OtoRhinoLaryngology News

Σάββατο 12 Αυγούστου 2017

Acceptance in chronic neck pain: associations with disability and fear avoidance beliefs

Chronic neck pain can result in significant levels of disability. Physiotherapy treatments often aim to modify cognitive factors and this approach benefits some, but not all, patients. Research from other pain conditions suggests that acceptance may be related to disability; however, it is unclear whether these associations exist in patients with neck pain. Moreover, it is unclear to what extent other cognitive factors are related to acceptance. Feasibly, if these factors are related, existing treatments may already be indirectly modifying acceptance. The aim of this study was therefore to establish the associations between acceptance and disability, and between acceptance and other cognitive factors. Cross-sectional data were collected from 149 patients and regression analyses were carried out. In the first analysis, disability was the dependent variable and the proportion of variance explained by two acceptance subscales (activities engagement and pain willingness) was calculated. In the second analyses, the acceptance subscales were the dependent variables. Measures of pain-related fear, catastrophizing and pain vigilance and awareness were entered as explanatory variables and the proportion of variance explained was calculated. In the first analysis, acceptance explained 18% of variance in disability (P

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Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients

To study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman's correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79–0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

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Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study

The aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants' ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA.

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Fatigue and physical fitness of mildly disabled persons with multiple sclerosis: a cross-sectional study

Fatigue is frequent and disabling in persons with multiple sclerosis (pwMS) with mild neurological disability. These patients also have impaired physical fitness. Whether mildly disabled pwMS are deconditioned, and this deconditioning is linked to fatigue, remains unknown. Our aim is to determine the physical fitness of mildly disabled patients with multiple sclerosis and study its relationship with perceived fatigue and to link perceived fatigue with other parameters. Twenty patients (14 women; mean age: 45.5 years) with mild disability (Expanded Disability Status Scale 0–4) underwent a 2-min walking test, Timed Up-and-Go test, aerobic capacity testing, and isometric knee extension testing to assess strength and neuromuscular fatigability. They completed questionnaires assessing perceived fatigue, psychological status, and physical activity. Correlation coefficients and multivariate regression were used to analyze the relationships among variables. Seventeen (85%) patients reported a high level of fatigue. Thirteen (65%) patients had subnormal aerobic capacity. Fatigue was weakly to moderately associated with aerobic capacity, mobility, walking capacity, depression, and neuromuscular fatigability. An association of disease duration, aerobic capacity, and the neuromuscular fatigability index explained 65.1% of fatigue. A high proportion of pwMS with mild neurological disability are fatigued and deconditioned. Perceived fatigue is linked to aerobic capacity, neuromuscular fatigability, depression, mobility, and walking capacity. Focusing on these parameters could help in the management of fatigue.

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Rasch validation and comparison of Slovenian, Croatian, and Italian versions of the Mini-BESTest in patients with subacute stroke

We aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get Up & Go; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability–item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.

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The concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis

This study aims to investigate the concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis against the Flexicurve. Thirty-three healthy individuals (age: 31±11.0 years, men: 17, height: 170.2±8.2 cm, weight: 64.2±12.0 kg) participated, with 29 re-examined for intrarater reliability 1–7 days later. Thoracic kyphosis was measured using the Flexicurve and the Microsoft Kinect consecutively in both standing and sitting positions. Both the kyphosis index and angle were calculated. The Microsoft Kinect showed excellent concurrent validity (intraclass correlation coefficient=0.76–0.82) and reliability (intraclass correlation coefficient=0.81–0.98) for measuring thoracic kyphosis (angle and index) in both standing and sitting postures. This study is the first to show that the Microsoft Kinect has excellent validity and intrarater reliability to measure thoracic kyphosis, which is promising for its use in the clinical setting.

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Evaluating and Refining Alkalinity Calculations Due to Sulfide and Bicarbonate Accessed by Titration in Anaerobic Sulfate-Reducing Bioreactors

Abstract

An anaerobic down-flow fixed-structured bed reactor (DFSBR) treating synthetic acid mine drainage (AMD) presented significant drops in alkalinity (from 2.45 to 1.30 g CaCO₃ L⁻¹) simultaneously with sulfide (HS⁻) precipitation induced by iron addition. To clarify this observation, the theoretical speciation of sulfide in aqueous solution was used to estimate the contribution of HS⁻ for the global alkalinity of the system. Standard solutions of bicarbonate (HCO₃⁻) and sulfide (HS⁻) were used to validate the proposed calculations for sulfide and bicarbonate alkalinities. The extent of buffer capacity of sulfide alkalinity under an overload of VFA was also evaluated. An overall assessment of the data obtained from the DFSBR showed that a concentration of total dissolved sulfide (TDS) close to 430 mg L⁻¹ at pH = 8.48 (424 mg HS⁻ L⁻¹) provided an effluent alkalinity of 642 mg CaCO₃ L⁻¹ exclusively due to HS⁻. Therefore, the refined calculations, presented and discussed in this paper, can be considered suitable to differentiate the fractions of alkalinity due to HS⁻ and HCO₃⁻ obtained by titration. This novel approach provides a better characterization of the buffer capacity in anaerobic systems, mainly in order to avoid an overestimation of the HCO₃⁻ produced by the sulfate-reducing bacteria (SRB) metabolism and to predict the potential alkalinity loss by sulfide removal.

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Spread of Water-Borne Pollutants at Traffic Accidents on Roads

Abstract

Traffic accidents sometimes lead to the spread of hazardous compounds to the environment. Accidental spills of hazardous compounds on roads in the vicinity of vulnerable objects such as water supplies pose a serious threat to water quality and have to be assessed. This study compared three different assessment methods, electrical resistivity measurements, analytical flow calculations, and 1D and 2D dynamic flow modeling, to describe rapid transport processes in the road shoulder and roadside verge after a major spill. The infiltration and flow paths of water-borne substances were described during simulated discharge of pollutants on different road types. Full-scale tracer tests using sodium chloride were carried out at nine different road locations in Sweden. Analysis of grain size distribution and infiltrometer tests were carried out at the road shoulder and verges. The pathways and travel times were traced using resistivity measurements and 3D inverse modeling. The resistivity measurements were compared to analytical flow calculations and 1D and 2D dynamic modeling. All measurement sites were highly heterogeneous, which caused preferential flow. Vertical flow velocities of 1.4–8.6 × 10⁻⁴ m/s were measured. The results of the analytical calculations and flow modeling were of the same order of magnitude. The measurements showed that almost all infiltration goes directly into the road embankment, hence the composition and structure of the built-up road must be considered. The non-destructive resistivity measurements and 3D modeling provided useful information for clarifying the infiltration and flow pattern of water-borne compounds from road runoff.

