Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Int J Audiol. 2017 Sep 14;:1-8

Authors: Li YL, Lin YH, Yang HM, Chen YJ, Wu JL

Abstract
OBJECTIVE: This study explored tone production, tone perception and intelligibility of produced speech in Mandarin-speaking prelingually deaf children with at least 5 years of cochlear implant (CI) experience. Another focus was on the predictive value of tone perception and tone production as they relate to speech intelligibility.
DESIGN: Cross-sectional research.
STUDY SAMPLE: Thirty-three prelingually deafened children aged over eight years with over five years of experience with CI underwent tests for tone perception, tone production, and the Speech Intelligibility Rating (SIR). A Pearson correlation and a stepwise regression analysis were used to estimate the correlations among tone perception, tone production, and SIR scores.
RESULTS: The mean scores for tone perception, tone production, and SIR were 76.88%, 90.08%, and 4.08, respectively. Moderately positive Pearson correlations were found between tone perception and production, tone production and SIR, and tone perception and SIR (p < 0.01, p < 0.01 and p < 0.01, respectively). In the stepwise regression analysis, tone production, as the major predictor, accounted for 29% of the variations in the SIR (p < 0.01).
CONCLUSIONS: Mandarin-speaking cochlear-implanted children with sufficient duration of CI use produce intelligent speech. Speech intelligibility can be predicted by tone production performance.

PMID: 28906160 [PubMed - as supplied by publisher]

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A Hebrew Adaptation of the Tinnitus Functional Index

Abstract

Tinnitus is the perception of sounds, when no external stimuli exists. Its prevalence has been estimated to be between 8% and 30% in the general population (1). Some patients describe intrusive tinnitus which affects many aspects of their lives, while others describe an insignificant disturbance caused by the tinnitus (2). Since tinnitus is a subjective symptom in most cases, defining its effect on patients' lives can be challenging. Several questionnaires have been developed in order to characterize the effects of tinnitus on patients' lives.

This article is protected by copyright. All rights reserved.

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Bacterial etiology of recalcitrant acute otitis media in sixty two children – high risk of pathogen colonization after treatment

Abstract

Acute otitis media (AOM), common childhood infection that is one of leading cause of antibiotic prescriptions for children, is diagnosed at least once in approximately 80% of preschool children and 30-40% of them have recurrent episodes. Antibiotic treatment of AOM is usually empiric, without isolation of otopathogens from middle ear fluid and their antibiotic susceptibility testing. Due to the improper antibiotic use, the infection can persist in some cases, termed AOM treatment failure.

This article is protected by copyright. All rights reserved.

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Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Int J Audiol. 2017 Sep 14;:1-5

Authors: Wakabayashi S, Saito H, Oishi N, Shinden S, Ogawa K

Abstract
OBJECTIVE: To assess the effects of tinnitus treatments on sleep disorders in patients with tinnitus.
DESIGN: Subjects completed the Pittsburg Sleep Quality Index (PSQI), Tinnitus Handicap Inventory (THI), Self-rating Depression Scale (SDS), and State Trait Anxiety Inventory (STAI). The questionnaire results and the patients' sex, age, time since the onset of tinnitus, and mean hearing level were examined, and differences between a sleep disorder group and a normal sleep group were examined. Patients completed the questionnaires again after initiating tinnitus treatments (counselling and use of sound generators), and the change in questionnaire scores at follow-up was evaluated.
STUDY SAMPLE: Patients (N = 100) with tinnitus who visited Keio University Hospital and started treatment without medication between 2005 and 2008.
RESULTS: Sixty-six percent of the patients had sleep disorders. Compared with patients without sleep disorders, patients with sleep disorders had significantly higher SDS and STAI scores at the first visit. The mean PSQI scores showed significant improvement at follow-up.
CONCLUSIONS: Sleep disorders in patients with tinnitus improved after tinnitus treatments. Complex interactions between depressive symptoms and anxiety may occur in these patients. The improvement in sleep disorders at follow-up was correlated with improvements in tinnitus severity and state anxiety.

PMID: 28906162 [PubMed - as supplied by publisher]

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Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Int J Audiol. 2017 Sep 14;:1-8

Authors: Li YL, Lin YH, Yang HM, Chen YJ, Wu JL

Abstract
OBJECTIVE: This study explored tone production, tone perception and intelligibility of produced speech in Mandarin-speaking prelingually deaf children with at least 5 years of cochlear implant (CI) experience. Another focus was on the predictive value of tone perception and tone production as they relate to speech intelligibility.
DESIGN: Cross-sectional research.
STUDY SAMPLE: Thirty-three prelingually deafened children aged over eight years with over five years of experience with CI underwent tests for tone perception, tone production, and the Speech Intelligibility Rating (SIR). A Pearson correlation and a stepwise regression analysis were used to estimate the correlations among tone perception, tone production, and SIR scores.
RESULTS: The mean scores for tone perception, tone production, and SIR were 76.88%, 90.08%, and 4.08, respectively. Moderately positive Pearson correlations were found between tone perception and production, tone production and SIR, and tone perception and SIR (p < 0.01, p < 0.01 and p < 0.01, respectively). In the stepwise regression analysis, tone production, as the major predictor, accounted for 29% of the variations in the SIR (p < 0.01).
CONCLUSIONS: Mandarin-speaking cochlear-implanted children with sufficient duration of CI use produce intelligent speech. Speech intelligibility can be predicted by tone production performance.

PMID: 28906160 [PubMed - as supplied by publisher]

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Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations.

Safe Use of Acoustic Vestibular-Evoked Myogenic Potential Stimuli: Protocol and Patient-Specific Considerations.

J Am Acad Audiol. 2017 Sep;28(8):708-717

Authors: Portnuff CDF, Kleindienst S, Bogle JM

Abstract
BACKGROUND: Vestibular-evoked myogenic potentials (VEMPs) are commonly used clinical assessments for patients with complaints of dizziness. However, relatively high air-conducted stimuli are required to elicit the VEMP, and ultimately may compromise safe noise exposure limits. Recently, research has reported the potential for noise-induced hearing loss (NIHL) from VEMP stimulus exposure through studies of reduced otoacoustic emission levels after VEMP testing, as well as a recent case study showing permanent sensorineural hearing loss associated with VEMP exposure.
PURPOSE: The purpose of this report is to review the potential for hazardous noise exposure from VEMP stimuli and to suggest clinical parameters for safe VEMP testing.
RESEARCH DESIGN: Literature review with presentation of clinical guidelines and a clinical tool for estimating noise exposure.
RESULTS: The literature surrounding VEMP stimulus-induced hearing loss is reviewed, including several cases of overexposure. The article then presents a clinical calculation tool for the estimation of a patient's safe noise exposure from VEMP stimuli, considering stimulus parameters, and includes a discussion of how varying stimulus parameters affect a patient's noise exposure. Finally, recommendations are provided for recognizing and managing specific patient populations who may be at higher risk for NIHL from VEMP stimulus exposure. A sample protocol is provided that allows for safe noise exposure.
CONCLUSIONS: VEMP stimuli have the potential to cause NIHL due to high sound exposure levels. However, with proper safety protocols in place, clinicians may reduce or eliminate this risk to their patients. Use of the tools provided, including the noise exposure calculation tool and sample protocols, may help clinicians to understand and ensure safe use of VEMP stimuli.

PMID: 28906242 [PubMed - in process]

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[Follow-up ultrasound of head and neck cancer].

Related Articles

[Follow-up ultrasound of head and neck cancer].

HNO. 2017 Sep 13;:

Authors: Künzel J, Bozzato A, Strieth S

Abstract
In Germany high-resolution sonography using the color duplex mode in addition to computed tomography (CT) is a well-established and proven method in the context of restaging after primary therapy of head and neck squamous cell cancer (HNSCC). There are no international evidence-based restaging guidelines. Decisions concerning neck dissection (ND) after primary radiochemotherapy (RCT) are often individually derived in the respective tumor conferences and are therefore subject to variance. Compared to the UK or USA, in Germany there is a high level of expertise in the use of ultrasound in combination with CT for the routine restaging of HNSCC after RCT. Using high-resolution sonography (B-mode and color duplex) morphological changes in neck lymph nodes can be clearly detected. Another important aspect in the field of sonographic follow-up is the accurate and standardized documentation of findings and control of dynamic changes during follow-up. In summary, clinical presentation and sonography enable therapeutic decisions and treatment from one source.

PMID: 28905170 [PubMed - as supplied by publisher]

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Iatrogenic patient injuries in otology during a 10-year period: review of national patient insurance charts.

Iatrogenic patient injuries in otology during a 10-year period: review of national patient insurance charts.

Acta Otolaryngol. 2017 Sep 14;:1-5

Authors: Helmiö P, Saarinen R, Aaltonen LM, Lehtonen L, Blomgren K

Abstract
OBJECTIVE: To assess patient injury characteristics and contributing factors in otology.
METHODS: Data on the accepted patient-injury claims involving otorhinolaryngology (ORL), closed between 2001 and 2011, from the Finnish Patient Insurance Centre registry was retrieved. We included all injuries concerning otology, with evaluation and classification of their causes and types.
RESULTS: During the 10-year study period, a total of 44 claims were accepted as compensated patient injuries in otology. From a total of 233 patient injuries in all ORL, this amounted to 19%. In outpatient care, occurred 12 (27%) injuries and in surgical procedures 32 (73%). Five (11%) patients were children. Errors in surgical technique were identified as the primary cause of the injury in 22 (69%) operation-related cases. Failure to remove all auricular tampons or packing in postoperative control was a contributing factor in 4 (13%) injuries, a facial nerve was damaged in 9 (28%) operations, and in 12 (38%) patients, the injury resulted in severe hearing loss or deafness. Six patients (21%) needed one or more re-operations related to the injury, of which two were due to an incomplete primary operation.
CONCLUSION: Typical compensated patient injuries in operative otology resulted from common complications of common operations in high volume centres.

