A Novel Rule Based Machine Translation Scheme from Greek to Greek Sign Language: Production of Different Types of Large Corpora and Language Models Evaluation

Publication date: Available online 14 April 2018
Source:Computer Speech & Language
Author(s): Dimitrios Kouremenos, Klimis Ntalianis, Stefanos Kollias
One of the aims of Assistive Technologies is to help people with disabilities to communicate with others and to provide means of access to information. As an aid to Deaf people, in this work we present a novel prototype Rule Based Machine Translation (RBMT) system for the creation of large and quality written Greek Sign Language (GSL) glossed corpora from Greek text. In particular, the proposed RBMT system assists the professional GSL translator in speeding up the production of different kinds of GSL glossed corpora. Then each glossed corpus is used for the production/creation of Language Model (LM) n-grams. With the GSL glossed corpus from Greek text, we can build, test and evaluate different kinds of Language Models for different kinds of glossed GSL corpora. Here it should be noted that it does not require grammar knowledge of GSL but only very basic GSL phenomena covered by manual RBMT rules as it assists the professional human translator. Furthermore, it should also be stressed that Language Models for written GSL gloss are missing from the scientific literature, thus this work is pioneer in this field. Evaluation of the proposed scheme is carried out for the weather reports domain, where 20,284 tokens and 1,000 sentences have been produced. By using the BiLingual Evaluation Understudy (BLEU) metric score, our prototype RBMT system achieves a relative score of 0.84 (84%) for 4-grams and 0.9 (90%) for 1-grams.



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Hypothyroidism During Tyrosine Kinase Inhibitor Therapy Is Associated with Longer Survival in Patients with Advanced Nonthyroidal Cancers

Thyroid, Volume 28, Issue 4, Page 445-453, April 2018.


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Future Meetings

Thyroid, Volume 28, Issue 4, Page 549-550, April 2018.


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Risk Factors for New Hypothyroidism During Tyrosine Kinase Inhibitor Therapy in Advanced Nonthyroidal Cancer Patients

Thyroid, Volume 28, Issue 4, Page 437-444, April 2018.


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Protocol for Objective Measurement of Infants’ Physical Activity using Accelerometry

Purpose This study aimed to evaluate methods for infants' physical activity measurement based on accelerometry, including the minimum number of measurement days and placement of a wrist or ankle device. We also evaluated the acceptability of the device among infants and mothers. Methods A cross-sectional mixed-methods study was conducted on a convenience sample of 90 infants. Physical activity was measured using the Actigraph GT3X+ accelerometer placed on the wrist and/or ankle for 7 consecutive days (worn for 24 h), and a qualitative interview was performed to verify acceptability. The intraclass correlation coefficient (ICC) method and the Bland and Altman's dispersion diagram were used to verify the minimum number of measurement days. All analyses were stratified by walking status. Results The mean (SD) age was 12.9 (1.70) months; the mean acceleration varied between 25.8 mg (95% confidence interval (CI), 14.3–52.7) and 27.3 mg (95% CI, 17.9–44.5) using the wrist placement, and between 24.9 mg (95% CI, 10.6–48.4) and 26.2 mg (95% CI, 11.7–65.6) using the ankle placement. The ICC results showed a lower acceleration variability between days among infants incapable of walking; they achieved an ICC of 0.80 with 1 d of measurement in both placements. Among those capable of walking, the minimum number of days to achieve an ICC of 0.80 was 2 d measured at the wrist (0.85; 95% CI, 0.71–0.93) and 3 d measured at the ankle (0.92; 95% CI, 0.84–0.96). The qualitative results pointed to the wrist placement as the preferred placement among the overall sample. Conclusions Two and three measurement days with the accelerometer placed on the wrist and ankle, respectively, seemed to adequately represent a week of measurement. The accelerometer placed on the wrist had better acceptance by the infants and mothers.

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Synchronizing Gait with Cardiac Cycle Phase Alters Heart Rate Response during Running

Timing foot strike to occur in synchrony with cardiac diastole may reduce left ventricular afterload and promote coronary and skeletal muscle perfusion. Purpose This study aimed to assess heart rate (HR) and metabolic responses to running when foot strikes are timed to occur exclusively during 1) the systolic phase of the cardiac cycle or 2) the diastolic phase. Methods Ten elite male distance runners performed a testing session on a treadmill at 4.72 m·s−1 while matching their steps to an auditory tone and wearing a chest strap that transmitted accelerometer and ECG signals. Testing comprised eight prompted 3-min stages, where a real-time adaptive auditory tone guided subjects to step with each ECG R-wave (systolic stepping) or alternatively, at 45% of each R-R interval (diastolic stepping), followed by a 3-min unprompted control stage. Metabolic variables were measured continuously. Results HR (P

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Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis

Purpose Evaluate the effects of a low-intensity resistance training (LI-RT) program associated with partial blood flow restriction on selected clinical outcomes in patients with knee osteoarthritis (OA). Methods Forty-eight women with knee OA were randomized into one of the three groups: LI-RT (30% one repetition maximum [1-RM]) associated (blood flow restriction training [BFRT]) or not (LI-RT) with partial blood flow restriction, and high-intensity resistance training (HI-RT, 80% 1-RM). Patients underwent a 12-wk supervised training program and were assessed for lower-limb 1-RM, quadriceps cross-sectional area, functionality (timed-stands test and timed-up-and-go test), and disease-specific inventory (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) before (PRE) and after (POST) the protocol. Results Similar within-group increases were observed in leg press (26% and 33%, all P

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Effect of Carbohydrate Mouth Rinse on Performance after Prolonged Submaximal Cycling

Previous studies have shown improved shorter duration (∼1 h) performance with carbohydrate (CHO) mouth rinsing (WASH), especially in overnight fasted/non-fuelled subjects. Purpose To determine the effect of WASH on cycling time trial (TT) performance and muscle activity (EMG) after 2 h of submaximal cycling while receiving CHO (FED). Methods In a double-blind, placebo-controlled crossover design, 10 well-trained males cyclists (V˙O2max: 65 mL·kg−1·min−1) completed two experimental trials. Each trial consisted of a standardized pretrial snack (2 h prior) followed by 120 min of steady-state (SS) cycling (∼60% V˙O2max) followed by an approximately 30-min TT, randomized as follows: 1) 30 g CHO·h−1 during SS + WASH during TT (every 20% of TT) (FEDWASH); 2) 30 g CHO·h−1 during SS + placebo (PLA) wash during TT (FEDPLA). Results Although FEDWASH was not significantly different than FEDPLA (P = 0.51), there was a 1.7% (90% confidence interval, +6.4% to −3.2%; ES, 0.21) decrease in TT time (35 s) for FEDWASH compared with FEDPLA, with qualitative probabilities of a 60% positive and 23% trivial outcome. For EMG, soleus showed significant increase, whereas medial gastrocnemius showed significant decrease in muscle recruitment from the beginning 20% TT segment to the last 20% only in the FEDPLA condition, which coincided with a slower (P = 0.01) last 20% of the TT in FEDPLA versus FEDWASH. Conclusions Contrary to previous studies, this investigation utilized conditions of high ecological validity including a pretrial snack and CHO during SS. Significant changes in muscle recruitment and time over the last 20% of the TT, along with an average 1.7% improvement in TT time, suggest CHO mouth rinse helps maintain power output late in TT compared with placebo. Although marginal gains were achieved with a CHO mouth rinse (35 s), small performance effects can have significant outcomes in real-world competitions.

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A Preventive Model for Muscle Injuries: A Novel Approach based on Learning Algorithms

Introduction The application of contemporary statistical approaches coming from Machine Learning and Data Mining environments to build more robust predictive models to identify athletes at high risk for injury might support injury prevention strategies of the future. Purpose The purpose was to analyze and compare the behavior of numerous machine learning methods to select the best-performing injury risk factor model to identify athlete at risk for lower extremity muscle injuries (MUSINJ). Methods A total of 132 male professional soccer and handball players underwent a preseason screening evaluation that included personal, psychological, and neuromuscular measures. Furthermore, injury surveillance was used to capture all the MUSINJ occurring in the 2013/2014 seasons. The predictive ability of several models built by applying a range of learning techniques were analyzed and compared. Results There were 32 MUSINJ over the follow-up period, 21 (65.6%) of which corresponded to the hamstrings, 3 to the quadriceps (9.3%), 4 to the adductors (12.5%), and 4 to the triceps surae (12.5%). A total of 13 injures occurred during training and 19 during competition. Three players were injured twice during the observation period so the first injury was used, leaving 29 MUSINJ that were used to develop the predictive models. The model generated by the SmooteBoost technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score, 0.747; true positive rate, 65.9%; true negative rate, 79.1) and hence was considered the best for predicting MUSINJ. Conclusions The prediction model showed moderate accuracy for identifying professional soccer and handball players at risk for MUSINJ. Therefore, the model developed might help in the decision-making process for injury prevention.

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The Effects of Sex and Motoneuron Pool on Central Fatigue

Purpose It is uncertain if sex influences central fatigue because the reduction in voluntary activation (VA) has been reported as not different between the sexes for elbow flexors (EF) but greater in males compared with females for knee extensors. This disparity could result from the facilitatory and inhibitory effects of group III/IV muscle afferents on flexor versus extensor motoneurons, respectively. The purpose of this study was to examine central fatigue and motoneuron responsiveness of EF and elbow extensors (EE) in males and females. Methods Twenty-two participants (11 females) performed a 2-min isometric maximal voluntary contraction of EF and EE (on separate days) followed by 2 min of recovery. EMG potentials were recorded from biceps or triceps brachii in response to the stimulation of the brachial plexus (Mmax), corticospinal tract (cervicomedullary motor evoked potential [CMEP]), and motor cortex (motor evoked potential [MEP]). Superimposed and resting doublets (for determining VA) were evoked via muscle belly stimulation of biceps or triceps brachii. Only CMEP and superimposed doublets were recorded during fatigue. Results There was no effect of sex on CMEP area for either muscle group during fatigue or recovery. During the 2 min after EE fatigue, mean normalized CMEP and MEP area were ∼85% and ∼141% of control, indicating inhibition and facilitation of the motoneurons and motor cortex, respectively. VA during recovery was significantly reduced in males but not females for the EF, and unchanged in either sex for the EE. Conclusion The findings do not support the concept that equivocal findings regarding sex differences in central fatigue are related to augmented effects of group III/IV afferent feedback in males compared with females.