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Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Cancer Biol Ther. 2017 Aug 11;:0

Authors: Li MY, Liu JQ, Chen DP, Li ZY, Qi B, He L, Yu Y, Yin WJ, Wang MY, Lin L

Abstract
Nasopharyngeal carcinoma (NPC) is a common malignant neoplasm of the head and neck which is harmful to human's health. Radiotherapy is commonly used in the treatment of NPC and it induces immediate cell cycle arrest and cell apoptosis. However, the mechanism remains unknown. Evidences suggested the activation of Ataxia telangiectasia mutated (ATM) pathway and Smad pathway are two of the important crucial mediators in the function of radiotherapy. In this study, we carried out in vitro assays with human nasopharyngeal carcinoma CNE-2 cells and in vivo assays with nude mice to investigate the role of the ATM and Smad pathways in the treatment of nasopharyngeal carcinoma with radiotherapy. The results suggested that radiation induced activation of ATM pathway by inducing expression of p-ATM, p-CHK1, p-CHK2, p15 and inhibiting expression of p-Smad3. In addition, Caspase3 expression was increased while CDC25A was decreased, leading to cell cycle arrest and cell apoptosis. On the other hand, activation of Smad3 can inhibited the ATM pathway and attenuated the efficacy of radiation. In summary, we suggest that both ATM and Smad pathways contribute to the cell cycle arrest and cell apoptosis during nasopharyngeal carcinoma cells treated with radiation.

PMID: 28799829 [PubMed - as supplied by publisher]

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Atmospheric emission of NOx from mining explosives: A critical review

Publication date: October 2017
Source:Atmospheric Environment, Volume 167
Author(s): Ibukun Oluwoye, Bogdan Z. Dlugogorski, Jeff Gore, Hans C. Oskierski, Mohammednoor Altarawneh
High-energy materials such as emulsions, slurries and ammonium-nitrate fuel-oil (ANFO) explosives play crucial roles in mining, quarrying, tunnelling and many other infrastructure activities, because of their excellent transport and blasting properties. These explosives engender environmental concerns, due to atmospheric pollution caused by emission of dust and nitrogen oxides (NOx) from blasts, the latter characterised by the average emission factor of 5 kg (t AN explosive)⁻¹. This first-of-its-kind review provides a concise literature account of the formation of NOx during blasting of AN-based explosives, employed in surface operations. We estimate the total NOx emission rate from AN-based explosives as 0.05 Tg (i.e., 5 × 10⁴ t) N per annum, compared to the total global annual anthropogenic NOx emissions of 41.3 × 10⁶ t N y⁻¹. Although minor in the global sense, the large localised plumes from blasting exhibit high NOx concentration (500 ppm) exceeding up to 3000 times the international standards. This emission has profound consequences at mining sites and for adjacent atmospheric environment, necessitating expensive management of exclusion zones. The review describes different types of AN energetic materials for civilian applications, and summarises the essential properties and terminologies pertaining to their use. Furthermore, we recapitulate the mechanisms that lead to the formation of the reactive nitrogen species in blasting of AN-based explosives, review their implications to atmospheric air pollution, and compare the mechanisms with those experienced in other thermal and combustion operations. We also examine the mitigation approaches, including guidelines and operational-control measures. The review discusses the abatement technologies such as the formulation of new explosive mixtures, comprising secondary fuels, spin traps and other additives, in light of their effectiveness and efficiency. We conclude the review with a summary of unresolved problems, identifying possible future developments and their impacts on the environment with emphasis on local and workplace loads.

Graphical abstract

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Trees in urban parks and forests reduce O3, but not NO2 concentrations in Baltimore, MD, USA

Publication date: October 2017
Source:Atmospheric Environment, Volume 167
Author(s): Vesa Yli-Pelkonen, Anna A. Scott, Viljami Viippola, Heikki Setälä
Trees and other vegetation absorb and capture air pollutants, leading to the common perception that they, and trees in particular, can improve air quality in cities and provide an important ecosystem service for urban inhabitants. Yet, there has been a lack of empirical evidence showing this at the local scale with different plant configurations and climatic regions. We studied the impact of urban park and forest vegetation on the levels of nitrogen dioxide (NO2) and ground-level ozone (O3) while controlling for temperature during early summer (May) using passive samplers in Baltimore, USA. Concentrations of O3 were significantly lower in tree-covered habitats than in adjacent open habitats, but concentrations of NO2 did not differ significantly between tree-covered and open habitats. Higher temperatures resulted in higher pollutant concentrations and NO2 and O3 concentration were negatively correlated with each other. Our results suggest that the role of trees in reducing NO2 concentrations in urban parks and forests in the Mid-Atlantic USA is minor, but that the presence of tree-cover can result in lower O3 levels compared to similar open areas. Our results further suggest that actions aiming at local air pollution mitigation should consider local variability in vegetation, climate, micro-climate, and traffic conditions.

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Origin of the water-soluble organic nitrogen in the maritime aerosol

Publication date: October 2017
Source:Atmospheric Environment, Volume 167
Author(s): Kiyoshi Matsumoto, Yuya Yamamoto, Kotaro Nishizawa, Naoki Kaneyasu, Tomohisa Irino, Hisayuki Yoshikawa-Inoue
In order to clarify the production process for the particulate WSON in the maritime atmosphere, measurements of the WSON and the associated species in the aerosols were conducted at the coastal site on Rishiri Island near the northern tip of Japan. The mean concentration of the WSON in the aerosols was 0.077 μg m⁻³, which was within the previous measurements from the remote or rural clean sites. The WSON accounted for about 13% of the WSTN in the aerosols, and about 90% of the WSON was detected in the fine-mode range (d < 2 μm). The WSON in both mode ranges was not associated with the air mass origin. The fine-mode WSON was correlated with nss-SO4^2- whether nss-SO4^2- was derived from anthropogenic or marine biogenic sources, suggesting that the WSON in the fine-mode range would be produced by the secondary processes in the acid particulate phase. EC and nss-K⁺, on the other hand, were not associated with the WSON in the fine-mode range, suggesting that the primary emissions from fossil fuel and/or biomass combustion are not important sources for the WSON. The coarse-mode WSON was not associated with any species. Negligible influence of dust particles and plant debris on coarse particle would cause very low concentrations of the WSON in the coarse-mode range.

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Bacterial abundance and viability in rainwater associated with cyclones, stationary fronts and typhoons in southwestern Japan

Publication date: October 2017
Source:Atmospheric Environment, Volume 167
Author(s): Wei Hu, Kotaro Murata, Satoshi Toyonaga, Daizhou Zhang
The abundance and viability of bacterial cells in rainwater at a suburban site in southwestern Japan between October 2014 and September 2015 were measured and their distinctiveness, according to synoptic weather systems, i.e., cyclones (cold fronts), stationary fronts (including Meiyu and non-Meiyu fronts) and typhoons, was examined. On average, the cell concentration of bacteria in the rainwater was 2.3 ± 1.5 × 10⁴ cells mL⁻¹, and bacterial viability, the ratio of viable cells to total cells, was 80 ± 10%. In the rainwater of cyclones when clouds were induced by the intrusion of continental air, the bacterial concentration was higher (3.5 ± 1.6 × 10⁴ cells mL⁻¹) and the viability was lower (75 ± 8%) than in the rainwater of other types. In the rainwater of Meiyu fronts and typhoons when clouds were significantly influenced by marine air, bacterial concentrations were 1.5 ± 0.5 × 10⁴ and 1.2 ± 0.3 × 10⁴ cells mL⁻¹, and bacterial viabilities were 84 ± 7% and 85 ± 7%, respectively. In the rainwater of non-Meiyu stationary fronts, the bacterial concentration was 2.4 ± 1.6 × 10⁴ cells mL⁻¹, and the viability was 78 ± 14%. Abundant bacteria were associated with ions nss-SO4²⁻, nss-Ca²⁺, and NO3⁻ in rainwater, but bacterial concentrations did not correlate with the ratios of airborne particle concentrations to the precipitation amounts. Further investigations with correlation and principal component analysis combining bacteria and ion species revealed that bacteria in the rainwater were likely enclosed in clouds at the stage of cloud formation in addition to below-cloud removal, and bacteria involved in the rainwater did not show confirmable growth.

