For more than two decades, real ear verification measurements have been positioned as the "gold standard" of the hearing aid fitting. This implies that verification is an extra, rather than essential, to the plan of care. This course discusses why verification should not be the "gold standard" of the hearing aid fitting process, but rather the "baseline minimum."
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Σάββατο 31 Μαρτίου 2018
Establishing Accuracy and Validity: Why Do We Verify?
A Rare Case of Clear Cell Carcinoma, Müllerian Type in the Renal Pelvis of a 21-Year-Old Woman
Clear Cell Carcinomas of Müllerian origin are extremely rare within the upper urinary system. Their morphology is identical to that of the Clear Cell Carcinomas of the female genital tract. When they arise in the urinary tract, it is thought to be due to ectopic Müllerian embryogenesis. Here, we present a case of a 21-year-old woman with a Clear Cell Carcinoma, Müllerian type, arising from the renal pelvis. Histologically, it consisted of tubulopapillary architecture with associated foamy macrophages and a mucinous background. The neoplastic cells exhibited variably sized round nuclei with prominent nucleoli, eosinophilic to vacuolated cytoplasm with occasional intracytoplasmic mucin vacuoles, and a hobnail appearance. Immunohistochemical stains showed that the neoplastic cells were positive for Pax-8, p53, CK7, HMWK 903, and INI-1 and focally positive for p504s (AMACR). The neoplastic cells were negative for GATA-3, CK5/CK6, p63, CK20, and CDX-2 immunostains, ruling out urothelial or enteric phenotype. Additional immunostains performed by an outside institution showed that the neoplastic cells were positive for HNF-1β. The overall morphology and immunophenotype were consistent with Clear Cell Carcinoma of Müllerian origin arising from the renal pelvis. Follow-up revealed no metastasis or other tumor sites, supporting that this was the primary location.
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A numerical simulation study on the impact of smoke aerosols from Russian forest fires on the air pollution over Asia
Source:Atmospheric Environment, Volume 182
Author(s): Qingzhe Zhu, Yuzhi Liu, Rui Jia, Shan Hua, Tianbin Shao, Bing Wang
Serious forest fires were observed over Siberia, particularly in the vast area between Lake Baikal and the Gulf of Ob, during the period of 18–27 July 2016 using Moderate Resolution Imaging Spectroradiometer (MODIS) data. The Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) satellite simultaneously detected a multitude of smoke aerosols surrounding the same area. Combing a Lagrangian Flexible Particle dispersion model (FLEXPART) executed using the Weather Research and Forecasting (WRF) model output, the transport of smoke aerosols and the quantification of impact of Russian forest fires on the Asia were investigated. From model simulations, two transport paths were determined for the smoke plumes from the Russian forest fires. The first path was directed southwestward from Russia to Central Asia and eventually Xinjiang Province of China, furthermore, the second path was directed southeastward through Mongolia to Northeast China. The FLEXPART-WRF model simulations also revealed that the smoke aerosol concentrations entering the Central Asia, Mongolia and Northern China were approximately 60–300 μg m−3, 40–250 μg m−3 and 5–140 μg m−3, respectively. Meanwhile, the aerosol particles from these forest fires have an impact on the air quality in Asia. With the arrival of smoke aerosols from the Russian forest fires, the near-surface PM10 concentrations over Altay, Hulunbuir and Harbin increased to 61, 146 and 42 μg m−3, respectively. In conclusion, smoke aerosols from Russian forest fires can variably influence the air quality over Central Asia, Mongolia and Northern China.
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Risk factors for postoperative pneumonia in elderly patients with colorectal cancer: a sub-analysis of a large, multicenter, case-control study in Japan
Abstract
Purpose
Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC.
Methods
We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0–III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic.
Results
Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22–6.20], 2.71 [1.22–6.30], 3.60 [1.37–8.55], and 3.57 [1.22–15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763).
Conclusions
Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events.
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Low expression of B-Cell-Associated protein 31 is associated with unfavorable prognosis in human colorectal cancer
Publication date: Available online 31 March 2018
Source:Pathology - Research and Practice
Author(s): Chong Ma, Ri-Ming Jin, Ke-Ji Chen, Tao Hao, Bao-Song Li, Da-Hua Zhao, Hong Jiang
Colorectal cancer (CRC) is one of the most common cancers worldwide. B cell-associated protein 31 (BAP31) was shown to participate in the apoptosis, and to be an immunotherapy target and a, prognostic factor for cancer, but its role in CRC has not been elucidated. In this study, we examined the expression of BAP31 in CRC to evaluate its prognostic values. We investigated the BAP31 expression level in 142 tissues (108 CRC and 17 paired human adjacent normal mucosa, and 17 liver metastatic CRC tissues) from 108 patients, using tissue microarray-based immunohistochemistry. We further investigated the association between BAP31 expression and overall survival (OS) and disease-free survival (DFS) in 77 CRC patients using Kaplan-Meier analysis. Univariate and multivariate Cox regression analyses were applied to evaluate the potential prognostic value of BAP31 in CRC patients. BAP31 expression level was significantly increased in CRC tissues (p = 0.0014) and liver metastatic CRC tissues (p < 0.0001) compared with corresponding adjacent normal mucosa. BAP31 expression was also significantly increased in liver metastatic CRC tissues compared with corresponding primary CRC tissues (p = 0.0116). Kaplan-Meier analyses showed that CRC patients with low BAP31 expression had significantly lower survival rate (p = 0.001) and lower disease-free survival rate (P = 0.009). Furthermore, multivariate Cox analysis showed that BAP31 was an independent prognostic factor for OS (hazard ratio = 0.410, 95% confidence interval = 0.195–0.862, p = 0.019).ConclusionsOur study demonstrated that BAP31 is a potential prognostic marker for CRC patients after surgery.
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The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study
To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.
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Multimodality Surgical Approach in Management of Laryngotracheal Stenosis
Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
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Spinal Accessory Nerve Duplication: A Case Report and Literature Review
Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed.
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Multimodality Surgical Approach in Management of Laryngotracheal Stenosis
Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
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Spinal Accessory Nerve Duplication: A Case Report and Literature Review
Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed.
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EEG-based neglect assessment: A feasibility study
Source:Journal of Neuroscience Methods
Author(s): Aya Khalaf, Jessica Kersey, Safaa Eldeeb, Gazihan Alankus, Emily Grattan, Laura Waterstram, Elizabeth Skidmore, Murat Akcakaya
BackgroundSpatial neglect (SN) is a neuropsychological syndrome that impairs automatic attention orienting to stimuli in the contralesional visual space of stroke patients. SN is commonly assessed using paper and pencil tests. Recently, computerized tests have been proposed to provide a dynamic assessment of SN. However, both paper- and computer-based methods have limitations.New methodElectroencephalography (EEG) shows promise for overcoming the limitations of current assessment methods The aim of this work is to introduce an objective passive BCI system that records EEG signals in response to visual stimuli appearing in random locations on a screen with a dynamically changing background. Our preliminary experimental studies focused on validating the system using healthy participants with intact brains rather than employing it initially in more complex environments with patients having cortical lesions. Therefore, we designed a version of the test in which we simulated SN by hiding target stimuli appearing on the left side of the screen so that the subject's attention is shifted to the right side.ResultsResults showed that there are statistically significant differences between EEG responses due to right and left side stimuli reflecting different processing and attention levels towards both sides of the screen. The system achieved average accuracy, sensitivity and specificity of 74.24%, 75.17% and 71.36% respectively.Comparison with existing methodsThe proposed test can examine both presence and severity of SN, unlike traditional paper and pencil tests and computer-based methods.ConclusionsThe proposed test is a promising objective SN evaluation method.