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Raw and Count Data Comparability of Hip-Worn ActiGraph GT3X+ and Link Accelerometers

To enable inter- and intrastudy comparisons it is important to ascertain comparability among accelerometer models. Purpose The purpose of this study was to compare raw and count data between hip-worn ActiGraph GT3X+ and GT9X Link accelerometers. Methods Adults (n = 26 (n = 15 women); age, 49.1 ± 20.0 yr) wore GT3X+ and Link accelerometers over the right hip for an 80-min protocol involving 12–21 sedentary, household, and ambulatory/exercise activities lasting 2–15 min each. For each accelerometer, mean and variance of the raw (60 Hz) data for each axis and vector magnitude (VM) were extracted in 30-s epochs. A machine learning model (Montoye 2015) was used to predict energy expenditure in METs from the raw data. Raw data were also processed into activity counts in 30-s epochs for each axis and VM, with Freedson 1998 and 2011 count-based regression models used to predict METs. Time spent in sedentary, light, moderate, and vigorous intensities was derived from predicted METs from each model. Correlations were calculated to compare raw and count data between accelerometers, and percent agreement was used to compare epoch-by-epoch activity intensity. Results For raw data, correlations for mean acceleration were 0.96 ± 0.05, 0.89 ± 0.16, 0.71 ± 0.33, and 0.80 ± 0.28, and those for variance were 0.98 ± 0.02, 0.98 ± 0.03, 0.91 ± 0.06, and 1.00 ± 0.00 in the X, Y, and Z axes and VM, respectively. For count data, corresponding correlations were 1.00 ± 0.01, 0.98 ± 0.02, 0.96 ± 0.04, and 1.00 ± 0.00, respectively. Freedson 1998 and 2011 count-based models had significantly higher percent agreement for activity intensity (95.1% ± 5.6% and 95.5% ± 4.0%) compared with the Montoye 2015 raw data model (61.5% ± 27.6%; P

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Exercise Increases Glucose Transporter-4 Levels on Peripheral Blood Mononuclear Cells

Purpose Glucose transporter 4 (GLUT4) plays a key role in the pathophysiology of type 2 diabetes. Glucose transporter 4 is upregulated in response to exercise, enhancing cellular glucose transport in skeletal muscle tissue. This mechanism appears to remain intact in individuals with insulin resistance. Details of the mechanism are poorly understood and are challenging to study due to the invasive nature of muscle biopsy. Peripheral blood mononuclear cells (PBMC) have documented insulin-sensitive GLUT4 activity and may serve as a proxy tissue for studying skeletal muscle GLUT4. The purpose of this study was to investigate whether GLUT4 in PBMC is affected by conditioning. Methods We recruited 16 student athletes from the cross-country running and skiing teams and fifteen sedentary students matched for age and sex from the University of Alaska Fairbanks. Peripheral blood mononuclear cells were collected with mononuclear cell separation tubes. The GLUT4 concentrations were measured using a commercially available enzyme linked immunosorbent assay. Additionally, correlations between PBMC GLUT4 and common indicators of insulin resistance were examined. Results Results indicate significantly higher PBMC GLUT4 levels in conditioned athletes than in their sedentary counterparts, similar to what has been documented in myocytes. Females were observed to have higher PBMC GLUT4 levels than males. Correlations were not detected between PBMC GLUT4 and hemoglobin A1c, glucose, insulin, homeostatic model assessment of insulin resistance, body mass index, or body fat. Conclusions This study provides evidence to support exploration of PBMC as a proxy tissue for studying GLUT4 response to exercise or other noninsulin factors.

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The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation

Introduction Aerobic interval training (AIT) has recently emerged as a more effective strategy than moderate-intensity continuous exercise (MICE) for improving peak oxygen consumption (V˙O2peak) in coronary artery disease (CAD) patients. The primary purpose of this retrospective study was to describe the change in V˙O2peak, and cardiovascular (CV) risk profile characteristics (secondary outcomes) after progressive AIT practiced in the largest, outpatient cardiac rehabilitation (CR) program in North America compared with usual care CR involving MICE. Methods Electronic database records were retrieved from consecutively enrolled patients with CAD who attended the Toronto Rehabilitation Institute, between January 1, 2005, and December 31, 2015. Patients were then separated into two, age and sex propensity score-matched groups: 772 patients were prescribed 26 wk of MICE (60%–80% of V˙O2peak, five times per week) as per usual care CR (56.0 ± 9.2 yr; 12% female/88% male; V˙O2peak: 20.8 ± 5.9 mL·kg−1·min−1), and 772 patients were prescribed 26 wk of progressive walk/jog intervals (15 min·mile−1 walking pace, 12 min·mile−1 jogging pace, five times per week) (55.9 ± 9.3 yr; 12% female/88% male; V˙O2peak: 24.8 ± 5.7 mL·kg−1 ·min−1). Treatment effect analysis of AIT on V˙O2peak and CV risk profile characteristics was performed using multiple regression with baseline values as covariates. Results Treatment effect analysis revealed a 3.84-mL·kg−1·min−1 superior improvement in V˙O2peak in the AIT group compared to usual care MICE group (P

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Beneficial Effects of Exercise Pretreatment in a Sporadic Alzheimer’s Rat Model

Purpose This study aimed to examine the effects of swimming exercise pretreatment on a streptozotocin (STZ)-induced sporadic Alzheimer's disease (AD) rat model and provide an initial understanding of related molecular mechanisms. Methods Male 2.5-month-old Sprague–Dawley rats were divided into the following four groups: (a) control, (b) swim + vehicle, (c) STZ without swim, and (d) swim + STZ. The Barnes maze task and novel object recognition test were used to measure hippocampus-dependent spatial learning and working memory, respectively. Immunofluorescence staining, Western blot analysis, enzyme-linked immunosorbent assay (ELISA) analysis, and related assay kits were used to assess synaptic proteins, inflammatory cytokines, total antioxidant capacity, antioxidant enzymes, amyloid-beta production, and tau hyperphosphorylation. Results Behavioral tests revealed that exercise pretreatment could significantly inhibit STZ-induced cognitive dysfunction (P

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Perceptual Responses to High- and Moderate-Intensity Interval Exercise in Adolescents

Purpose Continuous high-intensity exercise is proposed to evoke unpleasant sensations as predicted by the dual-mode theory and may negatively impact on future exercise adherence. Previous studies support unpleasant sensations in affective responses during continuous high-intensity exercise, but the affect experience during high-intensity interval exercise (HIIE) involving brief bursts of high-intensity exercise separated by low-intensity activity is poorly understood in adolescents. We examined the acute affective, enjoyment, and perceived exertion responses to HIIE compared with moderate-intensity interval exercise (MIIE) in adolescents. Methods Thirteen adolescent boys (mean ± SD: age, 14.0 ± 0.5 yr) performed two counterbalanced exercise conditions: 1) HIIE: 8 × 1-min work intervals at 90% maximal aerobic speed; and 2) MIIE: between 9 and 12 × 1-min work intervals at 90% ventilatory threshold where the number of intervals performed were distance-matched to HIIE. HIIE and MIIE work intervals were interspersed with 75 s active recovery at 4 km·h−1. Affect, enjoyment, and RPE were recorded before, during, and after exercise. Results Affect responses declined in both conditions but the fall was greater in HIIE than MIIE (P 0.64). Conclusions Despite elevated RPE, HIIE did not elicit prominent unpleasant feelings as predicted by the dual-mode theory and was associated with greater postexercise enjoyment responses than MIIE. This study demonstrates the feasibility of the application of HIIE as an alternative form of physical activity in adolescents.

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Role of Chronic Stress and Exercise on Microvascular Function in Metabolic Syndrome

Purpose The present study examined the effect of unpredictable chronic mild stress (UCMS) on peripheral microvessel function in healthy and metabolic syndrome (MetS) rodents and whether exercise training could prevent the vascular dysfunction associated with UCMS. Methods Lean and obese (model of MetS) Zucker rats (LZR and OZR) were exposed to 8 wk of UCMS, exercise (Ex), UCMS + Ex, or control conditions. At the end of the intervention, gracilis arterioles (GA) were isolated and hung in a pressurized myobath to assess endothelium-dependent (EDD) and endothelium-independent (EID) dilation. Levels of nitric oxide (NO) and reactive oxygen species (ROS) were measured through 4-amino-5-methylamino-2′,7′-difluorofluorescein diacetate and dihydroethidium staining, respectively. Results Compared with LZR controls, EDD and EID were lower (P = 0.0001) in LZR-UCMS. The OZR-Ex group had a higher EDD (P = 0.0001) and EID (P = 0.003) compared with OZR controls, whereas only a difference in EDD (P = 0.01) was noted between the LZR-control and LZR-Ex groups. Importantly, EDD and EID were higher in the LZR (P = 0.0001; P = 0.02) and OZR (P = 0.0001; P = 0.02) UCMS + Ex groups compared with UCMS alone. Lower NO bioavailability and higher ROS were noted in the LZR-UCMS group (P = 0.0001), but not OZR-UCMS, compared with controls. The Ex and UCMS-Ex groups had higher NO bioavailability (P = 0.0001) compared with the control and UCMS groups, but ROS levels remained high. Conclusions The comorbidity between UCMS and MetS does not exacerbate the effects of one another on GA EDD responses, but does lead to the development of other vasculopathy adaptations, which can be partially explained by alterations in NO and ROS production. Importantly, exercise training alleviates most of the negative effects of UCMS on GA function.

