Development and Standardization of a Test for Pragmatic Language Skills in Egyptian Arabic: The Egyptian Arabic Pragmatic Language Test (EAPLT)

Objective: The aim of this study was to standardize an Egyptian Arabic Pragmatic Language Test (EAPLT) using linguistically and socially suitable questions and pictures in order to be able to address specific deficits in this language domain. Participants and Methods: Questions and pictures were designed for the EAPLT to assess 3 pragmatic language subsets: pragmatic skills, functions, and factors. Ten expert phoniatricians were asked to review the EAPLT and complete a questionnaire to assess the validity of the test items. The EAPLT was applied in 120 typically developing Arabic-speaking Egyptian children (64 females and 56 males) randomly selected by inclusion and exclusion criteria in the age range between 2 years, 1 month, 1 day and 9 years, 12 months, 31 days. Children's scores were used to calculate the means and standard deviations and the 5th and 95th percentiles to determine the age of the pragmatic skills acquisition. Results: All experts have mostly agreed that the EAPLT gives a general idea about children's pragmatic language development. Test-retest reliability analysis proved the high reliability and internal consistency of the EAPLT subsets. A statistically significant correlation was found between the test subsets and age. Conclusion: The EAPLT is a valid and reliable Egyptian Arabic test that can be applied in order to detect a pragmatic language delay.
Folia Phoniatr Logop 2017;69:209–218

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From imaging to reimbursement: what the pediatric radiologist needs to know about health care payers, documentation, coding and billing

Abstract

Medical coding and billing processes in the United States are complex, cumbersome and poorly understood by radiologists. Despite the direct implications of radiology documentation on reimbursement, trainees and practicing radiologists typically receive limited relevant training. This article summarizes the payer structure including the state-based Children's Health Insurance Programs, discusses the essential processes by which radiologists request and receive reimbursement, details the mechanisms of coding diagnoses using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and imaging services using Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, and explores reimbursement and coding-related issues specific to pediatric radiology. Appropriate documentation, informed by knowledge of coding, billing and reimbursement fundamentals, facilitates appropriate payment for clinically relevant services provided by pediatric radiologists.

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Outcome Analysis of Microlaryngeal Surgery for Benign Lesions of Vocal Cord Using Videostroboscopy and Voice Handicap Index

Abstract

Benign vocal cord mass lesions are common causes of dysphonia which are often surgically correctable. They include lesions like vocal polyps, vocal cysts, vocal nodules and Reinke's edema. A prospective study of 30 patients was carried out at SMS medical college and hospital between April 2014 to November 2015 after institutional ethical committee clearance. The purpose of our study was to evaluate outcome of microlaryngeal surgery for benign lesions of vocal cord using videostroboscopy and voice handicap index. All cases between the age group 15–60 years with clinical evidence of benign lesions of vocal cord were included in study. Preoperative amplitude, mucosal wave, glottic closure was seen by videostroboscopy and subjective assessment of severity of handicap in voice was assessed by set of questionnaire using voice handicap index (Jacobson et al. in Am J Speech Lang Pathol 6: 66–70, 1997). Postoperative follow up was done at 3rd week and 10th week, and outcome of microlaryngeal surgery was assessed using videostroboscope and voice handicap index. At the end of study data was compiled systemically and analysed using paired 't' test and Chi square test. Our study observed statistically significant improvement in amplitude and mucosal wave and glottic closure. Subjective improvement in perception of severity of handicap in voice was analysed by voice handicap index which shows statistically significant data. Overall our study conclude microlaryngeal surgery as an effective way for improvement in speech parameters, that can be assessed by use of videostroboscopy and voice handicap index.

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A shift from papillary to reticular fibroblasts enables tumour–stroma interaction and invasion

A shift from papillary to reticular fibroblasts enables tumour–stroma interaction and invasion

A shift from papillary to reticular fibroblasts enables tumour–stroma interaction and invasion, Published online: 19 March 2018; doi:10.1038/s41416-018-0024-y

A shift from papillary to reticular fibroblasts enables tumour–stroma interaction and invasion

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Reply to ‘Comment on ‘MicroRNA-199b-5p attenuates TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma’’

Reply to 'Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma''

Reply to 'Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma'', Published online: 19 March 2018; doi:10.1038/s41416-018-0031-z

Reply to 'Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma''

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Comment on ‘MicroRNA-199b-5p attenuates TGF-β1-induced epithelial–mesenchymal transition in hepatocellular carcinoma’

Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial–mesenchymal transition in hepatocellular carcinoma'

Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial–mesenchymal transition in hepatocellular carcinoma', Published online: 19 March 2018; doi:10.1038/s41416-018-0013-1

Comment on 'MicroRNA-199b-5p attenuates TGF-β1-induced epithelial–mesenchymal transition in hepatocellular carcinoma'

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Clinical pharmacodynamic/exposure characterisation of the multikinase inhibitor ilorasertib (ABT-348) in a phase 1 dose-escalation trial

Clinical pharmacodynamic/exposure characterisation of the multikinase inhibitor ilorasertib (ABT-348) in a phase 1 dose-escalation trial

Clinical pharmacodynamic/exposure characterisation of the multikinase inhibitor ilorasertib (ABT-348) in a phase 1 dose-escalation trial, Published online: 19 March 2018; doi:10.1038/s41416-018-0020-2

Clinical pharmacodynamic/exposure characterisation of the multikinase inhibitor ilorasertib (ABT-348) in a phase 1 dose-escalation trial

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Cancers, Vol. 10, Pages 79: Erratum: Roche, J. The Epithelial-to-Mesenchymal Transition in Cancer. Cancers, 2018, 10, 52

Cancers, Vol. 10, Pages 79: Erratum: Roche, J. The Epithelial-to-Mesenchymal Transition in Cancer. Cancers, 2018, 10, 52

Cancers doi: 10.3390/cancers10030079

Authors: Joëlle Roche

The author wishes to make the following correction to the paper[...]

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Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee

Abstract

Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.

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After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans

Abstract

Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.

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Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee

Abstract

Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.

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After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans

Abstract

Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.

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European cancer mortality predictions for the year 2018 with focus on colorectal cancer

Abstract

Background

We projected cancer mortality statistics for 2018 for the European Union (EU) and its six more populous countries, using the most recent available data. We focused on colorectal cancer.

Materials and methods

We obtained cancer death certification data from stomach, colorectum, pancreas, lung, breast, uterus, ovary, prostate, bladder, leukaemia, and total cancers from the World Health Organisation database and projected population data from Eurostat. We derived figures for France, Germany, Italy, Poland, Spain, the UK, and the EU in 1970–2012. We predicted death numbers by age group and age-standardized (world population) rates for 2018 through joinpoint regression models.

Results

EU total cancer mortality rates are predicted to decline by 10.3% in men between 2012 and 2018, reaching a predicted rate of 128.9/100 000, and by 5.0% in women with a rate of 83.6. The predicted total number of cancer deaths is 1 382 000 when compared with 1 333 362 in 2012 (+3.6%). We confirmed a further fall in male lung cancer, but an unfavourable trend in females, with a rate of 14.7/100 000 for 2018 (13.9 in 2012, +5.8%) and 94 500 expected deaths, higher than the rate of 13.7 and 92 700 deaths from breast cancer. Colorectal cancer predicted rates are 15.8/100 000 men (−6.7%) and 9.2 in women (−7.5%); declines are expected in all age groups. Pancreatic cancer is stable in men, but in women it rose +2.8% since 2012. Ovarian, uterine and bladder cancer rates are predicted to decline further. In 2018 alone, about 392 300 cancer deaths were avoided compared with peak rates in the late 1980s.

Conclusion

We predicted continuing falls in mortality rates from major cancer sites in the EU and its major countries to 2018. Exceptions are pancreatic cancer and lung cancer in women. Improved treatment and—above age 50 years—organized screening may account for recent favourable colorectal cancer trends.