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Methodology and effects of repeated intranasal delivery of DNSP-11 in awake Rhesus macaques
Publication date: Available online 31 March 2018
Source:Journal of Neuroscience Methods
Author(s): M.J. Stenslik, A. Evans, F. Pomerleau, R. Weeks, P. Huettl, E. Foreman, J. Turchan-Cholewo, A. Andersen, W.A. Cass, Z. Zhang, R.C. Grondin, D.M. Gash, G.A. Gerhardt, L.H. Bradley
BackgroundTo determine if the intranasal delivery of neuroactive compounds is a viable, long-term treatment strategy for progressive, chronic neurodegenerative disorders, such as Parkinson's disease (PD), intranasal methodologies in preclinical models comparable to humans are needed.New MethodWe developed a methodology to evaluate the repeated intranasal delivery of neuroactive compounds on the non-human primate (NHP) brain, without the need for sedation. We evaluated the effects of the neuroactive peptide, DNSP-11 following repeated intranasal delivery and dose-escalation over the course of 10-weeks in Rhesus macaques. This approach allowed us to examine striatal target engagement, safety and tolerability, and brain distribution following a single 125I-labeled DNSP-11 dose.ResultsOur initial data support that repeated intranasal delivery and dose-escalation of DNSP-11 resulted in bilateral, striatal target engagement based on neurochemical changes in DA metabolites-without observable, adverse behavioral effects or weight loss in NHPs. Furthermore, a 125I-labeled DNSP-11 study illustrates diffuse rostral to caudal distribution in the brain including the striatum-our target region of interest.Comparison with Existing MethodsThe results of this study are compared to our experiments in normal and 6-OHDA lesioned rats, where DNSP-11 was repeatedly delivered intranasally using a micropipette with animals under light sedation.ConclusionsThe results from this proof-of-concept study support the utility of our repeated intranasal dosing methodology in awake Rhesus macaques, to evaluate the effects of neuroactive compounds on the NHP brain. Additionally, results indicate that DNSP-11 can be safely and effectively delivered intranasally in MPTP-treated NHPs, while engaging the DA system.
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Automatic cardiac cycle determination directly from EEG-fMRI data by multi-scale peak detection method
Source:Journal of Neuroscience Methods
Author(s): Chung-Ki Wong, Qingfei Luo, Vadim Zotev, Raquel Phillips, Kam Wai Clifford Chan, Jerzy Bodurka
BackgroundIn simultaneous EEG-fMRI, identification of the period of cardioballistic artifact (BCG) in EEG is required for the artifact removal. Recording the electrocardiogram (ECG) waveform during fMRI is difficult, often causing inaccurate period detection.New MethodSince the waveform of the BCG extracted by independent component analysis (ICA) is relatively invariable compared to the ECG waveform, we propose a multiple-scale peak-detection algorithm to determine the BCG cycle directly from the EEG data. The algorithm first extracts the high contrast BCG component from the EEG data by ICA. The BCG cycle is then estimated by band-pass filtering the component around the fundamental frequency identified from its energy spectral density, and the peak of BCG artifact occurrence is selected from each of the estimated cycle.ResultsThe algorithm is shown to achieve a high accuracy on a large EEG-fMRI dataset. It is also adaptive to various heart rates without the needs of adjusting the threshold parameters. The cycle detection remains accurate with the scan duration reduced to half a minute. Additionally, the algorithm gives a figure of merit to evaluate the reliability of the detection accuracy.Comparison with ExistingethodThe algorithm is shown to give a higher detection accuracy than the commonly used cycle detection algorithm fmrib_qrsdetect implemented in EEGLAB.ConclusionsThe achieved high cycle detection accuracy of our algorithm without using the ECG waveforms makes possible to create and automate pipelines for processing large EEG-fMRI datasets, and virtually eliminates the need for ECG recordings for BCG artifact removal.
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The bidirectional relationship between sleep duration and depression in community-dwelling middle-aged and elderly individuals: Evidence from a longitudinal study
There are several studies that have focused on the relationship between sleep duration and depression, however, only a few prospective studies have centered on the bidirectional relationship between them. This four-year longitudinal study aimed to identify the association between sleep duration and depression in community-dwelling mid-age and elderly individuals.
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The serotonin transporter 5-HTTLPR polymorphism and the risk for insomnia: a non-replication
In the June 2014 issue of Sleep Medicine, Huang et al. (2014) reported a genetic association study investigating the effect of 5-HTTLPR on insomnia [1]. In line with previous findings [2], results demonstrated that the short allele is associated with a higher insomnia risk relative to the long allele. The authors further revealed that an interaction between 5-HTTLPR and stress may contribute to this relationship which corresponds with earlier findings on subjective sleep quality [3].
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Validation of semiautomatic scoring of REM sleep without atonia in patients with RBD
To evaluate REM sleep without atonia (RSWA) in REM sleep behavior disorder (RBD) several automatic algorithms have been developed. We aimed to validate our algorithm (Mayer et al. 2008) in order to assess 1. capability of the algorithm to differentiate between RBD, night terror (NT), somnambulism (SW), Restless legs syndrome (RLS) and obstructive sleep apnea (OSA), 2. cut-off values for short (SMI) and long muscle activity (LMI), 3. which muscles qualify best for differential diagnosis, and 4. comparability of RSWA and registered movements between automatic and visual analysis of videometry.
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New technologies improve adenoma detection rate, adenoma miss rate and polyp detection rate: a systematic review and meta-analysis
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Cost-Effectiveness Analysis Comparing Lumen Apposing Metal Stents with Plastic Stents in the Management of Pancreatic Walled-Off Necrosis
EUS-guided transmural drainage is effective in the management of pancreatic walled-off necrosis (WON). A lumen-apposing metal stent (LAMS) has recently been developed specifically for the drainage of pancreatic fluid collections showing promising results. However, no cost-effectiveness data have been published in comparison to endoscopic drainage with traditional plastic stents (PSs). The aim is to compare the cost-effectiveness of LAMSs to PSs in the management of WON.
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Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Itır Şebnem Bilici, Yusuf Emes, Serhat Yalçın, Buket Aybar
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A Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats
Publication date: Available online 30 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lucas M. Ritschl, Leonard H. Schmidt, Andreas M. Fichter, Alexander Hapfelmeier, Klaus-Dietrich Wolff, Thomas Mücke
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation. Both monitoring tools were capable of detecting acute venous occlusion. ICG videoangiography data showed a significant decrease in the first and second maximum, and the area under the curve, during venous occlusion, whereas hemoglobin levels in the O2C analysis remained stable. Changes in fluorescence values in border areas of the flap correlated significantly with the incidence of necrosis. O2C data later showed significant correlation with the area of necrosis, and more individual changes during flap monitoring. ICG videoangiography might therefore be useful in the prediction of flap necrosis in critical areas of perfusion.
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Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation -
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Majeed Rana, Christoph Sproll, Julian Lommen, Madiha Rana, Alexander Zeller, Norbert Kübler, Karsten Hufendiek, Elvis Hermann, Nils-Claudius Gellrich, Henrik Holtmann
Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment.Over recent years minimally invasive surgical approaches have gained more importance in the treatment and diagnosis of cranio-maxillo-facial tumor and trauma.The aim of our study was to adapt and establish a precise procedure for orbital biopsies. 23 patients suffering from space-occupying lesions of unknown dignity were included. Trajectory-guided procedures were pre-planned for all cases. In most cases minimally invasive procedures were suitable for taking biopsies of the orbit. For only two patients a conventional, non-minimally invasive, lateral orbitotomy had to be performed. Further evaluation of the presented procedure demonstrates clearly that trajectory-guided biopsies of the orbit can be performed correctly and effectively, regardless of the suspected lesion's size.
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Vaginoplasty Complications
Source:Clinics in Plastic Surgery
Author(s): Cecile A. Ferrando
Teaser
Complications after vaginoplasty surgery for the transgender woman exist. These adverse outcomes can be minor and easily treatable, whereas others are considered major events and require ongoing care. Adverse outcomes can be immediate or remote after surgery and include bleeding, hematoma, infection, delayed wound healing, neovaginal stenosis, visceral injury, and fistula. Patients may also experience pelvic floor disorders after surgery. Providers performing these surgeries and those providers caring for postoperative patients should be aware of the incidence of these complications and the treatment options that exist to manage them.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EagZYx
Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders
Temporomandibular disorders (TMD) may originate from the joint itself or from pathologies of masticatory muscles. Most pathology seen is myofascial pain disorder (MPD). TMD are characterized by pain, muscle spasms, and constraints in the movements of the temporomandibular joint. In temporomandibular joint disorders, besides the internal derangement, protective muscle spasms are usually observed.
