Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial.

Objectives: Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring. Design: A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up. Results: After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohen's d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention. Conclusions: Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of iCBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required. Registered at clinicaltrials.gov: NCT02370810 on 5/03/2015. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Literature Commentary.

In this issue of Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD and Mark L. Moster, MD will discuss the following 6 articles: 1. Davoudi S, Ebrahimiadib N, Yasa C, Sevgi DD, Roohipoor R, Papavasilieou E, Comander J, Sobrin L. Outcomes in autoimmune retinopathy patients treated with rituximab. Am J Ophthalmol. 2017;180:124-132. 2. Metz LM, Li DKB, Traboulsee AL, Duquette P, Eliasziw M, Cerchiaro G, Greenfield J, Riddehough A, Yeung M, Kremenchutzky M, Vorobeychik G, Freedman MS, Bhan V, Blevins G, Marriott JJ, Grand'Maison F, Lee L, Thibault M, Hill MD, Yong VW; Minocycline in MS Study Team. Trial of minocycline in a clinically isolated syndrome of multiple sclerosis. N Engl J Med. 2017;376:2122-2133. 3. Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I; Movement Disorder Society-Endorsed PSP Study Group. Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria. Mov Disord. 2017;32:853-864. 4. Sodhi M, Sheldon CA, Carleton B, Etminan M. Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: nested case-control study. Neurology. 2017;89:792-795. 5. Suzuki S, Ishikawa N, Konoeda F, Seki N, Fukushima S, Takahashi K, Uhara H, Hasegawa Y, Inomata S, Otani Y, Yokota K, Hirose T, Tanaka R, Suzuki N, Matsui M. Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan. Neurology. 2017;89:1127-1134. 6. Hennes EM, Baumann M, Schanda K, Anlar B, Bajer-Kornek B, Blaschek A, Brantner-Inthaler S, Diepold K, Eisenkolbl A, Gotwald T, Kuchukhidze G, Gruber-Sedlmayr U, Hausler M, Hoftberger R, Karenfort M, Klein A, Koch J, Kraus V, Lechner C, Leiz S, Leypoldt F, Mader S, Marquard K, Poggenburg I, Pohl D, Pritsch M, Raucherzauner M, Schimmel M, Thiels C, Tibussek D, Vieker S, Zeches C, Berger T, Reindl M, Rostasy K; BIOMARKER Study Group. Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome. Neurology. 2017;89:900-908. (C) 2017 by North American Neuro-Ophthalmology Society

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The Optic Disc Drusen Studies Consortium Recommendations for Diagnosis of Optic Disc Drusen Using Optical Coherence Tomography.

Background: Making an accurate diagnosis of optic disc drusen (ODD) is important as part of the work-up for possible life-threatening optic disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) has improved the visualization of more deeply buried ODD. There is, however, no consensus regarding the diagnosis of ODD using OCT. The purpose of this study was to develop a consensus recommendation for diagnosing ODD using OCT. Methods: The members of the Optic Disc Drusen Studies (ODDS) Consortium are either fellowship trained neuro-ophthalmologists with an interest in ODD, or researchers with an interest in ODD. Four standardization steps were performed by the consortium members with a focus on both image acquisition and diagnosis of ODD. Results: Based on prior knowledge and experiences from the standardization steps, the ODDS Consortium reached a consensus regarding OCT acquisition and diagnosis of ODD. The recommendations from the ODDS Consortium include scanning protocol, data selection, data analysis, and nomenclature. Conclusions: The ODDS Consortium recommendations are important in the process of establishing a reliable and consistent diagnosis of ODD using OCT for both clinicians and researchers. (C) 2017 by North American Neuro-Ophthalmology Society

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Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension.

Purpose of review: To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). Recent findings: Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP. Summary: Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The role of frontal sinus drillouts in nasal polyposis.

Purpose of review: Historically, the common frontal sinusotomy has been reserved only for salvage frontal sinus surgery in patients with severely recalcitrant inflammatory sinus disease. By understanding the pathophysiology of inflammatory sinus disease and the long-term role of topical medication in their treatment, the indications for Draf3 have expanded. Recent findings: A major therapeutic impact from endoscopic sinus surgery for inflammatory sinus disease is imparted by allowing sinus access to topical therapies to work. Although traditionally, the Draf3 frontal sinus procedure has been reserved for revision surgery in severe cases, advancements in technology, instrumentation, and techniques has allowed the Draf3 to evolve to efficient and safe procedure, often applied primarily in select patients. There is evidence to support the indication for Draf3 in primary surgery for severe cases. Summary: In inflammatory sinus disease, the goal of endoscopic sinus surgery is to convert the complex and limited frontal sinus outflow tracts into a simple common cavity. This allows for local, topical anti-inflammatory treatments to control the disease. When patients have broader inflammatory airway disease and asthma, the Draf3, as part of a neo-sinus cavity, is commonly applied early in surgical care. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Local allergic rhinitis: evolution of concepts

The discovery of an exclusive local production of IgE antibodies dates back to the 1970s, but only recently the pathophysiology of such phenomenon was deeply investigated, leading to the concept of local aller...

