Sample-dependent diagnostic accuracy of prostaglandin d synthase in cerebrospinal fluid leak.

Sample-dependent diagnostic accuracy of prostaglandin d synthase in cerebrospinal fluid leak.

Clin Biochem. 2016 Sep 7;

Authors: Morell-Garcia D, Bauça JM, Sastre MP, Yañez A, Llompart I

Abstract
BACKGROUND: Prostaglandin D2 synthase, commonly known as β-trace protein (βTP), is an excellent biomarker for the assessment of cerebrospinal fluid (CSF) leaks. Despite being widely used, the limits for the diagnostic values of βTP are not well established to date, and currently suggested cut-off values in literature range from 0.25 to 6.0mg/L. Sample-specific and more accurate thresholds are a current need.
METHODS: A retrospective observational study, performed in a tertiary-care hospital, between January 2006 and January 2014. A total of 74 patients were included, with a definitive diagnosis after initial leak suspicion and at least one determination of βTP using a nephelometry-based assay. A total of 46 CSF samples were included in the control group. Samples were obtained from nasal secretions, ear secretions or spinal surgical injury, directly using sterile Eppendorf tubes. The analysis of 3 different cut-off values was performed and the receiver operating curve (ROC) analyses were calculated.
RESULTS: Initial diagnostic suspicion was confirmed in 51% of cases, most of which were of postoperative origin (51%) and traumatic (26%). The βTP median concentration in different samples was significantly higher in the presence of cerebrospinal fluid fistula, regardless of sample type (22.0mg/L vs. 0.24mg/L, 95% confidence interval: 19.0-30.8 vs. 0.08-0.40; p<0.001). Data from contingency tables show 100% sensitivity and specificity, depending on sample type and the cut-off value used: for rhinorrhea and otorrhea samples, the most appropriate it was 0.7mg/L, while values >2.0mg/L could be used for spine postoperative fluid leakage samples.
CONCLUSIONS: The cut off value for βTP in the diagnosis and follow-up of cerebrospinal fluid leaks should be modified depending on the type of secretion (sample type), for a better diagnostic accuracy.

PMID: 27614217 [PubMed - as supplied by publisher]

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Stem Cell-Based Tissue-Engineered Laryngeal Replacement.

Stem Cell-Based Tissue-Engineered Laryngeal Replacement.

Stem Cells Transl Med. 2016 Sep 9;

Authors: Ansari T, Lange P, Southgate A, Greco K, Carvalho C, Partington L, Bullock A, MacNeil S, Lowdell MW, Sibbons PD, Birchall MA

Abstract
: Patients with laryngeal disorders may have severe morbidity relating to swallowing, vocalization, and respiratory function, for which conventional therapies are suboptimal. A tissue-engineered approach would aim to restore the vocal folds and maintain respiratory function while limiting the extent of scarring in the regenerated tissue. Under Good Laboratory Practice conditions, we decellularized porcine larynges, using detergents and enzymes under negative pressure to produce an acellular scaffold comprising cartilage, muscle, and mucosa. To assess safety and functionality before clinical trials, a decellularized hemilarynx seeded with human bone marrow-derived mesenchymal stem cells and a tissue-engineered oral mucosal sheet was implanted orthotopically into six pigs. The seeded grafts were left in situ for 6 months and assessed using computed tomography imaging, bronchoscopy, and mucosal brushings, together with vocal recording and histological analysis on explantation. The graft caused no adverse respiratory function, nor did it impact swallowing or vocalization. Rudimentary vocal folds covered by contiguous epithelium were easily identifiable. In conclusion, the proposed tissue-engineered approach represents a viable alternative treatment for laryngeal defects.
SIGNIFICANCE: This report describes the production and in vivo implantation of a biologically derived hemilarynx and subsequent in vivo assessment and analysis under regulated Good Laboratory Practice conditions. This study illustrates how physiological laryngeal-related functions can be retained.

PMID: 27612519 [PubMed - as supplied by publisher]

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Spontaneous Resolution of Delayed Post-operative Extradural and Epicranial Pneumatocele.

Spontaneous Resolution of Delayed Post-operative Extradural and Epicranial Pneumatocele.

Mymensingh Med J. 2016 Jul;25(3):564-566

Authors: Satter RS, Shantana SH, Asif DS, Bhowmick K, Gaddam SS

Abstract
Extradural and epicranial pneumatocele is a rare condition. It may complicate with CSF rhinorrhoea and meningitis which can have a fatal outcome. We present a case of delayed post-operative extradural and epicranial pneumatocele in the frontal region following primary repair of the anterior skull base for a traumatic compound craniofacial injury with CSF leakage. There was no evidence of meningitis or raised ICP. As the patient was neurologically stable; he was managed conservatively and had a spontaneous resolution of the pneumatocele.

