Hold your horses: A comparison of human laryngomalacia with analogous equine airway pathology

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Rachael J. Lawrence, Matthew J. Butterell, James D. Constable, Matija Daniel
ObjectivesLaryngomalacia is the most common cause of stridor in infants. Dynamic airway collapse is also a well-recognised entity in horses and an important cause of surgical veterinary intervention. We compare the aetiology, clinical features and management of human laryngomalacia with equine dynamic airway collapse.MethodsA structured review of the PubMed, the Ovid Medline and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews).ResultsThere are numerous equine conditions that cause dynamic airway collapse defined specifically by the anatomical structures involved. Axial Deviation of the Aryepiglottic Folds (ADAF) is the condition most clinically analogous to laryngomalacia in humans, and is likewise most prevalent in the immature equine airway. Both conditions are managed either conservatively, or if symptoms require it, with surgical intervention. The operative procedures performed for ADAF and laryngomalacia are technically comparable.ConclusionDynamic collapse of the equine larynx, especially ADAF, is clinically similar to human laryngomalacia, and both are treated in a similar fashion.



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Priorities for future research into asthma diagnostic tools: A PAN-EU Consensus exercise from the European asthma research innovation partnership (EARIP)

Abstract

The diagnosis of asthma is currently based on clinical history, physical examination and lung function; and to date there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state-of-the-art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients.

Using a two-stage e-Delphi process and a summarising workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face to face workshop.

The three most important diagnostic/predictive tools ranked were: "New biological markers of asthma (e.g. genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring", "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath".

This article is protected by copyright. All rights reserved.

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High-expressed CKS2 is associated with hepatocellular carcinoma cell proliferation though down-regulating PTEN

Publication date: Available online 30 December 2017
Source:Pathology - Research and Practice
Author(s): Xiaonan Ji, Yayu Xue, Yu Wu, Fang Feng, Xiangdong Gao
BackgroundHepatocellular carcinoma (HCC) is a product of cumulative genetic, epigenetic, somatic, and endocrine aberrations. Identifying the differentially expressed genes (DEGs) in HCC is of critical importance for diagnosis and treatment. The purpose of the present study was to screen the key genes associated with hepatocellular carcinoma and to investigate the functions underlying hepatocellular carcinoma progression.Materials and MethodsThe gene expression profile of GSE64041, GSE40367 and GSE60502, including 100 specimens from HCC patients and 92 specimens from normal liver controls, was downloaded from the GEO database. DEGs were screened using the online analysis tool from the GCBI website and validated by Q-PCR and Kaplan-Meier survival analysis. After knockdown by siRNA in HepG2/C3A and Bel7402 HCC cells, the CCK-8 assay and colony formation assay were used to measure the clonogenic capacity of the tumor cells. Western blotting assay was used to measure the expression of PTEN.ResultsFive up-regulated genes were identified as overlapping genes associated with tumor cell activation. Upon validation by Q-PCR and Kaplan-Meier survival analysis, CKS2 was selected for further study. Although the results of CCK-8 did not show a significant difference, the colony formation assay results indicated that the silencing of CKS2 significantly inhibited cancer cell proliferation. Further study found that CKS2 knockdown induced PTEN up-regulation and may associate with P53 pathway activation.ConclusionThese findings indicated that CKS2 play a role in tumor activation and serve as a useful potential target for the treatment of HCC.



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Predictors of Successful Yield of Transbronchial Lung Biopsy in Patients With Sarcoidosis

Background: Transbronchial lung biopsy (TBLB) is an important bronchoscopic procedure used in the diagnosis of sarcoidosis. Only a few studies have evaluated determinants associated with successful diagnostic yield of TBLB. Herein, we evaluate the factors predicting successful yield of TBLB in subjects with sarcoidosis. Methods: Consecutive subjects with a clinical suspicion of sarcoidosis who underwent TBLB were enrolled. We evaluated the association between symptoms, spirometric lung function, radiologic stage of sarcoidosis, number of specimens, presence of floating biopsies, number of alveoli, and successful diagnostic yield (presence of granuloma) on TBLB. Results: Of the 223 subjects, sarcoidosis was diagnosed in 209 [mean (SD) age, 43.9 (12.6) y; 50.7% men] individuals. A total of 1021 TBLB specimens were obtained. Granulomas were demonstrated in 123 (58.9%) subjects on TBLB. On a multivariate analysis, there was no association between successful diagnostic yield and the presence of dyspnea, spirometric lung function, radiologic stage of sarcoidosis, presence of floating biopsies, presence of at least 50 alveoli, or crush artifacts during histopathologic examination. Complications were encountered in 25 (11.9%) subjects. There were no deaths. Conclusions: TBLB is a reasonably safe procedure with a good diagnostic yield. The present study did not identify any predictors associated with successful diagnostic yield of TBLB in sarcoidosis.

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Life-Threatening Massive Hemoptysis After Cryoablation for Atrial Fibrillation

A 59-year-old man developed massive hemoptysis, 1 month after undergoing cryoablation procedure for atrial fibrillation. He underwent emergent bronchoscopy that revealed massive, active bleeding with clots requiring repeated suctioning, epinephrine, and cold saline injection. The source of bleeding was identified in a follow-up bronchoscopy performed few days later—a 2×3 cm area of ulceration of the left main stem bronchus which was missed in the initial bronchoscopy owing to blood obscuring the field of vision. Considering the timeline, the ulcer most likely resulted from cryoablation-induced bronchial injury. Patient remained asymptomatic after stabilization and 2 months following discharge, another bronchoscopy was performed which showed the ulcer to be healing. Hemoptysis following cryoablation is quite rare with a reported incidence

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Preliminary data of a prospective study on the effectiveness and compliance of a mandibular advancement device alone versus a mandibular advancement device combined with a sleep positioning pillow in the treatment of mild to moderate sleep apnea

Introduction: Although continuous positive airway pressure treatment (CPAP) remains the primary intervention for moderate to severe obstructive sleep apnea (OSA), a wide array of therapeutic interventions exist for treating the milder sleep-related breathing disorders (SRBD). Oral appliances (in particular mandibular advancement devices–MAD) and positional therapy (PT) are the most frequently used in day-to-day practice as a result of their affordable pricing as well as their relative ease of use.

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The effects of insomnia symptoms and objective short sleep duration on memory performance in adolescents and young adults

Introduction: Insufficient sleep and sleep disruption, especially insomnia symptoms, are common problems among adolescents and young adults. While the association between insufficient sleep and poor memory performance is well established, there has been limited research on how insomnia may affect memory performance, especially in adolescents. Recent evidence suggests that insomnia with objective short sleep duration, a more severe insomnia phenotype, is associated with an elevated risk for medical morbidity as well as neurocognitive impairments.

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Effects of chronic sleep restriction on decision making in youth

Introduction: Adolescence is often linked to sleep deprivation and increased impulsivity and risk behaviours. Whilst previous research has found that sleep deprivation is associated with increased impulsivity and risk-taking, most of previous studies adopted an experimentally induced sleep deprivation paradigm for a certain period of time. There has been limited research on the effects of habitual chronic sleep restriction on behavioural consequences. The current study aimed to examine the influence of habitual chronic sleep restriction on decision making among youth.

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On the effects of two versions of slow wave sleep deprivation in the relation to REM sleep

Introduction: Although a number of interesting articles have been published about rapid eye movement (REM)-sleep regulation considering the results of total sleep deprivation or REM-sleep deprivation, the idea that REM-sleep propensity accumulates during waking or non-rapid eye movement sleep, slow wave sleep (SWS), in particular, is still debatable. This study was aimed to analyze the changes in sleep-wake architecture occurred during SWS deprivation and recovery periods.

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A path towards brain rejuvenation: the effect of chronic physical activity on EEG slow-wave activity in mice

Introduction: Physical activity is beneficial for health. It has been shown to improve brain functioning and cognition, reduce severity of mood disorders as well as promote healthy sleep and healthy aging. We recently found that aged mice have increased absolute electroencephalogram (EEG) slow-wave activity (SWA, EEG power density between 0.75-4.0 Hz) during non-rapid eye movement (NREM) sleep compared to young controls, suggesting changes in brain connectivity in the course of aging.

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Use of occlusal splint or mandibular advancement appliance by sleep bruxism patients do not normalize arousal related heart rate variability

Introduction: Oral appliance is among first-line therapy for sleep bruxism (SB). However, mechanism of action for SB remains unknown. The aim of study is to assess if changes in heart rate variability (HRV) related to SB arousal could explain their action.

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Graph theory-based analysis of EEG during nREM sleep reveals changes in functional connectivity in sleep-related hypermotor epilepsy (SHE)

Introduction: Dynamic key points of sleep microstrucure have been shown to be associated with epileptic activation in Sleep-Related Hypermotor Epilepsy (SHE), identified within the system of the cyclic alternating pattern (CAP), that correlate with reactive slow wave events [1].

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Treatment of obstructive sleep apnea decreases the recurrence of atrial and ventricular ectopy in patients with atrial fibrillation

Introduction: Obstructive Sleep Apnea (OSA) has been recognized as an independent risk factor for the development and progression of atrial fibrillation (AF). OSA decreases patients' response to anti-arrhythmic medication, and decreases the success rate of surgical ablation of AF. OSA remains undiagnosed in many patients with AF. There is evidence that continuous positive airway pressure (CPAP) treatment decreases the activity of the sympathetic nervous system and oxidative stress, which play a crucial role in the development of AF.

