Test-retest reliability and responsiveness of a Malay tinnitus questionnaire.

Test-retest reliability and responsiveness of a Malay tinnitus questionnaire.

Med J Malaysia. 2018 Feb;73(1):7-8

Authors: Mohd Normani Z, Wan Suhailah WH, Nik Adilah NO

Abstract
INTRODUCTION: Tinnitus is a common complaint among patients with ear diseases and can be serious if not treated. Recently, a Malay tinnitus questionnaire, known as the "Borang Evaluasi Soal selidik Tinnitus" (BEST) had been developed and preliminarily validated among Malayspeaking population. The aims of the present study were to determine the test-retest reliability and responsiveness of the BEST questionnaire.
METHOD: Forty-six Malay adults (aged 23-74 years) with tinnitus were enrolled. They were instructed to fill in the BEST questionnaire accordingly. After one week, 21 of them were asked to fill in the questionnaire again. The other 25 subjects underwent tinnitus intervention for three months and following this; the BEST was administered to them again.
RESULTS: In the test-retest reliability task, the intraclass correlation values obtained were acceptably high (0.70-0.90). After the intervention, significant differences in the BEST result were found in the mind domain, main domain and composite score (p<0.05) with moderate effect sizes (0.61- 0.70).
CONCLUSION: The test-retest reliability of the BEST was found to be good. It also showed good responsiveness to intervention. The clinical usefulness of the BEST in assessing patients with tinnitus was further supported by the present study.

PMID: 29531196 [PubMed - in process]

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REPLY TO LETTER REGARDING "THE EFFECT OF HEARING AIDS AND COCHLEAR IMPLANTS ON BALANCE DURING GAIT".

REPLY TO LETTER REGARDING "THE EFFECT OF HEARING AIDS AND COCHLEAR IMPLANTS ON BALANCE DURING GAIT".

Otol Neurotol. 2018 Apr;39(4):519-520

Authors: Weaver TS, Shayman CS, Hullar TE

PMID: 29533343 [PubMed - in process]

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RESPONSE TO WEAVER TS, SHAYMAN CS, HULLER TE. THE EFFECT OF HEARING AIDS AND COCHLEAR IMPLANTS ON BALANCE DURING GAIT. OTOL NEUROTOL 2017;38: 1327-1332.

RESPONSE TO WEAVER TS, SHAYMAN CS, HULLER TE. THE EFFECT OF HEARING AIDS AND COCHLEAR IMPLANTS ON BALANCE DURING GAIT. OTOL NEUROTOL 2017;38: 1327-1332.

Otol Neurotol. 2018 Apr;39(4):518-519

Authors: Hallemans A, Herssens N, Mertens G, Van de Heyning P, Van Rompaey V

PMID: 29533342 [PubMed - in process]

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[Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy].

[Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy].

Zhongguo Gu Shang. 2018 Jan 25;31(1):30-36

Authors: Yang F, Tan MS, Yi P, Tang XS, Hao QY, Qi YN

Abstract
OBJECTIVE: To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy.
METHODS: From June 2012 to June 2015, 73 patients with cervical spondylotic myelopathy were treated, including 42 males and 31 females, aged from 29 to 73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group (34 cases) and the operation combined with traditional Chinese medicine group(39 cases) according to the idea of themselves. The anterior discectomy or subtotal corpectomy with internal fixation or posterior simple open-door decompression with lateral mass screw fixation were performed in the patients. Among them, 39 cases were treated with traditional Chinese medicine after surgery. The Japanese orthopedic association (JOA) score of spinal cord function, the improvement rate of neural function, the neck dysfunction index (NDI) score and the governor vessel stasis syndrome score were compared between two groups preoperative and postoperative 1 week, 1 month and the final follow-up respectively. The internal fixation and the condition of spinal cord decompression were observed by CT, MRI and X-rays before and after operation.
RESULTS: All the operations were successful, no injuries such as dura mater, spinal cord and nerve root were found. All the wounds were healed without infection except one patient had a superficial infection. It was solved after intermittent debridement and anti-infective therapy. Hematoma occurred in 1 case, complicated with spinal cord compression, caused incomplete paralysis, and promptly performed the re-operation to remove the hematoma without any obvious sequelae. All the patients were followed up from 12 to 24 months, (14.6±0.8) months for simple operation group and (13.5±0.7) months for operation combined with traditional Chinese medicine group, and there was no significant difference(P>0.05). The scores of JOA, NDI and the governor's vessel stasis syndrome in simple operation group were 8.31±3.15, 29.91±4.52, 6.58±1.31 before operation, and 10.21±2.58, 18.67±4.31, 8.24±1.18 one week after operation, and 11.38±2.85, 16.11±3.18, 8.91±2.11 one month after operation, and 12.21±3.12, 14.61±3.28, 9.12±1.56 at final follow-up, respectively; and in operation combined with traditional Chinese medicine group were 8.29±3.47, 30.83±4.14, 6.38±1.81before operation, and 10.48±2.39, 17.59±5.14, 8.33±1.57 one week after operation, and 12.14±3.12, 13.14±3.21, 9.55±2.49 one month after operation, and 13.85±3.34, 12.11±2.51, 10.33±1.95 at final follow-up, respectively. Postoperative JOA , NDI, and the governor vessel stasis syndrome score of two groups were significantly higher than preoperativee(P<0.05). There was no significant difference in JOA, NDI, and the governor vessel stasis syndrome score between two groups one week after operation (P>0.05). The above items in operation combined with traditional Chinese medicine group was better than that of simple operation group one month and final follow-up after operation (P<0.05). The improvement rate of neural function in simple operation group was (67.59±10.78)%, and in operation combined traditional Chinese medicine group was (66.88±12.15)%, there was no significant difference between two groups(P>0.05). There were no complications such as internal fixation failure or re-dislocation of atlas by postoperative CT, MRI and X-rays examination.
CONCLUSIONS: Spinal card decompression for the treatment of cervical spondylotic myelopathy can extend the spinal canal, relieve the compression of nerve, achieve the deoppilation of governor vessel, the regulation of qi and blood, the restore of Yangqi, combined with traditional Chinese medicine of activating blood removing stasis, warming yang and activating meridians, reinforcing liver benefiting kidney, which may obtain better clinical effect.

PMID: 29533034 [PubMed - in process]

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Zenner H-P - Motility of outer hair cells as an active, actin-mediated process. Acta Oto-Laryngol 1988; 105: 39-44.

Zenner H-P - Motility of outer hair cells as an active, actin-mediated process. Acta Oto-Laryngol 1988; 105: 39-44.

Acta Otolaryngol. 2018 Mar;138(3):297-303

Authors: Hellström S

PMID: 29532731 [PubMed - in process]

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R Bárány. Die Beeinflussung des Ohrensausens durch intravenös injizierte Lokalanästhetica. Vorläufige Mitteilung. Acta Oto-Laryngol 1936; 23: 201-203.

R Bárány. Die Beeinflussung des Ohrensausens durch intravenös injizierte Lokalanästhetica. Vorläufige Mitteilung. Acta Oto-Laryngol 1936; 23: 201-203.

Acta Otolaryngol. 2018 Mar;138(3):247-250

Authors: Anniko M

PMID: 29532730 [PubMed - in process]

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Thomsen J et al. - The non-specific effect of endolymphatic sac surgery in treatment of Meniere's disease: A prospective, randomized controlled study comparing "classic" endolymphatic sac surgery with the insertion of a ventilating tube in tympanic membrane. Acta Oto-Laryngol 1998: 118: 769-773.

Thomsen J et al. - The non-specific effect of endolymphatic sac surgery in treatment of Meniere's disease: A prospective, randomized controlled study comparing "classic" endolymphatic sac surgery with the insertion of a ventilating tube in tympanic membrane. Acta Oto-Laryngol 1998: 118: 769-773.

Acta Otolaryngol. 2018 Mar;138(3):304-309

Authors: Hellström S

PMID: 29532729 [PubMed - in process]

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Acta Oto-Laryngologica.

Acta Oto-Laryngologica.

Acta Otolaryngol. 2018 Mar;138(3):192-193

Authors: Anniko M

PMID: 29532727 [PubMed - in process]

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H Engström & J Wersäll. Structure of the Organ of Corti: Outer Hair Cells. Acta Oto-Laryngol 2953; 43: 1-10.

H Engström & J Wersäll. Structure of the Organ of Corti: Outer Hair Cells. Acta Oto-Laryngol 2953; 43: 1-10.

Acta Otolaryngol. 2018 Mar;138(3):261-271

Authors: Anniko M

PMID: 29532726 [PubMed - in process]

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Schmiegelow E - Contribution to the pathology of the tuberculosis of the bronchial glands. Acta Oto-Laryngol 1918; 1: 1-37.

Schmiegelow E - Contribution to the pathology of the tuberculosis of the bronchial glands. Acta Oto-Laryngol 1918; 1: 1-37.

Acta Otolaryngol. 2018 Mar;138(3):198-235

Authors: Anniko M

PMID: 29532724 [PubMed - in process]

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Tjellström A et al. - Analysis of the mechanical impedance of bone-anchored hearing aids. Acta Oto-Laryngol 1980; 89: 85-92.

Tjellström A et al. - Analysis of the mechanical impedance of bone-anchored hearing aids. Acta Oto-Laryngol 1980; 89: 85-92.

Acta Otolaryngol. 2018 Mar;138(3):288-296

Authors: Hellström S

PMID: 29532723 [PubMed - in process]

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The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients - Randomized Clinical Trial.

The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients - Randomized Clinical Trial.

