Brain tissue plasticity: protein synthesis rates of the human brain

Abstract

All tissues undergo continuous reconditioning via the complex orchestration of changes in tissue protein synthesis and breakdown rates. Skeletal muscle tissue has been well studied in this regard, and has been shown to turnover at a rate of 1–2% per day in vivo in humans. Few data are available on protein synthesis rates of other tissues. Because of obvious limitations with regard to brain tissue sampling no study has ever measured brain protein synthesis rates in vivo in humans. Here, we applied stable isotope methodology to directly assess protein synthesis rates in neocortex and hippocampus tissue of six patients undergoing temporal lobectomy for drug-resistant temporal lobe epilepsy (Clinical trial registration: NTR5147). Protein synthesis rates of neocortex and hippocampus tissue averaged 0.17 ± 0.01 and 0.13 ± 0.01%/h, respectively. Brain tissue protein synthesis rates were 3–4-fold higher than skeletal muscle tissue protein synthesis rates (0.05 ± 0.01%/h; P < 0.001). In conclusion, the protein turnover rate of the human brain is much higher than previously assumed.

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VEGF, FGF-2 and TGFβ expression in the normal and regenerating epidermis of geckos: implications for epidermal homeostasis and wound healing in reptiles

Abstract

The skin is a bilayered organ that serves as a key barrier between an organism and its environment. In addition to protecting against microbial invasion, physical trauma and environmental damage, skin participates in maintaining homeostasis. Skin is also capable of spontaneous self-repair following injury. These functions are mediated by numerous pleiotrophic growth factors, including members of the vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and transforming growth factor β (TGFβ) families. Although growth factor expression has been well documented in mammals, particularly during wound healing, for groups such as reptiles less is known. Here, we investigate the spatio-temporal pattern of expression of multiple growth factors in normal skin and following a full-thickness cutaneous injury in the representative lizard Eublepharis macularius, the leopard gecko. Unlike mammals, leopard geckos can heal cutaneous wounds without scarring. We demonstrate that before, during and after injury, keratinocytes of the epidermis express a diverse panel of growth factor ligands and receptors, including: VEGF, VEGFR1, VEGFR2, and phosphorylated VEGFR2; FGF-2 and FGFR1; and phosphorylated SMAD2, TGFβ1, and activin βA. Unexpectedly, only the tyrosine kinase receptors VEGFR1 and FGFR1 were dynamically expressed, and only during the earliest phases of re-epithelization; otherwise all the proteins of interest were constitutively present. We propose that the ubiquitous pattern of growth factor expression by keratinocytes is associated with various roles during tissue homeostasis, including protection against ultraviolet photodamage and coordinated body-wide skin shedding.

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The Anatomical Society core anatomy syllabus for pharmacists: outcomes to create a foundation for practice

Abstract

The Anatomical Society has developed a series of learning outcomes that 'experts' within the field would recommend as core knowledge outputs for a Master's Degree Programme in Pharmacy (MPharm) within the UK. Using the Anatomical Society core gross anatomy syllabus for medical anatomy as a foundation, a modified Delphi technique was used to develop outcomes specific to pharmacy graduates. A Delphi panel consisting of medical practitioners, pharmacists and anatomists (n = 39) was created and involved 'experts' representing 20 UK Higher Education Institutions. The output from this study was 49 pharmacy-specific learning outcomes that are applicable to all pharmacy programmes. The new MPharm anatomy syllabus offers a basic anatomical framework upon which pharmacy educators can build the necessary clinical practice and knowledge. These learning outcomes could be used to develop anatomy teaching within an integrated curriculum as per requirements of the General Pharmaceutical Council (GPhC).

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Femoral Artery Bypass Graft Pseudoaneurysm Rupture in a Transfemoral Amputee: A Case Report

We describe the case of a patient with an actively bleeding pseudoaneurysm associated with remnants of a polytetrafluoroethylene (PTFE) femoral bypass graft in their transfemoral residual limb. Initial graft placement was due to peripheral arterial disease. During subsequent transfemoral amputation, remnants of the non-patent graft were retained in the residuum. Following four years of lower limb prosthesis use, a proximal anastomosis pseudoaneurysm developed (with avulsion of graft remnants). The patient presented to clinic with a 5-day history of increased left groin fullness and largely non-radiating pain (rated 10/10). He was diagnosed with a pseudoaneurysm (1.9 cm) originating from the left common femoral artery and an associated hematoma (8 cm) on CT; this required emergent reoperation. This case highlights the importance surrounding the decision to leave or explant neovascularization materials, which may carry significant risk for infection or physical disruption complications in residual limbs. Corresponding Author Information: Jonathan Dallas, 1303 Wade Avenue, Nashville, TN 37212. jonathan.c.dallas@vanderbilt.edu The authors report no competing interests, funding for this report, or financial benefits. The material in this manuscript has not been previously described or presented. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Preliminary use of the PANESS for detecting subtle motor signs in adolescents with sport-related concussion: a brief report

Sensitive examination tools are needed to optimize evaluation after sport-related concussion (SRC). We preliminarily examined the Physical and Neurological Examination of Subtle Signs (PANESS) for sensitivity to motor changes in a pilot cohort of adolescents aged 13-17 with SRC. 15 Adolescents (5 females) with SRC were evaluated up to 3 times: within 2 weeks of injury, approximately 1 month later (mean 35 days between visits), and for those not recovered at the second visit, again following clinical recovery (mean 70 days between first and last visits for all participants). Comparison data were acquired from 20 age and sex-matched never-concussed healthy control athletes with no history of concussion who were evaluated twice (mean 32 days apart). Main effects of group, time, and interaction effects were evaluated with an analysis of covariance which controlled for socioeconomic status, times tested, and days between testing sessions. Adolescents with concussion had poorer PANESS performance than controls at all time points. Performance improved between visits within the concussion group with no change within the control group. These findings suggest that the PANESS merits additional study in larger cohorts and in combination with other markers of injury to facilitate an enhanced understanding of sports-related concussion and recovery. *Work was conducted while Dr. Stephens was at Kennedy Krieger Institute and Johns Hopkins; she has since moved to Colorado State University. Corresponding Author: Stacy Suskauer, Kennedy Krieger Institute, 7007 N. Broadway, Baltimore, MD, 21205. Email: suskauer@kennedykrieger.org Disclosures: There are no competing interests or financial benefit to the authors to report. Study Funding This research was supported by the National Institutes of Health (J.S. 5T32HD007414); (T.M. & S.S., R21HD080378). Prior Presentation of the Research Prior presentations of this work have been limited to talks given by the senior author (S.S.). Acknowledgements: We thank Dr. Jennifer Reesman for assistance with study design and management. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study

Abstract

Purpose

To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP.

Methods

A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25–69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months.

Results

At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months.

Conclusion

Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Effects of a sodium fluoride- and phytate-containing dentifrice on remineralisation of enamel erosive lesions—an in situ randomised clinical study

Abstract

Objective

The objective of this work was to evaluate effects of a dentifrice containing sodium fluoride (1150 ppm F) and the organic polyphosphate phytate (0.85% w/w of the hexa-sodium salt) on in situ remineralisation of early enamel erosive lesions and resistance to subsequent demineralisation.

Materials and methods

Subjects (n = 62) wore palatal appliances holding eight bovine enamel specimens with pre-formed erosive lesions. They brushed their natural teeth with the phytate test dentifrice (TD); a positive control dentifrice (PC, 1150 ppm fluoride as NaF); a reference dentifrice (RD, disodium pyrophosphate + 1100 ppm fluoride as NaF) or a negative control dentifrice (NC, fluoride-free) in a randomised, double-blind, crossover design. Specimens were removed at 2, 4 and 8 h post-brushing and exposed to an ex vivo acid challenge. Surface microhardness (Knoop) was measured at each stage. The primary efficacy variable was relative erosion resistance (RER); other variables included the surface microhardness recovery (SMHR), acid resistance ratio (ARR) and enamel fluoride uptake (EFU).

Results

After 4 h, the results for RER, ARR and EFU were in the order PC > TD = RD > NC with PC > TD = RD = NC for SMHR. Results at 2 and 8 h were generally consistent with the 4 h data. Mineralisation progressed over time. Dentifrices were generally well-tolerated.

