Ocular Motor Manifestations of Multiple Sclerosis

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders. Evidence Acquisition: This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility. Results: Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus. Conclusions: The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.

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

Patient Safety: Its History and Relevance to Neuro-Ophthalmology

No abstract available

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

Ocular and Cerebral Emboli From an Atrial Myxoma

Abstract: Emboli from an atrial myxoma resulted in asymptomatic segmental retinal and choroidal arterial hyperfluorescent lesions on retinal angiography, mimicking an arteritis. The retinal lesions disappeared after removal of the atrial myxoma. Endothelial trauma by embolic material appears to be the mechanism of the angiographic findings.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wRW3mR

The Utility of Magnetic Resonance Imaging in Assessing Patients With Pituitary Tumors Compressing the Anterior Visual Pathway

Background: Pituitary tumors are one of the most common types of intracranial neoplasms, and can cause progressive visual loss. An ongoing challenge in the management of patients with pituitary tumors is the cost, availability, and reliability of current magnetic resonance imaging (MRI) techniques to capture clinically significant incremental tumor growth. The purpose of this study was to evaluate the various MRI-based structural analyses and to explore the relationship between measures of structure and function in the afferent visual pathway of patients with pituitary tumors. Methods: We performed a critical review of literature on MRI-based structural analyses of pituitary adenomas using PubMed, Embase, Cochrane Library, and Google Scholar. In addition, preoperative structural characteristics of the optic apparatus, optic nerve compression, and optic chiasm elevation identified as important in the literature review, were examined in 18 of our patients from October 2010 to January 2014. Results: In our review of literature, a total of 443 citations were obtained from our search strategy and review of bibliographies. Eight of these studies met inclusion/exclusion criteria and were retrieved for critical review. Of the 8 included studies, only 2 studies examined the relationship between MRI-based structural measurements and postoperative visual recovery. In our small case-series, MRI analysis of chiasm elevation, severity of optic nerve compression, chiasm position, height of chiasm, tumor height, and tumor volume failed to differentiate patients with postoperative visual dysfunction vs those with visual recovery (P > 0.05). Conclusions: Although MRI-based structural analysis is an important and useful tool for managing patients with pituitary tumors, there are limited objective measures shown to be predictive of postoperative visual recovery.

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

Limitations of Current Methodology for Assessment of Compression of the Optic Chiasm by Macroadenoma: The Neuroradiologic Perspective

No abstract available

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

Neuro-Ophthalmology and Stroke

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSoh0K

The QuantiFERON-TB Gold In-Tube Assay in Neuro-Ophthalmology

Background: Although QuantiFERON-TB Gold In-Tube (QFT-GIT) testing is regularly used to detect infection with Mycobacterium tuberculosis, its utility in a patient population with a low risk for tuberculosis (TB) has been questioned. The following is a cohort study analyzing the efficacy of QFT-GIT testing as a method for detection of active TB disease in low-risk individuals in a neuro-ophthalmologic setting. Methods: Ninety-nine patients from 2 neuro-ophthalmology centers were identified as having undergone QFT-GIT testing between January 2012 and February 2016. Patients were divided into groups of negative, indeterminate, and positive QFT-GIT results. Records of patients with positive QFT-GIT results were reviewed for development of latent or active TB, as determined by clinical, bacteriologic, and/or radiographic evidence. Results: Of the 99 cases reviewed, 18 patients had positive QFT-GIT tests. Of these 18 cases, 12 had documentation of chest radiographs or computed tomography which showed no evidence for either active TB or pulmonary latent TB infection (LTBI). Four had chest imaging which was indicative of possible LTBI. None of these 18 patients had symptoms of active TB and none developed active TB within the follow-up period. Conclusions: Based on our results, we conclude that routine testing with QFT-GIT in a low-risk cohort did not diagnose active TB infection. We do not recommend routine QFT-GIT testing for TB low-risk individuals, as discerned through patient and exposure history, ocular examination, and clinical judgment, in neuro-ophthalmology practice.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSufi4

Is Routine Imaging of the Aorta Warranted in Patients With Giant Cell Arteritis?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vFv3Z0

Color Pupillography in Dorsal Midbrain Syndrome

Objective: The purpose of this study was to evaluate the pupil response to chromatic stimuli in patients with lesions in the dorsal midbrain and possibly gain new insights into the afferent pupillary pathways. Methods: Color pupillography was performed in 5 patients with dorsal midbrain syndrome (DMS), and their results were compared with those of 20 healthy control subjects. We used full-field red stimuli (605 nm) that primarily address the rod/cone system and blue stimuli (420 nm) that preferentially activate intrinsically photosensitive retinal ganglion cells (ipRGCs) directly, with a duration of 4 seconds and a stimulus intensity of 28 lx corneal illumination under mesopic conditions. One eye was stimulated, and the consensual pupil response was recorded and analyzed. Results: The pupillary light reflex in patients with DMS was reduced, differed in shape, and showed a prolonged latency time compared to normal subjects. The blue response was less affected than the red response: the mean maximal relative amplitude (M) was 15.8% (SD = 7.8) in patients with DMS compared with 43.0% (SD = 5.5) in normal subjects for red stimulation, and M = 40.8%, SD = 8.4 (DMS) with M = 58.3%, SD = 4.8 (normals) for blue stimulation. The reduction was 63% for red stimulation but only 30% for blue stimulation in patients with DMS. Moreover, there was a preserved postillumination pupil response to blue stimulation in DMS patients. Conclusions: In DMS, the melanopsin-mediated ipRGC pathway appeared relatively preserved.

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

Selective Unidirectional Horizontal Saccadic Paralysis From Acute Ipsilateral Pontine Stroke: Response

No abstract available

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

Role of Nocturnal Arterial Hypotension in Nonarteritic Anterior Ischemic Optic Neuropathy

No abstract available

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

Structure-Function Analysis of Nonarteritic Anterior Ischemic Optic Neuropathy and Age-Related Differences in Outcome

Background: The optic nerve head is vulnerable to ischemia leading to anterior ischemic optic neuropathy (AION), the most common acute optic neuropathy in those older than 50 years of age. Methods: We performed a cross-sectional study of 55 nonarteritic anterior ischemic optic neuropathy (NAION) eyes in 34 patients to assess clinical outcome and perform structure-function correlations. Results: The peak age of NAION onset was between 50 and 55 years. Sixty-seven percent of patients presented with their first event between the ages of 40 and 60 years, and 32% presented at ≤50 years. Those with NAION onset at age ≤50 years did not have significantly better visual outcome per logMAR visual acuity, automated perimetric mean deviation (PMD) or optical coherence tomography (OCT) measurements. Kaplan–Meier survival curve and multivariate Cox proportional regression analysis showed that age >50 years at NAION onset was associated with greater risk of second eye involvement, with hazard ratio of 20. Older age at onset was significantly correlated with greater thinning of the ganglion cell complex (GCC) (P = 0.022) but not with logMAR visual acuity, PMD, or thinning of retinal nerve fiber layer (RNFL). Using area under receiver operating characteristic curve analyses, we found that thinning of RNFL and GCC was best able to predict visual outcome, and that mean RNFL thickness >65 μm or macular GCC thickness >55 μm significantly correlated with good visual field outcome. Conclusions: We showed that NAION onset at age >50 years had a greater risk of second eye involvement. Patients with OCT mean RNFL thickness >65 μm and mean macular ganglion cell complex thickness >55 μm had better visual outcomes.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wRMtA5

The 43rd Annual Meeting of the North American Neuro-Ophthalmology Society in Washington, DC

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSdy6e

Is Multiple Sclerosis Associated With a Lower Intraocular Pressure?

Objective: To determine if multiple sclerosis (MS) is associated with lower intraocular pressure (IOP) compared with individuals without MS. Methods: Thirty patients with clinically definite MS were identified and a retrospective chart review was conducted. Each patient with MS underwent IOP recording by a single investigator using kinetic applanation tonometry. Measurement of central corneal thickness (CCT) also was obtained. Similarly, 30 study controls were identified and kinetic applanation tonometry and CCT were recorded. Univariate analysis of covariance was conducted to determine a statistically significant difference between IOP between MS and control groups, controlling for age. Results: Analyses were adjusted for age and 2 subjects were excluded because of steroid use. The average IOP in MS group was 12.3 mm Hg (right eye = 12.3 mm Hg, left eye = 12.2 mm Hg) and in the control group was 17 mm Hg (right eye = 16.9 mm Hg, left eye = 17 mm Hg). There was a significant effect of presence of MS on IOP accounting for 53% variability in mean IOP (F(1,55) = 60.7; P

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wS2t5h

Vision Loss, Rash, and Abnormal Brain Magnetic Resonance Imaging in a 17 Year Old

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wS0uhp

Evaluation of Horner Syndrome in the MRI Era

Background: To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging. Methods: A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups. Results: Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined "idiopathic." Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain. Conclusions: HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wS84IU

Endodermal Cyst of the Third Nerve in a Child

Abstract: Endodermal cysts, also known as neurogenic, neuroenteric, foregut, bronchogenic, respiratory, epithelial, teratomatous, or gastrocytoma cysts, can be found in the central nervous system, predominantly in the subarachnoid space of the cervical and thoracic spinal cord. We describe a child with an endodermal cyst of the third nerve and highlight neuroimaging findings, pathological correlation, clinical course, and patient management.

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

Morbidity and mortality in children undergoing bronchoscopy for foreign body removal

Objectives/Hypothesis

Analyze morbidity and mortality among children undergoing bronchoscopy for foreign body removal.

Study Design

Multicenter retrospective review using the American College of Surgeons Pediatric National Surgical Quality Improvement Program from 2014 and 2015.