PMID: 28906175 [PubMed - as supplied by publisher]

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WASH overexpression enhances cancer stem cell properties and correlates with poor prognosis of esophageal carcinoma

Abstract

There is increasing evidence that cytoskeleton remodeling is involved in cancer progression. Wiskott-Aldrich syndrome Protein (WASP) family represents a key regulator of actin cytoskeleton remodeling. However, the underlying mechanism of WASP family in cancer progression remains elusive. Here, we studied the role of WASP and SCAR Homolog (WASH), a recently identified WASP family member, in human esophageal squamous cell carcinoma (ESCC). Using three human ESCC cell lines, we found that WASH expression was significantly elevated in cancer stem-like cells enriched by sphere formation assay. WASH knockdown decreased the sphere-forming capacity of esophageal cancer cells whereas WASH over-expression exhibited the opposite effect. Mechanistically, we identified interleukin-8 (IL-8) as a key downstream target of WASH. IL-8 Knockdown completely attenuated tumor sphere formation induced by WASH overexpression. WASH knockdown also delayed the growth of human ESCC xenografts in BALB/c nude mice. Importantly, high WASH levels were associated with poor clinical prognosis in a total of 145 human ESCC tissues. Collectively, our results suggest an essential role of WASH/IL-8 pathway in human ESCC via maintaining the stemness of cancer cells. Hence, targeting this pathway might represent a promising strategy to control human esophageal carcinoma.

This article is protected by copyright. All rights reserved.

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Identification of causative variants in TXNL4A in Burn-McKeown syndrome and isolated choanal atresia.

Identification of causative variants in TXNL4A in Burn-McKeown syndrome and isolated choanal atresia.

Eur J Hum Genet. 2017 Oct;25(10):1126-1133

Authors: Goos JAC, Swagemakers SMA, Twigg SRF, van Dooren MF, Hoogeboom AJM, Beetz C, Günther S, Magielsen FJ, Ockeloen CW, A Ramos-Arroyo M, Pfundt R, Yntema HG, van der Spek PJ, Stanier P, Wieczorek D, Wilkie AOM, van den Ouweland AMW, Mathijssen IMJ, Hurst JA

Abstract
Burn-McKeown syndrome (BMKS) is a rare syndrome characterized by choanal atresia, prominent ears, abnormalities of the outer third of the lower eyelid, structural cardiac abnormalities, conductive and sensorineural hearing loss, and cleft lip. Recently, causative compound heterozygous variants were identified in TXNL4A. We analyzed an individual with clinical features of BMKS and her parents by whole-genome sequencing and identified compound heterozygous variants in TXNL4A (a novel splice site variant (c.258-2A>G, (p.?)) and a 34 bp promoter deletion (hg19 chr18:g.77748581_77748614del (type 1Δ) in the proband). Subsequently, we tested a cohort of 19 individuals with (mild) features of BMKS and 17 individuals with isolated choanal atresia for causative variants in TXNL4A by dideoxy-sequence analysis. In one individual with BMKS unrelated to the first family, we identified the identical compound heterozygous variants. In an individual with isolated choanal atresia, we found homozygosity for the same type 1Δ promoter deletion, whilst in two cousins from a family with choanal atresia and other minor anomalies we found homozygosity for a different deletion within the promoter (hg19 chr18: g.77748604_77748637del (type 2Δ)). Hence, we identified causative recessive variants in TXNL4A in two individuals with BMKS as well as in three individuals (from two families) with isolated choanal atresia.

PMID: 28905882 [PubMed - in process]

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[Identification of a novel SLC26A4 mutation in a child with enlarge vestibular aqueduct syndrome].

Related Articles

[Identification of a novel SLC26A4 mutation in a child with enlarge vestibular aqueduct syndrome].

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2017 Jun 10;34(3):390-392

Authors: Sun D, Mu W, Zhang Y, Gao H, Fang F, Yu M, Zhao L, Zhang J, Mi D, Chang L, Cao Q

Abstract
OBJECTIVE: To analyze mutations of SLC26A4 gene and explore their origins for a patient with enlarge vestibuar aqueduct syndrome.
METHODS: Clinical data and peripheral venous blood samples were collected from the patient and her parents. Genome DNA was extracted from the peripheral blood. All of the 21 exons of the SLC26A4 gene were amplified with PCR and subjected to directly sequencing.
RESULTS: The patient was found to have carried two mutant alleles of the SLC26A4 gene, namely c.1522A to G and c.1229C to T, which were inherited from her father and mother, respectively.
CONCLUSION: SLC26A4 c.1522A to G is likely to be a pathogenic mutation. Above results may facilitate genetic counseling and prenatal diagnosis for this family.

PMID: 28604962 [PubMed - indexed for MEDLINE]

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A nearly full-recovery from AVM hemorrhagic stroke 17 years after insult using a new integrated neurodevelopmental approach: A case report.

A nearly full-recovery from AVM hemorrhagic stroke 17 years after insult using a new integrated neurodevelopmental approach: A case report.

Medicine (Baltimore). 2017 Sep;96(37):e8026

Authors: Friedmann AJ

Abstract
RATIONAL: With the prevalence of stroke increasing in the USA and the world along with increased survival and longevity due to medical advancements, it has become increasingly necessary to look at the chronic phase of stroke recovery. Previous paradigms of stroke treatment have proven ineffective when looking at 10, 15, or 20 years of survival post insult.
PATIENT CONCERNS: The patient, being a young man just out of high school, was concerned with his overall morbidity. He was highly concerned with the quality of life he could expect as a stroke survivor with a life expectancy of 60 years or more.
DIAGNOSES: C was diagnosed with a hemorrhagic AVM stroke that impacted several regions of the brain, particularly the right occipital and temporal lobes as well as bilateral motor control. C experienced severe hpertonicity of the musculature and significant vertigo.
INTERVENTIONS: This study investigated a novel approach to chronic-phase stroke rehabilitation using traditional child motor-learning techniques, play, and proprioceptive-building activities in addition to current stroke rehabilitation techniques. During an initial six-month period, followed by a three-year period, the participant used motor-developmental learning activities as well as traditional strength, gait, and balance training. During the initial phase of treatment, clinically-significant improvements were recorded along with self-reported lifestyle enhancements. These gains continued throughout the three-and-a-half year process.
OUTCOMES: C regained the ability to free-walk in small bouts and went from the use of a walker to canes. He regained use of his hands and removed a large partion of his vertigo. Of specific interest was the participant's ability to progress from using a walker to driving, returning to school, and starting a family.
LESSONS: This study lays the groundwork for future studies into this type of therapeutic approach as well as highlighting the ability of chronic-phase stroke patients to recover well into the second decade post stroke. After the initial six month period, as gains were being observed, a more formal measurement process was begun for a second six-month period. Initial measurements of progress were taken every six weeks using the Fugl-Meyer test, the Berg Balance Test, the Barthel Index, and the Stroke Specific Quality Of Life scale. Results showed clinically significant improvements in all areas of recovery.

PMID: 28906387 [PubMed - in process]

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Gamma Knife Radiosurgery for Vestibular Schwannomas and Quality of Life Evaluation.

Related Articles

Gamma Knife Radiosurgery for Vestibular Schwannomas and Quality of Life Evaluation.

Stereotact Funct Neurosurg. 2017;95(3):166-173

Authors: Berkowitz O, Han YY, Talbott EO, Iyer AK, Kano H, Kondziolka D, Brown MA, Lunsford LD

Abstract
BACKGROUND: Further investigation is needed to look at the impact of vestibular schwannoma (VS) on the health-related quality of life (QOL) of participants who undergo Gamma Knife® radiosurgery (GKRS).
OBJECTIVES: Investigators compared the QOL for VS participants to reported US population norms in order to evaluate disease burden and long-term QOL several years after GKRS.
METHODS: This cross-sectional study surveyed participants to assess hearing status, tinnitus, imbalance, vertigo, as well as the Short-Form 36-item Health Questionnaire (SF-36). The data were normalized, age adjusted, and functional status was correlated to determine clinically significant differences.
RESULTS: A total of 353 participants who underwent GKRS between 1997 and 2007 were included in this study with a median postoperative period of 5 years. SF-36 scores were very similar to population norms, and age-adjusted scores for participants followed the US population curve. Frequent vertigo and balance problems had the largest statistically and clinically significant effect on physical and mental component summary scores followed by nonuseful hearing in the tumor ear.
CONCLUSIONS: Participants reported a good long-term QOL that was very similar to the QOL of US population norms. Of the common VS symptoms, vertigo had the greatest impact on QOL followed by imbalance and then hearing loss.

PMID: 28531896 [PubMed - indexed for MEDLINE]

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Antiproliferative Effects of Bacillus coagulans Unique IS2 in Colon Cancer Cells.

Antiproliferative Effects of Bacillus coagulans Unique IS2 in Colon Cancer Cells.

Nutr Cancer. 2017 Sep 14;:1-7

Authors: Madempudi RS, Kalle AM

Abstract
In the present study, the in vitro anticancer (antiproliferative) effects of Bacillus coagulans Unique IS2 were evaluated on human colon cancer (COLO 205), cervical cancer (HeLa), and chronic myeloid leukemia (K562) cell lines with a human embryonic kidney cell line (HEK 293T) as noncancerous control cells. The Cytotoxicity assay (MTT) clearly demonstrated a 22%, 31.7%, and 19.5% decrease in cell proliferation of COLO 205, HeLa, and K562 cells, respectively, when compared to the noncancerous HEK 293T cells. Normal phase-contrast microscopic images clearly suggested that the mechanism of cell death is by apoptosis. To further confirm the induction of apoptosis by Unique IS2, the sub-G0-G1 peak of the cell cycle was quantified using a flow cytometer and the data indicated 40% of the apoptotic cells in Unique IS2-treated COLO cells when compared with their untreated control cells. The Western blot analysis showed an increase in pro-apoptotic protein BAX, decrease in antiapoptotic protein, Bcl2, decrease in mitochondrial membrane potential, increase in cytochrome c release, increase in Caspase 3 activity, and cleavage of poly(ADP-ribose) polymerase. The present study suggests that the heat-killed culture supernatant of B. coagulans can be more effective in inducing apoptosis of colon cancer cells and that can be considered for adjuvant therapy in the treatment of colon carcinoma.