Nutr Cancer. 2018 Mar 13;:1-7

Authors: Scislo L, Pach R, Nowak A, Walewska E, Gadek M, Brandt P, Puto G, Szczepanik AM, Kulig J

Abstract
BACKGROUND: Immunomodulating enteral nutrition in the perioperative period may reduce postoperative complications in cancer patients. Little is known if this effect translates to the better survival. The aim of study was to assess the impact of postoperative immunomodulating enteral nutrition on postoperative complications and survival of gastric cancer patients.
METHODS: A group of 98 gastric cancer patients was randomly assigned for postoperative immunomodulating enteral nutrition n = 44 (Reconvan, Fresenius Kabi, Bad Homburg, Germany), or standard enteral nutrition n = 54 (Peptisorb, Nutricia, Schipol, The Netherlands). Postoperative complications, mortality, 6-mo and 1-yr survival were analyzed.
RESULTS: The overall postoperative morbidity did not differ between the groups. The rate of pulmonary complications (excluding pneumonia) was significantly lower in immunomodulation group (0% vs 9.3%, p = 0.044), as well as 60-day mortality (0% vs. 11.1%, p = 0.037). There was no difference in 6-mo and 1-yr survival between the groups.
CONCLUSIONS: Postoperative immunomodulating enteral nutrition may reduce respiratory complications and postoperative mortality in comparison to standard enteral nutrition. Despite this effect, it did not improve 6-mo and 1-yr survival in immunomodulation group. Probably the beneficial effect of immunomodulating enteral nutrition is too weak to be significant in such a number of patients.

PMID: 29533110 [PubMed - as supplied by publisher]

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Head and Neck Cancer Patients Do Not Meet Recommended Intakes of Micronutrients without Consuming Fortified Products.

Head and Neck Cancer Patients Do Not Meet Recommended Intakes of Micronutrients without Consuming Fortified Products.

Nutr Cancer. 2018 Mar 13;:1-9

Authors: Nejatinamini S, Kubrak C, Álvarez-Camacho M, Baracos VE, Ghosh S, Wismer WV, Mazurak VC

Abstract
This study assessed dietary and micronutrient intakes of head and neck cancer (HNC) patients at key points in the disease trajectory and evaluated the contribution of oral nutritional supplements (ONS) to micronutrient intake. HNC patients (n = 114) completed a three-day dietary record and a tool to assess Nutrition Impact Scores (NIS) at baseline, post-treatment, and follow-up. Foods were classified into food categories. Micronutrient, protein, and energy intakes were compared to European Society for Parenteral and Enteral Nutrition guidelines for cancer patients. The majority of patients did not meet recommended dietary intakes for vitamins D, E, C, folate, and magnesium at any study time point. Relative to baseline, the proportion of calories from milk, soup, and ONS significantly increased at post-treatment, while grain, meat, potato, baked dessert, and oil and sugar decreased (P < 0.03). At all study time points, patients categorized as high ONS consumers (>15% of total daily calories from ONS) had higher intakes of micronutrients (P < 0.003). They also had a higher NIS (P = 0.006) and experienced greater weight loss (P < 0.04) during the study, despite having similar energy intake to patients consuming <15% kcal from ONS. Fortification of usually consumed foods to improve micronutrient intake among cancer patients should be evaluated.

PMID: 29533097 [PubMed - as supplied by publisher]

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Effects and Dose–Response Relationships of Motor Imagery Practice on Strength Development in Healthy Adult Populations: a Systematic Review and Meta-analysis

Abstract

Background

Motor imagery (MI), a mental simulation of a movement without overt muscle contraction, has been largely used to improve general motor tasks. However, the effects of MI practice on maximal voluntary strength (MVS) remain equivocal.

Objectives

The aims of this meta-analysis were to (1) estimate whether MI practice intervention can meaningfully improve MVS in healthy adults; (2) compare the effects of MI practice on MVS with its combination with physical practice (MI-C), and with physical practice (PP) training alone; and (3) investigate the dose–response relationships of MI practice.

Data Sources and Study Eligibility

Seven electronic databases were searched up to April 2017. Initially 717 studies were identified; however, after evaluation of the study characteristics, data from 13 articles involving 370 participants were extracted. The meta-analysis was completed on MVS as the primary parameter. In addition, parameters associated with training volume, training intensity, and time spent training were used to investigate dose–response relationships.

Results

MI practice moderately improved MVS. When compared to conventional PP, effects were of small benefit in favour of PP. MI-C when compared to PP showed unclear effects. MI practice produced moderate effects in both upper and lower extremities on MVS. The cortical representation area of the involved muscles did not modify the effects. Meta-regression analysis revealed that (a) a training period of 4 weeks, (b) a frequency of three times per week, (c) two to three sets per single session, (d) 25 repetitions per single set, and (e) single session duration of 15 min were associated with enhanced improvements in muscle strength following MI practice. Similar dose–response relationships were observed following MI and PP.

Conclusions

The present meta-analysis demonstrates that compared to a no-exercise control group of healthy adults, MI practice increases MVS, but less than PP. These findings suggest that MI practice could be considered as a substitute or additional training tool to preserve muscle function when athletes are not exposed to maximal training intensities.

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[Dependency of APHAB score in the ECu subscale on age, gender and subjective hearing loss : Hearing aid fitting in two subjective hearing loss groups].

[Dependency of APHAB score in the ECu subscale on age, gender and subjective hearing loss : Hearing aid fitting in two subjective hearing loss groups].

HNO. 2018 Mar 12;:

Authors: Löhler J, Wegner O, Wollenberg B, Schönweiler R

Abstract
OBJECTIVE: The Abbreviated Profile of Hearing Aid Benefit (APHAB) determines subjective impairment by hearing loss in four situations before and after hearing aid fitting. The first part (APHABu) of the questionnaire can be used independently of hearing aid fitting. Previous research has demonstrated that the answers in the ECu subscale for hearing under easy conditions are concentrated in two groups: one with subjectively better, one with subjectively worse hearing. This study aimed to investigate in a large collective whether there are differences between these two groups in terms of age, gender, and individual hearing loss.
PATIENTS AND METHODS: The data of 1755 patients were analyzed, whose APHAB answers and pure-tone thresholds had been collected during hearing aid fitting. Group 1 had an average ECu score ≤37.5%; in group 2 it was ≥67.5%. The individual hearing losses was determined. Statistical analysis was performed using Mann-Whitney U, χ2, Spearman, and Pearson tests.
RESULTS: The 616 members of group 1 were significantly younger (68.7 vs. 73.0 years) and comprised more females (53.9 vs. 46.1%) than the 1139 members of group 2. Hearing was frequency specific in group 1, and hearing loss as classified using standard audiograms and according to the three-frequency table was significantly lower in group 1 than in group 2, CONCLUSION: The distribution with two maximums in the ECu subscale can be explained by individual differences in terms of age and hearing loss, in part also by gender. The lower absolute number of patients in group 1 could be explained by the still relatively late fitting of hearing aids in general.

PMID: 29532108 [PubMed - as supplied by publisher]

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Wearable Smart System for Visually Impaired People.

Wearable Smart System for Visually Impaired People.

Sensors (Basel). 2018 Mar 13;18(3):

Authors: Ramadhan AJ

Abstract
In this paper, we present a wearable smart system to help visually impaired persons (VIPs) walk by themselves through the streets, navigate in public places, and seek assistance. The main components of the system are a microcontroller board, various sensors, cellular communication and GPS modules, and a solar panel. The system employs a set of sensors to track the path and alert the user of obstacles in front of them. The user is alerted by a sound emitted through a buzzer and by vibrations on the wrist, which is helpful when the user has hearing loss or is in a noisy environment. In addition, the system alerts people in the surroundings when the user stumbles over or requires assistance, and the alert, along with the system location, is sent as a phone message to registered mobile phones of family members and caregivers. In addition, the registered phones can be used to retrieve the system location whenever required and activate real-time tracking of the VIP. We tested the system prototype and verified its functionality and effectiveness. The proposed system has more features than other similar systems. We expect it to be a useful tool to improve the quality of life of VIPs.

PMID: 29533970 [PubMed - in process]

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Lymphoid aggregates in desmoplastic melanoma have features of tertiary lymphoid structures

Desmoplastic melanomas (DM) have unique and challenging clinical presentations and histomorphology. A characteristic feature is the presence of scattered lymphoid aggregates. However, the nature of these aggregates is not defined. We hypothesized that they may be tertiary lymphoid structures (TLS), and may be associated with programmed death ligand 1 (PD-L1) expression. We searched our tissue database for 'pure' DMs and for scars as control tissues, collected clinical information, and reviewed H&E histology. We performed multispectral imaging after staining for CD8, CD20, PNAd, FoxP3, CD83, and Ki67, and assessed PD-L1 expression by immunohistochemistry. Pure DM samples were evaluable in 11 patients. All had desmoplastic stroma and lymphoid aggregates on H&E. The lymphoid aggregates of eight of the 11 (72%) DM samples and only three of the 11 scars contained features of TLS, defined as distinct clusters of B cells and CD8+ T cells, CD83+ dendritic cells in T-cell zones, and PNAd+ vasculature resembling high endothelial venules. PD-L1 was expressed by at least 1% of melanoma cells in six and by at least 5% of immune cells in 10 of the 11 DM samples. We found that most lymphoid aggregates in DM are organized, classical TLS. PD-L1 expression was detected in most cases and was highest in two cases of DM with TLS. However, low PD-L1 expression in some cases suggests that some DM cells may be unresponsive to interferon-γ. TLS support antigen presentation and T-cell responses in chronic inflammation and cancer. Their presence in DM likely reflects an adaptive immune response, which may be enhanced with immune therapies. Correspondence to Craig L. Slingluff Jr, MD, Department of Surgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA Tel: +1 434 924 2129; fax: +1 434 982 5959; e-mail: cls8h@virginia.edu Received August 2, 2017 Accepted February 6, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oxytocin administration in the basolateral and central nuclei of amygdala moderately suppresses food intake