Methods

Patients were identified using Current Procedural Terminology code 31635. Demographics, time to surgery, operative times, hospitalization time, and complications were collected. Multivariate logistic regression was used to identify predictive factors for major adverse events.

Results

Three hundred thirty-four patients were included (mean age 3.7 years, 59.0% male). Preoperative sepsis syndrome was present in 5.7% of patients and 8.1% had asthma. Of the patients, 5.1% percent of patients had a tracheostomy. Bronchoscopy was performed by an otolaryngologist (65.4%) or a pediatric surgeon (33.1%). Mean operative time was 27.4 minutes, whereas mean total operating room time was 54.6 minutes. Airway foreign bodies were located in 269 patients (80.5%), with 62.5% being located in the mainstem bronchus. Operative time was longer when foreign bodies were in the mainstem bronchus or distal to it. Mean time to surgery from admission was 0 days, and mean duration of hospitalization was 1 day. One patient (0.3%) required reoperation for respiratory reasons, and three (0.9%) required readmission for related reasons. No patients remained hospitalized at 30 days. Two (0.6%) had a postoperative pneumonia, and two (0.6%) required reintubation. One patient death (0.3%) occurred within 2 weeks of bronchoscopy. No significant differences were identified in operative time, time to surgery, or hospitalization time based on age, gender, presence of a tracheostomy, or surgical specialty.

Conclusions

Bronchoscopy for identification and removal of airway foreign bodies had minimal morbidity in this group.

Level of Evidence

2b Laryngoscope, 2017

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vL3E6c

Myxofibrosarcoma in Head and Neck: Case Report of Unusually Aggressive Presentation

Publication date: Available online 16 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anastasiya Quimby, Abigail Estelle, Arun Gopinath, Rui Fernandes
Myxofibrosarcoma (MFS) is a malignant fibroblastic tumor that primarily affects lower and upper extremities. It is usually described as a slow growing tumor with high recurrence rates but low metastatic potential. Reported incidence of head and neck MFS is 2-4% rarely presenting with distant metastases[1, 2]. We present a case of maxillary MFS in a 72-year-old woman whose disease progression followed an atypical course with an extremely rapid rate of growth and early pulmonary and central nervous system lesions. Due to pulmonary symptoms as initial presentation, arriving at a final diagnosis was a challenge. Various diagnostic modalities and multidisciplinary collaboration were required. The disease course and management are outlined. To our knowledge, this is the first case of MFS originating in the maxillary alveolus with multiple metastases including brain and lungs in the early course of the disease.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v3Bkdv

Health Policy Research May Ensure the Future of Oral and Maxillofacial Surgery

Publication date: Available online 16 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nisarg A. Patel, Yisi D. Ji, Thomas B. Dodson, R. Bruce Donoff




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

African-Americans in Oral and Maxillofacial Surgery: Factors Affecting Career Choice, Satisfaction and Practice Patterns

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Thalia-Rae Criddle, Newton C. Gordon, George Blakey, R. Bryan Bell
IntroductionThere is little data available on experience of minority surgeons in the field of oral and maxillofacial surgery(OMS). Therefore, the purpose of this study is to: 1) explore factors that contribute to African-Americans choosing OMS as a career; 2) examine satisfaction among minority oral and maxillofacial surgeons with the residency application and training process; 3) report on practice patterns amongst minority oral and maxillofacial surgeons; and 4) to identify perceived bias for or against minority oral and maxillofacial surgeons in attempt to aid the efforts of OMS residency organizations to foster diversity.MethodsA 19-item survey was sent to 80 OMS practitioners using information from the National Society of Oral and Maxillofacial Surgeons, an AAOMS affiliated organization, mailing list. All surveys were sent by mail and were followed by a reminder mailing after eight weeks. Responses returned within 16 weeks were accepted for analysis.ResultsOf the 80 mailed surveys, 41 returned within the 16-week parameters representing a return rate of 51%. The majority of minority surgeon respondents were married males with a mean age of 60 who work as private practitioners. Most respondents practice on the eastern and western coasts of the United States. Exposure in dental school was the most important factor in selecting OMS as a specialty. Location and prestige were the most important factors in selecting a residency program. Most respondents reported that race did not affect the success of their application to residency and does not currently affect the success of their practice. However, 25-46% of participants experienced race-related harassment and 48-55% of participants feel there is a bias against African-Americans in OMS.ConclusionsOur data suggests that a significant number of minority oral and maxillofacial surgeons subjectively perceive race-based bias in their career, although it does not appear to affect professional success.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v3TiwF

Giant pilomatrix carcinoma of the face

Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sapna Lohiya, Yeshwant B. Rawal, Jasjit K. Dillon
This case report describes an unusually large facial pilomatrix carcinoma (PC) in a 60-year-old man. This PC had been growing slowly for 11 months and had recently ulcerated. It measured 9cm x 7cm x 5cm. An initial punch biopsy was inconclusive. The tumor was excised in total with 5mm margins in a supra-superficial musculoaponeurotic system (SMAS) plane. The defect was reconstructed with a cervicofacial bilobed rotational advancement flap. Histopathology confirmed the diagnosis of PC. There was no lymph node spread or distant metastasis. The patient recovered with a good esthetic result. This case represents one of the largest facial PCs reported in literature. Diagnostic challenges are discussed and literature is reviewed.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uKR9KI

Impact of machining on the flexural fatigue strength of glass and polycrystalline CAD/CAM ceramics

Publication date: Available online 14 August 2017
Source:Dental Materials
Author(s): Sara Fraga, Marina Amaral, Marco Antônio Bottino, Luiz Felipe Valandro, Cornelis Johannes Kleverlaan, Liliana Gressler May
ObjectivesTo assess the effect of machining on the flexural fatigue strength and on the surface roughness of different computer-aided design, computer-aided manufacturing (CAD/CAM) ceramics by comparing machined and polished after machining specimens.MethodsDisc-shaped specimens of yttria-stabilized polycrystalline tetragonal zirconia (Y-TZP), leucite-, and lithium disilicate-based glass ceramics were prepared by CAD/CAM machining, and divided into two groups: machining (M) and machining followed by polishing (MP). The surface roughness was measured and the flexural fatigue strength was evaluated by the step-test method (n=20). The initial load and the load increment for each ceramic material were based on a monotonic test (n=5). A maximum of 10,000 cycles was applied in each load step, at 1.4Hz. Weibull probability statistics was used for the analysis of the flexural fatigue strength, and Mann-Whitney test (α=5%) to compare roughness between the M and MP conditions.ResultsMachining resulted in lower values of characteristic flexural fatigue strength than machining followed by polishing. The greatest reduction in flexural fatigue strength from MP to M was observed for Y-TZP (40%; M=536.48MPa; MP=894.50MPa), followed by lithium disilicate (33%; M=187.71MPa; MP=278.93MPa) and leucite (29%; M=72.61MPa; MP=102.55MPa). Significantly higher values of roughness (Ra) were observed for M compared to MP (leucite: M=1.59μm and MP=0.08μm; lithium disilicate: M=1.84μm and MP=0.13μm; Y-TZP: M=1.79μm and MP=0.18μm).SignificanceMachining negatively affected the flexural fatigue strength of CAD/CAM ceramics, indicating that machining of partially or fully sintered ceramics is deleterious to fatigue strength.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uL3MFF

Impact of thio-urethane additive and filler type on light-transmission and depth of polymerization of dental composites

Publication date: Available online 12 August 2017
Source:Dental Materials
Author(s): André Luis Faria-e-Silva, Carmem Silvia Pfeifer
ObjectiveThis study evaluated the effects of filler type and the addition of thio-urethane oligomers on light-transmission, polymerization kinetics and depth of cure of resin composites.MethodsBisGMA:UDMA:TEGMA (5:3:2wt%) were mixed with 0 (control) or 20wt% thio-urethane. Fillers with various sizes and refractive indices were included and refractive index (RI) measured. Unfilled resins were used as controls. The RIs of materials were measured before and after polymerization. The irradiance reaching the bottom of 3-mm thick specimens was measured during the polymerization. Degree of conversion to a depth of 5mm was mapped. An optical bench was used to simultaneously follow conversion and light transmission.ResultsThe addition of thio-urethane increased the RI for all composites. As expected, RI also increased with conversion for all materials. The one exception was for the material filled with OX-50, in which the RI of the composite decreased with conversion. In this case, the irradiance at the bottom of the 3mm specimen was also the lowest among all groups. The addition of thio-urethanes had only minimal effect on light transmission within a filler type, but led to increased conversion in depth for all groups. The filler type itself had a greater effect on light transmission, and that correlated well with the degree of conversion.SignificanceThe effect of the thio-urethane addition on degree of conversion in depth was dependent on filler type. The additive can be tailored to improve the RI match with the filler to optimize light transmission in dental composites.

Graphical abstract

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

O210 Abnormal movements mimicking tremor in amyotrophic hands in adults

Adult patients presenting with slowly progressive hand weakness and wasting (HWW) without signs of upper motor neuron involvement and unconvincing cervical MRI signs of disk protrusion are a diagnostic challenge. Clinical and electrophysiological follow-up is needed to reach the most probable diagnosis.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3BYMM

P244 Normal cortical modulation of subcortical structures is altered in cervical dystonia

Blink reflex (BR) is obtained after different kinds of stimuli, such as trigeminal supraorbial branch stimulation (trigeminal BR, TBR) or median nerve stimulation at wrist (hand-evoked BR, HBR). Inhibition of TBR occurs when a preceding subthreshold stimulus is applied before trigeminal stimulation (prepulse inhibition, PPI). In healthy subjects, magnitude of HBR is increased and magnitude of PPI of TBR is decreased if the stimulated hand is positioned in the peripersonal space (PPS). Here, we aimed to investigate the changes of HBR and PPI of the TBR in PPS to understand alterations of cortical modulations of subcortical structures in cervical dystonia.