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TDP-43 regulates the alternative splicing of hnRNP A1 to yield an aggregation-prone variant in amyotrophic lateral sclerosis

Abstract

The RNA binding proteins TDP-43 (encoded by TARDBP) and hnRNP A1 (HNRNPA1) are each mutated in certain amyotrophic lateral sclerosis cases and are often mislocalized in cytoplasmic aggregates within motor neurons of affected patients. Cytoplasmic inclusions of TDP-43, which are accompanied by a depletion of nuclear TDP-43, are observed in most amyotrophic lateral sclerosis cases and nearly half of frontotemporal dementia cases. Here, we report that TDP-43 binds HNRNPA1 pre-mRNA and modulates its splicing, and that depletion of nuclear TDP-43 results in increased inclusion of a cassette exon in the HNRNPA1 transcript, and consequently elevated protein levels of an isoform containing an elongated prion-like domain, referred to as hnRNP A1B. Combined in vivo and in vitro approaches demonstrated greater fibrillization propensity for hnRNP A1B, which drives protein aggregation and is toxic to cells. Moreover, amyotrophic lateral sclerosis patients with documented TDP-43 pathology showed neuronal hnRNP A1B cytoplasmic accumulation, indicating that TDP-43 mislocalization may contribute to neuronal vulnerability and loss via altered HNRNPA1 pre-mRNA splicing and function. Given that TDP-43 and hnRNP A1 each bind, and thus modulate, a third of the transcriptome, our data suggest a much broader disruption in RNA metabolism than previously considered.

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Disrupted dynamic network reconfiguration of the language system in temporal lobe epilepsy

Abstract

Temporal lobe epilepsy tends to reshape the language system causing maladaptive reorganization that can be characterized by task-based functional MRI, and eventually can contribute to surgical decision making processes. However, the dynamic interacting nature of the brain as a complex system is often neglected, with many studies treating the language system as a static monolithic structure. Here, we demonstrate that as a specialized and integrated system, the language network is inherently dynamic, characterized by rich patterns of regional interactions, whose transient dynamics are disrupted in patients with temporal lobe epilepsy. Specifically, we applied tools from dynamic network neuroscience to functional MRI data collected from 50 temporal lobe epilepsy patients and 30 matched healthy controls during performance of a verbal fluency task, as well as during rest. By assigning 16 language-related regions into four subsystems (i.e. bilateral frontal and temporal), we observed regional specialization in both the probability of transient interactions and the frequency of such changes, in both healthy controls and patients during task performance but not rest. Furthermore, we found that both left and right temporal lobe epilepsy patients displayed reduced interactions within the left frontal 'core' subsystem compared to the healthy controls, while left temporal lobe epilepsy patients were unique in showing enhanced interactions between the left frontal 'core' and the right temporal subsystems. Also, both patient groups displayed reduced flexibility in the transient interactions of the left temporal and right frontal subsystems, which formed the 'periphery' of the language network. Importantly, such group differences were again evident only during task condition. Lastly, through random forest regression, we showed that dynamic reconfiguration of the language system tracks individual differences in verbal fluency with superior prediction accuracy compared to traditional activation-based static measures. Our results suggest dynamic network measures may be an effective biomarker for detecting the language dysfunction associated with neurological diseases such as temporal lobe epilepsy, specifying both the type of neuronal communications that are missing in these patients and those that are potentially added but maladaptive. Further advancements along these lines, transforming how we characterize and map language networks in the brain, have a high probability of altering clinical decision making in neurosurgical centres.

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Corrigendum

Patricia Rodriguez-Rodriguez, Anna Sandebring-Matton, Paula Merino-Serrais, Cristina Parrado-Fernandez, Alberto Rabano, Bengt Winblad, Jesús Ávila, Isidre Ferrer, Angel Cedazo-Minguez. Tau hyperphosphorylation induces oligomeric insulin accumulation and insulin resistance in neurons. Brain 2017; 140: 3269–3285; 10.1093/brain/awx256.

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Durable response of early-stage breast cancer to bilateral definitive SBRT in a medically inoperable patient

Publication date: Available online 18 March 2018
Source:Practical Radiation Oncology
Author(s): Robert W. Gao, Sean S. Park, James W. Jakub, Tina J. Hieken, Amy L. Conners, Lonzetta Neal, Sandhya Pruthi, Kimberly S. Corbin, Elizabeth S. Yan, Robert W. Mutter, Bradley J. Stish




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Comment on ‘MicroRNA-199b-5p attenuates TGF-β1-induced epithelial–mesenchymal transition in hepatocellular carcinoma’

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A shift from papillary to reticular fibroblasts enables tumour–stroma interaction and invasion

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Reply to ‘Comment on ‘MicroRNA-199b-5p attenuates TGF-β1-induced epithelial-mesenchymal transition in hepatocellular carcinoma’’

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Clinical pharmacodynamic/exposure characterisation of the multikinase inhibitor ilorasertib (ABT-348) in a phase 1 dose-escalation trial

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Using Objective Metrics to Measure Hearing Aid Performance

Objectives: The performance of hearing aids is generally characterized by a small set of standardized measurements. The primary goals of these procedures are to measure basic aspects of the hearing aid performance and to ascertain that the device is operating properly. A more general need exists for objective metrics that can predict hearing aid outcomes. Such metrics must consider the interaction of all the signal processing operating in the hearing aid and must do so while also accounting for the hearing loss for which the hearing aid has been prescribed. This article represents a first step in determining the clinical applicability of the hearing aid speech perception index (HASPI) intelligibility and hearing aid speech quality index (HASQI) speech quality metrics. The goals of this article are to demonstrate the feasibility of applying these metrics to commercial hearing aids and to illustrate the anticipated range of measured values and identify implementation concerns that may not be present for conventional measurements. Design: This article uses the HASPI intelligibility and HASQI speech quality metrics to measure the performance of commercial hearing aids. These metrics measure several aspects of the processed signal, including envelope fidelity, modifications of the temporal fine structure, and changes in the long-term frequency response, all in the context of an auditory model that reproduces the salient aspects of the peripheral hearing loss. The metrics are used to measure the performance of basic and premium hearing aids from three different manufacturers. Test conditions include the environmental factors of signal to noise ratio and presentation level, and the fitting configurations were varied to provide different degrees of processing from linear to aggressive nonlinear processing for two different audiograms. Results: The results show that the metrics are capable of measuring statistically significant differences across devices and processing settings. HASPI and HASQI measure both audibility and nonlinear distortion in the devices, and conditions are identified where predicted intelligibility is high but predicted speech quality is substantially reduced. The external signal properties of signal to noise ratio and presentation level are both statistically significant. Hearing loss is significant for HASPI but not for HASQI, and degree of processing is significant for both metrics. A quadratic model for manufacturer showed large effect sizes for HASPI and HASQI, but basic versus premium hearing aid model is not significant. Conclusions: The results presented in this article represent a first step in applying the HASPI and HASQI metrics to commercial hearing aids. Modern hearing aids often use several different processing strategies operating simultaneously. The proposed metrics provide a way to predict the total effect of this processing, including algorithm interactions that may be missed by conventional measurement procedures. The measurements in this article show significant differences between manufacturers, processing settings, and adjustment for different hearing losses. No significant differences were found between basic and premium hearing aid models. Further research will be needed to determine the clinical relevance of these measurements and to provide target values appropriate for successful fittings. Acknowledgments: Portions of this work were supported by a grant to the University of Colorado from GN ReSound and by a grant from the National Institutes of Health (1 R01 DC012289). The authors have no conflicts of interest to disclose. Address for correspondence: James M. Kates, University of Colorado, 409 UCB, Boulder, Colorado 80309, USA. E-mail: James.Kates@colorado.edu Received March 30, 2017; accepted January 31, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise

