Editorial Board

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121





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Mucins: Structural diversity, biosynthesis, its role in pathogenesis and as possible therapeutic targets

Publication date: Available online 24 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Suresh Sulekha Dhanisha, Chandrasekharan Guruayoorappan, Sudarsanan Drishya, Prathapan Abeesh
Mucins are the main structural components of mucus that create a selective protective barrier for epithelial surface and also execute wide range of other physiological functions. Mucins can be classified into two types, namely secreted mucins and membrane bounded mucins. Alterations in mucin expression or glycosylation and mislocalization has been seen in various types of pathological conditions such as cancers, inflammatory bowel disease and ocular disease, which highlight the importance of mucin in maintaining homeostasis. Hence mucins can be used as attractive target for therapeutic intervention. In this review, we discuss in detail about the structural diversity of mucins; their biosynthesis; its role in pathogenesis; regulation and as possible therapeutic targets.



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The ethical plausibility of the ‘Right To Try’ laws

Publication date: Available online 24 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): D. Carrieri, F.A. Peccatori, G. Boniolo
'Right To Try' (RTT) laws originated in the USA to allow terminally ill patients to request access to early stage experimental medical products directly from the producer, removing the oversight and approval of the Food and Drug Administration. These laws have received significant media attention and almost equally unanimous criticism by the bioethics, clinical and scientific communities. They touch indeed on complex issues such as the conflict between individual and public interest, and the public understanding of medical research and its regulation. The increased awareness around RTT laws means that healthcare providers directly involved in the management of patients with life-threatening conditions such as cancer, infective, or neurologic conditions will deal more frequently with patients' requests of access to experimental medical products.This paper aims to assess the ethical plausibility of the RTT laws, and to suggest some possible ethical tools and considerations to address the main issues they touch.



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Non pharmacological interventions and non-fentanyl pharmacological treatments for breakthrough cancer pain: a systematic and critical review

Publication date: Available online 23 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Sebastiano Mercadante
Background: Oral opioids or other pharmacological or non-pharmacological interventions are often suggested in the management of breakthrough cancer pain (BTcP). The aim of this systematic and critical review was to analyse and critically comment the evidence of any non-fentanyl therapies proposed for BTcP.MethodsA systematic literature search was carried out to find studies providing clinical data on any treatment excluding fentanyl products.ResultsNo data exist about the use of oral opioids. Some information is available on parenteral morphine in a large sample of patients and episodes of BTcP. For other treatments, including methadone, nitrous oxide, anti-inflammatory drugs, samarium, and gabapentin the existing data, observational and obtained in a small number of patients do not provide useful information to be generalized. Only ketamine, a drug difficult to use for many physicians, particularly in determined setting, provided some evidence according a randomized controlled double-blind study.ConclusionsRecommendations suggesting the use of oral opioids or other pharmacological and non-pharmacologic interventions for BTcP, are not based on any, even minimal evidence. These treatments are worthwhile of further investigation, particularly in determined conditions that should fit the pharmacokinetics of oral opioids.



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Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients: A systematic review and meta-analysis

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Ye Ming, Yun Hu, Yuyue Li, Jinfeng Yu, Haojue He, Leilei Zheng
ObjectivesThe purpose of this study was to assess, through a systematic review and meta-analysis, the efficacy of maxillary protraction appliances (MPAs) on improving pharyngeal airway dimensions in growing class III patients with maxillary retrognathism.MethodsAn electronic search in PubMed, Cochrane Library, Web of Science, and EMBASE was until September 2nd, 2017. The assessments of methodological quality of the selected articles were performed using the Newcastle-Ottawa Scale. Review Manager 5.3 (provided by the Cochrane Collaboration) was used to synthesize the effects of MPAs on pharyngeal airway dimensions.ResultsFollowing full-text articles evaluation for eligibility, 6 studies (168 treated subjects and 140 untreated controls) were included in final quantitative synthesis and they were all high-quality. Compared to untreated control groups, the treatment groups had increased significantly nasopharyngeal airway dimensions with the following measurements: PNS-AD1 (fixed: mean difference, 1.33 mm, 95% CI, 0.48mm-2.19 mm, P = .002), PNS-AD2 (random: mean difference, 1.91 mm, 95% CI, 0.02mm-3.81 mm, P = .05), aerial nasopharyngeal area (fixed: mean difference, 121.91 mm², 95% CI, 88.70 mm²-155.11 mm², P < .00001) and total nasopharyngeal area (fixed: mean difference, 142.73 mm², 95% CI, 107.90 mm²-177.56 mm², P < .00001). Meanwhile, McNamara's upper pharynx dimension (fixed: mean difference, 0.96 mm, 95% CI, 0.29mm-1.63 mm, P = .005), which was highly related to post-palatal airway dimension, was also improved significantly. However, no statistically significant differences in adenoidal nasopharyngeal area (P > .05) and McNamara's lower pharynx dimension (P > .05) existed.ConclusionsMPAs can increase post-palatal and nasopharyngeal airway dimensions in growing skeletal class III subjects with maxillary retrusion. It may be suggested that MPAs have the potential to reduce the risk of obstructive sleep apnea syndrome in children with maxillary retrusion by enlarging airway space.



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Cochlear implant symmetry via template

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): A.J. Hallwachs, J.E. Weinstein, B.K. Reilly
Current trends in bilateral cochlear implantation (CI) favor a minimally invasive subperiosteal pocket technique. Symmetric receiver-stimulator (R/S) placement is an important goal for bilateral CI, especially with regard to patient satisfaction. In this article, we describe a method easily adopted to achieve optimal symmetry. Upon reviewing the Senior Author's 11 bilateral CI cases using the direct subperiosteal pocket technique with the proposed "mirror template," we found improved symmetry, which translated into high patient and family satisfaction regarding the aesthetics of the symmetric R/S placement.



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Mature and immature pediatric head and neck teratomas: A 15-year review at a large tertiary center

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Harish Dharmarajan, Noémie Rouillard-Bazinet, Binoy M. Chandy
IntroductionPediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established.ObjectivesTo review the management and outcomes of pediatric head and neck teratomas. To distinguish differences between mature and immature tumors with respect to the age at presentation and surgery, tumor size and location, alpha fetoprotein (AFP) levels, airway management, and recurrence.MethodsA 15-year retrospective chart review of patients treated for head and neck teratomas at Texas Children's Hospital was performed. A total of 20 patients were included. Wilcoxon rank and Fisher's exact tests were used for statistical analysis.ResultsImmature teratomas were associated with both higher AFP levels (80800 ng/ml, p = 0.02) and maximum tumor dimensions (14.4 cm, p = 0.0034) than mature teratomas (24400 ng/ml and 6.44 cm). Patients with immature tumors were younger at the time of surgical resection (19.8 days, p = 0.025) compared to those with mature tumors (348 days). 89% of immature teratomas involved anterior neck localization compared to 27% for mature teratomas (p = 0.0098); 88% of the immature teratomas required an EXIT (Ex Utero Intrapartum Treatment) procedure compared with 40% of the mature teratomas (p = 0.0656). Recurrence was noted in only two cases: an immature teratoma 51 months after incomplete resection and a mature teratoma 33 months after complete resection. Long-term consequences of surgical resection included cleft palate (38.9%), dysphagia (33.3%), facial nerve paresis/paralysis (16.7%) and tracheotomy (16.7%).ConclusionImmature teratomas had higher AFP levels, tumor dimensions, frequency of anterior neck localization, and requirement of EXIT than mature teratomas. Given that there was no significant difference between the recurrence rates of immature and mature teratomas, follow-up vigilance should be maintained equally regardless of tumor maturity.



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Lingual tonsillectomy in children with Down syndrome: Is it safe?

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Jonathan R. Skirko, Emily L. Jensen, Norman R. Friedman
ObjectiveEvaluate peri-operative course and morbidity in children with Down syndrome (DS) who underwent a lingual tonsillectomy (LT) for residual obstructive sleep apnea (rOSA).MethodsRetrospective case series for children with DS who underwent LT for rOSA from April 2011 to July 2016. Our primary outcomes were length of stay, readmission and complications. Surgical effectiveness was evaluated by change in the obstructive apnea-hypopnea-index(OAHI) and oxygen saturation nadir.ResultsThirty-nine patients underwent LT. The mean length of stay was 1.3 days with n = 21(72%) staying one night. One subject (2.6%) had a post-operative bleed that did not require operative intervention. No other major complications occurred. In terms of effectiveness of surgery, twenty–nine children had sufficient data for inclusion. Median OAHI did not appreciably change (p = 0.07) from before surgery. Five subjects (17%) were cured of OSA (OAHI < 2/hour) and a mix of improvement and worsening was identified. The lowest oxygen saturation improved from 78% (SD = 7) before surgery to 82% (SD = 6) after surgery (p = 0.003).ConclusionLT has a favorable post-operative course but its effectiveness at curing rOSA in the DS population has not been established/proven. Further research is indicated to determine optimal surgical management for DS children with LTH.Level of evidence4.



