OtoRhinoLaryngology News: 10/29/17

Κυριακή 29 Οκτωβρίου 2017

A New Dimension in Hearing

An overview of Starkey's new Muse iQ, SoundLens Synergy iQ, and Halo iQ products that utilize the latest advanced signal processing, Acuity Immersion & Immersion Directionality, to focus on aspects of sound and hearing that contribute to the listener's spatial experience. The course will also introduce Starkey's latest 2.4 GHz accessory.

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The tympanic region of Otaria byronia (Otariidae, Carnivora) – morphology, ontogeny, age classes and dimorphism

Abstract

Here we describe and explore for the first time the ontogeny and sexual dimorphism of the auditory region of Otaria byronia. We studied the tympanic region of skulls of 237 specimens of different ages and sexes. Geometric morphometric methods were used to analyze the tympanic bulla. In addition, 3D reconstructions of the tympanic bulla were performed using computed tomography analysis scans and a serial wearing technique. We provide a description of the external and internal morphology of the tympanic bulla in both sexes and across different stages (bioclasses). The average shape of the bulla in O. byronia has a subtriangular contour, with variations between sexes and ages. Each stage (bioclasses I, II, and III) is characterized by the respective mean shape of the tympanic bulla and designated as a morphoclass (1, 2, and 3). In all cases, the ectotympanic shows greater surface area than the endotympanic, as in other otariids, in contrast to Phocidae. During ontogeny, the relative size of the ectotympanic increases, growing in all directions and covering the endotympanic. This pattern is seen to the greatest extent in adult males, in which the ectotympanic forms an extremely well-developed apophysis jugulare. No differences in internal morphology of the tympanic cavity were recorded between ages and sexes. The bulla does not increase in thickness in successive age classes; in fact, the walls are extremely thin in the adult stages, despite the extensive development of its processes. This pattern is opposite that observed in Phocidae. In morphoclass 3, adult males older than 7 years undergo hypermorphic change that results in a peramorphic condition when compared to adult females. These changes probably follow the same pattern shown by the rest of the skull and contribute to the marked sexual dimorphism of the species.

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Systematic analysis reveals a lncRNA-mRNA co-expression network associated with platinum resistance in high-grade serous ovarian cancer

Summary

Resistance to platinum-based chemotherapy is the major barrier to treating high-grade serous ovarian cancer (HGS-OvCa). To improve HGS-OvCa patient prognosis, it is critical to identify the underlying mechanisms that promote platinum resistance. The goal of the present study was to identify a lncRNA-mRNA co-expression network and key lncRNAs that predict resistance to platinum-based chemotherapy in ovarian cancer patients. By systematically analyzing the expression profiles of lncRNAs and mRNAs in HGS-OvCa samples from the Cancer Genome Atlas (TCGA), we revealed that lncRNAs play important roles in platinum resistance in HGS-OvCa patients and delineate a lncRNA-mRNA co-expression network in HGS-OvCa patients who exhibit platinum resistance. Within the platinum resistance-specific lncRNA-mRNA network, 35 lncRNAs and 270 mRNAs showed 124 significant lncRNA-mRNA co-expression relationships. Pathway analysis revealed that lncRNAs in the platinum resistance network may participate in platinum resistance by regulating metabolic pathways. Moreover, HGS-OvCa patients with low lncRNA RP5-1120P11.1 expression showed a poorer prognosis than those with high lncRNA RP5-1120P11.1 expression in TCGA dataset (P = 2.74 × 10⁻⁵, log rank test), which was also validated in the GSE63885 dataset (P = 0.0242, log rank test). Network and function analysis revealed that lncRNA RP5-1120P11.1 regulates many cancer-related signaling pathways, such as the PI3K-AKT signaling pathway (P = 1.02 × 10⁻⁵, hypergeometric test) and the Jak-STAT signaling pathway (P = 1.71 × 10⁻⁴, hypergeometric test). Particularly, lncRNA RP5-1120P11.1 expression is significantly positively correlated with ABCC10 gene expression (P = 3.89 × 10⁻³, Pearson correlation test). Both lncRNA RP5-1120P11.1 and ABCC10 were down-regulated in platinum-resistant HGS-OvCa patients, and RP5-1120P11.1 is located near ABCC10 on chromosome 6. Gene ABCC10 has been implicated in resistance to docetaxel treatment. The present study paves the way for investigating lncRNA functions in platinum drug resistance and identifying lncRNAs with prognostic and therapeutic potential in HGS-OvCa.

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Brain signal intensity changes as biomarkers in amyotrophic lateral sclerosis

Objectives

To evaluate the contribution of the demographical, clinical, analytical and genetic factors to brain signal intensity changes in T2-weighted MR images in amyotrophic lateral sclerosis (ALS) patients and controls.

Methods

Susceptibility-weighted and FLAIR sequences were obtained in a 3T MR scanner. Iron-related hypointensities in the motor cortex (IRhMC) and hyperintensities of the corticospinal tract (HCT) were qualitatively scored. Age, gender, family history and clinical variables were recorded. Baseline levels of ferritin were measured. C9orf72 was tested in all patients and SOD1 only in familial ALS patients not carrying a C9orf72 expansion. Patients who carried a mutation were categorized as genetic. Associations of these variables with visual scores were assessed with multivariable analysis.

Results

A total of 102 ALS patients (92 non-genetic and 10 genetic) and 48 controls (28 ALS mimics and 20 healthy controls) were recruited. In controls, IRhMC associated with age, but HCT did not. In ALS patients, both HTC and IRhMC strongly associated with clinical UMN impairment and bulbar onset. The intensity/extent of IRhMC in the different motor homunculus regions (lower limbs, upper limbs and bulbar) were linked to the symptoms onset site. Between genetic and sporadic patients, no difference in IRhMC and HCT was found.

Conclusions

IRhMC and HCT are reliable markers of UMN degeneration in ALS patients and are more frequent in bulbar onset patients, independently of the mutation status. Age should be considered when evaluating IRhMC. The regional measurement of IRhMC following the motor homunculus could be used as a measure of disease progression.

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Combining olfactory test and motion analysis sensors in Parkinson's disease preclinical diagnosis: a pilot study

Objectives

Preclinical diagnosis of Parkinson's disease (PD) is nowadays a topic of interest as the neuropathological process could begin years before the appearance of motor symptoms. Several symptoms, among them hyposmia, could precede motor features in PD. In the preclinical phase of PD, a subclinical reduction in motor skills is highly likely. In this pilot study, we investigate a step-by-step method to achieve preclinical PD diagnosis.

Material and methods

We used the IOIT (Italian Olfactory Identification Test) to screen a population of healthy subjects. We identified 20 subjects with idiopathic hyposmia. Hyposmic subjects underwent an evaluation of motor skills, at baseline and after 1 year, using motion analysis sensors previously created by us.

Results

One subject showed significant worsening in motor measurements. In this subject, we further conducted a dopaminergic challenge test monitored with the same sensors and, finally, he underwent [¹²³I]-FP/CIT (DaTscan) SPECT brain imaging. The results show that he is probably affected by preclinical PD.

Conclusions

Our pilot study suggests that the combined use of an olfactory test and motor sensors for motion analysis could be useful for a screening of healthy subjects to identify those at a high risk of developing PD.

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2. Do repeated limbic seizures induce depression-like behavior in rats?

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): W. McIntyre Burnham, Brian W. Scott
It has been reported that rapid kindling of the hippocampus produces lasting depression-like behavior in rats, as evidenced by increased immobility in the forced swim test and a loss of preference for sweetened water (Mazarati et al., 2007). This might suggest that repeated limbic seizure activity could be the cause of the depression often seen in patients with temporal lobe epilepsy.Sixty-day old male Wistar rats were implanted with electrodes in the amygdala and ventral hippocampus and kindled (or sham kindled) daily to a criterion of 10 stage 5 seizures. Two weeks later subjects were tested in the forced swim and sweet taste preference tests. No differences were found between the kindled and sham kindled animals.Subsequently, twenty-one day old male Wistar rat pups were implanted and quick kindled (or sham kindled) in the ventral hippocampus. Kindling was accomplished in a single day by stimulating every 5min for 84 stimulations. Four days or two weeks later they were tested in the forced swim and sweet taste preference tests. No differences were found between the kindled and sham kindled animals.The present data do not support the idea that repeated limbic seizures induce depression-like behavior in rats.

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Machine-based classification of ADHD and nonADHD participants using time/frequency features of event-related neuroelectric activity

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Hüseyin Öztoprak, Mehmet Toycan, Yaşar Kemal Alp, Orhan Arıkan, Elvin Doğutepe, Sirel Karakaş
ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is the most frequent diagnosis among children who are referred to psychiatry departments. Although ADHD was discovered at the beginning of the 20th century, its diagnosis is still confronted with many problems.MethodA novel classification approach that discriminates ADHD and nonADHD groups over the time-frequency domain features of event-related potential (ERP) recordings that are taken during Stroop task is presented. Time-Frequency Hermite-Atomizer (TFHA) technique is used for the extraction of high resolution time-frequency domain features that are highly localized in time-frequency domain. Based on an extensive investigation, Support Vector Machine-Recursive Feature Elimination (SVM-RFE) was used to obtain the best discriminating features.ResultsWhen the best three features were used, the classification accuracy for the training dataset reached 98%, and the use of five features further improved the accuracy to 99.5%. The accuracy was 100% for the testing dataset. Based on extensive experiments, the delta band emerged as the most contributing frequency band and statistical parameters emerged as the most contributing feature group.ConclusionThe classification performance of this study suggests that TFHA can be employed as an auxiliary component of the diagnostic and prognostic procedures for ADHD.SignificanceThe features obtained in this study can potentially contribute to the neuroelectrical understanding and clinical diagnosis of ADHD.

