Gustavo Polacow Korn, Carlos Michaelis Jr., Vania Rosa Moraes
Braz J Otorhinolaryngol.2017;83:609-10
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Σάββατο 11 Νοεμβρίου 2017
Ethical and legal aspects in the care of singers and actors
Health‐related quality of life and disability in patients with acute unilateral peripheral vestibular disorders
Maria Petri, Magdalena Chirilă, Sorana D. Bolboacă, Marcel Cosgarea
Braz J Otorhinolaryngol.2017;83:611-8
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The potential role of amlodipine on experimentally induced bacterial rhinosinusitis
Arzu Tatar, Mukadder Korkmaz, Muhammed Yayla, Elif Polat, Hakan Uslu, Zekai Halici, Secil N. Parlak
Braz J Otorhinolaryngol.2017;83:619-26
Resumo - Texto Completo - PDF
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Tracheostomy in children: a ten‐year experience from a tertiary center in southern Brazil
Cláudia Schweiger, Denise Manica, Carolina Fischer Becker, Larissa Santos Perez Abreu, Michelle Manzini, Leo Sekine, Gabriel Kuhl
Braz J Otorhinolaryngol.2017;83:627-32
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Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double‐blind, randomized and controlled clinical trial
Gustavo F. Wandalsen, Carolina Miranda, Luis Felipe Ensina, Flavio Sano, Roberto Bleul Amazonas, Joyce Macedo da Silva, Dirceu Solé
Braz J Otorhinolaryngol.2017;83:633-9
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Are people who have a better smell sense, more affected from satiation?
Seckin Ulusoy, Mehmet Emre Dinc, Abdullah Dalgic, Murat Topak, Denizhan Dizdar, Abdulhalim İs
Braz J Otorhinolaryngol.2017;83:640-5
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Significant association between osteoporosis and hearing loss: a systematic review and meta‐analysis
Sikarin Upala, Pattara Rattanawong, Wasawat Vutthikraivit, Anawin Sanguankeo
Braz J Otorhinolaryngol.2017;83:646-52
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Carotid blowout syndrome in patients treated by larynx cancer
Carlos Miguel Chiesa Estomba, Frank Alberto Betances Reinoso, Alejandra Osorio Velasquez, Olalla Castro Macia, Maria Jesus Gonzalez Cortés, Jesus Araujo Nores
Braz J Otorhinolaryngol.2017;83:653-8
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Subjective visual vertical after treatment of benign paroxysmal positional vertigo
Maristela Mian Ferreira, Maurício Malavasi Ganança, Heloisa Helena Caovilla
Braz J Otorhinolaryngol.2017;83:659-64
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Free Field Word recognition test in the presence of noise in normal hearing adults
Gleide Viviani Maciel Almeida, Angela Ribas, Jorge Calleros
Braz J Otorhinolaryngol.2017;83:665-9
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Identification of key genes involved in nasopharyngeal carcinoma
Xue Jiang, Lichun Feng, Baoqiang Dai, Liping Li, Weiwei Lu
Braz J Otorhinolaryngol.2017;83:670-6
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Nasal polyposis in cystic fibrosis: follow‐up of children and adolescents for a 3‐year period
Silke Anna Theresa Weber, Renata Mizusaki Iyomasa, Camila de Castro Corrêa, Wellington Novais Mafra Florentino, Giesela Fleischer Ferrari
Braz J Otorhinolaryngol.2017;83:677-82
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Arteriovenous malformation of the external ear: a clinical assessment with a scoping review of the literature
Shin Hye Kim, Seung Hoon Han, Yoonjae Song, Chang Sik Park, Jae‐Jin Song
Braz J Otorhinolaryngol.2017;83:683-90
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Effects of exposure to 2100MHz GSM‐like radiofrequency electromagnetic field on auditory system of rats
Metin Çeliker, Abdulkadir Özgür, Levent Tümkaya, Suat Terzi, Mustafa Yılmaz, Yıldıray Kalkan, Ender Erdoğan
Braz J Otorhinolaryngol.2017;83:691-6
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Translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil) to evaluate patients with head and neck cancer
William Eduardo Pirola, Bianca Sakamoto Ribeiro Paiva, Eliane Marçon Barroso, David W. Kissane, Claudia Valéria Maseti Pimenta Serrano, Carlos Eduardo Paiva
Braz J Otorhinolaryngol.2017;83:697-704
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Polymorphisms in chronic rhinosinusitis with nasal polyps – a systematic review
Vanessa Ramos Pires Dinarte, Anemari Ramos Dinarte dos Santos, Luiza Ferreira de Araújo, Mariah Guieiro Alves dos Reis, Edwin Tamashiro, Fabiana Cardoso Pereira Valera, Wilson Araújo da Silva Júnior, Wilma Terezinha Anselmo‐Lima
Braz J Otorhinolaryngol.2017;83:705-11
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Facial thread lifting with suture suspension
Joana de Pinho Tavares, Carlos Augusto Costa Pires Oliveira, Rodolfo Prado Torres, Fayez Bahmad Jr.
Braz J Otorhinolaryngol.2017;83:712-9
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The facial palsy as first symptom of the temporal bone lung cancer metastasis
Dragoslava Djeric, Ivan Boricic, Nada Tomanovic, Ljiljana Cvorovic, Srbislav Blazic, Miljan Folic, Igor Djoric
Braz J Otorhinolaryngol.2017;83:720-2
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A case of bilateral congenital middle ear cholesteatoma
Mihael Ries, Mirjana Kostić, Jakov Ajduk, Robert Trotić, Vladimir Bedeković
Braz J Otorhinolaryngol.2017;83:723-5
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Bilateral parotid glands infection caused by Calmette‐Guerin Bacillus after intravesical therapy for recurrent bladder cancer: a case report
Eviatar Friedlander, Paula Martínez Pascual, Pedro Montilla de Mora, Bartolomé Scola Yurrita
Braz J Otorhinolaryngol.2017;83:726-9
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Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite
Abstract
Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy. This study describes our initial experience with the MR overlay technique in the angiography suite during pediatric percutaneous extremity bone biopsies of lesions visible on MRI but not on CT or fluoroscopy and demonstrates its utility in relevant clinical cases.
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Cyclin-dependent kinase 5 regulates MAPK/ERK signaling in the skin of mice
Source:Acta Histochemica
Author(s): Xuexian Liu, Pengqian Zhang, Kaiyuan Ji, Junzhen Zhang, Shanshan Yang, Bin Du, Shuaipeng Hu, Ruiwen Fan
Cyclin-dependent kinase 5 (CDK5) is a proline-directed serine/threonine kinase that has been shown to play important roles in many tissues except the nervous system. We previously reported that CDK5 showed differential expression in the transcriptome profiles of the skin of alpacas with different hair colors. To understand the functional role of CDK5 in hair color determination, we constructed CDK5-knockdown mice and identified the effect on the mitogen-activated protein kinase (MAPK) pathway in the mouse skin. Quantitative real-time polymerase chain reaction, co-immunoprecipitation, and western blotting were performed to analyze the effects of CDK5-knockdown on the MAPK pathway in mice. The results showed that MAP3K6 was inhibited by phosphorylated CDK5 through its activator CDK7. The decrease in MAP3K6 levels caused down-regulation of MEK1 and ERK expression, leading to the up-regulation of miR-143-3p, which targets MAP3K6 via Dicer. Taken together, our findings indicate that CDK5 functions in regulating the MAPK pathway. Given that MAP3K6 was inhibited in two directions, this mechanism can provide insight into the contributions of the MAPK/ERK pathway to the inhibition of melanin production.
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Requirements of a new allergen regulation
Publication date: Available online 11 November 2017
Source:Allergologia et Immunopathologia
Author(s): Cristina Rivas-Juesas, Joan Tomás Bartra, Ana M. Purroy Tabar
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Use of Hydrodynamic Cavitation for Algae Removal: Effect on the Inactivation of Microalgae Belonging to Genus Scenedesmus
Abstract
Excessive algae growth has generated conflicts on the use of water supplies; therefore, the focus on new technologies to remove algae from water bodies is demanding. The aim of the present study was to assess the effect of hydrodynamic cavitation on the inactivation of microalgae belonging to genus Scenedesmus. A laboratory-scale experimental apparatus was built in order to accomplish this goal; it consisted of a Venturi device designed to generate the cavitation phenomenon. Suspended microalgae samples were treated for 60 minutes under different cavitation intensities (cavitation number—Cv—ranging from 0.17 to 0.27). Results evidenced that microalgae decay over time can be modeled through first-order kinetics. The maximum removal efficiency (85%) was recorded at the highest cavitation intensity (Cv = 0.17). The removal efficiency decreased as the cavitation number increased. Hydrodynamic cavitation was effective in inactivating Scenedesmus; it produced irreversible damages to cell morphology such as flotation spines removal, cell wall lesions, cytoplasm extravasation, and cavity formation. Assumingly, hydrodynamic cavitation has great potential to treat eutrophic water bodies. Furthermore, it represents a sustainable removal technique, since it does not produce secondary pollution.
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Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study
Abstract
Introduction
Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS.
Methods
Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49–82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model.
Results
The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size Kc = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman's rank correlation coefficient = 0.002).
Conclusions
Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.
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Evaluating the association between household air pollution and oral cancer
A World Health Organisation report in 2004 [1] assessed the disease burden from indoor smoke generated from combustion of household solid fuels. The report estimated that globally about 50% of all households especially rural household (90%) utilize solid fuels for domestic use. The solid fuels commonly used were coal in China and biomass (crop residues, animal dung, and wood) in India and Africa. Most of this household have relatively poor ventilation thus increasing the exposure to the smoke. The report revealed that women and young children due to their household roles were the most exposed, resulting in chronic pulmonary disease in women and the children suffered from acute infections of the lower respiratory tract [1].