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How does a bilingual environment affect the results in children with cochlear implants compared to monolingual-matched children? An Italian follow-up study

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Francesca Forli, Giada Giuntini, Annalisa Ciabotti, Luca Bruschini, Ulrika Löfkvist, Stefano Berrettini
ObjectivesTo compare the results after cochlear implantation achieved by monolingual and bilingual deaf children implanted at our Institution, with the aim of understanding if there are any differences between the two groups and if there is a correlation between the outcomes and some patients' variables.MethodsThe study group was composed by 14 bilingual deaf children and the control group by the same number of monolingual children implanted at our Institution. The control group was obtained by matching to each bilingual child a monolingual one with a similar clinical history regarding age at hearing loss diagnosis, age at first hearing-aids fitting and age at CI procedure. Children received a speech perception and linguistic development evaluation through specific structured tests. The linguistic competence of the patients both in mainstream and native language was determined by the Student Oral Language Observation Matrix (SOLOM).ResultsWe did not find any statistically significant differences between bilingual and monolingual children in speech perception outcomes. Nevertheless, we obtained different results concerning language skills: bilingual implanted children scored lower at structured language tests, even if the difference was not statistically relevant. Bilingual children scored significantly lower than monolingual ones at the SOLOM scale for linguistic competence.ConclusionThe results reported in the present study show better language skills after cochlear implant in Italian monolingual cases than in bilingual ones. This seems to be related to the condition of bilingualism in Italy, mainly related to immigration, and frequently associated with low socio-economic levels, poor competence in the mainstream language and poor social integration, with a suboptimal exposure to the mainstream language and difficulties in following the rehabilitative program.



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Are validated patient-reported outcomes used on children in pediatric otolaryngology? A systematic review

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kevin Wong, Jacquelyn Piraquive, Chelsea A. Troiano, Anita Sulibhavi, Kenneth M. Grundfast, Jessica R. Levi
ObjectivesReview the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics.MethodsIn October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (age<18) to complete PROs. Exclusion criteria included validation studies, reviews, and abstracts. Interreviewer agreement was determined using Cohen's kappa. Quality and rigor of validation testing for included PROs was determined using the COnsensus-based Standards for selection of health status Measurement Instruments.ResultsInterrater agreement was very good (κ = 0.91; 95% CI, 0.85–0.98). Out of 316 articles retrieved, 11 met inclusion criteria. Eight PROs were identified. Six PROs were tested for validity and three of these PROs were tested for validity specifically within children. The most frequently utilized PRO was the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire. Two studies (18.2%) utilized PROs within the scope of their validation. Seven studies (63.6%) used PROs outside the scope of their validation. Two studies (18.2%) used non-validated PROs.ConclusionsPatient-reported outcomes have become an integral part of research and quality improvement. There is a relative paucity of PROs directed towards children in pediatric otolaryngology and some studies utilized PROs that were not validated or not validated for use in this age group. Future efforts to design and validate more instruments may be warranted.



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EXIT (ex utero intrapartum treatment) in a growth restricted fetus with tracheal atresia

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): S. Kyle Gonzales, Steven Goudy, Kara Prickett, Jane Ellis
Congenital high airway obstruction syndrome (CHAOS) encompasses a heterogeneous group of pathologies leading to poor lung development and difficulty oxygenating the newborn after delivery. While previously uniformly fatal, the ex utero intrapartum therapy (EXIT) procedure has provided a method to treat these patients and provide an airway to potentiate survival. We present a patient diagnosed prenatally with CHAOS secondary to tracheal atresia complicated by severe intra-uterine growth restriction (IUGR) who was successfully delivered via an EXIT procedure at 33-weeks. Multidisciplinary care and planning is paramount.



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Profilactic role of simvastatin and mitomycin C in tracheal stenosis after tracheal damage: Study in rats

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Adnan Ekinci, Sema Koc, Ahmet Serhat Erdoğan, Hakan Kesici
ObjectivesWe aimed to investigate the prophylactic effect simvastatin of and mitomycin C (MMC) on laryngeal and tracheal stenosis in tracheotomised rats by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind.Material and methodStandard vertical tracheotomy was performed on 24 rats. Then the animals were randomly divided into three groups as A, B and C. In group A 0.4 mg/day once daily mitomycin C was injected to the paratracheal region for 14 days. In group B daily 30 mg/kg/day simvastatin was given via gavage to rats for 14 days. In group C 2 cc/day intraperitoneal saline given to rats and the created control group by 14 days follow up. After 10 days, tracheal cannulas were removed. Three weeks later, all animals were euthanized and trachea specimens were harvested. The present study investigates the effects of MMC and Simvastatin on fibrosis, inflammation, stenosis index and tracheal wall thickness in a tracheal injury model.ResultsThe difference between the groups in terms of degree of inflammation scores was statistically insignificant (P = 0,187). Differences between the groups were found to be insignificant in terms of the preventionof fibrosis (P = 0,993). There was no significant difference between groups in terms of stenosis index (P = 0.645). In terms of wall thickness, control, simvastatin and mitomycin C groups were statistically different (p = 0.038). The difference between post-hoc test results was between Mitomycin C and control groups (p = 0.036).Maximum wall thickness in the MMC group (0,299 mm) was significantly lower compared to the control group (0,382 mm)(P < 0,0001). Maximum wall thickness was statistically lower in the simvastatin (0.324 mm) group compared with the control group (0.382 mm) (P < 0.0001). There was no statistically significant difference between the simvastatin group (0,198 mm) and control group (0,200 mm) with respect to minimum wall thickness (P = 0.982). Minimum wall thickness was significantly lower in the mitomycin-C group (0,160 mm) comparison to the control group (0,200 mm) (P < 0.0001).ConclusionIt was detected that the simvastatin and MMC is not effective in preventing the tracheal stenosis, inflammation and fibrosis formation.



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Iatrogenic Cushing's syndrome and adrenal insufficiency in infants on intranasal dexamethasone drops for nasal obstruction – Case series and literature review

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Rohan R. Joshi, Alison Maresh
The use of intranasal steroid drops for nasal obstruction in infants is common practice and can prevent more invasive surgical procedures; however, it is not without complication. We describe 2 cases of iatrogenic Cushing's secondary to nasal steroids in infants with nasal obstruction, discuss the etiology of this unusual complication, and review previous literature reports. While reporting in the literature is sparse, these cases highlight the risk of development of adrenal insufficiency with usage of nasal steroid drops in infants as well as the need for close monitoring of administration and tapering of the drops. Additionally, we suggest an approach to the infant with symptomatic nasal obstruction that addresses the usage of intranasal steroid drops and emphasizes the need for quick tapering and possible endocrine consultation when appropriate.



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Impact of age on the anatomy of the pediatric pterygopalatine fossa and its relationship to the suprazygomatic maxillary nerve block

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Alexander P. Marston, Glenn Merritt, Jonathan M. Morris, Shelagh A. Cofer
ObjectivesThe suprazygomatic maxillary nerve block is associated with improved post-operative pain management after select craniofacial surgical procedures. This study's objective is to better define the impact of pediatric facial skeletal growth on techniques for accessing the pterygopalatine fossa (PPF).MethodsPediatric patients with prior thin-slice maxillofacial computed tomography imaging were identified in an institutional radiology database. Aquarius image-processing software (Ver. 4.4.11, TeraRecon, Inc., Foster City, CA) was used to measure from the suprazygomatic skin to the greater wing of the sphenoid where the needle is then re-oriented in an anterior and inferior trajectory allowing it to advance into the PPF.ResultsA total of 90 patients ranging from 0 to ≤18 years of age were included in the study. The mean distance from the suprazygomatic skin to the foramen rotundum in patients 0 to ≤12 months of age and >13 to ≤18 years of age was 38.6 (SD ± 4.7) and 47.1 (SD ± 3.2) mm, respectively (p < .0001). The statistical analysis demonstrated a positive correlation between age in years and all of the measured distances (p = .0001). With respect to the plane of the needle entry site, the anterior and inferior angles required for passage into the PPF in the 0 to ≤12 months age group were 11 (SD ± 2.1) and 9.0 (SD ± 2.5) degrees, respectively, compared to those in the >13 to ≤18 years of age group at 12.4 (SD ± 1.9) and 12.1 (SD ± 3.2) degrees, respectively. These data reveal that patients in the oldest compared to the youngest pediatric age groups require significantly greater needle insertion, yet the angles of needle re-orientation are clinically similar between these two pediatric age groups varying by up to only 3°.ConclusionAs expected, the distance from the skin to the foramen rotundum increases significantly with age; however, the angles of re-orientation with respect to the original needle entry site demonstrated up to only 3° of variability between the youngest and oldest age groups evaluated in this pediatric cohort.