PMID: 28910156 [PubMed - as supplied by publisher]

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Future Meetings.

Future Meetings.

Thyroid. 2017 Sep;27(9):1211

Authors:

PMID: 28910235 [PubMed - in process]

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Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Int J Audiol. 2017 Sep 14;:1-5

Authors: Wakabayashi S, Saito H, Oishi N, Shinden S, Ogawa K

Abstract
OBJECTIVE: To assess the effects of tinnitus treatments on sleep disorders in patients with tinnitus.
DESIGN: Subjects completed the Pittsburg Sleep Quality Index (PSQI), Tinnitus Handicap Inventory (THI), Self-rating Depression Scale (SDS), and State Trait Anxiety Inventory (STAI). The questionnaire results and the patients' sex, age, time since the onset of tinnitus, and mean hearing level were examined, and differences between a sleep disorder group and a normal sleep group were examined. Patients completed the questionnaires again after initiating tinnitus treatments (counselling and use of sound generators), and the change in questionnaire scores at follow-up was evaluated.
STUDY SAMPLE: Patients (N = 100) with tinnitus who visited Keio University Hospital and started treatment without medication between 2005 and 2008.
RESULTS: Sixty-six percent of the patients had sleep disorders. Compared with patients without sleep disorders, patients with sleep disorders had significantly higher SDS and STAI scores at the first visit. The mean PSQI scores showed significant improvement at follow-up.
CONCLUSIONS: Sleep disorders in patients with tinnitus improved after tinnitus treatments. Complex interactions between depressive symptoms and anxiety may occur in these patients. The improvement in sleep disorders at follow-up was correlated with improvements in tinnitus severity and state anxiety.

PMID: 28906162 [PubMed - as supplied by publisher]

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Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Int J Audiol. 2017 Sep 14;:1-8

Authors: Li YL, Lin YH, Yang HM, Chen YJ, Wu JL

Abstract
OBJECTIVE: This study explored tone production, tone perception and intelligibility of produced speech in Mandarin-speaking prelingually deaf children with at least 5 years of cochlear implant (CI) experience. Another focus was on the predictive value of tone perception and tone production as they relate to speech intelligibility.
DESIGN: Cross-sectional research.
STUDY SAMPLE: Thirty-three prelingually deafened children aged over eight years with over five years of experience with CI underwent tests for tone perception, tone production, and the Speech Intelligibility Rating (SIR). A Pearson correlation and a stepwise regression analysis were used to estimate the correlations among tone perception, tone production, and SIR scores.
RESULTS: The mean scores for tone perception, tone production, and SIR were 76.88%, 90.08%, and 4.08, respectively. Moderately positive Pearson correlations were found between tone perception and production, tone production and SIR, and tone perception and SIR (p < 0.01, p < 0.01 and p < 0.01, respectively). In the stepwise regression analysis, tone production, as the major predictor, accounted for 29% of the variations in the SIR (p < 0.01).
CONCLUSIONS: Mandarin-speaking cochlear-implanted children with sufficient duration of CI use produce intelligent speech. Speech intelligibility can be predicted by tone production performance.

PMID: 28906160 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2y3rqKN

Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Effects of tinnitus treatments on sleep disorders in patients with tinnitus.

Int J Audiol. 2017 Sep 14;:1-5

Authors: Wakabayashi S, Saito H, Oishi N, Shinden S, Ogawa K

Abstract
OBJECTIVE: To assess the effects of tinnitus treatments on sleep disorders in patients with tinnitus.
DESIGN: Subjects completed the Pittsburg Sleep Quality Index (PSQI), Tinnitus Handicap Inventory (THI), Self-rating Depression Scale (SDS), and State Trait Anxiety Inventory (STAI). The questionnaire results and the patients' sex, age, time since the onset of tinnitus, and mean hearing level were examined, and differences between a sleep disorder group and a normal sleep group were examined. Patients completed the questionnaires again after initiating tinnitus treatments (counselling and use of sound generators), and the change in questionnaire scores at follow-up was evaluated.
STUDY SAMPLE: Patients (N = 100) with tinnitus who visited Keio University Hospital and started treatment without medication between 2005 and 2008.
RESULTS: Sixty-six percent of the patients had sleep disorders. Compared with patients without sleep disorders, patients with sleep disorders had significantly higher SDS and STAI scores at the first visit. The mean PSQI scores showed significant improvement at follow-up.
CONCLUSIONS: Sleep disorders in patients with tinnitus improved after tinnitus treatments. Complex interactions between depressive symptoms and anxiety may occur in these patients. The improvement in sleep disorders at follow-up was correlated with improvements in tinnitus severity and state anxiety.

PMID: 28906162 [PubMed - as supplied by publisher]

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Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children.

Int J Audiol. 2017 Sep 14;:1-8

Authors: Li YL, Lin YH, Yang HM, Chen YJ, Wu JL

Abstract
OBJECTIVE: This study explored tone production, tone perception and intelligibility of produced speech in Mandarin-speaking prelingually deaf children with at least 5 years of cochlear implant (CI) experience. Another focus was on the predictive value of tone perception and tone production as they relate to speech intelligibility.
DESIGN: Cross-sectional research.
STUDY SAMPLE: Thirty-three prelingually deafened children aged over eight years with over five years of experience with CI underwent tests for tone perception, tone production, and the Speech Intelligibility Rating (SIR). A Pearson correlation and a stepwise regression analysis were used to estimate the correlations among tone perception, tone production, and SIR scores.
RESULTS: The mean scores for tone perception, tone production, and SIR were 76.88%, 90.08%, and 4.08, respectively. Moderately positive Pearson correlations were found between tone perception and production, tone production and SIR, and tone perception and SIR (p < 0.01, p < 0.01 and p < 0.01, respectively). In the stepwise regression analysis, tone production, as the major predictor, accounted for 29% of the variations in the SIR (p < 0.01).
CONCLUSIONS: Mandarin-speaking cochlear-implanted children with sufficient duration of CI use produce intelligent speech. Speech intelligibility can be predicted by tone production performance.

PMID: 28906160 [PubMed - as supplied by publisher]

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Do pancreatic cancer and chronic pancreatitis share the same genetic risk factors? A PANcreatic Disease ReseArch (PANDoRA) consortium investigation

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a very aggressive tumor with a five-year survival of less than 6%. Chronic pancreatitis (CP), an inflammatory process in of the pancreas, is a strong risk factor for PDAC. Several genetic polymorphisms have been discovered as susceptibility loci for both CP and PDAC. Since CP and PDAC share consistent number of epidemiologic risk factors, the aim of this study was to investigate whether specific CP risk loci also contribute to PDAC susceptibility. We selected five common SNPs (rs11988997, rs379742, rs10273639 rs2995271 and rs12688220) that were identified as susceptibility markers for CP and analyzed them in 2,914 PDAC cases, 356 CP cases and 5,596 controls retrospectively collected in the context of the international PANDoRA consortium. We found a weak association between the minor allele of the PRSS1-PRSS2-rs10273639 and an increased risk of developing PDAC (OR_homozygous=1.19, 95% CI 1.02-1.38, p=0.023). Additionally all the SNPs confirmed statistically significant associations with risk of developing CP, the strongest being PRSS1-PRSS2-rs10273639 (OR_heterozygous=0.51, 95% CI 0.39-0.67, p=1.10x10⁻⁶) and MORC4-rs 12837024 (OR_homozygous=2.07 (1.55-2.77, p_trend=0.7x10⁻¹¹). Taken together, the results from our study do not support variants rs11988997, rs379742, rs10273639 rs2995271 and rs12688220 as strong predictors of PDAC risk, but further support the role of these SNPs in CP susceptibility. Our study suggests that CP and PDAC probably do not share genetic susceptibility, at least in terms of high frequency variants. This article is protected by copyright. All rights reserved.

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Red and processed meat intake and cancer risk: Results from the prospective NutriNet-Santé cohort study

Abstract

The International Agency for Research on Cancer (WHO-IARC) classified red meat and processed meat as probably carcinogenic and carcinogenic for humans, respectively. These conclusions were mainly based on studies concerning colorectal cancer, but scientific evidence is still limited for other cancer locations. In this study, we investigated the prospective associations between red and processed meat intakes and overall, breast, and prostate cancer risk. This prospective study included 61,476 men and women of the French NutriNet-Santé cohort (2009-2015) aged ≥35y and who completed at least 3 24h dietary records during the first year of follow-up. The risk of developing cancer was compared across sex-specific quintiles of red and processed meat intakes by multivariable Cox models. 1,609 first primary incident cancer cases were diagnosed during follow-up, among which 544 breast cancers and 222 prostate cancers. Red meat intake was associated with increased risk of overall cancers (HR_Q5vs.Q1=1.31 (1.10–1.55), P_trend=0.01) and breast cancer (HR_Q5vs.Q1=1.83 (1.33–2.51), P_trend=0.002). The latter association was observed in both premenopausal (HR_Q5vs.Q1=2.04 (1.03-4.06)) and postmenopausal women (HR_Q5vs.Q1=1.79 (1.26-2.55)). No association was observed between red meat intake and prostate cancer risk. Processed meat intake was relatively low in this study (cut-offs for the 5^th quintile=46g/d in men and 29g/d in women) and was not associated with overall, breast or prostate cancer risk. This large cohort study suggested that red meat may be involved carcinogenesis at several cancer locations (other than colon-rectum), in particular breast cancer. These results are consistent with mechanistic evidence from experimental studies. This article is protected by copyright. All rights reserved.

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Bacterial penetration into filled root canals exposed to different pressures and to the oral environment—in vivo analysis

Abstract

Objectives

The study aims to correlate the depth of bacterial penetration into filled root canals with the time of exposure to the oral environment and different pressures.