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Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control

Abstract

Background

Despite intensive training, a few individuals with Type 1 diabetes mellitus (T1DM) fail to reach the desired metabolic targets.

Aim

To evaluate the association between disease-related emotional and cognitive aspects and metabolic control in subjects with T1DM.

Subjects and methods

Health locus of control (HLOC), sense of coherence (SOC), and self-esteem were assessed in T1DM subjects using validated questionnaires. Sixty-seven consecutive subjects who did not attain the desired HbA1c target (mean HbA1c, 8.3% [67 mmol/mol]) were compared with 30 cases in satisfactory metabolic control (HbA1c levels <7%–53 mmol/mol).

Results

In the overall population, SOC was negatively associated with BMI and average HbA1c, as was the association of self-esteem with HbA1c. Subjects attaining the desired metabolic target were characterized by higher SOC scores, higher Internal HLOC and prevalent Internal vs. Powerful-others HLOC. Compared to subjects in good metabolic control, subjects with unsatisfactory control had lower scores of SOC, Internal HLOC and Self-esteem, with no difference in Powerful others, or Chance HLOC. In the same group, SOC in the upper tertile was significantly associated with self-esteem (OR 1.35; 95% CI 1.08–1.69) and PHLOC (OR 1.24; 95% CI 1.03–1.49), after adjustment for age, sex, educational level, and comorbidities.

Conclusions

Patients who fail to reach a satisfactory metabolic control tend to rely on significant others, trusting in the physicians' skills or on the efficiency of the health-care system. Strategies aimed at increasing self-efficacy and SOC, based on personal ability, are eagerly awaited to help patients improve diabetes care.

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Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Cancer Biol Ther. 2017 Aug 11;:0

Authors: Li MY, Liu JQ, Chen DP, Li ZY, Qi B, He L, Yu Y, Yin WJ, Wang MY, Lin L

PMID: 28799829 [PubMed - as supplied by publisher]

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Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control

Abstract

Background

Despite intensive training, a few individuals with Type 1 diabetes mellitus (T1DM) fail to reach the desired metabolic targets.

Aim

To evaluate the association between disease-related emotional and cognitive aspects and metabolic control in subjects with T1DM.

Subjects and methods

Results

Conclusions

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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Int J Audiol. 2004;43(2):61-65

Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD

Abstract
The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.

PMID: 28793845 [PubMed]

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Modelling the risk of noise-induced hearing loss among military pilots.

Modelling the risk of noise-induced hearing loss among military pilots.

Int J Audiol. 2004;43(2):79-84

Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ

Abstract
Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.

PMID: 28793844 [PubMed]

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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Int J Audiol. 2004;43(2):61-65

Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD

PMID: 28793845 [PubMed]

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Modelling the risk of noise-induced hearing loss among military pilots.

Modelling the risk of noise-induced hearing loss among military pilots.

Int J Audiol. 2004;43(2):79-84

Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ

PMID: 28793844 [PubMed]

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Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Radiotherapy induces cell cycle arrest and cell apoptosis in nasopharyngeal carcinoma via the ATM and Smad pathways.

Cancer Biol Ther. 2017 Aug 11;:0

Authors: Li MY, Liu JQ, Chen DP, Li ZY, Qi B, He L, Yu Y, Yin WJ, Wang MY, Lin L

PMID: 28799829 [PubMed - as supplied by publisher]

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[Principles, modalities and indications of the administration of Radium in cancers, focus on metastatic prostate cancer: State of arts].

[Principles, modalities and indications of the administration of Radium in cancers, focus on metastatic prostate cancer: State of arts].

Bull Cancer. 2017 Aug 07;:

Authors: Bertolaso P, Leroy L, Gross-Goupil M, Aupee O, Ravaud A, Roubaud G, Cazeau AL, Le Moulec S

Abstract
Prostate cancer is the first cancer in men and has a specific tropism to bones. This tropism provided the rationale to develop bone targeting radiopharmaceutical agents, such as strontium, samarium and more recently the Radium-223, an alpha-emitter. In a phase III trial, ALSYMPCA, Radium-223 not only improved pain relief, but also impacted on overall survival. Despite an approval by both FDA and EMA, prescription of this agent remains limited by the lack of refund, especially in France. Radium-223 is currently evaluated in several clinical trials (combination with chemotherapy, radiotherapy or hormone therapy) in order to optimize the therapeutic sequences in metastatic bone prostate cancer and argues for being incorporated into the current therapeutic arsenal.

PMID: 28797482 [PubMed - as supplied by publisher]

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[A French multicenter research program for a personalized treatment of elderly head and neck cancer patient].

[A French multicenter research program for a personalized treatment of elderly head and neck cancer patient].

Bull Cancer. 2017 Aug 07;:

Authors: Guigay J, Mertens C, Le Caer H, Michel C, Ortholan C, Aupérin A

PMID: 28797481 [PubMed - as supplied by publisher]

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Sleep Location and Parent-Perceived Sleep Outcomes in Older Infants

Publication date: Available online 12 August 2017
Source:Sleep Medicine
Author(s): Jodi A. Mindell, Erin S. Leichman, Russel M. Walters
ObjectivesInitial studies indicate more independent and consolidated sleep in infants in the first few months who sleep separately. Little is known, however, about the relationship of sleep location (separate room, room-sharing, bed-sharing) with sleep outcomes in older infants (ages 6 to 12 months). It was expected that those who sleep in a separate room would have better parent-perceived sleep outcomes and more positive sleep health behaviors.MethodsParents of 6,236 infants (6 to 12 months) in the United States (US) and 3,798 in an international sample (Australia, Brazil, Canada, Great Britain, and New Zealand) completed a smartphone app-based expanded version of the validated Brief Infant Sleep Questionnaire.Results37.2% of the infants in the US and 48.4% in the international sample slept in a separate room. In both samples, infants who slept in a separate room as opposed to room-sharing or bed-sharing had parent-perceived sleep outcomes and sleep-related behaviors that reflected earlier bedtimes, shorter time to fall asleep, more nighttime and total sleep, and increased sleep consolidation. They were also more likely to have a consistent bedtime routine and fall asleep independently, as well as less likely to feed to sleep at bedtime and during the night. In addition, parents of separate room sleepers perceived bedtime to be less difficult and sleep to be better overall.ConclusionsOverall, 6 to 12-month-old infants who slept in a separate room had better reported sleep outcomes and fewer parent-perceived disturbances at bedtime than infants who room-shared with their parents, as well compared to those who slept in their parents' bed.