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A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Giulia Lorenzoni, Sekib Umihanić, Danila Azzolina, Emiliano Manza, Fuad Brkić, Dario Gregori
ObjectivesThe present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from European countries.MethodsThe analysis is based on FB injury cases included in the Susy Safe registry. Cases from the Ear-Nose-Throat (ENT) Clinic, University Clinical Center of Tuzla (B&H) were compared with cases from European countries participating in the Susy Safe project. Multiple Correspondence Analysis (MCA) was performed to elucidate differences within a large data set regarding mechanisms and objects causing injuries.ResultsThe results of the MCA showed that the first three dimensions explained 43% of the variability. The first dimension was identified by children hospitalized for FB ingestion, the second one by children hospitalized for FB aspiration (lower airways), and the third one by children with an FB in the ear or in the upper airways. The analysis of the median of coordinates of factors contributing to each dimension showed that the greatest difference between B&H and European countries regarded the third one. Looking at the profile of these patients, it might be suggested that the proportion of males and females and the type of activity in which they were involved at time of injury occurrence are different among the countries consideredConclusionsThis study proposes a simple tool for assessing differences among countries in the distribution of FB injuries. This case study shows that B&H has different patterns of FB injuries in the upper respiratory tract.



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Validity of automated threshold audiometry in school aged children

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): S.M. Govender, M. Mars
BackgroundAutomated hearing tests have the potential to reduce the burden of disease amongst learners by introducing such services within the school context.MethodsThe aim of the study was to conduct a validation study on normal and hearing impaired learners, comparing air and bone conduction automated test results to conventional test results in 50 school aged learners (n = 100 ears) within a noise controlled school environment using a cross sectional comparative study design. The KuduWave 5000 (Emoyo.net) was used in this study.Data analysisThe spearman's correlation coefficient was calculated to determine test-retest reliability. The mean and standard deviation (SD) was measured for each frequency. The absolute mean difference (AMD) and SD was calculated for both air and bone conduction testing at each frequency for automated testing. A paired sampled t-test and a one way ANOVA was used to identify any significant differences. Alpha was set as 0.05.ResultsThere was significant correlation between thresholds obtained for automated test one and test two for normal hearing and hearing impaired group. The spearmans correlation coefficient was high (close to +1) for majority of the results for both groups across the frequency range. Both air and bone conduction testing across the frequency range of 250 Hz–2000 Hz and at 8000 Hz were not statistically signfiicant (p < .005) for both groups, however at 4000 Hz for bone conduction testing in the hearing impaired group, there was a statisticially signficant difference (p = .003). This was attirubted to the variaibilty in bone conduction test results often due to force and placement of the bone vibrator.ConclusionThe findings indicate that automated audiometry can yield relaible results that are comparable to conventional test results. Key clinical considerations include extending the response time, regular rest periods, improving instructions and comfort levels.



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Plasticity after pediatric cochlear implantation: Implication from changes in peripheral plasma level of BDNF and auditory nerve responses

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Razieh Alemi, Masoud Motassadi Zarandy, Mohammad Taghi Joghataei, Ali Eftekharian, Mohammad Reza Zarrindast, Nasim Vousooghi
IntroductionSensory neural hearing loss could lead to some structural and physiological changes in the auditory pathways, such as alteration in the expression of neurotrophins. These factors, especially Brain-Derived Neurotrophic Factor (BDNF), play an important role in synaptic functions and experience-related plasticity. Restoring cochlear function after hearing loss is possible through cochlear implantation (CI). Evaluation of the blood concentration changes of neurotrophins as prerequisites of plasticity could help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array.MethodsHere we have studied the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (H.A). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds.ResultsPlasma BDNF concentration in children with CI increased significantly after CI surgery, while this difference in H.A group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes.ConclusionIt is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced-related plasticity after CI stimulation.



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Reliability and validity of the Chinese pediatric voice handicap index

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kena Liu, Shaofeng Liu, Zhou Zhou, Qinyi Ren, Jie Zhong, Renzhong Luo, Huabiao Qin, Siyi Zhang, Pingjiang Ge
ObjectivesTo evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI).Material and methodsThe original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient.ResultsThe internal consistency of total score and three subscales scores of Chinese pVHI were 0.788–0.944. The test-retest reliability was 0.631–0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694–0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01).ConclusionsThe Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia.



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A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Neha A. Patel, Randall A. Bly, Seth Adams, Kristen Carlin, Sanjay R. Parikh, John P. Dahl, Scott Manning
ObjectivesPostoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization.The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay.Study designInstitutional review board approved retrospective study (2010–2016).MethodsConsecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay.Results53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01).ConclusionsThe number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy.



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Central xanthoma of the mandible associated with hyperlipidemia: A rare presentation

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): John K. Brooks, Behzad Mostoufi, Ahmed S. Sultan, Zaid H. Khoury, Jeffery B. Price, John C. Papadimitriou, John R. Basile, Cinthia B. Drachenberg, Rania H. Younis
Xanthoma is a common, self-limiting cutaneous lesion of non-Langerhans cell, lipid-laden foamy histiocytes that is often concomitant with hyperlipidemia. The intraosseous counterpart is rarely encountered and typically presents as a painless, expansile osteolytic process in the context of hyperlipidemia or normolipidemia. Only a scant number of gnathic xanthomas have been reported in the otolaryngologic literature. We report the clinical, laboratory, radiographic, histopathologic, immunohistochemical, and ultrastructural studies of a mandibular lesion discovered in an asymptomatic 16-year-old male, and associated with 2 previously unreported comorbidities, namely hyperlipidemia and vitamin D deficiency.



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Proportion of CD4 and CD8 tumor infiltrating lymphocytes predicts survival in persistent/recurrent laryngeal squamous cell carcinoma

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Rebecca Hoesli, Andrew C. Birkeland, Andrew J. Rosko, Mohamad Issa, Kelsey L. Chow, Nicole L. Michmerhuizen, Jacqueline E. Mann, Steven B. Chinn, Andrew G. Shuman, Mark E. Prince, Gregory T. Wolf, Carol R. Bradford, Jonathan B. McHugh, J. Chad Brenner, Matthew E. Spector
Tumor infiltrating lymphocytes (TILs) have been shown to be an important prognostic factor in patients with previously untreated head and neck cancer. After organ preservation therapy for laryngeal cancer and subsequent persistence/recurrence, the prognostic value of TILs is unknown. Our goal was to determine if TILs have value as a prognostic biomarker in patients with surgically salvageable persistent/recurrent laryngeal squamous cell carcinoma.Levels of TILs were quantified on tissue microarrays from 183 patients undergoing salvage total laryngectomy for persistent/recurrent laryngeal cancer after radiation or chemoradiation between 1997 and 2014. Demographic and clinical data were abstracted. Immunohistology evaluation included CD4, CD8, PDL-1, p16, CD31, Vimentin, EGFR, and p53.Elevated levels of either CD8 or CD4 positive TILs were associated with improved disease specific survival (CD8: HR 0.46, 95% CI 0.24–0.88, CD4: HR 0.43; 95% CI 0.21–0.89) and disease free survival (CD8: HR 0.53, 95% CI 0.29–0.94, CD4: HR 0.52; 95% CI 0.27–0.99). Levels of CD8 (HR 0.74; 95% CI 0.47–1.17) or CD4 (HR 0.66; 95% CI 0.40–1.08) TILs were not significantly associated with overall survival. In bivariate analysis, patients with elevated CD4 and/or CD8 TILs had significantly improved disease specific survival (HR 0.42; 95% CI 0.21–0.83) and disease free survival (HR 0.45; 95% CI 0.24–0.84) compared to patients with low levels of CD4 and CD8. PDL-1, p16, CD31, Vimentin, EGFR, and p53 were not significant prognostic factors. On multivariate analysis, elevated CD8 TILs were associated with improved disease specific survival (HR 0.35; 95% CI 0.14–0.88, p = .02) and disease free survival (HR 0.41; 95% CI 0.17–0.96, p = .04).CD8, and possibly CD4, positive TILs are associated with favorable disease free and disease specific survival for recurrent/persistent laryngeal cancer.



