OtoRhinoLaryngology News: 01/05/18

Παρασκευή 5 Ιανουαρίου 2018

Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review

Publication date: Available online 5 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Maria Devine, Murtaza Hirani, Justin Durham, Donald R. Nixdorf, Tara Renton
Objective: To systematically identify criteria used to diagnose patients with trigeminal nerve injury. Study design: A systematic review of the literature registered in the PROSPERO database. Inclusion criteria: patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. Results: 28 articles included. Diagnostic tests included clinical neurosensory tests (CNT) (89%), thermal quantitative sensory testing (25%), electromyography (7%) and patient interview (14%). Neuropathic pain was assessed using visual analogue scale (39%), use of neuropathic medication (7%), questionnaires including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing CNT, application of diagnostic terms and diagnostic grading of nerve injury was not consistent among the included articles making direct comparison of results difficult. Conclusion: Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment and outcome reporting between stakeholder organisations in order to progress knowledge in this field.

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Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study

Publication date: Available online 5 January 2018
Source:Journal of Voice
Author(s): Christopher R. Watts, Kristie Knickerbocker
ObjectiveThe purpose of this study was to evaluate epidemiologic characteristics of a treatment-seeking population referred to a private practice community voice clinic.Study DesignThis is a retrospective cohort study.MethodsPatient files representing evaluation referrals over a 28-month period were reviewed. Variables tabulated from records included disorder diagnosis, age, gender, perceptual voice quality ratings, and self-perceived voice handicap at initial evaluation. Descriptive statistics were used to evaluate the diagnosis category and demographic patterns. Parametric statistics were applied to quantitative clinical measurements to test the effect of voice disorder category on perceptual voice quality ratings and self-perceived voice handicap.ResultsA total of 216 consecutive patient files were reviewed. Collectively, the most common disorder diagnosis was "other," consisting of a varied cluster of etiologies, including reflux laryngitis, chronic cough, bilateral paralysis or paresis, leukoplakia, and polypoid degeneration. The most common diagnosis in women was midmembranous lesions, and that in men was the "other" category followed by atrophy and bowing associated with presbylaryngis. The greatest severity and handicap measures were found in patients with unilateral paralysis.ConclusionsCollectively, the demographic patterns reported in this study align with those from specialty voice clinics housed in academic medical centers and community voice clinics led by laryngologists and general otolaryngologists. Translating these findings to professional practice, the data support the notion that speech-language pathologists specializing as voice therapists who seek to establish private practice clinics should possess competencies in the knowledge and skills required to serve treatment-seeking populations with a wide variety of voice impairments.

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Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study

The Influences of Chromium Supplementation on Glycemic Control, Markers of Cardio-Metabolic Risk, and Oxidative Stress in Infertile Polycystic ovary Syndrome Women Candidate for In vitro Fertilization: a Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

This study was carried out to investigate the effects of chromium intake on glycemic control, markers of cardio-metabolic risk, and oxidative stress in infertile polycystic ovary syndrome (PCOS) women candidate for in vitro fertilization (IVF). This randomized double-blind, placebo-controlled trial was done among 40 subjects with infertile PCOS candidate for IVF, aged 18–40 years old. Individuals were randomly allocated into two groups to take either 200 μg/day of chromium (n = 20) or placebo (n = 20) for 8 weeks. Biochemical parameters were assessed at baseline and at end-of-trial. Compared with the placebo, taking chromium supplements led to significant reductions in fasting plasma glucose (− 2.3 ± 5.7 vs. + 0.9 ± 3.1 mg/dL, P = 0.03), insulin levels (− 1.4 ± 2.1 vs. + 0.4 ± 1.7 μIU/mL, P = 0.004), homeostatic model of assessment for insulin resistance (− 0.3 ± 0.5 vs. + 0.1 ± 0.4, P = 0.005), and a significant increase in quantitative insulin sensitivity check index (+ 0.004 ± 0.008 vs. − 0.001 ± 0.008, P = 0.03). In addition, chromium supplementation significantly decreased serum triglycerides (− 19.2 ± 33.8 vs. + 8.3 ± 21.7 mg/dL, P = 0.004), VLDL- (− 3.8 ± 6.8 vs. + 1.7 ± 4.3 mg/dL, P = 0.004) and total cholesterol concentrations (− 15.3 ± 26.2 vs. − 0.6 ± 15.9 mg/dL, P = 0.03) compared with the placebo. Additionally, taking chromium supplements was associated with a significant increase in plasma total antioxidant capacity (+ 153.9 ± 46.1 vs. − 7.8 ± 43.9 mmol/L, P < 0.001) and a significant reduction in malondialdehyde values (−0.3 ± 0.3 vs. + 0.1 ± 0.2 μmol/L, P = 0.001) compared with the placebo. Overall, our study supported that chromium administration for 8 weeks to infertile PCOS women candidate for IVF had beneficial impacts on glycemic control, few variables of cardio-metabolic risk, and oxidative stress.

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The effects of transcutaneous low-level laser therapy on the skin healing process: an experimental model

Abstract

We aim to evaluate the action of transcutaneous laser in the initial wound healing process. The use of low-level laser therapy (LLLT) has proven to be effective on inflammatory modulation and wound healing. The trial was performed on five groups of rats, through a dorsal incision. All groups received treatment on auricular artery. Groups 1 and 3 were treated with transcutaneous LLLT over a period of 15 min. Groups 2 and 4 received one and two inactive laser applications (placebo), respectively. Group 5 was the control one. Blood samples were collected 2 h after the last application of LLLT so that cytokine levels could be measured by ELISA. Tissue fragments were harvested for morphometric, histomorphometric, and RT-qPCR analyses. The morphometric analysis revealed a greater decrease in the wounded area in G1 when compared with G2, whereas in G3, the improvement in the area was greater when compared with G4. Finally, the histomorphometric analysis showed that G1 was the group closer to G5 in terms of collagen fiber count. G2 and G4 had higher amounts of collagen fibers than G5 while G3 had a lower quantity. The use of the transcutaneous LLLT in the current study influenced the wound healing process.

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KLICK syndrome: an unusual phenotype

Erythrokeratoderma refers to a group of rare inherited disorders with both clinical and genetic heterogeneities.¹ Lesions usually start in infancy and are characterized by localized and well-demarcated erythematous and hyperkeratotic plaques, sometimes with a migratory nature. Erythrokeratoderma is often inherited as an autosomal dominant trait caused by mutations in the genes GJB3, GJB4, or GJA1, encoding connexins 31, 30.3, and 43, respectively. Erythrokeratoderma may be associated with neurological anomalies and can be caused by ELOVL4.² Recently, mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide pathway were also demonstrated to lead to erythrokeratoderma.³

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Striate palmoplantar keratoderma resulting from a missense mutation in DSG1

palmoplantar keratodermas (PPKs, OMIM #144200) refer to a large phenotypically and genetically heterogeneous group of keratinisation disorders characterised by marked hyperkeratosis on the surface of the palms and soles.

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Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Summary

Aim

Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD).

Setting and design

This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries.

Study exposure

Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52.

Primary outcome measures

Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16.

Results

740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.

Conclusions

Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.

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Centile charts for cranial sutures in children younger than 1 year based on ultrasound measurements

Abstract

Background

Cranial US allows for the evaluation of premature closure (synostosis) or abnormal widening of the cranial sutures. An understanding of the normal anatomy is required to help define the presence or absence of abnormality.

Objective

To provide reference for normal ultrasound measurements of cranial sutures during the child's first year.

Materials and methods

We included children ages 0 to 12 months who were referred to the hospital during 2011–2013 for radiographic evaluation of cranial sutures. Cranial US study was focused on evaluating the sagittal, coronal, lambdoid and metopic sutures. We measured the hypoechoic gap between the bones (patent suture). Two readers performed the measurements, blinded to clinical indications and previous reports. Estimates of the 10^th, 25^th, 50^th, 75^th and 90^th percentiles were achieved for ages 1–12 months.

Results

Of 129 children whose families consented to cranial US, 11 were excluded because of craniosynostosis and 3 for suboptimal quality of cranial US images. In 115 patients measurements of normal cranial sutures were obtained (75 boys [65%], ages 0.26–11.27 months). For each suture, the suture size decreased significantly with age (P<0.001). Only the metopic suture was noted to close completely toward the end of the first year of age. There were no statistically significant differences in age-related suture size by gender.

Conclusion

The current patient series represents a reference of percentiles of normal ultrasound measurements of cranial sutures during the first year of age.

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Strong coupling between slow oscillations and wide fast ripples in children with epileptic spasms: Investigation of modulation index and occurrence rate

Summary

Objective

Epileptic spasms (ES) often become drug-resistant. To reveal the electrophysiological difference between children with ES (ES+) and without ES (ES−), we compared the occurrence rate (OR) of high-frequency oscillations (HFOs) and the modulation index (MI) of coupling between slow and fast oscillations.

In ES+, we hypothesized that (1) pathological HFOs are more widely distributed and (2) slow oscillations show stronger coupling with pathological HFOs than in ES−.