Objectives: The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise. Design: In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps. Results: Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise. Conclusions: Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: We thank all subjects for their participation in this study. We thank the teachers and personnel of the Europaschool and Roelof Venema School for their cooperation. We thank Hans van Beek for preparing test software and technical support, Ilham Saadane for data collection in the initial part of the study, and Job Koopmans for useful comments on the manuscript. W.J.A.K. designed and performed the experiments, analyzed the data, and wrote the article. S.T.G. designed the experiments, discussed the results and implications, and commented on the manuscript at all stages. C.S. designed the experiments, analyzed the data, discussed the results and implications, and commented on the manuscript at all stages. This work was supported by the Ministry Onderwijs, Cultuur en Wetenschappen funding. The authors have no conflicts of interest to disclose. Address for correspondence: Cas Smits, Department of Otolaryngology-Head and Neck Surgery, Section Ear and Hearing, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: c.smits@vumc.nl Received March 4, 2017; accepted January 30, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography

Objectives: Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion. Design: In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extracochlear position—either adjacent to the stapes or on the promontory just superior to the RW. Recording from the fixed, extracochlear position continued during insertion of the CI in 63 cases. Results: Before CI insertion, responses to low-frequency tones at the RW were roughly 6 dB larger than when recording at either extracochlear site, but the two extracochlear sites did not differ from one another. During CI insertion, response losses from the promontory or adjacent to the stapes stayed within 5 dB in ≈61% (38/63) of cases, presumably indicating atraumatic insertions. Among responses which dropped more than 5 dB at any time during CI insertion, 12 subjects showed no response recovery, while in 13, the drop was followed by partial or complete response recovery by the end of CI insertion. In cases with recovery, the drop in response occurred relatively early (

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Celastrol inhibits colorectal cancer cell proliferation and migration through suppression of MMP3 and MMP7 by the PI3K/AKT signaling pathway

Colorectal cancer (CRC) is one of the most frequent malignant tumors. Signaling by the PI3K/AKT pathway is crucial for CRC development and progression, including proliferation and migration. Celastrol has an anticancer effect, but its mechanism needs to be determined. Here, we showed that celastrol suppressed CRC cell proliferation and migration. Celastrol treatment also decreased the PI3K/AKT pathway components, and MMP3 and MMP7 expression levels. In addition, knockdown of AKT, not mTOR, inhibited MMP3 and MMP7 expression levels and AKT silencing promoted the celastrol-induced effects on CRC cell proliferation and migration. Taken together, these findings indicated that the celastrol-induced antitumor effects were mediated through MMP3 and MMP7 by the PI3K/AKT signaling pathway. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/1hexVwJ Correspondence to Wang Ling, PhD, PhD Program for Immunology, Department of Oncology, the First Affiliated Hospital of Dalian Medical University, No. 193, Lian-He Road, Dalian 116011, People's Republic of China Tel: +86 180 9887 6728; fax: +86 411 8363 5963; e-mail: 516245530@qq.com Received October 2, 2017 Accepted February 26, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cochlear implants in developing countries: practical and ethical considerations

No abstract available

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Overcoming developing-world challenges in cochlear implantation: a South American perspective

Purpose of review Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. Recent findings Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. Summary Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries. Correspondence to Sady S. Da Costa, MD, PhD, Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 - Bairro Santa Cecília Porto Alegre, Rio Grande do Sul 90035-903, Brazil. E-mail: selaimen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia

Purpose of review Dysphagia in adults arises from a range of causes including acquired neurological disorders and some cancers. Previous research has suggested that treatment using neuromuscular electrical stimulation (NMES) when used in conjunction with conventional therapy is effective. This review describes the recent literature and a small prospective case series carried out in the United Kingdom. This study contributed to support National Institute of Clinical Excellence (NICE) guidance for clinicians who wish to include NMES in a rehabilitation programme for dysphagic patients, specifically with reference to safety and the impact on swallowing function of this intervention. Recent findings In 2014, the UK NICE issued guidelines enabling UK therapists to trial the use of NMES, but the guidelines also sought additional evidence on the impact on swallowing function of NMES and the incidence of side effects. This small prospective case series investigated both of these aspects with a group of patients with dysphagia of neurological origin who had not achieved adequate swallowing function with traditional therapy alone. This study recruited 10 adult patients with dysphagia of neurological origin. All had previously received traditional swallowing therapy for at least 6 months but only achieved a Functional Oral Intake Scale of 4 or less (a scale for amounts and types of oral intake). The total study period was 10 weeks for each subject comprising 5 weeks of traditional therapy delivered three times a week followed by 5 weeks of NMES concurrent with traditional therapy (NMES + traditional therapy) delivered three times a week using the VitalStim stimulator (VitalStim Therapy, UK). In addition, the Quality of Life in Swallowing and Eating Assessment Tool 10 (quality of life scales) were determined to allow comparison between studies. Nine subjects achieved an improvement in swallowing function after NMES + traditional therapy was measured using the Functional Oral Intake Scale, giving a statistically significant improvement (P 

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Cochlear implants in developing countries: practical and ethical considerations

No abstract available

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Overcoming developing-world challenges in cochlear implantation: a South American perspective

Purpose of review Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. Recent findings Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. Summary Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries. Correspondence to Sady S. Da Costa, MD, PhD, Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 - Bairro Santa Cecília Porto Alegre, Rio Grande do Sul 90035-903, Brazil. E-mail: selaimen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia

Purpose of review Dysphagia in adults arises from a range of causes including acquired neurological disorders and some cancers. Previous research has suggested that treatment using neuromuscular electrical stimulation (NMES) when used in conjunction with conventional therapy is effective. This review describes the recent literature and a small prospective case series carried out in the United Kingdom. This study contributed to support National Institute of Clinical Excellence (NICE) guidance for clinicians who wish to include NMES in a rehabilitation programme for dysphagic patients, specifically with reference to safety and the impact on swallowing function of this intervention. Recent findings In 2014, the UK NICE issued guidelines enabling UK therapists to trial the use of NMES, but the guidelines also sought additional evidence on the impact on swallowing function of NMES and the incidence of side effects. This small prospective case series investigated both of these aspects with a group of patients with dysphagia of neurological origin who had not achieved adequate swallowing function with traditional therapy alone. This study recruited 10 adult patients with dysphagia of neurological origin. All had previously received traditional swallowing therapy for at least 6 months but only achieved a Functional Oral Intake Scale of 4 or less (a scale for amounts and types of oral intake). The total study period was 10 weeks for each subject comprising 5 weeks of traditional therapy delivered three times a week followed by 5 weeks of NMES concurrent with traditional therapy (NMES + traditional therapy) delivered three times a week using the VitalStim stimulator (VitalStim Therapy, UK). In addition, the Quality of Life in Swallowing and Eating Assessment Tool 10 (quality of life scales) were determined to allow comparison between studies. Nine subjects achieved an improvement in swallowing function after NMES + traditional therapy was measured using the Functional Oral Intake Scale, giving a statistically significant improvement (P 

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Fate of mandibular canals displaced by enlarged cystic lesions: does the inferior alveolar neurovascular bundle relocate to its original position?

Publication date: Available online 17 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Y.-S. Han, H. Lee, B.-M. Seo
Our aim was to identify the positional changes of the inferior alveolar neurovascular bundle and evaluate the relocation of the displaced mandibular canal after enucleation of a cyst. Seventy patients (72 sites) who had had cysts enucleated were divided into three groups based on the degree of encroachment of the cystic lesion into the mandibular canal and whether a bone graft had been inserted after the cyst had been enucleated. The mean (range) of patients' ages was 45 (18–75) years, and there were 29 male and 41 female patients. Group A comprised cysts with encroachment on the mandibular canal that were enucleated without a bone graft; Group B consisted of cysts with no encroachment of the mandibular canal, but were enucleated without a bone graft; and Group C comprised cysts with encroachment of the mandibular canal that were enucleated with a bone graft. The displacement of the mandibular canal was identified from analysis of computed tomographic (CT) images. Changes in the position of the mandibular canal were measured on panoramic radiographs. The mandibular canal was repositioned superiorly by a mean (SD) of 2.4 (1.65)mm after enucleation of the cyst, which was significant in Group A (p<0.001), but not in Groups B and C. These results indicate that the displaced inferior alveolar neurovascular bundles that were not surrounded by bony canal tended to relocate towards a supposedly normal position, and after enucleation of the cyst the mandibular canal was remodelled in this new location. This tendency to relocate was blocked by bone grafting. Bone grafts are therefore recommended in cases where enough bony height is required for future insertion of implants.