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Transauricular vagus nerve stimulation at auricular acupoints Kindey (CO10), Yidan (CO11), Liver (CO12) and Shenmen (TF4) can induce auditory and limbic cortices activation measured by fMRI

Publication date: Available online 24 December 2017
Source:Hearing Research
Author(s): Liyan Peng, Ketao Mu, Aiguo Liu, liangqiang Zhou, Yueyue Gao, Imrit Tejvansh Shenoy, Zhigang Mei, Qingguo Chen
The purpose of this study was to explore the central mechanism of transauricular vagus nerve stimulation (taVNS) to human by fMRI and to find a suitable taVNS site for potential tinnitus treatment. 24 healthy subjects aged between 28 and 38 years were enrolled in the experiment. 8 subjects were stimulated in the auricular acupoints Kindey (CO10), Yidan (CO11), Liver (CO12) and Shenmen (TF4) in the left ear, 8 subjects were stimulated at the anterior wall of the auditory canal and left lower limb as an anterior stimulation group; 8 persons who were arranged in a sham group received taVNS at the left ear lobe and tail of the helix. Functional magnetic resonance imaging (fMRI) data from the cortices was collected and an Alphasim analysis was performed. We found that taVNS at auricular acupoints CO10-12, TF4 can instantly and effectively generate blood oxygenation level dependent (BOLD) signal changes in the prefrontal, auditory and limbic cortices of healthy subjects by fMRI. When comparing the acupoints group and the sham group in the left brain, the signals from the prefrontal cortex, the auditory ascending pathway including superior temporal gyrus, middle temporal gyrus, thalamus and limbic system regions such as putamen, caudate, posterior cingulate cortex, amygdala and parahippocampal gyrus were increased under our stimulation. The difference of the BOLD signal in the left brain between acupoints group and anterior group was in the superior temporal gyrus. We could also find signal differences in several regions of right brain among the groups. In conclusion, taVNS at acupoints CO10-12, TF4 could activate the prefrontal, auditory and limbic cortices of healthy brain and this scheme could be a promising tool for tinnitus treatment.



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NLGN1 and NLGN2 in the prefrontal cortex: their role in memory consolidation and strengthening

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): Aaron Katzman, Cristina M Alberini
The prefrontal cortex (PFC) is critical for memory formation, but the underlying molecular mechanisms are poorly understood. Clinical and animal model studies have shown that changes in PFC excitation and inhibition are important for cognitive functions as well as related disorders. Here, we discuss recent findings revealing the roles of the excitatory and inhibitory synaptic proteins neuroligin 1 (NLGN1) and NLGN2 in the PFC in memory formation and modulation of memory strength. We propose that shifts in NLGN1 and NLGN2 expression in specific excitatory and inhibitory neuronal subpopulations in response to experience regulate the dynamic processes of memory consolidation and strengthening. Because excitatory/inhibitory imbalances accompany neuropsychiatric disorders in which strength and flexibility of representations play important roles, understanding these mechanisms may suggest novel therapies.



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Intraoperative cortico-cortical evoked potentials shows disconnection of the motor cortex from the epileptogenic network during subtotal hemispherotomy

Publication date: Available online 23 December 2017
Source:Clinical Neurophysiology
Author(s): Takeshi Inoue, Hisashi Kawawaki, Masataka Fukuoka, Kiyohiro Kim, Megumi Nukui, Ichiro Kuki, Shin Okazaki, Saya Koh, Noritsugu Kunihiro, Takehiro Uda, Yasuhiro Matsuzaka, Masao Matsuhashi, Yasushi Iimura, Hiroshi Otsubo




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Substernal thyroidectomy: the trans-cervical approach

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Christine M. Dahlhausen, Nathaniel J. Walsh, David J. Terris
Substernal thyroid goiters that require surgery may pose unique challenges to thyroid surgeons based on the size and inferior extent of the disease. Consequently, there are multiple variations to the approach and additional considerations in operative planning and technique that are often required. While there is some debate on the precise definition of substernal thyroid, for the purposes of this manuscript it is considered to be thyroid tissue below the sternal notch or clavicle. This article aims to provide thyroid surgeons who encounter the challenges of substernal thyroid a straightforward algorithm for planning and operative techniques that have proven successful in the safe and effective management of this condition.



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Revision central neck dissection

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Gian-Marco Busato, Jeremy Freeman
Recurrent well differentiated thyroid cancer is an important problem and incidence is on the rise. Recurrence preferentially involves lymph nodes of the central and lateral neck. Detection and surveillance of such disease is commonly performed via serum thyroglobulin and high frequency neck ultrasonography. Management options include: active surveillance, local ablative techniques, RAI, external beam radiotherapy, and surgery. The gold standard of care is surgical removal in the form of comprehensive neck dissection. While revision surgery in the neck does carry increased risk, the use of well-established techniques can decrease this risk and allow surgeons to safely and effectively treat patients with recurrent neck disease.



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Preface

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Phillip Pellitteri




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Techniques for thyroid cancer involving extreme superior thyroid pole

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Daniel Kwon, Alfred Simental
Standard operative techniques for thyroidectomy have become well refined and widely disseminated. However, special circumstances, such as superior pole thyroid cancers, can present unique difficulties for the unprepared surgeon. Appropriate workup and appreciation of the unique anatomic relationships in the superior-most extent of the thyroid gland is vital in surgical planning. The ability to anticipate and manage a variety of contingencies such as superior laryngeal nerve sacrifice, vascular isolation / repair, laryngectomy, and repair of pharyngeal defects are essential for safe surgery for cancers of the extreme superior thyroid pole.



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Operative Techniques in Otolaryngology-Head and Neck Surgery

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Joseph Scharpf
The worldwide incidence of thyroid cancer has increased and generated great debate and study concerning the proper evidence-based management strategies. Despite this increase, there has been no significant increase in advanced, invasive thyroid cancers, which continue to represent the primary cause of thyroid cancer specific death. This section provides an evidence-based management review for thyroid cancer invading the aero-digestive tract and addresses critical issues of diagnosis, preoperative evaluation, surgical management, and adjuvant treatment germane to this important subset of patients. Illustrative examples of complex patients will be presented in the context of evidence-based literature to help guide the practitioner in an area less frequently encountered by many surgeons.



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Surgery for fibro adherent inflammatory thyroid disease

Publication date: Available online 23 December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): David Goldenberg, Warren Swegal, Mitchell Dunklebarger, Phillip K. Pellitteri
Inflammatory thyroid diseases include those which are mediated through autoimmune disorders such as Hashimoto′s thyroiditis and Grave′s disease, as well as inflammatory goiter and sub-acute thyroiditis. In patients with such disorders, the thyroid gland often becomes markedly enlarged with an associated fibro-vascular connective tissue reaction involving the thyroid capsule and surrounding soft tissues. This results in dense, adherent connective tissue which may compress and obscure critical central neck compartment structures and make capsular dissection challenging. Thyroid surgery in patients with fibro-adherent inflammatory thyroid disease are technically challenging and post-operative complication rates are higher for these procedures. Due to these increased risks for complications, operative procedures in these circumstances should be designed with careful consideration of the anatomic changes associated with the underlying inflammatory pathology. Elements important to successful surgical resection include appropriate patient preparation and surgical planning, together with execution of the operative procedure with adaptation to many of the changes induced by inflammation on both the thyroid gland and the surrounding central neck structures.



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Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients

Abstract

Background

Obstructive sleep apnea (OSA) is common in hemodialysis (HD) patients. The reasons for the high prevalence and whether OSA is associated with vascular impairment, end-organ damage, and prognosis are not completely clear.

Methods

We evaluated patients with low cardiovascular risk on HD, not treated by CPAP. Laboratory tests, sleep questionnaires (Berlin and Epworth) and polysonography studies, echocardiography, and markers of arterial stiffness and atherosclerosis were performed. After the initial evaluation, patients were followed up until cardiovascular events, renal transplantation, or death.

Results

Fifty-five patients (49% male, 50 ± 9 years, body mass index 24.7 ± 4.5 kg/m²) were included. OSA (apnea-hypopnea index ≥ 5 events/h) occurred in 73% of the patients. The proportion of patients with interdialytic weight gain > 2 kg was higher in patients with OSA than those without OSA (96 vs. 55%; p = 0.002). Left ventricular (LV) posterior wall thickness (10.0 ± 1.9 vs. 11.3 ± 1.8 mm; p = 0.04) and LV diastolic diameter (48 ± 5 vs. 53 ± 5 mm; p = 0.003) were higher in patients with OSA than in patients without OSA, respectively. Sleep questionnaires did not predict OSA. No significant differences were found in pulse wave velocity, carotid intima-media thickness, and ankle-brachial index between the groups. Multivariate analysis showed that interdialytic weight gain > 2 kg and LV diastolic diameter were independently associated with OSA. On follow-up (median 45 months), OSA was found to be associated with a higher incidence of cardiovascular (CV) events (28 vs. 7%, log-rank = 0.042).

Conclusions

OSA was associated with increased risk of CV events. Significant (> 2 kg) interdialytic weight gain was independently associated with OSA.

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Evaluation of afferent pain pathways in adrenomyeloneuropathic patients

X-linked adrenoleukodystrophy (ALD) is an inherited disorder of peroxisomal metabolism characterized by the accumulation of saturated very long chain fatty acids (VLCFA) in the brain, adrenal cortex and plasma. It is caused by mutations in the ABCD1 gene, which encodes an adenosine triphosphate-binding cassette peroxisomal transporter, involved in the import of VLCFA into the peroxisome for degradation (Moser et al., 2004). There is an evident wide range of phenotypic variability: childhood, adolescent and adult cerebral forms of ALD, adrenomyeloneuropathy (AMN), Addison's disease only and presymptomatic or asymptotic phenotype (Moser, 1997).