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Optimizing donor site closure following bilateral breast reconstruction with abdominal-based free flaps

Publication date: Available online 1 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Noelle M. Messina, Kristie Rossi, Lisa M. Wetherhold, Matthew J. Wetherhold, Samuel Litwin, Neal S. Topham, Eric I. Chang




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Rapidly growing mycobacteria infections among “cosmetic tourists” returning to the netherlands

Publication date: Available online 2 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Zachri Ovadja, Heleen Sluijmer, Esther Moerman, Marc van Ogtrop, Oren Lapid




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The liquid facelift: first hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy - a case series of 25 patients

Publication date: Available online 2 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kai O. Kaye, Sonja Kaestner, Felix J. Paprottka, Phillipp Gonser
ObjectiveRecently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in non-facial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients.MethodsTwenty-five patients (median age: 56 years) had facelift surgery under sedation, and the WAL technique was used for facial contouring, fat harvesting face-to-face lipotransfer, and hydrodissection of the facial skin flap. Patients were monitored for discomfort during the procedure. Complications such as bleeding, postoperative swelling, and hematoma formation were observed during a 1-week follow-up period, and intensity was rated by two independent surgeons using a special grading system. Furthermore, a patient survey (FACE-Q) was performed to analyze the patients' satisfaction and perception of the postsurgical esthetic results.ResultsThe WAL technique can be applied under intravenous sedation without causing any discomfort in all treated patients [mean 1.16, standard deviation (SD) 0.31]. Intraoperative bleeding during WAL-assisted facial dissection was judged as not present at all times (mean 1.3, SD 0.32). Postoperative swelling (day 1: mean 1.82, SD 0.28; day 7: mean 1.18, SD 0.28) and hematoma formation following surgery (day 1: mean 1.58, SD 0.34; day 7: mean 1.18, SD 0.31) were judged as minor in all cases. Overall, no skin necrosis was detected. There was no need for revision surgery. More than half of our treated patients (n=13) answered the FACE-Q questionnaire, verifying a high satisfaction rate with beneficial treatment results without the occurrence of any major complications.ConclusionsThe WAL technique seems to offer a safe and efficient treatment approach for facial contouring, facial fat harvesting, and simultaneous facial flap hydrodissection with only minor postoperative swelling and hematoma formation. Therefore, the authors believe that the WAL technique is a powerful and useful tool and should be used in modern facial plastic surgery.



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Evidence for the formal development of trauma subspecialty within plastic surgery in the united kingdom.

Publication date: Available online 2 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): R.M.T. Staruch, H. Lloyd-Hughes, A. Shiatis, S.P. Hettiaratchy
The Royal College of Surgeons working group on trauma recently recommended the reorganization of Plastic surgery training to incorporate a trauma subspeciality as a means to provide a sustainable workforce for trauma care provision nationally. The aim of this work was to gauge trainee opinion and aspiration in order to advice and shape the future of trauma training to meet this potential need. An online survey was conducted of UK Plastic surgical trainees to assess their interest in subspecialisiing in trauma. A total of 98 trainees responded to the survey. Eighty three percent of trainees are interested in gaining from experience in the management of trauma. Whilst sixty five percent would be interested in undertaking formal roles in trauma as a subspeciality. This survey has documented and highlighted the desire of UK trainees to play a significant role in the management of acute trauma.



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Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: surgical modifications for flap pedicle and donor site closure without skin graft

Publication date: Available online 1 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Zhenglin Chi, Yiheng Chen, Tinggang Chu, Weiyang Gao, Zhijie Li, Hede Yan, Yonghuan Song
BackgroundThe conventional procedure of the sural neuro-fasciocutaneous flap enables the supply of blood and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may lead to some complications and influence the aesthetic appearance. We report modifications for a distally based sural neuro-fasciocutaneous perforator flap and a relaying flap for donor site closure without skin graft.MethodsTwelve patients undergoing the modified flap for foot and ankle reconstruction were included in this study between 2014 and 2016. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A Z-shape skin incision was performed to explore the perforator vessels and a relaying island perforator flap was used to close the donor site.ResultsAll flaps survived completely without necrosis. The area of the flaps ranged from 16×8 cm to 30×15 cm. The diameter width of the pedicle ranged from 1.0 to 2.0 cm. A relaying perforator island flap was used in 10 cases for donor site closure and no skin graft was performed. There were no serious donor site complications. All patients were satisfied with the aesthetic outcome postoperatively at the final follow-up.ConclusionsThe distally based sural neuro-fasciocutaneous perforator flap is considered a reliable method for foot and ankle reconstruction. The modification for flap pedicle and donor site closure method without skin graft should be recommended.



