Fitting NTCP models to bladder doses and acute urinary symptoms during post-prostatectomy radiotherapy

To estimate the radiobiological parameters of three popular normal tissue complication probability (NTCP) models, which describe the dose-response relations of bladder regarding different acute urinary symptom...

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Ensemble support vector machine classification of dementia using structural MRI and mini-mental state examination

Publication date: Available online 3 February 2018
Source:Journal of Neuroscience Methods
Author(s): Lauge Sørensen, Mads Nielsen
BackgroundThe International Challenge for Automated Prediction of MCI from MRI data offered independent, standardized comparison of machine learning algorithms for multi-class classification of normal control (NC), mild cognitive impairment (MCI), converting MCI (cMCI), and Alzheimer's disease (AD) using brain imaging and general cognition.New methodWe proposed to use an ensemble of support vector machines (SVMs) that combined bagging without replacement and feature selection. SVM is the most commonly used algorithm in multivariate classification of dementia, and it was therefore valuable to evaluate the potential benefit of ensembling this type of classifier.ResultsThe ensemble SVM, using either a linear or a radial basis function (RBF) kernel, achieved multi-class classification accuracies of 55.6% and 55.0% in the challenge test set (60 NC, 60 MCI, 60 cMCI, 60 AD), resulting in a third place in the challenge. Similar feature subset sizes were obtained for both kernels, and the most frequently selected MRI features were the volumes of the two hippocampal subregions left presubiculum and right subiculum. Post-challenge analysis revealed that enforcing a minimum number of selected features and increasing the number of ensemble classifiers improved classification accuracy up to 59.1%.Comparison with existing method(s)The ensemble SVM outperformed single SVM classifications consistently in the challenge test set.ConclusionsEnsemble methods using bagging and feature selection can improve the performance of the commonly applied SVM classifier in dementia classification. This resulted in competitive classification accuracies in the International Challenge for Automated Prediction of MCI from MRI data.



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Editorial Board

Publication date: 1 February 2018
Source:Journal of Neuroscience Methods, Volume 295





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Cancers, Vol. 10, Pages 41: Phosphorylation of Sox2 at Threonine 116 is a Potential Marker to Identify a Subset of Breast Cancer Cells with High Tumorigenecity and Stem-Like Features

Cancers, Vol. 10, Pages 41: Phosphorylation of Sox2 at Threonine 116 is a Potential Marker to Identify a Subset of Breast Cancer Cells with High Tumorigenecity and Stem-Like Features

Cancers doi: 10.3390/cancers10020041

Authors: Nidhi Gupta Keshav Gopal Chengsheng Wu Abdulraheem Alshareef Alexandra Chow Fang Wu Peng Wang Xiaoxia Ye Gilbert Bigras Raymond Lai

We have previously identified a novel phenotypic dichotomy in breast cancer (BC) based on the response to a SRR2 (Sox2 regulatory region 2) reporter, with reporter responsive (RR) cells being more tumorigenic/stem-like than reporter unresponsive (RU) cells. Since the expression level of Sox2 is comparable between the two cell subsets, we hypothesized that post-translational modifications of Sox2 contribute to their differential reporter response and phenotypic differences. By liquid chromatography-mass spectrometry, we found Sox2 to be phosphorylated in RR but not RU cells. Threonine 116 is an important phosphorylation site, since transfection of the T116A mutant into RR cells significantly decreased the SRR2 reporter luciferase activity and the RR-associated phenotype. Oxidative stress-induced conversion of RU into RR cells was accompanied by Sox2 phosphorylation at T116 and increased Sox2-DNA binding. In a cohort of BC, we found significant correlations between the proportion of tumor cells immuno-reactive with anti-phosphorylated Sox2T116 and a high tumor grade (p = 0.006), vascular invasion (p = 0.001) and estrogen receptor expression (p = 0.032). In conclusion, our data suggests that phosphorylation of Sox2T116 contributes to the tumorigenic/stem-like features in RR cells. Detection of phospho-Sox2T116 may be useful in identifying a small subset of tumor cells carrying stem-like/tumorigenic features in BC.

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First data from a population based cancer registry in Ethiopia

Publication date: April 2018
Source:Cancer Epidemiology, Volume 53
Author(s): Genebo Timotewos, Asmare Solomon, Assefa Mathewos, Adamu Addissie, Solomon Bogale, Tigeneh Wondemagegnehu, Abraha Aynalem, Bekele Ayalnesh, Hailemariam Dagnechew, Wondatir Bireda, Eric Sven Kroeber, Rafael Mikolajczyk, Freddie Bray, Ahmedin Jemal, Eva Johanna Kantelhardt
BackgroundThe Addis Ababa City Cancer Registry, established in September 2011, is the only population-based cancer registry in Ethiopia, covering a catchment population of just over three million habitants. Herein, we report incidence data based on the first two years of registration, 2012–2013.MethodsNewly-diagnosed cancer cases in the capital city were actively collected from 22 hospitals, clinics, and diagnostic facilities.ResultsDuring 2012–2013, a total of 4139 newly diagnosed cases were recorded, with the majority (67%) occurring in females. Cancers of the breast (31.5%) and cervix (14.1%) were the two most common cancers among females, while colorectal cancers (10.6%) and non-Hodgkin lymphomas (10.2%) were the most common cancers among males. The average annual age-standardized rate for all sites 2012–13 were 136.2 (per 100,000) and 70.7 in females and males, respectively. Female age-standardized rates were 40.6 for breast cancer and 21.5 for cervix, while equivalent rates in males were 7.6 per 100,000 for colorectal cancer and 6.8 per 100,000 for non-Hodgkin lymphoma.ConclusionIn general, these incidence patterns were similar to those reported in neighboring countries, which suggests that the majority of cancer cases occurring in Addis Ababa are captured within this starting phase of the registry. However, our finding of colorectal cancer as the most commonly-diagnosed cancer in males is novel and requires further investigation.



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RHOA G17V Induces T Follicular Helper Cell Specification and Promotes Lymphomagenesis

Publication date: Available online 2 February 2018
Source:Cancer Cell
Author(s): Jose R. Cortes, Alberto Ambesi-Impiombato, Lucile Couronné, S. Aidan Quinn, Christine S. Kim, Ana C. da Silva Almeida, Zachary West, Laura Belver, Marta Sanchez Martin, Laurianne Scourzic, Govind Bhagat, Olivier A. Bernard, Adolfo A. Ferrando, Teresa Palomero
Angioimmunoblastic T cell lymphoma (AITL) is an aggressive tumor derived from malignant transformation of T follicular helper (Tfh) cells. AITL is characterized by loss-of-function mutations in Ten-Eleven Translocation 2 (TET2) epigenetic tumor suppressor and a highly recurrent mutation (p.Gly17Val) in the RHOA small GTPase. Yet, the specific role of RHOA G17V in AITL remains unknown. Expression of Rhoa G17V in CD4⁺ T cells induces Tfh cell specification; increased proliferation associated with inducible co-stimulator (ICOS) upregulation and increased phosphoinositide 3-kinase (PI3K) and mitogen-activated protein kinase signaling. Moreover, RHOA G17V expression together with Tet2 loss resulted in development of AITL in mice. Importantly, Tet2^−/−RHOA G17V tumor proliferation in vivo can be inhibited by ICOS/PI3K-specific blockade, supporting a driving role for ICOS signaling in Tfh cell transformation.

Graphical abstract

Teaser

Cortes et al. show that expression of Rhoa G17V in CD4⁺ T cells drives proliferation and Tfh polarization, and they develop an angioimmunoblastic T cell lymphoma model by combining Rhoa G17V expression and Tet2 loss. These tumors show increased ICOS and PI3K/MAPK signaling and are sensitive to pathway inhibition.


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Soluble delta-like 1 homolog (DLK1) stimulates angiogenesis through Notch1/Akt/eNOS signaling in endothelial cells

Abstract

Aim

Delta-like 1 homolog (DLK1) is a non-canonical ligand of Notch signaling, which plays a pivotal role in vascular development and tumor angiogenesis. This study aimed to elucidate the function and mechanism of DLK1 in angiogenesis.

Methods and results

By using in situ hybridization and immunohistochemical studies, expression analysis revealed a unique vascular tropism of DLK1 in vasculature of neuroblastoma and vascular tumors. Thus, it was hypothesized that DLK1 may be cleaved and then bound to endothelial cells, thereby regulating the endothelial function. To test such hypothesis, soluble DLK1 encompassing DLK1 extracellular domain (DLK1-EC) was generated and validated by its inhibitory function in adipogenesis assay. Recombinant DLK1-EC exhibited the preferential binding capability toward endothelial cells and stimulated the microvessels sprouting in aorta rings. Above all, implantation of DLK1-EC dose-dependently elicited the cornea neovascularization in rats. By using various angiogenesis assays, it was delineated that DLK1-EC stimulated the angiogenesis by promoting the proliferation, motility and tube formation of endothelial cells. By immunoblot and luciferase analysis, it was elucidated that DLK1-EC enhanced the expression and activities of Notch1/Akt/eNOS/Hes-1 signaling in dose- and time-dependent manners. Pharmaceutical blockage of Notch signaling using γ-secretase inhibitor DAPT abrogated the DLK1-EC-induced endothelial migration and Hes-1-driven luciferase activities. Furthermore, Notch1 inactivation by neutralizing antibodies or RNA interference reversed the DLK1-EC-induced angiogenesis.

Conclusions

The present study unveils the pro-angiogenic function and mechanism of soluble DLK1 through activation of Notch1 signaling in endothelial cells.