Methods

We retrospectively reviewed 24 children with drug-resistant multilobar onset epilepsy, who underwent intracranial video electroencephalography prior to multilobar resections. We measured the OR of HFOs and determined the electrodes with a high rate of HFOs by cluster analysis. We calculated MI, which reflects the degree of coupling between HFO (ripple/fast ripple [FR]) amplitude and 5 different frequency bands of delta and theta activities (0.5-1 Hz, 1-2 Hz, 2-3 Hz, 3-4 Hz, 4-8 Hz).

Results

In ES+ (n = 10), the OR₍_FR_s), the number of electrodes with high-rate FRs, and the MI₍_FR_{s & 3-4 Hz)} in all electrodes were significantly higher than in ES− (n = 14). In both the ES+ and ES− groups, MI_(ripples/_FR_{s & 3-4 Hz)} was the highest among the 5 frequency bands. Within the good seizure outcome group, the OR₍_FR_s) and the MI₍_FR_{s & 3-4 Hz)} in the resected area in ES+ were significantly higher than in ES− (OR_[FR_s], P = .04; MI_[_FR_{s & 3-4 Hz]}, P = .04).

Significance

In ES+, the larger number of high-rate FR electrodes indicates more widespread epileptogenicity than in ES−. High values of OR₍_FR_s) and MI₍_FR_{s & 3-4 Hz)} in ES+ compared to ES− are a signature of the severity of epileptogenicity. We proved that ES+ children who achieved seizure freedom following multilobar resections exhibited strong coupling between slow oscillations and FRs.

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Neonatal phenobarbital exposure disrupts GABAergic synaptic maturation in rat CA1 neurons

Summary

Objective

Phenobarbital is the most commonly utilized drug for the treatment of neonatal seizures. The use of phenobarbital continues despite growing evidence that it exerts suboptimal seizure control and is associated with long-term alterations in brain structure, function, and behavior. Alterations following neonatal phenobarbital exposure include acute induction of neuronal apoptosis, disruption of synaptic development in the striatum, and a host of behavioral deficits. These behavioral deficits include those in learning and memory mediated by the hippocampus. However, the synaptic changes caused by acute exposure to phenobarbital that lead to lasting effects on brain function and behavior remain understudied.

Methods

Postnatal day (P)7 rat pups were treated with phenobarbital (75 mg/kg) or saline. On P13-14 or P29-37, acute slices were prepared and whole-cell patch-clamp recordings were made from CA1 pyramidal neurons.

Results

At P14 we found an increase in miniature inhibitory postsynaptic current (mIPSC) frequency in the phenobarbital-exposed as compared to the saline-exposed group. In addition to this change in mIPSC frequency, the phenobarbital group displayed larger bicuculline-sensitive tonic currents, decreased capacitance and membrane time constant, and a surprising persistence of giant depolarizing potentials. At P29+, the frequency of mIPSCs in the saline-exposed group had increased significantly from the frequency at P14, typical of normal synaptic development; at this age the phenobarbital-exposed group displayed a lower mIPSC frequency than did the control group. Spontaneous inhibitory postsynaptic current (sIPSC) frequency was unaffected at either P14 or P29+.

Significance

These neurophysiological alterations following phenobarbital exposure provide a potential mechanism by which acute phenobarbital exposure can have a long-lasting impact on brain development and behavior.

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Tanshinone IIA induces cell death via Beclin-1-dependent autophagy in oral squamous cell carcinoma SCC-9 cell line

Abstract

Tanshinone IIA (TAN) is one of the major functional compounds of Salvia miltiorrhiza Bunge and possesses the ability to suppress the growth of multiple cancer cell types via its apoptosis- and autophagy-inducing functions. In this study, the effect of TAN therapy on the survival of oral squamous cell carcinoma (OSCC) was evaluated, and the underlying mechanism involved in the treatment was investigated. Human oral squamous cell carcinoma cell SCC-9 was used for in vitro assays and induction in an OSCC xenograft mouse model. The tumor cells were subjected to TAN administration at different concentrations. Then the apoptosis and autophagy processes in SCC-9 cells were evaluated and the activities of Beclin-1/Atg7/Atg12-Atg5 and PI3K/Akt/mTOR pathways were determined. In addition, by knocking down the expression of Beclin-1 in SCC-9 cells, the study also assessed the role of the indicator in the anti-OSCC effect of TAN. Results of in vitro assays were further validated with an OSCC xenograft mouse model. Administration of TAN-induced cell apoptosis and upregulated the expression of cleaved-caspase-3. Simultaneously, the autophagy process in SCC-9 cells was initiated by TAN, which was signaled by the formation of autophagosomes and increase in the ratio of LC3 II/LC3I. The above processes were associated with the activation of Beclin-1/Atg7/Atg12-Atg5 signaling and inhibition of PI3K/Akt/mTOR signaling. Our results also inferred a partially Beclin-1-dependent mechanism of action of TAN in OSCC cells: knockdown of the Beclin-1 blocked the effect of TAN on SCC-9 cells both in vivo and in vitro. Our study provided a preliminary explanation of the mechanism involved in TAN effect: the agent exerted its autophagy-inducing effect against OSCC in a multipronged manner, by both inducing the Beclin-1/Atg7/Atg12-Atg5 pathway and suppressing the PI3K/Akt/mTOR pathway.

Suppressing effect of Tanshinone IIA (TAN) on the survival of oral squamous cell carcinoma (OSCC), which was dependent on the Beclin-1-induced autophagic process.

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Patient-Reported Outcomes in Psychological Treatment for an Adolescent Oncology Patient: A Case Report

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.

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Exploring Dynamics of the Chlorophyll a -Total Phosphorus Relationship at the Lake-Specific Scale: a Bayesian Hierarchical Model

Abstract

Lake eutrophication has become a worldwide challenge, and the empirical chlorophyll a-total phosphorus (Chla-TP) relationship provides a management target for TP concentrations. Neglecting the dynamics of the relationship at the lake-specific scale would mislead the eutrophication control strategy. The Bayesian hierarchical model (BHM) is a flexible tool to explore dynamics of the Chla-TP relationship and improves the overall estimation accuracy by partial pooling of data. In this study, we used the BHM to show the spatial and seasonal dynamics of the Chla-TP relationship in one of the most eutrophic lakes in China (Lake Dianchi). We defined an indicator (the Chla/TP ratio, CPR), to represent the susceptibility of Chla to TP. We conducted a model selection process and used the CPR-TP curves to show the spatial and seasonal dynamics of the Chla-TP relationships. We determined that the wind caused the spatial dynamics due to the horizontal transport of phytoplankton, while the water temperature and the percentage of soluble reactive phosphorus led to the seasonal dynamics via increasing the growth rate of phytoplankton. These findings helped the eutrophication control in Lake Dianchi. We found that compared with the strategy to decrease the TP concentration, decreasing the susceptibility is expected to be more effective. Finally, we concluded that exploring the dynamics of the Chla-TP relationship provided an important basis for eutrophication control at the lake-specific scale.

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Editorial Board

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Pneumocephalus and seizures following combined spinal-epidural for labor

Most cases of pneumocephalus following neuraxial blocks are associated with accidental dural puncture using loss of resistance to air for identification of the epidural space [1]. To our knowledge, there are no published reports in literature following use of saline for loss of resistance. We report the finding of simultaneous pneumocephalus and a cavernoma in a patient who received a combined spinal-epidural analgesia for labor, using loss of resistance to saline (LORS). The patient provided written consent for the authors to publish this report.

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Clinical experiences of unilateral anterior sub-costal quadratus lumborum block for a nephrectomy

Among several quadratus lumborum (QL) blocks, an anterior sub-costal QL block is a new technique, and there are only a few reports of this new approach in the literature [1,2]. In this case, we reported two cases in which we used the anterior sub-costal QL block for a nephrectomy.

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Emergency insertion of the LMA protector airway in patients in the lateral position

The LMAR Protector™ Airway (Teleflex Medical Japan, Tokyo, Protector), a new type of second generation airway, has an integrated cuff pressure indicator that allows continuous cuff pressure monitoring at a glance [1,2]. Continuous cuff pressure monitoring contributes to safe management in the perioperative period in all situations. Here, we report two cases in which the Protector was inserted in an emergency situation with the patient in the lateral position.

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Under pressure: Evaluating the role of intraoperative hemodynamics in postoperative acute kidney injury

In this issue of Journal of Clinical Anesthesia, Wu et al. describe their well-designed randomized trial investigating the impact of targeted mean arterial pressure (MAP) ranges on postoperative acute kidney injury (AKI) [1]. Their study is of pressing concern: postoperative AKI remains a source of shared apprehension among anesthesiologists, surgeons, and nephrologists, for which prevention and treatment strategies are a matter of ongoing debate. The healthcare burden of postoperative AKI is well-described: it is common, costly, and life-threatening.

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Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week

Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads.

