Αρχειοθήκη ιστολογίου

Παρασκευή 29 Δεκεμβρίου 2017

Synchronous Central Nervous System Atypical Teratoid/Rhabdoid Tumor and Malignant Rhabdoid Tumor of the Kidney: Case Report of a Long-Term Survivor and Review of the Literature

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Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Mohammad H. Abu Arja, Priyal Patel, Summit H. Shah, Jeffery J. Auletta, Erin K. Meyer, Suzanne E. Conley, Jennifer H. Aldrink, Jonathan A. Pindrik, Mohamed S. AbdelBaki
BackgroundAtypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system (CNS) with synchronous or metachronous extra-CNS disease is a rare childhood malignancy with a dismal prognosis.Case DescriptionWe report a 7-week-old female with metastatic AT/RT and synchronous malignant rhabdoid tumor of the kidney who received an intensive multimodal approach combining surgical resection, intrathecal chemotherapy, and high-dose chemotherapy with autologous peripheral blood stem cell transplant (PBSCT). She is currently 24 months old without any evidence of disease. In addition, we completed an extensive literature review of cases with CNS AT/RT and synchronous or metachronous extra-CNS primary tumors. To date, 31 pediatric cases have been reported, and the median overall-survival was 6 months after diagnosis. The only 3 survivors received autologous PBSCT, and 2 of these patients had complete resection of their CNS tumor.ConclusionsThe rarity of CNS AT/RT with extra-CNS primary disease and the lack of standard treatment contribute to its reported dismal prognosis. We report a case of a long-term survivor with metastatic AT/RT and synchronous extra-CNS primary tumor. Maximal surgical resection, intrathecal chemotherapy, and consolidative autologous PBSCT may improve prognosis and avoid radiation.



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An Amendment to the Neidre and MacNab Classification System for Lumbosacral Nerve Root Anomaly and Its Implication in Percutaneous Endoscopic Lumbar Discectomy

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Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Chen Yu, Chang Zhengqi, Yu Xiuchun
BackgroundLumbar disc herniation complicated with nerve root anomaly presents great challenges to diagnosis and treatment. Improper selection of surgical procedures may cause inferior outcomes and neurologic injury.Case DescriptionA 66-year old man presented with low back pain and radicular symptoms involving bilateral L5 and S1 nerve roots. Instead of percutaneous endoscopic lumbar discectomy, aggressive decompression was carried out because of a deviation between the examination and imaging findings. Surgical detection disclosed a confluent nerve root comprising 2 adjacent contributions that arose from the thecal sac exiting from the left L5/S1 foramen, in the absence of the root otherwise exiting through the caudal foramen. We found that the overwhelming left radicular symptoms were attributable to compression on this swelling anomalous root by a narrowed L5/S1 root cannula. Aggressive decompression and distraction of the intervertebral space successfully released the nerve root. Twenty months postoperatively, the patient experienced evident relief of the radicular symptoms and improvement of muscle strength with no complication.ConclusionsLumbosacral nerve root anomaly should be remembered and ruled out before selecting surgical methods. Inappropriate procedures can not alleviate the symptoms associated with the anomalous roots and may expose such patients to the risk of neural injury. In clinical practice, surgeons should select percutaneous endoscopic lumbar discectomy with caution, and stop the procedure instantly when unexplainable radicular irritation is evoked.



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Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature

Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Mi Wang, Wael Saasouh, Thomas Botsford, Allen Keebler, Andrew Zura, Michael S. Benninger, Rafi Avitsian
BackgroundParkinson disease (PD), a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra of the midbrain, is commonly thought of as a motion disorder, but it can have significant effect on the respiratory system. Respiratory failure is the most common cause of death in these patients, but it can also affect laryngeal function causing dysphonia, dysphagia, and dysarthric speech. Acute upper airway obstruction is a rare finding in PD, especially in the perioperative settings. In this article we report a PD patient who developed upper respiratory obstruction postoperatively. We also review the literature and highlight the importance of preoperative evaluation to identify patients who may be at risk of this complication.Case DescriptionWe describe a PD patient presenting for brain stimulation electrode implantation under general anesthesia, who postoperatively developed stridor and near complete upper airway obstruction despite maintenance of oral anti-Parkinson medication regimen intraoperatively. The patient was reintubated in post-anesthesia-care unit, and tracheostomy was performed after 1 week due to persistent vocal cord dysfunction.ConclusionsBaseline vocal cord impairment in PD patients can be acutely aggravated perioperatively. Symptoms such as dysphagia and dysarthria, which can indicate susceptibility to postoperative upper airway obstruction, may not be well recognized by the patient and family. Surgical candidates should be carefully interviewed preoperatively, and watchful monitoring of respiratory function intraoperatively and postoperatively is of paramount importance. Neurosurgical and neuroanesthesia team should be aware of, and prepared to manage, this potentially life-threatening airway obstruction in PD patients.



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Anti-PD-1-induced high-grade hepatitis associated with corticosteroid-resistant T cells: a case report

Abstract

Effective treatment or prevention of immune side effects associated with checkpoint inhibitor therapy of cancer is an important goal in this new era of immunotherapy. Hepatitis due to immunotherapy with antibodies against PD-1 is uncommon and generally of low severity. We present an unusually severe case arising in a melanoma patient after more than 6 months uncomplicated treatment with anti-PD-1 in an adjuvant setting. The hepatitis rapidly developed resistance to high-dose steroids, requiring anti-thymocyte globulin (ATG) to achieve control. Mass cytometry allowed comprehensive phenotyping of circulating lymphocytes and revealed that CD4+ T cells were profoundly depleted by ATG, while CD8+ T cells, B cells, NK cells and monocytes were relatively spared. Multiple abnormalities in CD4+ T cell phenotype were stably present in the patient before disease onset. These included a population of CCR4CCR6 effector/memory CD4+ T cells expressing intermediate levels of the Th1-related chemokine receptor CXCR3 and abnormally high multi-drug resistance type 1 transporter (MDR1) activity as assessed by a rhodamine 123 excretion assay. Expression of MDR1 has been implicated in steroid resistance and may have contributed to the severity and lack of a sustained steroid response in this patient. The number of CD4+ rhodamine 123-excreting cells was reduced > 3.5-fold after steroid and ATG treatment. This case illustrates the need to consider this form of steroid resistance in patients failing treatment with corticosteroids. It also highlights the need for both better identification of patients at risk and the development of treatments that involve more specific immune suppression.



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Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis

Abstract

Objective

The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented.

Methods

Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure.

Results

The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups.

Conlusion

Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.



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Immunological hallmarks of cis -DDP-resistant Lewis lung carcinoma cells

Abstract

Purpose

Tumor cell resistance to platinum-based chemotherapeutic agents is one of the major hurdles to successful cancer treatment with these drugs, and is associated with alterations in tumor cell immune evasion and immunomodulatory properties. Immunocyte targeting is considered as a relevant approach to fight drug-resistant cancer. In this study, immunological hallmarks of cis-DDP-resistant Lewis lung carcinoma cells (LLC/R9) were investigated.

Methods

Immunological features of LLC/R9 cells cultured in vitro in normoxic and hypoxic conditions as well as of those that were grown in vivo were examined. The expression of immunologically relevant genes was evaluated by RT-PCR. Tumor cell susceptibility to the macrophage contact tumoricidal activity and NK-mediated cytolysis was investigated in MTT test. TNF-α-mediated tumor cell apoptosis as well as macrophage phagocytosis, oxidative metabolism, and CD206 expression after the treatment with conditioned media from normoxic and hypoxic tumor cells were studied by flow cytometry. Flow cytometry was also used to characterize dendritic cell maturity.

Results

When growing in vitro, LLC/R9 were characterized by slightly increased immunosuppressive cytokine gene expression. Transition to in vivo growth was associated with the enhancement of transcription of these genes in tumor cells. LLC/R9 cells had lowered sensitivity to contact-dependent macrophage-mediated cytotoxicity and to the TNFα-mediated apoptosis in vitro. Conditioned media from hypoxic LLC/R9 cells stimulated reactive oxygen species generation and CD206 expression in non-sensitized macrophages. Acquisition of drug resistance by LLC/R9 cells was associated with their increased sensitivity to NK-cell-mediated cytolysis. Meanwhile, the treatment of LLCR/9-bearing animals with generated ex vivo and loaded with LLC/R9 cell-lysate dendritic cells (DCs) resulted in profoundly enhanced tumor metastasizing.

Conclusion

Decreased sensitivity to macrophage cytolysis, polarizing effect on DCs maturation along with increased susceptibility to NK-cell cytotoxic action promote extensive local growth of chemoresistant LLC/R9 tumors in vivo, but hamper their metastasizing.



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Letter to the Editor concerning “Effects of lumbosacral orthoses on postural control in individuals with or without non-specific low back pain” by J. Mi et al. (Eur Spine J; 2017: DOI 10.1007/s00586-017-5355-5)



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Progression to bone-marrow carcinomatosis and extraosseous legion during treatment with radium-223 for multiple bone metastases

Abstract

A 67-year-old man with metastatic prostate cancer presented with progression to castration-resistant prostate cancer. After sequential therapies with flutamide, estramustine phosphate, docetaxel, enzalutamide, and cabazitaxel for castration-resistant prostate cancer, radium-223 was initiated and continued up to 4 cycles. However, concurrently with radiological and clinical progressions, pancytopenia was observed due to bone-marrow carcinomatosis by prostatic adenocarcinoma. This case suggested that radium-223 should be employed at appropriated timing before appearances of extraosseous and bone-marrow lesions in addition to visceral metastasis.