Conclusions

In this in situ model, addition of phytate or pyrophosphate to a fluoride dentifrice inhibited the remineralising effect of fluoride. Both formulations still delivered fluoride to the enamel and inhibited demineralisation, albeit to a lesser extent than a polyphosphate-free dentifrice.

Clinical relevance

Addition of phytate or pyrophosphate to a fluoride dentifrice may reduce its net anti-erosive properties.

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Correction to: Cone beam computed tomography and ultrasonography imaging of benign intraosseous jaw lesion: a prospective radiopathological study

Abstract

In the original version of this article, '123 lytic intraosseous jaw lesions diagnosed in 112 patients' was incorrectly presented as '123 lytic intraosseous jaw lesions diagnosed in 121 patients' and 'an average age of 31.7 ± 15.4 (range, 6–72)' was incorrectly presented as 'average age of 15.4 ± 31.7 (range, 6–72)'.

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Objectively Differentiating Movement Patterns between Elite and Novice Athletes

ABSTRACTIntroductionMovement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative, or data-driven methods can increase objectivity, remove issues related to inter-rater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal components analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance.MethodsMotion capture data from 542 athletes performing seven dynamic screening movements (i.e. bird-dog, drop jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data.ResultsDepending on the movement, the validated linear discriminate analysis models accurately classified 70.66-82.91% of athletes as either elite or novice.ConclusionWe have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e. skill level in this case). Improving this method can enhance screening, assessment and rehabilitation in sport, ergonomics and medicine. Introduction Movement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative, or data-driven methods can increase objectivity, remove issues related to inter-rater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal components analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance. Methods Motion capture data from 542 athletes performing seven dynamic screening movements (i.e. bird-dog, drop jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data. Results Depending on the movement, the validated linear discriminate analysis models accurately classified 70.66-82.91% of athletes as either elite or novice. Conclusion We have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e. skill level in this case). Improving this method can enhance screening, assessment and rehabilitation in sport, ergonomics and medicine. Corresponding Author: Ryan B. Graham, PhD, Assistant Professor, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, E-mail: rgraham@uottawa.ca, Phone: +1 613 562 5800 x 1025, Fax: +1 613 562 5497 We would like to thank our funding sources: the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Queen Elizabeth II Graduate Scholarships in Science and Technology (QEII-GSST), and the University of Ottawa School of Graduate Studies. In addition, we would like to thank the athletes who partook in the study. The results of the present study do not constitute endorsement by ACSM. In addition, the authors declare that there are no conflicts of interest. Although Motus is a for-profit company and the Director of Research at Motus, Brittany Dowling, is an author on the paper, the approach used in this paper is an objective, data-driven approach and is not only applicable to this data set. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation Accepted for Publication: 31 January 2018 © 2018 American College of Sports Medicine

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Issue Information

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Erratum

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Issue Information

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Nitrate Removal from Groundwater by Heterotrophic/Autotrophic Denitrification Using Easily Degradable Organics and Nano-Zero Valent Iron as Co-Electron Donors

Abstract

Heterotrophic/autotrophic denitrification (HAD) is an effective approach to remove nitrate from contaminated groundwater. To improve its performance, easily degradable organics (methanol, ethanol, oxalic acid, and sodium acetate) and nano-zero valent iron (nZVI) were selected as co-electron donors for HAD, and their effectiveness in enhancing HAD to remove nitrate from simulated groundwater was evaluated. It was found that the removal efficiency of HAD to nitrate was significantly affected by the species of easily degradable organics as their different biological availability. Among the tested organics, ethanol-supported HAD system exhibited a better removal efficiency, and after 10 days reaction, it could achieve a high nitrate removal rate to 85.6% with an initial concentration of 90.94 mg/l, and at the end of the test (27 days), nitrate was almost completely removed in the interaction of heterotrophic denitrification (HD) and autotrophic denitrification (AD), and there was no nitrite and ammonium accumulation (< 0.1 and 1.0 mg/l). Moreover, the initial C/N ratios (0.2, 0.5, 1.0, 2.0, and 4.0) of simulated groundwater had a significant influence on nitrate removal by HAD. Increasing the C/N from 0.2 to 2.0 could markedly enhance nitrate removal efficiency, but continuously increased to 4.0 the removal rate just decreased; nevertheless, the accumulation of nitrite and ammonium were closely related to both the C/N ratios and species of organics. The synergistic effect between HD and AD process plays a vital role in the mixotrophic environment. Therefore, this research provides an effective method for nitrate removal from contaminated water with low organic carbon.

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Outcomes of the use of Ligamentotaxor® for proximal interphalangeal fractures of the hand: North Bristol hand centre experience

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Nicotinamide N-methyltransferase: potential involvement in cutaneous malignant melanoma

Nicotinamide N-methyltransferase (NNMT) is an enzyme that catalyzes the N-methylation of nicotinamide and pyridine compounds, participating in xenobiotic and drug metabolism. Data on literature have evidenced a possible role of NNMT in many solid cancers, but no data are currently available in cutaneous melanoma. Recent important advances have been achieved in the treatment of advanced melanoma with targeted therapy and immunotherapy. However, the identification of biomarkers that can be used for the detection of early stage disease as well as for monitoring the therapeutic response during treatment is of utmost importance. The aim of this study was to study the possible role of NNMT in melanoma. In the present study, we carried out immunohistochemical analyses to evaluate the expression of the enzyme NNMT in 34 melanomas and 34 nevi. Moreover, we explored the relationship between NNMT levels and the prognostic parameters of patients with melanoma. The results obtained showed significantly (P

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Fracture Resistance of Titanium-Based Lithium Disilicate and Zirconia Implant Restorations

Abstract

Purpose

To evaluate the fracture resistance of a newer lithium disilicate abutment material.

Materials and Methods

A premolar-shaped implant crown was designed using CAD/CAM software, and four groups of implant and crown combinations were milled: (1) lithium-disilicate hybrid-abutment crown; (2) "screwmentable" lithium-disilicate hybrid abutment/lithium-disilicate crown with screw channel; (3) lithium-disilicate hybrid abutment/lithium-disilicate crown; and (4) zirconia hybrid abutment/lithium-disilicate crown (control). The specimens were cemented to a titanium-base implant system, subjected to thermocycling and cyclic loading, and fractured in a material testing device.

Results

The lithium-disilicate hybrid-abutment crown had significantly greater fracture load than all the other groups, which were not significantly different from each other.

Conclusions

Based on fracture load, the new lithium-disilicate hybrid-abutment material may serve as a viable alternative to the use of zirconia as a hybrid-abutment material.

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Clinical and Novel Biomarkers in the Management of Prostate Cancer

Opinion statement

Clinical outcomes in prostate cancer after initial screening and treatment for organ-confined disease and in advanced stage after drug intervention can be heterogeneous. Serum prostate-specific antigen which has a modest value as a screening biomarker while widely used in practice in all subsequent stages has limitations for prognostication or prediction of drug efficacy. Recent advances in genomic sciences and the identification of the mutational landscape of organ-confined and advanced-stage disease have contributed to the development of molecular biomarker profiling in addition to serum prostate-specific antigen. Genomic biomarkers are in development for application to screening for lethal disease subtypes, monitoring of disease recurrence after initial treatments, prognostication, as well as for prediction of drug efficacy. The application of translational molecular profiling in prostate cancer has the potential to enhance clinical management and outcomes in the future. Molecular biomarkers in development in organ-confined disease include both DNA- and RNA-based candidate and pathway-based biomarkers. In advanced-stage disease, molecular biomarker profiling has emerged for identifying therapeutic targets, prediction of drug efficacy, and for prognostication of survival that includes germline single nucleotide profiling and somatic aberrations including copy number variation and mutations and RNA-based profiling. This review summarizes the current state of clinical biomarkers used in practice, their limitations, and novel molecular biomarkers being developed for several clinical endpoints in early- and late-stage cancer.