Materials and methods

One-hundred and twenty-two root canals of male Beagle dog teeth were prepared and filled. The root canals were distributed into three groups, according to the pressure applied: (A) no pressure, (B) 30 kPa, and (C) 60 kPa. Then, the root canals were exposed to the oral environment, establishing sub-groups considering the time intervals of exposure: (1) 45 days and (2) 120 days (n = 17). Sub-groups had positive and negative controls (n = 5). The animals were sacrificed, and the specimens were prepared for histological analysis.

Results

There was no significant difference in the bacterial penetration among groups A, B, and C at 45 days (P = 0.903) and 120 days (P = 0.211). No statistically significant difference was found (P = 0.608) between the exposure time intervals. Most of the specimens from experimental groups exposed for 120 days presented moderate inflammatory infiltrate.

Conclusions

Pressures of 30 and 60 kPa did not affect sealing ability of root canal filling. The time of exposure did not influence bacterial penetration, which was limited to the first 4 mm of the root canals exposed for 120 days.

Clinical relevance

This animal study demonstrated that disinfection of the first millimeters of root canals could be considered before retreatment of their entire length. However, clinical studies in humans should be conducted before validation of this protocol.

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Interpreting signal-intensity ratios without visible T1 hyperintensities in clinical gadolinium retention studies

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Image-guided percutaneous removal of ballistic foreign bodies secondary to air gun injuries

Abstract

Background

Ballistic injuries with retained foreign bodies from air guns is a relatively common problem, particularly in children and adolescents. If not removed in a timely fashion, the foreign bodies can result in complications, including pain and infection. Diagnostic methods to identify the presence of the foreign body run the entire gamut of radiology, particularly radiography, ultrasound (US) and computed tomography (CT). Removal of the foreign bodies can be performed by primary care, emergency, surgical, and radiologic clinicians, with or without imaging guidance.

Objective

To evaluate the modalities of radiologic detection and the experience of image-guided ballistic foreign body removal related to air gun injuries within the interventional radiology department of a large pediatric hospital.

Materials and methods

A database of more than 1,000 foreign bodies that were removed with imaging guidance by the interventional radiologists at our institution was searched for ballistic foreign bodies from air guns. The location, dimensions, diagnostic modality, duration, complications and imaging modality used for removal were recorded. In addition, the use of sedation and anesthesia required for the procedures was also recorded.

Results

Sixty-one patients with ballistic foreign bodies were identified. All foreign bodies were metallic BBs or pellets. The age of the patients ranged from 5 to 20 years. The initial diagnostic modality to detect the foreign bodies was primarily radiography. The primary modality to assist in removal was US, closely followed by fluoroscopy. For the procedure, 32.7% of the patients required some level of sedation. Only two patients had an active infection at the time of the removal. The foreign bodies were primarily in the soft tissues; however, successful removal was also performed from intraosseous, intraglandular and intratendinous locations. All cases resulted in successful removal without complications.

Conclusion

Image-guided removal of ballistic foreign bodies secondary to air guns is a very effective procedure that can obviate the need for open surgical procedures in children.

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Effect of swallowing maneuver on fentanyl-induced coughing

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In reply: Sevoflurane in patients at risk of ventricular dysrhythmias

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Interfacial Fracture Toughness of Adhesive Resin Cement—Lithium-Disilicate/Resin-Composite Blocks

Abstract

Purpose

Resin composite blocks (RCB) are advocated as alternative to ceramic blocks (CB). Prior to use, adherence to these materials should characterized. This study aimed to test the null hypothesis (H₀) that material and surface treatment combinations do not influence interfacial fracture toughness (K_IC) of a self-cured adhesive resin cement [RelyX Ultimate (RXU)] to RCB or CB, under nonaged and aged conditions.

Materials and Methods

Two RCB, Lava Ultimate (LU) and Enamic (EN), and one CB, IPS e.max Press (EMP) were used. Half-size [(6 × 6 × 6 × 6 mm)] specimens were prepared for EMP (n = 30), EN (n = 30), and LU (n = 60). RCB specimens were prepared by wet cutting/grinding, while CB specimens were pressed. Surfaces of EMP and EN were preconditioned with hydrofluoric acid (5%); surfaces of LU were sandblasted with either 27 μm alumina (LUS) or 30 μm silica-modified alumina Rocatec soft (LUR). All specimens were bonded with Scotchbond Universal adhesive and RXU. Additionally, twenty (4 × 4 × 4 × 8 mm) RXU specimens were prepared. All specimens were stored in water at 37°C and tested after 1 and 60 days. Interfacial K_IC was determined with the notchless triangular prism specimen K_IC test. Results were analyzed with two-way ANOVA and Scheffé multiple means comparisons (α = 0.05). Preconditioned and selected fractured surfaces were characterized with scanning electron microscopy.

Results

At 24 hours, LUS-RXU and LUR-RXU had significantly higher interfacial K_IC than EN-RXU and EMP-RXU and were not different from K_IC of RXU. Aging lead to a significant decrease in K_IC of RXU and interfacial K_IC of LUS-RXU, LUR-RXU, and EMP-RXU; interfacial K_IC of EN-RXU was not affected. Based on the results, H₀ was rejected.

Conclusion

Under the conditions of this study, at 24 hours, interfacial K_IC of LUS-RXU and LUR-RXU was superior to EMP-RXU and EN-RXU. Aging in water at 37°C did not affect interfacial K_IC of EN-RXU but adversely affected K_IC of RXU and the other interfacial K_IC. Clinical Implications: The results suggest that RXU and its adherence to LU and EMP deteriorates upon exposure to water at 37°C. In making clinical decisions related to material selection, practitioners should consider in vitro results.

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Effect of Simulated Mastication on the Retention of Locator Attachments for Implant-Supported Overdentures: An In Vitro Pilot Study

Abstract

Purpose

Limited information is currently available relative to the effect of masticatory loads on the retentive properties of Locator attachments. The aims of this in vitro study were to assess and compare the effect of simulated mastication on the retention of white, pink, and blue Locator inserts for overdentures retained by 2 implants.

Materials and Methods

Thirty specimens simulating a nonanatomic edentulous flat ridge with two implants and an overdenture were divided into 3 groups according to the color of the fitted insert: transparent clear group (n = 10), pink group (n = 10), and blue group (n = 10). Retention forces were measured in an axial direction initially and after 100,000 cycles of simulated masticatory loads. One-way ANOVA followed by Tukey's post hoc tests were used to compare retention values and percentage retention loss between the 3 groups with significance set at p = 0.05.

Results

The 3 groups presented significant differences in retention at baseline (9.95 ± 1.91 N, 15.43 ± 4.08 N, and 41.73 ± 9.29 N for the blue, pink, and clear groups, respectively) and after simulated mastication (6.37 ± 2.64 N, 14.00 ± 3.89 N, 38.20 ± 5.11 N for the blue, pink, and clear groups, respectively). Within the same group, cyclic loading did not significantly affect retention in the clear and pink groups, while the blue inserts showed a significant retention loss (-37%) after loading.

Conclusions

The results suggest that short-term simulated mastication affects the extra-light blue inserts but not the more-retentive inserts.

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Relationship of Number of Missing Teeth to Hip Fracture in Elderly Patients: A Cohort Pilot Study

Abstract

Purpose

To determine the relationship between the number of missing natural teeth or remaining natural teeth and osteoporotic hip fracture in elderly patients and to determine the relationship between the number of missing teeth or remaining teeth and osteoporotic fracture risk assessment (FRAX) probability.

Materials and Methods

Number of missing teeth was determined by clinical oral exam on a total of 100 subjects, 50 with hip fractures and 50 without. Ten-year fracture risk and hip fracture risk probabilities were calculated using the FRAX tool. Statistical analyses were performed to determine strength of associations between number of missing natural teeth and likelihood of experiencing a fracture. Degree of correlation between number of missing natural teeth and FRAX probabilities were calculated.

Results

There appears to be an association between the number of missing natural teeth and hip fractures. For every 5-tooth increase in the number of missing teeth, the likelihood of being a subject in the hip fracture group increased by 26%. Number of missing natural teeth was positively correlated with FRAX overall fracture and hip fracture probability.

Conclusions

Number of missing natural teeth may be a valuable tool to assist members of medical and dental teams in identifying patients with higher FRAX scores and higher likelihood of experiencing a hip fracture. Additional research is necessary to validate these findings.

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Gonial Angle Measured by Orthopantomography as a Predictor of Maximum Occlusal Force

Abstract

Purpose

To establish the accuracy of measuring the gonial angle on an orthopantomogram (GAO), as defined by the anatomic relationship between the inferior and posterior borders of the mandible. Furthermore, to examine the relationship between GAO and maximum occlusal force (MOF) in the premolar and molar regions of healthy young adults.

Materials and Methods

Orthopantomograms of dry mandibles were obtained in three orientations in the sagittal plane, to represent variation in image acquisition in clinical settings. The GAO was measured using image-processing software, and reliability was analyzed using the intraclass correlation coefficient. Then, GAO, MOF, gender, and body mass index (BMI) were measured in a cohort of healthy young adult volunteers. MOF was measured using an Occlusal Force Meter GM 10 device. The relationships between GAO, MOF, sex, and BMI were examined using the Pearson correlation coefficient and multiple regression analysis.

Results

In five dry mandibles, there was a high correlation between the GAOs measured in the different orientations (p < 0.001). In 58 healthy volunteers (31 women and 27 men, mean age 24.6 years), the mean GAO was 123.3° ± 7.5°. The mean MOFs at the first premolar, second premolar, and first molar teeth were 256.4 N ± 128.3 N, 319.0 N ± 171.7 N, and 487.5 N ± 227.2 N, respectively. Men had significantly greater MOF than women at all teeth. The GAO was significantly inversely correlated with MOF at the second premolar (r = −0.376, p = 0.005) and first molar teeth (r = −0.479, p < 0.001). Multiple regression analysis showed that GAO was a significant explanatory factor for MOF at the second premolar and first molar teeth (p = 0.012 and 0.001, respectively).

Conclusions

GAOs were measured accurately on the orthopantomograms taken in this study and were a reliable predictor of MOF between the second premolar and first molar teeth. A smaller GAO was associated with a greater MOF at the second premolar and first molar teeth.