PMID: 27612908 [PubMed - as supplied by publisher]

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TSH and CD40L Stimulate Interleukin-12 Expression in Fibrocytes: Implications for pathogenesis of Thyroid Associated Ophthalmopathy.

TSH and CD40L Stimulate Interleukin-12 Expression in Fibrocytes: Implications for pathogenesis of Thyroid Associated Ophthalmopathy.

Thyroid. 2016 Sep 9;

Authors: Wu T, Mester T, Gupta S, Sun F, Smith TJ, Douglas R

Abstract
BACKGROUND: Increased numbers of bone marrow-derived progenitor cells, known as fibrocytes populate the peripheral circulation, orbit, and thyroid of patients with Graves' disease (GD). These cells have been implicated in the development of thyroid-associated ophthalmopathy (TAO). They can differentiate into myofibroblasts or adipocytes, produce inflammatory cytokines, and remodel tissue. We sought to determine whether thyroid-stimulating hormone (TSH) and CD40 ligand (CD40L) implicated in the pathogenesis of GD, induce interleukin-12 (IL-12) in human fibrocytes.
MATERIALS AND METHODS: IL-12 protein concentrations and mRNA levels were measured by Luminex and real-time polymerase chain reaction, respectively. Flow cytometry assessed intracellular IL-12 concentrations. Vector containing IL-12p40 promoter was transfected into cultured fibrocytes and promoter activity was monitored using luciferase assay.
RESULTS: TSH and CD40L stimulated intracellular IL-12 protein accumulation in peripheral blood fibrocytes. Inhibiting Akt and nuclear factor-κB (NF-κB) activity diminished IL-12 expression in fibrocytes while TSH did not induce promoter activity. TSH-mediated IL-12 production required de novo-synthesized proteins and augmented IL-12 mRNA stability. IL-12 production mediated by CD40L required tumor necrosis factor receptor-associated factor 6 (TRAF6).
CONCLUSION: TSH and CD40L induce IL-12 expression in fibrocytes, and Akt and NF-κB mediate this activity. Given the importance of IL-12 in immune function, its production by fibrocytes may promote an inflammatory immune response and tissue remodeling in TAO.

PMID: 27612658 [PubMed - as supplied by publisher]

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Hearing Loss and Tinnitus in Military Personnel with Deployment-Related Mild Traumatic Brain Injury.

Hearing Loss and Tinnitus in Military Personnel with Deployment-Related Mild Traumatic Brain Injury.

US Army Med Dep J. 2016 Oct-Dec;(3-16):52-63

Authors: Karch SJ, Capó-Aponte JE, McIlwain DS, Lo M, Krishnamurti S, Staton RN, Jorgensen-Wagers K

Abstract
The objective of this study was to analyze differences in incidence and epidemiologic risk factors for significant threshold shift (STS) and tinnitus in deployed military personnel diagnosed with mild traumatic brain injury (mTBI) due to either a blast exposure or nonblast head injury. A retrospective longitudinal cohort study of electronic health records of 500 military personnel (456 met inclusion criteria) diagnosed with deployment-related mTBI was completed. Chi-square tests and STS incidence rates were calculated to assess differences between blast-exposed and nonblast groups; relative risks and adjusted odds ratios of developing STS or tinnitus were calculated for risk factors. Risk factors included such characteristics as mechanism of injury, age, race, military occupational specialty, concurrent diagnosis of posttraumatic stress disorder (PTSD), and nicotine use. Among blast-exposed and nonblast patients, 67% and 58%, respectively, developed STS, (P=.06); 59% and 40%, respectively, developed tinnitus (P<.001). Incidence of STS was 24% higher in the blast-exposed than nonblast group. Infantry service was associated with STS; Marine Corps service, PTSD, and zolpidem use were associated with tinnitus. Unprotected noise exposure was associated with both STS and tinnitus. This study highlights potential risk factors for STS and tinnitus among blast-exposed and nonblast mTBI patient groups.

PMID: 27613210 [PubMed - in process]

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Corrigendum to "A systematic review of the reporting of tinnitus prevalence and severity" [Hear. Res. 337 (2016) 70-79].

Corrigendum to "A systematic review of the reporting of tinnitus prevalence and severity" [Hear. Res. 337 (2016) 70-79].

Hear Res. 2016 Sep;339:219

Authors: McCormack A, Edmondson-Jones M, Somerset S, Hall DA

PMID: 27612990 [PubMed - as supplied by publisher]

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Supporting a child with multiple disabilities to participate in social interaction: The case of asking a question.

