Testing Backpropagation Neural Network Approach in Interpolating Missing Daily Precipitation

Abstract

This study proposes a method, backpropagation (BP) neural network, for interpolating missing values in daily precipitation time series. Firstly, the BP neural network is adopted to interpolate missing daily rainfall data at three selected stations in Yantai, Shandong, China. Then, the temporal and spatial variations in precipitation extremes across Shandong are analyzed by utilizing the complete daily rainfall dataset derived from accurate propagation at 24 meteorological stations. The results show that the long-term trends in five selected extreme precipitation indices calculated from interpolated daily rainfall data are generally consistent with those from original nonmissing values. And the spatial patterns of trends in precipitation extremes also show better performance for BP neural network approach in interpolating missing daily rainfall gaps. Those suggest that this BP neural network algorithm can obtain a good fit in terms of space-time variability of regional precipitation extremes, in case that the correlation coefficients between the target stations with missing values and reference stations with complete daily rainfall dataset are relatively large. These findings could be crucial for investigating regional frequency of heavy rainfall and water resource management.

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Telemonitoring in continuous positive airway pressure−treated patients improves delay to first intervention and early compliance: a randomized trial

Publication date: Available online 30 September 2017
Source:Sleep Medicine
Author(s): F. Hoet, W. Libert, C. Sanida, S. Van den Broecke, A.V. Bruyneel, M. Bruyneel
ObjectiveTelemonitoring (TM) has been used in continuous positive airway pressure (CPAP)−treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome.MethodsPatients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device.ResultsDelay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018).ConclusionThis is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance.

Graphical abstract

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Identification of keratin 19-positive cancer stem cells associating human hepatocellular carcinoma using CYFRA 21-1

Abstract

The current lack of an easily measurable surrogate marker of cancer stem cells (CSCs) prevents the clinical application of CSCs for hepatocellular carcinoma (HCC). We previously reported that keratin 19 (K19) is a novel HCC-CSC marker associated with transforming growth factor beta (TGFβ)/Smad signaling, and that K19⁺ HCC-CSCs could be a new therapeutic target of TGFβ receptor 1 inhibitor LY2157299. In this study, we examined whether K19⁺ HCC-CSCs can be tracked using cytokeratin 19 fragment CYFRA 21-1. In 147 HCC patients who underwent curative resection and evaluated K19 expression by immunohistochemistry, preoperative serum CYFRA 21-1 levels were significantly higher in K19⁺ patients than in K19⁻ patients (P < 0.01). Receiver operating characteristic analyses revealed that serum CYFRA 21-1 was the statistically significant and the most sensitive predictor of tumor K19 expression among preoperative laboratory test values (P < 0.001). In HCC cells encoding with a K19 promoter-driven enhanced green fluorescent protein, fluorescence-activated cell sorting (FACS)-isolated K19⁺ cells displayed significantly higher levels of supernatant CYFRA 21-1 than K19⁻ cells (P < 0.01). Gain/loss of K19 function experiments confirmed that CYFRA 21-1 levels were regulated by K19 function in HCC cells. Furthermore, CYFRA 21-1 levels reflected the treatment efficacy of LY2157299 in K19⁺ cells. In conclusion, CYFRA 21-1 can be used to predict K19 expression in HCC, and should thereby aid in the development of novel therapeutic strategies targeting K19⁺ HCC-CSCs.

Keratin 19 (K19) is known to be a cancer stem cells (CSCs) marker in hepatocellular carcinoma (HCC). However, easily-measurable surrogate marker of K19 +  HCC-CSCs has not been identified. This study showed that serum CYFRA 21-1 is the significant predictor of K19 expression in human HCC, and that CYFRA 21-1 levels reflect K19 function and TGFβ receptor 1 inhibitor treatment efficacy in HCC cells.

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Le partage des données au service de l’éthique, de la transparence et de la reproductibilité de la science médicale

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): O. Laccourreye, P. Bonfils, R. Garrel, R. Jankowski, A. Karkas, N. Leboulanger, M. Makeieff, C. Righini, C. Vincent, C. Martin




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Chirurgie de l’hyperparathyroïdie primaire en ambulatoire : à propos d’une série de 67 cas

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D. Culié, B. Pescetto, O. Dassonville, N. Guevara, D. Benisvy, J. Santini
IntroductionLa chirurgie de l'hyperparathyroïdie primaire, ciblée par l'imagerie morphologique et fonctionnelle, remplit les conditions théoriques d'une réalisation ambulatoire. L'objectif de notre étude était de valider ce type de prise en charge sur une série homogène de patients.Patients et méthodesL'ensemble des patients chez qui a été réalisée une chirurgie d'hyperparathyroïdie primaire en ambulatoire dans notre institution entre janvier 2013 et avril 2015 a été inclus dans cette étude rétrospective. Les critères habituels d'évaluation de la chirurgie ambulatoire ont été étudiés.RésultatsDurant la période étudiée, 144 patients ont été opérés d'une hyperparathyroïdie primaire. Dans 67 cas une chirurgie ambulatoire a pu être réalisée, avec un diagnostic préopératoire d'adénome parathyroïdien en imagerie. La recherche de la glande pathologique a été réalisée par une échographie chez tous les patients, et chez 66 d'entre eux par une scintigraphie. Cela a permis une chirurgie unilatérale, ciblée, dans 98,5 % des cas. Deux patients ont dû être hospitalisés pour la nuit en lien avec des complications mineures.ConclusionLa chirurgie de l'adénome parathyroïdien peut, dans une population de patients bien sélectionnée, être réalisée sur des durées opératoires courtes et avec un minimum de complications permettant ainsi sa réalisation en ambulatoire.



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Connaissances concernant le syndrome d’apnées-hypopnées obstructives du sommeil par la population générale de Lorraine

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): F. Arous, J.-M. Boivin, A. Chaouat, C. Rumeau, R. Jankowski, D.T. Nguyen
ObjectifLe syndrome d'apnées-hypopnées obstructives du sommeil (SAHOS) semble être sous-diagnostiqué. L'objectif de cette étude était d'évaluer les connaissances du SAHOS par la population générale de Lorraine.MéthodesUne enquête à l'aide d'un questionnaire anonyme portant sur les connaissances des symptômes et des complications du SAHOS a été menée de juillet 2015 à novembre 2015, en région Lorraine. Le questionnaire a également été diffusé sur Internet à l'aide de réseaux sociaux. Les critères d'exclusion étaient les personnes de moins de 18 ans, le refus de remplir le questionnaire et la barrière linguistique.RésultatsAu total, 1307 personnes ont répondu à l'enquête : 1020 sous format papier et 287 via Internet. La plupart des symptômes étaient connus par environ deux tiers de la population. Les complications notamment cardiovasculaires et neurologiques étaient en revanche mal connues. Être atteint du SAHOS, avoir fait des études supérieures et avoir moins de 40 ans étaient des facteurs associés à une meilleure connaissance de la maladie. Les répondeurs sur Internet connaissaient aussi mieux cette pathologie.ConclusionMalgré des résultats concernant les symptômes du SAHOS plutôt encourageants, les connaissances du grand public concernant ses complications sont limitées. De nouvelles campagnes d'informations auprès des médecins ainsi qu'auprès du grand public devraient être réalisées afin d'informer la population de cette pathologie et de la sensibiliser sur ses complications.



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Résultats fonctionnels de la chirurgie endoscopique du diverticule de Zenker

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): A. Dissard, L. Gilain, R. Pastourel, T. Mom, N. Saroul
But du travailL'objectif principal de cette étude rétrospective était l'évaluation des résultats fonctionnels de la chirurgie endoscopique du diverticule de Zenker. Les objectifs secondaires étaient d'évaluer la sécurité de la procédure, d'identifier les facteurs de risque de récidive et d'en déterminer leur conduite en cas de récidive.Patients et méthodesDe 2000 à 2014, 50 patients ont bénéficié d'une chirurgie endoscopique avec marsupialisation d'un diverticule de Zenker. Les symptômes de régurgitations et de dysphagie ont été évalués par l'échelle FOIS avant et après chirurgie. Le taux de récidives et le taux de complications ont été déterminés de manière rétrospective avec un suivi minimal de 18 mois.RésultatsLes régurgitations et la dysphagie ont été améliorées respectivement chez 96 % et 86 % des patients. Le taux de complications était de 12 %, complications le plus souvent mineures. Les temps moyens d'hospitalisation et de reprise alimentaire orale étaient respectivement de 2,0 et 1,3jours. Neuf patients (18 %) ont présenté une récidive de leur symptomatologie initiale et ont nécessité une reprise chirurgicale dans un délai moyen de 2,7 années. Elle a pu être réalisée dans la majorité des cas par voie endoscopique. Un seul facteur de risque de récidive a été identifié : la petite taille du diverticule.ConclusionLa chirurgie endoscopique du diverticule de Zenker permet une amélioration fonctionnelle dans la majorité de cas. Associant sécurité et efficacité, elle est actuellement la procédure de choix dans le traitement du diverticule de Zenker.