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Geometric image biomarker changes of the parotid gland are associated with late xerostomia

Publication date: Available online 12 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lisanne V. van Dijk, Charlotte L. Brouwer, Hans Paul van der Laan, Johannes G.M. Burgerhof, Johannes A. Langendijk, Roel J.H.M. Steenbakkers, Nanna M. Sijtsema
Backgroundand purpose: The aim of this study was to identify a surrogate marker for late xerostomia 12 months after radiotherapy (Xer12m) based on information obtained shortly after treatment.Materials and methodsDifferences in parotid gland (PG) were quantified in image biomarkers (ΔIBMs) before and 6 weeks after radiotherapy of 107 patients. By performing step-wise forward selection, ΔIBMs that were associated with Xer12m were selected. Subsequently, other variables, such as PG dose and acute xerostomia scores were added to improve the prediction performance. All models were internally validated.ResultsPrediction of Xer12m based on PG surface reduction (ΔPG-surface) was good (AUC=0.82). PG dose was related to ΔPG-surface (p<0.001, R²=0.27). The addition of acute xerostomia scores to the ΔPG-surface improved the prediction of Xer12m significantly and vice versa. The final model including ΔPG-surface and acute xerostomia had outstanding performance in predicting Xer12m early after radiotherapy (AUC=0.90).ConclusionPG surface reduction was associated with late xerostomia. The early post-treatment model with ΔPG-surface and acute xerostomia scores can be considered as surrogate marker for late xerostomia.

Teaser

The aim of this study was to identify a surrogate marker for late xerostomia 12 months after radiotherapy based on information obtained shortly after treatment. Differences in parotid gland (PG) were quantified in image biomarkers (ΔIBMs) before and 6 weeks after radiotherapy of 107 patients. The early post-treatment model with parotid gland surface reduction and acute xerostomia scores is a good candidate surrogate marker for late xerostomia.

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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Int J Audiol. 2004;43(2):61-65

Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD

PMID: 28793845 [PubMed]

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Modelling the risk of noise-induced hearing loss among military pilots.

Modelling the risk of noise-induced hearing loss among military pilots.

Int J Audiol. 2004;43(2):79-84

Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ

PMID: 28793844 [PubMed]

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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

Int J Audiol. 2004;43(2):61-65

Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD

PMID: 28793845 [PubMed]

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Modelling the risk of noise-induced hearing loss among military pilots.

Modelling the risk of noise-induced hearing loss among military pilots.

Int J Audiol. 2004;43(2):79-84

Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ

PMID: 28793844 [PubMed]

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Endoscope-assisted repair of CSF otorrhea and temporal lobe encephaloceles via keyhole craniotomy.

Endoscope-assisted repair of CSF otorrhea and temporal lobe encephaloceles via keyhole craniotomy.

J Neurosurg. 2017 Aug 11;:1-5

Authors: Roehm PC, Tint D, Chan N, Brewster R, Sukul V, Erkmen K

Abstract
OBJECTIVE Temporal lobe encephaloceles and cerebrospinal fluid otorrhea from temporal bone defects that involve the tegmen tympani and mastoideum are generally repaired using middle fossa craniotomy, mastoidectomy, or combined approaches. Standard middle fossa craniotomy exposes patients to dural retraction, which can lead to postoperative neurological complications. Endoscopic and minimally invasive techniques have been used in other surgeries to minimize brain retraction, and so these methods were applied to repair the lateral skull base. The goal of this study was to determine if the use of endoscopic visualization through a middle fossa keyhole craniotomy could effectively repair tegmen defects. METHODS The authors conducted a retrospective review of 6 cases of endoscope-assisted middle fossa repairs of tegmen dehiscences at a tertiary care medical center within an 18-month period. RESULTS All cases were successfully treated using a keyhole craniotomy with endoscopic visualization and minimal retraction. Surgical times did not increase. There were no major postoperative complications, recurrences of encephaloceles, or cerebrospinal fluid otorrhea in these patients. CONCLUSIONS Endoscopic visualization allows for smaller incisions and craniotomies and less risk of brain retraction injury without compromising repair integrity during temporal encephalocele and tegmen repairs.

PMID: 28799867 [PubMed - as supplied by publisher]

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The role of depression and personality traits in patients with melanoma: a South-European study.

We explored the potential association of depression history and personality, evaluated through a robust questionnaire tool, namely the Eysenck Personality Scale, with disease risk and progression among Greek patients. A total of 106 melanoma patients and their 1 : 1 sex-matched controls were interviewed on the basis of a questionnaire comprising phenotypic, sociodemographic, lifestyle and medical history variables, as well as information on history of lifetime major depression. The Eysenck Personality Questionnaire, measuring the four personality dimensions (extraversion, neuroticism, psychoticism, lie), was thereafter completed. Adjusted odds ratios (ORs) for melanoma risk were derived through multiple logistic regression analyses, whereas potential predictors of survival were explored using Cox proportional hazards models. Sun sensitivity score [OR: 1.55, 95% confidence interval (CI): 1.16-2.06] and major depression history (OR: 5.72, 95% CI: 1.38-23.73) were significantly associated with melanoma, whereas inverse associations of extraversion (OR: 0.90, 95% CI: 0.83-0.97) and psychoticism score (OR: 0.88, 95% CI: 0.78-1.00) were noted. These associations were more pronounced and remained solely among female patients; notably, decreased extraversion (OR: 0.86, 95% CI: 0.76-0.98) and psychoticism score (OR: 0.63, 95% CI: 0.43-0.91), as well as increased depression history (OR: 10.69, 95% CI: 1.43-80.03) were evident. Cox-derived hazard ratios showed nonsignificant associations of depression history and personality with disease outcome. Our data support the hypotheses that depression history and personality are associated with melanoma risk. No effect on survival after cancer diagnosis was observed. If confirmed in future studies, these associations may contribute toward better understanding the etiology of melanoma, enhancing health-related quality of life. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Economic burden of advanced melanoma in France, Germany and the UK: a retrospective observational study (Melanoma Burden-of-Illness Study).

The aim of this study was to estimate the cost-of-illness associated with completely resected stage IIIB/IIIC melanoma with macroscopic lymph node involvement, overall and by disease phase, in France, Germany and the UK. This retrospective observational study included patients aged older than or equal to 18 years first diagnosed with stage IIIB/IIIC cutaneous melanoma between 1 January 2009 and 31 December 2011. Data were obtained from medical records and a patient survey. Direct costs, indirect costs and patient out-of-pocket expenses were estimated in euros ([Euro sign]) (and British pounds, [pounds]) by collecting resource use and multiplying by country-specific unit costs. National annual costs were estimated using national disease prevalence from the European cancer registry and other published data. Forty-nine centres provided data on 558 patients (58.2% aged

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Response to targeted therapy in two patients with metastatic melanoma carrying rare BRAF exon 15 mutations: A598_T599insV and V600_K601delinsE.

Concurrent BRAF-MEK inhibition improves clinical outcomes in patients with advanced BRAF V600E/K-mutant melanoma. There is currently less evidence for the efficacy of this treatment in patients with rare BRAF non-V600E/K genotypes. We report on two patients with rare BRAF exon 15 mutations - BRAF A598_T599insV and V600_K601delinsE - obtaining clinical benefit and a radiological response to inhibitors directed against the mitogen-activated protein kinase pathway. This highlights the importance of using tests that detect both V600E/K and non-V600E/K BRAF mutations to keep open the possibility of treatment with targeted therapy in patients with uncommon, yet potentially actionable, BRAF exon 15 mutations. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis.