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Options for Adjuvant Therapy for Uterine Leiomyosarcoma

Opinion statement

Uterine leiomyosarcoma (uLMS) is a rare disease; in the data from the SEER database, 3165 cases of uLMS were diagnosed between January 2000 and December 2012. While a majority of patients (60%) are diagnosed with early stage disease, recurrence rates are high. Five-year disease-specific survival is 76% for patients with FIGO stage I and 60% for patients with FIGO stage II disease. Adjuvant treatments, including radiation therapy, chemotherapy, and combined modality approaches, have been explored with the goal of demonstrating improved survival. However, heterogeneous patient populations, small sample sizes, and lack of no-treatment control arms have limited the interpretation and reliability of the results from these studies. A randomized trial of adjuvant pelvic radiation compared to no additional treatment showed that adjuvant radiation did not improve recurrence or survival outcomes for early-stage uterine LMS. To date, no prospective, randomized trial has been completed comparing adjuvant chemotherapy to observation. A recent well-designed retrospective study showed that women treated with adjuvant gemcitabine-docetaxel had no improvement in progression-free or overall survival compared to women who received no additional treatment. Thus, current data support our recommendation against adjuvant radiation or chemotherapy treatment for patients with non-morcellated, completely resected, and uterine-confined leiomyosarcoma. We recommend that these patients be observed with periodic surveillance imaging and physical examinations.

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Second Malignancies after Hematopoietic Stem Cell Transplantation

Opinion statement

Second malignancies are a rare but well-defined late complication after autologous and allogeneic hematopoietic stem-cell transplantation (SCT). Solid malignancies occur in up to 15% of patients 15 years after SCT with myeloablative conditioning, with no plateau in the incidence rates. They are responsible for 5–10% of late deaths after SCT. The incidence is increased with advanced age at SCT. The major risk factors are the use of total body irradiation, which is associated with adenocarcinomas and with chronic graft-versus-host disease which is associated with squamous cell cancers. There is less data on the incidence of second malignancies after reduced-intensity conditioning, but it may not be lower. The types of solid tumors reported in excess include melanoma and other skin cancers; cancers of the oral cavity and head and neck, brain, liver, uterine cervix, thyroid, breast, lung; and possibly gastrointestinal cancers. Therapy-related myeloid neoplasms (t-MN) are more common after autologous SCT and may be related mostly to pre-transplant therapies. Post-transplant lymphoproliferative disease is donor-cell-derived lymphoma that is more common after allogeneic SCT with T-cell depletion or intensive immune-suppression state. Second malignancies are most often treated similarly to the standard therapy for similar malignancies. Lifelong cancer screening and prevention interventions are required for all transplantation survivors.

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Novel Therapies for Older Adults With Acute Lymphoblastic Leukemia

Abstract

Purpose of Review

Older adults with acute lymphoblastic leukemia (ALL) have worse survival compared to their younger counterparts. Here, we review the reasons for the poorer outcomes of older patients with ALL and also summarize the current and future therapeutic approaches to ALL in the elderly population.

Recent Findings

The poor outcomes of older adults with ALL are driven largely by lack of tolerance to standard-dose chemotherapy, which leads to unacceptably high rates of myelosuppression-related deaths. Recent studies have shown promising results with the use of low-intensity or chemotherapy-free regimens in older patients with ALL, which are able to retain efficacy without excess toxicity.

Summary

Novel antibody constructs such as inotuzumab ozogamicin and blinatumomab as well as potent later-generation tyrosine kinase inhibitors such as ponatinib hold significant promise in the management of ALL in the older adult. Innovative combination strategies may further improve the outcomes of these patients.

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Postoperative chemoradiotherapy in patients with head and neck cancer aged 70 or older with positive margins or extranodal extension and the influence of nodal classification

Abstract

Background

Postoperative concomitant chemoradiotherapy (CRT) improves outcomes for younger adults with head and neck squamous cell carcinoma (HNSCC) and positive margins or extranodal extension (ENE), but its benefit for older adults is not well established.

Methods

Patients from the National Cancer Data Base (NCDB) with HNSCC undergoing curative-intent resection, neck dissection, and postoperative radiation with positive margins or ENE were identified.

Results

This analysis included 1199 patients aged ≥ 70 years with median follow-up of 42.6 months. Postoperative concurrent CRT was associated with improved overall survival (OS; hazard ratio [HR] 0.752; 95% confidence interval [CI] 0.638-0.886) compared to radiation alone in multivariable analysis. Three-year OS was 52.4% with CRT versus 43.4% with radiation (P = .012) in propensity-score matched cohorts. The survival impact of CRT varied by N classification (P = .002 for interaction), with benefit seen only in those with N2 to N3 disease.

Conclusion

Postoperative concurrent CRT may benefit older patients with HNSCC with positive margins or ENE, particularly those with higher nodal burden.

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Prevalence of adverse pathological features in 1 to 4 cm low-risk differentiated thyroid carcinoma

Abstract

Background

The American Thyroid Association (ATA) recommends thyroid lobectomy for 1 to 4 cm tumors without adverse features. We studied the prevalence of adverse pathological features in patients eligible for unilateral lobectomy.

Methods

We conducted a retrospective study of patients who underwent total thyroidectomy. Patients with differentiated thyroid cancer (DTC) with tumors measuring 1 to 4 cm with no known preoperative adverse features were included in this study. Patients with nodal and distant metastasis, tumors <1 cm to > 4 cm, age < 17 years old, and gross extrathyroidal extension were excluded. Patients with bilateral nodularity on imaging were excluded from the final analysis on adverse features.

Results

There were 59.1% of patients undergoing thyroidectomy with tumors measuring 1 to 4 cm and no preoperatively known adverse features who were eligible for lobectomy under current ATA guidelines who would have needed a completion thyroidectomy after pathological analysis of the index tumor.

Conclusion

Two thirds of the patients may require a completion thyroidectomy if unilateral lobectomy is done in tumors measuring 1 to 4 cm based on adverse pathological features.

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Quality of life during the first year after partial laryngectomy: Longitudinal study

Abstract

Background

This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.

Methods

The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance.

Results

Most subscales worsened 1 week postprocedure, but many recovered to baseline level after 1 year. Dyspnea and cognitive functioning deteriorated over time, with worst scores recorded after 1 year. Financial difficulties and fatigue increased after surgery and maintained that level throughout the follow-up period; sticky saliva remained worse than at baseline, despite some improvements over time.

Conclusion

The discovered limitations of QOL should be observed more closely during follow-up treatment, and patients should be informed about these potential effects before partial laryngectomy.

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Thyroidectomy in patients who have undergone gastric bypass surgery

Abstract

Background

Morbid obesity is a chronic condition that may be challenging to treat. Gastric bypass surgery is used to treat morbid obesity and its complications. Hypocalcemia, a known complication after thyroidectomy, is usually transient and treatable. There is a growing body of literature indicating that patients with previous gastric bypass surgery are at an increased risk for recalcitrant, symptomatic hypocalcemia after thyroidectomy. The management of hypocalcemia in patients with prior gastric bypass surgery may be exceedingly difficult.

Methods

Relevant articles published between 2008 and January 2017 were reviewed by topic. The review of literature was conducted using a systematic search of database resources, such as PubMed and EMBASE.

Results

Prior gastric bypass surgery may be an independent risk factor for developing profound hypocalcemia after thyroid surgery.

Conclusion

Refractory hypocalcemia in patients who have undergone gastric bypass surgery is underreported. Careful consideration should be given to performing staged thyroidectomy and, in some cases, reversal of the bariatric surgery.

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Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis

Abstract

Background

The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).

Methods

Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.

Results

Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124).

Conclusion

In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.

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Genetic profiling of cell-free DNA from cerebrospinal fluid: opening the barrier to leptomeningeal metastasis in EGFR-mutant NSCLC

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Final Validation of the ProMisE Molecular Classifier for Endometrial Carcinoma in a Large Population-based Case Series.

Abstract

Introduction

Based on The Cancer Genome Atlas, we previously developed and confirmed a pragmatic molecular classifier for endometrial cancers; ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer). ProMisE identifies four prognostically distinct molecular subtypes, and can be applied to diagnostic specimens (biopsy/curettings), enabling earlier informed decision-making. We have strictly adhered to the Institute of Medicine (IOM) guidelines for the development of genomic biomarkers, and herein present the final validation step of a locked-down classifier prior to clinical application.

Patients and Methods

We assessed a retrospective cohort of women from the Tübingen University Women's Hospital treated for endometrial carcinoma between 2003-13. Primary outcomes of overall, disease-specific and progression-free survival were evaluated for clinical, pathological, and molecular features.