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The Focused History and Physical - circa 100 BCE

Abstract

When modern physicians reflect on 'ancient medicine' or 'Greek medicine,' they typically think of Hippocrates and Galen. Few know of the raging, centuries-long intellectual debates among physicians about what exactly mattered in the treatment of illness, or about a group of physicians whose pattern-based, systematized approach to health and disease was a forerunner of how today's emergency medicine physicians evaluate and treat their patients.Methodist physicians (c. 100 BCE to 500 CE, active mostly in Rome but present throughout the Mediterranean world) were named after their "method" of healing.

This article is protected by copyright. All rights reserved.



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Characterization of newborn hearing screening failures in multigestational births

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Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Jonathan Ross Mallen, Jacob B. Hunter, Charles Auerbach, Leslie Wexler, Andrea Vambutas
ObjectiveTo define the rate and characterize the type of newborn hearing screening failures in multigestational births.MethodsRetrospective chart review of all multigestational births that occurred in a 10-year period (2002–2012) in which at least one newborn failed newborn hearing screening at two tertiary care hospitals in the Northwell Health System.ResultsOut of 125,405 total births, we identified 2961 multigestational births, of which 59 (2.0%) newborns failed newborn hearing screening. None of their 66 twin/triplet siblings failed their newborn hearing screens. Of 43 newborns that returned for follow-up, 56.0% (24/43) had confirmed hearing loss, resulting in an overall rate of 0.81% in all multigestational newborns with hearing loss. Of 19 infants that passed repeat testing, two were judged to need myringotomy tube placement. Twenty-four infants had a confirmed hearing loss, 11 of which had sensorineural hearing loss (0.37%), and 13 with a conductive or mixed hearing loss (0.44%).ConclusionsWe identified a greater than expected risk of conductive hearing loss, not attributable to otitis media, than sensorineural hearing loss in this population. These observations are consistent with the increased risk of birth defects in multigestational births.



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Sialoendoscopy for treatment of juvenile recurrent parotitis: The Brescia experience

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Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Marco Berlucchi, Vittorio Rampinelli, Marco Ferrari, Paola Grazioli, Luca O. Redaelli De Zinis
ObjectiveTo evaluate the role of sialoendoscopy associated with steroid irrigation for juvenile recurrent parotitis (JRP) at a tertiary referral hospital.MethodsClinical records of patients affected by JRP and treated with operative sialoendoscopy between June 2011 and April 2017 were retrospectively reviewed. Data on demographics, number of acute episodes per year before and after surgery, characteristics of the surgical procedure, hospitalization time, and rate of complications were collected. The outcome of the procedure was measured by comparing the number of episodes of parotid swelling before and after salivary endoscopic treatment.ResultsTwenty-three patients for a total of 34 operative sialoendoscopies were included in the study. Before the surgical endoscopic procedure, the mean number of parotid swelling was 10 episodes per year. At sialoendoscopy, typical endoscopic findings such as mucous plugs, stenosis of the duct, intraductal debris, and pale ductal appearance were evident. All patients were discharged on the first postoperative day. A significant decrease in the number of swelling episodes per year was observed compared to the preoperative rate (p = .0004). Complete resolution of the disorder was obtained in 35% of patients.ConclusionsOperative sialoendoscopy with steroid irrigation can be considered a valid therapeutic treatment for JRP. The technique is conservative, effective, safe, and, potentially repeatable. Short hospitalization time, rapid recovery, absence of peri-operative complications, and a high rate of good outcomes are the main advantages of this treatment.



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Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis

Abstract

Objective

The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented.

Methods

Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure.

Results

The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups.

Conlusion

Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.



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Popular and Classical Female Singers: Acoustic Comparison of Voice Use in the Song Melodia Sentimental (Sentimental Melody) by Heitor Villa-Lobos

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Publication date: Available online 29 December 2017
Source:Journal of Voice
Author(s): Natalia Eugenia Sanchez Escamez, Ana Paula Guimarães Silva, Marta Assumpção de Andrada e Silva
ObjectiveThis study aims to compare acoustic characteristics of classical and popular female singers' vocal performances in Heitor Villa-Lobos' Melodia Sentimental (Sentimental Melody).MethodLong-term average spectrum acoustic analysis and long-term voice onset time (VOT) were performed for two consonants /d/ in the first six verses of Melodia Sentimental sang by 10 professional singers: five classical (GC) and five popular (GP).ResultsClassical singers presented prominence in the region of the frequencies between 2.5 and 3.5 kHz, not observed in the majority of the popular singers' group. The GC group showed lighter spectral decline curves and the numerical value of decline was also lower. Classical singers presented lower long-term voice onset time values, which indicates a longer period of glottic closure.ConclusionAcoustic analysis revealed that classical singers have more energy in glottic closure associated with a shorter duration of glottic coaptation.



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Effects of a Straw Phonation Protocol on Acoustic and Perceptual Measures of an SATB Chorus

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Publication date: Available online 29 December 2017
Source:Journal of Voice
Author(s): Jeremy N. Manternach, James F. Daugherty
BackgroundRecent scholarship has suggested that semi-occluded vocal tract (SOVT) exercises may increase vocal economy of individuals by reducing vocal effort while maintaining or increasing acoustic output. Choral singers, however, may use different resonance techniques or change voicing behaviors in an effort to hear their own sound in relation to others. One investigation revealed significant increases in a choir's mean spectral energy after participating in a straw phonation protocol. However, that study reported only acoustic measures and did not include choristers' perceptions of the choral sound and their own voicing efficiency.ObjectiveThe purpose of this study was to measure the effect of a straw phonation protocol on acoustic (long-term average spectrum) and perceptual (self-report) measures of the choral sound of an intact soprano, alto, tenor, and bass (SATB) choir.Study designThis is a quasi-experimental, one-group, pretest-posttest design.MethodsAn SATB choir (N = 48 singers) performed a Renaissance motet, participated in a 4-minute voicing protocol with a small straw, and then sang the motet a second time. They completed the same procedure later in the rehearsal.ResultsLong-term average spectrum results indicated no statistically significant mean changes in spectral energy after the SOVT protocols. Most participants, however, perceived that the choir sounded better (78.26%) and that their own vocal production was more efficient or comfortable (73.91%) following the protocol.ConclusionChoristers perceived less vocal effort while maintaining vocal output after straw phonation, which may feasibly align with extant solo research. More research may determine whether this result is due specifically to SOVTs.



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Effects of progressive muscle relaxation training on sleep and quality of life in patients with pulmonary resection

Abstract

Background

The inadequate quality and nature of sleep is a commonly reported problem among hospitalized patients. The purpose of this study is to examine the effects of progressive muscle relaxation training program on sleep quality, sleep state, pain, and quality of life in patients who underwent pulmonary resection.

Methods

Our study was planned as a single-blind prospective randomized controlled trial. The study was conducted on 26 patients who underwent surgery by using posterolateral thoracotomy method. Progressive muscle relaxation training were given to the training group with a therapist two times a day. Sleep quality, daytime sleeping, pain, and quality of life were respectively evaluated in the morning before the surgery and 1 week after the surgery by using Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, visual analogue scale, and Euro Quality of Life-5D (EQ-5D).

Results

There is no significant difference between preoperative groups in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Euro Quality of Life-5D, and visual analogue scale scores (p > 0.05). The intra-group change in the study group showed a significant deterioration in the Euro Quality of Life-5D and visual analogue scale scores (p < 0.05). There was a significant deterioration in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, EQ-5D, and visual analogue scale scores in the control group (p < 0.05). The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Euro Quality of Life-5D scores showed significant improvements in the relaxation training group after treatment at 1 week (p < 0.05).

Conclusions

Progressive muscle relaxation prevents a decline in patient-reported sleep quality following pulmonary resection.



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Acoustic cues, not phonological features, drive vowel perception: Evidence from height, position and tenseness contrasts in German vowels

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Publication date: March 2018
Source:Journal of Phonetics, Volume 67
Author(s): Miquel Llompart, Eva Reinisch
Phonological features have frequently been singled out as the units of perception, especially for vowels. Evidence of the use of features has been provided for vowel height and vowel position, which have one acoustic correlate only. However, findings on acoustically complex features such as tenseness are less clear. The present study assessed the role of phonological features in perception using the selective adaptation paradigm. Selective adaptation effects on German vowel contrasts differing in vowel height (Experiment 1), position (Experiment 2) and tenseness (Experiment 3) were examined. We tested how the categorization of each vowel contrast was affected by adaptation to words containing vowels that differently resembled or diverged from the vowels in the critical contrast acoustically and in terms of their phonological feature specifications. Results showed that selective adaptation patterns could be predicted by the vowels' phonological features for the height and position contrasts, but not for the tenseness contrast. However, adaptation patterns for the latter can be explained by the relationship between adaptors and continuum endpoints in each of the relevant acoustic cues to the contrast. This suggests that vowel perception may be dependent on these acoustic cues rather than phonological features.



