 1, normative psychometric functions for the female speaker version of the NU No. 6 materials were established on 24 young adults for three monaural listening conditions (in quiet, in 60-dB SPL broadband noise, and in 60-dB SPL competing message). The 60-dB SPL broadband noise shifted the psychometric function for the NU No. 6 words 33 dB, whereas the 60-dB SPL competing message shifted the function only 18–22 dB. In contrast to the slopes of the quiet and noise conditions (4.5%/dB), the slope of the competing message function was more gradual (3.5%/dB). In Experiment 2, comparisons between the psychometric functions for the female and the original male speaker versions of NU No. 6 in quiet and in broadband noise were made on 8 young adults. In comparison to the psychometric functions for the male speaker version of NU No. 6, the functions for the female speaker version of NU No. 6 were displaced between the 10–90% correct points to higher sound-pressure levels by 10–13 dB in quiet and by 12–16 dB in noise. The difference in performance on the two versions of NU No. 6 is attributed to spectral differences between the two sets of materials that produced a calibration anomaly.

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NKG2D-based CAR-T cells and radiotherapy exert synergistic efficacy in glioblastoma

Chimeric antigen receptor (CAR) T cell therapy is an emerging immunotherapy against several malignancies including glioblastoma, the most common and most aggressive malignant primary brain tumor in adults. The challenges in solid tumor immunotherapy comprise heterogenously expressed tumor target antigens and restricted trafficking of CAR T cells to and impaired long-term persistence at the tumor site, as well as the unaddressed integration of CAR T cell therapy into conventional anti-cancer treatments. We addressed these questions using a NKG2D-based chimeric antigen receptor construct (chNKG2D) in fully immunocompetent orthotopic glioblastoma mouse models. ChNKG2D T cells demonstrated high IFN-γ production and cytolytic activity in vitro. Upon systemic administration in vivo, chNKG2D T cells migrated to the tumor site in the brain, did not induce adverse events, prolonged survival, and cured a fraction of glioma-bearing mice. Surviving mice were protected long-term against tumor re-challenge. Mechanistically, this was not solely the result of a classical immune memory response, but rather involved local persistence of chNKG2D T cells. A subtherapeutic dose of local radiotherapy in combination with chNKG2D T cell treatment resulted in synergistic activity in 2 independent syngeneic mouse glioma models by promoting migration of CAR T cells to the tumor site and increased effector functions. We thus provide preclinical proof-of-concept of NKG2D CAR T cell activity in mouse glioma models and demonstrate efficacy, long-term persistence, and synergistic activity in combination with radiotherapy, providing a rationale to translate this immunotherapeutic strategy to human glioma patients.

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A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia

Abstract

The purpose of this study was to explore perceptions among people with type 2 diabetes about foot ulcers and lower extremity amputations. This was a qualitative observational study utilizing open-ended, semistructured interviews of 39 people with diabetes who were purposively selected because they had either a foot ulcer (n = 19) or a lower extremity amputation (n = 20). Interviews were audio-recorded, deidentified, and entered into NVivo 10.0 for coding and analysis. Our integrated analytic approach combined inductively and deductively derived codes that were applied to all transcripts. Coded data were summarized and examined for patterns. Participants' description of the relationship between diabetes and their foot ulcer or amputation revealed a limited understanding of the disease process. Disruption and loss of independence was expressed whether the person had a foot ulcer or an amputation. Treatment recommendations for foot ulcers were viewed by most as extremely difficult. Amputation was a feared outcome, but some learned to adapt and, at times felt that the amputation enhanced their quality of life. Clinicians have assumed that a focus on limb salvage is preferred over a major amputation. However, because of the complexity of care requiring frequent healthcare provider visits, the frequency of care failure, the frequency of recurrence, and mortality associated with having had a foot ulcer, it may be more appropriate for clinicians to prioritize quality-of-life salvage. Foot ulcer treatment failure may be due to a lack of providers' understanding of the impact of treatment on a patient's life.

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Monocytes enhance neutrophil-induced blister formation in an ex vivo model of bullous pemphigoid

Abstract

Background

Lesions of bullous pemphigoid (BP), an autoimmune subepidermal blistering disease characterized by the presence of tissue-bound and circulating autoantibodies to hemidesmosomal antigens, harbour a mixed inflammatory cellular infiltrate. In various models, neutrophils, eosinophils, mast cells, monocytes as well as B and T cells have been shown to be involved in the pathogenesis of BP. However, their interactions with and effective role in blister formation remains uncertain. This study was aimed at investigating the effect of monocyte/neutrophil interaction on blister formation in an ex vivo BP model.