Results

Complete clinical and molecular data were evaluable from 452 women. Patient age ranged from 29 – 93 (median 65) years, and 87.8% cases were endometrioid histotype. Grade distribution included 282 (62.4%) G1, 75 (16.6%) G2, and 95 (21.0%) G3 tumors. 276 (61.1%) patients had stage IA disease, with the remaining stage IB (89 (19.7%)), stage II (26 (5.8%)), and stage III/IV (61 (13.5%)). ProMisE molecular classification yielded 127 (28.1%) MMR-D, 42 (9.3%) POLE, 55 (12.2%) p53abn, and 228 (50.4%) p53wt. ProMisE was a prognostic marker for progression-free (P=0.001) and disease-specific (P=0.03) survival even after adjusting for known risk factors. Concordance between diagnostic and surgical specimens was highly favorable; accuracy 0.91, kappa 0.88.

Discussion

We have developed, confirmed and now validated a pragmatic molecular classification tool (ProMisE) that provides consistent categorization of tumors and identifies four distinct prognostic molecular subtypes. ProMisE can be applied to diagnostic samples and thus could be used to inform surgical procedure(s) and/or need for adjuvant therapy. Based on the IOM guidelines this classifier is now ready for clinical evaluation through prospective clinical trials.

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Epigenetic modifiers as new immunomodulatory therapies in solid tumours

Abstract

Background

Immune therapies have revolutionized cancer treatment over the last few years by allowing improvements in overall survival. However, the majority of patients is still primary or secondary resistant to such therapies, and enhancing sensitivity to immune therapies is therefore crucial to improve patient outcome. Several recent lines of evidence suggest that epigenetic modifiers have intrinsic immunomodulatory properties, which could be of therapeutic interest.

Material and Methods

We reviewed preclinical evidence and clinical studies which describe or exploit immunomodulatory properties of epigenetic agents. Experimental approaches, clinical applicability and corresponding ongoing clinical trials are described.

Results

Several epigenetic modifiers, such as histone deacetylase inhibitors, DNA methyl transferase inhibitors, bromodomain inhibitors, lysine-specific histone demethylase 1 inhibitors and enhancer of zeste homolog 2 inhibitors, display intrinsic immunomodulatory properties. The latter can be achieved through the action of these drugs either on cancer cells (e.g. presentation and generation of neoantigens, induction of immunogenic cell death, modulation of cytokine secretion), on immune cells (e.g. linage, differentiation, activation status and antitumor capability), or on components of the microenvironment (e.g. regulatory T cells and macrophages). Several promising combinations, notably with immune checkpoint blockers or adoptive T cell therapy, can be envisioned. Dedicated clinically-relevant approaches for patient selection and trial design will be required to optimally develop such combinations.

Conclusion

In an era where immune therapies are becoming a treatment backbone in many tumour types, epigenetic modifiers could play a crucial role in modulating tumours' immunogenicity and sensitivity to immune agents. Optimal trial design, including window of opportunity trials, will be key in the success of this approach, and clinical evaluation is ongoing.

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Tumor necrosis and >20 mitoses per 50 high-power fields can distinguish ‘very high-risk’ and ‘highest-risk’ within ‘high-risk’ gastric gastrointestinal stromal tumor

Future Oncology, Ahead of Print.


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Why does a high-fat diet increase cancer risk?

Future Oncology, Ahead of Print.


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High-fat diet and colorectal cancer: myths and facts

Future Oncology, Ahead of Print.


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The immediate and short-term effects of bilateral intrahippocampal depth electrodes on verbal memory

Summary

In contrast to previous studies, Ljung et al. provide evidence of permanent cognitive consequences of bilateral intrahippocampal depth electrodes for verbal memory in patients who were not operated or operated in the right temporal lobe. Stimulated by this, we provide historical confirmatory and supplementary evidence of the detrimental effect of bilateral depth electrodes implanted along the longitudinal axis of the hippocampus on verbal learning and especially on delayed verbal memory and recognition performance. This is demonstrated in 31 patients with memory assessments before implantation, after explantation, and 3 months later after left/right temporal lobe surgery. After surgery, significant recovery from postimplantation impairment is found in right temporal patients. Left temporal resection patients stay on the level seen after implantation and do not recover. Surgery, however, has its own effects in addition to the implantation. Intracranial electrodes for electroencephalographic monitoring or electrical stimulation are commonly and increasingly used for diagnosis or treatment in pharmacoresistant epilepsies. Thus, the monitoring of invasive stereotactic approaches is recommended to find safe procedures for the patients. In response to the findings, we restricted indications and used different implantation schemes, different trajectories, and targets to minimize the risk of additional damage.

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The impact of anaemia, transfusion dependency, comorbidities and polypharmacy in elderly patients with low-risk myelodysplastic syndromes

Abstract

Myelodysplastic syndromes (MDS) are heterogeneous clonal disorders ranging from indolent conditions with a near-normal life expectancy to forms approaching acute myeloid leukaemia. Comorbid conditions have rarely been systematically studied among patients with MDS. Older age per se has a negative impact on survival of MDS patients, in particular of those with lower risk. However, age indirectly affects also the survival of higher-risk patients by limiting their eligibility to intensive treatments. In addition, ageing is associated with an increasingly high risk of developing comorbidity, and a high prevalence of comorbid diseases has indeed been reported in MDS patients. The impact of multi-morbidities/comorbidities and polypharmacy in patients with low-risk MDS patients is a poorly explored topic. We focused on medications, multi-morbidities and comorbidities of 155 low-risk MDS patients followed in the haematological outpatients clinics or in medical/oncology wards of our University Hospital. One or more comorbidities were present at diagnosis in 24 younger patients with MDS syndromes (31%), whereas 56 older patients with MDS (75%) presented 1 or more comorbidities (P < 0.001).The most frequent comorbidity was cardiac comorbidity 18% in younger patients and 25% in older patients. With no statistical significance between older and younger patients, congestive heart failure was the most frequent observed disease. Our study has shown a statistical correlation between transfusion dependency and polypathology (P = 0.0014). These data were also confirmed in a subanalysis of the younger group of patients. Our study has shown that comorbidity is very common among patients with MDS, potentially affecting the clinical course and outcome of MDS patients.

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Editorial Board

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Contents

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Light-emitting Diode Transilluminator for the Identification of Recipient Veins in Finger Reconstruction

No abstract available

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Gender-specific independent and combined dose–response association of napping and night sleep duration with type 2 diabetes mellitus in Chinese rural adults: the RuralDiab study

Publication date: Available online 7 February 2018
Source:Sleep Medicine
Author(s): Ruihua Liu, Yuqian Li, Zhenxing Mao, Xiaotian Liu, Haiqing Zhang, Kaili Yang, Honglei Zhang, Runqi Tu, Xinling Qian, Jingjing Jiang, Ronghai Bie, Chongjian Wang
ObjectiveThe aim of this study was to explore the independent and combined dose–response association of napping and night sleep duration with type 2 diabetes mellitus (T2DM) among different genders in Chinese rural population.MethodsA total of 19,257 participants were enrolled in the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study for this research. Napping and night sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). Restricted cubic splines and logistic regression were used to estimate the relationship between napping and night sleep duration with T2DM.ResultsA linear dose–response relationship between napping duration and T2DM as well as a U-shaped relationship between night sleep duration and T2DM were found. Compared with those who reported no napping, participants who had a napping duration of ≥ 91 min were associated with a 19% increase in prevalence of T2DM. Adjusted odds ratios (ORs) (95% confidence intervals (CIs)) for T2DM were 1.48 (1.03, 2.14) and 1.50 (1.22, 1.85) for shorter (≤5 h) and longer (>9 h) night sleep duration compared with the referential group. Additionally, the combination of longer napping duration (≥91 min) and night sleep duration (>9 h) increased 104% (95% CI: 45%, 128%) prevalence for T2DM. These associations were not found in males but were evident in females.ConclusionsLonger napping duration and extreme night sleep duration increased the prevalence of T2DM. Meanwhile, longer napping and night sleep duration might be jointly associated with a higher prevalence of T2DM.