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The effect of zonisamide on abnormal muscle tone during REM sleep in a mouse model of REM sleep behavior disorder

Introduction: Zonisamide, first launched as an anti-epileptic drug (Excegran® or Zonegran®), has been approved as a drug for Parkinson's disease (PD) in Japan (Trerief®). Zonisamide ameliorates motor symptoms and improves activities of daily living in patients with advanced PD. In addition, it has been recently reported that zonisamide also improves the symptom of REM sleep behavior disorder (RBD) in some PD patients. In this study, we examined the effectiveness of zonisamide for RBD, by using a novel RBD model, Glra1flox/flox; Chat-Cre mice.

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Obstructive sleep apnea is highly undetected in non-obese patients with atrial fibrillation

Introduction: Obstructive sleep apnea (OSA) is a sleep disorder associated with several cardiovascular morbidity. OSA is an independent risk factor for the development and progression of atrial fibrillation (AF). We aimed to estimate the prevalence of OSA in patients with AF, and to investigate the relation between obesity and OSA in these patients.

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Sleep disturbance mediates the relationship between injury severity and executive function difficulties in children 18 months following traumatic brain injury

Introduction: Sleep is a neurorestorative process and provides a plausible candidate mechanism to explain variability in children's functional outcomes after Traumatic Brain Injury (TBI). A common consequence of TBI is difficulty with self-regulation and the mental processes required for planning, working memory and focussed attention. The aim of this study was to examine whether sleep disturbance mediates the relationship between TBI severity and executive functioning difficulties.

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Clinical and polysomnographic differences in elderly patients with obstructive sleep apnea (OSA)

Introduction: Although sleep related complaints are common in the community, there is little information on the clinical and polysomnographic differences elderly patients with obstructive sleep apnea (OSA).

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Pain drawing characteristics and risk for sleep breathing disorders in an orofacial pain service

Introduction: Subjects living with chronic pain are at risk for developing sleep breathing disorders (SBD). Altered sleep modifies the perception and reported intensity of pain. Many tools exist to evaluate pain, including validated scales and pain drawings. Pain drawings are associated to psychological profiles and prognostic variables in published studies on nociceptive lower back or peripheral pain. The utility of pain drawings in the orofacial pain area may be associated to disability, pain intensity, and risk for altered sleep.

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Irregular sleep-wake rhythm disorder in a young woman with Townes-Brocks-syndrome

Introduction: Referral of female 22-year-old former psychology-student from oncology unit.

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Handheld mobile biofeedback of heart rate variability in patients with chronic insomnia disorder – a pilot study

Introduction: The hyperarousal concept in patients with insomnia has been tested by measuring autonomous variables, including electrocardiogram (ECG)-derived heart rate and heart rate variability. In stress-related insomnia an elevated nocturnal sympathetic activity was found, while parasympathetic activity was reduced. In this Pilot-study we tested the usefulness of a mobile heart-rate-variability (HRV) biofeedback device in outpatients of a specialized sleep clinic.

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Comparison of actigraphy scoring protocols to define the rest interval and optimally derive pediatric sleep dimensions

Introduction: While polysomnography is the established gold standard, technological advances have enabled more resource efficient (cost, time, user-ease) assessment of select sleep dimensions and patterns. Wrist actigraphy is an ambulatory wearable increasingly used in research and clinical settings as it permits unobtrusive measurement of sleep in one's home environment. Previous research analyzed accelerometry data to yield validated algorithms (e.g., Sadeh, Cole) to distinguish sleep/wake epochs.

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REM-associated sleep disordered breathing: prevalence and clinical significance in the hypnolaus cohort

Introduction: Nocturnal respiratory events are usually more frequent and of longer duration in rapid eyes movement sleep (REM) compared with non-REM sleep (NREM), probably due to greater pharyngeal muscle relaxation and a reduction in the hypoxic and hypercapnic ventilatory response throughout . However, the prevalence and clinical impact of REM-related sleep-disordered breathing (REM-SDB) are still debated. The aim of this study was to determined the prevalence of REM-related sleep-disordered breathing (REM-SDB) in the general population and to investigate the associations between REM-SDB and hypertension, metabolic syndrome, diabetes and depression.

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Association between SaO2 levels and brain connectivity using PDC (partial directed coherence) in a Brazilian populational based sample (EPISONO)

Introduction: Desaturation during sleep is initially associated with poor quality of sleep in short term. However, in long term, due to chronically intermittent hypoxia, some degree of brain structural impairment can be detected using interconnectivity dependence measurements like PDC (partial Directed Coherence) in PSG data during sleep. Our aim is to assess the association between Desaturation among sleep stages and EEG bands with PDC levels in a Brazilian populational Based sample (EPISONO).

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Effect of sleep apnea and insomnia on the association of depression with quantitative electroencephalogram measures (QEEG) in adult men during sleep – the MAILES study

Introduction: Quantitative EEG (qEEG) abnormalities are present in 80% of patients with psychiatric disorders. Small studies of resting, awake qEEG in patients with depression show variation in findings. Both increase and decrease in slow wave activity has been reported in depressed patients in addition to increased alpha and beta activity. We have previously shown co-morbid sleep apnea and insomnia have additive effects on depression prevalence and severity. We aimed to determine the effect of sleep apnea and insomnia symptoms on the relation between sleep qEEG parameters and depression in a large sample of community dwelling men.

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PSQI largely ignores sleep on work-free days both in the general population and in clinical sleep medicine samples

Introduction: The Pittsburgh Sleep Quality Index (PSQI) is currently the most common measure of sleep quality. Its questions refer to "usual" sleep habits over the past month. However, for long it is known that sleep timing and sleep duration varies significantly between workdays and work-free days. A recently submitted study in the general population used the original and two adapted versions of the PSQI that replaced "usual" by explicitly referring to sleep on work- or work-free days. This study showed, that also sleep quality differs significantly between work- and work-free days.

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Description of Particle Size, Distribution, and Behavior of Talc Preparations Commercially Available Within the United States

Background: Widespread use of talc pleurodesis remains controversial for many providers concerned by adverse events such as respiratory failure, which are sometimes fatal. Particle talc size has been implicated in these adverse effects, mainly on the basis of animal studies utilizing large amounts of talc or in observational studies performed on different continents with different talc preparations and doses. Our aim was to determine the particle size and distribution of only the commercially available US-talc preparations and whether the fluid content can affect this distribution. Methods: Commercially available US talc was evaluated under scanning electron microscopy and dynamic light scattering (DLS). Distribution of talc particle size was obtained in saline and various protein-based solutions. Results: Talc particle size by DLS was performed with commercially available Sterile Talc Powder and Sclerosol Intrapleural Aerosol. Sterile Talc Powder demonstrated a median diameter of 26.57 μm with a range of particle sizes from 0.399 μm to 100.237 μm. Sclerosol demonstrated a median diameter of 24.49 μm with a range of particle sizes from 0.224 μm to 100.237 μm. The exposure of talc to a protein rich environment (bovine serum albumin and human pleural fluid) led to the development of measureable, new, larger aggregated particle (>100 μm). Conclusions: Currently available US talc seems to have size characteristics similar to previous described "graded" talc preparations. The exposure of talc to a protein rich environment seems to modify the overall distribution of talc particle size when examined by DLS.

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Cryobiopsy of the Pleura: An Improved Diagnostic Tool

Background: Medical thoracoscopy (rigid and semirigid pleuroscopy) has revolutionized the approach to the diagnosis of pleural disease by offering a very high diagnostic yield. Rigid pleuroscopy offers the advantages of therapeutic intervention and larger biopsy specimens, whereas semirigid pleuroscopy using a standard biopsy forceps yields smaller and more superficial pleural samples. Cryobiopsy through semirigid pleuroscope in anecdotal studies has been used to overcome these disadvantages. We compared the safety and efficacy of cryobiopsy with conventional forceps biopsy in terms of the specimen size and diagnostic yield. Methods: We analyzed data of 139 (87 cryobiopsies and 52 forceps biopsies) patients with undiagnosed pleural effusion who underwent pleuroscopy using a semirigid pleuroscope. A cryoprobe (ERBE, 2.4 mm) was passed through the working channel of the semirigid pleuroscope, the target area of parietal pleura was frozen for an average freezing time of 8 seconds, then the semirigid pleuroscope along with the probe was forcibly withdrawn en bloc avulsing the frozen parietal pleura. Two to 3 samples were taken from each patient. Results: The diagnostic yield was 99% with cryobiopsy and 96% with forceps biopsy. The average specimen size through cryoprobe (13.2±6.7; range, 7 to 35 mm) was significantly larger than with the conventional forceps (6.8±3.3; range, 2 to 15 mm) (P

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Cortical inhibition assessed using paired-pulse TMS-EEG is increased in older adults

Publication date: Available online 30 December 2017
Source:Brain Stimulation
Author(s): George M. Opie, Simranjit K. Sidhu, Nigel C. Rogasch, Michael C. Ridding, John G. Semmler
BackgroundAlterations in inhibitory processes mediated by gamma-aminobutyric acid type B (GABAB) receptors may contribute to age-related functional impairments. However, investigation of these circuits using conventional paired-pulse transcranial magnetic stimulation (TMS) at long interstimulus intervals (∼100-200ms) have produced conflicting results in older adults, possibly due to the indirect nature of the TMS motor evoked potential (MEP).ObjectiveTo utilise electroencephalography and TMS coregistration (TMS-EEG) to more directly assess age-related changes in GABAB-mediated long-interval intracortical inhibition (LICI).MethodsIn 17 young (24.2 ± 1.1 years) and 17 older (71.4 ± 1.4 years) subjects, the TMS-evoked potential (TEP) was used to assess the global scalp response to single-pulse TMS and LICI applied at two interstimulus intervals of 100 ms (LICI100) and 150 ms (LICI150).ResultsFor single-pulse stimulation, P30 amplitude was unaffected by age. Despite this, N45 amplitude was increased in older adults and both N100 and P180 showed altered spatial distributions. Furthermore, the latency of P30 was shorter, while the latency of P180 was longer, in the elderly. In addition, inhibition of the N100 and P180 was increased in older adults following both LICI100 and LICI150.ConclusionsThese findings with TMS-EEG suggest that the ageing process is associated with a potentiation of GABAergic inhibition, particularly for the GABAB-receptor subtype.