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

P243 Functional connectivity analysis of cortico-cortical evoked potentials

The electrical stimulation of the cortical tissue can evoke early (N1) and late (N2) cortico-cortical evoked potential (CCEP) components. In this study, we applied functional connectivity analysis to investigate the attenuation and network topology induced by electrical stimulation. We also compared the synchronization and network topology in case of stimulations inside and outside the epileptic zone (EZ).

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

P219 Cortical excitability in Dystrophia Myotonica type 1

Dystrophia Myotonica type 1 (DM1) is characterized by distal muscle weakness, atrophy, myotonia and CNS involvement. Electrophysiological assessment of CNS involvement in DM1 patient refers to multimodal evoked potential studies. Herein we investigated the function of central motor pathways in DM1 patients by transcranial magnetic stimulation (TMS) and the possible relationships with disease duration, muscular impairment and MRI findings.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vKuyv0

O1-6-12. Cauda equina conduction time as a test for lumber spinal stenosis

We examined the cauda equina conduction time (CECT) in 20 patients (11 male), average age, 73years, low back pain therapy criterion score of Japan orthopaedic Association (JOA score), 17 points, and Oswestry Disability Index (ODI), 19 points and aged matched 17 healthy volunteers. Magnetic Augmented Translumbosacral Stimulation (MTATS) at L1 and S1 levels elicited a compound muscle action potential (CMAP) recordable from bilateral abductor hallucis muscle. We calculated the CECT as the difference between the latencies of CAMPs elicited by stimulation at L1 and S1 level.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3XFMN

P290 Reduced hand dexterity in parkinson’s disease patients is associated with impaired intracortical inhibition

To check whether hand dexterity in Parkinson's disease (PD) patients is linked with motor cortex excitability and plasticity.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vKMK7U

O2-6-06. The role of gaze in performing the trail making test

We studied the role of gaze in performing the trail-making test (TMT) in eight normal subjects, a task frequently used to assess frontal executive function in neurological patients. TMT was presented on a touch-panel monitor placed in front of the subjects, on which they were asked to connect the presented numbers with their fingers in an ascending order (version A), or with the added task of alternately connecting between the numbers and letters in ascending and alphabetical orders (version B), respectively.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3fhrY

O2-6-08. Mechanism of forelimb motor function restoration after cervical spinal cord hemisection in rats: Electorophysiological verification

The objective of this study was to electrophysiologically assess corticospinal tracts of adult rats and recovery of motor function of their forelimbs after cervical cord hemisection. Of 39 adult rats used, compound muscle action potentials (CMAPs) of forelimbs of 15 rats were evaluated, before they received left C5 segmental hemisection of the spinal cord, by stimulating the pyramid of medulla oblongata on one side using an exciting microelectrode. All 15 rats exhibited contralateral electrical activity, but their CMAPs disappeared after hemisection.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w4cKxM

P306 Motor cortex tRNS reduce pain and improve affective and cognitive impairment in patients with fibromyalgia: Preliminary results of a randomized sham-controlled trial

Fibromyalgia (FMS) is a clinical syndrome characterized by widespread musculoskeletal pain, chronic fatigue, cognitive deficit, sleep and mood disorders. Most pharmacological therapies showed limited effectiveness and there's need for new effective and well tolerated therapeutic tools. Recently, transcranial direct-current stimulation (tDCS) of motor cortex showed able to reduce pain, while dorsolateral prefrontal cortex (DLPFC) tDCS improved anxiety, depression and cognitive impairment in FMS. A new application, random noise stimulation (tRNS), using randomly changing alternating currents, showed very recently ability to ameliorate working memory and pain in limited series of FMS and neuropathic pain patients.

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

O-2-6-15. Immediate effects of anodal tDCS combined with patterned electrical stimulation on gait performance in patients with stroke

Anodal transcranial direct current stimulation (tDCS) combined with patterned electrical stimulation (PES) modulates spinal reciprocal inhibition and improves the ankle movement in patients with incomplete spinal cord injury (Yamaguchi et al., 2016). This study aimed to examine the immediate effects of anodal tDCS combined with PES on gait performance in patients with stroke. Twelve patients with subacute stroke participated in this double-masked, sham-controlled cross-over study. They randomly participated in the following sessions on separate days: (1) anodal tDCS+PES; (2) anodal tDCS+sham PES; (3) sham tDCS+PES.

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

P270 An unusual demyelinating neuropathy in a patient with defects in the DCTN1 gene

An unusual case of genetic disturbance resulting in an unusual neuropathy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w42gP0

O2-6-21. Comparison of muscle ultrasound findings between demyelinating neuropathy and axonopathy

Denervation causes increased echo intensity (EI) and decreased muscle thickness (MT) on muscle ultrasound (MUS). Chronic inflammatory demyelinating polyneuropathy (CIDP) does not present with denervation unless secondary axonal degeneration occurs. Hence, few MUS changes would occur compared to amyotrophic lateral sclerosis (ALS). The abductor pollicis brevis, abductor digiti minimi, and first dorsal interosseous muscles of 12 patients with CIDP and 13 patients with ALS were examined. There were no significant differences in Medical Research Council scales of each muscle between the CIDP and ALS group.

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

P237 Axonal excitability findings in type 1 diabetes mellitus – Median nerve versus tibial nerve comparison

Length dependent peripheral neuropathy is the most common complication of diabetes mellitus (DM). As no curative treatment for diabetic polyneuropathy (DMP) is available, its prevention and early detection is very important. Axonal excitability is defined as the capability of nodal and paranodal pathological changes in DMP. The aim of present study was to determine alterations in axonal excitability findings in tibial nerve by comparing median nerve axonal excitability findings in Type 1 DMP.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3BKFq

O-2-6-26. Effects of sleep on the epileptiform discharge in benign adult familial myoclonus epilepsy (BAFME)

Epileptiform discharges often increase in most epilepsy types. This study sought to clarify the effects of sleep modification on cortical irritability in benign adult familial myoclonus epilepsy (BAFME). We retrospectively reviewed 31 conventional electroencephalographies (EEGs) of 12 BAFME patients and analyzed epileptiform discharges during the awake and sleep periods of 6 EEGs in 5 BAFME patients (5 women, mean age: 49.6±20.3years). Using conventional EEG analysis, EEG was classified into awake (66.6%) and light sleep stages (Stage I and II) (33.4%).

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

P330 Event-related potential combined with middle latency somatosensory evoked potential improve the prediction of awakening from coma

To determine the evaluation day that evoked potentials (EPs) best correlates with wakening outcome for comatose patients; to determine whether middle latency somatosensory evoked potential (MLSEP) combined with event-related potential (ERP) improved the prediction of awakening.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w30td2

O3-6-04. Optogenetically induced motor evoked potentials in mice

Optogenetics is a powerful tool that utilizes light to control neurons genetically modified to express light-sensitive ion channels. This innovative technology, which allows for the activation or silencing of neurons on a millisecond time-scale, can be aimed at specific cell types, preventing the manipulation of cells that fall outside a target population. As such, optogenetics has the potential to improve impaired brain networks without side effects commonly associated with alternative strategies (e.g., electrical stimulation).

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

P314 Two distinct phenotypes of corticomotor hand representation in human motor cortex

Transcranial magnetic stimulation (TMS) can be used to map the corticomotor representations of hand muscles in the precentral motor-cortex (PMC). The spatial peak of the corticomotor representations is often not located in the primary motor cortex (M1HAND), but shows an anterior shift towards the dorsal premotor cortex (PMd). Here we used magnetic resonance imaging (MRI) to test the hypothesis that the PMC shows different structural and functional properties in individuals with a clear "premotor" representation compared to individuals with a preponderant "primary-motor" representation of hand muscles.

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

O3-6-21. Time-dependent changes in intraoperative monitoring findings during microvascular decompression for hemifacial spasm

We analyzed time-dependent changes in the intraoperative monitoring of abnormal muscle responses (AMRs) and facial motor evoked potentials (FMEPs) elicited by transcranial electrical stimulation during microvascular decompression (MVD) in 26 patients with hemifacial spasm. In the orbicularis oculi muscle, the AMRs disappeared in 11 patients before MVD, in six after MVD, and in three during dural closure. The AMRs persisted in six patients. FMEP amplitudes decreased to less than 50% in two patients before MVD, in four after MVD, and in six during dural closure.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2fNYK4R

Effect of Heat Exposure on Cognition in Persons with Tetraplegia

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


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x6hGPm

Swallowing Mechanics Associated With Artificial Airways, Bolus Properties, and Penetration–Aspiration Status in Trauma Patients

Purpose

Artificial airway procedures such as intubation and tracheotomy are common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to mechanical features of swallowing.

Method

Coordinates of anatomical landmarks were extracted at minimum and maximum hyolaryngeal excursion from 228 videofluoroscopic swallowing studies representing 69 traumatically injured U.S. military service members with dysphagia. Morphometric canonical variate and regression analyses examined associations between swallowing mechanics and bolus properties based on artificial airway and penetration–aspiration status.

Results

Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < .0001), extubated versus decannulated (D = 1.74, p < .0001), and decannulated versus tracheotomized (D = 1.24, p < .0001) groups per post hoc discriminant function analysis. Tracheotomy-in-situ and decannulated subgroups exhibited increased head/neck extension and posterior relocation of the larynx. Swallowing mechanics associated with (a) penetration–aspiration status and (b) bolus properties were moderately related for extubated and decannulated subgroups, but not the tracheotomized subgroup, per morphometric regression analysis.