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Sleep patterns associated with the severity of impairment in a large cohort of patients with chronic disorders of consciousness

Brain injury due to severe anoxic, hemorrhagic or traumatic events often lead to chronic disorders of consciousness (DOCs), which have recently received increasing attention because of growing medical and ethical concerns relating to patient management. A considerable proportion of survivors of severe brain damage enter an unresponsive wakefulness syndrome/vegetative state (UWS/VS) or minimally conscious state (MCS) (Laureys et al., 2010) and a number of studies have assessed more or less extensive series of DOC patients using imaging procedures or neurophysiological evaluations designed to provide information supporting the clinical assessment of different degrees of DOCs or to identify prognostic markers (see reviews by Bender et al., 2015; Kondziella et al., 2015).

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Automatic bad channel detection in intracranial electroencephalographic recordings using ensemble machine learning

Intracranial electroencephalographic (iEEG) recordings, either from depth electrodes (stereoelectroencephalography, SEEG) (Kahane and Dubeau 2014) or from subdural grids and strips (electrocorticography, ECoG) (Fernández and Loddenkemper 2013), are used to localize the epileptogenic zone in some patients with drug-resistant focal epilepsy where other non-invasive measures are limited. These techniques permit to collect prominent data for assessing brain dynamics in pathological and physiological conditions.

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Can clinical neurophysiology assist in patient selection for DBS in pediatric dystonia?

Globus pallidus internus (GPi) deep brain stimulation (DBS) has become established as an effective treatment for disabling, medically refractory generalized, segmental and focal dystonia (Coubes et al., 2004; Vidailhet et al., 2005; Kupsch et al., 2006; Volkmann et al., 2014). The greatest improvement in dystonia after GPi DBS occurs in isolated idiopathic or genetic (primary) dystonia, which respond better than acquired (secondary) dystonia (Eltahawy et al., 2004; Andrews et al., 2010; Vidailhet et al., 2009; Vidailhet et al., 2013).

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Neurophysiological correlates of word processing deficits in isolated reading and isolated spelling disorders

In English speaking countries, developmental dyslexia (DD) is primarily defined as a reading disorder which is characterized by deficits in word reading accuracy, that are frequently accompanied by spelling problems. The association between reading and spelling deficits is in line with theories of literacy development that generally assume a close, bidirectional relationship between reading and spelling development (e.g. Frith, 1985), with correlation scores of .77-.86 between the two domains (for a review see Ehri, 1997).

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Abnormal cortical brain integration of somatosensory afferents in ALS

Amyotrophic Lateral Sclerosis (ALS) is an adult-onset neurodegenerative condition characterized by the loss of motor neurons at cortical, brainstem and spinal levels (Kiernan et al., 2011). ALS is widely considered as a pure motor degeneration; sensory impairment is not a recognised feature of ALS or regarded as secondary to motor impairment (Fincham and Van Allen, 1964; Feller et al., 1966; Schulte-Mattler et al., 1999). However, in addition to the 10 % patients describing frank paraesthesia and neuropathic pain, sensory impairments have been reported in up to 60 % patients, including abnormal vibration, cutaneous and heat thresholds.

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Prediction of agenesis of the mandibular second premolar using the developmental stages of the mandibular canine, first premolar, and second molar

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Ji-Soo Song, Teo Jeon Shin, Young-Jae Kim, Jung-Wook Kim, Ki-Taeg Jang, Sang-Hoon Lee, Hong-Keun Hyun
ObjectiveThe aim in this study was to suggest a standard for early diagnosis of agenesis of the mandibular second premolars (L5) by estimating the developmental stages of the mandibular canines (L3), first premolars (L4), and second molars (L7).DesignAmong all 5136 pediatric patients aged 5–11 years who received panoramic radiographs between June 2008 and December 2009 at Seoul National University Dental Hospital, 215 control patients and 74 agenesis patients who met inclusion criteria were analyzed. The developmental stages of all L3, L4, L5, and L7 of control and agenesis patients were estimated using the method proposed by Demirjian. To identify the tooth (L3, L4, L7) with the developmental pattern most similar to that of L5, Kendall rank correlation coefficients and Bootstrap method were used. To verify that patients with agenesis of L5 show delayed development, Wilcoxon rank sum test was used. To identify the stages in which to diagnose agenesis of L5, we performed survival analysis.ResultsThere was a significant correlation between the developmental stages of L3, L4, L7 and L5. The developmental stages of those three teeth in the agenesis group were delayed compared with those in the control group at certain ages. If the developmental stages of at least two of those three teeth reach Demirjian stage D without the calcification of L5, agenesis of L5 can be confirmed.ConclusionsAgenesis of L5 can be confirmed when two of the three teeth (L3, L4, L7) reach Demirjian stage D.



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Patients should now be informed of the benefits of the use of a piezoelectric saw before orthognathic bilateral sagittal split osteotomy

Since the Montgomery ruling1, surgeons have had to widen the scope of consent to include any information that could be of material interest to patients before a procedure. Orthognathic patients who have had bilateral sagittal split osteotomy have traditionally been warned about high rates of permanent change of sensation to the lower lip or chin, and recent multicentre data from the UK has identified a self-reported rate of change of sensation of 56%.2

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Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

Two relatively new modalities, follicular unit extraction (FUE) and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5%) and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination.

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How do walkers behave when crossing the way of a mobile robot that replicates human interaction rules?

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Previous studies showed the existence of implicit interaction rules shared by human walkers when crossing each other. Especially, each walker contributes to the collision avoidance task and the crossing order, as set at the beginning, is preserved along the interaction. This order determines the adaptation strategy: the first arrived increases his/her advance by slightly accelerating and changing his/her heading, whereas the second one slows down and moves in the opposite direction. In this study, we analyzed the behavior of human walkers crossing the trajectory of a mobile robot that was programmed to reproduce this human avoidance strategy. In contrast with a previous study, which showed that humans mostly prefer to give the way to a non-reactive robot, we observed similar behaviors between human-human avoidance and human-robot avoidance when the robot replicates the human interaction rules. We discuss this result in relation with the importance of controlling robots in a human-like way in order to ease their cohabitation with humans.



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Perceptual-motor regulation in locomotor pointing while approaching a curb

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Steven van Andel, Michael H. Cole, Gert-Jan Pepping
Locomotor pointing is a task that has been the focus of research in the context of sport (e.g. long jumping and cricket) as well as normal walking. Collectively, these studies have produced a broad understanding of locomotor pointing, but generalizability has been limited to laboratory type tasks and/or tasks with high spatial demands. The current study aimed to generalize previous findings in locomotor pointing to the common daily task of approaching and stepping on to a curb.Sixteen people completed 33 repetitions of a task that required them to walk up to and step onto a curb. Information about their foot placement was collected using a combination of measures derived from a pressure-sensitive walkway and video data. Variables related to perceptual-motor regulation were analyzed on an inter-trial, intra-step and inter-step level.Similar to previous studies, analysis of the foot placements showed that, variability in foot placement decreased as the participants drew closer to the curb. Regulation seemed to be initiated earlier in this study compared to previous studies, as shown by a decreasing variability in foot placement as early as eight steps before reaching the curb. Furthermore, it was shown that when walking up to the curb, most people regulated their walk in a way so as to achieve minimal variability in the foot placement on top of the curb, rather than a placement in front of the curb. Combined, these results showed a strong perceptual-motor coupling in the task of approaching and stepping up a curb, rendering this task a suitable test for perceptual-motor regulation in walking.



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Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): M.C.M. Klotz, Britta K. Krautwurst, K. Hirsch, M. Niklasch, M.W. Maier, S.I. Wolf, T. Dreher
BackgroundThe aims of this study were to investigate if patellar tendon shortening (PTS) as a part of SEMLS (single event multilevel surgery) is effective for reduction of flexed knee gait in children with cerebral palsy (CP) and, if PTS leads to stiff knee gait.MethodsIn a randomized controlled study 22 children with flexed knee gait (age: 10.4 ± 2.6 years, GMFCS Level I–III) were randomized and allocated to two groups (1: SEMLS + PTS; 2: SEMLS no PTS): SEMLS was performed for correction of flexed knee gait either with or without additional PTS. Before and after surgery (follow up: 12.7 ± 1.6 months) kinematics (3-D motion analysis) and clinical parameters were compared.ResultsTwo children were lost to follow up. Maximum knee extension improved significantly in both groups after SEMLS while the patients with additional PTS showed much more correction (SEMLS + PTS: 37.6° to 11.4°, p = 0.007; SEMLS no PTS: 35.1° to 21.8°, p = 0.016). After surgery peak knee flexion decreased significantly (14.6°, p = 0.004) in the "SEMLS + PTS" group while there was no relevant change in the other group. There was a trend of increase in anterior pelvic tilt after surgery in both groups, but no statistical significant difference. After surgery knee flexion contracture (15.9°, p < 0.001) and popliteal angle (27.2, p = 0.009) measured on clinical examination only decreased significantly in the "SEMLS + PTS" group.ConclusionPTS is effective for correction of flexed knee gait and knee flexion contracture leading to superior stance phase knee extension. However, additional PTS may lead to stiff knee gait and a higher increase of anterior pelvic tilt.