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MED-EL Announces Winners of Its Ideas4Ears Competition

​MED-EL (http://ift.tt/1pfpn1t) has announced the winners of its global Ideas4Ears children's invention contest. Parker Welsh from Ozawkie, KS, won the grand prize with his entry involving inserting regenerative cells from salamanders, which are responsible for tissue repair and regeneration, into human macrophages. Welsh won a $1,000 college scholarship and a trip for two to MED-EL's international headquarters in Innsbruck, Austria. The Ideas4Ears competition challenged children to create a piece of artwork showcasing their invention to improve the quality of life for people living with hearing loss. More than 240 entries were received from around the world, and winners were selected from seven countries, including the United States, Austria, Brazil, Germany, Italy, New Zealand and the United Kingdom. Avery Bennett from Chicago, IL, was awarded the finalist prize.​

Published: 12/30/2017 5:23:00 PM

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Effect of different doses and durations of teriparatide therapy on resolution of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

To evaluate the effects of different doses and durations of teriparatide therapy on MRONJ resolution in rats.

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Overexpression of sprouty2 in human oral squamous cell carcinogenesis

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Pei-Hsien Liao, Yen-Yun Wang, Wen-Chen Wang, Chung-Ho Chen, Yu-Hsun Kao, Jing-Wei Hsu, Ching-Yi Chen, Ping-Ho Chen, Shyng-Shiou Yuan, Yuk-Kwan Chen
ObjectiveThis study investigated SPRY2 expression in human oral potentially malignant disorders (OPMDs) and oral squamous cell carcinomas (OSCCs).Methods75 OSCCs, 23 OPMDs with malignant transformation (MT), 17 OPMDs without MT, and eight normal oral mucosa (NOM) tissues were used for immunohistochemical staining; three OSCC tissues with normal tissue counterparts were used for western blotting. Three human oral cancer cell lines (OCCLs), an oral precancer cell line (DOK), and a NOM primary culture (NOMPC) were used for western blotting; OCCLs and NOMPC were employed for real-time quantitative reverse transcription-polymerase chain reaction. OCCLs were evaluated in terms of proliferation, migration, invasion and BRAF V600E point mutation assays.ResultsSignificantly increased SPRY2 protein expression was observed in OSCCs as compared with NOM, and SPRY2 expression also differed between OSCC patients with and without lymph-node metastasis. SPRY2 protein and mRNA expressions were significantly enhanced as compared with NOMPC. Increased phospho-ERK expression was observed in OCCLs as compared with NOMPC. Significant decreases in the proliferation rate, degrees of migration and invasion were noted in OCCLs with SPRY2 siRNA transfection as compared with those without SPRY2 siRNA transfection. No BRAF V600E point mutation was observed for OCCLs as compared with NOMPC. A significantly increased SPRY2 protein level was noted in OPMDs with MT as compared to those without MT, and was also found in OPMDs with MT in comparison with NOM, as well as in DOK in comparison with NOMPC.ConclusionsOur results indicated that SPRY2 overexpression is associated with human oral squamous-cell carcinogenesis.



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Superhydrophilic co-polymer coatings on denture surfaces reduce Candida albicans adhesion—An in vitro study

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Masahiro Hirasawa, Chiaki Tsutsumi-Arai, Kensuke Takakusaki, Toyohisa Oya, Kenji Fueki, Noriyuki Wakabayashi
ObjectiveIn this study, we aimed to investigate denture-base-resin coatings prepared with a crosslinkable co-polymer containing sulfobetaine methacrylamide (SBMAm) and the relationship between their surface characteristics and the initial adhesion of Candida albicans (C. albicans).MethodsAcrylic resin discs were coated with co-polymers containing various concentrations of SBMAm and N,N'-(4,7,10-trioxa-1,13-tridecadiamine) diacrylamide (JDA) as crosslinking agent. Uncoated discs were used as controls. An acquired pellicle was formed on each disc using artificial saliva, and the discs were immersed in a suspension of C. albicans (JCM2085) cells. After incubation, tetrazolium salt (XTT-reduction) and colony forming unit (CFU) assays were performed and the morphogenesis of C. albicans was examined using scanning electron microscopy (SEM). The surface roughness, film thickness, and the water contact angle of each disc surface were measured.ResultsAll coating groups showed significantly lower amounts of adhered C. albicans in the XTT-reduction and CFU assays than the control, confirmed by the SEM images. Many wrinkle structures were observed on the surfaces coated with co-polymers containing more than 30% SBMAm. There were no significant differences in surface roughness among all groups. The co-polymer films on the coated discs were less than 5.0 μm in thickness, and these surfaces exhibited significantly lower mean water contact angles than the control.ConclusionCrosslinkable co-polymers containing SBMAm can enhance the hydrophilicity of the surface of denture-base resins and reduce the initial adhesion of C. albicans.



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Immunoexpression of proteins involved in cytoskeleton remodeling in benign odontogenic lesions

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Paula Nascimento Antonio, Natália Galvão Garcia, Agnes Assao, José Roberto Pereira Lauris, Fernando Augusto Soares, Denise Tostes Oliveira
ObjectiveThe present study was designed to analyze the immunolocalization of proteins involved in cytoskeleton remodeling, such as moesin and Rho-A, in benign odontogenic lesions that present with expansive growth and invasive clinical behavior.Materials and methodsExpressions of moesin and Rho-A in odontogenic epithelium were evaluated by immunohistochemical analysis in 45 odontogenic lesions using monoclonal antibodies.ResultsOur results demonstrated strong membranous and cytoplasmic expressions of moesin in the epithelial cells in 66.7% and 44.4% of the odontogenic lesions, respectively. Furthermore, Rho-A expression in odontogenic epithelium was strong in the membrane and cytoplasm of 51.1% and 62.2% of the odontogenic lesions, respectively. A statistically significant correlation was found between the membranous and cytoplasmic expressions of moesin (p = 0.000) and those of Rho-A (p = 0.048) in odontogenic epithelial cells, while no statistically significant correlation was found between moesin and Rho-A expressions (p > 0.05).ConclusionsThe present study confirmed the strong expressions of moesin and Rho-A by odontogenic epithelial cells, suggesting their involvement in the development of benign odontogenic lesions. However, this study has failed to detect the connection between the moesin and Rho-A interaction in expansive growth and local invasiveness of these lesions.



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Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy

Publication date: Available online 29 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Nicholas S. Greaves, Aiden Moore, Dare Seriki, Jonathan Ghosh
ObjectiveThe aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy.MethodsA retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms.ResultsOvation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55–107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3–48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices.ConclusionsThe mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices.



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Reconsidering the Rupture Risk Potential of Abdominal Aortic Aneurysms in High Risk Patients

Publication date: Available online 29 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Kosmas I. Paraskevas




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Treatment of Femoral Vein Obstruction Concomitant with Iliofemoral Stenting in Patients with Severe Post-thrombotic Syndrome

Publication date: Available online 30 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Kaichuang Ye, Huihua Shi, Minyi Yin, Jinbao Qin, Xinrui Yang, Xiaobing Liu, Mier Jiang, Xinwu Lu
BackgroundThe aim was to assess the clinical and anatomical outcomes of iliofemoral stenting, with concomitant femoral stenting or balloon angioplasty alone, in patients with severe post-thrombotic syndrome (PTS) and compromised inflow.MethodsA database of patients with severe PTS who successfully underwent endovascular iliofemoral stenting was reviewed retrospectively. Patients with impaired inflow with chronic post-thrombotic obstructive lesions in the femoral vein (FV), but patent profunda vein, were selected and divided into two groups: the FV stenting (FV-S) group and the FV angioplasty (FV-A) group. Patients in the FV-S group were treated with concomitant iliofemoral and FV stenting, and patients in the FV-A group were treated with iliofemoral stenting and balloon angioplasty alone of the obstructed femoral vein. The clinical and stent outcomes were recorded and compared in the two groups.ResultsThere were 45 patients in the FV-S group and 69 patients in the FV-A group. The groups were well matched for age, gender, and diseased limbs. The pre-procedural symptoms, CEAP classifications, VCSS scores, Villalta scores, and prevalence of active ulcers were also similar between the two groups. Immediate failure (<30 days post-procedure) in the femoral segment occurred more frequently in the FV-A group (70% in FV-A group vs. 24% in FV-S group, p < .001); however, all treated femoral vein segments had occluded at 12 months. There was no significant difference between the FV-S and FV-A groups in cumulative primary and secondary patency rates of the iliofemoral stent at 3 years (55% vs. 52%, p = .71, and 77% vs. 85%, p = .32, respectively). Complete pain relief, swelling relief, VCSS score, Villalta score, and freedom from ulcers at a median of 22 months (1–48 months) following the procedure were similar in the two groups.ConclusionsStent placement to treat post-thrombotic iliofemoral obstruction with concomitant obstructed femoral vein but patent profunda vein shows cumulative patency rates and clinical outcomes similar to previous reports. Adjunctive femoral stenting or angioplasty of the obstructed femoral vein does not appear to improve clinical or stent outcomes in patients with severe PTS.