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Lidocaine post-nasal dripping (LPND): An easy way for awake nasal intubation

Several techniques of topical anesthesia for awake fiberoptic intubation (AFOI) have been described such as "spray as you go" [1,2], nebulization [2], atomization [3,4] transtracheal injection [5]. These require multiple complicated steps [1,2], specialized equipment [2–4], and are invasive [5].

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Severe type B lactic acidosis and insulin-resistant hyperglycemia related to cadaveric kidney transplantation

Lactic acidosis, increased lactate levels >2mmol/L with a high anion gap metabolic acidosis, commonly occurs due to hypoperfusion/hypoxia (type A) but may also arise due to other causes, often overlooked, such as thiamine deficiency (type B) [1]. We report the perioperative occurrence of severe type B lactic acidosis with insulin-resistant hyperglycemia related to cadaveric kidney transplantation and its rapid resolution after intravenous thiamine administration. Written consent was obtained from the patient.

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Use of dexmedetomidine in a cardiac intensive care unit

Delirium, pain and agitation, known as the "triad of Intensive Care Units (ICU)" [1] are very common in critical patients. At least 20% of patients develop delirium during their stay in the ICU, reaching 80% in those receiving mechanical ventilation [2]. There is a need to identify these patients for appropriate treatment and prevention, as this neuronal dysfunction is associated with increased mortality, length of hospitalization, dependency and disability at discharge [3,4].

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Bilateral adductor canal block catheters in patients undergoing simultaneous bilateral knee arthroplasty: A series of 17 patients

Continuous adductor canal blocks (ACB) have been shown to reduce pain with knee flexion, decrease opioid consumption, and enhance ambulation following total knee arthroplasty [1]. Of the patients who undergo bilateral knee arthroplasties, a small subset have the procedures performed during the same operative encounter rather than a staged procedure [2]. These patients present additional perioperative pain and rehabilitation challenges, in addition to a longer length of hospital stay [2,3]. Adequate analgesia is imperative for immediate postoperative rehabilitation; however, there is a paucity of research regarding regional techniques for simultaneous bilateral knee arthroplasty (SBKA).

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Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis

Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity.

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Retroclavicular approach to infraclavicular brachial plexus block for distal radius fracture in a patient with implanted pacemaker

Patients with implanted pacemaker underwent upper limb surgery under regional anesthesia in the literature are rarely. We report a case of successful retroclavicular approach to infraclavicular brachial plexus block (RA-IBPB) in a patient with implanted pacemaker and with requiring open osteosynthesis due to distal radius fracture.

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Anesthetic management for laparoscopic sleeve gastrectomy to a child

Anesthesia for obese children undergoing weight loss surgery poses a challenge for the anesthetists given that this population has high risk of developing psychosocial and medical comorbidities such as pulmonary and cardiovascular disorders, hypertension, dyslipidemia, obstructive sleep apnea and type 2 diabetes mellitus [1–3].

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Ketorolac dose-response for acute pain is well known and the safety rules for adequate prescribing are clear

The study by Duttchen et al. [1] shows almost no difference in analgesic efficacy when comparing 15 and 30mg of IV ketorolac given intraoperatively to provide postoperative pain relief. In the discussion, the authors indicate that another 2017 study performed in an emergency department similarly showed that in patients with acute pain 10, 15 and 30mg are of similar analgesic efficacy [2], suggesting that these data are new.

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Takotsubo cardiomyopathy complicating thoracoabdominal aortic aneurysm repair

We describe the management of a patient with symptomatic spinal cord hypoperfusion after thoracoabdominal aortic aneurysm repair, where the neurological insult and associated emotional stress precipitated Takotsubo cardiomyopathy. Transthoracic Echocardiography showed akinetic mid and apical left ventricular segments, while basal segments were spared. Emergent coronary angiography ruled out acute coronary syndrome. Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury.

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SMARCB1/INI1/BAF47- deficient pleural malignant mesothelioma with rhabdoid features

Malignant mesothelioma (MM) with rhabdoid features is an MM variant. Fifteen cases have been reported previously, all of which were combined with other types of MM. Herein, we report an autopsy case of pleural MM with monomorphic rhabdoid features. The patient was a 62-year-old male without a history of asbestos exposure. An autopsy revealed a soft, granular tumor that replaced the entire left pleura and had invaded to the diaphragm and lower lobe of the lung. The tumor cells, which had eosinophilic plump cytoplasm and eccentric nuclei, were loosely cohesive. Immunohistochemistry showed that the cells were diffusely positive for calretinin, D2-40, vimentin, CAM5.2, and AE1/AE3; and negative for WT-1, TTF-1, CK7, CEA, desmin, CD34, BCL-2, S100 protein, and p40. Neither homozygous deletion of p16 nor BAP-1 protein loss was observed. Loss of INI1/BAF47 protein, an indicator of malignant rhabdoid tumor, was observed. Therefore, MM with rhabdoid features was confirmed.

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MiR-449a suppresses cell migration and invasion by targeting PLAGL2 in breast cancer

Publication date: Available online 5 January 2018
Source:Pathology - Research and Practice
Author(s): Bin Xu, Xiping Zhang, Shanshan Wang, Bailing Shi
BackgroundBreast cancer is one of the most common malignancies worldwide. However, the detailed molecular mechanisms underlying breast cancer metastasis are still incompletely clear. MicroRNAs (miRNAs) play a crucial role in cancer metastasis. In this study, we aimed to analyze the expression and function of miR-449a in breast cancer.Material and MethodsA total of 15 human primary breast cancer tissues and adjacent non-cancerous tissues (10 pairs) were obtained. MiR-449a was examined in tumor tissues and adjacent nontumorous tissues of breast cancer patients and cell lines by real-time PCR. The protein expression levels were analyzed by western blot and immunohistochemistry staining. Luciferase reporter assays was used to validate the target of miR-449a. The effect of miR-449a on breast cancer cell migration and invasion were studied in vitro and in vivo.ResultsThe expression levels of miR-449a were significantly decreased in breast cancer tissues and cell lines. Overexpression of miR-449a suppressed breast cancer cell proliferation, clone formation, migration, invasion and metastasis in vitro and in vivo. Pleomorphic adenoma gene like-2 (PLAGL2) was identified as a major target of miR-449a. Both overexpression of miR-449a inhibited the expression of PLAGL2 significantly and the knockdown of PLAGL2 expression inhibited the breast cancer cell proliferation and metastasis.ConclusionWe demonstrate the miR-449a tumor suppressor role in breast cancer cell migration and invasion via targeting PLAGL2. These findings suggesting that miR-449a/PLAGL2 could serve as a therapeutic strategy for targeting breast cancer.

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Preoperative to postoperative change in neutrophil-to-lymphocyte ratio predict survival in colorectal cancer patients

Future Oncology, Ahead of Print.

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Issue Information - Ed Board

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Spatial and Cellular Expression Patterns of Erythropoietin-Receptor and Erythropoietin during a 42-Day Post-Lesional Time Course after Graded Thoracic Spinal Cord Impact Lesions in the Rat

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

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Suspected ontogeny of a recently described hypo-androgenic PCOS-like phenotype with advancing age

Abstract

Background

A recent report described a new PCOS-like phenotype in lean older infertile women, and was characterized by high age-specific anti-Müllerian hormone (AMH) but hypo- rather than the expected hyper-androgenism. The hypo-androgenism was, furthermore, characterized of, likely, adrenal origin and autoimmune etiology.

Patients and methods

We extracted data on 708 consecutive infertility patients, and separated them into three age-strata, <35, 36–42, and >42 years. In each stratum, we investigated how levels of anti-Müllerian hormone (AMH) and testosterone (T) interrelate between high-AMH (AMH ≥ 75th quantile) and normal AMH (25th–75th quantile) and low-T (total testosterone ≤19.0 ng/dL), normal-T (19.0–29.0 ng/dL) and high-T (>29.0 ng/dL). High-AMH cycles were presumed to reflect PCOS-like patients. Routine in vitro fertilization (IVF) cycle outcomes and clinical phenotypes of patients were then compared between groups with AMH and T as statistical variables.

Results

This hypo-androgenic PCOS-like phenotype already exists in age stratum <35 years. It appears to arise from a lean, at very young ages hyper-androgenic PCOS phenotype that develops in comparison to controls (likely autoimmune-induced) insufficiency of the adrenal zona reticularis (low-T and low-DHEAS) and zona fasciculata (low-C), and is characterized by frequent evidence of autoimmunity. A degree of adrenal insufficiency, thus, concomitantly appears to affect adrenal androgen and, to lesser degrees, glucocorticoid production (mineralocorticoids were not investigated).

Conclusions

Here investigated new PCOS-like phenotype demonstrates features compatible with what under Rotterdam criteria has been referred to as PCOS phenotype-D. If confirmed, the observation that the ontogeny of this phenotype already at young ages is, likely, driven by adrenal autoimmunity, supports the position of the androgen excess and PCOS society that the etiology of phenotype-D differs from that of classical hyper-androgenic PCOS of mostly ovarian etiology.