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A Novel Anterior Revision Surgery for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: Case Report and Review of the Literature

Publication date: May 2018
Source:World Neurosurgery, Volume 113
Author(s): Jinhao Miao, Jingchuan Sun, Jiangang Shi, Yu Chen, Deyu Chen
PurposeA 62-year-old blind man with severe ossification of the posterior longitudinal ligament was presented. The patient underwent posterior laminectomy and fixation. After surgery, the patient was not satisfied with the recovery of his upper limbs although his Japanese Orthopedic Association (JOA) score had increased from 9 to 12 points. Because the tactile sensation of his hands was especially important to his daily life, the patient asked for further treatment after 6 months. This report describes the novel revision surgery we invented and the outcome in the patient after the surgery.MethodsWe performed the revision surgery using an anterior approach from C3 to C7 with a novel technique, anterior controllable antedisplacement and fusion (ACAF). The patient was followed up for 6 months. The clinical data, including JOA score and radiologic images, were collected and analyzed.ResultsAfter the revision surgery, the patient had improved sensation in both hands, and his JOA score increased to 14 points. Satisfactory decompression was assessed by magnetic resonance imaging after operation. Bone fusion was confirmed by computed tomography 3 months after operation. No specific complications related to this surgery were observed.ConclusionsThe application of such an operative procedure in revision surgery for OPLL has not been reported earlier and might be an alternative choice for patients with an unsatisfactory outcome from previous posterior surgery.



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Bilateral Spontaneous Regression of Vestibular Schwannoma in Neurofibromatosis Type 2

Publication date: May 2018
Source:World Neurosurgery, Volume 113
Author(s): Martina Sebök, Christiaan Hendrik Bas van Niftrik, Oliver Bozinov
BackgroundPatients with neurofibromatosis type 2 and bilateral vestibular schwannoma (VS) are frequently treated surgically for any tumor progression, and often repeated surgery or radiation treatment is even considered. Some VS progression occurs without the development of new clinical symptoms, or it does not progress in size over many years, even in the absence of any specific treatment.Case DescriptionA 61-year-old male patient with neurofibromatosis type 2 presented with bilateral VS. In a long-term follow-up, both had increased in size but also showed bilateral spontaneous regression during an 11-year follow-up period with a "watch-and-wait" strategy.ConclusionsWe emphasize conservative treatment ("watch and wait") in older patients even with long-term tumor progression without significant compression-related clinical symptoms.



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Coil and Single-Stent Placement for Ruptured Dissecting Aneurysm of Middle Cerebral Artery: A Case Report

Publication date: May 2018
Source:World Neurosurgery, Volume 113
Author(s): Tomohiko Ozaki, Takeo Nishida, Yuya Fujita, Haruhiko Kishima, Manabu Kinoshita
BackgroundRuptured dissecting aneurysms located at the middle cerebral artery (MCA) are rare, and their standard treatment has not been defined. Furthermore, lenticulostriate artery involvement in the dissecting segment makes treatment extremely difficult, and no previous reports have described successful treatment for such conditions.Case DescriptionWe herein report the case of a 74-year-old woman who presented with sudden severe headache from subarachnoid hemorrhage due to dissection in the proximal M1 segment of left MCA involving lenticulostriate arteries. Digital subtraction angiography on day 6 showed that the dissecting aneurysm had enlarged despite strict blood pressure control. On day 8, the patient was treated successfully with a self-expanding closed cell stent and coil embolization, preserving blood flow in the lenticulostriate arteries as well as the MCA.ConclusionsFollow-up digital subtraction angiography performed 5 weeks after endovascular therapy showed healing of the dissecting lesion, and the patient was discharged neurologically intact.



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NTRK Fusions Define a Novel Uterine Sarcoma Subtype With Features of Fibrosarcoma

Tropomyosin receptor kinase (Trk) inhibitors have shown high response rates in patients with tumors harboring NTRK fusions. We identified 4 NTRK fusion-positive uterine sarcomas that should be distinguished from leiomyosarcoma and undifferentiated uterine sarcoma. NTRK rearrangements were detected by fluorescence in situ hybridization (FISH) and/or targeted RNA or DNA sequencing in 4 undifferentiated uterine sarcomas with spindle cell morphology. Because of histologic overlap with leiomyosarcoma, TrkA and pan-Trk immunohistochemistry was performed in 97 uterine leiomyosarcomas. NTRK1 and NTRK3 FISH was performed on tumors with TrkA or pan-Trk staining. We also performed whole transcriptome RNA sequencing of a leiomyosarcoma with TrkA expression and targeted RNA sequencing of 2 additional undifferentiated uterine sarcomas. FISH and/or targeted RNA or DNA sequencing in the study group showed TPM3-NTRK1, LMNA-NTRK1, RBPMS-NTRK3, and TPR-NTRK1 fusions. All tumors were composed of fascicles of spindle cells. Mitotic index was 7 to 30 mitotic figures per 10 high power fields; tumor necrosis was seen in 2 tumors. Desmin, estrogen receptor, and progesterone receptor were negative in all tumors, while pan-Trk was expressed in all tumors with concurrent TrkA staining in 3 of them. TrkA and/or pan-Trk staining was also seen in 6 leiomyosarcomas, but these tumors lacked NTRK fusions or alternative isoforms by FISH or whole transcriptome sequencing. No fusions were detected in 2 undifferentiated uterine sarcomas. NTRK fusion-positive uterine spindle cell sarcomas constitute a novel tumor type with features of fibrosarcoma; patients with these tumors may benefit from Trk inhibition. TrkA and pan-Trk expression in leiomyosarcomas is rare and does not correlate with NTRK rearrangement. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Sarah Chiang, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10044 (e-mail: chiangs@mskcc.org). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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TRAF3-interacting protein 3, a new oncotarget, promotes tumor growth in melanoma

TRAF3-interacting protein 3 (TRAF3IP3) is expressed in the immune system and participates in cell maturation, tissue development, and immune response. In a previous study, we reported that TRAF3IP3 levels were substantially increased in the vasculature of breast cancer tissues, suggesting a proangiogenic role. In this study, we investigated TRAF3IP3 tumorigenic function. TRAF3IP3 protein was present in several cancer cell lines, with highest levels in melanoma. In addition, tumor microarray analysis on 23 primary melanoma and nine positive lymph nodes revealed that 70% of human primary melanoma and 66% of lymph node metastases were positive for TRAF3IP3. Importantly, TRAF3IP3 downregulation correlated with an 83% reduction of tumor growth in a subcutaneous xenograft mouse model (n=10, P=0.005). Immunohistochemistry analysis of the tumors revealed that TRAF3IP3-shRNA tumors had increased apoptosis (n=4, P

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Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study

Background: Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. Methods: We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti—Childs Trust Hospital, Chennai, India. Results: One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). Conclusions: Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome. Address correspondence to Selvakumar Ambika, DO, DNB, Department of Neuro Ophthalmology, Sankara Nethralaya, A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai 600 006, India; E-mail: drsa@snmail.org The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Cerebrospinal Fluid Pressure Reduction Results in Dynamic Changes in Optic Nerve Angle on Magnetic Resonance Imaging