Methods

Skin cryosections were incubated with purified human neutrophils and monocytes, in the presence or absence of BP autoantibodies. Production of reactive oxygen species (ROS), degranulation, mediator release (neutrophil elastase (NE), myeloperoxidase (MPO), matrix metalloproteinase-9 (MMP-9)), binding of Fcγ receptor (CD16, CD32, CD64), and cell adhesion (CD18, ICAM-1) were investigated using appropriate inhibitors. Dermal-epidermal separation (DES) was assessed by light microscopy and quantified by Fiji software.

Results

Monocytes and neutrophils synergistically interact resulting in a significantly higher DES compared to either monocytes or neutrophils separately (P < 0.0001). Monocyte/neutrophil-induced DES was associated with increased ROS production and was dependent on adhesion and FcγRIII binding. Upon stimulation by the granule-poor fraction of monocyte supernatants, neutrophils increased their release of MMP-9, thereby also DES at the dermal-epidermal junction of skin cryosections.

Conclusion

Our observations suggest that the interaction of cells, as shown here for monocytes and neutrophils, enhances mediator release resulting in an increased subepidermal blister formation. Thus, blocking intercellular cross-talk promises a new therapeutic approach for blocking tissue damage in BP.

This article is protected by copyright. All rights reserved.

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Odontoblast-like differentiation and mineral formation of pulpsphere derived cells on human root canal dentin in vitro

The revitalization or regeneration of the dental pulp is a preferable goal in current endodontic research. In this study, human dental pulp cell (DPC) spheres were applied to human root canal samples to evalua...

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Presurgical language mapping using event-related high-gamma activity: The Detroit procedure

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Toshimune Kambara, Sandeep Sood, Zahraa Alqatan, Christine Klingert, Diksha Ratnam, Akane Hayakawa, Yasuo Nakai, Aimee F. Luat, Rajkumar Agarwal, Robert Rothermel, Eishi Asano
A number of investigators have reported that event-related augmentation of high-gamma activity at 70–110 Hz on electrocorticography (ECoG) can localize functionally-important brain regions in children and adults who undergo epilepsy surgery. The advantages of ECoG-based language mapping over the gold-standard stimulation include: (i) lack of stimulation-induced seizures, (ii) better sensitivity of localization of language areas in young children, and (iii) shorter patient participant time. Despite its potential utility, ECoG-based language mapping is far less commonly practiced than stimulation mapping. Here, we have provided video presentations to explain, point-by-point, our own hardware setting and time–frequency analysis procedures. We also have provided standardized auditory stimuli, in multiple languages, ready to be used for ECoG-based language mapping. Finally, we discussed the technical aspects of ECoG-based mapping, including its pitfalls, to facilitate appropriate interpretation of the data.



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Human subthalamic oscillatory dynamics following somatosensory stimulation

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Saskia Elben, Carlos Trenado, Jan Vesper, Alfons Schnitzler, Lars Wojtecki
ObjectiveElectrical median nerve somatosensory stimulation leads to a distinct modulation of cortical oscillations. Initial high frequency and gamma augmentation, as well as modulation of beta and alpha oscillations have been reported. We aimed at investigating the involvement of the subthalamic nucleus in somatosensory processing by means of local field potential recordings, since recordings during passive movements and peripheral somatosensory stimulation have suggested a prominent role.MethodsRecordings of subthalamic neuronal activity following median nerve stimulation in 11 Parkinson's disease patients were performed. Time-frequency analysis from 1 to 500 Hz was averaged and analyzed.ResultsSeveral oscillatory components in response to somatosensory stimulation were revealed in the time-frequency analysis: (I) prolonged increase in alpha band power, followed by attenuation; (II) initial suppression of power followed by a subsequent rebound in the beta band; (III) early broad-frequency increase in gamma band power; (IV) and sustained increase of 160 Hz frequency oscillations throughout the trial.ConclusionsThese results further corroborate the involvement of the subthalamic nucleus in somatosensory processing.SignificanceThe present results not only support the notion of somatosensory processing in the subthalamic nucleus. Moreover, an improvement of somatosensory processing during subthalamic deep brain stimulation in Parkinson's disease might be accounted for by enhancement of prevailing high frequency oscillations.