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Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies
Near Infrared (NIR) is a form of electromagnetic radiation of the wavelength of 700-1000 nanometers. It is positioned within range of the infrared waves, between visible light and radio waves. Tissues absorb photons of NIR radiation with an aid of the molecules called chromophores that include haemoglobin (85-88%), myoglobin (10%) and oxidase of cytochrome C (2-5%) (Boushel and Piantadosi, 2000; Boushel et al., 2001). Oxidation state i.e. oxygenation of the chromophores changes the intensity of the absorbed light.
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What is the optimal frequency range for quantifying slow EEG activity in neonates? Insights from power spectra
Several weeks before and following term age, intermittent anterior slow waves in the delta frequency range (<4 Hz) are a normative neonatal EEG feature (e.g., Clancy et al., 2014; Fig.1A). Various quantitative electroencephalographic (qEEG) studies of infants born preterm have analyzed relative power of delta and other frequency bands. For example, across 60 healthy infants born at 26-41 weeks and assessed with EEG on the third day, Bell et al. (1991) reported gestational age (GA) was negatively correlated with relative "lower-delta" (0.25-1 Hz) power.
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Oxyneurography: A non-invasive NIRS technique to measure nerve oxygenation
Few people doubt the importance of cerebral blood flow integrity for the preservation of neural tissue. Blood flow compromise, causing a cerebro-vascular accident (CVA), results in nervous tissue damage or stroke.
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Detection of proximal conduction blocks using a triple stimulation technique improves the early diagnosis of Guillain–Barré syndrome
Guillain–Barré syndrome (GBS) is an acute autoimmune peripheral neuropathy with different subtypes (Wakerley et al., 2014). The diagnostic criteria include: clinical presentation (Van der Meché et al., 2001; Wakerley et al., 2014; Fokke et al., 2014), electrophysiological data, (Ho et al., 1995; Hadden et al., 1998; Van den Bergh and Piéret, 2004; Rajabally et al., 2015) and biological clues (Wakerley et al., 2014).
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Attendance At Prescribed Pelvic Floor Physical Therapy In A Diverse, Urban Urogynecology Population
Pelvic floor physical therapy (PFPT) is a common and effective treatment for several pelvic floor disorders, but there is limited knowledge about adherence to the therapy or what factors influence attendance.
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Ultrasound finding of ischiofemoral impingement syndrome and novel treatment with botulinum toxin chemodenervation: a case report
Ischiofemoral impingement syndrome (IFIS) is a rare and poorly understood condition that leads to deep gluteal pain, groin, and/or medial thigh pain. It has unique diagnostic challenges, with limited non-operative treatment options. It is caused by the impingement of the quadratus femoris by the lesser trochanter and the ischium. Currently there are no validated physical examination maneuvers for IFIS, and the value of ischiofemoral interval for establishing IFIS is also uncertain. Ultrasound-guided corticosteroid injections have been reported.
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Bone autografts & allografts placed simultaneously with dental implants in rabbits
This study compared stability, removal torque, bone implant contact (BIC) and area (BA) of implants installed simultaneously with onlay autografts or allografts in rabbits' tibias.
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EM Nerd-The Case of the Man Made of Straw Continues
We often view the results of a trial from the perspective of our own preconceived notions. We extrapolate the results far beyond the limits of the data based on our own system of beliefs, using p-values and confidence intervals as statistical armor to substantiate our positions. It is with this in mind that we turn […]
EMCrit by Rory Spiegel.
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Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high dose-rate brachytherapy
Source:Brachytherapy
Author(s): Lucas C. Mendez, Ananth Ravi, Hans Chung, Chia-Lin Tseng, Matt Wronski, Moti Paudel, Merrylee McGuffin, Patrick Cheung, Andrew Loblaw, Gerard Morton
PurposeThe purposes of this study were to investigate the pattern of relapse in patients with low- or intermediate-risk prostate cancer treated with 19-Gy high-dose-rate brachytherapy (HDR-BT) and to calculate the dose received by the area of recurrence.Methods and MaterialsPatients included in this analysis were treated under a Phase II randomized trial that evaluated the role of 19-Gy HDR-BT monotherapy in low- and intermediate-risk prostate cancers. Multiparametric prostate MRI and prostate biopsy were performed in patients with suspicious local recurrence. The site of local relapse was compared with the initial site of disease. The dose received by the site of recurrence was investigated through registration of the posttreatment multiparametric prostate MRI with the HDR-BT treatment plan.ResultsEight of 87 treated patients were found to have local recurrence after 19-Gy HDR-BT. Seven of the eight recurrences were at the site of initial bulk disease. Seven patients were found to have a more aggressive histology in the posttreatment biopsy. The mean volume of prostate that had received 100% of prescription dose was 97%. Mean dose to area of recurrence was 29.1 Gy, whereas dose to 98% and dose to 90% of the recurrence were 21.6 Gy and 23.2 Gy, respectively.ConclusionsThe relapse pattern after a single 19-Gy HDR-BT is predominantly associated with the site of initial disease. This lends some rationale to future strategies of further focused dose escalation to initial site of disease, notwithstanding the fact that the calculated biologically equivalent dose using linear–quadratic assumptions is already very high.
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Evaluating the association between household air pollution and oral cancer
A World Health Organisation report in 2004 [1] assessed the disease burden from indoor smoke generated from combustion of household solid fuels. The report estimated that globally about 50% of all households especially rural household (90%) utilize solid fuels for domestic use. The solid fuels commonly used were coal in China and biomass (crop residues, animal dung, and wood) in India and Africa. Most of this household have relatively poor ventilation thus increasing the exposure to the smoke. The report revealed that women and young children due to their household roles were the most exposed, resulting in chronic pulmonary disease in women and the children suffered from acute infections of the lower respiratory tract [1].
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Comparison of lung tumor motion measured using a model-based 4DCT technique and a commercial protocol
Source:Practical Radiation Oncology
Author(s): D. O'Connell, N. Shaverdian, A.U. Kishan, D.H. Thomas, T.H. Dou, J.H. Lewis, J.M. Lamb, M. Cao, S. Tenn, P. Lee, D.A. Low
PurposeTo compare lung tumor motion measured with a model-based technique to commercial 4DCT and describe a workflow for using model-based 4DCT as a clinical simulation protocol.Methods20 patients were imaged using a model-based technique and commercial 4DCT. Tumor motion was measured on each commercial 4DCT dataset, and was calculated on model-based datasets for three breathing amplitude percentile intervals: 5th–85th, 5th–95th and 0th–100th. Internal target volumes (ITV) were defined on the 4DCT and 5th to 85th interval datasets and compared using Dice similarity. Images were evaluated for noise and rated by two radiation oncologists for artifacts.ResultsMean differences in tumor motion magnitude between commercial and model-based images were 0.47±3.0mm, 1.63±3.17mm, and 5.16±4.90mm for the 5th–85th, 5th–95th, and 0th–100th amplitude intervals, respectively. Dice coefficients between ITVs defined on commercial and 5th–85th model-based images had a mean value of 0.77±.09. Single standard deviation image noise was 11.6±9.6 HU in the liver and 6.8±4.7 HU in the aorta for the model-based images compared to 57.7±30 and 33.7±15.4 for commercial 4DCT. Mean model error within the ITV regions was 1.71±0.81mm. Model-based images exhibited reduced presence of artifacts at the tumor compared to commercial.ConclusionTumor motion measured with the model-based technique using the 5th to 85th percentile breathing amplitude interval corresponded more closely to commercial 4DCT than the 5th–95th or 0th–100th intervals, which showed greater motion on average. The model-based technique tended to display increased tumor motion when breathing amplitude intervals wider than 5th–85th were used due to the influence of unusually deep inhalations. These results suggest that care must be taken in selecting the appropriate interval during image generation when using model-based 4DCT methods.
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Three-Dimensional Printer-Aided Casting of Soft, Custom Silicone Boluses(Scsbs) for Head and Neck Radiotherapy
Source:Practical Radiation Oncology
Author(s): Tsuicheng Chiu, Jun Tan, Mathew Brenner, Xuejun Gu, Ming Yang, Kenneth Westover, Tobin Strom, David Sher, Steve Jiang, Bo Zhao
PurposeCustom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiotherapy.MethodsWe developed a method using 3D–printed parts for generating SCSBs for the treatment of head and neck cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose (PDD) and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on a HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of seven head and neck patients with lesions at nose, cheek, eye or ears. In vivo dose measurements with optically simulated luminescence dosimeters (OSLDs) were performed.ResultsTotal design and fabrication time from patient simulation to radiation treatment start required approximately one week, with fabrication constituting 1–2 working days depending on bolus surface area, volume and complexity. CT and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on seven treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3D printing technology. All treated patients tolerated SCSBs for the duration of therapy.ConclusionsGeneration and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers.