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Occurrence of nocturia is not mediated by nocturnal hypoxia length and severity in patients with sleep-disordered breathing

Publication date: Available online 7 February 2018
Source:Sleep Medicine
Author(s): P. Finamore, S. Scarlata, A. Laudisio, F. Galdi, M.E. Pipita, I. Chiarella, R. Giua, L. Cortese, C. Rivera, R. Antonelli Incalzi
BackgroundNocturia is highly prevalent in subjects with respiratory sleep disturbances (ie obstructive sleep apnea). The aim of our study is to evaluate whether nocturia is associated with intermittent desaturations or hypoxia length and severity in people undergoing polysomnography.MethodsWe recruited 275 consecutive subjects attending the outpatient clinic for respiratory diseases at Campus Bio-Medico Teaching Hospital. Nocturia was defined as a self-reported voiding frequency ≥ two per night. The groups with and without nocturia were compared with parametric and non-parametric tests, as appropriated. Multivariable logistic regression analysis was used to assess the association of nocturia with patients' characteristics, including oxygen desaturation index (ODI), respiratory efforts (RE) and oxygen saturation below 90% (TST90).ResultsSixty-six (24%) subjects reported nocturia, the median ODI was 15 (8-31), the median RE was 22 (12-38) and the median TST90 was 4.7 (0.3-20.6). ODI and RE were significantly higher in subjects with nocturia as compared with controls. In the multivariable model, ODI was associated with an increased probability of nocturia (OR=1.03; 95% CI=1.01-.1.06), and the higher the ODI score, the higher the probability to have nocturia (P for trend =.038). No significant association was found between TST90 and the occurrence of nocturia.ConclusionsIntermittent desaturations and not hypoxia length and severity, expressed by TST90, are associated with the occurrence of nocturia in subjects complaining sleep disturbances.



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An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective

Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation. There were 3 groups of women in this cohort study: (1) traditional historical control; (2) transition group with partial implementation; and (3) ERAS. Narcotic use, patient-reported pain scores, antiemetic use, time to regular diet, time to first walk, hospital length of stay, and 30-day postoperative complications were compared between the groups. Results: After implementation of the pathway, the use of parenteral narcotics was reduced by 88% (traditional, 112 mg; transition, 58 mg; ERAS, 13 mg; P

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Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty

Background: It has been proposed that negative pressure wound therapy (NPWT) applied prophylactically to a closed incision may decrease the incidence of wound complications. Patients undergoing reduction mammaplasty are at risk of wound complications such as delayed healing, infection, and dehiscence, and the bilateral nature of the surgery allows for a within-patient randomized study to evaluate incisional NPWT's effect in reducing healing complications. Methods: In this multicenter trial, 200 patients undergoing bilateral reduction mammaplasty were treated with PICO Single-Use NPWT System or standard wound-care dressings randomized to right or left breast for up to 14 days to enable within-patient comparison. Follow-up assessments were conducted to evaluate the difference in incision healing complications up to 21 days postsurgery. Healing complications (for the primary endpoint) were defined as delayed healing (incision not 100% closed by 7 days) and occurrence of dehiscence or infection within 21 days. Individual healing complications were assessed separately as secondary endpoints. Results: Significantly fewer healing complications (primary endpoint) were noted in NPWT-treated breasts [113 (56.8%)] versus standard care [123 (61.8%)]. The difference of 10 (5.0%) patients with fewer healing complications using NPWT was statistically significant (P = 0.004). NPWT also resulted in a significantly lower incidence of dehiscence (secondary endpoint) compared with standard care [32 patients (16.2%) versus 52 patients (26.4%)] by day 21, a relative reduction of 38% (P

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Successful Hand Replantation in a Case of Total Avulsion without Vein Graft

Summary: Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation—a completely amputated hand—by vascular anastomosis technique was successfully performed.1 Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.2 in 1968. The overall success rate of limb replantation surgery is around 83.2%.3 The mechanism of injury plays a role in the outcome; guillotine amputations—for example—carry a better prognosis than crush amputations.4 We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his hand successfully with good functional outcome.

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Single-Stage Breast Reconstruction Using an All-In-One Adjustable Expander/Implant

Background: When tissue expansion is necessary in breast reconstruction, a single-stage approach is possible using adjustable expander/implants, with or without the use of acellular dermal matrix. We aimed to present the senior author's single-stage experience over a period of 12 years using combined expander/implants in breast reconstruction. Methods: This is a Single-institution, retrospective review of breast reconstruction with combined expander/implants from 2002 to 2014. Logistic regression was performed to evaluate the impact of multiple variables on long-term outcomes. Results: A total of 162 implants in 105 patients were included in this study. Mean follow-up time was 81.7 months (SD, ± 39.2; range, 15–151). Complication rates were as follows: 0.62% extrusion, 1.2% mastectomy flap necrosis, 1.2% hematoma, 1.9% dehiscence, 2.5% seroma, 4.9% infection, and 15.4% deflation. The following associations were identified by logistic regression: adjuvant radiotherapy and capsular contracture (P = 0.034), tumor size and deflation (P = 0014), and smoking history and infection (P = 0.013). Conclusions: Overall, 81% of breasts were successfully reconstructed in a single stage. Single-stage reconstruction using all-in-one expander/implants reduces costs by eliminating the need for a second procedure under general anesthesia and can achieve results comparable with other alloplastic reconstructions reported in the literature.

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Dimensional Error in Rapid Prototyping with Open Source Software and Low-cost 3D-printer

Summary: Rapid prototyping models (RPMs) had been extensively used in craniofacial and maxillofacial surgery, especially in areas such as orthognathic surgery, posttraumatic or oncological reconstructions, and implantology. Economic limitations are higher in developing countries such as Mexico, where resources dedicated to health care are limited, therefore limiting the use of RPM to few selected centers. This article aims to determine the dimensional error of a low-cost fused deposition modeling 3D printer (Tronxy P802MA, Shenzhen, Tronxy Technology Co), with Open source software. An ordinary dry human mandible was scanned with a computed tomography device. The data were processed with open software to build a rapid prototype with a fused deposition machine. Linear measurements were performed to find the mean absolute and relative difference. The mean absolute and relative difference was 0.65 mm and 1.96%, respectively (P = 0.96). Low-cost FDM machines and Open Source Software are excellent options to manufacture RPM, with the benefit of low cost and a similar relative error than other more expensive technologies.

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Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis

Background: By eliminating economic hurdles, the Women's Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population. Methods: Using the Nationwide Inpatient Sample database (1992–2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts. Result: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (P

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Use of Viable Cryopreserved Placental Membrane as an Adjunct to Facial Keloid Resection

Summary: Keloids are the physical manifestation of an exaggerated inflammatory response resulting in excess collagen deposition. The resulting fibroproliferative mass can be distressing for patients due to appearance, pruritus, and/or pain. Despite extensive research into the pathophysiology of keloid formation and the development of numerous treatments, keloids remain a challenge to treat. Even when the initial treatment is successful, a risk of recurrence remains. Basic science research into viable cryopreserved placental membranes and viable cryopreserved umbilical tissue has demonstrated their anti-inflammatory and anti-fibrotic effects, which may decrease keloid recurrence after excision. In this article, we present the first-reported case of viable cryopreserved placental membrane, with living mesenchymal stem cells, to treat a painful preauricular keloid in conjunction with surgical resection.