Graphical abstract

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A systematic review of the gait characteristics associated with Cerebellar Ataxia

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Ellen Buckley, Claudia Mazzà, Alisdair McNeill
BackgroundCerebellar Ataxias are a group of gait disorders resulting from dysfunction of the cerebellum, commonly characterised by slowly progressing incoordination that manifests as problems with balance and walking leading to considerable disability. There is increasing acceptance of gait analysis techniques to quantify subtle gait characteristics that are unmeasurable by current clinical methods This systematic review aims to identify the gait characteristics able to differentiate between Cerebellar Ataxia and healthy controls.MethodsFollowing systematic search and critical appraisal of the literature, gait data relating to preferred paced walking in Cerebellar Ataxia was extracted from 21 studies. A random-effect model meta-analysis was performed for 14 spatiotemporal parameters. Quality assessment was completed to detect risk of bias.ResultsThere is strong evidence that compared with healthy controls, Cerebellar Ataxia patients walk with a reduced walking speed and cadence, reduced step length, stride length, and swing phase, increased walking base width, stride time, step time, stance phase and double limb support phase with increased variability of step length, stride length, and stride time.ConclusionThe consensus description provided here, clarifies the gait pattern associated with ataxic gait disturbance in a large cohort of participants. High quality research and reporting is needed to explore specific genetic diagnoses and identify biomarkers for disease progression in order to develop well-evidenced clinical guidelines and interventions for Cerebellar Ataxia.



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Comprehensive biomechanical characterization of feet in USMA cadets: Comparison across race, gender, arch flexibility, and foot types

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Jinsup Song, Kersti Choe, Michael Neary, Rebecca A. Zifchock, Kenneth L. Cameron, Michael Trepa, Marian T. Hannan, Howard Hillstrom
Lower extremity musculoskeletal injuries are common, complex, and costly problems. Literature supports associations between static foot structure and dynamic foot function, as well as between overuse injury and demographic characteristics. Previous studies failed to provide a comprehensive biomechanical foot characteristics of at-risk military personnel. In this study, foot structure, function, and arch height flexibility (AHF) were objectively measured in 1090 incoming cadets (16.3% female, mean age of 18.5years and BMI of 24.5kg/m²) of the United States Military Academy at the start of their training. A Generalized Linear Model with an identity link function was used to examine the effects of race, gender, foot types, and AHF while accounting for potential dependence in bilateral data. Planus and flexible feet independently demonstrated over-pronation, as measured by reduced Center of Pressure Excursion Index (CPEI). When comparing across race, Black participants showed a significantly lower arch height index (AHI), a larger malleolar valgus index (MVI), and a higher prevalence of pes planus (91.7% versus 73.3% overall). However, Asian participants with flexible arches, rather than Black with low arch, displayed over-pronation in gait. Females showed no significant difference in standing AHI and MVI but demonstrated a significantly greater AHF and a reduced CPEI than male participants. This was the first large scale investigation that comprehensively characterized biomechanical foot in a cohort of young at-risk individuals with lower limb musculoskeletal injuries. Long-term goal is to examine the relationship between these biomechanical features and injuries, ultimately to develop effective preventive measures.



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Reliability of upper limb and trunk joint angles in healthy adults during activities of daily living

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Susannah M. Engdahl, Deanna H. Gates
Assessments of upper limb performance should require participants to perform tasks that challenge the limits of their ability. In order to select appropriate tasks, it is important to know which joints are used to perform the movement and how reliably those movements can be measured. The purpose of this work was to quantify the reliability of upper limb and trunk joint angles in healthy adults during common activities of daily living (ADLs). Nineteen participants performed six ADLs with the right arm (applying deodorant, turning a doorknob, answering a desk telephone, placing a pushpin in a bulletin board, wiping a plate with a towel, and pouring water from a pitcher) during two separate sessions. Within- and between-session reliability was quantified using intraclass correlation coefficients (ICCs) and minimum detectable change values (MDCs). Reliability was generally better within-session than between-session. The ICCs exceeded 0.75 for 88% of the joint angles and exceeded 0.90 for 32% of the angles. All MDCs were less than 25° and 61% were also less than 10°. The MDCs represented a larger percent of the average angles for the trunk (61%) and wrist (62%) compared to the shoulder (18%) and elbow (26%). Although these results show that most angles can be measured reliably for these six ADLs, reliability varied considerably between joints. It is therefore important to select tasks for assessing of upper limb performance based on which specific joints need to be evaluated.



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The iFST: An instrumented version of the Fukuda Stepping Test for balance assessment

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Valeria Belluscio, Elena Bergamini, Marco Iosa, Marco Tramontano, Giovanni Morone, Giuseppe Vannozzi
The maintenance of the upright posture during dynamic balance requires the integration of sensory inputs regulated by the brain. After a neurological event, the assessment of balance control impairments is crucial for supporting health professionals in the design of personalized rehabilitation protocols. A commonly used test to assess balance ability is the Fukuda Stepping Test (FST). However, the clinical parameters traditionally considered are not fully representative of the patient's motor ability. The purpose of this study was to devise an instrumented version of the FST (iFST) that embodies inertial sensors and allows to obtain individual motor strategy information. Twenty-seven sub-acute stroke patients and 18 healthy adults performed a repeated stepping task with closed eyes wearing five inertial sensors located on both distal tibiae and at pelvis, sternum, and head levels. From final foot position, body rotation and linear displacements were measured. A set of indices related to upper-body stability were estimated from pelvis, sternum, and head accelerations: Root Mean Square, Attenuation Coefficients, and improved Harmonic Ratio. Two additional parameters based on upper-body angular velocities were devised to assess step-by-step repeatability and inter-segment velocity variations. The results suggest that the clinical parameters do not provide enough information about the two groups' motor strategies. Conversely, five iFST parameters were identified as predictors of patients' motor ability, discriminating not only between healthy and pathological subjects, but also between different motor deficit levels within the same pathology. The iFST could be included in the clinical routine assessment of balance impairments, supporting the design of personalized treatments.



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Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): David J. Clark, Sudeshna A. Chatterjee, Theresa E. McGuirk, Eric C. Porges, Emily J. Fox, Chitralakshmi K. Balasubramanian
BackgroundWalking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke.MethodsThirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist scoring of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities-specific Balance Confidence Scale, respectively.ResultsThere was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks.ConclusionThis study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke.



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The effect of augmented somatosensory feedback on standing postural sway

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Angela Smalley, Scott C. White, Robert Burkard
Impaired balance resulting from reduced postural control occurs with aging and various medical conditions. Sensory input for balance control is provided by the visual, vestibular and somatosensory systems. Previous research suggests that increased proprioceptive feedback from various lower extremity devices improves balance. Mixed results have been reported with the use of orthoses such as ankle foot orthoses (AFOs). In this study, 20 healthy subjects wore footplates in their shoes or straps around their lower legs in order to imitate the somatosensory feedback produced by wearing AFOs, but without providing ankle restriction. Subjects' standing balance was assessed using force plates and computerized dynamic posturography (the sensory organization test-SOT) to determine if either the footplates or the lower-leg straps would affect standing balance. The results revealed no significant difference with the use of the footplates, however, wearing the straps resulted in reduced postural sway for conditions when visual cue deprivation was combined with manipulation of somatosensory or vestibular feedback. This effect was more pronounced in participants with the poorest baseline measures of balance. These findings suggest that lower extremity devices, such as AFOs, may augment somatosensory feedback that could improve balance during challenging sensory deprivation conditions, independent of orthotic support at the ankle.



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The effect of spatial auditory landmarks on ambulation

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Adham M. Karim, Kavelin Rumalla, Laurie A. King, Timothy E. Hullar
The maintenance of balance and posture is a result of the collaborative efforts of vestibular, proprioceptive, and visual sensory inputs, but a fourth neural input, audition, may also improve balance. Here, we tested the hypothesis that auditory inputs function as environmental spatial landmarks whose effectiveness depends on sound localization ability during ambulation. Eight blindfolded normal young subjects performed the Fukuda-Unterberger test in three auditory conditions: silence, white noise played through headphones (head-referenced condition), and white noise played through a loudspeaker placed directly in front at 135 centimeters away from the ear at ear height (earth-referenced condition). For the earth-referenced condition, an additional experiment was performed where the effect of moving the speaker azimuthal position to 45, 90, 135, and 180° was tested. Subjects performed significantly better in the earth-referenced condition than in the head-referenced or silent conditions. Performance progressively decreased over the range from 0° to 135° but all subjects then improved slightly at the 180° compared to the 135° condition. These results suggest that presence of sound dramatically improves the ability to ambulate when vision is limited, but that sound sources must be located in the external environment in order to improve balance. This supports the hypothesis that they act by providing spatial landmarks against which head and body movement and orientation may be compared and corrected. Balance improvement in the azimuthal plane mirrors sensitivity to sound movement at similar positions, indicating that similar auditory mechanisms may underlie both processes. These results may help optimize the use of auditory cues to improve balance in particular patient populations.