Oxytocin (OT) at acting central nuclei decreases meal size and reduces intake of palatable sweet solutions. It remains largely unclear as to which brain sites mediate OT's effect on palatability versus energy or the combination of those aspects of consumption. Here, we expanded the search for sites that mediate anorexigenic properties of OT by focusing on two subdivisions of the amygdala, its central (CNA) and basolateral (BLA) nuclei. We injected OT directly into the BLA or CNA in rats and assessed intake of standard chow induced by energy deprivation and intake of sweet solutions in nondeprived animals. We examined whether these effects are reversible by OT receptor (OTr) antagonism and whether OT presence in BLA or CNA induces taste aversion. We also determined the effect of energy deprivation and exposure to sweet saccharin on BLA and CNA expression of OTr mRNA. OT administration in BLA at 0.3 μg and in CNA at 1 μg reduced standard chow intake after deprivation by ~25%. Only administration of OT in BLA was effective in suppressing consumption of sucrose and saccharin solutions. The anorexigenic effects of OT in BLA and CNA were attenuated by OTr antagonist, L-368,899, pretreatment. OT at anorexigenic doses did not promote acquisition of taste aversion. BLA OTr mRNA expression was affected by exposure to palatable saccharin, whereas that of CNA OTr, by energy deprivation. OT in the amygdala moderately decreases food intake. The functional relationship between amygdalar OT and energy intake versus palatability-driven intake depends on the discrete localization of the OTr within this complex structure. Correspondence to Pawel K. Olszewski, PhD, Department of Food Science and Nutrition, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand Tel: +64 78 384 658; fax: +64 78 384 324; e-mail: pawel@waikato.ac.nz Received February 4, 2018 Accepted February 20, 2018 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Mitochondrial calcium uniporter-mediated inhibition of 1-methyl-4-phenylpyridinium ions neurotoxicity in PC12 cells

Parkinson's disease (PD) is one of the most debilitating neurodegenerative disorders. The etiology of sporadic PD remains unknown. One prominent hypothesis is that impaired mitochondrial function may underlie slow and progressive neurodegeneration. Mitochondrial calcium uniporter (MCU) is a crucial component that regulates the intramitochondrial Ca2+ level. Ca2+ uptake to the mitochondria by MCU, resulting in activation of mitochondrial dehydrogenases and stimulation of ATP synthesis, but excessive Ca2+ uptake to the mitochondria resulting in cell apoptosis. Therefore, this study focused on whether MCU was involved in the apoptosis induced by 1-methyl-4-phenylpyridinium ions (MPP+) in PC12 cells. Our results showed that the viability of PC12 cells was inhibited by MPP+ in a concentration-dependent and time-dependent manner. The expression of MCU was decreased gradually with a certain concentration of MPP+. Meanwhile, MPP+ decreased the mitochondrial transmembrane potential and increased the apoptosis in PC12 cells. Notably, preincubated with Spermine, an MCU-specific agonist, or exogenously expressed MCU significantly alleviated cell apoptosis and decreased the reactive oxygen species production in PC12 cells that is induced by MPP+ treatment. Knockdown of endogenous MCU expression or preincubation with a specific inhibitor of MCU enhances the cell apoptosis and the reactive oxygen species in PC12. Thus, MCU is involved in the apoptosis in PC12 induced by MPP+. Correspondence to Wenjun Li, PhD, Department of Occupational Health and Occupational Medicine, School of Public Health, Southern Medical University, No. 1838, North Guangzhou Road, Guangzhou 510515, Guangdong Province, China Tel/fax: +86 206 278 9125; e-mail: cjlwj@smu.edu.cn or Correspondence to Fei Zou, Department of Occupational Health and Occupational Medicine, School of Public Health, Southern Medical University, No. 1838, North Guangzhou Road, Guangzhou 510515, Guangdong Province, China Tel: +86 206 164 8301; fax: +86 206 164 8324; e-mail: feizoudean@hotmail.com Received December 28, 2017 Accepted January 29, 2018 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Discontinuity of early and late event-related brain potentials for selective attention in dichotic listening

If a representation of an auditory attention channel was present in the auditory cortices but not in the subcortical structures, it would be predicted that the early event-related brain potential (ERP) would disagree with the late ERP in selective attention effects. To examine this idea, the present study recorded the auditory brain stem response (ABR) as an early ERP and also the negative difference, the processing negativity and the irrelevant positive difference waves as late ERPs during dichotic listening. Each participant experienced two dichotic conditions: (i) 500-Hz standard tones to the left ear and 1000-Hz ones to the right ear (L500/R1000), (ii) 1000-Hz standard tones to the left ear and 500-Hz ones to the right ear (L1000/R500). In a control task, participants performed visual detection and ignored auditory stimuli. Although the negative difference and processing negativity were found to be identical between the two dichotic conditions, the ABR demonstrated a significant difference between relevant and irrelevant tasks only for the L500/R1000 condition. A response preference to lower-frequency tones was found for behavioural measures and late ERPs but not for the ABR. These results suggest difficulty in representing attention channels in the auditory brain stem. In addition, a weak effect of dichotic sound combination in behaviours corresponded only with earlier ERPs. Correspondence to Kazunari Ikeda, PhD, Laboratory of Cognitive Psychophysiology, Center for the Research and Support of Educational Practice, Tokyo Gakugei University, 4-1-1 Nukui-kita, Koganei, Tokyo 184-8501, Japan Tel: +81 42 329 7685; fax: +81 42 329 7672; e-mail: kazunari@u-gakugei.ac.jp Received December 4, 2017 Accepted February 17, 2018 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Total Lower Lip Reconstruction With Functional Gracilis Free Muscle Flap

Free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss. Therefore, dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested. In this study, we present a case of a successful total lower lip repair with this flap. In a 78-year-old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip, bilateral modified radical neck dissection and full-thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side. After microvascular anastomoses, the motor nerve of the flap was coapted to the marginal mandibular branch of the fascial nerve. The entire intra- and extraoral surfaces of the flap were covered with a partial-thickness skin graft which was taken from the right thigh. There was no any intra- or early postoperative complication. The skin graft and flap survived without any problem. In the controls of the patient who was followed-up for 8 postoperative months, it was observed that the gracilis muscle flap was well-adapted to its place, gained a very good tonus, its volume reduced over time and reached to ideal dimensions, and the overlying skin graft provided a good color and texture match with the surrounding tissues. The motor activity of the muscle was monitored with the Tinel's test. The speech and facial expressions of the patient were very clear. Despite the patient has an edentulous mandible and was not using prosthesis, her feeding with fluid and solid foods was free of problems, oral competence was highly sufficient, and there was no any drooling. Esthetic appearance was very good and intraoral vestibular depth was sufficient. The mouth opening was 3 cm. When comparing with upper orbicularis oculi muscle on the electroneuromyography (ENMG) ordered at the 8th month, a similar nerve conduction time (3.3 versus 3.8 ms) and contraction amplitude (0.5 versus 0.4 mV) values were obtained from the gracilis muscle. Follow-up of the patient is still continued with no tumor recurrence observed during this period. Being the real dynamic flap and its tonus of the functional gracillis free muscle flap in opposite to the static methods provides a significant superiority over the other options in terms of oral functions; moreover, the overlying skin graft presents a very good color and texture harmony aesthetically. This method is a candidate to be an exclusive surgical technique in the repair of total or close to total lip losses in the future. Address correspondence and reprint requests to Dr Mehmet Akif Cakmak, MD, Ataturk Universitesi Tip Fakultesi, Yakutiye Arastirma Hastanesi, Plastik Rekonstruktif ve Estetik Cerrahi A.D., 25240 Erzurum, Turkey; E-mail: makifcakmak@gmail.com Received 20 October, 2017 Accepted 26 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Low-Grade Malignant Fibrous Histiocytoma Originating From the Medial Rectus Muscle

Purpose: Fibrous histiocytomas (FHs) involving the orbit are uncommon. To our knowledge, here the authors report the first patient with an orbital low-grade malignant FH originating from the medial rectus muscle. Methods: A clinical report relating clinical features as well as imaging and histopathologic findings is presented. Results: A 26-year-old female presented with a left eye proptosis that had been present for 4 months. A small left exotropia was observed and ocular motility evaluation revealed a −3 adduction and −1 abduction of the left eye. B-mode ultrasonic scans demonstrated a 2.5 × 2.0 cm mass with medium internal echo and a clear boundary located in the nasal region of the left orbit. Magnetic resonance imaging (MRI) showed a 2.8 × 2.0 cm oval extraconal orbital mass, with isointensity on T1-weighted MRI and hyperintensity on T2-weighted MRI. An anterior orbitotomy was performed and the tumor was completely removed. The mass originated from the medial rectus muscle. Histopathologic evaluation confirmed a low-grade malignant FH. After surgery, the left exotropia was no longer present. Ocular motility revealed a −1 adduction and −1 abduction of the left eye. No recurrence was evident at 1 year after surgery. Conclusions: This rare patient demonstrates that FH may originate from the medial rectus muscle. With careful surgical dissection, a near normal function of the involved muscle can be restored. Address correspondence and reprint requests to Jianhua Yan, MD, PhD, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Nan Road, Guangzhou 510060, China; E-mail: yanjh2011@126.com Received 18 November, 2017 Accepted 27 January, 2018 This work was supported by the Nature Science Foundation of China (Grant No. 81670885), the Science and Technology Program of Guangdong Province, China (Grant No. 2013B020400003), and the Science and Technology Program of Guangzhou, China (Grant No. 15570001). The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Overlapping Surgeries Are Not Associated With Worse Patient Outcomes: Retrospective Multivariate Analysis of 14,872 Neurosurgical Cases Performed at a Single Institution” by Bohl MA in Neurosurg [published online September 27, 2017] doi: 10.1093/neuros/nyx472

No abstract available

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Relations Between Hyoid-Related Cephalometric Measurements and Severity of Obstructive Sleep Apnea