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The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

Background: Previous surgery or slim body configuration can limit the size of the available abdominal flap in autologous breast reconstruction. However, redundant skin and subcutaneous tissue lateral to the mastectomy site can be utilized as the pedicled lateral intercostal artery perforator (LICAP) flap. This study evaluates the combination of a free abdominal flap and a pedicled LICAP flap to achieve increased breast size and improved cosmetic outcome. Methods: Patients undergoing secondary autologous breast reconstruction were included in a prospective study. The combination with a LICAP flap was used for women with insufficient abdominal flap tissue in relation to the desired breast size. The authors also assessed their modification of the original lateral thoracodorsal flap design to improve the aesthetic outcome. Results: In 109 patients, 121 free abdominal flaps were performed. The combination with a pedicled LICAP flap was used in 82 free abdominal flap reconstructions (68%). The LICAP flap provided additional volume and resulted in better projection and ptosis of the neo-mamma. The overall complication rate for the LICAP flaps was 26 %; all minor complications. Despite combining flaps, the majority of patients needed additional surgery to improve breast symmetry. Breast reduction of the native breast was the most common symmetrizing procedure. Conclusion: In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

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Adjuvant Therapy for Revision Rhinoplasty of Contracted Nose Using Polydeoxyribonucleotide and Invasive Bipolar Radiofrequency

Summary: Most cases of severely contracted nose require revision rhinoplasty and septoplasty, wherein preoperative and/or intraoperative expansion of nasal soft tissue is necessary for tension-free revision surgery. The present study aimed to evaluate the efficacy and safety of pre- and postoperative adjuvant therapy using polydeoxyribonucleotide (PDRN) and invasive, pulsed-type, bipolar, alternating current radiofrequency (RF) for revision surgery of a contracted nose. In total, 30 patients were treated with 16 sessions (8 preoperative sessions and 8 postoperative sessions) of intralesional injection of PDRN and invasive RF treatment using microneedle electrodes at 1-week intervals. One week after the final combined pretreatment using PDRN and invasive bipolar RF, the skin of contracted noses was sufficiently softened, and nasal skin mobility was notably improved in all the patients. During revision rhinoplasty and septoplasty, the contracted nasal skin in each patient was adequately released for proper covering of the nasal tip without tension. Postoperatively, 8 sessions of adjuvant therapy elicited marked clinical improvements in persistent nasal tip dimpling and contracture, septal deviation, and warping from the incomplete recovery of nasal contracture after revision surgery. In conclusion, our pre- and postoperative adjuvant therapies using PDRN and invasive bipolar RF remarkably improved the therapeutic outcomes of revision rhinoplasty and septoplasty for contracted skin of the nose without major side effects.

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Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

Background: Acellular dermal matrix was introduced in breast reconstruction in 2001 and is gradually becoming a standard component for immediate breast reconstruction and nipple-sparing mastectomy. The reconstructive technique allows for improved aesthetic outcomes. However, there seems to be uncertainty regarding complication rates. The aim of this review was to systematically evaluate complication rates related to this method. Methods: This systematic review was conducted according to the recommendations outlined in the Cochrane Handbook for reviews and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Relevant databases were searched for in the literature concerning the use of acellular dermal matrix in implant-based nipple-sparing mastectomy and immediate breast reconstruction. All studies underwent detailed quality assessment. Summarized outcome rates were computed using meta-analysis. Results: Nine of 1,039 studies were eligible for inclusion yielding 778 procedures. The quality was acceptable for all included studies. The meta-analysis found the rate of skin necrosis to be 11%, nipple necrosis 5%, infection in 12%, hematoma in 1%, treated seroma in 5%, explantation 4%, and unplanned return to the operating room in 9%. Conclusion: The use of acellular dermal matrix in nipple-sparing mastectomy and implant-based breast reconstruction can be done with acceptable complication rates in selected patients. We recommend future studies to include specific definitions when reporting complication rates. Furthermore, future studies should elaborate on demographic characteristics of the included study samples and include predictor analysis to enhance knowledge of high risk patients.

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V-shaped Internal Nasal Vestibular Flap for Reconstruction of Iatrogenic Columellar Defect

Summary: Columella is an important structure in the center of the face, and its structural integrity has an important functional, social, and psychological role. Columella reconstruction can be very challenging for surgeons and the ideal technique remains elusive. This article describes a reconstruction technique in a young woman with columella necrosis due to nasal continuous positive airway pressure treatment. The method of reconstruction described here, with a V-shaped internal nasal vestibular flap and a cartilage grafts from lateral crura, is simple and easily reproducible, providing an optimal aesthetic result and in addition the donor site does not create a secondary deformity by disrupting normal anatomy.

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Latissimus Dorsi and Immediate Fat Transfer (LIFT) for Complete Autologous Breast Reconstruction

Background: Despite the popularity of latissimus dorsi (LD) flap in breast reconstruction, a breast implant is often necessary to achieve sufficient volume. Prior reports describe fat grafting to the LD flap as a secondary procedure to correct contour deformities and improve volume. Our institution has instituted autologous breast reconstruction with an LD flap and immediate fat transfer (LIFT). Methods: A retrospective review of all patients undergoing the LIFT procedure was undertaken. Patient age, total volume of fat transfer, length of follow-up, need for adjuvant therapy, and complications were recorded. The procedure begins with harvest of the LD flap and fat. Prior to disorigination of the latissimus muscle, fat is injected into the flap. Flap harvest is then completed and inset to create a breast mound. Results: Eighteen patients underwent LIFT procedures over 3 years with an average follow-up of 8.7 months (range, 2–24). Four breasts (22.2%) had previously received adjuvant radiation therapy. The mean total fat grafting volume was 515.5 mL (range, 325–730) per breast. The average estimated fat graft take was 66.8% (range, 50–80%). Four patients (22.2%) experienced complications. Conclusion: Autologous augmentation of the LD flap with lipotransfer has been used to avoid placement of an implant. We improve the technique by performing lipotransfer during index reconstruction. Furthermore, we perform lipotransfer prior to disorigination of the LD muscle to minimize trauma to the flap and increase the efficiency of fat grafting. Our experience demonstrates that this technique is a viable autologous alternative to microsurgical breast reconstruction.

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Superficial Inferior Epigastric Artery Flap Salvage Technique Using Deep Inferior Epigastric Artery Graft

Summary: Superficial inferior epigastric artery (SIEA) flap salvage remains challenging, particularly in cases of arterial insufficiency due to vessel spasm, pedicle kinking, or thrombosis. The already small, short SIEA pedicle, in addition to its inherent tendency toward spasm, renders the SIEA flap more difficult to manage when anastomotic revision is required. Furthermore, arterial thrombosis will cause dilation of the internal mammary artery, exacerbating vessel mismatch. In our previously published experience with 145 SIEA flaps, no flap with postoperative arterial thrombosis was salvageable. Following this experience, a new salvage technique using deep inferior epigastric artery grafts has been utilized and is described here.

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Clinical Significance of Venous Anomalies in Syndromic Craniosynostosis

Background: The pattern of cranial venous drainage in syndromic craniosynostosis is unpredictable and not adequately understood. Collateral channels substitute for stenotic venous sinuses and pose potential risk for surgical intervention. The purpose of this study was to analyze the patterns of venous drainage in patients with syndromic craniosynostosis and their influence on operative planning and morbidity. Methods: A retrospective study of patients with syndromic craniosynostosis from 2000 to 2013 was performed. Demographic data were collected including phenotype and associated pathologies. Pre- and/or postoperative venous imaging was reviewed for venous sinus stenosis, collateral emissaries, and persistent fetal sinuses. Categorization of anomalous venous drainage was performed, and the relationship with surgical morbidity was assessed. Results: Forty-one patients were identified. Anomalies were present in 31 patients (76%) consisting of dural sinus stenosis in 28 (68%), dilated emissaries in 26 (63%), and fetal sinuses in 7 (17%). Pfeiffer syndrome was most commonly associated with anomalous drainage (100%). Venous anomalies were associated with elevated intracranial pressure (ICP), shunted hydrocephalus, Chiari malformations, and sleep apnea. In 5 cases, the surgical plan was adjusted based on anomalous anatomy. No mortalities occurred. Intraoperative complication rate was 7.3%, all with anomalous drainage. Median estimated blood loss was 1,100 cc for patients with anomalies versus 400 cc without anomalies (P = 0.181). Conclusion: Cranial venous anomalies are commonly detected in patients with syndromic craniosynostosis and may affect surgical morbidity and outcome with a higher estimated blood loss, alteration of procedure, and postoperative morbidity. Detailed preoperative imaging of the venous drainage is therefore recommended in cases of syndromic synostosis.

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Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients

Background: The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner. Methods: This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing. Results: Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7–70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1–34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur. Conclusions: This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease.

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Virtual Surgical Planning: The Pearls and Pitfalls

Objective: Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve. Methods: A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis. Results: Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy. Conclusion: Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.