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Données étiologiques des sous-maxillites aiguës et prise en charge étiologique

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): C. Bignet, J. Carvalho, E. Lemaire, A. Charpiot
ButL'objectif de notre étude est de vérifier l'hypothèse que les sous-maxillites aiguës sont liées à un obstacle sur les voies salivaires. Notre étude évalue les caractéristiques de ces obstacles et leurs prises en charge.Matériel et méthodesOnt été inclus de façon rétrospective les patients ayant fait un épisode de sous-maxillite aiguë entre 2009 et 2015. Tous les patients ont bénéficié d'une exploration des voies salivaires par imagerie et/ou par sialendoscopie, et un examen anatomopathologique en cas d'ablation de la glande pour le diagnostic étiologique. Concernant le traitement étiologique : si la lésion causale n'était pas traitable par sialendoscopie uniquement, l'opérateur pouvait avoir recours à une voie combinée aidée par sialendoscope. En cas d'échec de ces procédures, l'indication d'une sous-maxillectomie était posée.RésultatsVingt-neuf patients ont été inclus dans l'étude et 28 patients présentaient une anomalie des voies salivaires. Au moins un calcul était retrouvé chez 27 patients, ceux-ci étaient majoritairement uniques (n=20), dans le tiers moyen (n=21) et volumineux (7,7mm de moyenne). Une sténose était retrouvée chez 10 patients et pour 9 patients, associée à un calcul salivaire. Vingt-cinq patients avec un obstacle ont bénéficié d'une sialendoscopie. La prise en charge par sialendoscopie uniquement a été possible dans 5 cas et par voie combinée dans 13 cas.ConclusionUn épisode de sous-maxillite impose un examen des voies salivaires par sialendoscopie pour une prise en charge précoce en raison de la fréquence de calculs associés et du taux élevé de traitement conservateur guidé par sialendoscopie.



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Editorial Board

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5





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Carcinome indifférencié de type nasopharyngé chez l’enfant : particularités cliniques et évolutives

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): W.S. Zrafi, S. Tebra, S. Tbessi, S. Ouni, M. Jebsi, N. Bouaouina
ObjectifsParticularités épidémiologiques, cliniques et thérapeutiques du carcinome indifférencié de type nasopharyngé chez l'enfant.Matériel et méthodesÉtude rétrospective d'une série de 40 patients d'âge inférieur à 17 ans suivis pour un carcinome indifférencié du nasopharynx, dans les deux centres d'oncologie radiothérapie du centre tunisien entre 1995 et 2012.RésultatsL'âge médian était 14 ans, le sex-ratio 1,3. Le délai moyen de consultation était de 5 mois, la circonstance de découverte était l'apparition d'adénopathies cervicales dans 90 % des cas. Sur le plan thérapeutique, 37 patients ont reçu un traitement à visée curative. Le schéma thérapeutique était séquentiel dans 85 % des cas, commençant par une chimiothérapie puis une radiothérapie du cavum et des aires ganglionnaires cervicales. La dose médiane au niveau du cavum était de 70,4Gy. L'évolution a été marquée par la survenue de deux récidives locales, cinq rechutes métastatiques, toutes osseuses. Après un recul moyen de 80,5 mois (1–180), 29 patients (72,5 %) étaient en rémission complète, huit sont décédés et trois perdus de vue. La survie globale à 5 ans était de 77,7 %.ConclusionLe carcinome indifférencié du nasopharynx de l'enfant représente dans notre région 6 % des cas d'UCNT pris en charge dans nos institutions. Il est souvent découvert à un stade évolué. L'association séquentielle de chimiothérapie et de radiothérapie a permis un excellent taux de contrôle local.



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Exploration électrophysiologique de l’audition

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D. Bakhos, M. Marx, A. Villeneuve, E. Lescanne, S. Kim, A. Robier
Les examens audiométriques électrophysiologiques se sont développés depuis les années 1960 avec comme objectif la détermination objective des seuils auditifs. Ils sont maintenant utilisés pour le dépistage de la surdité néonatale. Si ces tests permettent de préciser les seuils auditifs, leur interprétation ne peut se faire qu'en complémentarité de l'audiométrie subjective que représente l'audiométrie tonale et vocale. En effet, si les tests objectifs permettent de préciser les seuils auditifs, ils ne peuvent généralement pas déterminer le type de surdité en cause. Chaque examen teste une région anatomique différente permettant l'exploration du système auditif de l'organe de Corti au cortex auditif. Ainsi, les examens d'audiométrie objective sont complémentaires.



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Le nez brûlé : une analyse en 4 dimensions

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): J. Bouguila, C. Ho Quoc, R. Viard, A. Brun, D. Voulliaume, J.-P. Comparin, J.L. Foyatier
De part sa position et sa projection, le nez est exposé aux diverses agressions comme les brûlures. Ce type de lésion peut concerner le nez de façon isolée ou entrer dans un contexte plus large constituant les brûlures nasofaciales. La reconstruction du nez constitue un défi, car cette entité anatomique est formée d'un ensemble tridimensionnel complexe, auquel s'ajoute même une « quatrième dimension » : la fonction. La prise en charge du nez brûlé constitue un défi esthétique et fonctionnel. Le traitement des séquelles doit s'adapter au degré d'atteinte du nez et aux impératifs esthétiques et fonctionnels de cette structure anatomique. Ce n'est qu'au terme de multiples interventions chirurgicales et de longs mois de rééducation que le patient brûlé retrouvera une vie sociale satisfaisante.



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Thérapie cellulaire et cordes vocales cicatricielles

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): A. Mattei, J. Magalon, B. Bertrand, C. Philandrianos, J. Veran, A. Giovanni
La microstructure des cordes vocales est complexe et peut être altérée par une microchirurgie laryngée. On peut alors observer un état cicatriciel n'autorisant plus le découplage mécanique entre épithélium et muscle, responsable de difficultés vibratoires à l'origine d'une dysphonie invalidante. Les possibilités thérapeutiques actuelles sont réduites et souvent inefficaces sur la vibration : elles n'apportent qu'un effet volumateur limitant la fuite glottique. L'objectif de cette revue de la littérature était double : i) décrire l'état actuel de la littérature quant à l'intérêt de la thérapie cellulaire dans la prise en charge des cordes vocales cicatricielles ; ii) analyser l'intérêt thérapeutique de la fraction vasculaire stromale d'origine adipeuse parmi l'arsenal thérapeutique préexistant. Notre recherche sur PubMed^® en septembre 2016 a référencé les articles originaux de langue anglaise ou française traitant de l'usage des cellules souches dans la prise en charge des cordes vocales cicatricielles. Vingt-sept articles publiés entre 2003 et 2016 répondaient aux critères de sélection. Les cellules souches mésenchymateuses étaient les plus utilisées, majoritairement extraites de la moelle osseuse ou du tissu adipeux. Quatre études étaient réalisées in vitro sur fibroblastes et dix-huit in vivo chez l'animal. Les critères d'évaluation étaient : i) l'analyse de la cicatrisation (morphologie macroscopique et microscopique, propriétés viscoélastiques, matrice extracellulaire, fibroblastes) ; ii) l'évaluation de la survie et différenciation des cellules souches. Ces études démontrent l'action bénéfique des cellules souches mésenchymateuses, notamment d'origine adipeuse. Par ailleurs, la fraction vasculaire stromale possède des propriétés qui pourraient permettre d'améliorer ces résultats, en facilitant la logistique de production.



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La maladie de Kikuchi-Fujimoto, une cause rare d’adénopathie en Afrique. Description de la première observation au Sénégal et revue de la littérature

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): C.-A. Lame, B. Loum, A.-K. Fall, J. Cucherousset, A.-R. Ndiaye
IntroductionLa maladie de Kikuchi-Fujimoto est une lymphadénite histiocytaire nécrosante. Cette pathologie bénigne atteint le plus souvent le sujet féminin d'âge mûr. Elle se manifeste généralement par des adénopathies cervicales fébriles. Elle doit être évoquée dans notre contexte d'exercice dominé par la fréquence des adénopathies tuberculeuses et des hémopathies malignes.ObservationNous rapportons le cas d'une femme sénégalaise âgée de 33 ans qui a présenté des adénopathies cervicales subaiguës dans un contexte fébrile. Il existait un syndrome inflammatoire biologique. Les bilans sérologique et tuberculeux étaient négatifs. L'analyse histopathologique d'une biopsie ganglionnaire, après échec d'un traitement antibiotique non spécifique, concluait à une maladie de Kikuchi-Fujimoto. L'évolution était favorable sous corticothérapie.ConclusionEn Afrique noire, l'association de polyadénopathies et de syndrome fébrile doit faire penser et rechercher, après la tuberculose et les lymphomes à des pathologies rares comme la maladie de Kikuchi-Fujimoto.



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Fibrose angiocentrique à éosinophiles ethmoïdo-orbitaire droite

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): S. Gorostis, M. Bacha, S. Gravier, T. Raguin
IntroductionLa fibrose angiocentrique à éosinophiles (EAF) est une affection bénigne et lentement progressive, affectant la muqueuse des voies aériennes supérieures ou l'orbite plus rarement. Elle appartient au spectre de la maladie associée aux IgG4.Cas cliniqueNous rapportons le cas d'un homme de 61 ans présentant une atteinte orbitaire (baisse d'acuité visuelle, douleurs, exophtalmie, œdème palpébral), céphalées et obstruction nasale. L'imagerie révèle une masse ethmoïdo-orbitaire droite infiltrant la graisse périorbitaire et englobant le nerf optique. L'analyse anatomopathologique a posé le diagnostic d'EAF devant l'infiltration périvasculaire par des cellules inflammatoires – majoritairement des polynucléaires éosinophiles – et des zones de fibrose « en bulbe d'oignon ». L'immunohistochimie a permis d'apparenter les lésions aux maladies associées aux IgG4. La prise en charge initiale par corticothérapie, puis dapsone n'a pas suffi au contrôle des crises évolutives, avec une importante corticodépendance. Une ethmoïdectomie chirurgicale emportant la lame papyracée a été réalisée dans le but de permettre l'expansion du globe oculaire vers la fosse nasale en cas de nouvelle crise.DiscussionL'association du rituximab à la chirurgie a permis la régression durable des douleurs et de l'exophtalmie.