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Effects of a Straw Phonation Protocol on Acoustic and Perceptual Measures of an SATB Chorus

Publication date: Available online 29 December 2017
Source:Journal of Voice
Author(s): Jeremy N. Manternach, James F. Daugherty
BackgroundRecent scholarship has suggested that semi-occluded vocal tract (SOVT) exercises may increase vocal economy of individuals by reducing vocal effort while maintaining or increasing acoustic output. Choral singers, however, may use different resonance techniques or change voicing behaviors in an effort to hear their own sound in relation to others. One investigation revealed significant increases in a choir's mean spectral energy after participating in a straw phonation protocol. However, that study reported only acoustic measures and did not include choristers' perceptions of the choral sound and their own voicing efficiency.ObjectiveThe purpose of this study was to measure the effect of a straw phonation protocol on acoustic (long-term average spectrum) and perceptual (self-report) measures of the choral sound of an intact soprano, alto, tenor, and bass (SATB) choir.Study designThis is a quasi-experimental, one-group, pretest-posttest design.MethodsAn SATB choir (N = 48 singers) performed a Renaissance motet, participated in a 4-minute voicing protocol with a small straw, and then sang the motet a second time. They completed the same procedure later in the rehearsal.ResultsLong-term average spectrum results indicated no statistically significant mean changes in spectral energy after the SOVT protocols. Most participants, however, perceived that the choir sounded better (78.26%) and that their own vocal production was more efficient or comfortable (73.91%) following the protocol.ConclusionChoristers perceived less vocal effort while maintaining vocal output after straw phonation, which may feasibly align with extant solo research. More research may determine whether this result is due specifically to SOVTs.



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Association between hemorrhagic transformation after endovascular therapy and poststroke seizures

Summary

Objective

Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy.

Methods

Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset. Patients were followed for up to 2 years for seizure occurrence.

Results

A total of 205 (57.1% male) patients were analyzed. Median age was 69 years (interquartile range [IQR] 57-78). Among patients with HT, 17.9% (10/56) developed poststroke seizures compared with 4.0% (6/149) among those without HT (hazard ratio [HR] 5.52; 95% confidence interval [CI] 2.00-15.22; P = .001). The association remained significant after adjustment for cortical involvement, baseline National Institutes of Health Stroke Scale score, age and use of intravenous tissue plasminogen activator and clot retrieval (HR 4.85; 95% CI 1.60-14.76; P = .005). In patients who developed seizures within the follow-up period, median time to first seizure was 111 days (IQR 28-369) in patients with HT and 36 days (IQR 0.5-183) in patients without HT.

Significance

A patient who develops HT following endovascular therapy for acute ischemic stroke had a nearly 5 times higher rate of developing poststroke seizures within 2 years. HT may be used as an imaging biomarker for poststroke seizures.



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Effect of fresh human amniotic membrane on radiation-induced wounds in a murine experimental model

Abstract

Background

Radiation-induced wounds are extremely difficult to treat. They may lead to severe infections and can even be life-threatening. Wound dressings, negative pressure wound treatment, hyperbaric oxygen therapy, and antibiotics are the main treatment modalities for radiation-induced wounds. Amniotic membrane is the innermost surface of the placenta. It has been shown that amniotic membrane induces re-epithelization, regulates angiogenesis, and decreases inflammation and fibrosis. Our proposed theory was that amniotic membrane can have a role in treating radiation-induced wounds by inducing epithelization and increasing wound tensile strength.

Methods

Out of 24 rats, 3 groups were composed. In group A, 21 days after one session of radiotherapy, a 2-cm incision was made on the gluteal region then an amniotic membrane was placed under the skin flaps. In group B, 21 days after one session of radiotherapy, a 2-cm incision made on the gluteal region and wound is sutured back after 2 × 2 cm of area was undermined. In group C, no radiotherapy is given. We just made an incision and sutured it back again with the same size of area undermined. Three weeks after these surgeries, wound regions were excised en bloc and taken out for biomechanical and histopathological assessments.

Results

The end results in amniotic membrane group (group A) were statistically higher than those in the other groups in the terms of wound healing and biomechanical measurements.

Conclusions

After biomechanical and histopathological evaluation, amniotic membrane, with its antimicrobial, anti-inflammatory, angiogenic, and epithelial-inductive effects, was found to be affective in post-radiation wound treatment. Due to the features of amniotic membrane mentioned above, it can be an option in treatment of patients which received neoadjuvant radiotherapy to prevent future wounds. It can also be used for the care and treatment of post-radiation wounds.

Level of Evidence: Not ratable



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Rhinoplasty in elderly patients: analysis of outcomes and patient’s satisfaction following 20 years experiences

Abstract

Background

Rhinoplasty is one of the most complex procedures in plastic surgery. In patients over 65, the procedure is even more demanding because of the coexistence of multiple complicating psychological and anatomical factors. The aims of our study were to analyze the necessity of rhinoplasty in elderly patients, to analyze the perception of patients before and after procedures and compare these patients with younger population, to review all cases done in our department over the past 20 years, and to summarize all procedures.

Methods

We designed a retrospective study of patients that had submitted to primary rhinoplasty by the same surgical team from 1997 to 2017. The inclusion criteria were as follows: Italian national patients of either sex over 65 years old who underwent primary rhinoplasty in our department. The exclusion criteria were as follows: psychiatric disorder, abuse of alcohol or drugs, patients who had undergone secondary rhinoplasty, or patients with previous trauma. Our final sample was 125 patients. We submitted FACE-Q rhinoplasty module to 25 patients comparing the results with a control group of younger patients.

Results

Of 1703 patients who underwent primary rhinoplasty in our Department of Plastic Surgery from 1997 to 2017, only 125 were over 65 years old. The average age was 68 years old, with 72 male and 53 female patients. From June 2016 to May 2017, the Italian version of FACE-Q rhinoplasty module was given to 25 elderly patients pre- and postoperatively and to 25 younger patients (control group), for comparison. All patients answered the postoperative module 6 months after their procedure. The most noticeable result was in tip perception, in fact in the > 65 years old group. Two surgeons reviewed and summarized all 125 cases and procedures, which were 89 open approach, 36 closed approach, 17 reduction rhinoplasty, 108 augmentation rhinoplasty, 47 dorsum grafts, 159 tip grafts, 9 alar region grafts, and 5 other grafts.

Conclusions

The tip of the nose is the focus of attention for older patients who want to undergo this surgery and require surgical procedures for increased projection and support. Augmentation rhinoplasty plays a fundamental role in the remodeling of the nose in patients over 65 years old.

Level of Evidence: Level III, risk/prognostic study.



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Pediatric radiology: practical imaging evaluation of infants and children (1st edn), by Edward Lee (ed)



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Oral potentially malignant disorders: risk of progression to malignancy.

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul M. Speight, Syed Ali Khurram, Omar Kujan
Oral potentially malignant disorders (OPMD) have a stastically increased risk of progessing to cancer, but the risk varies according to a range of patient or lesion related factors. It is difficult to predict the risk of progression for any individual patient and the clinician must make a judgement based an assessment of each case. The most commonly encountered OPMD is leukoplakia, but others including lichen planus, oral submucous fibrosis and erythroplakia may also be seen. Factors associated with an increased risk of malignant transformation include gender, the site and type of lesion, habits such as smoking and alcohol and the presence of epithelial dysplasia on histologic examination. In this review we attempt to identify the important risk factors, and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.



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Clinical complications in the application of polyglycolic acid sheets with fibrin glue after resection of mucosal lesions in oral cavity

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kohei Okuyama, Souichi Yanamoto, Tomofumi Naruse, Yuki Sakamoto, Satoshi Rokutanda, Seigo Ohba, Izumi Asahina, Masahiro Umeda
Objectives.Covering open wounds with a polyglycolic acid (PGA) sheet using fibrin glue after resection of oral mucosal lesions is reportedly useful. We focused on clinical complications of this procedure: development of marked granuloma-like neoplasm (GLN) and abnormal postoperative bleeding (APB) on the resected region.Study Design.The characteristics of 100 cases with PGA sheet application after the resection of oral mucosal lesion were examined retrospectively by the medical records and/or oral photographs at our department between 2010 and 2016.Results.These included 8 cases of GLN development and 7 cases of APB. There was a significantly higher risk of GLN development when the PGA sheet was applied to the raw surface of the tongue. There were no immediate APBs, but 4 APBs occurred several hours after surgery. All APB cases involved the tongue.ConclusionsBoth GLNs and APBs are minor complications. Although 8 cases of GLNs did not involve the recurrence of a tumor, follow-up with incisional or excisional biopsy should be performed. APB in the oral cavity induced by the PGA sheet peeling due to fluctuating adhesive force of the PGA sheets and fibrin glue can sometimes induce life-threatening events.



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OOOO as required reading in the dental school curriculum: an opportunity to both guide the curriculum and reinforce the relationship between biomedical science education and dental practice?