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A Format for Reviewing a Research Paper
Source:Practical Radiation Oncology
Author(s): Robert J. Amdur
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Irradiation préventive en une séance de 10Gy des sites d’intervention pleurale des patients atteints de mésothéliome pleural malin : étude de cohorte rétrospective monocentrique
Source:Cancer/Radiothérapie
Author(s): H. Carette, J.-C. Faivre, J. Salleron, A.-S. Baumann, L. Uwer, C. Clément-Duchêne, J.-M. Vignaud, I. Petit, J. Siat, A. Tiotiu, V. Beckendorf
Objectif de l'étudeLe recours à la radiothérapie prophylactique afin de prévenir les métastases des sites d'intervention pleurale dans le mésothéliome pleural malin demeure controversé et les pratiques cliniques variées. L'objectif était d'évaluer l'efficacité d'une séance unique de radiothérapie externe de 10Gy en prévention de l'ensemencement des sites d'intervention pleurale chez des patients atteints de mésothéliome pleural malin.Matériel et méthodesIl s'agit d'une étude épidémiologique descriptive rétrospective de cohorte, incluant les patients atteints d'un mésothéliome pleural malin histologiquement prouvé irradiés en regard des sites d'intervention pleurale par des électrons de 6 à 18MeV, entre janvier 1990 et décembre 2013 à l'institut de cancérologie de Lorraine.RésultatsQuatre-vingt-onze patients ont été traités par irradiation prophylactique des sites d'intervention pleurale, soit 120 sites d'intervention pleurale, 91 thoracoscopies, 17 thoracotomies avec drainage pleural, 12 ponctions-biopsies guidées par scanographie ou échographie. Le suivi médian était de 7 mois (intervalle interquartile entre 3 et 15 mois). La probabilité de survie globale était de 43,5 % à 12 mois, celle de survie sans progression de 43,7 %. L'incidence de la progression locale était de 8 % à 12 mois. Le temps médian écoulé entre l'irradiation et la progression locale était de 4 mois (2 ; 32). Il n'y a pas eu d'effet secondaire précoce ou tardif de grade supérieur ou égal à deux.ConclusionL'irradiation des sites d'intervention pleurale en une séance unique de 10Gy est efficace, bien tolérée, simple, rapide et peu coûteuse.PurposeProphylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma.Material and methodsThis is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10Gy with 6 to 18MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France).ResultsNinety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed.ConclusionIrradiation of pleural intervention sites with a single fraction of 10Gy is effective, well tolerated, simple, fast and cost effective.
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Robotic stereotactic treatment for malignant metastasis of solid tumour in the pancreas: A multiple case report and review of literature
Source:Cancer/Radiothérapie
Author(s): M. Loi, A. Magallon-Baro, C. Papalazarou, M. Milder, J.J. Nuyttens
Metastatic involvement of the pancreas occurs in 5% of patients affected by advanced malignancies. Surgical resection has been reported by number of authors as a valuable option to improve disease control, in particular in patients with limited disease burden and favourable histotypes; however, the benefit of this procedure has been questioned due to patient selection, technical challenges and relevant risk of perioperative mortality and severe complications. In the present study, a cohort of surgically unfit patients affected by a solitary metastasis in the pancreas from various primary tumours received stereotactic radiotherapy with an ablative dose schedule, obtaining promising local and distant disease progression-free delay with minor toxicity. This is the first report to our knowledge on the use of ablative stereotactic radiotherapy of metastasis in the pancreatic gland.
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4. Does small fiber pathology in PD change over time?
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): M. Nolano, V. Provitera, A. Stancanelli, A. Saltalamacchia, G. Caporaso, F. Lullo, I. Borreca, G. Piscosquito, B. Lanzillo, L. Santoro
Small fiber pathology is part of the clinical picture of PD. Cross-sectional studies have shown no correlation between intraepidermal nerve fiber (IENF) density and patient disease duration and severity. However, it is not known whether IENF density changes over time. We aimed to assess the progression of small fiber pathology in PD patients along the disease course.We assessed epidermal innervation at time 0 and after 1–9years (mean 3.5) in 17 PD patients (M/F=11/6, age=64.4±15.3) leg on punch biopsies. Patients were assessed in a rehabilitative setting. They underwent yearly 30-days hospitalizations and were trained to continue a home-personalized program of physical exercises between successive evaluations. Quantitative sensory testing and sudomotor assessment were also performed.Overall, no difference (p=0.12) between the first and the last IENF density (8.7±4.0 vs. 10.3±4.9) assessment was found. However, the IENF density variation correlated with the disease duration (r=0.71; p<0.01). In fact, while in patients with shorter disease duration IENF density increased over time, in patients with longer disease duration (approximately over 8years) an IENF loss was observed.The small fiber pathology associated to PD can improve to some extent by optimizing patient care, at least in the first stages of disease.
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Cerebellar transcranial direct current stimulation improves adaptive postural control
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Peter Poortvliet, Billie Hsieh, Andrew Cresswell, Jacky Au, Marcus Meinzer
ObjectiveRehabilitation interventions contribute to recovery of impaired postural control, but it remains a priority to optimize their effectiveness. A promising strategy may involve transcranial direct current stimulation (tDCS) of brain areas involved in fine-tuning of motor adaptation. This study explored the effects of cerebellar tDCS (ctDCS) on postural recovery from disturbance by Achilles tendon vibration.MethodsTwenty-eight healthy volunteers participated in this sham-ctDCS controlled study. Standing blindfolded on a force platform, four trials were completed: 60 s quiet standing followed by 20 min active (anodal-tDCS, 1 mA, 20 min, N = 14) or sham-ctDCS (40 s, N = 14) tDCS; three quiet standing trials with 15 s of Achilles tendon vibration and 25 s of postural recovery. Postural steadiness was quantified as displacement, standard deviation and path derived from the center of pressure (COP).ResultsBaseline demographics and quiet standing postural steadiness, and backwards displacement during vibration were comparable between groups. However, active-tDCS significantly improved postural steadiness during vibration and reduced forward displacement and variability in COP derivatives during recovery.ConclusionsWe demonstrate that ctDCS results in short-term improvement of postural adaptation in healthy individuals.SignificanceFuture studies need to investigate if multisession ctDCS combined with training or rehabilitation interventions can induce prolonged improvement of postural balance.
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12. New Telemedicine protocol and patented remote-EEG system from Terni S. Maria Hospital Neurophysiology Division: Experimental assessment and pathway towards large scale service
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): G. Stipa, F. Gabbrielli, D. Frondizi, C. Colosimo, S. Caproni, C. Fanelli, D. Gobbi, L. Giorgi, A. Mancini, M. Domiziani, R. Pasqui, S. Carletti
Terni S. Maria Hospital Neurophysiology Division successfully performed experimental trial for innovative Telemedicine service, using patented remote-EEG system.The Neurophysiologist can be connected from everywhere to the hospital information system through virtual private network and remote device. EEG-passive electrode device is effectively controlled by different direct Remote Desktop freeware softwares. EEG-diagnosis is possible at distance avoiding file exchanges and fulfilling privacy and safety criteria. The connection shares the graphic interface from EEG device desktop to the remote Neurophysiologist, who can also directly control EEG device functions. From 2009 to 2017 a total of 261 EEGs (standard and continuous monitoring) were examined. In the first 6years, specialists operated on EEG device at distance but they sent medical reports by telefax, while from 2016 to 2017 they used report files with digital signature.Two hospital deliberations (n. 875 dated 2008/12/29 and n. 198 dated 2015/03/18) validated the procedure for clinical use, even if into the research protocol. These trial-evidences as well the new regulations on Telemedicine (Intesa Stato-Regioni n. 123/CSR 2016/7/7; EU Directive 2011/24; EU Regulation 2016/679) pave the way for large scale usage of this protocol.The Group of study on Telemedicine in Neurophysiology founded by SINC and Digital-SIT works on this purpose.
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Editorial Board
Source:Clinical Neurophysiology, Volume 128, Issue 12
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Contents
Source:Clinical Neurophysiology, Volume 128, Issue 12
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8. Neurophysiological comparison among tonic, high frequency and burst spinal cord simulation: Novel insights into spinal and brain mechanisms of action
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): T. Bocci, G. De Carolis, D. Barloscio, L. Parenti, M. Valeriani, F. Sartucci
Spinal cord Stimulation (SCS) is an effective option for neuropathic pain treatment. New technological developments, as high-frequency (HF) and Theta Burst Stimulation (TBS), have shown promising results, although putative mechanisms of action are still debated.Twenty-five patients with lower back pain were enrolled and underwent LF, HF and TBS. LEPs were recorded by using a Nd:YAG laser: amplitudes and latencies of the main two components (N1, N2/P2) were compared among different experimental conditions. Similarly, changes in Resting Motor Threshold (RMT), cortical Silent Period (cSP), Short Intracortical Inhibition (SICI) and Intracortical Facilitation (ICF) were evaluated.TBS dampened LEP amplitudes compared with LF (N1: p=0.016; N2/P2: p=0.02) and HF stimulation (p=0.015; p=0.031); while RMT and SICI did not change among experimental conditions, TBS significantly prolonged cSP duration compared with baseline (p=0.002), LF (p=0.048) and HF-SCS (p=0.016); both HF (p=0.004) and TBS (p=0.0039) increased ICF.TBS modulates the sensory-discriminative and the affective-emotional dimension of pain through distinct mechanisms, thus involving intracortical GABAergic and Glutamatergic networks. These results have implications for therapy and for the choice of the stimulation protocol.
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Ultrasound in polyneuropathies – Is size or structure all that matters?