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Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Itır Şebnem Bilici, Yusuf Emes, Serhat Yalçın, Buket Aybar
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A Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats
Publication date: Available online 30 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lucas M. Ritschl, Leonard H. Schmidt, Andreas M. Fichter, Alexander Hapfelmeier, Klaus-Dietrich Wolff, Thomas Mücke
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation. Both monitoring tools were capable of detecting acute venous occlusion. ICG videoangiography data showed a significant decrease in the first and second maximum, and the area under the curve, during venous occlusion, whereas hemoglobin levels in the O2C analysis remained stable. Changes in fluorescence values in border areas of the flap correlated significantly with the incidence of necrosis. O2C data later showed significant correlation with the area of necrosis, and more individual changes during flap monitoring. ICG videoangiography might therefore be useful in the prediction of flap necrosis in critical areas of perfusion.
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Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation -
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Majeed Rana, Christoph Sproll, Julian Lommen, Madiha Rana, Alexander Zeller, Norbert Kübler, Karsten Hufendiek, Elvis Hermann, Nils-Claudius Gellrich, Henrik Holtmann
Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment.Over recent years minimally invasive surgical approaches have gained more importance in the treatment and diagnosis of cranio-maxillo-facial tumor and trauma.The aim of our study was to adapt and establish a precise procedure for orbital biopsies. 23 patients suffering from space-occupying lesions of unknown dignity were included. Trajectory-guided procedures were pre-planned for all cases. In most cases minimally invasive procedures were suitable for taking biopsies of the orbit. For only two patients a conventional, non-minimally invasive, lateral orbitotomy had to be performed. Further evaluation of the presented procedure demonstrates clearly that trajectory-guided biopsies of the orbit can be performed correctly and effectively, regardless of the suspected lesion's size.
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Translation, Adaptation, and Preliminary Validation of Dacakis and Davies' “Transsexual Voice Questionnaire (Male to Female)” in French
Source:Journal of Voice
Author(s): Dominique Morsomme, Joana Revis, Elisabeth Thomas
Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia.ObjectivesThis study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives.We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6].MethodsThis work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study.ResultsThe results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch.Concurrent validity could not be measured owing to lack of sufficiently detailed stories.ConclusionThe psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice.
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Injectable Silk Protein Microparticle-based Fillers: A Novel Material for Potential Use in Glottic Insufficiency
Source:Journal of Voice
Author(s): Joseph E. Brown, Christopher P. Gulka, Jodie E.M. Giordano, Maria P. Montero, Anh Hoang, Thomas L. Carroll
Objectives and HypothesisA novel, silk protein-based injectable filler was engineered with the intention of vocal fold augmentation as its eventual intended use. This injectable filler leverages the unique properties of silk protein's superior biocompatibility, mechanical tunability, and slow in vivo degradation to one day better serve the needs of otolaryngologists. This paper intends to demonstrate the mechanical properties of the proposed novel injectable and to evaluate its longevity in animal models.Materials and MethodsExperimental. The mechanical properties of silk bulking agents were determined to characterize deformation resistance and recovery compared with commercially available calcium hydroxylapatite through rheologic testing. Fresh porcine vocal fold tissue was used for injectable placement to simulate the mechanical outcomes of native tissue after bulking procedures. In vivo subcutaneous rodent implantation examined immune response, particle migration, and volume retention.ResultsPorous, elastomeric silk microparticles demonstrate high recovery (>90% original volume) from compressive strain and mimic the native storage modulus of soft tissues (1–3 kPa). Injectable silk causes only a slight increase in porcine vocal fold stiffness immediately after injection (20%), preserving the native mechanics of bulked tissue. In the subcutaneous rat model, silk demonstrated biocompatibility and slow degradation, thus enabling host cell integration and tissue deposition.ConclusionsThe presented novel silk injectable material demonstrates favorable qualities for a vocal fold injection augmentation material. An in vivo long-term canine study is planned.
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Implant stability using piezoelectric bone surgery compared with conventional drilling: a systematic review and meta-analysis
The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period.
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Implant stability using piezoelectric bone surgery compared with conventional drilling: a systematic review and meta-analysis
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. García-Moreno, J. González-Serrano, R.M. López-Pintor, B. Pardal-Peláez, G. Hernández, J.M. Martínez-González
The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period. Methodological quality was assessed using the Cochrane Collaboration tool. A meta-analysis was performed to compare primary stability (on day 0) and secondary stability (after 2 and 3months) between the two groups. The studies included were determined to have a high risk of bias. There was no significant difference between the two groups for primary stability (on day 0) (P=0.51). After 2 and 3months, secondary stability was statistically higher in implants placed with PBS preparation (P=0.04 and P=0.01, respectively). The implant survival rate was 97.5% in the CD group and 100% in the PBS group. PBS preparation improves secondary stability after 2 and 3months in comparison to CD, with similar implant survival rates. Further studies are needed to determine whether implant osseointegration periods could be shortened with PBS preparation.
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Translation, Adaptation, and Preliminary Validation of Dacakis and Davies' “Transsexual Voice Questionnaire (Male to Female)” in French
Publication date: Available online 30 March 2018
Source:Journal of Voice
Author(s): Dominique Morsomme, Joana Revis, Elisabeth Thomas
Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia.ObjectivesThis study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives.We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6].MethodsThis work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study.ResultsThe results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch.Concurrent validity could not be measured owing to lack of sufficiently detailed stories.ConclusionThe psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice.
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Injectable Silk Protein Microparticle-based Fillers: A Novel Material for Potential Use in Glottic Insufficiency
Publication date: Available online 30 March 2018
Source:Journal of Voice
Author(s): Joseph E. Brown, Christopher P. Gulka, Jodie E.M. Giordano, Maria P. Montero, Anh Hoang, Thomas L. Carroll
Objectives and HypothesisA novel, silk protein-based injectable filler was engineered with the intention of vocal fold augmentation as its eventual intended use. This injectable filler leverages the unique properties of silk protein's superior biocompatibility, mechanical tunability, and slow in vivo degradation to one day better serve the needs of otolaryngologists. This paper intends to demonstrate the mechanical properties of the proposed novel injectable and to evaluate its longevity in animal models.Materials and MethodsExperimental. The mechanical properties of silk bulking agents were determined to characterize deformation resistance and recovery compared with commercially available calcium hydroxylapatite through rheologic testing. Fresh porcine vocal fold tissue was used for injectable placement to simulate the mechanical outcomes of native tissue after bulking procedures. In vivo subcutaneous rodent implantation examined immune response, particle migration, and volume retention.ResultsPorous, elastomeric silk microparticles demonstrate high recovery (>90% original volume) from compressive strain and mimic the native storage modulus of soft tissues (1–3 kPa). Injectable silk causes only a slight increase in porcine vocal fold stiffness immediately after injection (20%), preserving the native mechanics of bulked tissue. In the subcutaneous rat model, silk demonstrated biocompatibility and slow degradation, thus enabling host cell integration and tissue deposition.ConclusionsThe presented novel silk injectable material demonstrates favorable qualities for a vocal fold injection augmentation material. An in vivo long-term canine study is planned.
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A perspective on brain-behavior relationships and effects of age and hearing using speech-in-noise stimuli
Publication date: Available online 31 March 2018
Source:Hearing Research
Author(s): Curtis J. Billings, Brandon M. Madsen
Understanding speech in background noise is often more difficult for individuals who are older and have hearing impairment than for younger, normal-hearing individuals. In fact, speech-understanding abilities among older individuals with hearing impairment varies greatly. Researchers have hypothesized that some of that variability can be explained by how the brain encodes speech signals in the presence of noise, and that brain measures may be useful for predicting behavioral performance in difficult-to-test patients. In a series of experiments, we have explored the effects of age and hearing impairment in both brain and behavioral domains with the goal of using brain measures to improve our understanding of speech-in-noise difficulties. The behavioral measures examined showed effect sizes for hearing impairment that were 6–10 dB larger than the effects of age when tested in steady-state noise, whereas electrophysiological age effects were similar in magnitude to those of hearing impairment. Both age and hearing status influence neural responses to speech as well as speech understanding in background noise. These effects can in turn be modulated by other factors, such as the characteristics of the background noise itself. Finally, the use of electrophysiology to predict performance on receptive speech-in-noise tasks holds promise, demonstrating root-mean-square prediction errors as small as 1–2 dB. An important next step in this field of inquiry is to sample the aging and hearing impairment variables continuously (rather than categorically) – across the whole lifespan and audiogram – to improve effect estimates.