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Effect of different doses and durations of teriparatide therapy on resolution of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

Publication date: Available online 30 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mohammad Zandi, Arash Dehghan, Najmeh Zandipoor, Payam Amini, Shideh Doulati
ObjectiveTo evaluate the effects of different doses and durations of teriparatide therapy on MRONJ resolution in rats.Subjectsand methods: A total of 120 rats that had been affected with MRONJ (after six weekly zoledronate injections and tooth extraction) were randomly divided into eight subgroups: 2, 10, and 20 μg/kg/day teriparatide were administered to L4, M4, and H4 for 4 weeks, and to L8, M8, and H8 for 8 weeks, respectively. C4 and C8 received saline for 4 and 8 weeks, respectively. One week after the final injection, rats were sacrificed and assessed clinically (bone exposure/fistula) and histologically (number of osteocytes in extraction socket and empty lacunae in alveolar bone).ResultsMRONJ was clinically improved in 72.2%, 61.5%, and 40% of stage I, II, and III experimental rats, respectively. In the control rats, the results were 20.8% for stage I and no improvement for stages II and III. Aside from L4 and L8, the experimental subgroups had a significantly higher rate of clinical and histological improvement compared with their corresponding controls. There was a significantly higher number of osteocytes and lower number of empty lacunae in M4 and H4 compared with C4, in H4 compared with L4, in M8 and H8 compared with C8, and in H8 compared with L8.ConclusionTeriparatide therapy improved clinical and histological features of MRONJ in a dose-dependent manner, but clinically relevant doses of teriparatide might not be sufficient for MRONJ resolution in rats. Extending the duration of teriparatide therapy from 4 to 8 weeks did not affect treatment outcomes.



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Comparative Evaluation of Clinical Outcomes Using Delta Plates and Conventional Miniplates for Internal Fixation of Mandibular Condylar Fractures In Adults

Publication date: Available online 30 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Suraj Arjun Ahuja, Jyotsna Galinde, Usha Asnani, Yusuf A. Mistry
PurposeIn recent years numerous osteosynthesis devices are available for management of condylar fracture, the aim of this study was to compare and evaluate the clinical outcomes of delta plates and conventional miniplates for internal fixation of mandibular condylar fractures in adults.Material and MethodsA prospective study was performed on 20 patients with subcondylar fracture requiring open reduction and internal fixation for their management. Patients were randomly divided into two groups using computer software, patients under Group A [N=10] were treatment using delta plate while under Group B [N=10] using conventional miniplates via extraoral retromandibular transparotid approach.ResultsThere was no statically difference between delta plates and conventional miniplates for internal fixation of mandibular condylar fractures in adults. However, the time taken for adaptation of the delta plates & ease of adaptation was significantly lower than that required for the two miniplates [p=0.000].ConclusionsThe study results indicated that delta plate and miniplate are equally effective in terms of long-term clinical success in the management of mandibular subcondylar fractures in adults. The delta plates are superior in terms of handling characteristics, such as ease of adaptation and time required for adaptation as only one plate and four screws are required as compared to two plates and eight screws.



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Impact of temporomandibular joint discectomy on condyle morphology: an animal study

Publication date: Available online 30 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Reinaldo Abdala-Júnior, Arthur Rodriguez Gonzalez Cortes, Eduardo Massaharu Aoki, Simone Ferreira, João Gualberto Cerqueira Luz, Emiko Saito Arita, Jefferson Xavier de Oliveira
PurposeTemporomandibular disorders (TMD) lead to parafunctional activity that may alter bone remodeling of mandibular components. This animal study aimed to assess the impact of temporomandibular joint discectomy on condyle bone microarchitecture.Material and MethodsA total of 30 one-month-old Wistar rats were assessed and divided in three equal groups (two tests and one control) of 10. The first test group underwent disc removal (DRm; the second test group underwent disc and condylar cartilage removal (DCR); and the 10 remaining rats were analyzed as sham-operated controls (CTR), following a split-mouth design. Rats were sacrificed two months after surgery, and the respective mandibles were scanned with micro-CT for quantitative morphometric analysis.ResultsThere were significant differences among the three groups analyzed (DR, DCR and CTR) for Bone volume fraction (BV/TV, p=0.044), Structure model index (p<0.001), Fractal Dimension (p=0.024) and porosity (p=0.023). In addition, operated and contralateral non-operated sides significantly differed for all variables in at least one of the test groups (p<0.05), but not in the control group (p>0.05).ConclusionWithin the limitations of this study, the present results suggest that discectomy may lead to alterations of the mandibular condylar morphology.



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In reply to recent letter to editor regarding: Towards consensus reporting of radiation induced liver toxicity in the treatment of primary liver malignancies: defining clinically relevant endpoints

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): Tobias R. Chapman, Stephen R. Bowen, Smith Apisarnthanarax




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Stereotactic radiosurgery for multiple brain metastases: Results of multi-centre benchmark planning studies

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): David J. Eaton, Jonathan Lee, Ian Paddick
PurposeStereotactic radiosurgery is indicated for treatment of multiple brain metastases. Various treatment platforms are available, but most comparisons are limited to single centre studies. As part of a national commissioning programme, benchmark planning cases were completed by 21 clinical centres, providing a unique dataset of current practice across a large number of providers and equipment platforms.Methods and MaterialsTwo brain metastases cases were provided, with images and structures pre-drawn, involving three and seven lesions. Centres produced plans according to their local practice, which were reviewed centrally using metrics for target coverage, selectivity, gradient fall-off and normal tissue sparing.Results50 plans were submitted, using 24 treatment platforms. 11 plans were revised following feedback, including two centres who acquired a new platform; and one other centre accepted a restriction of service. All centres prioritised coverage, with the prescription isodose covering ≥95% of 233/235 target volumes. Selectivity was much more variable, especially for smaller lesions, and when combined with poor gradient indices resulted in large volumes of normal tissue being irradiated. Tomotherapy submissions were outliers for either selectivity or gradient index, but other platforms could produce plans with relatively low gradient indices for larger lesion volumes. There was more variation among Varian and Elekta linac plans than for Gamma Knife and Cyberknife, and larger differences for smaller targets, both inter- and intra-treatment-platform. Doses to normal brain and brainstem were highest when margins were applied, but improvements were possible by re-planning alone.ConclusionsMulti-centre benchmarking exercises have highlighted some variation in clinical practice and priorities, with a few outliers. Most platforms are able to achieve comparable plans, except for the smallest volumes and when larger planning margins are used. The data will be used to progress standardisation and quality improvement of national services, and can provide useful guidance for centres worldwide.



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Regarding: “Towards consensus reporting of radiation-induced liver toxicity in the treatment of primary liver malignancies: defining clinically relevant endpoints”

Publication date: Available online 29 December 2017
Source:Practical Radiation Oncology
Author(s): Naoko Sanuki




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Optimal imaging surveillance after stereotactic ablative radiation therapy for early-stage non-small cell lung cancer: Findings of an International Delphi Consensus Study

Publication date: Available online 30 December 2017
Source:Practical Radiation Oncology
Author(s): Timothy K. Nguyen, Suresh Senan, Jeffery D. Bradley, Kevin Franks, Meredith Giuliani, Matthias Guckenberger, Mark Landis, Billy W. Loo, Alexander V. Louie, Hiroshi Onishi, Heidi Schmidt, Robert Timmerman, Gregory M.M. Videtic, David A. Palma
PurposeImaging after stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer can detect recurrences and second primary lung cancers; however, the optimal follow-up practice of these patients remains unclear. We sought to establish consensus recommendations for surveillance after SABR.Methods and materialsInternational opinion leaders in thoracic radiation oncology and radiology were invited to participate (n = 31), with 11 accepting (9 radiation oncologists, 2 radiologists). Consensus-building was achieved using a 3-round Delphi process. Participants rated their agreement/disagreement with statements using a 5-point Likert scale. An a priori threshold of ≥75% agreement/disagreement was required for consensus.ResultsA 100% response rate was achieved and final consensus statements were approved by all participants. The consensus statements were: (1.1) thoracic computed tomography (CT) scans should be ordered routinely in follow-up; (1.2) if there is a suspicion for local recurrence (LR), fludeoxyglucose positron emission tomography/CT scans are strongly recommended. Otherwise, there is limited evidence to guide routine use of fludeoxyglucose positron emission tomography /CT; (1.3) CT imaging is not recommended at 6 weeks, but is recommended at months 3, 6, and 12 in year 1 and then every 6 months in year 2 and annually in years 3 through 5; (1.4) after 5 years, CT imaging should continue, although no consensus was reached regarding the frequency. (2.1) Response Evaluation Criteria in Solid Tumors 1.1 criteria are not sufficient for detecting LR; (2.2) a formal scoring system, informed by validated data, should be used to classify high-risk imaging features predictive of LR; (2.3) CT findings suspicious for LR include: infiltration into adjacent structures, bulging margins, sustained growth, mass-like growth, spherical growth, craniocaudal growth, and loss of air bronchograms. (3) Salvage therapy without pathologic confirmation of recurrence is acceptable if imaging findings are highly suspicious and a biopsy is not safe/feasible or if an attempted biopsy was nondiagnostic.ConclusionsThese guidelines provide international expert consensus on areas of uncertainty in the management of early-stage non-small cell lung cancer patients after SABR.