Conclusion

Specific differences in swallowing mechanics associated with artificial airway status and certain bolus properties may guide therapeutic intervention in trauma-based dysphagia.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-16-0431/2649304/Swallowing-Mechanics-Associated-With-Artificial

Author Impact Metrics in Communication Sciences and Disorder Research

Purpose

The purpose was to examine author-level impact metrics for faculty in the communication sciences and disorder research field across a variety of databases.

Method

Author-level impact metrics were collected for faculty from 257 accredited universities in the United States and Canada. Three databases (i.e., Google Scholar, ResearchGate, and Scopus) were utilized.

Results

Faculty expertise was in audiology (24.4%; n = 490) and speech-language pathology (75.6%; n = 1,520). Women comprised 68.1% of faculty, and men comprised 31.9% of faculty. The percentage of faculty in the field of communication sciences and disorders identified in each database was 10.5% (n = 212), 44.0% (n = 885), and 84.4% (n = 1,696) for Google Scholar, ResearchGate, and Scopus, respectively. In general, author-level impact metrics were positively skewed. Metric values increased significantly with increasing academic rank (p < .05), were greater for men versus women (p < .05), and were greater for those in audiology versus speech-language pathology (p < .05). There were statistically significant positive correlations between all author-level metrics (p < .01).

Conclusions

These author-level metrics may serve as a benchmark for scholarly production of those in the field of communication sciences and disorders and may assist with professional identity management, tenure and promotion review, grant applications, and employment.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-H-16-0458/2650586/Author-Impact-Metrics-in-Communication-Sciences

Semantic and Phonological Encoding in Adults Who Stutter: Silent Responses to Pictorial Stimuli

Purpose

Research on language planning in adult stuttering is relatively sparse and offers diverging arguments about a potential causative relationship between semantic and phonological encoding and fluency breakdowns. This study further investigated semantic and phonological encoding efficiency in adults who stutter (AWS) by means of silent category and phoneme identification, respectively.

Method

Fifteen AWS and 15 age- and sex-matched adults who do not stutter (ANS) participated. The groups were compared on the basis of the accuracy and speed of superordinate category (animal vs. object) and initial phoneme (vowel vs. consonant) decisions, which were indicated manually during silent viewing of pictorial stimuli. Movement execution latency was accounted for, and no other cognitive, linguistic, or motor demands were posed on participants' responses. Therefore, category identification accuracy and speed were considered indirect measures of semantic encoding efficiency and phoneme identification accuracy and speed of phonological encoding efficiency.

Results

For category decisions, AWS were slower but not less accurate than ANS, with objects eliciting more errors and slower responses than animals in both groups. For phoneme decisions, the groups did not differ in accuracy, with consonant errors outnumbering vowel errors in both groups, and AWS were slower than ANS in consonant but not vowel identification, with consonant response time lagging behind vowel response time in AWS only.

Conclusions

AWS were less efficient than ANS in semantic encoding, and they might harbor a consonant-specific phonological encoding weakness. Future independent studies are warranted to discover if these positive findings are replicable and a marker for persistent stuttering.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-16-0323/2650587/Semantic-and-Phonological-Encoding-in-Adults-Who

Analysis of Item-Level Bias in the Bayley-III Language Subscales: The Validity and Utility of Standardized Language Assessment in a Multilingual Setting

Purpose

The purpose of this study was to improve standardized language assessments among bilingual toddlers by investigating and removing the effects of bias due to unfamiliarity with cultural norms or a distributed language system.

Method

The Expressive and Receptive Bayley-III language scales were adapted for use in a multilingual country (Singapore). Differential item functioning (DIF) was applied to data from 459 two-year-olds without atypical language development. This involved investigating if the probability of success on each item varied according to language exposure while holding latent language ability, gender, and socioeconomic status constant. Associations with language, behavioral, and emotional problems were also examined.

Results

Five of 16 items showed DIF, 1 of which may be attributed to cultural bias and another to a distributed language system. The remaining 3 items favored toddlers with higher bilingual exposure. Removal of DIF items reduced associations between language scales and emotional and language problems, but improved the validity of the expressive scale from poor to good.

Conclusions

Our findings indicate the importance of considering cultural and distributed language bias in standardized language assessments. We discuss possible mechanisms influencing performance on items favoring bilingual exposure, including the potential role of inhibitory processing.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-L-16-0196/2649302/Analysis-of-ItemLevel-Bias-in-the-BayleyIII

Histochemical and immunohistochemical examination of odontoblasts (petroblasts) in petrodentine formation of lungfish

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Shunya Oka, Ichiro Sasagawa, Mikio Ishiyama
ObjectivePetrodentine, the core of the lungfish tooth plate, is a well-mineralized tissue similar to mammalian enamel and analogous to enameloid in fish teeth. Petrodentine is formed solely by petroblasts, which are specialized odontoblasts, whereas enameloid is a composite tissue produced by both odontoblasts and dental epithelial cells. To clarify the details of petrodentine formation, petroblasts were investigated using histochemical and immunohistochemical techniques.MethodsExtant lungfish (Lepidosiren paradoxa) were used in this study. Tooth plates during the stage of petrodentine formation were observed by means of histochemistry and immunohistochemistry. Commercial kits were used to detect enzyme activity. Correlative sections were immunostained using antibodies against selected peptides. Routine staining such as periodic acid-Schiff (PAS) reaction to identify glycogen and Elastica van Gieson staining for the detection of elastic fibers in histological sections were performed. In addition, conventional transmission electron microscopy was used for observing the fine structure.ResultsPetroblasts showed marked acid and alkaline phosphatase activities, and positive immunoreactivities against anti-nestin, anti-V-ATPase, and anti-Ca²⁺-ATPase, during the maturation stage, but in the matrix formation stage, reactions were much weaker than that of the maturation stage. During the maturation stage, petroblasts showed intense PAS reactivity, and glycogen particles were observed in petroblasts by transmission electron microscopy. Glucose transporter 1-immunoreactivity was observed in petroblasts in the matrix formation stage and the initial to mid part of the maturation stage.ConclusionsThe results in this study suggested that petroblasts have two functional stages, matrix formation and maturation, and glycogen plays an important role in the modulation of petroblasts.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2fNBP9u

Diabetes increases interleukin-17 levels in periapical, hepatic, and renal tissues in rats

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Mariane Maffei Azuma, João Eduardo Gomes-Filho, Annelise Katrine Carrara Prieto, Renata Oliveira Samuel, Valéria Marçal Felix de Lima, Dóris Hissako Sumida, Edilson Ervolino, Luciano Tavares Angelo Cintra
ObjectivesThis study aimed to evaluate the association between endodontic infection and diabetes on interleukin-17 levels in periapical, hepatic, and renal tissues of rats.DesignForty male rats were divided into groups: normoglycemic rats (N), normoglycemic rats with apical periodontitis (N-AP), rats with experimental diabetes (ED), and rats with experimental diabetes and apical periodontitis (ED-AP). Diabetes was induced by intravenous streptozotocin injection, and blood sugar levels were monitored to confirm disease development. Apical periodontitis (AP) was induced by pulp exposure to the oral environment during 30days. After 30days, hepatic and renal tissues were obtained, and IL-17 levels were quantified by ELISA. The right hemi-jaw was used to quantify IL-17 levels by immunohistochemistry. The values obtained in parametric tests were tabulated and analyzed statistically by analysis of variance (ANOVA) and Tukey tests, and the values obtained for scores were statistically analyzed by using the Kruskal-Wallis and Dun tests. The level of significance was set at 5%.ResultsED and ED-AP groups expressed significantly higher IL-17 levels in both hepatic and renal tissues (p<0.05), compared to N and N-AP groups. Apical periodontitis (AP) in ED-AP group was significantly more severe than that in N-AP group (p<0.05). Furthermore, there was a significantly larger increase in the IL-17 levels in ED-AP group compared to N group (p<0.05).ConclusionOur results indicate that diabetes increases IL-17 levels in hepatic and renal tissues and also enhances IL-17 production in apical periodontitis area of rats.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2fM65S4

Bevacizumab in advanced lung cancer: state of the art

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vFIZ5u

Muscle Proprioceptors in Adult Rat: Mechanosensory Signaling and Synapse Distribution in Spinal Cord

Abstract The characteristic signaling and intra-spinal projections of muscle proprioceptors best described in the cat are often generalized across mammalian species. However, species-dependent adaptations within this system seem necessary to accommodate asymmetric scaling of length, velocity, and force information required by the physics of movement. In the present study we report mechanosensory responses and intraspinal destinations of three classes of muscle proprioceptors. Proprioceptors from triceps surae muscles in adult female Wistar rats anesthetized with isoflurane were physiologically classified as muscle spindle group Ia or II or as tendon organ group Ib afferents, studied for their firing responses to passive-muscle stretch, and in some cases, labeled and imaged for axon projections and varicosities in spinal segments. Afferent projections and the laminar distributions of provisional synapses in rats closely resembled those found in cat. Afferent signaling of muscle kinematics was also similar to reports on cat, but rat Ib afferents fired robustly during passive muscle stretch and Ia afferents displayed an exaggerated dynamic response, even after accounting for locomotor scaling. These differences in mechanosensory signaling by muscle proprioceptors may represent adaptations for movement control in different animal species.