Objective: To evaluate the relationship between the hyoid-related cephalometric measurements and the apnea-hypopnea index (AHI) in patients diagnosed with obstructive sleep apnea (OSA). Methods: A total of 56 subjects were evaluated by lateral cephalometric radiography and polysomnography (PSG). The OSA diagnosis was made according to the patients' AHI. Included were 13 primary snoring, 16 mild OSA, 10 moderate OSA, and 17 severe OSA. C3-hyoid distance and mentum-hyoid distance were measured on lateral cephalogram. Cephalometric measurements and PSG parameters were compared among the different OSA groups. Results: The distance between the mentum and hyoid was significantly longer in the severe OSA group than in the primary snoring, mild OSA, and moderate OSA groups (P = 0.029). There was a significant positive correlation between the AHI value and the distance of the mentum hyoid (r = 0.368, P = 0.005). The C3-hyoid distance among the groups was not statistically significant different (P = 0.889). Conclusion: The mentum-hyoid distance of patients with severe OSA was longer compared to the other OSA groups. These patients might have more benefit from the surgeries that have an impact on the position of the hyoid bone compared to other patients with OSA. Address correspondence and reprint requests to Suat Bilici, MD, Department of Otorhinolaryngology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul 34500, Turkey; E-mail: suatbilici@yahoo.com Received 25 May, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Transplantation of Autogenous Bone Block With an Osseointegrated Implant: Seedling Technique With Twelve-Month Follow-Up

Objective: Loss of teeth frequently results in compound horizontal and vertical alveolar bone defects. An appropriate bone structure is the key for implant placement and bony support of soft tissues. Advanced bone augmentation techniques are required for the reconstruction of these defects. This report will present a new bone block grafting technique with 12-month follow-up. Method: The seedling technique was used to augment the alveolar bone 3-dimensionally with autologous bone block and an osseointegrated implant in a 2-stage procedure. Horizontal and vertical bone loss is revealed after cone beam radiographic examination in the right maxillary lateral incisor area. Initially, the implant was placed at the right maxillary tuber area, where the bone was abundant. After 2-months healing phase, the osseointegrated implant was harvested with the surrounding bone and transplanted to the anterior region of maxilla to augment the horizontal and the vertical components of the recipient site. Transplanted implant inserted into autogenous bone block was fixed with mini plate to the adjacent native bone. Prosthetic restoration was applied 4 months after the transplantation. Results: Seven months after the first surgery, treatment of anterior bone deficiency was accomplished. The patient was fully satisfied with the function and the esthetics of the restoration. The radiological and clinical examinations at 1-year follow-up evaluation showed successful outcome of transplanted autogenous bone block without any resorption. Conclusion: This clinical report demonstrated that anterior maxillary single-tooth replacement, according to seedling concept of autogenous bone block with osseointegrated implant, is a successful and predictable treatment modality. Address correspondence and reprint requests to Tolga F. Tözüm, DDS, PhD, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, 801 S Paulina street, 60612 Chicago, IL; E-mail: ttozum@icloud.com Received 10 December, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Postoperative Complications Associated With Different Fixation Methods of Isolated Mandibular Angle Fractures

The objective of this study was to review the medical records of patients with a history of mandibular angle fracture who were attended at the Service of Oral and Maxillofacial Surgery and Traumatology of FOAr/UNESP in the last 5 years. The data collected were subjected to chi-squared test (significance level of 5%). The authors reviewed 19 medical records. The main cause was physical aggression (58.00%), but with no statistical difference in relation to the other etiologies (P > 0.05). Regarding the type of fixation, one 2.0-mm system plate associated with one 2.4-mm system plate and the fixation using only two 2.0-mm system plates were used in 7 patients each. The fixation method with a monocortical plate at the upper border was used in 5 patients. However, there was no statistically significant difference in the frequency of complications among the 3 fixation methods used (P > 0.05). In 52.64% of the patients, the third molar was removed intraoperatively. Despite this, there was no statistically significant difference in the frequency of complications when the third molar was in the fracture line or when it was removed postoperatively (P > 0.05). The complications observed were dehiscence associated with pain (44.44%), trismus (22.22%), infection (22.22%), and presence of bone spicules (11.11%). However, no statistical differences were observed between the frequency of different types of complications (P = 0.779). In the sample studied, there were no differences in the frequency of complications among the fixation methods applied. Address correspondence and reprint requests to Rafael Ferreira e Costa, DDS, Rua Professor Moraes, 72, apartamento 403, Bairro Funcionários, CEP 30150370 Belo Horizonte, MG, Brazil; E-mail: rafaelfcosta87@yahoo.com.br Received 25 May, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Complications of Cranioplasty

Cranioplasty is a time-honoured surgical procedure to restore the calvarial form and function that is associated with a relatively high complication rate. The present article analyzed various complications and reviewed the complications based on study of the relevant research in the craniofacial literature. Complications were broadly divided into 2 groups, intraoperative and postoperative, for ease of understanding. The etiological factors, local and systemic condition of the patient, prevention, and management of various complications were widely discussed. The article also highlighted problems and complications associated with various reconstructive materials. Insights into various complications of cranioplasty enable surgeon to understand them better, minimize the chances of occurrence, and improve surgical outcome. In spite of reported high rate of complications, serious complications like meningitis, air embolism, and death are rare. Address correspondence and reprint requests to Dr. Nanda Kishore Sahoo, MDS, FIBOMS, Department of Oral & Maxillofacial Surgery, CMDC (CC), Lucknow 226002, Uttar Pradesh, India; E mail colnksahoo@gmail.com. Received 21 August, 2017 Accepted 25 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Progress on Noma Disease and Its Surgical Treatment

No abstract available

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Quantifying tumor-infiltrating immune cells from transcriptomics data

Abstract

By exerting pro- and anti-tumorigenic actions, tumor-infiltrating immune cells can profoundly influence tumor progression, as well as the success of anti-cancer therapies. Therefore, the quantification of tumor-infiltrating immune cells holds the promise to unveil the multi-faceted role of the immune system in human cancers and its involvement in tumor escape mechanisms and response to therapy. Tumor-infiltrating immune cells can be quantified from RNA sequencing data of human tumors using bioinformatics approaches. In this review, we describe state-of-the-art computational methods for the quantification of immune cells from transcriptomics data and discuss the open challenges that must be addressed to accurately quantify immune infiltrates from RNA sequencing data of human bulk tumors.

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Post Stapedotomy Vestibular Deficit: Is CO 2 Laser Better than Conventional Technique? A Non-randomized Controlled Trial

Abstract

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO₂ Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO₂ Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO₂ Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO₂ Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO₂ Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

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Protective Effects of Silymarin Against Age-Related Hearing Loss in an Aging Rat Model

Abstract

Age-related hearing loss (ARHL) is one of the most common chronic degenerative disorders. Several studies have indicated that supplementation with some antioxidants can slow down the progression of ARHL. Despite several lines of evidence about the potent antioxidant and anti-aging effects of silymarin, its protective effect against ARHL has not evaluated yet. The aim of the current study was to investigate the effects of silymarin in prevention of ARHL in a d-Galactose-induced aging rat model for the first time. 45 male wistar rats aged 3-month old were divided into 5 groups: group 1, 2 and 3 received 500 mg/kg/day d-Gal plus 100, 200 and 300 mg/kg/day silymarin respectively for 8 weeks, placebo group received 500 mg/kg/day d-Gal plus propylene glycol as placebo, and control group received normal saline during this period of time. Auditory brainstem responses were measured at several frequencies (4, 6, 8, 12 and 16 kHz) before and after the intervention. Placebo group and group 3 showed significant ABR threshold increase across frequencies of 4, 6, 16 kHz compared with the other groups (P < 0.05). However, rats treated with silymarin 100 and 200 mg/kg/day plus d-Gal did not show any significant ABR threshold shifts. Similarly, ABR amplitude of P2 at 4, 8 kHz and P1, P4 at 4 kHz in the placebo group and group 3 were decreased significantly compared with other groups (P < 0.05). However, no significant differences are found in ABR absolute and inter-peak latencies between groups (P > 0.05). The findings indicates that silymarin with doses of 100 and 200 mg/kg/day has protective effect against ARHL and it can be supplemented into the diet of older people to slow down the progression of age-related hearing loss.

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Quantifying tumor-infiltrating immune cells from transcriptomics data

Abstract

By exerting pro- and anti-tumorigenic actions, tumor-infiltrating immune cells can profoundly influence tumor progression, as well as the success of anti-cancer therapies. Therefore, the quantification of tumor-infiltrating immune cells holds the promise to unveil the multi-faceted role of the immune system in human cancers and its involvement in tumor escape mechanisms and response to therapy. Tumor-infiltrating immune cells can be quantified from RNA sequencing data of human tumors using bioinformatics approaches. In this review, we describe state-of-the-art computational methods for the quantification of immune cells from transcriptomics data and discuss the open challenges that must be addressed to accurately quantify immune infiltrates from RNA sequencing data of human bulk tumors.

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Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment

Abstract

Purpose of Review

The complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.

Recent Findings

There are a broad range of assessment techniques, some of which require a background in psychology and some that do not, that can identify psychological differences in chronic pain patients and serve to guide intervention strategies. Chronic pain is often comorbid with depression, anxiety, catastrophizing, and various ineffective coping strategies. Some patients, however, have demonstrated more adaptive and effective strategies for cognitively and behaviorally coping with pain and normalizing their lives. Proper assessment enables the individualization of treatment to overcome and/or build upon each patient's psychological frame of mind to maximize the potential for effective functioning.

Summary

The use of standardized and documented psychological assessment techniques can lead to a better understanding of chronic pain patients and contribute in ways that can enhance response to medical treatment and improve quality of life. It is recommended that certain psychological tools be included to supplement the medical assessment of patients who have chronic pain. A basic assessment can include a short psychological-based clinical interview along with brief measures of depression, anxiety, and coping strategies. It is also recommended that the pain physician have access to professional psychological practitioners as a resource for more complicated assessments and psychological intervention services.