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miRNAs regulate the HIF switch during hypoxia: a novel therapeutic target

Abstract

The decline of oxygen tension in the tissues below the physiological demand leads to the hypoxic adaptive response. This physiological consequence enables cells to recover from this cellular insult. Understanding the cellular pathways that mediate recovery from hypoxia is therefore critical for developing novel therapeutic approaches for cardiovascular diseases and cancer. The master regulators of oxygen homeostasis that control angiogenesis during hypoxia are hypoxia-inducible factors (HIFs). HIF-1 and HIF-2 function as transcriptional regulators and have both unique and overlapping target genes, whereas the role of HIF-3 is less clear. HIF-1 governs the acute adaptation to hypoxia, whereas HIF-2 and HIF-3 expressions begin during chronic hypoxia in human endothelium. When HIF-1 levels decline, HIF-2 and HIF-3 increase. This switch from HIF-1 to HIF-2 and HIF-3 signaling is required in order to adapt the endothelium to prolonged hypoxia. During prolonged hypoxia, the HIF-1 levels and activity are reduced, despite the lack of oxygen-dependent protein degradation. Although numerous protein factors have been proposed to modulate the HIF pathways, their application for HIF-targeted therapy is rather limited. Recently, the miRNAs that endogenously regulate gene expression via the RNA interference (RNAi) pathway have been shown to play critical roles in the hypoxia response pathways. Furthermore, these classes of RNAs provide therapeutic possibilities to selectively target HIFs and thus modulate the HIF switch. Here, we review the significance of the microRNAs on the relationship between the HIFs under both physiological and pathophysiological conditions.

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Context-dependent lexical ambiguity resolution: MEG evidence for the time-course of activity in left inferior frontal gyrus and posterior middle temporal gyrus

Publication date: February–March 2018
Source:Brain and Language, Volumes 177–178
Author(s): Giovanna Mollo, Elizabeth Jefferies, Piers Cornelissen, Silvia P. Gennari
An MEG study investigated the role of context in semantic interpretation by examining the comprehension of ambiguous words in contexts leading to different interpretations. We compared high-ambiguity words in minimally different contexts (to bowl, the bowl) to low-ambiguity counterparts (the tray, to flog). Whole brain beamforming revealed the engagement of left inferior frontal gyrus (LIFG) and posterior middle temporal gyrus (LPMTG). Points of interest analyses showed that both these sites showed a stronger response to verb-contexts by 200 ms post-stimulus and displayed overlapping ambiguity effects that were sustained from 300 ms onwards. The effect of context was stronger for high-ambiguity words than for low-ambiguity words at several different time points, including within the first 100 ms post-stimulus. Unlike LIFG, LPMTG also showed stronger responses to verb than noun contexts in low-ambiguity trials. We argue that different functional roles previously attributed to LIFG and LPMTG are in fact played out at different periods during processing.



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To the Editor: Clinical Anatomy

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Arsenic Promotes the COX2/PGE2-SOX2 Axis to Increase the Malignant Stemness Properties of Urothelial Cells

Abstract

Chronic arsenic exposure is associated with the development of urothelial carcinoma of the bladder (UCB). To elucidate the contribution of arsenic exposure to urothelial cancer stem cell (CSC) generation, we established an in vitro stepwise malignant model transformed by chronically exposing human urothelial cells to arsenic. Using this model, we found that chronic arsenic exposure endows urothelial cells with malignant stemness properties including increased expression of stemness-related factors such as SOX2, sphere formation, self-renewal, invasion, and chemo-resistance. SOX2 was gradually and irreversibly overexpressed in line with acquired sphere-forming and self-renewal abilities. Following gene set enrichment analyses of arsenic-exposed and arsenic-unexposed cells, we found COX2 as an enriched gene for oncogenic signature. Mechanistically, arsenic-induced COX2/PGE2 increases SOX2 expression that eventually promotes malignant stem cell generation and repopulation. In urine samples from 90 subjects exposed to arsenic and 91 control subjects, we found a significant linear correlation between SOX2 and COX2 expression and the potential of SOX2 and COX2 expression as urinary markers to detect subjects exposed to arsenic. Furthermore, the combination marker yielded a high sensitivity for UCB detection in a separate cohort. Finally, our in vitro model exhibits basal-type molecular features, and dual inhibition of EGFR and COX2 attenuated stem cell enrichment more efficiently than an EGFR inhibitor alone. In conclusion, the COX2/PGE2-SOX2 axis promotes arsenic-induced malignant stem cell transformation. In addition, our findings indicate the possible use of SOX2 and COX2 expression as urinary markers for the risk stratification and detection of UCB. This article is protected by copyright. All rights reserved.

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Odontogenic myxoma: A causality dilemma – Report of a nonpareil case and review of literature

Sugunakar Raju Godishala Swamy, Sushma Naag, Sumit Bahl, Esther Priyadarshini

Journal of Oral and Maxillofacial Pathology 2018 22(4):2-6

Odontogenic myxoma is a benign locally aggressive neoplasm with a sparse prevalence and incertitude histogenesis. They constitute 3%–6% of odontogenic tumors in gnathic bones. It is ubiquitously seen between vicenarian to early quadragenarian group with female proclivity and fondness to the mandibular jaws. They are silent lesions clinically and show myxoid stroma amidst fibrous background. This report highlights central odontogenic myxoma in a 43-year-old male patient and focuses on concepts, differential diagnosis, molecular concepts and treatment aspect.

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Renal cell carcinoma metastatic to the maxillary gingiva: A case report and review of the literature

Daria Vasilyeva, Scott M Peters, Elizabeth M Philipone, Angela J Yoon

Journal of Oral and Maxillofacial Pathology 2018 22(4):102-107

Tumor metastasis to the oral cavity is rare and is usually an indication of late-stage disease and poor prognosis. While, there are reports of renal cell carcinoma (RCC) metastatic to oral cavity, vast majority of them are to the jaw. Herein, we present a case of a 78-year-old woman with RCC metastasis limited to the oral soft tissue without any bone involvement. As the lesion solely involved maxillary gingiva, it clinically mimicked that of a pyogenic granuloma, which is a reactive, nonneoplastic condition. This case was further complicated as the patient was unaware of primary cancer and appeared to be in good physical health. Her oral metastasis marked the initial manifestation of an otherwise silent primary renal cancer.

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Ameloblastoma arising in the wall of dentigerous cyst: Report of a rare entity

Sudheer Kanth Kondamari, Sravya Taneeru, Venkateswara Rao Guttikonda, Geetha Kumari Masabattula

Journal of Oral and Maxillofacial Pathology 2018 22(4):7-10

Dentigerous cyst (DC) is a developmental odontogenic cyst that encloses the crown of an unerupted tooth by expansion of its follicle with accumulation of fluid between the reduced enamel epithelium and the tooth crown and is attached to the neck of the tooth. The lining of DCs shows a potential for neoplastic transformation to ameloblastoma, squamous cell carcinoma, and mucoepidermoid carcinoma. Here, we report a rare case of an ameloblastoma arising in the wall of a DC.

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Proliferative endophytic lesion of the maxilla: A diagnostic challenge

R Shesha Prasad, Aditya Moorthy, Abhishek Bhadranna, Anuradha Pai

Journal of Oral and Maxillofacial Pathology 2018 22(4):82-86

Carcinoma cuniculatum (CC) is an extremely rare neoplasm of the oral cavity. It is essentially a well-differentiated variety of squamous cell carcinoma and shows lower metastasis risk. The histological features of CC can mimic that of papillary squamous cell carcinoma or verrucous carcinoma. CC commonly affects the plantar region of the foot, and very few cases have been described in the oral cavity. The classical histological characteristics noted are infiltration of underlying connective tissue by squamous epithelium with keratin cores and keratin-filled crypts. Herewith, we present a case of CC of the right maxilla in a young Dravidian male patient who works in a battery factory. The case presented a diagnostic challenge both clinically and histopathologically before it was completely resected using a total maxillectomy technique. The case delineates the diagnostic challenge and management of the disease.

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Aggressive adenomatoid odontogenic tumor of the mandible: A rare case report and review of the literature

Sana Shaikh, Shivani Bansal, Rajiv S Desai, Islam Ahmad

Journal of Oral and Maxillofacial Pathology 2018 22(4):11-15

Adenomatoid odontogenic tumor (AOT) is a relatively rare and distinct odontogenic tumor that is exclusively odontogenic epithelium in origin. Although considerable numbers of reports are available with regard to the clinical and histological spectrum of AOT, very few have highlighted its rare aggressive nature. This article focuses on an AOT causing jaw swelling in the mandibular anterior region with cortical plate expansion and perforation, root resorption and paresthesia. The present case had remarkably unusual clinical and radiographic features that distinguished it from most conventional AOTs and supported its neoplastic nature.

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A curious case of central odontogenic fibroma: A novel perspective

Chetana Chandrashekar, Subhalakshmi Sen, Venkadasalapathi Narayanaswamy, Raghu Radhakrishnan

Journal of Oral and Maxillofacial Pathology 2018 22(4):16-19

We appraise a case of central odontogenic fibroma (COF) with unusual histologic features of entrapped neural elements and mast cells. The presence of mast cells attributed to the release of stem cell factor, the principal growth and activating factor of mast cells. A putative role for C-kit and mast cells in the pathogenesis of COF is described.

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Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling

J Nandhini, S Ramasamy, Ronak Nazir Kaul, Ravi David Austin

Journal of Oral and Maxillofacial Pathology 2018 22(4):73-76

Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched.