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

Field repetition and local mapping in the hippocampus and medial entorhinal cortex

Hippocampal place cells support spatial cognition and are thought to form the neural substrate of a global 'cognitive map'. A widely held view is that parts of the hippocampus also underlie the ability to separate patterns, or to provide different neural codes for distinct environments. However, a number of studies have shown that in environments composed of multiple, repeating compartments, place cells and other spatially modulated neurons show the same activity in each local area. This repetition of firing fields may reflect pattern completion, and may make it difficult for animals to distinguish similar local environments. In this review we will (a) highlight some of the navigation difficulties encountered by humans in repetitive environments, (b) summarise literature demonstrating that place and grid cells represent local and not global space, and (c) attempt to explain the origin of these phenomena. We argue that the repetition of firing fields can be a useful tool for understanding of the relationship between grid cells in the entorhinal cortex and place cells in the hippocampus, the spatial inputs shared by these cells, and the propagation of spatially-related signals through these structures.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wh9crC

Asymmetric vestibular stimulation reveals persistent disruption of motion perception in unilateral vestibular lesions

Self-motion perception was studied in patients with unilateral vestibular lesions (UVL) due to acute vestibular neuritis at 1 week, 4, 8 and 12 months after the acute episode. We assessed vestibularly-mediated self-motion perception by measuring the error in reproducing the position of a remembered visual target at the end of 4 cycles of asymmetric whole-body rotation. The oscillatory stimulus consists of a slow (0.09Hz) and a fast (0.38Hz) half cycle. A large error was present in UVL patients when the slow half cycle was delivered towards the lesion side, but minimal towards the healthy side. This asymmetry diminished over time, but it remained abnormally large at 12 months. In contrast, vestibulo-ocular reflex responses showed a large direction-dependent error only initially, then they normalized. Normalization also occurred for conventional reflex vestibular measures (caloric tests, subjective visual vertical and head shaking nystagmus) and for perceptual function during symmetric rotation. Vestibular-related handicap, measured with the Dizziness Handicap Inventory (DHI) at 12 months, correlated with self-motion perception asymmetry but not with abnormalities in vestibulo-ocular function. We conclude that 1) a persistent self-motion perceptual bias is revealed by asymmetric rotation in UVLs despite vestibulo-ocular function becoming symmetric over time 2) this dissociation is caused by differential perceptual-reflex adaptation to high and low frequency rotations when these are combined as with our asymmetric stimulus 3) the findings imply differential central compensation for vestibulo-perceptual and vestibulo-ocular reflex functions 4) self-motion perception disruption may mediate long-term vestibular-related handicap in UVL patients.

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

Variance in exposed perturbations impairs retention of visuomotor adaptation

Sensorimotor control requires an accurate estimate of the state of the body. The brain optimizes state estimation by combining sensory signals with predictions of the sensory consequences of motor commands using a forward model. Given that both sensory signals and predictions are uncertain (i.e. noisy), the brain optimally weights the relative reliance on each source of information during adaptation. In support, it is known that uncertainty in the sensory predictions influences the rate and generalization of visuomotor adaptation. We investigated whether uncertainty in the sensory predictions affects the retention of a new visuomotor relationship. This was done by exposing three separate groups to a visuomotor rotation whose mean was common at 15° CCW but whose variance around the mean differed (i.e. SD of 0°, 3.2° or 4.5°). Retention was assessed by measuring the persistence of the adapted behaviour in a no vision phase. Results revealed that mean reach direction late in adaptation was similar across groups, suggesting it depended mainly upon the mean of exposed rotations and was robust to differences in variance. However, retention differed across groups, with higher levels of variance being associated with a more rapid reversion toward non-adapted behaviour. A control experiment ruled out that differences in retention were accounted for by differences in success rates. Exposure to variable rotations may have increased the uncertainty in sensory predictions, making the adapted forward model more labile and susceptible to change or decay.

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

State-dependent Sensorimotor Gating in a Rhythmic Motor System

Sensory feedback influences motor circuits and/or their projection neuron inputs to adjust ongoing motor activity, but its efficacy varies. Currently, less is known about regulation of sensory feedback onto projection neurons that control downstream motor circuits than about sensory regulation of the motor circuit neurons themselves. Here, we tested whether sensory feedback onto projection neurons is sensitive only to activation of a motor system, or also to the modulatory state underlying that activation, using the crab Cancer borealis stomatogastric nervous system. We examined how proprioceptor neurons (gastropyloric receptors, GPRs) influence the gastric mill (chewing) circuit neurons and the projection neurons (MCN1, CPN2) which drive the gastric mill rhythm (GMR). During gastric mill rhythms triggered by the VCN mechanosensory neurons, GPR was shown previously to influence gastric mill circuit neurons but its excitation of MCN1/CPN2 was absent. Here we tested whether GPR effects on MCN1/CPN2 are also absent during gastric mill rhythms triggered by the peptidergic POC neurons. The VCN and POC pathways both trigger lasting MCN1/CPN2 activation, but their distinct influence on circuit feedback to these neurons produces different gastric mill motor patterns. We show that GPR excites MCN1 and CPN2 during the POC-GMR, altering their firing rates and activity patterns. This action changes both phases of the POC-GMR, whereas GPR only alters one phase of the VCN-GMR. Thus, sensory feedback to projection neurons can be gated as a function of the modulatory state of an active motor system, not simply switched on/off with the onset of motor activity.

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

Perception of the dynamic visual vertical during sinusoidal linear motion.

The vestibular system provides information for spatial orientation. However, this information is ambiguous: because the otoliths sense the gravito-inertial force, they cannot distinguish gravitational and inertial components. As a consequence, prolonged linear acceleration of the head can be interpreted as tilt, referred to as the somatogravic effect. Previous modeling work suggests that the brain disambiguates the otolith signal according to the rules of Bayesian inference, combining noisy canal cues with the a priori assumption that prolonged linear accelerations are unlikely. Within this modeling framework the noise of the vestibular signals affects the dynamic characteristics of the tilt percept during linear whole-body motion. To test this prediction, we devised a novel paradigm to psychometrically characterize the dynamic visual vertical - as a proxy for the tilt percept - during passive sinusoidal linear motion along the inter-aural axis (0.33Hz motion frequency, 1.75m/s2 peak acceleration, 80cm displacement). While subjects (n=10) kept fixation on a central body-fixed light, a line was briefly flashed (5ms) at different phases of the motion, the orientation of which had to be judged relative to gravity. Consistent with the model's prediction, subjects showed a phase-dependent modulation of the dynamic visual vertical, with a subject-specific phase-shift with respect to the imposed acceleration signal. The magnitude of this modulation was smaller than predicted, suggesting a contribution of non-vestibular signals to the dynamic visual vertical. Despite their dampening effect, our findings may point to a link between the noise components in the vestibular system and the characteristics of dynamic visual vertical.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2whc8Ve

Intermittent apnea elicits inactivity-induced phrenic motor facilitation via a retinoic acid- and protein synthesis-dependent pathway

Respiratory motoneuron pools must provide rhythmic inspiratory drive that is robust and reliable, yet dynamic enough to respond to respiratory challenges. One form of plasticity that is hypothesized to contribute to motor output stability by sensing and responding to inadequate respiratory neural activity is inactivity-induced phrenic motor facilitation (iPMF), an increase in inspiratory output triggered by a reduction in phrenic synaptic inputs. Evidence suggests that mechanisms giving rise to iPMF differ depending on the pattern of reduced respiratory neural activity (i.e. neural apnea). A prolonged neural apnea elicits iPMF via a spinal TNFα-induced increase in atypical PKC activity, but little is known regarding mechanisms that elicit iPMF following intermittent neural apnea. We tested the hypothesis that iPMF triggered by intermittent neural apnea requires retinoic acid and protein synthesis. Phrenic nerve activity was recorded in urethane anesthetized and ventilated rats treated intrathecally with an inhibitor of retinoic acid synthesis (DEAB), a protein synthesis inhibitor (emetine) or vehicle (aCSF) prior to intermittent (5 episodes, ~1.25 min each) or prolonged (30 min) neural apnea. Both DEAB and emetine abolished iPMF elicited by intermittent neural apnea, but had no effect on iPMF elicited by a prolonged neural apnea. Thus, different patterns of reduced respiratory neural activity elicit phenotypically similar iPMF via distinct spinal mechanisms. Understanding mechanisms that allow respiratory motoneurons to dynamically tune their output may have important implications in the context of respiratory control disorders that involve varied patterns of reduced respiratory neural activity, such as central sleep apnea and spinal cord injury.

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

Face percept formation in human ventral temporal cortex

Loci in ventral temporal cortex are selectively active while viewing faces and other objects, but it remains unclear whether these areas represent accumulation of simple visual information, or processing of intact percept. We measured broadband electrocorticographic changes from implanted electrodes on the ventral temporal brain surface while showing patients noise-degraded images of faces and houses. In a subset of posterior fusiform gyrus face-selective regions, cortical activity decreased parametrically with noise increase, until the perceptual threshold. At noise levels higher than the perceptual threshold, and for house stimuli, activity remained at baseline. We propose that this convergence of proportional and thresholded response may identify active areas where face percepts are extracted from simple visual features. These loci exist within a topological structure of face percept formation in the human ventral visual stream, preceded by category non-selective activity in peri-calcarine early visual areas, and in concert with all-or-nothing activity in post-perceptual sub-regions of the ventral temporal lobe. This topological organization suggests a physiological basis for the anatomy of face perception, explaining different perceptual deficits following temporal lobe injury.

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

Effect of Heat Exposure on Cognition in Persons with Tetraplegia

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


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x6hGPm

Bevacizumab in advanced lung cancer: state of the art

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vFIZ5u

Abernethy malformation associated with Caroli’s syndrome in a patient with a PKHD1 mutation: a case report

Abernethy malformation is a rare congenital anomaly characterised by the partial or complete absence of the portal vein and the subsequent development of an extrahepatic portosystemic shunt. Caroli's disease i...