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul C. Edwards




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Radiological correlation between the thickness of the roof of the glenoid fossa and that of the bony covering of the superior semicircular canal

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rafael Crovetto-Martínez, Carlos Vargas, Iñigo Lecumberri, Amaia Bilbao, Miguel Crovetto-De la Torre, Jaime Whyte-Orozco
ObjectivesDehiscence of the superior semicircular canal (SSC) has been associated with alteration of the temporomandibular joint, although data explaining this association are lacking. The present study examined the correlations between the presence of dehiscences and thickness of the bone covering the SSC and the roof of the glenoid fossa (RGF).Study designComputed tomography was used in a cross-sectional analysis of the presence of dehiscences and thickness of the bone overlying the SCC and RGF in 156 temporal bones of 78 patients. The correlations of the presence of dehiscences in the SSC and ipsilateral RGF and the thickness of bone covering the SSC and RGF were analyzed with the chi-squared or Fisher exact test. The relationship between the thickness of the bone overlying the SCC and RGF was analyzed by the Spearman correlation coefficient and the Kruskal-Wallis test. The relationship of the thickness of the RGF to the covering of the SCC and to age and gender was analyzed with the general linear model.ResultsSignificant correlations were found between the presence of dehiscences and thickness of the bone overlying the SSC and RGF (p<0.001).ConclusionsThere is a morphological relationship between the structure of the SSC and RGF.



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Patient morbidity among residents extracting third molars: does experience matter?

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mohmedvasim Momin, Timothy Albright, Jennie Leikin, Michael Miloro, Michael R. Markiewicz
ObjectiveTo evaluate the complication rates for third molar extractions based upon resident level within an OMFS program, and identify the risk factors associated with postoperative complications following third molar extractions.Study DesignRecords of 1,992 subjects (5,466 third molar extractions) over a 5-year period were reviewed. The data was collected using appropriate CDT codes from July 1, 2011 – June 30, 2016. The cases were analyzed using demographic statistics, Pearson Chi-square test, and regression analysis.Results1,855 patients had sufficient data available for analysis and inclusion in the study. There were 146 adverse outcomes. The common complication was alveolar osteitis. Nerve injuries and retained root tips were encountered less frequently. There was a significant association between the depth of impaction and developing a postoperative complication. There was a direct correlation between the level of resident training and the likelihood of an adverse outcome.ConclusionThe study indicates that there are identifiable risk factors associated with postoperative complications following third molar extraction in an OMFS residency program. These factors include location, depth of impaction, use of a surgical drill, and level of resident training, which are correlated directly with the development of negative outcomes following third molar extractions.



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Historical perspective and nomenclature of potentially malignant or potentially premalignant oral epithelial lesions with emphasis on leukoplakia; some suggestions for modifications

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Isaäc van der Waal
Of the potentially (pre)maligant oral epithelial lesions leukoplakia is the most common one. A brief overview is presented of the various definitions of leukoplakia that have been used in the past. A proposal has been made to adjust the presently existing definition. Clinically, leukoplakias have been subdivided for decades in homogeneous and non-homogeneous leukoplakias, being further divided in different subtypes. A proposal has been made to slightly rearrange these subtypes. Furthermore, attention has been paid to a number of keratotic lesions that have been reported in the literature.In view of the increasing knowledge on carcinogenesis, including the various genetic aspects, it is expected that this knowledge will be reflected in the definition of oral potentially (pre)malignant lesions in the near future.



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Mandibular pain, trismus, and weight loss in a 75-year-old man

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hiroshi Yamazaki, Takatsugu Suzuki, Yuya Denda, Yasuhiro Nakanishi, Masahiro Uchibori, Rena Kojima, Yusuke Kondo




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Electromagnetic navigated condylar positioning after high oblique sagittal split osteotomy of the mandible: a guided method to attain pristine temporomandibular joint conditions?

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Moritz Berger, Igor Nova, Sebastian Kallus, Oliver Ristow, Urs Eisenmann, Hartmut Dickhaus, Michael Engel, Christian Freudlsperger, Jürgen Hoffmann, Robin Seeberger
ObjectivesReproduction of the exact preoperative proximal-mandible position after osteotomy in orthognathic surgery is difficult to achieve. This clinical pilot study evaluates an electromagnetic navigation (EM) system for condylar positioning after high oblique sagittal split osteotomy.Study DesignFollowing high oblique sagittal split osteotomy as part of two-jaw surgery, the position of ten condyles was intraoperatively guided by an EM navigation system. As a control, 10 proximal segments were positioned by standard manual replacement. Accuracy was measured by pre- and postoperative cone beam computer tomography imaging.ResultsOverall, EM condyle repositioning was equally accurate compared with manual repositioning (p>0.05). Subdivided into the three axis, significant differences could be identified (p<0.05). Nevertheless, no significantly and clinically relevant dislocations of the proximal segment of either the EM or the manual repositioning method could be shown (p>0.05).ConclusionThis pilot study introduces a guided method for proximal segment positioning, after high oblique sagittal split osteotomy, by applying the intraoperative EM system. The data demonstrate the high accuracy of EM navigation, although manual replacement of the condyles could not be surpassed. However, EM navigation can avoid clinically hidden, severe malpositioning of the condyles.



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Treatment of enucleated odontogenic jaw cysts. a systematic review.

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Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): M. Buchbender, F.W. Neukam, R. Lutz, C. Schmitt
ObjectivesIn this systematic review, we aimed to assess the impact of filling or not filling enucleated odontogenic jaw cysts on bony defect consolidation. In terms of filling we aimed to assess which is the best filling material based on current evidence.Study designAn electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "odontogenic cysts" AND "jaw cysts" AND "treatment AND therapy".ResultsThirteen studies with primary enucleation (6 with filling and 7 without filling) were included. In terms of filling either synthetic bone substitutes or autologous bone were used. The primary outcome was bony regeneration judged by radiographic follow-up measurements. 2D radiographic follow-up measurements (densitometry) revealed a bone density increase and comparable bone regeneration in both groups.ConclusionsDue to the low number of studies and the heterogeneity of the included data, evidence based treatment recommendations cannot be given at this time. Also outcomes based on 2D measurements should be interpreted with caution. However, the following factors are suggested having an impact on bony defect consolidation: defect size, defect configuration, the preservation of the periosteum and localization (upper or lower jaw). Prospective comparable clinical studies with a 3D follow-up are needed.



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Pan-cancer insights from The Cancer Genome Atlas: the pathologist's perspective

ABSTRACT

The Cancer Genome Atlas (TCGA) represents one of several international consortia dedicated to performing comprehensive genomic and epigenomic analyses of selected tumor types to advance understanding of disease and provide an open-access resource for worldwide cancer research. Thirty-three tumor types (selected by histology or tissue of origin, to include both common and rare diseases), comprising over 11,000 specimens were subjected to DNA sequencing, copy number and methylation analysis, and transcriptomic, proteomic, and histologic evaluation. Each cancer type was analyzed individually to identify tissue-specific alterations, and make correlations across different molecular platforms. The final data set was then normalized and combined for the PanCancer Initiative which seeks to identify commonalities across different cancer types or cells of origin/lineage, or within anatomically or morphologically-related groups. An important resource generated along with the rich molecular studies is an extensive digital pathology slide archive, comprised of frozen section tissue directly related to the tissues analyzed as part of TCGA, and representative formalin-fixed paraffin-embedded, hematoxylin and eosin (H&E) stained diagnostic slides. These H&E image resources have primarily been used to verify diagnoses and histologic subtypes with some limited extraction of standard pathologic variables such as mitotic activity, grade, and lymphocytic infiltrates. Largely overlooked is the richness of these scanned images for more sophisticated feature extraction approaches coupled with machine learning, and ultimately correlation with molecular features and clinical endpoints. Here we document initial attempts to exploit TCGA imaging archives, describe some of the tools, and the rapidly evolving image analysis / feature extraction landscape. Our hope is to inform, and ultimately inspire and challenge the pathology and cancer research communities to exploit these imaging resources so that the full potential of this integral platform of TCGA can complement and enhance the insightful integrated analyses from the genomic and epigenomic platforms.



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RING-finger protein 6 amplification activates JAK/STAT3 pathway by modifying SHP-1 ubiquitylation and associates with poor outcome in colorectal cancer

Objective The E3 ubiquitin ligase RNF6 (RING-finger protein 6) plays a crucial role in carcinogenesis. However, the copy number and expression of RNF6 were rarely reported in colorectal cancer (CRC). We aimed to explore the mechanical, biological and clinical role of RNF6 in CRC initiation and progression. Design The copy number and expression of RNF6 were analyzed from Tumorscape and The Cancer Genome Atlas (TCGA) datasets. Gene expressions were examined by real time PCR, western blot and immunohistochemical staining. Gene expression profiling studies were performed to identify pivotal genes regulated by RNF6. Biological function of RNF6 on tumor growth and metastasis was detected in vivo and vitro. Role of RNF6 in modulating SHP-1 expression was examined by co-immunoprecipitation and confocal microscopy respectively. Results The copy number of RNF6 was significantly amplified in CRC and the amplification was associated with RNF6 expression level. Amplification and overexpression of RNF6 positively correlated with CRC patients with poor prognosis. GSEA analysis revealed cell proliferation and invasion-related genes were enriched in RNF6 high-expressed CRC cells as well as in patients from TCGA dataset. Down-regulation of RNF6 impaired the CRC cell proliferation and invasion in vitro and vivo. RNF6 may activate JAK/STAT3 pathway and increase pSTAT3 levels by inducing the ubiquitination and degradation of SHP-1. Conclusions Genomic amplification drives RNF6 overexpression in CRC. RNF6 may be a novel biomarker in colorectal carcinogenesis, and RNF6 may increase pSTAT3 level via promoting SHP-1 ubiquitylation and degradation. Targeting the RNF6/SHP-1/STAT3 axis provides a potential therapeutic option for RNF6-amplified tumors.