Supporting a child with multiple disabilities to participate in social interaction: The case of asking a question.

Clin Linguist Phon. 2016 Sep 9;:1-22

Authors: Norén N, Sigurd Pilesjö M

Abstract
Asking a question can be a highly challenging task for a person with multiple disabilities, but questions have not received much attention in research on augmentative and alternative communication (AAC). Conversation analysis is employed to examine an instance of multiparty interaction where a speech and language therapist supports a child with multiple disabilities to ask a question with a communication board. The question is accomplished through a practice where the action is built as a trajectory of interactional steps. Each step is built using ways of involvement that establish different participation spaces designed to deal with different aspects of asking a question: agreeing on the action type, the speaker and recipient, the content of the question, and then asking the question. The segmentation of a question into discrete steps and participation spaces can be used in intervention to model the construction of a question for AAC users and significant others.

PMID: 27612402 [PubMed - as supplied by publisher]

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Ear health and hearing surveillance in girls and women with Turner's Syndrome: recommendations from the Turner's Syndrome Support Society.

Ear health and hearing surveillance in girls and women with Turner's Syndrome: recommendations from the Turner's Syndrome Support Society.

Clin Otolaryngol. 2016 Sep 10;

Authors: Kubba H, Smyth A, Wong SC, Mason A

Abstract
BACKGROUND: Turner's syndrome (TS) is a common chromosomal disorder, affecting 1 in 2000 newborn girls, in which part or all of one X chromosome is missing. Ear and hearing problems are very common in girls and women with TS. The aim of this review was to review the published literature in order to suggest recommendations for otological health surveillance.
METHOD: A keyword search of Ovid Medline was performed for published literature on the subject and evidence rated according to the GRADE criteria.
RESULTS: Middle ear disorders are very common and persistent in girls and women with TS, as are progressive sensorineural hearing loss and balance disorders.
CONCLUSIONS: Otolaryngologists should be aware of the high prevalence and challenging nature of all forms of ear disease in individuals with TS. Early intervention may offer benefits to health and education and we advocate routine lifelong annual hearing screening in this group. This article is protected by copyright. All rights reserved.

PMID: 27614170 [PubMed - as supplied by publisher]

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Coconut Model for Learning First Steps of Craniotomy Techniques and CSF Leak Avoidance.

Coconut Model for Learning First Steps of Craniotomy Techniques and CSF Leak Avoidance.

World Neurosurg. 2016 Sep 6;

Authors: Braga BD, Peleja SB, Macedo G, Drummond CR, Costa PH, Garcia-Zapata MT, Oliveira MM

Abstract
INTRODUCTION: Neurosurgery simulation has gained attention recently due to changes in the medical system. First-year neurosurgical residents in low-income countries usually perform their first craniotomy on a real subject. Development of high-fidelity, cheap, and largely available simulators is a challenge in residency training. An original model for the first steps of craniotomy with cerebrospinal fluid (CSF) leak avoidance practice using a coconut is described.
MATERIAL AND METHODS: The coconut is a drupe from Cocos nucifera L. (coconut tree). The green coconut has four layers and some similarity can be seen between these layers and the human skull. The materials used in the simulation are the same as those used in the operating room.
PROCEDURE: The coconut is placed on the head holder support with the face up. The burr holes are made until endocarp is reached. The mesocarp is dissected, and the conductor is passed from one hole to the other with the Gigli saw. The hook handle for the wire saw is positioned, and the mesocarp and endocarp are cut. After sawing the four margins, mesocarp is detached from endocarp. Four burr holes are made from endocarp to endosperm. Careful dissection of the endosperm is done, avoiding liquid albumen leak. The Gigli saw is passed through the trephine holes. Hooks are placed, and the endocarp is cut. After cutting the four margins, it is dissected from the endosperm and removed. The main goal of the procedure is to remove the endocarp without fluid leakage.
DISCUSSION: The coconut model for learning the first steps of craniotomy and CSF leak avoidance has some limitations. It is more realistic while trying to remove the endocarp without damage to the endosperm. It is also cheap and can be widely used in low-income countries. However, the coconut does not have anatomical landmarks. The mesocarp makes the model less realistic because it has fibers that make the procedure more difficult and different from a real craniotomy.
CONCLUSION: The model has a potential pedagogic neurosurgical application for freshman residents before they perform a real craniotomy for the first time. Further validity is necessary to confirm this hypothesis.

PMID: 27613497 [PubMed - as supplied by publisher]

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