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Postexercise Fructose–Maltodextrin Ingestion Enhances Subsequent Endurance Capacity

Purpose Restoring skeletal muscle and hepatic glycogen content during short-term (

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Replacement of Sedentary Time with Physical Activity: Effect on Lipoproteins

Purpose Limited data on the relationship between physical activity and lipoprotein particle profiles exist. Our objective was to investigate associations between objectively measured physical activity and lipoprotein particle size and number, and specifically whether substituting daily sedentary behavior with light activity or moderate-to-vigorous physical activity (MVPA) is associated with beneficial alterations to the lipoprotein profile among adults and those at increased cardiometabolic risk (obese and insulin-resistant subjects). Methods Sedentary behavior and physical activity intensity and duration were measured for 7 consecutive days using the GENEActiv accelerometer in a cross-sectional adult cohort (n = 396; mean age, 59.6 ± 5.5 yr). Lipoprotein particle size and subclass concentrations were determined using nuclear magnetic resonance spectroscopy. Isotemporal substitution regression modeling quantified the associations between replacing 30 min·d−1 of sedentary behavior with equal amounts of light activity and MVPA on lipoprotein profiles. Results Daily duration of MVPA was inversely associated with large VLDL particles and lipoprotein insulin resistance scores (P

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Lower-Limb Dominance, Performance, and Fiber Type in Resistance-trained Men

Introduction Large imbalances between limbs are common and potentially dangerous, yet few studies have simultaneously examined performance and physiological asymmetries. The current study examined the associations between lower-limb dominance, drop-jumping kinematics, maximal strength, and myosin heavy-chain (MHC) fiber type in the vastus lateralis. Methods Thirteen resistance-trained men (age, 24.3 ± 2.7 yr; height, 181.4 ± 6.6 cm; mass, 87.7 ± 11.3 kg) identified their dominant (DOM) and nondominant (ND) limb, performed drop jumps (30 cm) and maximal knee extensions (1-repetition maximum, or 1RM), and provided biopsies from both vastus lateralis muscles for single-fiber (109 ± 36 per limb per person) MHC fiber-type identification (FT%). Results All participants selected "right" as the "preferred kicking limb" (DOM). DOM displayed a trend for a greater eccentric knee angular velocity (EKV; P = 0.083) and a significantly greater concentric knee angular velocity (CKVl P = 0.002) during drop jump. DOM also tended to be stronger than ND (64.3 ± 11.3 vs 61.0 ± 8.8 kg, P = 0.063). Slow-twitch (MHC I) fibers were more prevalent in DOM (P 5% were present in 6 of 12 participants for EKV, 2 of 12 for CKV, 6 of 13 for 1RM, 12 of 13 for MHC I, and 11 of 13 for MHC IIa. However, only a single participant expressed asymmetries of >5% in all dependent variables (EKV, CKV, 1RM, MHC I, and MHC IIa). Conclusions Several statistically and clinically relevant asymmetries were identified. The FT% differences between lower limbs were large and common. The findings also seem to conclude that DOM was stronger, moved faster, and contained more MHC I. However, only 23% of participants actually displayed that result. This highlights the need to analyze and report both group and individual data, particularly when interpreting findings across multiple related, but not necessarily causal, measurements.

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An improved inventory of polychlorinated biphenyls in China: A case study on PCB-153

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Yue Xu, Chongguo Tian, Xiaoping Wang, Jianmin Ma, Jianhui Tang, Yingjun Chen, Jun Li, Gan Zhang
Emission inventory of pollutants is essential for the environmental fate study and management of the pollutant. To construct a reasonable PCB (polychlorinated biphenyls) inventory in China, this study estimates PCB usage and emission using power generating capacity, installed capacity of power plants and transformer substations, population density and GDP as surrogates. Inventory of representative PCB (PCB-153) with a resolution of 1/4° latitude × 1/4° longitude in China from 1952 to 2005 was generated and assessed as an example. Totally, about 20.3 kt PCBs were applied in China, of which 179 t were PCB-153. By the end of 2005, most of them (56.4%) were emitted into the soil, 2.7% entered the air, and about 20.8% was sealed in storage site or still in service. Historical emissions exhibited increasing trends after 1968, 1984 and 1994, which were mainly associated with usage or disposal processes. Although primary emission has been declined since 2005, the influence of secondary emission from soils, unintentionally produced PCBs (UP-PCB), and reemission from storage sites could be a long-lasting issue in the future. This new emission inventory improves previous PCB emission inventory significantly, which underestimated PCB emission in China considerably.

Graphical abstract

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Isoprene emission response to drought and the impact on global atmospheric chemistry

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Xiaoyan Jiang, Alex Guenther, Mark Potosnak, Chris Geron, Roger Seco, Thomas Karl, Saewung Kim, Lianhong Gu, Stephen Pallardy
Biogenic isoprene emissions play a very important role in atmospheric chemistry. These emissions are strongly dependent on various environmental conditions, such as temperature, solar radiation, plant water stress, ambient ozone and CO2 concentrations, and soil moisture. Current biogenic emission models (i.e., Model of Emissions of Gases and Aerosols from Nature, MEGAN) can simulate emission responses to some of the major driving variables, such as short-term variations in temperature and solar radiation, but the other factors are either missing or poorly represented. In this paper, we propose a new modelling approach that considers the physiological effects of drought stress on plant photosynthesis and isoprene emissions for use in the MEGAN3 biogenic emission model. We test the MEGAN3 approach by integrating the algorithm into the existing MEGAN2.1 biogenic emission model framework embedded into the global Community Land Model of the Community Earth System Model (CLM4.5/CESM1.2). Single-point simulations are compared against available field measurements at the Missouri Ozarks AmeriFlux (MOFLUX) field site. The modelling results show that the MEGAN3 approach of using of a photosynthesis parameter (Vcmax) and soil wetness factor (βt) to determine the drought activity factor leads to better simulated isoprene emissions in non-drought and drought periods. The global simulation with the MEGAN3 approach predicts a 17% reduction in global annual isoprene emissions, in comparison to the value predicted using the default CLM4.5/MEGAN2.1 without any drought effect. This reduction leads to changes in surface ozone and oxidants in the areas where the reduction of isoprene emissions is observed. Based on the results presented in this study, we conclude that it is important to simulate the drought-induced response of biogenic isoprene emission accurately in the coupled Earth System model.



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Quantitative assessment of tumor-associated tissue eosinophilia and mast cells in tumor proper and lymph nodes of oral squamous cell carcinoma

Shivani Jain, Rashmi GS Phulari, Rajendrasinh Rathore, Arpan K Shah, Sankalp Sancheti

Journal of Oral and Maxillofacial Pathology 2018 22(1):145-145

Background: Oral squamous cell carcinoma (OSCC) is the most common cancer of oral cavity. Tumor stage, thickness, lymph node metastasis (LNM), extranodal spread, perineural invasion, tumor differentiation, mutations, human papillomavirus infection, and tumor microenvironment are independent prognostic indicators of OSCC. However, clinically, among all factors, LNM is considered an important prognostic factor in OSCC as it not only determines the stage of disease but also the strongest independent factor which predicts recurrence of disease. Further research proves that there are several biologically important factors in tumor tissue and LNs which promote or defend LNM. While it is proposed that tumor-associated tissue eosinophils (TATE) and mast cells (MCs) have "immuno-protective" effect, this remains unproven and various researchers have conflicting opinion. Aim: The aim is to determine the presence of TATE and MCs in OSCC and to evaluate if any association exists between them and LNM. Study Design: It is a comparative-retrospective study between 2 groups including 35 OSCC cases positive and 35 negative for LNM. Materials and Methodology: Quantification of cells was done by counting total number of cells in 10 high-power fields under ×40 objective lens using "zigzag" method and dividing it by total number of fields. Eosinophils stained bright red with carbol chromotrope and MCs purple-violet with toluidine blue. Statistics: Independent t-test and Pearson's correlation were done using STATA IC 0.2 software. Level of significance was at 5%. Comparison of eosinophil and MC infiltration was done based on gender, metastatic, nonmetastatic LN, and in tumor proper. Results and Conclusion: This study showed weak positive correlation between mean eosinophils count in tumor and LNs. Recognition of TATE and MCs as integral to tumor biology opens an avenue for novel approaches to cancer therapies. We conclude that an increased number of immunological cells are a favorable prognostic indicator in OSCC.

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Toxoplasmosis submandibular lymphadenitis: Report of an unusual case with a brief review

Susmita Saxena, Sanjeev Kumar, Jitin Kharbanda

Journal of Oral and Maxillofacial Pathology 2018 22(1):116-120

A 16-year-old male patient reported with swelling of the right submandibular region for 3 months. The patient was asymptomatic and gave a history of fever lasting for 2 days before observing the swelling. Fine-needle aspiration cytology revealed nonspecific lymphadenitis, and since there was no apparent cause detected in the oral cavity or any systemic condition noted, the enlarged lymph node was surgically excised and submitted for histopathologic examination. The inflammatory condition and large numbers of macrophages appeared nonspecific while granuloma formation was not seen. Specific antibody titer against Toxoplasma gondii was carried out and extremely high level of IgG for toxoplasma was detected confirming the diagnosis of toxoplasmosis leading to lymphadenitis.