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Suspected ontogeny of a recently described hypo-androgenic PCOS-like phenotype with advancing age

Abstract

Background

Patients and methods

Results

Conclusions

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Breast carcinoma with 21-gene recurrence score lower than 18: rate of locoregional recurrence in a large series with clinical follow-up

Abstract

Background

The 21-gene recurrence score (RS) assay determines the benefit of adding chemotherapy to endocrine therapy for patients with early stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. The RS risk groups predict the likelihood of distant recurrence and have recently been associated with an increased risk of locoregional recurrence (LRR). This study analyzed clinicopathologic features of patients with low RS and LRR.

Methods

In our institutional database, we identified 1396 consecutive female patients with lymph node negative, ER+/HER2- invasive breast carcinoma and low RS (<18) results, treated at our center from 2008 to 2013. We collected data on clinicopathologic features, treatment and outcome.

Results

The median patient age was 57 years (range 22–90). The median tumor size was 1.2 cm (range 0.3–5.8). Overall, 66.6% (930/1396) women were treated with breast conserving surgery (BCS) and radiation therapy, 3.4% (48/1396) with BCS alone, 29.7% (414/1396) with total mastectomy, and 0.3% (4/1396) with total mastectomy and radiation therapy. Most patients (84.8%; 1184/1396) received endocrine therapy alone, 12.1% (169/1396) were treated with chemotherapy plus endocrine therapy, and only 3.1% (43/1396) received no systemic therapy. At a median follow-up of 52 months, 0.9% (13/1396) of patients developed LRR. Sites of LRR included the ipsilateral breast (n = 8), chest wall (n = 3), axillary node (n = 1), and internal mammary node (n = 1). All patients with LRR had negative resection margins at the initial surgery. The rate of LRR in patients treated with adjuvant endocrine therapy alone was 0.7% (8/1184). All eight patients received standard local treatment. Three patients had lymphovascular invasion but no other significant risk factors for LRR were identified.

Conclusions

Our study of node negative, ER+/HER2- breast cancer patients with low RS observed extremely low rates of LRR: 0.9% (13/1396) in the whole cohort and 0.7% (8/1184) in patients treated with endocrine therapy alone. As the largest series to date, we report detailed clinicopathologic data and clinical outcomes of this cohort and provide a comprehensive characterization of patients who developed LRR.

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A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States – How, what and when?

Abstract

Background

Interventions to improve fecal testing for colorectal cancer (CRC) exist, but are not yet routine practice. We conducted this systematic review to determine how implementation strategies and contextual factors influenced the uptake of interventions to increase Fecal Immunochemical Tests (FIT) and Fecal Occult Blood Testing (FOBT) for CRC in rural and low-income populations in the United States.

Methods

We searched Medline and the Cochrane Library from January 1998 through July 2016, and Scopus and clinicaltrials.gov through March 2015, for original articles of interventions to increase fecal testing for CRC. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. A qualitative synthesis described the relationship between changes in fecal testing rates for CRC, intervention components, implementation strategies, and contextual factors. A technical expert panel of primary care professionals, health system leaders, and academicians guided this work.

Results

Of 4218 citations initially identified, 27 unique studies reported in 29 publications met inclusion criteria. Studies were conducted in primary care (n = 20, 74.1%), community (n = 5, 18.5%), or both (n = 2, 7.4%) settings. All studies (n = 27, 100.0%) described multicomponent interventions. In clinic based studies, components that occurred most frequently among the highly effective/effective study arms were provision of kits by direct mail, use of a pre-addressed stamped envelope, client reminders, and provider ordered in-clinic distribution. Interventions were delivered by clinic staff/community members (n = 10, 37.0%), research staff (n = 6, 22.2%), both (n = 10, 37.0%), or it was unclear (n = 1, 3.7%). Over half of the studies lacked information on training or monitoring intervention fidelity (n = 15, 55.6%).

Conclusions

Studies to improve FIT/FOBT in rural and low-income populations utilized multicomponent interventions. The provision of kits through the mail, use of pre-addressed stamped envelopes, client reminders and in-clinic distribution appeared most frequently in the highly effective/effective clinic-based study arms. Few studies described contextual factors or implementation strategies. More robust application of guidelines to support reporting on methods to select, adapt and implement interventions can help end users determine not just which interventions work to improve CRC screening, but which interventions would work best in their setting given specific patient populations, clinical settings, and community characteristics.

Trial registration

In accordance with PRISMA guidelines, our systematic review protocol was registered with PROSPERO, the international prospective register of systematic reviews, on April 16, 2015 (registration number CRD42015019557).

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Doxorubicin resistance in breast cancer cells is mediated by extracellular matrix proteins

Abstract

Background

Cancer cell resistance to therapeutics can result from acquired or de novo-mediated factors. Here, we have utilised advanced breast cancer cell culture models to elucidate de novo doxorubicin resistance mechanisms.

Methods

The response of breast cancer cell lines (MCF-7 and MDA-MB-231) to doxorubicin was examined in an in vitro three-dimensional (3D) cell culture model. Cells were cultured with Matrigel™ enabling cellular arrangements into a 3D architecture in conjunction with cell-to-extracellular matrix (ECM) contact.

Results

Breast cancer cells cultured in a 3D ECM-based model demonstrated altered sensitivity to doxorubicin, when compared to those grown in corresponding two-dimensional (2D) monolayer culture conditions. Investigations into the factors triggering the observed doxorubicin resistance revealed that cell-to-ECM interactions played a pivotal role. This finding correlated with the up-regulation of pro-survival proteins in 3D ECM-containing cell culture conditions following exposure to doxorubicin. Inhibition of integrin signalling in combination with doxorubicin significantly reduced breast cancer cell viability. Furthermore, breast cancer cells grown in a 3D ECM-based model demonstrated a significantly reduced proliferation rate in comparison to cells cultured in 2D conditions.

Conclusion

Collectively, these novel findings reveal resistance mechanisms which may contribute to reduced doxorubicin sensitivity.

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TMS of primary motor cortex with a biphasic pulse activates two independent sets of excitable neurones

Publication date: Available online 5 January 2018
Source:Brain Stimulation
Author(s): Martin Sommer, Matteo Ciocca, Raffaella Chieffo, Paul Hammond, Andreas Neef, Walter Paulus, John C. Rothwell, Ricci Hannah
BackgroundBiphasic pulses produced by most commercially available TMS machines have a cosine waveform, which makes it difficult to study the interaction between the two phases of stimulation.ObjectiveWe used a controllable pulse TMS (cTMS) device delivering quasi-rectangular pulse outputs to investigate whether monophasic are more effective than biphasic pulses.MethodsTemporally symmetric ("biphasic") or highly asymmetric ("monophasic") charge-balanced biphasic stimuli were used to target the hand area of motor cortex in the anterior-posterior (AP) or posterior-anterior (PA) initial current direction.ResultsWe observed the lowest motor thresholds and shortest motor evoked potential (MEP) latencies with initial PA pulses, and highest thresholds and longest latencies with AP pulses. Increasing pulse symmetry tended to increase threshold with a PA direction whereas it lowered thresholds and shortened latencies with an AP direction. Furthermore, it steepened the MEP input-output curve with both directions.Conclusions"Biphasic" TMS pulses can be viewed as two monophasic pulses of opposite directions, each stimulating a different set of interneurons with different thresholds (PA < AP). At threshold, the reverse phase of an initially PA pulse increases threshold compared with "monophasic" stimulation. At higher intensities, the reverse phase begins to activate AP-sensitive neurones and increase the effectiveness of stimulation above that of a "monophasic" PA pulse. "Biphasic" stimulation with initially AP pulses is dominated at threshold by activation produced by the lower threshold reverse (PA) phase.SignificanceThe effects of biphasic stimulation are best understood as the summed output of two independent sets of directionally selective neural populations.