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3qpoB

Adaptive Global Innovative Learning Environment for Glioblastoma: GBM AGILE

Glioblastoma (GBM) is a deadly disease with few effective therapies. While much has been learned about the molecular characteristics of the disease, this knowledge has not been translated into clinical improvements for patients. At the same time, many new therapies are being developed. Many of these therapies have potential biomarkers to identify responders. The result is an enormous amount of testable clinical questions that must be answered efficiently. The GBM Adaptive Global Innovative Learning Environment (GBM AGILE) is a novel, multi-arm, platform trial designed to address these challenges. It is the result of the collective work of over 130 oncologists, statisticians, pathologists, neurosurgeons, imagers, and translational and basic scientists from around the world. GBM AGILE is comprised of two stages. The first stage is a Bayesian adaptively randomized screening stage to identify effective therapies based on impact on overall survival compared with a common control. This stage also finds the population in which the therapy shows the most promise based on clinical indication and biomarker status. Highly effective therapies transition in an inferentially seamless manner in the identified population to a second confirmatory stage. The second stage uses fixed randomization to confirm the findings from the first stage in order to support registration. Therapeutic arms with biomarkers may be added to the trial over time while others complete testing. The design of GBM AGILE enables rapid clinical testing of new therapies and biomarkers to speed highly effective therapies to clinical practice.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wh0Joo

Personalized Medicine Based Approach to Model Patterns of Chemoresistance and Tumor Recurrence Using Ovarian Cancer Stem Cell Spheroids

Purpose: Chemoresistant ovarian cancers grow in suspension within the ascites fluid. In order to screen the effect of chemotherapeutics and biologics on resistant ovarian cancers with a personalized basis, we developed a 3D hanging drop spheroid platform. Experimental Design: We initiated spheroids with primary ALDH+ CD133+ ovarian cancer stem cells (OvCSCs) from different patient samples, and demonstrated that stem cell progeny from harvested spheroids was similar to the primary tumor. OvCSC spheroids were utilized to initiate tumors in immune-deficient mice. Drug responses to cisplatin and ALDH targeting compound or JAK2 inhibitor determined if the OvCSC population within the spheroids could be targeted. Cells that escaped therapy were isolated and used to initiate new spheroids and model tumor re-emergence in a personalized manner. Results: OvCSC spheroids from different patients exhibited varying, and personalized responses to chemotherapeutics. Xenografts were established from OvCSC spheroids, even with one single spheroid. Distinct responses to therapy were observed in distinct primary tumor xenografts similar to those observed in spheroids. Spheroids resistant to Cisplatin/ALDH inhibitor therapy had persistent, albeit lower ALDH expression and complete loss of CD133 expression while those resistant to cisplatin/JAK2 inhibitor therapy were enriched for ALDH+ cells. Conclusions: Our 3D hanging drop suspension platform can be used to propagate primary OvCSCs that represent individual patient tumors effectively by differentiating in vitro, and initiating tumors in mice. Therefore, our platform can be used to study cancer stem cell biology, and model tumor re-emergence to identify new targeted therapeutics from an effective personalized medicine standpoint.

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

Combined CDK4/6 and mTOR inhibition is synergistic against glioblastoma via multiple mechanisms

Purpose: Glioblastoma (GBM) is a deadly brain tumor marked by dysregulated signaling and aberrant cell cycle control. Molecular analyses have identified that the CDK4/6-Rb-E2F axis is dysregulated in about 80% of GBMs. Single-agent CDK4/6 inhibitors have failed to provide durable responses in GBM, suggesting a need to combine them with other agents. We investigate the efficacy of the combination of CDK4/6 inhibition and mTOR inhibition against GBM. Experimental Design: Preclinical in vitro and in vivo assays using primary GBM cell lines were performed. Results: We show that the CDK4/6 inhibitor palbociclib suppresses the activity of downstream mediators of the mTOR pathway, leading to rebound mTOR activation that can be blocked by the mTOR inhibitor everolimus. We further show that mTOR inhibition with everolimus leads to activation of the Ras mediator Erk that is reversible with palbociclib. The combined treatment strongly disrupts GBM metabolism, resulting in significant apoptosis. Further increasing the utility of the combination for brain cancers, everolimus significantly increases the brain concentration of palbociclib. Conclusions: Our findings demonstrate that the combination of CDK4/6 and mTOR inhibition has therapeutic potential against GBM and suggest it should be evaluated in a clinical trial.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2whe2oO

A systematic review of molecular responses to cancer therapy in normal human mucosa

Publication date: Available online 15 August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mette Marcussen, Conni Skrubbeltrang, Julie Støve Bødker, Ilse Christiansen, Martin Bøgsted, Karen Dybkær, Olav Jonas Bergmann, Hans Erik Johnsen
ObjectiveCancer therapy-induced inflammation of oral and gastrointestinal mucosa affects patients non-uniformly. Preventive strategies are limited; no biomarker exists for pretreatment identification of patients likely to be severely affected. Animal models are preferred for studying molecular responses in mucosa during chemotherapy, but translation into clinical practice is difficult. We performed a systematic review to retrieve papers that described molecular changes in human mucosa during cancer therapy.Study DesignWe searched MEDLINE and Ovid Embase searches for English-language literature from January 1990 to November 2016 and studies referenced in selected papers, that analyzed human mucosa from patients at risk of developing mucositis during cancer therapy. Two authors extracted data according to predefined data fields, including study quality indicators.ResultsWe identified 17 human studies on chemotherapy (n=9) and radiotherapy (n=8), but no targeted therapy studies. Studies were heterogeneous regarding patient cohort, analysis methods, cancer treatment, biopsy timing, and correlations to clinical mucositis. Consequently, meta-analysis was not feasible.ConclusionsFew human studies described the molecular responses of normal mucosa to cancer therapy. Studies were heterogeneous with sparse correlations to clinical mucositis. We proposed a model for acquiring data on treatment- and disease-specific phenotypes and transcriptomes for predictive or preventive initiatives.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x5WZTB

Are facial injuries really different? An observational cohort study comparing appearance concern and psychological distress in facial trauma and non-facial trauma patients

Facial injuries are widely assumed to lead to stigma and significant psychosocial burden. Experimental studies of face perception support this idea, but there is very little empirical evidence to guide treatment. This study sought to address the gap.Data were collected from 193 patients admitted to hospital following facial or other trauma. Ninety (90) participants were successfully followed up eight months later. Participants completed measures of appearance concern and psychological distress (post-traumatic stress symptoms, depressive symptoms, anxiety symptoms).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3u7P0

Patient Rated Long-Term Results after Complete Denervation of the Wrist

The aim of this study was to examine the long-term results after the denervation of the wrist. Between 1977 and 2001 we treated 375 patients in our clinic. The mean age was 43.5 years, 81% were male and 19% female. The long-term results were assessed by a questionnaire assessing pain on a visual analogue scale and patient satisfaction and by the DASH questionnaire. After a mean follow-up of 12.23 years, we found an overall pain reduction of 52.1%. In 67.7% of the patients we found a relief of pain; of these patients, 44% are free of pain until today, and 56% were temporarily asymptomatic.

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

Subungual Melanoma – Management in the Modern Era

Subungual melanoma is a rare subtype of cutaneous melanoma that arises from the structures of the nail apparatus. It presents most commonly in older patients and at an advanced stage.A retrospective review of all patients with subungual melanoma in a single institution over a 15-year period was performed. 54 patients were included (26 males, average age 62.9 years). 28 cases involved the upper limb. Median tumour thickness was 4.5mm. 18 patients had lymph node metastasis at diagnosis, including 11 of 36 patients with positive sentinel lymph node biopsy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3BW7l

Reconstructive microsurgical approach for treatment of pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a rare type of autoimmune disease that results in progressive ulcers with or without previous trauma. PG is not well understood to date, and its treatment therefore remains a challenge. Because of the disease's systemic characteristic and the unpredictability of the clinical course, no gold standard treatment is available, especially concerning surgical procedures to treat pyodermic lesions. Often, PG is not recognized during routine clinical practice, and standard ulcer treatment (conservative wound care, debridement, skin grafting, and local flap coverage) is started; this induces an autoinflammatory response, resulting in disastrous ulcers, thereby making free flap coverage necessary.

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

Putting the heart into microvascular training: The Micropump, a practical “heart-like” device to enhance vascular anastomosis non-living simulation

Non-living simulation models are effective training platforms in learning to achieve a structurally patent microvascular anastomosis. However, a gap still exists between non-living and living models in providing physiological feedback. We have an ethical obligation to optimise non-living resources, to minimise the use of living animals in microsurgical training.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3wgu9

Anatomic and high resolution computed tomographic angiography study of the lateral femoral condyle flap: implications for surgical dissection

The Lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin to allow for a safe and effective harvest.

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

Does videoendoscopy provide three-dimensional vision in closed rhinoplasty?

Rhinoplasty is a common procedure in cosmetic surgery all over the world. Patients desire enhancement of their facial beauty by the correction of preexisting nasal deformities. Precisely performed operations lead to better results, and, enhancing technical accuracy accordingly results in more successful outcomes.Endoscopy helps us to visualize the closed parts of the body with the aid of an illuminated optical device. The objective behind present case series was bringing the advantages of open and closed rhinoplasty together by using endoscopic vision systems.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3a2bR

An implant for autologous soft tissue reconstruction based on an adipose-derived stem cell colonized alginate scaffold

Adipose-derived stem cells represent an interesting option for soft tissue replacement since they are easy to procure and can generate their own blood supply through the production of angiogenic factors. We seeded adipose-derived stem cells on a bioresorbable, biocompatible polymer alginate scaffold to generate autologous soft tissue constructs for repair.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vK4LTJ

Analysis of the Correlation between Deformational Plagiocephaly and Neurodevelopment delay

Deformational plagiocephaly (DP) refers to cranial asymmetry resulting from uneven external forces. A strong association exists between DP and developmental delay. We investigated the effect of DP severity on developmental delay.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3ofp7

Does self-consciousness of appearance influence postoperative satisfaction in rhinoplasty?