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Orthokeratinized odontogenic cyst with calcification: A rare case report of a distinct entity

Mamata Kamat, Sampada Kanitkar, Uma Datar, Sanjay Byakodi

Journal of Oral and Maxillofacial Pathology 2018 22(4):20-23

Orthokeratinized odontogenic cyst (OOC) is a relatively rare odontogenic cyst, distinct from odontogenic keratocyst (OKC). In the 4th edition of WHO Classification of Head and Neck Tumors (2017), OOC has been included as a separate entity in the category of developmental odontogenic cysts. It presents as a unilocular radiolucent lesion in the posterior mandible and is frequently related to impacted teeth, thus mimicking dentigerous cyst. Due to low local aggressiveness and no association with nevoid basal cell carcinoma syndrome, it does not show tendency to recur. When compared to OKC, OOC exhibits substantial number of differences with respect to clinical, pathological and behavioral features and treatment modalities. Hence, recognizing OOC as unique lesion is mandatory to avoid unnecessary overtreatment. This paper aims to report a rare case of OOC associated with impacted tooth, showing calcifications and emphasizes its differences from OKC. Furthermore, the recent concepts about OKC and OOC are discussed.

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Hemangiomatous ameloblastoma: Case report with a brief review

Aparna Venigalla, Manasa Bojji, Soujanya Pinisetti, Suresh Babburi

Journal of Oral and Maxillofacial Pathology 2018 22(4):24-28

Ameloblastoma is a benign epithelial odontogenic tumor with many histological variants. Hemangiomatous ameloblastoma (HA) is a very rare variant which shows unique histopathological features varying from conventional ameloblastoma. We present a case of a 35-year-old female patient with a swelling over right lower back region of jaw, showing mixed radiolucent-opacity. Incisional biopsy showed microscopic features of desmoplastic ameloblastoma showing extensive desmoplasia and compressed odontogenic epithelial islands. Excisional biopsy revealed ameloblastomatous areas with extensive vascular component microscopically. Based on these findings, a diagnosis of HA was made.

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Mucormycosis in immunocompetent patient resulting in extensive maxillary sequestration

Deepak Venkatesh, Satyajit Dandagi, Pramod Redder Chandrappa, KN Hema

Journal of Oral and Maxillofacial Pathology 2018 22(4):112-116

Mucormycosis or zygomycosis, also called phycomycosis, is an uncommon, invasive, potentially lethal and an aggressive fungal infection of the order Mucorales that usually affects patients with alteration of their immunological system. From its initial description (Paltauf, 1885), this entity still has a high mortality. Imaging techniques are not usually diagnostic, and cultures are not totally reliable. Definitive diagnosis is exclusively obtained by means of histopathological examination. Early recognition and aggressive treatment are of paramount importance and have reduced the mortality and morbidity. We present here a case report of oral mucormycosis in a 32-year-old male, immunocompetent individual resulting in extensive maxillary sequestration.

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A mixed odontogenic sarcoma: A challenging histopathologic case and brief review of the literature

Saede Atarbashi-Moghadam, Ali Lotfi, Sepideh Mokhtari

Journal of Oral and Maxillofacial Pathology 2018 22(4):29-34

Ameloblastic fibro-odontosarcoma (AFOS) is an extremely rare malignant mixed odontogenic tumor. The ectomesenchymal part of the neoplasm shows malignancy, whereas the epithelial component is rather benign. In addition, small areas with deposition of enamel matrix and dentine material are seen. The rarity of this neoplasm and microscopic similarities with other malignant and benign tumors can lead to diagnostic problems. Here, we describe the histopathologic features of a new case of AFOS of the mandible in a 34-year-old female patient. It is essential for oral pathologists to be familiar with the microscopic features of this rare neoplasm to have a proper diagnosis. This is also the first reported case of AFOS that closely resembles osteosarcoma in some areas.

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Chondrosarcoma of maxilla

Asha Karadwal, Shailja Chatterjee

Journal of Oral and Maxillofacial Pathology 2018 22(4):35-38

Chondrosarcoma is a rare malignant cartilaginous tumor of the head and neck region. It is a slow-growing tumor and is mostly detected in the anterior maxilla and the base of the skull. We report a case of "Grade II Chondrosarcoma" of the posterior right side of the palate invading maxillary sinus and perforating the floor of the orbit.

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Keratinizing pleomorphic adenoma: An unusual case report

Aanchal Tandon, Rohit Jaiswal, Safia Siddiqui, Bharadwaj Bordoloi

Journal of Oral and Maxillofacial Pathology 2018 22(4):69-72

Pleomorphic adenoma (PA) is the most common benign tumor of major or minor salivary glands. PA exhibits a great histological diversity, such as differentiation into oncocytic, sebaceous, mucinous, squamous, chondroid, osseous or adipose cells. Squamous metaplasia rarely results in the formation of extensive keratin-filled cyst lined by squamous epithelium. Extensive squamous metaplasia can be mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Here, we report a case of slowly enlarging PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland in hard palate and discuss its microscopic features.

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Metastatic renal cell carcinoma presenting as maxillary lesion: Report of two rare cases

Samira Derakhshan, Sedighe Rahrotaban, Nazanin Mahdavi, Faeze Mirjalili

Journal of Oral and Maxillofacial Pathology 2018 22(4):39-43

Oral cavity is not a usual site for metastasis, accounting about 1% of all oral tumors. The majority site for metastasis is the mandible and less common the maxilla followed by intraoral soft tissue. These tumors may be the first clinical manifestation of the primary lesion. One of the most important sites of the primary neoplasm that metastasizes to the jaws is kidney. Therefore, considering to this fact that the metastatic tumors always are not seen in a typical site, it is necessary to rule out the metastatic carcinomas to jaws. We presented two cases of metastatic renal cell carcinoma to maxilla with two different clinical features, one of them with an intraosseous lytic lesion and the other one with a large exophytic mass.

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Leukemic gingival enlargement: A case report and review of literature

Kanika Chowdhri, Shruti Tandon, Arundeep Kaur Lamba, Farrukh Faraz

Journal of Oral and Maxillofacial Pathology 2018 22(4):77-81

The oral cavity manifests signs of various systemic diseases. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Occasionally, oral signs can be an expression of systemic conditions such as endocrine imbalance, nutritional deficiencies and blood disorders. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. Oral changes maybe the first and only presenting features in leukemia patients, making it imperative for the dentist to diagnose the disease accurately.

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Melanotic neuroectodermal tumor of infancy: A rare case report

Abhishek Kumar, V Deepthi, Ruchi Aggarwal, Hema Malini Aiyer

Journal of Oral and Maxillofacial Pathology 2018 22(4):44-47

Melanotic neuroectodermal tumor of infancy is a rare benign but locally aggressive neoplasm of neural crest origin with a high recurrence rate. It usually affects infants of

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Non-replication of neurophysiological predictors of non-response to rTMS in depression and neurophysiological data-sharing proposal

Publication date: Available online 2 February 2018
Source:Brain Stimulation
Author(s): Noralie Krepel, Alexander T. Sack, Leon J. Kenemans, Paul B. Fitzgerald, Wilhelmus H. Drinkenburg, Martijn Arns




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Longitudinal study of radiation-induced brain microstructural alterations with S-index, a Diffusion MRI biomarker, and MR Spectroscopy

Publication date: Available online 2 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): E.A. Pérès, O. Etienne, A. Grigis, F. Boumezbeur, F.D. Boussin, D. Le Bihan
PurposeRadiotherapy is widely used for the treatment of brain tumors but it may lead to severe cognitive impairments. Previous studies have shown that ionizing radiation induces demyelination, blood-brain barrier alterations and impaired neurogenesis in animal models. Hence, non-invasive and sensitive biomarkers of radiation injury are needed to investigate these effects in patients and improve radiotherapy protocols.Methods and MaterialsThe heads of 3-months old male C57BL/6RJ mice (CTL: n=15; IR: n=15) were exposed to radiation doses of 3x5Gy from a ⁶⁰Co source with a medical irradiator. A longitudinal study was performed to investigate cranial radiation-induced (3x5Gy) microstructural tissue alterations using water diffusion MRI (dMRI) and MR Spectroscopy (MRS) in different areas of the mouse brain (cortex, thalamus, striatum, olfactory bulbs (OB), hippocampus and the subventricular zone (SVZ)). In addition to the quantification of standard non-Gaussian diffusion parameters, ADC0 (Apparent Diffusion Coefficient) and K (Kurtosis), we evaluated a new composite diffusion metric, designated as S-index.ResultsWe observed a significant decrease in S-index in the SVZ, from 1 month to 8 months after brain radiation (p<0.05). Interestingly, along with a decrease in Taurine (up to -15% at 2 months, p<0.01), a delayed S-index drop was also observed in the OB from 4 months after irradiation and maintained until the end of our experiment (p<0.0001). These observations suggest that S-index variations revealed the radiation-induced decline of neurogenesis that was further confirmed by a decrease of neural stem cells in the SVZ and of newborn neurons in the OB of irradiated animals.ConclusionsThis study demonstrates that dMRI, especially through the S-index approach, is a relevant imaging modality to monitor brain radiation injury and probe microstructural changes underlying radiation-induced cognitive deficits.

Teaser

Cancer patients frequently suffer from cognitive impairments following brain radiotherapy. To monitor radiation-induced microstructural tissue damage, especially in neurogenic areas, we have investigated the potential of diffusion MRI and MR spectroscopy. The diffusion S-index calculated from diffusion MRI signal acquired at two optimized values of diffusion-weighting appeared as the most sensitive biomarker revealing subtle brain tissue alterations induced by ionizing radiation.