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Effect of different doses and durations of teriparatide therapy on resolution of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

Publication date: Available online 30 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mohammad Zandi, Arash Dehghan, Najmeh Zandipoor, Payam Amini, Shideh Doulati
ObjectiveTo evaluate the effects of different doses and durations of teriparatide therapy on MRONJ resolution in rats.Subjectsand methods: A total of 120 rats that had been affected with MRONJ (after six weekly zoledronate injections and tooth extraction) were randomly divided into eight subgroups: 2, 10, and 20 μg/kg/day teriparatide were administered to L4, M4, and H4 for 4 weeks, and to L8, M8, and H8 for 8 weeks, respectively. C4 and C8 received saline for 4 and 8 weeks, respectively. One week after the final injection, rats were sacrificed and assessed clinically (bone exposure/fistula) and histologically (number of osteocytes in extraction socket and empty lacunae in alveolar bone).ResultsMRONJ was clinically improved in 72.2%, 61.5%, and 40% of stage I, II, and III experimental rats, respectively. In the control rats, the results were 20.8% for stage I and no improvement for stages II and III. Aside from L4 and L8, the experimental subgroups had a significantly higher rate of clinical and histological improvement compared with their corresponding controls. There was a significantly higher number of osteocytes and lower number of empty lacunae in M4 and H4 compared with C4, in H4 compared with L4, in M8 and H8 compared with C8, and in H8 compared with L8.ConclusionTeriparatide therapy improved clinical and histological features of MRONJ in a dose-dependent manner, but clinically relevant doses of teriparatide might not be sufficient for MRONJ resolution in rats. Extending the duration of teriparatide therapy from 4 to 8 weeks did not affect treatment outcomes.



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"Asian Pac J Cancer Prev"[jour]; +34 new citations

34 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

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Effect of Telemedicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence. The Tele-OSA Randomized Trial

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 1, Page 117-126, January 1, 2018.


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The Impact of the ASAP Trial: Maybe We Shouldn’t Act So Quickly

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 1, Page 142-143, January 1, 2018.


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We Have to Learn to Do without Knowing Enough: Antieosinophilic Treatments for Severe Asthma

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 1, Page 1-2, January 1, 2018.


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Mesenchymal Stromal Cell Exosomes Ameliorate Experimental Bronchopulmonary Dysplasia and Restore Lung Function through Macrophage Immunomodulation

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 1, Page 104-116, January 1, 2018.


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Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study

Abstract

Purpose

Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions.

Methods

We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured.

Results

In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm.

Conclusion

Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.

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Osteotomies in ankylosing spondylitis: where, how many, and how much?

Abstract

Introduction

This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine.

Methods

This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed.

Results

Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented.

Conclusion

The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.

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Fetal sigmoid colon mesentery − in relevance in fetal ultrasound application. A pilot study

Publication date: Available online 29 December 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Slawomir Wozniak, Jerzy Florjanski, Henryk Kordecki, Marzena Podhorska-Okolow, Zygmunt Domagala
IntroductionUltrasound examinations during pregnancy are routine procedures used to detect fetal congenital malformations. Ultrasound monitoring of sigmoid colon mesenterial development could be useful for early detection of subjects at risk of sigmoid colon volvulus.ObjectiveThe aim of our paper was to assess the sigmoid colon length, and sigmoid colon mesentery width and height in the late fetal period, and, using the results, to estimate the surface area of the mesocolon (in mm²) in living fetuses. Moreover, we attempted to repeat some of these measurements in living fetuses using ultrasound imaging.MethodsThe study was carried out on 209 formalin fixed human fetuses (100 female and 109 male) aged from 4th to 7th gestational months (102–203 days), with a crown-rump length of 132–342mm. The length of the sigmoid colon, as well as the height and width of its mesentery were measured. The surface area of the mesocolon was estimated. Correction for formalin induced shrinkage was applied. Pilot ultrasound examinations of live fetuses were performed.ResultsMean values of sigmoid colon length, mesenteric width and height (formalin fixed fetuses) for respective gestational ages were: month 4: 21.46±6.7mm, 6.80±2.1mm, 5.5±1.49mm; month 5: 27.32±1.2mm, 7.62±2.01mm, 7.33±2.17mm; month 6: 47.56±9.57mm, 11.68±3.8mm, 10.3±3.05mm; month 7: 56.92±17.48mm. 15.32±8 mm, 12.81±3.16mm. The surface area ranges of the sigmoid colon mesentery found for respective gestational months (intrauterine fetuses) were as follows: month 4: 33.24 − 51.95mm²; month 5: 49.63 − 77.6mm²; month 6: 106.89 − 167.15mm² and month 7: 145.69 − 272.53mm².ConclusionThe surface area of the sigmoid colon mesentery can be used as a simple parameter applied in fetal ultrasonographic evaluation. The development of the sigmoid colon accelerates in the 6th gestational month, and decelerates in the 7th gestational month. The sigmoid colon mesentery width was larger than its height between the 4th and 7th gestational months.



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Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study

Abstract

Purpose

Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions.

Methods

We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured.

Results

In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm.

Conclusion

Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.

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Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation.

Related Articles

Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation.

Otol Neurotol. 2017 Dec 28;:

Authors: Yang S, Zhu H, Zhu B, Wang H, Chen Z, Wu Y, Chen B, Shi H, Li Y, Zou J, Yin S

Abstract
OBJECTIVE: This study was performed to reevaluate the diagnostic significance of clinically well-accepted audiological tests in indicating endolymphatic hydrops (EH) in Menière's disease (MD).
STUDY DESIGN: Retrospective case review.
SETTINGS: Hospital.
PATIENTS: Fifty patients (52 affected ears) diagnosed with MD were enrolled.
INTERVENTION: Diagnostic.
MAIN OUTCOME MEASURE: To analyze the correlations between endolymphatic hydrops and results of audiological test including the pure-tone audiometry threshold, suprathreshold function tests, electrocochleogram, and glycerol test.
RESULTS: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging demonstrated EH in either the vestibule or cochlea to various degrees in all of the MD patients, 24 hours after intratympanic gadolinium chelate injection. Both vestibular and cochlear EH were significantly correlated with PTA threshold. However, EH was not associated with alternate binaural loudness balance or the tone decay test, although a correlation was observed with the short-increment sensitivity index. There was also a correlation between vestibular EH, but not cochlear EH, and the negative summating potential/action potential (-SP/AP) ratio. Neither vestibular EH nor cochlear EH was correlated with the glycerol test results. In addition, the frequency of vertigo attacks, the existence of tinnitus, and aural fullness did not correlate with EH.
CONCLUSIONS: Disrupted ionic homeostasis in the inner ear, but not the EH, may contribute to changes in the -SP/AP ratio. The relevance of glycerol test in identifying EH through detection of hearing changes needs further investigation in the future.

PMID: 29287037 [PubMed - as supplied by publisher]

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Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation.

Related Articles

Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation.

Otol Neurotol. 2017 Dec 28;:

Authors: Yang S, Zhu H, Zhu B, Wang H, Chen Z, Wu Y, Chen B, Shi H, Li Y, Zou J, Yin S

Abstract
OBJECTIVE: This study was performed to reevaluate the diagnostic significance of clinically well-accepted audiological tests in indicating endolymphatic hydrops (EH) in Menière's disease (MD).
STUDY DESIGN: Retrospective case review.
SETTINGS: Hospital.
PATIENTS: Fifty patients (52 affected ears) diagnosed with MD were enrolled.
INTERVENTION: Diagnostic.
MAIN OUTCOME MEASURE: To analyze the correlations between endolymphatic hydrops and results of audiological test including the pure-tone audiometry threshold, suprathreshold function tests, electrocochleogram, and glycerol test.
RESULTS: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging demonstrated EH in either the vestibule or cochlea to various degrees in all of the MD patients, 24 hours after intratympanic gadolinium chelate injection. Both vestibular and cochlear EH were significantly correlated with PTA threshold. However, EH was not associated with alternate binaural loudness balance or the tone decay test, although a correlation was observed with the short-increment sensitivity index. There was also a correlation between vestibular EH, but not cochlear EH, and the negative summating potential/action potential (-SP/AP) ratio. Neither vestibular EH nor cochlear EH was correlated with the glycerol test results. In addition, the frequency of vertigo attacks, the existence of tinnitus, and aural fullness did not correlate with EH.
CONCLUSIONS: Disrupted ionic homeostasis in the inner ear, but not the EH, may contribute to changes in the -SP/AP ratio. The relevance of glycerol test in identifying EH through detection of hearing changes needs further investigation in the future.

PMID: 29287037 [PubMed - as supplied by publisher]

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The Effects of Quinine on Neurophysiological Properties of Dopaminergic Neurons.

Related Articles

The Effects of Quinine on Neurophysiological Properties of Dopaminergic Neurons.