Facial plastic surgeons and patients benefit from knowledge about how psychological aspects can influence the outcome of cosmetic surgery. The influence of pre-operative self-consciousness of appearance and its effect on benefit after surgery in rhinoplasty patients has not been explored before in other studies.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vK4T5F

Starting a sentinel node service for melanoma: is there a role for predictive nomograms?

A letter to author regarding predictive nomograms for sentinel node status in melanoma.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w2wv92

Antibiotic Prophylaxis in Breast Reduction Surgery: A Systematic Review and Meta-analysis

To determine the effectiveness and harm of using antibiotic prophylaxis versus placebo or no intervention in patients undergoing breast reduction surgery to prevent surgical site infection.

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

The Physiological and Metabolic Differences between Visceral and Subcutaneous Adipose Tissues in Nile Tilapia (Oreochromis niloticus)

Background: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SCAT) have different structures and metabolic functions, and play different roles in the regulation of mammal systemic endocrine. However, little is known about morphology and physiological and metabolic functions between VAT and SCAT in fish. Methods: We compared the morphological, physiological and biochemical characteristics of VAT and SCAT in Nile Tilapia and measured their functions in energy intake flux, lipolytic ability, and gene expression patterns. Results: SCAT contained more large adipocytes and non-adipocytes than VAT in Nile tilapia. VAT had a higher lipid and was the primary site for lipid deposition. Conversely, SCAT had higher hormone-induced lipolytic activity. Furthermore, SCAT had a higher percentage of monounsaturated and lower polyunsaturated fatty acids than VAT. SCAT had higher mitochondrial DNA, gene expression for fatty acid β-oxidation, adipogenesis and brown adipose tissue characteristics, but it also had a lower gene expression for inflammation and adipocyte differentiation than VAT. Conclusions: SCAT and VAT have different morphological structures, as well as physiological and metabolic functions in fish. VAT is the preferable lipid deposition tissue, whereas SCAT exhibits higher lipid catabolic activity than VAT. General Significance: The physiological functions of SCAT in fish are commonly overlooked. The present study indicates SCAT has specific metabolic characteristics that differ VAT. The differences between VAT and SCAT should be considered in future metabolism studies using fish as models, either in biomedical or aquaculture studies.

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

Filling the void: a role for exercise induced BDNF and brain amyloid precursor protein processing

Inactivity, obesity, and insulin resistance are significant risk factors for the development of Alzheimer's disease (AD). Several studies have demonstrated that diet induced obesity, inactivity, and insulin resistance exacerbates neuropathological hallmarks of AD. The aggregation of beta-amyloid peptides is one of these hallmarks. Beta-site amyloid precursor protein cleaving enzyme 1 (BACE1) is the rate-limiting enzyme in amyloid precursor protein (APP) processing, leading to beta-amyloid peptide formation. Understanding how BACE1 content and activity is regulated is essential for establishing therapies aimed at reducing and/or slowing the progression of AD. Exercise training has proven to reduce the risk of AD as well as decrease beta-amyloid production and BACE1 content and/or activity. However, these long-term interventions also result in improvements in adiposity, circulating metabolites, glucose tolerance, and insulin sensitivity making it difficult to determine the direct effects of exercise on brain APP processing. This review highlights this large void in our knowledge and aims discusses our current understanding the direct of effect of exercise on beta-amyloid production. We have concentrated on the central role that brain-derived neurotrophic factor (BDNF) may play in mediating the direct effects of exercise on reducing brain BACE1 content and activity as well as beta-amyloid production. Future studies should aim to generate a greater understanding of how obesity and exercise can directly alter APP processing and AD related pathologies. This knowledge could provide evidence-based hypotheses for designing therapies to reduce the risk of AD and dementia.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wgYFN4

Chondrosarcoma of the Epiglottis: A Case Report and Literature Review

Laryngeal chondrosarcoma (LCS) is an exceedingly rare malignancy and least frequently reported in the epiglottis.

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

Medications and Adverse Voice Effects

To identify the medications used by patients with dysphonia, describe the voice symptoms reported on initial speech-language pathology (SLP) examination, evaluate the possible direct and indirect effects of medications on voice production, and determine the association between direct and indirect adverse voice effects and self-reported voice symptoms, hydration and smoking habits, comorbidities, vocal assessment, and type and degree of dysphonia.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w2EYIZ

Annexin A2 could enhance multidrug resistance by regulating NF-κB signaling pathway in pediatric neuroblastoma

Chemotherapy is one of major therapeutic regimens for neuroblastoma (NB) in children. However, recurrence and metastasis associated with poor prognosis caused by acquired multidrug resistance remains a challen...

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w359PP

Facilitation and Debriefing in Simulation Education

Successful simulation requires effective facilitation and debriefing to achieve educational goals. Simulation educational methods are diverse, ranging from partial task training to complicated, interdisciplinary team training. Various debriefing models have emerged based on method of instruction, learner experience, time and equipment capability, and physical facilities. The general structure of most debriefing sessions focuses on participant reactions, followed by analysis, and ending with a discussion of lessons learned. Two leading debriefing models, the Structured and Supported Debriefing Model and the Debriefing with Good Judgment Model, are described in further detail.

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

Otologic Skills Training

This article presents a summary of the current simulation training for otologic skills. There is a wide variety of educational approaches, assessment tools, and simulators in use, including simple low-cost task trainers to complex computer-based virtual reality systems. A systematic approach to otologic skills training using adult learning theory concepts, such as repeated and distributed practice, self-directed learning, and mastery learning, is necessary for these educational interventions to be effective. Future directions include development of measures of performance to assess efficacy of simulation training interventions and, for complex procedures, improvement in fidelity based on educational goals.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2i7BlM7

Improving Rhinology Skills with Simulation

The convergence of technology and medicine has led to many advances in surgical training. Novel surgical simulators have led to significantly improved skills of graduating surgeons, leading to decreased time to proficiency, improved efficiency, decreased errors, and improvement in patient safety. Endoscopic sinus surgery poses a steep learning curve given the complex 3-dimensional anatomy of the nasal and paranasal cavities, and the necessary visual-spatial motor skills and bimanual dexterity. This article focuses on surgical simulation in rhinological training and how innovative high-fidelity and low-fidelity simulators can maximize resident training and improve procedural skills before operating in the live environment.

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

Alterations in SCAI Expression during Cell Plasticity, Fibrosis and Cancer

Abstract

Suppressor of cancer cell invasion (SCAI) has been originally characterized as a tumor suppressor inhibiting metastasis in different human cancer cells, and it has been suggested that SCAI expression declines in tumors. The expression patterns and role of SCAI during physiological and pathophysiological processes is still poorly understood. Earlier we demonstrated that SCAI is regulating the epithelial-mesenchymal transition of proximal tubular epithelial cells, it is downregulated during renal fibrosis and it is overexpressed in Wilms' tumors. Here we bring further evidence for the involvement of SCAI during cell plasticity and we examine the prognostic value and expression patterns of SCAI in various tumors. SCAI prevented the activation of the SMA promoter induced by angiotensin II. SCAI expression decreased in a model of endothelial-mesenchymal transition and increased during iPS reprogramming of fibroblasts. During renal fibrosis SCAI expression declined, as evidenced in a rat model of renal transplant rejection and in TGF-β1 overexpressing transgenic mice. High expression of SCAI correlated with better survival in patients with breast and lung cancers. Intriguingly, in the case of other cancers (gastric, prostate, colorectal) high SCAI expression correlated with poor survival of patients. Finally, we bring evidence for SCAI overexpression in colorectal cancer patients, irrespective of stage or metastatic status of the disease, suggesting a diverse role of SCAI in various diseases and cancer.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x5WZDo

Dentoskeletal parameters related to visual perception of facial asymmetry in patients with skeletal class III malocclusion after orthognathic surgery

The purpose of the study is to explore the critical parameters determining the visual perception of postoperative facial symmetry. This study retrospectively included 24 patients with skeletal class III malocclusion and double-jaw orthognathic surgery (OgS). The patients were classified according to the outcome of subjective visual perception scores (SVPS) based on the postoperative frontal images by 10 orthodontists: symmetrical surgical outcome (S group, n=12) and facial asymmetry after surgery (A group, n=12).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3pPYd

Precise osteotomies for mandibular distraction in infants with Robin sequence using virtual surgical planning

Mandibular distraction osteogenesis (MDO) has become the first-line operation in many centers for the management of obstructive sleep apnea (OSA) in infants with (Pierre) Robin sequence (RS) not relieved by non-surgical approaches. Preoperative virtual surgical planning (VSP) may improve precision and decrease complications for this operation. This article reports a retrospective study of RS infants who underwent MDO for OSA using preoperative VSP and three-dimensionally printed cutting guides performed by one surgeon.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vJIbL9

The value of cone beam computed tomography in the detection of salivary stones prior to sialendoscopy

This study aimed to assess the value of cone beam computed tomography (CBCT) in the detection of salivary stones in patients with signs and symptoms of salivary gland obstruction. A total of 142 major salivary glands were analysed in a cohort of 127 patients with signs and symptoms of salivary gland obstruction. CBCT scans were performed in order to determine the presence of one or more salivary stones. All glands were also investigated by sialendoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the submandibular gland, the parotid gland, and the whole group, based on the observers' abilities to diagnose the presence or absence of calculi in the CBCT scan using the sialendoscopy data as the gold standard.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2w3mQ1U

Signs of disease occur in the majority of third molars in an adult population

The purpose of this study was to assess clinical and radiographic signs of disease in third molars within a population that is representative of the Finnish adult population aged 30 years and older. A two-stage stratified cluster sampling method was used to collect the 6005 subjects, who were examined clinically and also by panoramic radiography. The state of impaction, presence of dentinal caries and/or restorations, presence of root canal fillings, periodontal pocket depth, and additional pathological findings such as over-eruption and widened follicle were assessed.