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Bioluminescence Tomography Guided Small Animal Radiotherapy and Tumor Response Assessment

Publication date: Available online 2 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Junwei Shi, Thirupandiyur S. Udayakumar, Keying Xu, Nesrin Dogan, Alan Pollack, Yidong Yang
Purposes: The image-guided SMall Animal Arc Radiation Treatment platform (iSMAART) has adopted onboard cone beam computed tomography (CBCT) and bioluminescence tomography (BLT). In this study, we used BLT to guide radiation delivery and quantitatively assess radiation-induced tumor response.Methods and MaterialsBLT was first validated on a tissue-simulating phantom, where the internal chemiluminescent liquid had a constant volume while its luminescence intensity gradually decayed. Then, in vivo experiments were performed on BALB/c mice orthotopically inoculated with 4T1 breast carcinoma cells expressing luciferase. Animals received either radiation treatment (RT group, n=9) or not (Control group, n=9). BLT was used to guide delivery of a single fraction of 5 Gy radiation dose to the tumor, and to evaluate the treatment response. The terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was used to evaluate the radiation-induced DNA damage and cell apoptosis.ResultsPhantom results showed that BLT not only recovered the constant target volume with <2% deviation, but also accurately monitored the decay of the chemiluminescent molecules. For the RT animal group, there was significant reduction in both BLT-based tumor volume (21±10%, P=0.001) and bioluminescence intensity (48±17%, P=0.0008). For the control group, the significant increase was detected in the BLT tumor volume (35±12%, P<0.0001), but not in the BLT bioluminescence intensity (P=0.4). There was a significant difference in the BLT tumor volume between the RT and control group 7 days after radiation (P=0.03). Regression analysis suggests a strong correlation between the BLT and CBCT tumor volume (R²=0.93). The TUNEL staining analysis showed a significant difference in tumor cell apoptosis between the RT and control group (20.6±2.9% vs 3.2±1.7%, P<0.05).ConclusionBLT onboard the iSMAART can be used to accurately guide radiation delivery, and to quantitatively assess treatment response by simultaneously monitoring tumor volume and cancer cell population.



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IDEAL 2a phase-II study of ultra-focal brachytherapy for low and intermediate risk prostate cancer

Publication date: Available online 2 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Pierre Graff, Daniel Portalez, Amélie Lusque, Thomas Brun, Richard Aziza, Jonathan Khalifa, Mathieu Roumiguié, Marie-Laure Quintyn Ranty, Thomas Filleron, Jean-Marc Barchaud, Bernard Malavaud
PurposeFocal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterised index tumours (IT).We assessed the feasibility of low-dose-rate ultra-focal brachytherapy (UFB).Methods & MaterialsIRB-approved European Clinical Trials Database-registered phase II protocol. Patients referred (10/2013-8/2016) for active surveillance [PSA<10ng/mL, cT1c-cT2a, Gleason sum on referring biopsies ≤6(3+3), ≤3 positive biopsies, ≤50% of cancer] were pre-selected. Inclusion was confirmed when complementary image-guided biopsies informed a single PI-RADS.v1≥3 Gleason sum ≤7a(3+4) lesion.A single ultrasound-visible ancillary marker was positioned within the IT using 3D-TRUS/MRI elastic fusion registration (Koelis°). Ultra-focal transperineal delivery of I-125 seeds then used classical 2D-Transrectal ultrasonography (Bard-FlexFocus°) and dose-optimization (Variseed Treatment Planning System°).Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering ≥95% of the prescribed dose (160Gy) to the IT (primary objective). Adverse-events (CTCAE) and quality-of-life (IIEF-5, IPSS) were recorded. 1-year control biopsies were obtained in IT and untreated segments.Results27/44 of pre-selected patients failed inclusion. 16/17 of UFB-treated patients met the primary objective (per-protocol success). Prescription dose was delivered to 14.5±6.4% of the prostate volume resulting in negligible urethral and rectal irradiations and toxicities. No recurrences were evidenced on 1-year control MRI and IT biopsies. Seven non-clinically significant cancers and one Gleason sum 7a(3+4) cancer (salvage prostatectomy) were observed in the untreated parenchyma.ConclusionsRecent technology allows selective and effective brachytherapy of small MRI targets.



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Long-Term Outcomes and Prognostic Factors Following Pencil-Beam Scanning Proton Radiotherapy for Spinal Chordomas: A Large, Single-Institution Cohort

Publication date: Available online 2 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): J.W. Snider, Ralf A. Schneider, Davey Poelma-Tap, Sonja Stieb, Fritz R. Murray, Lorenzo Placidi, Francesca Albertini, Antony Lomax, Alessandra Bolsi, Ulrike Kliebsch, Robert Malyapa, Damien C. Weber
PurposeTo evaluate the efficacy and safety of high-dose pencil-beam scanning proton therapy (PBS-PT) in the adjuvant treatment of spinal chordomas.Methods and MaterialsBetween 1997 and 2015, 100 patients with spinal chordomas (median age, 56 years; range, 25–81 years) were treated with adjuvant PBS-PT at the XXXX: cervical (n=46), thoracic (n=4), lumbar (n=12), and sacral (n=38). The majority (88%) received PBS-PT alone rather than combined photon–proton therapy. The median radiotherapy dose prescribed was 74 Gy(RBE) (range, 59.4–77 Gy[RBE]). Thirty-nine (39%) patients had undergone surgical stabilization (SS), primarily with titanium hardware, prior to radiotherapy.ResultsWith a median follow-up of 65 months (range, 13–175 months), 5-year local control, disease control, and overall survival rates were 63% (95%CI: 57.7–68.7%; median, 103 months), 57% (95%CI: 50.9-62.1%; median, 82 months), and 81% (95%CI: 76.8-85.6%; median, 157 months), respectively. On univariate and multivariate analyses, the presence of SS was highly prognostic for worsened outcomes. Multivariate analysis also revealed the extent of treatment volumes and presence of gross residual disease to be important in predicting outcomes. High-grade (≥grade 3) toxicities were rare in both the acute (8%) and late (6%) settings.ConclusionFor spinal chordomas, PBS-PT remains a highly effective and safe method for delivery of dose-escalated adjuvant radiotherapy. The presence of metallic SS prognosticates for worsened outcomes. Further investigation is warranted to characterize ideal treatment volumes and effect of SS on therapy for these challenging tumors.



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Combined transoral–transhyoid endoscopic approach for hypopharyngeal cancer

Endoscopic transoral surgery for hypopharyngeal cancer is an effective treatment option to avoid invasive open surgery or chemoradiation. Here we describe the case of a 66-year-old patient with cT2N0M0 pyriform sinus cancer whom we treated using a transoral–transhyoid endoscopic approach. Using this approach, a transhyoid route was created in addition to the transoral route and used to extirpate the tumor. En bloc resection of the tumor was completed without difficulty. A combined transoral–transhyoid approach is a useful surgical option for treatment of selected patients with hypopharyngeal cancer.

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Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS).

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Conservative treatment for cutaneous fistula resulted from abscess formation in patients with tuberculous cervical lymphadenitis

This study describes the clinical characteristics and course of conservative treatment using anti-Tb medication and dressing in patients with tuberculous cervical fistula resulting from abscess formation, and to investigate factors prognostic of dressing and treatment duration.

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Instrumental head impulse test changes after intratympanic gentamicin for unilateral definite Ménière’s disease: A systematic review and meta-analysis

To estimate how much could intratympanic gentamicin (ITG) interfere with the vestibular-ocular reflex (VOR) parameters on instrumental head impulse test (HIT), either with scleral search coil or video head impulse test and, eventually, foresee the control of vertigo crisis in unilateral intractable Ménière's disease (MD).

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Reply to “Is it significant? Is it relevant?”

We thank Drs. Manca and Deriu for their insightful comments (Manca and Deriu, 2018). We agree that the scientific and clinical relevance of a study is not necessarily reflected by the statistical significance of a specific test. A statistical cut-off, using a pre-defined significance threshold, should not be equated with the presence or absence of a scientifically or clinically relevant finding. Judging the scientific or clinical relevance requires more than simply referring to statistical significance.

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Anatomical anomalies of the Eustachian tube and chronic otitis media

I read with great interest the excellent article titled "Eustachian tube diameter: Is it associated with chronic otitis media development?" by Paltura et al. [1]. The authors measured the Eustachian tube (ET) diameter (ETd) on the diseased and healthy sides of the head in patients with unilateral chronic otitis media (COM) (a tympanic membrane perforation with or without purulent discharge), and found that anatomical anomalies of the ET were correlated with the incidence of COM. We recommend measuring the bony diameter of the ET during routine temporal computed tomography.

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Renal protective effect of a hydration supplemented with magnesium in patients receiving cisplatin for head and neck cancer

Our study analyzes the effect of magnesium supplementation on nephrotoxicity in patients receiving cisplatin for head and neck cancer.

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A rare presentation of cytomegalovirus infection in an immunocompetent patient

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Life after Per-oral Endoscopic Myotomy (POEM): Long-term Outcomes of Quality of Life and Their Association with Eckardt Score

The clinical efficacy of POEM has been commonly established by the reduction in the Eckardt score (<3) after the procedure. However, achalasia can lead to significant impairment in the patient's quality of life that may go beyond the 4 classical achalasia symptoms as measured by the Eckardt score. The aims of our study were (1) to evaluate the effect of POEM on short and long-term health-related quality of life (HRQOL) and to (2) assess the association between HRQOL and Eckardt scores.

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FAMI Screws for Mandibulo-Maxillary Fixation in Mandibular Fracture Treatment – Clinico-radiological Evaluation

Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications.

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Establishment of a Finite Element Model of a neonate´s skull to evaluate the stress pattern distribution resulting during Nasoalveolar Molding therapy of cleft lip and palate patients

Nasoalveolar Molding (NAM) is associated with ambivalent acceptance regarding effectiveness and unknown long-term results. Our purpose was to analyze the stress distribution patterns within the viscero- and neurocranium of neonates during the first phase of NAM therapy.A finite element (FE) model of a healthy four-week-old neonate was generated, derived from a computed tomography scan allowing the implementation of a bone-density-dependent material model. The influence of dental germs with variable material properties, the cleft width and area of expected force application were analyzed in a worst-case scenario.