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Quantifying tumor-infiltrating immune cells from transcriptomics data

Abstract

By exerting pro- and anti-tumorigenic actions, tumor-infiltrating immune cells can profoundly influence tumor progression, as well as the success of anti-cancer therapies. Therefore, the quantification of tumor-infiltrating immune cells holds the promise to unveil the multi-faceted role of the immune system in human cancers and its involvement in tumor escape mechanisms and response to therapy. Tumor-infiltrating immune cells can be quantified from RNA sequencing data of human tumors using bioinformatics approaches. In this review, we describe state-of-the-art computational methods for the quantification of immune cells from transcriptomics data and discuss the open challenges that must be addressed to accurately quantify immune infiltrates from RNA sequencing data of human bulk tumors.

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Hirayama disease

Abstract

Purpose

Hirayama disease is an initially progressive disease caused by cervical neck flexion compressing the anterior horns of the lower cervical spinal cord. It is primarily seen in young males of Indian or Asian descent. With increasing dispersion of these populations this condition is increasingly being encountered internationally. This grand round reviews this rare but increasingly recognized condition.

Materials and methods

We present a classic case of a young Indian male with progressive hand and forearm weakness. We discuss the typical clinical presentation, appropriate investigations and management of this condition.

Results

Our patient presented with oblique amyotrophy and underwent a diagnostic flexion MRI scan which revealed anterior translation of the posterior dura with compression of the anterior horns of the lower cervical cord. He has been successfully treated in a cervical collar.

Conclusions

This case illustrates the typical presentation, diagnostic investigations and treatment of Hirayama syndrome. It is hoped that this review will alert clinicians of this condition and optimize the management of affected individuals.

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Ultrasonic bone scalpel: utility in cervical corpectomy. A technical note

Abstract

Purpose

Anterior cervical corpectomy and fusion (ACCF) is a technically challenging surgery. Use of conventional instruments like high-speed burr and kerrison rongeurs is associated with high complication rates such as increased blood loss and incidental durotomy. Use of ultrasonic bone scalpel (UBS) in cervical corpectomy helps to minimize such adverse events.

Methods

We performed a retrospective study based on the data of 101 consecutive patients who underwent cervical corpectomies with UBS for different cervical spine pathologies from December 2014 to December 2016. Total duration of surgery, time taken for corpectomy, estimated blood loss, and incidental durotomies were noted.

Results

Total surgical time was 30–80 min (59.36 ± 13.21 min) for single-level ACCF and 60–120 min (92.74 ± 21.04 min) for double-level ACCF. Time taken for single-level corpectomy was 2 min 11  ± 10 s and 3 min 41  ± 20 s for double-level corpectomy. Estimated blood loss ranged from 20–150 ml (52.07 ± 29.86 ml) in single level and 40–200 ml (73.22 ± 41.64 ml) in double level. Four (3.96%) inadvertent dural tears were noted, two during single-level corpectomy and other two during double-level corpectomy.

Conclusions

Use of UBS is likely to provide a safe, rapid, and effective surgery when compared to conventional rongeurs and high-speed burr. The advantages such as lower blood loss and lower intra-operative incidental dural tears were noted with the use of UBS.

Graphical abstract

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Issue Information

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What neurons tell themselves: autocrine signals play essential roles in neuronal development and function

Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Kelsey A Herrmann, Heather T Broihier
Although retrograde neurotrophin signaling has provided an immensely influential paradigm for understanding growth factor signaling in the nervous system, recent studies indicate that growth factors also signal via cell-autonomous, or autocrine, mechanisms. Autocrine signals have been discovered in many neuronal contexts, providing insights into their regulation and function. The growing realization of the importance of cell-autonomous signaling stems from advances in both conditional genetic approaches and in sophisticated analyses of growth factor dynamics, which combine to enable rigorous in vivo dissection of signaling pathways. Here we review recent studies defining autocrine roles for growth factors such as BDNF, and classical morphogens, including Wnts and BMPs, in regulating neuronal development and plasticity. Collectively, these studies highlight an intimate relationship between activity-dependent autocrine signaling and synaptic plasticity, and further suggest a common principle for coordinating paracrine and autocrine signaling in the nervous system.



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The perception and production of British English vowels and consonants by Arabic learners of English

Publication date: May 2018
Source:Journal of Phonetics, Volume 68
Author(s): Bronwen G. Evans, Wafaa Alshangiti
This study investigated the perception of British English vowels and consonants by native Saudi Arabic learners of English from a range of proficiency levels. Twenty-six participants completed consonant and vowel identification tasks in quiet and noise. To investigate if predicted difficulties with vowel perception were also present in production, participants also recorded vowels embedded in words and read a short story. The results demonstrated that all learners were better able to identify consonants than vowels in quiet and noise, with more experienced learners outperforming early learners. Although learners were likely able to rely on mapping non-native to native categories when identifying consonants, there was some evidence that they had started to establish new vowel targets. This appeared to start early in learning but even highly experienced learners continued to find vowels with no direct Arabic counterpart difficult. Additionally, there was some evidence for a link between perception and production: vowel perception was better in those who had more accurate production. Overall, the results shed light on problematic phonemic contrasts for Arabic learners, and suggest that though learners may be able to establish new phonetic categories early in learning, other contrasts continue to remain difficult even for highly experienced learners.



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Massive Ovarian Edema in a Girl with Hemoglobin SC Disease

Massive ovarian edema is a benign tumor like lesion of the ovary. The widely accepted mechanism is disruption of vascular drainage resulting in accumulation of fluid within the stroma and enlargement of the ovary. We report a case of massive ovarian edema in a teenage girl with hemoglobin SC disease. A 16-year-old female with hemoglobin SC disease was admitted with right lower quadrant pain. An ultrasound and CT scan showed a large, heterogeneous solid, and cystic pelvic mass. Due to the size and the possibility of malignancy, the patient underwent a salpingo-oophorectomy. The mass was an 8.3 cm hemorrhagic cyst with some solid areas. Histologic exam showed diffuse edema with scattered entrapped follicles and a narrow rim of normal appearing ovarian stroma. Dilated and occluded capillaries were seen along with hemorrhage and sickled red blood cells but no necrosis was identified. These histologic features were consistent with massive ovarian edema. Massive ovarian edema is thought to be caused by disturbance of the vascular outflow resulting in fluid buildup in the stroma. It is most often attributed to intermittent ovarian torsion that disrupts capillary and venous flow, but arterial flow is maintained. Rare cases of massive ovarian edema caused by tumor emboli or external compression by tumors have been reported, but this is the first case of a patient with hemoglobin SC disease developing vasoocclusions resulting in this lesion.

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The risk of carotid stenosis in head and neck cancer patients after radiation therapy

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): David J. Carpenter, Yvonne M. Mowery, Gloria Broadwater, Anna Rodrigues, Amy J. Wisdom, Jennifer A. Dorth, Pretesh R. Patel, Cynthia K. Shortell, Robert Clough, David M. Brizel
ObjectivesHead and neck radiotherapy (RT) is a risk factor for cerebrovascular disease. We performed a retrospective cohort study to evaluate carotid artery stenosis (CAS) incidence in head and neck cancer (HNC) patients undergoing RT, characterizing associated risk factors.Materials and methodsRecords were retrospectively reviewed for HNC patients undergoing carotid ultrasound screening after definitive or adjuvant RT between January 2000 and May 2016. CAS was defined as ≥50% stenosis on imaging, stroke, or transient ischemic attack. Actuarial CAS rates were calculated by Kaplan-Meier method. Univariate and multivariate analyses predicted CAS risk based on carotid dosimetric and clinical parameters.Results366 patients met inclusion criteria. Median time from RT completion to last follow-up was 4.1 yr. Actuarial risk for CAS was 29% (95% CI 22–36%) at 8 years. Univariate analysis showed that smoking (HR 1.7; 95% CI 1.1–2.7), hyperlipidemia (HR 1.6; 95% CI 1.03–2.6), diabetes (HR 2.8; 95% CI 1.6–4.8), coronary artery disease (HR 2.4; 95% CI 1.4–4.2), and peripheral artery disease (HR 3.6; 95% CI 1.1–11.6) were significantly associated with increased CAS. In multivariate analysis, diabetes was predictive of time to CAS (HR 1.9; 95% CI 1.1–3.4). Carotid dose parameters were not significantly associated with CAS.ConclusionsCAS incidence is high after head and neck radiotherapy, gradually rising over time. No clear dose-response effect between carotid dose and CAS was identified for HNC patients. Carotid artery screening and preventative strategies should be employed in this high-risk patient population.

Graphical abstract

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Beneficial effects of anti-EGFR agents, Cetuximab or Nimotuzumab, in combination with concurrent chemoradiotherapy in advanced nasopharyngeal carcinoma

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Mei Lin, Rui You, You-Ping Liu, Yi-Nuan Zhang, Hao-Jiong Zhang, Xiong Zou, Qi Yang, Chao-Feng Li, Yi-Jun Hua, Tao Yu, Jing-Yu Cao, Ji-Bin Li, Hao-Yuan Mo, Ling Guo, Ai-Hua Lin, Ying Sun, Chao-Nan Qian, Jun Ma, Hai-Qiang Mai, Ming-Yuan Chen
ObjectiveThis study aimed to evaluate the efficacy and safety in locoregionally advanced nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) plus Cetuximab (CTX) or Nimotuzumab (NTZ) compared to those receiving induction chemotherapy (IC) plus CCRT.Materials and methodsFrom January 2008 to December 2013, 715 eligible patients were enrolled in the study. Using propensity scores to adjust for gender, age, Karnofsky performance status (KPS), tumor stage, node stage, and clinical stage, a well-balanced cohort was created by matching each patient who received CTX/NTZ plus CCRT (137 patients) with two patients who underwent IC plus CCRT (274 patients). The primary endpoint was overall survival (OS), and other outcome variables included disease-free survival (DFS), distant metastasis-free survival (DMFS) and loco-regional relapse-free survival (LRRFS).Results and conclusionThe median follow-up was 57.0 months and 55.0 months for the CTX/NTZ plus CCRT group and IC plus CCRT group, respectively. No significant differences were found between the CTX/NTZ plus CCRT group and the IC plus CCRT group in 3-year OS (95.5% vs. 94.7%, P = 0.083), 3-year DFS (93.3% vs. 86.1%, P = 0.104), 3-year DMFS (96.2% vs. 92.5%, P = 0.243) and 3-year LRRFS (97.0% vs. 95.1%, P = 0.297). Patients undergoing IC plus CCRT suffered from severe hematologic toxicity and diarrhea compared with those treated with CTX/NTZ plus CCRT. The combination of CTX/NTZ with CCRT is comparable to IC plus CCRT treatment in survival outcomes for locoregionally advanced NPC patients but has a better safety profile than IC plus CCRT treatment.