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The coupled effects of crouch gait and patella alta on tibiofemoral and patellofemoral cartilage loading in children

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Scott C.E. Brandon, Darryl G. Thelen, Colin R. Smith, Tom F. Novacheck, Michael H. Schwartz, Rachel L. Lenhart
BackgroundElevated tibiofemoral and patellofemoral loading in children who exhibit crouch gait may contribute to skeletal deformities, pain, and cessation of walking ability. Surgical procedures used to treat crouch frequently correct knee extensor insufficiency by advancing the patella. However, there is little quantitative understanding of how the magnitudes of crouch and patellofemoral correction affect cartilage loading in gait.MethodsWe used a computational musculoskeletal model to simulate the gait of twenty typically developing children and fifteen cerebral palsy patients who exhibited mild, moderate, and severe crouch. For each walking posture, we assessed the influence of patella alta and baja on tibiofemoral and patellofemoral cartilage contact.ResultsTibiofemoral and patellofemoral contact pressures during the stance phase of normal gait averaged 2.2 and 1.0 MPa. Crouch gait increased pressure in both the tibofemoral (2.6–4.3 MPa) and patellofemoral (1.8–3.3 MPa) joints, while also shifting tibiofemoral contact to the posterior tibial plateau. For extended-knee postures, normal patellar positions (Insall-Salvatti ratio 0.8–1.2) concentrated contact on the middle third of the patellar cartilage. However, in flexed knee postures, both normal and baja patellar positions shifted pressure toward the superior edge of the patella. Moving the patella into alta restored pressure to the middle region of the patellar cartilage as crouch increased.ConclusionsThis work illustrates the potential to dramatically reduce tibiofemoral and patellofemoral cartilage loading by surgically correcting crouch gait, and highlights the interaction between patella position and knee posture in modulating the location of patellar contact during functional activities.



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Effects of plantar hypothermia on quasi-static balance: Two different hypothermic procedures

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Andresa M.C. Germano, Tobias Heß, Daniel Schmidt, Thomas L. Milani
Inducing hypothermia to examine its effects on balance is performed with various approaches. However, data interpretations of underlying postural mechanisms often do not consider the applied hypothermic protocol. In this context, the effects of diminished plantar mechanoreceptor activity on quasi-static balance performance were investigated, examining the applicability of a continuously cooling thermal platform in comparison with conventional ice pads. Increased instability for the thermal platform compared to cooling with ice pads was hypothesized, since we expected increased temperatures for the ice pad group directly after balance tests. Similar scores on a Visual Analogue Scale (VAS) were predicted regarding subjective pain. Results showed that both cooling procedures successfully induced plantar hypothermia. However, the thermal platform was more effective with respect to reaching and maintaining the desired temperature throughout the trials, especially when comparing temperatures before and after balance tests. Therefore, balance tests indeed demonstrated increased COP parameters exclusively after permanent cooling via the thermal platform as early as after the first 10 min of cooling. Reduced plantar input may result in this postural instability, but without the need of other sensory systems to compensate. The VAS generally demonstrated higher pain scores for the ice pads, rejecting our hypothesis. This is an important finding, since pain is known to influence balance. Therefore, permanent and controllable cooling via the thermal platform should be taken into consideration when conducting related research.



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Influence of handrail height and fall direction on center of mass control and the physical demands of reach-to-grasp balance recovery reactions

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Vicki Komisar, Konika Nirmalanathan, Alison C. Novak
The ability to maintain and recover center of mass (COM) and trunk control after a destabilization is critical for avoiding falls and fall-related injuries. Handrails can significantly enhance a person's ability to recover from large destabilizations, by enabling the person to grasp and apply high forces to the rail to stabilize their COM. However, the influence of handrail height and falling direction on COM control and the demands of grasping are unknown. We investigated the effect of handrail height (34, 38, 42 in.) and fall direction (forward, backward) on COM and trunk control, and the corresponding physical demands of reach-to-grasp balance reactions. Thirteen young adults were destabilized with platform perturbations, and reached to grasp a nearby handrail to recover balance without stepping. COM kinematics and applied handrail forces were collected. COM control was evaluated in terms of: (1) COM range and peak displacement, velocity and momentum in all Cartesian axes; and (2) trunk angular displacement, velocity and momentum in the roll and pitch axes. The physical demands of grasping were estimated via resultant handrail impulse. Compared to forward-directed falling, backward-directed falling was generally associated with greater peak COM and trunk angular displacement, velocity and momentum, along with greater handrail impulse. Higher handrails generally resulted in reduced peak COM and trunk angular displacement, velocity and momentum, as well as reduced handrail impulse. These results suggest that higher handrails may provide a stability advantage within the range of handrail heights tested, with better COM control achieved with lower physical demands of grasping.



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How accurate is visual determination of foot strike pattern and pronation assessment

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Frédéric Meyer, Mathieu Falbriard, Kamiar Aminian, Gregoire P. Millet
Nowadays, choosing adequate running shoes is very difficult, due to the high number of different designs. Nevertheless, shoes have two main characteristics to fit runners' technique and morphology: drop and arch support. Retailers' advices are usually based on the visual assessment of the customer's running technique. Such method is subjective and requires an experimented examiner while objective methods require expensive material, such as 3D motion system and pressure insoles. Therefore, the aim of this study was to determine the accuracy of foot strike pattern and pronation assessment using video cameras, compared to a gold standard motion tracking system and pressure insoles. 34 subjects had to run at 8, 12 and 16 Km/h shod and 12 Km/h barefoot during 30 s trials on a treadmill. Agreement between foot strike pattern assessment methods was between 88% and 92%. For pronation, agreement on assessment methods was between 42% and 56%. The results obtained indicate a good accuracy on foot strike pattern assessment, and a high difficulty to determine pronation with enough accuracy. There is therefore a need to develop new tools for the assessment of runner's pronation.



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Increasing mediolateral standing sway is associated with increasing corticospinal excitability, and decreasing M1 inhibition and facilitation

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Tulika Nandi, Beth E. Fisher, Tibor Hortobágyi, George J. Salem
In standing, corticospinal excitability increases and primary motor cortex (M1) inhibition decreases in response to anterior posterior or direction unspecific manipulations that increase task difficulty. However, mediolateral (ML) sway control requires greater active neural involvement. Therefore, the primary purpose of this study was to determine the pattern of change in neural excitability when ML postural task difficulty is manipulated and to test whether the neural excitability is proportional to ML sway magnitude across conditions. Tibialis anterior corticospinal excitability was quantified using motor evoked potential (MEP) and postural sway was indexed using ML center of pressure (COP) velocity. Additionally, we examined inhibition and facilitation processes in the primary motor cortex using the paired pulse short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) techniques respectively. Measurements were repeated in four conditions with quiet stance as a control. Differences between conditions were tested using one-way repeated measures ANOVAs, on log transformed data. Associations were quantified using Spearman's Rank Correlation Coefficient. There was a significant main effect of condition on all the neural excitability measures with MEP (p<0.001) being highest in the most difficult condition, and SICI (p=0.01), ICF (p<0.001) being lowest in the most difficult condition. Increasing ML COP velocity was significantly associated with increasing MEP amplitude (r=0.68, p<0.001), but decreasing SICI (r=0.24, p=0.03) and ICF (r=−0.54, p<0.001). Our results show that both corticospinal and M1 excitability in standing are scaled in proportion to ML task difficulty.



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Accuracy evaluation of a method to partition ground reaction force and center of pressure in cane-assisted gait using an instrumented cane with a triaxial force sensor

Publication date: February 2018
Source:Gait & Posture, Volume 60
Author(s): Arinori Kamono, Mizuki Kato, Naomichi Ogihara
Clarifying the biomechanics of cane-assisted gait in elderly individuals and patients with gait disorders is important for developing better therapeutic interventions in the fields of rehabilitation and orthopedics. However, if the foot and the cane in the ipsilateral hand are placed on the same force plate simultaneously, the force plate cannot separate the forces as it records the sum of the forces. To overcome this indeterminacy problem of the ground reaction force (GRF) and the center of pressure (COP) in cane-assisted gait analysis, a method to partition the GRF and COP using an instrumented cane with a force transducer has been proposed. However, the accuracy and precision of the estimated GRF and COP has not been evaluated previously. We therefore reestablished a framework to partition the foot and cane forces during walking using an instrumented cane with a triaxial force sensor and evaluated the accuracy and precision of the method using a force plate array. Cane-assisted gait of healthy adults and hemiplegic patients were measured. Mean accuracy and precision associated with the GRF and COP measurements were approximately 0.4±1.4N and 0.2±2.7mm, respectively, indicating that the separations of the GRF and COP were sufficiently accurate for kinetic gait analysis. Although some methodological limitations certainly apply, this system will serve as a useful tool for improved therapeutic interventions.