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Carcinome mucoépidermoïde sclérosant de la glande sublinguale

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D.H. Lee, J.H. Kim, J.K. Lee, S.C. Lim
IntroductionLe carcinome mucoépidermoïde sclérosant de la glande salivaire est un sous-type rare de carcinome mucoépidermoïde. Les sites les plus touchés par le carcinome mucoépidermoïde sclérosant des glandes salivaires sont par ordre de fréquence la glande parotide, la glande sous-mandibulaire et les glandes salivaires accessoires.ObservationNous rapportons ici le premier cas de carcinome mucoépidermoïde sclérosant de la glande sublinguale.DiscussionLes cliniciens doivent évoquer le carcinome mucoépidermoïde sclérosant dans le diagnostic différentiel du néoplasme de la glande salivaire. L'exérèse chirurgicale avec marges saines est une option thérapeutique initiale qui semble suffisante pour le carcinome mucoépidermoïde sclérosant de la glande salivaire.



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Démarche diagnostique devant un œdème labial diffus isolé d’apparition soudaine

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): O. Laccourreye, F. Rubin, J. Delort, P. Bonfils
À partir d'un cas d'œdème labial diffus isolé de survenue soudaine, les auteurs précisent les points clefs de la démarche diagnostique ainsi que les principales données épidémiologiques et cliniques.



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Les corps étrangers nasaux chez les enfants dans un hôpital pédiatrique au Sénégal : une évaluation de 3 ans

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): P.E.J. Regonne, M. Ndiaye, A. Sy, Y. Diandy, A.D. Diop, B.K. Diallo
ObjectifsLes corps étrangers nasaux (CEN) sont un accident domestique fréquent chez les enfants. L'objectif de ce travail était de présenter les particularités des CEN chez les enfants dans un hôpital pédiatrique sénégalais et décrire notre attitude thérapeutique.Matériel et méthodesÉtude rétrospective descriptive au service d'oto-rhino-laryngologie du Centre hospitalier national pour enfants de Diamniadio du 1^er janvier 2013 au 31 décembre 2015 incluant tous les enfants de moins de 15 ans reçus pour CEN. Les variables étudiées étaient l'âge, le sexe, la provenance, le motif de consultation, le délai de consultation, la nature du CEN, la méthode d'extraction et les complications.RésultatsCinquante-huit CEN avaient été recensés. L'âge moyen était de 3 ans 4 mois. Parmi les patients, 93 % avaient moins de 5 ans. Il y avait une prédominance féminine (53,45 %), soit un sex-ratio de 0,87. Les CEN étaient localisés chez 43 patients (74,1 %) à droite. Le premier motif de consultation était la rhinorrhée purulente retrouvée chez 51,7 % ; parmi les patients, 17,24 % étaient amenés en consultation dans les 24 premières heures. La mousse était le premier CEN (29,3 %), suivie des graines (20,7 %). L'extraction a été réalisée en consultation chez 84,5 % et chez 15,5 % au bloc opératoire. La morbidité était de 22,41 %. Il s'agissait dans 17,24 % d'une épistaxis et dans 5,17 % d'une infection nasale.ConclusionLes CEN sont des accidents fréquents chez l'enfant de moins de 5 ans. Notre contexte est marqué par un retard à la consultation.



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Tuméfaction inflammatoire basicervicale

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): H. Benkhatar, F. Scotte, O. Laccourreye, C. Benoit




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Masse fluctuante cervicale : lettre à l’éditeur et revue de la littérature de phlébectasie de la veine jugulaire antérieure

Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): M.Y. Abboud, A. de Lafontaine-Ruel, B. Riederer, D. Philippon




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Molecular characterization of Cryptococcus neoformans isolated from the environment in Beijing, China

Abstract

The molecular type of environmental Cryptococcus neoformans in Beijing was not clear. Our study aims to reveal the molecular characterization of C. neoformans complex from environment in Beijing, China. A total of 435 samples of pigeon droppings from 11 different homes in Beijing were collected from August to November in 2015. Pigeon droppings were inoculated onto caffeic acid cornmeal agar (CACA) to screen C. neoformans complex. Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed for species identification. Serotype and mating type was determined by specific primers. Restriction fragment length polymorphisms of URA5 (URA5-RFLP) were applied to genotype. Multi-locus sequence typing (MLST) was done for further identification and sequence type (ST) determination. Altogether, 81 isolates of C. neoformans AFLP1/VNI were recognized from 435 pigeon droppings in this study. The positive rate for C. neoformans AFLP1/VNI from pigeon droppings in different homes varied from 5.0% to 52.6%, the average was 20.2%. All of these cryptococcal strains were serotype A, MATα. They were genotyped as VNI by URA5-RFLP and were confirmed by MLST. No other molecular types of C. neoformans and Cryptococcus gattii isolates were isolated. Their STs were identified as ST 31 (n = 54, 66.7%), followed by ST 53 (n = 10), ST 191 (n = 8), ST 5 (n = 5), ST 57 (n = 3), and ST 38 (n = 1). We concluded that not only clinical but also environmental isolates of C. neoformans need to be investigated more deeply and more extensively. The virulence difference between ST 5 and ST 31 need to be explored in the future.

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Yeasts from Scarlet ibises ( Eudocimus ruber ): A focus on monitoring the antifungal susceptibility of Candida famata and closely related species

Abstract

This study aimed to identify yeasts from the gastrointestinal tract of scarlet ibises (Eudocimus ruber) and from plant material collected from the environment where they live. Then, the isolates phenotypically identified as Candida famata were submitted to molecular identification of their closely related species and evaluated for their antifungal susceptibility and possible resistance mechanisms to antifungal drugs. Cloacal swabs from 20 scarlet ibises kept in captivity at Mangal das Garças Park (Brazil), pooled stool samples (n = 20) and samples of trunks and hollow of trees (n = 20) obtained from their enclosures were collected. The samples were seeded on Sabouraud agar supplemented with chloramphenicol. The 48 recovered isolates were phenotypically identified as 15 Candida famata, 13 Candida catenulata, 2 Candida intermedia, 1 Candida lusitaniae, 2 Candida guilliermondii, 1 Candida kefyr, 1 Candida amapae, 1 Candida krusei, 8 Trichosporon spp., and 4 Rhodotorula spp. The C. famata isolates were further identified as 3 C. famata, 8 Debaryomyces nepalensis, and 4 C. palmioleophila. All C. famata and C. palmioleophila were susceptible to caspofungin and itraconazole, while one D. nepalensis was resistant to fluconazole and voriconazole. This same isolate and another D. nepalensis had lower amphotericin B susceptibility. The azole resistant strain had an increased efflux of rhodamine 6G and an alteration in the membrane sterol content, demonstrating multifactorial resistance mechanism. Finally, this research shows that scarlet ibises and their environment harbor C. famata and closely related species, including antifungal resistant isolates, emphasizing the need of monitoring the antifungal susceptibility of these yeast species.

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Effect of peritoneal dialysis fluids on activity of echinocandins against Candida spp. biofilm

Abstract

Peritoneal dialysis fluids (PDFs) impair microorganisms' growth, which may compromise effectivity of some antimicrobials. The purpose of this study was to investigate the effect of three different PDFs (lactate/bicarbonate-buffered Physioneal 40^® with 2.2% glucose, lactate-buffered Nutrineal PD4^® with 1.1% amino acid, and lactate-buffered Extraneal^® with 7.5% icodextrin) on biofilm formation of four different Candida spp and antibiofilm effectiveness of anidulafungin, caspofungin and micafungin against Candida spp. biofilm in PDFs. All tested PDFs attained inhibitory effect on the biofilm formation but also reduced biofilm effectiveness of echinocandins against biofilm in PDFs was detected.

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Identification of a Novel Rhizopus -specific Antigen by Screening with a Signal Sequence Trap and Evaluation as a Possible Diagnostic Marker of Mucormycosis

Abstract

Mucormycosis is the second most common mould infection, often indistinguishable from other invasive mould infections such as aspergillosis. Although an appropriate antifungal therapy is effective at an early stage of the infection, there is no reliable diagnostic method for decision making. Thus, it is necessary to develop an efficient method that can detect mucormycosis rapidly and accurately. We searched for secreted or membrane-bound proteins of Rhizopus oryzae, which is the most common pathogen of mucormycosis, using the method of a signal sequence trap by retrovirus-mediated expression (SST-REX). Among the identified proteins, a Rhizopus-specific antigen was selected as a candidate, and efficacy of this specific antigen was evaluated using R. oryzae–infected mice. Of 302 clones obtained from the SST-REX library, a hypothetical protein (23 kDa, named "protein RSA") was selected as a candidate because of its highest prevalence of clones. Protein RSA was detected at significantly higher concentrations in serum and in lung homogenates of the infected mice as compared to those of uninfected mice. Our study indicates that protein RSA may be a promising biomarker of R. oryzae infection. SST-REX may be useful for comprehensive screening of prospective eukaryotic biomarkers of intractable mould infections.