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From the editor's desk

T Smitha

Journal of Oral and Maxillofacial Pathology 2018 22(1):1-1



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Dr. A. T. Biviji

Puneet Ahuja

Journal of Oral and Maxillofacial Pathology 2018 22(1):4-5



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Quantitative analysis of dental age estimation by incremental line of cementum

G Swetha, Kiran Kumar Kattappagari, Chandra Shekar Poosarla, Lalith Prakash Chandra, Sridhar Reddy Gontu, Venkata Ramana Reddy Badam

Journal of Oral and Maxillofacial Pathology 2018 22(1):138-142

Aim: This study aims to examine the correlation between age and number of incremental lines in human dental cementum among single-rooted teeth (incisors and canines) and to assess the best tooth to estimate age group by studying cementum under phase-contrast microscope and to assess the use of cementum in age estimation. Materials and Methods: The present study was carried out in the Department of Oral Pathology and Microbiology. A sample of eighty single-rooted undecalcified longitudinal ground sections is prepared from freshly collected teeth with age noted separately and observed under phase-contrast microscope, photographed and counted. Counting the number of alternating dark and light lines of the cementum and adding them to the average age at which the analyzed tooth erupts provided an estimate of the chronological age of the individual. Results: The results obtained in the present study were statistically significant and positive correlation was observed between the actual age and the estimated age. The number of incremental lines was found to be gradually increased with increase in age of the individual. On an average, ±2 years of age difference were observed in our study on comparing the actual age with estimated age. Conclusion: Hence, the incremental lines of the cementum were found to be gradually increased with increase in age and hence can be used as one of the adjuvant tools in dental age estimation.

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Modifications and recent updates in the 8th edition of tumor node metastasis staging pertaining to oropharynx and oral cavity

T Smitha, Aishwarya Dinakaran

Journal of Oral and Maxillofacial Pathology 2018 22(1):6-8



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Evaluation of biosafe alternatives as xylene substitutes in hematoxylin and eosin staining procedure: A comparative pilot study

Taneeru Sravya, Guttikonda Venkateswara Rao, Masabattula Geetha Kumari, Yerraguntla Vidya Sagar, Yeluri Sivaranjani, Kondamarri Sudheerkanth

Journal of Oral and Maxillofacial Pathology 2018 22(1):148-148

Background: Xylene is synthetic hydrocarbon produced from coal tar known for its wide usage as universal solvent which has many hazardous effects. The aim of this study is to compare the efficacy of xylene-free hematoxylin and eosin (H and E) sections with conventional H and E sections. Materials and Methods: The study included ninety paraffin-embedded tissue blocks. Of these, sixty blocks were processed with sesame oil (xylene alternative) and thirty blocks with xylene. The study sample was divided into three groups. Sixty sections which are taken from sesame oil-processed blocks were stained with xylene-free H and E staining method. In xylene-free staining method, 95% diluted lemon water (Group A) and 1.7% dish washing solution (DWS, Group B) were used as deparaffinizing agents whereas the remaining 30 sections were processed with xylene and stained with conventional H and E staining method (Group C). Slides were scored for the following parameters: (i) nuclear staining (adequate = score 1, inadequate = score 0), (ii) cytoplasmic staining (adequate = score 1, inadequate = score 0), (iii) uniformity (present = score 1, absent = score 0), (iv) clarity (present = score 1, absent = score 0) and (v) intensity (present = score 1, absent = score 0). Score ≤2 was considered inadequate for diagnosis while scores 3–5 were considered adequate for diagnosis. Results: Adequate nuclear staining was noted in 90% of sections of Group A and 100% each in Group B and Group C (P < 0.05); adequate cytoplasmic staining in 96.7% in Group A and 100% each in Group B and Group C (P > 0.05); adequate uniformity of staining in 53.3% of sections of Group A, 70% in Group B and 83.3% in Group C (P < 0.05); adequate clarity of staining in 73.3% sections of Group A, 80% in Group B and 83.3% in Group C (P > 0.05) and adequate intensity of staining in 76.7% sections of Group A, 93.3% in Group B and 100% in Group C (P < 0.05). Group C sections stained adequate for diagnosis (93.3%) followed by Group B (88.7%) and Group A (78%; P< 0.05). Conclusion: Tissues processed with sesame oil and stained using 1.7% DWS were found to be effective alternative to xylene.

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Sanderson's polster

Deepak Pandiar, T Smitha

Journal of Oral and Maxillofacial Pathology 2018 22(1):9-10



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Basaloid squamous cell carcinoma: Report of two cases with review of literature

Pooja Aggarwal, Chitrapriya Saxena, Arun Kumar, Vijay Wadhwan

Journal of Oral and Maxillofacial Pathology 2018 22(1):108-111

Basaloid squamous cell carcinoma is a rare distinct histologic variant of squamous cell carcinoma of the head and neck region. Majority of them can be differentiated from squamous cell carcinoma by their aggressive clinical course and their histological features: the usual site of occurrence of basaloid squamous cell carcinoma is the upper areodigestive tract, floor of mouth and base of tongue. We hereby present two cases of a rare but aggressive basaloid squamous cell carcinoma, both affecting mandible.

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Evaluation of epidermal growth factor receptor expression by a new scoring system in head-and-neck squamous cell carcinoma and its association with various pathological prognostic factors

Jyoti Verma, Vishal Dhingra, Sapan Srivastava, Vatsala Misra, Kachnar Varma, Shilpy Singh

Journal of Oral and Maxillofacial Pathology 2018 22(1):11-17

Context: Squamous cell carcinoma is an aggressive epithelial malignancy of the upper aerodigestive tract comprising 90% of all head-and-neck squamous cell carcinoma (HNSCC). It is the sixth leading cancer worldwide, with approximately 600,000 cases reported annually. It is one of the most common cancers in India. Aims and Objective: Epidermal growth factor receptor (EGFR) being the most promising marker has potentially offered new methods to prognosticate and plays an essential role in early diagnosis and treatment apart from tumor, node and metastasis staging which has been used till now. Therefore, this study has been undertaken to evaluate the expression of EGFR in HNSCC cases, according to the new scoring system and find its association with various pathological prognostic factors. Materials and Methods: Forty-eight resected specimens of oral squamous cell carcinoma were received. Cases were appropriately staged, and paraffin-embedded tumor sections, stained with hematoxylin and eosin, were graded. EGFR expression was evaluated as extent score, intensity score and total score (TS). Statistical Analysis: Data obtained were transferred on to an excel sheet. Chi-square test with and without Yate's correction was employed to compare various parameters. P ≤ 0.05 was taken as critical level of significance. Results: A significant association was observed between TS of EGFR expression and tumor grade but not with tumor stage or lymph node metastasis. Conclusion: A significant association of EGFR expression exists with tumor grade as per the new scoring system adopted. High EGFR expression suggests uncontrolled growth which depicts that EGFR upregulation may be an early event during HNSCC carcinogenesis.

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Clear cell carcinoma of palatine salivary gland: A diagnostic challenge

Karpagaselvi Sanjai, Divya Shivalingaiah, Ranjini Sharath, Bhavna Pandey

Journal of Oral and Maxillofacial Pathology 2018 22(1):128-131



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Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries

Swati Sharma, L Satyanarayana, Smitha Asthana, KK Shivalingesh, Bala Subramanya Goutham, Sujatha Ramachandra

Journal of Oral and Maxillofacial Pathology 2018 22(1):18-26

Objectives: To summarize and provide an overview of age-specific oral cancer incidence reported in 29 population-based cancer registry in India. Materials and Methods: Secondary data on age-adjusted rates (AARs) of incidence of oral cancer and other associated sites for all ages (0–75 years) were collected from the report of the National Cancer Registry Programme 2012–2014 in 29 population-based control registries. Results: Among both males and females, mouth cancer had maximum Age adjusted incidence rates (64.8) in the central zone, while oropharynx cancer had minimum AAR (0) in all regions. Conclusion: Oral cancer incidence increases with age with typical pattern of cancer of associated sites of oral cavity seen in the northeast region.

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Prevalence of commissural lip pits in population of central Gujarat: A hospital-based study

Mansi Narendra Tailor, Manjiri Uttam Joshi

Journal of Oral and Maxillofacial Pathology 2018 22(1):144-144

Background: Commissural lip pits (CLPs) fall among the rare congenital deformities recorded. CLP usually follows dominant hereditary pattern and may be associated with other congenital defects. CLP can appear as unilateral depression or bilateral depression. Objective: To assess the prevalence, age distribution, site and gender predilection of CLP in a central Gujarat population. Materials and Methods: Outdoor patients over a period of 6 months were examined for clinical evidence of CLPs. Results: A total of 14,403 patients were examined for the presence of CLP. CLP was identified in 381 patients with a prevalence of 2.65%. The occurrence of CLP was more in male patients. The maximum number of patients was in the age groups of 20–29 years. No significant statistical difference was observed in the distribution of CLP. Unilaterally distributed CLP was more common on the left side. Conclusion: Our study showed 2.65% prevalence of isolated CLPs with a male predilection. There was almost equal distribution of unilateral and bilateral CLP. In unilateral cases, the left side was affected the most. Although literature says lip pits can be an associated feature of certain syndromes, there were no syndromic patients in our study.

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Estimation of cortisol levels in patients with premalignant disorders and oral squamous cell carcinoma

Priyanka Sharma, Simarpreet Virk Sandhu, Rajat Bhandari, Indu Verma, Ramanpreet Kaur Bhullar, Rajbir Kaur Khangura

Journal of Oral and Maxillofacial Pathology 2018 22(1):27-34

Introduction: Oral cancer has been a scourge on the human population that drastically affects the quality of life-causing chronic anxiety and depression leading to disturbance in hypothalamus pituitary axis reflected by cortisol hormone dysregulation. Stress hormones affect tumor progression at different levels such as initiation, tumor growth and metastasis. Cortisol dysregulation has been reported in other malignancies; however, a thorough review of English literature revealed only anecdotal studies investigating it in patients with oral squamous cell carcinoma (OSCC). Objectives: The objective of this study is to evaluate morning plasma and salivary cortisol levels in patients with OSCC, premalignant disorders (PMD's) and smokers and/or drinkers without any lesion (risk group) and control group and its correlation with Hospital Anxiety And Depression Scale (HADS-subjective) and Hamilton Rating Scale for Anxiety and Depression (HRSA, HRSD-objective). Materials and Methods: This cross-sectional study was carried out on 25 patients each of OSCC, PMD's, risk and control group. Self-administered HADS and clinician-rated HRSD, HRSA were applied to each patient. Morning unstimulated saliva and venous blood sample were collected between 08:00 and 11:00 h to avoid diurnal variations. Morning salivary and plasma cortisol levels were analyzed using enzyme-linked immunosorbent assay method. Results: Both morning plasma and salivary cortisol levels were significantly higher in patients in OSCC group as compared to other three groups in the study which were further supported by higher scores obtained from HADS, HRSA and HRSD scales. Conclusion: The study observed that there was marked dysregulation of both morning plasma and salivary cortisol levels along with higher scores of anxiety and depression in OSCC.