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Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone

Background: The lateral arm flap is used for composite defects in need of vascularized soft tissue, skin, and bone. From its original description, the distal humeral metaphysis can be included with the flap, supplied by the periosteal extensions of the posterior branch of the radial collateral artery. We sought to reexplore the anatomy of the lateral arm to determine its utility as a donor site for vascularized bone. Methods: Twelve fresh, silicone-injected cadaver dissections were performed. Arteriovenous anatomy, pedicle length and diameter, and anatomic variability as well as photo documentation was recorded. Results: The distal extent of the deltoid, lateral intermuscular septum and lateral humeral epicondyle were identified before the dissection. A septocutaneous perforator was consistently located 10 cm proximal to the lateral humeral epicondyle, which could be used for a skin paddle to monitor. Harvest of a 1.5 cm × 2 cm corticocancellous bone graft was performed. Average pedicle length was 9.1 ± 1.1 cm, and average pedicle diameter was 1.74 ± 0.52 mm. The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm were consistently identified and preserved. Conclusion: The predictable anatomy of the lateral distal humerus make it an ideal donor site for small segments of vascularized bone.

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ASBA Diplomates Treat Hall of Fame NFL Players at Super Bowl Screening Provided by Pro Player Health Alliance and Project Rose

Gary Baxter, Andre Collins, Earl Campbell, Dr. Rosario, David Gergen, Dr. Wilson and Dr. Roberts

In the days leading up to February 4^th, 2018, most of the country was preparing for what is referred to as "The Big Game". The city of Minneapolis was covered with posters that said "Welcome to The Bold North", likely referring to the below freezing temperatures that Minnesota is famous for in the winter. Visitors and locals alike stayed warm indoors, but the men who paved the way for the "Big Game" as we know it today were forging a different path that didn't lead to a field or stadium, but to an office located in the Medical Arts Building – Downtown Minneapolis that saw the likes Mike Singletary, Carl Eller, Earl Campbell and Mike Haynes.

The freezing cold winds of the Bold North didn't stop former NFL players from attending the NFLPA sponsored sleep apnea screening provided by Project Rose and Pro Player Health Alliance (PPHA) on February 1-2, 2018. When David Gergen, CEO OF PPHA, inquired space for the event, Dr. Mark Wilson, DDS was honored to provide his dental/medical office. Dr. Wilson is known as one of the top periodontists in the country and has been trained in sleep for over ten years. Upon arrival, the retired professional athletes were directed to sign official consent forms that allowed their data to be used for research. After completing screener forms that determine if they are at high risk for sleep apnea, Dr. Inell Rosario, MD reviewed the findings and, when medically indicated, ordered home sleep tests (HST) for them. Project Rose, led by NFL great Gary Baxter, provided HST's for the players that weekend. Results were immediately uploaded and reviewed the next day and treatment options were provided.

Dr. Mark Wilson, DDS and Dr. Greg Ross, who are sleep dentists and Diplomates of the American Sleep and Breathing Academy (ASBA), were able to take digital scans of the players' teeth to have Gergen's Sleep Appliance Lab begin fabricating instantly. David Gergen only refers ASBA Diplomates to treat the former NFL players.

Sleep dentists working in collaboration with an ENT who is board-certified in sleep, [Dr. Rosario] ensured a quick, efficient and effective service for the players that impressed participants of the event. Former NFL Linebacker Rick Graf said, "I was so happy to hear about this happening this week. I knew I needed to be tested. I snore, but I knew there was something wrong with my breathing at night too. I'm hoping this oral appliance will change my life. My former teammate, Andre Collins, made this program a reality and I'll be forever thankful to him."

To become a Diplomate of the ASBA, click here.

To register for the ASBA Annual Conference and see the likes of NFL greats mentioned in this article and previous articles, click here.

 

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Prefrontal direct current stimulation in hoarding disorder: A case report

Publication date: Available online 7 February 2018
Source:Brain Stimulation
Author(s): Mirjam Handrack, Ulrich Voderholzer, Caroline Schwartz, Alkomiet Hasan, Frank Padberg, Ulrich Palm




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Transcranial direct current stimulation unveils covert consciousness

Publication date: Available online 7 February 2018
Source:Brain Stimulation
Author(s): Aurore Thibaut, Camille Chatelle, Audrey Vanhaudenhuyse, Géraldine Martens, Helena Cassol, Charlotte Martial, Manon Carrière, Alice Barra, Steven Laureys, Olivia Gosseries




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FDA Approves Test of New Drug to Protect Hearing

The first clinical trial of a new drug designed to protect humans' hearing will involve a compound developed at the University of Washington (UW).

The U.S. Food and Drug Administration has approved ORC-13661 as an investigational drug to protect people from the hearing-damaging side effects of aminoglycosides, a class of antibiotics used to combat serious infections.  The FDA approval clears the way for a Phase I trial of volunteers to confirm whether the drug, which demonstrated significant protective ability in animal models, is safe for humans.

ORC-13661 represents more than a decade of work by two UW scientists: Edwin Rubel, a professor of hearing sciences in the departments of otolaryngology-head and neck surgery and physiology & biophysics, and David Raible, a professor of biological structure in the School of Medicine.

"Our collaboration started in 2001; it was a novel idea and we got funded," Rubel said. "The goal was to discover how the receptor cells in the inner ear die. Why do some people start to lose their hearing at age 40 and others have good hearing at age 80?"

Their study of zebrafish was pivotal to understanding the mechanisms that affect hearing in humans. Fish have external hair cells akin to the receptor-cell structures in humans' cochleas, which turn sound waves into electrical impulses for the brain to interpret.

"With the hair cells on the outside of their bodies, we could observe them very readily for genetic and molecular studies," Rubel said.

Human receptor cells can be damaged as a secondary effect of antibiotics called aminoglycosides, which doctors employ against severe infections in cases of cystic fibrosis, immune suppression, and premature newborns, among other conditions. These powerul antibiotics – for example, gentamicin and streptomycin – can kill the receptor cells in the cochlea and balance organs, causing permanent hearing loss and unsteadiness for patients.

Over 16 years, Rubel and Raible confirmed that the fishes' hair cells are similar genetically and in other ways to hearing receptor cells in humans and other mammals.

In concert with Julian Simon, a medicinal chemist based at the Fred Hutchinson Cancer Research Center, and others, they tested the ability of more than 10,000 molecules to protect the zebrafishes' hair cells from the toxic effects of these antibiotics.

"We did a phenotypic screen," said Raible. "It's a different approach from many drug screens that target a specific receptor or protein known to be important, and then design a molecule to fit the active site of the protein. Instead, we screened libraries of chemicals to find ones that stopped zebrafish hair cells from dying, and used the one that worked best. But we can't say we know exactly why it works."

Their breakthrough results, published last month, involved a change that amplified the effectiveness of a promising compound from earlier studies. The drug demonstrated outstanding safety and 100-percent protection of hair cells in zebrafish and rats in vivo. This spurred the FDA's action.

In 2013 Raible and Rubel co-founded a company, Oricula Therapeutics, which exclusively licenses patents for ORC-13661 held by the University of Washington and Fred Hutch.  Oricula made the application to the FDA and will pursue funding for the Phase I trial of the drug's safety in humans, Rubel said. If that were to succeed, the next step would be testing the drug's effectiveness among patients who must take aminoglycosides to stave off life-threatening infections.

Both scientists reflected on the infusion of $34,000 that got them going back in 2001. The money came from the UW's Royalty Research Fund, a mechanism in which UW's royalty and licensing fee income is selectively reinvested in promising new research.

"It's such a cool thing that the university uses royalties to seed new ideas that might one day reinfuse the fund," Raible said. "The people who came up with the fund should know that it does make a difference in these ventures."

This news original appeared in the UW Medicine Newsroom.