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Evaluation of 8-Hydroxyquinoline Derivatives as Hits for Antifungal Drug Design

Abstract

Clioquinol is an 8-hydroxyquinoline derivative that was widely used from the 1950s to 1970s as an oral antiparasitic agent. In 1970, the oral forms were withdrawn from the market due to reports of toxicity, but topical formulations for antifungal treatment remained available. Thus, the purpose of this study was to evaluate the toxicity, anti-Candida and antidermatophyte activity and to determine pharmacodynamic characteristics of clioquinol and other 8-hydroxyquinoline derivatives (8-hydroxy-5-quinolinesulfonic acid and 8-hydroxy-7-iodo-5-quinolinesulfonic acid). Antifungal activity was tested by broth microdilution and the fungicidal or fungistatic effect was checked by a time-kill assay. Permeation and histopathological evaluation were performed in Franz diffusion cells with ear skin of pigs and examined under light microscopy. An HET-CAM test was used to determine the potential irritancy. The three compounds were active against all isolates showing anti-Candida and antidermatophyte activity, with MIC ranges of 0.031–2 μg/ml, 1–512 μg/ml, and 2–1024 μg/ml for clioquinol, 8-hydroxy-5-quinolinesulfonic acid, and 8-hydroxy-7-iodo-5-quinolinesulfonic acid, respectively. All compounds showed fungistatic effect for Candida, 8-hydroxy-5-quinolinesulfonic acid, and 8-hydroxy-7-iodo-5-quinolinesulfonic acid showed a fungicidal effect for M. canis and T. mentagrophytes, and clioquinol showed a fungicidal effect only for T. mentagrophytes. Furthermore, they presented a fungicidal effect depending on the time and concentration. The absence of lesions was observed in histopathological evaluation and no compound was irritating. Moreover, clioquinol and 8-hydroxy-5-quinolinesulfonic acid accumulated in the epithelial tissue, and 8-hydroxy-7-iodo-5-quinolinesulfonic acid had a high degree of permeation. In conclusion, 8-hydroxyquinoline derivatives showed antifungal activity and 8-hydroxy-5-quinolinesulfonic acid demonstrated the potential for antifungal drug design.

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Planktonic growth and biofilm formation profiles in Candida haemulonii species complex

Abstract

Candida haemulonii species complex have emerged as multidrug-resistant yeasts able to cause fungemia worldwide. However, very little is known regarding their physiology and virulence factors. In this context, planktonic growth and biofilm formation of Brazilian clinical isolates of Candida haemulonii (n = 5), Candida duobushaemulonii (n = 4), and Candida haemulonii var. vulnera (n = 3) were reported. Overall, the fungal planktonic growth curves in Sabouraud dextrose broth reached the exponential phase in 48 h at 37°C. All the clinical isolates formed biofilm on polystyrene in a time-dependent event, as judged by the parameters evaluated: biomass (crystal violet staining), metabolic activity (XTT reduction), and extracellular matrix (safranin incorporation). No statistically significant differences were observed when the average measurements among the three Candida species were compared regarding both planktonic and biofilm lifestyles; however, typical isolate-specific differences were clearly noticed in fungal growth kinetics.

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Is a biomarker-based diagnostic strategy for invasive aspergillosis cost effective in high-risk haematology patients?

Abstract

Empirical antifungal therapy is frequently used in hematology patients at high risk of invasive aspergillosis (IA), with substantial cost and toxicity. Biomarkers for IA aim for earlier and more accurate diagnosis and targeted treatment. However, data on the cost-effectiveness of a biomarker-based diagnostic strategy (BDS) are limited. We evaluated the cost effectiveness of BDS using results from a randomized controlled trial (RCT) and individual patient costing data. Data inputs derived from a published RCT were used to construct a decision-analytic model to compare BDS (Aspergillus galactomannan and PCR on blood) with standard diagnostic strategy (SDS) of culture and histology in terms of total costs, length of stay, IA incidence, mortality, and years of life saved. Costs were estimated for each patient using hospital costing data to day 180 and follow-up for survival was modeled to five years using a Gompertz survival model. Treatment costs were determined for 137 adults undergoing allogeneic hematopoietic stem cell transplant or receiving chemotherapy for acute leukemia in four Australian centers (2005–2009). Median total costs at 180 days were similar between groups (US$78,774 for SDS [IQR US$50,808–123,476] and US$81,279 for BDS [IQR US$59,221–123,242], P = .49). All-cause mortality was 14.7% (10/68) for SDS and 10.1% (7/69) for BDS, (P = .573). The costs per life-year saved were US$325,448, US$81,966, and US$3,670 at 180 days, one year and five years, respectively. BDS is not cost-sparing but is cost-effective if a survival benefit is maintained over several years. An individualized institutional approach to diagnostic strategies may maximize utility and cost-effectiveness.

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Report on novel environmental niches for Cryptococcus neoformans and Cryptococcus gattii in Colombia: Tabebuia guayacan and Roystonea regia

Abstract

Knowledge of the environmental distribution of C. neoformans/C. gattii is important in the epidemiology and ecology of the etiological agent, which causes cryptococcosis, a deadly disease worldwide. The aim of this report is to describe the presence of C. neoformans/C. gattii in new environmental niches in Colombia. A total of 837 environmental samples were collected from six different species of trees across four cities; molecular type was determined by PCR fingerprinting and RFLP. Molecular type VNI and VGIII were isolated from different species of trees, resulting in two novel niches for this pathogen: Tabebuia guayacan and Roystonea regia.

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Epidemiology of Trichophyton verrucosum infection in Rennes University Hospital, France: A 12-year retrospective study

Abstract

Trichophyton verrucosum is a zoophilic dermatophyte, known as a causative agent of inflammatory mycoses of the skin and the scalp in humans. In this study, we reviewed all cases of T. verrucosum infection diagnosed in our laboratory over a 12-year period, to determine epidemiological and clinical characteristics. Among 18,340 samples analyzed, 5,186 cultured positive with dermatophytes (2674 patients), of which 64 samples (41 patients) were positive for T. verrucosum. Our data show that there was a strong influence of age on the type of lesion, with children and adults presenting more frequently with tinea capitis and skin infections, respectively (P < .0001). Infection of children and adults resulted more frequently from indirect and direct exposure to cattle, respectively (P < .01). We observed a marked increase of cases over the last 4 years, with a correlation of the number of cases and the mean annual rainfall (P < .05), suggesting that increasing humidity favors cattle infection, and thereby, human infection. Whether this increase is the consequence of climate changes remains to be determined but should be considered.

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Study of differential expression of miRNAs in lung tissue of mice submitted to experimental infection by Paracoccidioides brasiliensis

Abstract

MicroRNAs (miRNAs) are small single stranded RNA sequences involved in post-transcriptional regulation of different biological and physiological processes. Paracoccidioidomycosis (PCM) is an infection caused by Paracoccidioides brasiliensis, and it is a major cause of mortality due to systemic mycoses in Brazil. To date, there have been few reports on the role of miRNAs in the immune response against fungi, especially PCM. The objective of this study was to evaluate the differential expression of miRNAs related to the inflammatory response associated with pulmonary infection by P. brasiliensis. For this purpose, lungs from BALB/c mice, intravenously infected with P. brasiliensis (2.7×10⁷ yeast cells/ml, n = 12) and noninfected BALB/c mice (n = 8), were collected at the 28 and 56 day after infection. The lung parenchyma presented a great number of yeast cells, granulomas, and edema at 28 days and a framework of resolution of the inflammatory process after 56 days. The mRNAs gata-3, ror-γt, foxp3, and IL-6 were positively regulated at the moment at the 56 day, while the TGF-β1 mRNA was positively regulated at both moments. The miRNAs 126a-5p, 340–5p, 30b-5p, 19b-3p, 221–3p, 20a-5p, 130a-3p, and 301a-3p, 466k presented the greatest increase in expression levels 28 days after infection, and the miRNAs let-7f-5p, let-7a-5p, 5p-26b, let-7e-5p and 369-3p, 466k presented a greater increase in levels of expression 56 days after infection. This study shows a set of differentially expressed miRNAs possibly involved in the immune response in mice during pulmonary infection by P. brasiliensis.

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Employment of methylene blue irradiated with laser light source in photodynamic inactivation of biofilm formed by Candida albicans strain resistant to fluconazole

Abstract

A promising approach for the eradication of biofilm formed by the yeast Candida albicans seems to be photodynamic inactivation (PDI). This work presents a use of methylene blue (MB, 1 mM) irradiated with a red laser (output power 190 mW/cm², wavelength 660 nm) for the eradication of a biofilm formed by the fluconazole-resistant (FLC-resistant) strain C. albicans CY 1123 compared to the standard strain C. albicans SC5314. The periods of irradiation corresponded to the fluence of 15, 23 and 57 J/cm². Effectiveness of PDI was evident with following percentage of survived biofilm cells: 24.57, 23.46, and 22.29% for SC5314 and 40.28, 17.91, and 5.89% for CY 1123, respectively, compared to the samples without irradiation. Light and confocal laser scanning microscopy confirmed the effectiveness of PDI. However, the morphological form of C. albicans seems to play an important role as well, since prolonged duration of irradiation did not increase efficiency of PDI on C. albicans SC5314. An experiment with the yeast-to-hyphae transition revealed that the FLC-resistant strain expressed a markedly reduced capacity to form hyphae compared to SC5314. We summarized that PDI was effective on biofilm formed by the FLC-resistant strain, but resistance most likely did not play significant role in PDI. Additionally, we observed differences in susceptibility to PDI between biofilms composed of the mycelia and only of the yeasts, and finally, the employment of a laser in PDI enabled a decreasing period of irradiation while maintaining the high effectiveness of PDI.