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Kerasnoudis, K. Pitarokoilli, M.-S. Yoon
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16. Safety and effects on motor cortex of closely repeated cathodal transcranial direct current stimulations (C-tDCS)
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Uncini, F. Zappasodi, G. Musumeci, R. Navarra, M. Caulo, V. Di Lazzaro
To assess safety and effects of five C-tDCS (charge density 342,857C/m2) delivered at increasing time intervals in 25h.Safety was defined as absence of serious adverse events and by magnetic resonance imaging and spectroscopy. Effects on motor cortex excitability were evaluated by motor evoked potential (MEP) amplitudes. Inter-individual MEP variability was calculated by the SEM at baseline and subjects were classified on the basis of the ratio between normalized MEPs after the first stimulation compared to baseline.Thirty-two healthy subjects were enrolled. No serious adverse events occurred. Magnetic resonance imaging and spectroscopy did not show structural and biochemical alterations. Only 56% of subjects responded to cathodal-tDCS with the expected reduction of MEP amplitude, 25% were non-responders and 19% opposite responders. In responders, MEP suppression was 32% one hour after the first cathodal-tDC, 21% three hours after the second, no longer present four hours after the third and 12h after the fourth cathodal-tDCS. Loss of effect was due to the increasing interval between C-tDCS and not to intervening homeostatic plasticity.Five C-tDCS in 25h are safe. Interindividual variability on motor cortex excitability and effect duration limited to three hours should be considered in planning therapeutic trials utilizing repeated C-tDCS.
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First virtual special issue (VSI) in Clinical Neurophysiology: A novel way of enhancing accessibility and visibility of published research
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Ulf Ziemann
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2. Pain catastrophizing and features of cortical response to painful stimuli in fibromyalgia
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): K. Ricci, E. Vecchio, M. Delussi, A. Montemurno, E. Gentile, M. de Tommaso
Gamma Band Oscillations (GBO) after laser stimuli are currently considered a correlate of subjective pain perception. Habituation of laser evoked potentials (LEPs) is reduced in patients with central amplification of pain stimuli.To correlate LEPs habituation and GBO induced by laser stimulation with subjective pain rating and pain catastrophizing in patients with Fibromyalgia (FM) and controls.We recorded LEPs in 30 FM patients and 15 healthy controls by stimulating the dorsum of the right hand. At the end of each series, the perceived pain was rated on a visual pain analogue scale (VAS). All subjects were submitted to the Pain Catastrophizing Scale – Italian version (PCS-I).The FM patients showed reduced LEPs habituation and increased laser-related GBO. Both patterns correlated with the PCS-I, but not with subjective pain rating.LEPs habituation and GBO may be the expression of cortical mechanisms of nociceptive stimuli processing and exaggerated attentional orientation toward pain experiences.
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6. Trigeminal neuralgia typical and atypical. A disease or two?
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): C.M. Leone, G. Di Stefano, G. Cruccu, A. Truini
Trigeminal Neuralgia (TN) is a clinical condition characterized by a sudden, usually unilateral, brief, stabbing, recurrent pain with a distribution consistent with one or more divisions of the fifth cranial nerve. In the classical form, the genesis of paroxysmal pain has been attributed to areas of focal demyelination due to vascular compression on the nerve. The 20–50% of patients with TN have an atypical form characterized by the presence of constant pain, often described as burning continuous or sub-continuous, as well as paroxysmal pain.We hypothesize an axonal damage underlying the constant pain component.We enrolled 55 patients with typical (n=36) and atypical (n=19) TN according to the criteria of the 3rd edition of the International Classification of Headache Disorders (ICHD-3). Each patient underwent magnetic resonance imaging (MRI), laser evoked potentials (LEPs) and trigeminal reflexes.The comparison between the duration of disease between the two groups showed no significant differences. We found a greater asymmetry of amplitude (healthy side vs affected side) of N2-P2 component from thermal stimulation in the group with atypical TN (p<0.047).The atypical form has an axonal damage and is not a time-bound phenomenon. The involvement of C-fibers could be the mechanism behind continuous pain.
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10. Neurophysiological prognosis in comatose patients after cardiac arrest: The Italian Multicentric Study (ProNeCA)
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): A. Grippo, R. Carrai, D. Audenino, C. Callegarin, M.G. Celani, M. Lombardi, A. Marrelli, O. Mecarelli, C. Minardi, F. Minicucci, L. Motti, L. Politini, F. Valzania, E. Vitelli, M. Scarpino, M. Spalletti, G. Lanzo, C. Cossu, A. Peris, S. Amantini
To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) with a prospectic multicentre study.Twelve hospitals participated to the study. EEG and SEPs were recorded within 12, 24, and at 72hs after CA. EEG was classified into "non-continuous" and "continuous". SEPs were dichotomized into "bilaterally absent" (BA) and "present". Neurologic outcome was evaluated at 6months by Cerebral Performance Category.Among the 392 patients admitted after CA in the 11 hospitals 298 where enrolled. Within 12h (120 patients) after CA, continuous EEG predicted good outcome and BA SEPs predicted poor outcome. Continuous EEG and BA-SEPs were never found in the same patient. At 48–72h after CA (142 patients) both grade 2 EEG and BA-SEPs predicted poor outcome.The combination of EEG/SEP findings allows prediction of good and poor outcome (within 12h after CA) and of poor outcome (after 48–72h). Recording of EEG and SEPs in the same patients allows always an increase in the number of cases correctly classified, and an increase of the reliability of prognostication in a single patient due to concordance of patterns.
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14. Cerebellar direct current stimulation modulates hand blink reflex: Implications for defensive behavior in humans
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): T. Bocci, R. Ferrucci, D. Barloscio, L. Parenti, F. Cortese, A. Priori, F. Sartucci
The cerebellum is involved in a wide number of integrative functions. We evaluated the role of cerebellum in peripersonal defensive behavior, as assessed by the so-called hand blink reflex (HBR).Twenty subjects underwent to cerebellar (sham, anodal, cathodal) and motor cortex (anodal or cathodal) tDCS (20′, 2mA). For the recording of HBR, electrical stimuli were delivered using a surface bipolar electrode placed on the median nerve at the wrist and EMG activity recorded from the orbicularis oculi muscle bilaterally. HBR was assessed in four different conditions: "hand far", "hand near" (eyes open), "side hand" and "hand patched" (eyes closed).While sham and cathodal cerebellar stimulation had no significant effect, anodal tcDCS dramatically dampened the magnitude of the HBR, as measured by the area under the curve (AUC), in the hand-patched and side hand conditions only, for ipsilateral (p<0.0001; p=0.0008) as well as contralateral recordings (p=0.46; p=0.66). tDCS applied over the motor area did not affect HBR.Our results support a role of the cerebellum in the defensive responses within the peripersonal space surrounding the face and suggesting a cerebellar involvement in visual-independent learning of defensive behavior.
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18. Intraoperative monitoring in calcified giant thoracic disc herniations in anterior thoracic approach surgery
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): C. Minardi, F. Cultrera, M. Bocchino, G. Pugliese, G. Fedeli, R. Donati
Giant herniated thoracic disc (GHTD) is a surgical challenge with high rate of complication. This was a retrospective study of all patients with calcified GHTD operated between July 2012 and February 2017 with intraoperative neurophysiological monitoring (IOM).The study included 10 patients (9 females and 1 male).IOM study comprised: transcranial electric motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) from all limbs in supine position and after lateral position.IOM MEP at the end of surgery were reduced in 4 recovered in 1, stable in 5 patients and disappeared at left lower limb in 1 patient.IOM SEP were stable in 6 patients, reduced in amplitude in 2, disappeared in 1 and in 1 case SEP at lower limbs were absent from preoperative study.The neurological outcome was stable in 9 and transitory worsened in 1 patient, who lost MEP in lower left limb.The surgical strategy was modified according to IOM findings in 4 cases leading to a partial disc excision, one where IOM MEP disappeared and 3 where MEP decreased without recovering.IOM is usefull in this combined surgery (thoracic surgery and neurosurgery) and can help to remove safely GHDT without new permanent neurological deficits.
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22. New frontiers in neurophysiological instrumental diagnostics in the neonatal intensive care unit: “Smart-EEG”
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): I. Capuano, S. Gabbanini, M. Bastianelli, C. Cossu, I. Roma, S. Lori
The neurophysiological instrumental diagnostics is gaining increasingly an undisputed value, revealing an indispensable practice for both diagnostic and prognostic purposes.Many novelties in medicine have introduced an innovative model of Electronic Health, called E-Health.The purpose of this study is to verify that a new modular device, the BluNet®, is a device able to maximize patient comfort and to operate in a way effective but minimally invasive.The study was conducted on a sample of 10 neonates (5F), with gestational ages between the 27+6 and 41weeks, and the recordings were done simultaneously with two devices: NeMus® (gold standard) and BluNet.We made a visual comparison with the reading software, we extracted and compared the frequency of polygraphic channels (ECG and abdominal breathing) and we made two Bland-Altman-Plots. We also conducted a spectral analysis of the traces.The signals' studies showed that there aren't substantial differences between the signals acquired through the two different methods.BluNet, thanks to its innovative features, is a valid tool for electroencephalographic evaluation and the prospects for future use are manifold: screening for early differential diagnosis, initial evaluation for possible hospitalization, ability to get tests at home.
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1. Laser evoked potential in clinical practice: The diagnostic field in small fiber neuropathy
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): G. Devigili, S. Rinaldo, C. Lettieri, R. Eleopra
Small fiber neuropathy (SFN) is frequently encountered in clinical practice. Due to the small nerve fiber characteristics, the diagnosis requires the use of not conventional tests like skin biopsy, Quantitative sensory testing (QST) and Laser Evoked Potentials (LEPs). The aim of this study was to evaluate the diagnostic value of A-delta LEPs in clinical practice in a large cohort of patients with diagnosis of "definite" SFN.We screened 296 patients evaluated in our institution with confirmed diagnosis of sensory neuropathy. We collected 140 patients with pure SFN and 79 patients with mixed fiber neuropathy (MFN). All underwent clinical evaluation, sensory, painful thermal and mechanical detection thresholds, and quantification of somatic intraepidermal nerve fibers (IENF) by skin biopsy to define the diagnosis. Then, all SFN and MFN patients underwent LEPs. The sensitivity and specificity were calculated compared with our normative data on 67 healthy age-matched subjects. A-delta LEPs at dorsal foot showed 76% sensitivity and 80% specificity in SFN diagnosis, and, if performed bilaterally, the sensitivity and specificity increased (81% and 84%). We did not find any correlation between LEPs and entity of skin denervation, but we found good concordance with warm, heat pain thresholds and pinprick perception.