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Bacterial penetration into filled root canals exposed to different pressures and to the oral environment—in vivo analysis

Abstract

Objectives

The study aims to correlate the depth of bacterial penetration into filled root canals with the time of exposure to the oral environment and different pressures.

Materials and methods

One-hundred and twenty-two root canals of male Beagle dog teeth were prepared and filled. The root canals were distributed into three groups, according to the pressure applied: (A) no pressure, (B) 30 kPa, and (C) 60 kPa. Then, the root canals were exposed to the oral environment, establishing sub-groups considering the time intervals of exposure: (1) 45 days and (2) 120 days (n = 17). Sub-groups had positive and negative controls (n = 5). The animals were sacrificed, and the specimens were prepared for histological analysis.

Results

There was no significant difference in the bacterial penetration among groups A, B, and C at 45 days (P = 0.903) and 120 days (P = 0.211). No statistically significant difference was found (P = 0.608) between the exposure time intervals. Most of the specimens from experimental groups exposed for 120 days presented moderate inflammatory infiltrate.

Conclusions

Pressures of 30 and 60 kPa did not affect sealing ability of root canal filling. The time of exposure did not influence bacterial penetration, which was limited to the first 4 mm of the root canals exposed for 120 days.

Clinical relevance

This animal study demonstrated that disinfection of the first millimeters of root canals could be considered before retreatment of their entire length. However, clinical studies in humans should be conducted before validation of this protocol.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2x6yUPE

Association of fetuin B with markers of liver fibrosis in nonalcoholic fatty liver disease

Abstract

Objective

The liver-derived plasma protein fetuin B is associated with nonalcoholic fatty liver disease (NAFLD) and impaired glucose homeostasis in mice. However, its association with non-invasive ultrasound- and magnetic resonance (MR)-based markers of liver fibrosis and steatosis, the enhanced liver fibrosis (ELF) score, liver biopsy, as well as rs738409 in PNPLA3, has not been elucidated in NAFLD, so far.

Design and methods

The association of circulating fetuin B and transient elastography (TE), controlled attenuation parameter (CAP), ¹H-MR-spectroscopy, the ELF score, liver biopsy, as well as risk alleles in rs738409 in PNPLA3, was studied in 101 NAFLD patients as compared to 15 healthy controls.

Results

Serum fetuin B levels did not differ between NAFLD patients and controls (p = 0.863). Fetuin B was independently and negatively associated with transient elastography liver stiffness measurement (LSM) (p = 0.002), but not with the steatosis markers CAP or ¹H-MR-spectroscopy. Fetuin B serum concentrations were significantly lower in individuals with LSM > 7.0 kPa as compared to patients with LSM < 7.0 kPa (p = 0.024). Furthermore, the ELF score and histologically proven fibrosis were independent and negative predictors of circulating fetuin B. Moreover, serum fetuin B significantly depended on number of rs738409 risk alleles (p = 0.026).

Conclusions

Fetuin B is independently and negatively associated with non-invasive markers of liver fibrosis and PNPLA3 status in NAFLD patients but does not show a correlation with the hepatic lipid content. Future studies need to elucidate the pathophysiological significance of fetuin B in NAFLD and its potential value as predictor for disease severity.

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Association of fetuin B with markers of liver fibrosis in nonalcoholic fatty liver disease

Abstract

Objective

The liver-derived plasma protein fetuin B is associated with nonalcoholic fatty liver disease (NAFLD) and impaired glucose homeostasis in mice. However, its association with non-invasive ultrasound- and magnetic resonance (MR)-based markers of liver fibrosis and steatosis, the enhanced liver fibrosis (ELF) score, liver biopsy, as well as rs738409 in PNPLA3, has not been elucidated in NAFLD, so far.

Design and methods

The association of circulating fetuin B and transient elastography (TE), controlled attenuation parameter (CAP), ¹H-MR-spectroscopy, the ELF score, liver biopsy, as well as risk alleles in rs738409 in PNPLA3, was studied in 101 NAFLD patients as compared to 15 healthy controls.

Results

Serum fetuin B levels did not differ between NAFLD patients and controls (p = 0.863). Fetuin B was independently and negatively associated with transient elastography liver stiffness measurement (LSM) (p = 0.002), but not with the steatosis markers CAP or ¹H-MR-spectroscopy. Fetuin B serum concentrations were significantly lower in individuals with LSM > 7.0 kPa as compared to patients with LSM < 7.0 kPa (p = 0.024). Furthermore, the ELF score and histologically proven fibrosis were independent and negative predictors of circulating fetuin B. Moreover, serum fetuin B significantly depended on number of rs738409 risk alleles (p = 0.026).

Conclusions

Fetuin B is independently and negatively associated with non-invasive markers of liver fibrosis and PNPLA3 status in NAFLD patients but does not show a correlation with the hepatic lipid content. Future studies need to elucidate the pathophysiological significance of fetuin B in NAFLD and its potential value as predictor for disease severity.

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Expression of Concern: “Characterization of a novel epigenetically-silenced, growth-suppressive gene, ADAMTS9, and its association with lymph node metastases in nasopharyngeal carcinoma” by Lung, H. L., Lo, P. H. Y., Xie, D., Apte, S. S., Cheung, A. K. L., Cheng, Y., Law, E. W. L., Chua, D., Zeng, Y.-X., Tsao, S. W., Stanbridge, E. J. and Lung, M. L.

An Expression of Concern is issued in relation to the above article, published online on 30 April 2008 in Wiley Online Library (wileyonlinelibrary.com), and in Volume 123, pp. 401–408, by agreement between the authors, the journal Editor-in-Chief, Prof. Peter Lichter, and John Wiley & Sons Ltd. The Expression of Concern has been agreed to due to concerns about Fig. 2a. Despite being unable to retrieve the original data due to the time that has elapsed, the authors believe the gene expression results of those DNA samples to be reproducible.

Reference

Lung, H. L., Lo, P. H. Y., Xie, D., Apte, S. S., Cheung, A. K. L., Cheng, Y., Law, E. W. L., Chua, D., Zeng, Y.-X., Tsao, S. W., Stanbridge, E. J. and Lung, M. L. (2008), Characterization of a novel epigenetically-silenced, growth-suppressive gene, ADAMTS9, and its association with lymph node metastases in nasopharyngeal carcinoma. Int. J. Cancer, 123:401–408. DOI:10.1002/ijc.23528

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EXTERNAL VALIDATION OF THE CLAIMS-BASED FRAILTY INDEX IN THE NATIONAL HEALTH AND AGING TRENDS STUDY COHORT

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RE: “INDOOR TANNING AND MELANOMA RISK: LONG-TERM EVIDENCE FROM A PROSPECTIVE POPULATION-BASED COHORT STUDY”

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The Harm Done to Reproducibility by the Culture of Null Hypothesis Significance Testing

Abstract

In the last few years, stakeholders in the scientific community have raised alarms about a perceived lack of reproducibility of scientific results. In reaction, guidelines for journals have been promulgated and grant applicants have been asked to address the rigor and reproducibility of their proposed projects. Neither solution addresses a primary culprit, which is the culture of null hypothesis significance testing that dominates statistical analysis and inference. In an innovative research enterprise, selection of results for further evaluation based on null hypothesis significance testing is doomed to yield a low proportion of reproducible results and a high proportion of effects that are initially overestimated. In addition, the culture of null hypothesis significance testing discourages quantitative adjustments to account for systematic errors and quantitative incorporation of prior information. These strategies would otherwise improve reproducibility and have not been previously proposed in the widely cited literature on this topic. Without discarding the culture of null hypothesis significance testing and implementing these alternative methods for statistical analysis and inference, all other strategies for improving reproducibility will yield marginal gains at best.

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Invited Commentary: Can Issues With Reproducibility in Science Be Blamed on Hypothesis Testing?

Abstract

In the accompanying article (Am J Epidemiol. 2017;186(6):646–647), Dr. Timothy Lash makes a forceful case that the problems with reproducibility in science stem from our "culture" of null hypothesis significance testing. He notes that when attention is selectively given to statistically significant findings, the estimated effects will be systematically biased away from the null. Here I revisit the recent history of genetic epidemiology and argue for retaining statistical testing as an important part of the tool kit. Particularly when many factors are considered in an agnostic way, in what Lash calls "innovative" research, investigators need a selection strategy to identify which findings are most likely to be genuine, and hence worthy of further study.

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Invited Commentary: The Need for Cognitive Science in Methodology

Abstract

There is no complete solution for the problem of abuse of statistics, but methodological training needs to cover cognitive biases and other psychosocial factors affecting inferences. The present paper discusses 3 common cognitive distortions: 1) dichotomania, the compulsion to perceive quantities as dichotomous even when dichotomization is unnecessary and misleading, as in inferences based on whether a P value is "statistically significant"; 2) nullism, the tendency to privilege the hypothesis of no difference or no effect when there is no scientific basis for doing so, as when testing only the null hypothesis; and 3) statistical reification, treating hypothetical data distributions and statistical models as if they reflect known physical laws rather than speculative assumptions for thought experiments. As commonly misused, null-hypothesis significance testing combines these cognitive problems to produce highly distorted interpretation and reporting of study results. Interval estimation has so far proven to be an inadequate solution because it involves dichotomization, an avenue for nullism. Sensitivity and bias analyses have been proposed to address reproducibility problems (Am J Epidemiol. 2017;186(6):646–647); these methods can indeed address reification, but they can also introduce new distortions via misleading specifications for bias parameters. P values can be reframed to lessen distortions by presenting them without reference to a cutoff, providing them for relevant alternatives to the null, and recognizing their dependence on all assumptions used in their computation; they nonetheless require rescaling for measuring evidence. I conclude that methodological development and training should go beyond coverage of mechanistic biases (e.g., confounding, selection bias, measurement error) to cover distortions of conclusions produced by statistical methods and psychosocial forces.

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Comparison of Health Examination Survey Methods in Brazil, Chile, Colombia, Mexico, England, Scotland, and the United States

Abstract

Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007–2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States—countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18–64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.