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The role of macrophages and eosinophils in reactive lesions of the oral cavity

Amir Ala Aghbali, Ayshin Akbarzadeh, Maryam Kouhsoltani

Journal of Oral and Maxillofacial Pathology 2018 22(1):147-147

Background: Many studies have reported that macrophages and eosinophils are involved in the pathogenesis of several diseases. To the best of our knowledge, this is the first study comparing macrophages and eosinophils in oral reactive lesions. Aims: In this study, we aimed to determine the contribution of macrophages and eosinophils to the pathogenesis of oral reactive lesions and the relationships between these biomarkers and the diverse histopathologic features. Methods: Seventy-five paraffin-embedded tissue samples were assessed in this study. Five categories (15 cases for each group), including peripheral ossifying fibroma, pyogenic granuloma, fibroma, inflammatory fibrous hyperplasia, and peripheral giant-cell granuloma, were considered. Anti-CD68 immunohistochemical and hematoxylin-eosin staining was carried out. Results: We found that macrophages, but not eosinophils, were a significant internal component of oral reactive lesions. Macrophages were observed in high densities in all studied groups and diffusely distributed or clustered throughout these lesions. The number of macrophages was increased in peripheral giant-cell granuloma compared with other groups. Conclusions: Our findings suggest that macrophages are involved in the pathogenesis and the variation of microscopic features of oral reactive lesions. However, further clinical studies should be conducted to identify the biological process behind macrophages and the molecular interactions of these cells, with the ultimate aim of suggesting a new potential therapeutic target for these lesions. We found that eosinophils were not involved in the fibrotic process and the variation of microscopic features in oral reactive lesions. Our results showed that peripheral giant-cell granulomas highly demonstrated histiocytic characteristics.

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Elevated tissue nitric oxide in oral squamous cell carcinoma

Varsha A Sangle, Smita J Chaware, Meena A Kulkarni, Yashwant C Ingle, Pratibha Singh, Pooja VK

Journal of Oral and Maxillofacial Pathology 2018 22(1):35-39

Context: Nitric oxide (NO) is a diatomic molecule that has been implicated in tumor progression of oral squamous cell carcinoma (OSCC). However, the mechanism of NO affecting tumor growth and progression remains unknown. Tumor progression has been recently received considerable attention, and there is increasing evidence of correlation of tumor biology and behavior. Aims: We aim to evaluate tissue NO of OSCC patients and correlate these findings with grade and stage of the OSCC patients. Materials and Methods: To count tissue nitric oxide in normal and OSCC cases. To compare the findings of tissue nitric oxide between normal and OSCC cases. Subjects and Methods: Forty-two fresh tissue specimens from the excisional biopsy of OSCC patients and 42 tissue samples of normal healthy mucosa using ultraviolet visible spectrophotometer. Statistical Analysis Used: Statistical analysis was done using Student's unpaired t-test and Tukey's post hoc analysis. Results: Tissue NO level was higher in OSCC compared with control group (P < 0.01). There was an increase in NO levels with advanced clinical staging and with decreased differentiation of tumor. Conclusions: Increased tissue NO levels in OSCC patients along with an increase in the clinical stage of the tumor and decreased differentiation of tumor indicates the association of NO with tumor growth and with staging and grading of is well recognized.

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Granuloma of the labial minor salivary glands in tuberculosis

Adriana Handra-Luca

Journal of Oral and Maxillofacial Pathology 2018 22(1):150-150

Minor salivary gland granuloma is rare in tuberculosis. We present a case of labial minor salivary gland granulomas occurring in the course of tuberculosis along with skin, mediastinal and liver granulomas. The patient (46-year-old man) presented with asthenia, nocturne transpiration, weight loss and compressive thoracic adenopathies. The angiotensin I converting enzyme was elevated as well as calcemia. The QuantiFERON test and culture of a mediastinal specimen were positive for Mycobacterium tuberculosis. Multinucleated-cell-granulomas (focally with necrosis) were identified on skin, mediastinal, liver and minor salivary gland biopsies. Kidney biopsy was suggestive of IgA-glomerulonephritis. Treatment (isoniazid, rifampicin, ethambutol and moxifloxacin) was started and corticoids 15 days afterward. At 1 year, the patient had recovered. In conclusion, a case of labial minor salivary gland granulomas occurring in the course of tuberculosis is reported. Tuberculosis should be included in the differential diagnoses of labial minor salivary gland granulomas as treatments may be more complex than those for other granulomas including sarcoidosis.

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Coalition of E-cadherin and vascular endothelial growth factor expression in predicting malignant transformation in common oral potentially malignant disorders

P Sharada, Uma Swaminathan, BR Nagamalini, K Vinod Kumar, BK Ashwini, VLN Lavanya

Journal of Oral and Maxillofacial Pathology 2018 22(1):40-47

Background: Reduced E-cadherin expression and increased VEGF expression is known to be involved in tissue growth and transformation of Oral Potentially Malignant Disorders (OPMDs) and has been correlated with their differing histological grades in numerous studies. Aim: To evaluate Immunohistochemical (IHC) expression of both E-cadherin and VEGF in predicting the malignant transformation potential of common OPMDs. Materials And Methods: Ten cases each of Normal Oral mucosa (NOM), Mild Oral Epithelial Dysplasia (OED), Moderate OED, Severe OED, Oral Submucous Fibrosis, (OSMF) and Oral Squamous Cell Carcinoma (OSCC) were stained and evaluated for the expression of Ecadherin and VEGF. Quick score (QS) for expression intensity in all epithelial layers was calculated for both markers and results statistically analysed using Kruskal –Wallis ANOVA and Mann-Whitney "U" test. Results: E-cadherin expression was continuous and membranous in all the layers of NOM and reduced with progressing grades of OED to OSCC. In OSMF, expression was intermediate between moderate and severe OED. VEGF expression increased as the disease progressed from normal to increasing grades of OED to malignancy. In OSMF, expression was similar to that in mild OED. VEGF, E-cadherin expression for basal and parabasilar cells showed a strong statistically significant negative correlation in NOM. A very strong statistically significant positive correlation with perfect monotonic relation was noted in superficial cells in severe OED group and OSCC group. Conclusion: E-Cadherin and VEGF could be used as combination markers to predict the potential risk for malignant transformation in OEDs.

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Suffocation From Balloon Bronchoplasty

Negative pressure pulmonary edema is a well-described complication of upper airway obstruction. However, the simultaneous occurrence of blood-stained secretions and petechial tracheobronchial hemorrhage are rarely recognized and a potential complication of transient intentional occlusion of the airways. We described a case of "hemorrhagic bronchial mucosa syndrome" and asymptomatic blood-tinged pulmonary edema after balloon bronchoplasty for a concentric tracheal stenosis using a flexible bronchoscopy. This was characterized by interval appearance of diffuse petechial tracheobronchial bleeding and a persistent blood-tinged alveolar effluent after sustained occlusion of the airway. The simultaneous occurrence of both phenomena in this patient suggests different degrees of injury in a common pathogenic spectrum. We postulate that sustained, complete occlusion of the airway produces variable degrees of mechanical disruption of the bronchial and alveolar vasculature that lead to the development of negative pressure pulmonary edema and tracheobronchial hemorrhage. In this case, the syndrome was self-limited and without major consequences but highlights an unrecognized potential complication of balloon bronchoplasty.

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Is Septoplasty Necessary When Using the Endoscopic Endonasal Transsphenoidal Approach for a Deviated Nasal Septum?

J Neurol Surg B
DOI: 10.1055/s-0038-1641602

Objective This article describes the role played by endoscopic endonasal transsphenoidal approach (EETSA) to the sphenoidal process of the septal cartilage of a deviated nasal septum. Design Case series with chart review. Setting Tertiary referral center. Participants Between 2009 and 2016, 177 patients with skull base tumors who underwent EETSA were included. Main Outcome Measures In 8 cases, the conventional two nostrils–four hands technique was employed (group A). In 16 cases, we placed a right-side conventional nasoseptal flap and a left-side modified nasoseptal rescue flap (group B), and in 153 cases, bilateral modified nasoseptal rescue flaps (group C). The number of septoplasty-required cases and the change of nasal cavity area differences reflecting septal deviation were measured. Results Septoplasty during EETSA was performed in two cases: one from group B and one from group C. There was no significant difference in the ratio of septoplasty-required cases among the three groups (p = 0.127). Between pre- and postoperative nasal cavity, the cross-sectional area difference at the anterior end of the middle turbinate level significantly decreased (p = 0.045). Also, the angle of deviation at the level of ostiomeatal unit significantly decreased after EETSA (p < 0.001). Conclusion Separation of a deviated complex surrounding the sphenoidal process of the septal cartilage is the key to relieving a deviated nasal septum. EETSA combined with the two nostrils–four hands technique allows posterior septectomy (including removal of this deviated complex) to be performed. Thus, EETSA may commence without preceding septoplasty even in cases with severe nasal septum deviations.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Incidence of Prolonged Systemic Steroid Treatment after Surgery for Acoustic Neuroma and Its Implications