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Squamous cell carcinoma of the maxilla: Analysis of clinicopathological predictors for disease recurrence and metastatic behavior

Squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common cancer in the world, accounting for approximately 5% of all malignant tumors (with regional differences) (Torre et al. 2015). Cancer of the maxilla, however, is relatively rare and accounts for only 0.5–5% of oral cancers in general, depending on anatomical classification (Brown et al. 2000, Pathak et al. 2007, Binahmed et al. 2008, Sagheb et al. 2014). While the available literature can point to a large number of epidemiological studies that investigate cancers of the head and neck or the oral cavity in general, few authors have examined maxillary carcinoma exclusively.

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Mechanical stress in plates for bridging reconstruction mandibular defects and purposes of double plate reinforcement

To evaluate the biomechanical performance of a commercially available bridging plate (2.4) as well as screws and bone simulating the reconstruction of hemimandibular defects and to indicate alternatives of reinforcement to prevent plate fractures either by strength or fatigue.

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Show and Tell: Video Modeling and Instruction Without Feedback Improves Performance but Is Not Sufficient for Retention of a Complex Voice Motor Skill

Modeling and instruction are frequent components of both traditional and technology-assisted voice therapy. This study investigated the value of video modeling and instruction in the early acquisition and short-term retention of a complex voice task without external feedback.

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Cross-cultural Adaption and Validation of the Danish Voice Handicap Index

We aimed to assess psychometric properties, including internal consistency, reliability, and clinical validity of the Danish version of the Voice Handicap Index (VHI).

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The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research

The burden attributable to headache disorders has multiple components: a simple measure summarising them all does not exist. The Migraine Disability Assessment (MIDAS) instrument has proved useful, estimating ...

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Response to: Studying the blood pressures of antegrade and retrograde internal mammary vessels: Do they really work as recipient vessels? Tomioka YK, Uda H, Yoshimura K, Sunaga A, Kamochi H, Sugawara Y. J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1391-1396.

We congratulate Tomioka et al. on an interesting article assessing intraoperatively the arterial and venous pressures in both the antegrade and retrograde limbs of the internal mammary vessels.1 The authors report positively on the recorded arterial and venous pressures in the retrograde vessels, demonstrating clearly that in their series of ten free flap breast reconstructions, there is adequate arterial flow and sufficiently low venous back pressure to allow perfusion of a second microsurgery recipient site.

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The pedicled internal pudendal artery perforator flap for ischial pressure sore reconstruction: technique and long-term outcome of a cohort study

The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold.

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Upgrading the BREAST-Q questionnaire with donor site evaluation after PAP flap breast reconstruction.

Dear Sir:

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The ‘wifi’ otoplasty : combined concentric posterior microchondrectomies and sutures for correction of prominent ears

Prominent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications.

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Reduction of the DIEP flap donor site morbidity through a minimally invasive pedicle harvest with jacob's ladder incisions.

Despite the decrease of donor-site morbidity through the introduction of the deep inferior epigastric artery perforator (DIEP) flap as successor of the free transverse rectus abdominis (TRAM) flap, abdominal complications still occur. The etiology of lower abdominal bulging following breast reconstruction with the DIEP flap is still under debate. Most studies estimate the incidence for a postoperative lower abdominal bulging to be between 0.7% and 5%. However, a higher number of undetected and unreported cases is not unusual.

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Time course of improvement after re-repair procedure for VPI management

Palatal re-repair aims to improve velar function by retro-positioning the levator veli palatini muscles. The surgery includes extensive dissection, leading to tissue edema and scar formation which may need time to remodel. Together with the change of muscle orientation and tension, it is expected that a period of time is needed to reach the final functional performance. This study attempts to determine how much time is required to reach the optimum performance of the palate after re-repair.

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‘Abdominal reanimation’ and massive flank hernias: moving towards a more functional reconstruction

Dear Sir,

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The impact of a career night information session on medical students' perceptions of the scope of practice of plastic surgeons

- Misconceptions surrounding the scope of practice of plastic surgeons are common amongst health care professionals. Medical students are vulnerable to these misconceptions. The aim of this study is to assess the impact of an information event on medical students with respect to their interest and knowledge of the scope of practice of plastic surgeons.

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Free second dorsal metacarpal artery flap for digital reconstruction: when you cannot go local, you can go free

Traditionally flaps based on the dorsal metacarpal artery system are used as pedicled or islanded flaps to cover defects on the dorsum of the hand or digits. In these areas they provide like for like tissues in texture, colour and quality to skin over the digits. 1, 2, 3.

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Breast reconstruction and risk of arm lymphedema development: a meta-analysis breast

Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between Breast Reconstruction (BR) and lymphedema.

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Anatomical relationship of the right internal jugular vein and the spinal accessory nerve – a word of caution.

We wish to report an usual relationship between the internal jugular vein and the spinal accessory nerve. We highlight this as a word of caution to head and neck surgeons performing neck dissections, so that they are aware of this anomalous relationship in an effort to prevent iatrogenic injury.

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Time to re-group and save: do we routinely need to perform group-and-save in patients undergoing free deep inferior epigastric perforator (DIEP) flap breast reconstruction?

Dear Sir,

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2s0xbuF

“Current evidence on the role of smoking in plastic surgery elective procedures: a systematic review and meta-analysis.”

Smoking is considered to be a significant risk factor for the development of postoperative complications after various surgical procedures, mainly by limiting oxygen delivery to tissues. Evidence on the collective impact of smoking in aesthetic procedure outcomes is scarce. The aim of this study is to evaluate the current evidence on the association between smoking and postoperative outcomes in patients who underwent common elective procedures in plastic surgery.

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Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the lateral circumflex femoral artery for reconstruction of soft-tissue defect of the knee

Anteromedial thigh flaps are far less clinically appealing than their anterolateral counterparts, and are occasionally considered as an alternative to the anterolateral thigh flap. Herein, we report the study of soft-tissue defects reconstruction in the knee using a distally based anteromedial thigh flap pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery.Patients and Methods: Between July 2008 and September 2016, a distally based anteromedial thigh flap was used to reconstruct soft-tissue defects of the knee in 5 patients (3 males, 2 females; age range at surgery 4–55 years old).

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Intralesional cryotherapy versus excision with corticosteroid injections or brachytherapy for keloid treatment: randomised controlled trials.

Keloids are a burden for patients due to physical, aesthetic and social consequences. Treatment remains a challenge due to therapy resistance and high recurrence rates. The main goals of treatment are to improve scar appearance and symptoms and patients' quality of life (QoL).

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The use of SERI™ surgical scaffolds in direct-to-implant reconstruction after skin-sparing mastectomy: a retrospective study on surgical outcomes and a systematic review of current literature.

Little is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction.

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Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure

The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion.

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Does platelet-rich fibrin have a role in osseointegration of immediate implants? A randomized, single-blind, controlled clinical trial

Immediate implants are a valuable treatment option to replace natural teeth in the aesthetic region. The hypothesis of this randomized controlled clinical trial was that immediate implants grafted with autologous platelet-rich fibrin (PRF) have better clinical and radiographic outcomes than non-grafted controls. Forty-one implants were placed in 31 subjects with one or more non-restorable single-rooted teeth. Autologous PRF was placed in the peri-implant region of the study group (n=21) and no augmentation was done in the control group (n=20).

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Biopsychosocial Distress in Young Adult Oncology Patients: Examining Sex Differences in Sources of High Distress and Requests for Assistance

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


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Intervención en trastornos pragmáticos: consideraciones metodológicas

Publication date: Available online 1 February 2018
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Marc Monfort, Adoración Juárez Sánchez
Partiendo de las necesidades propias de una perspectiva clínica, se realiza una revisión de los principales modelos interpretativos de los trastornos pragmáticos en niños y su relación con propuestas de intervención. Frente a la diversidad de los síntomas y de los cuadros patológicos y ante la pobreza de pruebas empíricas suficientes, se propone un análisis metodológico de dichas propuestas que facilite un diseño individualizado de la intervención.Based on the needs of a clinical perspective, a review of the main interpretative models of pragmatic disorders in children and their relationship with action proposals is carried out. A methodological analysis of these proposals is suggested, which provides an individualized intervention to deal with the wide range of symptoms and pathological processes and the paucity of sufficient empirical evidence.



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Role of Imaging in Acute Ischemic Stroke

Rapid multimodal imaging is essential in the workup and management of acute ischemic stroke. Early parenchymal findings on non-contrast CT or standard MRI are used to triage patients for intravenous thrombolysis and to provide insight on prognosis. In the wake of recent endovascular stroke trials, advanced techniques including perfusion imaging and noninvasive vascular imaging are becoming important tools to guide potential endovascular treatment or expand therapy windows. Advanced imaging is also important in pediatric ischemic stroke which requires a slightly different workflow and treatment approach.

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Hypoxic, Toxic and Acquired Metabolic Encephalopathies at the Emergency Room: The Role of Magnetic Resonance Imaging

Our purpose is to describe typical computed tomography and magnetic resonance imaging findings in encephalopathies in the emergency. The focus of this article are the most frequent toxic and acquired metabolic diseases and their preferential sites of involvement, such as hepatic encephalopathy, hypoglicemia, non-ketotic hyperglycemia, osmotic demyelination, posterior reversible encephalopathy syndrome, uremia, illegal drug abuse, carbon monoxide poisoning and hypoxic-ischemic encephalopathy. The radiologist must be able to identify the most usual patterns of lesion in computed tomography and magnetic resonance imaging in these settings.

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Intracranial hemorrhage imaging

Intracranial hemorrhage is a medical event frequently encountered in the clinical practice of radiology that has significant potential for patient morbidity and mortality. The expedient and accurate identification of intracranial hemorrhage as well as elucidation of the underlying cause can assist in optimizing the care of these patients. In this review, we attempt to familiarize the reader with the imaging appearance of multiple types of intracranial hemorrhage, both intra-axial and extra-axial and utilizing both CT and MRI, as well as to provide a framework for assessment of the underlying cause of the hemorrhage.