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Expressions and clinical significance of HER4 and CD44 in sinonasal mucosal malignant melanoma

Sinonasal mucosal malignant melanoma (SNMMM) is a rare disease. The aim of this study was to investigate the expressions of HER4 and CD44 in human SNMMM tissues and their relationship with the clinicopathological features and prognosis of patients. In total, 64 paraffin-embedded samples of SNMMM treated in our hospital from 29 December 1999 to 24 June 2011 were collected. HER4 and CD44 were detected in the tissues of SNMMM by immunohistochemistry. The differences in the HER4 and CD44 expressions in the tissues were evaluated and matched with clinicopathological parameters and the survival rate, respectively. The positive rates of the HER4 and CD44 expressions were 70.3 and 65.6%, respectively; the positive expression of HER4 was correlated with a positive expression of CD44 (P0.05). The expressions of HER4 and CD44 were not significantly correlated with sex, age, pigment, tumor site, etc. (P>0.05). Our results further emphasize a correlation between HER4 and CD44 expressions in SNMMM tissues and point out that a positive HER4 expression might be an important factor in valuing the prognosis of patients with SNMMM. *Wenjia Zhu and Shimin Li contributed equally to the writing of this article. Correspondence to Shuyi Wang, MD, Department of Pathology, Eye and ENT Hospital, Fudan University, #83 Fenyang Road, Xuhui District, Shanghai 200031, China Tel: +86 138 168 80539; fax: +86 021 643 77134;e-mail: wangshuyi@eent.shmu.edu.cn Received August 7, 2017 Accepted December 14, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparative outcomes and toxicities for ruthenium-106 versus palladium-103 in the treatment of choroidal melanoma

For the treatment of choroidal melanoma, palladium-103 (103Pd) and ruthenium-106 (106Ru) plaque brachytherapy shows reduced toxicity compared with the historical standard iodine-125. No report has directly compared the clinical outcomes between 103Pd and 106Ru, and the reasons for the selection of one over the other remain purely theoretical. Patients with choroidal melanoma with apical tumor height up to 5 mm were included. Patients from Emory University were treated with 103Pd between 1993 and 2012. Patients from Cleveland Clinic were treated with 106Ru between 2005 and 2010. Medical records were retrospectively reviewed. We compared post-treatment visual acuity (VA), toxicity, and oncologic outcomes. 103Pd patients (n=124) and 106Ru patients (n=42) had a median follow-up of 4.2 and 5.0 years, respectively. Radiation retinopathy-free survival was similar for both radioisotopes, but 106Ru had lower grades of retinopathy (P=0.006). 103Pd was associated with worse VA preservation (≥20/40) by year 3 (odds ratio: 3.8; 95% confidence interval: 1.01–14.31, P=0.048). 103Pd was associated with higher distant metastases-free survival (DMFS) in multivariate analysis (hazard ratio: 0.10; 95% confidence interval: 0.02–0.38; P

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Nuclear translocation of DJ-1 protects adult neuronal stem cells in an MPTP mouse model of Parkinson’s disease

DJ-1, originally identified as an oncogene product, is involved in multiple processes, including cellular transformation, the oxidative stress response, and transcriptional regulation. We had previously found that DJ-1 was closely associated with the proliferation and differentiation of cultured neuronal stem cells. In this study, we further investigated the functions of DJ-1 to determine how adult neurogenesis was affected in the subgranular zones (SGZ), subventricular zone (SVZ), and olfactory bulb (OB), which are brain areas closely related to early nonmotor symptoms of Parkinson's disease, using a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mouse model of Parkinson's disease. The results showed that the numbers of 5-bromo-2-deoxyuridine-positive (BrdU+) cells in the SGZ and SVZ of mice in the MPTP group were not significantly different from those in the saline controls, whereas the number of BrdU+ cells in the olfactory granule cell layer and glomerulus layer of the OB in the MPTP group changed markedly. We also found that DJ-1 was translocated into the nuclei of BrdU+ cells in the SGZ and SVZ, but not in the OB. This may indicate that the nuclear translocation of DJ-1 in the SGZ and SVZ protects adult neuronal stem cells from damage caused by MPTP so that the normal number is maintained, but is not involved in the protective mechanism in the OB. Correspondence to Yi Sun, PhD, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, No. 38 Xue Yuan Road, Haidian Dist, Beijing 100191, China Tel: +86 10 82802648; fax: +86 10 82802431; e-mail: sunyi@bjmu.edu.cn Received October 11, 2017 Accepted November 28, 2017 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Mirror imaging of finger mechanical stimulation affects secondary somatosensory response

The aim of this study was to investigate the effect of finger-tip touch on the somatosensory cortex under mirror imaging conditions. Magnetoencephalographic recordings of somatosensory-evoked field responses to mechanical tactile stimulation of the index finger in both hands were obtained for the right-handed healthy participants as part of the following mirror or nonmirror tasks. Both hands were screened and mechanical stimuli were delivered to the right index finger pulp. A mirror was placed in front of the patient with the right hand facing the reflective surface, as if it were the left side (mirror task). Another task comprised the screening of right hands behind a partition, after which mechanical stimuli were delivered to the right index finger pulp without a mirror (nonmirror task). The same tasks for the left hand were also examined. The estimated current dipoles were identified and analyzed. In the measurements following all the tasks, the equivalent current dipoles (ECDs) were estimated in the corresponding contralateral primary somatosensory area (cSI). The other ECDs were estimated in the secondary somatosensory area both contralateral (cSII) and ipsilateral (iSII) to the stimulus side. The amplitudes of ECDs in the cSII area following the left index stimuli in the mirror task were significantly larger than those in the nonmirror task (P=0.043). The mirror effect on the somatosensory cortex in this study may be small, but a positive variation was shown in the form of a response to the actual stimulation in the hand opposite to the hand which was hidden behind the mirror. Correspondence to Kazuyoshi Nakanishi, MD, PhD, Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan., 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan Tel: +81 822 575 232; fax: +81 822 575 234; e-mail: kazn@hiroshima-u.ac.jp Received December 10, 2017 Accepted December 15, 2017 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Calcium-regulated chloride channel anoctamin-1 is present in the suprachiasmatic nuclei of rats

Calcium-regulated chloride channel (CaCC) anoctamin-1 has been recently identified in neurons. In neurons, which express the Na+–K+–2Cl− cotransporter, activation of CaCCs increases firing frequency, by reversion between the Cl− equilibrium potential and the membrane resting potential, leading to membrane depolarization by Cl− extrusion from the cell. Although there are no reports of CaCCs present in the suprachiasmatic nuclei (SCN), the fact that Na+–K+–2Cl− cotransporter is present in SCN neurons, where it has been shown to be involved in the excitatory effects of γ-aminobutyric acid, together with the increase of neuronal firing rate induced by release of intracellular Ca2+ after administration of 100 nM ryanodine, leads us to determine whether CaCCs are present in the SCN. Immunohistochemistry and western blots show the expression of the CaCCs anoctamin-1 protein. Quantitative PCR demonstrated the expression of anoctamin-1 mRNA in the SCN. These results clearly indicate the presence of CaCC in SCN of rats. Correspondence to Raúl Aguilar-Roblero, MD, PhD, Departamento de Neurociencias Cognitivas, División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, PO Box 70-253, Mexico City 04510, Mexico Tel: +52 55 5622 5650; fax: +52 55 5622 5607; e-mail: raguilar@ifc.unam.mx Received October 27, 2017 Accepted October 31, 2017 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Practice-Based Patient Management Strategies in Gluteal Augmentation with Implants

Publication date: Available online 5 January 2018
Source:Clinics in Plastic Surgery
Author(s): Douglas M. Senderoff

Teaser

This article focuses on practice-based recommendations for surgeons performing gluteal augmentation with implants (GAI). Preoperative planning, including the indications, precautions, and contraindications to GAI, is discussed. Advantages and disadvantages of subfascial and intramuscular implantation are addressed along with recommendations for implant size, shape, and position. Recommendations for patient management before and after surgery along with operative and nonoperative strategies for postoperative complications, including wound dehiscence, infection, and seroma, are included. Aesthetic concerns and recommendations for the management of poor results are addressed. A comprehensive literature review is included along with illustrative preoperative and postoperative photos.

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Endoscopic Management of Developmental Anomalies of the Skull Base

J Neurol Surg B
DOI: 10.1055/s-0037-1615815

Developmental anomalies of the skull base may present in childhood or as an adult. The most common pathologies include dermoid, encephalocele, and glioma. Encephaloceles may present as part of a syndrome. Other entities include infantile hemangiomas and teratoma. Endoscopic techniques provide a less invasive and morbid option for treatment. Proper evaluation and treatment is necessary to prevent complications such as meningitis.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Developmental Considerations in Pediatric Skull Base Surgery

J Neurol Surg B
DOI: 10.1055/s-0037-1617449

Objectives To review developmental surgical anatomy and technical nuances related to pediatric skull base surgery. Design Retrospective, single-center case series with literature review. Setting MD Anderson Cancer Center. Participants Patients undergoing pediatric skull base surgery. Main Outcome Measures Review developmental anatomy of the pediatric skull base as it relates to technical nuance of various surgical approaches and insight gained from a 25-year institutional experience with this unique patient population. Results Thirty-nine patients meeting these criteria were identified over a 13-year period from 2003 to 2016 and compared to a previously reported earlier cohort from 1992 to 2002. The most common benign pathologies included nerve sheath tumors (11%), juvenile nasopharyngeal angiofibromas (9.5%), and craniopharyngiomas (4.8%). The most common malignancies were chondrosarcoma (11%), chordoma (11%), and rabdomyosarcoma (11%). Varied surgical approaches were utilized and were similar between the two cohorts save for the increased use of endoscopic surgical techniques in the most recent cohort. The most common sites of tumor origin were the infratemporal fossa, sinonasal cavities, clivus, temporal bone, and parasellar region. Gross total resection and postoperative complication rates were similar between the two patient cohorts. Conclusions Pediatric skull base tumors, while rare, often are treated surgically, necessitating an in depth understanding of the anatomy of the developing skull base.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Fibro-Osseous Lesions of the Skull Base in the Pediatric Population