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Bone and joint infections caused by mucormycetes: A challenging osteoarticular mycosis of the twenty-first century

Abstract

Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5–73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10–180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.

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Inhibition of dermatophytes by photodynamic treatment with curcumin

Abstract

Treatment of dermatophytoses with currently available antimycotic agents is often tedious and sometimes unsatisfactory. A search for better therapeutic methods—ideally with an immediate fungicidal effect—has, among others, lead to photodynamic procedures as a promising alternative, and recently curcumin was found to be a suitable agent for this application. In this study the effect of photodynamic treatment with curcumin on dermatophytes was tested in vitro. Wells of microtiter plates were filled with conidia of Trichophyton rubrum, Trichophyton interdigitale, Trichophyton terrestre, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum in buffer. Then curcumin was added to the conidia and after 20 min the assays were irradiated one time only with visible light (peak wave length 367 nm, 5 J/cm²). Thereafter the wells were filled up with Sabouraud's glucose broth and in the following fungal growth was measured photometrically. The results showed that all dermatophytes were markedly inhibited depending on the concentration of curcumin. With 5.4 mg/l curcumin plus irradiation fungal growth was significantly suppressed over a period of 96 h (P < .001). Even after 96 h inhibition of T. rubrum was still complete and marked for all other species as well. M. gypseum was least susceptible. Our results are very encouraging to pursue the development of a photodynamic therapy of tinea with curcumin. The outstanding tolerance of curcumin and the innocuousness of the required light are favorable preconditions for this task.

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Cathelicidin (LL-37) level in the scalp hair of patients with tinea capitis

Abstract

Antimicrobial peptides (AMPs) are considered an important first line of defense against pathogens. Cathelicidin LL-37 was upregulated in response to fungal infection. In this work we aimed to evaluate cathelicidin LL-37 in the hair of tinea capitis and compare it to normal controls. Hair samples were collected from 30 children and 30 controls aged from 2 to10 years old, and the level of cathelicidin LL-37 in the hair was detected by quantitative real-time PCR. The 30 patients were further subdivided into three subgroups according to their clinical type. Ten patients were scaly type, 10 patients were black dots type, and 10 patients were kerion type. Cathelicidin level in patients ranged from 6.0 to 17.5 with mean ± SD (11.3 ± 2.3) and in control ranged from 1.02 to 6.2, with mean ± SD (2.8 ± 1.5). There was a significant difference between the patients and controls regarding the cathelicidin level; P value was 0. The mean cathelicidin level was lowest in the kerion type10.73 ± 2.6 and highest in the black dot type 12.05 ± 2.76. However, there was no significant difference between the cathelicidin level of the different clinical types of tinea capitis; P value was 0.58. In conclusion, the level of cathelicidin LL-37 in hair specimens of human tinea capitis was significantly higher than controls.

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Givinostat exhibits in vitro synergy with posaconazole against Aspergillus spp

Abstract

In vitro interactions of givinostat, a hydroxamate-derived histone deacetylase inhibitor, and antifungals including itraconazole, voriconazole, posaconazole, amphotericin B and caspofungin against Aspergillus spp. were assessed via broth microdilution checkerboard technique system. A total of 30 isolates of Aspergillus spp., including 20 strains of A. fumigatus and 10 strains of A. flavus were studied. The results revealed favorable synergistic effects between givinostat and posaconazole (83.3%) against Aspergillus isolates. Limited synergism was observed when givinostat was combined with itraconazole or voriconazole. No interaction was observed between givinostat and amphotericin B or caspofungin. No antagonism was observed in all combinations.

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How to obtain and use chromoendoscopy dyes for surveillance colonoscopy: A technical guide

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Donor Site Morbidity of the Anterolateral Thigh Flap

The purpose of this study was to investigate donor site morbidity after reconstruction of defects in the head and neck region with an anterolateral thigh (ALT) flap.

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Navigation-guided resection of maxillary tumours: The accuracy of computer-assisted surgery in terms of control of resection margins: a feasibility study

Surgical treatment of maxillary tumours is often highly complex. The three-dimensional anatomy of the mid-face renders both correct intraoperative orientation and adequate oncological safety difficult to obtain. Recently, computer-assisted techniques and intraoperative navigation have been applied to oncological surgery treating head and neck cancer. However, only a few studies have explored whether preoperative virtual resection planning and intraoperative control of resection margins allow assessment of the surgical margins of the tumour.

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Use of a monopolar microneedle device in a transconjunctival, retroseptal approach

Transconjunctival approach is a standard procedure to address fractures of orbit and the infraorbital rim. Modifications such as transcaruncular or lateral canthal widening allow for extended orbital wall exposure. Especially concerning aesthetics, the transconjunctival approach shows benefits compared to the transcutaneous incisions, such as the transciliary and infraorbital access. Moreover, transconjunctival approach is favored in the literature concerning lid retraction. Monopolar devices have become popular in surgery in the past decades because of good depth control and simultaneous haemostasis with consequently improved overview.

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Telemonitoring in continuous positive airway pressure−treated patients improves delay to first intervention and early compliance: a randomized trial

Telemonitoring (TM) has been used in continuous positive airway pressure (CPAP)−treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome.

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P 40 Correlation between hypothalamus and third ventricle of patients with affective disorders

Former studies proved the key role of the hypothalamus in the pathophysiology of affective disorders. Because of limited imaging methods and difficult delineation, attested volumetric changes has only been verified post-mortem, so in vivo studies made use of the adjacent third ventricle as an indirect marker of hypothalamic changes. Considering that these former ventricle studies leave sufficient scope for methodical improvements, it was our aim to replicate and complement these findings by using a high-resolution 7T-MRI for the first time.

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P 75 Movement-induced γ oscillations in the subthalamic nucleus are increased by dopamine and scaled by velocity in patients with Parkinson’s disease

Parkinson's disease (PD) is a basal ganglia disorder that results in general slowness of movement and an effective treatment option consists in subthalamic deep brain stimulation (DBS). Postoperatively, DBS-electrodes are externalized which gives the unique opportunity of recording local field potentials (LFP). Previous studies have shown that there are disease specific oscillatory patterns at rest, most prominently an increased β synchronization (Kühn, 2006) that correlates with clinical symptoms of PD such as rigidity and bradykinesia (Neumann, 2016).

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P 91 Changes of cerebral perfusion and cerebral pressure induced by rapid altitude changes of 1000m in an alpine region? – results of a neurosonographic study of volume flow rate and optic sheath diameter

As the clinical implications of altitude sickness are well known, the etiology of this potential life threatening disease is far from understood completely. We studied noninvasively by means of Neurosonography the effects of a rapid change of altitude in the alpine region on the cerebral volume flow and intracranial pressure.

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P 57 The influence of sports expertise on the extent of physiological mirror-EMG-activity in the upper and lower extremity

During unimanual motor tasks, muscle activity may not be restricted to the contracting muscle, but has also been reported to occur involuntarily in the contralateral resting limb in healthy subjects, referred to as physiological mirror electromyographic (MEMG) activity (Sehm et al., 2015). To date, however, it is unknown if the physiological form of MEMG can also be observed in lower extremities during the performance of unilateral isometric leg contractions. Furthermore it still remains elusive if and how MEMG is affected by long-term exercise training.

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P 83 Parasomnia, parkinsonism, impulse control disorder and bulbar palsy with IgLON5 antibodies: A new case report

In 2014 a complex neurological syndrome with parasomnia, sleep breathing dysfunction and variable bulbar symptoms associated with antibodies to IgLON5, a neuronal cell-adhesion protein, was described (Sabater et al., 2016). Postmortal studies revealed tauopathy predominately involving the hypothalamus and tegmentum of the brainstem (Gelpi et al., 2016). To the best of our knowledge, there are 16 published cases so far.

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P 67 Electrophysiological correlates of language improvements after intensive language therapy in patients with chronic post-stroke aphasia

Aphasia affects approximately one third of all stroke patients and may lead to chronic disability. Effective neurorehabilitation programs focusing on improving speech and language in patients with post-stroke aphasia are essential. A better understanding of the neurobiological processes accompanying language deficits and rehabilitation may bear fruit in the advancement of neurorehabilitation programs.

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P 48 The time of the ALSFRS-R to decrease to 50% (D50) in a sigmoidal decay model sufficiently describes the complete disease course of amyotrophic lateral sclerosis

The progression of ALSFRS-R is not linear (Gordon et al., 2010; Proudfoot et al., 2016); the often used calculated progression rate using PR=((48-ALSFRS-R)/disease duration) presents the progression at a certain time point rather than reflecting the entire disease course. A model describing the disease progression at different time points would facilitate the stratification of ALS patients according to disease severity and progression type and will in combination with other biomarkers enable identification of effective drugs in clinical trials.

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P 32 Insufficient evidence for structural gray matter alterations in late life minor depression – results from LIFE-adult study

Minor depressive episode is diagnosed when two to four depressive symptoms (including depressed mood or loss of interest) disturb the patient during at least two weeks. In late life minor depression is more prevalent than major depression. Newertheless, publications investigating pathophysiology of minor depression are missing.