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Hearing, self-motion perception, mobility, and aging
Publication date: Available online 31 March 2018
Source:Hearing Research
Author(s): Jennifer Campos, Robert Ramkhalawansingh, M. Kathleen Pichora-Fuller
Hearing helps us know where we are relative to important events and objects in our environment and it allows us to track our changing position dynamically over space and time. Auditory cues are used in combination with other sensory inputs (vision, vestibular, proprioceptive) to help us perceive our own movements through space, known as self-motion perception. Whether we are maintaining standing balance, walking, or driving, audition can provide unique and important information to help optimize self-motion perception, and consequently to support safe mobility. Recent epidemiological and experimental studies have shown evidence that hearing loss is associated with greater walking difficulties, poorer overall physical functioning, and a significantly increased risk of falling in older adults. Importantly, the mechanisms underlying the associations between hearing status and mobility are poorly understood. It is also critical to consider that age-related hearing loss is often concomitant with declines in other sensory, motor, and cognitive functions and that these declines may interact, particularly during realistic, everyday tasks. Overall, exploring the role of auditory cues and the effects of hearing loss on self-motion perception specifically, and mobility more generally, is important to both building fundamental knowledge on the perceptual processes underlying the ability to perceive our movements through space, as well as to optimizing mobility-related interventions for those with hearing loss so that they can function better when confronted by everyday real-world sensory-motor challenges. The goal of this paper is to explore the role of hearing in self-motion perception across a range of mobility-related behaviors. First, we briefly review the ways in which auditory cues are used to perceive self-motion and how sound inputs affect behaviors such as standing balance, walking, and driving. Next, we consider age-related changes in auditory self-motion perception and the potential consequences to the performance of mobility-related tasks. We then describe how hearing loss is associated with declines in mobility-related abilities and increased adverse outcomes such as falls. We describe age-related changes to other sensory and cognitive functions and how these may interact with hearing loss in ways that affect mobility. Finally, we briefly consider the implications of the hearing-mobility associations with respect to applied domains such as screening for mobility problems and falls risk in those with hearing loss and developing interventions and training approaches targeting safe and independent mobility throughout the lifespan.
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A perspective on brain-behavior relationships and effects of age and hearing using speech-in-noise stimuli
Source:Hearing Research
Author(s): Curtis J. Billings, Brandon M. Madsen
Understanding speech in background noise is often more difficult for individuals who are older and have hearing impairment than for younger, normal-hearing individuals. In fact, speech-understanding abilities among older individuals with hearing impairment varies greatly. Researchers have hypothesized that some of that variability can be explained by how the brain encodes speech signals in the presence of noise, and that brain measures may be useful for predicting behavioral performance in difficult-to-test patients. In a series of experiments, we have explored the effects of age and hearing impairment in both brain and behavioral domains with the goal of using brain measures to improve our understanding of speech-in-noise difficulties. The behavioral measures examined showed effect sizes for hearing impairment that were 6–10 dB larger than the effects of age when tested in steady-state noise, whereas electrophysiological age effects were similar in magnitude to those of hearing impairment. Both age and hearing status influence neural responses to speech as well as speech understanding in background noise. These effects can in turn be modulated by other factors, such as the characteristics of the background noise itself. Finally, the use of electrophysiology to predict performance on receptive speech-in-noise tasks holds promise, demonstrating root-mean-square prediction errors as small as 1–2 dB. An important next step in this field of inquiry is to sample the aging and hearing impairment variables continuously (rather than categorically) – across the whole lifespan and audiogram – to improve effect estimates.
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Hearing, self-motion perception, mobility, and aging
Source:Hearing Research
Author(s): Jennifer Campos, Robert Ramkhalawansingh, M. Kathleen Pichora-Fuller
Hearing helps us know where we are relative to important events and objects in our environment and it allows us to track our changing position dynamically over space and time. Auditory cues are used in combination with other sensory inputs (vision, vestibular, proprioceptive) to help us perceive our own movements through space, known as self-motion perception. Whether we are maintaining standing balance, walking, or driving, audition can provide unique and important information to help optimize self-motion perception, and consequently to support safe mobility. Recent epidemiological and experimental studies have shown evidence that hearing loss is associated with greater walking difficulties, poorer overall physical functioning, and a significantly increased risk of falling in older adults. Importantly, the mechanisms underlying the associations between hearing status and mobility are poorly understood. It is also critical to consider that age-related hearing loss is often concomitant with declines in other sensory, motor, and cognitive functions and that these declines may interact, particularly during realistic, everyday tasks. Overall, exploring the role of auditory cues and the effects of hearing loss on self-motion perception specifically, and mobility more generally, is important to both building fundamental knowledge on the perceptual processes underlying the ability to perceive our movements through space, as well as to optimizing mobility-related interventions for those with hearing loss so that they can function better when confronted by everyday real-world sensory-motor challenges. The goal of this paper is to explore the role of hearing in self-motion perception across a range of mobility-related behaviors. First, we briefly review the ways in which auditory cues are used to perceive self-motion and how sound inputs affect behaviors such as standing balance, walking, and driving. Next, we consider age-related changes in auditory self-motion perception and the potential consequences to the performance of mobility-related tasks. We then describe how hearing loss is associated with declines in mobility-related abilities and increased adverse outcomes such as falls. We describe age-related changes to other sensory and cognitive functions and how these may interact with hearing loss in ways that affect mobility. Finally, we briefly consider the implications of the hearing-mobility associations with respect to applied domains such as screening for mobility problems and falls risk in those with hearing loss and developing interventions and training approaches targeting safe and independent mobility throughout the lifespan.
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Language function in childhood idiopathic epilepsy syndromes
Source:Brain and Language
Author(s): D.C. Jackson, J.E. Jones, D.A. Hsu, C.E. Stafstrom, J.J. Lin, D. Almane, M.A. Koehn, M. Seidenberg, B.P. Hermann
PurposeTo examine the impact of diverse syndromes of focal and generalized epilepsy on language function in children with new and recent onset epilepsy. Of special interest was the degree of shared language abnormality across epilepsy syndromes and the unique effects associated with specific epilepsy syndromes.MethodsParticipants were 136 youth with new or recent-onset (diagnosis within past 12 months) epilepsy and 107 healthy first-degree cousin controls. The participants with epilepsy included 20 with Temporal Lobe Epilepsy (TLE; M age = 12.99 years, SD = 3.11), 41 with Benign Epilepsy with Centrotemporal Spikes (BECTS; M age = 10.32, SD = 1.67), 42 with Juvenile Myoclonic Epilepsy (JME; M age = 14.85, SD = 2.75) and 33 with absence epilepsy (M age = 10.55, SD = 2.76). All children were administered a comprehensive test battery which included multiple measures of language and language-dependent abilities (i.e., verbal intelligence, vocabulary, verbal reasoning, object naming, reception word recognition, word reading, spelling, lexical and semantic fluency, verbal list learning and delayed verbal memory). Test scores were adjusted for age and gender and analyzed via MANCOVA.ResultsLanguage abnormalities were found in all epilepsy patient groups. The most broadly affected children were those with TLE and absence epilepsy, whose performance differed significantly from controls on 8 of 11 and 9 of 11 tests respectively. Although children with JME and BECTS were less affected, significant differences from controls were found on 4 of 11 tests each. While each group had a unique profile of language deficits, commonalities were apparent across both idiopathic generalized and localization-related diagnostic categories.DiscussionThe localization related and generalized idiopathic childhood epilepsies examined here were associated with impact on diverse language abilities early in the course of the disorder.