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Abnormal functional connectivity of high-frequency rhythms in drug-naïve schizophrenia

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Tetsuya Takahashi, Takashi Goto, Sou Nobukawa, Yuji Tanaka, Mitsuru Kikuchi, Masato Higashima, Yuji Wada
ObjectiveThe "dysconnection hypothesis" has been proposed as a core neural basis for schizophrenia. Although growing neuroimaging-based evidence suggests atypical functional connectivity in patients with schizophrenia, the results are inconsistent and the effects of antipsychotic treatment remain elusive.MethodsWe performed resting-state electroencephalography (EEG) in 21 drug-naïve patients with schizophrenia (14 patients were re-evaluated after administration of antipsychotic treatment) and 31 age-matched healthy control subjects. We estimated functional connectivity, using the phase lag index (PLI), which captures the true synchronization of EEG signals.ResultsThe patients had reduced functional connectivity of the beta band across frontal regions and of the gamma band throughout the scalp when compared to the control subjects. In the schizophrenia group, symptom severity did not seem associated with functional connectivity. Antipsychotic treatment led to no alterations in functional connectivity.ConclusionsSynchronous activity within and across brain areas over multiple frequencies reflect the integration of various types of information processing. Our findings of abnormal frequency- and region-specific functional connectivity patterns may provide further insight into the "dysconnection hypothesis" of schizophrenia.SignificanceThe PLI may serve as a useful measure for the characterization and understanding of the intrinsic pathophysiological mechanisms of schizophrenia, and as a reliable biomarker for this disease.



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Cramps frequency and severity are correlated with small and large nerve fiber measures in type 1 diabetes

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Alon Abraham, Carolina Barnett, Leif E. Lovblom, Bruce A. Perkins, Vera Bril, Hans D. Katzberg
ObjectivesTo explore the correlations between different muscle cramp characteristics including cramp frequency and severity and clinical and large and small nerve fiber measures in patients with diabetes type 1 (DM 1) and 2 (DM 2).MethodsProspective cross sectional study of healthy controls and patients with DM 1 and DM 2 recruited between April 2009 and November 2012. Participants underwent clinical evaluation and large and small nerve fiber studies, and the frequency and correlations of muscle cramps were explored.Results37 controls, 51 patients with DM 1, and 69 patients with DM 2 were studied. Muscle cramps were the most frequent symptom captured by the Toronto Clinical Neuropathy Score (TCNS) in all groups, up to 78% in patients with DM 2. In patients with DM 1, but not DM 2, muscle cramp frequency and severity were correlated with clinical (TCNS) and both large (electrophysiology and vibration perception thresholds) and small nerve fiber measures.ConclusionsMuscle cramps are frequent in diabetes and are correlated with clinical and both small and large nerve fiber measures in DM 1, suggesting that their origin and propagation might extend beyond the motor nerve.SignificanceMuscle cramps correlate with nerve fiber measures in DM 1.



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Detection of proximal conduction blocks using a triple stimulation technique improves the early diagnosis of Guillain–Barré syndrome

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Amandine Sevy, Aude-Marie Grapperon, Emmanuelle Salort Campana, Emilien Delmont, Shahram Attarian
ObjectiveCurrent diagnostic electrophysiological criteria can miss the early stages of Guillain–Barré syndrome (GBS). We evaluated the diagnostic efficiency of the triple stimulation technique (TST) in highlighting proximal conduction blocks (CBs) in patients who do not meet the electrophysiological criteria for GBS.MethodsAll patients with a diagnosis of clinical GBS referred to our center between September 2014 and January 2016 were included in the study. For patients who did not fulfill the electrophysiological criteria of GBS, we performed the TST examination.ResultsAmong the 44 included patients, 86% fulfilled the electrophysiological criteria of GBS during the initial nerve conduction study (NCS). The six remaining patients had proximal CBs revealed by TST examination. Therefore, a combination of a conventional NCS and the TST allowed 100% of the patients to be electrophysiologically diagnosed.ConclusionsTST is useful for the diagnosis of GBS in association with NCS, particularly in the early stages of the disease.SignificanceTST is a useful tool for GBS diagnosis at the early stages of the disease.



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Clinical features of otolith organ-specific vestibular dysfunction

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Chisato Fujimoto, Sayaka Suzuki, Makoto Kinoshita, Naoya Egami, Keiko Sugasawa, Shinichi Iwasaki
ObjectiveTo elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals.MethodsWe reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT).ResultsWe identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis. 37% of patients could not be categorized into any of the established clinical entities that could cause a balance disorder and did not show sensorineural hearing loss. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo with a duration of 1–12 h.ConclusionsThe most common diagnosis of otolith organ-specific vestibular dysfunction was BPPV. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo.SignificanceSpecific dysfunction of the otolith organs occurs in association with some of the undiagnosed patients with recurrent rotatory vertigo.