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Cervicofacial actinomycosis can obscure a malignancy: A case report

Publication date: Available online 13 March 2018
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil




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A turning point in therapy for ameloblastomas

Publication date: Available online 13 March 2018
Source:Oral Oncology
Author(s): Masanobu Abe, Liang Zong, Takahiro Abe, Kazuto Hoshi




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Chronic cutaneous graft-versus-host disease in children: A report of 14 patients from a tertiary care pediatric dermatology clinic

Abstract

Background/Objectives

Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment option for many life-threatening disorders in children. Chronic graft-versus-host disease (cGVHD) is a significant complication of HSCT, and its treatment is challenging. Skin is the most common organ affected in cGVHD, with protean manifestations posing a challenge in diagnosis and management. The objective was to have a better understanding of the spectrum of chronic cutaneous GVHD (cc-GVHD) in children.

Methods

Hospital records of 14 children with cc-GVHD, registered over 9 years, were reviewed.

Results

All the patients had received HSCT from related donors. Median duration between HSCT and onset of cc-GVHD was 7.5 months. Eighty-six percent of the patients had a prior history of aGVHD, and 14% had de novo onset of cc-GVHD. Of 14 patients, 71% had classic cc-GVHD. Overlap syndrome was observed in 29%. Tandem occurrence of multiple morphologies was noticed in 6 (43%) patients. Of classic cc-GVHD, lichen planus-like cc-GVHD was most common (57%) followed by scleroderma-like (29%) and poikiloderma (7%). Rare variants included eczema-like (14%) and psoriasis-like (7%) cc-GVHD. Mucosal involvement was seen in 78.6% of the patients, nail involvement in 50%, and hair abnormalities in 43%. After a median follow-up of 4.8 years, complete remission was observed in 50% and mortality in 14%.

Conclusion

The study signifies the diverse nature of cc-GVHD and indicates the need for multicenter surveys including larger number of patients to have proper insight into and develop treatment guidelines for cc-GVHD in children.

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Noisy but not placebo: defining metrics for effects of neurofeedback

Sir,

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Reply: Noisy but not placebo: defining metrics for effects of neurofeedback

Sir,

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A neurocomputational account of reward and novelty processing and effects of psychostimulants in attention deficit hyperactivity disorder

Abstract

Computational models of reinforcement learning have helped dissect discrete components of reward-related function and characterize neurocognitive deficits in psychiatric illnesses. Stimulus novelty biases decision-making, even when unrelated to choice outcome, acting as if possessing intrinsic reward value to guide decisions toward uncertain options. Heightened novelty seeking is characteristic of attention deficit hyperactivity disorder, yet how this influences reward-related decision-making is computationally encoded, or is altered by stimulant medication, is currently uncertain. Here we used an established reinforcement-learning task to model effects of novelty on reward-related behaviour during functional MRI in 30 adults with attention deficit hyperactivity disorder and 30 age-, sex- and IQ-matched control subjects. Each participant was tested on two separate occasions, once ON and once OFF stimulant medication. OFF medication, patients with attention deficit hyperactivity disorder showed significantly impaired task performance (P = 0.027), and greater selection of novel options (P = 0.004). Moreover, persistence in selecting novel options predicted impaired task performance (P = 0.025). These behavioural deficits were accompanied by a significantly lower learning rate (P = 0.011) and heightened novelty signalling within the substantia nigra/ventral tegmental area (family-wise error corrected P < 0.05). Compared to effects in controls, stimulant medication improved attention deficit hyperactivity disorder participants' overall task performance (P = 0.011), increased reward-learning rates (P = 0.046) and enhanced their ability to differentiate optimal from non-optimal novel choices (P = 0.032). It also reduced substantia nigra/ventral tegmental area responses to novelty. Preliminary cross-sectional evidence additionally suggested an association between long-term stimulant treatment and a reduction in the rewarding value of novelty. These data suggest that aberrant substantia nigra/ventral tegmental area novelty processing plays an important role in the suboptimal reward-related decision-making characteristic of attention deficit hyperactivity disorder. Compared to effects in controls, abnormalities in novelty processing and reward-related learning were improved by stimulant medication, suggesting that they may be disorder-specific targets for the pharmacological management of attention deficit hyperactivity disorder symptoms.

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Optical coherence tomography in autosomal recessive spastic ataxia of Charlevoix-Saguenay

Abstract

Autosomal recessive spastic ataxia of Charlevoix-Saguenay is a rare neurodegenerative disorder caused by mutations in the SACS gene. Thickened retinal nerve fibres visible on fundoscopy have previously been described in these patients; however, thickening of the retinal nerve fibre layer as demonstrated by optical coherence tomography appears to be a more sensitive and specific feature. To test this observation, we assessed 292 individuals (191 patients with ataxia and 101 control subjects) by peripapillary time-domain optical coherence tomography. The patients included 146 with a genetic diagnosis of ataxia (17 autosomal spastic ataxia of Charlevoix-Saguenay, 59 Friedreich's ataxia, 53 spinocerebellar ataxias, 17 other genetically confirmed ataxias) and 45 with cerebellar ataxia of unknown cause. The controls included 13 asymptomatic heterozygotes for SACS mutations and 88 unaffected controls. The cases with autosomal recessive spastic ataxia of Charlevoix-Saguenay included 11 previously unpublished SACS mutations, of which seven were nonsense and four missense mutations. Most patients were visually asymptomatic and had no previous history of ophthalmic complaints and normal or near normal visual test results. None had visual symptoms directly attributable to the retinal changes. Twelve of the 17 cases (70.6%) had thickened retinal nerve fibres visible on fundoscopy. All patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay had thickening of the peripapillary retinal nerve fibre layer on optical coherence tomography, whereas all the remaining cases and controls except one showed normal or reduced average peripapillary retinal nerve fibre layer thickness on optical coherence tomography. We propose a cut-off value of 119 µm in average peripapillary retinal nerve fibre layer thickness, which provides a sensitivity of 100% and specificity of 99.4% amongst patients affected with ataxia. This is the largest cohort of patients with this condition to undergo systematic evaluation by optical coherence tomography. This is a useful tool in identifying cases of autosomal recessive spastic ataxia of Charlevoix-Saguenay from other causes of ataxia. Visualization of thickened retinal fibres by direct fundoscopy is less sensitive. We therefore advocate the use of this technique in the assessment of possible cases of this condition.

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CaMKII-dependent endoplasmic reticulum fission by whisker stimulation and during cortical spreading depolarization

Abstract

Cortical spreading depolarization waves, the cause underlying migraine aura, are also the markers and mechanism of pathology in the acutely injured human brain. Propagation of spreading depolarization wave uniquely depends on the interaction between presynaptic and postsynaptic glutamate N-methyl-d-aspartate receptors (NMDARs). In the normally perfused brain, even a single wave causes a massive depolarization of neurons and glia, which results in transient loss of neuronal function and depression of the ongoing electrocorticographic activity. Endoplasmic reticulum is the cellular organelle of particular importance for modulation of neurotransmission. Neuronal endoplasmic reticulum structure is assumed to be persistently continuous in neurons, but is rapidly lost within 1 to 2 min of global cerebral ischaemia, i.e. the organelle disintegrates by fission. This phenomenon appears to be timed with the cardiac arrest-induced cortical spreading depolarizations, rather than ensuing cell death. To what extent NMDAR-dependent processes may trigger neuronal endoplasmic reticulum fission and whether fission is reversible in the normally perfused brain is unknown. We used two-photon microscopy to examine neuronal endoplasmic reticulum structural dynamics during whisker stimulation and cortical spreading depolarizations in vivo. Somatosensory stimulation triggered loss of endoplasmic reticulum continuity, a likely outcome of constriction and fission, in dendritic spines within less than 10 s of stimulation, which was spontaneously reversible and recovery to normal took 5 min. The endoplasmic reticulum fission was inhibited by blockade of NMDAR and Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) activated downstream of the NMDARs, whereas inhibition of guanosine triphosphate hydrolases hindered regain of endoplasmic reticulum continuity, i.e. fusion. In contrast to somatosensory stimulation, endoplasmic reticulum fission during spreading depolarization was widespread and present in dendrites and spines, and was preceded by dramatic rise in intracellular Ca²⁺. The endoplasmic reticulum fission during spreading depolarization was more persistent, as 1 h after the depolarization cortical neurons still exhibited loss of endoplasmic reticulum continuity. Notably, endoplasmic reticulum fission was accompanied with loss of electrocorticographic activity, whereas subsequent regain of synaptic function paralleled the organelle fusion. Furthermore, blocking CaMKII activity partly rescued endoplasmic reticulum fission and markedly shortened the recovery time of brain spontaneous activity. Thus, prevention of endoplasmic reticulum fission with CaMKII inhibitors may be a novel strategy to rescue brain function in patients with migraine and a promising therapeutic avenue in the acutely injured brain.