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Genomics-Driven Precision Medicine for Advanced Pancreatic Cancer - Early Results from the COMPASS Trial.

Purpose: To perform real time whole genome sequencing (WGS) and RNA sequencing (RNASeq) of advanced pancreatic ductal adenocarcinoma (PDAC) to identify predictive mutational and transcriptional features for better treatment selection.  Experimental Design: Patients with advanced PDAC were prospectively recruited prior to first-line combination chemotherapy. Fresh tumor tissue was acquired by image guided percutaneous core biopsy for WGS and RNASeq. Laser capture microdissection was performed for all cases. Primary endpoint was feasibility to report WGS results prior to first disease assessment CT scan at 8 weeks. The main secondary endpoint was discovery of patient subsets with predictive mutational and transcriptional signatures. Results:Sixty three patients underwent a tumor biopsy between December 2015 and June 2017. WGS and RNASeq were successful in 62 (98%) and 60 (95%), respectively. Genomic results were reported at a median of 35 days (range 19-52 days) from biopsy, meeting the primary feasibility endpoint. Objective responses to first line chemotherapy were significantly better in patients with the classical PDAC RNA subtype compared to those with the basal-like subtype (P=0.004). The best progression free survival was observed in those with classical subtype treated with m-FOLFIRINOX. GATA6 expression in tumor measured by RNA in situ hybridization was found to be a robust surrogate biomarker for differentiating classical and basal-like PDAC subtypes. Potentially actionable genetic alterations were found in 30% of patients. Conclusions:Prospective genomic profiling of advanced PDAC is feasible and our early data indicate that chemotherapy response differs among patients with different genomic/transcriptomic subtypes.



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CD47 Blockade as an Adjuvant Immunotherapy for Resectable Pancreatic Cancer

Purpose: Patients with pancreatic ductal adenocarcinoma (PDAC) who undergo surgical resection and adjuvant chemotherapy have an expected survival of only two years due to disease recurrence, frequently in the liver. We investigated the role of liver macrophages in progression of PDAC micrometastases to identify adjuvant treatment strategies that could prolong survival. Experimental Design: A murine splenic injection model of hepatic micrometastatic PDAC was used with five patient-derived PDAC tumors. The impact of liver macrophages on tumor growth was assessed by 1) depleting mouse macrophages in nude mice with liposomal clodronate injection, and 2) injecting tumor cells into nude vs. NOD-scid-gamma mice. Immunohistochemistry and flow cytometry were used to measure CD47 ("don't eat me signal") expression on tumor cells and characterize macrophages in the tumor microenvironment. In vitro engulfment assays and mouse experiments were performed with CD47-blocking antibodies to assess macrophage engulfment of tumor cells, progression of micrometastases in the liver and mouse survival. Results: In vivo clodronate depletion experiments and NOD-scid-gamma mouse experiments demonstrated that liver macrophages suppress the progression of PDAC micrometastases. Five patient-derived PDAC cell lines expressed variable levels of CD47. In in vitro engulfment assays, CD47-blocking antibodies increased the efficiency of PDAC cell clearance by macrophages in a manner which correlated with CD47 receptor surface density. Treatment of mice with CD47-blocking antibodies resulted in increased time-to-progression of metastatic tumors and prolonged survival. Conclusions: These findings suggest that following surgical resection of PDAC, adjuvant immunotherapy with anti-CD47 antibody could lead to substantially improved outcomes for patients.



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Case series: Slowing alpha rhythm in late-stage ALS patients

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Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Matthias R. Hohmann, Tatiana Fomina, Vinay Jayaram, Theresa Emde, Jennifer Just, Matthis Synofzik, Bernhard Schölkopf, Ludger Schöls, Moritz Grosse-Wentrup
The alpha peak frequency (APF) of the human electroencephalogram (EEG) is a reliable neurophysiological marker for cognitive abilities. In these case series, we document a shift of the APF towards the lower end of the EEG spectrum in two completely locked-in ALS patients. In not completely locked-in ALS patients, the alpha rhythm lies within the common frequency range. We discuss potential implications of this shift for the largely unknown cognitive state of completely locked-in ALS patients.



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Neurophysiologic effects of transcutaneous auricular vagus nerve stimulation (taVNS) via electrical stimulation of the tragus: A concurrent taVNS/fMRI study and review

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Publication date: Available online 29 December 2017
Source:Brain Stimulation
Author(s): Bashar W. Badran, Logan T. Dowdle, Oliver J. Mithoefer, Nicholas T. LaBate, James Coatsworth, Joshua C. Brown, William H. DeVries, Christopher W. Austelle, Lisa M. McTeague, Mark S. George
BackgroundElectrical stimulation of the auricular branch of the vagus nerve (ABVN) via transcutaneous auricular vagus nerve stimulation (taVNS) may influence afferent vagal networks. There have been 5 prior taVNS/fMRI studies, with inconsistent findings due to variability in stimulation targets and parameters.ObjectiveWe developed a taVNS/fMRI system to enable concurrent electrical stimulation and fMRI acquisition to compare the effects of taVNS in relation to control stimulation.MethodsWe enrolled 17 healthy adults in this single-blind, crossover taVNS/fMRI trial. Based on parameters shown to affect heart rate in healthy volunteers, participants received either left tragus (active) or earlobe (control) stimulation at 500 μs 25 HZ for 60 s (repeated 3 times over 6 min). Whole brain fMRI analysis was performed exploring the effect of: active stimulation, control stimulation, and the comparison. Region of interest analysis of the midbrain and brainstem was also conducted.ResultsActive stimulation produced significant increased BOLD signal in the contralateral postcentral gyrus, bilateral insula, frontal cortex, right operculum, and left cerebellum. Control stimulation produced BOLD signal activation in the contralateral postcentral gyrus. In the active vs. control contrast, tragus stimulation produced significantly greater BOLD increases in the right caudate, bilateral anterior cingulate, cerebellum, left prefrontal cortex, and mid-cingulate.ConclusionStimulation of the tragus activates the cerebral afferents of the vagal pathway and combined with our review of the literature suggest that taVNS is a promising form of VNS. Future taVNS/fMRI studies should systematically explore various parameters and alternative stimulation targets aimed to optimize this novel form of neuromodulation.



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Test-retest reliability of transcranial magnetic stimulation EEG evoked potentials

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Publication date: Available online 29 December 2017
Source:Brain Stimulation
Author(s): Lewis J. Kerwin, Corey J. Keller, Wei Wu, Manjari Narayan, Amit Etkin
BackgroundTranscranial magnetic stimulation (TMS)-evoked potentials (TEPs), recorded using electroencephalography (TMS-EEG), offer a powerful tool for measuring causal interactions in the human brain. However, the test-retest reliability of TEPs, critical to their use in clinical biomarker and interventional studies, remains poorly understood.Objective/HypothesisWe quantified TEP reliability to: (i) determine the minimal TEP amplitude change which significantly exceeds that associated with simply re-testing, (ii) locate the most reliable scalp regions of interest (ROIs) and TEP peaks, and (iii) determine the minimal number of TEP pulses for achieving reliability.MethodsTEPs resulting from stimulation of the left dorsolateral prefrontal cortex were collected on two separate days in sixteen healthy participants. TEP peak amplitudes were compared between alternating trials, split-halves of the same run, two runs five minutes apart and two runs on separate days. Reliability was quantified using concordance correlation coefficient (CCC) and smallest detectable change (SDC).ResultsSubstantial concordance was achieved in prefrontal electrodes at 40 and 60 ms, centroparietal and left parietal ROIs at 100 ms, and central electrodes at 200 ms. Minimum SDC was found in the same regions and peaks, particularly for the peaks at 100 and 200 ms. CCC, but not SDC, reached optimal values by 60–100 pulses per run with saturation beyond this number, while SDC continued to improve with increased pulse numbers.ConclusionTEPs were robust and reliable, requiring a relatively small number of trials to achieve stability, and are thus well suited as outcomes in clinical biomarker or interventional studies.



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Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop

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Publication date: Available online 29 December 2017
Source:Brain Stimulation
Author(s): Marom Bikson, Andre R. Brunoni, Leigh E. Charvet, Vincent Clark, Leonardo G. Cohen, Zhi-De Deng, Jacek Dmochowski, Dylan Edwards, Flavio Frohlich, Emily Kappenman, Kelvin O. Lim, Colleen Loo, Antonio Mantovani, David McMullen, Lucas C. Parra, Michele Pearson, Jessica D. Richardson, Judith Maureen Rumsey, Pejman Sehatpour, David Sommers, Gozde Unal, Eric M. Wassermann, Adam J. Woods
BackgroundNeuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity transcranial electrical stimulation (tES) with direct currents (transcranial direct current stimulation, tDCS) or alternating currents (transcranial alternating current stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities.ObjectiveThis report seeks to promote the science, technology and effective clinical applications of these modalities, identify research challenges, and suggest approaches for addressing these needs in order to achieve rigorous, reproducible findings that can advance clinical treatment-->.MethodsThe National Institute of Mental Health (NIMH) convened a workshop in September 2016 that brought together experts in basic and human neuroscience, electrical stimulation biophysics and devices, and clinical trial methods to examine the physiological mechanisms underlying tDCS/tACS, technologies and technical strategies for optimizing stimulation protocols, and the state of the science with respect to therapeutic applications and trial designs.ResultsAdvances in understanding mechanisms, methodological and technological improvements (e.g., electronics, computational models to facilitate proper dosing), and improved clinical trial designs are poised to advance rigorous, reproducible therapeutic applications of these techniques. A number of challenges were identified and meeting participants made recommendations made to address them.ConclusionsThese recommendations align with requirements in NIMH funding opportunity announcements to, among other needs, define dosimetry, demonstrate dose/response relationships, implement rigorous blinded trial designs, employ computational modeling, and demonstrate target engagement when testing stimulation-based interventions for the treatment of mental disorders.