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Hormone Therapy Use and Risk of Chronic Disease in the Nurses’ Health Study: A Comparative Analysis With the Women's Health Initiative

Abstract

Observational studies and randomized controlled trials of menopausal hormone therapy (HT) and chronic disease risk appear to have divergent results for cardiovascular disease. However, differences may be related to a modifying effect of age, time since menopause, and HT formulation. In the Nurses' Health Study (NHS) (enrolling during 1980–1994 and following participants until 2002), we investigated associations between the use of oral conjugated equine estrogens (CEE) (0.625 mg/day) plus medroxyprogesterone acetate (MPA) (<10 mg/day) or oral CEE alone and cardiovascular disease, cancer, all-cause mortality, and other major endpoints among postmenopausal women, aged 50–79 years at HT initiation. Among women aged 50–59 years at HT initiation, associations of CEE alone or CEE+MPA with most clinical outcomes were highly concordant between NHS and Women's Health Initiative (WHI). However, for myocardial infarction, results for CEE+MPA were in the direction of risk elevation in WHI and in the direction of risk reduction in NHS. When examined according to years since menopause onset (<10 years) rather than age group, results were nonsignificant and concordant for both studies. Because few women in the NHS initiated HT after age 60 years, we did not examine associations in this group. Discrepancies between NHS and WHI could largely be attributed to differences in the age structure of the populations and age at HT initiation.

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Sleep Apnea, Disability Pensions, and Cause-Specific Mortality: A Swedish Nationwide Register Linkage Study

Abstract

Sleep apnea is a common problem affecting daily functioning and health. We evaluated associations between sleep apnea and receipt of a disability pension and mortality in a prospective study of 74,543 cases of sleep apnea (60,125 outpatient, 14,418 inpatient) from the Swedish Patient Register (2000–2009 inclusive). Cases were matched to 5 noncases (n = 371,592) and followed from diagnosis/inclusion to December 31, 2010, via nationwide registers. During a mean follow-up period of 5.1 (standard deviation, 2.7) years, 13% of men and 21% of women with inpatient sleep apnea received a disability pension. Inpatient sleep apnea was associated with higher total mortality (for men, hazard ratio (HR) = 1.71, 95% confidence interval (CI): 1.59, 1.84; for women, HR = 2.33, 95% CI: 2.04, 2.67), with associations being strongest for deaths due to ischemic heart disease (for men, HR = 2.27, 95% CI: 1.94, 2.65; for women, HR = 5.27, 95% CI: 3.78, 7.34), respiratory disorders (for men, HR = 3.29, 95% CI: 2.45, 4.42; for women, HR= 5.24, 95% CI: 3.52, 7.81), and suicide (for men, HR = 1.76, 95% CI: 1.19, 2.60; for women, HR = 4.33, 95% CI: 1.96, 9.56). There were no associations of inpatient sleep apnea with cancer mortality. Outpatient sleep apnea was associated with a higher risk of receiving a disability pension but not higher total mortality. In conclusion, inpatient sleep apnea is related to a higher risk of disability pension receipt and mortality a decade after diagnosis.

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Who Among the Elderly Is Most Vulnerable to Exposure to and Health Risks of Fine Particulate Matter From Wildfire Smoke?

Abstract

Wildfires burn more than 7 million acres in the United States annually, according to the US Forest Service. Little is known about which subpopulations are more vulnerable to health risks from wildfire smoke, including those associated with fine particulate matter. We estimated exposure to fine particles specifically from wildfires, as well as the associations between the presence of wildfire-specific fine particles and the amount of hospital admissions for respiratory causes among subpopulations older than 65 years of age in the western United States (2004–2009). Compared with other populations, higher fractions of persons who were black, lived in urban counties, and lived in California were exposed to more than 1 smoke wave (high-pollution episodes from wildfire smoke). The risks of respiratory admissions on smoke-wave days compared with non–smoke-wave days increased 10.4% (95% confidence interval: 1.9, 19.6) for women and 21.7% (95% confidence interval: 0.4, 47.3) for blacks. Our findings suggest that increased risks of respiratory admissions from wildfire smoke was significantly higher for women than for men (10.4% vs. 3.7%), blacks than whites (21.7% vs. 6.9%), and, although associations were not statistically different, people in lower-education counties than higher-educated counties (12.7% vs. 6.1%). Our study raised important environmental justice issues that can inform public health programs and wildfire management. As climate change increases the frequency and intensity of wildfires, evidence on vulnerable subpopulations can inform disaster preparedness and the understanding of climate change consequences.

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Apolipoprotein C-III and High-Density Lipoprotein Subspecies Defined by Apolipoprotein C-III in Relation to Diabetes Risk

Abstract

Apolipoprotein C-III (apoC-III) is a potentially novel biomarker that may play an important role in the pathogenesis of diabetes, particularly when present on the surface of high-density lipoprotein (HDL). In a case-cohort study carried out among 434 incident diabetes cases occurring before 2007 and 3,101 noncases in the Danish Diet, Cancer, and Health Study, we examined associations of baseline (1993–1997) plasma concentrations of apoC-III and subspecies of HDL defined by the presence or absence of apoC-III with risk of diabetes using Cox regression. ApoC-III was strongly associated with risk of diabetes (for top quintile vs. bottom quintile, hazard ratio (HR) = 3.43, 95% confidence interval (CI): 1.75, 6.70; P-trend < 0.001). The cholesterol concentration of HDL (HDL cholesterol (HDL-C)) without apoC-III was inversely associated with risk of diabetes (HR = 0.48, 95% CI: 0.27, 0.85; P-trend = 0.002), more so than total HDL-C (HR = 0.60, 95% CI: 0.35, 1.03; P-trend = 0.04), whereas HDL-C with apoC-III was not associated (HR = 1.05, 95% CI: 0.50, 2.21; P-trend = 0.44) (for HDL-C with apoC-III vs. HDL-C without apoC-III, P-heterogeneity = 0.002). ApoC-III itself is a strong risk marker for diabetes, and its presence on HDL may impair the antidiabetogenic properties of HDL. ApoC-III has potential to be a therapeutic target for the prevention of diabetes.

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Maternal Exposure to Nitrogen Dioxide, Intake of Methyl Nutrients, and Congenital Heart Defects in Offspring

Abstract

Nutrients that regulate methylation processes may modify susceptibility to the effects of air pollutants. Data from the National Birth Defects Prevention Study (United States, 1997–2006) were used to estimate associations between maternal exposure to nitrogen dioxide (NO₂), dietary intake of methyl nutrients, and the odds of congenital heart defects in offspring. NO₂ concentrations, a marker of traffic-related air pollution, averaged across postconception weeks 2–8, were assigned to 6,160 nondiabetic mothers of cases and controls using inverse distance-squared weighting of air monitors within 50 km of maternal residences. Intakes of choline, folate, methionine, and vitamins B₆ and B₁₂ were assessed using a food frequency questionnaire. Hierarchical regression models, which accounted for similarities across defects, were constructed, and relative excess risks due to interaction were calculated. Relative to women with the lowest NO₂ exposure and high methionine intake, women with the highest NO₂ exposure and lowest methionine intake had the greatest odds of offspring with a perimembranous ventricular septal defect (odds ratio = 3.23, 95% confidence interval: 1.74, 6.01; relative excess risk due to interaction = 2.15, 95% confidence interval: 0.39, 3.92). Considerable departure from additivity was not observed for other defects. These results provide modest evidence of interaction between nutrition and NO₂ exposure during pregnancy.

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Trends in the Relationship Between Obesity and Disability, 1988–2012

Abstract

Rising obesity rates, coupled with population aging, have elicited serious concern over the impact of obesity on disability in later life. Prior work showed a significant increase in the association between obesity and disability from 1988 to 2004, calling attention to disability as a cost of longer lifetime exposure to obesity. It is not known whether this trend has continued. We examined functional impairment and impairment in activities of daily living (ADL) (defined as severe or moderate to severe) for adults aged 60 years or older (n = 16,770) over 3 time periods in the National Health and Nutrition Examination Survey. The relative odds of impairment for obese individuals versus normal-weight individuals significantly increased from period 1 (1988–1994) to period 2 (1999–2004) for all outcomes. In period 3 (2005–2012), this association remained stable for functional and severe ADL impairment and decreased for moderate-to-severe ADL impairment. The fraction of population disability attributable to obesity followed a similar trend. The trend of an increasing association between obesity and disability has leveled off in more recent years, and is even improving for some measures. These findings suggest that public health and policy concerns that obesity would continue to become more disabling over time have not been borne out.

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Risk Factors Associated With Suicide Completions Among US Enlisted Marines

Abstract

US enlisted Marines have experienced a substantial increase in suicide rates. We sought to identify risk factors for suicide completions among male Marines who entered basic training in San Diego, California, between June 2001 and October 2010. Suicides that occurred during active-duty military service were counted from June 1, 2001, through June 30, 2012. A total of 108,930 male Marines (66,286 deployers and 42,644 never deployed) were followed for 467,857 person-years of active-duty service time. Of the 790 deaths, 123 (15.6%) were suicides. In the final multivariate hazard model, preservice characteristics of not being a high-school graduate (hazard ratio (HR) = 2.17, 95% confidence interval (CI): 1.28, 3.68) and being a smoker at the time of enlistment (HR = 1.91, 95% CI: 1.32, 2.76) were significantly associated with a higher risk for suicide completion. Diagnosed with traumatic brain injury (HR = 4.09, 95% CI: 2.08, 8.05), diagnosed with depression (HR = 2.36, 95% CI: 1.22, 4.58), and received relationship counseling (HR = 3.71, 95% CI: 1.44, 9.54) during military service were significant risks for suicide death. Deployment alone was not significantly associated with a risk for suicide death (HR = 0.53, 95% CI: 0.26, 1.05).