J Neurol Surg B
DOI: 10.1055/s-0038-1641752

Objectives To determine the incidence of prolonged postoperative systemic corticosteroid therapy after surgery for acoustic neuroma as well as the indications and associated risk factors that could lead to prolonged steroid administration, and the incidence of steroid-related adverse effects. Study Designs Retrospective chart review. Methods Retrospective chart review of patients undergoing resection of acoustic neuroma between 2010 and 2017 at two tertiary care medical centers. Patient and tumor characteristics, operative approach, hospital length of stay, initial postoperative taper length, number of discrete postoperative steroid courses, and postoperative complications were analyzed. Results There were 220 patients (99 male, 121 female) with an average age of 49.4 (range 16–78). There were 124 left-sided tumors and 96 right-sided tumors. Within the group, 191 tumors were operated through a retrosigmoid approach, 25 tumors through a translabyrinthine approach, and 4 tumors with a combined retrosigmoid–translabyrinthine approach under the same anesthetic. In total, 35 (15.9%) patients received an extended initial course of postoperative systemic steroids, defined as a taper longer than 18 days. Twenty six (11.8%) patients received additional courses of systemic steroids after the initial postoperative taper. There were 5 (2.3%) patients who required an extended initial taper as well as additional courses of steroids. Aseptic meningitis, often manifested as headache, was the most common indication for additional steroids (14 cases of prolonged taper and 17 cases of additional courses). None of the patient or tumor factors including age, gender, side, size, and approach were statistically significantly associated with either a prolonged initial steroid taper or additional courses of steroids. An extended hospital length of stay was associated with a prolonged initial steroid taper (p = 0.03), though the initial taper length was not predictive of additional courses of steroids. The cumulative number of days on steroids was associated with need for additional procedures (p < 0.01) as well as steroid-related side effects (p = 0.05). The administration of steroids was not found to significantly improve outcomes in postoperative facial paresis. Steroid-related complications were uncommon, seen in 9.26% of patients receiving steroids, with the most common being psychiatric side effects such as agitation, anxiety, and mood lability. Conclusions Systemic corticosteroids are routinely administered postoperatively for patients undergoing craniotomy for the resection of acoustic neuromas. In a review of 220 patients operated by a single neurotologist, no patient or tumor factors were predictive of requiring prolonged initial steroid taper or additional courses of steroids. The cumulative number of days on systemic steroids was associated with undergoing additional procedures and steroid-related side effects. The most common indications for prolonged or additional steroids were aseptic meningitis, cerebrospinal fluid leak, and facial paresis. Additional steroids for postoperative facial paresis did not significantly improve outcomes. Patient-reported steroid-related complications were infrequent and were most commonly psychiatric including agitation, anxiety, and mood lability.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Lumbar Puncture for the Injection of Intrathecal Fluorescein: Should It Be Avoided in a Subset of Patients Undergoing Endoscopic Endonasal Resection of Sellar and Parasellar Lesions?

J Neurol Surg B
DOI: 10.1055/s-0038-1635257

Objectives The use of intrathecal fluorescein (ITF) has become an increasingly adopted practice for the identification of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery for pituitary adenomas. Administration through lumbar puncture can result in postoperative positional headaches, increasing morbidity, cost, and length of stay. We sought to identify the incidence of and variables associated with postoperative headaches to determine if there was a subgroup of patients in whom this procedure should be avoided. Methods We conducted a retrospective single-institution review of 148 patients who underwent endoscopic resection with ITF for pituitary adenoma between December 2003 and February 2016. We excluded patients who had lumbar drains and with intraoperative CSF leak, as these patients may have other headache etiologies. Patient demographics, comorbidities, tumor features, surgical approach, surgical closure, and histology were recorded. Primary outcomes included the presence of postoperative and positional headaches. Results We identified 62 patients with postoperative headaches (41.9%) and 10 with positional headaches (6.8%), of whom 6 underwent blood patch with complete resolution. Following univariate analysis, there was a significant positive association with prolactin-secreting tumors (p = 0.008). There was a negative association with a history of hypertension (p = 0.0001) and age (p = 0.01). Following multivariate modeling, the significance for hypertension (p = 0.01) was preserved. Conclusions Positional headaches in patients who receive ITF are uncommon and should not limit its use in the preparations for endoscopic resection of pituitary adenomas. Avoiding ITF in younger patients without hypertension with prolactinomas might decrease the risk of post-ITF positional headaches.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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To Train or Not to Train: Admission of Pediatricians into Pediatric Rehabilitation Medicine Fellowships

For both scenarios, Dr Louise Spierre will argue for admitting pediatricians into PRM fellowship training programs, and Dr Robert Rinaldi will argue against admitting pediatricians into PRM fellowship training programs.

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Copyright Page

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Information for Authors

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Academy News – April PM&R Journal

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Table of Contents

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The Role of Physiatrists in Natural Disasters

After Hurricane Katrina hit New Orleans in 2005, the images and stories of the role of health care providers caused alarm. Questions of misconduct, extreme duress, and unimaginable choices emerged. In a recent article entitled, "The Duty of Mind: Ethical Capacity in a Time of Crisis [1]," the authors argue that "the physician is obliged to always make life-and-death decisions under conditions of maximal ethical clarity." (pg. 1) and that the stresses and chaos of a disaster can impact decision-making.

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Spanish Translated Abstracts

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Editorial Board

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Nasal polyposis (or chronic olfactory rhinitis)

Publication date: Available online 13 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): R. Jankowski, C. Rumeau, P. Gallet, D.T. Nguyen
The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis.



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Office-based endoscopic botulinum toxin injection in laryngeal movement disorders

Publication date: Available online 13 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Kaderbay, C.A. Righini, P.F. Castellanos, I. Atallah
IntroductionBotulinum toxin injection is widely used for the treatment of laryngeal movement disorders. Electromyography-guided percutaneous injection is the technique most commonly used to perform intralaryngeal botulinum toxin injection.ObjectiveWe describe an endoscopic approach for intralaryngeal botulinum toxin injection under local anaesthesia without using electromyography.TechniqueA flexible video-endoscope with an operating channel is used. After local anaesthesia of the larynx by instillation of lidocaine, a flexible needle is inserted into the operating channel in order to inject the desired dose of botulinum toxin into the vocal and/or vestibular folds.ConclusionEndoscopic botulinum toxin injection under local anaesthesia is a reliable technique for the treatment of laryngeal movement disorders. It can be performed by any laryngologist without the need for electromyography. It is easy to perform for the operator and comfortable for the patient.



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Clinical Next-Generation Sequencing for Precision Oncology in Rare Cancers

Background: The European Society for Medical Oncology defines rare cancers as 5 or fewer cases per 100,000 persons/year. For many rare cancers, no standard of care exists, and treatment is often extrapolated. Identifying potentially targetable genomic alterations is a rational approach to improving treatment options. We sought to catalog these mutations in rare tumors and assess their clinical utility. Methods: For this retrospective analysis, we selected rare tumors from a dataset of patients who underwent clinical genomic profiling. Sarcomas were excluded. To index potentially actionable alterations, patients' reports were reviewed for mutations in cancer associated genes and pathways. Respective records were abstracted to appraise the benefit of using a targeted therapy approach. Actionable alterations were defined as targeted by a drug available on-label, off-label, or in clinical trials. Results: The 95 patients analyzed had 40 different tumor subtypes, most common being adenoid cystic(13%), cholangiocarcinoma(7%), and metaplastic breast(6%). At least one genomic alteration was identified in 87 patients(92%). The most common identifiable mutations were in TP53(23%), KRAS(10%), PIK3CA(9%), CDKN2A/B(8%), BRAF(7%), MLL(7%), and ARID1A(6%). Thirty-six patients (38%) with 21 different tumors had at least one potentially actionable alteration. Thirteen patients received targeted therapy. Of these, 4 had a partial response, 6 had stable disease, and 3 had progressive disease as the best response. Conclusion: Addition of genomic profiling to management of rare cancers adds a potential line of therapy for cancers that have little or no standard of care. In our analysis, tumors with a BRAF alteration responded well to BRAF inhibitors.

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A short BRCA2-derived cell-penetrating peptide targets RAD51 function and confers hypersensitivity towards PARP inhibition

Under conditions of genotoxic stress, cancer cells strongly rely on efficient DNA repair to survive and proliferate. The human BRCA2 tumor suppressor protein is indispensable for the repair of DNA double-strand breaks by homologous recombination (HR) by virtue of its ability to promote RAD51 loading onto single-stranded DNA. Therefore, blocking the interaction between BRCA2 and RAD51 could significantly improve the efficacy of conventional anti-cancer therapies. However, targeting protein-protein interaction (PPI) interfaces has proven challenging because flat and large PPI surfaces generally do not support binding of small molecule inhibitors. In contrast, peptides are more potent for targeting PPIs but are otherwise difficult to deliver into cells. Here, we report that a synthetic 16-mer peptide derived from the BRC4 repeat motif of BRCA2 is capable of blocking RAD51 binding to BRCA2. Efficient non-cytotoxic cellular uptake of a nona-arginine (R9)-conjugated version of the BRC4 peptide interferes with DNA damage-induced RAD51 foci formation and HR. Moreover, transduction of the BRC4 peptide impairs replication fork protective function of BRCA2 and triggers MRE11-dependent degradation of nascent DNA in response to DNA replication stress. Finally, the BRC4 cell-penetrating peptide (CPP) confers selective hypersensitivity to PARP inhibition in cancer cells but spares non-cancerous cells. Taken together, our data highlight an innovative approach to develop novel peptide-based DNA repair inhibitors and establish BRCA2-derived CPPs as promising anti-cancer agents.