Melanoma metastasis to the brain is associated with a poor prognosis. We sought to determine patient demographics and primary tumor factors associated with the development of brain metastasis (BM) and survival. We also investigated whether the BM detection setting (routine screening vs. symptomatic presentation) affected clinical outcomes. A database of melanoma patients seen from 1999 to 2015 at our institution was reviewed to identify patients who developed BM. Patients with BM were matched by initial stage with patients who did not develop BM as a control group. Patient demographics, primary tumor characteristics, and clinical outcomes were analyzed. A total of 123 patients with BM were matched by initial presenting stage to 237 patients without BM. The characteristics of the primary melanoma tumor associated with BM development included location on the scalp (P=0.030), nodular histologic type (P=0.020), and Breslow depth more than 4 mm (P=0.048), whereas location on the leg was associated with decreased BM risk (P=0.006). In patients with BM, time to first recurrence for melanomas of the scalp was significantly shorter (10.8 vs. 24.8 months, P=0.007) than nonscalp head and neck tumors. Patient stage, tumor depth, nodular type, and ulceration were also associated with worse clinical outcomes. There were no differences in the clinical outcomes between patients whose BM were detected upon routine screening versus those detected upon symptomatic presentation. In summary, factors predictive of development of BM included primary scalp location, nodular type, and depth. In BM patients, scalp location, stage, tumor depth, nodular type, and ulceration, but not detection setting, were associated with worse clinical outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery.

Background: Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia. Methods: Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 [mu]g of fentanyl, and 100 [mu]g of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups. Results: No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68). Conclusions: In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Psoas Versus Femoral Blocks: A Registry Analysis of Risks and Benefits.

Background and Objectives: Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections. Methods: We extracted 22,434 surgical cases from the German Network for Regional Anesthesia registry (2007-2014) and grouped cases as psoas (n = 7593) and femoral (n = 14,841) blocks. Insertion-related complications (including single-shot blocks and catheter) and infectious complications (including only catheter) in each group were compared with [chi]2 tests. The groups were compared with multivariable logistic models, adjusted for potential confounding factors. Results: After adjustment for potential confounding factors, psoas blocks were associated with more complications than femoral blocks including vascular puncture 6.3% versus 1.1%, with an adjusted odds ratio (aOR) of 3.6 (95% confidence interval [CI], 2.9-4.6; P

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Evaluation of nonablative fractional laser treatment in scar reduction

Abstract

Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4–8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars.

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Resting state functional connectivity of the anterior striatum and prefrontal cortex predicts reading performance in school-age children

Publication date: November 2017
Source:Brain and Language, Volume 174
Author(s): Sarael Alcauter, Liliana García-Mondragón, Zeus Gracia-Tabuenca, Martha B. Moreno, Juan J. Ortiz, Fernando A. Barrios
The current study investigated the neural basis of reading performance in 60 school-age Spanish-speaking children, aged 6 to 9years. By using a data-driven approach and an automated matching procedure, we identified a left-lateralized resting state network that included typical language regions (Wernicke's and Broca's regions), prefrontal cortex, pre- and post-central gyri, superior and middle temporal gyri, cerebellum, and subcortical regions, and explored its relevance for reading performance (accuracy, comprehension and speed). Functional connectivity of the left frontal and temporal cortices and subcortical regions predicted reading speed. These results extend previous findings on the relationship between functional connectivity and reading competence in children, providing new evidence about such relationships in previously unexplored regions in the resting brain, including the left caudate, putamen and thalamus. This work highlights the relevance of a broad network, functionally synchronized in the resting state, for the acquisition and perfecting of reading abilities in young children.

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A Systematic Review of Patient-Reported Outcomes for Surgically Amenable Epiphora.

Purpose: In evaluating epiphora and its management, the bottom line for all stakeholders is whether an intervention confers any real benefit on quality of life. A review was conducted to identify and appraise patient-reported outcome measures (PROMs) in surgically amenable epiphora. Methods: A systematic search was conducted of studies relating to surgical intervention for epiphora. Patient-reported outcome measures were identified and assessed against standard criteria. Results: Of 30,544 identified articles, 227 were eligible for data extraction. Of these, 69% reported a PROM as the primary outcome. PROMs identified included single-item symptom scores (48% of primary outcome PROMs), single-item reports of improvement (30%), the Glasgow Benefit Inventory (3%), Lacrimal Symptom Questionnaire (0.5%), Nasolacrimal Duct Obstruction Symptom Score (0.5%), Ocular Surface Disease Index (0.5%), Visual Function Questionnaire-25, the Short Form-36 Health Survey, and 3 other symptom scores. None were developed through consultation with the target population, and there was inadequate testing of content validity. The strengths and limitations of each PROM are presented, with regard to interpretation, responsiveness, reliability, and validity. Discussion: The importance of robust and psychometrically sound PROMs is essential if the under-reporting of quality of life improvement in patients treated for epiphora is to change. Recommendations for the use of each identified PROM are discussed. Conclusions: Several PROMs have been used in the recent literature to evaluate patients undergoing surgery to treat epiphora. Assessed against standard criteria, no PROM has proven to be both psychometrically robust and clinically meaningful for use in this population. Future PROM development should be guided by this standard framework. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Recognition and Management of Acute Dacryocystic Retention.

Purpose: Acute noninfectious dacryocystic retention is an under-recognized condition heralded by painful lacrimal sac swelling, obstruction, and epiphora. This longitudinal chart review aimed to estimate the incidence of this condition in an urban Australian population, while further defining the signs and symptoms of the disease and options for management. Methods: We retrospectively reviewed the charts of 1,593 consecutive patients presenting with acquired nasolacrimal duct obstruction and epiphora between 1990 and 2015. The records of patients with acute dacryocystic retention were analyzed for age, gender, clinical features, and management. Results: Of all patients presenting with nasolacrimal duct obstruction, 20 were found to have acute dacryocystic retention. The mean age was 42.2 +/- 9.3. There was an equal distribution of laterality, and only 2 cases (10%) were bilateral. There was a statistically significant female predominance, and most patients presented reporting 2 to 3 previous episodes. At presentation, 30% of patients reported spontaneous passage of a dacryolith. Despite this, 70% of affected patients required surgical management, with a 64% incidence of stones noted at the time of dacryocystorhinostomy. Conclusions: Acute dacryocystic retention is an uncommon, but even less frequently identified condition, most common in middle-aged women. Improved understanding of this condition and its natural history is likely to enhance patient counseling and avoid ineffective use of antibiotics in affected patients. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Clinical Outcomes in Children With Orbital Cellulitis and Radiographic Globe Tenting.

Purpose: Axial displacement of the globe with tenting centered on the optic nerve-globe junction is a predictor of visual loss in adults. The purpose of this study was to determine the visual outcomes of children with orbital cellulitis and globe tenting. Methods: The records of 46 consecutive children with orbital cellulitis at a single tertiary children's hospital were reviewed retrospectively. Initial and final visual acuities were available for 34 of 46 patients (74%). Globe tenting was defined by an angle of 130[degrees] or less at the optic nerve-globe junction as derived from sagittal CT or MRI. Visual acuities of 4 children with globe tenting (mean age, 10.3 +/- 3.3 years) were compared with those of 30 children without globe tenting (mean age, 10.8 +/- 3.5 years). Final logarithm of the minimum angle of resolution visual acuities were analyzed. Results: The mean posterior globe angle was 124.5[degrees] +/- 8.0[degrees] in patients with globe tenting, compared with 145.6[degrees] +/- 7.4[degrees] in the affected eye of the patients without globe tenting (p = 0.002). Final visual acuity was logarithm of the minimum angle of resolution = 0 following treatment in patients with globe tenting and logarithm of the minimum angle of resolution = 0.02 in patients without tenting (p = 0.70). Discussion: We propose that the increased elastic compliance of the optic nerve sheath and sclera in children may contribute to better visual outcomes. Conclusions: Pediatric orbital cellulitis with globe tenting may not lead to devastating vision loss as previously seen in adults. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery.