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Biocompatibility and efficiency of biodegradable magnesium-based plates and screws in the facial fracture model of beagles

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Byung Jun Kim, Yinglan Piao, Maierdanjiang Wufuer, Woo-Chan Son, Tae Hyun Choi
PurposeA biodegradable magnesium alloy system has been developed as a substitute for conventional plates and screws made of titanium or absorbable polymer. However, previous studies were limited to small animal experiments using screws or wires. In the present study, we preliminarily evaluated the biocompatibility and effectiveness of human standard-sized biodegradable magnesium-based plates and screws in facial fractures of beagles.MethodsFracture lines were created bilaterally in the zygomatic arches of six beagles. They were fixed in situ with plates and screws made of magnesium alloy mixed with calcium and zinc (experimental group) or absorbable polymer (control group). Laboratory testing, radiologic imaging, histological analysis, and mechanical testing were performed 4 weeks postoperatively.ResultsInflammatory reactions were not significantly increased in any animal. Mechanical testing showed higher ultimate load and structural stiffness values in the experimental group. In the histologic analysis, the void area and bone regeneration area were increased in the experimental group, while the implant area and soft tissue area were increased in the control group. Radiologically, three-dimensional micro-computed tomography showed no difference in the bone gap area between the two groups. A temporary increase in hydrogen gas around the magnesium implants regressed spontaneously and did not affect bone healing significantly.ConclusionMagnesium-based biodegradable plates and screws showed good biocompatibility and offered considerable stability for fixating facial bone fractures in the early bone-healing process. These results show the possibilities for the future development of magnesium alloy plates and screws for craniomaxillofacial fixation in humans.



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Rhabdomyolysis after Prolonged Surgery: Report of Two Cases and Review of Literature

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rebecca Grammer, Jingping Wang, Edward Lahey
Rhabdomyolysis is a condition in which damaged muscle tissue breaks down and intracellular contents, including myoglobin, are released into circulation. This produces a non-specific clinical syndrome including electrolyte disturbances, hypovolemia, metabolic acidosis, coagulopathies, and risk for acute kidney injury. Rhabdomyolysis has been reported as a complication of prolonged surgical procedures but has rarely been reported in the oral and maxillofacial surgery literature. Early diagnosis and treatment of rhabdomyolysis are important to avoid long-term complications such as renal failure. We present two cases of postoperative rhabdomyolysis following prolonged maxillofacial surgical procedures in which the patients were managed without long-term sequelae. The pathophysiology, risk factors, diagnosis and treatment for postoperative rhabdomyolysis are discussed here with a brief review of the literature.



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Idiopathic isolated unilateral hypoglossal nerve palsy: a report of two cases and review of the literature

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Akio Shibata, Masashi Kimura, Kenichiro Ishiabashi, Masahiro Umemura
Hypoglossal nerve palsy (HNP) is a common finding in neurological diseases when associated with other cranial nerve palsies or further pathology and exhibits characteristic clinical manifestations, including unilateral atrophy of the musculature of the tongue. It occasionally appears as the initial or solitary sign of an intracranial or extracranial space-occupying lesion, head/neck injury, or vascular abnormality of the internal carotid artery. There are few cases of idiopathic isolated unilateral HNP, which should be diagnosed through exclusion. Here, we describe two patients who experienced different outcomes and present a literature review of idiopathic isolated unilateral HNP. Case 1 was a 71-year-old man who was referred with a 1-month history of dysphagia and speech impairment. Intraoral examination revealed marked left-sided hemiatrophy of the tongue and deviation toward the left on protrusion. On coronal Tl-weighted magnetic resonance imaging (MRI), left-sided hemiatrophy of the tongue was clearly visible through the deviation of the median septum to the left. The patient was diagnosed with idiopathic isolated unilateral HNP through exclusion, and was treated with steroids and mecobalamin, but he did not recover. Case 2 was a 32-year-old man complaining of tongue weakness since 2 days. On examination, left HNP was evident, with deviation of the tongue to the left on protrusion. He was diagnosed with idiopathic isolated unilateral HNP through exclusion, and was treated with steroids. After 3 weeks, the patient had completely recovered. To the best of our knowledge, this is the first detailed literature review on idiopathic isolated unilateral HNP. This condition is very rare but should be considered for diagnosis. It warrants a thorough and stepwise approach for etiological diagnosis.



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Syngnathia - Congenital maxillo-mandibular fusion: Case Report and Literature Review.

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Amit Mohan
Congenital maxillo-mandibular fusion is a rare disorder of the craniofacial region. Maintenance of the airway and difficulty in feeding are the main concerns in such patients. We performed a PUBMED search to identify reported cases of syngnathia. In reference to the site of fusion and corresponding anomalies, the available articles were reviewed. The maxillo-mandibular fusion can be anterior fusion, unilateral or bilateral fusion and complete fusion. The condition can be seen as an isolated problem or associated with a syndrome. The condition may require an immediate attention as it can be fatal. A case of isolated unilateral syngnathia has been discussed in this manuscript along with the detailed review of the literature.



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Open reduction and internal fixation of mandibular condylar base and neck fractures using strut plates

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Carolin Lechler, Florian Probst, Carl-Peter Cornelius, Wenko Smolka
PurposeEvaluation of the clinical, radiological and functional outcomes of patients with condylar neck or base fractures treated with open reduction and internal fixation using strut plates.Patients and MethodThirty patients with a total of 34 condylar neck and base fractures were included in the study. Transoral endoscopically assisted, submandibular or transparotid approaches were performed. Clinical and radiological outcomes were evaluated. Functional outcomes were assessed with the Helkimo index in a subgroup of 15 patients.ResultsStrut plates were successfully placed through all surgical approaches used in this study. Fracture healing was without complications in 33 condylar processes. One plate fracture occurred. In the subgroup, 7 patients had good functional outcome, 7 had slightly impaired and one patient had moderately impaired functional outcome.ConclusionStrut plates are appropriate for retromandibular transparotid, endoscopic assisted transoral or submandibular approaches in the management of condylar neck or base fractures. Intraoperative handling and fitting accuracy of the strut plates are good. Good to slightly impaired functional outcome was observed in a subgroup of patients.



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Streptococcus anginosus dental implant-related osteomyelitis of the jaws: An insidious and calamitous entity

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sybille Chatelain, Tommaso Lombardi, Paolo Scolozzi
PurposeTo analyze a series of patients with dental implant-related suppurative osteomyelitis of the jaws (DIOMJ) due to Streptococcus anginosus.Patients and MethodsThe charts of all patients seen for osteomyelitis of the jaws between 2011 and 2016 were reviewed. The primary outcome variable was Streptococcus anginosus DIOMJ. Other variables included age, gender, smoking habits, associated co-morbidities, dental implant localization, type of osteomyelitis, delay between dental implant placement and DIOMJ, microbiological examination and antibiogram, antibiotherapy, type of surgery and final outcome.Cases from previous reports of DIOMJ in the literature were also analyzed for comparison.Descriptive statistics were computed.Results26 patients had jaw osteomyelitis, of whom 6 (26%) occurred after dental implant placement. S. anginosus was found in 5 patients and Escherichia coli in one. The osteomyelitis was located in the mandible and associated with a deep neck abscess in all cases. All of the patients were women and were either smokers or had co-morbidities affecting bone metabolism. In all of the cases, dental implants were removed and several surgical debridement procedures (at least two) and prolonged antibiotherapy (6 months on average) were needed. Half of the patients needed a radical surgical reconstructive procedure with partial resection and bone graft.ConclusionThis study demonstrated that Streptococcus anginosus DIOMJ is a particularly aggressive form of osteomyelitis, which has a propensity to develop in the mandible in women in their 60s who are either smokers or have co-morbidities.



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Management of Bilateral Edentulous Mandible Fractures through an Intraoral Approach Using CAD/CAM Technology: A Case Report

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Howard D. Wang, Christopher Frost, Alessandro Cusano, Amir H. Dorafshar
Surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of a 58-year-old man with bilateral edentulous mandible fractures. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.



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Activation of pial and dural macrophages and dendritic cells by CSD (67 chrs)

Abstract

Objective:

Cortical spreading depression (CSD) has long been implicated in migraine attacks with aura. The process by which CSD, a cortical event that occurs within the blood brain barrier (BBB), results in nociceptor activation outside the BBB is likely mediated by multiple molecules and cells. The objective of this study was to determine whether CSD activates immune cells inside the BBB (pia), outside the BBB (dura), or in both, and if so, when.

Methods:

Investigating cellular events in the meninges shortly after CSD, we used in-vivo 2-photon imaging to identify changes in macrophages and dendritic cells (DC) that reside in the pia, arachnoid, and dura, and their anatomical relationship to TRPV1 axons.

Results:

We found that activated meningeal macrophages retract their processes and become circular, and that activated meningeal DC stop migrating. We found that CSD activates pial macrophages instantaneously, pial, subarachnoid and dural DC 6-12 minutes later, and dural macrophages 20 minutes later. Dural macrophages and DC can appear in close proximity to TRPV1-positive axons.

Interpretation:

The findings suggest that activation of pial macrophages may be more relevant to cases where aura and migraine begin simultaneously, that activation of dural macrophages may be more relevant to cases where headache begins 20-30 minutes after aura, and that activation of dural macrophages may be mediated by activation of migratory DC in the SAS and dura. The anatomical relationship between TRPV1-positive meningeal nociceptors, and dural macrophages and dendritic cells support a role for these immune cells in the modulation of head pain. This article is protected by copyright. All rights reserved.

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Rivaroxaban plasma levels in acute ischemic stroke and intracerebral hemorrhage

Abstract

Objective:

Information about Rivaroxaban plasma levels (RivLev) may guide treatment decisions in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) taking rivaroxaban.