Background: Optic nerve sheath tortuosity is a previously reported, but incompletely characterized, finding in idiopathic intracranial hypertension (IIH). We hypothesized that optic nerve angle (ONA), as a quantitative measure of tortuosity, would change dynamically with cerebrospinal fluid (CSF) pressure status of patients with IIH immediately before and after lumbar puncture (LP). Methods: Consecutive patients with suspected IIH referred for MRI and diagnostic LP were prospectively enrolled in this single institution, institutional review board–approved study. Each patient underwent a pre-LP MRI, diagnostic LP with opening pressure (OP) and closing pressure (CP), and then post-LP MRI all within 1 session. Sagittal and axial ONAs were measured on multiplanar T2 SPACE images by 2 neuroradiologists on pre- and post-LP MRI. Effects of measured pressure and CSF volume removal on changes in ONA were analyzed as was interrater reliability for ONA measurement. Results: Ten patients with IIH were included {all female, median age 29 (interquartile range [IQR] 25–32)}. All patients had elevated OP (median 37, IQR 34–41 cm H2O), and significantly reduced CP (median 18, IQR 16–19 cm H2O, P

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Neuro-Ophthalmology in Turkey

No abstract available

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Evaluation of Vision-Related Quality of Life in Chinese Patients With Leber Hereditary Optic Neuropathy and the G11778A Mutation

Objective: To assess quality of life (QoL) measures in Chinese Leber hereditary optic neuropathy (LHON) patients with the G11778A mutation. Methods: Chinese LHON patients with the G11778A mutation were prospectively evaluated using the Visual Function Index (VF-14) at 6 months, 1 year, and 3 years after the involvement of the second eye. Patients who completed the VF-14 at all 3 follow-up time designations were included in the analysis. Results: Fifty-five patients met the inclusion criteria. The median age of patients when their vision was bilaterally affected was 16.3 years old (interquartile range: 13.9–18.3 years). In our patient cohort, 89.1% (n = 49) were male, and the ratio of males to females was 8.2:1. The median logMAR visual acuity was 2.0 (interquartile range: 1.0–2.6). The mean VF-14 scores of patients with LHON at 6-month, 1-year, and 3-year follow-ups were 18.0 ± 19.2 (range 0–85.4), 19.9 ± 20.0 (range 0–85.4), and 20.7 ± 20.2 (range 0–85.4), and the differences were statistically significant (P

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Effect of inpatient rehabilitation on activities of daily living in pediatric cancer patients in Japan

Most pediatric cancer patients decline physical performance therapy, resulting in limitations in the activities of daily living. The objective of this study was to investigate the effects of rehabilitation in pediatric patients with cancer using the functional independence measure (FIM) score. This retrospective study included 25 inpatient children diagnosed with cancer at a single university hospital from January 2016 to December 2016. All patients underwent rehabilitative intervention during their hospital stay. We investigated the contents of the rehabilitation program and the FIM scores before and after the rehabilitative intervention. The average FIM scores improved in all patients; however, only the total-FIM scores (+4.96 points, P=0.009) and motor-FIM scores (+4.04 points, P=0.005) improved significantly. Conversely, cognitive-FIM score did not significantly improve (+0.92 points, P=0.159). In addition, motor-FIM subgroup scores for locomotion (walk/wheelchair and stairs) were significantly higher (+0.36 points, P=0.039 and +0.64 points, P=0.046, respectively) after rehabilitative intervention, regardless of the length of hospital stay. This study showed that FIM score, particularly motor-FIM score and locomotion subgroup scores, significantly improved owing to participation in inpatient rehabilitation. In conclusion, we found that rehabilitative intervention improved physical activity, especially locomotion. Correspondence to Kazue Taguchi, MD, 3284-1 Kawarabuki, Ageo-shi 362-0022, Saitama-ken, Japan Tel: +81 298 533 795; fax: +81 486 715 771; email: s1630434@u.tsukuba.ac.jp Received January 14, 2018 Accepted February 24, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study

Background: Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. Methods: We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti—Childs Trust Hospital, Chennai, India. Results: One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). Conclusions: Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome. Address correspondence to Selvakumar Ambika, DO, DNB, Department of Neuro Ophthalmology, Sankara Nethralaya, A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai 600 006, India; E-mail: drsa@snmail.org The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Cerebrospinal Fluid Pressure Reduction Results in Dynamic Changes in Optic Nerve Angle on Magnetic Resonance Imaging

Background: Optic nerve sheath tortuosity is a previously reported, but incompletely characterized, finding in idiopathic intracranial hypertension (IIH). We hypothesized that optic nerve angle (ONA), as a quantitative measure of tortuosity, would change dynamically with cerebrospinal fluid (CSF) pressure status of patients with IIH immediately before and after lumbar puncture (LP). Methods: Consecutive patients with suspected IIH referred for MRI and diagnostic LP were prospectively enrolled in this single institution, institutional review board–approved study. Each patient underwent a pre-LP MRI, diagnostic LP with opening pressure (OP) and closing pressure (CP), and then post-LP MRI all within 1 session. Sagittal and axial ONAs were measured on multiplanar T2 SPACE images by 2 neuroradiologists on pre- and post-LP MRI. Effects of measured pressure and CSF volume removal on changes in ONA were analyzed as was interrater reliability for ONA measurement. Results: Ten patients with IIH were included {all female, median age 29 (interquartile range [IQR] 25–32)}. All patients had elevated OP (median 37, IQR 34–41 cm H2O), and significantly reduced CP (median 18, IQR 16–19 cm H2O, P

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Neuro-Ophthalmology in Turkey

No abstract available

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Evaluation of Vision-Related Quality of Life in Chinese Patients With Leber Hereditary Optic Neuropathy and the G11778A Mutation

Objective: To assess quality of life (QoL) measures in Chinese Leber hereditary optic neuropathy (LHON) patients with the G11778A mutation. Methods: Chinese LHON patients with the G11778A mutation were prospectively evaluated using the Visual Function Index (VF-14) at 6 months, 1 year, and 3 years after the involvement of the second eye. Patients who completed the VF-14 at all 3 follow-up time designations were included in the analysis. Results: Fifty-five patients met the inclusion criteria. The median age of patients when their vision was bilaterally affected was 16.3 years old (interquartile range: 13.9–18.3 years). In our patient cohort, 89.1% (n = 49) were male, and the ratio of males to females was 8.2:1. The median logMAR visual acuity was 2.0 (interquartile range: 1.0–2.6). The mean VF-14 scores of patients with LHON at 6-month, 1-year, and 3-year follow-ups were 18.0 ± 19.2 (range 0–85.4), 19.9 ± 20.0 (range 0–85.4), and 20.7 ± 20.2 (range 0–85.4), and the differences were statistically significant (P

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Stereotactic Body Radiation Therapy (SBRT) for Hepatocellular Carcinoma: High Rates of Local Control With Low Toxicity

Objectives: Stereotactic body radiotherapy (SBRT) is potentially curative treatment for small hepatocellular carcinomas (HCC), but data are limited on its efficacy and toxicity. We hypothesized that SBRT can achieve excellent local control (LC) with acceptable toxicity treating HCC lesions, even in advanced cirrhosis. Materials and Methods: Thirty-seven nonmetastatic HCC patients received SBRT to 43 lesions between October 2012 and April 2016. Median dose was 50 Gy/5 fractions. All Child-Pugh (CP) ≥B patients underwent a planned 1-month break after the first 3 fractions to assess hepatic toxicity. Patients were treated without separately placed fiducial markers using Linac-based SBRT with breath-hold (67%) or 4D-computed tomography with compression belt (33%) to reduce motion. Patients underwent magnetic resonance imaging q3 months post-SBRT. Results: Median age was 65 (range, 44 to 88). Pre-SBRT mean CP was 6.4 (range, A5 to C11). Nine (24%) had CP≥B8. Thirty-one of 33 patients (93%) had prior liver-directed therapy (median 2). Seventeen (40%) had solitary lesions. Median lesion diameter was 2.7 cm (range, 1.1 to 5.6). Median follow-up was 14 months (range, 2 to 45). There was 1 local failure (multifocal HCC with 3 prior transarterial chemoembolization). LC, freedom from liver progression, and overall survival at 12 months was 95%, 66%, 87% in the full cohort, and 100%, 76%, 93% for patients with solitary lesions. Four had grade 3 toxicity (ascites [n=2]/gastrointestinal bleed [n=1]/capsular pain [n=1]). Eight of 9 CP≥B8 patients had no grade ≥3 hepatic toxicity. Conclusions: SBRT for HCC is well-tolerated even in patients with advanced cirrhosis and prior liver-directed treatment and provides excellent LC even for larger lesions that cannot be controlled with radiofrequency ablation. LC with SBRT compares favorably to other liver-directed therapies. Prospective studies comparing SBRT with other liver-directed therapies are warranted. The authors declare no conflicts of interest. Reprints: Brian C. Baumann, MD, Department of Radiation Oncology, Washington University in St. Louis, 4921 Parkview Place, Lower Level, St. Louis, MO 63110. E-mail: brian.baumann@wustl.edu. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparing Simultaneous Liver-Kidney Transplant Strategies: A Modified Cost-Effectiveness Analysis