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Thirst induced by low frequency right hemisphere focal rTMS

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Publication date: Available online 29 December 2017
Source:Brain Stimulation
Author(s): Mélanie Cogné, Jérome Aupy, Cédric Gil-Jardiné, Bertrand Glize




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Participation of delta annexin A3 in the ribosomal protein S19 C-terminus-dependent inhibitory mechanism of the neutrophil C5a receptor through delta lactoferrin

Although C5a receptor (C5aR) interacting with its agonist C5a promotes acute inflammation during the initiation phase, the roles of the recycling C5aR during the resolution phase are still unclear. We found that C5aR interacted with its antagonist/agonist ribosomal protein S19 (RP S19) polymer or a RP S19 polymer functional analogue S-tagged C5a/RP S19, which connects an RP S19 C-terminus (IAGQVAAANKKH) to the S-tagged C5a C-terminus, promoted acute inflammation at the resolution phase via an activation of the apoptosis-inducing transcription factor delta lactoferrin (δLf) in neutrophils and the membrane mobilizing factor full-length annexin A3 (ANXA3) in macrophages. To confirm the antagonistic system of the recycling C5aR, S-tagged δLf-coupled BrCN-activated Sepharose 4B beads were incubated with cytoplasmic proteins and identified a neutrophil-specific δANXA3 via pull-down experiments. The S-tagged C5a/RP S19-induced agonistic functions in macrophage-like cells that were differentiated from human promyelocytic leukemia HL-60 cells by phorbol-12-myristate-13-acetate were suppressed by δLf and δANXA3 co-overexpression. δANXA3 seems to participate in the antagonistic system of the neutrophil C5aR involving IAGQVAAANKKH and δLf. Most likely, δANXA3 works as antagonist for the recycling C5aR on neutrophils during the resolution phase of acute inflammation.



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Colonic inflammatory fibroid polyp with PDGFRA expression



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High-grade transformation/dedifferentiation of an adenoid cystic carcinoma of the minor salivary gland to myoepithelial carcinoma

High-grade transformation (HGT)/dedifferentiation is an unusual phenomenon in salivary gland carcinomas. Here we report a case of adenoid cystic carcinoma (ACC) with HGT/dedifferentiation to myoepithelial carcinoma, occurring in the epipharynx of a 42-year-old woman. The surgically resected tumor was a pedunculated mass, 31 × 25 mm in size, which had two histologically distinct carcinomatous areas, including a high-grade sarcomatoid area composed of pleomorphic spindle cells and an area consisting of low-grade typical ACC. These two components gradually changed from the low-grade to the high-grade component. MIB-1 index in the low-grade and high-grade component was 15% and 50%, respectively. An immunohistochemical profile of the high-grade component showed immunoreactivity for α-SMA, p63, calponin and focal S100, as well as for several cytokeratin markers, which were compatible with the features of myoepithelial carcinoma. In contrast, the immunohistochemical profile of the low-grade component coincided with that of typical ACC. This HGT/dedifferentiation to myoepithelial carcinoma is extremely rare. The pathogenesis of HGT/dedifferentiation in salivary gland carcinomas still remains largely unknown, regardless of the presence or absence of myoepithelial differentiation. Further studies are required due to the more aggressive biological behavior and poorer prognosis associated with ACC with HGT/dedifferentiation, compared with conventional ACC.



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The Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and the Skull Base

J Neurol Surg B
DOI: 10.1055/s-0037-1615804

Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion

J Neurol Surg B
DOI: 10.1055/s-0037-1612617

Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging). Study Design Retrospective study. Setting Tertiary care academic center. Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion. Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047). Conclusion This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Location of the euryon in scaphocephalic vs. non-scaphocephalic controls: A novel assessment of cranial vault remodeling outcomes

We describe a novel measurement of cranial morphology in pre- and post-operative scaphocephalic patients to complement the cephalic index. This will better describe restoration of normal skull and head shape, further defining the nuances of the corrected skull. In this retrospective comparative study the location of the euryon on the skull was statistically significantly different in preoperative scaphocephalic patients versus non-scaphocephalic controls. This difference was resolved with surgical cranial vault remodeling, indicating restoration of a normal skull profile.

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Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures

To compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures.

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Machine Guns Underwater

Imagine you are on a fishing trip on the Colorado River Delta where the river flows into the Sea of Cortez by Baja California. You spot a section of water that seems to be churned up and muddy, almost muddy like someone was mixing cocoa powder to make hot chocolate. You get a bit closer, and all of a sudden you instinctively duck under the nearest deck chair. It sounds like someone is firing a machine gun at you. But the sound does not stop and only keeps getting louder.



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Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature.

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Success Found in the NFLPA’s Sleep Program

Andre Collins and David Gergen

Andre Collins and David Gergen

Proper Sleep is More Than a Curfew

Football players are used to strict curfew guidelines, largely designed to ensure the proper amount of sleep. And yet, lying in bed with eyes closed does not necessarily lead to clinically proper sleep. In some situations, it can be quite the opposite. The story of defensive end Reggie White, in particular, has become a cautionary tale on the hazards of obstructive sleep apnea (OSA), a disorder characterized by complete or partial obstruction of the upper airway.

At the time of his retirement in 2000, the 6-ft 5-inch "minister of defense" had 198 sacks, the most in the history of the game (since eclipsed by Bruce Smith's 200 sacks). When White died at the age of 43 in 2004, the official cause of death was cardiac issues, with OSA listed as a contributor. White's wife cared about the topic so deeply that she helped start the Reggie White Sleep Disorders Research and Education Foundation after her husband's death.

During OSA episodes, shallow or paused breathing can lead to reduced blood oxygen saturation, which is measured as an apnea hypopnea index (AHI) during sleep tests. Physicians agree that a high AHI degrades organ function over time, which can eventually contribute to premature death. Reduced energy during the day is another obvious result of poor sleep. Those with high AHI numbers are literally waking up several times per hour, making restorative sleep impossible. The goal of sleep apnea treatment is to reduce the AHI number to single digits, or even zero.

For current players, sleep apnea can translate into poor performance on the field, which could lead to less money on the next contract, not to mention a less healthy body. "Consider that NFL players seek out every edge they can to capitalize on what amounts to short and lucrative careers," says David Gergen, CEO of the American Sleep and Breathing Academy (ASBA). "Proper sleep, and avoiding OSA, should be top of mind for current NFL players who are looking to improve their health and better their performance on the field."

Meanwhile, many ex players who used to throw around their weight to great effect on the field, are often obese after retirement. "Some of those linemen at over 300 pounds stop playing and they have a very high incidence of sleep apnea," says Harry Sugg, DDS, owner of Dallas-based Wheatland Dental, and a dentist at Project Rose in Tyler, Texas.

"When a player's athletic career ends, the level of exercise is reduced dramatically while caloric intake often remains high," adds Andre Collins, executive director of the Professional Athletes Foundation and NFLPA director of Former Players. "This could lead to obesity, along with other serious comorbidities."

 

tackling sleepYour Mind, Your Body, Your Health

The NFLPA family has long provided its members (via its Your Mind, Your Body, Your Health program) with the tools to address football-, and non-football-related health concerns. Much like the growing awareness surrounding brain trauma and its long-term effects, the problem of poor sleep is gaining traction in the public eye. Thanks partly to ASBA (in conjunction with Pro Player Health Alliance [PPHA]) events that work closely with current and retired NFL players, members of the public are paying attention because their gridiron heroes are willing to talk about the problems of poor sleep.

Players are eager to talk about OSA because they see the benefits of oral appliance therapy (OAT), particularly OAT that involves the Herbst Appliance. Effective on chronic snoring and mild to moderate OSA sufferers, the appliance allows patients to move laterally and vertically without disengaging the appliance, and very few adjustments are required.

The hard acrylic of the Herbst appliance snaps into place, and when requested, retention clasps can be added and adjusted with telescopic hardware. The Sleep Herbst can be fabricated in hard acrylic, thermo active, or soft/hard materials. Gergen's Lab and Space Maintainers Lab were the only two labs in 2012 to be Medicare cleared to fabricate these devices, but more labs across the United States are applying for and gaining clearance.

The ASBA's mission is firmly in line with the NFLPA's own stated goal to tell real stories and "equip our current and former members and their families with the knowledge needed to tackle tough subjects…and live the healthiest life possible."

Super Bowl Champion and All Pro offensive lineman, Derek Kennard, went a long way toward living a healthier life when OSA treatment lowered his AHI from 72 to 2. He used some of the extra energy from radically improved slumber to work out more often, eventually losing a whopping 145 pounds.