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Cancer-testis Specific Gene OIP5: A Downstream Gene of E2F1 that Promotes Tumorigenesis and Metastasis in Glioblastoma by Stabilizing E2F1 Signalling

Abstract

Background

The cancer-testis specific gene Opa interacting protein 5 (OIP5) is a testis-specific gene that is reactivated in many human cancers, but its functions in glioblastoma remain unclear. Here, we assessed the significance of OIP5 in the tumorigenesis and metastasis of glioblastoma for the first time.

Methods

An immunohistochemistry assay was performed to detect OIP5 expression changes in glioblastoma patients. Overall survival analysis was performed to evaluate the prognostic significance of OIP5. Growth curve, colony formation and transwell assays were used to analyse cell proliferation and metastasis. Tumorigenicity potential was investigated in orthotopic tumour models, and immunoprecipitation, chromatin immunoprecipitation, and luciferase assays were employed to explore the mechanisms underlying the activation of OIP5 expression by E2F transcription factor 1 (E2F1) to stabilize and maintain E2F1 signalling.

Results

OIP5 was found to be upregulated in glioblastoma patients and to impair patient survival, and the increased expression of OIP5 was positively correlated with tumour stage. Compared with shGFP cells, cells in which OIP5 was knocked down exhibited significantly reduced proliferation, metastasis, colony formation and tumorigenicity abilities, whereas OIP5 recovery enhanced these abilities. OIP5 was highly correlated with cell cycle progression but had no obvious effects on apoptosis. Notably, we demonstrated a feed-back loop in which E2F1 activates the expression of OIP5 to stabilize and maintain E2F1 signalling, promote the E2F1-regulated gene expression that is required for aggressive tumour biology.

Conclusions

Collectively, our findings demonstrate that OIP5 promotes glioblastoma progression and metastasis, suggesting that OIP5 is a potential target for anti-cancer therapy.

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How Much Noise is an Oral and Maxillofacial Surgeon Exposed to?

Publication date: Available online 14 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Esha Kulkarni, Yasmine Abdallah, Dennis Hanseman, Deepak G. Krishnan
IntroductionA common concern among Oral and Maxillofacial Surgeons (OMSs) is the progressive loss of hearing throughout their careers. Although this has not been critically studied, there may be several factors that may contribute to this detriment, including drills, saws, suction, music and other sounds within the closed operating environment. Our study observed the intensity of noise in the operating theatres and in clinical settings during the use of drills, saws, surgical handpieces, and other tools.Materials and MethodsIn the cross-sectional study sound intensities were measured in decibels using a CEM DT-8851 industrial high accuracy digital sound noise level meter data logger in the clinic and operating rooms. The device measured the intensities of sound during the entire duration of procedures. The recorded drilling periods were extracted from the data and t-tests were run to determine if a statistically significant difference existed between the non-drilling and drilling periods. In addition, the duration of time was measured during which intensity was greater than or equal to 85 decibels (dB).Results50 procedures were recorded in the clinical setting and in the OR. The results of this study proved that OMSs were indeed exposed to sound intensities in decibels that exceeded OSHA guidelines but, these exposures occurred less than 1% of the time. It was discovered that the maximum recorded intensities, in both the clinic and OR recordings were during a non-drilling period and this was attributed to the suction.ConclusionOSHA guidelines were exceeded in the clinical setting and OR setting, but the results were not significant. We believe this is a very promising study for future endeavors. We found that we exceed the threshold set by OSHA at points during surgical procedures in the clinic and operating room. This prompts future studies focusing recordings when suction is used and longitudinal studies on a sample of individual OMSs.



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Effect of verbascoside on apoptosis and metastasis in human oral squamous cell carcinoma

Abstract

Despite significant advances in therapy, the five-year survival rates for patients with advanced stage oral cancers still remains poor as an appropriate treatment has not been found yet, due to side effects of chemo/radiotherapy. Verbascoside (VB), a major bioactive constituent of the Tsoong herb, displays pharmacological properties by exhibiting anti-oxidative, anti-inflammatory, and anti-cancer activities. However, the underlining function and mechanism of VB in human oral squamous cell carcinoma (OSCC) remains unclear. In this study, we show that VB significantly decreased the viability and metastasis of HN4 and HN6 tumor cells, while promoting apoptosis. A xenograft OSCC mouse model further showed that intraperitoneal injection of VB strongly inhibited growth and lung metastasis of implanted tumor cells. Immunoblot analysis confirmed that VB effectively suppressed NF-κB activation and downstream Bcl-2/Bcl-XL expression, resulting in increased OSCC cell apoptosis. In addition, VB suppressed mRNA and protein expression of matrix metalloproteinase-9 (MMP-9) via suppression of NF-κB activation, thereby inhibiting tumor cell metastasis. Inspiringly, compared with cisplatin (DDP)-treated group, VB is a biocompatible agent without significant side effects in vivo. Collectively, our results demonstrate that VB effectively inhibits OSCC tumor cell growth and metastasis via suppression of IKK/NF-κB-related signaling activation, suggesting that VB has potential use as a potent anticancer agent in OSCC therapeutic strategies. This article is protected by copyright. All rights reserved.

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CLCA2 epigenetic regulation by CTBP1, HDACs, ZEB1, EP300 and miR-196b-5p impacts prostate cancer cell adhesion and EMT in metabolic syndrome disease

Abstract

Prostate cancer (PCa) is the most common cancer among men. Metabolic syndrome (MeS) is associated with increased PCa aggressiveness and recurrence. Previously, we proposed C-terminal binding protein 1 (CTBP1), a transcripcional co-repressor, as a molecular link between these two conditions. Notably, CTBP1 depletion decreased PCa growth in MeS mice. The aim of this study was to investigate the molecular mechanisms that explain the link between MeS and PCa mediated by CTBP1. We found that CTBP1 repressed Chloride Channel Accessory 2 (CLCA2) expression in prostate xenografts developed in MeS animals. CTBP1 bound to CLCA2 promoter and repressed its transcription and promoter activity in PCa cell lines. Furthermore, we found that CTBP1 formed a repressor complex with ZEB1, EP300 and HDACs that modulates the CLCA2 promoter activity. CLCA2 promoted PCa cell adhesion inhibiting Epithelial-Mesenchymal Transition (EMT) and activating CTNNB1 together with epithelial markers (CDH1) induction, and mesenchymal markers (SNAI2 and TWIST1) repression. Moreover, CLCA2 depletion in PCa cells injected s.c. in MeS mice increased the Circulating Tumor Cells (CTCs) foci compared to control. A miRNA expression microarray from PCa xenografts developed in MeS mice, showed 21 miRNAs modulated by CtBP1 involved in angiogenesis, extracellular matrix organization, focal adhesion and adherents junctions, among others. We found that miR-196b-5p directly targets CLCA2 by cloning CLCA2 3'UTR and performing reporter assays. Altogether, we identified a new molecular mechanism for PCa and MeS link based on CLCA2 repression by CTBP1 and miR-196b-5p molecules that might act as key factors in the progression onset of this disease. This article is protected by copyright. All rights reserved.

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Assessing the causal association between 25-hydroxyvitamin D and the risk of oral and oropharyngeal cancer using Mendelian randomization

Abstract

Circulating 25-hydroxyvitamin D (25OHD) is an appealing potential intervention for cancer risk and has been associated with oral and oropharyngeal cancer risk but evidence is inconsistent. The availability of genetic variants, uncorrelated with known confounders, but predictive of 25OHD and genetic data in a large oral and oropharyngeal cancer collaboration aids causal inference when assessing this association.

5,133 oral and oropharyngeal cancer cases and 5,984 controls with genetic data were included in the study. Participants were based in Europe, North America and South America and were part of the Genetic Associations and Mechanisms in Oncology (GAME-ON) Network. Five genetic variants reliably associated with circulating 25OHD were used to create a relative genetic measure of 25OHD. In the absence of measured 25OHD, two-sample Mendelian randomization using individual level outcome data was used to estimate causal odds ratios (OR) for cancer case status per standard deviation increase in log25OHD. Analyses were replicated in an independent population based cohort (UK Biobank).

In the GAME-ON study there was little evidence of a causal association between circulating 25OHD and oral cancer (OR=0.86 [0.68;1.09], p=0.22), oropharyngeal cancer (OR=1.28 [0.72;2.26], p=0.40) or when sites were combined (OR=1.01 [0.74;1.40], p=0.93). Replication in UK Biobank and pooled estimates produced similar results.

This study suggests that a clinically relevant protective effect of 25OHD on oral and oropharyngeal cancer risk is unlikely and supplementation of the general population with 25OHD is unlikely to be beneficial in preventing these cancers. This article is protected by copyright. All rights reserved.

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Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review

Abstract

Aim

Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopy for the treatment of SC of the temporomandibular joint (TMJ).

Materials and Methods

A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out.

Results

Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgical treatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period.

Conclusions

Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3 mm or without extra-articular extension.

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Corrigendum to “Rechallenge with BRAF-directed treatment in metastatic melanoma: A multi-institutional retrospective study*” [Eur J Cancer 91 (2018) 116–124]

Publication date: Available online 13 March 2018
Source:European Journal of Cancer
Author(s): Sara Valpione, Matteo S. Carlino, Johanna Mangana, Meghan J. Mooradian, Grant McArthur, Dirk Schadendorf, Axel Hauschild, Alexander M. Menzies, Ana Arance, Paolo A. Ascierto, AnnaMaria Di Giacomo, Francesco de Rosa, James Larkin, John J. Park, Simone M. Goldinger, Ryan J. Sullivan, Wen Xu, Elisabeth Livingstone, Michael Weichenthal, Rajat Rai, Lydia Gaba, Georgina V. Long, Paul Lorigan




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Response to letter commenting on published paper: Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis

Publication date: Available online 13 March 2018
Source:European Journal of Cancer
Author(s): Larysa H.M. Rydzewska, Sarah Burdett, Claire L. Vale, Mahesh K.B. Parmar, Jayne F. Tierney




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Effects of an individualized home-based unsupervised aerobic training on body composition and physiological parameters in obese adults are independent of gender

Abstract

Purpose

Evaluation of the effects of an individualized home-based unsupervised aerobic training on body composition, physical and physiological parameters in female and male obese adults.