Background The proportion of patients with kidney failure at time of liver transplantation is at an historic high in the United States. The optimal timing of kidney transplantation with respect to the liver transplant is unknown. Methods We used a modified cost-effectiveness analysis to compare four strategies: the old system ("pre-OPTN"), the new Organ Procurement Transplant Network (OPTN) system since August 10, 2017 ("OPTN"), and two strategies which restrict simultaneous liver-kidney transplants ("safety net" and "stringent"). We measured "cost" by deployment of deceased donor kidneys (DDKs) to liver transplant recipients and effectiveness by life years (LYs) and quality-adjusted life years (QALYs) in liver transplant recipients. We validated our model against Scientific Registry for Transplant Recipients data. Results The OPTN, safety net and stringent strategies were on the efficient frontier. By rank order, OPTN > safety net > stringent strategy in terms of LY, QALY and DDK deployment. The pre-OPTN system was dominated, or outperformed, by all alternative strategies. The incremental LY per DDK between the strategies ranged from 1.30 to 1.85. The incremental QALY per DDK ranged from 1.11 to 2.03. Conclusion These estimates quantify the "organ"-effectiveness of various kidney allocation strategies for liver transplant candidates. The OPTN system will likely deliver better liver transplant outcomes at the expense of more frequent deployment of DDKs to liver transplant recipients. Corresponding Authors: Jane C. Tan, 750 Welch Rd, Suite 200, MC 5785, Palo Alto CA 94304, 650-725-9891. janetan@stanford.edu; W. Ray Kim, 300 Pasteur Drive, Always M211, Stanford CA 94305, 650-725-6511. wrkim@stanford.edu Authorship: X.S.C.: Research design, data acquisition, data analysis, results interpretation, paper writing. W.R.K.: Research design, results interpretation, paper writing. J.C.T.: Research design, data acquisition, results interpretation, paper writing. G.M.C.: Research design, results interpretation, paper writing. J.G.: Research design, data analysis, results interpretation, paper writing. The authors declare no conflict of interest. Research reported here was supported by the John M. Sobrato Gift Fund (J.C.T.) and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K24DK092336 (W.R.K.) and K24 DK085446 (G.M.C.). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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High-Frequency Neuromuscular Electrical Stimulation Increases Anabolic Signaling

Purpose Neuromuscular electrical stimulation (NMES) is commonly used in rehabilitation settings to increase muscle mass and strength. However, the effects of NMES on muscle growth are not clear and no human studies have compared anabolic signaling between low-frequency (LF-) and high-frequency (HF-) NMES. The purpose of this study was to determine the skeletal muscle anabolic signaling response to an acute bout of LF- and HF-NMES. Methods Eleven young healthy volunteers (6 men; 5 women) received an acute bout of LF- (20 Hz) and HF- (60 Hz) NMES. Muscle biopsies were obtained from the vastus lateralis muscle prior to the first NMES treatment and 30-mins following each NMES treatment. Phosphorylation of the following key anabolic signaling proteins was measured by Western blot and proteins are expressed as a ratio of phosphorylated to total: mammalian target of rapamycin (mTOR), p70-S6 kinase 1 (S6K1), and eukaryotic initiation factor 4E binding protein 1 (4E-BP1). Results Compared to Pre-NMES, phosphorylation of mTOR was upregulated 40.2% for LF-NMES (P = 0.018) and 68.4% for HF-NMES (P 0.05). There were no differences between treatment conditions for 4E-BP1 phosphorylation (P > 0.05). Conclusion An acute bout of LF- and HF-NMES upregulated anabolic signaling with HF-NMES producing a greater anabolic response compared to LF-NMES, suggesting that HF-stimulation may provide a stronger stimulus for processes that initiate muscle hypertrophy. Additionally, the stimulation frequency parameter should be considered by clinicians in the design of optimal NMES treatment protocols. Correspondence to: Joni A. Mettler, PhD, ATC, CSCS, Texas State University, Department of Health and Human Performance, Division of Exercise and Sport Science, 601 University Drive, San Marcos, TX 78666-4684, Phone: 512-245-9691, Fax: 512-245-8678, Email: jam388@txstate.edu This study was funded by The National Athletic Trainers' Association Research and Education Foundation Grant to JA Mettler (Grant # 14GGP004) and by a College of Education Student Research Grant to DM Magee. The authors report no conflicts of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 March 2018 © 2018 American College of Sports Medicine

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Impaired Trunk Flexor Strength, Fatigability, and Steadiness in Postpartum Women

Purpose To determine whether postpartum women (vaginal and Cesarean delivery) have deficits in trunk flexor strength, fatigability and steadiness, compared with nulligravid women, up to 26 weeks postpartum. We hypothesized that postpartum women would be weaker, more fatigable and have greater torque fluctuations than controls, with Cesarean delivery showing greater deficits than vaginal delivery. Methods 22 control women (nulligravid) and 29 postpartum women (20-40 years, 19 who delivered via vaginal birth, 13 via Caesarian section) participated. Postpartum women were tested 8-10 and 24-26 weeks postpartum. Control women were tested 16-18 weeks apart. Maximal voluntary isometric contractions (MVC) were performed at multiple trunk positions with the trunk flexor muscles. To determine trunk flexor fatigability, subjects performed intermittent isometric contractions at 50% MVC (6-s contraction, 4-s rest) in upright sitting until task failure. An MVC was performed during the fatiguing task (one/min) and at 10 and 20 minutes of recovery. Results At 8 and 26 weeks, postpartum women (groups pooled) were weaker at all trunk angles (38% & 44% respectively, p

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Acute High-Intensity Interval Cycling Improves Postprandial Lipid Metabolism

Purpose To examine the effects of 2 exercise regimes on physiological and postprandial lipemic responses. Methods Thirty-six active men (peak oxygen uptake (VO2peak): 46.5 ± 6.4 mL/kg/min) were randomly assigned to a high-intensity interval exercise (HIIE), involving 10 × 60 s cycling at 85% VO2peak interspersed with 120 s recovery; a moderate-intensity continuous exercise (MICE), involving 50 min continuous exercise at 65% VO2peak; and a nonexercise control (Con). In the next morning after evening exercising, fasting blood samples were obtained. Additional blood samples were obtained 1–4 hr after eating a given high-fat meal that based on participants' body mass. Carbohydrate and fat oxidation rates were measured before and after the meal. Results After exercise, glucose and insulin concentrations decreased by 33% and 70% in the MICE compared with those in the HIIE (P = 0.00–0.03). During the 1–2 hr postprandial periods, the fat oxidation rate increased by 24%–37% in the HIIE compared with that in the MICE and Con (P = 0.01–0.03); however, the carbohydrate oxidation rate was not significantly different among the conditions (P = 0.28). During the postprandial period, insulin (P = 0.02–0.04) and triglyceride (P = 0.02–0.03) concentrations were lower in the HIIE than in the MICE and Con. No difference was observed in free fatty acid (FFA) or the total areas under the curve of triglyceride and FFA among the conditions (P = 0.24–0.98). Conclusion Acute MICE improved glucose and insulin metabolism immediately after exercise. However, HIIE performed in the evening exerts more favorable effects than MICE for decreasing postprandial insulin and triglyceride levels and increasing fat oxidation in the next morning. Corresponding Author: Chia-Lun Lee, Division of Physical and Health Education, Center for General Education, National Sun Yat-sen University, Mailing address: NO. 21-2 Wang-Sheng-Ming Rd., Fengshan Dist, Kaohsiung City, Taiwan, R. O. C. Telephone: +886 920165693. Fax numbers: +886 77191435. e-mail: karenlee1129@gmail.com The authors declare no conflicts of interest or source of funding in this study. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and do not constitute. This study was supported by a grant from the Ministry of Science and Technology, Taiwan (MOST 105-2410-H-110-042). © 2018 American College of Sports Medicine