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P 87 The perfusion changes in temporal and parietal lobe epilepsy

The aim of this study was to assess the regional relative interictal and postictal perfusion changes in temporal and parietal lobe epilepsy.

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P 79 Physiological assessment of the sense of agency in psychogenic movement disorders

Psychogenic movement disorders (PMD) are conditions characterized by the occurrence of unwanted motoric symptoms in which a somatic reason cannot be found. As patients suffering from PMD experience their pathological movements as non-voluntary, it is hypothesized that those patients have an altered sense of agency (SoA). SoA is defined as the feeling of controlling ones own actions and through them controlling events in the external world (Haggard and Tsakiris, 2009). SoA can be assessed by measuring the intentional binding (IB) effect.

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P 71 Levodopa modulates beta and gamma oscillations in the cortico-basal ganglia loop with a higher efficacy than the dopamine receptor agonist apomorphine in experimental Parkinsonism

The pharmacotherapy of Parkinson's disease (PD) is based on levodopa, and dopamine receptor agonists, such as apomorphine. Although both types of agents provide beneficial clinical effects on motor and non-motor symptoms in PD clinical efficiency and side effects differ substantially between levodopa and dopamine receptor agonists. Levodopa is known to provide a greater symptomatic relief than dopamine receptor agonists. Since long-term levodopa treatment often results in debilitating motor fluctuations, dopamine receptor agonists are recommended in younger patients.

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P 63 Investigating the effects of tRNS variants and task dependency on cortical excitability

Transcranial random noise stimulation (tRNS) has specific benefits and is fundamentally different as compared to more established methods such as transcranial direct current stimulation (tDCS) in modulating brain function (Terney et al., 2008; Ambrus et al., 2010). For example, previous research in the motor system has shown corticospinal excitability (CSE) to be task-dependent (Terney et al., 2008). It remains unresolved and largely unaddressed what the critical stimulation parameters of tRNS are, e.g.

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P 53 Impact of acoustic stimulation on motor response inhibition and error monitoring

Previous studies suggested that acoustic stimulation can be used to modulate cognition, to reduce anxiety level as well as to enhance mood. In this study we investigated whether acoustic stimulation can modulate response inhibition and error monitoring in a continuous performance task. Using the Go-NoGo paradigm in healthy adults during MEG recordings, Mazaheri et al. (2009) was able to predict errors during response inhibition by theta-alpha coupling. Thus, it seems likely that frontal theta activity after an error may boost an adjustment of the mental state of individuals towards more preparatory alertness resulting in alpha decrease and better sustained performance.

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P 44 Brisk jerk reflexes in a CMT case – novel heterozygous variant c.785T>C; p.Leu262Pro in KIF5A explaining the mixed phenotype

Charcot-Marie-Tooth (CMT) disease is a progressively disabling syndrome phenotypically comprising distal muscle weakness and atrophy, foot deformities, sensory loss, and reduced or absent tendon reflexes. In spastic paraplegia (SPG), a hereditary disorder affecting the upper motor neuron only, pareses are spastic, and deep tendon reflexes increased. Mixed forms between both diseases have been previously described (Liu et al., 2014). By multiple gene panel based analysis using next-generation-sequencing (NGS), we herein identified the novel variant c.785T>C; p.Leu262Pro in KIF5A as the putative cause of a mixed CMT and SPG phenotype.

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P 36 Structural and functional imaging findings in somatoparaphrenia

With regard to somatosensory delusion, neglect or deficits of body integrity a great number of overlapping pathophysiological concepts exist. Moreover, the range of assumed underlying psychiatric and neurologic syndromes only partially is thought to be related to even diverse neuroanatomical structures so far: Alien Hand Syndrome, Body Dysmorphic Disorder (BDD), Body Integrity Identity Disorder (BIID), Depersonalization, Somatoparaphrenia and Xenomelia. Specific deafferentiation within temporal regions, the insula or representational structures of the somatosensory cortex of the right parietal lobe is thought to be related only in some variants.

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P 28 Voxel-based Morphometry (VBM) subcortical white matter changes correlate with disease progression in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive, multisystemic disorder.Signs of lower motor neurone involvement are readily detectable but the involvement of the upper motor neurone is elusive.Hence, we must identify the extent and development of ALS related changes in the brain in different subtypes of ALS to facilitate an early diagnosis and stratification for clinical trials.Previous studies applying Voxel-based morphometry (VBM) provided inconsistent results.

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P 89 Case presentation – Clinically unrecognized status epilepticus in neuronal ceroid lipofuscinosis (CLN 3 gene)

On the previous day the 12-year-old boy P.-J. had a convulsive spasm (duration about 30s) in the morning and at noon. After that, he recovered and went outside for a walk. Before the evening meal P.-J. cramped again. Since then, he was not really awake, was not responsive, and had repeatedly convulsions (seven times on the day of admission). In between he was always sleepy and unresponsive. Since noon on the previous day, P. Luca did not eat and drink any more and did not take his medication. In the evening, the emergency physician was called, who did not administer any medicines because of stable vital parameters and only a short convulsive spasm when drawing blood from the vein.

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P 85 KCNQ-2 missense mutations and phosphatidylinositol 4,5-bisphosphate in familial epilepsy

The KCNQ2/3 channel is a slowly activating, non-inactivating voltage-gated potassium channel. It causes the M-current and sustains the resting membrane potential. Therefore, it is crucial for the regulation of neuronal plasticity. If a neuron does not reach the resting-potential after activation, excitation may spread throughout the neuronal network and a seizure may follow.In this work we study the influence of the intracellular second messenger phosphatidylinositol 4,5-bisphosphate (PIP2) on channels containing mutant KCNQ2 subunits associated with Benign Familial Neonatal Convulsions (BFNC).

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P 81 Voiding disorder – almond or walnut?

Limbic encephalitis is an inflammatory disease of the central nervous system. The subacute development of short-term memory deficit is typical of this disease, as are psychiatric symptoms and seizures. Limbic encephalitis is caused by auto -immunity and is associated with cancer in about 60 per cent of cases. Since 1999, several antibodies associated with limbic encephalitis have been identified.

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P 77 Optogenetic stimulations of striatal cholinergic interneurons in an animal model of dystonia

Dystonias are movement disorders, defined by sustained or intermittent muscle contractions causing twisting movements and postures. The most prevalent inherited form of dystonia is caused by a mutation in the gene for torsin A (DYT1, ΔGAG) with incomplete penetrance. It has been hypothesized that an increased activity of cholinergic interneurons in the striatum, resulting in abnormal synaptic plasticity, plays an important role in the disease pathophysiology. However, this hypothesis is merely based on ex vivo electrophysiological recordings in brain slices of animal models which do not show a dystonic phenotype.

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A new concept for implant-borne dental rehabilitation; how to overcome the biological weak-spot of conventional dental implants?

Every endosseous dental implant is dependent on an adequate amount and quality of peri-implant hard and soft tissues and their fully functional interaction. The dental implant could fail in cases of insufficie...

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iSepsis – Death by Fluids, Part 1

A recent study demonstrating the harm from aggressive fluid resuscitation of septic shock

EMCrit by Paul Marik.

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Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases

Pain is a very common condition in patient undergoing rehabilitation for neurological disease; however the presence of primary headaches and other cranio-facial pains, particularly when they are actually or ap...

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Brain networking analysis in migraine with and without aura

To apply effective connectivity by means of nonlinear Granger Causality (GC) and brain networking analysis to basal EEG and under visual stimulation by checkerboard gratings with 0.5 and 2.0 cpd as spatial fre...

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Tidal Carbon Dioxide as a Prognostic Feature in Inoperable Chronic Thromboembolic Pulmonary Hypertension

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1603-1604, October 2017.


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Six-Month Morbidity and Mortality among Intensive Care Unit Patients Receiving Life-Sustaining Therapy. A Prospective Cohort Study

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1562-1570, October 2017.


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Subcutaneous mastectomy in female-to-male transsexuals – optimizing perioperative and operative management in 8 years clinical experience

Publication date: Available online 29 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Wolter, T. Scholz, N. Pluto, J. Diedrichson, A. Arens-Landwehr, J. Liebau
IntroductionThe incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33 %. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with recent patient cohort (2014-2016).Patients and methodsThe records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (peri- and postoperative standard procedure and implementation of a care path in our institution, C1, 01/2008 - 12/2013, 346 mastectomies) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate were obtained in both cohorts.ResultsThe mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p<0,05). The overall complication rate could be diminished from 11.8 % to 5.5 % (p<0,05), the acute hematoma revision rate from 9.2 % to 4.1 % (p<0,05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88 % to 93.5 % „very satisfied" to „satisfied" patients.ConclusionHematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an institutional care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.