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Interdigitating dendritic cell sarcoma: Clinicopathologic study of 8 cases with review of the literature
Publication date: Available online 30 March 2018
Source:Annals of Diagnostic Pathology
Author(s): Tian Xue, Xiangnan Jiang, Weige Wang, Xiaoyan Zhou, Xiaoqiu Li
To investigate the clinicopathologic features and differential diagnoses of interdigitating dendritic cell sarcoma (IDCS), the clinical, morphological and immunohistochemical features of eight cases of IDCS were collected and analyzed. Three patients were males and five were females, the mean age and the median age were 56.5 years and 57 years respectively. Clinically, the majority of cases involved lymph nodes. Microscopically, neoplastic cells were spindle or ovoid, forming fascicles or whorls. Every case had active mitosis figures. Immunohistochemically, these neoplastic cells were consistently positive for S100, but negative for CD21 and specific B-cell and T-cell associated antigens. Follow-up results were available in 7 cases, of which 5 cases of localized lesions survived, 2 cases died of organ involvement. Interdigitating dendritic cell sarcoma is an extremely rare neoplasm, with inferior prognosis and without standard treatment regimen. IDCS has similar but unique clinicopathologic features and the differential diagnoses include other histiocytic and dendritic cell neoplasms and malignant melanoma.
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Positron Emission Tomography and Computed Tomographic (PET/CT) Imaging for Radiation Therapy Planning in Anal Cancer: a Systematic Review and Meta-analysis
Publication date: Available online 31 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Per Albertsson, Charlotte Alverbratt, Ann Liljegren, Emil Björkander, Annika Strandell, Ola Samuelsson, Stig Palm, Andreas Hallqvist
To improve the accuracy of chemoradiation therapy in anal cancer patients PET/CT is frequently used in the planning of radiation therapy. A systematic review was performed to assess impact on survival, quality of life, symptom score, change in target definition and treatment intention. Systematic literature searches were conducted in Medline, EMBASE, the Cochrane Library, and Centre for Reviews and Dissemination. Ten cross-sectional studies were identified. No data were available on survival or quality of life. The summary estimate of the proportion of patients in which PET/CT had an impact on the target definition, was 23% (95% CI 16;33). The corresponding summary estimate of a change in treatment intent from curative to palliative was 3% (95% CI 2;6). Almost one in four patients had a change in target definition, which supports the use of PET/CT in radiation therapy planning, but the consequence regarding survival and quality of life is still uncertain.
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Glucocorticoids as an adjunct to oncologic treatment in solid malignancies – not an innocent bystander
Publication date: Available online 31 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Corinne Maurice-Dror, Ruth Perets, Gil Bar-Sela
Glucocorticoids are steroidal hormones which exert their action via genomic and non-genomic mechanisms. In the clinical setting, glucocorticoids are utilized for their anti-inflammatory, anti-allergenic and immunomodulatory effects and for their well-established, pro-apoptotic effects on hematological malignancies. In the treatment of solid tumors, glucocorticoids serve primarily for alleviation of tumor- and treatment-related symptoms and in most cases are not considered to have a direct effect on tumor growth and spread. However, significant pre-clinical data suggest that glucocorticoids have diverse effects on tumor progression, both pro- and anti- tumorigenic. In contrast, the clinical data regarding the pro- and anti-tumorigenic effects of glucocorticoids on solid tumors is scarce, and summarized in this review. The following review presents the suggested glucocorticoids mechanism of action and the effects of glucocorticoids on tumor cells, on the tumor microenvironment and on tumor response to cytotoxic therapy, in the pre-clinical and clinical settings.
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Prediction models for endometrial cancer for the general population or symptomatic women: a systematic review
Publication date: Available online 31 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Maaike Alblas, Kimberley Velt, Nora Pashayan, Martin Widschwendter, Ewout Steyerberg, Yvonne Vergouwe
ObjectiveTo provide an overview of prediction models for the risk of developing endometrial cancer in women of the general population or for the presence of endometrial cancer in symptomatic women.MethodsWe systematically searched the Embase and Pubmed database until September 2017 for relevant publications. We included studies describing the development, the external validation, or the updating of a multivariable model for predicting endometrial cancer in the general population or symptomatic women.ResultsOut of 2756 references screened, 14 studies were included. We found two prediction models for developing endometrial cancer in the general population (risk models) and one extension. Eight studies described the development of models for symptomatic women (diagnostic models), one comparison of the performance of two diagnostic models and two external validation. Sample size varied from 60 (10 with cancer) to 201,811 (855 with cancer) women. The age of the women was included as a predictor in almost all models. The risk models included epidemiological variables related to the reproductive history of women, hormone use, BMI, and smoking history. The diagnostic models also included clinical predictors, such as endometrial thickness and recurrent bleeding. The concordance statistic (c), assessing the discriminative ability, varied from 0.68 to 0.77 in the risk models and from 0.73 to 0.957 in the diagnostic models. Methodological information was often limited, especially on the handling of missing data, and the selection of predictors. One risk model and four diagnostic models were externally validated.ConclusionsOnly a few models have been developed to predict endometrial cancer in asymptomatic or symptomatic women. The usefulness of most models is unclear considering methodological shortcomings and lack of external validation. Future research should focus on external validation and extension with new predictors or biomarkers, such as genetic and epigenetic markers.
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Re-irradiation as salvage treatment in recurrent glioblastoma: a comprehensive literature review to provide practical answers to frequently asked questions
Publication date: Available online 31 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Silvia Scoccianti, Giulio Francolini, Giulio Alberto Carta, Daniela Greto, Beatrice Detti, Gabriele Simontacchi, Luca Visani, Muhammed Baki, Linda Poggesi, Pierluigi Bonomo, Monica Mangoni, Isacco Desideri, Stefania Pallotta, Lorenzo Livi
The primary aim of this review is to provide practical recommendations in terms of fractionation, dose, constraints and selection criteria to be used in the daily clinical routine.Based on the analysis of the literature reviewed, in order to keep the risk of severe side effects <3,5%, patients should be stratified according to the target volume. Thus, patients should be treated with different fractionation and total EQD2 (<12,5 ml: EQD2 < 65 Gy with radiosurgery; >12,5 ml and <35 ml: EQD2 < 50 Gy with hypofractionated stereotactic radiotherapy; >35 m l and <50 ml: EQD2 < 36 Gy with conventionally fractionated radiotherapy).Concurrent approaches with temozolomide or bevacizumab do not seem to improve the outcomes of reirradiation and may lead to a higher risk of toxicity but these findings need to be confirmed in prospective series.
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Pelvic excursion during walking post-stroke: A novel classification system
Source:Gait & Posture
Author(s): Virginia L. Little, Theresa E. McGuirk, Lindsay A. Perry, Carolynn Patten
BackgroundResearchers and clinicians often use gait speed to classify hemiparetic gait dysfunction because it offers clinical predictive capacity. However, gait speed fails to distinguish unique biomechanical characteristics that differentiate aspects of gait dysfunction.Research QuestionHere we describe a novel classification of hemiparetic gait dysfunction based on biomechanical traits of pelvic excursion. We hypothesize that individuals with greater deviation of pelvic excursion, relative to controls, demonstrate greater impairment in key gait characteristics.MethodsWe compared 41 participants (61.0 ± 11.2yrs) with chronic post-stroke hemiparesis to 21 non-disabled controls (55.8 ± 9.0yrs). Participants walked on an instrumented split-belt treadmill at self-selected walking speed. Pelvic excursion was quantified as the peak-to-peak magnitude of pelvic motion in three orthogonal planes (i.e., tilt, rotation, and obliquity). Raw values of pelvic excursion were compared against the distribution of control data to establish deviation scores which were assigned bilaterally for the three planes producing six values per individual. Deviation scores were then summed to produce a composite pelvic deviation score. Based on composite scores, participants were allocated to one of three categories of hemiparetic gait dysfunction with progressively increasing pelvic excursion deviation relative to controls: Type I (n = 15) – minimal pelvic excursion deviation; Type II (n = 20) – moderate pelvic excursion deviation; and Type III (n = 6) – marked pelvic excursion deviation. We assessed resulting groups for asymmetry in key gait parameters including: kinematics, joint powers temporally linked to the stance-to-swing transition, and timing of lower extremity muscle activity.ResultsAll groups post-stroke walked at similar self-selected speeds; however, classification based on pelvic excursion deviation revealed progressive asymmetry in gait kinematics, kinetics and temporal patterns of muscle activity.SignificanceThe progressive asymmetry revealed in multiple gait characteristics suggests exaggerated pelvic motion contributes to gait dysfunction post-stroke.