All pro and two time MVP runner up, Roy Green, who started at wide receiver most of his career and for a few years started both sides of the ball, had three heart attacks and two strokes before being treated with an oral appliance for OSA. Since beginning the treatment, he has had no further heart attacks or strokes. With an AHI that went from 32 to 7 since using the Herbst Appliance, the 60-year-old Green says he feels better than he has in decades.

Green and Gergen have spread the word about OSA through the ASBA-affiliated Pro Player Health Alliance, holding free public awareness events in cities across the United States. Green's extensive connections, along with his involvement in PPHA, has brought hundreds of former players, and countless NFL fans, to try much-needed OSA treatment.

Additional NFL Players Who Benefitted from OSA Treatment

  • Legendary running back Eric Dickerson played the bruising position for a decade, and for years woke up with morning headaches, while also feeling tired during the day. After being treated with an oral appliance, his AHI went from 26 to 4. His bite was vertically restored by the combined treatment of Dr. Harry Sugg and Dr. Rebecca Lauck in Dallas, TX The morning headaches went away, and his energy returned.

 

  • Lance Smith, an 11-year pro (offensive line), significantly lowered his AHI and lost more than 100 pounds on his 6-ft, 3-inch frame.

 

  • Billy Thompson, a 12-year pro defensive back who played his entire career with the Denver Broncos, had central apneas, which are more difficult to remedy. In his case, an oral appliance was not suitable. "By putting the patient first through the program," says David Gergen, "we were able to get him started on the best path. He was treated with diet and exercise and is now doing fine. He has since become a huge supporter of the NFLPA and the sleep program."

 

  • Eleven-year pro Karl Mecklenburg, a linebacker with the Denver Broncos, cut his AHI from 17 to 1, and his wife is "happier than ever" now that he does not snore.

 

Roy Green, Dr. Archie Roberts, David Gergen and Whitney Reynolds

Roy Green, Dr. Archie Roberts, David Gergen and Whitney Reynolds

The program's roots began forming when David Gergen was invited to a coaching camp where former NFL players would be at different football positions helping youth develop their skills in that particular area (lineman, wide receivers, running backs, quarterbacks, defensive backs etc.). David, a state champion head football coach, was chosen to help develop the coaches of youth football teams. He saw Derek Kennard one morning and came to the conclusion that he must have been drinking all night or he had terrible sleep apnea. He then proceeded by getting Derek treated for sleep apnea with oral appliance therapy and during Derek's treatment, Derek's brother died from sleep apnea caused issues. Derek became passionate about it and worked with David Gergen to spread the word to his "NFL brothers". It was after this that the sleep apnea awareness began spreading through the former NFL player community.

Mike Haynes, who is passionate about former player health after defeating prostate cancer, joined the team and began spreading awareness as well. It wasn't long after that, David Gergen was then introduced to Dr. Archie Roberts (Founder of Living Heart Foundation). Dr. Roberts has been in charge of the Living Heart Foundation health screenings for former players nationwide for many years.

Health evaluations for the players named above began with the Living Heart Foundation's HOPE Program that was launched in 2012. Roberts added the sleep component after meeting with Gergen, CEO of the Gergen's Sleep Appliance Lab and PPHA. After treating many of the players across the country and proving through data from sleep tests, Mike Haynes and David Gergen presented the information to Andre Collins (Executive Director in the NFLPA) and together they created the Sleep Apnea Program for Former NFL Players through the "Player Athletes Foundation".

It was eventually made mandatory that doctors be trained through the ASBA to ensure the best OSA treatment for former players. A newly implemented "sleep coordinator course" mandates that at least one member of the doctor's staff be certified in sleep with special training.

Current and former players who take Your Mind, Your Body, Your Health to heart should not overlook the vital component of proper sleep in a healthy lifestyle. If you are interested in learning more about the sleep program, contact David Gergen at 602-478-9713.

 



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Custom Fabrication of 3D Printed Helmet for Improved Socialization and Subjective Self-Assessment in a case of Acquired Cranial Defect: A Case Report

Traumatic injury and subsequent residual cosmetic deformity are subject of intense scrutiny for their effects on objective health measures assessing patient morbidity and mortality. While these remain principle concern of all members of the treatment team, of less immediate yet lasting importance to the patient are the social costs of such disfigurement. Subjective feelings of unease and embarrassment can hinder social reintegration and encourage deteriorating psychosocial health. The following presents a case of one such individual who sustained traumatic brain injury and associated pneumocephalus and osteomyelitis requiring surgical debridement with bifrontal craniectomy and lobotomy.

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Association between community noise and adiposity in patients with cardiovascular disease

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Angel M Dzhambov, Penka D Gatseva, Mariya P Tokmakova, Nikolai G Zdravkov, Stefka V Vladeva, Dolina G Gencheva, Nevena G Ivanova, Krasimir I Karastanev, Emanuela V Vasileva, Aleksandar T Donchev

Noise and Health 2017 19(91):270-277

Introduction: This study aimed to explore the effect of community noise on body mass index (BMI) and waist circumference (WC) in patients with cardiovascular disease (CVD). Materials and Methods: A representative sample of 132 patients from three tertiary hospitals in the city of Plovdiv, Bulgaria was collected. Anthropometric measurements were linked to global noise annoyance (GNA) based on different residential noise annoyances, day–evening–night (Lden), and nighttime (Lnight) road traffic noise exposure. Noise map Lden and Lnight were determined at the living room and bedroom façades, respectively, and further corrected to indoor exposure based on the window-opening frequency and soundproofing insulation. Results and Discussion: Results showed that BMI and WC increased (non-significantly) per 5 dB. The effect of indoor noise was stronger in comparison with that of outdoor noise. For indoor Lden, the effect was more pronounced in men, those with diabetes, family history of diabetes, high noise sensitivity, using solid fuel/gas for domestic heating/cooking, and living on the first floor. As regards indoor Lnight, its effect was more pronounced in those with low socioeconomic status, hearing loss, and using solid fuel/gas for domestic heating/cooking. GNA was associated with lower BMI and WC. Conclusion: Road traffic noise was associated with an increase in adiposity in some potentially vulnerable patients with CVD.

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Cognitive function predicts listening effort performance during complex tasks in normally aging adults

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Jennine Harvey, Deborah von Hapsburg, Scott Seeman

Noise and Health 2017 19(91):254-262

Purpose: This study examines whether cognitive function, as measured by the subtests of the Woodcock–Johnson III (WCJ-III) assessment, predicts listening-effort performance during dual tasks across the adults of varying ages. Materials and Methods: Participants were divided into two groups. Group 1 consisted of 14 listeners (number of females = 11) who were 41–61 years old [mean = 53.18; standard deviation (SD) = 5.97]. Group 2 consisted of 15 listeners (number of females = 9) who were 63–81 years old (mean = 72.07; SD = 5.11). Participants were administered the WCJ-III Memory for Words, Auditory Working Memory, Visual Matching, and Decision Speed subtests. All participants were tested in each of the following three dual-task experimental conditions, which were varying in complexity: (1) auditory word recognition + visual processing, (2) auditory working memory (word) + visual processing, and (3) auditory working memory (sentence) + visual processing in noise. Results: A repeated measures analysis of variance revealed that task complexity significantly affected the performance measures of auditory accuracy, visual accuracy, and processing speed. Linear regression revealed that the cognitive subtests of the WCJ-III test significantly predicted performance across dependent variable measures. Conclusion: Listening effort is significantly affected by task complexity, regardless of age. Performance on the WCJ-III test may predict listening effort in adults and may assist speech-language pathologist (SLPs) to understand challenges faced by participants when subjected to noise.

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Cardiovascular risk factors in noise-exposed workers in china: Small area study

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Xiaoyuan Wu, Daya Yang, Wendong Fan, Chunyue Fan, Guifu Wu

Noise and Health 2017 19(91):245-253

Introduction: The aim of the present study was to evaluate whether there are changes in cardiovascular risk factors among noise-exposed workers and to explore the possible mechanisms of a long-term noise exposure leading to cardiovascular disease and the sex differences of cardiovascular risk factors in this population. Materials and Methods: Two hundred workers engaged in noise-related work, and a control group of 200 nonnoise-exposed workers hospitalized for occupational health examination were assigned into the study. All workers underwent a medical examination, electrocardiogram recording, blood pressure test, other blood tests, and audiometry. The collected blood was used to detect homocysteine (HCY), renin, angiotensin II, and other markers of cardiovascular risk factors. Results: Our study suggests that the type of work with long-term exposure to noise might pose a cardiovascular risk, as evidenced by associated increases in plasma HCY levels, incidence of type 2 diabetes, and incidence of hypertension. Discussion: Our research also reveals that among male workers, the levels of triglycerides, uric acid, HCY, renin activity, and the incidence of hypertension are higher than female, while high-density lipoprotein cholesterol is lower than female workers had. Additionally, the study emphasizes again the importance of weight control for reducing cardiovascular risk. Conclusion: Our study suggests that noise is a cardiovascular risk factor. Interventions in the work environment could be a preventable and controllable manner for reducing the incidence of cardiovascular disease.