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Reappraisal of Pediatric Diastatic Skull Fractures in the 3-Dimensional CT Era: Clinical Characteristics and Comparison of Diagnostic Accuracy of Simple Skull X-Ray, 2-Dimensional CT, and 3-Dimensional CT

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Sook Young Sim, Hyun Gi Kim, Soo Han Yoon, Jong Wook Choi, Sung Min Cho, Mi Sun Choi
BackgroundDiastatic skull fractures (DSFs) in children are difficult to detect in skull radiographs before they develop into growing skull fractures; therefore, little information is available on this topic. However, recent advances in 3-dimensional (3D) computed tomography (CT) imaging technology have enabled more accurate diagnoses of almost all forms of skull fracture. The present study was undertaken to document the clinical characteristics of DSFs in children and to determine whether 3D CT enhances diagnostic accuracy.MethodsTwo hundred and ninety-two children younger than 12 years with skull fractures underwent simple skull radiography, 2-dimensional (2D) CT, and 3DCT. Results were compared with respect to fracture type, location, associated lesions, and accuracy of diagnosis.ResultsDSFs were diagnosed in 44 (15.7%) of children with skull fractures. Twenty-two patients had DSFs only, and the other 22 had DSFs combined with compound or mixed skull fractures. The most common fracture locations were the occipitomastoid (25%) and lambdoid (15.9%). Accompanying lesions consisted of subgaleal hemorrhages (42/44), epidural hemorrhages (32/44), pneumocephalus (17/44), and subdural hemorrhages (3/44). A total of 17 surgical procedures were performed on 15 of the 44 patients. Fourteen and 19 patients were confirmed to have DSFs by skull radiography and 2D CT, respectively, but 3D CT detected DSFs in 43 of the 44 children (P < 0.001).Conclusion3D CT was found to be markedly superior to skull radiography or 2D CT for detecting DSFs. This finding indicates that 3D CT should be used routinely rather than 2D CT for the assessment of pediatric head trauma.



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Chronologic Evaluation of Cerebral Hemodynamics by Dynamic Susceptibility Contrast Magnetic Resonance Imaging After Indirect Bypass Surgery for Moyamoya Disease

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Yosuke Ishii, Yoji Tanaka, Toshiya Momose, Motoshige Yamashina, Akihito Sato, Shinichi Wakabayashi, Taketoshi Maehara, Tadashi Nariai
ObjectiveAlthough indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast–magnetic resonance imaging (DSC-MRI).MethodsWe retrospectively analyzed the cases of 25 patients with MMD (37 sides; mean age, 14.7 years; range, 3–36 years) who underwent indirect bypass surgery and repeated DSC-MRI measurement within 6 months after the operation. The difference in the mean transit time (MTT) between the target regions and the control region (cerebellum) was termed the MTT delay, and we measured the MTT delay's chronologic changes after surgery.ResultsThe postoperative MTT delay was 1.81 ± 1.16 seconds within 1 week after surgery, 1.57 ± 1.01 at weeks 1–2, 1.55 ± 0.68 at weeks 2–4, 1.32 ± 0.68 at months 1–2, 0.95 ± 0.32 at months 2–3, and 0.77 ± 0.33 at months 3–6. Compared with the preoperative value (2.11 ± 0.98 seconds), the MTT delay decreased significantly from 2 to 4 weeks after surgery (P < 0.05).ConclusionsThe amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.



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Asymptomatic Ischemic Risks in Microsurgical Clipping for Unruptured Intracranial Aneurysms in Anterior Circulation

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Katsuhiro Shinagawa, Toshinori Matsushige, Takahito Okazaki, Daizo Ishii, Nobuhiko Ichinose, Shigeyuki Sakamoto, Kaoru Kurisu
BackgroundThe ischemic risk in prophylactic treatments of unruptured intracranial aneurysms (UIAs) is a serious health concern.ObjectiveThe aim of this study was to elucidate the incidence and characteristics of ischemic events in microsurgical clipping of anterior circulation UIAs.MethodsIschemic events were prospectively evaluated before and after surgery between April 2011 and March 2017. The location, volume, minimum value of apparent diffusion coefficient in high-intensity spots (HIS) on 3-T magnetic resonance diffusion-weighted imaging (DWI), and radiographic outcomes were analyzed. The relationships between DWI positivity and patient demographics, surgical procedures, and intraoperative vessel features were assessed.ResultsOverall, 78 consecutive patients including 29 men and 49 women (median age, 62 years; range, 24–77 years) with 99 UIAs were analyzed. A total of 10 in 78 craniotomies (13%) detected HIS on DWI, which were all asymptomatic. Seventeen HIS were shown, 5 of which were located in the basal ganglia, 6 in the white matter, and 6 in the cortex. The volume and minimum value of apparent diffusion coefficient were 180.4 ± 31.2 mm³ and 0.56 ± 0.03 × 10⁻³ mm²/second, respectively. Radiographic outcomes at follow-up showed that 71% of HIS on DWI led to irreversible brain ischemia. The maximum diameter of aneurysms, atherosclerotic features of the aneurysm wall, and procedure-related factors were associated with DWI positivity.ConclusionsThe asymptomatic ischemic risk associated with microsurgical clipping was not low and most lesions were irreversible. Although the mechanism could be various, the use of clips for atherosclerosis of the aneurysm and/or parental vessels requires much attention.



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Radiologic Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-Center Study

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): José L. Sanmillán, Alberto Torres-Diaz, Juan José Sanchez-Fernández, Ruth Lau, Cristina Ciller, Paloma Puyalto, Andreu Gabarrós
BackgroundPreoperative radiologic evaluation of pituitary adenomas is essential. Despite the efforts made to determine the achieved resection grade after pituitary adenoma surgery, there is a high level of disagreement among all the available classifications and measurement methods used. Our study aimed to determine pituitary adenoma imaging features, easily obtained from preoperative magnetic resonance, which could be used as resection predictor variables. Second, we analyzed the usefulness of the ellipsoid method in pituitary adenoma volume determination.MethodsTwo-hundred and ninety-four pituitary adenomas, which were surgically treated in our department, were retrospectively analyzed. Age, gender, surgical approach, hormonal status, greater tumor diameter, volume, cavernous sinus invasion, and extent of resection were evaluated.ResultsOne-hundred and forty-eight surgical procedures were conducted with a microsurgical transsphenoidal approach whereas 146 were conducted with an endoscopic endonasal approach. Gross total resection was achieved in 54.08% of cases. There were no significant differences in the extent of resection regarding the approach used, age, gender, or hormonal production by the tumor. Only Knosp grade (P < 0.001) and tumor volume (P < 0.05) had a statistically and independent significant relationship with the extent of resection. Furthermore, we found a high correlation between the calculated volume, using the ellipsoid method, and the volume measurement obtained with complex planimetry methods.ConclusionsPituitary adenoma volume and cavernous sinus invasion, graded with the Knosp scale, are 2 pituitary tumor features that, when used in combination, predict the complexity of the surgery and the difficulty of achieving gross total resection in pituitary adenoma surgery.



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Removable complete digital dentures: A workflow that integrates open technologies

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Lucio Lo Russo, Angelo Salamini
Digitalization of the design and manufacture of removable complete dentures has numerous advantages. The workflow as presented integrates current open digital technologies into a functional protocol, enabling complete dentures to be designed and fabricated without system-specific trays or instruments. This is done by using a conventional technique to acquire anatomic information.



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Impact of bacterial ice nucleating particles on weather predicted by a numerical weather prediction model

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Maher Sahyoun, Ulrik S. Korsholm, Jens H. Sørensen, Tina Šantl-Temkiv, Kai Finster, Ulrich Gosewinkel, Niels W. Nielsen
Bacterial ice-nucleating particles (INP) have the ability to facilitate ice nucleation from super-cooled cloud droplets at temperatures just below the melting point. Bacterial INP have been detected in cloud water, precipitation, and dry air, hence they may have an impact on weather and climate. In modeling studies, the potential impact of bacteria on ice nucleation and precipitation formation on global scale is still uncertain due to their small concentration compared to other types of INP, i.e. dust. Those earlier studies did not account for the yet undetected high concentration of nanoscale fragments of bacterial INP, which may be found free or attached to soil dust in the atmosphere. In this study, we investigate the sensitivity of modeled cloud ice, precipitation and global solar radiation in different weather scenarios to changes in the fraction of cloud droplets containing bacterial INP, regardless of their size. For this purpose, a module that calculates the probability of ice nucleation as a function of ice nucleation rate and bacterial INP fraction was developed and implemented in a numerical weather prediction model. The threshold value for the fraction of cloud droplets containing bacterial INP needed to produce a 1% increase in cloud ice was determined at 10⁻⁵ to 10⁻⁴. We also found that increasing this fraction causes a perturbation in the forecast, leading to significant differences in cloud ice and smaller differences in convective and total precipitation and in net solar radiation reaching the surface. These effects were most pronounced in local convective events. Our results show that bacterial INP can be considered as a trigger factor for precipitation, but not an enhancement factor.



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Isoprenoid emission variation of Norway spruce across a European latitudinal transect

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Ylva van Meeningen, Min Wang, Tomas Karlsson, Ana Seifert, Guy Schurgers, Riikka Rinnan, Thomas Holst
Norway spruce (Picea abies) is one of the dominant tree species in the European boreal zone with the capacity to grow over large areas within Europe. It is an important emitter of biogenic volatile organic compounds (BVOCs), which can act as precursors of photochemical smog and ozone and contribute to the formation and growth of secondary organic aerosols (SOA) in the atmosphere.Isoprenoid emissions were measured from Norway spruce trees at seven different sites, distributed from Ljubljana in Slovenia to Piikkiö in Finland. Four of the sites were part of a network of genetically identical spruce trees and contained two separate provenances. The remaining three sites were part of other networks which have been used to conduct studies in the European boreal zone.There were minimal differences in the standardized emission rates between sites and across latitudes. The emission profile differed between provenances and sites, but there were not any distinct patterns which could be connected to a change in latitude. By using genetically identical trees and comparing the emission rates between sites and with genetically different trees, it was observed that the emission patterns were mostly influenced by genetics. But in order to confirm this possible stability of the relative emission profile based on genetics, more studies need to be performed.The effects of branch height, season and variation between years on observed emission pattern variations were also investigated. There were indications of potential influences of all three factors. However, due to different experimental setups between measurement campaigns, it is difficult to draw any robust conclusions.