J Neurol Surg B
DOI: 10.1055/s-0037-1617440

Fibro-osseous lesions of the skull base include a variety of lesions with different biologic behavior. The most common lesions include fibrous dysplasia, osteoma, aneurysmal bone cyst, and juvenile ossifying fibroma. The diagnosis can usually be established with radiographic imaging. In the absence of symptoms, slow-growing lesions can often be observed. When surgery is indicated for relief of symptoms, endoscopic endonasal techniques are well suited for all age groups.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Skull Base Reconstruction in the Pediatric Patient

J Neurol Surg B
DOI: 10.1055/s-0037-1615806

Introduction Pediatric skull base and craniofacial reconstruction presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Objectives To suggest an algorithm for skull base reconstruction in children and adolescents after tumor resection. Materials and Methods Comprehensive literature review and summary of our experience. Results We advocate soft-tissue reconstruction as the primary technique, reserving bony flaps for definitive procedures in survivors who have reached skeletal maturity. Free soft-tissue transfer in microvascular technique is the mainstay for reconstruction of large, three-dimensional defects, involving more than one anatomic region of the skull base, as well as defects involving an irradiated field. However, to reduce total operative time, intraoperative blood loss, postoperative hospital stay, and donor-site morbidity, locoregional flaps are better be considered the flap of first choice for skull base reconstruction in children and adolescents, as long as the flap is large enough to cover the defect. Our "workhorse" for dural reconstruction is the double-layer fascia lata. Advances in endoscopic surgery, image guidance, alloplastic grafts, and biomaterials have increased the armamentarium for reconstruction of small and mid-sized defects. Conclusions Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Relevance of 3d culture systems to study osteosarcoma environment

Osteosarcoma (OS) is the most common primary malignant tumor of bone, which preferentially develops lung metastasis. Although standard chemotherapy has significantly improved long-term survival over the past f...

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The Prevalence of Cosmetic Facial Plastic Procedures among Facial Plastic Surgeons

Facial plast Surg
DOI: 10.1055/s-0037-1617423

This is the first study to report on the prevalence of cosmetic facial plastic surgery use among facial plastic surgeons. The aim of this study is to determine the frequency with which facial plastic surgeons have cosmetic procedures themselves. A secondary aim is to determine whether trends in usage of cosmetic facial procedures among facial plastic surgeons are similar to that of nonsurgeons. The study design was an anonymous, five-question, Internet survey distributed via email set in a single academic institution. Board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) were included in this study. Self-reported history of cosmetic facial plastic surgery or minimally invasive procedures were recorded. The survey also queried participants for demographic data. A total of 216 members of the AAFPRS responded to the questionnaire. Ninety percent of respondents were male (n = 192) and 10.3% were female (n = 22). Thirty-three percent of respondents were aged 31 to 40 years (n = 70), 25% were aged 41 to 50 years (n = 53), 21.4% were aged 51 to 60 years (n = 46), and 20.5% were older than 60 years (n = 44). Thirty-six percent of respondents had a surgical cosmetic facial procedure and 75% has at least one minimally invasive cosmetic facial procedure. Facial plastic surgeons are frequent users of cosmetic facial plastic surgery. This finding may be due to access, knowledge base, values, or attitudes. By better understanding surgeon attitudes toward facial plastic surgery, we can improve communication with patients and delivery of care. This study is a first step in understanding use of facial plastic procedures among facial plastic surgeons.
[...]

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

Article in Thieme eJournals:
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Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars

Facial plast Surg
DOI: 10.1055/s-0037-1606096

Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords "scar(s)," "acne vulgaris," "carbon dioxide," and "fraction* laser(s)" for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.
[...]

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

Article in Thieme eJournals:
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Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries

This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21–0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature. Accepted for publication October 9, 2017. Address correspondence to: Marina Gitman, MD, Department of Anesthesiology, College of Medicine, University of Illinois, 1740 W Taylor St, Suite 3200 W, Chicago, IL 60612 (e-mail: gitman@uic.edu). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Obtaining Adequate Lamina Propria for Subepithelial Fibrosis Evaluation in Pediatric Eosinophilic Esophagitis

Subepithelial fibrosis in eosinophilic esophagitis (EoE) can be detected only in esophageal biopsies with adequate amounts of lamina propria (LP). We investigated how often pediatric esophageal biopsies contain adequate LP, and whether esophageal eosinophilia influences the acquisition rates.

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Effectiveness of cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus

The use of a transparent cap has been found to be effective in retrieval of esophageal foreign body. However, data on the use of a cap in food bolus obstruction (FBO) are limited. This study aims to assess the effectiveness of a cap-assisted technique compared with conventional techniques in removal of FBO.

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Endoscopic mucosal resection of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and outcomes of a tertiary referral cohort (with video)

Endoscopic mucosal resection (EMR) of peri-appendiceal sessile laterally spreading lesions (PA-LSLs) is technically demanding due to poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs.

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Comparison of the diagnostic performance between magnifying chromoendoscopy and magnifying narrow-band imaging for superficial colorectal neoplasm: an online survey

Magnifying narrow-band imaging (mag-NBI) and magnifying chromoendoscopy using crystal violet staining for pit pattern analysis (pit pattern) is highly accurate for invasion depth diagnosis for superficial colorectal neoplasm. However, NBI and pit pattern have not been compared.

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Technical feasibility, diagnostic yield, and safety of micro forceps biopsies during EUS evaluation of pancreatic cystic lesions (with video)

Through-the-needle micro forceps are a recent addition to the EUS armamentarium for evaluation of pancreatic cystic lesions (PCLs). The main aim of this study was to assess the technical feasibility, diagnostic yield and safety of EUS-guided micro forceps biopsy for PCLs.

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Pancreatic cancer screening in high-risk individuals with germline genetic mutations

Pancreas cancer (PC) is a deadly disease, which is most commonly diagnosed at an incurable stage. Different high-risk genetic variants and cancer syndromes increase the lifetime risk of developing PC. This study aims to assess the yield of initial PC screening in patients with high-risk germline mutations.

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High Channel Count Microphone Array Accurately and Precisely Localizes Ultrasonic Signals from Freely-Moving Mice

Publication date: Available online 5 January 2018
Source:Journal of Neuroscience Methods
Author(s): Megan R. Warren, Daniel T. Sangiamo, Joshua P. Neunuebel
BackgroundAn integral component in the assessment of vocal behavior in groups of freely interacting animals is the ability to determine which animal is producing each vocal signal. This process is facilitated by using microphone arrays with multiple channels.New Method and Comparison with Existing MethodsHere, we made important refinements to a state-of-the-art microphone array based system used to localize vocal signals produced by freely interacting laboratory mice. Key changes to the system included increasing the number of microphones as well as refining the methodology for localizing and assigning vocal signals to individual mice.ResultsWe systematically demonstrate that the improvements in the methodology for localizing mouse vocal signals led to an increase in the number of signals detected as well as the number of signals accurately assigned to an animal.ConclusionsThese changes facilitated the acquisition of larger and more comprehensive data sets that better represent the vocal activity within an experiment. Furthermore, this system will allow more thorough analyses of the role that vocal signals play in social communication. We expect that such advances will broaden our understanding of social communication deficits in mouse models of neurological disorders.

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The transgenic mouse line Igsf9-eGFP allows targeted stimulation of inferior olive efferents

Publication date: 15 February 2018
Source:Journal of Neuroscience Methods, Volume 296
Author(s): Christina Pätz, Simone Brachtendorf, Jens Eilers
BackgroundThe inferior olive (IO) innervates the cerebellum forming synapses in the deep cerebellar nuclei (DCN) and the cerebellar cortex. Beside the well-known exception of synapses on Purkinje neurons, synapses between IO efferents and other neuronal targets have not been studied intensively, mostly due to the technical challenge of unequivocally identifying IO efferents in electrophysiological experiments.New methodWe describe the transgenic mouse line Igsf9-eGFP, which expresses GFP in IO neurons, as a suitable tool for studying IO efferents using live imaging, immunohistochemistry and electrophysiology.ResultsIn the Igsf9-eGFP line, GFP-positive neurons are found in all IO subnuclei. Their efferents show the expected trajectories innervating the DCN and, as climbing fibers (CFs), the cerebellar cortex. In the DCN the dentate nucleus shows the strongest innervation, and, within the cerebellar cortex, CFs show a rostral-to-caudal gradient. GFP-positive CFs undergo a normal postnatal maturation, and evoke normal synaptic responses in Purkinje neurons and DCN neurons.Comparison with existing methodsIO efferents have been labelled via anterograde labelling, viral transfection and in transgenic mouse lines. The latter approach does not require stereotactic injections. However, available mouse lines show only a sparse GFP expression, harbor GFP-positive axons of other cerebellar fibers, or have not been characterized in detail.ConclusionsThe Igsf9-eGFP line is characterized by a moderate density of GFP-positive IO efferents, which can be visually targeted for extracellular stimulation with micrometer precision. The mouse line will allow studying fiber-specific responses in all neurons targeted by the IO.