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Time Spent Commuting to Work and Mental Health: Evidence From 13 Waves of an Australian Cohort Study

Abstract

Time-related stressors, such as long working hours, are recognized as being detrimental to health. We considered whether time spent commuting to work was a risk factor for poor mental health. Data from the Household, Income Labour Dynamics in Australia Survey were used to conduct fixed-effects longitudinal regression analyses. The outcome variable was the Mental Health Inventory, and the main exposure represented hours per week traveling to and from a place of paid employment. Effect modifiers included sex, low job control, high demands, and low job security. Compared with when a person commuted for ≤2 hours per week, there was a small decline (coefficient = −0.33, 95% CI: −0.62, −0.04; P = 0.025) in the Mental Health Inventory score when they commuted for over 6 hours per week. Compared with persons with high job control, persons working in jobs with low job control experienced significantly greater declines in the Mental Health Inventory score when commuting 4 to 6 hours per week and when commuting over 6 hours per week. We found no influence from the other hypothesized effect modifiers. These results suggest the importance of considering commuting time as an additional work-related time stressor.

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Associations of Statin Use With Colorectal Cancer Recurrence and Mortality in a Danish Cohort

Abstract

In earlier studies of the influence of hydroxymethylglutaryl-coenzyme A reductase inhibitors (also known as statins) on colorectal cancer prognosis, investigators reported a reduced rate of cancer-specific mortality. Studies of recurrence are few and small. Using data from Danish registries, we followed 21,152 patients diagnosed with stage I–III colorectal cancer from 2001 to 2011. We estimated the association between statin use in the preceding year and cancer recurrence, cancer-specific mortality, and all-cause mortality rates. We identified 5,036 recurrences, 7,084 deaths from any cause, and 4,066 deaths from colorectal cancer. After adjustment for potential confounders, statin use was not associated with recurrence (adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.93, 1.09), but it was associated with death from colorectal cancer (aHR = 0.72, 95% CI: 0.65, 0.79) and death from any cause (aHR = 0.72, 95% CI: 0.67, 0.76). Statin use in the year preceding recurrence was associated with a reduced risk of cancer-specific mortality (aHR = 0.83, 95% CI: 0.74, 0.92) but also a reduced risk of death from any other cause (aHR = 0.78, 95% CI: 0.61, 1.00). Statin use was not associated with a reduced rate of colorectal cancer recurrence, but it was associated with a reduced rate of cancer-specific mortality, which suggests that there is no cancer-directed benefit; therefore, there is no basis to prescribe statins to colorectal cancer patients who do not have cardiovascular indications.

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Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.

BACKGROUND: Caudal anesthesia has been used for postoperative pain control in pediatric surgical patients, but the duration of the analgesic effect is occasionally unsatisfactory. Intravenous steroids have been shown to be effective for postsurgical pain management after certain surgeries. The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the analgesic effect of steroids in patients administered with caudal anesthesia. METHODS: This study was a systematic review and meta-analysis. A search of published literature was conducted in the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases and in trial registration sites. Randomized controlled trials that compared intravenous steroids with a placebo in pediatric patients who had received caudal anesthesia for surgery were included in the study. The primary outcomes from the present meta-analysis were the analgesic duration and the number of patients who required rescue analgesics. The analgesic duration and incidence of rescue use were summarized using mean difference or risk ratio with a 97.5% confidence interval (CI), respectively. If the 97.5% CI of the mean difference or risk ratio included a value of 0 or 1, respectively, we considered the difference not to be significant. We used the random effects model to combine the results. Heterogeneity was quantified with the I2 statistic. The quality of the trials was evaluated using the Cochrane methodology. Moreover, a TSA with a risk of type 1 error of 2.5% and power of 90% was performed. We established the minimum clinically meaningful difference of analgesic duration as 3 hours. The target sample size for meta-analysis was also calculated in the TSA. We also assessed adverse events. RESULTS: Six trials with 424 patients were included; 211 patients received intravenous steroids. All trials compared dexamethasone of at least 0.5 mg/kg dose with a placebo. Dexamethasone prolonged the duration of caudal analgesia (mean difference, 244 minutes; 97.5% CI, 188-300). Heterogeneity was considerable with an I2 value of 94.8%. Quality of evidence was very low. The TSA suggested that only 17.0% of the target sample size had been reached, but the cumulative Z score crossed the trial sequential monitoring boundary to indicate a benefit. Rescue use was reported in 4 studies with 260 patients. Rescue use was not significantly reduced in the dexamethasone group (risk ratio, 0.53; 97.5% CI, 0.09-3.30; I2, 98.7%). No increase in adverse events was reported. CONCLUSIONS: Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary. (C) 2017 International Anesthesia Research Society

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Dexmedetomidine Maintains Its Direct Cardioprotective Effect Against Ischemia/Reperfusion Injury in Hypertensive Hypertrophied Myocardium.

BACKGROUND: Dexmedetomidine (DEX) has a direct cardioprotective effect against ischemia/reperfusion injury through endothelial nitric oxide synthase (eNOS) phosphorylation via [alpha]2-adrenoreceptor ([alpha]2-AR). By using spontaneously hypertensive rat (SHR) and Wistar-Kyoto (WKY) rat models, the cardioprotective effect of DEX in hypertrophied myocardium and the differential characteristics of cardiac [alpha]2-AR and the I1 imidazoline receptor (I1R) were examined. METHODS: Langendorff-perfused rat hearts underwent 40 minutes of global ischemia followed by 120 minutes of reperfusion in the presence or absence of DEX before ischemia. Infarct size was measured, and eNOS phosphorylation was assessed by Western blotting. The presence and expression of the receptors were assessed by immunohistochemistry, real-time reverse transcriptase polymerase chain reaction, and Western blotting. RESULTS: In WKY, DEX significantly decreased infarct size and increased phosphorylated-eNOS/eNOS. These effects were counteracted by yohimbine ([alpha]2-AR antagonist) and efaroxan ([alpha]2-AR and I1R antagonist). In SHR, DEX significantly decreased infarct size, and the effect was counteracted by efaroxan but not yohimbine. DEX did not alter phosphorylated-eNOS/eNOS in SHR. [alpha]2-AR and I1R were observed in WKY and SHR hearts. Although alpha2A-AR and alpha2B-AR messenger RNA and protein levels were upregulated in SHR, I1R expression was comparable between the 2 species. CONCLUSIONS: In the hypertrophied heart, DEX maintains its direct cardioprotective effect against ischemia/reperfusion injury via I1R in an eNOS-nondependent manner despite upregulation of [alpha]2-AR. (C) 2017 International Anesthesia Research Society

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Meanings of Pain.

No abstract available

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Assessing the Utility of Fluoroscopy for Epidural Catheter Placement: What End Points Are Important?.

No abstract available

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Sedation After Cardiac Surgery With Propofol or Dexmedetomidine: Between Scylla and Charybdis?.

No abstract available

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In Response: Sedation After Cardiac Surgery With Propofol or Dexmedetomidine: Between Scylla and Charybdis?.

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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Multiple events of gene manipulation via in pouch electroporation in a marsupial model of mammalian forebrain development

Publication date: Available online 14 September 2017
Source:Journal of Neuroscience Methods
Author(s): Annalisa Paolino, Laura R. Fenlon, Peter Kozulin, Linda J. Richards, Rodrigo Suárez
BackgroundThe technique of in utero electroporation has been widely used in eutherians, such as mice and rats, to investigate brain development by selectively manipulating gene expression in specific neuronal populations. A major challenge, however, is that surgery is required to access the embryos, affecting animal survival and limiting the number of times it can be performed within the same litter. New method: Marsupials are born at an early stage of brain development as compared to eutherians. Forebrain neurogenesis occurs mostly postnatally, allowing electroporation to be performed while joeys develop attached to the teat. Here we describe the method of in pouch electroporation using the Australian marsupial fat-tailed dunnart (Sminthopsis crassicaudata, Dasyuridae).ResultsIn pouch electroporation is minimally invasive, quick, successful and anatomically precise. Moreover, as no surgery is required, it can be performed several times in the same individual, and littermates can undergo independent treatments. Comparison with existing method: As compared to in utero electroporation in rodents, in pouch electroporation in marsupials offers unprecedented opportunities to study brain development in a minimally invasive manner. Continuous access to developing joeys during a protracted period of cortical development allows multiple and independent genetic manipulations to study the interaction of different systems during brain development.ConclusionsIn pouch electroporation in marsupials offers an excellent in vivo assay to study forebrain development and evolution. By combining developmental, functional and comparative approaches, this system offers new avenues to investigate questions of biological and medical relevance, such as the precise mechanisms of brain wiring and the organismic and environmental influences on neural circuit formation.

Graphical abstract

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Stereotaxic 18F-FDG PET and MRI Templates with Three-dimensional Digital Atlas for Statistical Parametric Mapping Analysis of Tree Shrew Brain

Publication date: Available online 14 September 2017
Source:Journal of Neuroscience Methods
Author(s): Qi Huang, Binbin Nie, Chen Ma, Jing Wang, Tianhao Zhang, Shaofeng Duan, Shang Wu, Shengxiang Liang, Panlong Li, Hua Liu, Hua Sun, Jiangning Zhou, Lin Xu, Baoci Shan
BackgroundTree shrews are proposed as an alternative animal model to nonhuman primates due to their close affinity to primates. Neuroimaging techniques are widely used to study brain functions and structures of humans and animals. However, tree shrews are rarely applied in neuroimaging field partly due to the lack of available species specific analysis methods.New methodIn this study, 10 PET/CT and 10 MRI images of tree shrew brain were used to construct PET and MRI templates; based on histological atlas we reconstructed a three-dimensional digital atlas with 628 structures delineated; then the digital atlas and templates were aligned into a stereotaxic space. Finally, we integrated the digital atlas and templates into a toolbox for tree shrew brain spatial normalization, statistical analysis and results localization.ResultsWe validated the feasibility of the toolbox by simulated data with lesions in laterodorsal thalamic nucleus (LD). The lesion volumes of simulated PET and MRI images were (12.97±3.91)mm³ and (7.04±0.84)mm³. Statistical results at p < 0.005 showed the lesion volumes of PET and MRI were 13.18mm³ and 8.06mm³ in LD.Comparison with existing method(s)To our knowledge, we report the first PET template and digital atlas of tree shrew brain. Compared to the existing MRI templates, our MRI template was aligned into stereotaxic space. And the toolbox is the first software dedicated for tree shrew brain analysis.ConclusionsThe templates and digital atlas of tree shrew brain, as well as the toolbox, facilitate the use of tree shrews in neuroimaging field.