Methods:

In a multicenter registry-based study (Novel-Oral-Anticoagulants-In-Stroke-Patients collaboration;NOACISP;ClinicalTrials.gov:NCT02353585) of patients with stroke while taking rivaroxaban, we compared RivLev in patients with AIS and ICH. We determined how many AIS-patients had RivLev≤100ng/ml, indicating possible eligibility for thrombolysis and how many ICH-patients had RivLev≥75ng/ml, possibly eligible for the use of specific reversal agents. We explored factors associated with RivLev (Spearman correlation; regression models) and studied the sensitivity and specificity of INR-thresholds to substitute RivLevs using cross tables and ROC curves.

Results:

Among 241 patients (median age 80 years[IQR73-84], median time-from-onset-to-admission 2 hours[IQR1-4.5hours], median RivLev 89ng/ml[31-194]), 190 had AIS and 51 had ICH. RivLev were similar in AIS-patients (82ng/ml[IQR30-202] and ICH-patients (102ng/ml[IQR 51-165]; p=0.24). Trough RivLev_{(≤137ng/ml)} occurred in 126/190 (66.3%) AIS- and 34/51 (66.7%) ICH-patients. Among AIS-patients, 108/190 (56.8%) had RivLev≤100ng/ml. In ICH-patients 33/51(64.7%) had RivLev≥75ng/ml. RivLev were associated with rivaroxaban dosage, inversely with renal function and time-since-last-intake (each p<.05). INR≤1.0 had a specificity of 98.9% and a sensitivity of 25.7% to predict RivLev≤100ng/ml. INR≥1.4 had a sensitivity of 59.3% and specificity of 90.1% to predict RivLev≥75ng/ml.

Interpretation:

RivLev did not differ between patients with AIS and ICH. Half of the patients with AIS under Rivaroxaban had RivLev low enough to consider thrombolysis. In ICH-patients, 2/3 had RivLev high enough to meet the eligibility for the use of a specific reversal agent. INR-thresholds perform poor to inform treatment decisions in individual patients. This article is protected by copyright. All rights reserved.

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Sleep and Cognitive Decline: A Prospective Non-demented Elderly Cohort Study

Abstract

Objective: To investigate sleep disturbances that induce cognitive changes over four years in non-demented elderlies.

Methods: Data were acquired from a nationwide, population-based, prospective cohort of Korean elderlies (2,238 normal cognition [NC] and 655 mild cognitive impairment [MCI]). At baseline and 4-year follow up assessments, sleep-related parameters (mid-sleep time, sleep duration, latency, subjective quality, efficiency and daytime dysfunction) and cognitive status were measured using Pittsburgh Sleep Quality Index and Consortium to Establish a Registry for Alzheimer's Disease Assessment, respectively. We used logistic regression models adjusted for covariates including age, sex, education, apolipoprotein E genotype, Geriatric Depression Scale, Cumulative Illness Rating Scale, and physical activity.

Results: In participants with NC, long sleep latency (> 30 min), long sleep duration (≥ 7.95 hr), and late mid-sleep time (after 3:00AM) at baseline were related to the risk of cognitive decline at 4-year follow-up assessment; odds ratio (OR) was 1.40 for long sleep latency, 1.67 for long sleep duration, and 0.61 for late mid-sleep time. These relationships remained significant when these variables maintained their status throughout the follow-up period. Newly developed long sleep latency also doubled the risk of cognitive decline. In those with MCI, however, only long sleep latency reduced the chance of reversion to NC (OR = 0.69).

Interpretation: As early markers of cognitive decline, long sleep latency can be used for elderlies with NC or MCI, while long sleep duration and relatively early sleep time might be used for cognitively normal elderlies only. This article is protected by copyright. All rights reserved.

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Mutations in MICAL-1 cause autosomal dominant lateral temporal epilepsy

Abstract

Objective: Autosomal dominant lateral temporal epilepsy (ADLTE) is a genetic focal epilepsy characterized by auditory symptoms. Two genes, LGI1 and RELN, encoding secreted proteins, are implicated in the etiology of ADLTE, but half of the affected families remain genetically unsolved, and the underlying molecular mechanisms are yet to be clarified. We aimed to identify additional genes causing ADLTE to better understand the genetic basis and molecular pathway underlying this epileptic disorder.

Methods: A cohort of Italian ADLTE families was examined by whole exome sequencing combined with genome-wide single nucleotide polymorphism-array linkage analysis.

Results: We identified two ADLTE-causing variants in the MICAL-1 gene: a p.Gly150Ser substitution occurring in the enzymatically active monooxygenase (MO) domain, and a p.Ala1065fs frameshift indel in the C-terminal domain, which inhibits the oxidoreductase activity of the MO domain. Each variant segregated with ADLTE in a single family. Examination of candidate variants in additional genes excluded their implication in ADLTE. In cell-based assays, both variants significantly increased MICAL-1 oxidoreductase activity and induced cell contraction in COS7 cells, which likely resulted from deregulation of F-actin dynamics.

Interpretation: MICAL-1 oxidoreductase activity induces disassembly of actin filaments, thereby regulating the organization of the actin cytoskeleton in developing and adult neurons and in other cell types. This suggests that dysregulation of the actin cytoskeleton dynamics is a likely mechanism by which MICAL-1 pathogenic variants lead to ADLTE. This article is protected by copyright. All rights reserved.

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Increase of HCN current in the aberrant excitability of spinal muscular atrophy

Abstract

Objective

The pathophysiology of spinal muscular atrophy (SMA) is still unclear.

Methods

The nerve excitability test in SMA patients and a mouse model of SMA was carried out to explore the pathophysiology of nodal and internodal currents, and quantitative PCR, Western blotting and whole-cell patch-clamp recording were used for the identified hypothesis.

Results

The nerve excitability test in SMA patients showed increased inward rectification in the current-threshold relationship and increased overshoot after hyperpolarizing threshold electrotonus, which indicates increased hyperpolarization-activated cyclic nucleotide-gated (HCN) current; these findings correlated with disease severity. Increased inward rectification in the current-threshold relationship was reproducible in a mouse model of mild SMA and the abnormality preceded the decline of compound motor action potential amplitudes. Furthermore, quantitative PCR of spinal cord tissues and Western blotting of the spinal cord and sciatic nerves showed increased HCN1 and HCN2 expression in the SMA mice, and voltage-clamp recording in dissociated spinal motor neurons from SMA mice also showed increased HCN current density. Treatment with ZD7288, an HCN channel blocker, also reduced early mortality, improved motor function, and restored neuromuscular junction architecture in a mouse model of severe SMA.

Interpretation

This study shows that increased HCN current underlies the pathophysiology of SMA and can be a novel non-SMN-target for SMA therapy. This article is protected by copyright. All rights reserved.

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Interpreting Alzheimer's disease polygenic scores

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Significant association of increased PD-L1 and PD-1 expression with nodal metastasis and a poor prognosis in oral squamous cell carcinoma

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Maruse, S. Kawano, T. Jinno, R. Matsubara, Y. Goto, N. Kaneko, T. Sakamoto, Y. Hashiguchi, M. Moriyama, T. Toyoshima, R. Kitamura, H. Tanaka, K. Oobu, T. Kiyoshima, S. Nakamura
Programmed cell death ligand 1 (PD-L1) and its receptor PD-1 are immune checkpoint molecules that attenuate the immune response. Blockade of PD-L1 enhances the immune response in a variety of tumours and thus serves as an effective anti-cancer treatment. However, the biological and prognostic roles of PD-L1/PD-1 signalling in oral squamous cell carcinoma (OSCC) remain to be elucidated. The purpose of this study was to examine the correlation of PD-L1/PD-1 signalling with the prognosis of OSCC patients to assess its potential therapeutic relevance. The expression of PD-L1 and of PD-1 was determined immunohistochemically in 97 patients with OSCC and the association of this expression with clinicopathological characteristics was examined. Increased expression of PD-L1 was found in 64.9% of OSCC cases and increased expression of PD-1 was found in 61.9%. Univariate and multivariate analysis revealed that increased expression of PD-L1 and PD-1 positively correlated with cervical lymph node metastasis. The expression of CD25, an activated T-cell marker, was negatively correlated with the labelling index of PD-L1 and PD-1. Moreover, the patient group with PD-L1-positive and PD-1-positive expression showed a more unfavourable prognosis than the group with PD-L1-negative and PD-1-negative expression. These data suggest that increased PD-L1 and PD-1 expression is predictive of nodal metastasis and a poor prognosis and is possibly involved in cancer progression via attenuating the immune response.



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Patient Concerns Inventory (at diagnosis) and intention to treat

Treatment of head and neck cancer is often radical, with patients going through considerable emotional distress at some point before, during, or after treatment.1 Both disease and treatment can adversely affect the health-related quality of life.2 For patients to be involved with making decisions about their care, it is crucial that they are able to communicate their needs and concerns effectively.3 Care can be improved by screening problems, thereby facilitating effective management of resources and provision of appropriate interventions.

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Transdermal scopolamine for the prevention of a salivary fistula after parotidectomy

Our aim was to investigate whether perioperative transdermal application of scopolamine could help to prevent fistulas after parotidectomy, and to this end we retrospectively studied the records of all patients (n=645) who had benign parotid tumours treated by partial parotidectomy between 2011 and 2016. We found that scopolamine led to a significant decrease in the incidence of salivary fistulas from 54/371(15%) in the group not given it to 10/274 (4%) in the group given it (p<0.0001). The "number needed to treat" was 9.17.

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Otosclerosis

Otosclerosis is pathologically characterized by abnormal bony remodeling, which includes bone resorption, new bone deposition, and vascular proliferation in the temporal bone. Sensorineural hearing loss in otosclerosis is associated with extension of otosclerosis to the cochlear endosteum and deposition of collagen throughout the spiral ligament. Persistent or recurrent conductive hearing loss after stapedectomy has been associated with incomplete footplate fenestration, poor incus-prosthesis connection, and incus resorption in temporal bone specimens. Human temporal bone pathology has helped to define the role of computed tomography imaging for otosclerosis, confirming that computed tomography is highly sensitive for diagnosis, yet limited in assessing cochlear endosteal involvement.