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Systematic review of structural and functional brain alterations in psychosis of epilepsy

This systematic review critically assesses structural and functional neuroimaging studies of psychosis of epilepsy (POE). We integrate findings from 18 studies of adults with POE to examine the prevailing view that there is a specific relationship between temporal lobe epilepsy (TLE) and POE, and that mesial temporal lobe pathology is a biomarker for POE. Our results show: (1) conflicting evidence of volumetric change in the hippocampus and amygdala; (2) distributed structural pathology beyond the mesial temporal lobe; and (3) changes in frontotemporal functional network activation. These results provide strong evidence for a revised conceptualisation of POE as disorder of brain networks, and highlight that abnormalities in mesial temporal structures alone are unlikely to account for its neuropathogenesis. Understanding POE as a disease of brain networks has important implications for neuroimaging research and clinical practice. Specifically, we suggest that future neuroimaging studies of POE target structural and functional networks, and that practitioners are vigilant for psychotic symptoms in all epilepsies, not just TLE.

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Standardised Frankincense extract: new possible therapeutic option for patients with relapsing-remitting multiple sclerosis

Oral standardized frankincense extracts could open a new therapeutic era in treatment of relapsing-remittingmultiple sclerosis patients

Over the last 20 years, the treatment landscape of relapsing-remitting multiple sclerosis (RRMS) has impressively changed and new oral first-line agents have been licensed. Indeed, from a complete lack of any treatment, neurologists have gone to drugs that are increasingly effective but which are associated with significant risks that can affect the survival of their patients. Neurologist specialised in the treatment of MS have to expand their medical skills and become familiar with haematological, cardiac, hepatic, renal and endocrine adverse events which were reported with the use of newer treatments now available. Neurologists must also become aware of the risk of opportunistic infections (progressive multifocal leucoencephalitis by natalizumab or other disease-modifying drugs)1 and other infectious complications, which, taken together and put on the complex process regarding therapy choice for patients with MS, dramatically increase...

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Constraining the uncertainty in emissions over India with a regional air quality model evaluation

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Alexandra Karambelas, Tracey Holloway, Gregor Kiesewetter, Chris Heyes
To evaluate uncertainty in the spatial distribution of air emissions over India, we compare satellite and surface observations with simulations from the U.S. Environmental Protection Agency (EPA) Community Multi-Scale Air Quality (CMAQ) model. Seasonally representative simulations were completed for January, April, July, and October 2010 at 36  km × 36  km using anthropogenic emissions from the Greenhouse Gas-Air Pollution Interaction and Synergies (GAINS) model following version 5a of the Evaluating the Climate and Air Quality Impacts of Short-Lived Pollutants project (ECLIPSE v5a). We use both tropospheric columns from the Ozone Monitoring Instrument (OMI) and surface observations from the Central Pollution Control Board (CPCB) to closely examine modeled nitrogen dioxide (NO2) biases in urban and rural regions across India. Spatial average evaluation with satellite retrievals indicate a low bias in the modeled tropospheric column (−63.3%), which reflects broad low-biases in majority non-urban regions (−70.1% in rural areas) across the sub-continent to slightly lesser low biases reflected in semi-urban areas (−44.7%), with the threshold between semi-urban and rural defined as 400 people per km². In contrast, modeled surface NO2 concentrations exhibit a slight high bias of +15.6% when compared to surface CPCB observations predominantly located in urban areas. Conversely, in examining extremely population dense urban regions with more than 5000 people per km² (dense-urban), we find model overestimates in both the column (+57.8) and at the surface (+131.2%) compared to observations. Based on these results, we find that existing emission fields for India may overestimate urban emissions in densely populated regions and underestimate rural emissions. However, if we rely on model evaluation with predominantly urban surface observations from the CPCB, comparisons reflect model high biases, contradictory to the knowledge gained using satellite observations. Satellites thus serve as an important emissions and model evaluation metric where surface observations are lacking, such as rural India, and support improved emissions inventory development.



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Estimating representative background PM2.5 concentration in heavily polluted areas using baseline separation technique and chemical mass balance model

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Shuang Gao, Wen Yang, Hui Zhang, Yanling Sun, Jian Mao, Zhenxing Ma, Zhiyuan Cong, Xian Zhang, Shasha Tian, Merched Azzi, Li Chen, Zhipeng Bai
The determination of background concentration of PM2.5 is important to understand the contribution of local emission sources to total PM2.5 concentration. The purpose of this study was to exam the performance of baseline separation techniques to estimate PM2.5 background concentration. Five separation methods, which included recursive digital filters (Lyne-Hollick, one-parameter algorithm, and Boughton two-parameter algorithm), sliding interval and smoothed minima, were applied to one-year PM2.5 time-series data in two heavily polluted cities, Tianjin and Jinan. To obtain the proper filter parameters and recession constants for the separation techniques, we conducted regression analysis at a background site during the emission reduction period enforced by the Government for the 2014 Asia-Pacific Economic Cooperation (APEC) meeting in Beijing. Background concentrations in Tianjin and Jinan were then estimated by applying the determined filter parameters and recession constants. The chemical mass balance (CMB) model was also applied to ascertain the effectiveness of the new approach. Our results showed that the contribution of background PM concentration to ambient pollution was at a comparable level to the contribution obtained from the previous study. The best performance was achieved using the Boughton two-parameter algorithm. The background concentrations were estimated at (27 ± 2) μg/m³ for the whole year, (34 ± 4) μg/m³ for the heating period (winter), (21 ± 2) μg/m³ for the non-heating period (summer), and (25 ± 2) μg/m³ for the sandstorm period in Tianjin. The corresponding values in Jinan were (30 ± 3) μg/m³, (40 ± 4) μg/m³, (24 ± 5) μg/m³, and (26 ± 2) μg/m³, respectively. The study revealed that these baseline separation techniques are valid for estimating levels of PM2.5 air pollution, and that our proposed method has great potential for estimating the background level of other air pollutants.



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Impact of chemical lateral boundary conditions in a regional air quality forecast model on surface ozone predictions during stratospheric intrusions

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Diane Pendlebury, Sylvie Gravel, Michael D. Moran, Alexandru Lupu
A regional air quality forecast model, GEM-MACH, is used to examine the conditions under which a limited-area air quality model can accurately forecast near-surface ozone concentrations during stratospheric intrusions. Periods in 2010 and 2014 with known stratospheric intrusions over North America were modelled using four different ozone lateral boundary conditions obtained from a seasonal climatology, a dynamically-interpolated monthly climatology, global air quality forecasts, and global air quality reanalyses. It is shown that the mean bias and correlation in surface ozone over the course of a season can be improved by using time-varying ozone lateral boundary conditions, particularly through the correct assignment of stratospheric vs. tropospheric ozone along the western lateral boundary (for North America). Part of the improvement in surface ozone forecasts results from improvements in the characterization of near-surface ozone along the lateral boundaries that then directly impact surface locations near the boundaries. However, there is an additional benefit from the correct characterization of the location of the tropopause along the western lateral boundary such that the model can correctly simulate stratospheric intrusions and their associated exchange of ozone from stratosphere to troposphere. Over a three-month period in spring 2010, the mean bias was seen to improve by as much as 5 ppbv and the correlation by 0.1 depending on location, and on the form of the chemical lateral boundary condition.



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Aerosols in Northern Morocco: Input pathways and their chemical fingerprint

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): A. Benchrif, B. Guinot, M. Bounakhla, H. Cachier, B. Damnati, B. Baghdad
The Mediterranean basin is one of the most sensitive regions in the world regarding climate change and air quality. Deserts and marine aerosols combine with combustion aerosols from maritime traffic, large urban centers, and at a larger scale from populated industrialized regions in Europe. From Tetouan city located in the North of Morocco, we attempted to better figure out the main aerosol transport pathways and their respective aerosol load and chemical profile by examining air mass back trajectory patterns and aerosol chemical compositions from May 2011 to April 2012. The back trajectory analysis throughout the sampling period led to four clusters, for which meteorological conditions and aerosol chemical characteristics have been investigated. The most frequent cluster (CL3: 39%) corresponds to polluted air masses coming from the Mediterranean Basin, characterized by urban and marine vessels emissions out of Spain and of Northern Africa. Two other polluted clusters were characterized. One is of local origin (CL1: 22%), with a marked contribution from urban aerosols (Rabat, Casablanca) and from biomass burning aerosols. The second (CL2: 32%) defines air masses from the near Atlantic Ocean, affected by pollutants emitted from the Iberian coast. A fourth cluster (CL4: 7%) is characterized by rather clean, fast and rainy oceanic air masses, influenced during their last 24 h before reaching Tetouan by similar sources with those affecting CL2, but to a lesser extent.The chemical data show that carbonaceous species are found in the fine aerosols fraction and are generally from local primary sources (low OC/EC) rather than long-range transported. In addition to fresh traffic and maritime vessel aerosols, our results suggest the contribution of local biomass burning.



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