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Objective measures of unobstructed walking and obstacle avoidance in Parkinson’s disease subtypes
Source:Gait & Posture
Author(s): Diego Orcioli-Silva, Rodrigo Vitório, Ellen Lirani-Silva, Paulo Cezar Rocha dos Santos, Victor Spiandor Beretta, Lilian Teresa Bucken Gobbi
BackgroundObjective measures of gait in Parkinson's disease (PD) patients according to motor subtypes are not yet fully understood. Although recent advances have been made for unobstructed walking, further work is required on locomotor tasks challenging postural stability, such as obstacle avoidance.Research questionThis study aimed to investigate the influence of PD motor subtypes on objective measures of locomotion during unobstructed walking and obstacle avoidance.MethodsThirty-five PD patients classified as postural instability and gait disorder (PIGD) and 30 as tremor dominant (TD), as well as 45 healthy controls (CG) walked along an 8-m pathway under two conditions: (a) unobstructed walking and (b) obstacle avoidance. Outcome measures included spatiotemporal parameters recorded by an optoelectronic tridimensional system.ResultsDuring unobstructed walking, the PIGD group exhibited shorter stride length, slower velocity, and longer double support phase compared to the TD and CG groups. The TD group also presented slower stride velocity compared to the CG. The PIGD and TD groups presented shorter stride duration than the CG. Regarding obstacle avoidance, the PIGD group exhibited shorter distances for leading foot placement before obstacle, trailing foot placement after obstacle and trailing crossing step length compared to the TD and CG groups. The PIGD group exhibited wider leading crossing step width, lower trailing toe clearance, and slower leading and trailing velocity during obstacle avoidance compared to the CG.SignificancePIGD subtype patients showed worse modifications in objective measures of unobstructed walking and obstacle avoidance. The observed modifications may contribute to increased fall occurrence in PIGD patients.
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A novel approach for the detection and exploration of joint coupling patterns in the lower limb kinetic chain
Source:Gait & Posture
Author(s): Kevin Deschamps, Maarten Eerdekens, Jurre Geentjens, Lieselot Santermans, Lien Steurs, Bart Dingenen, Maarten Thysen, Filip Staes
BackgroundA comprehensive perspective on foot and lower limb joint coupling is lacking since previous studies did not consider the multi-articular nature of the foot and lower limb neither accounted for biomechanical heterogeneity.Research questionThe current manuscript describes a novel methodological process for detection and exploration of joint coupling patterns in the lower limb kinetic chain.MethodsThe first stage of the methodological process encompasses the measurement of 3D joint kinematics of the foot and lower limb kinetic chain during dynamic activities. The second stage consists of selecting the kinematic waveforms of interest. In the third stage, cross-correlation coefficients are calculated across the selected one-dimensional continua of each subject. In the fourth stage, all cross-correlation coefficients per subject are used as input variable in a cluster algorithm. Algorithm specific qualitative metrics are subsequently considered to determine the most robust clustering. Finally, in the fifth stage the process of biomechanical interpretation is initiated and further exploration is recommended by triangulating with other biomechanical variables.ResultsA first clinical illustration of the novel method was provided using data of fourteen young elite athletes. Cross-correlation coefficients for each leg were calculated across continua of the pelvis, hip, knee, rear foot and midfoot. A hierarchical clustering approach stratified the coefficients into two distinct clusters which was mainly guided by the frontal plane knee kinematics. Both clustered differed significantly from each other with respect to their frontal plane ankle, knee and hip kinetics.SignificanceThe presented method seems to provide a valuable approach to gain insight into foot and lower joint coupling.
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Modeling margin of stability with feet in place following a postural perturbation: Effect of altered anthropometric models for estimated extrapolated centre of mass
Source:Gait & Posture
Author(s): Keaton A. Inkol, Andrew H. Huntley, Lori Ann Vallis
BackgroundMaintaining the centre of mass (CoM) of the body within the base of support is a critical component of upright balance; the ability to accurately quantify balance recovery mechanisms is critical for many research teams.Research QuestionThe purpose of this study was to investigate how exclusion of specific body segments in an anthropometric CoM model influenced a dynamic measure of postural stability, the margin of stability (MoS) following a support-surface perturbation.MethodsHealthy young adults (n = 10) were instrumented with kinematic markers and a safety harness. Sixteen support-surface translations, scaled to ensure responses did not involve a change in base of support, were then issued (backwards, forwards, left, or right). Whole-body CoM was estimated using four variations of a 13-segment anthropometric model: i) the full-model (WFM), and three simplified models, ii) excluding upper limbs (NAr); iii) excluding upper and lower limbs (HTP); iv) pelvis CoM (CoMp). The CoM calculated for each variant was then used to estimate extrapolated CoM (xCoM) position and the resulting MoS within the plane of postural disturbance.ResultsComparisons of simplified models to the full model revealed significant differences (p < 0.05) in MoS for all models in each perturbation condition; however, the largest differences were following sagittal-based perturbations. Poor estimates of WFM MoS were most evident for HTP and CoMp models; these were associated with the greatest values of RMS/maximum error, poorest correlations, etc. The simplified models provided low-error approximates for frontal perturbations.SignificanceFindings suggest that simplified calculations of CoM can be used by researchers without reducing MoS measurement accuracy, however the degree of simplification should be context-dependent. For example,CoMp models may be appropriate for questions pertaining to frontal MoS; sagittal MoS necessitates inclusion of lower limb and HTP segments to prevent underestimation of postural stability.
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Antenatal non-medical risk assessment and care pathways to improve pregnancy outcomes: a cluster randomised controlled trial
Abstract
Social deprivation negatively affects health outcomes but receives little attention in obstetric risk selection. We investigated whether a combination of (1) risk assessment focused on non-medical risk factors, lifestyle factors, and medical risk factors, with (2) subsequent institution of risk-specific care pathways, and (3) multidisciplinary consultation between care providers from the curative and the public health sector reduced adverse pregnancy outcomes among women in selected urban areas in the Netherlands. We conducted a cluster randomised controlled trial in 14 urban municipalities across the Netherlands. Prior to the randomisation, municipalities were ranked and paired according to their expected proportion of pregnant women at risk for adverse outcomes at birth. The primary outcome was delivery of a preterm and/or small for gestational age (SGA) baby, analysed with multilevel mixed-effects logistic regression analysis adjusting for clustering and individual baseline characteristics. A total of 33 community midwife practices and nine hospitals participated throughout the study. Data from 4302 participants was included in the Intention To Treat (ITT) analysis. The intervention had no demonstrable impact on the primary outcome: adjusted odds ratio (aOR) 1.17 (95% CI 0.84–1.63). Among the secondary outcomes, the intervention improved the detection of threatening preterm delivery and fetal growth restriction during pregnancy [aOR 1.27 (95% CI 1.01–1.61)]. Implementation of additional non-medical risk assessment and preventive strategies into general practices is feasible but did not decrease the incidence of preterm and/or SGA birth in the index pregnancy in deprived urban areas.
Trial registration Netherlands National Trial Register (NTR-3367).
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Suggestion of reduced cancer risks following cardiac x-ray exposures is unconvincing
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An audiological evaluation of syndromic and non-syndromic craniosynostosis in pre-school going children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Liang Chye Goh, Ali Azman, Hufaidah binti Konting Siti, Wee Vien Khoo, Premala a/p Muthukumarasamy, Meow Keong Thong, Zulkiflee Abu Bakar, Anura Michelle Manuel
ObjectiveTo study the audiological outcome and early screening of pre-school going children with craniosynostosis under follow-up at the University of Malaya Medical Center(UMMC), Kuala Lumpur, Malaysia over a 10 year period.MethodsA retrospective descriptive cohort study on the audiological findings detected during the first hearing assessment done on a child with craniosynostosis using otoacoustic emissions, pure tone audiometry or auditory brainstem response examination. The main aim of this study was to evaluate the type and severity of hearing loss when compared between syndromic and non-sydromic craniosynostosis, and other associated contributory factors.ResultsA total of 31 patients with 62 ears consisting of 14 male patients and 17 female patients were evaluated. Twenty two patients (71%) were syndromic and 9 (29%) were non-syndromic craniosynostosis. Amongst the syndromic craniosynostosis, 9 (41%) had Apert syndrome, 7 (32%) had Crouzon syndrome, 5 (23%) had Pfieffer syndrome and 1 (4%) had Shaethre Chotzen syndrome. Patients with syndromic craniosynostosis were more likely to present with all types and severity of hearing loss, including severe to profound sensorineural hearing loss while children with non-syndromic craniosynostosis were likely to present with normal hearing (p < 0.05). In addition, when the first hearing test was done at a later age, a hearing loss including sensorineural hearing loss is more likely to be present in a child with syndromic craniosynostosis (p < 0.05).ConclusionOur study suggested that children who are born with syndromic craniosynostosis were more likely to suffer from a hearing loss, including that of a severe to profound degree compared to children with non-syndromic craniosynostosis. In addition to that, hearing loss is more likely to be detected when the first hearing test is done at a later age, and this can be an irreversible sensorineural hearing loss. We would like to advocate the need for early audiological screening and follow up in children with syndromic craniosynostosis.