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Rare Report of Unilateral Postauricular Dermoid Cyst

Dermoid cysts are benign developmental anomalies that occurred as a result of the sequestration of the skin along the lines of embryonic closure. Those occurring in the cervicofacial region are uncommon, accounting for about 7% of all dermoids and its presence in postauricular region is further exceptionally rare. A healthy 19-year-old Asian boy presented with a unilateral postauricular cyst that had been present since childhood without any symptom. The computed tomography scan revealed an encapsulated tumor with no intracranial extension. Histological examination of a biopsy taken from the lesion revealed a unilocular cyst found in the deep dermis and subcutaneous tissue. Multinuclear giant cells and fragments of hair shaft are infiltrated in the cystic wall. Some keratin materials are seen in the intracystic area. However, the lining cells are not found. These histologic findings were suggested of the dermoid cyst. Patients with postauricular dermoid cysts usually seek medical advice for the cosmetic reasons because of the embarrassing look of the prominent unilateral or bilateral ears. The treatment of postauricular dermoid cyst is complete surgical excision of the cyst wall. Incomplete removal may result in recurrence or infection; thus, complete surgical excision is necessary. The prognosis is excellent without further complication. Address correspondence and reprint requests to Hwan Jun Choi, MD, PhD, Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Bongmyeong-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do 330-721, Republic of Korea; E-mail: medi619@hanmail.net Received 28 August, 2017 Accepted 17 December, 2017 This work was supported by the Soonchunhyang University Research Fund. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Traumatic Bony Ankylosis of Temporomandibular Joint as a Complication After Reduction Malarplasty

Reduction malarplasty is one of the most commonly performed cosmetic and plastic surgery in Asian countries. Bony ankylosis of the temporomandibular joint (TMJ) occurs usually as a result of trauma, infection, failed surgeries, and autoimmune diseases. Reduction malarplasty has low incidence of TMJ-related complications. A 33-year-old female patient came with complaint of restricted mouth opening around 18 mm, which was developed immediately after the reduction malarplasty 2 years before. On computed tomography image, bony adhesion and the defect from the surgical drilling were found around right TMJ. The TMJ interpositional gap arthroplasty with temporalis myofascial pedicled flap was done with simultaneous right coronoidectomy. Interincisal opening increased up to 47 mm intraoperatively. Address correspondence and reprint requests to Jun-Young Paeng, DDS, PhD, Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Republic of Korea; (e-mail: jypaeng@gmail.com). Received 4 November, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reevaluation of Mandibular Morphometry According to Age, Gender, and Side

Aim: This study aims to reevaluation the linear and angular measurements of mandibles with multidetector computed tomography (MDCT) that is a new method and used frequently in recent years. Materials and Methods: The archived MDCT images of 100 adult patients (age range, 15–74 years) without mandibular operation and trauma history were evaluated retrospectively. Mandibular ramus heights, maximal mandibular length, mandibular symphysis height, mandibular angles, and mandibular foramen distance measurements were performed on MDCT images. All measurement parameters were analyzed by gender, age groups, and sides. Results: Mandibular linear length measurements were higher in males than in females (P 

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Characteristics of the Development of the Maxillae and Vomer in Patients With Bilateral Cleft Lip and Palate

The aim of this study was to investigate the anatomical features of the maxillae and vomer in patients with bilateral cleft lip and palate (BCLP). Craniofacial measurements of 24 adult BCLP patients (GB) and 32 normal adult controls (GN) were carried out. We measured the width and length of the maxillae, their relative positions with respect to the coronal plane passing through the basion, and the volume, length, cross-sectional area, and mean width of the vomer. Between-group differences were assessed using independent-sample t tests. Finite element models (FEMs) were used to explore the bite forces acting on the bone by evaluating the distribution of stress and bone displacement. The mean vomer volume and width were significantly larger in the GB group than in the GN group (P = 0.000), whereas the length was significantly shorter (P = 0.000). The anterior maxillary length (A1-P3M⊥CP) was significantly larger in the GB group (P = 0.013), whereas the posterior maxillary length (P3M-P6M⊥CP) and overall maxillary length (A1-P6M⊥CP) at the dental level were significantly reduced (P 

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An Algorithm for Airway Management in Patients With Pierre Robin Sequence

Purpose: Airway management in neonates with Pierre Robin sequence (PRS) can be challenging. The goal was to describe the algorithm developed by the authors over the past 8 years. Methods: A retrospective case series analyzing airway management in neonates with PRS admitted to the neonatal intensive care unit at a tertiary care pediatric hospital was performed. The utility of the proposed algorithm for airway management incorporating more consistent use of polysomnography (PSG), and airway assessment was assessed. Results: A total of 31 neonates with PRS (12 men, 19 women) with a mean gestational age of 38.2 weeks were analyzed. Thirteen (41.9%) patients had a named syndrome, chromosomal abnormality, or global delay. Twenty (64.5%) patients had pre-intervention PSG, and severe obstructive sleep apnea with an apnea-hypopnea index (AHI) ≥ 10 events/hour was identified in 19 (95.0%). Mandibular distraction osteogenesis was performed in 18 (58.1%) patients, and improved the AHI on post-operative PSGs. Direct assessment of the upper and lower airways was performed in 19 patients, and 13 (68.4%) were found to have secondary airway pathology. Presence of a concomitant syndrome was significantly associated with need for tracheostomy. Conclusion: The algorithm differs from previous ones in that it relies on rigorous pre- and post-intervention PSG (including with a nasopharyngeal airway), as well as that it allows flexibility between treatment options given the whole-patient clinical scenario and endoscopic findings. Results from these studies may be integrated to stratify patients into those who are most likely to benefit from conservative interventions or surgical procedures. Address correspondence and reprint requests to Jeffrey C. Rastatter, MD, Division of Otolaryngology – Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 25, Chicago, IL 60611; E-mail: jrastatter@luriechildrens.org Received 18 August, 2017 Accepted 29 January, 2018 Presented at the American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting, September 20, 2016, San Diego, CA. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Osteosarcoma of the Ethmoid Sinus

Osteosarcoma (OS) is a malignant bone tumor and it is very rare in head and neck region. If it arises in this area, most common localizations of this tumor are mandible and maxilla and ethmoid sinus is very rare site for this malignancy. A 43-year-old female admitted to our clinic with the complaint of pain in the right half of the face and headache persisting for 2 months. According to the clinical symptoms and imaging studies, sinonasal ossifying fibroma was suspected. For this reason, patient was operated endoscopically and histopathological examination revealed that osteoid matrix producing atypical osteoblastic cells so these findings identified osteoblastic variant OS. This article is about a very rare case of OS of ethmoid sinus. The differential diagnosis, general characteristics, and classification of this tumor, radiological features, and surgical techniques are also presented. Address correspondence and reprint requests to Zülküf Burak Erdur, MD, Department of Otolaryngology Head and Neck Surgery, Istanbul University Cerrahpasa Medicine Faculty, Istanbul Üniversitesi Cerrahpaşa Tip Fakültesi Yerleşkesi Kocamustafapaşa Cd. No: 53, Cerrahpaşa, 34098 Fatih/Istanbul, Turkey; E-mail: burakerdur@hotmail.com Received 6 December, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of Complex Facial Asymmetry: Problems and Refinements