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Interindividual variability in response to continuous theta-burst stimulation in healthy adults

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Ali Jannati, Gabrielle Block, Lindsay M. Oberman, Alexander Rotenberg, Alvaro Pascual-Leone
ObjectiveWe used complete-linkage cluster analysis to identify healthy subpopulations with distinct responses to continuous theta-burst stimulation (cTBS).Methods21 healthy adults (age±SD, 36.9±15.2years) underwent cTBS of left motor cortex. Natural log-transformed motor evoked potentials (LnMEPs) at 5–50min post-cTBS (T5–T50) were calculated.ResultsTwo clusters were found; Group 1 (n=12) that showed significant MEP facilitation at T15, T20, and T50 (p's<0.006), and Group 2 (n=9) that showed significant suppression at T5–T15 (p's<0.022). LnMEPs at T10 and T40 were best predictors of, and together accounted for 80% of, cluster assignment.In an exploratory analysis, we examined the roles of brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) polymorphisms in the cTBS response. Val66Met participants showed greater facilitation at T10 than Val66Val participants (p=0.025). BDNF and cTBS intensity predicted 59% of interindividual variability in LnMEP at T10. APOE did not significantly affect LnMEPs at any time point (p's>0.32).ConclusionsData-driven cluster analysis can identify healthy subpopulations with distinct cTBS responses. T10 and T40 LnMEPs were best predictors of cluster assignment. T10 LnMEP was influenced by BDNF polymorphism and cTBS intensity.SignificanceHealthy adults can be sorted into subpopulations with distinct cTBS responses that are influenced by genetics.

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Effect of local cooling on excitation-contraction coupling in myasthenic muscle: Another mechanism of ice-pack test in myasthenia gravis

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Daisuke Yamamoto, Tomihiro Imai, Emiko Tsuda, Takayoshi Hozuki, Rika Yamauchi, Shin Hisahara, Jun Kawamata, Shun Shimohama
ObjectiveThe ice-pack test is a convenient diagnostic testing procedure for myasthenia gravis (MG). We investigated the underlying mechanism of the ice-pack test performed on bilateral masseters.MethodsWe performed trigeminal repetitive nerve stimulation (RNS), excitation-contraction (E-C) coupling assessment (Imai's method) and bite force measurement before and after cooling of the masseters in MG patients and normal controls. After placing the ice-pack on the masseters for 3min, serial recordings of the three tests were performed at various time intervals during 10min after cooling.ResultsThe bite force increased significantly after cooling in ice-pack-positive MG patients. The acceleration and acceleration ratio (acceleration at a given time to baseline acceleration) of jaw movement increased significantly after cooling of the masseters in ice-pack-positive MG patients compared to ice-pack-negative patients and normal controls. The prolonged effect of cooling continued until the end of recording even though decremental response to RNS had returned to baseline value.ConclusionsCooling of myasthenic muscle may induce two effects. One is relatively short effect on electrical synaptic transmission at the endplate, and another is prolonged effect on E-C coupling in the muscle.SignificanceThe ice-pack test induces a prolonged effect of ameliorating impaired E-C coupling in MG.

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Reduced motor cortical inhibition in migraine: A blinded transcranial magnetic stimulation study

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): J.P. Neverdahl, P.M. Omland, M. Uglem, M. Engstrøm, T. Sand
ObjectiveTo investigate motor cortical excitability, inhibition, and facilitation with navigated transcranial magnetic stimulation (TMS) in migraine in a blinded cross-sectional study.MethodsResting motor threshold (RMT), cortical silent period (CSP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were compared in 27 interictal migraineurs and 33 controls. 24 female interictal migraineurs and 27 female controls were compared in subgroup analyses. Seven preictal migraineurs were also compared to the interictal group in a hypothesis-generating analysis. Investigators were blinded for diagnosis during recording and analysis of data.ResultsSICI was decreased in interictal migraineurs when compared to healthy controls (p=0.013), CSP was shortened in female interictal migraineurs (p=0.041). ICF was decreased in preictal compared to interictal migraineurs (p=0.023). RMT and ICF were not different between interictal migraineurs and controls.ConclusionCortical inhibition was decreased in migraineurs between attacks, primarily in a female subgroup, indicating an importance of altered cortical inhibition in migraine.SignificancePrevious studies on motor cortical excitability in migraineurs have yielded varying results. This relatively large and blinded study provides support for altered cortical inhibition in migraine. Measuring intracortical facilitation in the period preceding migraine attacks may be of interest for future studies.

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Intermittent theta-burst stimulation induces correlated changes in cortical and corticospinal excitability in healthy older subjects

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Tamara Gedankien, Peter J. Fried, Alvaro Pascual-Leone, Mouhsin M. Shafi
ObjectiveWe studied the correlation between motor evoked potentials (MEPs) and early TMS-evoked EEG potentials (TEPs) from single-pulse TMS before and after intermittent Theta Burst Stimulation (iTBS) to the left primary motor cortex (M1) in 17 healthy older participants.MethodsTMS was targeted to the hand region of M1 using a MRI-guided navigated brain stimulation system and a figure-of-eight biphasic coil. MEPs were recorded from the right first dorsal interosseous muscle using surface EMG. TEPs were extracted from a 61-channel EEG recording. Participants received 90 single TMS pulses at 120% of resting motor threshold before and after iTBS.ResultsAcross all participants, the change in N15-P30 TEP and MEP amplitudes were significantly correlated (r=0.69; p<0.01). Average TEP responses did not change significantly after iTBS, whereas MEP amplitudes showed a significant increase.ConclusionsChanges in corticospinal reactivity and cortical reactivity induced by iTBS are related. However, the effect of iTBS on TEPs, unlike MEPs, is not straightforward.SignificanceOur findings help elucidate the relationship between changes in cortical and corticospinal excitability in healthy older individuals. Going forward, TEPs may be used to evaluate the effects of theta-burst stimulation in non-motor brain regions.

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Corticomuscular coherence in the acute and subacute phase after stroke

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Lisbeth Hoejkjaer Larsen, Ivan Chrilles Zibrandtsen, Troels Wienecke, Troels Wesenberg Kjaer, Mark Schram Christensen, Jens Bo Nielsen, Henning Langberg
ObjectiveStroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke.MethodsWe examined 19 patients with clinically diagnosed stroke and 18 controls. The patients had unilateral mild to moderate weakness of the hand. Each patient attended two sessions at approximately 3days (acute) and 38days post stroke (subacute). Task-related changes in the communication between motor cortex and muscles were evaluated from coupling in the frequency domain between EEG and EMG during movement of the paretic hand.ResultsCorticomuscular coherence (CMC) and intermuscular coherence (IMC) were reduced in patients as compared to controls. Paretic hand motor performance improved within 4–6weeks after stroke, but no change was observed in CMC or IMC.ConclusionsCMC and IMC were reduced in patients in the early phase after stroke. However, changes in coherence do not appear to be an efficient marker for early recovery of hand function following stroke.SignificanceThis is the first study to demonstrate sustained reduced coherence in acute and subacute stroke.

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Editorial Board

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11

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4. Prevention of trauma-induced epileptogenesis in mice via manipulation of the network excitability

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): S. Soltani, J. Seigneur, S. Chauvette, I. Timofeev
A large proportion of patients with severe brain damage become epileptic several months to years after the trauma. The mechanisms leading to the development of epilepsy (epileptogenesis) are unknown. We hypothesize that brain damage leads to partial deafferentation and a drop in excitability of the affected area. To compensate, the brain employs a variety of mechanisms to restore this drop of excitability and if not properly controlled, this leads to epilepsy. We performed undercut in the somatosensory area in adult C57/BL6 mice and implanted LFP and EMG electrodes for continuous electrographic recordings for at least two months. We proposed to manipulate (increase or decrease) network activities in order to prevent/enhance epileptogenesis applying DREADD technology. Target cortical regions were injected with AAV-hM3D(Gq) or AAV-hM4D(Gi). Activation of the designed receptor in infected neurons was achieved by clozapine-N-oxide continuously injected via an osmotic pump. Activation of hM3D(Gq) leads to depolarization and increased firing in infected neurons, while the activation of hM4D(Gi) induces a hyperpolarization of neurons. If our hypothesis is true, we expect to obtain epileptogenesis in adult mice without DREADD manipulations, either abolition or strong reduction of epileptogenesis in hM3D(Gq) mice, and increased epileptogenesis symptoms in hM4D(Gi) mice. In the following weeks all adult mice without DREADD manipulations revealed recurrent seizure activities. Mice in which hM4D(Gi) was activated revealed earlier and more severe seizures. Mice with hM3D(Gq) activation did not reveal paroxysmal activities. These results will lead to the development of new preventive treatments of epileptogenesis induced by brain damage.Supported by CIHR and NSERC.