Purpose: This study will determine the safety of laryngeal mask airway (LMA) compared with endotracheal tube (ETT) in patients undergoing general anesthesia for dacryocystorhinostomy (DCR) surgery. Methods: In this retrospective cohort study, intraoperative and postoperative outcomes of patients who underwent DCR at UAB Callahan Eye Hospital using either LMA or ETT were compared. Results: Over a period of 52 months, 429 patients underwent external DCR surgery. An ETT was used in 37 patients and LMA in 392 patients. Baseline patient characteristics and anesthetic management were similar. No documented cases of blood or gastric aspiration occurred in the total cohort. Our study confirmed the findings of others that there is less cardiovascular lability on LMA placement than with ETT intubation.1 A 30% increase in heart rate from baseline after intubation (ETT 10.8%, LMA 1.8%; p = 0.010) and after incision (ETT 8.1%, LMA 1.8%; p = 0.047) occurred more frequently in the ETT group. Airway management with an LMA was also less difficult compared with an ETT (ETT 5.7%, LMA 0.5%; p = 0.035). Conclusions: The use of an LMA for airway control is safe and effective in patients undergoing general anesthesia for DCR surgery. No events of aspiration occurred with LMA use. Heart rate increase was significantly less in the LMA group. In our opinion, use of an LMA for airway control during DCR surgery is superior to use of an ETT. Airway protection, improved hemodynamics, and less difficulty in placement of the laryngeal airway device are all validated by this study. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction.

Background: The need to restore both the missing breast volume and breast surface area makes achieving excellent aesthetic outcomes in delayed breast reconstruction especially challenging. Autologous breast reconstruction can be used to achieve both goals. The aim of this study was to identify surgical maneuvers that can optimize aesthetic outcomes in delayed breast reconstruction. Methods: This is a retrospective review of operative and clinical records of all patients who underwent unilateral or bilateral delayed breast reconstruction with autologous tissue between April 2014 and January 2017. Three groups of delayed breast reconstruction patients were identified based on patient characteristics. Results: A total of 26 flaps were successfully performed in 17 patients. Key surgical maneuvers for achieving aesthetically optimal results were identified. A statistically significant difference for volume requirements was identified in cases where a delayed breast reconstruction and a contralateral immediate breast reconstruction were performed simultaneously. Conclusions: Optimal aesthetic results can be achieved with: (1) restoration of breast skin envelope with tissue expansion when possible, (2) optimal positioning of a small skin paddle to be later incorporated entirely into a nipple areola reconstruction when adequate breast skin surface area is present, (3) limiting the reconstructed breast mound to 2 skin tones when large area skin resurfacing is required, (4) increasing breast volume by deepithelializing, not discarding, the inferior mastectomy flap skin, (5) eccentric division of abdominal flaps when an immediate and delayed bilateral breast reconstructions are performed simultaneously; and (6) performing second-stage breast reconstruction revisions and fat grafting. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Classification of the Residual Cranial Defects and Selection of Reconstruction Materials.

The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operator's choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice. (C) 2017 by Mutaz B. Habal, MD.

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Gummy Smile Correction Using Lingual Orthodontics and Augmented Corticotomy in Extremely Thin Alveolar Housing.

Background: Tooth movement out of anatomic limitations was assisted by augmented corticotomy using deproteinized bovine bone mineral. Methods: Lip protrusion can be reduced by premolar extraction followed by retraction of the anterior teeth. Surgical intervention is appropriate when the alveolar bone housing of the anterior region is insufficient for the tooth movement. In this patient, corticotomy in upper palatal area and anterior segmented osteotomy in the mandible were performed. Anatomic limitation to the retraction was expanded by xenograft. An antero-posterior lingual appliance was used to bodily retract the upper anterior teeth. The gummy smile was resolved by intrusion of upper entire arch using 2 mid-palatal temporary skeletal anchorage devices. Results: New bone formation was observed on palatal side of upper anterior teeth. The teeth were moved into augmented area without fenestration or vitality loss. Lip protrusion was resolved, and the gummy smile was effectively improved. Conclusions: Orthodontic tooth movement beyond the limitation of the alveolar bone housing can be achieved with surgical assistance, which can be performed under local anesthesia. Without orthognathic surgery, the gummy smile can be reduced using an antero-posterior lingual retractor with mid-palatal skeletal anchorage. (C) 2017 by Mutaz B. Habal, MD.

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Eyelid and Periorbital Surgery, Second Edition, edited by Mark A. Codner and Clinton D. McCord, Jr Boca Raton, FL: CRC Press, 2016.

No abstract available

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Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip.

Introduction: The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. Methods: The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Results: Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P

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Congenital Salivary Fistula From Parotid Main Gland.

Congenital parotid fistulas are extremely rare diseases. Herein, the authors report a patient with congenital salivary fistula from parotid main gland in a 15-year-old boy. Therefore, clinicians should consider the possibility of congenital parotid fistula form parotid main gland. Surgical excision of the fistula and parotid gland can be effective treatment option of congenital parotid fistula. (C) 2017 by Mutaz B. Habal, MD.

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Orbital Cellulitis Following Orbital Blow-out Fracture.

Orbital cellulitis and abscess have been described in the literature as complication that usually occur secondary to infection in the maxillary, ethmoidal, and frontal sinuses. If left untreated, it can lead to blindness, cavernous sinus thrombosis, meningitis, or cerebral abscess. Orbital fractures are a common sequela of blunt orbital trauma, but are only rarely associated with orbital cellulitis. So, the authors present rare orbital cellulitis after orbital blow-out fracture. A 55-year-old Asian complains of severe orbital swelling and pain on the left side. These symptoms had started 2 days earlier and worsened within the 24 hours before hospital admission resulting in visual disturbances such as diplopia and photophobia. Contrast-enhanced computed tomography scan showed considerable soft tissue swelling and abscess formation on the left side. Patient was subjected to surgical drainage under general anesthesia in the operation room. In this case, the postoperative period was uneventful and the rapid improvement of symptoms was remarkable. In conclusion, the abscess of the orbit is a surgical emergency in patients whose impairment of vision or ocular symptoms cannot be controlled with medical therapy using antibiotics. In our case, orbital cellulitis can occur after blunt orbital trauma without predisposing sinusitis. Early and prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision in case of orbital cellulitis. (C) 2017 by Mutaz B. Habal, MD.

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Subependymal Heterotopia Mimicking Mass in Conventional Magnetic Resonance Imaging: Demonstration With 3T Advanced Neuroimages.

The authors reported a rare patient with large subependymal heterotopia mimicking cerebral neoplasia. A 22-year-old female was admitted with a history of right-sided paresthesia accompanied by progressive headache. Cerebral magnetic resonance (MR) imaging showed a large solid lesion in the left frontal lobe. Advanced MR images proved that the lesion was compatible with subependymal heterotopia. Large subependymal heterotopia may mimick cerebral neoplasia. (C) 2017 by Mutaz B. Habal, MD.