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Thyroid evaluation of children and adolescents with Williams syndrome in Zhejiang Province
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Relation between circulating oxidized-LDL and metabolic syndrome in children with obesity: the role of hypertriglyceridemic waist phenotype
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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High aldosterone and cortisol levels in salt wasting congenital adrenal hyperplasia: a clinical conundrum
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Etiologies of short stature in a pediatric endocrine clinic in Southern Thailand
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Diabetic ketoacidosis, hyperuricemia, and encephalopathy intractable to regular-dose insulin
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Could a combination of heterozygous ABCC8 and KCNJ11 mutations cause congenital hyperinsulinism?
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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Commentary on “Popliteal Artery Aneurysms in Women”
Publication date: Available online 11 November 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): John D. Kakisis, George Geroulakos
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Delayed clinical complete response to intensity-modulated radiotherapy in nasopharyngeal carcinoma
Source:Oral Oncology, Volume 75
Author(s): Wen-Fei Li, Yuan Zhang, Xu Liu, Ling-Long Tang, Li Tian, Rui Guo, Li-Zhi Liu, Ying Sun, Jun Ma
ObjectiveTwelve weeks after radiotherapy is the recommended time-point for assessing tumor response in nasopharyngeal carcinoma (NPC); however, regression after 12 weeks remains unclear. We explored NPC regression and the prognosis of patients with delayed clinical complete response (cCR).Materials and methodsMRI images of 556 NPC patients treated with intensity-modulated radiotherapy (IMRT) between 2009 and 2012 were retrospectively reviewed. Clinical tumor response was assessed at 3–4 (assessment 1) and 6–9 months (assessment 2) after IMRT, and survival rates were compared.ResultsOf the 556 patients, 463 (83.3%) had cCR at assessment 1 (early cCR). Of the 93 patients with partial response at assessment 1, 45 (48.4%) achieved cCR at assessment 2 (delayed cCR), and 48 did not have cCR at assessment 2 (non-cCR). Locoregional failure rate was lower in patients with a cCR than those without a cCR at assessment 1 (7.1% vs. 26.9%, P < .001) and assessment 2 (7.1% vs. 45.8%, P < .001). Multivariate analysis showed cCR was a favorable prognostic factor for locoregional failure-free survival (LRFFS), failure-free survival (FFS), and overall survival (OS). Early and delayed cCR groups had better 5-year LRFFS (92.6% vs. 93.3% vs. 54.2%), FFS (83.8% vs. 84.4% vs. 48.5%) and OS (92.1% vs. 90.6% vs. 65.4%) than the non-cCR group (all P < .001).ConclusionsNearly half of the patients with partial response at 3–4 months achieve cCR by 6–9 months; delayed cCR is not a poor prognosticator. We suggest later assessment of cCR at 6–9 months after IMRT is acceptable in responding NPC.
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Unplanned readmission following transoral robotic surgery
Source:Oral Oncology, Volume 75
Author(s): Michael C. Topf, Amanda Vo, Patrick Tassone, Christopher Shumrick, Adam Luginbuhl, David M. Cognetti, Joseph M. Curry
ObjectivesTo determine the rate of unplanned readmission after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of readmission.Materials and methodsRetrospective chart review of all patients who underwent TORS for squamous cell carcinoma at our institution from March 2010 through July 2016. Primary outcome was unplanned readmission to the hospital within 30 days of discharge. Univariable and multivariable logistic regression were performed to identify risk factors for unplanned readmission.Results297 patients met eligibility criteria. 23 patients (7.7%) had unplanned readmissions within 30 days. Most common reasons for readmission were oropharyngeal bleed (n = 13) and pain/dehydration (n = 10). Average time to unplanned readmission was 6.52 days (range 0–25 days). Discharge on clopidogrel was the only variable independently associated with an increased risk of 30-day unplanned readmission on multivariable analysis with an OR = 6.85 (95% CI 1.59–26.36). Unplanned return to the operating room during initial hospitalization (OR = 7.55, 95% CI 1.26–38.50) and discharge on clopidogrel (OR = 10.45, 95% CI 1.06–82.69) were associated with increased risk of postoperative bleeding. Bilateral neck dissection (OR = 5.17, 95% CI 1.15–23.08) was associated with significantly increased odds of unplanned readmission secondary to pain and dehydration.ConclusionUnplanned readmission following TORS occurs in a small but significant number of patients. Oropharyngeal bleeding and dehydration were the most common reasons for unplanned readmission following TORS.
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Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap
Source:Oral Oncology, Volume 75
Author(s): Tingwei Bao, Jianfeng He, Changyang Yu, Wenquan Zhao, Yi Lin, Huiming Wang, Jianhua Liu, Huiyong Zhu
ObjectivesWe evaluated the effects of three-dimensional virtual planning and the use of a plate-embedded surgical guide in mandibular reconstruction with microvascular fibula flaps.Materials and MethodsWe retrospectively reviewed 35 patients who underwent primary mandibular reconstruction with a free fibula flap. They were divided into three groups according to the therapy they received. In group A, 12 patients underwent reconstruction using the modified surgical guide system, including virtual surgeries, pre-bent titanium plates, screw-predesignated cutting guides for mandibular and fibular osteotomies, and plate-embedded shaping guides. In group B, 14 patients underwent reconstruction using the common surgical guide system, including virtual surgeries, cutting guides and pre-bent plates. In group C, 9 patients underwent reconstruction based on the surgeon's experience. All cases were reviewed for the total operative time, ischemia time of the fibula flaps, accuracy of surgery, and postoperative complications.ResultsAll of the fibula flaps survived. In group A, the ischemia time was shorter than that of groups B and C (P < .05). The average gonion and condyle shift was lower in group A than in groups B and C (P < .01).ConclusionsApplication of the screw-predesignated and plate-embedded surgical guide system can reduce the ischemia time and operation time in mandibular reconstruction with a fibula flap, and can increase reconstruction accuracy. This method is a precise and highly reliable technique for improving the clinical outcome of mandibular reconstruction.
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Clinicopathological Profile of Cervical Tubercular Lymphadenitis with Special Reference to Fine Needle Aspiration Cytology
Abstract
Tuberculosis (TB) is a major killer with a majority of 80–100 per lakh and 2–3% of patients attending our hospital are suffering from tuberculosis. Glandular TB appears to be high in our society. Fifty cases of cervical lymph nodes were collected in ENT department and studied. The diagnosis of TB cervical lymph nodes by disease process is only on 'Histopathological ground'.The aim of the present study is to establish the claim of TB cervical lymph node as a disease process.
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Clinicopathological Profile of Cervical Tubercular Lymphadenitis with Special Reference to Fine Needle Aspiration Cytology
Abstract
Tuberculosis (TB) is a major killer with a majority of 80–100 per lakh and 2–3% of patients attending our hospital are suffering from tuberculosis. Glandular TB appears to be high in our society. Fifty cases of cervical lymph nodes were collected in ENT department and studied. The diagnosis of TB cervical lymph nodes by disease process is only on 'Histopathological ground'.The aim of the present study is to establish the claim of TB cervical lymph node as a disease process.
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Sino-Nasal Outcome Test-22 quality of life patterns in patients presenting with nasal septal perforation
Abstract
Objectives
To assess the impact of nasal septal perforation on quality of life.
Design
Retrospective cohort study.
Setting
Rhinology clinics from two hospitals in Liverpool, United Kingdom.
Participants
Patients diagnosed with nasal septal perforation (NSP).
Main outcome measures
Patients (n=26) diagnosed with NSP completed the Sino-Nasal Outcome Test-22 (SNOT-22). The collated data was compared with SNOT-22 scores from a cohort of healthy volunteers (n=34) and a cohort of patients (n=30) diagnosed with chronic rhinosinusitis (CRS).
Results
The mean total SNOT-22 score of NSP and CRS cohorts were higher than that observed in healthy volunteers. The mean total SNOT-22 score in the CRS cohort (57.2, standard deviation SD 10.3) was the higher than NSP (50.2, SD 23.5), although this difference did not achieve statistical significance. The mean score for the rhinologic-specific domains (rhinologic symptoms, extra-nasal rhinologic symptoms), ear/facial symptoms and psychological dysfunction domain were higher in the CRS cohort compared to NSP, although statistical significance was only observed in the extranasal rhinologic symptoms domain (11.2, SD 2.4 vs. 6.4, SD 4.1). Conversely, the mean sleep dysfunction domain score for NSP (12.7, SD 7.5) was higher than CRS (10.0, SD 4.9 respectively) although this was not statistically significant.
Conclusions
The present study has assessed the clinimetric and psychometric properties of patients suffering with symptomatic NSP. Future reports should consider inclusion of SNOT-22 data but with the addition of perforation-specific symptoms (nasal crusting, epistaxis, whistling noise).