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Electrical impedance myography changes after incomplete cervical spinal cord injury: An examination of hand muscles

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Le Li, Henry Shin, Argyrios Stampas, Xiaoyan Li, Ping Zhou
ObjectiveThis study was to apply the newly developed electrical impedance myography (EIM) technique to examine hand muscles in patients with an incomplete cervical spinal cord injury (SCI).MethodsEIM was performed on the thenar, hypothenar, and first dorsal interosseous (FDI) muscles of SCI (n=16) and age-matched healthy control (n=18) subjects. By sending low intensity and high frequency current through the skin and measuring the consequent voltage, EIM estimates the major impedance parameters, which include resistance (R), reactance (X) and phase angle (θ).ResultsThe SCI group had lower reactance and phase angle (p<0.0001) as compared to the control group in all three muscles, and lower resistance in the thenar muscle (p<0.05). The SCI group also demonstrated a smaller anisotropy in resistance (p<0.0001) and larger anisotropy in phase angle (p<0.05) compared to those from healthy controls.ConclusionThe reduced reactance and phase angle of paralyzed muscles could be due tochanges of membrane integrity and fat infiltration, whereas the change in the anisotropy may reflect the rearrangement of muscle fiber geometry.SignificanceThe EIM provides a quick and convenient tool for examination of muscle alterations after SCI.

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Plasticity induced by non-invasive transcranial brain stimulation: A position paper

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Ying-Zu Huang, Ming-Kue Lu, Andrea Antal, Joseph Classen, Michael Nitsche, Ulf Ziemann, Michael Ridding, Masashi Hamada, Yoshikazu Ugawa, Shapour Jaberzadeh, Antonio Suppa, Walter Paulus, John Rothwell
Several techniques and protocols of non-invasive transcranial brain stimulation (NIBS), including transcranial magnetic and electrical stimuli, have been developed in the past decades. Non-invasive transcranial brain stimulation may modulate cortical excitability outlasting the period of non-invasive transcranial brain stimulation itself from several minutes to more than one hour. Quite a few lines of evidence, including pharmacological, physiological and behavioral studies in humans and animals, suggest that the effects of non-invasive transcranial brain stimulation are produced through effects on synaptic plasticity. However, there is still a need for more direct and conclusive evidence. The fragility and variability of the effects are the major challenges that non-invasive transcranial brain stimulation currently faces. A variety of factors, including biological variation, measurement reproducibility and the neuronal state of the stimulated area, which can be affected by factors such as past and present physical activity, may influence the response to non-invasive transcranial brain stimulation. Work is ongoing to test whether the reliability and consistency of non-invasive transcranial brain stimulation can be improved by controlling or monitoring neuronal state and by optimizing the protocol and timing of stimulation.

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After-effects of transcranial alternating current stimulation on evoked delta and theta power

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Miles Wischnewski, Dennis J.L.G. Schutter
ObjectivePhase synchronization is suggested to be among the mechanisms that can explain the effects of transcranial alternating current stimulation (tACS). However, little is known about the effects of tACS on event-related oscillatory activity. Therefore the objective was to investigate frequency-related effects of frontal tACS on event-related oscillatory power.MethodsIn a double blind randomized controlled cross-over design, twenty-four participants received 12min of delta (2.5Hz), theta tACS (5Hz) and sham tACS at an intensity of 1mA peak-to-peak. Event-related delta- and theta-related oscillatory activity was recorded to reward- and punishment-related feedback signals.ResultsDelta tACS decreased feedback-related oscillatory power in the 1.5 and 3.5Hz frequency range. This effect was driven by power changes below the tACS frequency stimulation.ConclusionExogenous field potentials can attenuate event-related oscillatory activity in a rhythm slightly below the stimulation frequency. Our findings suggest an interaction between tACS and event-related rhythmic activity that extends beyond phase synchronization.SignificanceThese findings add novel insights into the mechanisms of tACS after-effects.

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1. Across all the seven seas: Fifty years in neurology, EEG and epilepsies

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Paul Hwang
Since the 1960s, major neuroscience advances have facilitated the development of new antiepilepsy drugs (AEDs) targeting specific neurotransmitter-receptor systems, particularly the GABAergic, the NMDA-receptors and voltage-gated ion channels. In addition to the classical AEDs, carbamazepine and cogeners act at the voltage-gates sodium channels, while ethosuxumide acts at the calcium channel, improving the treatment of partial and generalized seizures. But approximately 30% of partial complex seizures remain refractory to AEDs, leading to novel AEDs: levetiracetam, tiagabine, lacosamide, perampanel and others. The pharmacoresistant epilepsies are typically dyscognitive partial-onset, arising from limbic structures of mesial temporal lobes, better visualised by improved neuroimaging methods eg. MRI and PET. Together with invasive intracranial monitoring in specialized units with long-term recording of multichannelled EEG and videorecording of behaviour, the localization of the seizure-onset zone has allowed targeted excision of the epileptogenic tissue for better outcome.Functional neurosurgical methods include vagal nerve stimulation and deep brain stimulation of selected targets in affected circuits, mapped by new EEG criteria including gamma rhythm, HFOs, ripples and clusters. Novel intervention in refractory epilepsies include the ketogenic diet and variants, neurosteroids, hormones eg. progestins and ACTH. A number of genetic mutations and copy number variants have been linked to epilepsies. It remains to be seen how expanded knowledge of the genetic bases of the epilepsies and epileptic encephalopathies leads to new intervention improving long-term prognosis and quality of life in persons afflicted with this ancient curse of the human condition, 'The Falling Sickness' also known as 'The Sacred Disease' (Hippocrates).In the words of Sir William Osler: 'He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all' ('Aequanimitas' by Osler), quoted in Herbert Ho Ping Kong, 'The Art of Medicine: Healing and the Limits of Technology' (ECW Press, 2014 Toronto).

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3. Asymmetric hypsarrythmia: An insight into the pathophysiology of infantile spasms. A retrospective cohort

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): B. Desnous, M. Arbour, H.S. Nguyen, A. Lortie, D. Chartrand, E. Rossignol, P. Diadori, P. Major, L. Carmant, A. Birca
Infantile spasms (IS) is a catastrophic epilepsy where treatment precocity improves outcome. Previous studies demonstrated an association between asymmetric hypsarrhythmia on EEG and ipsilateral hemispheric lesions on MRI, suggesting a possible role of cortical lesions in the initiation of IS. Epileptiform abnormalities appearing during early infancy have also been linked to IS emergence. We hypothesized that focal lateralized EEG abnormalities during the prehyspasrrhythmic period will be associated with asymmetric hypsarrhythmia at IS onset.We recruited a retrospective cohort of 80 infants, 7.4±3.6months old at the onset of hypsarrhythmia and IS, admitted to Sainte-Justine Hospital between 2007 and 2016. Seven infants showed an asymmetric hypsarrhythmia pattern and, as expected, all of them had lateralized lesions on MRI. Of the remaining 73, 42 had abnormal MRI, but only 3 infants had lateralized lesions (100% vs 7.1%, p<0.01). Thirty-four patients had pre-hypsarrhythmic EEG recordings at the age of 4.6±2.6months, 3±2months before IS onset, including four infants with asymmetric hypsarrhythmia. Five infants had no pre-hypsarrhythmic epileptiform abnormalities.Six had focal lateralized, while 23 multifocal abnormalities. The proportion of patients with focal abnormalities was higher in those who developed asymmetric compared to symmetric hypsarrhythmia (50% vs 13.3%, p<0.05).Our data confirm the link between asymmetric hypsarrhythmia and lateralized MRI lesions. Moreover, we show that focal lateralized EEG abnormalities precede asymmetric hypsarrythmia, which supports the involvement of cerebral cortex in the IS genesis. More sensitive EEG biomarkers of high IS risk may help developing preventative treatments that will improve outcomes in IS.

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Neural network topology in ADHD; evidence for maturational delay and default-mode network alterations

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): T.W.P. Janssen, A. Hillebrand, A. Gouw, K. Geladé, R. Van Mourik, A. Maras, J. Oosterlaan
ObjectiveAttention-deficit/hyperactivity disorder (ADHD) has been associated with widespread brain abnormalities in white and grey matter, affecting not only local, but global functional networks as well. In this study, we explored these functional networks using source-reconstructed electroencephalography in ADHD and typically developing (TD) children. We expected evidence for maturational delay, with underlying abnormalities in the default mode network.MethodsElectroencephalograms were recorded in ADHD (n=42) and TD (n=43) during rest, and functional connectivity (phase lag index) and graph (minimum spanning tree) parameters were derived. Dependent variables were global and local network metrics in theta, alpha and beta bands.ResultsWe found evidence for a more centralized functional network in ADHD compared to TD children, with decreased diameter in the alpha band (ηp²=0.06) and increased leaf fraction (ηp²=0.11 and 0.08) in the alpha and beta bands, with underlying abnormalities in hub regions of the brain, including default mode network.ConclusionsThe finding of a more centralized network is in line with maturational delay models of ADHD and should be replicated in longitudinal designs.SignificanceThis study contributes to the literature by combining high temporal and spatial resolution to construct EEG network topology, and associates maturational-delay and default-mode interference hypotheses of ADHD.