This article describes 2 patients with complex facial asymmetry characterized by hemiarhinia, microorbitism, palpebral fissure shortening, ipsilateral canthal dystopia, maxillomandibular hypoplasia, and occlusal plane inclination. These unusual phenotypes are part of the oculoauriculo-vertebral spectrum. Their devastating functional, esthetic, and psychologic effects demand the use of different craniofacial surgery techniques, in order to alleviate the profound impact of these pathologies. Initial skeletal balance through bimaxillary distraction osteogenesis and orbital expansion sets the basis for further reconstruction of the nose and periorbital area with local tissue. Address correspondence and reprint requests to Oswaldo Javir Gómez Díaz, MD, Division of Plastic Surgery, School of Medicine, National University of Colombia, Caracas Avenue 1–13, Office of Surgical Specialties, Third Floor, Bogotá D.C., Colombia; E-mail: oswaldogomez@me.com Received 28 May, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Combined Application of Database and Three-Dimensional Image Registration Technology in the Restoration of Total Nose Defect

Objective: The purpose of this study is to present a virtual planning protocol based on the database and three-dimensional (3D) image registration technology for the restoration of the total nasal defect, and evaluate its feasibility and clinical efficacy. Methods: Patients were scanned with a FaceScan to obtain the 3D facial model which was stored in an Extensible Neuroimaging Archive Toolkit (XNAT) database. Personalized search and similarity evaluation were performed in the database to find a normal 3D facial model with the highest similarity to the patient's. Then, the 2 models were imported into the dedicated software for 3D image registration to get the 3D model of the nasal defect part and the preoperative planning 3D facial model of virtual restoration. Subsequently, the dimensionality reduction algorithm was conducted to transform the 3D model of the nasal defect to a 2D flatten one for determining the scope of the forehead flap during surgery. Four weeks after the insetting surgery of forehead flap pedicle, the postoperative 3D facial model was gained. At last, the clinical efficacy was evaluated by comparing the difference between the preoperative planning and postoperative 3D facial model. Results: The nasal shapes of the patients were good after the operation, and the results revealed that the maximum error was ranging from 3.12 to 4.07 mm with the mean error from 0.92 to 1.04 mm. Conclusion: The database and 3D image registration technology provide a new approach for precisely determining the scope of total nasal defect and the forehead flap, which may be used for reference in the accurate restoration of other facial soft tissue defects. Address correspondence and reprint requests to Wei Tang, MD, PhD, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, NO. 14 3rd Section, Renmin South Road, Chengdu 610041, China; E-mail: mydrtw@vip.sina.com Received 2 December, 2017 Accepted 2 February, 2018 The first 2 authors contributed equally to this work. This study was supported by Program of Science and Technology Department of Sichuan Province (2014SZ0157-2). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar

Third lower molar partially erupted is commonly encountered in dental practice. This situation challenges clinicians with the dilemma whether to remove or to monitor it, because this molar can cause pathology of the adjacent second molar. The aim of this retrospective study is to evaluate the relationship between third mandibular molar and distal cervical caries in second molar. This retrospective study analyzed 55 digital orthopantograms of adult patients and a total number of 95 mandibular third molars were assessed for eruption status, angulation, radiographic evidence of caries or restoration in the mandibular third molar, and radiographic evidence of caries or restoration in the distal surface of the mandibular second molar. The distal cervical caries in second molar is associated with fully erupted and partially erupted wisdom molar in horizontal, mesioangular and vertical position and less with presence of caries in third molar. There are caries lesions in distal second molars in mesioangular position when adjacent third molar is caries free. Address correspondence and reprint requests to Eitan Mijiritsky, DMD, Scientific Coordinator of Maxillofacial Surgery, Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Ehud Str 12, Tel-Aviv 69350, Israel; E-mail: Mijiritsky@bezeqint.net Received 29 November, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Congenital Vomer Defect Incidentally Detected on Preoperative Evaluation for Nasal Septoplasty and Turbinoplasty

A perforation in posterioinferior portion of nasal septum is rare and caused by vomeral defect. We report a case of 56-year-old man who had a vomer defect, which was detected incidentally during preoperative evaluation of nasal septoplasty and turbinoplasty. The patient had a surgery of septoplasty and bilateral turbinoplasty under general anesthesia. There was no septal mucosal tear or defect during septoplasty and turbinoplasty. When the patient who has vomeral defect with nasal obstruction is planned for septoplasty and turbinoplasty, the surgery should be performed carefully to protect the mucosa. Address correspondence and reprint requests to Jung Hyun Chang, MD, PhD, Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10444, Republic of Korea; E-mail: jhrhino.chang@gmail.com Received 24 July, 2017 Accepted 4 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Nano-Biphasic Calcium Phosphate Ceramic for the Repair of Bone Defects

Calcium phosphate bioceramics has recently experienced increased interest in bone reconstruction. Mimicking of natural structure of bone, like the use of nanomaterials, is an attractive approach for generating scaffolds for bone regeneration. The aim of present study was to evaluate the effect of nanonization on the biphasic calcium phosphate (BCP) ceramic in the repair of bone cavities in the canine mandible. A commercial BCP was dry-milled in a high energy planetary ball mill with zirconia balls and container. Three holes (8 mm in diameter) were outlined to the depth of cortical bone of mandibular angle of 5 dogs bilaterally. The first hole (positive control group A, n = 10) was filled in with commercial BCP material. The second hole was loaded with the nanonized BCP (experimental group C, n = 10) and the third one was left untreated (negative control group B, n = 10). The defects were allowed to regenerate for 8 weeks. New bone formation was greater in groups A and C than in B. No difference was seen between group A and group C (P = 0.676). The residual bone material in group C (19.34 ± 8.03) was as much as one-half of that in group A (38.69 ± 7.90%) (P = 0.000). The negative control group B presented the highest amount of soft tissue within the bone defects. The least percentage of marrow space was found in the positive control group (13.23 ± 13.52). Our results depicted that the rate of resorption increased significantly after nanonization even though the nano-sized BCP failed to make a superior regeneration than the ordinary BCP. Address correspondence and reprint requests to Majid Rezaei, DDS, MSc, No 501, Sobhan Building, Javanshir St, Kermanshah 67137-433227, Iran; E-mail: m.rezaei@kums.ac.ir Received 15 November, 2017 Accepted 7 February, 2018 This study was financially supported by vice chancellery for research and technology, Kermanshah University of Medical Sciences (No 94123). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cranioplasty: An Institutional Experience

Cranioplasty is a common procedure in neurosurgical practice, but associated with high complication rates. In the current study, the authors describe surgical characteristics and results of cranioplasty performed in a tertiary teaching hospital in Brazil. Data were obtained from electronic medical records of cranioplasties performed between January 2013 and November 2016. The sample comprised of 33 patients, and the mean follow-up time was 16 months. Patients presented most of the times a good preoperative status, with 84.8% of patients classified between 0 and 3 at modified Rankin scale and 78.7% with 4 or 5 points at Glasgow Outcome Scale. The most common initial diagnosis was vascular disease (48% of patients) followed by traumatic brain injury (36% of patients). The majority of cranioplasties used an autograft: the autologous bone flap removed during a previous surgery (craniectomy) and stored in the abdominal subcutaneous fat (67% of patients). In 3 patients, the polymethylmethacrylate prosthesis was custom-made prior to the operation using 3-dimensional printing, based on computed tomography images. Five patients (15% of patients) developed symptoms related to surgical site infection, manifesting at an average of 5 weeks following the procedure. Three of them presented scalp dehiscence before the infection symptoms. Cranioplasty should be performed early, as long as clinical conditions are good and the patient has overcome the acute phase of neurological injury. Address correspondence and reprint requests to Aderaldo Costa Alves Junior, MD, Departamento de Neurologia, Psicologia e Psiquiatria, Distrito de Rubião Jr, S/N, Botucatu, SP, Brazil. CEP: 18618-970; E-mail: aderaldoneuro@gmail.com Received 24 September, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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