Neurotox Res. 2017 Dec 29;:

Authors: Zou L, Xue Y, Jones M, Heinbockel T, Ying M, Zhan X

Abstract
Quinine is an antimalarial drug that is toxic to the auditory system by commonly inducing hearing loss and tinnitus, presumably due to its ototoxic effects on disruption of cochlear hair cells and blockade of ion channels of neurons in the auditory system. To a lesser extent, quinine also causes ataxia, tremor, and dystonic reactions. As dopaminergic neurons are implicated to play a role in all of these diseases, we tested the toxicity of quinine on induced dopaminergic (iDA) neurons derived from human pluripotent stem cells (iPSCs) and primary dopaminergic (DA) neurons of substantia nigra from mice brain slices. Patch clamp recordings and combined drug treatments were performed to examine key physiological properties of the DA neurons. We found that quinine (12.5-200 μM) depolarized the resting membrane potential and attenuated the amplitudes of rebound spikes induced by hyperpolarization. Action potentials were also broadened in spontaneously spiking neurons. In addition to quinine attenuating hyperpolarization-dependent conductance, the tail currents following withdrawal of hyperpolarizing currents were also attenuated. Taken together, we found that iPSC-derived DA neurons recapitulated all the tested physiological properties of human DA neurons, and quinine had distinct effects on the physiology of both iDA and primary DA neurons. This toxicity of quinine may be the underlying mechanism for the movement disorders of cinchonism or quinism and may play a role in tinnitus modulation.

PMID: 29285614 [PubMed - as supplied by publisher]

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Hemi-laryngeal Setup for Studying Vocal Fold Vibration in Three Dimensions.

Hemi-laryngeal Setup for Studying Vocal Fold Vibration in Three Dimensions.

J Vis Exp. 2017 Nov 25;(129):

Authors: Herbst CT, Hampala V, Garcia M, Hofer R, Svec JG

Abstract
The voice of humans and most non-human mammals is generated in the larynx through self-sustaining oscillation of the vocal folds. Direct visual documentation of vocal fold vibration is challenging, particularly in non-human mammals. As an alternative, excised larynx experiments provide the opportunity to investigate vocal fold vibration under controlled physiological and physical conditions. However, the use of a full larynx merely provides a top view of the vocal folds, excluding crucial portions of the oscillating structures from observation during their interaction with aerodynamic forces. This limitation can be overcome by utilizing a hemi-larynx setup where one half of the larynx is mid-sagittally removed, providing both a superior and a lateral view of the remaining vocal fold during self-sustained oscillation. Here, a step-by-step guide for the anatomical preparation of hemi-laryngeal structures and their mounting on the laboratory bench is given. Exemplary phonation of the hemi-larynx preparation is documented with high-speed video data captured by two synchronized cameras (superior and lateral views), showing three-dimensional vocal fold motion and corresponding time-varying contact area. The documentation of the hemi-larynx setup in this publication will facilitate application and reliable repeatability in experimental research, providing voice scientists with the potential to better understand the biomechanics of voice production.

PMID: 29286438 [PubMed - in process]

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A Retrospective Analysis on Anesthetic Management during Rigid Bronchoscopy in Children with Foreign Body Aspiration: Propofol and Sevoflurane with Controlled Ventilation.

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A Retrospective Analysis on Anesthetic Management during Rigid Bronchoscopy in Children with Foreign Body Aspiration: Propofol and Sevoflurane with Controlled Ventilation.

Anesth Essays Res. 2017 Oct-Dec;11(4):871-874

Authors: Annigeri RV, Patil RS

Abstract
Background: Bronchoscopic removal of foreign body in the airway is one of the important life-saving procedure and demands skill and expertise on the part of the surgeon and anesthesiologist.
Aim: To study the outcome of controlled ventilation during rigid bronchoscopy in children with foreign body aspiration.
Materials and Methods: A review of fifty cases of foreign body in the bronchi, from January 2014 to December 2015 was undertaken in Vittal Institute of Child Care Hospital, Dharwad, through patient case records. Patients between 6 months and 14 years were included in the study. Cases of foreign body in the larynx and trachea were excluded. Patients were induced with propofol and maintained on sevoflurane. The parameters observed were bronchoscopy attempts, succinylcholine requirement, episodes of laryngospasm, cough, bronchospasm and spontaneous recovery. Statistical analysis was done by Chi-square test using software OpenEpi version 7.3.
Results: Of 45 patients with organic foreign body, 42 (94%) patients required one attempt of bronchoscopy and 3 (6%) patients required two attempts. Five (100%) patients with inorganic foreign body required single attempt (P = 0.66). Forty-three (96%) patients with organic foreign body required two repeat doses of succinylcholine and 2 (4%) patients required three repeat doses. All 5 (100%) patients with inorganic foreign body required two repeat doses (P = 0.7461). Two (4%) patients aspirated with organic foreign body had laryngospasm, and there was no cough or bronchospasm with either patient. Two (4%) patients with organic foreign body required tracheostomy. Inorganic foreign body group of patients had lesser complications.
Conclusion: In our study, patients on controlled ventilation had few intraoperative complication and smooth early recovery. Controlled ventilation with relaxation should be preferred for any pediatric bronchoscopies. Eliciting history of type of foreign body helps in planning and management of procedure.

PMID: 29284841 [PubMed]

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Morphological Characteristics of the Oropharyngeal Cavity (Tongue, Palate and Laryngeal Entrance) in the Eurasian Coot (Fulica atra, Linnaeus, 1758).

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Morphological Characteristics of the Oropharyngeal Cavity (Tongue, Palate and Laryngeal Entrance) in the Eurasian Coot (Fulica atra, Linnaeus, 1758).

Anat Histol Embryol. 2017 Aug;46(4):347-358

Authors: Abumandour MMA, El-Bakary NER

Abstract
The present study represents the first definitive anatomical description of the oropharyngeal cavity of the coot Fulica atra. For this purpose, the organs of six birds were prepared to examine grossly and by SEM and stereomicroscope. The oval lingual apex had multiple overlapping branched acicular processes on its anterior and lateral border. The lingual apex and body had multiple caudally directed filiform-like papillae. By stereomicroscopy, the lingual root had a characteristic appearance and consisted of four parts. The openings of the anterior glands were present on the dorsal lingual surface of the body, while the projected papillae with wide openings of the posterior glands were present on the dorsal surface of lingual root. There was a row of caudally directed pharyngeal papillae at the caudal border of the laryngeal mound. Grossly, the pharyngeal papillae arrangement took a W-shape, while by stereomicroscopy was observed to be heart shape. The palate was divided into two regions: a small rostral non-papillary and a large caudal papillary region, but the rostral region was characterized by the presence of three longitudinal ridges. The papillary crest had two paramedian longitudinal papillary rows, which continued caudally until the beginning of the third median row. The freely distributed papillae took a caudolateral direction, while the papillae encircling the rostral part of choanal cleft took a caudomedial direction. There was a transverse papillary row between the two parts of choanal cleft. There was a transverse papillary row between the caudal border of the infundibular cleft and oesophagus.

PMID: 28543621 [PubMed - indexed for MEDLINE]

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A fast and flexible MRI system for the study of dynamic vocal tract shaping.

Related Articles

A fast and flexible MRI system for the study of dynamic vocal tract shaping.

Magn Reson Med. 2017 Jan;77(1):112-125

Authors: Lingala SG, Zhu Y, Kim YC, Toutios A, Narayanan S, Nayak KS

Abstract
PURPOSE: The aim of this work was to develop and evaluate an MRI-based system for study of dynamic vocal tract shaping during speech production, which provides high spatial and temporal resolution.
METHODS: The proposed system utilizes (a) custom eight-channel upper airway coils that have high sensitivity to upper airway regions of interest, (b) two-dimensional golden angle spiral gradient echo acquisition, (c) on-the-fly view-sharing reconstruction, and (d) off-line temporal finite difference constrained reconstruction. The system also provides simultaneous noise-cancelled and temporally aligned audio. The system is evaluated in 3 healthy volunteers, and 1 tongue cancer patient, with a broad range of speech tasks.
RESULTS: We report spatiotemporal resolutions of 2.4 × 2.4 mm2 every 12 ms for single-slice imaging, and 2.4 × 2.4 mm2 every 36 ms for three-slice imaging, which reflects roughly 7-fold acceleration over Nyquist sampling. This system demonstrates improved temporal fidelity in capturing rapid vocal tract shaping for tasks, such as producing consonant clusters in speech, and beat-boxing sounds. Novel acoustic-articulatory analysis was also demonstrated.
CONCLUSION: A synergistic combination of custom coils, spiral acquisitions, and constrained reconstruction enables visualization of rapid speech with high spatiotemporal resolution in multiple planes. Magn Reson Med 77:112-125, 2017. © 2016 Wiley Periodicals, Inc.

PMID: 26778178 [PubMed - indexed for MEDLINE]

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Optimising care in an age of austerity: patient-reported outcome measures in paediatric ENT, journal bias, tonsillectomy and endoscopic ear surgery.

Optimising care in an age of austerity: patient-reported outcome measures in paediatric ENT, journal bias, tonsillectomy and endoscopic ear surgery.

J Laryngol Otol. 2018 Jan;132(1):1

Authors: Fisher E, Youngs R, Hussain M, Fishman J

PMID: 29286000 [PubMed - in process]

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Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients.

Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients.

Otol Neurotol. 2017 Dec 28;:

Authors: Brodsky JR, Lipson S, Wilber J, Zhou G

Abstract
OBJECTIVE: This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary care center.
PATIENTS: One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV.
MAIN OUTCOME MEASURES: Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence.
RESULTS: BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ± 3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ± 190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either.
CONCLUSIONS: BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.