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Transient Amaurosis and Diplopia After Inferior Alveolar Nerve Block.

A 40-year-old female patient was admitted to the authors' oral and maxillofacial clinic for removal of her lower left second molar under local anesthesia. The patient's medical history revealed that she had cardiac arhythmia and hypertension. Inferior alveolar nerve block was achieved using 2 mL of sefacaine (%3 mepivacaine HCL, without epinephrine). The patient complained of loss of vision in her left eye. All procedures were stopped immediately. Within 2 minutes the patient reported diplopia. All of the symptoms disappeared about 5 minutes after initial observation. Follow-up after 1 day revealed no complications. The procedure was then performed uneventfully. (C) 2017 by Mutaz B. Habal, MD.

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"Clinical and quantitative isokinetic comparison of abdominal morbidity and dynamics following DIEP versus muscle-sparing free TRAM flap breast reconstruction".

Background: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (msTRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. We aimed to compare quantitative measurements of abdominal function obtained with an isokinetic dynamometer after DIEP and msTRAM flap elevation. Methods: Patients who underwent unilateral single-pedicled DIEP (n = 42) or msTRAM flap (n = 36) breast reconstruction performed by a single surgeon were included in this study. Pre- and postoperative trunk flexion parameters were measured prospectively using an isokinetic dynamometer in all patients. The occurrence of postoperative pain, stiffness, and bulging along with patient activity level were also investigated. Results: At 3 months postoperatively, abdominal functions were decreased in both groups, with a larger decline in the msTRAM group. However, at 6 months postoperatively, abdominal muscle function recovered to preoperative levels in both groups. These findings were consistent with the absence of a statistically significant difference in patient postoperative abdominal pain and stiffness, activity level, and the incidence of bulging between the two groups at 6 months postoperatively. Conclusions: From these results, we propose that the surgeon can select the msTRAM flap, without hesitation or concern regarding abdominal morbidity, when a thick and reliable perforator does not exist and multiple thin perforators must be incorporated. (C)2017American Society of Plastic Surgeons

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Revisiting the Abdominal Donor Site: Introducing a Novel Nomenclature for Autologous Breast Reconstruction.

Summary: As abdominally-based free flaps for breast reconstruction continue to evolve, significant effort has been invested in minimizing donor-site morbidity. The impact on the donor-site remains a prevailing principle for breast reconstruction, and thus must be adequately reflected when classifying what is left behind following flap harvest. Although successful in describing the type of flap harvested, the existing nomenclature falls short of incorporating certain critical variables, such as degree of muscular preservation, fascial involvement, mesh implantation, and segmental nerve anatomy. Thus, in an effort to expand upon Nahabedian's 2002 classification system, this descriptive study revisits and critically reviews the existing donor-site classification system following abdominally-based breast reconstruction. We propose a nomenclature system that emphasizes variability in flap harvest technique, degree of muscular violation, fascial resection, mesh implantation, and degree of nerve transection. With this revised classification system, reconstructive surgeons can begin reporting more clinically-relevant and accurate information with regards to donor-site morbidity. (C)2017American Society of Plastic Surgeons

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"Optimizing Your Post-Surgical Scars: A Systematic Review on Best Practices in Preventative Scar Management"1.

Background: Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine post-operative care, there has yet to be a comprehensive analysis of the available literature over the last decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date. Methods: A computerized MEDLINE search was performed for clinical studies addressing scar management. The resulting publications were screened randomized clinical trials that met our specified inclusion/exclusion criteria. Results: This systematic review was performed in May 2016. The initial search for MeSH term "cicatrix" and modifiers "therapy, radiotherapy, surgery, drug therapy, prevention and control" yielded 13,101 initial articles. Applying our inclusion/exclusion criteria resulted in 12 relevant articles. All included articles are randomized, controlled clinical trials. Conclusions: Optimal scar care requires taking into account factors such as incisional tension, anatomic location, and Fitzpatrick skin type. We present a streamlined algorithm for scar prophylaxis based on contemporary level I and II evidence to guide clinical practice. (C)2017American Society of Plastic Surgeons

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The Tissue Engineered Tendon Bone Interface: In Vitro and In Vivo Synergistic Effects of Adipo-Derived Stem Cells, Platelet Rich Plasma and Extracellular Matrix Hydrogel.

Introduction: Suboptimal healing of the tendon bone interface (TBI) remains an unsolved problem. One solution is a biocompatible tissue engineered construct that promotes augmented healing. We hypothesisze that 1.) the presence of Platelet Rich Plasma (PRP) and prolonged in vitro incubation produces tissue engineered tendon bone interface scaffolds with greater reseeding of viable Adipo-derived Stem Cells (ADSC) and 2.) when implanted with extracellular matrix hydrogel, constructs will display superior in vivo strength repair and biocompatibility. Materials and Methods: 1. Achilles-calcaneal composite TBI scaffold grafts were harvested from thirty Wistar rats. After physicochemical decellularization and lyophilization, paired scaffolds were revitalized in either rat plasma or 100% activated rat PRP and reseeded with 1x106ADSCs/mL for 3, 7 and 14 days. Reseeding efficacy was quantified by live cell and total cell assays and qualified histologically. Statistical analysis of live cell and total cell assay data was performed using a paired Students t-test. 2. Ninety Sprague Dawley rats underwent Wistar tissue engineered TBI scaffold allograft reconstruction with one of five scaffold revitalization/reseeding conditions: (1) Decellularized, lyophilized, phosphate buffered saline , (2) Decellularized, Lyophilized, 100% activated PRP, (3) Decellularized, lyophilized, 100% activated PRP and extracellular matrix hydrogel, (4) Decellularized, lyophilized, 100% activated PRP and 14 day reseeding with ASC-luc2-eGFP cells and (5) Decellularized, lyophilized, 100% activated PRP, 14 day reseeding with ADSC-luc2-eGFP cells and extracellular matrix hydrogel. Daily, real-time in vivo bioluminescence imaging of all rats containing reseeded grafts was performed to follow cell viability. Subjects were sacrificed at weeks 2, 4, and 8 and constructs underwent biomechanical and histological evaluation. Comparisons across groups for biomechanical testing data was performed by one- way analysis of variance (ANOVA). Significance was set at p

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Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits.

INTRODUCTION: Acellular dermal matrix (ADM) has gained widespread acceptance in immediate expander/implant reconstruction due to perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of ADM on other outcomes, including patient-reported measures. METHODS: The Mastectomy Reconstruction Outcomes Consortium (MROC) Study used a prospective cohort design to evaluate patients undergoing post-mastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women receiving immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and PRO data, using the BREAST-Q and Numeric Pain Rating Scale (NPRS) instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. RESULTS: A total of 1,297 patients were evaluated, including 655 (50.5%) with ADM and 642 (49.5%) without ADM. Controlling for demographic and clinical covariates, no significant differences were seen between ADM and non-ADM cohorts in overall complications (OR=1.21, p=0.263), major complications (OR=1.43, p=0.052), wound infections (OR=1.49, p=0.118), or reconstructive failures (OR=1.55, p=0.089) at two years following reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p=0.78). No significant differences were observed in PRO scores, including satisfaction with breast, psychosocial well-being, sexual well-being, physical well-being and postoperative pain. CONCLUSION: In our multicenter, prospective analysis, we found no significant ADM effects on complications, time to exchange or PRO in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of ADM in these patients. (C)2017American Society of Plastic Surgeons

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The Prevention of Recurrent Cholesteatoma in CWU Surgery: The Use of Titanium Sheeting.