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Surgical timing for bilateral simultaneous cochlear implants: When is best?
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Sebastiano Franchella, Roberto Bovo, Luigia Bandolin, Flavia Gheller, Silvia Montino, Daniele Borsetto, Sara Ghiselli, Alessandro Martini
IntroductionHearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births.Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition.The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination.The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing.Materials and methodsThe study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age.ResultsThe statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age.ConclusionsThe results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.
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Acute Monocular Blindness Due to Orbital Compartment Syndrome Following Pterional Craniotomy
Source:World Neurosurgery, Volume 114
Author(s): Jeroen G.V. Habets, Roel H.L. Haeren, Suen A.N. Lie, Noel J.C. Bauer, Jim T.A. Dings
BackgroundWe present a case of orbital compartment syndrome (OCS) leading to monocular irreversible blindness following a pterional craniotomy for clipping of an anterior communicating artery aneurysm. OCS is an uncommon but vision-threatening entity requiring urgent decompression to reduce the risk of permanent visual loss. Iatrogenic orbital roof defects are a common finding following pterional craniotomies. However, complications related to these defects are rarely reported.Case DescriptionA 65-year-old female who underwent an anterior communicating artery clipping via a pterional approach 4 days before developed proptosis, ocular movement paresis, and irreversible visual impairment following an orthopedic surgery. Computed tomography images revealed an intraorbital cerebrospinal fluid (CSF) collection, which was evacuated via an acute recraniotomy. The next day, proptosis and intraorbital CSF collection on computed tomography images reoccurred and an oral and maxillofacial surgeon evacuated the collection via a blepharoplasty incision and blunt dissection. In addition, the patient was treated with acetazolamide and an external lumbar CSF drainage during 12 days. Hereafter, the CSF collection did not reoccur. Unfortunately, monocular blindness was persistent. We hypothesize the CSF collection occurred due to the combination of a postoperative orbital roof defect and a temporarily increased intracranial pressure during the orthopedic surgery.ConclusionWe plead for more awareness of this severe complication after pterional surgeries and emphasize the importance of 1) strict ophthalmologic examination after pterional craniotomies in case of intracranial pressure increasing events, 2) immediate consultation of an oral and maxillofacial surgeon, and 3) consideration of CSF-draining interventions since symptoms are severely invalidating and irreversible within a couple of hours.
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Vertebral Venous Collaterals with Underlying Agenesis of the Inferior Vena Cava: Implications for Spinal Surgery
Source:World Neurosurgery, Volume 114
Author(s): Jang W. Yoon, Sara Ganaha, Clarence Watridge
BackgroundCongenital agenesis of the inferior vena cava (IVC) can lead to the development of a prominent venous collateral system within and around the spine due to the development of venous collaterals. In such patients, surgery can carry a risk of catastrophic bleeding or decompensation of a delicate venous drainage pattern during spinal manipulation or even epidural exploration.Case DescriptionA 49-year-old man with a congenital agenesis of the IVC presented with signs and symptoms of an L5 radiculopathy. A computed tomography scan of the lumbar spine showed the characteristic finding of fenestrated or "holey" pedicles within the lumbar spine, due to chronic venous engorgement within the pedicles.ConclusionsTo our knowledge, this is the first report to describe the characteristic sign of "holey" pedicles on radiographic imaging in a patient with an underdeveloped IVC. This finding may be useful for the detection of abnormal spinal venous anatomy. In such patients, spinal surgery may carry greater risks and requires special consideration.
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Chiari Malformation and Hydrocephalus Masking Neurocysticercosis
Source:World Neurosurgery, Volume 114
Author(s): Sharad Rajpal, Colson Tomberlin, Andrew Bauer, Robert C. Forsythe, Sigita Burneikiene
BackgroundVarious diagnostic characteristics associated with neurocysticercosis have been well studied; however, their potential to be implicated in other differential diagnoses has not been well demonstrated.Case DescriptionWe report the case of a 55-year-old Hispanic man who underwent a Chiari decompression surgery, which was complicated with hydrocephalus. Despite a ventriculoperitoneal shunt placement, he continued to have headaches and was soon found to have several skull base subarachnoid lesions, which were later diagnosed as the sequelae of an active neurocysticercosis infection.ConclusionThis case report highlights the importance of overlapping symptoms between diseases in a short temporal context.
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Neurocutaneous Melanosis in an Adult Patient with Intracranial Primary Malignant Melanoma: Case Report and Review of the Literature
Source:World Neurosurgery, Volume 114
Author(s): Mian Ma, Zhi-Liang Ding, Zhi-Qi Cheng, Gang Wu, Xiao-Yu Tang, Peng Deng, Jian-Dong Wu
BackgroundTo explore the clinical characteristics of neurocutaneous melanosis (NCM) in adult patients to help improve diagnosis and treatment of this disease, we present a rare case of an adult patient suffering from NCM with malignant melanoma, as well as a review of the relevant Chinese and English literature.Case DescriptionThe patient reported here plus the patients identified in our literature review total 30 adults with NCM (20 males [66.7%] and 10 females [33.3%]), age 19–65 years (average, 27.9 years). These include 24 cases of malignant melanoma (80.0%), 3 cases of melanocytoma (10.0%), 2 cases of diffuse melanocytosis (6.7%), and 1 case of unknown pathology (3.3%). Satellite nevi were reported in 25 cases (83.3%) and in 5 cases their presence was unknown (16.7%). Intracranial lesions were present in 28 cases (93.3%), and intraspinal lesions were present in 2 cases (6.7%). There are 4 cases of combined hydrocephalus (13.3%), and 2 cases of combined Dandy–Walker deformity (6.7%).ConclusionsNCM is a rare disease, especially in adults. With the onset of symptoms, the diagnosis is generally confirmed. In children with congenital giant nevus, regular periodic surveys of the central nervous system (brain and spinal cord) with magnetic resonance imaging or cerebrospinal fluid analysis should be performed to diagnose NCM. Active treatment should be undertaken to improve the prognosis.
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Improving Dual-Task Control with a Posture-Second Strategy in Early-Stage Parkinson’s Disease
Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cheng-Ya Huang, Yu-An Chen, Ing-Shiou Hwang, Ruey-Meei Wu
ObjectiveTo examine the task prioritization effects on postural-suprapostural dual task performance in patients with early-stage Parkinson's disease (PD) without clinical observed postural symptoms.DesignCross-sectional study. Participants performed a force-matching task while standing on a mobile-platform, and were instructed to focus their attention on either the postural task (posture-first strategy) or the force-matching task (posture-second strategy).SettingUniversity research laboratory.Participants16 individuals with early-stage PD who has no clinical observed postural symptoms.InterventionsNot applicable.Main Outcome MeasuresDual-task change (DTC, % change between single-task and dual-task performance) of posture error, posture approximate entropy (ApEn), force error, and reaction time (RT). Positive DTC values indicate higher postural error, posture ApEn, force error, and force RT during dual-task conditions compared to single-task conditions.ResultsCompared to the posture-first strategy, the posture-second strategy was associated with smaller DTC of posture error and force error, and greater DTC of posture ApEn. In contrast, greater DTC of force RT was observed under posture-second strategy.ConclusionsContrary to typical recommendations, our results suggest that the posture-second strategy may be an effective dual-task strategy in patients with early-stage PD who has no clinical observed postural symptoms in order to reduce the negative effect of dual-tasking on performance and facilitate postural automaticity.