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International consensus (ICON) on comprehensive management of the laryngeal nerves risks during thyroid surgery

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Périé, J. Santini, H.Y. Kim, H. Dralle, G.W. Randolph
The laryngeal monitoring of the inferior and superior laryngeal nerves, and the vagus nerve, has advanced for last years, in practice of thyroid and parathyroid surgery. Different methods are used, using direct or indirect laryngeal stimulation and also intermittent or continuous nerve registration. At present time, various recommendations of it in the world use are reported, and availability of the tool used remains a limit in some countries. The aim of this Icon during Ifos 2017 was to share knowledge about laryngeal intraoperative nerve monitoring (LIONM) procedures and to evaluate current practices used to improve the quality of thyroid and parathyroid surgery. Benefits of LIONM were discussed with three experts (Pr G. Randolph from Boston, Pr Henning Dralle from Halle in Germany, Pr Hoon Yub KIM from Seoul). All of them have been actively involved in the development and use of laryngeal nerve monitoring during thyroid and parathyroid surgery.



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International consensus (ICON) on assessment of oropharyngeal dysphagia

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Espitalier, A. Fanous, J. Aviv, S. Bassiouny, G. Desuter, N. Nerurkar, G. Postma, L. Crevier-Buchman
ObjectiveTo present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation).MethodsFollowing a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting.ResultsFor the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.



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International consensus (ICON) on audiological assessment of hearing loss in children

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Farinetti, A. Raji, H. Wu, B. Wanna, C. Vincent
The prevalence of hearing loss in newborns and infants is estimated between 1 to 3.47 cases per 1000 live births. Early diagnosis and rehabilitation of congenital hearing loss are mandatory in order to achieve a satisfactory linguistic and cognitive development. Without appropriate opportunities to learn language, these children will fall behind their normal hearing peers in communication, cognition, reading and socio-emotional development. After promising results, neonatal screening for hearing loss and audiological evaluation are becoming more extensively carried out. In planning universal neonatal hearing screening programs, transient evoked otoacoustic emissions and auditory brainstem responses are the gold standard for the screening and diagnosis program. However, there is no consensus regarding the use of audiometry and other electrophysiological tests (such as auditory steady-state responses) in current practices. Several screening and audiological assessment procedures have been described and advocated all around the world. But, a systematic scheme of performing diagnosis in the pediatric audiology population is lacking. A consensus conference was held at the International Federation of Oto-rhino-laryngological Societies Congress, in June 2017, to discuss the different current practices and to identify the best neonatal hearing screening and audiological assessment management. This article is intended to provide professionals with recommendations about the "best practice" based on consensus opinion of the session's speakers, and a review of the literature on the efficacy of various assessment options for children with hearing loss.



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Forestier syndrome and obstructive sleep apnea: Surgical treatment

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D.K. Ribeiro, J.A. Pinto, G.S. Freitas
IntroductionWe report a case of obstructive sleep apnea that occurred as a result of Forestier disease and describe the surgical treatment that was performed.SummaryThe patient is a 56-year-old man who presented dysphagia for solids and liquids, snoring (score 10) and excessive daytime sleepiness for 5 years. On fiber optic laryngoscopy examination, there was interarytenoid edema and protrusion of the posterior wall of the larynx. The cervical X-Ray showed protrusion of intervertebral disc between C3–C5 (skeletal hyperostosis) and the polysomnography revealed apnea-hypopnea index (AHI) of 56 events/h. Surgery was performed by the otorhinolaryngology and orthopedic teams. The patient evolved with complete symptom resolution and an AHI of 3,9 events/h on the control polysomnography.DiscussionsThis is the first reported case of Forestier Syndrome (FS) associated with Obstructive Sleep Apnea (OSA) that was proposed surgical treatment and the patient evolved with complete symptom improvement.



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International consensus (ICON) on treatment of sudden sensorineural hearing loss

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Marx, E. Younes, S.S. Chandrasekhar, J. Ito, S. Plontke, S. O'Leary, O. Sterkers
Sudden sensorineural hearing loss (SSNHL) is a common and alarming symptom that often prompts an urgent visit to an ENT specialist. Treatment of SSNHL remains one of the most problematic issues for contemporary otorhinolaryngology: although many meta-analyses and national guidelines have been issued, management is not standardized in terms of medical treatment, and duration and route of administration. We present several methodological suggestions for the study of treatments for SSNHL. These were developed from the existing level of evidence of the main treatments used in SSNHL by experts who convened at the IFOS 2017 ENT World Congress in Paris, France. All panelists agreed that one of the main limitations present in studies on SSNHL is related to the wide heterogeneity, which characterizes both the initial hearing deficit and the amount of hearing recovery. Although evidence of the efficacy of systemic steroids cannot be considered as strong enough to recommend their use, it is still the most widespread primary therapy and can be considered as the current standard of care. Therefore, systemic steroids stand as an adequate control for any innovative treatment. To reduce the number of subjects we suggest that the inclusion criteria should be restricted to moderate to profound levels of hearing loss. The efficacy of trans-tympanic steroids as a salvage therapy was suggested in several reports on small populations and needs to be confirmed with larger randomized controlled trials.



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International consensus (ICON) on functional and aesthetic rhinoplasty

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Albert, F. Simon, A.-J. Tasman, D. Chua, R. Grigg, A. Jaklis, T. Wang, F. Disant
During the 2017 IFOS international congress in Paris, a roundtable discussion on the topic of functional and aesthetic rhinoplasty was organised. Five experts, from the five continents and renown in the field of rhinoplasty, were brought together to discuss the issue from an international perspective and to put forward a consensus or on the contrary practical differences. Five questions were put to the experts beforehand to guarantee independent answers, which were then discussed during the roundtable. The questions were the following:– What are the age limits for achieving a rhinoplasty?– Do you use objective measurements before, during and after surgery? (facial landmarks, airflow, peroperative measurements)– How do you manage the preoperative general information and computer imaging of the patient?– What are the indications in your practice to perform a CT-scan or endoscopic examination before doing a rhinoplasty?– What kind of graft or prosthesis do you use for an augmentation rhinoplasty? This paper offers a synthesis of the roundtable based on the experts' answers to the different questions.



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An unusual neck tumor

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Gaudreau, A. Belisle, T. Ayad




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Age of pubertal events among school girls in Lagos, Nigeria

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


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Performance of the 2012 systemic lupus international collaborating clinics classification criteria versus the 1997 American College of Rheumatology Classification Criteria in adult and juvenile systemic lupus Erythematosus. A systematic review and meta-analysis

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Esther A.R. Hartman, Annet van Royen-Kerkhof, Johannes W.G. Jacobs, Paco M.J. Welsing, Ruth D.E. Fritsch-Stork
ObjectiveTo evaluate the performance in classifying systemic lupus erythematosus by the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC'12), versus the revised American College of Rheumatology criteria from 1997 (ACR'97) in adult and juvenile SLE patients.MethodsA systematic literature search was conducted in PubMed and Embase for studies comparing SLICC'12 and ACR'97 with clinical diagnosis. A meta-analysis was performed to estimate the sensitivity and specificity of SLICC'12 and ACR'97. To assess classification earlier in the disease by either set, sensitivity and specificity were compared for patients with disease duration <5 years. Sensitivity and specificity of individual criteria items were also assessed.ResultsIn adult SLE (nine studies: 5236 patients, 1313 controls), SLICC'12 has higher sensitivity (94.6% vs. 89.6%) and similar specificity (95.5% vs. 98.1%) compared to ACR'97. For juvenile SLE (four studies: 568 patients, 339 controls), SLICC'12 demonstrates higher sensitivity (99.9% vs. 84.3%) than ACR'97, but much lower specificity (82.0% vs. 94.1%). SLICC'12 classifies juvenile SLE patients earlier in disease course. Individual items contributing to diagnostic accuracy are low complement, anti-ds DNA and acute cutaneous lupus in SLICC'12, and the immunologic and hematologic disorder in ACR'97.ConclusionBased on sensitivity and specificity SLICC'12 is best for adult SLE. Following the view that higher specificity, i.e. avoidance of false positives, is preferable, ACR'97 is best for juvenile SLE even if associated with lower sensitivity. Our results on the contribution of the individual items of SLICC'12 and ACR´97 may be of value in future efforts to update classification criteria.



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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Kwang Seob Lee, Andreas Kronbichler, Michael Eisenhut, Keum Hwa Lee, Jae Il Shin
Systemic autoimmune diseases can affect various kinds of organs including the kidney, the skin, soft tissue and the bone. Among others, cardiovascular involvement in rheumatic diseases has been shown to affect myocardium, pericardium, cardiac vessels, conduction system and valves, eventually leading to increased mortality. In general, underlying chronic inflammation leads to premature atherosclerosis, but also other manifestations such as arrhythmia and heart failure may have a 'silent' progress. Traditional cardiovascular risk factors play a secondary role, while disease-specific factors (i.e. disease duration, severity, antibody positivity, persistent disease activity) can directly influence the cardiovascular system. Therefore, early diagnosis is critical to optimize management and to control inflammatory activity and recent data suggest that risk factors (i.e. hypercholesterolemia and hypertension) need intensive treatment as well. With the advent of immunosuppressive agents, most rheumatic diseases are well controlled on treatment, but information related to their cardioprotective efficacy is not well-defined. In this review, we focus on cardiovascular involvement in rheumatic diseases and highlight current evidence which should be of help for the treating physicians. Moreover, cardiotoxicity of immunosuppressive drugs is a rare issue and such potential adverse events will be briefly discussed.



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