PMID: 29287036 [PubMed - as supplied by publisher]

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

Publication date: Available online 29 December 2017
Source:American Journal of Otolaryngology
Author(s): W.X. Yeo, S.H. Xu, T.Y. Tan, Y.M. Low, H.W. Yuen
IntroductionJugular 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.ObjectivesTo report two cases of pulsatile tinnitus with jugular bulb and/or sigmoid sinus diverticulum, and their management strategies and outcomes. In this series, we describe the first reported successful case of pulsatile tinnitus due to jugular bulb diverticulum that was surgically-treated.Subjects and methodsTwo patients diagnosed with either jugular bulb and/or sigmoid sinus diverticulum, who had presented to the Otolaryngology clinic with pulsatile tinnitus between 2016 and 2017, were studied. Demographic and clinical data were obtained, including their management details and clinical outcomes.ResultsTwo cases (one with jugular bulb diverticulum and one with both sigmoid sinus and jugular bulb diverticula) underwent surgical intervention, and both had immediate resolution of pulsatile tinnitus post-operatively. This was sustained at subsequent follow-up visits at the outpatient clinic, and there were no major complications encountered for both cases intra- and post-operatively.ConclusionTransmastoid reconstruction/resurfacing of jugular bulb and sigmoid sinus diverticulum with/without obliteration of the diverticulum is a safe and effective approach in the management of bothersome pulsatile tinnitus arising from these causes.



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IJRB: looking toward the future

Volume 94, Issue 1, January 2018, Page 1-1
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Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study.

Related Articles

Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study.

Eur Arch Otorhinolaryngol. 2017 Dec 29;:

Authors: Satmis MC, van der Torn M

Abstract
OBJECTIVES: The aim of this study is to assess the subjective and objective short-term results and safety of transnasal balloon dilatation of the Eustachian tube (BET) in adult patients with chronic dilatory Eustachian tube dysfunction (ETD).
DESIGN: Retrospective cohort study. Data collection was performed preoperatively, 1 and 3 months after BET.
SETTING: Tertiary referral hospital.
PARTICIPANTS: A cohort of 42 consecutive patients (66 ears).
MAIN OUTCOME MEASURES: ETDQ-7 score, bone conduction threshold, air-bone gap, the ability to perform Valsalva's and/or Toynbee's manoeuvre, tympanic membrane and middle ear conditions were collected pre- and postoperatively. Subjective satisfaction and complications were collected postoperatively.
RESULTS: The ETDQ-7 score improved significantly from 4.28 to 3.09 1 month postoperatively and from 4.10 to 2.96 3 months postoperatively. Bone conduction thresholds did not differ significantly postoperatively. A significant improvement of air-bone gap was found postoperatively. The tympanic membrane and middle ear condition showed improvement in 62%. Subjective satisfaction 1 and 3 months postoperatively was around 43 and 48%. A small number of minor (self-limiting) complications did occur.
CONCLUSIONS: BET has shown to be a safe intervention, which may have a positive effect on objective and subjective indicators for chronic dilatory ETD in adult patients. We observed subjective positive effects in less than half of the patients. For certain indications, there was a measurable positive effect on the findings of the eardrum and ETDQ-7, whereas in other patients it seemed not to have any effect at all. Careful patient selection may improve this success rate. Randomized controlled trials with a prolonged follow-up are required to assess the value of BET in comparison to grommets.

PMID: 29285624 [PubMed - as supplied by publisher]

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Impact of alcohol dehydrogenase-aldehyde dehydrogenase polymorphism on clinical outcome in patients with hypopharyngeal cancer.

Impact of alcohol dehydrogenase-aldehyde dehydrogenase polymorphism on clinical outcome in patients with hypopharyngeal cancer.

Head Neck. 2017 Dec 29;:

Authors: Avinçsal MO, Shinomiya H, Teshima M, Kubo M, Otsuki N, Kyota N, Sasaki R, Zen Y, Nibu KI

Abstract
BACKGROUND: The purpose of this research was to investigate the association between alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2) polymorphisms and hypopharyngeal squamous cell carcinoma (SCC) survival.
METHODS: We genotyped ADH1B (rs1229984) and ALDH2 (rs671) single nucleotide polymorphisms (SNPs) in 85 Japanese male patients with hypopharyngeal SCC. The independent prognostic values of ADH1B-ALDH2 genotypes were analyzed by univariate and multivariate proportional hazard Cox regression, taking well-known clinical risk factors into account.
RESULTS: Heavy drinkers with ALDH2*2 allele resulted in significantly worse overall survival (OS; P = .028) and disease-free survival (DFS; P = .029) compared with other patients. Heavy drinkers with ALDH2*2 allele remained statistically significant in multivariate analysis for OS and DFS, indicating independent poor prognostic factor (hazard ratio [HR] 2.251; 95% confidence interval [CI] 1.018-4.975 and HR 2.261; 95% CI 1.021-5.006, respectively).
CONCLUSION: We conclude that heavy drinkers with the ALDH2*2 allele are associated with poor outcome in hypopharyngeal SCC.

PMID: 29286190 [PubMed - as supplied by publisher]

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In vitro biofilm growth on modern voice prostheses.

In vitro biofilm growth on modern voice prostheses.

Head Neck. 2017 Dec 29;:

Authors: Leonhard M, Zatorska B, Tan Y, Moser D, Schneider-Stickler B

Abstract
BACKGROUND: Biofilm formation on voice prostheses in laryngectomized patients usually limits the lifetime of the device. The purpose of this study was to compare the biofilm resistance of different valve flaps of modern voice prostheses in an in vitro simulation of an oropharyngeal biofilm.
METHODS: Growth of biofilm deposits on valve flaps (n = 12) removed from Provox 2, Provox Vega, Provox ActiValve, Blom Singer Advantage, and Phonax voice prostheses was evaluated and compared to medical-grade silicone (n = 12) in an in vitro biofilm model (22 days) after incubation with a multispecies bacterial-fungal biofilm composition.
RESULTS: The Provox ActiValve and the Blom Singer Advantage prostheses showed significantly less surface biofilm formation than the other prostheses and then silicone.
CONCLUSION: The use of silver oxide and Teflon as valve flap materials proves to reduce long-term biofilm formation in vitro. The applied model allows rapid screening for novel biofilm-inhibitive materials and durable coatings designated for more biofilm resistant medical devices.

PMID: 29286184 [PubMed - as supplied by publisher]

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Leiomyosarcoma of the head and neck: A 17-year single institution experience and review of the National Cancer Data Base.

Leiomyosarcoma of the head and neck: A 17-year single institution experience and review of the National Cancer Data Base.

Head Neck. 2017 Dec 29;:

Authors: Workman AD, Farquhar DR, Brody RM, Parasher AK, Carey RM, Purkey MT, Nagda DA, Brooks JS, Hartner LP, Brant JA, Newman JG

Abstract
BACKGROUND: Leiomyosarcoma is a rare neoplasm of the head and neck. The purpose of this study was to present our single-institution case series of head and neck leiomyosarcoma and a review of cases in the National Cancer Data Base (NCDB).
METHODS: Patients with head and neck leiomyosarcoma at the University of Pennsylvania and in the NCDB were identified. Demographic characteristics, tumor factors, treatment paradigms, and outcomes were evaluated for prognostic significance.
RESULTS: Nine patients with head and neck leiomyosarcoma from the institution were identified; a majority had high-grade disease and cutaneous leiomyosarcoma, with a 5-year survival rate of 50%. Two hundred fifty-nine patients with leiomyosarcoma were found in the NCDB; macroscopic positive margins and high-grade disease were associated with poor prognosis (P < .01), and positive surgical margins were related to adjuvant radiation (P < .001).
CONCLUSION: Head and neck leiomyosarcoma presents at a high grade and is preferentially treated with surgery. Several demographic and tumor-specific factors are associated with outcomes and prognosis.

PMID: 29286183 [PubMed - as supplied by publisher]

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Computer-aided system for diagnosing thyroid nodules on ultrasound: A comparison with radiologist-based clinical assessments.

Computer-aided system for diagnosing thyroid nodules on ultrasound: A comparison with radiologist-based clinical assessments.

Head Neck. 2017 Dec 29;:

Authors: Gao L, Liu R, Jiang Y, Song W, Wang Y, Liu J, Wang J, Wu D, Li S, Hao A, Zhang B

Abstract
BACKGROUND: The purpose of this study was to compare the diagnostic efficiency of a thyroid ultrasound computer-aided diagnosis (CAD) system with that of 1 radiologist.
METHODS: This study retrospectively reviewed 342 surgically resected thyroid nodules from July 2013 to December 2013 at our center. The nodules were assessed on typical ultrasound images using the CAD system and reviewed by 1 experienced radiologist. The radiologist stratified the risk of malignancy using the Thyroid Imaging Reporting and Data Systems (TIRADS) and the American Thyroid Association (ATA) guidelines.
RESULTS: The radiologist, using TI-RADS and ATA guidelines, performed better than the CAD system (P < .01). The sensitivity of the CAD system was similar to that of an experienced radiologist (P > .05; P < .01; and P > .05). However, we found that the CAD system had lower specificity (P < .01).
CONCLUSION: The sensitivity of a thyroid ultrasound CAD system in differentiating nodules was similar to that of an experienced radiologist. However, the CAD system had lower specificity.

PMID: 29286180 [PubMed - as supplied by publisher]

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Endoscopic Repairs of Sinonasal Cerebrospinal Leaks: Outcome and Prognostic Factors.

Endoscopic Repairs of Sinonasal Cerebrospinal Leaks: Outcome and Prognostic Factors.