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Effectiveness of home-based exercises without supervision by physical therapists for patients with early-stage amyotrophic lateral sclerosis: A pilot study
Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kosuke Kitano, Takashi Asakawa, Naoto Kamide, Keisuke Yorimoto, Masaki Yoneda, Yutaka Kikuchi, Makoto Sawada, Tetsuo Komori
ObjectiveThis study aimed to verify the effects of structured home-based exercises without supervision by a physical therapist on patients with early-stage amyotrophic lateral sclerosis (ALS).DesignThis is a historical controlled study that is part of a multicenter collaborative study.SettingRehabilitation departments at general hospitals and outpatient clinics with a neurology department in Japan.ParticipantsTwenty-one patients with ALS were enrolled and designated as the Home-EX group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features.InterventionThe Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months.Main outcome measureThe primary outcome was the score on the ALS Functional Rating Scale-Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, and a higher score indicates better function.ResultsIn the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out due to medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function sub-score and total score on ALSFRS-R than the control group at follow-up (p < 0.001 and p < 0.05, respectively).ConclusionStructured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS.
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Sensitivity of the SCI-FI/AT in Individuals with Traumatic Spinal Cord Injury
Publication date: Available online 31 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tamra Keeney, Mary Slavin, Pamela Kisala, Pengsheng Ni, Allen W. Heinemann, Susan Charlifue, Denise C. Fyffe, Ralph J. Marino, Leslie R. Morse, Lynn A. Worobey, Denise Tate, David Rosenblum, Ross Zafonte, David Tulsky, Alan M. Jette
ObjectiveTo examine the ability of the Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) measure to detect change in persons with SCI.DesignMulti-site, longitudinal (12-month follow-up).Setting9 SCI Model Systems programs.Participants165 adults with SCI enrolled in the SCI Model Systems database.InterventionsNot applicable.Main Outcome MeasuresSCI-FI/AT CAT (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation) completed at discharge from rehabilitation and 12 months post-SCI. For each domain, effect size (ES) estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.ResultsSample demographics: 46% paraplegia, 76% male, 57% used a manual wheelchair, 38% used a power wheelchair, 30% were ambulatory. For individuals with paraplegia the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significant, large amount of change; in contrast, the Fine Motor and Wheelchair domains detected only small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor, and Self-Care domains detected a small amount of change; while the Ambulation item domain detected a medium amount of change. The Wheelchair domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.ConclusionSCI-FI/AT CAT item banks detected an increase in function from discharge to 12-months after SCI onset. SCI-FI/AT CAT ES estimates vary by domain and level of lesion. Findings support use of the SCI-FI/AT CAT in the SCI population and highlight the importance of multidimensional functional measures.
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Thyroid Cartilage Window Approach to Extract a Foreign Body after Migration into the Paraglottic Space
We report a case of fish bone impaction in the paraglottic space, which caused palsy of the left vocal cord. The patient was a 45-year-old man. He presented with throat pain and hoarseness of voice for approximately one week. The diagnosis was made after careful history taking and confirmed by the use of computed tomography scan as the fish bone was not visible endoscopically under local and general anaesthesia. The patient underwent thyroid cartilage window approach, and the fish bone was retrieved. His symptoms have improved significantly, and he did not require tracheostomy. Other cases reported the removal of foreign bodies by other techniques such as laryngofissure and posterolateral approach. Our case is different in that we used a modification of thyroplasty type 1 technique as it has less reported complications than other approaches that were published in literature.
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Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation
Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.
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Antenatal non-medical risk assessment and care pathways to improve pregnancy outcomes: a cluster randomised controlled trial
Abstract
Social deprivation negatively affects health outcomes but receives little attention in obstetric risk selection. We investigated whether a combination of (1) risk assessment focused on non-medical risk factors, lifestyle factors, and medical risk factors, with (2) subsequent institution of risk-specific care pathways, and (3) multidisciplinary consultation between care providers from the curative and the public health sector reduced adverse pregnancy outcomes among women in selected urban areas in the Netherlands. We conducted a cluster randomised controlled trial in 14 urban municipalities across the Netherlands. Prior to the randomisation, municipalities were ranked and paired according to their expected proportion of pregnant women at risk for adverse outcomes at birth. The primary outcome was delivery of a preterm and/or small for gestational age (SGA) baby, analysed with multilevel mixed-effects logistic regression analysis adjusting for clustering and individual baseline characteristics. A total of 33 community midwife practices and nine hospitals participated throughout the study. Data from 4302 participants was included in the Intention To Treat (ITT) analysis. The intervention had no demonstrable impact on the primary outcome: adjusted odds ratio (aOR) 1.17 (95% CI 0.84–1.63). Among the secondary outcomes, the intervention improved the detection of threatening preterm delivery and fetal growth restriction during pregnancy [aOR 1.27 (95% CI 1.01–1.61)]. Implementation of additional non-medical risk assessment and preventive strategies into general practices is feasible but did not decrease the incidence of preterm and/or SGA birth in the index pregnancy in deprived urban areas.
Trial registration Netherlands National Trial Register (NTR-3367).
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Suggestion of reduced cancer risks following cardiac x-ray exposures is unconvincing
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Thyroid Cartilage Window Approach to Extract a Foreign Body after Migration into the Paraglottic Space
We report a case of fish bone impaction in the paraglottic space, which caused palsy of the left vocal cord. The patient was a 45-year-old man. He presented with throat pain and hoarseness of voice for approximately one week. The diagnosis was made after careful history taking and confirmed by the use of computed tomography scan as the fish bone was not visible endoscopically under local and general anaesthesia. The patient underwent thyroid cartilage window approach, and the fish bone was retrieved. His symptoms have improved significantly, and he did not require tracheostomy. Other cases reported the removal of foreign bodies by other techniques such as laryngofissure and posterolateral approach. Our case is different in that we used a modification of thyroplasty type 1 technique as it has less reported complications than other approaches that were published in literature.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2J83vQL
Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation
Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.
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Cdc20/p55 mediates the resistance to docetaxel in castration-resistant prostate cancer in a Bim-dependent manner
Abstract
Purpose
At least to date, no effective treatment for advanced castration-resistant prostate cancer (CRPC) has been established. Recent studies indicated that cell division cycle 20 homolog (Cdc20) overexpression is associated with poor prognosis in patients with castration-resistant prostate cancer. However, the mechanism of Cdc20 in the development of docetaxel resistance in CRPC remains elusive.
Methods
In this study, the transcription of Cdc20 was confirmed in three independent CRPC cell lines derived from different tissues, including LNCaP, PC3, and DU145. Docetaxel resistant (DR) cell lines were generated within the background of DU145 and PC3. The protein levels of Cdc20 and the biological phenotype were detected in both wild-type and DR cell lines. To further explore the mechanism of Cdc20 overexpression, stable cell lines with Cdc20 or Bcl-2 interacting mediator of cell death (Bim) deprivation were generated and examined for biological parameters. In addition, a specific Cdc20 inhibitor was used in DR cell lines to explore the potential solution for docetaxel resistant CRPC.
Results
Here, we identified Cdc20 is overexpressed in docetaxel resistant CRPC cell lines, including LNCaP, PC3, and DU145. We also reported that DR cell lines, which mimic the recurrent prostate cancer cells after docetaxel treatment, have higher levels of Cdc20 protein compared with the CRPC cell lines. Interestingly, the protein levels of Bim, an E3 ligase substrate of Cdc20, were decreased in DR cell lines compared with the wild-type, while the mRNA levels were similar. More importantly, in DR cell lines, the biological phenotype induced by Cdc20 deletion could be significantly reversed by the additional knockdown of Bim. As a result, docetaxel resistant prostate cancer cells treated with the pharmacological Cdc20 inhibitor became sensitive to docetaxel treatment.
Conclusions
In conclusion, our data collectively demonstrated that Cdc20 overexpression facilitates the docetaxel resistant of the CRPC cell lines in a Bim-dependent manner. Furthermore, additionally targeting Cdc20 might be a promising solution for the treatment of the CRPC with docetaxel resistance.
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