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Rectus femoris branch: an alternative blood supply for a distally based anterolateral thigh flap

Publication date: Available online 1 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Shanshan Li, Yuanbo Liu, Mengqing Zang, Shengji Yu, Wei Guo, Rongli Yang
Successful raising of a distally-based anterolateral thigh (dALT) flap mainly depends on a well-developed lateral circumflex femoral artery (LCFA) descending branch and an intact vascular connection between the descending branch and the vascular network of the knee. However, in some clinical scenarios, the descending branch is hypoplastic or the vascular connection of the knee is compromised. We present six cases of using dALT flaps in soft tissue defect reconstruction of the knee with either of the above-mentioned conditions. In these cases, the flaps relied on the reverse blood flow through the rectus femoris branch and showed complete survival postoperatively. We believe the reverse flow from the rectus femoris branch could be an alternative blood supply for the dALT flap in the presence of hypoplasia of the LCFA descending branch or compromise of the vascular connection between the descending branch and the articular geniculate network.



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Calycosin inhibits the in vitro and in vivo growth of breast cancer cells through WDR7-7-GPR30 Signaling

Clinically, breast cancer is generally classified into estrogen receptor-positive (ER+) or estrogen receptor-negative (ER−) subtypes. The phytoestrogen calycosin has been shown to inhibit the proliferation of ...

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Circular RNAs: emerging cancer biomarkers and targets

CircRNAs are a class of RNA molecules that structurally form closed loops. CircRNAs are abundant in eukaryotic transcripts and show certain levels of tissue and cell specificity. CircRNAs have been suggested t...

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Glomangiomyoma of the neck in a child in Nepal: a rare case report and literature review

Glomangiomyoma is a rare histological variant of glomus tumour. Clinically, it mimicks as a haemangioma and is challenging to diagnose. Its occurrence in the neck of a child has not been previously described.

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The effects of lapatinib on CYP3A metabolism of midazolam in patients with advanced cancer

Abstract

Purpose

The potential inhibition of CYP3A4 by lapatinib was studied using midazolam as a probe substrate in patients with cancer.

Methods

This was a partially randomized, 4-period, 4-sequence, 4-treatment, cross-over study in 24 patients with advanced cancer. Single 1-mg IV and 3-mg oral doses of midazolam were given 2 days apart, in a partially random order, on study days 1, 3, 9, and 11. Lapatinib 1500-mg was administered orally once daily on study days 4 through 11. Midazolam plasma concentrations were measured up to 24-h post dosing, and lapatinib plasma concentrations measured prior to each midazolam dose.

Results

Lapatinib increased the geometric mean (95% CIs) midazolam AUC_(o−∞) by 45% (31–60%) after the oral dose and by 14% (0–29%) after the IV dose, and prolonged the midazolam elimination half-life by 48% (22–81%) after the oral dose and by 20% (2–40%) after the IV dose. Lapatinib decreased midazolam total clearance by 13% (1–23%), while total bioavailability was increased 23% (4–46%) without changes in apparent volume of distribution or hepatic bioavailability.

Conclusion

These data show that lapatinib caused weak inhibition of gastrointestinal CYP3A4 in vivo. This suggests that oral CYP3A4 drug substrates with a narrow therapeutic index may need dose reduction if lapatinib is to be co-prescribed.

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The effects of lapatinib on CYP3A metabolism of midazolam in patients with advanced cancer

Abstract

Purpose

The potential inhibition of CYP3A4 by lapatinib was studied using midazolam as a probe substrate in patients with cancer.

Methods

This was a partially randomized, 4-period, 4-sequence, 4-treatment, cross-over study in 24 patients with advanced cancer. Single 1-mg IV and 3-mg oral doses of midazolam were given 2 days apart, in a partially random order, on study days 1, 3, 9, and 11. Lapatinib 1500-mg was administered orally once daily on study days 4 through 11. Midazolam plasma concentrations were measured up to 24-h post dosing, and lapatinib plasma concentrations measured prior to each midazolam dose.

Results

Lapatinib increased the geometric mean (95% CIs) midazolam AUC_(o−∞) by 45% (31–60%) after the oral dose and by 14% (0–29%) after the IV dose, and prolonged the midazolam elimination half-life by 48% (22–81%) after the oral dose and by 20% (2–40%) after the IV dose. Lapatinib decreased midazolam total clearance by 13% (1–23%), while total bioavailability was increased 23% (4–46%) without changes in apparent volume of distribution or hepatic bioavailability.

Conclusion

These data show that lapatinib caused weak inhibition of gastrointestinal CYP3A4 in vivo. This suggests that oral CYP3A4 drug substrates with a narrow therapeutic index may need dose reduction if lapatinib is to be co-prescribed.

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Renal clear cell carcinoma metastasis to the breast ten years after nephrectomy: a case report and literature review

Renal cell carcinoma most commonly metastasizes to the lungs, skeleton or liver. Metastatic renal cell carcinoma to the breast is very rare, especially for clear cell carcinoma, and few cases regarding this co...

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Complete mimicry: a case of alveolar rhabdomyosarcoma masquerading as acute leukemia

A small number of rhabdomyosarcoma (RMS) cases involve the bone marrow. A leukemic presentation of RMS has been reported in a few case series, although almost all cases of leukemic RMS are not completely mimic...

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Temporal and spatial dose distribution of radiation pneumonitis after concurrent radiochemotherapy in stage III non-small cell cancer patients

Radiation pneumonitis (RP) is the most common subacute side effect after concurrent chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer. Several clinical and dose-volume (DV) parameters are...

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