Methods

Two hundred and twenty obese adults (age 47.9 ± 12.4 years; BMI 38.0 ± 7.2 kg/m²) entered the 4-month training program. Body composition, physiological and functional capacities were assessed pre- and post-intervention. All subjects were requested to perform unsupervised aerobic training with the intensity based on heart rate, walking speed and OMNI-RPE score corresponding to the individual ventilatory threshold for at least 5 days/week.

Results

After 4-month study period, 40% of patients completed the protocol, 24% had high compliance (HC) (exercise ≥ 3 days/week), while 16% had low compliance (LC) to exercise prescription (exercise < than 3 days/week). In HC group, a significant improvement of body composition variables after training was performed. Moreover, oxygen uptake and metabolic equivalent at peak significantly increased after training. Six-minute walking test (6MWT) distance significantly increased while heart rate during 6MWT was significantly lower after training. No significant differences were found in LC group between pre- and post-intervention in all variables. Interestingly, gender does not influence the effects of training.

Conclusions

Our results indicate that subjects, independent of gender, with high compliance to the aerobic training based on a new individualized method can achieve a significant reduction in weight loss and also an improvement in physical and physiological parameters. This innovative personalized prescription could be a valuable tool for exercise physiologist, endocrinologists, and nutritionists to approach and correct life style of obese subjects.

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Clinical relevance of endoscopic three-dimensional imaging for quantitative assessment of phonation

Objective/Hypothesis

Laser-based three-dimensional (3D) imaging allows realistic visualization and absolute measurement of the vocal folds for comprehensive characterization of the oscillation pattern.

Study Design

Exploratory study with descriptive data analysis in healthy cohort.

Methods

The custom-developed miniaturized measuring device is an endoscopic camera-laser setup for stereo triangulation and suitable for in vivo application. The laser projection unit generates a regular laser grid that is projected on the vocal folds and recorded at 4000 fps using a high-speed camera. Recordings are performed during sustained phonation on 10 healthy subjects.

Results

We present absolute values for the lateral and vertical displacement amplitudes and maximum velocities during opening and closing phase. On average over all study participants, the vertical parameters are at least 50% higher than their lateral counterparts. The mean male/female amplitudes are 0.93 mm/0.80 mm in the lateral and 1.28 mm/1.45 mm in the vertical direction. Only 20% of the healthy subjects displayed slight asymmetries in the lateral direction, but 70% showed significant asymmetries in the vertical component. In only 30% of all subjects, the asymmetry trends matched in the lateral and vertical direction.

Conclusions

The study illustrates the additional benefit of 3D imaging: consideration of the vertical component and computation of metric units. New, relevant, and even unexpected information was obtained by the incorporation of the additional vertical dimension. Metric units allow for an absolute evaluation of anatomy and dynamics and therefore enables cross-study comparability. The noninvasive acquisition of quantitative measures for evidence-based medicine has the potential to enhance diagnostic and therapeutic procedures as well as basic medical research.

Level of Evidence

4 Laryngoscope, 2018

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Cadaver head holder for transoral surgical simulation

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Redefining the nasal septal L-strut: A quantitative analysis of septal arcs and angles

Objective

To define and quantify common points and relationships within the anterior nasal septum and recognize the anatomic curvature of the dorsal and caudal septum as arcs with certain rises.

Study Design

Case series study.

Methods

Forty cadaveric quadrangular cartilages were dissected. Points along the septum were defined and relationships measured. Angles that composed the anterior septum using values that did account for the curvature of the anterior nasal septum, or classical L-strut values, were compared to C-strut values, which included rises away from the L-strut.

Results

The mean arc of the nasal septum dorsum was significantly longer than the caudal arc (25.9 ± 5.14 mm vs. 23.96 ± 4.07 mm, P = 0.048); the mean rise of the dorsal arc was significantly shorter than the rise of the caudal arc (3.04 ± 1.25 mm vs. 3.88 ± 1.42 mm, P = 0.006). The mean point of furthest rise of the dorsal arc was slightly anterior to the midpoint of the dorsal strut (13.43 ± 5.07 mm); the mean caudal equivalent was slightly posterior to the midpoint of the caudal strut (8.55 ± 4.33 mm). Septal angles measured using L-strut versus C-strut values were significantly different.

Conclusion

The L-strut leading edge is not congruent with the anatomic septum and can be better described as a C-strut with arcs and rises away from classically interpreted straight L-strut lines, all of which may guide surgeons in the creation of a more natural, supportive cartilage framework while encouraging quantifiable septorhinoplasty teaching.

Level of Evidence

NA. Laryngoscope, 2018

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Prognostic factors for human papillomavirus–positive and negative oropharyngeal carcinomas

Objectives/Hypothesis

Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) are distinct disease entities. Prognostic factors specific to each entity have not been adequately explored. Goals for this study were: 1) to determine whether HPV-positive and HPV-negative OPSCCs have distinct prognostic factors, and 2) to explore the prognostic significance of sex and race in OPSCC after HPV stratification

Study Design

Retrospective case series.

Methods

A retrospective review of 239 incident OPSCC patients from 1995 to 2012, treated at Johns Hopkins and University of California–San Francisco was conducted. Women and nonwhite races were oversampled. All analyses were stratified by tumor HPV in situ hybridization status. The effects of sex and race on survival were considered in Kaplan-Meier and unadjusted and adjusted Cox regression models.

Results

One hundred thirty-four (56.1%) OPSCC patients were HPV positive. On univariate analysis, women had better overall survival than men among HPV-positive (hazard ratio [HR]: 0.47, 95% confidence interval [CI]: 0.20-1.07; P = .06) but not HPV-negative (HR: 0.73, 95% CI: 0.43-1.24; P = .24) OPSCCs. On multivariate analysis, women with HPV-positive OPSCCs remained at lower risk of death (adjusted hazard ratio [aHR]: 0.34, 95% CI: 0.12-0.96; P = .04). Survival did not vary significantly by race among HPV-positive patients. Among HPV-negative patients, Hispanic patients had significantly better survival in unadjusted (HR: 0.27, 95% CI: 0.08-0.91; P = .04) but not adjusted (aHR: 0.93, 95% CI: 0.11-7.36; P = .94) analysis.

Conclusions

Women with HPV-positive OPSCC may have improved overall survival compared to men. Sex does not play a prognostic role in HPV-negative OPSCC. There are no differences in prognosis by race among HPV-positive or HPV-negative patients.

Level of Evidence

4 Laryngoscope, 2018

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Fine needle aspiration cytology of the normal kidney: A cyto-histological and immunocytochemical correlation study

Background

Differentiation between normal renal cellular structures and renal tumors can be a diagnostic challenge during fine needle aspiration. It is of particular relevance during percutaneous thermal ablation because of the small size of tumors and when performing rapid on-site evaluation.

Methods

A cyto-histological correlation study assisted by immunocytochemistry was performed. The study was based on 10 nephrectomy specimens. For the identification of proximal tubular cells we used CD10 and α-methylacyl coenzyme A racemase (AMACR). PAX8 and GATA3 were used for the recognition of distal and collecting duct cells. For a precise correlation representative cytologic groups were photographed before and after immunocytochemistry.

Results

All cases showed: (a) glomeruli; (b) presence of at least 2 different epithelial cell populations that distribute separately, one representing the proximal tubule and the other more distal segments; and (c) existence of isolated, laminar basement fragments and slender, intact tubular structures. Proximal tubular cells were large with granular cytoplasm, indistinct cell borders, moderate anisonucleosis, and variable presence of pigment. Their immunophenotype was CD10+, AMACR+, PAX8–, and GATA3–. In all cases, cellular aggregates different of nonproximal tubular cells were present. They were smaller than proximal tubular cells with less cytoplasm, better-defined cell borders and uniform nuclei. Their immunophenotype was CD10–, AMACR–, PAX8+, and GATA3+

Conclusion

Aspirates from the normal kidney show characteristic features that permit a specific recognition. Different segments of the tubular system can be specifically recognized avoiding confusion with renal tumors. In difficult cases immunocytochemistry is a very helpful aid.

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Androgen excess and metabolic disorders in women with PCOS: beyond the body mass index

Abstract

Background

Insulin resistance is a common feature among women with polycystic ovary syndrome (PCOS), especially in those patients with hyperandrogenism and chronic anovulation. PCOS women are at risk for developing metabolic syndrome, impaired glucose tolerance and type II diabetes mellitus (DM II).

Objective

The aim of this review is to explore the existing knowledge of the interplay between androgen excess, pancreatic β-cell function, non-alcoholic fatty liver disease (NAFLD), intra-abdominal and subcutaneous (SC) abdominal adipocytes in PCOS, providing a better comprehension of the molecular mechanisms of diabetologic interest.

Methods

A comprehensive MEDLINE^® search was performed using relevant key terms for PCOS and DM II.

Results

Insulin-induced hyperandrogenism could impair pancreatic β-cell function, the SC abdominal adipocytes' lipid storage capacity, leading to intra-abdominal adipocyte hypertrophy and lipotoxicity, which in turn promotes insulin resistance, and could enhance NAFLD. Fetal hyperandrogenism exposure prompts to metabolic disorders. Treatment with flutamide showed to partially reverse insulin resistance.

Conclusions

Metabolic impairment seems not to be dependent only on the total fat mass content and body weight in women with PCOS and might be ascribed to the androgen excess.

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