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Hip movement pathomechanics of patients with hip osteoarthritis aim at reducing hip joint loading on the osteoarthritic side

Publication date: January 2018
Source:Gait & Posture, Volume 59
Author(s): A.G. Meyer Christophe, Mariska Wesseling, Kristoff Corten, Angela Nieuwenhuys, Davide Monari, Jean-Pierre Simon, Ilse Jonkers, Kaat Desloovere
This study aims at defining gait pathomechanics in patients with hip osteoarthritis (OA) and their effect on hip joint loading by combining analyses of hip kinematics, kinetics and contact forces during gait. Twenty patients with hip OA and 17 healthy volunteers matched for age and BMI performed three-dimensional gait analysis. Hip OA level was evaluated based on plane radiographs using the Tönnis classification. Hip joint kinematics, kinetics as well as hip contact forces were calculated. Waveforms were time normalized and compared between groups using statistical parametric mapping analysis. Patients walked with reduced hip adduction angle and reduced hip abduction and external rotation moments. The work generated by the hip abductors during the stance phase of gait was largely decreased. These changes resulted in a decrease and a more vertical and anterior orientation of the hip contact forces compared to healthy controls. This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining.



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Plasticity of white matter connectivity in phonetics experts.

Related Articles

Plasticity of white matter connectivity in phonetics experts.

Brain Struct Funct. 2016 Sep;221(7):3825-33

Authors: Vandermosten M, Price CJ, Golestani N

Abstract
Phonetics experts are highly trained to analyze and transcribe speech, both with respect to faster changing, phonetic features, and to more slowly changing, prosodic features. Previously we reported that, compared to non-phoneticians, phoneticians had greater local brain volume in bilateral auditory cortices and the left pars opercularis of Broca's area, with training-related differences in the grey-matter volume of the left pars opercularis in the phoneticians group (Golestani et al. 2011). In the present study, we used diffusion MRI to examine white matter microstructure, indexed by fractional anisotropy, in (1) the long segment of arcuate fasciculus (AF_long), which is a well-known language tract that connects Broca's area, including left pars opercularis, to the temporal cortex, and in (2) the fibers arising from the auditory cortices. Most of these auditory fibers belong to three validated language tracts, namely to the AF_long, the posterior segment of the arcuate fasciculus and the middle longitudinal fasciculus. We found training-related differences in phoneticians in left AF_long, as well as group differences relative to non-experts in the auditory fibers (including the auditory fibers belonging to the left AF_long). Taken together, the results of both studies suggest that grey matter structural plasticity arising from phonetic transcription training in Broca's area is accompanied by changes to the white matter fibers connecting this very region to the temporal cortex. Our findings suggest expertise-related changes in white matter fibers connecting fronto-temporal functional hubs that are important for phonetic processing. Further studies can pursue this hypothesis by examining the dynamics of these expertise related grey and white matter changes as they arise during phonetic training.

PMID: 26386692 [PubMed - indexed for MEDLINE]

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Simulation-based education to ensure provider competency within the healthcare system

Abstract

The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic: "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on ''Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes,'' held on May 16, 2017, in Orlando, FL. Although simulation-based training is a quality and safety imperative in other high-reliability professions such as aviation, nuclear power, and the military, health care professions still lag behind in applying simulation more broadly. This is likely a result of a number of factors, including cost, assessment challenges, and resistance to change. This consensus subgroup focused on identifying current gaps in knowledge and process related to the use of simulation for developing, enhancing, maintaining individual provider competency. The resulting product is a research agenda informed by expert consensus and literature review.

This article is protected by copyright. All rights reserved.

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Chairside molecular imaging of aberrant glycosylation in subjects with suspicious oral lesions using fluorescently labeled wheat germ agglutinin

Abstract

Background

Aberrant sialylation is accepted as a carcinogenic biomarker. In previous work, fluorescently labeled wheat germ agglutinin (WGA) distinguished between cancerous and normal oral biopsies. The purpose of this study was to investigate WGA-fluorescein isothiocyanate (FITC) as a point-of-care tool for detecting oral malignant and dysplastic lesions in vivo.

Methods

Subject recruitment was divided into two groups: (1) the clinically normal oral mucosa group; or (2) the presence of clinically suspicious oral lesion(s) group. A WGA-FITC solution was topically applied to observable lesions or to half the subject's mouth (sagittal plane) if lesions were absent. Fluorescent molecular imaging was used to evaluate WGA-FITC localization.

Results

Fluorescent imaging in 55 subjects demonstrated that WGA-FITC could detect histopathologically-confirmed cancerous and dysplastic lesions with high sensitivity (100% and 81%, respectively) and specificity (82%).

Conclusion

This study supports in vivo fluorescent molecular imaging of WGA-FITC to visualize aberrant sialic acid expression associated with carcinogenesis. This technique resulted in the immediate chairside detection of oral cancerous and dysplastic lesions.

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Predictors of contralateral-bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Abstract

Background

Oropharyngeal squamous cell carcinoma (SCC) frequently presents with cervical metastasis. Roles of human papillomavirus (HPV) status, among other factors, on laterality are elusive.

Methods

The National Cancer Database was reviewed for oropharyngeal SCC diagnosed from 2010-2014. Predictors of clinically evident contralateral or bilateral nodal disease were identified.

Results

A total of 15 517 patients with oropharyngeal SCC met criteria. The majority was HPV-positive. Histologically poorly differentiated tumors were more frequent in the HPV-positive group (55.7% vs 37.6%; P < .001). By incidence, there was no statistical difference in contralateral or bilateral nodal disease between HPV-positive and HPV-negative patients (14.2% vs 14.5%, respectively; P = .769). On multivariable analysis, notable predictors of contralateral or bilateral nodal disease included HPV-positivity (odds ratio [OR] 1.26; 99% confidence interval [CI] 1.10-1.44), base of tongue (BOT) location (OR 2.15; 99% CI 1.88-2.45), poorly differentiated tumor (OR 1.72; 99% CI 1.20-2.46), and T4 classification (OR 6.65; 99% CI 5.34-8.28).

Conclusion

Patients with HPV-associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yzBs6z

Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer

Abstract

Background

The purpose of this study is to report the economic outcomes of a new synchronous telepractice service providing speech pathology intervention to patients with head and neck cancer at nonmetropolitan facilities.

Methods

A multisite randomized controlled trial comparing standard care versus a new synchronous telepractice model was conducted within a large Australian public cancer service. Data pertaining to health service costs (staff wages, equipment, and patient travel reimbursement), patient +/- carer costs (travel and wages), and patient-reported quality of life (Assessment of Quality of Life questionnaire 4D) were collected.

Results

Eighty-two referrals (39 standard care and 43 synchronous telepractice care) were managed. The new telepractice service reported average cost savings of 12% (P < .0058) for the health service and $40.05 saving per patient per referral. An equivalent positive increase in quality of life (0.04) was reported for both groups.

Conclusion

The synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.

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

Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer

Abstract

Background

This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF).

Methods

The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22-28 and 18-22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively.

Results

The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor-site aesthetic results were better.

Conclusion

The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique.

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

Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism

Abstract

Background

To prevent hypocalcemia, this study examined the efficiency of a calcium supplement formula guided by predicted calcium requirement in patients with renal failure after parathyroidectomy with autotransplantation.

Methods

In the first phase, a protocol was followed whereby intravenous calcium gluconate was repeatedly titrated based on serum calcium levels in 22 patients with parathyroidectomy with autotransplantation. In the second phase, the first equation protocol was applied in 74 patients with parathyroidectomy with autotransplantation and revised.

Results

There is a significant correlation between the postoperative amount of calcium requirement and preoperative serum alkaline phosphatase level (r = 0.442; P < .001) and parathyroid hormone level (PTH; r = 0.889; P < .001). For prediction of insufficient calcium supplement, the cutoff point of PTH and alkaline phosphatase level values were calculated by receiver operating characteristic (ROC) curve analysis and modified equations were developed by regression analysis.

Conclusion

The preoperative PTH and alkaline phosphatase levels can predict postoperative calcium requirements, such that equations of calcium supplement allow the management of hypocalcemia efficiently in patients on dialysis after parathyroidectomy with autotransplantation.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2fZ5t9c

Role of macrophage migration inhibitory factor in head and neck cancer and novel therapeutic targets: A systematic review

Abstract

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in systemic, autoimmune, and inflammatory diseases, such as obesity, rheumatoid arthritis, and systemic lupus erythematosus. For the 2 past decades, MIF has been reported to participate in carcinogenesis, disease prognosis, tumor cell proliferation, invasion, and tumor-induced angiogenesis in many cancers. The purpose of this article is to review published experimental and clinical data for MIF and its involvement in upper aerodigestive tract cancers. Based on the current literature, we propose a biomolecular model describing the mechanisms underlying the involvement of MIF in the initiation, progression, apoptosis, and proliferation of head and neck tumor cells. In reference to this model, potential therapeutic approaches based on the use of MIF antagonists and neutralizing antibodies are described. It is concluded that MIF is a promising target for future therapeutic strategies, both with and without chemoradiation strategies.

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