Objective: Assessment of the outcomes of a technique of prevention of recurrent cholesteatoma in canal wall up (CWU) mastoidectomy, using titanium sheeting to repair the external auditory canal wall. Patients: Sixty four cholesteatoma cases were managed during a period from 2007 to 2015. The cases were unselected; the surgery was performed by the senior author. Cholesteatoma Patterns Were: Forty two attic, nine pars tensa, seven combined attic-pars tensa, three congenital, and three other. Primary surgery was undertaken in 33 cases. Interventions: All cases underwent CWU surgery that employed canal wall repair using fine titanium sheeting combined with overlying organic material to repair canal wall defects. Drum repairs employed cymba conchae cartilage-perichondrium composite grafts. Chain reconstruction used Spanner struts or Grace Alto PORPs or TORPS. Results: Two cases suffered mesotympanic residual disease, and three, mesotympanic recurrence one of which extended into the attic. Two other cases incurred atticomastoid residues. Transient myringitis occurred in three cases. Conclusion: The surgery was judged on its ability to avoid atticomastoid recurrence, and was regarded as highly successful. The titanium sheeting offers a relatively simple but effective technique. The mesotympanic complications are those also commonly found in both CWD and other CWU methods. As in other CWU procedures, the problems of the open cavity were avoided. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Evaluation of Maximal Speech Intelligibility With Vibrant Soundbridge in Patients With Sensorineural Hearing Loss.

Objective: The study investigated improvements in maximal speech intelligibility after Vibrant Soundbridge (VSB) implantation and analyzed the effect of the hearing loss pattern on maximal speech intelligibility represented by a phonetically balanced word score (PBmax). The effect of middle ear implants on PBmax has not been evaluated yet. Study Design: Study. Setting: Tertiary academic medical center. Patients/Interventions: Sixty patients who underwent VSB from December 2011 to January 2016 were retrospectively reviewed. All the patients had hearing aids preoperatively. Main Outcome Measures: Pure-tone and speech audiometry were checked with and without hearing aids and then with the VSB. The patients were divided into two groups: flat and down-sloping type of hearing loss. PBmax score was evaluated at the most comfortable listening level before and after VSB implantation and compared with scores with/without HA. Results: PBmax for both conventional HA and VSB were significantly higher compared with the unaided condition. The improvement in speech recognition was significantly better using VSB than using HA (p = 0.003). However, there was no significant difference in the improvement provided by VSB and HA in patients with a flat hearing loss. Patients with a down-sloping audiogram showed significantly better improvement with VSB than with HA (p = 0.003). Moreover, patients with greater preoperative high-frequency hearing loss had greater improvement in PBmax after VSB implantation. Conclusion: Speech intelligibility can be significantly improved by VSB implantation, especially in patients with a down-sloping hearing loss. This finding can help select patients who will benefit most from VSB implantation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Single-center Experience of Over a Hundred Implantations of a Transcutaneous Bone Conduction Device.

Objective: To assess outcomes with a novel passive transcutaneous bone conduction device (t-BCD). Study Design: Prospective data collection and patient review. Setting: Tertiary referral center. Patients: Patients who underwent implantation with the t-BCD between November 2013 and September 2016. Intervention: Implantation of BAHA Attract. Main Outcome Measures: Surgical outcome, patient reported outcomes including the "Glasgow Benefit Inventory" and the "Client Oriented Scale of Improvement" for adults and the "Speech, Spatial and Qualities of Hearing scale" (SSQ-12) for children. Results: One hundred five patients were implanted. Numbness superior to the incision was commonly noticed. Four patients (3.8%) developed skin tenderness and redness that settled with conservative measures. Among those patients who had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD) to the t-BCD (n=15), 1 (0.9%) developed seroma and 2 (1.9%) developed skin dehiscence at the edge of the implant magnet. Significant improvement in Client Oriented Scale of Improvement and Glasgow Benefit Inventory scores with a global satisfaction of 84% and 77.4% was observed for those previously aided and unaided respectively, with use of the device. A 22% improvement in SSQ-12 mean score was observed in the pediatric population. Conclusion: This is the largest single-center series reported on this t-BCD. The complication rate is small but caution is required in patients of conversion from a percutaneous BCHD. The patients' satisfaction is high and the need for aftercare is minimal. Cost-effectiveness evaluation of these devices, development of core outcome sets and well-designed, prospective trials to compare the different BCHDs should be the focus of future research. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Monolithic Zirconia for Prosthetic Reconstructions: Advantages and Limitations

Abstract

Purpose of Review

Due to frequent clinical reports on chipping of the veneering ceramic applied on zirconia frameworks, non-veneered monolithic zirconia has been proposed in an attempt to improve the lifetime of metal-free fixed dental prostheses (FDPs). This review highlights the effects of microstructure and chemical composition on optical properties and mechanical properties of monolithic zirconia that may be detrimental on the longevity of FDPs and the antagonist dentition.

Recent Findings

The reviewed studies indicated that the lack of veneering ceramic in monolithic solutions yields to less favourable optical outcome and decreased mechanical stability. Efforts are being made to improve translucency of monolithic zirconia through modifying the grain size, increasing cubic phase, and decreasing alumina content, final density and level of impurities.

Summary

There appears room for improvement in the microstructure of monolithic zirconia ceramics to achieve better optical results and low antagonist wear, without jeopardizing its mechanical properties.

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The Synthesis of NZVI and Its Application to the Removal of Phosphate from Aqueous Solutions

Abstract

Nanoscale zero valent iron (NZVI) was synthesized by the reduction of natural limonite under hydrogen conditions. The adsorption performance of the as-prepared NZVI on phosphate was evaluated through batch and column experiments. The removal of phosphate (PO₄³⁻) significantly decreased with an increase of pH from 2.0 to 11, whereas a remarkable increase of PO₄³⁻ removal was observed in the presence of SO₄²⁻ and S₂O₃²⁻. In addition, Cl⁻ and NO₃⁻ also improved phosphate removal at concentrations of more than 0.2 mmol/L. Kinetic studies indicated that the removal process of PO₄³⁻ on NZVI can be easily followed with the pseudo-second-order kinetic model. The removal of phosphate from the oxic system was significantly higher than that of the anoxic system, which was attributed to the formation of the secondary phase by the further oxidization of Fe²⁺. The adsorption capacity of the as-prepared NZVI of the oxic system was 16 mg/g, and the pH was 6.3. The column experiments further demonstrated that the as-prepared NZVI presented a high removal capacity for PO₄³⁻-P. These findings indicated that the as-prepared NZVI displayed an excellent ability to remove phosphate from aqueous solutions.

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The early history of our understanding of the functions of the spinal cord

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Monolithic Zirconia for Prosthetic Reconstructions: Advantages and Limitations

Abstract

Purpose of Review

Recent Findings

Summary

There appears room for improvement in the microstructure of monolithic zirconia ceramics to achieve better optical results and low antagonist wear, without jeopardizing its mechanical properties.

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Αρχειοθήκη ιστολογίου

Σάββατο 12 Αυγούστου 2017

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