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

High-dose-rate interstitial brachytherapy boost in inoperable locally advanced tongue carcinoma

Publication date: Available online 12 August 2017
Source:Brachytherapy
Author(s): Miguel Angel Santos, Jose Luis Guinot, Maria Isabel Tortajada, Paula Santamaría, Valentin Campo, Laura Oliver, Marina Peña, Leoncio Arribas
PurposeLocally advanced tongue carcinomas (LATCs) in inoperable lesions are managed with external beam radiation therapy (EBRT) and chemotherapy. In our institution, the boost to the gross tumor volume is delivered with high-dose-rate brachytherapy (HDR-BT) after EBRT. We review the outcome of these patients when HDR-BT is added as a boost.Methods and MaterialsFrom May 2000 to December 2014, a total of 24 patients with LATC, nonsurgical oral tongue, and base of tongue carcinomas were treated with EBRT and with interstitial plastic tubes for brachytherapy; median dose was 18–24 Gy in 6–8 fractions after 50–60 Gy of EBRT. Mean age was 60 years, 20 men and 4 women. The distribution by stages was 11 patients in Stage III and 13 patients in Stage IV. All cases but one received chemotherapy.ResultsWith a median followup of 44 months, local control (LC) rate at 4 years was 80% for the entire group, 78% in Stage III, and 90% in Stage IV. The cause-specific survival was 68% at 4 years; the regional control was 76%. Four patients developed distant metastasis with disease free from distant metastasis of 77% at 4 years. The overall survival was 68% at 4 years.ConclusionsHDR-BT yields similar results to low dose rate in treatment of patients with LATC, with better results than those reported with exclusive EBRT. HDR-BT allows to increase the local dose, with good LC rates. In patients with large tumors requiring very mutilating surgery and patients who refuse surgery, EBRT with HDR-BT boost is a good option to increase the LC and cause-specific survival while keeping a better functional outcome.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v3egLW

Commentary on “Late Dacron Patch Inflammatory Reaction After Carotid Endarterectomy”

Publication date: Available online 12 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): J.-B. Ricco, M. Gargiulo




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

Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio

Publication date: Available online 12 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Juan P. Suárez, María L. Domínguez, Francisco J. de Santos, José M. González, Nuria Fernández, Fidel J. Enciso
Introducción y objetivosLa cirugía radioguiada es una técnica de tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario. Los objetivos de este estudio fueron estudiar el porcentaje de éxito de esta técnica y realizar una comparación de la misma con el estudio histológico intraoperatorio.MétodosEstudiamos retrospectivamente a 84 pacientes con hiperparatirodismo primario con gammagrafía paratiroidea positiva. Se administró una dosis de Tc-99m sestamibi previa a la cirugía y se utilizó una sonda gammadetectora intraoperatoria para detectar el tejido paratiroideo anómalo, siguiendo la «regla del 20%». En todos los casos se realizó estudio anatomopatológico intraoperatorio y seguimiento clínico y analítico durante al menos 6 meses. Asimismo, se comparó el valor predictivo positivo de la ecografía cervical respecto a la gammagrafía paratiroidea.ResultadosEl porcentaje de éxito de la cirugía radioguiada fue 99%. La sonda gammadetectora intraoperatoria tuvo una sensibilidad, especificidad, valores predictivos positivo y negativo respecto al estudio histológico intraoperatorio de 99, 73, 97 y 89%, respectivamente. La calcemia se normalizó en 83 de 84 pacientes (99%) y la paratohormona se normalizó en 77 de los 84 pacientes (92%). La ecografía mostró un bajo valor predictivo positivo (41%) comparada con la gammagrafía.ConclusionesLa cirugía radioguiada es una técnica con excelentes resultados en el tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario y podría sustituir tanto al estudio anatomopatológico intraoperatorio como a la determinación intraoperatoria de paratohormona. Esta última posibilidad debe ser demostrada en futuros estudios.Introduction and objectivesRadioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis.MethodsWe retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared.ResultsRadioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy.ConclusionsRadioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings.



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

Herbicide Mixtures from Usual Practice in Sugarcane Crop: Evaluation of Oxidative Stress and Histopathological Effects in the Tropical Fish Oreochromis niloticus

Abstract

Sugarcane is one of the world's most important commodities. In order to control weeds in the plantations and increase productivity, the mixing of different herbicides during spraying operations is commonplace. This practice is unregulated, and the impact on water quality and nontarget tropical species is poorly understood. In the present work, exposure and recovery assays were used to evaluate antioxidant enzyme activity and histopathological alterations in the liver of tilapia (Oreochromis niloticus) following exposure to mixtures of the herbicides widely used in sugarcane crops: ametryn (AMT), tebuthiuron (TBUT), diuron (DIU), and hexazinone (HZN). The greatest biochemical changes were observed for the mixture (DIU+HZN)+AMT+TBUT at the highest concentration tested (1/10 96hLC50). This mixture caused a significant increase (p < 0.01) of approximately 82% in GST activity after 14 days of exposure. For three of the mixtures evaluated, GST and CAT could be considered potential biochemical biomarkers of exposure to the herbicide mixtures due to the frequency, intensity, and statistical significance of alterations in the assimilation phase. Although morphological changes were evident in the hepatic tissue, severe damage was only noted in a few samples, and there were no statistically significant differences, relative to the control. The results of hepatic lesion recovery assays suggested that the most sensitive individuals affected by the xenobiotics were unable to achieve full recovery. It is anticipated that the data obtained may assist in the selection of biomarkers for monitoring purposes, as well as in reinforcing standards of conduct in the use of agrochemical mixtures in agriculture.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uK4Qtn

Analysis of the Correlation between Deformational Plagiocephaly and Neurodevelopment delay

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mohammed Ahmed Hussein, Taeyong Woo, In Sik Yun, Hanna Park, Yong Oock Kim
BackgroundDeformational plagiocephaly (DP) refers to cranial asymmetry resulting from uneven external forces. A strong association exists between DP and developmental delay. We investigated the effect of DP severity on developmental delay.MethodsBetween 2010 and 2016, data from 155 patients with DP were reviewed retrospectively. Two indices were used to evaluate the deformation quantitatively: cranial index (CI) and cranial vault asymmetry index (CVAI). The Bayley Scales of Infant Development-II was used to evaluate the neurodevelopment of patients.ResultsAccording to the CI of the study population, 2 patients showed scaphocephaly, 12 showed mesocephaly, and 141 showed brachycephaly. For CVAI, 10 patients showed values of <3.5, 10 patients showed mild deformity (3.5-6.25), 27 patients showed moderate deformity (6.25-8.75), and 108 patients showed severe deformity. The means of the mental development index (MDI) and psychomotor development index (PDI) were 91.69 ± 16.8 and 92.28 ± 17.59, respectively; after the exclusion of patients with confounding factors, the values were 96.26 and 92.9, respectively. The Spearman correlation coefficients between MDI and CI and CVAI were -0.019662 and 0.118916, respectively, whereas for PDI the values were -0.195428 and -0.012386, respectively.ConclusionsThere is a statistically significant neurodevelopmental delay was found in patients with DP. However, accelerated neurodevelopment was also encountered in many patients. MDI was found to be more affected by multiple confounding factors than PDI, whereas PDI was only affected by congenital anomalies. There was no definitive relationship between the severity of DP and the degree of developmental delay in our study group.



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

Patient Rated Long-Term Results after Complete Denervation of the Wrist

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): T. Fuchsberger, C.E. Boesch, F. Tonagel, T. Fischborn, H.E. Schaller, P. Gonser
The aim of this study was to examine the long-term results after the denervation of the wrist. Between 1977 and 2001 we treated 375 patients in our clinic. The mean age was 43.5 years, 81% were male and 19% female. The long-term results were assessed by a questionnaire assessing pain on a visual analogue scale and patient satisfaction and by the DASH questionnaire. After a mean follow-up of 12.23 years, we found an overall pain reduction of 52.1%. In 67.7% of the patients we found a relief of pain; of these patients, 44% are free of pain until today, and 56% were temporarily asymptomatic. Patients with a painful osteoarthritic condition without dynamic instability and good range of motion are ideal candidates to benefit from the denervation. The complete denervation of the wrist is an effective treatment option in patients with painful wrist conditions to reduce pain and improve the overall function.



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

Are facial injuries really different? An observational cohort study comparing appearance concern and psychological distress in facial trauma and non-facial trauma patients

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Emmylou Rahtz, Kamaldeep Bhui, Iain Hutchison, Ania Korszun
Facial injuries are widely assumed to lead to stigma and significant psychosocial burden. Experimental studies of face perception support this idea, but there is very little empirical evidence to guide treatment. This study sought to address the gap.Data were collected from 193 patients admitted to hospital following facial or other trauma. Ninety (90) participants were successfully followed up eight months later. Participants completed measures of appearance concern and psychological distress (post-traumatic stress symptoms, depressive symptoms, anxiety symptoms). Participants were classified by site of injury (facial or non-facial injury).Overall levels of appearance concern were comparable to those of the general population, and there was no evidence of more appearance concern among people with facial injuries. Women and younger people were significantly more likely to experience appearance concern at baseline. Baseline and Eight month psychological distress, although common in the sample, did not differ according to the site of injury. Changes in appearance concern were, however, strongly associated with psychological distress at follow up.We conclude that, although appearance concern is severe among some people with facial injury it is not especially different to the those with non-facial injuries or the general public; changes in appearance concern, however, appear to correlate with psychological distress. We therefore suggest that interventions might focus on those with heightened appearance concern, and should target cognitive bias and psychological distress.



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