Published: 2/6/2018 1:09:00 PM

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Nekrotisierende zervikale Lymphadenopathie mit unklaren Hautläsionen

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-101433

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Hörsturz mit Surditas, Schwindel und Tinnitus - eine 12-jährige Odyssee

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-100517

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma

J Neurol Surg B
DOI: 10.1055/s-0038-1623526

We present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible.Hormonal panel showed no hormonal deficits. The initial diagnosis was of a type II transinfundibular craniopharyngioma (as classified by Kassam et al).An endoscopic endonasal transplanum transtuberculum approach was done using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. The tumor was carefully dissected away from the optic apparatus while preserving the vessels, mainly the superior hypophyseal artery. The stalk was identified around the tumor and preserved. The third ventricle was entered and inspected at the end of the procedure and a near-total resection (a small residual in the right hypothalamus) with decompression of the optic apparatus was achieved. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap. Patient had an uneventful postoperative stay and was discharged on POD 4, neurologically stable with no hormonal deficits. Pathology confirmed an adamantinomatous craniopharyngioma. Due to a small growth of the residual, patient underwent fractionated stereotactic radiation (50.4Gy in 28 sessions). He presented with panhypopituitarism 2 years after radiation therapy. At 3-month follow-up, his vision was back to normal and 6-year postoperative magnetic resonance imaging showed no signs of recurrence.The link to the video can be found at: https://youtu.be/chG7XIz7a_A.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Macrophage Density Predicts Facial Nerve Outcome and Tumor Growth after Subtotal Resection of Vestibular Schwannoma

J Neurol Surg B
DOI: 10.1055/s-0038-1627474

Introduction Vestibular schwannoma (VS) behavior following subtotal resection (STR) is highly variable. Overall progression rates have been reported as high as 44%, and optimal treatment is controversial. Correspondingly, identification of a reliable clinical or pathologic marker associated with progression after STR would help guide decision-making. Methods A prospectively maintained institutional VS registry from 1999 to 2014 was retrospectively reviewed for sporadic VS patients who underwent primary STR without preceding stereotactic radiosurgery (SRS) by a single neurosurgery-neurotology team. Primary endpoints included tumor progression and postoperative facial nerve function. Pathologic specimens were stained for Ki67, CD68, S100, and SOX10 and were quantitated by digital imaging analysis. Macrophage density was defined as the ratio of CD68+ macrophages to S100+ macrophages and Schwannian tumor cells. Clinical outcomes were correlated with pathologic markers. Results Forty-six patients met the study inclusion criteria. Thirteen (28%) progressed during a mean 57 months of follow-up (range 15–149). Favorable postoperative facial nerve function (House–Brackmann I–II) was achieved in 37 (80%). CD68+ cells were present at significantly higher concentrations in tumors that progressed (p = 0.03). Higher macrophage density was significantly associated with both tumor progression (p = 0.02) and unfavorable facial nerve function (p = 0.02). Ki67 percent positivity was not significantly associated with either primary endpoint (p = 0.83; p = 0.58). Conclusions Macrophage density may provide an important marker for individuals at the highest risk for progression of VS after STR, potentially prompting closer surveillance or consideration for upfront SRS following STR. This finding supports preceding conclusions that an intratumoral macrophage-predominant inflammatory response may be a marker for tumor growth and a potential therapeutic target.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Prognostic significance of HPV status in the re-irradiation of recurrent and second primary cancers of the head and neck

To evaluate the prognostic significance of human papillomavirus (HPV) status among patients treated by salvage radiation therapy for local-regional recurrences and second primary cancers of the head and neck arising in a previously irradiated field.

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Forehead reduction and orbital contouring in facial feminisation surgery for transgender females

Forehead reduction and orbital contouring form a considerable component of the procedures available to feminise the face in transgender females. In this paper I shall discuss the history and development of techniques to reduce bossing of the forehead and contour the orbits, and describe their classification, assessment, surgical approach, and complications.

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Use of ultrasound-activated resorbable sheets and pins in the management of fractures of the condylar neck of the mandible: a case series

The need to treat fractures of the mandibular condyle remains controversial, but when the decision to operate has been made, then multiple forms of fixation are advocated. Traditionally, metal plates and screws have been used, but this is thought to have several disadvantages, particularly in the growing skeleton. Resorbable fixation for maxillofacial fractures has not gained widespread acceptance because of technical difficulties with the materials and concern about inflammatory reactions during their resorption.

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Association of sleep habits with behavior problems and resilience of 6- to 7-year-old children: results from the A-CHILD study

Childhood sleep habits are associated with mental health development; however, little is known about the impact of irregular bedtimes on the mental health of early school-aged children. The aims of this study were to examine the effect of weekday sleep habits (varying bedtimes depending on the night of the week and later than 22:00 h. bedtime) on behavior problems, prosocial behavior, and resilience of children aged 6–7 years.

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Gender-specific independent and combined dose–response association of napping and night sleep duration with type 2 diabetes mellitus in Chinese rural adults: the RuralDiab study

The aim of this study was to explore the independent and combined dose–response association of napping and night sleep duration with type 2 diabetes mellitus (T2DM) among different genders in Chinese rural population.

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Prevalence and characteristics of sleep-disordered breathing in familial dysautonomia

Familial dysautonomia (FD) is an autosomal recessive disorder characterized by impaired development of sensory and afferent autonomic nerves. Untreated sleep-disordered breathing (SDB) has been reported to increase the risk of sudden unexpected death in FD. We aimed to describe the prevalence and characteristics of SDB in FD.

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Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials

To assess the efficacy and tolerability of trazodone compared with placebo in patients with insomnia.

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Occurrence of nocturia is not mediated by nocturnal hypoxia length and severity in patients with sleep-disordered breathing

Nocturia is highly prevalent in subjects with respiratory sleep disturbances (ie obstructive sleep apnea). The aim of our study is to evaluate whether nocturia is associated with intermittent desaturations or hypoxia length and severity in people undergoing polysomnography.

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Characteristics of napping in community-dwelling insomnia patients

We aimed to determine napping characteristics of community-dwelling patients with insomnia disorder (ID) compared to characteristics of normal controls (NC), and to examine the effect of napping on nocturnal sleep.

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Experiences with a modified preauricular mini INCISION with subdermally dissection in condylar and subcondylar fractures of the mandible

Condylar and subcondylar fractures (CSFs) are among the most common mandible fractures. If reduction of these fractures is not carried out correctly, serious complications can result, including infection, damage to temporomandibular joint (TMJ) function, malocclusion, nonunion, malunion, and ankylosis of the TMJ.

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Survival in patients with submandibular gland carcinoma — Results of a multi-institutional retrospective study

Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.

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A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan

We used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.

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The gray scale value of ear tissues undergoing volume-rendering high-resolution cone-beam computed tomography

When the thresholds for VR reconstruction from multi-slice CT images are changed, problems develop when assessing pathologies in the absence of standardized thresholds. The advantages of CBCT include lower radiation exposure compared with other techniques and better visualization of small ear structures. However, a disadvantage is that the scanner provides unstandardized gray scale values, thus not CT numbers (Hounsfield units, HU).

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Effects of AUT00063, a Kv3.1 channel modulator, on noise-induced hyperactivity in the dorsal cochlear nucleus

Publication date: Available online 7 February 2018
Source:Hearing Research
Author(s): Lyall Glait, Weiwen Fan, Gina Stillitano, Sharon Sandridge, Nadia Pilati, Charles Large, Giuseppe Alvaro, James A. Kaltenbach
The purpose of this study was to test whether a Kv3 potassium channel modulator, AUT00063, has therapeutic potential for reversing noise-induced increases in spontaneous neural activity, a state that is widely believed to underlie noise-induced tinnitus. Recordings were conducted in noise exposed and control hamsters from dorsal cochlear nucleus (DCN) fusiform cells before and following intraperitoneal administration of AUT00063 (30 mg/kg). Fusiform cell spontaneous activity was increased in sound-exposed animals, approximating levels that were nearly 50% above those of controls. Administration of AUT00063 resulted in a powerful suppression of this hyperactivity. The first signs of this suppression began 13 min after AUT00063 administration, but activity continued to decline gradually until reaching a floor level which was approximately 60% of pre-drug baseline by 25 min after drug treatment. A similar suppressive effect of AUT00063 was observed in control animals, with onset of suppression first apparent at 13 min post-treatment, but continuing to decline toward a plateau that was 54% of pre-drug baseline and was reached 28 min after drug treatment. In contrast, no suppression of spontaneous activity was observed in animals given similar injections of vehicle (control) solution. The suppressive effect of AUT00063 was achieved without significantly altering heart rate and with minimal effects on response thresholds, supporting the interpretation that the reductions of hyperactivity were not a secondary consequence of a more general physiological suppression of the brain or auditory system. These findings suggest that Kv3 channel modulation may be an effective approach to suppressing spontaneous activity in the auditory system and may provide a future avenue for treatment of tinnitus resulting from exposure to intense sound.



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