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In Reply
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kani Bilginaylar
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Re: Bilginaylar K: The Use of Platelet Rich Fibrin for Immediate Closure of Acute Oroantral Communications: An Alternative Approach
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Uğur Gülşen, Mehmet Fatih Şentürk, İlham Mehdiyev
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In-continuity neck dissection: long-term oncological outcomes in squamous cell carcinoma of the buccal mucosa
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Li Xie, Yuanyuan Zhang, Wenxiao Huang, Jie Chen, Jianjun Yu, Xiao Zhou
PurposeTo introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients.MethodsA retrospective review of patients treated for BMSCC between 2006 and 2016 was performed. We adopted Kaplan-Meier analysis and log-rank test of local control (LC), regional control (RC), distant metastasis (DM) and disease specific survival (DSS) of in-continuity ND versus discontinuous ND in 220 previously untreated patients with BMSCC, followed by a multivariate Cox regression that included all significant variables.Results53 patients received discontinuous ND and 167 patients received in-continuity ND. Two groups were comparable. Univariate Kaplan-Meier analysis revealed that the 5-year DSS rates for discontinuous ND group and in-continuity ND group were 38 and 62% (P=0.023), respectively. The 5-year RC rate for in-continuity ND group (81%) was significantly better (P=0.004) than discontinuous ND group (54%). On Cox regression analysis, in-continuity ND significantly contributed to both higher RC rate and subsequently better DSS.ConclusionCompared with discontinuous ND, in-continuity ND predicted favorable oncological outcomes in BMSCC patients. We suggest in-continuity ND as a practical approach in the surgical management of BMSCC.
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The effects of Icariin on wound healing of extraction sites with administration of Zoledronic and Dexamethasone: A rat model study
Abstract
Objective
This study was intended to investigate the effects of Icariin on the healing of tooth extraction sites under systemic administration of Zoledronic and Dexamethasone.
Method
Thirty female rats underwent bilateral ovariectomy and were randomly assigned to 5 groups: SS group received weekly injection of saline while ZD, ZD+LICA, ZD+MICA and ZD+HICA groups received Zoledronic with Dexamethasone for 8 weeks. One week later, mandibular first molars were extracted in all groups. Then 30, 60, 120mg/kg Icariin were intragastricly given to ZD+LICA, ZD+MICA and ZD+HICA groups daily for 10 weeks while saline was given to SS group and ZD group. Blood samples and mandibles were harvested for examinations after 10 weeks.
Results
Significantly smaller wound area was noted in SS and ZD+HICA groups but the incidence of bisphosphonates-related osteonecrosis of the jaws (BRONJ) was not significantly different. Groups injected with Zoledronic and Dexamethasone had higher C-terminal crosslinked telopeptide of type 1 collagen (CTX-1), tartrate-resistant acid phosphatase 5b (TRACP 5b) and the number of osteoclast cells, with less vascular endothelial growth factor (VEGF) and osteocalcin (OCN). In contrast, CTX-1, TRACP 5b and the number of osteoclast cells declined after using Icariin and promoted VEGF and OCN were noted; and the effects were in a dosage-dependent manner.
Conclusion
Concurrent use of Zoledronic and Dexamethasone inhibits expression of VEGF, OCN and wound healing; and increases the number of osteoclast cells, serum CTX-1 and TRACP-5b after discontinuation for ten weeks. Icariin weakens those effects at a dose-dependent manner but does not influence onset of BRONJ.
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Effect of non-thermal atmospheric plasma on the dentin-surface topography and composition and on the bond strength of a universal adhesive
This study investigated the effect of application of non-thermal atmospheric plasma (NTAP) on the topography and composition of the dentin surface, as well as the microtensile bond strength (μTBS) of a universal adhesive to NTAP-treated dentin. Exposed flat dentin surfaces from human third molars were either treated with NTAP for 10 and 30 s or untreated (control). The dentin-surface topography and chemical composition were characterized by atomic force microscopy (n = 3) and Raman confocal spectroscopy (n = 5), respectively. The μTBS (n = 8) of Scotchbond Universal to dentin was determined after storage for 24 h and 1 yr, either by direct water exposure or under simulated pulpal pressure. In-situ zymography was used to evaluate the influence of NTAP on the dentin-enzymatic activity. Non-thermal atmospheric plasma produced no remarkable topographical or chemical alterations at the dentin surface; only the amount of phosphate decreased following 10 s of treatment with NTAP. After 1 yr of direct water exposure, the μTBS of NTAP-treated specimens did not differ statistically significantly from that of untreated controls, whereas simulated pulpal pressure-aging resulted in a significantly higher μTBS for NTAP-treated dentin. The dentin-enzymatic activity appeared to be treatment-dependent, but the untreated controls showed more intense fluorescence within the hybrid layer. Scotchbond Universal maintained its μTBS strength after 1 yr of direct water exposure and simulated pulpal pressure, although remarkable statistical differences between treatments were observed depending on the aging condition.
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Natural stable isotopic compositions of mercury in aerosols and wet precipitations around a coal-fired power plant in Xiamen, southeast China
Source:Atmospheric Environment, Volume 173
Author(s): Shuyuan Huang, Lumin Sun, Tingjin Zhou, Dongxing Yuan, Bing Du, Xiuwu Sun
In this study, samples of 18 wet precipitations (WPs) and 38 aerosols were collected around a coal-fired power plant (CFPP) located in Xiamen, southeast China, which was equipped with a seawater flue gas desulfurization system. Total particulate mercury (TPM) in aerosol samples, and total mercury (WP-TM), dissolved mercury (WP-DM) and particulate mercury (WP-PM) in WP samples were analyzed for the natural isotopic compositions of mercury. For the first time, both mass dependent fractionation (MDF) and mass independent fractionation of odd (odd-MIF) and even (even-MIF) isotopes of WP-DM and WP-PM were reported and discussed. Both WP-TM and TPM displayed negative MDF and slightly positive even-MIF. Negative odd-MIF was observed in TPM and WP-PM, whereas positive odd-MIF was observed in WP-TM and WP-DM. It was found that the mercury budget in WP-PM samples was mainly controlled by atmospheric particles. Potential sources of mercury in samples were identified via analysis of mercury isotopic signatures and meteorological data with the NOAA HYSPLIT model. The results showed that TPM and WP-PM in solid samples were homologous and the isotopic compositions of WP-TM depended on those of WP-DM. The ratios of Δ199Hg/Δ201Hg resulting from photochemical reactions and positive Δ200Hg values (from -0.06‰ to 0.27‰) in all samples indicated that the mercury coming from local emission of the CFPP together with long-distance transportation were the two main contributing sources.
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DIDEM - An integrated model for comparative health damage costs calculation of air pollution
Publication date: January 2018
Source:Atmospheric Environment, Volume 173
Author(s): Marco Ravina, Deborah Panepinto, Maria Chiara Zanetti
Air pollution represents a continuous hazard to human health. Administration, companies and population need efficient indicators of the possible effects given by a change in decision, strategy or habit. The monetary quantification of health effects of air pollution through the definition of external costs is increasingly recognized as a useful indicator to support decision and information at all levels. The development of modelling tools for the calculation of external costs can provide support to analysts in the development of consistent and comparable assessments. In this paper, the DIATI Dispersion and Externalities Model (DIDEM) is presented. The DIDEM model calculates the delta-external costs of air pollution comparing two alternative emission scenarios. This tool integrates CALPUFF's advanced dispersion modelling with the latest WHO recommendations on concentration-response functions. The model is based on the impact pathway method. It was designed to work with a fine spatial resolution and a local or national geographic scope. The modular structure allows users to input their own data sets. The DIDEM model was tested on a real case study, represented by a comparative analysis of the district heating system in Turin, Italy. Additional advantages and drawbacks of the tool are discussed in the paper. A comparison with other existing models worldwide is reported.
Graphical abstract
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Evaluating commercial marine emissions and their role in air quality policy using observations and the CMAQ model
Publication date: January 2018
Source:Atmospheric Environment, Volume 173
Author(s): Allison M. Ring, Timothy P. Canty, Daniel C. Anderson, Timothy P. Vinciguerra, Hao He, Daniel L. Goldberg, Sheryl H. Ehrman, Russell R. Dickerson, Ross J. Salawitch
We investigate the representation of emissions from the largest (Class 3) commercial marine vessels (c3 Marine) within the Community Multiscale Air Quality (CMAQ) model. In present emissions inventories developed by the United States Environmental Protection Agency (EPA), c3 Marine emissions are divided into off-shore and near-shore files. Off-shore c3 Marine emissions are vertically distributed within the atmospheric column, reflecting stack-height and plume rise. Near-shore c3 Marine emissions, located close to the US shoreline, are erroneously assumed to occur only at the surface. We adjust the near-shore c3 Marine emissions inventory by vertically distributing these emissions to be consistent with the off-shore c3 Marine inventory. Additionally, we remove near-shore c3 Marine emissions that overlap with off-shore c3 Marine emissions within the EPA files.The CMAQ model generally overestimates surface ozone (O3) compared to Air Quality System (AQS) site observations, with the largest discrepancies occurring near coastal waterways. We compare modeled O3 from two CMAQ simulations for June, July, and August (JJA) 2011 to surface O3 observations from AQS sites to examine the efficacy of the c3 Marine emissions improvements. Model results at AQS sites show average maximum 8-hr surface O3 decreases up to ∼6.5 ppb along the Chesapeake Bay, and increases ∼3–4 ppb around Long Island Sound, when the adjusted c3 Marine emissions are used.Along with the c3 Marine emissions adjustments, we reduce on-road mobile NOX emissions by 50%, motivated by work from Anderson et al. 2014, and reduce the lifetime of the alkyl nitrate species group from ∼10 days to ∼1 day based on work by Canty et al. 2015, to develop the "c3 Science" model scenario. Simulations with these adjustments further improve model representation of the atmosphere. We calculate the ratio of column formaldehyde (HCHO) and tropospheric column nitrogen dioxide (NO2) using observations from the Ozone Monitoring Instrument and CMAQ model output to investigate the photochemical O3 production regime (VOC or NOX-limited) of the observed and modeled atmosphere. Compared to the baseline, the c3 Science model scenario more closely simulates the HCHO/NO2 ratio calculated from OMI data.Model simulations for JJA 2018 using the c3 Science scenario show a reduction of surface O3 by as much as ∼13 ppb for areas around the Chesapeake Bay and ∼2–3 ppb at locations in NY and CT downwind of New York City. These reductions are larger in 2018 than in 2011 due to a change in the photochemical O3 production regime in the Long Island Sound region and the projected decline of other (non-c3 Marine) sources of O3 precursors, highlighting the importance of proper representation of c3 Marine emissions in future modeling scenarios.