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Walking Forward: A Narrative from South Dakota

Publication date: Available online 14 September 2017
Source:Practical Radiation Oncology
Author(s): Daniel G Petereit




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Editorial.

No abstract available

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Management of Type I and Type II laryngeal clefts: controversies and evidence.

Purpose of review: To summarize the pediatric Type I and Type II laryngeal cleft literature, paying special attention to recent trends, including evolution of surgical techniques, standardization of outcome assessments, and utilization of management algorithms. Recent findings: There are a variety of options to choose from whenever considering Type I and Type II cleft repair, including endoscopic repair, transoral robotic surgery, and injection laryngoplasty. Conservative management including feeding therapy and treatment of comorbid medical conditions is recommended prior to repair. Validated outcome measures have arisen for swallow study interpretation and timing, as well as caregiver quality-of-life assessment. In addition, a series of medical algorithms have been proposed, which provide specific recommendations for diagnosis, treatment, and follow-up. Summary: For clefts that fail conservative management, endoscopic repair has become the gold standard. In addition, injection laryngoplasty appears to provide both a diagnostic and therapeutic option in the management of these patients. Transoral robotic-assisted endoscopic repair appears well tolerated and feasible, although broader implementation of this technology remains limited. The development and refinement of best practice algorithms can help standardize management and improve decision-making. Furthermore, incorporating validated outcome measures, recorded and followed over time, will improve both patient care and research efforts moving forward. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Change in Eyelid Position Following Muller's Muscle Conjunctival Resection With a Standard Versus Variable Resection Length.

Purpose: This study compares the use of a standard 7 mm resection length to a variable 4:1 ratio of resection length to desired elevation nomogram when performing Muller's muscle conjunctival resection surgery. Methods: In this cross-sectional case control study, 2 groups were defined. The first underwent Muller's muscle conjunctival resection surgery with a standard 7 mm resection length and the second underwent the same surgery with a variable resection length determined by a 4:1 ratio of resection length to desired elevation nomogram. Groups were matched for age (within 5 years) and sex. Pre- and postoperative photographs were measured digitally. Change in upper marginal reflex distance 1 (MRD1) and final MRD1 were the primary outcome measures. The study was powered to detect a 1 mm difference in MRD1 to a beta error of 0.95. Results: No significant preoperative differences between the groups were noted. No significant difference in final MRD1 (0.1 mm; p = 0.74) or change in MRD1 (0.2 mm; p = 0.52) was noted. Mean resection length to elevation ratios were 3.9:1 for standard group and 4.3:1 for the variable group (p = 0.54). Conclusion: The authors were not able to detect a significant difference in final MRD1 or change in MRD1 for patients undergoing Muller's muscle conjunctival resection surgery with standard or variable resection lengths. These results tend to argue against a purely mechanical mechanism for Muller's muscle conjunctival resection surgery. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Effect of Time to Operative Intervention on Motility Outcomes Following Orbital Floor Fracture Repair in Children.

Purpose: To evaluate the relationship between time to surgical intervention and extraocular motility outcomes in children following repair of an orbital floor fracture with inferior rectus entrapment. Methods: After institution review board's approval, a retrospective, consecutive case series of 28 children with unilateral orbital floor fractures entrapping the inferior rectus muscle was conducted. Clinical examinations and CT images were performed on all children. The main outcomes measures were postoperative motility measurements. Results: Eleven patients underwent surgery within 24 hours of reported injury, while 17 patients underwent surgery after 24 hours. There was no statistically significant difference in average age at the time of surgery (p = 0.47) or average preoperative motility scores (p = 1.0) between the 2 groups. Patients who underwent surgery within 24 hours of reported injury had an improved likelihood of recovery (log hazard ratio = 0.469; 95% confidence interval, -0.42 to 1.36). Conclusions: Our exploratory study suggests that surgical reduction of inferior rectus entrapment in pediatric orbital floor fractures within 24 hours from the time of injury shows an improved, but nonstatistically significant, likelihood of recovery in motility deficits with earlier surgical intervention. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Diffuse Staining for Activated NOTCH1 Correlates With NOTCH1 Mutation Status and is Associated With Worse Outcome in Adenoid Cystic Carcinoma.

NOTCH1 is frequently mutated in adenoid cystic carcinoma (ACC). To test the idea that immunohistochemical (IHC) staining can identify ACCs with NOTCH1 mutations, we performed IHC for activated NOTCH1 (NICD1) in 197 cases diagnosed as ACC from 173 patients. NICD1 staining was positive in 194 cases (98%) in 2 major patterns: subset positivity, which correlated with tubular/cribriform histology; and diffuse positivity, which correlated with a solid histology. To determine the relationship between NICD1 staining and NOTCH1 mutational status, targeted exome sequencing data were obtained on 14 diffusely NICD1-positive ACC specimens from 11 patients and 15 subset NICD1-positive ACC specimens from 15 patients. This revealed NOTCH1 gain-of-function mutations in 11 of 14 diffusely NICD1-positive ACC specimens, whereas all subset-positive tumors had wild-type NOTCH1 alleles. Notably, tumors with diffuse NICD1 positivity were associated with significantly worse outcomes (P=0.003). To determine whether NOTCH1 activation is unique among tumors included in the differential diagnosis with ACC, we performed NICD1 IHC on a cohort of diverse salivary gland and head and neck tumors. High fractions of each of these tumor types were positive for NICD1 in a subset of cells, particularly in basaloid squamous cell carcinomas; however, sequencing of basaloid squamous cell carcinomas failed to identify NOTCH1 mutations. These findings indicate that diffuse NICD1 positivity in ACC correlates with solid growth pattern, the presence of NOTCH1 gain-of-function mutations, and unfavorable outcome, and suggest that staining for NICD1 can be helpful in distinguishing ACC with solid growth patterns from other salivary gland and head and neck tumors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Diagnostic Utility of SATB2 in Metastatic Krukenberg Tumors of the Ovary: An Immunohistochemical Study of 70 Cases With Comparison to CDX2, CK7, CK20, Chromogranin, and Synaptophysin.

SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKT-AdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4%) MKTs-stomach (40% cells), 7/13 (54%) MKTs-colorectum (mean: 17% cells, median: 7%, range: 2% to 60%), and 19/19 (100%) of MKT-AdexGCCs (mean: 97% cells, median: 100%, range: 80% to 100%) (P0.05) or synaptophysin (59%, 63%, 84%, respectively; P>0.05) but they had significant difference in CK7 staining (93%, 8%, 42%, respectively; P

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Radiologically Undetected Hepatocellular Carcinoma in Patients Undergoing Liver Transplantation: An Immunohistochemical Correlation With LI-RADS Score.

Orthotopic liver transplantation is the best option for patients with carefully selected unresectable disease because of underlying liver dysfunction. The 5-year survival rate after orthotopic liver transplantation for early detected hepatocellular carcinoma (HCC) is high, and a similar or even higher rate is reported in those with radiologically undetected HCC. This study evaluated and compared the histologic features of pretransplant radiologically undetected (14 patients, 25 tumors) versus detected (36 patients, 45 tumors) HCCs. Tumor size, tumor differentiation, number of unpaired arteries, mitotic count per 10 high-power fields, CD34 immunostain to assess microvessel density, and Ki67 immunostain were compared with the Liver Imaging Reporting and Data System score, which was retrospectively assigned to each tumor in both groups. The Liver Imaging Reporting and Data System score was significantly higher in the HCC detected group (P=2 cm, whereas 51% of the detected HCCs were >=2 cm in size. Higher rate of moderate to poor tumor differentiation was noted in the detected HCCs compared with the undetected group (89% vs. 60%; P=0.004). No statistically significant difference in the number and distribution of unpaired arteries, or mitotic count was observed in 2 groups (although fewer unpaired arteries were identified in the undetected group). The detected HCCs had a higher rate of 2+ CD34 staining compared with the undetected HCCs (68% vs. 27%; P=0.002), whereas the opposite was observed for 1+ CD34 staining (59% undetected HCCs vs. 17% detected HCCs; P=0.002). Ki67 proliferative index was not statistically different between the 2 groups (120.8/1000 cells detected HCCs vs. 81.8/1000 cells undetected HCCs; P=0.36). The factors associated with failing to detect HCCs pretransplant by radiologic studies include small tumor size (

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Optimizing Nipple Position following Nipple-Sparing Mastectomy.

Background: The best treatment for nipple malposition following nipple-sparing mastectomy is prevention. This article reviews basic elements for success in nipple-sparing mastectomy and offers an option to patients with grade 2-3 breast ptosis who strongly desire to preserve the nipple. Methods: Retrospective review identified patients undergoing nipple-sparing mastectomy and immediate reconstruction. Results: Patient selection centered on realistic goals for postoperative breast size, nipple position, and when not to save the nipple. The choice of device considered projection and nipple centralization as equal components and led to wider, lower profile devices selectively for the first stage of reconstruction. In severe grade 2-3 nipple ptosis, an inferior vertical incision or wedge excision was used to enhance nipple position postoperatively. Eighteen consecutive patients underwent 32 implant-based breast reconstructions following nipple-sparing mastectomy with the vertical incision. The average age was 45 years old, and the average body mass index was 26.7. Direct-to-implant reconstruction was performed in 25%, whereas 75% had tissue expander-implant reconstruction. Overall complications included infection (3%) and nipple necrosis (3%) leading to explant in 1 reconstruction. Conclusions: The final nipple position following nipple-sparing mastectomy can be optimized with preoperative planning. The vertical incision, combined with proper patient selection and choice of device, may increase eligibility for nipple- sparing procedures in patients with grade 2-3 ptosis who desire nipple preservation. 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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