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5. Epilepsy and EEG activity in early-onset Alzheimer’s disease

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Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Ángela Milán-Tomás, Paul Hwang
ObjectiveThe aim of this review was to evaluate and summarize the current literature regarding the incidence and features of epileptic seizures in early onset Alzheimer's disease (AD) as well as its epileptiform characteristics as described by electroencephalography (EEG).BackgroundThe incidence of epilepsy in AD is higher than in the general population, although the true prevalence of seizures has remained unclear due to methodological problems detecting these events in a cognitively impaired population.Design/MethodsA literature search using Medline with PubMed and EMBASE was carried out identifying papers published focusing on EEG and epilepsy in early-onset Alzheimer's disease (EOAD). A total of 767 abstracts were obtained, 55 full publications were screened and references were checked for additional material where appropriate.ResultsOnly 20 studies included EEG data regarding epilepsy in Alzheimer's disease of which 11 were animal models. AD due to amyloid precursor protein (APP) mutations has been described as one of the most common early-onset AD forms presenting with epileptic seizures. Neurodegeneration of the hippocampal region causing aberrant excitatory neuronal activity is the most accepted hypothesis for the occurrence of epilepsy in AD.ConclusionsThere is a need for better methodological studies addressing the role of EEG in the diagnosis and characterization of seizures in AD. Subclinical epileptiform activity may lead to a faster decline in cognition and they occur more often during sleep stages, therefore a prolonged sleep EEG can be an effective diagnostic tool for detecting this activity.

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Obituary for Professor Hugo L. Obwegeser

One of the most comprehensive, influential, and illustrious careers in the history of oral and maxillofacial surgery came to conclusion on September 2, 2017, with the death of Hugo L. Obwegeser, in Zurich. Professor Obwegeser had been in deteriorating health for most of the year, and succumbed to respiratory complications some six weeks short of his 97th birthday.

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Announcements

Dear Colleagues,

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EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Editorial Board

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Curiethérapie prostatique de rattrapage : solution pour les rechutes localisées après irradiation ?

Publication date: Available online 28 October 2017
Source:Cancer/Radiothérapie
Author(s): J.-M. Cosset, G. Créhange

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Curiethérapie prostatique de rattrapage : solution pour les rechutes localisées après irradiation ?

Immediate chest wall reconstruction using an external oblique myocutaneous flap for large skin defects after mastectomy in advanced or recurrent breast cancer patients: A single center experience

Background and Objectives

We report 75 single-stage chest-wall reconstructions using ipsilateral external oblique myocutaneous flap (EOMCF) to cover the extensive skin defects following resection of advanced or recurrent breast tumours at the Pusan National University Hospital.

Methods

Between January 2007 and October 2015, 75 women with advanced or recurred breast cancer who underwent extensive mastectomy with immediate chest wall reconstruction using EOMCF were reviewed retrospectively.

Results

Mean age was 50.5 ± 9.8 years and mean follow-up period was 36.7 ± 25.1 months. A total of 59 patients (78.7%) had stage III disease and the remaining 16 patients (21.3%) had stage IV. Mean excised breast tissue weight was 687.6 ± 416.5 g (range, 120.3-2797.1 g). The mean chest wall skin defect covered with an EOMCF was 228.3 ± 168.1 cm² and corresponded to an approximately 15 × 15 cm defect. Average operative time for reconstruction was <2 h. There were no major complications such as flap loss, full thickness skin necrosis, or surgical site infections. With respect to loco-regional recurrence, nine patients (12%) experienced recurrence. Among the 59 non-stage IV patients, loco-regional relapse occurred in five patients (8.5%).

Conclusions

EOMCF can effectively cover large chest wall defects with a few minor complications and reliable local disease control.

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Does the Pringle maneuver affect survival and recurrence following surgical resection for hepatocellular carcinoma? A western series of 441 patients

Background

The impact of the Pringle maneuver (PM) on long-term outcome after curative resection for hepatocellular carcinoma (HCC) is controversial, with eastern series reporting conflicting results. We aim to evaluate the impact of the PM in a western cohort.

Methods

We retrospectively analyzed patients with HCC who underwent liver resection between January 2001 and August 2015. Patients were divided in two groups based the use of the PM during resection. Primary outcomes were overall survival (OS) and disease-free survival (DFS).

Results

A total of 441 patients were analyzed. Of these, 176 patients (39.9%) underwent PM. Median OS was 46.4 months (95%CI: 34.1-58.7) for the PM group and 56.5 months (95%CI: 37.1-75.9) for the no-PM group (P = 0.188), with a median DFS of 26.7 months (95%CI: 15.7-37.7) and 24.9 months (95%CI: 18.1-31.7), respectively (P = 0.883).

Conclusions

These results suggest that PM does not increase the risk of tumor recurrence or decrease long-term survival.

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Utilization of Indocyanine green to demonstrate lymphatic mapping in colon cancer

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Long-term outcomes of cement in cement technique for revision endoprosthesis surgery

Background and Objective

Cemented endoprosthetic reconstruction after resection of primary bone sarcomas has been a standard-of-care option for decades. With increased patient survival, the incidence of failed endoprostheses requiring revision surgery has increased. Revision of cemented endoprotheses by cementing into the existing cement mantle (CiC) is technically demanding.

Methods

This is a retrospective review of our endoprosthesis database of 512 consecutive cemented endoprosthetic reconstructions performed for oncologic diagnoses between 1980 and 2014. A total of 54 implants (mean patient age 32 years, range 13-81) were revised with a CiC technique. Outcomes evaluated were prosthesis survival, revision surgery categorized according to the Henderson Failure Mode Classification, complications, and functional scores.

Results

Fifteen-year Kaplan-Meier survival rate was 34% for initial revision and 39% for subsequent revision implants. Mean revised Musculoskeletal Tumor Society (MSTS) Score was 27 at latest follow-up. Infection rate was 2%, 9%, and 13% for primary endoprostheses, initial revisions, and subsequent revisions, respectively. Limb salvage rate was 87%.

Conclusions

At long-term follow up, endoprostheses revised with the CiC technique showed consistent 15-year survival from initial (34%) to subsequent (39%) revision. Despite a relatively high failure rate, these results are encouraging and demonstrate that this is a conservative, repeatable technique.

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Minimally invasive surgery and enhanced recovery after surgery: The ideal combination?

Enhanced recovery after surgery (ERAS) and minimally invasive surgery are both in the limelight due to their potential positive effects on surgical outcome. Large randomized trials and meta-analyses validated the use of both, laparoscopy and ERAS protocol, as individual measures. A synergistic effect of both entities might contribute to even better outcomes. This review hence assessed the literature upon up-to-date studies combining both methods.

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EMCrit Podcast 211 – Expertise with Anders Ericsson

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Expertise & Deliberate Practice with Anders Ericsson and @resuspadawan

EMCrit by Scott Weingart.

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Acknowledgment to Reviewers

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Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry

Publication date: Available online 28 October 2017
Source:Brachytherapy
Author(s): Prashant Gabani, Amy E. Cyr, Jacqueline E. Zoberi, Laura L. Ochoa, Melissa A. Matesa, Maria A. Thomas, Jose Garcia, Julie A. Margenthaler, Michael J. Naughton, Cynthia Ma, Souzan Sanati, Imran Zoberi
PurposeLong-term outcome reports of accelerated partial-breast irradiation (APBI) are limited. Here, we report the 10-year outcomes of APBI delivered using multicatheter interstitial implant (ISI) brachytherapy.Methods and materialsPatients with early-stage breast cancer treated with APBI via ISI brachytherapy were enrolled in a prospective registry. Selection criteria included age ≥40 years, ductal carcinoma in situ or invasive tumor ≤3 cm, negative margins (≥2 mm), and negative axillary nodes. 34 Gy in 10 twice-daily fractions was administered to 2 cm of breast tissue surrounding the surgical bed. Toxicity and cosmetic outcomes were collected prospectively.ResultsA total of 175 patients were included. The median followup time was 10.0 years. Ten-year ipsilateral breast tumor control, regional control, freedom from distant metastasis, breast cancer–specific survival, and overall survival were 92.1%, 96.9%, 97.4%, 97.1%, and 81.2%, respectively. High-grade disease was correlated with increase in the rate of ipsilateral breast tumor recurrence. Grade 1 or 2 skin toxicity was present in 44 patients, and Grade 3 skin toxicity was present in only 1 patient. There were no Grade 4 or higher toxicities observed. Thirty-seven patients developed fat necrosis. Dose Homogeneity Index of ≤0.85 and integrated reference air-kerma of >3400 cGycm²/h correlated with higher rates of fat necrosis. There were 115 (66%), 51 (29%), 8 (5%), and 0 (0%) patients having excellent, good, fair, and poor cosmetic outcomes, respectively.ConclusionsAPBI using ISI brachytherapy offers excellent clinical outcomes in appropriately selected patients with excellent cosmetic outcomes and low rates of toxicities such as symptomatic fat necrosis.