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Efficient gene silencing in brain tumors with hydrophobically modified siRNAs

Glioblastoma (GBM) is the most common and lethal form of primary brain tumor with dismal median and two-year survivals of 14.5 months and 18%, respectively. The paucity of new therapeutic agents stems from the complex biology of a highly adaptable tumor that uses multiple survival and proliferation mechanisms to circumvent current treatment approaches. Here, we investigated the potency of a new generation of small interfering RNAs (siRNAs) to silence gene expression in orthotopic brain tumors generated by transplantation of human glioma stem-like cells (GSCs) in athymic nude mice. We demonstrate that cholesterol-conjugated, nuclease-resistant siRNAs (Chol-hsiRNAs) decrease mRNA and silence luciferase expression by 90% in vitro in GBM neurospheres. Furthermore, Chol-hsiRNAs distribute broadly in brain tumors after a single intratumoral injection, achieving sustained and potent (>45% mRNA and >90% protein) tumor-specific gene silencing. This readily available platform is sequence-independent and can be adapted to target one or more candidate GBM driver genes, providing a straightforward means of modulating GBM biology in vivo.

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RAS-MAPK reactivation facilitates acquired resistance in FGFR1-amplified lung cancer and underlies a rationale for upfront FGFR-MEK blockade

The Fibroblast Growth Factor Receptor (FGFR) kinases are promising therapeutic targets in multiple cancer types including lung and head and neck squamous cell carcinoma, cholangiocarcinoma and bladder cancer. Although several FGFR kinase inhibitors have entered clinical trials, single agent clinical efficacy has been modest and resistance invariably occurs. We therefore conducted a genome-wide functional screen to characterize mechanisms of resistance to FGFR inhibition in a FGFR1-dependent lung cancer cellular model. Our screen identified known resistance drivers, such as MET, and additional novel resistance mediators including members of the neurotrophin receptor pathway (NTRKs), the TAM family of tyrosine kinases (TYRO3, MERTK, AXL) and MAPK pathway, which were further validated in additional FGFR-dependent models. In an orthogonal approach, we generated a large panel of resistant clones by chronic exposure to FGFR inhibitors in FGFR1- and FGFR3-dependent cellular models, and characterized gene expression profiles employing the L1000 platform. Notably, resistant clones had enrichment for NTRK and MAPK signaling pathways. Novel mediators of resistance to FGFR inhibition were found to compensate for FGFR loss in part through reactivation of MAPK pathway. Intriguingly, co-inhibition of FGFR and specific receptor tyrosine kinases identified in our screen was not sufficient to suppress ERK activity or to prevent resistance to FGFR inhibition, suggesting a redundant re-activation of RAS-MAPK pathway. Dual blockade of FGFR and MEK, however, proved to be a more powerful approach in preventing resistance across diverse FGFR-dependencies, and may represent a therapeutic opportunity to achieve durable responses to FGFR inhibition in FGFR-dependent cancers.

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Antibody dependent cellular phagocytosis by macrophages is a novel mechanism of action of elotuzumab.

Elotuzumab, a recently approved antibody for the treatment of multiple myeloma (MM), has been shown to stimulate Fc receptor (FcR)-mediated antibody-dependent cellular cytotoxicity (ADCC) by natural killer (NK) cells towards myeloma cells. The modulatory effects of elotuzumab on other effector cells in the tumor microenvironment, however, has not been fully explored. Antibody dependent cellular phagocytosis (ADCP) is a mechanism by which macrophages contribute to anti-tumor potency of monoclonal antibodies. Herein, we studied the NK cell independent effect of elotuzumab on tumor associated macrophages (TAMs) using a xenograft tumor model deficient in NK and adaptive immune cells. We demonstrate significant anti-tumor efficacy of single agent elotuzumab in immunocompromised xenograft models of multiple myeloma, which is in part mediated by Fc-FcR interaction of elotuzumab with macrophages. Elotuzumab is shown in this study to induce phenotypic activation of macrophages in-vivo and mediates ADCP of myeloma cells though a FcR dependent manner in-vitro. Together, these findings propose a novel immune mediated mechanism by which elotuzumab exerts anti-myeloma activity and helps to provide rationale for combination therapies that can enhance macrophage activity.

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Induced Telomere Damage to Treat Telomerase Expressing Therapy-Resistant Pediatric Brain Tumors

Brain tumors remain the leading cause of cancer-related deaths in children and often are associated with long-term sequelae among survivors of current therapies. Hence, there is an urgent need to identify actionable targets and to develop more effective therapies. Telomerase and telomeres play important roles in cancer, representing attractive therapeutic targets to treat children with poor-prognosis brain tumors such as diffuse intrinsic pontine glioma (DIPG), high-grade glioma (HGG) and high-risk medulloblastoma (MB). We have previously shown that DIPG, HGG and MB frequently express telomerase activity. Here we show that the telomerase-dependent incorporation of 6-thio-2'deoxyguanosine (6-thio-dG), a telomerase substrate precursor analog, into telomeres leads to telomere dysfunction-induced foci (TIFs) along with extensive genomic DNA damage, cell growth inhibition and cell death of primary stem-like cells derived from patients with DIPG, HGG and MB. Importantly, the effect of 6-thio-dG is persistent even after drug withdrawal. Treatment with 6-thio-dG elicits a sequential activation of ATR and ATM pathways, and induces G2/M arrest. In vivo, treatment of mice bearing MB xenografts with 6-thio-dG delays tumor growth, increases in-tumor TIFs and apoptosis. Furthermore, 6-thio-dG crosses the blood-brain barrier and specifically targets tumor cells in an orthotopic mouse model of DIPG. Together, our findings suggest that 6-thio-dG is a promising novel approach to treat therapy-resistant telomerase-positive pediatric brain tumors.

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Photodynamic Therapy Using Indocyanine Green Loaded on Super Carbonate Apatite as Minimally Invasive Cancer Treatment

Minimally invasive treatment is getting more and more important in an aging society. The purpose of this study was to explore the possibility of ICG loaded on super carbonate apatite (sCA) nanoparticles as a novel photodynamic therapy (PDT) against cancers. Using colon cancer cells, ICG uptake and anti-tumor effects were examined between the treatments of ICG and sCA-ICG. Reactive oxygen species (ROS) production and temperature rise were also evaluated to explore the underlying mechanism. Atomic force microscopy revealed that the size of sCA-ICG ranged from 10 to 20 nm. In aqueous solution with 0.5% albumin, the temperature increase after laser irradiation was 27.1°C and 23.1°C in sCA-ICG and ICG, respectively (control DW: 5.7oC). A significant increase in ROS generation was noted in cell cultures treated with sCA-ICG plus irradiation compared to those treated with ICG plus irradiation (P<0.01). Uptake of ICG in the tumor cells significantly increased in sCA-ICG compared with ICG in vitro and in vivo. The fluorescence signals of ICG in the tumor, liver, and kidney faded away in both treatments by 24 h. Finally, the HT29 tumors treated with sCA-ICG followed by irradiation exhibited drastic tumor growth retardation (P<0.01), whereas irradiation of tumors after injection of ICG did not inhibit tumor growth. This study shows that sCA is a useful vehicle for ICG-based PDT. Quick withdrawal of ICG from normal organs is unique to sCA-ICG and contrasts to the other nanoparticles remaining in normal organs for a long time.

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Mechanistic Investigations of Diarrhea Toxicity Induced by anti-HER2/3 Combination Therapy

Combination of targeted therapies is expected to provide superior efficacy in the treatment of cancer either by enhanced anti-tumor activity or by preventing or delaying the development of resistance. Common challenges in developing combination therapies include the potential of additive and aggravated toxicities associated with pharmacologically-related adverse effects. We have recently reported that combination of anti-HER2 and anti-HER3 antibodies, pertuzumab and lumretuzumab, along with paclitaxel chemotherapy in metastatic breast cancer resulted in a high incidence of diarrhea that ultimately limited further clinical development of this combination. Here, we further dissected the diarrhea profile of the various patient dose cohorts and carried out in vitro investigations in human colon cell lines and explants to decipher the contribution and the mechanism of anti-HER2/3 therapeutic antibodies to intestinal epithelium malfunction. Our clinical investigations in patients revealed that while dose reduction of lumretuzumab, omission of pertuzumab loading dose and introduction of a prophylactic anti-diarrheal treatment reduced most severe adverse events, patients still suffered from persistent diarrhea during the treatment. Our in vitro investigations showed that pertuzumab and lumretuzumab combination treatment resulted in up-regulation of chloride channel activity without indication of intestinal barrier disruption. Overall, our findings provide a mechanistic rationale to explore alternative of conventional anti-gut motility using medication targeting chloride channel activity to mitigate diarrhea of HER combination therapies.

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Resistance to Antibody-Drug Conȷugates

Antibody–drug conjugates (ADC) are multicomponent molecules constituted by an antibody covalently linked to a potent cytotoxic agent. ADCs combine high target specificity provided by the antibody together with strong antitumoral properties provided by the attached cytotoxic agent. At present, four ADCs have been approved and over 60 are being explored in clinical trials. Despite their effectiveness, resistance to these drugs unfortunately occurs. Efforts to understand the bases underlying such resistance are being carried out with the final purpose of counteracting them. In this review, we report described mechanisms of resistance to ADCs used in the clinic along with other potential ones that may contribute to resistance acquisition. We also discuss strategies to overcome resistance to ADCs. Cancer Res; 1–7. ©2018 AACR.