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Observation-based trends in ambient ozone in the Czech Republic over the past two decades
Source:Atmospheric Environment, Volume 172
Author(s): Iva Hůnová, Vít Bäumelt
We present the trends in ambient ozone concentrations based on high quality data measured continuously at 26 long-term monitoring sites (9 urban, 17 rural including 10 mountain stations) in the Czech Republic in 1994–2015. We considered annual and summer medians, the 10th and 98th percentiles, maximum daily 8-h running mean concentrations and exposure index AOT40F. For all indicators taken into account except for the 10th percentile, our results showed a similar pattern with significant decreasing trends for about one half of the examined sites. We obtained similar results for all types of sites. The most pronounced decrease in O3 concentrations was recorded at mountain sites. Namely, at the Šerlich mountain site, with an overall decrease per year in annual median by 0.43 ppb, summer median by 1.17 ppb, maximal daily 8-h average by 0.45 ppb, the 10th percentile by 0.62 ppb. The peak concentrations indicated by the 98th percentile and AOT40F decreased most at urban site České Budějovice by 0.75 ppb and 0.84 ppb h per year, respectively. For sites exhibiting significant decreasing trends, an overall decrease per year in annual median was 0.22 ppb, in summer median 0.41 ppb, in the 10th percentile 0.23 ppb, in the 98th percentile 0.53 ppb, and in AOT40F 0.51 ppb h. A significant increasing trend was detected only in the 10th percentile at just three sites, with the highest increase of 0.19 ppb per year recorded at the rural site Sněžník. Moreover, a consistent decrease in limit value exceedances was detected, with by far the highest violation recorded in the meteorologically exceptional year of 2003.Out of the 26 sites under review, seven have not recorded a significant decreasing trend in O3 in any of the considered statistics. The lack of trends in O3 at these seven sites is likely associated with changing time patterns in local NO and NO2 emissions: in particular, with the increasing ratio in NO2/NOx. There is an obvious geographical pattern in recorded O3 trends: most of the sites with no trend detected are situated in the North-western region of the CR with numerous energy-producing large emission sources, partly denitrified recently. Our results clearly indicated that, for O3 decrease, the ratio between individual NO and NO2 forms is critical, and that a simultaneous significant decrease in both NO and NO2 concentrations is not a sufficient prerequisite. Apart from changes in car fleet in urban areas or near motorways, this factor might be of particular relevance in formerly highly polluted areas, where emissions from large power plants recently substantially decreased.
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Sensory recovery of myomucosal flap oral cavity reconstructions
Abstract
Background
Sensory restoration of the oral cavity is a primary aim of reconstructive surgery in posttraumatic or postablative defects. Sensitivity plays a key role in oral function, whose impairment strongly affects the patient's quality of life. Cheek myomucosal flaps provide a reliable and tissue-like reconstruction of these regions but their sensitive recovery, which we still know little about, deserves thorough assessment.
Methods
In this retrospective study, the myomucosal cheek flaps were tested for different aspects of sensory recovery: touch; 2-point discrimination; pain; sharp/smooth discrimination; ability to feel hot/cold stimulus; stereognosis; and taste.
Results
Fifty-two myomucosal flap reconstructions were investigated. All sensitivity tests showed positive results. When comparison was possible, sensitivity seemed significantly close to the contralateral healthy side. Sensory recovery proved to be even better than that reported on reinnervated microvascular free flap reconstructions of the oral cavity.
Conclusion
Myomucosal flap reconstruction demonstrated a high degree of sensory recovery.
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Patterns of vascularization and surgical morbidity in juvenile nasopharyngeal angiofibroma: A case series, systematic review, and meta-analysis
Abstract
Background
Vascular patterns of juvenile nasopharyngeal angiofibroma (JNA) are poorly defined. We performed both institutional and systematic literature reviews to characterize the relationship between arterial supply patterns of JNA with intraoperative blood loss and tumor recurrence.
Methods
A retrospective review of 26 patients with JNA treated at our institution from 1995 to 2015 with available angiograms, and systematic reviews and meta-analyses of 828 JNA cases undergoing angiographic embolization published between 1995 and 2015 were completed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
The systematic review (828 cases) found internal carotid artery (ICA) supply in 35.6% of tumors, and 30.8% of tumors received bilateral vascular supply. Our institutional data (n = 26) indicated 69% had bilateral supply. Meta-analysis of data from 5 studies demonstrated ICA/bilateral arterial supply is predictive of increased operative blood loss (P < .01).
Conclusion
Complex vascular contributions to JNA are frequent, underreported, and portends increased blood loss. This information can justifiably be included in staging systems to enhance prognostic counseling of patients.
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Dose-finding and efficacy confirmation trial of the superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for locally advanced maxillary sinus cancer (Japan Clinical Oncology Group 1212): Dose-finding phase
Abstract
Background
We are currently undertaking a multi-institutional prospective trial of the superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy for patients with T4aN0M0 or T4bN0M0 locally advanced maxillary sinus squamous cell carcinomas (SCC). We herein report the results of the dose-finding phase.
Methods
The dose-finding phase sought to evaluate the incidence of dose-limiting toxicities and determine the recommended number of cycles of the intra-arterial infusion of cisplatin. In this phase, 100 mg/m2 of cisplatin was administered intra-arterially weekly for 7 weeks with concomitant radiotherapy (70 Gy).
Results
All 18 patients received a full dose of radiotherapy. The number of cycles of cisplatin was 7 in 13 patients and 6 in 5 patients. The dose-limiting toxicities were observed in 5 patients.
Conclusion
These results indicated that this therapy is safe and well-tolerated at 7 cycles of cisplatin, which was determined to be the recommended number of cycles for locally advanced maxillary sinus SCC.
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A variant in PPP4R3A protects against Alzheimer-related metabolic decline
Abstract
Objectives: A reduction in glucose metabolism in the posterior cingulate cortex (PCC) predicts conversion to Alzheimer's disease (AD) and tracks disease progression, signifying its importance in AD. We aimed to use decline in PCC glucose metabolism as a proxy for the development and progression of AD to discover common genetic variants associated with disease vulnerability.
Methods: We performed a genome-wide association study (GWAS) of decline in PCC [18F] FDG PET measured in Alzheimer's Disease Neuroimaging Initiative (ADNI) participants (n=606). We then performed follow-up analyses to assess the impact of significant single nucleotide polymorphisms (SNPs) on disease risk and longitudinal cognitive performance in a large independent dataset (n=870). Lastly, we assessed whether significant SNPs influence gene expression using two RNA sequencing (RNA-Seq) datasets (n=210 & n=159).
Results: We demonstrate a novel genome-wide significant association between rs2273647-T in the gene PPP4R3A and reduced [18F] FDG decline (p= 4.44 x 10−8). In a follow-up analysis using an independent dataset, we demonstrate a protective effect of this variant against risk of conversion to MCI or AD (p=0.038) and against cognitive decline in individuals who develop dementia (p = 3.41 x 10−15). Furthermore, this variant is associated with altered gene expression in peripheral blood and altered PPPP4R3A transcript expression in temporal cortex, suggesting a role at the molecular level.
Interpretations: PPP4R3A is a gene involved in AD risk and progression. Given the protective effect of this variant PPP4R3A should be further investigated as a gene of interest in neurodegenerative diseases and as a potential target for AD therapies. This article is protected by copyright. All rights reserved.
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Heterogenous migraine aura symptoms correlate with visual cortex fMRI responses
Abstract
Objective: Migraine aura is sparsely studied due to the highly challenging task of capturing patients during aura. Cortical spreading depression (CSD) is likely the underlying phenomenon of aura. The possible correlation between the multifaceted phenomenology of aura symptoms and the effects of CSD on the brain has not been ascertained.
Methods: Five migraine patients were studied during various forms of aura symptoms induced by hypoxia, sham or physical exercise and photostimulation. The blood oxygenation level-dependent (BOLD) functional MRI (fMRI) signal response to visual stimulation was measured in retinotopic mapping defined visual cortex area V1 - V4.
Results: We found reduced BOLD response in patients reporting scotoma and increased response in patients who only experienced positive symptoms. Furthermore, patients with bilateral visual symptoms had corresponding bi-hemispherical changes in BOLD response.
Interpretation: These findings suggest that different aura symptoms reflect different types of cerebral dysfunction, which correspond to specific changes in BOLD signal reactivity. Furthermore, we provide evidence of bilateral CSD recorded by fMRI during bilateral aura symptoms. This article is protected by copyright. All rights reserved.