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Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study

The purpose of this study was to evaluate epidemiologic characteristics of a treatment-seeking population referred to a private practice community voice clinic.

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Complications in Orthognathic Surgery

The aim of this study was to analyze the presence of complications related to orthognathic surgery performed by surgeons in train. A retrospective study was conducted between 2005 and 2014, analyzing the clinical records of patients treated in the authors' Department. Patients who underwent orthognathic surgery were included, under a bidimensional analysis and with the conventional orthosurgical sequence; intraoperative complications were identified, such as the occurrence of a bad split, bleeding, tissue injury, among others and postoperative variables such as impaired sensation, infection, and alterations in the osteosynthesis systems. A statistical analysis was done using χ2 and Student t tests, considering a statistical significance when P

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Protection of Inferior Alveolar Neurovascular Bundle in Alveolar Bone Operation

Purpose: The aim of this study was to investigate the protection of the inferior alveolar neurovascular bundle in alveolar bone operation in conditions such as chronic osteomyelitis and cementoma. Patients and Methods: The study enrolled 7 cases, 4 with chronic osteomyelitis and 3 with cementoma with pain. Computed tomography scan and 3-dimensional reconstruction were performed for the diseases. Data were processed by ProPlan CMF 1.3 software. The edge of lesion was defined and the inferior alveolar nerve was marked. Template was designed to guide the osteotomy line. Piezosurgery was used for osteotomy, with the avoidance of nerve canal. Current perception threshold (CPT) was performed to evaluate the nerve function after operation. Results: The CPT difference of the affected side before and after operation showed no statistically significant differences compared with that of the unaffected side (P = 0.0556). Conclusions: Digital template protects the inferior alveolar neurovascular bundle with the aid of piezosurgery during alveolar bone resection, which obtained satisfying clinical results. As powerful assistive tools of functional surgery, digital template and piezosurgery achieve both the purposes of treatment and function. Address correspondence and reprint requests to Minjie Chen, MD, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-zao-ju Road, Shanghai 200011, China; E-mail: chenminjietougao@126.com; 407102560@qq.com Received 6 April, 2017 Accepted 4 October, 2017 The authors disclose no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Interpositional Arthroplasty by Temporalis Fascia Flap and Galea Aponeurotica Combined With Distraction Osteogenesis: a Modified Method in Treatment of Adult Patients With Temporomandibular Joint Ankylosis and Mandibular Dysplasia

Background: Interpositional arthroplasty (IPA) with temporalis fascia flap has been one of the most frequently performed procedures to treat temporomandibular joint (TMJ) ankylosis. However, recurrence often occurs when the flap lacks bulk or atrophies. Whether to perform IPA or distraction osteogenesis (DO) first has long been a controversial issue when patients presented mandibular dysplasia (MD). This study provided IPA a new graft material sufficient to prevent recurrence, combined the modified protocol of performing DO 6 months after IPA, and evaluated its efficacy in treating TMJ ankylosis patients with MD. Methods: Six patients with unilateral TMJ ankylosis and MD were treated in the authors' study. The temporalis fascia flap and part of adjacent galea aponeurotica were filled the space after surgical release. Mouth-opening exercises started immediately post-IPA. Distraction osteogenesis was performed 6 months after IPA and had a 4-month consolidation. The maximum interincisal distance at preoperative, immediately post-IPA and the latest follow-up were recorded, as was the distraction length. The body mass index was measured at each patient's postoperative visit. Result: All patients had significant improvements in facial aesthetic, mouth-opening, and occlusion. No major complication or recurrence was observed at 3 to 4 years' follow-up. The mean maximum interincisal distance was 4.83 ± 2.79 mm preoperative and 35.67 ± 3.39 mm at the latest follow-up. The mean distraction distance was 16.17 ± 5.98 mm. The body mass index improved from 17.33 ± 0.64 kg/m2 preoperative to 18.75 ± 0.60 kg/m2 before DO. Conclusions: Temporalis fascia flap and adjacent galea aponeurotica as new graft materials are recommended for IPA. The modified staged treatment proved to be reliable and effective to prevent recurrence, improve mandibular length and final occlusion. Address correspondence and reprint requests to Bing Yu, MD, The Craniofacial Center One, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing 100144, China; E-mail: bybybysun@163.com Received 4 May, 2017 Accepted 4 October, 2017 This study was funded by China Scholarship Council. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Patient Perception and Satisfaction Questionnaire for Microtia Reconstruction: A New Clinical Tool to Improve Patient Outcome

Background: Patients' satisfaction is an increasingly important indicator for successful ear reconstruction surgeries. However, there is no scientifically sound patient-based outcome instrument in this field. This study aims at developing a patient-reported outcome measure for microtia reconstruction for investigating patients' satisfaction and perception of reconstructed ear and clinical researches. Methods: The development of questionnaire included 3 stages. Traditional psychometric tests were used for analysis. At first stage, a preliminary version of the questionnaire was developed using qualitative methods, including interviews with 10 patients. At second stage, the questionnaire was field tested by survey of 76 patients. Redundant items were deleted; acceptability, reliability, and responsiveness were examined. At third stage, survey was conducted to another 94 patients with the shortened questionnaire to further evaluate the acceptability, reliability, and validity. Results: A questionnaire of 12 items for microtia reconstruction was developed. Results demonstrated the instrument satisfied the current criteria. The acceptability (missing data 0.80, item-total correlations >0.7, interitem correlation

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Wedge Osteotomy for Correction of Chin Asymmetry

Chin deviation is generally the visible reflex of a mandibular asymmetry. The difficulty in obtaining a symmetrical result exists, but it can be minimized with the appropriate surgical technique. This article reports the mentoplasty technique with wedge osteotomy performed in an individual with a right-sided chin deviation. Three osteotomies were performed vertically and equidistantly, forming a bone wedge on the contralateral side of the deviation. Horizontal repositioning associated with the rotation caused by the vertical impaction of the chin after bone wedge removal was effective in solving esthetic problems of facial asymmetry, meeting the patient's main complaint. Address correspondence and reprint requests to Pedro Jorge Cavalcante Costa, DDS, MSc, Centro Universitário Tiradentes, Av Comendador Gustavo Paiva, 5017, Cruz das Almas, Maceió AL 57038-000, Brazil; E-mail: pedrojorgeccosta@hotmail.com Received 28 July, 2017 Accepted 5 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Readiness of US General Surgery Residents for Independent Practice” by George BC, Bohnen JD, Williams RG, Meyerson SL, Schuller MC, Clark MJ, Meier AH, Torbeck L, Mandell SP, Mullen JT, Smink DS, Scully RE, Chipman JG, Auyang ED, Terhune KP, Wise PE, Choi JN, Foley EF, Dimick JB, Choti MA, Soper NJ, Lillemoe KD, Zwischenberger JB, Dunnington GL, DaRosa DA, Fryer JP; Procedural Learning and Safety Collaborative (PLSC) in Ann Surg 266: 582–594, 2017

No abstract available

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Maxillary Sagittal Position in Relation to the Forehead: A Target for Orthognathic Surgery

The relationship of the maxillary incisor to forehead position and angulation may be a predictor for the esthetic antero-posterior maxillary position in orthognathic surgery, but this has not been fully explored in the existing literature. Additionally, this analysis requires a lateral smiling photograph, which is not typically included in orthodontic/orthognathic records. This is a bidirectional study of Caucasian orthodontic patients with malocclusions correctable with nonsurgical and nonextraction treatment. Subjects for Group 1 were enrolled prospectively and records included a lateral smiling photograph. Group 2 patients were collected retrospectively with standard records. The analysis described in Andrews' Element II of The Six Elements of Orofacial Harmony was applied to the smiling photographs for Group 1, resulting in "Incisor- goal anterior limit line (GALL)" measurements. A modified analysis utilizing cephalometric tracings was applied for both the groups, and the results were compared. Forty-nine subjects with mean age 11.8 ± 1.2 years were included (n = 14 for Group 1, n = 35 for Group 2). Mean Incisor-GALL distances were 3.71 ± 5.39 mm for females and 4.47 ± 5.06 mm for males. Correlation between analyses was excellent (intraclass correlation coefficient = 0.872). In conclusion, a modified approach to measuring the Incisor-GALL distance using standard orthodontic records correlated closely with the analysis described by Andrews. Normal values for this measurement are presented for Caucasian patients. Address correspondence and reprint requests to Dr Cory M. Resnick, DMD, MD, Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; E-mail: cory.resnick@childrens.harvard.edu Received 15 August, 2017 Accepted 12 October, 2017 Dr CMR and Dr ASR are married. This relationship did not introduce any conflict of interest into this study design or implementation, and Dr ASR is an independently credentialed research affiliate of Boston Children's Hospital. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of a Compound Oromandibular Defect by Means of Chimeric Scapular–Parascapular Free Flap Assisted by Virtual Surgical Planning