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What is the optimal frequency range for quantifying slow EEG activity in neonates? Insights from power spectra

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Simon Finnigan, Paul B. Colditz




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Four-dimensional map of the human early visual system

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Yasuo Nakai, Akari Nagashima, Akane Hayakawa, Takuya Osuki, Jeong-won Jeong, Ayaka Sugiura, Erik C. Brown, Eishi Asano
ObjectiveWe generated a large-scale, four-dimensional map of neuronal modulations elicited by full-field flash stimulation.MethodsWe analyzed electrocorticography (ECoG) recordings from 63 patients with focal epilepsy, and delineated the spatial-temporal dynamics of visually-elicited high-gamma70-110 Hz amplitudes on a standard brain template. We then clarified the neuronal events underlying visual evoked potential (VEP) components, by correlating with high-gamma amplitude measures.ResultsThe medial-occipital cortex initially revealed rapid neural activation followed by prolonged suppression, reflected by augmentation of high-gamma activity lasting up to 100 ms followed by attenuation lasting up to 1000 ms, respectively. With a number of covariate factors incorporated into a prediction model, the eccentricity representation independently predicted the magnitude of post-activation suppression, which was more intense in regions representing more parafoveal visual fields compared to those of more peripheral fields. The initial negative component on VEP was sharply contoured and co-occurred with early high-gamma augmentation, whose offset then co-occurred with a large positive VEP peak. A delayed negative VEP peak was blunt and co-occurred with prolonged high-gamma attenuation.ConclusionsEccentricity-dependent gradient in neural suppression in the medial-occipital region may explain the functional difference between peripheral and parafoveal/central vision. Early negative and positive VEP components may reflect neural activation, whereas a delayed negative VEP peak reflecting neural suppression.SignificanceOur observation provides the mechanistic rationale for transient scotoma or mild flash-blindness, characterized by physiological afterimage preferentially formed in central vision following intense but non-injurious light exposure.



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Short-term intraindividual variability of the posterior dominant alpha frequency in the electroencephalogram

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): A. Khan, W. Paulus, C. Stephani




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Diagnosing Kernohan-Woltman notch phenomenon by somatosensory evoked potentials in intensive care unit

Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Florent Gobert, Jan H. Baars, Thomas Ritzenthaler, Mehdi Afathi, Sébastien Boulogne, Nathalie André-Obadia, Fréderic Dailler




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Improving Hearing Aid Self-Efficacy and Utility Through Revising a Hearing Aid User Guide: A Pilot Study

Purpose

This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance.

Method

In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996).

Results

SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group.

Conclusions

These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.

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Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4cm in size

To establish the prognostic factors for primary intraosseous squamous cell carcinoma we designed a retrospective study of patients treated in the head and neck department of a tertiary referral centre in China from 2010–2015. We collected clinical, radiological, and histopathological data from 36 patients treated during the given time period, among which 34 were followed up. There were 22 male and 12 female patients, 13 of whom gave a history of smoking tobacco and four who drank alcohol. All 34 patients were treated by segmental mandibulectomy and neck dissection.

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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

We are grateful to Zhengcai-Lou et al. for having appreciated our study entitled 'Endoscopic versus microscopic approach in attic cholesteatoma surgery [1].

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Telepractice in University Au.D. Programs: Survey of Program Directors

Permanent hearing loss is a global health care burden; 360 million people, including 32 million (9%) children, have disabling hearing loss (Chadha & Stevens, 2013, p. 2). About 80 percent of these people live in developing nations without access to hearing care services. The American Academy of Audiology (AAA, 2014) has reported "ongoing efforts to explore and enhance the use of telepractice…to expand the availability and accessibility of hearing and balance care" to individuals across the world. The American Speech-Language-Hearing Association (2014c) has also endorsed advances in telepractice for the world's millions with hearing loss and related disorders, and encouraged institutional involvement as a future direction for audiology training. In the first publishing of this nature, this report shares survey responses from 28 of the nation's 74 graduate programs about their inclusion of telepractice in the Clinical Doctor of Audiology (Au.D.) curriculum. Results suggest a slow response from university programs and challenges in addressing telepractice in current course and clinical offerings. Results also support a direction of change to include telepractice in future Au.D. curricula.

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Coordinator's Column

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Early Hearing Detection and Intervention by Telepractice

Early hearing detection and intervention (EHDI) refers to a system of care to ensure that infants who are deaf or hard of hearing receive early diagnosis and intervention. Components of this system include newborn hearing screening (NBS), follow-up diagnostic audiological evaluation (DAE), medical/otological assessment and treatment, audiological habilitation such as hearing aid fitting, and enrollment in early intervention services (EI). A significant barrier to achieving prompt diagnosis of and EI for every baby is lack of access to audiologists and speech-language pathologists (SLPs) with specific expertise in diagnosis, (re)habilitation, and intervention for infants who are deaf or hard of hearing. To improve access to services, clinicians are exploring the use of telepractice for specific components of the EHDI system. At Children's Hospital Colorado, we developed telepractice services that include two components of EHDI, DAE, and speech-language EI services. We discuss the development, implementation, outcomes, and advantages and disadvantages of telepractice for these components of an EHDI system.

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