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Long-term evaluation of urinary, sexual, and quality of life outcomes after brachytherapy for penile carcinoma

Publication date: Available online 28 October 2017
Source:Brachytherapy
Author(s): Dimitri Gambachidze, Cédric Lebacle, Pierre Maroun, Alexandre Escande, Alberto Bossi, Pierre Blanchard, Eric Deutsch, Christine Haie-Meder, Cyrus Chargari
PurposeBrachytherapy (BT) is an effective organ-preserving treatment for selected localized penile carcinoma, providing high local control rates. Long-term functional results however, are still insufficiently evaluated.Methods and MaterialsAll consecutive patients treated with low-dose-rate or pulse-dose-rate BT in our institute for a localized penile cancer and who were in first complete remission and followed for at least 3 years were included. A self-reporting questionnaire was sent, to assess: 1/urinary function, 2/sexual function, 3/cosmetic aspect of the penis, and 4/quality of life.ResultsThirty-nine patients fulfilled inclusion criteria and were sent the questionnaire. Twenty-three patients (59%) answered. Median age was 63.4 years, (interquartile range [IR]: 49.7–67.0). Median followup was 5.9 years (IR: 5.2–6.7). The urinary scores showed moderate lower urinary tract symptoms. During the followup, a urethral dilation or self-catheterization had been necessary in 30% and 13%, respectively. Sixteen (70%) patients continued to maintain a sexual activity and the erectile dysfunction was mild. Finally, quality of life was good with a median score of 80/100 (IR = 65–90) and was only impacted by pain (p = 0.02). Overall, 57% and 39% declared having none or moderate pain/discomfort, respectively.ConclusionsAlthough this questionnaire needs to be validated in an independent cohort, our results show the moderate impact of BT on functional outcomes, confirming that it is an adequate first-intent organ-sparing strategy in patients with localized penile carcinoma.

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Tanner–Whitehouse Skeletal Ages in Male Youth Soccer Players: TW2 or TW3?

Abstract

Background

The Tanner–Whitehouse radius-ulna-short bone protocol (TW2 RUS) for the assessment of skeletal age (SA) is widely used to estimate the biological (skeletal) maturity status of children and adolescents. The scale for converting TW RUS ratings to an SA has been revised (TW3 RUS) and has implications for studies of youth athletes in age-group sports.

Objectives

The aim of this study was to compare TW2 and TW3 RUS SAs in an international sample of male youth soccer players and to compare distributions of players by maturity status defined by each SA protocol.

Methods

SA assessments with the TW RUS method were collated for 1831 male soccer players aged 11–17 years from eight countries. RUS scores were converted to TW2 and TW3 SAs using the appropriate tables. SAs were related to chronological age (CA) in individual athletes and compared by CA groups. The difference of SA minus CA with TW2 SA and with TW3 SA was used to classify players as late, average, or early maturing with each method. Concordance of maturity classifications was evaluated with Cohen's Kappa coefficients.

Results

For the same RUS score, TW3 SAs were systematically and substantially reduced compared with TW2 SAs; mean differences by CA group ranged from − 0.97 to − 1.16 years. Kappa coefficients indicated at best fair concordance of TW2 and TW3 maturity classifications. Across the age range, 42% of players classified as average with TW2 SA were classified as late with TW3 SA, and 64% of players classified as early with TW2 SA were classified as average with TW3 SA.

Conclusion

TW3 SAs were systematically lower than corresponding TW2 SAs in male youth soccer players. The differences between scales have major implications for the classification of players by maturity status, which is central to some talent development programs.

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Talent Identification in Sport: A Systematic Review

Abstract

Background

Talent identification (TID) programs are an integral part of the selection process for elite-level athletes. While many sport organizations utilize TID programs, there does not seem to be a clear set of variables that consistently predict future success.

Objective

This review aims to synthesize longitudinal and retrospective studies examining differences between performance variables in highly skilled and less-skilled athletes in elite-level sport.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies (N = 20).

Results

There was a clear overrepresentation of studies that (1) examined physical profiles of athletes (60%); (2) focused on male samples (65%); (3) examined athletes between the ages of 10 and 20 years (60%); and (4) were published between the years 2010 and 2015 (65%). On closer examination, there was a high degree of variability in the factors that were found to discriminate between skilled and less-skilled individuals.

Conclusion

Findings from this review highlight how little is known about TID in elite sport and emphasize the need for greater diversity in TID research.

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Safety and Efficacy of the New Micromesh-Covered Stent CGuard in Patients Undergoing Carotid Artery Stenting: Early Experience From a Single Centre

Publication date: Available online 28 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Renato Casana, Valerio Tolva, Andrea Odero, Chiara Malloggi, Aldo Paolucci, Fabio Triulzi, Vincenzo Silani
Objective/BackgroundPlaque protrusion through stent struts represents one of the principal causes of cerebral embolisation during carotid artery stenting (CAS) and the stent healing period. The aim of this study was to evaluate the safety (technical success) and efficacy (clinical success) of the CGuard stent system – a new nitinol stent covered by a closed-cell polyethylene terephthalate mesh designed to prevent embolic events.MethodsEighty-two consecutive patients who underwent CAS with CGuard from June 2015 were included in this study. The same surgeon performed all procedures. Primary endpoints included technical and clinical success. Clinical success was considered to be absence of death, major or minor stroke. The incidence of new ischaemic brain lesions was also evaluated by diffusion weighted magnetic resonance imaging (DW-MRI) in a subgroup of patients as a secondary endpoint.ResultsIn this study, 82 patients (73.8 ± 8.5 years, 75% male, 19% symptomatic) underwent CAS procedures. Immediate technical success was 100%, with the stenosis diameter reduced from 81.4 ± 4.9% to 11.0 ± 3.5%. There was peri-operative technical and clinical success in 100% of symptomatic patients, and in 98.5% of asymptomatic patients, because of the occurrence of one acute stent thrombosis 4 hours post-CAS followed by a minor stroke. In the post-operative period (30 days), no new events were registered. The most recent 21 patients (24%) underwent DW-MRI in the peri-operative period: new ischaemic brain lesions were recorded in 23.8% of patients and the average lesion volume per patients was 0.039 ± 0.025 cm³.ConclusionsThe technical and clinical outcomes of this single centre study suggest that the CGuard may be a safe and effective device for endovascular treatment of symptomatic and asymptomatic subjects, independent of aortic arch anatomy. Further larger comparative studies are needed to confirm these benefits.

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Occurrence and Classification of Proximal Type I Endoleaks After EndoVascular Aneurysm Sealing Using the Nellix™ Device

Publication date: Available online 28 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Leo H. van den Ham, Andrew Holden, Janis Savlovskis, Andrew Witterbottom, Kenneth Ouriel, Michel M.P.J. Reijnen
Objective/BackgroundProximal type I endoleaks are associated with abdominal aortic aneurysm (AAA) growth and rupture and necessitate repair. The Nellix™ EndoVascular Aneurysm Sealing (EVAS) system is a unique approach to AAA repair, where the appearance and treatment of endoleaks is also different. This study aimed to analyse and categorise proximal endoleaks in an EVAS treated cohort.MethodsAll patients, treated from February 2013 to December 2015, in 15 experienced EVAS centres, presenting with proximal endoleak were included. Computed tomography scans were analysed by a core laboratory. A consensus meeting was organised to discuss and qualify each case for selection, technical aspects, and possible causes of the endoleak. Endoleaks were classified using a novel classification system for EVAS.ResultsDuring the study period 1851 patients were treated using EVAS at 15 centres and followed for a median of 494 ± 283 days. Among these, 58 cases (3.1%) developed a proximal endoleak (1.5% early and 1.7% late); of these, 84% of 58 patients were treated outside the original and 96% outside the current, refined, instructions for use. Low stent positioning was the most likely cause in 44.6%, a hostile anatomy in 16.1%, and a combination of both in 33.9%. Treatment, by embolisation or proximal extension, was performed in 47% of cases, with a technical success of 97%.ConclusionThe overall incidence of proximal endoleak after EVAS is 3.1% after a mean follow-up period of 16 months, with 1.5% occurring within 30 days. Their occurrence is related to patient selection and stent positioning. Early detection and classification is crucial to avoid the potential of sac rupture.