Background: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. Objective: This article reports a complex patient with a composite oromandibular defect. Methods: The patient had undergone multiple surgeries with bad results. She presented an orostoma of 5 cm in diameter, osteoradionecrosis and fracture of the left mandibular body, and relapse in the ipsilateral posterior maxilla. Reconstruction was performed by means of a scapular/parascapular chimeric free flap. A customized reconstruction plate was designed virtually based on the mirror image of the contralateral mandibular body. Surgery and the postoperative phase passed without incident. The patient recovered vocal, swallowing, and respiratory function without any problems. At the end of a 1-year follow-up, no complications or tumor relapse had occurred. Conclusions: Composite defects are a surgical challenge in which free flap reconstruction is an evolution that has facilitated treatment and led to improved outcomes. Virtual treatment planning produces more exact results and greater control of surgical techniques. Address correspondence and reprint requests to Josué Hernando, MS, DDS, PhD, University Donostia Hospital, Paseo Dr Beguiristain s/n, San Sebastian (Guipuzkoa), Spain; E-mail: josue.hernando@gmail.com Received 14 September, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Treatment of Synovial Chondromatosis in the Inferior Compartment of the Temporomandibular Joint With Articular Disc Involvement

The authors report an unusual case of painful synovial chondromatosis originated in the inferior compartment of the temporomandibular joint (TMJ) with articular disc involvement in a 56-year-old woman with complaint of severe pain in the right preauricular region. Magnetic resonance images showed advanced destruction of the right articular disc anteriorly displaced, condylar erosion, and distinct nodules within an extremely expanded inferior joint compartment with large amount of fluid, as well as a large TMJ effusion. A scintigraphy showed elevated bone uptake in the right TMJ, demonstrating intense bone remodeling activity in the region. After a right internal maxillary artery embolization, the patient underwent open surgery. The intraoperative procedures, including articular disc removal, condylar remodeling, and replacement of the articular disc, are described in detail. Synovial chondromatosis of the TMJ is a rare disease, especially when it affects the inferior compartment and the articular disc. Initial diagnosis is challenging and imaging techniques (magnetic resonance imaging and scintigraphy) play an important role in identifying signs, making accurate diagnosis, and offering additional information not available with conventional imaging, such as TMJ inflammation or remodeling. In these patients, open surgery may be considered a definitive treatment, since the postoperative recurrence rate is very low. Address correspondence and reprint requests to Amanda Lury Yamashita, DDS, MSc, Dentistry Department, State University of Maringá, Avenida Mandacaru no 1550, CEP: 87080-000, Maringá, Paraná, Brazil; E-mail: amandayamashita@gmail.com Received 14 September, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Dimensional Radiological Assessment of Alveolar Bone Volume Preservation Using Bovine Bone Xenograft

Introduction: Alveolar bone is critical in supporting natural teeth, dental implants as well as a removable and fixed prosthesis. Alveolar bone volume diminishes when its associated natural tooth is lost. Objective: The aim of this study is to evaluate the effectiveness of bovine bone granules on alveolar bone socket augmentation for ridge preservation following atraumatic tooth extraction. Materials and Methods: Twenty medically fit patients (12 males and 8 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of 1 mandibular premolar tooth were divided randomly and equally into 2 groups. In control group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In group II, the empty extraction socket wound was filled with lyophilized bovine bone xenograft granules 0.25 to 1 mm of size, 1 mL/vial. A resorbable pericardium membrane was placed to cover the defect. Clinical and 3-dimensional radiological assessments were performed at day 0, 3 months, and 9 months postoperative. Results: There were no clinical differences in general wound healing between the groups. Comparisons within the groups showed a significant difference of bone resorption of 1.49 mm (95% confidence interval, 0.63–2.35) at 3 months, and further resorption of 1.84 mm (P ≤ 0.05) at 9 months in the control group. No significant changes of bone resorption were observed in group II during the same time interval. Comparison between groups showed a significant difference of bone resorption at 3 and 9 months (2.40 and 2.88 mm, respectively). Conclusion: The use of lyophilized demineralized bovine bone granules in socket preservation to fill in the extraction socket seems essential in preserving the alveolar bone dimension as it showed excellent soft and hard tissue healing. This study concludes that the alveolar bone socket exhibited a dynamic process of resorption from the first day of tooth extraction. Evidence shows the possibility of using bovine bone granules routinely in socket volume preservation techniques following tooth extraction. Address correspondence and reprint requests to Ali Al Qabbani, DDS, MSc, Clinical Instructor/Oral Surgery, Department of Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE, and School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia; E-mail: aqabbani@sharjah.ac.ae Received 5 April, 2017 Accepted 10 October, 2017 All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee. Ethical approval was obtained from the Ethical and Research Committee, University of Sharjah and from Human Research Ethics Committee University Sains Malaysia ethical number (No DFCM/18/02/14/027) and (USM/JEPeM/15020045), respectively. The study was supported by a competitive grant from the University of Sharjah and Sharjah Institute for Medical Research. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Mandibular Osteonecrosis Associated With Raloxifene

Osteonecrosis is a disease with diverse pathophysiology, clinical presentation, and management. It may be associated with some medications used to treat systemic issues with bone metabolism. A few cases of jaw bone osteonecrosis have been associated with raloxifene. In this paper, the authors present a clinical report of a 64-year-old woman who presented with a necrosis foci in the right alveolar ridge of the mandible, associated with continued raloxifene use. Address correspondence and reprint requests to Hélder Antônio Rebelo Pontes, DDS, PhD, José Malcher Street, No. 1913, Ap. 801, 66060-230, São Braz, Belém, Pará, Brazil; E-mail: harp@ufpa.br. Received 19 July, 2017 Accepted 20 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?” by Krawczyk M in Ann Surg 266;703–705, 2017

No abstract available

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Review of “A Lifetime of Surgical Education: Can We Do Better?” by Lillemoe KD, Klingensmith ME, Darzi A, Taylor SM in Ann Surg 266:555-563, 2017

No abstract available

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Unusual Craniofacial Distraction

A retrospective Institutional Review Board-approved review was performed at the Institute of Reconstructive Plastic Surgery, NYU Langone Medical Center, of patients undergoing craniofacial distraction osteogenesis procedures using the rigid external distractor device between 2000 and 2010. Three particularly challenging cases were identified and are presented here. Address correspondence and reprint requests to Aina V.H. Greig, PhD, FRCS(Plast), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; E-mail: aina.greig@gstt.nhs.uk Received 25 May, 2017 Accepted 19 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Peripheral Giant Cell Granuloma Associated With Dental Implants

Abstract: Peripheral giant cell granuloma (PGCG) is a nonneoplastic lesion of the oral mucosa arising on the buccal or lingual attached gingiva or alveolar mucosa and the crest of the edentulous alveolar ridge and contains numerous giant cells. This case series describes 3 cases regarding the clinical and surgical management of PGCG associated with dental implants. Materials and Methods: This case series presents 3 patients, mean age 36 years, who showed a pedunculated painless lesion associated with dental implants that radiographically appeared as an osseous rarefaction corresponding the implants. Discussion: Histological examination provided the diagnosis of PGCG. The treatment approach consisted in a surgical complete resection of the lesion and implant removal. After 1-year-follow-up, all the investigated cases did not show signs of recurrence. Conclusion: A correct diagnosis and an appropriate surgical treatment of peri-implant giant cell granuloma are very important aspects for proper management of the lesion. Correspondence to Antonio Scarano, DDS, MD, Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti-Pescara, Italy; E-mail: antonio.scarano@unich.it Received 5 August, 2017 Accepted 9 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Facing a New Face: An Interpretative Phenomenological Analysis of the Experiences of a Blind Face Transplant Patient and His Partner

Increasing evidence points to good functional, aesthetic, and psychosocial outcomes after face transplantation. However, research investigating how patients and their families subjectively experience the transplantation process is lacking thus far. This study aims to investigate the personal experiences of a blind face transplant patient and his partner. In-depth interviews exploring different experiences were conducted with both partners separately 20 months after face transplantation. The interviews were analyzed using interpretative phenomenological analysis. Seven themes were identified in both interviews: coping with the facial trauma, motivation for the face transplantation, outcomes of the face transplantation, acceptance of the new face, gratitude toward the donor family, relation to the medical team, and dealing with the media. Two further themes were only mentioned by the patient (coping with complications and coping with blindness) and one theme only by the partner (loss of choices). The results of this study increase our understanding of the transplantation process as experienced by a face transplant recipient and his partner. They may help to better inform professionals to optimize transplantation procedures or supportive interventions. Address correspondence and reprint requests to Gilbert M. D. Lemmens, PhD, Department of Psychiatry, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; E-mail: gilbert.lemmens@ugent.be Received 14 August, 2017 Accepted 10 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Αρχειοθήκη ιστολογίου

Παρασκευή 5 Ιανουαρίου 2018

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