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A localized pallidal physiomarker in cervical dystonia
Abstract
Objective: Deep brain stimulation (DBS) allows for direct recordings of neuronal activity from the human basal ganglia. In Parkinson's disease, a disease-specific physiomarker was identified that is now used to investigate adaptive closed-loop stimulation in first studies. In dystonia such a physiomarker is missing.
Methods: Pallidal oscillations were recorded from 153 contact pairs in 27 patients. We investigated whether power amplitudes in theta and beta bands correlate with dystonic symptom severity across patients. We then projected theta power from each contact pair onto standard subcortical anatomy. This way, we defined a theta hot spot on a group level and investigated whether proximity of the active DBS contacts to it correlates with clinical improvement.
Results: Dystonic symptom severity significantly correlated with theta, but not beta oscillatory amplitudes (ρ=0.4; P=0.009) and interhemispheric coherence (ρ=0.5; P=0.002). The sweet spot of theta activity localized to the posterior third of the internal pallidum and theta power correlated with proximity to this location (ρ=0.23; P=0.002), which coincided with three previously published coordinates describing optimal stimulation targets. Finally, motor improvement through pallidal long term DBS correlated with theta peak amplitude (ρ=0.38; P=0.018).
Interpretation: Our findings suggest that theta oscillations in the internal pallidum are robustly associated with dystonic symptoms in cervical dystonia and may be a useful biomarker for adaptive closed-loop stimulation. Furthermore, theta oscillatory activity may have a predictive value for the clinical benefit after chronic DBS that could be used to improve intraoperative neurophysiological target mapping during electrode implantation. This article is protected by copyright. All rights reserved.
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Nasal Duplication Combined with Cleft Lip and Palate: Surgical Correction and Long-Term Follow-Up
Background: Diprosopus dirrhinus, or nasal duplication, is a rare entity of partial craniofacial duplication. Methods: The case we present is the first report of diprosopus dirrhinus associated with complete cleft lip and palate. The baby was born in Cambodia at full term by normal vaginal delivery with no significant perinatal and family history. Physical examination revealed significant facial deformity due to the duplicated nose and the left complete cleft lip/palate on the right subset. Results: There were 4 nostrils; both medial apertures including the cleft site were found to be 10–15 mm deep cul-de-sac structures without communication to the nasopharynx. The upper third of the face was notable for hypertelorism with a duplication of the soft-tissue nasion and glabella. Between the 2 nasal dorsums, there was a small cutaneous depression with a lacrimal fistula in the midline. Surgical treatment included the first stage of primary lip and nose repair and the second stage of palatoplasty. Conclusions: The patient was followed up at the age of 10 years showing satisfactory results for both aesthetic and functional aspects. Further management in the future will be required for the hypertelorism and nasal deformity.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zmwlL7
Diagnostic accuracy of Magnetic Resonance Imaging in Post-Traumatic Brachial Plexus Injuries: A Systematic Review
Source:Clinical Neurology and Neurosurgery
Author(s): Helen K.B. Fuzari, Armèle Dornelas de Andrade, Clarice F. Vilar, Larissa B. Sayão, Paula R.B. Diniz, Fernando H. Souza, Daniella A. de Oliveira
Computed Tomographic Myelography (CTM) is a gold-standard imaging test for evaluating the brachial plexus and has been used for a long time. Another imaging test more recently used is Magnetic Resonance imaging (MRI), which is also part of the plexus evaluation. The purpose of this study was to determine the accuracy of MRI in diagnosing post-traumatic injuries of the brachial plexus. We conducted a Systematic Review with cross-sectional studies of diagnostic accuracy. Studies with populations presenting post-traumatic brachial plexus injury, over 16 years old, both genders, and examined by CT Myelography and MRI were evaluated. The trial resulted in three studies that covered the inclusion criteria. The sample consisted of 46 participants. The tool Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies, and the software RevMan was used to identify the homogeneity of the studies that entered the analysis. The study was registered in PROSPERO under the number CRD42016041720. Studies showed moderate to high risk of bias, with low or very low quality of evidence due to the limitations of studies and differences in comparing the assessment groups. The heterogeneity of the studies made it impossible to create meta-analyzes. MRI has been an excellent test for assessing traumatic brachial plexus injuries in clinical practice; however, the quantitative analysis of studies identified a lack in methodological rigor. Future studies should focus on methodological rigor, providing more accurate assessments of modalities and their benefits.
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A novel index in the diagnosis of iNPH and its association with disproportionately enlarged subarachnoid space pathophysiology?
Source:Clinical Neurology and Neurosurgery
Author(s): Halil Onder
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Pornography Headache
Source:Clinical Neurology and Neurosurgery
Author(s): Wei-Hsi Chen, Kuo Yen Chen, Hsin-Ling Yin
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Profiles of Women in Science: Prof. Ingrid Olson of Temple University
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NUT Co Reactivity - Acquiring Knowledge for Elimination Recommendations (NUT CRACKER) Study
Abstract
Background
Ambiguities exist regarding the diagnosis of tree-nut allergy, necessitating either elimination or performance of oral food challenges (OFC).
Objective
To examine the co-incidences of allergies among tree-nuts and improve diagnostic testing to minimize the need for OFC.
Methods
Eighty three patients prospectively evaluated for walnut, pecan, cashew, pistachio, hazelnut and almond allergy. A history of previous reactions was obtained and standardized skin prick tests (SPT) using finely ground tree-nut solution and basophil activation tests (BAT) were performed. Patients underwent OFC for each tree-nut they eliminated and to which a reaction in the previous 2 years was not documented.
Results
While most patients were sensitized to 5-6 tree-nuts, over 50% were allergic to only 1-2 tree-nuts. The highest rate of allergy in sensitized patients was observed for walnut (74.6%) and cashew (65.6%). The rate of co-allergy for most tree-nuts was < 30%. Two thirds of walnut- and cashew-allergic patients were also allergic to pecan and pistachio, respectively, while all pecan- and pistachio-allergic patients were allergic to walnut and cashew, respectively. Receiver operating characteristic analysis for SPT and BAT was tree-nut dependent and yielded area under the curve (AUC) values ranging from 0.75-0.94. Knowledge of co-incident allergies in these pairs along with the combination of SPT and BAT correctly distinguished allergic from tolerant patients for walnut (87%), pecan (66%), cashew (71%) and pistachio (79%).
Conclusion
The data presented here should assist in differentiating between allergic and tolerant patients, decrease the need for OFC and allow for appropriate elimination recommendations.
This article is protected by copyright. All rights reserved.
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Dendritic cell phenotype in severe asthma reflects clinical responsiveness to glucocorticoids
Abstract
Background
Subsets of patients with severe asthma remain symptomatic despite prolonged, high dosage glucocorticoid therapy. We hypothesised that the clinical glucocorticoid sensitivity of these asthmatics is reflected in differences in peripheral blood dendritic cell subsets.
Objective
To compare peripheral blood leukocyte populations using flow cytometry at baseline and after 2 weeks of systemic glucocorticoid (steroid) treatment to identify immunological differences between steroid sensitive (SS) and steroid resistant (SR) asthmatics.
Methods
Adult severe asthmatics (SS n=12; SR n=23) were assessed for their response to two weeks of therapy with oral prednisolone. Peripheral blood was obtained before and after therapy and stained for lymphocyte (CD3, CD19, CD4, CD8 and Foxp3) and dendritic cell markers (Lineage negative [CD3, CD14, CD16, CD19, CD20, CD56], HLA-DR+, CD304, CD11c, ILT3 and CD86).
Results
A higher median frequency of myeloid DCs (mDCs) but not plasmacytoid DCs (pDCs) was observed in the blood of SR as compared to SS asthmatics (p=0.03). Glucocorticoid therapy significantly increased median B cell, but not T cell numbers in both cohorts, with a trend for increased numbers of Foxp3+ Tregs in SS (p=0.07), but not SR subjects. Oral prednisolone therapy significantly reduced the median numbers and frequencies of total DCs and pDCs in both SS and SR asthmatics. Interestingly the expression of HLA-DR and ILT3 was also reduced on pDCs in all patients. In contrast, therapy increased the median frequency of mDCs in SS, but reduced it in SR asthmatics.
Conclusions
Myeloid DC frequency is elevated in SR compared with SS asthmatics, and mDC show a differential response to oral prednisolone therapy.
This article is protected by copyright. All rights reserved.
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Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism
Abstract
Background
Induction of general anesthesia and endotracheal intubation may precipitate parathyroid hormone (PTH) elevation in patients with primary hyperparathyroidism (HPT). The purposes of this study were to revisit this observation and to study its impact in healthy patients.
Methods
Patients with primary HPT who underwent parathyroidectomy were retrospectively studied. The PTH was sampled and compared: before, immediately after general anesthesia and endotracheal intubation, and 15 minutes after parathyroidectomy. Healthy adults who underwent elective operations were prospectively studied. The PTH was sampled before general anesthesia and endotracheal intubation, immediately after, and 15 minutes later.
Results
Thirty-one patients, aged 28-89 years (mean 60.1 ± 13 years), were retrospectively studied. The PTH was significantly elevated after general anesthesia and endotracheal intubation (P = .014). Fifty patients, aged 21-86 years (mean 54 ± 15 years), were prospectively studied. The PTH elevation after general anesthesia and endotracheal intubation was not significant.
Conclusion
General anesthesia and endotracheal intubation causes an immediate, steep, and significant PTH elevation in patients with primary HPT but only a minor change in healthy adults. The difference may be attributed to an impaired adrenergic response in patients with primary HPT.
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