J Craniofac Surg. 2018 Jan;29(1):182-187

Authors: Song X, Wang D, Sun X, Liu Q, Hu L, Gu Y, Zhang H

Abstract
OBJECTIVE: The aim of this study was to review the management of sinonasal cerebrospinal fluid (CSF) leaks and outcome of endoscopic repairs and to provide experience regarding leaks at the lateral wall of sphenoid sinus and the posterior wall of frontal sinus.
METHODS: Patients who underwent endoscopic repairs of CSF leaks were reviewed. Characteristics of different etiologies were compared, and prognostic factors were analyzed.
RESULTS: The study included 144 patients with 150 CSF leaks, in which spontaneous leaks account for 55%. Patients with traumatic leaks were significantly younger than those with spontaneous leaks (P = 0.012), and most traumatic leaks occurred in men (P < 0.001). The computed tomography scan showed an overall accuracy of 86.7%. For 17 leaks at the lateral wall of sphenoid sinus, transnasal (29%), transethmoid (24%), and transpterygoid (47%) approaches were used, with a success rate of 75%. For 11 defects at the posterior wall of the frontal sinus, 2 were managed by draf III surgery, and 3 by trephination-assisted procedure successfully. Success rate for primary repair was 95.6%, reaching 100% after a second repairing. Six leaks failed to be repaired included 4 spontaneous leaks, and 3 occurred at the lateral wall of the sphenoid sinus, 4 occurred in patients with elevated body mass index (BMI), 4 had evidence of raised intracranial pressure (ICP).
CONCLUSION: Repair of leaks at lateral sphenoid sinus and posterior frontal sinus could achieve favorable results via selected endoscopic approaches. The failure of repair was associated with inaccessible leak sites, spontaneous leaks, raised ICP, and elevated BMI.

PMID: 29286998 [PubMed - in process]

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Minimally invasive repair of a pseudomeningocele caused by a sheared intrathecal catheter following implantation of a drug delivery system.

Related Articles

Minimally invasive repair of a pseudomeningocele caused by a sheared intrathecal catheter following implantation of a drug delivery system.

Surg Neurol Int. 2017;8:297

Authors: Raju S, Champagne PO, Walsh L, Denis DJ

Abstract
Background: Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage.
Case Description: A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome. A minimally invasive approach through a tubular retractor was employed to access the spinal canal via a laminotomy, the sheared catheter was removed and the dural defect repaired. Complete resolution of the pseudomeningocele and efficient pain control were observed at follow-up.
Conclusion: Minimally invasive approach to the spine is demonstrated as a safe and effective alternative in this case of retained catheter induced cerebrospinal fluid (CSF) leak.

PMID: 29285413 [PubMed]

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Intensified blood glucose treatment in diabetic patients undergoing a liver transplant: impact on graft evolution at 3 months and at 5 years

Abstract

Purpose

The debate about the impact of intensified hyperglycemia treatment is still ranging. The main objective was to assess whether intensive glycemic control in hospitalized diabetic patients undergoing a liver transplant is associated with a lower rate of graft rejection at 3 months and at 5 years post-transplant.

Methods

Cross-sectional study comparing a cohort of patients undergoing liver transplant in 2010 and 2011, in whom an intensive insulin protocol was applied, with a retrospective group of patients undergoing a liver transplant in 2005 and 2006, in whom a conventional insulin protocol was applied. Both diabetics and non-diabetics were compared. As intensive insulin therapy is applied mainly in diabetic patients, it is expected that, when comparing both periods, the treatment would only benefit those patients.

Results

The logistic regression model showed a statistically significant interaction between the treatment group and the presence of diabetes for the rejection rate 3 months and 5 years post-transplant. At both time points, the intensive insulin treatment group had lower rejection rates in the case of diabetic patients, which did not occur in non-diabetic patients.

Conclusions

Our study shows a decrease in the rate of liver graft rejection in diabetic patients undergoing intensive insulin treatment.

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Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report.

Related Articles

Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report.

Acta Neurochir (Wien). 2017 Dec 28;:

Authors: Inoue T, Nonaka Y, Hirai H, Shima A, Suzuki F, Matsuda M, Fukushima T

Abstract
Extensive large dumbbell-shaped hypoglossal schwannoma is extremely rare, and total resection is nearly impossible. We present a case of a 61-year-old male with a giant-size hypoglossal schwannoma with moderate tongue atrophy. The tumor extended from the enlarged hypoglossal canal to the brainstem intradurally and the high cervical region extradurally. Through the extreme lateral infrajugular transcondylar (ELITE) skull base approach, the tumor was totally removed in a single-stage operation. Single-stage total resection is feasible by an experienced skull base team utilizing transcondylar skull base techniques and high cervical dissection.

PMID: 29285680 [PubMed - as supplied by publisher]

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Prepontine arachnoid cyst presenting with headache and diplopia: A case report study.

Related Articles

Prepontine arachnoid cyst presenting with headache and diplopia: A case report study.

Surg Neurol Int. 2017;8:289

Authors: Rezaee O, Ebrahimzadeh K, Maloumeh EN, Jafari A, Shafizad M, Hallajnejad M

Abstract
Background: Arachnoid cysts are found everywhere in cerebrospinal axis, most often in the middle cranial fossa. They are very rare in prepontine location.
Case Description: In this study, we report a 26-year-old female presenting with a 3-month history of headache and diplopia. On physical examination, she had clinical manifestations of sixth cranial nerve palsy. Magnetic resonance imaging revealed a prepontine arachnoid cyst with extension into interpeduncular and suprasellar cisterns. Computed tomography scan demonstrated no evidence of hydrocephalus. The patient was treated surgically by endoscopic fenestration of the cyst with endonasal transsphenoidal approach. The cyst was opened to prepontine, interpeduncular, and suprasellar cisterns.
Conclusion: Endoscopic endonasal fenestration of the cyst to adjacent cistern may be safe in prepontine arachnoid cysts with sellar and suprasellar extension; it may be effective and less invasive compare to transcranial approach.

PMID: 29285405 [PubMed]

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Subtemporal Approach for Gross Total Resection of Retrochiasmatic Craniopharyngiomas: Our Experience on 30 Cases.

Related Articles

Subtemporal Approach for Gross Total Resection of Retrochiasmatic Craniopharyngiomas: Our Experience on 30 Cases.

World Neurosurg. 2018 Jan;109:e265-e273

Authors: Zieliński G, Sajjad EA, Robak Ł, Koziarski A

Abstract
BACKGROUND: Surgical treatment of retrochiasmatic craniopharyngiomas is associated with higher rates of complications, mortality, failure of complete removal, and recurrence compared with craniopharyngiomas located elsewhere. These tumors lie behind the optic chiasm and when large can extend upward into the third ventricle and downward along the brain stem, making their adequate exposure challenging. Most of the proposed techniques either use a translamina terminalis route or require wide bony exposures. In this study, we assessed the feasibility of a subtemporal approach for achieving gross total resection of retrochiasmatic craniopharyngiomas.
METHODS: Thirty patients with retrochiasmatic craniopharyngioma underwent surgery via a subtemporal approach. The technique and surgical and preoperative and postoperative endocrinologic outcomes are described in detail.
RESULTS: Gross total resection was achieved in all cases. The average tumor volume was 7.59 mL. The average postsurgical observation time was 73.8 months. During this time, 3 recurrences were observed (10.7%). The perioperative mortality was 6.6%. The pituitary stalk was preserved in 13 cases. Partial preservation of the pituitary stalk did not offer any advantage in terms of pituitary function. No postoperative vision worsening or new fixed neurologic deficits were observed. Among the 22 patients with preoperative vision impairment, 18 reported a significant improvement. The most common abnormalities within the temporal lobe on the side of the exposure seen on control magnetic resonance imaging were mild temporal horn enlargement (13 cases) and T2 hyperintensity (7 cases).
CONCLUSIONS: A subtemporal approach can be an attractive alternative approach to accessing retrochiasmatic craniopharyngiomas. Outcomes are comparable to those associated with other widely used and time-consuming exposures.

PMID: 28987834 [PubMed - indexed for MEDLINE]

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Olfaction, Philosophy and the Missing Object

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Incidence, risk and prognostic role of anti-epidermal growth factor receptor-induced skin rash in biliary cancer: a meta-analysis

Abstract

Background

Anti-epidermal growth factor receptor (EGFR)-induced skin rash is a common adverse event and is considered a prognostic factor of various cancers. However, the role of rash is rarely known in biliary cancer, possibly owing to the low incidence of this frequently fatal malignancy. We thus performed a meta-analysis to investigate the incidence, risk and prognostic significance of skin rash related to anti-EGFR treatment for biliary cancer.

Methods

Eligible studies were enrolled after a systematic search of electronic databases. A fixed-effects or random-effects model was utilized according to the heterogeneity.

Results

Fourteen clinical trials published between 2006 and 2017 comprising 1,106 patients with advanced biliary cancer were included. The overall incidence of all-grade and high-grade (grade ≥3) rash was 78.2% [95% confidence interval (CI) 70.4–84.3] and 11.3% (7.6–16.5), respectively. Anti-EGFR treatment correlates with a significantly increased risk of all-grade [risk ratio (RR) 7.37, 95% CI 5.11–10.64, p < 0.0001] and high-grade (RR 6.94, 95% CI 1.89–25.45, p = 0.0035) rash compared with control medication. Higher grades of skin rash correlate with a higher objective response rate (RR 3.50, 95% CI 1.47–8.33, p = 0.0048), and a longer overall [hazard ratio (HR) 0.47, 95% CI 0.31–0.71, p = 0.0003) and progression-free survival (HR 0.51, 95% CI 0.36–0.72, p = 0.0001) compared with lower grades or no rash in patients who received anti-EGFR treatment.

Conclusions

Anti-EGFR treatment correlates with an increased risk of skin rash in advanced biliary cancer. Stratifying patients by the severity of rash may have major implications for survival benefit regarding anti-EGFR treatment for biliary cancer.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2CclN3E