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Mitotic Exit dysfunction through the deregulation of APC/C characterizes cisplatin resistant state in epithelial ovarian cancer

Purpose: Acquired resistance to cisplatin is a major barrier to success in treatment of various cancers and understanding mitotic mechanisms unique to cisplatin resistant cancer cells can provide the basis for developing novel mitotic targeted therapies aimed at eradicating these cells. Experimental Design: Using cisplatin resistant models derived from primary patient epithelial ovarian cancer (EOC) cells, we have explored the status of mitotic exit mechanisms in cisplatin resistant cells. Results: We have uncovered an unexpected role of long-term cisplatin treatment in inducing mitotic exit vulnerability characterized by increased spindle checkpoint activity and functional dependency on Polo-like kinase 1 (PLK1) for mitotic exit in the presence of Anaphase Promoting Complex/Cyclosome (APC/C) dysfunction in a cisplatin resistant state. Accordingly, PLK1 inhibition decreased the survival of cisplatin resistant cells in-vitro and in-vivo, and exacerbated spindle checkpoint response in these cells. APC/C ^CDC20 inhibition increased sensitivity to pharmacologic PLK1 inhibition further confirming the existence of APC/C dysfunction cisplatin resistant cells. In addition, we uncovered that resistance to Volasertib, PLK1 inhibitor, is due to maintenance of cells with low PLK1 expression. Accordingly, stable PLK1 downregulation in cisplatin resistant cells induced tolerance to Volasertib. Conclusions: We provide the first evidence of APC/C dysfunction in cisplatin resistant state, suggesting that understanding APC/C functions in cisplatin resistant state could provide basis for developing novel mitotic exit based therapies to eradicate cisplatin resistant cancer cells. Our results also show that PLK1 down-regulation could underlie emergence of resistance to PLK1 targeted therapies in cancers.

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Spectrophotometric analysis of discoloration and internal bleaching after use of different antibiotic pastes

Abstract

Objectives

To investigate teeth's antibiotic-induced color differences after bleaching using two different techniques.

Materials and methods

One hundred twenty extracted maxillar human incisors were examined. The specimens were randomly divided into six groups, each receiving one of six antibiotic paste fillings: (1) triple antibiotic paste (TAP) with minocycline, (2) double antibiotic paste (DAP), (3) TAP with amoxicillin, (4) TAP with cefaclor, (5) TAP with doxycycline, and (6) no filling (control group). Spectrophotometric measurements were obtained at baseline and then during the first, second, and third weeks after paste placement. The specimens discolored by antibiotics pastes were randomly divided into two subgroups: (1) internal bleaching with hydrogen peroxide (H₂O₂₎ and (2) internal bleaching with H₂O₂ plus Nd-YAG laser irradiation. The ∆E value was calculated and analyzed using a two-way analysis of variance and post-hoc Tukey's test (α = 0.05).

Results

The ∆E for all groups showed color differences exceeding the perceptibility threshold (∆E ˃ 3.7) at all time points except in the control and DAP groups. Minocycline-induced TAP showed the most severe coronal discoloration (32.42). When the ∆E was examined, thermo/photo bleaching (22.01 ± 8.23) caused more bleaching than walking bleaching (19.73 ± 5.73) at every time point (P = 0.19). No group returned to the original color after bleaching (P < 0.05).

Conclusions

Except for DAP, all antibiotic pastes caused discoloration. Internal bleaching with Nd-YAG laser can be useful for bleaching/removing this discoloration.

Clinical relevance

For clinically successful final appearances, understanding the effects of bleaching procedures on antibiotic paste discoloration is important.

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Otometrics Unveils the Next Generation Bio-logic solutions

​Otometrics has introduced the next generation Bio-logic® solutions. Bio-logic has been the trusted brand among professionals for easy-to-use and accurate hearing diagnostics and screening since 1979. Natus Medical Incorporated acquired Bio-logic in 2006 and today Otometrics is reintroducing this legacy brand as part of its global portfolio. "Bio-logic is a well-loved brand with a proud legacy of providing reliable testing," said Mona Dworsack, AuD, Global Director of Product Management, Hearing Assessment and Screening."Our innovation is inspired by the professional's work flow. Our next generation Bio-logic products offer a range of test combinations in a single device – so it's easy to adapt to changing patient needs." 

Bio-logic diagnostic solutions are especially well suited for audiologists who need space-saving devices that are efficient and flexible. Powered by advanced modular technology, the next generation Bio-logic allows screeners to choose a test combination to suit the needs of their clinic​. Four new Bio-logic products will be on display at AAA 2018 booth #621. The products are available for sale in select countries at the conclusion of the conference. Existing Bio-logic users and Otometrics customers are encouraged to contact their local Otometrics/Audiology Systems representatives to start customizing their next generation Bio-logic solution. 

Published: 4/13/2018 5:50:00 PM

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Eosera to Expand Cerumen Removal Product Line

​Eosera (https://earcaremd.com/), the maker of Earwax MD, is releasing new cerumen-targeted products, and will be offering a sneak peek at all the new products at AudiologyNow! 2018 in Nashville, TN. Among Eosera's new products to be unveiled is WaxBlaster MD, a rinsing device to be used after cleaning the ear canal with Earwax MD. Elyse Dickerson, co-founder and CEO of Eosera, said the market has responded well to Earwax MD since last year when it was first introduced. "In retailers carrying the product, dollar sales are up over 18 percent in the ear care category. This growth is primarily driven by the introduction of Earwax MD," Dickerson said. Eosera will sell the products directly and via various resellers for sale in-clinic. At AudiologyNow! 2018, attendees can find out more about Earwax MD and Eosera's new products, including WaxBlaster MD, at Booth 434​. 

Published: 4/13/2018 5:47:00 PM

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Evaluating the Training of Chinese-Speaking Community Health Workers to Implement a Small-Group Intervention Promoting Mammography

Abstract

This study evaluated the training of Chinese American Community Health Workers (CHWs) to implement a small-group mammography video and discussion program as part of a randomized controlled trial that had the goal to increase adherence to mammography screening guidelines among Chinese American women. A total of 26 Chinese American CHWs in the metropolitan Washington DC area, Southern California, and New York City participated in a 4-h training workshop and completed surveys before and after the workshop to assess their knowledge regarding mammography screening guidelines and human subjects protection rules. The results showed significantly increased knowledge of mammography screening guidelines and human subjects protection rules (both p < 0.01) after the training. CHWs were also trained to lead a discussion of the video, including screening benefits and misconceptions. Forty-three audio recordings of discussions led by 13 active CHWs were transcribed and qualitatively analyzed to assess implementation fidelity. Ten out of 13 active CHWs fully addressed about 3 of the 5 benefit items, and 11 out of 13 CHWs fully addressed more than 5 of the 9 misconception items. Chinese CHWs can be trained to implement research-based intervention programs. However, a one-time training resulted in moderate adherence to the discussion protocol. Ongoing or repeat trainings throughout the intervention period may be needed to enhance implementation fidelity.

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Noninflammatory Diffuse Follicular Hypertrophy/Hyperplasia of Graves Disease: Morphometric Evaluation in an Experimental Mouse Model

Objectives: Experimental models of Graves hyperthyroid disease accompanied by Graves orbitopathy (GO) can be efficiently induced in susceptible inbred strains of mice by immunization by electroporation of heterologous human TSH receptor (TSHR) A-subunit plasmid. The interrelated pathological findings in the thyroid glands of Graves disease (GD) that explain the core changes classically include diffuse follicular hyperplasia and multifocal mild lymphocytic infiltrate. However, the relative contributions of different thyroid tissue components (colloid, follicular cells, and stroma) have not been previously evaluated. In this study, we characterize the thyroid gland of an experimental mouse model of autoimmune GD. Our objective was to define the relative contribution of the different thyroid tissue components to the pathology of glands in the experimental model. Methods: Mice were immunized with human TSHR A-subunit plasmid. Antibodies induced to human TSHR were pathogenic in vivo due to their cross-reactivity to mouse TSHR. Results: Autoimmune thyroid disease in the model was characterized by histopathology of hyperplastic glands with large follicular cells. Further examination of thyroid glands of immunized animals revealed a significantly increased follicular area and follicle/stroma ratio, morphometrically correlated with a noninflammatory follicular hyperplasia/hypertrophy. The increased follicle/stroma ratio was the most relevant morphometrically variable summarizing the pathological changes for screening purposes. Conclusion: GD thyroid glands are enlarged and characterized by a noninflammatory diffuse follicular cell hyperplasia/hypertrophy and a significant increase in the follicles with an increased follicle/stroma ratio. Overall, this mouse model is a faithful model of an early hyperthyroid status of GD (diffuse glandular involvement and follicular expansion).
Eur Thyroid J

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Appearance on face reading (cheek line) after orthognathic surgery

Publication date: Available online 12 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Y.-C. Tseng, H.-J. Chen, J.-H. Cheng, P.-H. Chen, C.-Y. Pan, S.-T. Chou, C.-M. Chen
The cheek line (face reading) is an aesthetic element of the facial profile. The purpose of our study was to investigate the changes in the cheek line after mandibular setback surgery. Forty patients (20 female and 20 male, mean (SD) age 22 (5) years) were diagnosed with mandibular prognathism and treated by intraoral vertical ramus osteotomy alone. Cephalograms were obtained before operation (T1), at least a year postoperatively (T2), and final surgical changes over a year (T2-T1). The cheek line and landmarks (soft and hard tissues) were compared using the paired t test. The hypothesis was that the cheek line did not change significantly after mandibular setback. At the time of the final follow-up (T2-T1), the mean (SD) horizontal setback of pogonion (Pog) was 12.3 (3.5) mm for women and 11.7 (4.3) mm for men. The ratios of soft:hard tissue, labrale inferius:incisor inferius, labiomental sulcus:point B, soft tissue Pog:Pog, and cheek point:Pog in women were 0.96, 0.98, 0.98, and 0.08, and in men 0.91, 1.01, 0.94, and 0.13, respectively. The nasolabial and cervicomental angles in women were significantly increased by 11.1° and 11.4°, respectively, and in men the nasolabial angle was significantly increased by 11.1° and the mentolabial angle reduced by 9.9°. The cheek line (T2-T1) was moved significantly forwards. The hypothesis was therefore rejected. In conclusion, the cheek line was advanced significantly after isolated mandibular setback.



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Re: Is a fractured mandible an emergency?

Publication date: Available online 12 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T.F.A. Lees, G.J. Knepil




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