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Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Publication date: Available online 29 October 2017
Source:American Journal of Otolaryngology
Author(s): Neha A. Patel, Kristen Carlin, Joseph M. Bernstein
SignificanceCurrent grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.ObjectiveTo propose and validate an easy-to-use flexible fiberoptic endoscopic grading system that provides physicians with a more accurate sense of the three-dimensional relationship of the tonsillar fossa to the upper-airway.Methods50 consecutive pediatric patients were prospectively recruited between February 2015 and February 2016 at a pediatric otolaryngology outpatient clinic. The patients had no major craniofacial abnormalities and were aged 1 to 16years. Each patient had data regarding BMI, Friedman palate position, OSA-18 survey results collected. For each child, digital video clips of fiberoptic nasopharyngeal, oropharyngeal and laryngeal exams were presented to 2 examiners. Examiners were asked to independently use the proposed Endoscopic tonsillar grading system, the Brodsky tonsillar grading scale, the Modified Brodsky tonsillar grading scale with a tongue depressor, and the Parikh adenoid grading system to rate adenotonsillar hypertrophy. Cohen's Kappa and weighted Kappa scores were used to assess interrater reliability for each of the four grading scales. The Spearman correlation was used to test the associations between each scale and OSA-18 scores, as well as Body Mass Index (BMI).Results50 pediatric patients were included in this study (mean age 6.1years, range of 1year to 16years). The average BMI was 20. The average OSA-18 score was 61.7. The average Friedman palate position score was 1.34. Twelve percent of the patients had a Friedman palate position score≥3, which made traditional Brodsky grading of their tonsils impossible without a tongue depressor. All four scales showed strong agreement between the two raters. The weighted Kappa was 0.83 for the Modified Brodsky scale, 0.89 for the Brodsky scale, 0.94 for the Parikh scale to 0.98 for the Endoscopic scale (almost perfect agreement). The Endoscopic scale showed the most consistent agreement between the raters during the study. There was a moderate association between the Parikh adenoid grading system with OSA-18 scores (Spearman's ρ=0.58, p<0.001) compared to a low association of the tonsillar grading systems with OSA- 18 scores. None of the scales correlated with patient BMI.ConclusionsThe proposed Endoscopic tonsillar grading system is as reliable of a method of grading tonsillar size as conventional grading systems. It offers the advantage of allowing for critical evaluation of the tonsils without any anatomic distortion which may occur with the use of a tongue blade. This new validated endoscopic grading system provides a tool for communicating the degree of airway obstruction at the level of the oropharynx regardless of Friedman palate position and may be used in future outcomes projects.

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Cat ownership, cat allergen exposure, and trajectories of sensitization and asthma throughout childhood

Publication date: Available online 28 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Healson Ihuoma, Danielle C. Belgrave, Clare S. Murray, Philip Foden, Angela Simpson, Adnan Custovic
Exposure to cat and/or cat allergens can confer either an increase in risk, or protection, or will have no effect, depending on the age of the assessment, study design and the choice of study population.

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Monitoring inflammatory heterogeneity with multiple biomarkers for multidimensional endotyping of asthma

Publication date: Available online 5 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ioana Agache, Daniel S. Strasser, Gabin M. Pierlot, Hervé Farine, Kenji Izuhara, Cezmi A. Akdis

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Nitrogen dioxide exposure in school classrooms of inner-city children with asthma

Publication date: Available online 5 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jonathan M. Gaffin, Marissa Hauptman, Carter R. Petty, William J. Sheehan, Peggy S. Lai, Jack M. Wolfson, Diane R. Gold, Brent A. Coull, Petros Koutrakis, Wanda Phipatanakul
BackgroundAmbient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure.ObjectiveWe aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma.MethodsChildren enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level.ResultsThe mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = −0.05; 95% CI, −0.08 to −0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = −22.8; 95% CI, −36.0 to −9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes.ConclusionIn children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.

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Modifications in lower leg muscle activation when walking barefoot or in minimalist shoes across different age-groups.

Publication date: Available online 28 October 2017
Source:Gait & Posture
Author(s): Simon Franklin, François-Xavier Li, Michael J. Grey
Ageing is associated with a decline in muscle strength and impaired sensory mechanisms which contribute to an increased risk of falls. Walking barefooted has been suggested to promote increased muscle strength and improved proprioceptive sensibility through better activation of foot and ankle musculature. Minimalist footwear has been marketed as a method of reaping the suggested benefits of barefoot walking whilst still providing a protective surface. The aim of this study was to investigate if walking barefoot or in minimalist footwear provokes increased muscle activation compared to walking in conventional footwear. Seventy healthy adults (age range 20-87) volunteered for this study. All participants walked along a 7m walking lane five times in four different footwear conditions (barefoot (BF), minimalist shoes (MSH), their own shoes (SH) and control shoes (CON)). Muscle activity of their tibialis anterior (TA), gastrocnemius medialis (GCM) and peroneus longus (PL) were recorded simultaneously and normalised to the BF condition. MSH are intermediate in terms of ankle kinematics and muscle activation patterns. Walking BF or in MSH results in a decrease in TA activity at initial stance due to a flatter foot at contact in comparison to conventional footwear. Walking BF reduces PL activity at initial stance in the young and middle age but not the old. Walking in supportive footwear appears to reduce the balance modulation role of the GCM in the young and middle age but not the old, possibly as a result of slower walking speed when BF.

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Clinical significance of the coexistence of carotid artery plaque and white matter disease in patients with symptomatic cerebral infarction

Publication date: Available online 28 October 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Mami Ishikawa, Hitoshi Sugawara, Toshiyuki Tsuji, Mutsumi Nagai, Gen Kusaka, Heiji Naritaka
ObjectivesSymptomatic cerebral infarction (CI) can occur in patients without main cerebral artery stenosis or occlusion. This study investigated the unique features of carotid artery plaque and white matter disease (WMD) in patients with symptomatic CI and transient ischemic attack (TIA) but without stenosis or occlusion of a main cerebral artery.Patients and MethodsWe studied 647 patients who underwent both carotid ultrasound examination and brain magnetic resonance images. Plaque score (PS), plaque number, maximal plaque intima-media thickness and grades of WMD were examined. Subjects were divided into four groups, the CI group, TIA group, myocardial infarction (MI) group and risk factor (RF) group. Plaque and WMD were analyzed in cerebral ischemia group (CI and TIA), compared to non-cerebral ischemia groups and to a high PS group and a high WMD grade group from the RF group.ResultsBoth of each value of plaque and grades of WMD in the cerebral ischemia group were significantly higher than those in other groups. Grades of WMD in the cerebral ischemia group were significantly higher than those in the high PS group, although there was no significant difference of the each value of plaque between the two groups. The each value of plaque in the cerebral ischemia group was also significantly higher than those in the high WMD grade group, although there was no significant difference of grade of WMD between the two groups.ConclusionSimultaneous increases in carotid artery plaque and WMD are associated with symptomatic CI, which is not caused by stenosis or occlusion of a main cerebral artery.

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Preoperative determination of nerve of origin in patients with vestibular schwannoma.

Preoperative determination of nerve of origin in patients with vestibular schwannoma.

HNO. 2017 Oct 27;:

Authors: Rahne T, Plößl S, Plontke SK, Strauss C

Abstract
BACKGROUND: Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin.
METHODS: The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively.
RESULTS: The novel scoring system was applied to five consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery.
CONCLUSION: The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.

PMID: 29079887 [PubMed - as supplied by publisher]

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A new evaluation of masticatory ability in patients with dysphagia: The Saku-Saku Test.

A new evaluation of masticatory ability in patients with dysphagia: The Saku-Saku Test.

Arch Gerontol Geriatr. 2017 Oct 18;74:106-111

Authors: Tagashira I, Tohara H, Wakasugi Y, Hara K, Nakane A, Yamazaki Y, Matsubara M, Minakuchi S

Abstract
OBJECTIVE: In the elderly and patients with dysphagia, masticatory problems often cause aspiration or choking. Although simple methods to predict aspiration and silent aspiration exist, methods for evaluating the masticatory function of patients with dysphagia are lacking. Accordingly, we developed a simple test to assess the chewing and swallowing ability of patients with dysphagia.
METHODS: One hundred and five patients with dysphagia were included. We used the Saku-Saku Test (SST), in which patients were asked to eat a rice cracker, and evaluated the quality of mandibular rotation during mastication. We studied the participants' ability to grind, aggregate, and swallow using videoendoscopic evaluation (VE) and investigated its association with mandibular rotation.
RESULTS: The SST showed good reliability between two examiners, with a kappa coefficient of 0.80. 92.4% of the patients ate the rice cracker without aspiration. The SST showed a high sensitivity of 73.3% and specificity of 93.3% for the degree of grinding. The degree of food bolus aggregation had a sensitivity of 45.0% and specificity of 90.6%, and aspiration had a sensitivity of 25.0% and specificity of 84.5%, both of which showed high specificity.
CONCLUSIONS: The results of this study suggested that the SST might be simple and useful for identifying patients with dysphagia who are able to masticate, even if they do not eat foods that need chewing and could be used before starting these patients on foods that need chewing.

PMID: 29080497 [PubMed - as supplied by publisher]

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Preoperative determination of nerve of origin in patients with vestibular schwannoma.

Preoperative determination of nerve of origin in patients with vestibular schwannoma.

HNO. 2017 Oct 27;:

Authors: Rahne T, Plößl S, Plontke SK, Strauss C

PMID: 29079887 [PubMed - as supplied by publisher]

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A new evaluation of masticatory ability in patients with dysphagia: The Saku-Saku Test.

A new evaluation of masticatory ability in patients with dysphagia: The Saku-Saku Test.

Arch Gerontol Geriatr. 2017 Oct 18;74:106-111

Authors: Tagashira I, Tohara H, Wakasugi Y, Hara K, Nakane A, Yamazaki Y, Matsubara M, Minakuchi S

PMID: 29080497 [PubMed - as supplied by publisher]

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Preoperative determination of nerve of origin in patients with vestibular schwannoma.

Preoperative determination of nerve of origin in patients with vestibular schwannoma.