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Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: An exploratory analysis

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Wenjia Wei, Stefanie Heinze, Doris G Gerstner, Sandra M Walser, Dorothee Twardella, Christina Reiter, Veronika Weilnhammer, Carmelo Perez-Alvarez, Thomas Steffens, Caroline E.W Herr

Noise and Health 2017 19(91):263-269

Background: Studies investigating leisure noise effect on extended high frequency hearing are insufficient and they have inconsistent results. The aim of this study was to investigate if extended high-frequency hearing threshold shift is related to audiometric notch, and if total leisure noise exposure is associated with extended high-frequency hearing threshold shift. Materials and Methods: A questionnaire of the Ohrkan cohort study was used to collect information on demographics and leisure time activities. Conventional and extended high-frequency audiometry was performed. We did logistic regression between extended high-frequency hearing threshold shift and audiometric notch as well as between total leisure noise exposure and extended high-frequency hearing threshold shift. Potential confounders (sex, school type, and firecrackers) were included. Results: Data from 278 participants (aged 18–23 years, 53.2% female) were analyzed. Associations between hearing threshold shift at 10, 11.2, 12.5, and 14 kHz with audiometric notch were observed with a higher prevalence of threshold shift at the four frequencies, compared to the notch. However, we found no associations between total leisure noise exposure and hearing threshold shift at any extended high frequency. Conclusion: This exploratory analysis suggests that while extended high-frequency hearing threshold shifts are not related to total leisure noise exposure, they are strongly associated with audiometric notch. This leads us to further explore the hypothesis that extended high-frequency threshold shift might be indicative of the appearance of audiometric notch at a later time point, which can be investigated in the future follow-ups of the Ohrkan cohort.

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Using auditory steady-state responses for measuring hearing protector occlusion effect

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Olivier Valentin, Frédéric Laville

Noise and Health 2017 19(91):278-285

Introduction: The currently available methods for measuring the occlusion effect (OE) of hearing protection devices (HPDs) have limitations. Objective microphonic measurements do not assess bone-conducted sounds directly transmitted to the cochlea. Psychophysical measurements at threshold are biased due to the low-frequency masking effects from test participants' physiological noise and the variability of measurements based on subjective responses. An auditory steady-state responses (ASSRs) procedure is used as a technique that might overcome these limitations. Participants and Methods: Pure-tone stimuli (250 and 500 Hz), with amplitude modulated at 40 Hz, were presented to twelve adults with normal hearing through a bone vibrator at three levels in 10-dB steps. The following two conditions were assessed: the unoccluded ear canal and occluded ear canal. ASSR amplitude data as a function of the stimulation level were linearized using least-square regressions. The ASSR-based "physiological" OE was then calculated as the average difference between the two measurements. Results: A significant statistical difference was found between the average threshold-based psychophysical OE and the average ASSR-based OE. Conclusion: This study successfully ascertained that it is possible to objectively measure the OE of HPD using ASSRs collected on the same participant both with and without protectors.

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MyD88-mediated innate sensing by oral epithelial cells controls periodontal inflammation

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Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Andrea E. Delitto, Fernanda Rocha, Ann M. Decker, Byron Amador, Heather L. Sorenson, Shannon M. Wallet
Periodontal diseases are a class of non-resolving inflammatory diseases, initiated by a pathogenic subgingival biofilm, in a susceptible host, which if left untreated can result in soft and hard tissue destruction. Oral epithelial cells are the first line of defense against microbial infection within the oral cavity, whereby they can sense the environment through innate immune receptors including toll-like receptors (TLRs). Therefore, oral epithelial cells directly and indirectly contribute to mucosal homeostasis and inflammation, and disruption of this homeostasis or over-activation of innate immunity can result in initiation and/or exacerbation of localized inflammation as observed in periodontal diseases. Dynamics of TLR signaling outcomes are attributable to several factors including the cell type on which it engaged. Indeed, our previously published data indicates that oral epithelial cells respond in a unique manner when compared to canonical immune cells stimulated in a similar fashion. Thus, the objective of this study was to evaluate the role of oral epithelial cell innate sensing on periodontal disease, using a murine poly-microbial model in an epithelial cell specific knockout of the key TLR-signaling molecule MyD88 (B6K5Cre.MyD88plox). Following knockdown of MyD88 in the oral epithelium, mice were infected with Porphorymonas gingivalis and Aggregatibacter actinomycetemcomitans by oral lavage 4 times per week, every other week for 6 weeks. Loss of oral epithelial cell MyD88 expression resulted in exacerbated bone loss, soft tissue morphological changes, soft tissue infiltration, and soft tissue inflammation following polymicrobial oral infection. Most interestingly while less robust, loss of oral epithelial cell MyD88 also resulted in mild but statistically significant soft tissue inflammation and bone loss even in the absence of a polymicrobial infection. Together these data demonstrate that oral epithelial cell MyD88-dependent TLR signaling regulates the immunological balance within the oral cavity under conditions of health and disease.



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Effects of a Straw Phonation Protocol on Acoustic and Perceptual Measures of an SATB Chorus

Recent scholarship has suggested that semi-occluded vocal tract (SOVT) exercises may increase vocal economy of individuals by reducing vocal effort while maintaining or increasing acoustic output. Choral singers, however, may use different resonance techniques or change voicing behaviors in an effort to hear their own sound in relation to others. One investigation revealed significant increases in a choir's mean spectral energy after participating in a straw phonation protocol. However, that study reported only acoustic measures and did not include choristers' perceptions of the choral sound and their own voicing efficiency.

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Popular and Classical Female Singers: Acoustic Comparison of Voice Use in the Song Melodia Sentimental (Sentimental Melody) by Heitor Villa-Lobos

This study aims to compare acoustic characteristics of classical and popular female singers' vocal performances in Heitor Villa-Lobos' Melodia Sentimental (Sentimental Melody).

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Male-specific Association Between Fat-Free Mass Index and Fecal Microbiota in 2- to 3-Year-Old Australian Children

imageABSTRACTObjectives:Maturation of the gut microbiota has been shown to influence childhood growth, whereas alterations in microbiota composition are proposed to be causally related to the development of overweight and obesity. The objective of this study is to explore the association between microbiota profile, body size, and body composition in young children.Methods:Fecal microbiota was examined by 16S rRNA gene sequencing, whereas body composition was assessed using the deuterium oxide dilution technique in a cohort of 37 well-nourished 2- to 3-year-old Australian children.Results:Microbiota composition (weighted UniFrac distance) was shown to be significantly associated with FFMI (fat-free mass index) z score (P = 0.027, adonis) in boys but not girls. In boys, FFMI z score was significantly correlated with the relative abundance of an OUT (Operational Taxonomic Unit) belonging to the Ruminococcaceae family (Rho = 0.822, P 

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Neonatal Exposure to Hepatitis C Virus Antigens in Uninfected Children Born to Infected Mothers

imageABSTRACTObjective:Vertical transmission of hepatitis C virus (HCV) infection is uncommon and occurs in approximately 5% of births from HCV-infected mothers. The reason for the low transmission rate is unclear. We aimed to investigate whether there is evidence of HCV exposure also in the noninfected children born to HCV-infected mothers by the presence of a detectable immune response.Methods:Serum and peripheral blood mononuclear cells from 9 HCV vertically infected children, 32 uninfected children born to HCV infected mothers, and 15 HCV chronically infected mothers, were analyzed. HCV-RNA-negative adults and children were used as controls. HCV-specific T cell responses were analyzed by interferon gamma using an enzyme-linked immunospot assay and 3H-thymidine incorporation assay. HCV antibodies were also analyzed.Results:An HCV-specific T cell response was detected in 73% (11/15) of the HCV-infected mothers, 67% (6/9) of the vertically infected children, 56% (18/32) of the exposed but uninfected children and in 10% and 20% of the control groups, respectively. The 2 groups of HCV-exposed children both had a significantly higher proportion of HCV-specific T cell responders compared to pediatric controls (P = 0.01 and P = 0.02).Conclusions:HCV-specific immune responses were more common in children born to HCV-infected mothers, regardless of the presence of HCV RNA. We conclude that noninfected children born to HCV-infected mothers may have been exposed to HCV antigens. Objective: Vertical transmission of hepatitis C virus (HCV) infection is uncommon and occurs in approximately 5% of births from HCV-infected mothers. The reason for the low transmission rate is unclear. We aimed to investigate whether there is evidence of HCV exposure also in the noninfected children born to HCV-infected mothers by the presence of a detectable immune response. Methods: Serum and peripheral blood mononuclear cells from 9 HCV vertically infected children, 32 uninfected children born to HCV infected mothers, and 15 HCV chronically infected mothers, were analyzed. HCV-RNA-negative adults and children were used as controls. HCV-specific T cell responses were analyzed by interferon gamma using an enzyme-linked immunospot assay and 3H-thymidine incorporation assay. HCV antibodies were also analyzed. Results: An HCV-specific T cell response was detected in 73% (11/15) of the HCV-infected mothers, 67% (6/9) of the vertically infected children, 56% (18/32) of the exposed but uninfected children and in 10% and 20% of the control groups, respectively. The 2 groups of HCV-exposed children both had a significantly higher proportion of HCV-specific T cell responders compared to pediatric controls (P = 0.01 and P = 0.02). Conclusions: HCV-specific immune responses were more common in children born to HCV-infected mothers, regardless of the presence of HCV RNA. We conclude that noninfected children born to HCV-infected mothers may have been exposed to HCV antigens.

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