HNO. 2017 Oct 27;:

Authors: Rahne T, Plößl S, Plontke SK, Strauss C

PMID: 29079887 [PubMed - as supplied by publisher]

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Improvement of tinnitus with trifluoperazine in a patient with psychosis and ear disease.

Improvement of tinnitus with trifluoperazine in a patient with psychosis and ear disease.

Asian J Psychiatr. 2017 Oct 23;30:177-178

Authors: Jain S, Srivastava AS, Madhu, Maggu G, Pandey M

PMID: 29080514 [PubMed - as supplied by publisher]

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Hearing impairment accompanied with low-tone tinnitus during all trans retinoic acid containing chemotherapy.

Hearing impairment accompanied with low-tone tinnitus during all trans retinoic acid containing chemotherapy.

Pediatr Blood Cancer. 2017 Oct 28;:

Authors: Fujiki T, Nishimura R, Ikawa Y, Noguchi K, Mase S, Kuroda R, Araki R, Maeba H, Yachie A

PMID: 29080387 [PubMed - as supplied by publisher]

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Pain after tonsillectomy: effectiveness of current guidelines?

Pain after tonsillectomy: effectiveness of current guidelines?

Eur Arch Otorhinolaryngol. 2017 Oct 27;:

Authors: Walrave Y, Maschi C, Bailleux S, Falk AT, Hayem C, Carles M, De la Brière F

Abstract
BACKGROUND: Tonsillectomy is one of the most common major surgical procedures performed in children. In 2013, the use of codeine in children was severely restricted. French guidelines for treating tonsillectomy's postoperative pain at home have been reconsidered OBJECTIVE: The aim of our study was to measure effectiveness and safety of two schedules: acetaminophen + ibuprofen (A + I) and acetaminophen + tramadol (A + T) in children who underwent tonsillectomy.
SETTING AND PATIENTS: We undertook a 1 year prospective and observational single-center study. All children who underwent tonsillectomy were eligible. The choice of the regimen, A + I group or A + T group, was left for the anesthesiologist in charge, done during the pre-anesthetic assessment. After hospital discharge, parents had to give systematically A + I or A + T, 4 times a day during 5 days and then acetaminophen alone for the next 5 days The primary endpoint was the home pain assessed using Parents' Postoperative Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints were the rate of further hospitalization and/or surgery due to tonsillectomy-related adverse events.
RESULTS: Over the study period, 342 tonsillectomies were performed. The return rate of PPPM-SF scales was 58%. Two hundred patients were analyzed. The median age was 4 [3; 5.2] years and was lower in group A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were greater than or equal to 3 in both groups during the first 6 postoperative days. The mean decrease of PPPM-SF score over time was higher in group A + I than in group A + T (p = 0.007). Readmission rate was significantly higher in group A + T (A + I: 0; A + T: 7; p = 0.002) as the rate of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049).
CONCLUSION: Home pain management after tonsillectomy should be improved. In clinical practice, A + I seems at least as effective as the combination A + T, without increasing readmission and/or additional surgery for bleeding.

PMID: 29080148 [PubMed - as supplied by publisher]

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Non-invasive intraoperative monitoring of cochlear function by cochlear microphonics during cerebellopontine-angle surgery.

Non-invasive intraoperative monitoring of cochlear function by cochlear microphonics during cerebellopontine-angle surgery.

Eur Arch Otorhinolaryngol. 2017 Oct 27;:

Authors: Lourenço B, Madero B, Tringali S, Dubernard X, Khalil T, Chays A, Bazin A, Mom T, Avan P

Abstract
In vestibular-schwannoma (VS) surgery, hearing-preservation rate remains low. Besides damage to the cochlear nerve, intraoperative cochlear ischemia is a potential cause of hearing loss. Here, we used non-invasive cochlear microphonic (CM) recordings to detect the cochlear vascular events of VS surgery. Continuous intraoperative CM monitoring, in response to 80-95 dB SPL, 1-kHz tone-bursts, was performed in two samples of patients undergoing retrosigmoid cerebellopontine-angle surgery: one for VS (n = 31) and one for vestibular neurectomy or vasculo-neural conflict causing intractable trigeminal neuralgia, harmless to hearing (n = 19, control group). Preoperative and postoperative hearings were compared as a function of intraoperative CM changes and their chronology. Monitoring was possible throughout except for a few tens of seconds when drilling or suction noises occurred. Four patterns of CM time course were identified, eventless, fluctuating, abrupt or progressive decrease. Only the VS group displayed the last two patterns, mainly during internal-auditory-canal drilling and the ensuing tumor dissection, always with postoperative loss of hearing as an end result. Conversely, eventless and fluctuating CM patterns could be associated with postoperative hearing loss when the cochlear nerve had been reportedly damaged, an event that CM is not meant to detect. Cochlear ischemia is a frequent event in VS surgery that leads to deafness. The findings that CM decrease raised no false alarm, and that CM fluctuations, insignificant in control cases, were easily spotted, suggest that CM intraoperative monitoring is a sensitive tool that could profitably guide VS surgery.

PMID: 29080147 [PubMed - as supplied by publisher]

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Use of narrow band imaging and 4K technology in otology and neuro-otology: preliminary experience and feasibility study.

Use of narrow band imaging and 4K technology in otology and neuro-otology: preliminary experience and feasibility study.

Eur Arch Otorhinolaryngol. 2017 Oct 27;:

Authors: Zhang H, Wong PY, Magos T, Thaj J, Kumar G

Abstract
The advent of the endoscope has facilitated otological surgery in recent years. Advances in optical technology have led to the development of high definition visualisation, such as 4K magnification. Narrow band imaging (NBI) has been shown to improve visualisation of tissue based on varying degrees of vascularity. This is a feasibility study, the first of its kind, aiming to investigate the appearances of middle ear anatomy and pathology (tympanic membrane, tympanosclerosis, cholesteatoma, granulation, endolymphatic sac hydrops, otosclerosis) under the NBI filter, using a high definition 4K endoscope. Qualitative analysis of image detail and operating time in minutes were recorded. The study demonstrates that these two technologies can be implemented with ease into practice, and show a clear differentiation between pathology and normal anatomy. NBI and 4K magnification prove to be useful adjuncts to the surgeon during endoscopic ear surgery.

PMID: 29080146 [PubMed - as supplied by publisher]

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Comparison of contact radiographed and stained histological sections for osseointegration analysis of dental implants: an in vivo study.

Comparison of contact radiographed and stained histological sections for osseointegration analysis of dental implants: an in vivo study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jun 23;:

Authors: Bissinger O, Götz C, Jeschke A, Haller B, Wolff KD, Kaiser P, Kolk A

Abstract
OBJECTIVES: Histology is still regarded as the gold-standard to determine bone implant contact (BIC) as a parameter representing implant stability. As the further processing of cut slices for contact radiography (CR) to stained and polished histological sections is time consuming and error prone, our aim was to assess agreement between CR and Giemsa-eosin (GE) stained sections with regard to dental implants.
STUDY DESIGN: Threaded dental titanium implants (n = 54) from the maxillae of Goettingen minipigs were evaluated. After 28 and 56 days, BIC and the ratio of bone volume to total volume (BV/TV; 1000 μm) were determined on the same sections by using CR and GE staining, and the results were compared.
RESULTS: Moderate differences for BIC (0.6%; P = .53) and BV/TV (1.3%; P = .01) between the methods were determined, in which CR overestimated BIC and BV/TV. A strong correlation was seen between the modalities concerning BIC (28 days: r = 0.84; 56 days: r = 0.85; total: r = 0.85) and BV/TV (r = 0.96; r = 0.94; r = 0.96; all: P < .0001).
CONCLUSIONS: CR enabled determination of the bone-to-implant interface in comparison with GE-stained sections. BIC and BV/TV were slightly overestimated but correlated strongly between the methods. Therefore, if BIC and BV/TV are sufficient endpoints, CR is adequate and no further preparation and staining are necessary.

PMID: 29079369 [PubMed - as supplied by publisher]

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P14 methylation: an epigenetic signature of salivary gland mucoepidermoid carcinoma in the Serbian population.

P14 methylation: an epigenetic signature of salivary gland mucoepidermoid carcinoma in the Serbian population.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep 28;:

Authors: Nikolic N, Carkic J, Ilic Dimitrijevic I, Eljabo N, Radunovic M, Anicic B, Tanic N, Falk M, Milasin J

Abstract
OBJECTIVE: To investigate the prevalence of p16(INK4 a), p14(ARF), tumor protein p53 (TP53), and human telomerase reverse transcriptase (hTERT) promoter hypermethylation in mucoepidermoid carcinomas (MECs) and search for a possible association between methylation status and clinicopathological parameters.
STUDY DESIGN: DNA extracted from 35 formalin-fixed and paraffin-embedded MEC samples and 10 normal salivary gland (NSG) tissue samples was analyzed for the presence of promoter hypermethylation using methylation-specific polymerase chain reaction testing.
RESULTS: The percentages of gene hypermethylation in MECs versus NSGs were the following: p14: 100% versus 20% (P<.001); p16: 60% versus 20% (P = .035); hTERT: 54.3% versus 20% (P = .078); and TP53: 31.4% versus 30% (P = .981). Multiple sites were found to be methylated in 86% of MECs compared with 10% in NSGs (P< .001). TP53 and hTERT were more often methylated in lower clinical stages (P = .033 and P = .005, respectively).
CONCLUSIONS: Hypermethylation of p14 appears to be an important event in the development of mucoepidermoid carcinoma. High frequency of gene hypermethylation and high incidence of methylation at multiple sites point to the importance of epigenetic phenomena in the pathogenesis of MECs, although with modest impact on clinical parameters.

PMID: 29079368 [PubMed - as supplied by publisher]

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Laryngocardiac Reflex: A Case Report and Review of the Literature.

Laryngocardiac Reflex: A Case Report and Review of the Literature.

J Voice. 2017 Oct 24;:

Authors: Pingree CS, Majors JS, Howard NS, Eller RL

Abstract
INTRODUCTION: The vagus nerve has sensory and motor function in the larynx, as well as parasympathetic function in the thorax and abdomen. Stimulation of the superior laryngeal nerve can cause reflexive bradycardia.
CASE: We describe a case of a 45-year-old man with pre-syncopal symptoms while exercising, and bradycardia found during cardiology workup. Radiography and flexible laryngoscopy showed evidence of a right-sided, vascular laryngeal mass. Exercise testing before and after superior laryngeal nerve block showed reversal of the symptoms with the block. Subsequent resection of the lymphovascular malformation with CO2 laser eliminated the patient's symptoms.
DISCUSSION: This is the first case reported of the laryngocardiac reflex producing symptomatic bradycardia as a result of exercise-induced engorgement of a supraglottic lymphovascular malformation, which was then cured by surgical excision. We discuss this case and the literature regarding lymphovascular malformations in the airway and the neural pathways of the laryngocardiac reflex.

PMID: 29079124 [PubMed - as supplied by publisher]

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Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature.

Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature.

J Voice. 2017 Oct 24;:

Authors: Hamdan AL, Khalifee E, Tabet G

Abstract
OBJECTIVE: The objective of this study was to report the first case of unilateral vocal fold paralysis in a patient with Parkinson disease (PD) and to review the literature.
METHODS: This is a case report and literature review following PubMed search using the keywords "Parkinson," "vocal fold paralysis," "vocal fold palsy," "vocal fold immobility," "vocal fold adductor palsy," "airway obstruction," and "stridor."
RESULTS: A total of 18 subjects diagnosed with PD and vocal fold paralysis were described. In all cases, the vocal fold paralysis was bilateral and the main presenting symptoms were stridor and shortness of breath necessitating intubation and tracheostomy. This article describes the first case of PD presenting with dysphonia secondary to unilateral vocal fold paralysis (left). The management consisted of injection laryngoplasty for medialization of the paralyzed vocal fold.
CONCLUSIONS: Patients with PD can present with unilateral vocal fold paralysis. Early treatment is advocated in view of the advent of injection laryngoplasty as a safe office procedure.

PMID: 29079122 [PubMed - as supplied by publisher]

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Treatment Outcomes of In-Office KTP Ablation of Vocal Fold Granulomas.

Treatment Outcomes of In-Office KTP Ablation of Vocal Fold Granulomas.

Ann Otol Rhinol Laryngol. 2017 Oct 01;:3489417738790

Authors: Dominguez LM, Brown RJ, Simpson CB

Abstract
OBJECTIVE: To determine the effectiveness of in-office potassium-titanyl-phosphate (KTP) treatment of vocal fold granulomas and identify any predictors of complete lesion resolution.
METHODS: A retrospective review of patients who underwent in-office KTP ablation of vocal fold granulomas between 2007 and 2016 was performed. Medical records were reviewed for use of acid suppression medication, prior surgical treatment, voice therapy, laser settings, number of treatments, follow-up time, and Voice Handicap Index-10 (VHI-10) scores.
RESULTS: Twenty-six patients underwent a total of 43 laser treatments. Eighty percent of patients were previously on acid suppression medication, and 42.3% had failed previous endoscopic treatments. Patients underwent a mean number of 1.65 ± 1.16 in-office treatments with decrease in size in 96.2% of cases. The VHI-10 was not significantly affected. Complete resolution occurred in 73.1% of cases with follow-up time ranging from 1 to 86 months (median = 9.5 months). No recurrences occurred in patients with complete resolution. Other than undergoing a single KTP treatment, no variable was found to be predictive of complete lesion resolution. Granuloma etiology was not predictive of lesion resolution but did correlate with symptom improvement.
CONCLUSION: In-office pulsed KTP laser is an effective treatment option for vocal fold granulomas as the lesion resolves in the majority of cases.

PMID: 29078715 [PubMed - as supplied by publisher]

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Gender Differences in the Reporting of Vocal Fatigue in Teachers as Quantified by the Vocal Fatigue Index.

Gender Differences in the Reporting of Vocal Fatigue in Teachers as Quantified by the Vocal Fatigue Index.

Ann Otol Rhinol Laryngol. 2017 Oct 01;:3489417738788

Authors: Hunter EJ, Banks RE

Abstract
OBJECTIVES: Occupational voice users report higher instances of vocal health problems. Women, who are more likely than men to report voice problems, are the largest members of some occupational voice users, such as teachers. While a common complaint among this population is vocal fatigue, it has been difficult to quantify. Therefore, the goal of this study is to quantify vocal fatigue generally in school teachers and investigate any related gender differences.
METHODS: Six hundred forty (518 female, 122 male) teachers were surveyed using an online questionnaire consisting in part of the Vocal Fatigue Index (VFI), an index specifically designed to quantify vocal fatigue.
RESULTS: Compared to vocally healthy adults, the teachers surveyed were 3 times as likely to report vocal tiredness or vocal avoidance and over 3 times as likely to report physical voice discomfort. Additionally, female teachers were more likely to have scores approaching those with dysphonia.
CONCLUSIONS: The VFI quantified elevated levels of vocal fatigue in teachers, with a significant prevalence of symptoms reported among females compared to males. Further, because the VFI indicated elevated complaints (between normal and dysphonic) in a population likely to be elevated, the VFI might be used to identify early indications of voice problems and/or track recovery.

PMID: 29078706 [PubMed - as supplied by publisher]

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Comparisons of Auricular Cartilage Tissues from Different Species.

Comparisons of Auricular Cartilage Tissues from Different Species.

Ann Otol Rhinol Laryngol. 2017 Oct 01;:3489417738789

Authors: Chiu LLY, Giardini-Rosa R, Weber JF, Cushing SL, Waldman SD

Abstract
OBJECTIVES: Tissue engineering of auricular cartilage has great potential in providing readily available materials for reconstructive surgeries. As the field of tissue engineering moves forward to developing human tissues, there needs to be an interspecies comparison of the native auricular cartilage in order to determine a suitable animal model to assess the performance of engineered auricular cartilage in vivo.
METHODS: Here, we performed interspecies comparisons of auricular cartilage by comparing tissue microstructure, protein localization, biochemical composition, and mechanical properties of auricular cartilage tissues from rat, rabbit, pig, cow, and human.
RESULTS: Human, pig, and cow auricular cartilage have smaller lacunae compared to rat and rabbit cartilage ( P < .05). Despite differences in tissue microstructure, human auricular cartilage has similar biochemical composition to both rat and rabbit. Auricular cartilage from pig and cow, alternatively, display significantly higher glycosaminoglycan and collagen contents compared to human, rat, and rabbit ( P < .05). The mechanical properties of human auricular cartilage were comparable to that of all 4 animal species.
CONCLUSIONS: This is the first study that compares the microstructural, biochemical, and mechanical properties of auricular cartilage from different species. This study showed that different experimental animal models of human auricular cartilage may be suitable in different cases.

PMID: 29078705 [PubMed - as supplied by publisher]

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Bipolar Radiofrequency Ablation (Coblation) of External Auditory Canal Lymphatic Malformation and Other Soft Stenoses.

Bipolar Radiofrequency Ablation (Coblation) of External Auditory Canal Lymphatic Malformation and Other Soft Stenoses.

Ann Otol Rhinol Laryngol. 2017 Oct 01;:3489417739011

Authors: Gu A, Bauman NM

Abstract
INTRODUCTION: Soft tissue occlusion of the external auditory canal (EAC) can cause intense pruritis, recurrent foul smelling otorrhea, recurrent otitis externa, and conductive hearing loss. Occlusion of the EAC can be challenging to treat as the area is prone to circumferential scarring.
METHODS: We describe the novel use of serial bipolar radiofrequency ablation (coblation) to treat 3 children with complete EAC occlusion from congenital and acquired conditions including lymphedema (1), microcystic lymphatic malformation (1), and venolymphatic malformation (1).
RESULTS: Patients underwent a mean of 3 procedures with postoperative EAC stenting (7 days) and antibiotic and steroid aural preparations (10 days). Otologic symptoms resolved in all patients, and their EACs remained patent 14 months after last procedure (range, 4-32 months). One patient experienced a pinpoint tympanic membrane perforation that healed spontaneously 2 weeks later.
CONCLUSIONS: Coblation of soft tissue stenosis of the EAC can be an effective treatment for this problematic condition.

PMID: 29078703 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Κυριακή 29 Οκτωβρίου 2017

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